Tongue Trills Research Articles

The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises. Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min. Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR. Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.

Recognition of the Effect of Vocal Exercises by Fuzzy Triangular Naive Bayes, a Machine Learning Classifier: A Preliminary Analysis

Machine learning (ML) methods allow the development of expert systems for pattern recognition and predictive analysis of intervention outcomes. It has been used in Voice Sciences, mainly to discriminate between healthy and dysphonic voices. Parameter patterns of vocal acoustic analysis and vocal perceptual assessment can be evaluated by ML classifiers, such as the Fuzzy Triangular Naive Bayes (FTriangNB), after using techniques that improve the vocal quality of individuals with healthy or dysphonic voices. Thus, the goal of this study was to analyze the performance of the FTriangNB to detect patterns in the acoustic parameters and the auditory-perceptual assessment of 12 women with dysphonia and 12 vocally healthy women, after performing three vocal exercises (tongue trills, semi-occluded vocal tract exercise with a high-resistance straw - SOVTE, and over-articulation). The FTriangNB classifier contained in the Fuzzy Class package was implemented in the data analysis software R Studio version 1.4.1106 for Macintosh. The confusion matrix was extracted, as well as the accuracy, the Kappa coefficient, and the class statistics. The final result was compared with those generated by FTriangNB with the same variables from the preapplication database of the exercises. The FTriangNB presented good accuracy (87.5%) and Kappa coefficient (81.3%), and showed almost perfect agreement after application of the exercises, while the results before the application of the exercises demonstrated accuracy without acceptable discrimination capacity (33.3%) and Kappa coefficient with a poor agreement (-6.67%). The Semioccluded Vocal Tract Exercises(SOVTE) with high strength straw presented with a sensitivity and Negative Predictive Value (NPV) of value 1 (one), and the over-articulation's specificity and Positive Predictive Value (PPV) also showed a value of 1 (one). The FTriangNB showed great accuracy in recognizing the effect of vocal exercises. Exploratory studies with larger samples using FTriangNB, as well as other Machine Learning classifiers should be further carried out for this purpose in the Voice Science to enable inferences.

Effects of the Voiced Tongue Trill Technique in Glissandos on the Voice Range Profile of Choir Members: A Preliminary Study

The objective of this study was to verify the immediate effect of the voiced tongue trill technique in ascending and descending glissandos on the voice range profile of choir members. A total of 25 sopranos, mezzo-sopranos, contraltos, tenors, and baritones participated in the study. They were choir members, aged 20 to 45 years, with no voice symptoms, and able to perform the voiced tongue trill technique. Their voice range profile was analyzed before and after performing the ascending and descending technique for 2 and 5 minutes. The maximum fundamental frequency values in the study groups increased after performing the ascending and descending technique for 2 minutes (P=0.001) and 5 minutes (P=0.003). The range in Hz increased after 2 minutes (P=0.010) and 5 minutes (P=0.050) of the ascending technique and after 2 minutes (P=0.001) of the descending technique, and the minimum fundamental frequency mean value suffered interference from the type of technique (ascending/descending). The immediate effects of VTTT in glissandos on the VRP of choir members' considering the two factors: condition and time, in ascending and descending glissandos for 2 and 5 minutes increased the maximum frequency and the range in Hz of choristers. Regarding volume levels results, no difference was found in intensity after applying the technique.

Tissue Mobilization During Double Source of Vibration Semioccluded Vocal Tract Exercises: A Neck and Face Surface Acceleration Study.

Purpose This study primarily aimed at observing the possible tissue mobilization on facial, neck, and chest tissues caused by different double source of vibration semioccluded vocal tract exercises (DSV-SOVTEs). Another goal was to inspect the degree of self-perceived sensation of a massage-like sensation. Method Fifty-five participants engaged in a set of several DSV-SOVTEs: (a) phonation with a silicone tube submerged 2 and 8 cm below water surface, (b) Acapella Choice device, (c) lip trills, and (d) tongue trills. A self-perceived massage-like sensation was also assessed. All exercises were performed at three loudness levels. Tissue mobilization signal was captured by four accelerometers placed in four different body regions: (a) over the cheek, (b) over the neck, (c) over the thyroid cartilage, and (d) over the suprasternal notch. Results There is a differential effect of all DSV-SOVTEs on tissue mobilization. All four observed dependent variables from tissue oscillation modulation (frequency, amplitude, jitter, and shimmer) showed significant three-way interactions. In general, amplitude and frequency of tissue oscillation modulation increases with loudness. A self-perceived massage-like sensation showed highly significant differences between DSV-SOVTEs. Conclusions All DSV-SOVTEs do mobilize tissues. Type of exercise, loudness level, and body region produce an effect on all tissue oscillation variables. Acapella device produces the largest amplitude of vibration, lowest frequency, and more regular oscillation of tissue. Water resistance therapy showed the most irregular tissue oscillation. Control of these variables is likely to be relevant to obtain the best outcomes in patients.

