Using Semi-Occluded Vocal Tract Exercises in Voice Therapy:

The Clinicians Primer

Marci D. Rosenberg
Vocal Health Center, University of Michigan
Ann Arbor, MI
Disclosure: Financial: Marci D. Rosenberg has no financial interests to disclose.
Nonfinancial: Marci D. Rosenberg has no nonfinancial interests to disclose.

Abstract
Semi-occluded vocal tract (SOVT) exercises have long been used by voice trainers and
pedagogues and have been particularly popular in Scandinavia dating as far back as
the 1800s. Titze (1988, 1994, 2006; Titze, Riede, & Popolo, 2008; Titze & Verdolini-Abbot,
2012) has contributed significantly to the exploration of the SOVT and impact on voice
production, and these types of exercise have become ubiquitous in the clinical voice arena.
Although SOVT exercises are commonly used, there continue to be questions about the
exact nature of how they impact phonation and improved vocal economy. This article aims
to explore the physiology of a SOVT on vocal fold vibration and vocal output. Several
variations are described within context of recent research.
Voice production can be viewed as a conversion of arodynamic energy into acoustic
energy at the level of the vocal folds, which control the glottal airflow. At this point, the acoustic
energy travels away from the sound source up the vocal tract as a column of air, radiating
outward into vocal sound. When that acoustic energy intersects with a narrowing anywhere along
the vocal tract, some of it is redirected back toward the sound source, creating a backpressure
and an un-pressing of the vocal folds (Titze & Verdolini-Abbott, 2012). Much of the literature
investigating the impact of a vocal tract narrowing on voice describes the interaction between the
sound source and the vocal tract with specific reference to impedance matching between the
sound source and vocal tract. The result is more efficient conversion of aerodynamic to acoustic
energy. To further clarify this phenomenon, a brief discussion of impedance follows. Impedance
refers to a lack of a response to an applied stimulus (Titze & Verdolini-Abbot, 2012). The
stimulus creates an excitation resulting in some form of movement (response). In voice science,
impedance is measured as a ratio of acoustic pressure in the vocal tract to glottal airflow. The
glottal airflow provides the stimulus creating momentum and acceleration (response) to the
column of air (acoustic pressure) in the vocal tract. The timing and coordination of this event
can impact quality of sound. Reactive impedance describes a scenario where there is a difference
in the timing of the response to the stimulus. This difference can be either as an advanced
response (i.e., compliant) or delayed response (i.e., inertive). Compliant reactance can hinder
vocal fold vibration, resulting in a non-resonant voice. In this scenario, the sound source does
not efficiently convert aerodynamic into acoustic energy, resulting in sensation of vibration in
the laryngeal region with a non-resonant quality. Conversely, inertive reactance (delay) occurs
when the sound source converts aerodynamic energy efficiently into acoustic energy, resulting
in more resonant voice production.
The goal of voice training or voice therapy is to facilitate areas of inertive reactance along
the vocal tract to maximize vocal efficiency. Figure 1 depicts a diagram of impedance. There
are numerous ways to increase inertive areas of the vocal tract and SOVT exercises allow for
many of these adjustments (Figure 2). Among these are (1) adjusting the shape of the vocal tract
(e.g., tongue position, megaphone vs. inverted megaphone), (2) adjusting vocal tract length
(e.g., straws, tubes, lip protrusion, laryngeal height adjustment), and (3) epilaryngeal narrowing.
These adjustments can have an additive effect. More in depth explanation of interaction between
the vocal tract and sound source can be found in Titze and Verdolini-Abbot (2012).
71
Figure 1. Diagram of Impedance (Used with Permission from Rosenberg and LeBorgne (2014).

Figure 2. Ways to Alter Vocal Tract Inertance (Used with Permission from Rosenberg and LeBorgne
(2014).

