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INTRODUCTION
Semi-occluded vocal tract (SOVT) exercises involve narrowing
the vocal tract, usually near the lips or tongue tip, while voicing.
These exercises have been used for many years by singers and
voice professionals as warm-ups and more recently have been
incorporated into therapeutic approaches by speech-language
pathologists (SLPs) for people with voice disorders. Although
there is a growing body of research about the physiological
impact of SOVTs, and growing clinical sentiment about the
therapeutic benefits, empirical data are lacking describing
expected laryngeal adjustments, identification of those for
whom the exercises may be of most benefit, dosing of the exercises for maximum gains, and other issues. This study contributes information about within subject changes in aerodynamic
and electroglottographic (EGG) measures of voice after
completing a brief trial of three different SOVTs.
Types of semi-occluded vocal tracts
SOVTs vary from high-to-low resistance to air flow in the vocal
tract. Increased resistance is created by narrowing or lengthening of the vocal tract; conversely, lower resistance is created
by opening or shortening the vocal tract. Examples of SOVTs
listed from higher to lower resistance are as follows: phonating
while holding a straw between the lips, humming, sustaining a
voiced labiodental fricative, voicing during lip or tongue trill,
sustaining voiced alveolar or velar nasal consonants, and
Accepted for publication May 23, 2014.
Portions of this work have been presented at The Voice Foundation, Philadelphia, PA,
June 2, 2012 (Speaker Differences in Laryngeal Activity, The Voice Foundation, Philadelphia, PA, June 2, 2012) and the National Center for Voice and Speech, Salt Lake City,
UT, July, 9, 2011 (Stroboscopic and Aerodynamic Changes Associated with SemiOccluded Vocal Tract Exercises-Preliminary Data,).
From the Hearing and Speech Department, University of Kansas Medical Center,
Kansas City, KS.
Address correspondence and reprint requests to Troy Clifford Dargin, 1000 Sunnyside
Avenue, 3017 Dole Human Development Center, Lawrence, KS 66045-7555. E-mail:
troydargin@yahoo.com
Journal of Voice, Vol. 29, No. 2, pp. 155-164
0892-1997/$36.00
2015 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2014.05.009
156
vocal fold movement with reduced vocal fold collision due to
lower PTP. In contrast, Cordeiro, Montagnoli, and Tsuji,7
concluded that the maximum amplitude of vocal fold vibration
is greater during lip and tongue trills than in nonoccluded voice.
Changes during semi-occluded vocal tracts
Aerodynamic changes. Laryngeal aerodynamics are
expected to change when doing SOVTs. According to Titze,3
manipulation of supraglottal inertance and supraglottal resistance could be used to achieve optimal PTP values. PTP
increases with supraglottal resistance and decreases with supraglottal inertance. Straw phonation results in both of these
changes within the supraglottal tract, effectively canceling out
the respective influence on PTP and allowing for PTP to remain
within a target range of approximately 00.5 kPa.3 It has been
shown that PTP is elevated after excessive vocal use8 and sometimes after warm-up exercises at high pitches.9 SOVTs may provide one means of helping reestablish a more favorable PTP
after excessive use or as a warm-up exercise because of the
beneficial impact on PTP. The aerodynamic changes that are
derived from SOVTs are expected to lessen vocal fold loading.2
Vocal fold movement and closure changes. The lessening of the vocal load resulting from SOVTs should be
apparent in other measures of phonation such as the closed quotient from EGG and vibration amplitude from stroboscopic
measures. Stroboscopic studies of laryngeal changes during
or after SOVTs are limited. Cordiero et al,7 performed a study
with 14 healthy subjects that had at least 3 years of professional
classical voice work and who used lip and tongue trills on a regular basis. The subjects produced a sustained nonoccluded /3/
vowel, lip trills, and tongue trills while videolaryngostroboscopy and EGG were performed. Stroboscopically, they found
that tongue and lip trills had similar amplitude of vocal fold
vibration (at high and low intensity voicing), which were both
larger amplitudes compared with those during a nonoccluded
