Vocal Warm-up Increases Phonation Threshold Pressure

in Soprano Singers at High Pitch

Tamara Motel, Kimberly V. Fisher and Ciara Leydon

Evanston, Illinois

Summary: Vocal warm-up is thought to optimize singing performance. We

compared effects of short-term, submaximal, vocal warm-up exercise with
those of vocal rest on the soprano voice (n ⫽ 10, ages 19–21 years). Dependent
variables were the minimum subglottic air pressure required for vocal fold
oscillation to occur (phonation threshold pressure, Pth), and the maximum
and minimum phonation fundamental frequency. Warm-up increased Pth for
high pitch phonation (p ⫽ 0.033), but not for comfortable (p ⫽ 0.297) or low
(p ⫽ 0.087) pitch phonation. No significant difference in the maximum
phonation frequency (p ⫽ 0.193) or minimum frequency (p ⫽ 0.222) was
observed. An elevated Pth at controlled high pitch, but an unchanging maximum
and minimum frequency production suggests that short-term vocal exercise
may increase the viscosity of the vocal fold and thus serve to stabilize the
high voice.
Key Words: Larynx—Singing—Voice therapy—Voice disorders—Exercise.

INTRODUCTION instrument” (p. 39). Comparison of pre-exercise

Vocal warm-up is thought to be prerequisite for
optimal singing.1–4 Elliot et al5 tested the proposed
benefit of a 30-minute warm-up exercise in singers.
Their subjects reported that after warm-up, “it
was easier to sing, particularly at high pitches,
and that the voice appeared as a more obedient
Accepted for publication May 16, 2002.
Presented at the 30th Annual Symposium: Care of the Profes-
sional Voice, Philadelphia, Pennsylvania, June 14, 2001.
From the Department of Communication Sciences and Disor-
ders, Northwestern University, Evanston, Illinois.
Address correspondence and reprint requests to Kimberly V.
Fisher, Department of Communication Sciences and Disorders,
Northwestern University, 2299 N. Campus Dr., Evanston, IL
60208. E-mail: kim-fisher@northwestern.edu
Journal of Voice, Vol. 17, No. 2, pp. 160–167
쑕 2003 The Voice Foundation
0892-1997/2003 $30.00⫹0
doi:10.1016/S0892-1997(03)00003-1
and post-exercise voice range profiles, however, did
not reveal a reliable physiologic correlate of the per-
ceived benefit. Although vocal warm-up is a routine
element in most singers’ regimens, there has been
surprisingly little research to define the phonatory
effects of short-term, sub-maximal vocal exercise.
Only two published studies have demonstrated phona-
tory benefits of long-term vocal exercise (increased
glottal efficiency and high pitch range) when exer-
cise was employed twice daily over a period of
four weeks.6 Vocal warm-up is also a component
of vocal hygiene and therapy programs,7–9 yet no
scientific evidence is available to support its use. In
this study, we aimed to show whether or how the
high-pitch singing voice may benefit from short-
term, submaximal exercise in the form of a vocal
warm-up.
Although singing warm-up may alter central pro-
cesses like attention, memory, and mental prepared-
ness for artistic performance, some physiologic