72
Application of Semi-Occluded Vocal Tract Exercises
in the Clinical Arena
Efficacy of SOVT exercises have been demonstrated in speech pathology literature
as a means of reducing pressed phonation (Stemple, Lee, DAmico, & Pickup, 1994;
Verdolini-Marston, Burke, Lessac, Glaze, & Caldwell, 1995; Verdolini-Marston, Drucker, Palmer
& Samawi, 1998). The neutralized level of vocal fold adduction (not too pressed, not too
breathy), makes SOVT exercises a good tool for many voice diagnoses where hyperfunction is
targeted for remediation. SOVT exercises can be taught in a multitude of ways, allowing them
to be used for a variety of patient populations and skill levels. They allow the patient to tune into
forward, resonant sensations, helping facilitate carryover to connected speech, which does not
inherently always allow for semi-occlusions.
Additionally, motor learning literature indicates that providing an external focus helps
facilitate long-term learning of a new motor skill (Wulf, McNevin, Fuchs, Ritter & Toole, 2000;
Wulf & Prinz, 2001). Many variations of SOVT exercises provide an opportunity to direct the
patient to external, kinesthetic feedback, which may result in better long-term acquisition of
that skill. Further, recent data suggest that the low-impact nature of a resonant hum may
inhibit acute vocal fold inflammation and promote wound healing (Verdolini-Abbot et al., 2012).

Semi-Occluded Vocal Tract Variations

Below is a brief description of some of the more commonly used SOVT exercises with
some additional variations. Generally speaking, the higher resistance variations provide the
greatest occlusive affect but are the most artificial. In contrast, the lowest resistance variations
are more comparable to connective speech, but result in a reduced occlusive affect (Titze, 2006).
Figure 3 shows a general progression of SOVT exercises from more resistant to less resistant.

Figure 3. Hierarchy of Semi-Occluded Vocal Tract Exercises (Used with Permission from Rosenberg
and LeBorgne (2014).

Lip and Tongue Trill

These facilitate inertive reactance in the vocal tract via the anterior constriction of the lip
or tongue during the voiced trill. Studies looking at the impact of lip and/or tongue trills have

73
demonstrated some variability with results, but generally have shown some degree of positive
impact on voice production. Gaskill and Erickson (2008) reported a reduction in the closed
quotient of 50% with the lip trill compared to an open vowel. They noted that differences were
most notable in the untrained subjects. Other studies have also demonstrated reduced closed
quotient with tongue trill (Hamdan et al., 2011). Another study showed positive response with
use of a tongue trill with the best voice rating at 5 minutes of duration. However, they noted
decline in voice quality at 7 minutes of duration of a tongue trill in dysphonic women, suggesting
that perhaps for certain patients, duration of practice should be considered (Menezes et al.,
2011). Although the exact physiology of tongue and lip trill on voice is not fully understood,
these are among the most commonly used SOVT exercise in both the voice therapy and
pedagogy arenas.
Many patients are able to generate either a lip or tongue trill spontaneously while
others require some training. In this case, a hierarchical approach is often helpful. Start in a
comfortable range and move up and down in pitch if comfortable. Some use fingers to hold the
sides of the cheek to facilitate the lip trill. These exercises can then progress to open vowels
and more complex speech tasks. If patients are unable to complete a tongue or lip trill, straw
phonation, or use of sustained fricatives can serve as an alternative.
Lessac Y-Buzz
Described by Arthur Lessac (1997), Y-Buzz creates an occlusion in the anterior oral cavity
as the patient is cued to generate both /y/ as in yellow combined with the vowel /i/ as in easy.
Kinesthetic feedback is offered as the patient senses the friction or buzzing against the anterior
portion of the hard palate and front of the face. Comfortable speaking range is targeted and
an inverted megaphone shape is also executed during this task. One study reported improved
acoustic measures, lower formant frequencies, and resonant after Y-Buzz in 54 actors
(Barrichelo-Lindstrom & Behlau, 2007). This method is very popular in voice training for
actors.
Phonation Through Tubes and Straws
Use of resonating tubes and straws has long been popular for Finnish voice training
(Laukkanen, 1992). This has become a standard choice for voice training in the United States.
This is one of the simplest variations of the SOVT exercises that impacts inertive reactance in the
vocal tract not only by introducing an area of constriction, but also by lengthening the vocal tract
and resulting in a lowering of the first formant (F1). When F1 is lowered, the impedance of the
vocal tract above the level of the vocal folds is altered (inertive reactance; Titze, 1988). There have
been numerous studies investigating the use of tubes and straws on voice. Post-tube measurements
yielded varied closed quotient results with individualized post-tube response, highlighting the
need to establish patient-specific parameters (Gaskill & Quinney, 2011). Other studies have
demonstrated increased velopharyngeal closure, lowered larynx, and increased cross-sectional
dimensions of the hypopharynx. Additionally, it has been shown that there is a clustering of
the third and fourth formants during and after tube phonation for a trained singer (Guzman
et al., 2013; Vampola, Laukkanen, Horacek, & Svec 2011).
The clinician can use varied diameters of straws depending on patient response. A
drinking straw or smoothie straw is often a good choice to begin with. The straw is placed in
the mouth with no air leaking around the lips and the patient is encouraged to sustain gentle,
easy phonation in the form of glides and sirens through the straw. The patient should be
encouraged to generate sound as if the straw were not present, allowing for adequate airflow
and volume. It may take several minutes of practice before the patient settles into easy phonation
through the straw. It is important to allow the patient time to get the feel of the exercise before
adding to the complexity. It is useful to provide an external focus such as feeling vibration on the
fingertips (which are holding the straw near the lips), and sending the sound through the straw
across the room. At this point, patient can be encouraged to expand pitch range. Patients will