/3/ vowel. Schwarz and Cielo10 also evaluated subjects stroboscopically before and after completing SOVTs. Twenty-four
women performed three series of 15 trills with a 30 second
interval of rest between each series. They found a statistically
significant increase in vibration amplitude after the SOVT exercises. In a group of singers and nonsingers, contact quotients
(CQs) as derived from EGG were reduced by about 50%
when phonating on a vowel /a/ as compared with a lip trill in
a study by Gaskill and Erickson.11 The reduction in CQ was
more prominent for the nonsingers. A study of the Mediterranean tongue trill, which is used during joyful celebration, also
showed a reduction in CQ.12 In contrast, Cordiero, Montagnoli,
and Tsuji7 reported an increase in the mean CQ at high intensity
but not low intensity. Additionally, they found that intraspeaker
standard deviation in CQ was significantly elevated during the
lip and tongue trills compared with the sustained vowel. Cordiero et al suggested that to complete the trill subjects must
increase pulmonary air flow to sustain vibration of both the
vocal folds and the lips or tongue. Greater pulmonary drive
can elevate subglottal pressure causing greater excursion of
the vocal fold edge during vibration.13
157
To help elicit these sensations, various SOVTs, such as humming, are completed. Several outcome studies support the
effectiveness of LMVT.2025
The present study compared aerodynamic and EGG
measures acquired immediately after completing each of three
commonly used SOVTs in four classically trained singers. The
intent was to evaluate each subject as their own case study given
the expectation that there might be substantial across subject
variability in the effect of each SOVT.
METHODS
Participants
A convenience sample of three male tenors and one female
soprano from one Midwestern and one East coast graduate
music program participated. Demographic and voice training
history for each are in Table 1. All participants were recruited
in compliance with the guidelines of the Institutional Review
Board at the University of Kansas Medical Center, and written
informed consent was obtained from each participant. None had
known vocal pathology at the time of scoping. None of the subjects reported a history of laryngeal disease or significant voice
trouble in their past. Tenor 3 reported a history with reflux but
was not currently on medication. The other three subjects
reported no reflux history or medication history of importance
to the study.
Instrumentation
Aerodynamic recordings were obtained with the Phonatory
Aerodynamic System (PAS Model 6600, KayPENTAX, Montvale, NJ). This system allowed for recording of air flow, air
pressure, and the acoustic signal. EGG was obtained using
the 6103 KayPENTAX (KayPENTAX, Montvale, NJ) system.
Procedures
Baseline. PreSOVT aerodynamic and EGG measures were
taken with the subject seated in a quite clinic room. The PAS
facemask-pneumotach system was held firmly on the face by
the subject. Research personnel confirmed the mask was seated
flush against the skin at the start of and throughout data
recording. The system was calibrated per the manufacturer
instructions before data collection. The two EGG electrodes
were place on the neck at the level of the thyroid cartilage.
The EGG signal was acquired simultaneously with the aerodynamic signals and was displayed in the PAS software
environment.
TABLE 1.
Demographic and Voice History Training of Participants
Subject
Tenor 1
Tenor 2
Tenor 3
Soprano 1
Gender
Age
Years of Classical
Voice Training
M
M
M
F
28
32
28
25
10+
10+
10+
10+
MMopera performance
DMAvocal performance
MMvocal performance
MMopera performance
Yes
Yes
No
No
158
and after the silence interval). SPL values, aerodynamic resistance (cm H2Oliters/sec), mean air flow during voice (L/s),
and mean peak air pressure (cm H2O) measures were obtained
from the VE subroutine using default settings. Given the small
subject numbers and the preliminary nature of this study, group
analyses were avoided in favor of a within subject descriptive
approach. Raw air flow data for T3 were exceptionally low
during baseline and after some SOVT trials suggesting either
equipment or procedureal errors. For that reason no air flow
or resistance values (ie, dependent on air flow measure for the
calculation) are reported for that subject.