160
 VOCAL WARM-UP IN SINGERS
changes may affect the vocal fold’s muscular body
or mucosal cover directly. In skeletal muscle, sub-
maximal exercise redistributes ions and water in
blood and muscle.10 In as little as 10 minutes of
submaximal exercise, water begins to move from
blood plasma11 into interstitial and intracellular
spaces.12,13 Sjogaard et al12 reported a 41% increase
in extracellular muscle water content and a 2% in-
crease in intracellular water content of the vastus
lateralis after submaximal knee extension. More sub-
stantial effects were shown for maximal exercise,
and those effects began to reverse in as little as 3
minutes of rest. Thus, one can expect that striated
muscle will accumulate water after submaximal ex-
ercise, an effect that is temporally linked to the
performance of that exercise. It is likely that much
of this water is protein bound, as exercise-induced
hemoconcentration is accompanied by reduction of
globulin proteins in the vascular space.11 The exer-
cise-induced water flux into striated muscle has been
attributed to increases in muscle contraction and
arterial blood flow that amplify capillary hydrostatic
pressure. This pressure moves plasma ultrafiltrate
into spaces outside vascular tissue.10,14 Working
muscle also accumulates metabolic products such
as lactate.15 These metabolites increase the osmotic
pressure of muscle tissue, encouraging water to flow
from vascular tissue into muscle tissue.
It is unclear whether similar changes would occur
in laryngeal muscle after vocal warm-up. If the stri-
ated laryngeal and skeletal musculature were similar
metabolically, one could hypothesize similar accu-
mulation of metabolites and associated osmotic
water flux after a short duration vocal exercise. The
increased hydrostatic pressure gradient would also
contribute to hydration of laryngeal muscle, as sing-
ing is associated with a rise in blood pressure and
sympathetic tone. Exercise-induced water efflux
from the circulatory volume and into laryngeal
muscle would increase the stiffness of laryngeal
musculature, thereby shifting the frequency range
upward and favoring the production of high pitches.
This prediction assumes that the exercise is not per-
formed to exhaustion, wherein a loss of potassium
from muscle cells and a failure of excitation–
contraction coupling could cause decline in the force-
generating capacity of the muscles that elevate vocal
161
fundamental frequency. The intrinsic laryngeal mus-
cles, however, are relatively fatigue resistant.16,17
Warm-up potentially alters the water environment
of vocal fold mucosa as well. Water is a major
constituent of the lamina propria. The osmotic pres-
sure of the lamina propria will be determined in
large part by its charge density, and thus the rela-
tively stable concentration of charged molecules
(like hyauluronan) that are present in the extracellu-
lar matrix. These molecules serve to bind water,
inflate the matrix, and thus sustain compressive
load18,19 as during phonation. Vocal fold oscillation,
however, produces shear and compression forces
that may temporarily collapse the capillaries, thereby
reducing water flux from the capillaries into the
mucosa. Reduced water efflux from the circulatory
volume into vocal fold mucosa may increase the
viscosity of the mucosa.
Increases in vocal fold stiffness and viscosity were
expected to influence high-pitch singing. Influx of
protein-bound water into muscle may increase the
stiffness of the laryngeal muscle. Decreased water
flux into the mucosa would increase its viscosity,
rendering the tissue less free to flow. The minimum
subglottic pressure required for small amplitude
vocal fold oscillation (phonation threshold pres-
sure, Pth) varies directly with viscosity.20 We thus hy-
pothesized that submaximal vocal exercise in the
form of a singing warm-up would increase the maxi-
mum and minimum vocal fundamental frequencies,
as well as Pth.
METHODS
Participants
Ten women who were soprano singers from
Northwestern University’s School of Music (Table
1) volunteered to participate in the study in accor-
dance with a protocol approved by Northwestern
University’s Institutional Review Board. All partici-
pants were in full health, and they reported normal
voice and hearing. All presented with perceptually
normal speech and voice on the days of the experi-
ment. The ages of participants ranged from 19 to 21
years (Mean age ⫽ 20.4 years, SD ⫽ 0.699 years).
Participants had received an average of 7.3 years of
formal instruction in singing (SD ⫽ 2.1 years) and
spent an average of 10.3 hours per week singing
Journal of Voice, Vol. 17, No. 2, 2003
162 TAMARA MOTEL ET AL

