Why SOVTEs?, TEACHERS!, & Prioritize Your Voice Reminders...

The Week of Feb 14th BLOG <3:  

TUESDAY TOSS UP:  Why SOVTEs? (Gimme One Reason...)

HOW BOUT A TON OF (research-based) REASONS?!
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How do semi-occluded vocal tract exercises (SOVTEs) promote VOCAL SUCCESS? SOVTEs make a world of difference for your voice quality, vocal efficiency, vocal use patterns, AND reduce your vocal fatigue and vocal effort. They easily RESET the voice between your daily vocal tasks (however strenuous), & they easily serve as a WARM-UP or cool-down. They also PREP your voice to be its BEST at whatever you’re doing—speaking, singing, instructing, projecting, motivating, &/or speaking on the phone (just to name a few ways we use our beautiful vocal instruments everyday!)…
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Check out the VIDEO for a ton of research based ways that SOVTEs are AWESOME.  Or real below for ALL the details and citations!
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They’re an effective tool in both rehabilitation and habilitation of voice and have been hypothesized to increase the inertance of the vocal tract (resulting in a more economic and efficient voice), thereby generating more sonority and better voice quality with less phonatory effort or discomfort (Castillo-Allendes et al., 2021). Economy-oriented voice training centers on the idea that vocal injury can be minimized if VF collision stress and vibration dose are reduced (Berry et al., 2001).

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In general, SOVTEs elicit voice production that relies more heavily on non-linear source filter interaction than on adductory stress to give the voice acoustic power. Therefore, the exercises lead to more economic phonation, which minimizes voice injury. The greater supraglottic pressure achieved by semi-occlusion results in reduced transglottic pressure (difference between sub and supraglottis pressure) which leads to a relatively small vibrational amplitude, decreased glottal resistance and slightly separated vocal folds. Because the impact stress on the VFs diminishes, phonation with high subglottic pressure and high pitch can be achieved with minimal risk of injury to the vocal fold mucosa, making SOVTEs ideal for vocal warmups. A barely abducted or barely adducted VF configuration is associated with a voice production that is neither breathy nor pressed; and therefore, it is the target for both patients with laryngeal hyperfunction and those with hypofunction. (Meerschman et al., 2021)

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Semi-occluded vocal tracts are beneficial in general because they heighten interaction between the source and the filter, and this can increase vocal intensity, efficiency, and economy.  More efficient sound production then leads to a sensation of tissue vibration all over the facial structures. **Applying this to conversational and occupational voice use is the ideal progression of SOVTE work to daily (economic) voice use.**

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SOVTEs have the potential to improve both vocal efficiency and vocal economy, thereby reducing the possibility of vocal fold injury, and the majority have positive vocal effects whether the semi-occlusion occurs in the oral cavity or via an artificially extended vocal tract using straws/tubes submerged in or out of water (Belsky et al., 2021).

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SOVTEs have been used to improve voice quality and increase loudness in an effortless way, to reduce hyperfunctional voice patterns, increase adductory vocal fold activity (without pressing or strain), and increase the vocal tract impedance resulting in changes in the inertive reactance which provides favorable effects to the voice production by decreasing the phonation threshold pressure and by increasing skewing of the glottal flow waveform. (Frisancho et al., 2020).

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A 2013 study by Guzman et al. found a lowering of the larynx, widening of the pharynx, and narrowing of the epilarynx during all exercises. Savareh et al. (2021) found statistically significant results that displayed positive changes in the electromyographic & acoustic measurements, suggesting that the results of  “SOVTEs through VOCAL ECONOMY lead to a reduction to the load applied to the phonatory system”.

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In another 2019 study, Manternach & Daugherty found that just a 4 minute voicing protocol w/a small straw caused the participants to perceive their vocal performance sounded better (~78%) & also that it was more efficient/comfortable (~74%)—less vocal effort was perceived while maintaining vocal output after straw phonation. 

