is vocal fry a speech impediment

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Is Vocal Fry Ruining My Voice?

Featured Experts:

Lee Akst, M.D.

Kristine M. Pietsch, M.A.

Yeah, I use vocal fry. So what?

What do the Kardashians, Zooey Deschanel and Katy Perry all have in common? They all are well-known for their use of vocal fry, a creaky voice tone. But women aren’t the only ones using vocal fry —men use it too.

What is vocal fry?

Vocal fry is the lowest register (tone) of your voice characterized by its deep, creaky, breathy sound.

When you speak, your vocal cords naturally close to create vibrations as air passes between them. Like a piano or guitar string, these vibrations produce sound (your voice). When you breathe, your vocal cords are relaxed and open to let air pass through freely, which doesn’t produce any sound.

When you use vocal fry, you relax your vocal cords but do not increase the amount of air you’re pushing past your vocal cords, which produces slower vibrations and ultimately results in the lower creaky sound.

Does vocal fry affect your health?

Vocal fry is not physically harmful to the health of your voice. “The vocal anatomy is not damaged by speaking in vocal fry. However, like any behavior, vocal or otherwise, it can become a habit,” explains Johns Hopkins otolaryngologist, Lee Akst, M.D.

What are side effects of vocal fry?

Vocal fry can affect how others perceive you. “Having a little vocal fry in the voice can sometimes give off the impression of the person being more relaxed,” explains speech-language pathologist Kristine Pietsch, M.A. “It's become more common for radio personalities to use vocal fry in an attempt to sound more natural and accessible to their audience; however some listeners can find it grating."

Nevertheless, for some professions, this relaxed tone may unintentionally imply a speaker is uninterested, bored or unambitious.

When is vocal fry a problem?

Does the quality of your voice interfere with your ability to meet your personal, professional, social or occupational needs?” Akst queries patients considering intervention. If the answer is yes, he refers patients to a speech-language pathologist.

“With voice therapy , people learn to coordinate their airflow, vocal fold (cord) vibration and resonance to produce a better sound,” Pietsch says. “We work together to make that better sound a habit.” Similar to singing lessons, treatment involves exercises, including vocal warmups, to get patients used to using their muscles in a different way to produce the sound.

Whether you use it or not, vocal fry is a pattern of voice use that does not cause harm to your voice. However, if you’re not satisfied with your voice, a speech-language pathologist can help improve its quality. These methods train you to produce a stronger, more powerful voice.

Akst also encourages anyone experiencing persistent vocal roughness to receive an examination to rule out vocal cord disorders that can only be diagnosed during an exam.

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Vocal Fry: Defining a Common Language Register

• Creative Uses
• Stopping Vocal Fry

Vocal fry is a way of speaking that's characterized by a deep, gravely, creaky, scratchy, or raspy tone. When it’s done intentionally (i.e., someone changing the natural tone of their voice), it’s most noticeable at the end of sentences. This type of vocal fry is often associated with young women, although anyone can have vocal fry.

During vocal fry, the larger vocal cords relax and vibrate more slowly. In some people, vocal fry is their natural voice register. Vocal fry can also indicate an underlying respiratory or neurological condition.

This article will explain vocal fry in more detail.

FG Trade / Getty Images

Effects of Vocal Fry

The following signs may suggest you have a voice condition:

• Hoarse or raspy voice
• No longer able to hit some high notes when singing
• Suddenly deeper-sounding voice
• Raw, achy, or strained feeling in your throat
• Talking that is more effortful
• Clearing your throat more often

When you intentionally change your voice, temporary effects can occur. The effects of vocal fry can cause voice hoarseness. It can also cause a scratchy sensation in the throat, which may lead to throat clearing. However, some experts believe that vocal fry does not cause lasting effects. Even after years of vocal fry, such as from singing, vocal cord damage is not detected.

However, other experts note that this type of voice pitch is not encouraged by trained professionals and could cause:

• Vocal dysfunction
• Vocal damage
• In severe cases, vocal tissue scarring 

Vocal Fry and Mental Health

If vocal fry can causing mental health issues with self-esteem and self-image due to the negative connotations associated with vocal fry. If you feel this way, it’s a sign to consult with a mental health professional.

It’s important to note that anyone of any gender can experience or put on vocal fry. It can carry negative connotations and influence how a person with vocal fry is perceived. Back in 2014, a study suggested that women who vocal fry in job interviews are perceived as:

• Less competent
• Less hirable
• Less educated
• Less trustworthy 

Even outside hiring environments, the article says, this laconic tone associated with the Kardashians can sound “annoying” to many people. The article adds that vocal is among other speech patterns women may consider avoiding to increase their credibility in job interviews and chances of being hired.

Critics, though, claim that instructing women on how they should or should not speak is sexist and reinforces harmful gender-based stereotypes.

Causes: Why Do Some People Have a Vocal Fry?

Some people have vocal fry due to vocal cord health conditions. These can cause irregular or vocal cord vibrations, causing the distinctive creak and low pitch of the voice. One study suggests people with thicker and less stiff vocal cords are more likely to have vocal tone irregularities.

Voice problems like vocal fry can also be caused by:

• Upper respiratory infections
• Gastroesophageal reflux (GERD, acid reflux, heartburn)
• Vocal fold growths, such as vocal nodules or laryngeal papillomatosis
• Larynx (voice box) cancer
• Neurological diseases including vocal fold paralysis

Creative Uses of Vocal Fry in Singing

Singing experts say vocal fry requires shortening and thickening of your vocal cords. This allows for more coordination and control of these muscles when singing low notes. They also say its creative utility is effective for singers struggling with removing strain and tension from their voices. Some people can use vocal fry to enter the contrabass range, an extremely low vocal register.

Retraining Yourself to Stop Vocal Fry (If You Want)

The National Institute on Deafness and Other Communication Disorders says some 17.9 million U.S. adults report voice problems. They say some of these disorders can be avoided by caring for your voice. You can stop anytime if you have been intentionally putting on a vocal fry. When stopping, you may need to retrain your voice and care for your throat to help recover from hoarseness. 

Expert tips for taking care of your voice when retraining vocal fry:

• Stay hydrated (if you drink caffeine, drink even more water to compensate).
• Rest your voice throughout the day and avoid overuse, loud talking, singing.
• Use a humidifier in your home (30% humidity is recommended).
• Avoid or limit the use of medications that may dry out the vocal folds, including some common cold and allergy medications .
• Ask your healthcare provider which medications would be appropriate to use.
• Avoid smoking and eating spicy foods.
• Exercise regularly to maintain core strength, stamina, and muscle tone. 
• Avoid mouthwashes and rinses with irritating chemicals or alcohol.
• Get enough rest and eat a balanced diet to support healing. 

Vocal fry is a way of speaking that’s often associated with women. It sounds deep, gravely, raspy, and creaky. Anyone can put on vocal fry or develop it as a symptom of other health conditions or medications. Vocal fry can be used in singing but isn’t recommended as a regular speech pattern as it can cause voice hoarseness and may lead to voice complications. Effects of vocal fry include voice problems and feeling self-conscious about how your voice sounds.

You can retrain your voice if you stop vocal fry and take care of your voice and throat by staying hydrated, using a humidifier, keeping healthy habits, and avoiding overusing your voice, smoking, and consuming or using substances that can be irritating including certain alcohol-based mouthwashes.

Blum H. Totally fried . ASHA Lead . 2016;21(2). doi:10.1044/leader.FTR2.21022016.50

National Institute on Deafness and Other Communication Disorders. Taking care of your voice .

UCLA Keys to Voice Studies. Vocal fry .

Voices. What is vocal fry and what does it sound like? 

Anderson RC, Klofstad CA, Mayew WJ, Venkatachalam M. Vocal fry may undermine the success of young women in the labor market . Snyder J, ed.  PLoS ONE . 2014;9(5):e97506.

Zhang Z. Mechanics of human voice production and control . J Acoust Soc Am . 2016;140(4):2614. doi:10.1121/1.4964509

Vocal Advancement. Vocal fry as a tool for teaching voice .

National Center for Voice and Speech. Self-help for vocal health .

By Michelle Pugle Pulge is a freelance health writer focused on mental health content. She is certified in mental health first aid.

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What Is Vocal Fry?

Cristina Mutchler is a Peabody award-winning journalist, specializing in health and wellness content for over a decade.

Is Vocal Fry Harmful?

• How to Stop It

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Vocal fry is a term used to describe a raspy, scratchy voice tone that's often most noticeable at the end of sentences. The change in voice is produced when larger, relaxed vocal cords vibrate slowly. Vocal fry may also be referred to as creaky voice.

The lower pitch can be a natural vocal register for some while others may choose to switch to the lower register at any time, on and off. Vocal fry can also be a sign of certain health conditions.

While vocal fry itself is not necessarily harmful, in some cases it can be a sign of an underlying condition. Vocal fry can be a side effect of a voice disorder or another health issue like a respiratory or neurological condition.

For people whose vocal fry is not caused by a health condition and who instead have a naturally raspy tone or who choose to switch to the lower register, vocal fry may cause hoarseness or a scratchy feeling in the throat. Otherwise, vocal fry may not be physically harmful.

While vocal fry is likely not physically harmful, it may negatively—and unfairly—affect other aspects of your life. Your voice plays a part in people's perception of your social status, personality traits, and emotions. Despite observations that the vocal fry trend is perhaps becoming more socially acceptable or common, researchers have observed that vocal fry can still negatively impact how a person may be viewed by their peers or acquaintances.

For example, research has shown that young adult women with vocal fry may be perceived as less educated, competent, or hirable in the workplace. Some findings even suggest that men speaking with vocal fry aren't perceived as negatively as women with the same speech pattern.

Why Do People Have Vocal Fry?

Everyone's voice is different. What makes each person's voice quality unique is the size and shape of the vocal cords (also called vocal folds), which are two strips of muscle tissue on each side of the larynx. When you speak, these vocal cords move or vibrate to produce a sound, then close when you're not speaking to allow airflow. A person with vocal fry typically has thicker vocal cords that vibrate slowly and may not squeeze closed quite as tightly.

Vocal fry might also be a learned social habit, which might be particularly noticeable at the end of sentences. As researchers have suggested, this includes those who have intentionally—and perhaps not-so-intentionally—picked up vocal fry speaking habits, likely thanks to pop culture or other societal influences.

The way of talking is particularly popular in the English language. People who are bilingual tend to use vocal fry more when speaking English than when speaking another language they know, such as Spanish or French.

Others may experience vocal fry from irregular vibrations of the vocal cords due to a health condition like vocal fold lesions. When vocal fry is due to a health condition, the vocal change is usually persistent throughout a sentence, not just at the end. The vocal fry would also be just one symptom, with others possibly being vocal fatigue or throat pain .

While people whose larynx functions normally can switch vocal fry on and off at their choosing, those with a health condition cannot.

Anyone of any gender can have vocal fry.

How To Get Rid of Vocal Fry

If it's not due to a medical issue, you probably don't need to make major changes to the way you speak. That said, overusing and misusing your voice can have an impact on your throat health and speaking patterns.

If you're noticing that vocal fry is becoming bothersome or uncomfortable, there are some things you can do at home to help protect and strengthen your voice:

• Stay hydrated by drinking plenty of water .
• Rest your voice for periods throughout the day.
• Refrain from speaking at an unnatural pitch that's too low or too high or too soft or too loud.
• Avoid acid reflux triggers like spicy or acidic foods.
• Limit your use of medications that might dry out the vocal folds, such as certain allergy medications (only after consulting with your healthcare provider).
• Exercise regularly to maintain good posture and muscle tone, which can support voice strength.
• Get enough rest and relieve stress to eliminate any effects that tension or fatigue may have on your voice.

If it's suspected that your vocal fry is due to an underlying health condition, a healthcare provider may perform an exam of the back of your throat. Known as a laryngoscopy, the procedure involves putting a small device down your throat so they can see your larynx and vocal cords.

Any vocal cord disorder an ear, nose, and throat specialist (otolaryngologist) or other healthcare provider finds that is causing your vocal fry may benefit from voice therapy sessions with a trained speech language pathologist. This can be particularly helpful for retraining and adjusting the vocal pattern.

Some techniques that may be utilized in voice therapy training include practicing speaking clearly with supportive sentence ends (instead of tapering off with a creaky or raspy tone) and implementing good breathing techniques via deep supportive breaths from the chest rather than the throat.

A Quick Review

Vocal fry describes a raspy, creaky voice that can be the result of a person's natural vocal tone, a medical issue, or a learned social habit. When the lower voice register is unrelated to a medical condition, the change is most apparent at the end of sentences. When vocal fry is due to a medical condition, the vocal change can be heard throughout sentences. Anyone can have vocal fry. It isn't physically harmful to your vocal cords. However, even though it is popular, the use of vocal fry speech patterns seems to have resulted in negative societal perceptions, especially and unfairly for young women. If you're experiencing vocal fry that's becoming bothersome, there are several at-home tips you can try to help protect and strengthen your voice overall. If at-home changes don't work, consider checking with a healthcare provider who specializes in speech-language pathology to rule out a voice disorder and to receive the medical treatment or voice training you may need.

Merriam-Webster. Vocal fry .

Blum H. Totally fried . ASHA Lead . 2016;21(2). doi:10.1044/leader.FTR2.21022016.50

Wolk L, Abdelli-Beruh NB, Slavin D. Habitual use of vocal fry in young adult female speakers. J Voice . 2012;26(3):e111-6. doi:10.1016/j.jvoice.2011.04.007

Zhang Z. Mechanics of human voice production and control . J Acoust Soc Am . 2016;140(4):2614. doi:10.1121/1.4964509

Anderson RC, Klofstad CA, Mayew WJ, Venkatachalam M. Vocal fry may undermine the success of young women in the labor market . PLoS One . 2014;9(5):e97506. doi:10.1371/journal.pone.0097506

National Institute on Deafness and Other Communication Disorders. Taking care of your voice .

Zhang Z. Vocal instabilities in a three-dimensional body-cover phonation model . J Acoust Soc Am . 2018;144(3):1216. doi:10.1121/1.5053116

Zhang Z. The physical aspects of vocal health . Acoust Today . 2021;17(3):60-68. doi:10.1121/at.2021.17.3.60

Cantor-Cutiva LC, Bottalico P, Webster J, Nudelman C, Hunter E. The effect of bilingualism on production and perception of vocal fry . JVoice . 2021;S0892-1997(21)00180-6. doi:10.1016/j.jvoice.2021.06.002

National Center for Voice and Speech. Self-help for vocal health .

MedlinePlus. Laryngoscopy and nasolaryngoscopy .

Stachler RJ, Francis DO, Schwartz SR, et al.  Clinical Practice Guideline: Hoarseness (dysphonia) (Update) .  Otolaryngol Head Neck Surg . 2018;158(1_suppl):S1-S42. doi:10.1177/0194599817751030

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What Is Vocal Fry? A Speech-Language Pathologist Explains

The ASHA Leader asks Washington, D.C.-based SLP Laura Purcell Verdun four questions about vocal fry and how she treats it in clients. Read more about vocal fry: https://on.asha.org/2CfpEdh TRANSCRIPT: Glottal or vocal fry is really the lowest vocal register that’s produced. [What is Vocal Fry?] It’s this aperiodic staccato sound that’s formed by compression of the arytenoid cartilages or the vocal processes which are at the back of the vocal folds. Yet the vocal folds are maintained in a relatively loose position – there’s very little air flow – then the voice becomes very sort of a popping or a creaking sound. [So What Does It Sound Like?] It will sound such as, “ahhh,” or within speech it may sound [like], “Today is Tuesday.” [How Do You Aim to Treat It?] So the primary issue with vocal fry is really based upon the nature of the vocal fry which is that there is — Did you catch that? “Vocal fry” — where the nature of the voice changes related to insufficient air flow. So the goal with normalizing voice production or normalized voice quality is based upon sufficient air flow, periodic vibrations of the vocal folds, and then a four word resonance. [How Do You Work On It With Clients?] So from a therapy standpoint we would very much direct our efforts towards attending to the air flow, making sure they take a breath, make sure they check their posture — their shoulders, and their chest are well-stabilized — and that they’re using sufficient air flow really from the beginning to the end of the sentence as it occurs most often at the end of the sentence. So instead of saying, “Today is Tuesday, November 17th.” You would say, “Today is Tuesday, November 17th,” in an effort to sustain the air flow. When you sing, you keep the air moving as you sing when you would never trail off. People tend to do that when they speak so it’s about reinforcing that consistent steady air stream from the beginning to the end.