Immediate Effect of Semioccluded Vocal Tract Exercises Using Resonance Tube Phonation in Water on Women Without Vocal Complaints

To analyze the immediate effects of semioccluded vocal tract exercises on vocal quality and vocal self-assessment using resonance tube phonation in water in women without voice complaints, and to compare these results with those obtained using tongue trills and unvoiced fricative exercises. This was a quasi-experimental study. The participants were 30 women aged 18-39 years and without vocal complaints. All participants performed three exercises for 3 minutes: experimental exercise (EE: phonation into a resonance flexible tube in water exercise), control exercise (tongue trill exercise), and placebo exercise (PE: unvoiced fricative exercise). Three outcomes were analyzed-vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis. The vocal self-assessment showed significantly greater improvement after EE than after the other exercises. There were no significant differences in auditory-perceptual evaluation or acoustic analyses in any of the voice exercises. The EE promoted an immediate positive effect in the subjective self-assessment, with better results compared with PE. However, the clinical vocal evaluation did not indicate immediate positive effects after 3 minutes of EE, control exercise, or PE.

Effects of a straw phonation protocol on acoustic and perceptual measures of choirs

Voice instructors, choral directors, and voice professionals have long utilized semi-occluded vocal tract (SOVT) exercises to evoke efficient voicing from their students or clients. These exercises, which involve narrowing and/or lengthening the vocal tract as a means of increasing pharyngeal pressure, can include nasal consonants, lip or tongue trills, raspberries, or vocalizing through a tube or straw. Researchers have noted that the increased pressure reduces the amount of breath pressure required to initiate voicing (i.e., phonation threshold pressure) while maintaining or increasing acoustic output (e.g., sound pressure level, formant intensity). The result may be increased “vocal economy” or “vocal efficiency” (i.e., increased vocal output with decreased effort). Until recently, however, this research was limited to effects on individuals. This paper includes a series of studies in which choirs of varied voicing (SATB, SSAA, and TTBB) sang unaccompanied pieces prior to and after performing voicing exercises through a small stirring straw. Long-term average spectra have indicated that most choirs maintained or increased acoustic output in the conglomerate, choral sound after the protocols. Singers have also perceived improved choral sound and decreased singing effort. These results may interest choral directors who wish to improve the vocal economy of their ensembles.

The Impact of Double Source of Vibration Semioccluded Voice Exercises on Objective and Subjective Outcomes in Subjects with Voice Complaints

The present study reports the effects of double source of vibration semioccluded vocal tract exercises (SOVTEs) on subjective and objective variables in subjects with voice complaints. Eighty-four participants with voice complaints were randomly assigned to one of four treatment groups: (1) water resistance therapy, (2) tongue trills, (3) lip trills, and (4) raspberry (tongue and lip trills at the same time). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, and acoustic assessments. Measures for the Vocal Tract Discomfort Scale (VTDS), self-assessment of resonant voice quality, and sensation of muscle relaxation were also obtained. Three assessment sessions were conducted: (1) before the therapy session (Pre), (2) immediately after the voice therapy session (Post 1), and (3) 1 week after home practice (Post 2). Significant differences between baseline (Pre) and both post measures were found for the perception of muscle relaxation and resonant voice quality. No significant differences between Post 1 and Post 2 for any exercises were observed. This indicates that all voice exercises improved subjective self-perceived voice quality immediately after exercises and that improvement remained stable after 1 week of practice. Water resistance therapy and raspberry attained the highest effect. A significant decrease for all exercises was also observed for VTDS values after 1 week of practice. Although some significant changes were observed in objective variables, no clear patterns could be detected. SOVTEs with secondary source of vibration may reduce vocal symptoms related to physical discomfort in subjects with voice complaints. Objective variables apparently do not fully reflect subjective positive outcomes, or they are not sensitive enough to capture changes. No significant differences between four observed SOVTEs were observed.

