Advertisement
Research Article| Volume 34, ISSUE 3, P398-409, May 2020

Immediate Effects of the Semi-Occluded Ventilation Mask on Subjects Diagnosed With Functional Dysphonia and Subjects With Normal Voices

Published:November 10, 2018DOI:https://doi.org/10.1016/j.jvoice.2018.10.004

      Summary

      Purpose

      The present study was designed to assess the immediate effects of the semi-occluded ventilation mask (SOVM) in subjects with functional dysphonia and subjects with normal voice.

      Methods

      Sixty-four participants were included in this study (48 women and 16 men). Thirty-one of them were diagnosed with functional dysphonia and 33 with normal voice. All subjects were randomly assigned to one of two conditions: an experimental condition using the SOVM (n = 33) and a control condition with participants not using the SOVM (n = 31). Thus, within both conditions, participants could be either dysphonic or normal-voiced. This produced a total of four different groups: (1) subjects with normal voice with SOVM (n = 17), (2) subjects with normal voice without SOVM (n = 16), (3) dysphonic subjects with SOVM (n = 16), and (4) dysphonic subjects without SOVM (n = 15). All participants underwent aerodynamic, electroglottographic (EGG), and acoustic assessments, and were also asked to assess their own voice, before and after voice exercises.

      Results

      Significant differences were found for aerodynamic, EGG, and acoustic variables when comparing SOVM conditions (dysphonic and normal) against control. Cepstral peak prominence and EGG contact quotient showed an increase among dysphonic participants with SOVM. L1-L0 showed an increase for all participants in SOVM condition (dysphonic and normal). Self-perceived resonant voice quality showed an increase for both groups in SOVM condition. Glottal airflow showed a decrease for the dysphonic participants in SOVM condition. Phonation threshold pressure and subglottic pressure showed a decrease for both groups in SOVM condition.

