Research Article| Volume 34, ISSUE 3, P487.e21-487.e30, May 2020

A Pilot Study Assessing the Therapeutic Potential of a Vibratory Positive Expiratory Pressure Device (Acapella Choice) in the Treatment of Voice Disorders

  • Brian Saccente-Kennedy
    Address correspondence and reprint requests to Brian Saccente-Kennedy, Speech and Language Therapy (ENT), The Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London WC1X 8DB, United Kingdom.
    Speech and Language Therapy (ENT), The Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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  • Pedro Amarante Andrade
    Faculty of Sport, Health and Wellbeing, Department of Health and Wellbeing, Plymouth Marjon University, Plymouth, United Kingdom
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  • Ruth Epstein
    Speech and Language Therapy (ENT), The Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Published:October 26, 2018DOI:



      Semioccluded vocal tract exercises (SOVTEs) can involve a single source of vibration (eg, vocal folds in the straw exercise) or a dual source of vibration (eg, vocal folds and water bubbling in tube phonation) in the vocal tract. Oftentimes, this secondary source of vibration causes large oscillations in intraoral pressure and has been likened to a "massage effect." This study assesses the implementation of a positive expiratory pressure device (Acapella Choice) as a possible alternative SOVTE, which presents a secondary source of vibration without the need of a water container.


      Twenty-two normophonic participants underwent acoustic, electroglottographic, and aerodynamic assessment before, during, and after phonation with two different established SOTVEs (silicone tube in water and straw in air) in addition to Acapella Choice.


      Acapella Choice produced the largest peak-to-peak amplitudes of intraoral pressure oscillation. Straw in air produced the largest static intraoral pressure. Straw in air and Acapella Choice presented significantly larger ranges of static pressures than tube in water phonation. Post-exercise condition showed a statistically larger sound pressure level for Acapella Choice.


      Positive expiratory pressure devices, such as Acapella Choice, may be a promising alternative to established SOVTEs as it promotes large oscillatory pressures in the vocal tract without the need for a water container. This exercise also produces larger sound pressure level with no significant changes in glottic contact quotient, indicating improved vocal economy.

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