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From Upspeak To Vocal Fry: Are We 'Policing' Young Women's Voices?

Women get policed more often for "vocal fry" and "upspeak" than their male counterparts. Jaqueline Bissett/Getty Images/Ikon Images hide caption

Women get policed more often for "vocal fry" and "upspeak" than their male counterparts.

Journalist Jessica Grose is no stranger to criticism of her voice. When she was co-hosting the Slate podcast, the DoubleX Gabfest , she would receive emails complaining about her "upspeak" — a tendency to raise her voice at the end of sentences. Once an older man she was interviewing for an article in Businessweek told her that she sounded like his granddaughter.

"That was the first moment I felt [my voice] was hurting my career beyond just irritating a couple listeners," Grose tells Fresh Air's Terry Gross.

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Grose sought help from a voice coach in an effort to make herself sound more professional, but Stanford linguistics professor Penny Eckert argues that women shouldn't have to change their voices to suit society.

Eckert points out that the complaints about female upspeak and vocal fry (a tendency to draw out the end of words or sentences with a low, creaky voice) ignore the fact that men also engage in those habits. "People are busy policing women's language and nobody is policing older or younger men's language," Eckert tells Gross.

Grose and Eckert join speech pathologist Susan Sankin for a conversation about upspeak, vocal fry and how women's voices are changing — and whether that's a problem.

Interview Highlights

On some of the comments that came in about Jessica Grose's voice when she hosted the Slate Double X Gabfest

Jessica Grose is a freelance writer and former senior editor at Slate Magazine. She is also a former host of Slate's DoubleX Gabfest podcast. Judith Ebenstein hide caption

Jessica Grose is a freelance writer and former senior editor at Slate Magazine. She is also a former host of Slate's DoubleX Gabfest podcast.

Jessica Grose: There were some very impassioned commenters on our Facebook page and in my email who objected to my upspeak. I remember one in particular said I sounded like "a valley girl and a faux socialite," and there were a couple of comments that echoed that, and the tenor of them was pretty nasty. And before that I had never really thought about my voice, one way or the other. No one had ever commented on it to me. ... I was hurt — that sounds a little silly, I'm a big girl, I write all the time on the Internet, and so I'm used to criticism, but there's something really personal about your voice, and especially if it's something you've never thought about as unpleasant. It's not fun to hear that people find it irritating.

On linguist Penny Eckert's reaction to the criticism of young women's voices

Dr. Penny Eckert is a professor of linguistics at Stanford University and the co–author of the book Language and Gender. Linda Cicero/Stanford University hide caption

Penny Eckert: It makes me really angry. And it makes me angry, first of all, because the biggest users of vocal fry traditionally have been men, and it still is; men in the U.K, for instance. And it's considered kind of a sign of hyper-masculinity ... and by the same token, uptalk, it's clear that in some people's voices that has really become a style, but it has been around forever, and people use it stylistically in a variety of ways — both men and women.

On whether or not vocal fry and upspeak are a "problem"

Susan Sankin is a speech pathologist who offers vocal coaching to individuals who want to change their voices. Susan Sankin hide caption

Susan Sankin is a speech pathologist who offers vocal coaching to individuals who want to change their voices.

Susan Sankin: For the people who come to see me, they're unhappy with their speech. They don't like the way they sound. They sound tentative to themselves. They sound unsure to themselves as well, and they feel that when they present themselves that it sounds as if they lack confidence, even though they're very capable, and they know that they have the capacity to sound better, more confident, more assured with some help. They just have developed a speech pattern that's a habit, and they don't know how to break out of it. When we present ourselves, the way we speak is our verbal image. Much as the way people in the professional world typically don't go to work in sweats and a t-shirt, they are more concerned about how they present themselves, a lot of the clients that come to see me are concerned about how they're presenting themselves verbally.

Grose: Patterns change. Just to hop off the statement you made about wearing sweatpants; Mark Zuckerberg wears a hoodie to work every day. Because he is a young man, that's the dominant Silicon Valley way of dressing now. It wasn't 20 years ago or 30 years ago, but now that's what it is. And even young women in Silicon Valley — I've read personal essays about how they don't feel comfortable dressing up and looking cute for work because they feel like it won't get them taken seriously — they also have to wear hoodies and look like Mark Zuckerberg. So it sort of feels like even when the culture is changing it changes so that usually white men are still the defaults and how we should all be behaving.

On how attitudes toward hearing vocal fry, upspeak and other youthful ways of talking are generational

Eckert: I was shocked the first time I heard this style on NPR. I thought, "Oh my god, how can this person be talking like this on the radio?" Then I played it for my students, and I said, "How does she sound?" and they said, "Good, authoritative." And that was when I knew that I had a problem. ... That I was not a part of the generation that understood what that style means. ... There's been a change and those of us who are bothered by some of these features are probably just getting old.

On the idea of learning about your voice and working with it to sound the way you want to sound

Sankin: I continue to feel that glottal fry used in that way and also upspeak used as pervasively ... is just distracting from the message. For me, and I know for a lot of people, it appears to distract from what people are trying to say. And I've heard what everybody's been saying. It still has a feeling to me of sounding hesitant, less sure of yourself, and less decisive. And I might be old, too ... but there are a lot of things that I really like in spite of my age. This just happens to be one of the things that I think is just an irritating way of speaking.

On accepting the wide diversity of ways people speak

Eckert: You only get change by not allowing it to be a problem to you. And I think this is something that has been huge in all of the years that people have been studying minority dialects. African-American vernacular English is a very rich dialect, and yet little kids are told they better not speak that if they want to succeed in the world. So the question is, do you knuckle under to that or do you try to make the world change a little bit? And certainly, that's how I feel about a lot of the women's styles is that if we all cower under and say do what I did in 1973 [consciously speak lower to be taken seriously], well then, what's going to change?

On why Grose stopped trying to change her voice, even after a session with a speech coach

Grose: I felt like it was blunting my emotional range. I felt when I was self-conscious about my voice it lost that expressive, connective quality ... There was something lost when I wasn't being myself, whatever that is. ... I have started thinking of voice almost as the way I think about outfits. If I'm going for a job interview I'm going to wear a different outfit than when I'm out with my friends. And before I wouldn't have thought, "Oh I use a different voice when I'm at a job interview and when I'm out with my friends", and now I do think of it a little bit more as these two separate things, whereas before I had zero awareness of it. And I don't know if that's necessarily a bad thing. I think it's just about wanting to change for yourself instead of feeling like you're being forced to change by external forces.

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What’s a Young Voice Anyway? Vocal Fry is Hip But Unintelligible

This is the third and final post in the short series on why some voices are difficult to hear, even with hearing aids. The first two posts considered aging effects on voicing and some exercises to mitigate those effects. Today’s post veers in a different direction – to voicing and voicing aberrations among the young.

You’d think Young Voices were just the inverse of Old Voices and that may be the case for starters, but it’s more complicated than that.  Let’s start by stating a clinical impression: few if any people over 50 think young people speak well.  

That probably doesn’t come as a surprise to those with hearing loss, who frequently comment that young people talk too loud, too fast, they mumble, etc. We’ve been addressing this issue in the last two posts on voicing as we age.

Fried Speech

Yes, older people with or without hearing loss all generally agree that young people, especially females, are difficult to understand.  But, do any of these people complain that Young People’s voices are frying ?  No, not really, yet this is the newest trend in voices and explains a lot about their unintelligibility. 

Vocal fry is a speech disorder, which doesn’t sound great. Or maybe it’s not a speech disorder, but a normal aspect of voicing that’s becoming more common. Whatever the linguists eventually decide about its origins and staying power, at least they agree that vocal fry is characterized by speech that is “ creaky, rough, gutteral. ”  

The popular view is that the voice style started with Britney Spears, Kesha, one of the many Kardashians, and others whose names may or may not ring a bell with older listeners. Whether they started it or just made it popular doesn’t really matter as much as the fact that they’ve taken it over the top and others seem to be adopting it in a trendy way.

If you want to hear vocal fry is, just click here for a youtube video that gives  earfuls of Kim Kardashian at her fryin’ best . Seriously, could you understand even one word of what Kim had to say?  Can you imagine conducting a meaningful, long conversation with someone that talks like that?

The Young, The Old, and The (Un)Intelligible

Before you answer those questions, it should go on the record that hearing aids aren’t going to fix Kim’s voice and make it intelligible to those with hearing loss.

Ironically, just as young people are frying their vocal folds, older people are exercising theirs to achieve what they remember Young speech used to sound like. Vocal frying is not part of what they remember, thank goodness, so their efforts are likely to produce more speech that is more intelligible for their peers.

Meantime, will young people keep frying?  Apparently so — according to Mark Liberman , a linguist at the University of Pennsylvania, vocal fry is just one more sound change in speech. None of us talk the way people did 100 years ago. Vocal fry is just one more step in the evolution of how people talk. Dr Liberman further informs us that young people start these changes and females lead the crowd.  Young women tend to start talking in the new style about a half generation ahead of the guys.  

No wonder there are generation gaps — people literally cannot understand each other.

Audiologists do not have a solution to this conundrum, except to assure their patients that they are hearing well and those Young People are not speaking well.  It is possible that, armed with words like “vocal fry,” patients can impress and influence a few fryers into talking “old style,” just for the sake of intelligibility.

feature image from youtube

What is the evidence that speech produced with vocal fry is unintelligible?

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Keep an eye on vocal fry – it’s all about power, status and gender

Director of the University of Sydney Voice Research Laboratory, University of Sydney

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Cate Madill is owner of Cate Madill Voice and Speech, a speech pathology practice based in Sydney, NSW and Director of Voicecraft International Pty Ltd. She is a member of Speech Pathology Australia, the Australian Voice Association, the Australian Society for Performing Arts Healthcare and the Laryngology Society of Australasia.

University of Sydney provides funding as a member of The Conversation AU.

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Much has been written about vocal fry in recent years, with the focus on what it is, where it comes from and what it means. For those who don’t know, the term refers to the lowest vocal register, where the vocal cords are tightly closed for a very long time in the vibration pattern, resulting in a low pitched, creaky voice.

Some of the most recent commentary has focused on how women who use vocal fry are perceived, with detractors and champions, researchers and social commentators weighing in on what is a growing phenomenon.

So why is vocal fry, a commonly occurring phenomenon across all speakers, becoming the focus of commentary and criticism of young women in Australia, the UK and the US?

There are numerous blogs on vocal fry – with commentary , opinion and current media and YouTube examples.

Vocal, or glottal, fry is a description of voice quality (not pitch or loudness). It is also called glottalisation, and is considered a normally occurring feature in many tonal languages, such as Vietnamese, Wu Chinese and Burmese.

It occurs in everyone (men and women) at some time, usually momentarily, and most commonly when we wake up in the morning, before we are fully conscious; when we are tired or de-energised; at the end of phrases, specifically on the last word or syllable; and when we are stressed or anxious.

Vocal fry is perceived as “creaky” or “croaky” and low-pitched as it is the result of very slow and somewhat uneven vibration of the true vocal cords .

It is caused by a more flaccid, thicker vocal cord movement and the recruitment of the false vocal cords (the muscles that sit above the vocal cords that we use to hold our breath and cough).

This type of vocal cord vibration results in increased collision force of the true vocal folds (remember the true vocal folds are the only muscles in the body that hit each other).

This increase in force during vibration of the vocal folds can be traumatic and cause injury to the vocal folds if it occurs a lot – injuries such as laryngitis, vocal fold swelling, and vocal nodules, to name just a few.

Vocal fry is a commonly occurring symptom of a voice disorder (when it is present in a person’s voice a lot of the time).

So, fry occurs normally in many languages, cultures and contexts. It is a descriptor of the lowest part of the vocal range, a symptom of a voice disorder, and currently, a cultural phenomenon related to gender, age and geography.

But what does it mean and what attributions do people make when they hear it?

The semiotics of voice quality

The meaning or attribution given to voice quality has been investigated in many studies – the most rigorous research was conducted by Jeffry Pittam and Cindy Gallois in Queensland in the 1980s.

They found that people attribute meaning to the sound of the voice, specifically: solidarity (is this person like me or like-able; are they one of my tribe?) or status (are they more or less powerful than me).

In my (unpublished) PhD, undertaken at the University of Sydney, women with croaky voices were perceived as being more neurotic than men with croaky voices. Women who had clear voices were perceived as being less neurotic than men with clear voices.

That suggests croakiness in women’s voices has a stronger effect in attribution of neuroticism by others than men, and that voice quality is judged more in women than men.

This parallels the findings in other research that women are judged on their physical attributes more than men.

The relationship between power, gender and the voice

Traditionally, older people are attributed more power than younger people and men are attributed more power than women.

A lower pitch is perceived almost universally as the speaker (male or female) having more authority and/ or greater status. We know that the average pitch of women in Australia has dropped since the 1950s.

This fact coincides with a greater participation in the workforce and overall empowerment of women in modern societies in the same timeframe. It also coincides with the empowerment of the younger generation relative to the older generation.

It has been reported that vocal fry as a vocal phenomenon is occurring more frequently in young women (in their 20s and 30s) in the US, the UK and Australia.

Anecdotally, it is also being observed by speech pathologists more commonly in young women in Brazil, but is not reported as a phenomenon in Europe.

There are three likely hypothesis for the increase in vocal fry in young women in modern, western society:

1) A lower pitch is a sign of empowerment, and we know young women are generically feeling more empowered in these societies; therefore, they may be unconsciously signalling this empowerment by lowering the pitch.

The only problem is that when women are in their twenties and thirties, their pitch is still relatively high due to the anatomy and physiology of the voice (pitch naturally lowers in women over time due to changes in cartilage, muscle tone and hormones).

Vocal fry has the effect of perceptually lowering pitch, even though it is not clear sounding. Thus, young women may be unconsciously signalling their own sense of personal power using this voice quality.

Unfortunately though, we know that both male and female listeners will perceive women more negatively if they use a hoarse, rough, creaky tone. Also, continued use of vocal fry is more likely to lead to a voice problem in women that can limit communicative effectiveness and reduced vocal capability.

2) The second possible hypothesis relates to the solidarity attribution we have observed in previous voice research . A person’s accent and/ or native language identifies them as being part of a common tribe.

We all know of the phenomenon whereby we unconsciously mimic a communication partner’s physical movements, accent or verbal style as a means of improving the effectiveness and sense of ease of communication.

Voice quality can also be an identifier of tribal belonging. Vocal fry is a distinct, easily identified vocal feature (unlike many other less obvious features of resonance or vocal clarity) and may be used as an identifier of a gender generation – young women living in a democracy who may have a similar value system and sense of belonging in that tribe.

3) A less likely hypothesis is that the cause of vocal fry is the opposite to empowerment – it is a sign of anxiety and stress. The voice box responds to the “fight and flight” response (in which anxiety is only the continuum) by tightening (holding the breath) in preparation to stabilise the thoracic region to provide greater strength to the limbs for fleeing or fighting.

As women participate more in verbal–based activities, and as their profile rises in the media, we are hearing women’s “voices” more and more. We may be hearing the sound of women under pressure.

This is a less likely hypothesis given the prevalence of vocal fry in social communication settings, where it likely that young women feel more at ease with each other.