      Conclusion

      The present study suggests that immediate positive effect could be produced by connected speech phonatory tasks using the SOVM in both dysphonic subjects and subjects with normal voice, the change being greater among the former. SOVM seems to promote an easy voice production and a more efficient phonation.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Titze I.
        The physics of small-amplitude oscillation of the vocal folds.
        J Acoust Soc Am. 1988; 83: 1536-1552
        • Titze I.R.
        Principles of Voice Production.
        National Center for Voice and Speech, Iowa City, IA2000: 99-103
        • Titze I.
        Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.
        J Speech Lang Hear Res. 2006; 49: 448-459
        • Titze I.
        • Riede T.
        • Popolo P.
        Nonlinear source-filter coupling in phonation: vocal exercises.
        J Acoust Soc Am. 2008; 123 (1902-1015.5)
        • Titze I.
        • Verdolini-Abbot K.
        Vocology: The Science and Practice of Voice Habilitation.
        The National Center for Voice and Speech, Salt Lake City, UT2012
        • Simberg S.
        • Laine A.
        The resonance tube method in voice therapy: description and practical implementations.
        Logoped Phoniatr Vocol. 2007; 32: 165-170
        • Sovijärvi A.
        • Häyrinen R.
        • Orden-Pannila M.
        • et al.
        Aänifysiologisten kuntoutusharjoitusten ohjeita [Instructions for voice exercises].
        Publications of Suomen Puheopisto, Helsinki1989
        • Sovijärvi A.
        Die Bestimmung der Stimmkategorien mittels Resonanzröhren.
        Int Kongr Phon Wiss. 1965; : 532-535
        • Sovijärvi A.
        Äänifysiologiasta ja artikulaatiotekniikasta[On Voice Physiology and Articulatory Technique].
        Department of Phonetics, University of Helsinki Press, Helsinki, Finland1966
        • Sovijärvi A.
        Nya metoder vid behandlingen av röstrubbningar.
        Tale og Stemme. 1969; 3: 121-131
        • Story B.H.
        • Laukkanen A.-M.
        • Titze I.
        Acoustic impedance of an artificially lengthened and constricted vocal tract.
        J Voice. 2000; 14: 455-469
        • Rothenberg M.
        Acoustic interaction between the glottal source and the vocal tract.
        in: Stevens K.N. Hirano M. Vocal Fold Physiology. University of Tokyo Press, Tokio, Japan1981: 305-328
        • Titze I.
        • Story B.
        Acoustic interactions of the voice source with the lower vocal tract.
        J Acoust Soc Am. 1997; 101: 2234-2243
        • Titze I.
        • Laukkanen A.
        Can vocal economy in phonation be increased with an artificially lengthened vocal tract? A computer modeling study.
        Logoped Phoniatr Vocol. 2007; 32: 147-156
        • Titze I.
        Phonation threshold pressure measurement with a semi-occluded vocal tract.
        J Speech Lang Hear Res. 2009; 52: 1062-1072
        • Fant G.
        • Lin Q.
        Glottal source-vocal tract acoustic interaction.
        STL-QPSR. 1987; 1: 13-27
        • Verdolini-Marston K.
        • Burke M.
        • Lessac A.
        • et al.
        A preliminary study of two methods of treatment for laryngeal nodules.
        J Voice. 1995; 9: 74-85
        • Verdolini-Marston K.
        • Drucker G.
        • Palmer M.
        • et al.
        Laryngeal adduction in resonant voice.
        J Voice. 1998; 12: 315-327
        • Gaskill C.
        • Erickson M.
        The effect of a voiced lip trill on estimated glottal closed quotient.
        J Voice. 2008; 22: 634-643
        • Titze I.
        Lip and tongue trills – what do they do for us?.
        J Sing. 1996; 52: 51
        • Munro M.
        • Leino T.
        • Wissing D.
        Lessac's as a pedagogical tool in the teaching of the projection of an actor's voice.
        S Afr J Ling. 1996; 14: 25-36
        • Lessac A.
        The Use and Training of the Human Voice: A Practical Approach to Speech and Voice Dynamics.
        3rd ed. McGraw-Hill, Santa Monica, CA1997
        • Aderhold E.
        Sprecherziehung Des Schauspielers. [Speech Training of the Actor]. Grundlagen und Methoden [Principles and Methods].
        Henscheverlag, Berlin, Germany1963
        • Fouquet M.L.
        • Vieira T.P.G.
        • Murata C.J.M.
        • et al.
        Hands-over-mouth exercise in supracricoid horizontal partial laryngectomy: initial study.
        Rev Soc Bras Fonoaudiol. 2012; 17: 346-350
        • Rosenberg M.
        Using semi-occluded vocal tract exercises in voice therapy: the clinician's primer.
        Perspect Voice Disord. 2014; 24: 71-79
        • Rosenberg M.
        • LeBorgne W.
        The Vocal Athlete: Application and Technique for the Hybrid Singer.
        Plural, San Diego, CA2014