TABLE 1. times on each of two mornings. On Day 1, data

Age Formal Singing Singing Time were collected immediately before (pre) and after
Subject (Yrs) Training (Yrs) Per Week (Hrs) a 10-minute vocal warm-up exercise (post). At the
same time on Day 2, data were collected immedi-
1 20 5.0 10
ately before and after a 10-minute period of complete
2 20 7.0 7
3 21 9.0 12 vocal rest. Differences between pre treatment and
4 20 12.0 15 post treatment condition measures were com-
5 20 5.0 12 pared, where the two treatment conditions were
6 21 5.5 11 vocal warm-up (Day 1) and rest (Day 2).
7 21 7.0 5 Because Pth is known to vary directly with vocal
8 21 7.0 7
9 21 8.0 10 pitch, target pitches were selected based on each
10 19 7.5 14 participant’s individual maximum phonatory fre-
quency range prior to warm-up. The method for
Note: Mean ⫾ SD: 20.4 ⫾ 0.7, 7.3 ⫾ 2.1, 10.3 ⫾ 3.2.
establishing target pitches was as follows. On Day
1, using an electronic keyboard, participants were
(SD ⫽ 3.2 hours). All participants sang regularly in coached to glide up to the highest phonatory pitch
private lessons, a choir, or other musical group. that they could sustain for one second. This highest
No participants smoked or took medication other pitch was matched with the keyboard to the near-
than birth control. Participants were instructed to est semitone. Participants then glided downward to
maintain their customary dietary and sleep habits the lowest pitch that they could sustain for one
on the days of the experiment. All participants ar- second. This lowest pitch was also matched with
rived for the experiment without having prepared the keyboard to the nearest semitone. The maximum
for singing and denied any feeling that their voices phonatory pitch range was calculated in semitones
were already warmed-up or fatigued. All were naı̈ve based on the lowest and highest musical notes that
to the experimental hypotheses. were sustained for one second. Three target pitches
were calculated to the nearest semitone based on
Instrumentation the 10%, 20%, and 80% levels of each subject’s
Volume velocity airflow was obtained using a maximum phonatory range in semitones. These
wide bandwidth differential pressure transducer target pitches (hereafter called low, comfort, and
(Glottal Enterprises PTW-1) coupled to the right high pitch) were held constant on both days of
side of a vented pneumotachograph facemask. Oral the experiment.
pressure was obtained with a low bandwidth pres- Each participant was trained to execute the phona-
sure transducer (Glottal Enterprises PTL-1) housed tion threshold task. Phonation threshold pressure
on the left side of the facemask. The oral pressure was defined for the participants as the minimum
transducer was coupled to a disposable catheter, subglottic pressure required for small amplitude
1 in long and 1 mm in diameter, placed translabially vocal fold oscillation to begin. Each participant was
at a 45⬚ angle. The volume velocity flow and pressure instructed to “speak very softly” at her comfortable
signals from the transducers were amplified (Glottal (20%) pitch. She then practiced speaking /p/ repeat-
Enterprises MSIF-2) and then digitized at 20,000 edly at a suprathreshold level with a rate of 1.5
Hz and 200 Hz, respectively, using a MacLab/8s syllables per second following a metronome pulse.
AD converter and a Power Macintosh 7500/100 She next held the facemask snug over her nose and
computer. MacLab/s v3.5 software was used to plot mouth and spoke the /p/ syllable string of seven
and store the data. Flow and pressure signals were syllables on a single breath. The participant was
calibrated prior to each day’s data collection. cued with the correct pitch and prompted to produce
the syllable string with a “smooth and constant flow
Experimental Protocol of air.” Following the suprathreshold practice, each
A within-subject repeated measures design was participant practiced the task at a subthreshold level.
used in which every participant was tested two Finally, the participant practiced the syllable string