In any case, it’s hard to ignore the fact that it’s fine to fry if you’re:

1) A man 2) An older woman (see the video of Angela Catterns above) 3) A person in a position of status, e.g. a news reader (see the videos of Leigh Sales and Chris Bath above).

Let’s compare the fry of the last two prime ministers.

Comment on Julia Gillard’s voice was common when she was the prime minister, yet she used fry at the end of her phrases in her maiden speech in Parliament without any ensuing commentary on her voice.

Interestingly, there was no comment on Tony Abbott’s fry before or while he was prime minister.

We also have to ask ourselves who is doing the criticising? I’m yet to hear young women criticise themselves for using it; in fact, it seems they don’t notice or comment that they are using it.

Vocal fry may be the new voice for young upwardly mobile American women. So who has the problem? Clearly not the young, empowered women in question.

It’s hard not to conclude that all this commentary about vocal fry is not actually about the voice, but about power and status, and who is allowed to have it.

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What Is Vocal Fry?

By arika okrent | aug 8, 2023, 5:32 pm edt.

You may have heard of the linguistic fad that has crept into U.S. speech and is undermining your job chances. Or maybe you know it as the “debilitating speaking disorder afflicting North American women” or the “verbal tic of doom.” It’s called vocal fry, and it’s the latest “uptalk” or “valleyspeak,” a.k.a. the “ditzy girl” speaking style that people love to hate.

Unlike uptalk, which is a rising intonation pattern, or valleyspeak, which covers a general grab bag of linguistic features (including vocabulary), vocal fry describes a specific sound quality caused by the movement of the vocal folds. In regular speaking mode, the vocal folds rapidly vibrate between a more open and more closed position as the air passes through. In vocal fry, the vocal folds are shortened and slack so they close together completely and pop back open, with a little jitter, as the air comes through. That popping, jittery effect gives it a characteristic sizzling or frying sound. (It’s unclear if that’s how fry actually got its name, but that’s the story you hear most often.)

Vocal fry, which has also been called creaky voice, laryngealization, glottal fry, glottal scrape, click, pulse register, and Strohbass (straw bass), has been discussed in musical and clinical literature since at least the middle of the 20th century. It is a technique (not necessarily encouraged) that lets a singer go to a lower pitch than they would otherwise be capable of. It shows up with some medical conditions affecting the voice box. It is also an important feature in some languages, like Zapotec Mayan, where fry can mark the distinction between two different vowels. These days, however, you mostly hear about it as a social phenomenon, as described (and decried) as “the way a Kardashian speaks” in this video by Faith Salie.

Certainly, a compilation like this makes vocal fry look like a new thing, but looks can be deceiving. As Mark Liberman showed at Language Log , evidence for its rise is only anecdotal, and it’s not hard to find examples of it going way back. People’s voices naturally drop in pitch at the end of phrases, and in many speakers, it will drop into the fry zone at that point.

The evidence that it’s a woman thing is also anecdotal. Plenty of men fall into vocal fry. For instance, Noam Chomsky has it pretty bad—and no one seems to be complaining that his creaky voice makes him sound ditzy.

In fact, as linguist Penny Eckert told NPR, “the biggest users of vocal fry traditionally have been men, and it still is; men in the UK, for instance. And it’s considered kind of a sign of hyper-masculinity.”

Whether or not vocal fry is actually on the rise, it is clear that people noticing fry, especially in young women, is on the rise. In a 2015 segment on This American Life , Ira Glass said “listeners have always complained about young women reporting on our show. They used to complain about reporters using the word like and about upspeak … But we don’t get many emails like that anymore. People who don’t like listening to young women on the radio have moved on to vocal fry.”

Glass talked to Eckert, who did a study asking people to rate how authoritative a radio reporter with vocal fry sounded. The response depended on the age of the rater. Those under 40 thought it sounded authoritative while those over 40 did not. Basically, as summed up by Glass, “if people are having a problem with these reporters on the radio, what it means is they’re old.”

A version of this story ran in 2015; it has been updated for 2023.

You Asked: What Is Vocal Fry?

W hether or not you’re familiar with vocal fry, you’ve heard someone using it. Kim Kardashian’s use of vocal fry is notorious, as is Zooey Deschanel’s. (Searching for a good vocal fry example? YouTube has you covered .)

But vocal fry isn’t just for celebrities; all people employ it to some extent. And it seems to be gaining popularity among young people, which may be bad news for their job prospects.

What is vocal fry?

Vocal fry involves dropping the voice to its lowest natural register, which changes the way a person’s vocal folds vibrate together. Those changes create inconsistencies in the vibrations and lend the speaker’s voice a subtly choppy or creaky quality—which is why vocal fry is sometimes referred to as “creaky voice,” says Casey Klofstad, an associate professor of political science at the University of Miami.

There’s some evidence that people respond negatively to vocal fry. In a 2014 study , Klofstad and colleagues found that recordings of speakers who used vocal fry were judged harshly by listeners, compared to recordings of people speaking normally. These negative judgments were strongest when both the speaker and listener were women. “Young adult female voices exhibiting vocal fry are perceived as less competent, less educated, less trustworthy, less attractive, and less hirable,” Klofstad and his colleagues write.

Other research has found that young women who use vocal fry are perceived as hesitant and nonaggressive—but also educated and upwardly mobile.

The research right now is confusing and sometimes conflicting. But it has fueled a debate about whether young women are being unfairly scrutinized for their speech patterns.

Male vocal fry vs female vocal fry

Women aren’t the only ones who use vocal fry. In a forthcoming study of 18- to 22-year-olds, researchers at Centenary College of Louisiana found that young men not only fry, but they do so more than young women. “Our data showed that men spend about 25% of their time speaking using fry, while women use it about 10% of the time,” says Jessica Alexander, an assistant professor of psychology at the college.

While men were the more frequent fryers, they employed the speech habit differently than women. “Men were dropping down into that lower register on and off throughout their utterances, while women were using it mostly at the end of utterances,” Alexander says.

Men typically have lower overall pitch than women, she says, so their voices descend into fry more easily. “Women have to dip further into their range to go into fry, so we may pick up on it more when women do it,” she adds.

The way some young women are using vocal fry may sound less natural or more pronounced, Klofstad says. “We tend to view behaviors that aren’t normal as untrustworthy,” he says. That may explain the negative bias against women fryers that his research turned up.

Is vocal fry becoming more common?

That’s up for debate. “As a social affectation, it has gotten more attention of late, largely due to reality stars like the Kardashians or Bachelorette contestants, who anecdotally seem to use this form of speech frequently,” Klofstad says. While vocal fry isn’t new, “there’s some evidence that it’s being used more regularly in speech,” Alexander adds.

Vocal fry may be spreading

It’s well established that people mimic one another’s posture, mannerisms and even their speech patterns in order to establish trust and facilitate conversation.“People modify their behaviors to more closely align with others,” says Stephanie Borrie, an assistant professor of speech language pathology at Utah State University. Sometimes referred to as “social mirroring” or entrainment, this practice “just helps people feel more connected,” she says. “If we’re talking to people who use a lot of vocal fry, we’re going to use a lot of vocal fry.”

Looked at this way, she says, the question of whether creaky voice is helpful or detrimental to a speaker largely depends on context.

Her own research shows that other aspects of speech—including pitch and speed—also play a role in whether vocal fry is perceived as positive or negative. “There’s a ton of research on speech rate showing the faster you speak, the more intelligent you sound,” she says. “So all these things, not just vocal fry, have interplay in a listener’s appreciation.”

The debate—and research—about vocal fry will continue. But one thing is certain: the ways that people speak, from the words they use to the tone of their voices, change over time. (If you doubt that, just watch a film made in the 1940s or 50s, or listen to old-time radio.) If it turns out young people really are using vocal fry more than their predecessors, that speech characteristic may soon be the rule, not the exception.

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The 'annoying' rise of U.S. women's 'growling speech'

Blame Britney Spears and Ke$ha. A low, creaky speech pattern has become increasingly common in young women

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Researchers are noticing a trend emerging among college-age women. No, it doesn't have to do with fashion, hair, or sexuality; it's related to their vocal patterns. Scientists say an increasing number of these women are exhibiting a growly, creaky, "annoying" speech pattern known as vocal fry. Here, a brief guide to the rise of " growling speech ":

What's happening?

A new study of young women in New York state has found that many are adopting a "curious vocal pattern" called vocal fry, or glottalization, which is characterized by "low, creaky vibrations." Pop stars like Britney Spears and Ke$ha sometimes deliberately use it to hit low notes or add intrigue to their singing. Kim Kardashian is also a notorious vocal frier. Once considered a speech disorder, vocal fry is the lowest of the three vocal registers, which also include modal and falsetto. "In other words, it is the sort of gritty, sexy voice that 85-year-old habitual smokers develop," says Roberta Anderson in the International Business Times .

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How was the study conducted?

Researchers from New York's Long Island University looked at the predominance of vocal fry in college-age women. They recorded 34 young women speaking. Two speech pathologists then listened to and analyzed the recordings, looking for vocal fry. More than two-thirds of the women in the study were found to use vocal fry. Most often the subjects used vocal fry at the end of sentences. But more research is needed to determine how widespread this is, and why it's happening. "As a piece of research, this paper is more of an amuse-bouche than an entree," says Veronique Greenwood at Discover Magazine . "In the meantime, phoneticists, rejoice: You've now got an army of curious folks who will be listening for vocal fry wherever they go."

How and why does vocal fry happen?

It is produced when the vocal chords slowly vibrate and flutter. It's unclear why we might consciously or unconsciously choose to employ it. "It is possible that these college students have either practiced or observed this vocal register and modeled it to match popular figures," say the study's authors . It could also be a social link among young women , as they tend to creak when they get together. Others note that radio interviewers might use it to imply intimacy with their subjects.

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Is this a bad thing?

Not necessarily. While vocal fry was once classified as a speech disorder and has the potential to damage vocal chords, researchers say the fry that the study's subjects exhibited isn't likely to do so because it was fairly sporadic. "In some ways, this work is a reminder that conversational English, though we don't think about it much, does have aspects of a tonal language," says Greenwood . "Mandarin Chinese has four different tones, each of which encodes explicit meaning, so one syllable, depending on the tone used, can have four very different meanings."

Sources: Discover Magazine , International Business Times , Jezebel , NYU Local , Science Now

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Vocal fry: Exploring the controversial stereotypes

Graphic illustration by Lauren Liu

The sound of a woman speaking with vocal fry immediately invites prejudice.

Lillian Fu and Amishi Chandra October 6, 2021

Vocal fry — when someone drops their voice to their lowest register and fry their vocal cords — is commonly associated with the Valley Girl accent, made prominent by celebrities like Kim Kardashian, Katy Perry and Hannah Simone. There is a great deal of scrutiny surrounding the speech habit, but upon further inspection, much of it is characteristic of the misogyny-riddled criticism that falls upon female-dominated habits and activities.

When a person speaks, their vocal cords naturally close to create vibrations as air passes between them, and these vibrations produce the sound of a person’s voice. In contrast, people relax their vocal cords, taking in a low amount of air to produce slower vibrations and a low, creaky sound when using vocal fry.

Vocal fry’s first prominent appearance was in Britney Spears’s 1999 song, Hit Me Baby (One More Time). The sound was heavily criticized when it first appeared, and it is currently an emblem of the Valley Girl stereotype, a negative caricature of ditzy and materialistic upper class girls from California.  

Regardless of whether or not they actually fit this stereotype, the sound of a woman speaking with vocal fry immediately invites prejudice. Anything she tries to communicate is sabotaged by that initial perception.

“Words themselves actually only contribute about 7% of the content or the message conveyed,” said Nicole Tsent, Lynbrook speech and language pathologist. “About 38% of the message is conveyed through vocal elements which relate to tone, rate of speech, how loud you speak and intonation.”

Although most often associated with women, vocal fry is also common among men. For example, male rock singers like Kurt Cobain and Mick Jagger are well known for using vocal fry in their singing. But while the creaky voices of young women evoke an image of superficiality and low intelligence, the gravel tones of their male counterparts suggest a sense of manliness and authority.  

One reason for this may lie in the difference between the ways men and women use vocal fry. A study done by the Centenary College of Louisiana discovered that men who used vocal fry employed it about 25% of the time, while women only used it in 10% of their speech. Men tended to use it more consistently through each sentence, while women used it mainly near the end. Furthermore, the already deeper pitch of male voices make their dips into their lowest register less perceptile than the dips in higher pitched female voices. As vocal fry is more easily perceived in women, the trend becomes associated mainly with females.

Another reason for the difference in societal perception of male versus female vocal fry may be the double standard imposed on women. Double standards based on gender are numerous and often systemic in modern society; for example, the sexual double standard between men and women objectifies women while simultaneously condemning them for expressing sexual liberty. Men, on the other hand, are applauded for their promiscuity. Vocal fry may be another manifestation of this inequality. Women who use vocal fry are seen as shallow or weak of character, while men who follow the same trend are seen as confident and individualistic.

“I don’t think anyone should be criticized for it,” senior Bhuvana Mukkalama said. “And we shouldn’t set standards that men need to have this kind of voice and women need to have this kind of voice to be taken seriously or to be found attractive. I just think people should be able to be happy with their voices without having to change it.”

This difference in reception reveals how society may expect more of women while making allowances for men. In general, image matters more for women: Their physical presentation, everything from clothing to makeup that enhances their attractiveness, invites harsh judgement from all angles while simultaneously being crucial to their acceptance in society. From their professional to private life, appearance plays a substantial role in how well women are received, while men are not held to that strict of a standard.

Style of speech is just another factor of appearance, and similarly, it is judged in the same way.

“No. 1, the first thing we look at is appearance,” Tseng said. “Then, speaking ability in the sense of, ‘Does a person speak with pitch, tone or rate that is appealing and able to be followed and understood?’ is definitely second.”

However, vocal frying sometimes may not be a conscious choice, like in the instance of social mirroring. Listening to key figures who use vocal fry can lead a person to imitate their behavior unconsciously. In fact, a majority of people who use vocal fry do it unintentionally, and people generally only use it to sound more laid back and authoritative like these celebrities.

“I noticed that Kim Kardashian talked funny at times,” Mukkamala said. “But she does it to the point where it just becomes normal to hear and she’s identified that way. I do it purposely, like if I’m trying to be funny.”

For many young women, speaking with vocal fry is simply a form of self expression picked up from the public figures they follow. The scrutiny and bias that this choice garners is wholly unwanted and largely rooted in the misogynistic values present in current society.

Lillian is a senior and a Design Editor. In her free time she enjoys reading, playing with her cat and wasting time on the internet.

(she/her) Amishi is a senior and a staffer on the Epic this year. When she isn't stressing life she enjoys watching marvel movies, drinking boba, running,...

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Jimmy Doodle • Oct 16, 2023 at 9:47 am

I acknowledge double standards of all kinds exist.

Mention of Kobain & Jagger and men in general doing it in the middle of sentences has been going on for decades.

Vocal fry at the end of sentences is a more recent fad, mass subconscious imitation of Kardashian / Valley Girls, etc.

It converts cynism about what they are saying, or criticism, or being above the fray.

When there are guests on TV or podcasts ending nearly every sentence with vocal fry, it becomes unlistenable.

I saw a TikTok video, maybe staged, where a guy gave crap to a fast foot cashier for vocal fry. He goaded her into speaking normally, to sound like she gave a crap.

It was great.

It goes to show how immensely impressionable EVERYONE is.

Do your own research? Nah. Everybody just follows this flock and that flock.

That’s why social media is so destructive.

Linda Ribbach • May 2, 2023 at 2:20 pm

I think vocal fry started in the ghetto. And just like hip hop started in the ghetto and ended up with Eminem. I think the same is true for vocal fry and the kardashians. Although i’ve just heard now that it started with british men and I can understand that but I never noticed it before. I noticed it especially when women started doing it because I feel it in my throat when they speak that low. I am a soprano and I very seldom speak low enough to do that to my vocal folds.