Treatment for Vocal Polyps: Lips and Tongue Trill

Vocal polyps do not have a well-defined therapeutic indication. The recommended treatment is often laryngeal microsurgery, followed by postoperative speech therapy. Speech therapy as the initial treatment for polyps is a new concept and aims to modify inappropriate vocal behavior, adjust the voice quality, and encourage regression of the lesion. This study aimed to determine the effectiveness of the sonorous lips and tongue trill technique in the treatment of vocal polyps. The sample consisted of 10 adults diagnosed with a polyp who were divided into two subgroups: treatment and control. Ten speech therapy sessions were conducted, each lasting 30-45 minutes, based on the sonorous lips and tongue trill technique, accompanied by continuous guidance about vocal health. Speech therapy was effective in three of the five participants. The number of symptoms presented by the participants decreased significantly after voice therapy (P = 0.034) and vocal self-evaluation (P = 0.034). The acoustic evaluation showed improvements in parameters of noise values (P = 0.028) and jitter (P = 0.034). The size of the polyp and the degree of severity of dysphonia, hoarseness, and breathiness showed a significant reduction after treatment (P = 0.043). Among the remaining two participants, one opted out of laryngeal surgery, indicating that the improvement obtained was sufficient to avoid surgery. The sonorous lips and tongue trill technique was thus considered effective in 60% of the participants, and as laryngeal surgery was avoided in 80% of them, it should be considered a treatment option for vocal polyps.

Evaluation of Electrostimulation Effect in Women With Vocal Nodules

To evaluate the effect of transcutaneous electrical nerve stimulation (TENS) with and without tongue trills in women with vocal nodules. Randomized, prospective, comparative intra-subject study. A total of 60 women aged 18-55 years were included. Visual-perceptual assessment of laryngeal configuration, auditory-perceptual assessment of voice quality, acoustic analyses, and self-assessment of phonation effort were assessed after TENS. Sixty participants participants were randomized into two experimental groups: (1) subjects receiving TENS (EG1), (2) subjects receiving TENS plus tongue trills (EG2). The control group was composed of 15 subjects of EG1 and 15 subjects of EG2. The TENS condition involved electrostimulation for 20 minutes. Audio and video perceptual assessments were performed by three speech therapists with expertise in voice; all were blinded to the experimental conditions. The acoustic parameters included were fundamental frequency, jitter, and shimmer during sustained phonation. Subjects also reported the degree of vocal effort before and after TENS. TENS applied alone or combined with tongue trills aided in glottal closure and in improved comfort during phonation. When the TENS was administered with tongue trills, roughness of voice quality improved. TENS applied alone or combined with tongue trills was associated with improved glottal closure and phonation comfort. TENS associated with tongue trills yielded improved voice quality.

Do Different Semi-Occluded Voice Exercises Affect Vocal Fold Adduction Differently in Subjects Diagnosed with Hyperfunctional Dysphonia?

Objective: To observe the possible differential effects of 8 different semi-occluded vocal tract exercises on glottal contact quotient (CQ) as a measure of vocal fold impact stress. Patients and Methods: Eighty participants were divided into two groups: an experimental group with hyperfunctional dysphonia and a control group of vocally healthy subjects. The participants were recorded before, during and after the exercises. Electroglottographic samples were analyzed to obtain CQ. Results: For the experimental group, all exercises, except lip trills and tongue trills, had an overall significant effect when conditions before, during and after the exercises were compared. The CQ presented differently across the 8 semi-occluded postures during exercise for both groups. For the experimental group, most exercises increased the CQ during practice. Only lip and tongue trills demonstrated lower CQ during exercise. Conclusions: Different semi-occluded exercises differentially affect vocal fold adduction. Lip and tongue trills produced the lowest CQ. Therefore, they may be recommended for decreasing glottal adduction. A straw submerged 10 cm below the water surface presented the greatest CQ. A shallower depth led to a lower CQ, while deeper submersion produced a higher CQ.