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An even more recent study (2019) by Meerschman et al. found that warm up exercises including lip trills, straw phonation, & water-resistance therapy all had a positive impact on one or more outcomes of the multidimensional voice assessment (significant improvements in DSI, significant decrease in audio-perceptual grade & roughness, significant decrease in VHI scores, & report from subjects of a better self-perceived vocal quality & more comfortable voice production)—of note, NO changes were found in the control group (those who did not do the aforementioned exercises).

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In 2017, Meerschman et al. found that SOVTEs (resonant voice training & straw phonation) positively impact the vocal quality & vocal capacities of occupational voice users, with resonant voice training causing improved DSI & straw phonation causing expansion of the vocal intensity range.

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In 2013, Guzman et al. found that the use of phonatory tasks with STRAW exercises can have IMMEDIATE THERAPEUTIC acoustic effects in dysphonic voices.

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When comparing vocal function exercises & phonation thru a flow-resistant tube (straw), a 2015 study by Kapsner-Smith et al. found significant improvement in VHI scores for both treatment groups vs the control group as well as significant reductions in roughness on the CAPE-V (for the straw group), & the general findings concluded that these methods may improve the quality of life of participants & that straw phonation was non-inferior to vocal function exercises in improving voice QOL.

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Maxfield et al. (2015) ranked 13 SOVT postures according to intra-oral pressure levels; semi-occlusion showing the highest level of oral pressure was phonation into a tube submerged in water (compared to phonation into a tube in the air and other SOVTE).

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Water bubbling produced during WRT voice exercises (ex: straw in water) has been linked to a massage-like effect due to the oscillation in oral pressure caused by bubbles during phonation; patients usually report that water bubbling positively impacts their voice production because of the relaxing effect in both laryngeal and pharyngeal areas. A massage-like effect with the reduction of muscle hypertension could be desirable in patients with voice complaints, especially in subjects reporting vocal fatigue and vocal effort.

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Reduced vibrational amplitude was noticed during straw phonation in water, which suggests decreased VF impact stress and therefore creates an ideal basis for voice training/therapy. Straw phonation in air led to a significantly reduced supraglottic mediolateral compression both during the execution and after the therapy session, indicating less false VF adduction and consequently less hyperfunction.  (Meerschman et al, 2021).

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Another study done in 2017 (Mailander, Muhre, & Barsties) found that Lax Vox (straw submerged in water) training appears to improve the select measures of voice quality, maximum phonation time, vocal function, self-evaluation, & perceived applicability in teachers. The acoustic measures of vocal function showed an expansion in the upper contour of voice range profiles after training—particularly improvements in the modal & beginning of the falsetto voice registers as well as an increase in intensity levels by about 4.6dB.

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Additionally, a study by Guzman et al. (2015) compared 8 different SOVTEs & their effect on glottal contact quotient (CQ) as a measure of VF impact stress. They found that the different SOVTEs differentially affect VF adduction (closure) with lip & tongue trills producing the lowest CQ & may be recommended for decreasing glottal adduction (possibly to reduce impact stress/heal/encourage healthy vibration of swollen or injured VFs). Also, they found a straw submerged 10cm below the water surface displayed the greater CQ, a shallower depth led to a lower CQ, while deeper submersion produced a higher CQ. 

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Physiologic voice therapy based on water resistance therapy exercises including connected speech seems to be an effective tool to improve voice in subjects diagnosed with voice complaints, with changes occurring more often in perceptual variables related to the physical discomfort associated with voice production (a reduction in phonatory effort and perceptual aspects of vocal fatigue were the main improvements). (Guzman et al., 2020)