Having said that, I have read nothing that substantiates my idea that light skinned women speaking in the low vocal fold to create fry has anything to do with the color of one skin. But it does seem like euro americans have copied african americans throughout time.

• Jul 12, 2023

Vocal Fry in Children: Is It a Sign of a Larger Speech Disorder?

If you have noticed your child using vocal fry, you may be worried that it is a sign of a larger speech disorder. Or, perhaps, someone like a teacher or childcare provider has made you aware of your child using vocal fry, and you don’t even know where to begin.

Vocal fry is a low register tone produced by a person’s vocal cords. Some people use it intentionally others do not. It does not harm a person physically, but it can become a habit and has societal implications.

So, let’s explore reasons children use vocal fry and whether or not that can be a sign of a speech disorder.

What is Vocal Fry?

Glottal fry or vocal fry is when a person uses a lower pitch when speaking. This is the lowest vocal register a person can make and usually comes with a raspy sound. It often occurs at the end of a sentence when a person doesn’t have enough breath to sustain the entire speech. Vocal fry can be used intentionally and unintentionally.

According to the National Institution on Deafness and Other Communication Disorders , voice is produced when air flows into the lungs and through the vocal folds at high speeds. When we breathe, the air pressure increases in the larynx until the vocal folds blow apart. But, during voice production, much like a stringed instrument, the vocal cords will vibrate, generating sound.

A child will then use their nose, mouth, lips, and tongue to shape the sounds and produce the words they communicate with.

The vocal register includes the range of sounds a person can make with their voice. There are several types of vocal registers, which include vocal fry, falsetto, modal, and whistle register. A modal vocal register is considered normal.

When a child is using vocal fry, they are relaxing their vocal cords without changing the amount of air pressure they are using. This generates slower vibrations and a lower tone. Vocal fry is characterized by a low, creaky voice sound quality. Some people think it sounds like bacon sizzling in a pan. It also is characterized as being raspy.

The qualities of jitter and shimmer, which are the pitch and volume of the voice, change in the production of vocal fry based on the gender of the person.

Some people think the sound of vocal fry is cool. Many celebrities have a vocal fry that has gotten a lot of notice recently. Other people think it is annoying and offputting and just want people to use their normal voices.

Ultimately, it means that your child isn’t using their breath in a way that sustains the entire sentence.

Is Vocal Fry Harmful To Your Child’s Voice?

In general, vocal fry is not physically harmful to children. It can, however, be a sign of an underlying condition. If it is not done intentionally, your child may have respiratory issues that are making it difficult for them to produce enough air to sustain their voice. Or, it could be a result of a neurological condition that makes it difficult for them to use their vocal cords correctly. Vocal fry can also be a sign of a voice disorder or be a learned habit.

If vocal fry is used intentionally by your child, there could be some side effects, although it is rare. Since your vocal cords vibrate chaotically when using vocal fry, a child who overuses this speech sound can be more susceptible to scarring and nodules on their vocal folds. Usually, this is not a cause for concern.

The main avenue where vocal fry may become harmful is in a child’s social life. Voice affects your life in many other ways than just physically. People and society perceive others based on how they use their voices. Vocal fry can negatively impact the way others perceive your child.

Recently, vocal fry has become a fad. Spurred on by the popularity of celebrities such as Kim Kardashian, Britney Spears, and Zooey Deschanel, vocal fry is a voice register that some young people use intentionally to make themselves sound more interesting. (This trend is not to be confused with uptalk, which is a way of speaking that ends everything as if you are asking a question.)

Some children may mimic the hoarseness of these celebrities to sound more trendy. Specifically, young adult women tend to use vocal fry more for the sound of it than others.

Unfortunately, female voices, in society, can be negatively assessed if they do not meet certain criteria. In a study by Long Island University in Brookville, New York, two-thirds of college-aged women in the study used vocal fry. This unpublished study suggests that women were more likely to use vocal fry in everyday speaking situations.

However, this prevalence has led to some unforeseen backlash. Young women, in particular, are perceived as less educated and less hirable in the workplace with the use of vocal fry. These female speakers are perceived as less competent by many bosses. Although this is a perception by the public, it can affect a person’s job prospects.

Although job prospects may not be foremost on the mind of parents to a younger child, the way they choose to speak can affect a child’s confidence, how others react to their child, and how others view their child.

If they are using vocal fry intentionally, they may get into the habit of using it which could have future consequences.

What Causes Vocal Fry?

People have different voices because everyone’s vocal tract is different. Vocal folds have different shapes and sizes. A person who naturally has a vocal fry register generally has thicker vocal cords that don’t close as tightly. These thicker cords may also vibrate more slowly than others. This is what produces that raspy sound.

Vocal fry can also be a learned habit. Children may use vocal fry intentionally to give their voice a sound quality they like. Once a child uses this vocal register over and over, it is hard for them to not use it. So, they have to get retrained on how to speak if they want to break the habit.

The American English language has more vocal fry to it than many other languages. If your child has learned American English as a second language, their vocal fry may be a result of that.

However, sometimes vocal fry has an underlying cause. If vocal fry is part of a voice disorder, it is often one of many symptoms. If your child’s vocal fry is accompanied by vocal fatigue and throat pain, they may have something else going on.

It is important to note that children who choose to use vocal fry can turn it on and off, whereas children with an underlying illness cannot.

Is Vocal Fry a Symptom of a Voice Disorder?

According to the American Speech-Language-Hearing Association , voice disorders are characterized by a change in how the voice sounds. Voices disorders can be caused by structural issues such as changes in the tissues of the vocal folds or physical changes in the larynx.

They can also be caused by neurogenic factors such as vocal fold paralysis, spasmodic dysphonia, or vocal tremor.

Vocal fatigue, muscle tension dysphonia or aphonia, diplophonia, and ventricle phonation are also functional causes of voice disorders.

Your child could be using vocal fry as a result of any of those. Some children cannot sustain the breath needed to complete a line of speech because they are not able to use their breath effectively. Others have poor posture for structural reasons they cannot sustain their airflow.

If your child’s vocal fry is accompanied by other symptoms, they likely have a voice disorder.

Symptoms that indicate a voice disorder include the following:

Rough, breathy, or strained vocal quality

Abnormal pitch, loudness, or resonance

Phonation breaks

Gurling, wet voice sound

pulsed, shrill, or tremulous voice

Decreased vocal endurance

Running out of breath quickly

Differences in voice quality at different parts of the day

Increased vocal effort

Throat or laryngeal pain

If your child is experiencing these symptoms, it is important to seek out your pediatrician for further evaluation.

How is Vocal Fry Diagnosed and Treated?

If you are concerned about your child using vocal fry, or you have noticed vocal fry associated with other symptoms, it is time to get your child evaluated by a professional.

First, take your child to their pediatrician to make sure no physical problems are causing the vocal fry. Temporary vocal fry may be the result of an upper respiratory illness that is making it difficult for your child to breathe.

Based on your pediatrician’s evaluation, your child may be sent to an ears, nose, and throat doctor (ENT) to help clear the airway for better airflow. The ENT will further evaluate your child and decide on a course of action for any physical obstructions that may be causing your child’s vocal fry.

After your child has been evaluated for physical causes of vocal fry, you may want to see if your child is using this method of speaking to sound more trendy. This may be a faze and your child might outgrow the vocal fry.

Or, sometimes children are unaware of their speech patterns. Making your child aware of the way they speak can go a long way. If you point out that they speak this way, they may make a more conscientious effort to change it.

However, if the vocal fry persists, it may be time to seek out a speech-language pathologist (SLP).

How Can a Speech Therapist Help?

A speech-language pathologist is a trained professional who can evaluate your child’s vocal fry.

Once you set up a speech therapy appointment, the SLP will evaluate your child’s speech. They can tell you if the vocal fry is due to an underlying vocal disorder and come up with a treatment plan to help your child use their airflow more effectively.

SLPs are trained in speech-language pathology to be able to help children practice techniques to improve their voice quality. In voice therapy, your child will learn to use their posture to improve their airflow. They will also practice voice strength. The more your child works with the SLP the stronger their voice and communication skills will become.

Other strategies that you can use to support your child while they are in speech therapy are to make sure your child stays hydrated and remind them to take breaths when speaking. Sometimes children get overexcited when speaking and don’t take care of their voice.

It is also important to support your child throughout this whole process, as it can hurt their self-esteem to have speaking difficulties. Let them know that no matter what is going on, you have their back.

Use any tips or techniques that the SLP recommends to reinforce their learning at home.

How to Find a Speech Language Pathologist?

If you aren’t sure how to get started setting up an appointment with a speech therapist, the California Scottish Rite Foundation can help.

If you are worried speech therapy may not be covered by your insurance , we offer free speech, language, education, and literacy programs to help your child be successful. Our trained SLPs will teach your child strategies to become more confident and improve their communication skills.

Rite Care clinics are located conveniently throughout the state of California, serving communities in 17 locations. We also partner with local universities throughout the state to train and foster skilled speech pathologists who can diagnose and treat a large range of speech, language, learning, and voice disorders.

It’s easy to get started and can make a world of difference in your child’s life.

Vocal fry may be a trendy way of speaking for young women, but it can affect them in the workplace. It can also be a symptom of a larger voice disorder. If you are ready to get your child evaluated for a voice disorder, reach out to a speech-language pathologist. They can give your child a complete diagnosis and give them strategies to help improve the way they communicate.

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December 17, 2011

A Quirk of Speech May Become a New Vocal Style

What used to be thought of as a symptom of a speech disorder might now be a hot trend in vocal style among rock stars and young women. Christie Nicholson reports

A long-existing speech phenomenon has recently become a big thing among young women. Called vocal fry, it’s a low guttural vibration typically found at the end of sentences. You can hear it in this young reporter's voice. [Listen to podcast for audio sample.]

Vocal fry was often thought of as a symptom of a speech disorder. But scientists say they’re now hearing it commonly in pop culture figures like Kim Kardashian and Britney Spears.

On supporting science journalism

If you're enjoying this article, consider supporting our award-winning journalism by subscribing . By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.

Recently speech scientists noticed an increase in vocal fry in female undergraduate students. To test their observation, they had 34 females read a piece of prose. And two thirds of the women demonstrated vocal fry. The study will be published in the Journal of Voice .

They also tested men and found no evidence of vocal fry. More research is required to see if this is truly a newfound fad among young women, since there have been no previous studies on the prevalence of vocal fry.

Right now they don't know why vocal fry appears to be catching on as a style of speech. But it's common for young women, and others, too, to imitate actresses, fellow peers, or high-status people.

At least this is a bit more bearable and sexy than other vocal trends like the uptick at the end of sentences.  

—Christie Nicholson

[ The above text is a transcript of this podcast. ]

American Speech-Language-Hearing Association

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Voice Disorders

View All Portal Topics

The scope of this page focuses on voice disorders of organic, functional, and psychogenic origin(s).

See the Voice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

For information on gender-affirming voice services, see ASHA’s Practice Portal page on Gender Affirming Voice and Communication .

A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 2011; Stemple et al., 2010; Verdolini & Ramig, 2001).

For the purposes of this document, voice disorders are categorized as follows:

• alterations in vocal fold tissues (e.g., edema or vocal nodules) and/or
• structural changes in the larynx due to aging.
• vocal tremor,
• spasmodic dysphonia, or
• vocal fold paralysis.
• vocal fatigue,
• muscle tension dysphonia or aphonia,
• diplophonia, or
• ventricular phonation.

Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple et al., 2010). These voice disorders are rare. Speech-language pathologists (SLPs) may refer individuals suspected of having a psychogenic voice disorder to other appropriate professionals (e.g., psychologist and/or psychiatrist) for diagnosis and may collaborate in subsequent behavioral treatment.

The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor (Stemple et al., 2014; Verdolini et al., 2006). For example, vocal fold nodules may result from behavioral voice misuse (functional etiology). However, the voice misuse results in repeated trauma to the vocal folds, which may then lead to structural (organic) changes to the vocal fold tissue.

SLPs may also be involved in the assessment and treatment of disorders that affect the laryngeal mechanism (i.e., the aerodigestive tract) and that are not classified as voice disorders, such as the following:

• Paradoxical vocal fold movement (PVFM)—a condition in which there is intermittent adduction of the vocal folds that interferes with breathing. When this is suspected, SLPs may be consulted to help identify abnormal laryngeal and respiratory function and to teach various techniques (e.g., vocal exercises, relaxation techniques, quick-release breathing techniques, and proper breath management) to improve laryngeal and respiratory control (Mathers-Schmidt, 2001; Patel et al., 2015; Traister et al., 2016).
• Exercise-induced laryngeal obstruction (EILO)—EILO is most often diagnosed in adolescence and is typically due to obstruction at the laryngeal level due to inappropriate glottic closure or adduction/collapse of supraglottic structures (Maat et al., 2011). EILO may go by other names such as supraglottic airway obstruction during exercise (Murry & Milstein, 2016).

For further information, see ASHA’s Practice Portal page on Aerodigestive Disorders .

Incidence and Prevalence

Incidence of voice disorders refers to the number of new cases identified in a specific time period.

Prevalence refers to the number of individuals who are living with voice disorders in a given time period.

Estimates of incidence and prevalence vary due to a number of factors, including etiology, age, gender, and occupation.

In the pediatric population, the reported prevalence of a voice disorder has ranged from 1.4% to 6.0% (Black et al., 2015; Carding et al., 2006). Longer stays in the neonatal intensive care unit and prolonged intubation (more than 28 days) were associated with more severe dysphonia in premature infants (Hseu et al., 2018). An estimated range of 41%–73% of children were identified with vocal nodules, indicating vocal nodules as a predominant cause of pediatric dysphonia (Martins et al., 2015); however, there can be a variety of causes other than vocal fold nodules that result in dysphonia in the pediatric population. Rates indicated no statistically significant differences across race in preschool-aged children (Duff et al., 2004).

Approximately one out of 13 adults in the United States will experience a voice problem annually, but only a relative minority seek treatment (10%; Bhattacharyya, 2014). The rate of young adults (aged 24–34 years) with voice disorders was estimated to be 6%, with no significant difference across age groups, race/ethnicity, or education levels (Bainbridge et al., 2017). Prevalence was reported to be higher in adults aged 60 years and older, with estimates ranging from 4.8% to 29.1% in population-based studies (de Araújo Pernambuco et al., 2014).

Among adults (between 19 and 60 years of age) with a voice disorder, the most frequent diagnoses included functional dysphonia (20.5%), acid laryngitis (12.5%), and vocal polyps (12%; Martins et al., 2015).

Of individuals over the age of 60 years who had been evaluated for vocal problems, voice disorders were most commonly associated with presbyphonia (changes associated with aging voice), reflux/inflammation, functional dysphonia, vocal fold paralysis/paresis, and Reinke’s edema (Martins et al., 2015). Laryngeal cancer diagnoses were reported to have peaked in adults between 75 and 79 years of age and decreased thereafter (Roy et al., 2016).

Studies reported results based on gender; however, there were no indications whether the data collected were based on sex assigned at birth and/or gender identity. Voice disorders were reported to be significantly more prevalent in male children than in female children (Carding et al., 2006; Martins et al., 2015). In adulthood, however, prevalence was higher in female adults than in male adults, with a reported ratio of 1.5:1.0 (Martins et al., 2015; Roy et al., 2005).

Although female adults more frequently received diagnoses of dysphonia with no specific cause noted, male adults were more frequently diagnosed with chronic laryngitis (Cohen et al., 2012). Also, after the age of 40 years, male adults had higher prevalence rates of laryngeal cancer than female adults (Cohen et al., 2012).

Teachers were estimated to be two to three times more likely than the general population to develop a voice disorder (Martins et al., 2014). Certain factors, such as number of classes per week, noise generated outside of the school setting, and volume of voice while lecturing, were indicated to increase the risk of teachers developing a voice disorder (Byeon, 2019).

