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How to use the flow resistant straws
Abstract
Shares the author's experience in working with flow resistant straws and how they lead in a logical sequence to other warm-up exercises. Notes that the article is a follow-up to a previous scientific article titled "Raising Lung Pressure and Pitch in Vocal Warm-Ups: The Use of Flow Resistant Straws."
... sub-and supraglottic pressure) which leads to a relatively small vibrational amplitude, decreased glottal resistance and slightly separated vocal folds. 1,8,[13][14][15][16][17][18][19] Because the impact stress on the vocal folds diminishes, phonation with high subglottic pressure and high pitch can be achieved with minimal risk of injury to the vocal fold mucosa, making SOVT exercises ideal for voice warm-up. 1,8,13,14,[15][16][17][18][19] Moreover, a barely abducted or barely adducted vocal fold configuration is associated with a voice production that is neither breathy nor pressed; and, therefore, it is the target for both patients with laryngeal hyperfunction and those with hypofunction. ...
... 1,8,[13][14][15][16][17][18][19] Because the impact stress on the vocal folds diminishes, phonation with high subglottic pressure and high pitch can be achieved with minimal risk of injury to the vocal fold mucosa, making SOVT exercises ideal for voice warm-up. 1,8,13,14,[15][16][17][18][19] Moreover, a barely abducted or barely adducted vocal fold configuration is associated with a voice production that is neither breathy nor pressed; and, therefore, it is the target for both patients with laryngeal hyperfunction and those with hypofunction. 11,[20][21][22] SOVT exercises can have either a single (ie, only the vocal folds) or a double vibratory source. ...
... Due to lower transglottic pressure, reduced vibrational amplitude could be expected during SP. 1,8,[13][14][15][16][17][18][19]25 A trend suggesting this phenomenon was noted in the SP-in-water group (non-significantly decreased left amplitude: mean decrease from 56% to 49%), which indicates lower vocal fold impact stress that offers promising vocal training and rehabilitation opportunities with minimal risk of phonotraumatic reactions. 1,8,[13][14][15][16][17][18][19] The current results are consistent with two recent studies using high-speed rigid videolaryngoscopy during water resistance therapy with a flexible silicone tube. ...
Purpose The first purpose of this study was to investigate and compare the short-term effects after a semi-occluded vocal tract (SOVT) therapy session consisting of straw phonation (SP) in air or water on vocal fold vibration and supraglottic activity of adult patients with voice disorders, visualized with strobovideolaryngoscopy (SVL). The second purpose of this study was to investigate and compare immediate changes in the patients’ vocal fold vibration and supraglottic activity during SP in air or water, visualized with SVL.
Methods Twelve adult patients with voice disorders (eight women and four men, mean age 52 years) were assigned randomly to one of two study groups: SP in air or SP in water. Immediately before and after a therapy session of 15 min, participants underwent a rigid SVL to determine the short-term effects of the SP session. At the posttherapy examination, flexible SVL while performing SP was added to determine the effects occurring during SP. The visual-perceptual ratings were performed blindly and in random order by three laryngologists, using the Voice-Vibratory Assessment with Laryngeal Imaging rating form for stroboscopy.
Results Short-term effects after SP: After the SP-in-air session, the supraglottic mediolateral compression decreased significantly. The SP-in-water session led to significantly increased left vibrational amplitude. Immediate effects during SP: During SP in air, a significantly increased left amplitude and mucosal wave, and significantly decreased mediolateral supraglottic activity, were found. SP in water tended to decrease the vibrational amplitude during performance of the task. A trend toward higher anteroposterior supraglottic compression was observed during both SP in air and water, being more prominent in the latter.
Conclusion SP in air led to less false vocal fold adduction and consequently less hyperfunction. The small increment in anteroposterior supraglottic activity during SP in air and water might be related to epilarynx narrowing, an economic phenomenon associated with SOVT exercises. The effects on vibrational amplitude were rather ambiguous. The small reduction in amplitude during SP in water is expected to diminish vocal fold impact stress and therefore creates an ideal basis for voice therapy. The increment in amplitude and mucosal wave during SP in air might indicate insufficient supraglottic pressure to obtain the favorable effects of semi-occlusion. Whether or not the rise in amplitude after the SP-in-water session is due to voice efficiency or voice fatigue remains unknown. Future larger-scale investigation in subgroups of voice patients is needed to explore these hypotheses.