        • Guzman M.
        • Laukkanen A.-M.
        • Krupa P.
        • et al.
        Vocal tract and glottal function during and after vocal exercising with resonance tube and straw.
        J Voice. 2013; 27: 305-311
        • Laukkanen A.-M.
        About the so called “resonance tubes” used in Finnish voice training practice.
        Scand J Logop Phoniatr. 1992; 17: 151-161
        • Vampola T.
        • Laukkanen A.-M.
        • Horacek J.
        • et al.
        Vocal tract changes caused by phonation into a tube: a case study using computerized tomography and finite-element modeling.
        J Acoust Soc Am. 2011; 129: 310-315
        • Shivo M.
        • Denizoglu I.
        Lax Vox: Voice Therapy Technique.
        AD, Izmur, Turkey2007
        • Paes S.
        • Zambon F.
        • Yamasaki R.
        • et al.
        Immediate effects of the Finnish resonance tube method on behavioral dysphonia.
        J Voice. 2013; 27: 717-722
        • Guzman M.
        • Jara R.
        • Ch O.
        • et al.
        Efficacy of water resistance therapy in subjects diagnosed with behavioral dysphonia: a randomized controlled trial.
        J Voice. 2017; 31 (385.e1-e10)
        • Borrogán A.
        • del Barrio J.A.
        • Gutierrez J.N.
        El juego Vocal Para Prevenir Problemas De La Voz.
        Aljibe, Archidona, Malaga1999
        • Mills R.
        • Hays C.
        • Al-Ramahi J.
        • et al.
        Validation and evaluation of the effects of semi-occluded face mask straw phonation therapy methods on aerodynamic parameters in comparison to traditional methods.
        J Voice. 2016; (in press)https://doi.org/10.1016/j.jvoice.2016.04.009
        • Fantini M.
        • Succo G.
        • Crosetti E.
        • et al.
        Voice quality after a semi-occluded vocal tract exercise with a ventilation mask in contemporary commercial singers: acoustic analysis and self-assessments.
        J Voice. 2016; (in press)https://doi.org/10.1016/j.jvoice.2016.05.019
        • Gaskill C.S.
        • Erickson M.L.
        The effect of an artificially lengthened vocal tract on estimated glottal contact quotient in untrained male voices.
        J Voice. 2010; 24: 57-71
        • Gaskill C.
        • Quinney D.
        The effect of resonance tubes on glottal contact quotient with and without task instruction: a comparison of trained and untrained voices.
        J Voice. 2012; 26: e79-e93
        • Cordeiro G.F.
        • Montagnoli A.N.
        • Nemr N.K.
        • et al.
        Comparative analysis of the closed quotient for lip and tongue trills in relation to the sustained vowel /ε/.
        J Voice. 2012; 26: 17-22
        • Hamdan A.L.
        • Nassar J.
        • Al Zaghal Z.
        • et al.
        Glottal contact quotient in Mediterranean tongue trill.
        J Voice. 2012; 26 (669, e11-e15)
        • Guzman M.
        • Rubin A.
        • Muñoz D.
        • et al.
        Changes in glottal contact quotient during resonance tube phonation and phonation with vibrato.
        J Voice. 2013; 27: 305-311
        • Andrade P.A.
        • Wood G.
        • Ratcliffe P.
        • et al.
        Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.
        J Voice. 2014; 28: 589-595
        • Guzman M.
        • Calvache C.
        • Romero L.
        • et al.
        Do different semi-occluded voice exercises affect vocal fold adduction differently in subjects diagnosed with hyperfunctional dysphonia.
        Folia Phoniatr Logop. 2015; 67: 68-75
        • Andrade P.
        • Wistbacka G.
        • Larsson H.
        • et al.
        The flow and pressure relationships in different tubes commonly used for semi-occluded vocal tract exercises.
        J Voice. 2016; 30: 36-41
        • Stemple J.
        • Lee L.
        • D'Amico B.
        • et al.
        Efficacy of vocal function exercises as a method of improving voice production.
        J Voice. 1994; 8: 271-278
        • Tanner K.
        • Sauder C.
        • Thibeault S.
        • et al.
        Vocal fold bowing in elderly male monozygotic twins: a case study.
        J Voice. 2010; 24: 470-476
        • Nguyen D.D.
        • Kenny D.T.
        Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers.
        J Otolaryngol Head Neck Surg. 2009; 38: 261-278
        • Kotby M.N.
        • El-Sady S.R.
        • Basiouny S.E.
        • et al.
        Efficacy of the accent method of voice therapy.
        J Voice. 1991; 5: 316-320
        • Sabol J.W.
        • Lee L.
        • Stemple J.C.
        The value of vocal function exercises in the practice regimen of singers.
        J Voice. 1995; 9: 27-36
        • Roy N.
        • Weinrich B.
        • Gray S.D.
        • et al.
        Three treatments for teachers with voice disorders: a randomized clinical trial.