The mean prevalence of voice disorders was estimated to be 46% among singers (Pestana et al., 2017). The most prevalent laryngeal pathologies and voice disorder symptoms reported in singers included, but were not limited to, Reinke’s edema, polyps, gastroesophageal reflux disease, laryngeal pain, and hoarseness; however, risk of developing laryngeal pathologies or vocal cord symptoms may vary based on differences in singing style and genre (Kwok & Eslick, 2019).

According to a claims-based study, almost 30% of dysphonia claims were individuals in the service industry. Those in the service industry were estimated to be 2.6 times more likely to develop benign laryngeal growth and individuals in the manufacturing industry were estimated to be 1.4 times more likely to develop malignant laryngeal growth compared to the general population (Benninger et al., 2017).

Signs and Symptoms

The term dysphonia encompasses the auditory-perceptual symptoms of voice disorders. Dysphonia is characterized by altered vocal quality, pitch, loudness, or vocal effort.

Perceptual signs and symptoms of dysphonia include

• rough vocal quality (raspy, audible aperiodicity in sound);
• breathy vocal quality (audible air escape in the sound signal or bursts of breathiness);
• strained vocal quality (increased effort; tense or harsh);
• strangled vocal quality (as if talking with breath held);
• abnormal pitch (too high, too low, pitch breaks, decreased pitch range);
• abnormal loudness/volume (too high, too low, decreased range, unsteady volume);
• abnormal resonance (hypernasal, hyponasal, cul-de-sac resonance);
• aphonia (loss of voice);
• phonation breaks;
• asthenia (weak voice);
• gurgly/wet-sounding voice;
• pulsed voice (fry register, audible creaks or pulses in sound);
• shrill voice (high, piercing sound, as if stifling a scream); and
• tremorous voice (shaky voice; rhythmic pitch and loudness undulations).

Other signs and symptoms include

• increased vocal effort associated with speaking,
• decreased vocal endurance or onset of fatigue with prolonged voice use,
• variable vocal quality throughout the day or during speaking,
• running out of breath quickly,
• frequent coughing or throat clearing (may worsen with increased voice use), and
• excessive throat or laryngeal tension/pain/tenderness.

Signs and symptoms can occur in isolation or in combination. As treatment progresses, some may dissipate, and others may emerge as compensatory strategies are eliminated.

Auditory-perceptual quality of voice in individuals with voice disorders can vary depending on the type and severity of the disorder, the size and site of the lesion (if present), and the individual’s compensatory responses. The severity of the voice disorder cannot always be determined by auditory-perceptual voice quality alone. Therefore, further instrumental assessment may be indicated to determine the severity and/or etiology of a voice disorder.

Normal voice production depends on power and airflow supplied by

• the respiratory system;
• laryngeal muscle activation;
• balance, coordination, and stamina of respiration, phonation, and resonation subsystems; and
• oral cavity, and
• nasal cavity.

A disturbance in one of these subsystems or in the physiological balance among the systems may lead to or contribute to a voice disorder. Disruptions can be due to organic, functional, and/or psychogenic causes.

Organic causes include the following:

• vocal nodules, cysts, or polyps
• glottal stenosis
• recurrent respiratory papilloma
• sarcopenia (muscle atrophy associated with aging)
• arthritis of the cricoarytenoid or cricothyroid,
• laryngitis, or
• laryngopharyngeal reflux
• intubation trauma
• chemical exposure
• external trauma
• recurrent laryngeal nerve paralysis
• adductor/abductor spasmodic dysphonia
• Parkinson’s disease
• multiple sclerosis
• pseudobulbar palsy

Functional causes include the following:

• phonotrauma such as
• excessive throat clearing/coughing
• speaking in too high or too low pitch
• muscle tension dysphonia
• ventricular phonation
• vocal fatigue due to

Psychogenic causes include the following:

• chronic stress disorders
• conversion reaction such as
• conversion aphonia
• conversion dysphonia

Making modifications to pitch without the guidance of a skilled service provider is not recommended and may result in vocal misuse. However, voice services may be provided to assist with appropriate pitch modifications.

Recognizing associations among these factors, along with patient history, may help in identifying the possible causes of the voice disorder. Even when an obvious cause is identified and treated, the voice problem may persist. For example, an upper respiratory infection could be the cause of the dysphonia, but poor or inefficient compensatory techniques may cause dysphonia to persist, even when the infection has been successfully treated.

Roles and Responsibilities

SLPs play a central role in the assessment, diagnosis, and treatment of voice disorders. The professional roles and activities in speech-language pathology include the following:

• prevention and advocacy
• administration

SLPs are trained to evaluate voice use and function to determine the cause of reported symptoms and select treatment methods for improving voice production.

Appropriate roles for SLPs include the following:

• Provide prevention information to individuals and groups known to be at risk for voice disorders, as well as to individuals working with those at risk.
• Conduct a comprehensive voice assessment, including clinical and instrumental evaluation.
• Identify normal and abnormal vocal function, describe perceptual qualities of voice, and assess vocal habits.
• Diagnose a voice disorder.
• Refer individuals to other professionals as needed to obtain a medical diagnosis (e.g., unilateral vocal fold immobility as the cause of dysphonia).
• Refer individuals to other health care professionals when medical/surgical or psychological evaluation and treatment are indicated and facilitate patient access to comprehensive services.
• Make decisions about management of voice disorders and develop culturally responsive treatment plans.
• Provide treatment, document progress, and determine appropriate dismissal criteria.
• Counsel patients and provide education aimed at preventing further complications from voice disorders.
• Serve as an integral member of a collaborative team (see ASHA’s resources on  collaboration and teaming  and  interprofessional education/interprofessional practice [IPE/IPP] ) that includes professionals such as
• otolaryngologists/laryngologists,
• pulmonologists,
• allergists,
• gastroenterologists,
• neurologists,
• endocrinologists,
• mental health professionals, and
• vocal coaches or voice teachers.
• Consult with other professionals, family members, and caregivers to facilitate program development and to provide
• supervision,
• evaluation, and/or
• expert testimony (as appropriate).
• Remain informed of research related to voice disorders and help advance the knowledge base related to the nature and treatment of voice disorders.
• Advocate for individuals with voice disorders at the local, state, and national levels.

As indicated in the ASHA  Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so.

See the Assessment section of the Voice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Screening may be conducted if a voice disorder is suspected. It may be triggered by concerns from individuals, parents, teachers, or health care providers. When deviations from normal voice are detected during screening, further evaluation is warranted.

Screening includes evaluation of vocal characteristics related to

• respiration;
• resonance; and
• pitch range, and

Clinicians may use a formal screening tool (Lee et al., 2004) or obtain data using informal tasks. Standardized self-report questionnaires can be included for a more thorough screening (e.g., Deary et al., 2003; Hogikyan & Sethuraman, 1999; Jacobson et al., 1997).

Comprehensive Assessment

All patients/clients with voice disorders should be examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician’s examination may occur before or after the voice evaluation by the SLP. Consultation with an otolaryngologist can be important, particularly in the case that an SLP does not have access to instrumentation for evaluation. Assessment and treatment of voice disorders may require use of appropriate personal protective equipment .

A comprehensive assessment is conducted for individuals suspected of having a voice disorder, using both standardized and nonstandardized measures (see ASHA’s resource on assessment tools, techniques, and data sources ). For a review of clinical voice assessments, see Roy et al. (2013).

Diagnostic therapy may be performed as part of the comprehensive assessment to help in making a diagnosis and to determine if the individual is stimulable to voice therapy efforts.

Comprehensive assessment is conducted to identify and describe

• impairments in body structure and function , including underlying strengths and weaknesses in speech sound production and verbal/nonverbal communication;
• comorbid deficits such as other health conditions and medications that can affect voice;
• limitations in activity and participation , including functional status in communication and interpersonal interactions;
• contextual (environmental and personal) factors that affect communication and life participation; and
• quality of life related to communication impairment and functional limitations.

See ASHA’s resource titled person-centered focus on function: voice [PDF] for an example of assessment data.

Comprehensive Assessment for Voice Disorders: Typical Components

Case history.

• the individual’s description of the voice problem, including onset and variability of symptoms
• medical status and history, including surgeries, chronic disorders, and medications
• previous voice treatment
• daily habits related to vocal hygiene

Self-Assessment

• the individual’s self-perception of voice/vocal quality
• emotions and self-image and
• the ability to communicate effectively in everyday activities as well as in social and work settings (e.g., Hogikyan & Sethuraman, 1999; Jacobson et al., 1997; Ma & Yiu, 2001)

Oral-Peripheral Examination

• assessment of structural or motor-based deficits that may affect communication and voice, including oral musculature, strength, speed, and range of motion
• assessment (during rest and purposeful speech tasks) of symmetry and movement of structures of the face, oral cavity, head, neck, and respiratory system
• testing of mechano-sensation of face and oral cavity
• testing of chemo-sensation (i.e., taste and smell)
• assessment of laryngeal sensations (dryness, tickling, burning, pain, etc.) and palpation of extrinsic laryngeal musculature, as indicated

Assessment of Respiration

• respiratory pattern (abdominal, thoracic, clavicular)
• coordination of respiration with phonation (breath-holding patterns, habitual use of residual air, length of breath groups)
• maximum phonation time (Dejonckere, 2010; Speyer et al., 2010)
• s/z ratio to assess for glottal insufficiency, which may be indicative of laryngeal pathology (Eckel & Boone, 1981; Stemple et al., 2010)

Auditory-Perceptual Assessment

This subjective assessment is based on the clinical impressions of the SLP during production of sustained vowels, sentences, and running speech.

Voice Quality

• roughness —irregularity in voicing source
• breathiness —audible air escape in voice
• strain —perception of excessive vocal effort
• pitch —perceptual correlate of fundamental frequency
• loudness —perceptual correlate of sound intensity
• overall severity —global, integrated impression of voice deviance
• additional perceptual features
• diplophonia
• pitch instability
• wet/gurgly quality

The perceptual features above are defined in ASHA’s Consensus Auditory-Perceptual Evaluation of Voice ( CAPE-V ; ASHA, n.d., 2002; Kempster et al., 2009).

See ASHA’s Practice Portal page on Resonance Disorders .

• Assess resonance quality, such as
• hypernasal, or
• cul-de-sac.
• If abnormal, assess stimulability for normal resonance.
• If normal, evaluate the focus of resonance, such as
• pharyngeal/laryngeal, or
• voice onset/offset characteristics, such as
• delayed voice onset and
• quality of voice at onset
• ability to sustain voicing for appropriate phrasing during speech
• ability to demonstrate a strong and consistent rate of vocal fold valving during diadochokinesis

Rate of Speech

Rate of speech may be indirectly impacted by voice disorders. For instance, a patient with a voice disorder may deliberately slow rate of speech to compensate for a voice disorder and increase intelligibility. For reasons such as these, an SLP may consider assessment of rate of speech (e.g., via diadochokinetic rate assessment).

Instrumental Assessment

Physicians are the only professionals qualified and licensed to render medical diagnoses related to the identification of laryngeal pathology as it affects voice. Imaging should be viewed and interpreted by an otolaryngologist with training in this procedure when it is used for medical diagnostic purposes. 

Laryngeal Imaging

Measures of structure and gross function (using videoendoscopy) and measures of vocal fold vibration during phonation (using videostroboscopy). Please see ASHA’s resource on Vocal Tract Visualization and Imaging for more information.

Acoustic Assessment

Objective measures of vocal function related to vocal loudness, pitch, and quality (Patel et al., 2018).

• Vocal amplitude
• habitual sound pressure level (SPL) in decibels (dB)—typical sound level of voice during connected speech
• minimum and maximum vocal SPL (dB)—softest and loudest sustainable phonation
• Vocal frequency
• mean vocal F0 in hertz (Hz)—average of the estimates of the F0 for acoustic signal recorded during connected speech
• vocal F0 standard deviation (Hz)—standard deviation of the estimates of the F0 for acoustic signal recorded during connected speech
• minimum and maximum vocal F0 (Hz)— F0 values for the lowest and highest pitched sustainable phonations
• Vocal signal quality
• vocal cepstral peak prominence (dB)—relative amplitude of the peak in the cepstrum that represents the dominant harmonic of the vocal acoustic signal (sustained vowels and connected speech samples)

Aerodynamic Assessment

Measures (using noninvasive procedures) of glottal aerodynamic parameters required for phonation.

• Glottal airflow
• average glottal airflow rate (L/sec or mL/sec)—estimated from oral airflow rate during vowel production
• Subglottal air pressure
• average subglottal air pressure (centimeters of water [cmH 2 O] or kilopascals [kPa])—estimated for intraoral air pressure produced during repetition of stop consonants in syllable strings
• Mean vocal SPL and F0 —extracted from simultaneously recorded acoustic signal; facilitates interpretation of airflow and air pressure measurements

SLPs should be aware of potential sources of error or impediments to recording quality during aerodynamic assessment. Sources of error may contribute to inaccurate data. These error sources include

• a microphone,
• a preamplifier,
• analog-to-digital conversion (i.e., digital interface), and
• consistent distance of sound source (voice) to microphone;
• acoustic qualities of room; and
• ambient noise (Patel et al., 2018; Švec & Granqvist, 2018).

Pediatric Voice Assessment Considerations

Although many of the same voice disorders may exist among children and adults, the following conditions tend to be unique to the pediatric population (Sapienza & Ruddy, 2009):

• This is the most common cause of infant inspiratory stridor.
• inspiratory stridor,
• immature laryngeal cartilage,
• floppy epiglottis, and/or
• foreshortened aryepiglottic folds.
• This occurs more frequently in the pediatric population during the 4th to 10th week of gestation.
• This may cause airway blockage.
• This may be acquired due to laryngeal trauma.
• Dyspnea and inspiratory stridor are associated symptoms.
• Type I—Interarytenoid deficit above the true vocal folds.
• Type II—The cricoid lamina is involved; the cleft extends below the true vocal folds.
• Type III—A total cricoid cleft that extends through the cricoid cartilage and may extend into the cervical trachea.
• Type IV—A cleft that extends into the posterior thoracic trachea wall and may extend to the carina.
• Puberphonia —a functional voice disorder that may occur to male adolescents following a voice change during puberty that results in maintaining a high-pitched voice

Further information regarding laryngomalacia and laryngeal cleft may be found in ASHA’s Practice Portal page on Aerodigestive Disorders .

See the Treatment section of the Voice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Intervention is conducted to achieve improved voice production and coordination of respiration and laryngeal valving. The ASHA Practice Portal page on Head and Neck Cancer addresses intervention aimed at acquisition of alaryngeal speech sufficient to allow for functional oral communication.

Intervention is designed to

• establish appropriate vocal hygiene routines/practices;
• capitalize on strengths and address weaknesses related to underlying structures and functions that affect voice production;
• improve self-awareness of voice quality and kinesthetic factors (e.g., tension);
• facilitate the individual’s activities and life participation by assisting the person in acquiring new communication skills and strategies;
• modify contextual factors to reduce barriers and enhance facilitators of successful communication and participation; and
• provide appropriate accommodations and other supports as well as training in how to use them.

Voice use within different settings should be considered when determining vocal needs and establishing goals. For example, vocal needs within the workplace may be different from those within the community (e.g., home and social settings).

Collaborating With Other Professionals

SLPs often team with otolaryngologists/laryngologists and other medical professionals (e.g., pulmonologists, gastroenterologists, neurologists, allergists, endocrinologists, and occupational medicine physicians) and, if appropriate, develop treatment plans to support the medical plan and to optimize outcomes. Collaboration with otolaryngologists/laryngologists is especially important to rule in or rule out underlying pathologies. SLPs can only diagnose functional abnormalities, and only otolaryngologists can diagnose organic pathologies (e.g., nodules, polyps, tumors).