Semioccluded Vocal Tract Exercises: Changes in Laryngeal and Pharyngeal Activity During Stroboscopy

The purpose of this study was to compare the changes in laryngeal activity from baseline during three different semioccluded vocal tract exercises (SOVTs). This is a prospective case-series study. Transnasal stroboscopy was performed while four singers performed three SOVTs (straw phonation, lip trill, and tongue trill) to evaluate laryngeal changes during the execution of SOVTs. Evaluations using a modified Stroboscopy Evaluation Rating Form captured the following parameters: amplitude of vocal fold movement, mucosal wave, phase closure, glottal closure, anterior-posterior vocal tract constrictions, medial-lateral vocal tract constrictions, laryngeal ascension, and pharyngeal constriction during a pitch glide. The parameters that changed from baseline, as well as the direction and magnitude of change that occurred across SOVTs, varied within and between each subject. All the singers benefited from at least one SOVT, but no single SOVT benefited all four singers. Although SOVTs result in endoscopic and stroboscopic changes that might be considered beneficial, the results indicate marked variability across SOVTs and singers in terms of the laryngeal and pharyngeal adjustments induced by the exercises. Singing teachers and Speech Language Pathologists (SLPs) may need to more carefully assess the impact of specific SOVTs when deciding which one(s) to prescribe as a teaching or therapeutic exercise.

Comparison of Tongue and Lip Trills with Phonation of the Sustained Vowel /<i>ε</i>/ Regarding the Periodicity of the Electroglottographic Waveform and the Amplitude of the Electroglottographic Signal

Aim: The aim is to compare the vocal fold vibration seen during lip and tongue trills with that seen during phonation of the sustained vowel /ε/, in terms of the periodicity of the EGG waveform and the amplitude of the EGG signal, in professional voice users. Study design: This was a quasi-experimental study. Methods: We used electroglottography (EGG) to compare the vocal fold vibration seen during tongue and lip trills with that seen during phonation of the sustained vowel /ε/, in terms of the EGG waveform periodicity and signal amplitude, in 10 classically trained, professional singers. The participants produced the sustained vowel /ε/ and performed tongue and lip trills at the same frequency and intensity. The periodicity of the waveform and the amplitude of the signal were visually analyzed by three blinded, experienced readers. To confirm the visual analysis results, we measured the jitter and shimmer of the signal and the frequency of variation in vocal fold vibration during the trill exercises. Results: The EGG waveform was classified as periodic for the sustained vowel phonation task and as quasi-periodic for the trill exercises, the vibration pattern repeating at approximately 24 Hz. Conclusion: The vibration of the vocal folds was modified according to the supraglottic movement in trills exercises.

Semi-Occluded Vocal Tract Exercises: Aerodynamic and Electroglottographic Measurements in Singers

The purpose of this study was to describe changes in aerodynamic and electroglottographic (EGG) measures immediately after completing three semi-occluded vocal tract (SOVT) exercises. Prospective case series. Aerodynamic and EGG measurements were obtained before and immediately after performing three SOVTs (straw phonation, lip trill, and tongue trill) in four singers for prepost comparisons to evaluate laryngeal changes persisting beyond the execution of SOVTs. Mean air flow, sound pressure level, and EGG closed quotient tended to increase after completing SOVTs. The magnitude of change and consistency of change in measures across the SOVTs varied from subject-to-subject. Aerodynamic and EGG changes did occur during and immediately after completing SOVTs. However, there was marked variability within and across participants. Further investigation is needed to better understand which SOVTs are likely to benefit a particular individual.

Glottal Contact Quotient in Mediterranean Tongue Trill

To determine the effect of a Mediterranean tongue trill (Zalghouta) on estimated glottal closed quotient (CQ). A total of 10 female subjects participated in this study. Vocal fold CQ was measured for both sustained vowel [a] and the tongue trill named Zlaghouta using electroglottography. Frequencies and means (±standard deviation) were used to describe categorical and continuous variables, respectively. The Wilcoxon signed nonparametric test was used to determine any significant changes in CQ means pretrill and during trill. There was a significant decrease in the mean CQ during the Mediterranean tongue trill (Zalghouta) versus the sustained vowel [a] (P value of 0.002) by 15.98. When stratified by training status there was a significant decrease for the trained group (P value of 0.031) and a nonsignificant decrease for the untrained group (P value of 0.125). Zalghouta induces a decrease in the vocal fold contact time. The potential benefits of the Mediterranean tongue trill in vocal therapy need consideration.