... Some of the most well-known SOVTEs are represented by lip and tongue trills, hummings, hand-over-mouth (which are carried out without any tool), resonance tubes, flow resistant straw and Lax Vox ® (performed with the help of a device) [13][14][15][16][17][18]. Andrade et al. [19] compared electroglottographic (EGG) and acoustic features of the most common SOVTEs and divided them into three groups: steady, fluctuating and combined. ...
... The results of the present study are similar to those reported in literature by other authors who investigated semi-occlusions obtained through face masks, both in steady or fluctuating modes. A limitation of traditional SOVTEs is that they hinder a free articulation and can be proposed as single-phoneme tasks [9][10][11][12][13][14][15][16][17][18]. This represents an obstacle (both in voice training and voice therapy) to the transfer of the achieved vocal economy and efficiency to the conversational speech and/or singing. ...
Objective: The present study aims at investigating the immediate effects of the Semi-Occluded Bubble Mask Technique (SOBM) performed with the device VocalFeel® as a vocal warm-up in a group of professional singers.
Study Design: A randomized controlled study was carried out.
Methods: Forty-four vocally healthy professional singers were randomly divided into two groups on recruitment: an experimental group and a control group. The same vocal warm-up exercise was performed by the experimental group with the SOMB technique and by the control group without semi-occlusion. Self assessments, acoustic analysis and aerodynamic analysis of Peak Nasal Inspiratory Flows (PNIF) and Peak Oral Inspiratory Flows (POIF) were performed.
Results: Significant improvements after the SOBM technique were detected in the experimental group concerning some acoustic parameters (Jitt%; Shimm%) and aerodynamic measures (PNIF and POIF). No significant improvements after the warm-up exercise were observed in the control group. Significant differences between the experimental and the control group were found for ΔJitt%, ΔShimm%, ΔNHR, ΔPOIF and self assessments.
Conclusions: The results of the present study support the efficacy of a vocal warm-up performed with the SOBM technique using VocalFeel® device in terms of acoustic quality, aerodynamic measures and perceived phonatory comfort in professional singers.
... 우리나라에서는 VFI가 두 가지 버전으로 번안되어 이용되 고 있다 (Kang et al., 2017;Kim, 2017 (Kim, 2022;Titze, 2006). SOVTE는 즉각적인 음성변화를 유도 하며 (Fadel et al., 2016) (Gaskill & Erickson, 2008;Kim, 2019;Laukkanen, Titze, Hoffman, & Finnegan, 2008;Lee, Choi, Lim, & Lee, 2017;Ogawa et al., 2014;Titze, 2006;Vlot et al., 2017 (Andrade et al., 2016;Dargin & Searl, 2015;Guzman, Castro, Testart, Munoz, & Gerhard, 2013;Guzman et al., 2017a;Guzman et al., 2013;Guzman et al., 2017b;Kim, 2019;Paes, Zambon, Yamasaki, Simberg, & Behalus, 2013;Story, Laukkanen, & Titze, 2000;Titze, 2002Titze, , 2018Titze, Finnegan, Laukkanen, & Jaiswal, 2002;Titze & Laukkanen, 2007 ...