Some individuals develop voice disorders in the absence of structural pathology (e.g., functional aphonia, muscle tension dysphonia, and mutational/functional falsetto) and may benefit from psychological counseling in addition to what can be provided by the SLP. Counseling, direct manipulation of the voice, and use of interview questions can be used to probe possible factors contributing to the voice problem. SLPs refer the individual to the appropriate health care professional(s) to address issues outside the SLP’s scope of practice (ASHA, 2016).

See ASHA’s resources on collaboration and teaming and interprofessional education/interprofessional practice (IPE/IPP) .

Treatment Approaches

Approaches can be direct or indirect, and SLPs often incorporate aspects of more than one therapeutic approach in developing a treatment plan.

Direct Approaches

Direct approaches focus on manipulating the voice-producing mechanisms (phonation, respiration, and musculoskeletal function) to modify vocal behaviors and establish healthy voice production (Colton & Casper, 2011; Stemple, 2000).

Indirect Approaches

Indirect approaches modify the cognitive, behavioral, psychological, and physical environments in which voicing occurs (Roy et al., 2001; Thomas & Stemple, 2007). Indirect approaches include the following two components:

• Patient education —discussing normal physiology of voice production and the impact of voice disorders on function; providing information about the impact of vocal misuse and strategies for maintaining vocal health (vocal hygiene).
• Counseling —identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health (Van Stan et al., 2015).

Therapeutic Plan

A therapeutic plan typically involves at least one direct approach and one or more indirect approaches based on the patient’s condition and goals. Some clinicians concentrate on directly modifying the specific symptoms of the inappropriate voice, whereas others take a more holistic approach, with the goal of balancing the physiologic subsystems of voice production—respiration, phonation, and resonance.

Clinicians may begin by

• identifying behaviors that are contributing to the voice problems, including unhealthy vocal hygiene practices such as
• talking loudly over noise,
• throat clearing, and
• poor hydration.
• implementing practices to reduce vocally traumatic behaviors (e.g., voice conservation) and healthy vocal hygiene practices such as
• drinking plenty of water and
• talking at a moderate volume.

Use of personal protective equipment (PPE) (i.e., face mask) can potentially cause increased strain on voice and perception of vocal effort (Ribeiro et al., 2020). Please see ASHA's Aerosol Generating Procedures and the Resources section below for further information.

Pediatric Voice Treatment Considerations

There may be differences between treating voice disorders in adults and pediatrics due to differences in anatomy, etiology, and developmental level. According to Braden (2018), anatomical differences between pediatric and adult voice include the following:

• laryngeal size
• size of the vocal tract
• Pediatric vocal folds are shorter than adult vocal folds.
• Pediatric vocal folds lack the five-layer structure until adolescence.
• Infant vocal folds are monolayer.
• Infant vocal folds have hyaluronic acid distributed evenly (concentrated in adults).
• Infant vocal folds have more fibroblasts than adults in the lamina propria.
• The newborn larynx is located at approximately C4.
• The adult larynx is located at approximately C6-C7.

As a child’s phonatory structures grow and develop, the respective speaking pitch decreases (decreased frequency of vocal tract formants and fundamental frequency). There is a rapid decrease in mean fundamental frequency in the first 3 years, with another significant change at puberty (McAllister & Sjölander, 2013). Abnormal voice changes may be monitored during adolescence as they may be indicative of a functional voice disorder such as puberphonia. Stridor should also be closely monitored in the pediatric population as it could potentially indicate a compromised airway (Theis, 2010).

Many treatment approaches used for adult populations may be considered for the pediatric population, although adaptations may be needed to meet each child’s developmental level (Braden, 2018). Comorbid developmental disorders such as expressive or receptive language deficits may further complicate treatment of voice in the pediatric population. Some children may not have an internal concept of normal versus abnormal voicing (Hooper, 2004) and, therefore, may have difficulty addressing dysfunction.

Another consideration is potential difficulties that may occur in obtaining treatment in the school-based setting. Challenges may include

• difficulty obtaining referrals to ENT/voice specialists,
• delays in scheduling pediatrician and/or ENT visits,
• difficulty accessing imaging and medical records,
• insurance coverage or payment for MD visits, and
• barriers in eligibility criteria and determining adverse effects on educational performance.

Please see Childes et al. (2017) for further consideration of barriers and challenges.

Treatment Options

The following subsections offer brief descriptions of general and specific treatments for individuals with voice disorders. They are organized under two categories: physiologic voice therapy (i.e., those treatments that directly modify the physiology of the vocal mechanism) and symptomatic voice therapy (i.e., those treatments aimed at modifying deviant vocal symptoms or perceptual voice components using a variety of facilitating techniques). The inclusion of any specific treatment approach does not imply endorsement by ASHA. For more information about treatment approaches and their use with various voice disorders, see Stemple et al. (2010).

Treatment selection depends on the type and severity of the disorder and the communication needs of the individual. Clinicians incorporate functional daily voice needs into goals that reflect inclusion and participation in home, work, and social communities. Linguistic features in some languages may influence the need for specific aspects of voice treatment, such as influences of tonal languages on resonance. In addition, consideration of individuals’ needs, such as gender and/or gender expression or use of regional accents, is an important aspect of goal development.

Physiologic Voice Therapy

Physiologic voice therapy programs strive to balance the three subsystems of voice production (respiration, phonation, and resonance) as opposed to working directly on isolated voice symptoms. Most physiologic approaches may be used with a variety of disorders that result in hyper- and hypofunctional vocal patterns. Below are some of the physiologic voice therapy programs, arranged in alphabetical order.

Accent Method

The accent method is designed to increase pulmonary output, improve glottic efficiency, reduce excessive muscular tension, and normalize the vibratory pattern during phonation. During therapy, the clinician may do one or more of the following tasks (Kotby et al., 1993; Malki et al., 2008):

• facilitate abdominal breathing by initially placing the patient in a recumbent position;
• use rhythmic vocal play with models of accented phonation patterns, which the patient then imitates; and/or
• transfer rhythms to articulated speech, initially being given a model and eventually progressing through reading, monologues, and conversational speech.

Conversation Training Therapy (CTT)

CTT focuses exclusively on voice awareness and production in patient-driven conversational narrative, without the use of a traditional therapeutic hierarchy. Grounded in the tenets of motor learning, CTT strives to guide patients in achieving balanced phonation through clinician reinforcement, imitation and modeling in conversational speech. CTT incorporates six interchangeable components (Gartner-Schmidt et al., 2016; Gillespie et al., 2019), as follows:

• clear speech
• auditory and kinesthetic awareness
• negative practice/labeling
• embedding basic training gestures into speech
• prosody, projection, and pauses
• rapport building

Expiratory Muscle Strength Training (EMST)

EMST improves respiratory strength during phonation. Increase in maximum expiratory pressure can be trained with specific calibrated exercises over time, thus improving the relationship between respiration, phonation, and resonance. EMST uses an external device to mechanically overload the expiratory muscles. The device has a one-way, spring-loaded valve that blocks the flow of air until the targeted expiratory pressure is produced. The device can be calibrated to increase or decrease physiologic load on the targeted muscles (Pitts et al., 2009).

Lee Silverman Voice Treatment (LSVT)

LSVT (Ramig et al., 1994) is an intensive treatment developed for patients with Parkinson’s disease. It is designed to maximize phonatory and respiratory function using a set of simple tasks. Individuals are instructed to produce a loud voice with maximum effort and to monitor the loudness of their voices while speaking. The effort that is involved generates improved respiratory support, laryngeal muscle activity, articulation, and even facial expression and animation. Using a sound-level meter, visual biofeedback may be provided to demonstrate the effort necessary to increase loudness. LSVT is provided by clinicians who are trained and certified in the administration of this technique.

Five basic principles are followed in LSVT, as follows:

• Individuals should “think loud.”
• Speech effort must be high.
• Treatment must be intensive.
• Patients must recalibrate their loudness level.
• Improvements are quantified over time.

Manual Circumlaryngeal Techniques

Manual circumlaryngeal techniques are intended to reduce musculoskeletal tension and hyperfunction by re-posturing the larynx during phonation. There are three main manual laryngeal re-posturing techniques, as follows:

• Push-back maneuver—place forefinger on the thyroid cartilage and push back to change the shape of the glottis.
• Pull-down maneuver—place thumb and forefinger in the thyrohyoid space and pull the larynx downward.
• Medial compression and downward traction—place thumb and forefinger in the thyrohyoid space and apply medial compression.

Applying these maneuvers during vocalization allows the individual to hear resulting changes in voice quality (Andrews, 2006; Roy et al., 1997). Care is taken when employing these techniques, as some patients report discomfort.

Phonation Resistance Training Exercises (PhoRTE)

PhoRTE (Ziegler & Hapner, 2013) was adapted from LSVT and consists of four exercises, as follows:

• producing /a/ with loud maximum sustained phonation
• producing /a/ with loud ascending and descending pitch glides over the entire pitch range
• producing functional phrases using a loud and high (pitched) voice
• producing the same functional phrases using a loud and low (pitched) voice

Individuals are reminded to maintain a “strong” voice throughout these treatment exercises. PhoRTE has a less intensive intervention schedule than LSVT. PhoRTE also differs in that it combines both loudness and pitch when producing phrases (i.e., loud and low pitch, loud and high pitch). Use of PhoRTE has been studied in adults with presbyphonia (aging voice) as a way to improve vocal outcomes (e.g., decrease phonatory effort) and increase voice-related quality of life (Ziegler et al., 2014).

Resonant Voice Therapy

Resonant voice therapy uses a continuum of oral sensations and easy phonation, building from basic speech gestures through conversational speech. Resonant voice is defined as voice production involving oral vibratory sensations, usually on the anterior alveolar ridge or lips or higher in the face in the context of easy phonation. The goal of resonant voice therapy is to achieve the strongest, “cleanest” possible voice with the least effort and impact between the vocal folds to minimize the likelihood of injury and maximize the likelihood of vocal health (Stemple et al., 2010). The program incorporates humming and both voiced and voiceless productions that are shaped into phrase and conversational productions (Verdolini, 1998, 2000).

Stretch and Flow Phonation

Stretch and flow phonation —also known as Casper-Stone Flow Phonation —is a physiological technique used to treat functional dysphonia or aphonia (Stone & Casteel, 1982). It focuses on airflow management and is used for individuals with breath-holding tendencies. Individuals are instructed to focus on a steady outflow of air during exhalation. Various biofeedback methods are used, including placing a piece of tissue in front of the mouth or holding one’s hand in front of the mouth to monitor airflow. Voicing is introduced once the individual masters continuous airflow during exhalation. As such, this technique produces a breathy voice quality and a slowed speaking rate. Eventually, this voice quality is carried into trials with spoken words and phrases, and the breathiness is gradually reduced.

Flow phonation (Gartner-Schmidt, 2008, 2010) is a hierarchical therapy program designed to facilitate increased airflow, ease of phonation, and forward oral resonance. It was modified from stretch and flow phonation by eliminating the “stretch” component, which reduced the rate of speech in the original therapy.

Vocal Function Exercises (VFEs)

VFEs are a series of systematic voice manipulations designed to facilitate return to healthy voice function. VFEs work to strengthen and coordinate laryngeal musculature and improve efficiency of the relationship among airflow, vocal fold vibration, and supraglottic treatment of phonation (Stemple, 1984). Sounds used in training are specific, and correct production is encouraged. VFEs consist of four exercises—warm-up, stretching, contracting, and power exercises. Exercises are completed twice a day (morning and evening) in sets of two. Maximum phonation time goals are set on the basis of individual lung capacity and an airflow rate of 80 mL/sec. Individuals are advised to use a soft, engaged tone and are trained to use a semi-occluded vocal tract (SOVT) without tension during voice productions.

Symptomatic Voice Therapy

Symptomatic voice therapy focuses on the modification of vocal symptoms or perceptual voice components. Symptomatic voice therapy assumes voice improvement through direct symptom modification using a variety of voice facilitating techniques (Boone et al., 2010) that are either direct or indirect. Symptoms to be addressed may include

• pitch that is too high or too low,
• voice that is too soft or too loud,
• breathy phonation,
• hard glottal attacks, or
• glottal fry.

Amplification

Amplification devices such as microphones can be used to increase voice loudness in any situation that requires increased volume (e.g., when speaking to large groups or during conversation when the individual’s voice is weak). As such, voice amplification can function as a supportive tool or as a means of augmentative communication. It can help prevent vocal hyperfunction that may be a result of talking at increased volume or for extended periods of time.

Auditory Masking

Auditory masking is used in cases of functional aphonia/dysphonia and often results in changed or normal phonation. Individuals are instructed to talk or read passages aloud while wearing headphones with masking noise input. Using a loud noise background, the individual often produces voice at increased volume (Lombard effect) that can be recorded and used later in treatment as a comparison (e.g., Adams & Lang, 1992; Brumm & Zollinger, 2011).

Biofeedback

Biofeedback is the concept that self-control of physiologic functions is possible given external monitoring of internal bodily state. Biofeedback may be kinesthetic, auditory, or visual and is intended to provide clear and reliable information in response to alterations in voice production. Thus, patients may make real-time adjustments regarding vocal pitch, loudness, quality, and effort. Ideally, biofeedback helps increase awareness of physical sensations with respect to respiration, body position, and vibratory sensation. This awareness may help individuals understand physiological processes when generating voice.

Chant Speech

Chant speech uses a rhythmic, prosodic pattern as a template for spoken utterances. It is used in therapy to help reduce phonatory effort that results in vocal fatigue and decreased phonatory capabilities. Chant speech requires pitch fluctuations and coordination of respiratory, phonatory, and resonance subsystems. Speakers habituate to these more efficient vocal patterns. The increased lung pressure required for these tasks may also decrease reliance on laryngeal resistance and reduce fatigue (e.g., McCabe & Titze, 2002).

Confidential Voice

Confidential voice is designed to reduce laryngeal tension/hyperfunction and increase airflow (Casper, 2000). The individual begins with an easy and breathy vocal quality and builds to normal voicing without decreasing airflow. This technique is intended to address excessive vocal tension and to facilitate relaxation in the muscles of the larynx.

Inhalation Phonation

Inhalation phonation is used to facilitate true vocal vibration in the presence of habitual ventricular fold phonation, functional aphonia, and/or muscle tension dysphonia. Individuals produce a high-pitched voice on inhalation. Upon inhalation voicing, the true vocal folds are in a stretched position, suddenly adducted, and in vibration. Upon exhalation, patients try to achieve a nearly matched voice. This approach eases the way to gaining true vocal fold vibration.

The patient is instructed in the technique of sitting with upright posture and with the shoulders in a low, relaxed position to facilitate voice production with less effort. Collaboration with a physical therapist or an occupational therapist may be necessary with some patients.

In cases of vocal hyperfunction, a variety of relaxation techniques may be useful as a tool to reduce both whole-body and laryngeal area tension. The goal of these techniques is to reduce effortful phonation. Frequently used techniques include progressive muscle relaxation (slowly tensing and then relaxing successive muscle groups), visualization (forming mental images of a peaceful, calming place or situation), and deep breathing exercises.

Semi-Occluded Vocal Tract (SOVT) Exercises

SOVT exercises involve narrowing at any supraglottic point along the vocal tract in order to maximize interaction between vocal fold vibration (sound production) and the vocal tract (the sound filter) and to produce resonant voice.

Cup bubble , also known as Lax Vox , is an aerodynamic building task aimed at improving the ability to sustain phonation while speaking. It is done by having a patient blow air initially into a cup of water without voice. Voicing can be added for subsequent trials, and in time, pitch can be altered across and within trials. Eventually, the cup is removed during voicing, and the phonation continues. These exercises are thought to widen the vocal tract during phonation and reduce tension in the vocal folds. Biofeedback increases the individual’s awareness of their healthy voice production (e.g., Denizoglu & Sihvo, 2010; Simberg & Laine, 2007).

