International scientific center "Khoomei" of RT together with medical research institutes has, since 1995, paid special attention to the question of  pension benefits for professional khoomei performers during the past 10 years, together with the history and  music ethnography, in the context of shamanic culture and playing of traditional wind instruments, with the aim of preserving the phenomenon of national culture, as well as development of the traditional art as a component of social life of Tuvans.

The result of  many years of research of study of both khoomei and its performers - khoomeizhi (throat singers) was a study at Roosevelt Hospital in New York (NY, USA). The head - Doctor of Medicine, director of the laboratory of voice, of otolaryngology and head and neck surgery department - professor Anat-Keidor, doctor of medicine Anthony John, author of this article, (informants  - Boris Kherlii, Ivan Saryglar in 1995, and Ayas Danzyryn). These observations revealed micro-hemorrhages on the mucosa of vocal cords.

Research was conducted at the experimental laboratory of University of  Tokyo "Otolaryngology, physiological mechanism of larynx" (Japan). The leader of this research is Doctor of Medicine professor Massa, and author of this material (informants: Ayas Danzyryn, Nachyn Choodu, Shonchalai Oorzhak, Vadim Saryglar, 2000).

The entire organism of the singer is involved in singing vocalization. Based on the experiments of Japanese physiologists, during the throat-singing vocalization with "breath-holding", the "khorekteer" technique predominates, which is different from all the imitations of the Sayan-Altai people. I will emphasize: data found in medical literature which involve ordinary vocal work loads cannot be applied to throat-singing performers, because of the principal idiosyncracies of throat-singing.

Because of the lack of  information about the specifics of clinical effects on the health of  khoomei performers in both international literature as well as in scientific medical literature forced us to take a serious look at the problem. Between 2002 - 2008, on the basis of the International Scientific Center "Khoomei" of Republic Tuva,  research was conducted by scientists - profession pathologists of FGUN Novosibirsk Scientific Research institute of Hygiene "Rospotrebnadzor". The leader was professor, doctor of medicine, pro-rector of NGMU N. L. Poteryayeva; members of research team: professor, doctor of medicine I. A. Nesina, doctor of Biology N. G. Nikiforova, physician-pulmonologist C. Y. Saryglar,  and the author of this article. Department of professional pathologies (Note: work-related health problems, translator.)  of Novokuznetsk State Institute for continued medical education became involved: head - academician RAN, doctor of medicine, head of department of professional pathologies V.V. Razumov, candidate of medical science, docent V. D. Osipova (physician-otolaryngologist, 2001).

The research aimed at discovering the adverse effects of Tuvan throat-singing on human organism. As a result, the following data were obtained. Disruption of respiratory regularity was observed because of the prolonged periods of "breath-holding" with compression of air with contracted thoracic muscles, which in turn leads to disruption of functions of the cardiorespiratory system, that is: it leads to changes in the gas content of blood, disruption of hemodynamics, and consequent hypoxia and hyperkalemia of organs and tissues.

The increased pressure of  external breathing in professional performers leads to changes of internal alveolar ventilation.  This makes blood circulation more difficult in the pulmonary tissue capillary system.

The chief consequence of the described mechanisms is loss of elasticity, inflammatory changes and fibrosis of lung tissue, which determines the alveolar-capillary barrier with consequent development of arterial hypoxia and hypercapnia. Arterial hypoxia leads to reflexive blood pressure increase in pulmonary vessels with consequent development of pulmonary hypertension.

Furthermore, in a group of highly trained professional singers, as measured by peak expiratory flow rate, there was a decline of lung function and appearance of polycythemic syndrome.

Analysis of  the changes of hemoglobin oxygen saturation showed that on the whole, in both professional singers and in amateur group, after throat-singing, there was an observable decrease of blood oxygen saturation indices. In the group of professional singers with more than 20 years of work experience, more substantial decrease  of blood oxygen saturation was seen, with  weakness, and recovery of  the index within three minutes was not observed, in contrast to the amateur group. A tendency towards increased lowering of oxygen hemoglobin saturation after singing with increase in the age of the performer was observed.

It was also ascertained that in the group of professional singers, adaptive compensatory capacities of cardiovascular system were decreased, as shown by the pulse frequency and diastolic pressure, which did not recover within three minutes after stopping the singing, and reliably differed from baseline values.

This is an extremely significant finding because in the given group of subjects, represented by young men (32.9 years of age, plus-minus 4.1 year), arterial pressure results were within the range defined as hypertension. Today, if you take arterial blood pressure of the strongest professional throat-singers, it shows: Igor K. - 220, Bady-Dorzhu O. - 200, Andrei M. - 160; it is difficult to list them all. And, of course, everybody knows that the longer the blood pressure remains elevated, the bigger the risk of damage to various organs.

Consequently, it is possible to state that in professional throat-singers the performance of khoomei represents a high load on the functional condition of the cardiovascular system, leading to increased risk and overstressing of respiration which demands substantial effort, and in professional singers it leads to pulmonary hypertension with risk increasing the longer they work.  Other adverse factors in the work of professional throat-singers include the highly stressful work process of concert activities, and intensive stress of the vocal apparatus, with significant nervous and emotional tension.

All these factors of  harmful effects, in combination with those listed, show the adverse influence on the health condition of the artists. After all, every khoomeizhi, in contrast to the traditional free performance, as people used to sing,  is also a musical instrument and is subjected to severe pressures and exhaustion of the entire organism. The study used adequate methods of clinical, laboratory and instrumental research. Aside from that, it represents a successfully defended doctoral dissertation at Novosibirsk Conservatory.

Government of Tuva has been attempting to decide the matter of retirement pension benefits for professional throat-singers since the early 1990's.  This scientific research should serve as significant documentation.

Because the schedule of determination and payment of the pension is regulated by federal legislature, results of the discovered adverse effects of throat-singing on the organism of performers,  demonstrating the harmful factors in the work of professional khoomei performers, will allow intercession  with the Government of RF to add amendments and changes in the corresponding normative legislative documents.

With help of scientific research, it was determined: because of high risk factor of vocal exhaustion, after 18 years of work on professional stage, a throat-singer needs his pension benefits a lot earlier than other musicians. Government of RT turned to the appropriate organs of Russian federation, the federal supervisory service  for defense of consumers' rights and human prosperity , and federal state science foundation.   According to President  of RF D.A. Medvedev, all questions associated with the scientific research work have now been explained. Because this is a new specialty, the facts had to be proved and verified. All the research work of  ISC "Khoomei" have been submitted to the Ministry of Health and Ministry of Labor of Russia.

We are waiting for the results of the decision process…