Objectives: This study aimed to investigate the vocal changes in adults experiencing subjective vocal fatigue through a three-week intervention employing a semi-occluded ventilation mask (SOVM), which is a type of semi-occluded vocal tract exercise (SOVTE), and Korean speech materials. Methods: We implemented a three-week intervention program using an SOVM and a protocol based on Korean speech materials for 22 Korean adults (5 males and 17 females, aged 25.81 ± 7.31 years) reporting subjective vocal fatigue. The SOVM was fabricated by establishing a semi-occluded environment using a silicone plug with a central hole, which was inserted into the front opening of an air-cushion mask, typically used in medical context. Participants were also instructed to perform home training sessions twice a day until the subsequent intervention. The outcomes of multi-dimensional voice evaluations were compared pre-and post-intervention to assess vocal changes. Results: Post-intervention, significant improvements were observed in specific acoustic measurements (jitter percent, shimmer percent, noise-to-harmonic ratio, and cepstral peak prominence of vowel phonation) and the severity indices derived from those acoustic parameters. Additionally, a significant reduction in patient-reported outcome measures was noted following the intervention. Conclusion: The findings suggest that voice intervention using the SOVM and Korean speech materials has the potential to alleviate vocal fatigue and enhance vocal quality in individuals with vocal fatigue complaints.
... However, the qualitative analysis shows how SOVTEs may lead to an improvement over hygiene, placebo or non-intervention; also, this aspect finds large confirmation, since it is widely demonstrated that active exercise increases voice awareness, thus leading to clinical-functional improvements. 58 Finally, the favorable trend of SOVTEs when compared to other active interventions may be explained in their physics: this type of exercises may be able to reduce the collision impact between the vocal folds during phonation, thus being at high vocal economy 59 and representing a valid rehabilitation tool to improve vocal quality, limit vocal fold traumatism, and reduce laryngeal hyperkinesia. 35,60 In this regard, some considerations about populations of the included studies should be made. ...
Background
Dysphonia is a disorder characterized by an alteration in the overall quality of the voice which reduces quality of life. Therefore, we assessed the effectiveness of SOVTEs in the management of dysfunctional and organic dysphonia for acoustic, perceptual-auditive, aerodynamic parameters and self-perception of the disease.
Methods
a systematic review and meta-analysis were conducted. Findings were reported according to the PRISMA statement. Five databases were searched for RCTs and non- or quasi-RCTs. Studies were independently assessed using the Cochrane Risk of bias (RoB) and ROBINS-I tools. Effect sizes (ES) were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence.
Results
eight articles were included. Studies investigated several SOVTEs, alone or in combination. None of the study was completely judged at low RoB. The quality of evidence resulted very low for each analysis. SOVTEs revealed to be statistically more effective than control interventions in improving F0 (ES: -14.42; CI 95%: -27.16, -1.69); P = 0.03), whereas shimmer did not change significantly (ES: -0.43; CI 95%:-02.02, 1.15; P = 0.59). Not significant changes in favor of control groups were found for jitter (ES: 0.13; CI 95%: -0.14, 0.40; P = 0.34) and overall gravity in the perceptual-auditory evaluation (ES: 0.13 CI 95%: -0.50, 0.77; P = 0. 68). Among secondary outcomes, evidence suggested that SOVTEs are more effective than control interventions in Psub reduction (ES: -1.47; CI 95%: -2.84, -0.10; P = 0.03); self-assessment resulted not significantly in favor of SOVTEs (VHI/VRQoL: ES -0.23; CI 95% -1.14, 0.69; P = 0.63 and VTDS/VDSI: ES -4.85, CI 95% -25.13, 15.42; P = 0.64).
Conclusion
results obtained showed that voice therapy based on SOVTEs is not to consider significantly superior if compared to other treatments, even if a favorable trend was detected and should be taken into consideration. Further high-quality RCTs on specific SOVTEs are recommended to produce better-quality evidence.
... Previous studies have demonstrated that high impedance equalizes the subglottic and supraglottic pressures, and increases the transglottal pressure, which consequently can generate better vocal fold waveform. 9,19,21,23 This condition could have reduced the aperiodic mucosal waveform and generated a reduction in the perception of hoarseness in women. Thus, even in patients with behavioral dysphonia who have benign mass lesions or edema, the exercise may possibly promote the improvement of vibration and coaptation of the vocal fold mucosa and reduce the audible noise present in the voice. ...
Objectives
To analyze the immediate effects of voiced high-frequency oscillation (VHFO) and Lax Vox technique on vocal quality and self-reported intensity of vocal and laryngeal symptoms in individuals with behavioral dysphonia.
