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Lingering Effects of Straw Phonation Exercises on Aerodynamic,

Electroglottographic, and Acoustic Parameters

Article · June 2018

DOI: 10.1016/j.jvoice.2018.05.002

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 ARTICLE IN PRESS
Lingering Effects of Straw Phonation Exercises on
Aerodynamic, Electroglottographic, and Acoustic
Parameters
*Jing Kang, *Chao Xue, †David Piotrowski, *Ting Gong, *Yi Zhang, and *Jack J. Jiang, *Shanghai, China, and †Madison,
Wisconsin

Summary: Objective. This study aimed to investigate the duration of straw phonation effects using aerodynamic,
electroglottographic, and acoustic metrics.
Methods. Twenty-four participants were recruited to perform both a 5-minute and a 10-minute straw phonation ex-
ercise. Upon completion of the exercises, phonation threshold pressure (PTP), mean airflow, contact quotient, fundamental
frequency, jitter, shimmer, and noise-to-harmonics ratio were measured over a 20-minute time frame. Parameters were
measured before the intervention (baseline), immediately after the intervention (m0), 5 minutes (m5), 10 minutes (m10),
15 minutes (m15), and 20 minutes (m20) after the intervention.
Results. PTP significantly decreased immediately after 5 minutes of straw phonation and returned to initial state within
5 minutes. PTP remained decreased over 5 minutes after 10 minutes of straw phonation. Mean airflow increased im-
mediately after both 5 minutes and 10 minutes of straw phonations and remained improved for 20 minutes. No significant
changes were obtained for contact quotient and acoustic parameters over the intervention period.
Conclusions. The results extended our knowledge of proper clinical application of straw phonation regarding the
duration of exercise. This study confirmed that 10 minutes of straw phonation lead to optimal and relatively continu-
ous effects in PTP and mean airflow. Although straw phonation did show lingering effects in aerodynamics, repeated
practices were recommended to obtain optimum and therapeutic effects.
Key Words: Semi-occluded vocal tract–Straw phonation–Contact quotient–Aerodynamics–Acoustics.