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Because SOVTEs are often using sustained vowel tasks or other variations of “one sound”, this only precludes co-articulated speaking and singing. This team also concluded that there are immediate positive effects produced by connected speech phonatory tasks using the semi-occluded ventilation mask in both dysphonic and normal subjects with the effect being greater in the dysphonic speakers; this suggests that use of this mask seems to promote an easy voice production and a more efficient phonation. These findings also support the idea that connected speech could be an important part of both voice rehabilitation and voice training AND may be used as a transition between SOVTEs with sustained vowel and spontaneous running speech. Another study by Belsky et al. (2021) found that there was an immediate effect of decreased vocal effort in singing after variably occluded face mask training.  Gillespie et al. (2020) found that phonation with a VOFM achieved the best results for improved acoustic and aerodynamic voice outcomes using a 6.4mm occlusion face mask, and effect sizes for aerodynamic outcomes were larger after training for five minutes compared to 2 minutes.

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Awan et al. (2019) found that beneficial changes in both aerodynamic and acoustic characteristics of voice may be obtained in dysphonic speakers using a VOFM. By moving the place of occlusion outside the oral cavity, therapeutic stimuli options may be extended beyond vowel and humming elicitations to syllable and speech contexts and assist with generalization of voice therapy targets to conversational speech.

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A study by Fantini et al. (2017) found immediate advantageous effects on the singing voice after use of a SOVTE w/a ventilation mask in terms of acoustic quality, phonatory comfort, & voice quality perception in contemporary commercial singers.

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A training protocol based on an abundance of /n/, /n/, and other resonant productions, and their smooth and prolonged connections to vowels, seems to improve not only normal speech, but also speech with known voice disorders. Perhaps the issue is not so much the percentage of time spent on these semi-occlusive sounds in speech, but a change in the overall pattern of vibration that has occurred with practice (Titze, 2006).

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As an occupational voice user, the voice IS your instrument, & you should condition it as such. Start incorporating the daily practice of SOVTEs! When the mouth is partially closed as it will be in all of these exercises, back pressure reflects at the lips to help the VFs vibrate with more ease & less muscular effort (a.k.a. VOCAL ECONOMY!).

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Check out last week’s post for several examples of SOVTEs. Commit to shorter practice periods, & you will be encouraging motor learning , constantly “resetting” the voice, & promoting healthy VF activation & vibration multiple times throughout your day as well!).

HUMP DAY HEALTH:  TEACHERS & VoiceDisorders...

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This includes ALL teachers of all levels and disciplines. To me, this also includes fitness instructors, professors, lecturers, and coaches.
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As a teacher, you are an occupational voice user and you place higher demands on your vocal instrument to uphold the daily (vocal) requirements of your job. Just like an athlete places higher demands on the body (and is at higher risk of physical injury), occupational voice users (especially teachers!) place higher demands on the voice and are therefore at higher risk for vocal injury.
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Teachers are expected to project their voices all day long (often over background noise) to several children or adults depending on the setting. They may be required to lecture for hours and dynamic voice use is often required. Hydration may be sub optimal because there’s minimal time for restroom breaks. Amplification should be used but is often undervalued.
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Teachers (again, of ALL types!) exude a PASSION for educating others, as well as inspiring, guiding, and sharing. Their message and MISSION are important. It is crucial their VOICES are reliable, healthy, and efficient.  For ALL occupational voice users (ESPECIALLY THIS GROUP!), it is incredibly important to protect, train, condition, learn about, and prioritize the voice! 

PRIORITIZE YOUR VOICE!  

It’s Prioritize Your Voice Friday… So how are you prioritizing your voice today? And everyday? As an OCCUPATIONAL VOICE USER, it should be one of your top priorities!

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CHECK OUT the @voxfit_ instagram page every Friday as now several people are participating in the weekly challenge to PRIORITIZE YOUR VOICE. Make it a point everyday to make good healthy vocal decisions, and especially on Fridays! I will share it if you tag @voxfit_.  Remember the importance of prioritizing the vocal health and wellness of your vocal instrument as well as its efficiency and dynamics (when needed).  Your VOICE is my PASSION... REACH OUT if you have any questions about your voice or if you need suggestions related to how to achieve YOUR most optimal vocal success.

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