The Immediate and Long-Term Effects of Tube and Mask+Tube Phonation in Water Exercises and Their Duration as Measured by Electroglottographic and Nasometric Parameters



      This study investigated the immediate effects and their persistence (at 15 minutes) of various durations of semi-occluded vocal tract exercise (SOVTE) (standard tube into water and modified mask+tube into water exercises) as measured by electroglottographic (EGG) and nasometric parameters.


      The study included 30 women aged 19 through 28 years with healthy voices, and it comprised five randomly implemented procedures (Ps): P1-tube phonation into water for 5 minutes; P2-tube phonation into water for 10 minutes; P3-tube+ventilation mask phonation into water for 5 minutes; P4-tube+ventilation mask phonation into water for 10 minutes; P5-phonation with ventilation mask for 5 minutes. Fifteen-minute voice rest breaks were provided between each procedure. Nasometric and electroglottographic measurements were taken before, during, immediately after and at 5, 10, and 15 minutes after the exercises, and the recorded measurements were analyzed.


      The immediate effects of P3 and P4 on voice quality showed better performance than the other procedures. Among all the procedures, P1 had the smallest effect on voice quality in terms of nasometric and EGG parameters and the least degree of effect permanence. In all the fluctuating SOVTE procedures except P1, the nasalance scores decreased (P1, P2, P3, and P4: fluctuating SOVTE; P5: steady SOVTE).


      The tube phonation exercises modified by the addition of a ventilation mask were highly advantageous in terms of EGG parameters. In addition to this, regardless of the mode of application of the retention time, it was observed that the positive effect (ie, lower vertical laryngeal position) of the exercises applied for 10 minutes was higher than the exercises applied for 5 minutes.

      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


        • Meerschman I
        • Van Lierde K
        • Peeters K
        • et al.
        Short-term effect of two semi-occluded vocal tract training programs on the vocal quality of future occupational voice users: “Resonant Voice Training Using Nasal Consonants” Versus “Straw Phonation.
        J Speech Lang Hear Res. 2017; 60: 2519-2536
        • Titze IR
        Phonation into a straw as a voice building exercise.
        Journal of Singing. 2000; 57: 27-28
        • Dargin TC
        • Searl J
        Semi-occluded vocal tract exercises: aerodynamic and electroglottographic measurements in singers.
        J Voice. 2015; 29: 155-164
        • 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
        • Titze IR
        • Finnegan EM
        • Laukkanen AM
        • et al.
        Raising lung pressure and pitch in vocal warm-ups.
        Journal of Singing. 2002; 58: 329-338
        • 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
        • Titze IR
        • Abbott KV
        Vocology: The Science and Practice of Voice Habilitation.
        National Center for Voice and Speech, Salt Lake City, UT2012
        • 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
        • Kapsner-Smith MR
        • Hunter EJ
        • 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
        • Meerschman I
        • Van Lierde K
        • Redman YG
        • et al.
        Immediate effects of a semi-occluded water resistance ventilation mask on objective and subjective vocal outcomes in musical theater students.
        J Speech Lang Hear Res. 2020; 63: 661-673
        • 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. 2017; 31: 323-328
        • Guzman M
        • Denizoglu I
        • Fridman D
        • et al.
        Physiologic voice rehabilitation based on water resistance therapy with connected speech in subjects with vocal fatigue.
        J Voice. 2021;
        • 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
        • Menezes MH
        • Ubrig-Zancanella MT
        • Cunha MGB
        • et al.
        The relationship between tongue trill performance duration and vocal changes in dysphonic women.
        J Voice. 2011; 25: e167-e175
      1. Bassetto, MR, & Constantini, AC (2021). Is there an ideal performance time for the latex tube exercise?. J Voice. doi:10.1016/j.jvoice.2021.07.016