INTRODUCTION after subjects participated in a sounded blowing exercise with

Semi-occluded vocal tract exercises (SOVTEs), characterized semi-occluded vocal tract.7 Increased open quotient and minimum
by a reduction in the cross-sectional area of the distal part of airflow rates were obtained after the vocal function exercises.8
the vocal tract while voicing, have been widely used in voice Recent studies suggest that straw phonation is one of the best
training and voice rehabilitation.1 A partial list of SOVTEs pre- ways to achieve therapeutic intraoral pressures among all of the
sented in descending order of glottal resistance includes straw other SOVTEs. Straw phonation is surmised to enjoy several out-
phonation, lip trill, tongue trill, nasal consonants /m/.2 standing features such as easy accessibility, great efficiency, and
The benefits to the voice from SOVTEs are salient, especial- controllability when compared with other SOVTEs.9,10 Further-
ly for specific occupations that rely on a worker’s healthy voice. more, vocal instruction for straw phonation is relatively simpler
Occupations that have a higher risk of voice overuse, includ- than other SOVTE instruction, which may require patients to
ing teachers and salesmen, may lead to higher incidences of perform complicated biomechanical routines.11
dysphonia.3 SOVTEs are methods of voice therapy that have been The physical mechanism of straw phonation is explained by
thoroughly investigated and validated for its positive effect on increased inertance in the vocal tract during phonation. Inertance
the voice. In singing voice studies, fatigue resistance can be de- is a positive type of impedance, which produces a time-
veloped through targeted warm-up or singing activities including delayed buildup of supraglottal pressure.12 Time-delayed stimulus
SOVTEs.4 Acoustic metrics, such as jitter, shimmer, and singing and response lead to a negative supraglottal pressure during the
power ratio, and self-assessments, such as phonatory comfort closing phase, thus creating suction that pulls the vocal folds apart.
and voice quality, have been observed to improve after warm- This push-pull relationship facilitates self-sustained vibration and
up using an occluded ventilation mask SOVTEs.5 Additionally, decreases phonation threshold pressure (PTP).13 Inertance is gov-
fundamental frequency has been shown to increase, whereas erned by the equation I = ρL/A, where I is inertance, ρ is the
glottal-to-noise excitation ratio has been found to decrease after density of the oral and laryngeal air column, L is its length, and
phonation through a LaxVox tube.6 For the speaking voice, im- A is its cross-sectional area.12 According to the maximum power
provements in perceptual-auditory evaluation scores were observed transfer theorem, optimum power transfer from glottis to lips
occurs when source impedance is matched to vocal tract input
Accepted for publication May 8, 2018.
From the *Department of Otolaryngology-Head and Neck Surgery, EENT Hospital of
impedance. It has been validated by computer simulation ex-
Fudan University, Shanghai, China; and the †Department of Surgery, Division of periments that SOVTEs result in higher vocal tract impedance,
Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, Univer-
sity of Wisconsin-Madison, Madison, Wisconsin.
which better matches glottal impedance.14,15 Moreover, phona-
Address correspondence and reprint requests to Jack J. Jiang, Department of tion through thin tubes or straws provided resistance best
Otolaryngology-Head & Neck Surgery, EENT Hospital of Fudan University, 83 Fenyang
Road, Shanghai, 200031, China. E-mail: [email protected]
comparable with glottal resistance when comparing 13 semi-
Journal of Voice, Vol. ■■, No. ■■, pp. ■■-■■ occluded vocal tract gestures.2 Less airflow is expected to dissipate
0892-1997
© 2018 Published by Elsevier Inc. on behalf of The Voice Foundation.
from glottis to lips, which may lead to increased mean airflow
https://doi.org/10.1016/j.jvoice.2018.05.002 during phonation. In addition, increased subglottal pressure and
 ARTICLE IN PRESS
2 Journal of Voice, Vol. ■■, No. ■■, 2018