74
often notice a nice calibration effect of their voice after these exercises. It is often useful to vary
the diameter and have the patient rotate from a smaller diameter to a larger diameter.
As a variation, straws and tubes can also be placed in water during phonation (Shivo &
Denizoglu, 2007). A study investigating the effect of the Finnish resonance tube method reported
increased perceived phonatory ease and comfort after the tube phonation task in 52% of teachers
with dysphonia (Paes, Zambon, Yamasaki, Simberg, & Behlau, 2013).
Card Kazoo
This simple variation of the finger kazoo (see Figure 4) is a nice alternative for patients
who are unable to easily execute lip or tongue trills. A small card or Post-it Note is lined up
perpendicularly to the lips. The lips are quite pursed and the patient is cued to glide comfortably
up and down, beginning first in a comfortable range. This variation provides an external auditory
cue of a kazoo buzz when done correctly. Additionally, the patient is also cued to feel the crisp
vibration at the lips when executing this skill. The patient is able to hear that he or shie is
generating adequate airflow by listening for the kazoo buzz. An inverted megaphone-shaped
vocal tract can be achieved by cueing the patient to maintain and open space in the back of the
throat while maintaining the pursed lips anteriorly. With this variation, inertance is facilitated
by the constriction at the lips. Additionally, the widened pharynx promotes an inverted
megaphone shape, which creates areas of inertance in the speaking range (0350 Hz; Titze &
Verdolini-Abbot, 2012).

Figure 4. Example of the Card Kazoo Technique.

Resonant Voice Therapy

A popular voice therapy method, resonant voice therapy was designed to increase efficiency
of vocal fold vibration by using a hierarchical approach stemming from a forward hum and
progressing to connected speech over a series of sessions. Vocal tract impedance is improved via
the narrowing provided by the smaller nasal passage. The patient is encouraged to sustain the
nasal phoneme /m/, noting sensations of vibration in the front of the face with little effort in
the throat. The patient is encouraged to note how these sounds feel. A hierarchical approach

75
employing motor learning principals is used when introducing this method to a patient (Verdolini-
Marston et al., 1998; Verdolini-Marston et al., 1995).
Cup Phonation
This variation allows for varying the vowel and executing connected speech while still
maintaining some resistance via the cup. In this exercise, a standard 10 oz. Styrofoam coffee cup
is used. A hole approximately the diameter of a pencil or slightly bigger is punctures on the
bottom. The larger open portion of the cup is completely sealed around the mouth (Figures 5a, b).
The patient is instructed to generate a neutral vowel. Sound travels through the hole on the bottom
of the cup only. Level of resistance can be modified by altering the size of the hole. The benefit of
this variation is the ability to move from neutral vowels to closed vowels to connected speech. This
variation is also very useful for singers to help facilitate a more mixed vocal registrar (Rosenberg
& LeBorgne, 2014).

