Short- and Longer-Term Effects of Three Intensive Straw Phonation Interventions on the Voice of Female Speech-Language Pathology Students With Mild Dysphonia: A Randomized Controlled Trial

IF 2.1 3区医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

International Journal of Language & Communication Disorders Pub Date : 2025-07-07 DOI:10.1111/1460-6984.70070

Casey Dewanckele, Tara Mouton, Evelien D'haeseleer, Anke Adriaansen, Imke Kissel, Clara Leyns, Tine Papeleu, Charis Van der Straeten, Peter Tomassen, Frederick Dochy, Kristien Rycek, Kaat Pieters, Kristiane Van Lierde, Iris Meerschman

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引用次数: 0

Abstract

Purpose

The purpose of this study was to examine the short- and longer-term effects (3-month follow-up) of a 1-month intensive straw phonation (SP) therapy on the voice quality and voice-related quality of life of female speech-language pathology (SLP) students with mild dysphonia.

Method

Thirty-two female SLP students (mean age: 18.5 years, range: 17.8–19.8 years) with mild dysphonia were included in this study. A randomized controlled trial was used with three experimental groups and a control group. The experimental groups received a short-term intensive voice therapy of one month with SP in air (n = 8), SP in 2 cm water (n = 8) or SP in 5 cm water (n = 8). The control group (n = 8) received a comparable voice therapy by using [u] phonation with similar soft onset and slightly pursed lips as in SP but without a straw. Three maintenance sessions were provided via telepractice in the next month. A multidimensional voice assessment was performed immediately before therapy (pre), immediately after therapy (post 1) and at 1 month (after the maintenance therapy = post 2) and 3 months follow-up (post 3) by an assessor blinded to the group assignment and study phase.

Results

No significant time-by-group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time among the four groups. Primary outcomes: Within-group analyses showed a significant increase (improvement) in Dysphonia Severity Index (DSI) between post 1 and post 2 in the SP in 2 cm water group. Trends of improvement were visible in DSI between pre and post 1 in the SP in air group, and between pre/post 1 and post 2 in the SP in 5 cm water group. A clinically relevant decrease (improvement) in Acoustic Voice Quality Index (AVQI) was found between pre and post 1 in the SP in 2 cm water group. Secondary outcomes: Within-group analyses further showed a significant increase in the SP in 2 cm water group in the highest intensity between pre and post 1/post 2, a significant decrease in the lowest frequency between pre and post 3, and a significant decrease in Vocal Fatigue Index between pre and post 1/post 2. The SP in the air group showed an increase in the highest frequency between pre and post 2. The SP in 5 cm water group showed improvements in the auditory-perceptual parameters, roughness, and strain between pre and post 1.

Conclusions

Positive effects were found for the three SP interventions. The most promising results were found for SP in 2 cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population of female SLP students with mild dysphonia.

WHAT THIS PAPER ADDS

What is already known on the subject

Straw phonation (SP) exercises have shown positive effective for patients with dysphonia. However, to date, there remains a lack of clarity regarding the training conditions generating the most optimal effects, emphasizing the need for further research. For example, there is still uncertainty about a potential additional benefit of submerging the straw in water, creating extra resistance to airflow and a potential massage-like effect. To date, most studies investigated the immediate effects of SP. Consequently, there is limited evidence regarding whether a SP intervention results in a more economical and efficient voice production in the longer term.

What this paper adds to existing knowledge

The purpose of this study was to examine the short- and longer-term effects (3 months follow-up) of a one-month intensive SP intervention on the voice quality and voice-related quality of life of female speech-language pathology (SLP) students diagnosed with mild dysphonia, using a randomized controlled trial. The effects of SP in air, SP in 2cm water and SP in 5cm water were compared. Positive effects were found for the three SP interventions. However, the most promising results were found for SP in 2cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population.

What are the potential or actual clinical implications of this work?

In line with the current state of the art, an intervention using straw phonation (with stirring straws) demonstrated positive effects on the phonation of the investigated female SLP students with mild dysphonia. Among the three conditions tested, a stirring straw submerged 2 cm in water appeared to be the most effective for this population. Further research is needed to determine whether these findings extend to other voice users. The ultimate clinical goal of such efficacy studies is to refine and individualize the selection of SP types for specific populations in clinical practice. To achieve this, future large-scale randomized controlled trials focusing on specific patient subgroups are warranted.