decreased transglottal pressure are acquired when vocal tract is University, who were given written informed consent to partic-
occluded.16 This aerodynamic alteration, which helps keep the ipate. The mean age was 23.71 ± 2.24 years. Inclusion criteria
vocal folds slightly abducted, in turn, is expected to produce a for this study were as follows: (1) above the age of 18; (2) non-
lower contact quotient (CQ) of the electroglottograph (EGG). smoking; (3) nonhabitual drinking; (4) no history of diagnosed
Although related research suggests that straw phonation ben- voice disorders or other laryngeal pathology (polyps, nodules,
efits voice production, it is still unknown whether straw phonation etc); (5) no acute respiratory infections within 2 weeks of the
has a lingering effect or transient response for any amount of study participation; and (6) no straw phonation experiences. Par-
time after the exercise. Based on the aforementioned theory of ticipants were required not to have prior straw phonation
inertance, high inertance can be achieved by lengthening or nar- experience because the experience may impact the influence du-
rowing vocal tract during SOVTEs, such as when a straw is ration after straw phonation.
included in the system during straw phonation. Once the straw To control for systemic and vocal fold physiological con-
is removed from the system, it is expected that any alteration founders, participants were asked to maintain their typical daily
of impedance or pressure in the vocal tract should be indica- voice use for 24 hours before participation. They were also asked
tive of a system without the straw. However, several studies to consume a sufficient amount of water before each session to
provide evidence suggesting that the effects of straw phona- avoid dehydration. The participants were also asked to refrain
tion are sustained for a period of time after the exercise. A from eating 2 hours before testing and to avoid foods that would
decreasing trend in CQ and a significant increase in mean airflow stimulate gastric reflux, such as carbonated and caffeinated drinks
were observed after straw phonation tasks.17,18 Additionally, a and spicy food. Female subjects were not tested 3 days before
significant decrease in PTP was obtained after completing 10 or after ovulation and menstruation to avoid confounding effects
minutes of straw phonation.19 Because the measurement of CQ of sex hormones.
and aerodynamics were taken after the exercise, when the straw
is removed, one would expect the measured values to reflect the
initial status instead of the improved conditions unless straw pho- Protocol
nation had lingering effects after the exercise. Two durations of straw phonation, 5 minutes and 10 minutes,
To our knowledge, no other research has evaluated the lin- were chosen as test groups based on our previous study, con-
gering effects of straw phonation. Such investigations would cluding that 5 minutes of straw phonation exposure might be
complete the mechanism of straw phonation and make great pro- the most cost- and time-effective, whereas 10 minutes may result
gress toward better clinical application. The lingering effects help in the best outcome.19 All subjects were enrolled in both 5-minute
formulate a dosage schedule in straw phonation. A therapy that straw phonation exercise and 10-minute straw phonation exer-
has limited lingering effects needs to be given more frequently cise. The two sessions were completed 24 hours apart, at
to build up and maintain a dose high enough to be therapeuti- approximately the same time on two consecutive days. The testing
cally effective. Therefore, this study set out to observe the order was randomized to minimize order effects. Each subject
lingering effects of straw phonation using aerodynamic, CQ, and practiced the exercises separately with a speech therapist who
acoustic parameters within 20 minutes; investigate how long the was guiding the participant. The data were obtained before the
related effects will last after 5 minutes and 10 minutes of straw intervention (baseline), just after the intervention (m0), at the
phonation; and further determine optimum duration of straw pho- fifth (m5), the tenth (m10), the fifteenth (m15), and the twen-
nation in consideration of the immediate and lingering effects. tieth (m20) minute after straw phonation. Immediate effects
It was hypothesized that aerodynamic and EGG variables would correspond to m0 and lingering effects correspond to any time
improve after straw phonation, remain improved for a period of after m0.
time after the exercise, and then finally return to the initial state For the straw phonation exercises, subjects were instructed
that was observed before straw phonation. It was also hypoth- using the video “Ingo Titze’s tip for tired voices: Grab a straw!”
esized that 10-minute duration straw phonation would result in produced by the National Center for Voice and Speech.20 Sub-
greater and longer changes than 5-minute straw phonation. jects phonated into a 19.5-cm long, 6-mm diameter straw. Each
However, because the acoustics were found to be less sensitive participant practiced forming an airtight seal with his or her lips,
to reflect precision variation than aerodynamics, no significant then exhaling through the straw comfortably before attempting
changes were expected to be observed in acoustics, including sound production. Subjects were instructed to phonate with
fundamental frequency (F0), jitter, shimmer, and noise-to- support from expiratory flow and intra-abdominal pressure to
harmonics ratio (NHR) after straw phonation. maintain relaxed neck muscles. Most importantly, the subjects
were required to phonate at a pitch and loudness that was most
comfortable through the straw. The exercises began with a pro-
METHODS longed note to verify adequate sound production, and then
Subjects gradually transitioned to a series of vocal glides. The glides started
A total of 24 subjects (7 males, 17 females) were included in very low in the subject’s phonatory range, ascended to the top
this study, which was approved by the Research Ethics Com- of their range, and descended gradually again to the lowest note.
mittee of the Institution of Eye & ENT Hospital of Fudan Following the glides, the participants added a number of accents
University (protocol no. 2017031). All volunteered subjects were using abdominal support, each of which produced a temporary
either undergraduate or graduate medical students from Fudan alteration in pitch and volume. Finally, the participants sang
 ARTICLE IN PRESS
Jing Kang, et al Lingering Effects of Straw Phonation Exercises 3

specified melodies which were tractable through the straw without

Effects of Time and Type of Exercise, as Well as Time-Type Interaction on Aerodynamic and Acoustic Variables, Determined by Two-way ANOVA (N = 24

0.525
0.774
0.366
neck tension.

