Elsevier

Journal of Voice

Volume 33, Issue 3, May 2019, Pages 381.e1-381.e9
Journal of Voice

The Effects of Phonation Into Glass, Plastic, and LaxVox Tubes in Singers: A Systematic Review

https://doi.org/10.1016/j.jvoice.2017.12.005Get rights and content

Summary

The present study aimed to perform a systematic literature review to assess the effects of phonation therapy on voice quality and function in singers. The systematic search was performed in February and updated in October 2017. No restriction of year, language, or publication status was applied. The primary electronic databases searched were LILACS, SciELO, PubMed, and Cochrane. Kappa coefficient was used to assess the agreement between examiners in judging article eligibility. The eligible articles were analyzed based on their risk of bias using the tools proposed by the Joanna Briggs Institute. Mendeley Desktop 1.13.3 software package (Mendeley Ltd, London, UK) was used to standardize the references of identified articles. The general sample consisted of 1965 articles screened out of the electronic databases. Two examiners analyzed the sample in the search for eligible articles. The agreement between examiners reached excellent outcomes (kappa coefficient = 0.88). After the selection, phase 6 articles remained eligible. Together, the eligible studies accounted 141 subjects (65 men and 76 women) aged between 18 and 72 years old. Electroglottography was considered as the most common method (83.33%) of assessment of the effects of phonation therapy in singers. The most prevalent exercises within the therapies were phonation into straws and phonation into glass tubes. The phonation into glass tubes immersed in water, straws, and LaxVox tubes promoted positive effects on the voice quality in singers, such as more comfortable phonation, better voice projection, and economy in voice emission.

Introduction

Individuals who use their voice as work instruments, such as singers, represent a population with intense voice performance. Variations in voice projection and adjustments between breathing, articulation, and resonance are common in these individuals.1, 2 Additionally, the frequency, intensity, timing, and duration of the phonation may be higher in singers than in other professionals who use their voice for working.2, 3 From a physiological point of view, the increase in voice frequency and intensity expands the amplitude of vibration in the vocal folds, decreases the amplitude of surface wave in the mucosa, increases the phonation threshold pressure, and consequently leads to the lack of energy due to the increase of friction.4

Work-related voice disorders are defined as any phonetic alteration caused by voice misuse during labor activities that hamper professional communication.5 Usually, these disorders are observed more often in singers who use their voice intensely and improperly.6, 7 High prevalence rates of self-reported voice disorders are observed among singers of classical and popular music, as well as voice coaches, during their career (46.09%). These rates become even more evident considering music students.3 In this context, preventive approaches play an important part in the prevention of voice disorders.3

Semioccluded vocal tract exercises (SOVTEs) are broadly explored in the clinical routine to promote better glottal coaptation and less activation of the laryngeal vestibule.8 Phonation into tubes emerges as an exercise to improve the proprioception of the larynx and to enhance the relation between source and filter.9, 10, 11 Consequently, an improved phonation is achieved with economic vibration of the vocal folds and efficient emission of voice.4, 10, 12 In this context, SOVTEs are valuable to support singers with intense and energetic performances.13

Phonation into tubes may be performed using plastic straws,14 Sovijärv's glass tubes,15 and LaxVox tubes.16, 17 The immersion of tubes in water may be set with different depths according to vocal and laryngeal characteristics specific for each individual. This exercise is founded on the relation between water pressure and depth—the deeper the tube, the higher the resistance to voice resonance.18

Knowing the effects of voice exercises is essential to support their application in practice. Based on that, optimal exercises could lead to optimal therapeutic outcomes, performances, and longevity for singers and their voices.19 Considering the scarce scientific lines of evidence that explore voice exercises, the present study aimed to perform a systematic literature review to assess the effects of resonance in tubes in the voice quality, glottal function, and vocal tract of singers.

Section snippets

Research protocol and registration

The present systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)20 and Cochrane.21 The systematic review was registered in the PROSPERO database under the protocol CRD42017078823. (https://www.crd.york.ac.uk/PROSPERO/)

Study design and eligibility criteria

The present research aimed to answer the following question: what are the effects of phonation into tubes on the voice quality, glottal function, and vocal tract of singers?

The research question was based in the PVO

Study selection

The initial sample selection in the four electronic databases resulted in 1965 articles. After excluding duplicates, 1080 remained for title and abstract readings. Next, 960 articles were excluded. Full-text reading was performed in 120 articles and resulted in 114 exclusions. The reasons behind the exclusions were (1) studies that did not use phonation into tubes as a method of intervention (85 articles), (2) reports of case studies (2 articles), (3) reports of case series (2 articles), (4)

Discussion

Voice disorders impact the quality of life and may lead to social problems, especially for those who use their voices for working. Specifically, these disorders may hamper labor performances by limiting basic functions related to the transmission of verbal and emotional messages.28, 29 The present study assessed the effects of phonation into tubes on voice quality, glottal function, and the vocal tract of singers through a systematic literature review. According to the extracted data, positive

Conclusion

The outcomes of the articles considered eligible in the present study revealed the positive effects of voice therapy using phonation into tubes on the voice quality of singers. Specifically, these effects promoted comfortable phonation, voice projection, voice economy, and an increase in the limit for collision during the phonation into glass tubes immersed in water, straws, and LaxVox. Additionally, an enlargement of the vocal tract and a reduction in F1 were also observed. The vocal effects

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  • Cited by (0)

    This research was performed in the Postgraduation Program in Applied Health Sciences, Universidade Federal de Sergipe (UFS), Lagarto, Sergipe, Brazil.

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