        J Speech Lang Hear Res. 2003; 46: 670-688
        • Law T.
        • Lee K.Y.
        • Ho F.N.
        • et al.
        The effectiveness of group voice therapy: a group climate perspective.
        J Voice. 2012; 26: e41-e48
        • Gillivan-Murphy P.
        • Drinnan M.
        • O'Dwyer T.
        • et al.
        The effectiveness of a voice treatment approach for teacher with self-reported voice problems.
        J Voice. 2006; 20: 423-431
        • Sauder C.
        • Roy N.
        • Tanner K.
        • et al.
        Vocal function exercises for presbylaryngis: a multidimensional assessment of treatment outcomes.
        Ann Otol Rhinol Laryngol. 2010; 119: 460-467
        • Bassiouny S.
        Efficacy of the accent method of voice therapy.
        Folia Phoniatr Logop. 1998; 50: 146-164
        • Kapsner-Smith M.R.
        • Hunter E.J.
        • Kirkham K.
        • et al.
        A randomized controlled trial of two semi-occluded vocal tract voice therapy protocols.
        J Speech Lang Hear Res. 2015; 58: 535-549
        • Simberg S.
        • Sala E.
        • Tuomainen J.
        • et al.
        The effectiveness of group therapy for students with mild voice disorders: a controlled clinical trial.
        J Voice. 2006; 20: 97-109
        • Tapani M.
        Resonaattoriputki toiminnallisen ääihäirion hoitmenetelmänä. Seitsemän naispotilaan Seurantatutukimus [Resonance Tube as a Therapy Method for a Functional Voice Disorder. A Follow-Up Study of Seven Female Patients] (in Finnish).
        University of Helsinki, Helsinki, Finland1992
        • Guzman M.
        • Higueras D.
        • Fincheira C.
        • et al.
        Immediate acoustic effects of Straw phonation exercises in subjects with dysphonic voices.
        Logoped Phoniatr Vocol. 2013; 38: 35-45
        • Costa C.B.
        • Costa L.H.
        • Oliveira G.
        • et al.
        Immediate effects of the phonation into a straw exercise.
        Braz J Otorhinolaryngol. 2011; 77: 461-465
        • Titze I.R.
        Acoustic interpretation of resonant voice.
        J Voice. 2001; 15: 519-528
        • Conroy E.R.
        • Hennick T.M.
        • Awan S.N.
        • et al.
        Effect of variations to a simulated system of straw phonation therapy on aerodynamic parameters using excised canine larynges.
        J Voice. 2014; 28: 1-6
        • Chen S.H.
        • Hsiao T.Y.
        • Hsiao L.C.
        • et al.
        Outcome of resonant voice therapy for female teachers with voice disorders: perceptual, physiological, acoustic, aerodynamic, and functional measurements.
        J Voice. 2007; 21: 415-425
        • Horácek J.
        • Radolf V.
        • Bula V.
        • et al.
        Air-pressure, vocal folds vibration and acoustic characteristics of phonation during vocal exercising. Part 2: measurement on a physical model.
        Eng Mech. 2014; 21: 193-200
        • Rothenberg M.
        Cosí fan tutte and what it means or nonlinear source-tract acoustic interaction in the soprano voice and some implications for the definition of vocal efficiency.
        in: Baer T. Sasaki C. Harris K.S. Vocal Fold Physiology: Laryngeal Function in Phonation and Respiration. College-Hill Press, San Diego, CA1986: 254-263
        • Kitch J.A.
        • Oates J.
        The perceptual features of vocal fatigue as self-reported by a group of actors and singers.
        J Voice. 1994; 8: 207-214
        • Kotby M.N.
        • Fex B.
        The accent method: behavior readjustment voice therapy.
        Logoped Phonatr Vocol. 1998; 23: 39-43
        • Heman-Ackah Y.D.
        • Heuer R.J.
        • Michael D.D.
        Cepstral peak prominence: a more reliable measure of dysphonia.
        Ann Otol Rhinol Laryngol. 2003; 112: 324-333
        • Heman-Ackah Y.D.
        • Michael D.D.
        • Goding Jr, G.S.
        The relationship between cepstral peak prominence and selected parameters of dysphonia.
        J Voice. 2002; 16: 20-27
        • Heman-Ackah Y.D.
        Reliability of calculating the cepstral peak without linear regression analysis.
        J Voice. 2004; 18: 203-208
        • Zieger K.
        • Schneider C.
        • Gerull G.
        • et al.
        Cepstrum analysis in voice disorders.
        Folia Phoniatr Logop. 1995; 47: 210-217
        • Awan S.N.
        • Roy N.
        Acoustic prediction of voice type in women with functional dysphonia.
        J Voice. 2005; 19: 268-282
        • Watts R.
        The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.
        J Voice. 2015; 29: 191-199
        • Guzman M.
        • Rubin A.
        • Cox P.
        • et al.
        Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness.
        J Voice. 2014; 28: 216-225