P
NHR
Data collection

0.794
0.084
1.082

Abbreviations: ANOVA, analysis of variance; PTP, phonation threshold pressure, CQ, contact quotient, SPL, sound pressure level, F0, fundamental frequency, NHR, noise-to-harmonics ratio.
Aerodynamic parameters were analyzed by the Phonatory Aero-

F
dynamic System Model 6600 (KayPENTAX, Montvale, NJ). The
measurement of PTP was based on the method of airflow in-

0.540
0.776
0.415
terruption by full-lip occlusion, as described by Sivasankar and

P
Shimmer
Fisher.21 The subjects wore a face mask with an oral tube in-
serted 2 cm into the subject’s mouth. The subjects were instructed

0.815
0.082
1.006
to utter the /pi/ as softly as possible but not whisper at a con-

F
versational pitch. Every five /pi/ syllables constituted one trial
and every subject produced three trials for a total of 15 /pi/ syl-

0.102
0.915
0.892
lables. Because the first and the last /pi/ syllable were unstable

P
and diverse, the first and the last syllables in every trail were

Jitter
discarded. The mean value of the three middle /pi/ syllables was

1.970
0.011
0.275
statically analyzed.

F
Mean airflow and EGG measures were captured by the Pho-
natory Aerodynamic System Model 6600 (KayPENTAX). Mean

0.636
0.719
0.863
airflow and CQ were collected during this task, with the elec-

P
trodes on the surface of both sides of the thyroid cartilage and

F0
the mask snugly over the nose and mouth to prevent air leakage.

0.580
0.131
0.258
Participants were instructed to produce three repetitions of the

F
sustained speaking vowel /a/ at their comfortable pitch and
volume. An interval of the airflow and EGG signal (approxi-

0.834
0.780
0.209
mately 3 seconds) was selected from the most stable part to

P
compute a mean airflow and EGG value. The mean values were

SPL
statistically analyzed.

0.312
0.079
1.517
The Multi-Dimensional Voice Program Model 5105

F
(KayPENTAX) was used to analyze the acoustic parameters, in-
cluding F0, jitter, shimmer, and NHR, via the same unidirectional
moving-coil microphone (Shure, Niles, IL) located diagonally
0.568
0.421
0.197
P
15 cm from the mouth in an acoustically treated room. Sub-
CQ

jects produced the sustained vowels /a/ three times at a

comfortable pitch and volume; the mean values of the acoustic
0.695
0.659
1.563
F

parameters were included in the statistics. Subjects were re-

quired to take a 5-second break between every two pronunciations
to prevent voice fatigue.
<0.001*
0.411
0.933
Mean Airflow
P

Statistical analysis
SPSS 20.0 (IBM Corp., Armonk, NY) was used for the statis-
6.056
0.690
0.158

tical analysis of the data. A two-way analysis of variance with

F

repeated measures were performed to compare the main effects

of time, type (5-minute straw phonation or 10-minute straw pho-
<0.001*

nation), and time-type interaction. If the main effects of time

0.905
0.484

and/or type were significant, the within-type and/or between-

P

type comparisons were conducted to further compare the means.

PTP

For between-type comparisons, a type t test was completed and

α was set at 0.05. For within-type comparisons, two-tailed paired
12.873
0.014
0.856
F

t tests were performed for each coupling of time points to de-

termine where the significant differences took place. A Bonferroni
adjustment yielded α = 0.01.
Time × type
Subjects)
TABLE 1.

*P < 0.01.

RESULTS
Effect
Time
Type

There was no significant interaction between time and type on

PTP (P = 0.484), as shown in Table 1. The main effect of time
 ARTICLE IN PRESS
4 Journal of Voice, Vol. ■■, No. ■■, 2018