Comparative Analysis of the Closed Quotient for Lip and Tongue Trills in Relation to the Sustained Vowel /ε/

Various types of trill exercises have been used for a long time as a tool in the treatment and preparation of the voice. Although they are reported to produce vocal benefits in most subjects, their physiology has not yet been studied in depth. The aim of this study was to compare the mean and standard deviation of the closed quotient in exercises of lip and tongue trills with the sustained vowel /ε/ in opera singers. Ten professional classical (operatic) singers, reportedly in perfect laryngeal health, served as subjects for this study and underwent electroglottography. During the examination, the subjects were instructed to deliver the sustained vowel /ε/ and lip and tongue trills in a same preestablished frequency and intensity. The mean values and standard deviation of the closed quotient were obtained using the software developed for this purpose. The comparison of the results was intrasubjects; maximum intensities were compared only among them and so were minimum intensities. The means of closed quotient were statistically significant only in the strong intensities, and the lip trill was different from the tongue trill and the sustained vowel /ε/. The standard deviation of the closed quotient distinguished the sustained vowel /ε/ from the lip and tongue trills in the two intensities. We concluded that there is oscillation of the closed quotient during the exercises of tongue and lip trills, and the closed quotient is higher during the performance of exercises of the lip trill, when compared with the two other utterances, only in the strong intensities.

The Relationship Between Tongue Trill Performance Duration and Vocal Changes in Dysphonic Women

To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women. Prospective clinical study, with intrasubject comparison. Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic. In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG. Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.

Voice Training and Therapy With a Semi-Occluded Vocal Tract: Rationale and Scientific Underpinnings

Voice therapy with a semi-occluded vocal tract has a long history. The use of lip trills, tongue trills, bilabial fricatives, humming, and phonation into tubes or straws has been hailed by clinicians, singing teachers, and voice coaches as efficacious for training and rehabilitation. Little has been done, however, to provide the scientific underpinnings. The purpose of the study was to investigate the underlying physical principles behind the training and therapy approaches that use semi-occluded vocal tract shapes. Computer simulation, with a self-oscillating vocal fold model and a 44 section vocal tract, was used to elucidate source-filter interactions for lip and epilarynx tube semi-occlusions. A semi-occlusion in the front of the vocal tract (at the lips) heightens source-tract interaction by raising the mean supraglottal and intraglottal pressures. Impedance matching by vocal fold adduction and epilarynx tube narrowing can then make the voice more efficient and more economic (in terms of tissue collision). The efficacious effects of a lip semi-occlusion can also be realized for nonoccluded vocal tracts by a combination of vocal fold adduction and epilarynx tube adjustments. It is reasoned that therapy approaches are designed to match the glottal impedance to the input impedance of the vocal tract.

Acoustic loading exercises in singing training

Singing teachers have devised vocal exercises that present variable acoustic loads to the sound source. These exercises consist of lip and tongue trills, nasal consonants, and vowels with small mouth openings (like /u/). Some pedagogues and clinicians have advocated phonating into long and narrow tubes. Since none of these exercises produce either a strong or aesthetically pleasing acoustic output in and of themselves, their merit must lie in facilitating the respiratory and phonatory systems. Recent Hopf bifurcation analysis has shown that inertive acoustic loads, resulting from deliberate constricting and lengthening of some portion of the vocal tract, can lower the oscillation threshold pressure, thereby facilitating the ease of vocal onset. Resistive acoustic loads, either upstream or downstream of the vocal folds, have a less beneficial effect on oscillation threshold pressure. [Work supported by Grant No. P60 DC00976 from the National Institute on Deafness and Other Communication Disorders.]

Mechanisms for tongue-tip trills

Possible mechanisms for the production of tongue-tip trills are discussed. It is necessary that energy be transferred from the airstream to the tongue tip to enable it to vibrate. A two-mass model, similar to that of the vocal folds, is one possible model for tongue trills, but there are others that allow the tongue one-degree-of-freedom motion. It is possible that the boundary-layer separation point is affected by the acceleration of air, which is not accounted for in the quasistatic approximation. An argument will be given that the acceleration term produces a favorable energy transfer during trills. Also, the capacitive loading of the vocal tract behind the tongue constriction can provide necessary phase shifts between constriction volume velocity and intraoral pressure for favorable energy transfer. A numerical simulation of the latter model is presented with parameters derived from measurements of oral-nasal volume velocity and intraoral pressure during sustained trills. Some of the features of the trills are reproduced with this simulation.