Immediate Effects of Performance Time of the Voiced High-frequency Oscillation With Two Types of Breathing Devices in Vocally Healthy Individuals

Published:October 01, 2021DOI:



      To verify safety and compare the immediate effects of voiced high-frequency oscillation (VHFO) using two types of breathing devices on self-perception and vocal quality according to performance time in vocally healthy individuals.


      Thirty individuals (15 women and 15 men) without vocal complaints or any history of dysphonia participated. Each participant performed the VHFO technique with the New Shaker and Shaker Plus devices for 3 (T3), 5 (T5), and 7 minutes (T7). All answered a questionnaire that investigated the intensity of laryngopharyngeal and vocal symptoms before and after performing the VHFO with each device and at different times. After VHFO, at each time, the voice was recorded for further analysis of vocal quality. The participants also answered a self-assessment questionnaire about vocal, laryngeal, breathing, and articulatory sensations.


      T3 showed a decrease in the laryngopharyngeal symptoms “pain when swallowing,” “secretion in the throat,” and “phlegm” for both genders and both devices. T7 showed an increase in “dry throat” for both genders and both devices. There was an increase in the symptom “fatigue when speaking” in T3 for both genders after VHFO with the New Shaker device. We also observed a decrease in the symptoms “voice failure” and “dry cough” after VHFO with the Shaker Plus for men in T3, and “voice failure” after VHFO with the New Shaker for women in T5. We found a decrease in the acoustic parameter shimmer for women in T5 and the NHR parameter in T7 for both genders, regardless of the breathing device. There were no changes in the auditory-perceptual analysis of the voice and self-assessment of sensations after VHFO with both devices and for both genders.


      VHFO performed with New Shaker and Shaker Plus is safe and can be used in clinical vocal practice in vocally healthy individuals.

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        • Enflo L
        • Sundberg J
        • Romedahl C
        • et al.
        Effects on vocal fold collision and phonation threshold pressure of resonance tube phonation with tube end in water.
        J Speech, Lang Hear Res. 2013; 56: 1530-1538
        • Titze IR.
        Voice training and therapy with a.
        Hear Res. 2006; 49: 448-460
        • 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
        • Laukkanen AM
        • Titze IR
        • Hoffman H
        • et al.
        Effects of a semioccluded vocal tract on laryngeal muscle activity and glottal adduction in a single female subject.
        Folia Phoniatr Logop. 2009; 60: 298-311
        • Simberg S
        • Laine A.
        The resonance tube method in voice therapy: description and practical implementations.
        Logop Phoniatr Vocol. 2007; 32: 165-170
        • Calvache C
        • Guzman M
        • Bobadilla M
        • et al.
        Variation on vocal economy after different semioccluded vocal tract exercises in subjects with normal voice and dysphonia.
        J Voice. 2019; (Published online 2019)
        • Maxfield L
        • Titze I
        • Hunter E
        • et al.
        Intraoral pressures produced by thirteen semi-occluded vocal tract gestures.
        Logop Phoniatr Vocol. 2015; 40: 86-92
        • Mills RD
        • Rivedal S
        • DeMorett C
        • et al.
        Effects of straw phonation through tubes of varied lengths on sustained vowels in normal-voiced participants.
        J Voice. 2018; 32: 386.e21-386.e29
        • Story BH
        • Titze IR
        Acoustic impedance of an artificially lengthened vocal tract.
        J Voice. 2000; 14: 455-469
        • Andrade PA
        • 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
        • Duarte PECR
        • da Silva VL
        • Lins e de Silva DA
        Análise do funcionamento do Shaker à diversos níveis de fluxo.
        Pulmäo RJ. 2007; 16: 70-75
        • Gava MV
        • Ortenzi L.
        Estudo analítico dos efeitos fisiológicos e da utilização do aparelho Flutter VRP 1®.
        Fisioter em Mov. 1998; 11: 37-48
        • Gomide L
        • Silva C
        • Matheus JP.
        Atuação da fisioterapia respiratória em pacientes com fibrose cística: uma revisão da literatura: [revisão].
        Arq ciênc saúde. 2007; 14: 227-233
        • Morrison L
        • Agnew J.
        Oscillating devices for airway clearance in people with cystic fibrosis.
        Cochrane Database Syst Rev. 2014; 2014
        • Araújo EVCLS
        • Freitas ERFS
        • Mesquita R
        • et al.
        Acute effects of high-frequency oral oscillation on cardiorespiratory parameters in COPD: comparison between the equipments Flutter VRP1 and Shaker.
        ASSOBRAFIR Ciência. 2012; 3: 9-18
        • Da Silva KM
        • Bromerschenckel AIM
        Fisioterapia respiratória nas doenças pulmonares obstrutivas crônicas.
        Rev Hosp Univ Pedro Ernesto. 2013; 12
        • Antonetti AE da S
        • Ribeiro VV
        • Moreira PAM
        • et al.
        Voiced high-frequency oscillation and LaxVox: analysis of their immediate effects in subjects with healthy voice.
        J Voice. 2019; 33: 808.e7-808.e14
        • Saters T
        • Marotti BD
        • Ribeiro VV
        • et al.
        The voiced oral high-frequency oscillation technique's immediate effect in individuals with dysphonic and normal voices.
        J Voice. 2019; 32: 449-458
      1. NCS, Saúde E para promoção de. No Title. Published online 2016: Accessed August 17, 2021.