Figure 5. Example of the Use of Cup Phonation, First Preparing the Cup (Left); and Sealing the Cup
Around the Mouth (Right).

Wave in a Cave
This exercise is a variation of the standing wave exercise described by Behlau & Oliveira
(Behrman & Haskell, 2013). It involves creating a cave with both hands cupped together
(Figure 6). A neutral vowel is generated into the cave and resistance is adjusted by altering the
shape of the cave. The patient is cued to seek maximum vibration with a bounce-back of the
sound back into the oropharyngeal space. Glides are used in a natural speech pitch contour.
Once stable, this can be built upon with rote speech and more complex tasks.

76
Figure 6. Example of Wave in a Cave Technique, Requiring Creating a Cave Shape with the Hands.

Vocal Function Exercises

Vocal function exercises are a series of four exercises designed to improve glottal efficiency
and function through a series of specific isometric exercises. Vocal tract inertance is maximized
with narrowed occlusion at the lips. Vocal function exercises are commonly used in voice therapy,
and numerous studies have demonstrated their efficacy (Gorman, Weinrich, Lee, & Stemple,
2008; Sabol, Lee, & Stemple, 1995; Stemple et al., 1994).
In general, SOVT exercises can be completed for several minutes at a time multiple times
during the day. However, the clinician should gauge this recommendation based on the patients
need including diagnosis, vocal endurance, and time post-surgery, if applicable. The clinician
should ensure correct execution of these exercises in therapy to avoid the patient perfecting
errors at home with incorrect practice. This can be best achieved by having the patient provide
frequent self-feedback as to what they are feeling, hearing, and experiencing during and
after these exercises during the voice therapy session. Using a varied-practice schedule (i.e.,
alternating after several trials from one SOVT variation to another) may help promote better
long-term learning of the motor patterns associated with these voice tasks (Schmidt & Lee,
2010). Additionally, having the patient review with the clinician each session how they are
practicing at home will allow the clinician to assess and modify as needed. Making audio and
video recording is another way to optimize correct practice.

Conclusion
SOVT exercises are a popular therapy tool in the clinical voice arena. They are generally
easy to execute and the multitude of variations allows the clinician to alter and modify based
on patient need. These exercises allow for increasing vocal tract inertance, resulting in more
efficient voice. The resultant un-pressing of the vocal folds make this group of exercises useful
for reducing hyperfunction. Studies have shed some light on the effect of SOVT exercises on the
voice, but there continue to be questions regarding the full nature of the impact of a SOVT on
the source/filter interaction. Regardless, voice pedagogues, trainers and clinicians continue to
use these exercises to maximize voice efficiency and production.