RESULTS
Aerodynamic data
Sound pressure level. The SPL values for the /pa/ syllable
train are in Table 2. Table 3 displays data by participant for SPL
(plus all other measures) denoting the direction of change from
baseline. To be marked as a change in the table a participant had
to demonstrate a change of 10% or greater from the preSOVT
sample. On average, SPL increased by approximately six to
seven SPL after completing each SOVT. However, there was
notable variation across subjects in the magnitude of the
increase. For tenors 1 and 2 the SPL increase was substantial
(greater than seven SPL) and occurred consistently across the
three SOVTs. For tenor 3, there was essentially no increase after
straw phonation or lip trill (approximately one SPL), and a
modest gain after tongue trill (three SPL). For Soprano 1 there
were modest gains after straw phonation and lip trill (three and
a half SPL), but no change after tongue trill. The SPL data gathered after 2 minutes of quiet after completion of all SOVTs indicated a substantial increase for two subjects (1 and 2), a modest
to small gain for another (tenor 3) and essentially no change for
the Soprano.
Mean air flow during voicing (L/s). Mean air flow data
during the /pa/ syllable train are in Tables 3 and 5. For T1
and S1, the three SOVTs resulted in at least a 1050%
increase in air flow over the precondition. For T2 a sizable
increase occurred for straw phonation (22%), a limited
increase for tongue trill (7%), but a decrease for lip trill (7%).
The three participants had an increase in mean air flow
immediately after completing the SOVTs plus 2 minutes of
rest (increases as a percent of the preSOVT recordings were
50%, 39%, and 13% for T1, T2, and S1, respectively).
Mean peak air pressure (cm H2O). Pressure data are presented in Tables 3 and 4. There was substantial variability in air
pressure changes across participants. Pressures for T1 increased
between 2.53 cm H2O (3946%) after each SOVT. T2s
pressures decreased by 3.5 cm H2O (24%) for straw
TABLE 2.
Sound Pressure Level (dB SPL) Values Before and After Each SOVT and After a Rest Period at the End of the Protocol
(PostSOVT)
Straw Phonation
Subject
Singer
T1
T2
T3
S1
Group
Mean
SD
Lip Trill
Tongue Trill
PostSOVT
PreSOVT
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
86.87
82.10
95.71
90.03
95.26
96.28
96.95
93.53
8.39
14.18
1.24
3.50
95.06
97.27
96.97
93.72
8.19
15.17
1.26
3.69
94.17
97.33
99.08
90.13
7.3
15.23
3.37
0.10
95.62
93.77
98.50
91.17
8.75
11.67
2.79
1.14
88.68
5.71
95.51
1.49
6.83
5.74
95.76
1.67
7.08
6.11
95.18
3.93
6.50
6.52
94.77
3.09
6.09
4.95
Abbreviations: T1, tenor 1; T2, tenor 2; T3, tenor 3; S1, soprano 1; SD, standard deviation.
159
TABLE 3.
Predominant Direction of Change for Each Measure Across the Four Participants
Parameter
SPL
Mean expiratory
flow
Oral pressure
Mean flow during
voicing
Laryngeal
resistance
% Closed quotient
T1
T2
T3
S1
Outcome Versus
PreSOVT
Outcome Versus
PreSOVT
Outcome Versus
PreSOVT
Outcome Versus
PreSOVT
SP
LT
TT
CO
SP
LT
TT
CO
SP
LT
CO
SP
LT
TT
CO
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
No data
TT
>
>
>
>
>
>
>
>
>
>
>
>
>
<
>
<
>
>
No data
<
<
>
>
<
>
<
>
>
<
<
<
<
<
<
<
<
>
>
>
>
>
No data
>
>
>
>
Abbreviations: SP, straw phonation; LT, lip trill; TT, tongue trill; CO, carryover condition.
Notes: To be considered a change, the measure had to increase or decrease by 10% versus the preSOVT value.
TABLE 4.
Mean Peak Air Pressure Values (cm H2O) Before and After Each SOVT and After a Rest Period at the End of the Protocol
(PostSOVT)
Straw Phonation
Subject
Singer
T1
T2
T3
S1
Group
Mean
SD
Lip Trill
Tongue Trill
PostSOVT
PreSOVT
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
6.46
14.52
8.88
9.00
9.50
11.00
12.17
6.88
3.04
3.52
3.29
2.12
9.18
11.46
9.15
8.31
2.72
3.06
0.27
0.69
8.88
13.85
8.56
8.00
2.42
0.67
0.32
1.00
8.13
14.00
7.58
7.23
1.67
0.52
1.30
1.77
9.72
3.41
9.89
2.28
0.17
3.50
9.53
1.35
0.19
2.39
10.00
2.71
0.29
1.57
9.25
3.20
0.47
1.48
160
TABLE 5.