Methods
This experimental, prospective, randomized cross-over study, investigated thirty adults (15 women and 15 men) with behavioral dysphonia (vocal complaints, altered voice on auditory-perceptual evaluation, vocal nodules or mucosal thickening, and incomplete glottic closure). The outcome variables analyzed were auditory-perceptual analysis, acoustic analysis (voice quality characteristics), and self-reported intensities of vocal and laryngeal symptoms. Each participant performed two exercises—VHFO and Lax Vox technique—in a random sequence for 3 minutes. A 7-day washout period was provided between the exercises. The data were analyzed using the paired t-test and Wilcoxon test (P < 0.05).
Results
After VHFO, no significant difference was observed on auditory-perceptual evaluation in all participants, whereas the Lax Vox technique worsened breathiness among women (P = 0.027). VHFO significantly increased the fundamental frequency (P = 0.014) and decreased the noise harmonic ratios for women (P = 0.026). Among men, there was a decrease in shimmer parameter (P = 0.035). Moreover, symptoms such as “lump in the throat” (P = 0.005), “voice loss” (P = 0.017), and “high-pitched voice” (P = 0.023) decreased in women after VHFO, whereas in men, “itchiness” and “hoarseness” (P < 0.001) decreased after VHFO. The Lax Vox technique decreased “hoarseness” (P = 0.003) in women, without any effect in men.
Conclusion
The VHFO exercise provided more positive immediate effects results than the Lax Vox technique regarding vocal quality and self-reported symptom intensity in participants with behavioral dysphonia.
Celem prowadzonych badań było sprawdzenie, czy ćwiczenie fonacji ze zwężonym traktem głosowym może wpłynąć na poprawę wybranych parametrów głosu u wokalistów. Grupę badaną tworzyło 10 osób (5 kobiet i 5 mężczyzn) w wieku 20–29 lat, które w chwili badania kształciły się wokalnie i były zdrowe, tj. nie zgłaszały chorób przewlekłych ani innych chorób i infekcji. Osoby badane w ramach treningu właściwego wykonały 2,5‑minutowy zestaw ćwiczeń z wykorzystaniem słomki o wymiarach 0,5 × 21,5 cm. Przed wykonaniem zadań, a także po ich zakończeniu głos badanych został poddany ocenie (ogólna jakość głosu, brzmienie głosu, poziom zmęczenia głosu, łatwość, z którą głos jest wydobywany czy umiejętność przejścia pomiędzy rejestrami). Wyniki przeprowadzonych badań wskazują na skuteczność ćwiczeń SOVT, co potwierdziło się w samoocenie jakości głosu, badaniu odsłuchowym oraz wynikach pomiaru maksymalnego czasu fonacji na głosce [a].
In Japan, voice therapy by speech therapist (STs) is rarely provided for professional singers with dysphonia. However, I believe that voice therapy by STs should be provided for professional singers who complain of singing voice problems that affect their work performance, even though their vocal cord lesions are minute. The purpose of this paper is to review the literature on the efficacy of voice therapy for professional singers with dysphonia and to provide some key pointers for undertaking voice therapy in practice.
The most important points of vocal hygiene advised to professional singers are: 1) avoid abuse and misuse of the voice other than singing, 2) keep the vocal cords moist, and 3) undertake vocal warm-up/cool-down. The following points should be kept in mind regarding vocal training: 1) intensive training should be provided whenever the patient is able to come to the clinic, 2) trial voice therapy should be provided and the most appropriate technique should be used, and 3) instruction in singing techniques (how to sing well) should be provided by a singing coach. The use of semi-occluded vocal tract exercises for vocal training has been reported to reduce damage from vocal cord contact and improve vocal function in singers.
Objective
To analyze the effect of phonation in a glass tube immersed in water compared to other interventions on general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment in vocally healthy individuals.