        • Bonette MC
        • Ribeiro VV
        • Xavier-Fadel CB
        • et al.
        Immediate effect of semioccluded vocal tract exercises using resonance tube phonation in water on women without vocal complaints.
        J Voice. 2020; 34 (962-e19)
        • Kang J
        • Xue C
        • Piotrowski D
        • et al.
        Lingering effects of straw phonation exercises on aerodynamic, electroglottographic, and acoustic parameters.
        J Voice. 2019; 33 (810-e5)
        • de Almeida Ramos L
        • Gama ACC
        Effect of performance time of the semi-occluded vocal tract exercises in dysphonic children.
        J Voice. 2017; 31: 329-335
        • Paes SM
        • Behlau M
        Efeito do tempo de realização do exercício de canudo de altaresistênciaemmulheresdisfônicas e nãodisfônicas. 29. Sociedade Brasileira de Fonoaudiologia, 2017 (In CoDAS)
        • Englert M
        • Barsties v. Latoszek B
        • Maryn Y
        • et al.
        Validation of the acoustic breathiness index to the Brazilian Portuguese language.
        Logopedics Phoniatrics Vocology. 2020; : 1-7
        • Kantak SS
        • Winstein CJ
        Learning–performance distinction and memory processes for motor skills: a focused review and perspective.
        Behav Brain Res. 2012; 228: 219-231
        • Gillespie AI
        • Fanucchi A
        • Gartner-Schmidt J
        • et al.
        Phonation with a variably occluded facemask: effects of task duration.
        J Voice. 2020; 36: 183-193
        • Karakoc O
        • Akcam T
        • Birkent H
        • et al.
        Nasalance scores for normal-speaking Turkish population.
        J Craniofac Surg. 2013; 24: 520-522
        • 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
        • 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.
        Logopedics Phoniatrics Vocology. 2015; 40: 113-121
        • 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)
        • Tyrmi J
        • Radolf V
        • Horáček J
        • et al.
        Resonance tube or lax vox?.
        J Voice. 2017; 31: 430-437
        • Robieux C
        • Galant C
        • Lagier A
        • et al.
        Direct measurement of pressures involved in vocal exercises using semi-occluded vocal tracts.
        Logopedics Phoniatrics Vocology. 2015; 40: 106-112
        • Titze IR
        Major benefits of semi-occluded vocal tract exercises.
        Journal of Singing. 2018; 74: 311-312
        • Titze IR
        Phonation threshold pressure measurement with a semi-occluded vocal tract.
        J Speech Lang Hear Res. 2009; 52: 1062-1072
        • Guzman M
        • Bertucci T
        • Pacheco C
        • et al.
        Effectiveness of a physiologic voice therapy program based on different semioccluded vocal tract exercises in subjects with behavioral dysphonia: a randomized controlled trial.
        J Commun Disord. 2020; 87106023
        • Awan SN
        • Gartner-Schmidt JL
        • Timmons LK
        • et al.
        Effects of a variably occluded face mask on the aerodynamic and acoustic characteristics of connected speech in patients with and without voice disorders.
        J Voice. 2019; 33 (809-e1)
        • 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. 2017; 31: 336-341
        • Frisancho K
        • Salfate L
        • Lizana K
        • et al.
        Immediate effects of the semi-occluded ventilation mask on subjects diagnosed with functional dysphonia and subjects with normal voices.
        J Voice. 2020; 34: 398-409
        • 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)
        • 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
        • Rosenberg MD
        Using semi-occluded vocal tract exercises in voice therapy: the clinician's primer.
        Perspectives on Voice and Voice Disorders. 2014; 24: 71-79
        • Lowell SY
        • Kelley RT
        • Colton RH
        • et al.
        Position of the hyoid and larynx in people with muscle tension dysphonia.
        Laryngoscope. 2012; 122: 370-377
        • Honda K
        Laryngeal and extra-laryngeal mechanisms of F0 control.
        Producing speech: contemporary issues. 1995; : 215-232
        • Honda K
        • Hirai H
        • Masaki S
        • et al.
        Role of vertical larynx movement and cervical lordosis in F0 control.
        Lang Speech. 1999; 42: 401-411
        • Madill C
        • Nguyen DD
        Impact of instructed laryngeal manipulation on acoustic measures of voice–preliminary results.
        J Voice. 2020;
        • Shipp T
        Vertical laryngeal position: research findings and application for singers.
        J Voice. 1987; 1: 217-219