TABLE 2.
Intragroup Comparison of PTP and Mean Airflow Between Different Time Points (N = 24 Subjects)
5-Minute Straw 10-Minute Straw
Phonation Phonation
Variables Time (a) Time (b) d (b − a) P d (b − a) P
PTP Baseline m0 −0.188 ± 0.066 0.009** −0.287 ± 0.063 <0.001**
Baseline m5 0.033 ± 0.088 0.714 −0.148 ± 0.050 0.007**
Baseline m10 0.014 ± 0.073 0.854 −0.045 ± 0.045 0.323
Baseline m15 0.109 ± 0.067 0.121 0.067 ± 0.069 0.341
Baseline m20 0.113 ± 0.072 0.130 0.063 ± 0.058 0.292
m0 m5 0.220 ± 0.066 0.003** 0.139 ± 0.066 0.045*
m0 m10 0.201 ± 0.081 0.021* 0.241 ± 0.060 0.001**
m0 m15 0.296 ± 0.098 0.006** 0.354 ± 0.058 <0.001**
m0 m20 0.301 ± 0.098 0.005** 0.350 ± 0.054 <0.001**
m5 m10 −0.019 ± 0.069 0.784 0.102 ± 0.043 0.026*
m5 m15 0.076 ± 0.086 0.387 0.215 ± 0.069 0.005**
m5 m20 0.081 ± 0.077 0.302 0.211 ± 0.076 0.01*
m10 m15 0.095 ± 0.055 0.097 0.112 ± 0.055 0.053
m10 m20 0.100 ± 0.057 0.092 0.108 ± 0.057 0.069
m15 m20 0.005 ± 0.046 0.918 −0.004 ± 0.042 0.924
Mean airflow Baseline m0 0.021 ± 0.008 0.015* 0.018 ± 0.008 0.039*
Baseline m5 0.021 ± 0.008 0.011* 0.024 ± 0.010 0.022*
Baseline m10 0.021 ± 0.009 0.026* 0.027 ± 0.011 0.019*
Baseline m15 0.027 ± 0.012 0.034* 0.027 ± 0.011 0.025*
Baseline m20 0.024 ± 0.09 0.014* 0.028 ± 0.011 0.025*
m0 m5 0.000 ± 0.005 1.000 0.005 ± 0.005 0.272
m0 m10 0.000 ± 0.007 0.954 0.009 ± 0.007 0.252
m0 m15 0.006 ± 0.010 0.565 0.008 ± 0.004 0.059
m0 m20 0.003 ± 0.011 0.787 0.009 ± 0.006 0.153
m5 m10 0.000 ± 0.005 0.937 0.003 ± 0.009 0.713
m5 m15 0.006 ± 0.008 0.484 0.003 ± 0.006 0.643
m5 m20 0.003 ± 0.008 0.725 0.004 ± 0.008 0.637
m10 m15 0.006 ± 0.007 0.357 0.000 ± 0.007 0.953
m10 m20 0.003 ± 0.007 0.647 0.000 ± 0.007 0.950
m15 m20 −0.003 ± 0.007 0.674 0.001 ± 0.005 0.877
* P < 0.05; ** P < 0.01.
Abbreviation: PTP, phonation threshold pressure.

was significant (P < 0.001) (Table 1). t Tests for the time effects
of 5-minute straw phonation revealed a significant decrease
between m0 compared with baseline (d = −0.188 ± 0.066,
P = 0.009) and a significant increase in m5, m15, and m20 com-
pared with m0 (d = 0.220 ± 0.066, P = 0.003; d = 0.296 ± 0.098,
P = 0.006; and d = 0.301 ± 0.098, P = 0.005, respectively), as
shown in Table 2 and Figure 1. t Tests for the time effects of
10-minute straw phonation revealed significant decreases between
m0 and m5 compared with baseline (d = −0.287 ± 0.063,
P < 0.001 and d = −0.148 ± 0.050, P = 0.007, respectively). There
were significant increases for m10, m15, and m20 compared with
m0 (d = 0.241 ± 0.060, P = 0.001; d = 0.354 ± 0.058, P < 0.001;
and d = 0.350 ± 0.054, P < 0.001, respectively) and m15 com-
pared with m5 (d = 0.215 ± 0.069, P = 0.005) (Table 2). However,
no significant differences were obtained in the main effect of FIGURE 1. Comparison of PTP in 5-minute straw phonation and 10-
type (P = 0.905) (Table 1). minute straw phonation before and after intervention.
 ARTICLE IN PRESS
Jing Kang, et al Lingering Effects of Straw Phonation Exercises 5