Journal of Voice, Vol. 17, No. 2, 2003

 VOCAL WARM-UP IN SINGERS
at a level between the supra- and sub-threshold
levels. She was instructed to speak “as softly as
possible without whispering.” The participant and
experimenter viewed the glottal volume velocity on
a computer monitor. The participant was instructed
to make the glottal volume velocity waveform “as
small as possible, but not flat.” In this manner, a
minimum threshold was identified above which pho-
nation occurred but below which phonation ceased.
After the training period, five threshold trials were
collected for each pitch condition (comfortable,
high, and low). Trials were excluded and repeated
if voicing of the stop consonant was detected or if
nasal airflow greater than that expected for small
mask movements (12 ml/s) was observed. Trials
were also excluded and repeated if pressure peaks
were unstable or not flat.
To collect maximum F0, each participant per-
formed an upward pitch glide on vowel /u/ to sustain
her highest pitch for 1 sec, a task repeated three
times. To collect minimum F0, each participant per-
formed a downward pitch glide on vowel /u/ to
sustain her lowest pitch for 1 sec, a task also repeated
three times. To assure that participants were ex-
tending their vocal range as far as possible, they were
prompted with the keyboard as described previously.
The vocal warm-up exercises performed on Day
1 were developed by Karen Brunssen, a professional
vocal instructor and Associate Professor in the
Music Performance Studies Department at North-
western University. The warm-up activity closely
resembled the protocol participants performed at the
beginning of a routine voice lesson. Participants
reviewed an audiotape recording of Dr. Brunssen
describing and performing the exercises with piano
accompaniment. Participants performed the warm-
up with audiotaped piano accompaniment and with
reference, as necessary, to a written sheet of music.
The 10-minute warm-up consisted of five exer-
cises: (1) descending stepwise scales spanning one
octave on a text of /zi/ in legato style; (2) ascending
and descending stepwise scales spanning one fifth
using a text of /zi/ in legato style; (3) ascending
major triads on a text of /i/ in staccato style; (4)
descending, stepwise thirds on a text of /trioioi/
spanning one half-octave; and (5) allegro ascending
and descending scales spanning one octave on a text
of /vi/. Upon completion of the vocal warm-up, data
163
collection for the phonation threshold, maximum
and minimum frequency tasks was repeated. On Day
2, the protocol was repeated with a 10-minute period
of complete vocal rest replacing the vocal warm-up.
After completing the experiment on Day 2, parti-
cipants were asked to recall the warm-up from Day
1. Participants then rated their perceived degree of
warm-up at that time on an equal appearing interval
scale of 1–10, where 1 indicated “not warmed-up
at all” and 10 indicated “warmed-up enough for per-
formance.”
Data Reduction and Analysis
The dependent variables were Pth (⫾0.1 cm H2O),
and the maximum and minimum vocal fundamental
frequencies (⫾4 Hz). Pth was estimated from the
oral pressure during bilabial voiceless stop conso-
nants of quietly spoken consonant-vowel-consonant
syllable strings as described and validated else-
where.21–25 From each seven-syllable trial, the
five middle /p/ occlusions were selected for analysis.
Pairs of adjacent oral pressure peaks were averaged
to approximate the subglottic pressures during the
four intervening /i/ vowels. The averaging process
yielded 20 subglottic pressure values for each pitch
and condition (20 pressure values × 3 pitches × 4
conditions). Five percent of the subglottic pressure
data files were reanalyzed a second time to calcu-
late re-measure reliability. First and second measures
were strongly correlated (r ⫽ 0.99) and yielded an
average absolute difference of 0.027 cm H2O, sug-
gesting reliability was adequate for the purposes of
this study.
Vocal fundamental frequency was calculated as
the inverse of the glottal period derived from the
volume velocity airflow. The fundamental frequency
trajectory for each glide was obtained and displayed
by using computer-automated software for glottal
cycle analysis (MacLab). A total of 1 sec, quasi-
periodic phonations of the highest and lowest funda-
mental frequency were selected by cursor placement
for each of the three high-pitch and three low-pitch
trials, respectively. The average of the three highest
frequency trials was taken as the maximum funda-
mental frequency (Max F0). The average of the three
lowest mean fundamental frequency trails was taken
as the minimum fundamental frequency (Min F0).
Five percent of the Max F0 and Min F0 data files
Journal of Voice, Vol. 17, No. 2, 2003
164 TAMARA MOTEL ET AL
FIGURE 1. Mean Pth differences (⫾SD) for the rest and vocal
warm-up treatments at each of three pitch levels (comfortable,
low, and high). Positive and negative differences indicate in-
creases and decreases in mean Pth, respectively.
were reanalyzed a second time to calculate re-
measure reliability. First and second measures
were strongly correlated (r ⫽ 0.99) and yielded an
average absolute difference of 9.66 Hz.
A mean pre treatment–post treatment difference
was computed for each dependent variable for each
subject within each condition. This reduced each
participant’s data set to a Day 1 warm-up difference
and a Day 2 rest difference for each dependent
variable. As inequality of variance was observed
among the treatment differences, the non-parametric
Wilcoxon Signed Rank Test was used to determine