Methods
This is a systematic review and meta-analysis developed from the research question: “In vocally healthy individuals, what is the effect of phonation into a glass tube immersed in water versus other vocal interventions, other activities, or no intervention on general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment?” An electronic search was performed using Medline, LILACS, Cochrane Library, Embase, Web of Science, and SCOPUS databases, and a manual search was performed in the gray literature (Brazilian Digital Library of Theses and Dissertations and OpenGrey), the Journal of Voice, and the citations of the studies. Studies with (P) population of adults with healthy voices, (I) intervention with phonation into a glass tube immersed in water, (C) comparison with other vocal interventions, other activities, or no intervention, (O) outcomes of the general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment, and an (S) study with the experimental or quasi-experimental design were included. Risk of bias assessment and meta-analysis of the outcomes were performed.
Results
A total of 457 studies were found in the search; four were selected for the systematic review and meta-analysis. In the risk of bias assessment, there was an uncertain risk of selection and performance bias in 100% of the studies and uncertain risk of detection bias of 75%. All studies had an experimental design, and most of them were conducted on women. In the fundamental frequency analysis, there was no difference between the effect sizes of the interventions (z = 0.471, P = 0.638). In the vocal self-assessment, the estimated odds ratio was 1.31, showing a greater chance of improvement in the intervention group than with the comparison group (z = 3.45, P < 0.001). There were not enough studies to analyze the general degree of vocal deviation and sound pressure level outcomes.
Conclusion
Phonation into a glass tube immersed in water has a greater positive effect on vocal self-assessment than other interventions in vocally healthy individuals.
Objective
The present study aimed to investigate the effect of vocal loading and the immediate effects of straw phonation in water exercises on parameters of vocal loading in Carnatic classical singers.
Study Design
A within-subject pretest-posttest design.
Methods
Twelve healthy Carnatic classical singers participated in the vocal loading experiment for 2 days, referred to as no-treatment and treatment conditions. The vocal loading task consisted of 1 hour of continuous singing in the presence of background noise. For the treatment condition, the participants followed a 10-minute straw phonation in water exercises before the vocal loading task. Acoustic, electroglottographic, and self-rated perceptual voice measures were recorded before and after the vocal loading task on both days.
Results
Pretest and posttest comparison of various outcome measures during no-treatment day suggested a significant increase in shimmer percent, decrease in maximum phonation duration of vowel /a/, and increase in perceived phonatory effort, perceived vocal effort, and Evaluation of Ability to Sing Easily scores. Pretest and posttest comparisons during treatment day showed a significant increase in Mean F0, Highest F0, and Lowest F0, perceived phonatory effort, and perceived vocal effort scores. However, changes in Mean F0, Highest F0, and Lowest F0 measures were small in the posttest condition compared to pretest.
Conclusion
The present results suggest that vocal loading did induce changes in Carnatic classical singers' voices. However, there is no substantial evidence that straw phonation is effective in reducing the vocal loading in Carnatic classical singers. Further studies are required to corroborate the current findings.
Objective
Effects of exercises using a tool that promotes a semi-occluded artificially elongated vocal tract with real-time visual feedback of airflow – the flow ball – were tested using voice maps of EGG time-domain metrics.
Methods
Ten classically trained singers (5 males and 5 females) were asked to sing messa di voce exercises on eight scale tones, performed in three consecutive conditions: baseline (‘before’), flow ball phonation (‘during’), and again without the flow ball (‘after’). These conditions were repeated eight times in a row: one scale tone at a time, on an ascending whole tone scale. Audio and electroglottographic signals were recorded using a Laryngograph microprocessor. Vocal fold contacting was assessed using three time-domain metrics of the EGG waveform, using FonaDyn. The quotient of contact by integration, Qci, the normalized peak derivative, QΔ, and the index of contacting Ic, were quantified and compared between ‘before’ and ‘after’ conditions.
Results
Effects of flow ball exercises depended on singers’ habitual phonatory behaviours and on the position in the voice range. As computed over the entire range of the task, Qci was reduced by about 2% in five of ten singers. QΔ was 2–6% lower in six of the singers, and 3–4% higher only in the two bass-baritones. Ic decreased by almost 4% in all singers.
Conclusion
Overall, vocal adduction was reduced and a gentler vocal fold collision was observed for the ‘after’ conditions.
Significance
Flow ball exercises may contribute to the modification of phonatory behaviours of vocal pressedness.
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