77
References
Barrichelo-Lindstrom, V., & Behlau, M. (2007). Resonant voice in acting students: Perceptual and acoustic
correlates of the trained Y-Buzz by Lessac. Journal of Voice, 23, 603609.
Behrman, A., & Haskell, J. (2013). Exercises for voice therapy. (2nd ed.). San Diego, CA: Plural.
Gaskill, C., & Erickson, M. (2008). The effect of voice lip trill on estimated glottal closed quotient. Journal
of Voice, 22, 634643.
Gaskill, C., & Quinney, D. (2011). The effect of resonance tubes on glottal contact quotient with and without
task instruction: A comparison of trained and untrained voices. Journal of Voice, 26, 7993.
Gorman, S., Weinrich, B., Lee, L., & Stemple, J. (2008). Aerodynamic changes as a result of vocal function
exercises in ederly men. Laryngoscope, 118, 19001903.
Guzman, M., Laukkanen, A., Krupa, P., Horacek, J., Svec, J., & Geneid, A. (2013). Vocal tract and glottal
function during and after vocal exercising with resonance tube and straw. Journal of Voice, 4, 1934.
Hamdan, A., Nassar, J., Zaghal, Z., El-Khoury, E., Bsat, M., & Tabri, D. (2011). Glottal contact quotient
in Mediterranean tongue trill. Journal of Voice, 26, 669.e1115.
Laukkanen, A. M. (1992). About the so called resonance tubes used in Finnish voice training practice.
Scandanavian Journal of Logopedics and Phoniatrics, 17, 151161.
Lessac, A. (1997). The use and training of the human voice: A practical approach to speech and voice
dynamics (3rd ed.). Santa Monica, CA: McGraw-Hill.
Menezes, M., Ubrig-Zancanella, M., Cunha, M., Cordeiro, G., Nemr, K., & Tsuji, D. (2011). The relationship
between tongue trill performance duration and vocal changes in dysphonic women. Journal of Voice, 25,
e167175.
Paes, S., Zambon, F., Yamasaki, R., Simberg, S., & Behlau, M. (2013). Immediate effects of the Finnish
resonance tube method on behavioral dysphonia. Journal of Voice, 27, 717722.
Rosenberg, M., & LeBorgne, W. (2014) The vocal athlete: Application and technique for the hybrid singer.
San Diego, CA: Plural.
Sabol, J., Lee, L., & Stemple, J. (1995). The value of vocal function exercises in the practice regimen of
singers. Journal of Voice, 9, 2736.
Schmidt, R., & Lee, T. (2010). Motor control and learning: A behavioral emphasis (5th ed.). Champaigne, IL:
Human Kinetics Publishers.
Shivo, M., & Denizoglu, I. (2007). Lax vox: Voice therapy technique. Izmir, Turkey: AD.
Stemple, J., Lee, L., DAmico, B., & Pickup, B. (1994). Efficacy of vocal function exercises as a method of
improving voice production. Journal of Voice, 8, 271278.
Titze, I. (1988). The physics of small-amplitude oscillation of the vocal folds. Journal of the Acoustical Society
of America, 83, 15361552.
Titze, I. (1994). Principles of voice production. Englewood Cliffs, NJ: Prentice Hall.
Titze, I. (2006). Voice training and therapy with a semi-occluded vocal tract: Rationale and scientific
underpinnings. Journal of Speech, Language, and Hearing Research, 49, 448459.
Titze, I., Riede, T., & Popolo, P. (2008). Nonlinear source-filter coupling in phonation: Vocal exercises.
Journal of the Acoustical Society of America, 123(4), 19021915.
Titze, I., & Verdolini-Abbot, K. (2012). Vocology: The science and practice of voice habilitation. Salt Lake City,
UT: The National Center for Voice and Speech.
Vampola, T., Laukkanen, A. M., Horacek, J., & Svec, J. G. (2011). Vocal tract changes caused by phonation
into a tube: A case study using computerized tomography and finite-element modeling. Journal of the
Acoustical Society of America, 129(1), 310315.
Verdolini Abbot, K., Li, N. Y., Branski, R. C., Rosen, C. A., Grillo, E., Steinhouer, K., & Hebda, P. A. (2012).
Vocal exercise may attenuate acute vocal fold inflammation. Journal of Voice, 26, 814.e113.
Verdolini-Marston, K., Burke, M. K., Lessac, A., Glaze, L., & Caldwell, E. (1995). Preliminary study of two
methods of treatment for laryngeal nodules. Journal of Voice, 9, 7485.

78
Verdolini-Marston, K., Drucker, D. G., Palmer, P. M., & Samawi, H. (1998). Laryngeal adduction in resonant
voice. Journal of Voice, 12, 315327.
Wulf, G., McNevin, N., Fuchs, T., Ritter, F., & Toole, T. (2000). Attentional focus in complex skill learning.
Research Quarterly for Exercise and Sport, 71, 229239.
Wulf, G., & Prinz, W. (2001). Directing attention to movement effects enhances learning: A review.
Psychonomic Bulletin and Review, 8, 648660.

79
Copyright of Perspectives on Voice & Voice Disorders is the property of American Speech-
Language-Hearing Association and its content may not be copied or emailed to multiple sites
or posted to a listserv without the copyright holder's express written permission. However,
users may print, download, or email articles for individual use.