Straw phonation is one of the most frequently used methods to create semi-occlusion in the vocal tract (Titze, 2006). Narrowing the vocal tract increases air pressure above the vocal folds, keeping them slightly separated during phonation and reducing the impact collision force. To accomplish this, the individual semi-occludes the vocal tract by phonating through a straw or tube. Resistance can be manipulated by varying the length and diameter of the straw or immersing the opposite end of the straw in water. Individuals practice sustaining vowels, performing pitch glides, humming songs, and transitioning to the intonation and stress patterns of speech. Eventually, use of the straw is reduced and eliminated.

Lip trills can be used to create semi-occlusion at the level of the lips. This technique involves a smooth movement of air through the oral cavity and over the lips, causing a vibration (lip buzz), similar to blowing bubbles underwater. Often, the trills are paired with phonation and pitch changes. The focus is to improve breath support and produce voicing without tension.

Twang Therapy

Twang therapy is used for individuals with hypophonic voice. It involves the narrowing of the aryepiglottic sphincter using a “twang” voice to create a high-intensity voice quality while maintaining low vocal effort (Lombard & Steinhauer, 2007). The desired outcome is decreasing phonatory effort and increasing vocal efficiency.

This facilitating technique uses the natural functions of yawning and sighing to overcome symptoms of vocal hyperfunction (e.g., elevated larynx and vocal constriction). The technique is intended to lower the position of the larynx and subsequently widen the supraglottal space in order to produce a more relaxed voice and encourage a more natural pitch.

Treatment Considerations: Telepractice and Telecommuting

SLPs should take appropriate measures whether services are being delivered in-person or through telepractice. Teletherapy may not provide as reliable sound quality as in-person. Therefore, additional equipment (e.g., microphones) can enhance vocal quality while reducing vocal strain. Additionally, SLPs should take into consideration whether or not the patient is telecommuting for their profession, as there is some emerging research regarding effects of telecommunications on voice (Tracy et al., 2020).

Please see ASHA’s Practice Portal page on Telepractice and ASHA’s Telepractice Evidence Map .

Treatment Considerations: Rehabilitation of Professional Voice

Additional training/education may be necessary to provide professional voice rehabilitation. Clients who use their voice professionally (e.g., singers, voice actors) may have different needs than the usual client with a voice disorder and may seek services from multiple disciplines, including:

• an otolaryngologist
• a singing teacher
• a voice and speech trainer

Service Delivery

Refer to the Service Delivery section of the Voice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

In addition to determining the type of speech and language treatment that is optimal for individuals with voice disorders, SLPs consider other service delivery variables—including format, provider, dosage, and timing—that may affect treatment outcomes.

• Format —the structure of the treatment session (e.g., group vs. individual; direct and/or consultative).
• Provider —the person offering the treatment (e.g., SLP, trained volunteer, caregiver).
• Dosage —the frequency, intensity, and duration of service. Clinicians consider the unique needs of each patient and the nature of the voice disorder in determining appropriate dosage for therapy. Some voice therapy programs will have specific dosage parameters. See De Bodt et al. (2015) for a summary of international practices regarding temporal variables (dosage and frequency) in voice therapy.
• Timing —when intervention is conducted relative to the diagnosis.
• Setting —location of treatment (e.g., home, community-based, work).

ASHA Resources

• Aerosol Generating Procedures
• ASHA CAPE-V Form
• ASHA Code of Ethics
• ASHA Scope of Practice in Speech-Language Pathology
• Consumer Resource Related to Voice Disorders
• Cultural Responsiveness
• Definitions of Communication Disorders and Variations
• Gender Affirming Voice and Communication
• Graduate Curriculum on Voice and Voice Disorders [PDF] (Developed by ASHA Special Interest Group 3: Voice and Voice Disorders)
• Multicultural Issues in the Treatment of Voice Disorders
• Preferred Practice Patterns for the Profession of Speech-Language Pathology
• States with Specific Instrumental Assessment Requirements
• Using Masks for In-Person Service Delivery During COVID-19 Pandemic: What to Consider
• Vocal Tract Visualization and Imaging 

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• American Academy of Otolaryngology–Head and Neck Surgery: Clinical Practice Guidelines
• The National Center for Voice and Speech
• National Institute on Deafness and Other Communication Disorders
• National Spasmodic Dysphonia Association
• RCSLT: New Long COVID Guidance and Patient Handbook
• Speech-Language & Audiology Canada: Covid-19 changes the way many people use their voices
• The Voice Foundation
• World Voice Day

Adams, S. G., & Lang, A. E. (1992). Can the Lombard effect be used to improve low voice intensity in Parkinson’s disease? International Journal of Language & Communication Disorders , 27 (2), 121–127. https://doi.org/10.3109/13682829209012034

American Speech-Language-Hearing Association. (n.d.). ASHA Cape-V Form . https://www.asha.org/Form/CAPE-V/

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant paper]. https://www.asha.org/policy/RP1993-00208/

American Speech-Language-Hearing Association. (2002). Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) form. https://www2.asha.org/Form/CAPE-V/

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. http://www.asha.org/policy/SP2016-00343/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/et2016-00342/

Andrews, M. L. (2006). Manual of voice treatment: Pediatrics through geriatrics (3rd ed.). Thomson Delmar Learning.

Aronson, A. E., & Bless, D. M. (2009). Clinical voice disorders (4th ed.). Thieme.

Bainbridge, K. E., Roy, N., Losonczy, K. G., Hoffman, H. J., & Cohen, S. M. (2017). Voice disorders and associated risk markers among young adults in the United States. The Laryngoscope, 127 (9), 2093–2099. https://doi.org/10.1002/lary.26465

Benninger, M. S., Holy, C. E., Bryson, P. C., & Milstein, C. F. (2017). Prevalence and occupation of patients presenting with dysphonia in the United States. Journal of Voice, 31 (5), 594–600. https://doi.org/10.1016/j.jvoice.2017.01.011

Bhattacharyya, N. (2014). The prevalence of voice problems among adults in the United States. The Laryngoscope, 124 (10), 2359–2362. https://doi.org/10.1002/lary.24740

Black, L. I., Vahratian, A., & Hoffman, H. J. (2015). Communication disorders and use of intervention services among children aged 3–17 years: United States, 2012 (NCHS Data Brief, No. 205). National Center for Health Statistics.

Boone, D. R., McFarlane, S. C., Von Berg, S. L., & Zraick, R. I. (2010). The voice and voice therapy . Allyn & Bacon.

Braden, M. (2018). Advances in pediatric voice therapy. Perspectives of the ASHA Special Interest Groups, 3 (3), 68–76. https://doi.org/10.1044/2018_PERS-SIG3-2018-0005

Brumm, H., & Zollinger, S. A. (2011). The evolution of the Lombard effect: 100 years of psychoacoustic research. Behaviour, 148 (11–13), 1173–1198. https://doi.org/10.1163/000579511X605759

Byeon, H. (2019). The risk factors related to voice disorder in teachers: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 16 (19), 3675. https://doi.org/10.3390/ijerph16193675

Carding, P. N., Roulstone, S., Northstone, K., & ALSPAC Study Team. (2006). The prevalence of childhood dysphonia: A cross-sectional study. Journal of Voice , 20 (4), 623–630. https://doi.org/10.1016/j.jvoice.2005.07.004

Casper, J. (2000). Confidential voice. In J. C. Stemple (Ed.), Voice therapy: Clinical studies (pp. 128–139). Singular.

Childes, J., Acker, A., & Collins, D. (2017). Multiple perspectives on the barriers to identification and management of pediatric voice disorders. Perspectives of the ASHA Special Interest Groups , 2 (3), 49–56. https://doi.org/10.1044/persp2.SIG3.49

Cohen, S. M., Kim, J., Roy, N., Asche, C., & Courey, M. (2012). Prevalence and causes of dysphonia in a large treatment-seeking population. The Laryngoscope , 122 (2), 343–348. https://doi.org/10.1002/lary.22426

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

de Araújo Pernambuco, L., Espelt, A., Balata, P. M. M., & de Lima, K. C. (2014). Prevalence of voice disorders in the elderly: A systematic review of population-based studies. European Archives of Oto-Rhino-Laryngology, 272 (10), 2601–2609. https://doi.org/10.1007/s00405-014-3252-7

Deary, I. J., Wilson, J. A., Carding, P. N., & MacKenzie, K. (2003). VoiSS: A patient-derived Voice Symptom Scale. Journal of Psychosomatic Research , 54 (5), 483–489. https://doi.org/10.1016/S0022-3999(02)00469-5

De Bodt, M., Patteeuw, T., & Versele, A. (2015). Temporal variables in voice therapy. Journal of Voice , 29 (5), 611–617. https://doi.org/10.1016/S0022-3999(02)00469-5

Dejonckere, P. H. (2010). Assessment of voice and respiratory function. In M. Remacle & H. E. Eckel (Eds.), Surgery of larynx and trachea (pp. 11–26). Springer.

Denizoglu, I., & Sihvo, M. (2010). Lax Vox voice therapy technique. Current Practice in Otorhinolaryngology , 6, 285–295.

Duff, M. C., Proctor, A., & Yairi, E. (2004). Prevalence of voice disorders in African American and European American preschoolers. Journal of Voice , 18 (3), 348–353. https://doi.org/10.1016/j.jvoice.2003.12.009

Eckel, F. C., & Boone, D. R. (1981). The s/z ratio as an indicator of laryngeal pathology. Journal of Speech and Hearing Disorders, 46 (2), 147–149. https://doi.org/10.1044/jshd.4602.147

Gartner-Schmidt, J. (2008). Flow phonation. In A. Behrman (Ed.), The complete voice therapy workbook. Plural.

Gartner-Schmidt, J. (2010). Flow phonation. In J. Stemple & L. T. Fry (Eds.), Voice therapy: Clinical case studies (3rd ed.). Plural.

Gartner-Schmidt, J., Gherson, S., Hapner, E., Roth, D., Schneider, S., & Gillespie, A. (2016). The development of conversation training therapy: A concept paper. Journal of Voice, 30 (5), 563–573. https://doi.org/10.1016/j.jvoice.2015.06.007

Gillespie, A., Yabes, J., Rosen, C. A., & Gartner-Schmidt, J. (2019). Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Journal of Speech, Language, and Hearing Research , 62 (11), 4062–4079. https://doi.org/10.1044/2019_JSLHR-S-19-0136

Hogikyan, N. D., & Sethuraman, G. (1999). Validation of an instrument to measure voice-related quality of life (V-RQOL). Journal of Voice, 13 (4), 557–569. https://doi.org/10.1016/S0892-1997(99)80010-1

Hooper, C. R. (2004). Treatment of voice disorders in children. Language, Speech, and Hearing Services in Schools, 35 (4), 320–326. https://doi.org/10.1044/0161-1461(2004/031)

Hseu, A., Nohamin, A., Kosuke, K., Woodnorth, G., & Nuss, R. (2018). Voice abnormalities and laryngeal pathology in preterm children. Annals of Otology, Rhinology & Laryngology , 127 (8), 508–513. https://doi.org/10.1177%2F0003489418776987

Jacobson, B. H., Johnson, A., Grywalski, C., Silbergleit, A., Jacobson, G., Benninger, M. S., & Newman, C. W. (1997). The Voice Handicap Index (VHI): Development and validation. American Journal of Speech-Language Pathology, 6 (3), 66–70. https://doi.org/10.1044/1058-0360.0603.66

Kempster, G. B., Gerratt, B. R., Abbott, K. V., Barkmeier-Kraemer, J., & Hillman, R. E. (2009). Consensus Auditory-Perceptual Evaluation of Voice: Development of a standardized clinical protocol. American Journal of Speech-Language Pathology, 18 (2), 124–132. https://doi.org/10.1044/1058-0360(2008/08-0017)

Kotby, M. N., Shiromoto, O., & Hirano, M. (1993). The Accent Method of voice therapy: Effect of accentuations on F0, SPL, and airflow. Journal of Voice , 7 (4), 319–325. https://doi.org/10.1016/S0892-1997(05)80120-1

Kwok, M., & Eslick, G. D. (2019). The impact of vocal and laryngeal pathologies among professional singers: A meta-analysis. Journal of Voice, 33 (1), 58–65. https://doi.org/10.1016/j.jvoice.2017.09.002

Lee, L., Stemple, J. C., Glaze, L., & Kelchner, L. N. (2004). Quick screen for voice and supplementary documents for identifying pediatric voice disorders. Language, Speech, and Hearing Services in Schools, 35 (4), 308–319. https://doi.org/10.1044/0161-1461(2004/030)

Lombard, L. E., & Steinhauer, K. M. (2007). A novel treatment for hypophonic voice: Twang therapy. Journal of Voice, 21 (3), 294–299. https://doi.org/10.1016/j.jvoice.2005.12.006

Ma, E. P.-M., & Yiu, E. M.-L. (2001). Voice activity and participation profile assessing the impact of voice disorders on daily activities. Journal of Speech, Language, and Hearing Research, 44 (3), 511–524. https://doi.org/10.1044/1092-4388(2001/040)

Maat, R. C., Hilland, M., Røksund, O. D., Halvorsen, T., Olofsson, J., Aarstad, H. J., & Heimdal, J.-H. (2011). Exercise-induced laryngeal obstruction: Natural history and effect of surgical treatment. European Archives of Oto-Rhino-Laryngology , 268 (10), 1485–1492. https://doi.org/10.1007/s00405-011-1656-1

Malki, K. H., Nasser, N. H., Hassan, S. M., & Farahat, M. (2008). Accent method of voice therapy for treatment of severe muscle tension dysphonia. Saudi Medical Journal , 29 (4), 610–613.

Martins, R. H. G., do Amaral, H. A., Tavares, E. L. M., Martins, M. G., Gonҫalves, T. M., & Dias, N. H. (2015). Voice disorders: Etiology and diagnosis. Journal of Voice , 30 (6), 761.e1–761.e9. https://doi.org/10.1016/j.jvoice.2015.09.017

Martins, R. H. G., Pereira, E. R., Hidalgo, C. B., & Tavares, E. L. M. (2014). Voice disorders in teachers: A review. Journal of Voice, 28 (6), 716–724. https://doi.org/10.1016/j.jvoice.2014.02.008

Mathers-Schmidt, B. A. (2001). Paradoxical vocal fold motion: A tutorial on a complex disorder and the speech-language pathologist’s role. American Journal of Speech-Language Pathology, 10 (2), 111–125. https://doi.org/10.1044/1058-0360(2001/012)

McAllister, A., & Sjölander, P. (2013). Children’s voice and voice disorders. Seminars in Speech and Language , 34 (2), 71–79. https://doi.org/10.1055/s-0033-1342978

McCabe, D. J., & Titze, I. R. (2002). Chant therapy for treating vocal fatigue among public school teachers: A preliminary study. American Journal of Speech-Language Pathology , 11 (4), 356–369. https://doi.org/10.1044/1058-0360(2002/040)

Murry, T., & Milstein, C. F. (2016). Laryngeal movement disorders and their management. Perspectives of the ASHA Special Interest Groups , 1 (3), 75–82. https://doi.org/10.1044/persp1.SIG3.75

Patel, R. R., Awan, S. N., Barkmeier-Kraemer, J., Courey, M., Deliyski, D., Eadie, T., Paul, D., Švec, J. G., & Hillman, R. (2018). Recommended protocols for instrumental assessment of voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function. American Journal of Speech-Language Pathology, 27 (3), 887–905. https://doi.org/10.1044/2018_AJSLP-17-0009

Patel, R. R., Venediktov, R., Schooling, T., & Wang, B. (2015). Evidence-based systematic review: Effects of speech-language pathology treatment for individuals with paradoxical vocal fold motion. American Journal of Speech-Language Pathology , 24 (3), 566–584. https://doi.org/10.1044/2015_AJSLP-14-0120

Pestana, P. M., Vaz-Freitas, S., & Manso, M. C. (2017). Prevalence of voice disorders in singers: Systematic review and meta-analysis. Journal of Voice , 31 (6), 722–727. https://doi.org/10.1016/j.jvoice.2017.02.010

Pitts, T., Bolser, D., Rosenbek, J., Troche, M., Okun, M. S., & Sapienza, C. (2009). Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. CHEST , 135 (5), 1301–1308. https://doi.org/10.1378/chest.08-1389

Rahbar, R., Rouillon, I., Roger, G., Lin, A., Nuss, R. C., Denoyelle, F., McGill, T. K., Healy, G. B., & Garabedian, E. (2006). The presentation and management of laryngeal cleft: A 10-year experience. Archives of Otolaryngology—Head & Neck Surgery , 132 (12), 1335–1341. https://doi.org/10.1001/archotol.132.12.1335

Ramig, L. O., Bonitati, C., Lemke, J., & Horii, Y. (1994). Voice treatment for patients with Parkinson disease: Development of an approach and preliminary efficacy data. Journal of Medical Speech-Language Pathology , 2, 191–209.

