INTRODUCTION

A hard glottal attack, or a glottal coup, occurs when subglottic pressure becomes very great before
producing a word that begins with a vowel sound. When the word is finally produced, the vocal folds are
blown apart with great force (Stemple, Glaze and Gerdeman, 2000). The sound is characterized by an
abrupt, explosive, and hard-edged onset of phonation. It can be produced in two ways: the first is when
medial compression occurs simultaneously with the onset of phonation, and the second one is
characterized with pre-phonatory laryngeal constriction, wherein the ventricular folds, arytenoids, and
epiglottis all approach each other, hiding the true vocal folds from view (Boone, McFarlane, Von Berg, and
Zraick, 2005). This abrupt vocal onset is harmful to the laryngeal mechanism— causing excessive tension
and strain on the area, making it vulnerable to various pathologies.

EASY ONSET OF PHONATION

The speech is efficient when all its components, namely respiration, phonation, resonation and
articulation, are effectively demonstrated. During phonation, a substantive amount of air coming from our
respiratory system, known as subglottal pressure, is required to be able to produce the sound we desire.
With building subglottal pressure, the vocal folds are tightly adducted and medially compressed to prevent
escape of air. Once there is enough pressure, the air busts open the two vocal folds as it vibrates to produce
speech.

In some cases, an abnormal characteristic of voice occurs and its manifestation is an abrupt
production of speech. This is known as a hard glottal attack. A hard or harsh glottal attack (HGA) refers to
the sudden approximation of the vocal folds on words that begin with vowels (Sataloff, R., 2006). This
results to a glottal click or a glottal stroke acoustically, where it sounds like a sharp, explosive sound. A
hard glottal attack is often associated with benign lesions in the vocal folds or even possibly to singers who
display vocal misuse. Several therapies and treatment are made and one of which is Easy Onset phonation.

Easy Onset phonation is a technique only applicable to words that start with vowel sounds. As we know,
vowels are voiced sounds wherein the preparation to produce them requires the engagement or vibration
of the vocal folds. Thus, they are more susceptible to produce a harsh glottal attack. Easy Onset phonation
refers to the gentle contact and approximation of the vocal folds during word production .The primary goal
of Easy Onset phonation is to minimize hard glottal attacks, or slamming together of the vocal folds, during
speech (De Vore & Cookman, 2009). Early Onset phonation is done efficiently when there is no sudden
friction of the vocal folds as a vowel-initiated word is produced. This can be done by several techniques.
An example of this is practicing a sentence with words starting with vowel sounds, and putting an /h/ sound
in every word to make if “flowy” and gradual from one word to another. This thus prevents the sudden burst
of sound that a hard glottal attack manifests.

TECHNIQUES

In therapies, Speech pathologists make use of different techniques and strategies to help the client
understand and perform Easy Onset phonation. These techniques vary from one client to another.

The following are techniques for Early Onset Phonation:

1. Counseling
As therapists, it is but right to explain to the client the reason for the given therapy. An important factor in
therapy is counseling, and informing the client about the problem. More than informing, they should
understand this as well. Once the client recognizes and understands their voice problem, it will be easier
for them to control themselves into producing a better voice. In addition, clients who know what they are
doing, and what they are doing it for will tend to participate better.

As for Easy Onset phonation, explaining what it is with no jargons will help them better understand what is
happening inside their neck region. An example of this is

“Whenever we speak, our 2 vocal folds come in contact with each other. Once this happens, we produce a
sound. There are instances where people tend to contact their two cords harshly and more abrupt than
usual. This sometimes result to hoarseness and a sudden attack of sound. When this always occur, there
is a big possibility that it will swell and may develop into a pathology. What we would need to do is to
practice and try to start speaking without our two vocal folds clashing into each other that fast and forceful.”

2. Negative Practice

Negative practice is effective and can be provided for home practice (Sataloff, 2006). This is when the
clinician presents to the client contrasts of abrupt initiation and easy onset. With this technique, it is easier
for the client to distinguish and discriminate how both is produced. As the clinician says a word, she or he
may task the client to produce the word with a hard onset, and then say it easy. Moreover, another option
of the clinician can be to produce a word with either a hard or easy onset, and then ask the client if the word
is said correctly (easy onset) or not.

3. Visual Stimulus / Cueing

Not all clients easily understand concepts, more so when it is hard to be seen. As for this instance, clients
usually have a hard time processing it because they do not see what they are trying to control. One
technique that is seen to be effective is by presenting videos. This way, clients will see what occurs in the
glottis during phonation. Clinician may present a video of normal phonation,hard glottal attack, and easy
onset so that the client may decipher their differences, and possibly help them identify what kind of
phonation they themselves produce.

Next, therapies and easy onset exercises often need a guiding visual stimulus. An example of this is figure
1 and 2. Here, it is seen that the upward slope or the stairs is the part where one should inhale. The gradual
downward slope is where the slow release of air takes place while the bottom of the slope is where the
word or the vowel is gently produced. This way, the client is guided that saying a word with a vowel onset
should not be abrupt but rather smooth and “easy.” Clinician may opt to make the exercise creative by
making a story out of it or compare the hard glottal attack that the client is producing with a steeper slide.
For children, or any age group who needs it for that matter, may use their fingers to follow through the
slope, helping them produce Easy Onset phonation easier.
 Figure 1. Figure 2.