查看原文本刊更多论文

三种强化稻草发声干预对轻度语音障碍女言语语言病理学学生语音的短期和长期影响：一项随机对照试验

目的探讨1个月强化稻草发声（SP）疗法对轻度语音障碍女性言语语言病理（SLP）学生的语音质量和语音相关生活质量的短期和长期影响（随访3个月）。方法选取32名患有轻度语音障碍的SLP女生（平均年龄18.5岁，范围17.8 ~ 19.8岁）为研究对象。采用随机对照试验，设3个实验组和1个对照组。实验组分别采用空气SP （n = 8）、2 cm水中SP （n = 8）或5 cm水中SP （n = 8）进行为期1个月的短期强化语音治疗。对照组（n = 8）接受了类似的语音治疗，使用与SP相似的软起音和轻微噘起的嘴唇，但不使用吸管。下个月通过远程实践提供了三次维护课程。在治疗前（治疗前）、治疗后（治疗后1）、1个月（维持治疗后=治疗后2）和3个月（治疗后3），由一名对小组分配和研究阶段不知情的评估者进行多维语音评估。结果在任何结果测量中都没有发现显著的组间相互作用，这表明四组之间随时间的进化没有显著差异。主要结局：组内分析显示，SP在2 cm水组中1和2后的语音障碍严重程度指数（DSI）显著增加（改善）。空气组SP前、后1、5 cm水组SP前、后1、后2 DSI均有明显改善趋势。2 cm水组SP治疗前后的声学语音质量指数（AVQI）均有临床相关的降低（改善）。次要结果：组内分析进一步显示，2 cm水组在最高强度的SP在前和1/ 2岗位之间显著增加，最低频率在前和3岗位之间显著降低，声带疲劳指数在前和1/ 2岗位之间显著降低。空气组SP的最高频率在2前和2后之间有所增加。5 cm水组SP的听觉知觉参数、粗糙度和应变在1前后均有改善。结论三种SP干预均有积极效果。最令人鼓舞的结果是在2厘米的水中发现了SP，这表明在患有轻度发音障碍的女性SLP学生的特定人群中，声道和声门之间存在最佳阻抗匹配。这篇论文补充了什么已经知道的主题吸管发声（SP）练习已经显示出积极有效的患者发声障碍。然而，迄今为止，关于产生最佳效果的训练条件仍然缺乏清晰度，强调需要进一步研究。例如，将吸管浸入水中是否有额外的好处，比如对气流产生额外的阻力和潜在的按摩效果，目前还不确定。到目前为止，大多数研究调查了SP的直接影响。因此，关于SP干预是否能在长期内更经济、更有效地产生语音的证据有限。本研究的目的是通过随机对照试验，考察一个月的强化SP干预对诊断为轻度语音障碍的女性言语语言病理学（SLP）学生的语音质量和语音相关生活质量的短期和长期影响（随访3个月）。比较了空气中、2cm水中和5cm水中SP的影响。三种SP干预均有积极效果。然而，最有希望的结果是在2cm水中发现的SP，这表明在这一特定人群中声道和声门之间存在最佳阻抗匹配。这项工作的潜在或实际临床意义是什么？根据目前的技术水平，使用吸管发声（用搅拌吸管）的干预对轻度发音障碍的SLP女学生的发声表现出积极的影响。在测试的三种条件中，将搅拌吸管浸入水中2厘米似乎对该种群最有效。需要进一步的研究来确定这些发现是否适用于其他语音用户。这种疗效研究的最终临床目标是在临床实践中针对特定人群细化和个性化SP类型的选择。为了实现这一目标，未来需要进行针对特定患者亚组的大规模随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Language & Communication Disorders AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

3.30

自引率

12.50%

发文量

116

审稿时长

6-12 weeks

期刊介绍： The International Journal of Language & Communication Disorders (IJLCD) is the official journal of the Royal College of Speech & Language Therapists. The Journal welcomes submissions on all aspects of speech, language, communication disorders and speech and language therapy. It provides a forum for the exchange of information and discussion of issues of clinical or theoretical relevance in the above areas.