Mean Air flow During Voicing (L/s)
Straw Phonation
Subject
Singer
T1
T2
T3
S1
Group
Mean
SD
Lip Trill
Tongue Trill
PostSOVT
PreSOVT
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
0.15
0.31
0.30
0.20
0.38
0.33
0.05
0.07
0.03
0.23
0.29
0.37
0.08
0.02
0.07
0.21
0.33
0.36
0.06
0.02
0.06
0.23
0.43
0.34
0.08
0.12
0.04
0.20
0.14
0.24
0.16
0.04
0.03
0.24
0.12
0.05
0.05
0.32
0.07
0.12
0.15
0.34
0.08
0.14
0.12
CQ was that two subjects (T3, S1) had a 10% or greater increase
after each SOVTs and the other two had no change on any of the
SOVTs.
Table 9 also includes the predominate direction of change for
each measure after completing all three SOVTs and 2 minutes
of vocal rest (ie, carryover). For the carryover condition, four
measures had a predominant direction of change. Mean expiratory flow on sustained vowel and mean air flow on /pa/ both
were increased, laryngeal resistance was decreased, and %CQ
increased for most of the participants in the carryover condition.
SPL, which was consistently increased immediately after each
SOVT, had no predominant direction of change in the carryover
condition.
DISCUSSION
The purpose of this study was to evaluate aerodynamic and
EGG closed quotient changes immediately after completion
of each of three SOVTs relative to preSOVT values. Singers
were chosen as participants because use of SOVTs is routinely
incorporated into their training. However, very little empirical
data on changes to voice measures extending beyond the time
of execution of the SOVT are available. Likewise, there is
limited data evaluating differences in laryngeal function within
the same speaker across different SOVTs. If SOVTs are to be
used as a training tool or therapeutic approach it is of importance to determine not only whether laryngeal function can
TABLE 6.
Laryngeal Resistance (cm H2O/L/s)
Straw Phonation
Subject
Singer
T1
T2
T3
S1
Group
Mean
SD
PreSOVT
Mean
41
46
31
45
28
20
39.33
7.64
31
12.77
Versus Pre
4
18
11
8.33
11.24
Lip Trill
Mean
Versus Pre
Tongue Trill
Mean
Versus Pre
PostSOVT
Mean
39
46
22
2
0
9
42
41
22
1
5
9
35
33
21
35.67
12.34
3.67
4.73
35
11.27
4.33
5.03
29.67
7.57
Versus Pre
6
13
10
9.67
3.51
161
TABLE 7.
Mean Expiratory Air flow (L/s) During Sustained Vowel
Straw Phonation
Lip Trill
Tongue Trill
PostSOVT
Subject
PreSOVT
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
Mean
Versus Pre
Singer
T1
T2
T3
S1
Mean
SD
0.16
0.23
0.31
0.19
0.11
0.19
0.43
0.37
0.32
0.10
0.03
0.20
0.06
0.14
0.11
0.18
0.41
0.38
0.34
0.11
0.02
0.18
0.07
0.15
0.14
0.17
0.49
0.37
0.36
0.14
0.01
0.26
0.06
0.18
0.17
0.20
0.31
0.33
0.31
0.09
0.04
0.08
0.02
0.13
0.16
sustained vowel productions were both at or above the normative values. Laryngeal resistance values in our four subjects
(group mean 39 cm H2O/L/s) were lower than those in the
normative sample (68 and 79 cm H2O/L/s for females and
males, respectively). Overall, compared with young adult nonsingers in the Zraick et al study, the four singers produced samples with higher SPL, oral air pressure, and air flow rates, and
lower laryngeal resistance. It is possible that the patterns of
change after SOVT execution described in the following are
unique to those with singing training. It should be considered
that in some respects the aerodynamic differences that our
singers demonstrated in the baseline condition compared with
the norms suggest a somewhat optimized phonation situation
with perhaps restricted room to show change on the measures
that were evaluated.