if any treatment differences in Pth, Max F0, and Min
F0 for warm-up were significantly different from
differences due to vocal rest. Participant 10 was
excluded from the Pth analysis because her Day
2 estimate of subglottic pressure was found to be
invalid.
RESULTS
Figure 1 compares the mean Pth differences for
rest and vocal warm-up at each of the three pitches
(comfortable, low, and high). At high pitch, the
mean Pth difference was greater for warm-up than
rest (N ⫽ 9, z ⫽ ⫺1.836; df: 1,8; p ⫽ 0.033), but not
at comfortable pitch (N ⫽ 9; z ⫽ ⫺.533; df: 1,8;
p ⫽ 0.297) or at low pitch (N ⫽ 9; z ⫽ ⫺1.362;
df: 1,8; p ⫽ 0.087). With warm-up, the positive Pth
difference at high pitch was 0.61 ⫾ 0.74 cm H2O,
Journal of Voice, Vol. 17, No. 2, 2003
FIGURE 2. Monotonically decreasing mean Pth for three indi-
vidual participants (S6, S7, S9) in different pitch conditions
(comfort or high-pitch, respectively) across the time-ordered
measurement periods (Day1 Pre, Day1 Post, Day2 Pre, Day2
Post).
whereas with rest, there was a negative difference
of ⫺0.05 ⫾ 0.63 cm H2O. Between-participant vari-
ability in Pth (revealed by the standard deviation of
the mean) was greatest at high pitch. At high pitch,
six of nine participants demonstrated positive differ-
ences in Pth with warm-up. Also, six of nine partici-
pants demonstrated a negative difference in Pth with
the rest condition. In five of these six participants,
a negative difference with rest was less than 0.5
cm H2O.
To determine whether a practice effect had
contributed to the observed negative differences, a
chronological analysis of each participant’s four
conditions (Day 1 Pre-, Day 1 Post-, Day 2 Pre-,
Day 2 Post) was performed. Three of the nine partici-
pants (S6, S7, S9) improved their ability to phonate
with minimum subglottic pressure as they became
more experienced with the task (Figure 2). Note
the monotonically decreasing Pth values; a trend that
in two participants (S7 and S9) ran counter to the
increased Pth for the group after warm-up when
tested under the high-pitch condition. The signifi-
cantly increased Pth effect for high pitch, however,
was detected despite the opposing effect of practice
in these participants.
Differences in the Max F0 (N ⫽ 10; z ⫽ ⫺.866;
df : 1,9; p ⫽ 0.193) and Min F0 (N ⫽ 10;
z ⫽ ⫺0.764; df : 1,9; p ⫽ 0.222) between warm-
up and rest conditions were not significant (Figure
3). Six of ten participants had differences of one
 VOCAL WARM-UP IN SINGERS
semitone or less after the warm-up. Participant 1,
however, extended her maximum pitch by 3.84 semi-
tones and elevated her low pitch by 2.14 semitones,
effectively shifting her range upward. Participant 5
lost 3.89 semitones at the low end of her range with
the warm-up. Warm-up ratings obtained after the
completion of the experiment ranged from 4 to 8
and indicated that all participants felt somewhat
warmed-up but not enough for performance. Partici-
pant 1 gave the maximum warm-up rating.
DISCUSSION
Vocal warm-up is advocated for optimal singing
performance.1–4 Here, we have shown that a con-
trolled warm-up exercise significantly increased Pth
when participants vocalized at a frequency that was
80% of their pre-exercise range. This finding was ob-
served despite a Pth training effect in three partici-
pants that ran counter to the experimental effects. An
increase of Pth with warm-up may appear intuitively
inconsistent with the subjective impression that after
warm-up it is “easier to sing particularly at high
pitches.”5 In contrast, our findings indicate that a
greater expiratory effort was required for phonation
at high pitch after vocal warm-up. Additionally,
there were no reliable effects of vocal warm-up
for the participants’ Max and Min F0 (viz., mean
differences ⬍1 ST). Consistent increases in Pth,, but
not in Max F0 and Min F0 production after warm-
up, suggest that a more substantial physiologic effect
occurred in the vocal fold mucosa than in the muscle.
For the mucosa, Titze,20 derived an equation that
describes the minimum pressure required for small
amplitude oscillation:
Pth⫽kBcw/T (1)
where Pth is phonation threshold pressure, k is the
transglottal pressure coefficient, B is the mean damp-
ing coefficient for mechanical vibration, c is the
mucosal wave velocity, w is the prephonatory glottal
half-width, and T is the vocal fold thickness (assum-
ing a one-mass model of the vocal folds), and k
is a constant (≈1.1). This equation posits a direct
relationship between Pth and the tissue damping co-
efficient (B), a factor directly related to viscosity of
165
FIGURE 3. Mean semitone differences in minimum (Min)
and maximum (Max) vocal pitch for vocal rest and warm-up
treatments. Positive and negative differences indicate increases
and decreases, respectively.
the mucosa. The increase in Pth with vocal warm-
up in the present investigation leads one to consider
that submaximal vocal exercise possibly increased
the viscosity of the mucosa. This increase in viscos-
ity may have resulted from a loss of water from
the vocal fold mucosa during warm-up, despite a
simultaneous increase in water in the muscle. The
vascular supply to the mucosa is anatomically and
functionally distinct from that of the muscular vocal
fold.26,27 In dogs, vocal fold oscillation induces a
transient ischemia in the superior layer of the
lamina propria.28 As the endothelium is more per-
meable when exposed to shear stress, a transient
ischemia may be necessary to prevent vascular
injury during phonation. Such a transient, oscilla-
tion-induced ischemia would decrease the volume
