Effect of Varied Tube Phonation in Water Exercises on Nasometric and Electroglottographic parameters: Modification in Terms of Fluid Density and Tube Submerged Depth



      Within the scope of semi-occluded vocal tract exercises (SOVTEs), we aimed to examine the effects of four exercise combinations, which involved various fluid densities and tube submersion depths, on acoustic and electroglottographic (EGG) parameters.


      Four procedures (P) were applied consecutively to 30 female participants with normal voices using different tube submersion depths and fluid densities, including P1 (2 cm, water), P2 (2 cm, nectar), P3 (10 cm, water), and P4 (10 cm, nectar). Nasometric (Nasometer II model 6450) and EGG (Electroglottograph model 6103) measurements were taken before the procedures were initiated (pre-test) and at the end of each procedure. In addition, EGG measurements were taken for each procedure during the application.


      For all three velar positions (oral passage, oro-nasal passage, nasal passage), the only procedure that caused a significant change compared to the pre-test stage in regard to nasalance score was P2 (2 cm nectar) in common. All other procedures except P1 (2 cm water) significantly increased velar closure compared to pre-test levels. However, when the differences between the exercises were examined, the least velar closure, compared to the other procedures, was obtained after P4 (10 cm nectar). While there was no significant difference between the procedures in the EGG measurements during the exercise, a significantly higher tendency to contact was observed after the procedures with a denser consistency, and an increase in the fundamental frequency (fo) values occurred in the pairwise comparisons of the procedures in the measurements after the exercises.


      In SOVTEs in which water phonation is performed with a tube, the use of a fluid with a consistency denser than water can be considered a particularly promising approach. In addition, exercises performed with increasing consistencies in 2 cm depth can provide more vocal cord and velopharyngeal port closure by increasing EGG-CQ and nasalance score values. However, more care should be taken while increasing the consistency at a submersion depth of 10 cm.