validated the immediate and lingering effects using aerody-

namic parameters; however, no significant immediate and
lingering effects were obtained in EGG and acoustic measure-
ment. Comparisons across measurement conditions showed a
significant decrease in PTP and a significant increase in mean
airflow immediately after completing both types of straw pho-
nation. Increased mean airflow was found to last 20 minutes after
both types of straw phonation exercises, whereas PTP could only
remain decreased for 5 minutes after 10 minutes of straw
phonation.
Significant differences were observed in aerodynamic param-
eters after straw phonation. As one can volitionally modify their
vocal output through compensatory mechanisms that result in
FIGURE 2. Comparison of mean airflow in 5-minute straw phona- a voice of approximately normal acoustic quality, even though
tion and 10-minute straw phonation before and after intervention. the aerodynamics used to produce that voice may be quite
effortful.22 Aerodynamic parameters of phonation, sensitively re-
flecting vocal fold geometry, and biomechanical properties of
For mean airflow, two-way analysis of variance testing re- the vocal fold, have been the focus of numerous theoretical and
vealed no significant interaction effect between time and type experimental studies in the past decade.23 In particular, PTP is
(P = 0.933) (Table 1). The main effect of time was significant an index of the minimum pressure required to produce tissue
(P < 0.001) (Table 1). t Tests for the time effects of 5-minute oscillation, which provides an objective indication of such sub-
straw phonation revealed an increased trend between m0, m5, jective sensations as vocal effort and the “ease of phonation.”12
m10, m15, and m20 compared with baseline (d = 0.021 ± 0.008, The improvement in aerodynamics after straw phonation exer-
P = 0.015; d = 0.021 ± 0.008, P = 0.011; d = 0.021 ± 0.009, cises demonstrated that straw phonation targeted improvements
P = 0.026; d = 0.027 ± 0.012, P = 0.034; and d = 0.024 ± 0.09, in vocal efficiency and fatigue resistance, which could play an
P = 0.014, respectively). t Tests for the time effects of 10- important role in clinical application.
minute straw phonation revealed an increased trend between Recent studies confirmed that straw phonation exercise im-
m0, m5, m10, m15, and m20 compared with baseline proved aerodynamics of the vocal tract by increasing inertance;
(d = 0.018 ± 0.008, P = 0.039; d = 0.024 ± 0.010, P = 0.022; however, the mechanisms in which increased inertance was sus-
d = 0.027 ± 0.011, P = 0.019; d = 0.027 ± 0.011, P = 0.025; and tained remain to be investigated. A few hypotheses were generated
d = 0.028 ± 0.011, P = 0.025, respectively) (Table 2 and Figure 2). to explain the sustained inertance, including sustained im-
However, no significant differences were obtained in the main proved vocal tract configuration and motor learning of improved
effect of type (P = 0.411) (Table 1). phonation technique.
Results for CQ showed no interaction between time and type Sustained improved configuration of the vocal tract may be
(P = 0.197), no significant main effect of time (P = 0.568), and the reason why the improvement of aerodynamics could be ac-
no significant effect of type (P = 0.421) (Table 1). quired after completing straw phonation exercises. According
Concerning sound pressure level, no significant difference was to the computerized tomography results in both of Guzman et al’s
found in interaction between time and type (P = 0.209), main studies,11,24 a larger ratio between the inlet of the lower pharynx
effect of time (P = 0.834), and main effect of type (P = 0.780) and the outlet of the epilaryngeal tube was obtained during and
(Table 1). after straw phonation, which has been reported as a contribut-
For F0, no significant difference was observed in interaction ing factor for increased vocal tract inertance.25,26
between time and type (P = 0.863), main effect of time Furthermore, motor learning may play a role in the phenom-
(P = 0.636), and main effect of type (P = 0.719) (Table 1). enon for sustainability of an increased inertance. With practice,
Results for jitter showed no interaction between time and type the neural connections that represent the task become relative-
(P = 0.892), no significant main effect of time (P = 0.102), and ly permanent (motor learning) and can be used to accomplish
no significant effect of type (P = 0.915) (Table 1). similar tasks (generalizability).27 The longer the exercises and
For shimmer, our results demonstrated no significant differ- learning process last, the stronger motor learning stays. There-
ence in interaction between time and type (P = 0.415), main effect fore, our results indicate that participants practiced the adjusted
of time (P = 0.540), and main effect of type (P = 0.776) (Table 1). configuration of the vocal tract during straw phonation and main-
Concerning NHR, no significant difference was obtained in tain the improved status, with higher inertance even after
interaction between time and type (P = 0.366), main effect of completing the exercises.9 This hypothesis could also explain why
time (P = 0.525), and main effect of type (P = 0.774) (Table 1). the lingering effects of PTP were longer in 10 minutes of straw
phonation exercises than in 5 minutes of exercises. Because all
DISCUSSION the subjects took the exercises for the first time, 10 minutes of
In this study, aerodynamic, EGG, and acoustic measurements straw phonation could maintain improved PTP for only 5 minutes.
were monitored over 20 minutes after straw phonation exer- Improved configuration and decreased PTP are expected to remain
cises in normal-voiced subjects. Our results presented and longer with increased practice frequency.
 ARTICLE IN PRESS
6 Journal of Voice, Vol. ■■, No. ■■, 2018