of water available to the mucosa, thereby increasing
viscosity. It is interesting to consider that an increase
in viscosity, when not extreme, may also allow sing-
ers to stabilize high vocal pitches more easily, a
desirable outcome of vocal warm-up. Detailed
understanding of mechanisms that underlie the in-
creased Pth due to a decrease in internal or superficial
vocal fold hydration awaits further study. Oral
breathing, more common in singing than in rest
breathing, reduces the humidity of inspired air and
may contribute to superficial drying of the airway
mucosa.29,30
The large standard deviations of means of all
dependent variables demonstrate individual vari-
ability in the effects of the warm-up task. It is likely
Journal of Voice, Vol. 17, No. 2, 2003
166 TAMARA MOTEL ET AL
that a controlled warm-up task does not provide
equal exercise and thus equal warm-up for different
individuals. Although each participant had a unique
baseline frequency range and singing skill, the
warm-up tasks were inflexible in tempo and as-
cended to a fixed pitch. The level and pattern of
muscle activation used by subjects in this study may
have varied. Singers with a more restricted upper
frequency limit may use a higher level of muscle
activation than singers who can easily extend their
vocal capabilities beyond the task demands. When
a task requires sustained muscle activation that ex-
ceeds 40% of maximum voluntary contraction,
muscle ischemia can occur.31 To better equate the
perceived degree of warm-up among participants,
an alternative procedure (albeit less rigorously con-
trolled) could have been employed wherein each
participant performed her personalized vocal exer-
cises such that she felt adequately prepared for
performance. The subjective rating at the end of this
experiment confirmed that not all participants felt
equally warmed-up at the end of the exercise. On
the 1–10 scale, scores ranged from 4 to 8. Participant
1, who extended her upper range by almost four
semitones with the warm-up, reported the subjective
rating of 8, indicating nearly performance ready.
The lack of significant effect on Max and Min
F0 did not confirm the hypothesized increase in
muscle or mucosal stiffness with vocal warm-up.
We have considered the possibility that the laryngeal
muscles are metabolically unlike skeletal muscles
in the extremities.32 The larynx may have robust
mechanisms for maintaining a consistent fluid envi-
ronment when the vocal system is put under a stress
such as sub-maximal exercise. For example, laryn-
geal muscles may possess enzymes that transport
or process exercise-induced metabolites before they
have an opportunity to accumulate in the muscle
tissue. Transient ischemia introduced by sustained
isometric contraction also might minimize water
flux into muscle. In either case, an increase in muscle
stiffness would not occur to an appreciable degree and
a dramatic upward shift in range of frequency pro-
duction would not be observed. Some tissue charac-
teristics may also vary across individuals according to
genetic influence. To achieve reliable and substantial
increases in the upper frequency limit may require
an extended program of vocal exercise33 that offers
Journal of Voice, Vol. 17, No. 2, 2003
potential for vocal motor learning, as well as
changes in muscle fiber type or density to accommo-
date the characteristics of neural input.
Although this study examined phonation thres-
hold pressure and range of frequency production, a
study of other phonatory measures could further show
how vocal warm-up affects the voice. Measures of
vocal stability (perturbation), accuracy, onset, and
aerodynamic power or efficiency are just a few
possibilities. Such measures might be sensitive to
improvements in coordination, mental readiness, or
carrying power of the voice. The present investiga-
tion, however, demonstrates that short-term vocal
exercise in the form of a warm-up can engender
physiologic change with potential to enhance
vocal performance.
Submaximal exercise in the form of a vocal warm-
up affects phonation in a manner different from that
previously supposed. An elevated phonation thres-
hold pressure has long been associated with pathol-
ogical voice and considered detrimental to vocal
performance. Yet six of the nine healthy singers who
participated in this study experienced an elevated Pth
at high pitch after warm-up. Participants denied that
voice worsened after the warm-up. The warm-up
also was one used effectively by the students in prior
training. These results compel us to reexamine some
assumptions about optimal vocal performance. Is
lowering phonation threshold pressure always desir-
able? Perhaps an elevated phonation threshold is a
negative trade-off for other more desirable pho-
natory effects. It is possible that the increased Pth
relates to a protective ischemia that prevents vascu-
lar injury in the vocal fold mucosa during high fre-
quency phonation. We propose that increased vocal
fold viscosity may even stabilize high frequency
phonation, making the soprano voice less susceptible
to disruption and “a more obedient instrument.”5
Acknowledgements: This work was completed in par-
tial fulfillment of The Honor’s Program in Human Com-
munication Sciences and Disorders at Northwestern
University. The authors gratefully acknowledge the assis-
tance of Karen Brunssen and Charles Larson. This project
was supported in part by K23 DC00168 from the National
Institution of Deafness and Other Communication Dis-
orders.
 VOCAL WARM-UP IN SINGERS
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