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


        • Laukkanen AM
        • Lindholm P
        • Vilkman E
        • et al.
        A physiological and acoustic study on voiced bilabial fricative /β:/as a vocal exercise.
        J Voice. 1996; 10: 67-77
        • 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
        • Bele IV
        Artificially lengthened and constricted vocal tract in vocal training methods.
        Logoped Phoniatr Vocol. 2005; 30: 34-40
        • Story BH
        • Laukkanen AM
        • Titze IR
        Acousticimpedance of an artificially lengthened and constricted vocal tract.
        J Voice. 2000; 14: 455-469
        • Kang J
        • Xue C
        • Piotrowski D
        • Gong T
        • et al.
        Lingering effects of straw phonation exercises on aerodynamic, electroglottographic, and acoustic parameters.
        J Voice. 2019; 33: 810-8e5
        • Titze IR
        Regulating glottal airflow in phonation: application of the maximum power transfer theorem to a low dimensional phonation model.
        J Acoust Soc Am. 2002; 111: 367-376
        • Titze IR
        • Laukkanen AM.
        Can vocal economy in phonation be increased with an artificially lengthened vocal tract? A computer modeling study.
        Logoped Phoniatr Vocol. 2007; 32: 147-156
        • Mills RD
        • Rivedal S
        • De Morett 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
        • Titze IR
        The physics of small-amplitude oscillation of the vocal folds.
        J Acoust Soc Am. 1988; 83: 1536-1552
        • 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
        • Guzman M
        • Jara R
        • Olavarria C
        • et al.
        Efficacy of water resistance therapy in subjects diagnosed with behavioral dysphonia: a randomized controlled trial.
        J Voice. 2017; 31 (385-e1)
        • Titze I
        Major benefits of semi-occluded vocal tract exercises.
        J Sing. 2018; 74: 311-312
        • 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
        • Lã FM
        • Ternström S
        Flow ball-assisted voice training: immediate effects on vocal fold contacting.
        Biomed Signal Process Control. 2020; 62102064
        • 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
        • Mendes ALF
        • do Carmo RD
        • de Araújo AMGD
        • et al.
        The effects of phonation into glass, plastic, and Lax Vox tubes in singers: a systematic review.
        J Voice. 2019; 33 (381-e1)
        • Tangney J
        • Scholp A
        • Kang J
        • et al.
        Effects of varying lengths and diameters during straw phonation on an excised canine model.
        J Voice. 2019; 35: 85-93
        • 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 Mec. 2014; 21: 53-59
        • 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?.
        Foliaphoniatrica et logopaedica. 2015; 67: 68-75
        • Tyrmi J
        • Laukkanen AM
        How stressful is “deep bubbling”?.
        J Voice. 2017; 31 (262-e1)
        • Cichero JA
        • Lam P
        • Steele CM
        • et al.
        Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework.
        Dysphagia. 2017; 32: 293-314
        • 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. 2020; 34: 582-589
        • Echternach M
        • Köberlein M
        • Gellrich D
        • et al.
        Duration of biodynamic changes associated with water resistance therapy.
        Logoped Phoniatr Vocol. 2021; 46: 126-133
        • Gillespie AI
        • Fanucchi A
        • Gartner-Schmidt J
        • et al.
        Phonation with a variably occluded facemask: effects of task duration.
        J Voice. 2020; 33 (809.e1-809.e10)
        • Pentax K
        Reel-Time EGG Analysis, Model 6103.
        Software instruction Manual, Issue F, Lincoln Park, NJ2013
        • Karakoc O
        • Akcam T
        • Birkent H
        • et al.
        Nasalance scores for normal-speaking Turkish population.
        J Craniofac Surg. 2013; 24: 520-522
        • Titze IR
        Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.
        J Speech Lang Hear Res. 2006; 49: 448-459
        • Vampola T
        • Laukkanen AM
        • Horáček J
        • et al.
        Vocal tract changes caused by phonation into a tube: a case study using computer tomography and finite-element modeling.
        J Acoust Soc Am. 2011; 129: 310-315
        • Laukkanen AM
        • Horáček J
        • Krupa P
        • et al.
        The effect of phonation into a straw on the vocal tract adjustments and formant frequencies. A preliminary MRI study on a single subject completed with acoustic results.
        Biomed Signal Process Control. 2012; 7: 50-57
        • Guzman M
        • Ortega A
        • Olavarria C
        • et al.
        Comparison of supraglottic activity and spectral slope between theater actors and vocally untrained subjects.
        J Voice. 2016; 30 (767-e1)
        • Tyrmi J
        • Radolf V
        • Horáček J
        • et al.
        Resonance tube or lax vox?.
        J Voice. 2017; 31: 430-437
        • Gaskill CS
        • Quinney DM
        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)
        • Wentworth CD
        Helium speech: an application of standing waves.
        The Physics Teacher. 2011; 49: 212-215
        • Vorperian H
        • Kent R
        Vowel acoustic space development in children: a synthesis of acoustic and anatomic data.
        J Speech Lang Hear Res. 2008; 50: 1510-1545
      1. Nakamura T Kaneko S Inada F Flow-Induced Vibrations: Classifications and Lessons from Practical Experiences. Butterworth-Heinemann, Amsterdam, The Netherlands2013: 213
        • Ball MJ
        Clinical phonology of vowel disorders.
        Handbook of Vowels and Vowel Disorders. Psychology Press, New York, NY2013: 424-446
        • Robieux C
        • Galant C
        • Lagier A
        • et al.
        Direct measurement of pressures involved in vocal exercises using semi-occluded vocal tracts.
        Logoped Phoniatr Vocol. 2015; 40: 106-112
        • Verdolini K
        • Chan R
        • Titze IR
        • et al.
        Correspondence of electroglottographic closed quotient to vocal fold impact stress in excised canine larynges.
        J Voice. 1998; 12: 415-423
        • Horáček 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
        • Guzman M
        • Laukkanen AM
        • Traser L
        • et al.
        The influence of water resistance therapy on vocal fold vibration: a high-speed digital imaging study.
        Logoped Phoniatr Vocol. 2017; 42 (99-10.7)
        • Granqvist S
        • Simberg S
        • Hertegård S
        • et al.
        Resonance tube phonation in water: high-speed imaging, electroglottographic and oral pressure observations of vocal fold vibrations-a pilot study.
        Logoped Phoniatr Vocol. 2015; 40: 113-121
        • Portillo MP
        • Rojas S
        • Guzman M
        • et al.
        Comparison of effects produced by physiological versus traditional vocal warm-up in contemporary commercial music singers.
        J Voice. 2018; 32 (2017): 200-208