did, in fact, tend to increase regardless of which SOVT was being done. For two other measures, oral pressure (as an estimate
of subglottal pressure) and %CQ, there was no predominant
pattern of change occurring across the three SOVTs. Guzman27 found that subglottal air pressure increased during straw
phonation and remained higher for a short time afterward. In
the present study, there was not a consistent direction or
magnitude of change in the air pressure measure. The %CQ deserves further mention, however. Although only half of the participants had a change for each of the SOVTs, it was always the
same two subjects who showed the increase whereas the other
two remained unchanged. In this case, it seems that the impact
of the SOVT is dependent more on the individual rather than
the specific SOVT. Cordiero et al,7 found significant differences with higher mean %CQ during the lip and tongue trill
as compared with the nonoccluded /3/ at high intensities only.
Overall, the results support a tentative conclusion that SPL
and air flow measures are likely to increase for singers immediately after completing any of the three SOVTs trialed here.
Additionally, some individuals consistently have an increase
in %CQ after doing any of the SOVTs, but others may consistently not show a change in this measure. None of these SOVTs
induced a consistent change in oral air pressure.
Recall that participants also were assessed at the end of the
full protocol after resting the voice for a brief period of time.
This final measurement was an attempt to see if changes in
aerodynamic or EGG measures persisted beyond the immediate
postexercise time (ie, did the effects carry over for a brief period
TABLE 8.
Percent Closed Quotient (%CQ)
Straw Phonation
Subject
Singer
T1
T2
T3
S1
Group
Mean
SD
PreSOVT
Mean
Versus Pre
Lip Trill
Mean
Versus Pre
Tongue Trill
Mean
Versus Pre
PostSOVT
Mean
Versus Pre
48
40
41
27
50
42
47
31
2
2
6
4
51
42
48
30
3
2
7
3
52
41
47
31
4
1
6
4
53
40
48
31
5
0
7
4
39.0
8.76
42.5
8.35
3.5
1.91
42.75
9.29
3.75
2.22
42.75
9.03
3.75
2.06
43.0
9.63
4.0
2.94
162
TABLE 9.
Predominant Direction of Change for Each Measure Across the Three SOVT Conditions and the Carryover Condition
Straw Phonation
Data
Considered
From N
Participants
Parameter
Lip Trill
Tongue Trill
Predominant
Outcome
Versus
PreSOVT
# Participants
Showing
Predominant
Outcome
Predominant
Outcome
Versus
PreSOVT
# Participants
Showing
Predominant
Outcome
Predominant
Outcome
Versus
PreSOVT
# Participants
Showing
Predominant
Outcome
Predominant
Outcome
Versus
PreSOVT
# Participants
Showing
Predominant
Outcome
2>
2
3/3
SPL mean
>
3/4
>
3/4
>
3/4
None
Expiratory
flow
Oral pressure
>
3/3
>
2/3
>
2/3
>
None
2>
2<
None
None
3/3
>
>
2
1>
1<
2/3
None
>
2
1>
1<
2/3
>
1
1>
2<
3/3
<
2/3
3/3
<
2/3
<
2/3
None
2
2>
None
2
2>
None
2
2>
>
3/4
3
4
Mean flow
during
voicing
Laryngeal
resistance
% Closed
quotient
Abbreviations: , less than a 10% change; None, there was no consistent outcome across subjects.
Notes: To be considered a change, the measure had to increase or decrease by 10% versus the preSOVT value.
163
There are several limitations to this study. The small number of participants precluded generalization of results. The
types and magnitude of changes in the voice varied substantially after the SOVTs, indicating that very large groups of
participants will be needed to better define what changes
should be anticipated from these exercises. However, within
this small sample it is noted that significant individual variation in aerodynamic and EGG parameters was noted. The
period of SOVT execution was brief and may not reflect durations of exercise activity that an SLP or singing teacher may
request. However, even with just brief periods of SOVT
execution, aerodynamic and EGG differences did occur. It is
possible that longer periods of SOVT execution within the
setting or over an extended number of days or weeks may
result in more consistent, impressive, or different changes
than what were found here. Related to this issue is the fact
that persistent use of the SOVTs, as opposed to one-time
use in this study, may be necessary for adjustments to occur
or to stabilize. It would be of interest to compare baseline
to postSOVT exercises with participants completing a more
rigorous SOVT schedule over an extended time frame.
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