4. Minimal Pair Exercises

Minimal Pairs refer to words with minimal differences in its production, usually in the beginning of
the word. Effective minimal pair exercises include putting the /h/ sound as the initial sound of the word to
let the clients decipher themselves the difference between an initially opened glottis (hair) to when its
supposed to gently close to produce its cognate (air). This technique for early onset can be made through
games and activities such as matching the cognates with proper production of the words. Some examples
of minimal pairs are indicated below:

hate eight high eye

heat eat hale ale

howl owl heart art

hiss is heel eel

5. Single Words

As air naturally precedes the adduction of vocal folds when producing h-initiated sounds and as h
always is followed by a vowel, it is then helpful to phonate vowel-initiated words by adding a light /h/ sound
in the start. In addition, Therapists sometimes ask the client to produce a breathy quality all throughout an
utterance to get rid of the hard glottal attacks. Client may practice apple as “hhhhh-apple” and then “hhh-
apple” to “h-apple” to train himself until the minimal /h/ sound can be removed.

For young clients, this activity can be interesting by talking about his or her favorite toys. Below are
the possible word stimulus to be practiced based on a toy category.

Food Animals

Apple Orange Elephant Antelope

 Eggplant Asparagus Iguana Octopus

Olives Oat Ostrich Eagle

Almond Apricot Owl Otter

6. Delay Approach

With words beginning with vowel sounds, it is important and helpful to time the onset of the breath
support. This is done by asking the patient to position his or her articulators to the word that is to be
produced but delay the onset of production until the air is in the level of the vocal folds. Instructions such
as “wait for the air to be at the level of your neck before you say the word” may be useful for the client. This
technique makes the client conscious of the action of the air as they produce speech.

APPLICATION

The use of easy onset is often included in most treatment programs of voice disorders particularly
in the management of hyperfunctional voice disorders where there is a presence of hard glottal attacks. A
hyperfunctional disorder is characterized by tension in the general laryngeal area causing the vocal folds
to adduct with excessive force. Possible causes include reaction to stress or vocal misuse and abuse. They
are common among actors, politicians and untrained singers and it also describes the vocal quality of
people who have lesions on the posterior portion of the glottis. The presence of hard glottal attacks can
also mean the possible presence of strain and tension. Contact ulcers, vocal nodules and polyps,
spasmodic dysphonia are some examples of voice disorders that are characterized by the presence of hard
glottal attacks. When left untreated, it may cause mild edema and erythema on the anterior-middlle portion
of the glottis margin. Through easy onset, a gentle airflow is established helping the speaker better
coordinate airflow with phonation to soften his/her glottal attacks.

Easy onset can be administered to clients across all ages. The technique is modified to cater to the
needs and capabilities of the client. For younger clients who have limited concentration and sitting span,
activities such as singing or using nursery rhymes and poems can be combined with the technique to make
it more fun for the client. Play could also be used as reinforcement. On the other hand, for older clients,
easy onset could be administered purely, beginning with word levels and then increasing in complexity as
the client becomes more accustomed to using the technique. A brief explanation and modelling of the
technique can also be provided and done by the clinician.

EVIDENCE

There is evidence that using an easy onset of phonation lessens involuntary movements of the
larynx during phonation, but only during mild cases (Freed, ). In addition, techniques like easy initiation of
phonation can help reduce vocal tract tension, reducing the force of vocal fold contact and medial
compression, teach an easy coordination of airflow and phonation, and to counteract hard glottal attacks
and vocal tract tension. They are useful to patients who have difficulty in using a breathy voice for general
conversations and would need more ste-by-step procedures to achieve this ( Colton, Casper, and Leonard,
2011).
 SOURCES

Boone, D., McFarlane, S., & Von Berg, S. (2005). The voice and voice therapy (7th ed.). US: Pearson Education.

Colton, R.H., Casper, J.K., Leonard, R. (2011). Understanding voice problems: A physiological perspective for
diagnosis and treatment (4th ed.). PA, US: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

Cookman, S. & De Vore, K. (2009). The voice book. Chicago Illinois, Chicago Review Press

Deem, J. & Miller, L. (1999). Manual of voice therapy (2nd ed.). US: PRO-ED, Inc.

Freed, D.B. (2000). Motor speech disorders: Diagnosis and treatment. Boston, MA: Cengage Learning

Sataloff, R. (2005). Treatment of voice disorders. Oxfordshire United Kingdom, Plural Publishing

Sataloff, R. (2006). Vocal health and pedagogy. Oxfordshire United Kingdom, Plural Publishing

Stemple, J., Glaze, L., & Klaben, B.G. (2000). Clinical voice pathology: Theory and management. US: Singular Thomson
Learning

Williamson, G. (2014). Early Onset. Retrieved on April 11 at http://www.sltinfo.com/easy-onset/