Another important factor should be taken into account when A limitation of this study was that participants performed straw
considering mean airflow apart from increased inertance. As the phonation exercises for the first time, which might have led to
supraglottal impedance increases, more subglottal pressure is re- a transient or immediate effect. It can be thus suggested that after
quired to initiate and maintain the vibration of the vocal folds. repeated training of straw phonation, aerodynamic parameters
Thus, more breath support should be provided. In the process could stay improved for a longer period, deriving from the motor
of straw phonation, repeated utilization of the corresponding learning acquirement. Another limitation of this study is the
organs and the surrounding structures can not only coordinate absence of the control group. Future studies on the current topic
the subsystems but also exercise the respiratory muscles, leading are still recommended. There is abundant room for further pro-
to improved respiratory function.28 Increased mean airflow values gress in determining whether the required duration and frequency
that lasted for 20 minutes indicated that the enthusiasm mobi- of straw phonation will change with the degree of familiarity
lization of respiratory system was easier to arouse and sustain and vocal training of exercises.
compared with adjustive configuration.
Surprisingly, no significant trend in CQ was acquired during
CONCLUSIONS
and after straw phonation. Diverse consequences were ob-
Our present study detected aerodynamic, EGG, and acoustic mea-
tained in CQ after straw phonation in different studies. Thirty
sures before and within 20 minutes after straw phonation.
subjects were asked to perform a 15-minute session of straw
Increased mean airflow was found to last 20 minutes after both
phonation by Portillo et al and no significant changes were
types of straw phonation exercises, whereas PTP could only
found when before and after conditions in CQ were compared.29
remain decreased for 5 minutes after 10 minutes of straw pho-
Andrade et al recruited 23 healthy volunteers to assess EGG
nation. Owing to the limited lingering effects of straw phonation,
measures during straw phonation.30 No significant changes were
repeated exercises are needed to build up and maintain thera-
found in CQ when straw phonation and comfortable phonation
peutic effects. This study has not only confirmed that 10 minutes
were compared. No significant change during and after 5 minutes
of straw phonation lead to optimal and relatively continuous
of straw phonation for vocally healthy subjects was found,
effects, but has also extended our knowledge of proper clinical
whereas a significant increase in CQ was obtained during ex-
applications of straw phonation.
ercise for participants with hyperfunctional dysphonia in Guzman
et al’s study.31 A classically trained singer was recruited in
another Guzman et al’s study, and decreased CQ was obtained Acknowledgments
after straw phonation exercises.24 There is little doubt that the This study was supported by the NSFC (81329001).
experience of phonation into the straw lead to a change in
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