        • Suzan ABBM
        • Galvão F
        • Ribeiro AF
        • et al.
        Oscilação oral de alta frequência e fibrose cística: comparação entre instrumentais.
        ConScientiae Saúde. 2015; 14: 283-290
        • Silva RLF
        • Antonetti AE
        • da S
        • Ribeiro VV
        • et al.
        Voiced high-frequency oscillation or Lax Vox technique? Immediate effects in dysphonic individuals.
        J Voice. 2020; (Published online 2020)
        • Piragibe PC
        • Silverio KCA
        • Dassie-Leite AP
        • et al.
        Comparison of the immediate effect of voiced oral high-frequency oscillation and flow phonation with resonance tube in vocally-healthy elderly women.
        Codas. 2020; 32: 1-10
        • Andrade PA
        • 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
        • Guzman M
        • Laukkanen AM
        • Krupa P
        • et al.
        Vocal tract and glottal function during and after vocal exercising with resonance tube and straw.
        J Voice. 2013; 27: 523.e19-523.e34
        • Radolf V
        • Laukkanen AM
        • Horáček J
        • et al.
        Air-pressure, vocal fold vibration and acoustic characteristics of phonation during vocal exercising. Part 1: measurement in vivo.
        Eng Mech. 2014; 21: 53-59
        • Menezes MHM
        • Ubrig-Zancanella MT
        • Cunha MGB
        • et al.
        The relationship between tongue trill performance duration and vocal changes in dysphonic women.
        J Voice. 2011; 25
        • Menezes MH
        • De Campos Duprat A
        • Costa HO
        Vocal and laryngeal effects of voiced tongue vibration technique according to performance time.
        J Voice. 2005; 19: 61-70
      2. Clinical Trials. Glossary of common site terms. Glossary of common site terms.

        • De Assis Moura Ghirardi AC
        • Piccolotto Ferreira L
        • Pimentel Pinto Giannini S
        • et al.
        Screening index for voice disorder (SIVD): development and validation.
        J Voice. 2013; 27: 195-200
        • Landis JR
        • Koch GG.
        Landis amd Koch1977_agreement of categorical data.
        Biometrics. 1977; 33: 159-174
        • Antonetti AE da S
        • Ribeiro VV
        • Brasolotto AG
        • et al.
        Effects of performance time of the voiced high-frequency oscillation and Lax Vox technique in vocally healthy subjects.
        J Voice. 2020; (Published online 2020: IN PRESS)
        • Oliveira LHS
        • Santigo Rosa IC
        • Baganha RJ
        • et al.
        Comparação da expectoração em pacientes com pneumonia tratados com os dispositivos de fisioterapia respiratória FLUTTER® VRP1 e SHAKER®.
        Rev Ciências Em Saúde. 2018; 8: 2-6
        • Silveira ACT
        • Cunha CS
        • Pacheco DB
        • et al.
        Uso da Oscilação Oral de Alta Freqüência em Pacientes Ventilados Mecanicamente, um Estudo Prospectivo e Revisão de Literatura The use of the oral high frequency oscillation in mechanically ventilated patients, a study prospective and literature revision.
        Rev Científica do Cent Univ Volta Redon. 2007; 2: 104-110
        • de Conto CL
        • Vieira CT
        • Fernandes KN
        • et al.
        Prática fisioterapêutica no tratamento da fibrose cística.
        ABCS Heal Sci. 2014; 39: 96-100
        • Gomes JSM
        • de Souza SB
        • Alcâmtara EC.
        Oral high frequency oscillation in mechanically ventilated patients – “drug-free”: integrative review.
        ASSOBRAFIR Ciência. 2014; 5: 65-76
        • Santana ER
        • de Araújo TM
        • Masson MLV.
        Self-perception of surface hydration effect on teachers’ voice quality: an intervention study.
        Rev CEFAC. 2018; 20: 761-769
        • Horacek J
        • Radolf V
        • Bula V
        • et al.
        Air-pressure, vocal folds vibration and acoustic characteristics of phonation during vocal exercising. Part 2.
        Meas Phys Model. 2014; 21: 193-200
        • Wistbacka G
        • Andrade PA
        • Simberg S
        • et al.
        Resonance tube phonation in water—the effect of tube diameter and water depth on back pressure and bubble characteristics at different airflows.
        J Voice. 2018; 32: 126.e11-126.e22
        • Guzman M
        • Acuña G
        • Pacheco F
        • et al.
        No title impact of double source of vibration semioccluded voice exercises on objective and subjective outcomes in subjects with voice complaints.
        J Voice. 2018; 32: 770.e1-770.e9
        • Bielamowicz S
        • Kreiman J
        • Gerratt BR
        • et al.
        A comparison of voice analysis systems for perturbation measurement.
        J Acoust Soc Am. 1993; 93: 2337