OBJECTIVE: This study will determine factors that influence the self-perceived handicap associated with singing voice problems. STUDY DESIGN: A prospective cohort. SUBJECT AND METHODS: Singers presenting to a voice clinic prospectively completed the Singing Voice Handicap Index (SVHI) before evaluation and treatment. Demographic data, singing style, professional status, duration of symptoms, medical problems, and diagnosis were collected. Univariate and multivariate analysis was performed. RESULTS: One hundred seventy-one singers completed the SVHI. The duration of symptoms, being an amateur singer or singing teacher, benign vocal fold lesions, and neurologic voice disorders were associated with increased SVHI scores (P < 0.05, multiple linear regression). Age greater than 50 years and gospel singing were predictive of increased SVHI scores only on univariate analysis (P < 0.05, t test). CONCLUSION: Singers experience significant handicap as a result of their singing problems with certain factors associated with greater impairment. Targeting interventions at patients more severely affected may improve outcomes.