Ribeiro, V. V., Dassie-Leite, A. P., Pereira, E. C., Santos, A. D. N., Martins, P., & Irineu, R. A. (2020). Effect of wearing a face mask on vocal self-perception during a pandemic. Journal of Voice. Advance online publication. https://doi.org/10.1016/j.jvoice.2020.09.006

Roy, N., Barkmeier-Kraemer, J., Eadie, T., Sivasankar, M. P., Mehta, D., Paul, D., & Hillman, R. (2013). Evidence-based clinical voice assessment: A systematic review. American Journal of Speech-Language Pathology, 22 (2), 212–226. https://doi.org/10.1044/1058-0360(2012/12-0014)

Roy, N., Bless, D. M., Heisey, D., & Ford, C. N. (1997). Manual circumlaryngeal therapy for functional dysphonia: An evaluation of short- and long-term treatment outcomes. Journal of Voice , 11 (3), 321–331. https://doi.org/10.1016/S0892-1997(97)80011-2

Roy, N., Gray, S. D., Simon, M., Dove, H., Corbin-Lewis, K., & Stemple, J. C. (2001). An evaluation of the effects of two treatment approaches for teachers with voice disorders: A prospective randomized clinical trial. Journal of Speech, Language, and Hearing Research, 44 (2), 286–296. https://doi.org/10.1044/1092-4388(2001/023)

Roy, N., Kim, J., Courey, M., & Cohen, S. M. (2016). Voice disorders in the elderly: A national database study. The Laryngoscope , 126 (2), 421–428. https://doi.org/10.1002/lary.25511

Roy, N., Merrill, R. M., Gray, S. D., & Smith, E. M. (2005). Voice disorders in the general population: Prevalence, risk factors, and occupational impact. The Laryngoscope , 115 (11), 1988–1995. https://doi.org/10.1097/01.mlg.0000179174.32345.41

Sapienza, C., & Ruddy, B. H. (2009). Voice disorders . Plural.

Simberg, S., & Laine A. (2007). The resonance tube method in voice therapy: Description and practical implementations. Logopedics Phoniatrics Vocology , 32 (4), 165–170. https://doi.org/10.1080/14015430701207790

Speyer, R., Bogaardt, H. C., Passos, V. L., Roodenburg, N. P., Zumach, A., Heijnen, M. A., Baijens, L. W., Fleskens, S. J., & Brunings, J. W. (2010). Maximum phonation time: Variability and reliability. Journal of Voice, 24 (3), 281–284. https://doi.org/10.1016/j.jvoice.2008.10.004

Stemple, J. C. (1984). Clinical voice pathology: Theory and management. Charles E. Merrill.

Stemple, J. C. (2000). Voice therapy: Clinical studies. Singular.

Stemple, J. C., Glaze, L. E., & Klaben, B. G. (2010). Clinical voice pathology: Theory and management (4th ed.). Plural.

Stemple, J. C., Roy, N., & Klaben, B. G. (2014). Clinical voice pathology: Theory and management (5th ed.). Plural.

Stone, R. E., & Casteel, R. (1982). Restoration of voice in nonorganically based dysphonia. In M. Filter (Ed.), Phonatory voice disorders in children (pp. 132–165). Charles C Thomas.

Švec, J. G., & Granqvist, S. (2018). Tutorial and guidelines on measurement of sound pressure level in voice and speech. Journal of Speech, Language, and Hearing Research , 61 (3), 441–461. https://doi.org/10.1044/2017_JSLHR-S-17-0095

Theis, S. M. (2010). Pediatric voice disorders: Evaluation and treatment. The ASHA Leader , 15 (14), 12–15. https://doi.org/10.1044/leader.FTR1.15142010.12

Thomas, L. B., & Stemple, J. C. (2007). Voice therapy: Does science support the art? Communicative Disorders Review, 1, 49–77.

Titze, I. R. (2006). Voice training and therapy with a semi-occluded vocal tract: Rationale and scientific underpinnings. Journal of Speech, Language, and Hearing Research, 49 (2), 448–459. https://doi.org/10.1044/1092-4388(2006/035)

Tracy, L. F., Segina, R. K., Cadiz, M. D., & Stepp, C. E. (2020). The impact of communication modality on voice production. Journal of Speech, Language, and Hearing Research , 63 (9), 2913–2920. https://doi.org/10.1044/2020_JSLHR-20-00161

Traister, R. S., Fajt, M. L., & Petrov, A. A. (2016). The morbidity and cost of vocal cord dysfunction misdiagnosed as asthma. Allergy & Asthma Proceedings , 37 (2), e25–e31. https://doi.org/10.2500/aap.2016.37.3936

Van Stan, J. H., Roy, N., Awan, S., Stemple, J. C., & Hillman, R. E. (2015). A taxonomy of voice therapy. American Journal of Speech-Language Pathology, 24 (2), 101–125. https://doi.org/10.1044/2015_AJSLP-14-0030

Verdolini, K. (1998). Resonant voice therapy . The National Center for Voice and Speech.

Verdolini, K. (2000). Resonant voice therapy. In J. C. Stemple (Ed.), Voice therapy: Clinical studies (pp. 46–61). Singular.

Verdolini, K., & Ramig, L. O. (2001). Review: Occupational risks for voice problems. Logopedics Phoniatrics Vocology, 26 (1), 37–46. https://doi.org/10.1080/14015430119969

Verdolini, K., Rosen, C., & Branski, R. C. (Eds.). (2006). Classification manual for voice disorders-I . Erlbaum.

Ziegler, A., & Hapner, E. R. (2013). Phonation Resistance Training Exercise (PhoRTE) therapy. In A. Behrman & J. Haskell (Eds.), Exercises for voice therapy (Vol. 2). Plural.

Ziegler, A., Verdolini Abbott, K., Johns, M., Klein, A., & Hapner, E. R. (2014). Preliminary data on two voice therapy interventions in the treatment of presbyphonia. The Laryngoscope, 124 (8), 1869–1876. https://doi.org/10.1002/lary.24548

About This Content

Acknowledgements.

Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Voice Disorders page:

• Julie M. Barkmeier-Kraemer, PhD, CCC-SLP
• Jennifer N. Craig, MS, CCC-SLP
• Archie B. Harmon, PhD, CCC-SLP
• Robert E. Hillman, PhD, CCC-SLP
• Barbara Jacobson, PhD, CCC-SLP
• Rita R. Patel, PhD, CCC-SLP
• Bari Hoffman Ruddy, PhD, CCC-SLP
• Joseph C. Stemple, PhD, CCC-SLP
• Yumi A. Sumida, MS, MFA, CCC-SLP
• Kristine Tanner, PhD, CCC-SLP
• Shannon M. Theis, PhD, CCC-SLP
• Miriam R. van Mersbergen, PhD, CCC-SLP
• Laura Purcell Verdun, MA, CCC-SLP

In addition, ASHA thanks the members of the ASHA-Special Interest Division 3: Working Group on Voice and Voice Disorders, whose work was foundational to the development of this content. Members of the working group were Julie Barkmeier (Chair), Glenn W. Bunting, Douglas M. Hicks, Michael P. Karnell, Stephen C. McFarlane, Robert E. Stone, Shelley Von Berg, and Thomas L. Watterson. Alex F. Johnson served as monitoring vice president. Amy Knapp and Diane R. Paul served as ex officio members.

ASHA also thanks the American Academy of Otolaryngology-HNS Speech, Voice and Swallowing Committee members and ASHA Special Interest Division 3, Voice and Voice Disorders Steering Committee members whose work was foundational to the development of this content.

The members of the AAO-HNS Speech, Voice and Swallowing Committee included Robert Sataloff, Jonathan Aviv, Mary Beaver, Alison Behrman (ASHA representative), Mark Courey, Glendon Gardner, Norman Hogikyan, Christy Ludlow (ASHA representative), Roger Nuss, Clark Rosen, Mark Shikowitz, Robert Stachler, Lee Akst, and Susan Sedory Holzer (staff liaison).

The members of the ASHA Special Interest Division 3, Voice and Voice Disorders Steering Committee included Leslie Glaze (coordinator), Bernice Klaben, Lori Lombard, Mary Sandage (associate coordinator), Susan Thibeault, and Michelle Ferketic (ex officio). Celia Hooper, vice president for professional practices (2003–2005), served as monitoring vice president for ASHA.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Voice Disorders. (Practice Portal). Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/ .

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Watch CBS News

Are "creaking" pop stars changing how young women speak?

By Ryan Jaslow

December 16, 2011 / 12:37 AM EST / CBS News

(CBS) Are young women's voices sounding a bit more "creaky" these days? New research suggests lots of young women are taking a lead from pop stars Ke$ha and Britney Spears by rolling their voice into low, creaky, back-of-the-throat sounding vibrations.

It's known as "vocal fry" among speech experts, and celebrities including Kim Kardashian are accused of fueling its presence in young women. The study's authors say vocal fry is sometimes considered a speech impediment, but they and their colleagues are hearing it more than ever ( Click here for some vocal fry impressions ).

For the study, published in the Journal of Voice , Long Island University researchers enlisted 34 native English speakers and recorded them reading sentences. Speech pathologists analyzed the recordings for vocal fry. What did they find? More than two-thirds of the women broke into vocal fry at the end of sentences.

"Young students tend to use it when they get together," study author Dr. Nassima Abdelli-Beruh, assistant professor of speech sciences at Long Island University, told Science magazine . "Maybe this is a social link between members of a group."

Abdelli-Beruh called the patterns "normal" and said vocal fry won't likely cause long-term damage because the women in the study didn't do it after every sentence.

Is vocal fry spreading like wildfire?

Dr. Milan R. Amin, director of the NYU Voice Center and associate professor of otolaryngology at NYU Langone Medical Center, and his colleague Dr. Ryan C. Branski, assistant professor of otolaryngology at NYU Langone, told CBS News they've heard many complaints from voice trainers who say kids are constantly slipping into a creak.

"We spend every day in the clinic trying to improve people's efficiency to get the most sound of their mouths for the least amount of work," Branski told CBS News. Vocal fry, he said, is an inefficient way to speak.

Branksi said women's vocal cords vibrate hundreds of times per second, but vocal fry is a "super slow oscillation" of cords. It's an inefficient and "inherently traumatic" way to speak because you're using muscles in the throat and neck that aren't supposed to be used for speech, which causes strain, he said. That creaking, clicking sound? It's the sound of vocal cords banging against each other.

"Making voices is supposed to be easy, it's physics," Branski said.

Don't pin this phenomenon on just women either. "I bet younger males are doing it as well," Branski said.

Dr. Amin says there's no evidence that vocal creaking can cause long-term damage. In fact, he says it "might go away when you get older" because of changes to vocal cord anatomy that make it more difficult to do a vocal fry.

Other experts weren't swayed by the study.

"These 'low creaky vibrations' have been common since forever," Dr. Mark Liberman, director of the linguistic data consortium at the University of Pennsylvania wrote on the "Language Log" blog . "This tiny bit of evidence is certainly consistent with the traditional view that vocal fry has long been a common feature of sentence-final low pitches in American English. Whether there's a generational effect...remains to be seen"

Tell us if you've noticed more people speaking with vocal fry.

Ryan Jaslow is CBSNews.com's health editor.

More from CBS News

What is Vocal Fry and Why Is It Common With Women?

I’m a fan of HGTV. One of the shows I like is Flip or Flop with telegenic husband-wife team Tarek and Christina El Moussa. Every time I hear Christina talk, I’m always struck by how often she uses the voice register known in the media as vocal fry /creaky voice. Vocal fry is common with women who speak in a lower register.

Here’s an example of her speech . Pay attention to the ends of her sentences where the low, scratchy sounds of vocal fry are most pronounced:

If you listened to the whole clip, you might have noticed low, scratchy sounds in the speech of the two young women co-hosts, again particularly at the ends of their sentences. It is very pronounced when one of them says, “Yeah.”

Linguists call this register creaky voice. It’s produced by closing the space between the arytenoid cartilages in the larynx.

Decades ago phonetician Peter Ladefoged identified a continuum of phonation types, depending on the degree of opening or closure of the arytenoid cartilages:

The History of Vocal Fry

Breathy voice brings to my mind Marilyn Monroe. As far as vocal fry goes, Ladefoged noted that some languages make contrasts in certain consonants between creaky and modal (normal) voicing, and these contrasts help make meaning contrasts. He says creaky voice consonants are common in Northwest American Indian languages, such as Kwakw’ala, Montana Salish, Hupa, and Kashaya Pomo.

Now to the contemporary American English phenomenon. Here vocal fry doesn’t make meaning contrasts, it makes social contrasts. Christina El Moussa is a thirty-something Southern California woman, and she is representative of the social group using the vocal fry/creaky voice feature as a marker of identity. I doubt she’s aware she’s doing it. But through this register, she is identifying herself with her generation of young, educated, upwardly-mobile women.

Vocal Fry in Pop Culture

About five years ago discussions of vocal fry/creaky voice burst into the media. In 2011 lots of commentary swirled around the speech patterns of young women such as Kesha , Katy Perr y, Britney Spears , Zooey Deschane l, the Kardashians, and even Meredith Grey the main character on Grey’s Anatomy , all of whom use various degrees of creaky voice.

Speculation was that these pop culture figures popularized this speech style, and I think this is highly possible. However, they didn’t create the style, because vocal fry/creaky voice has been in American speech for a long time, always more in the speech of women than men. You can hear it in Mae West’s famous “Why don’t you come up some time and see me?” Here she is.

It’s also not just a feature of young women’s speech. Sociolinguist Norma Mendoza-Denton has identified creaky voice as a feature of hardcore Chicano gangster speech found in Southern California.

Vocal Fry Today

The style is alive and well. Last semester a young woman in one of my classes had a very pronounced creaky speaking style. When I pointed it out to her, she was surprised, because she’d never heard of it before. As a point of information, she’s from Texas.

Anything that is a marker of feminine (and/or ethnic) identity is going to come under scrutiny and, unfortunately, under attack. When discussion of vocal fry erupted five years ago much of it was about how it was annoying, irritating, and possibly an impediment to a woman’s career. One such critic was Howard Stern.

Much hay was made of the potential danger this speaking style posed to women’s larynxes and, indeed, the term fry does suggest something harmful. Therapies for the so-called condition have been proposed.

However, if languages around the world use creaky voice for various communicative purposes, then it seems unlikely to me this register is actively harmful. Furthermore, younger men aren’t criticized when they on occasion use the creaky register. Rather, the negative perception of it, along with the – in some cases, well meaning if misguided – attempts to eliminate it, smack of a move to control yet another part of a woman’s body, this time her delicate little arytenoid cartilages.

Women are criticized when their voices go into higher registers. They’re called shrill. Women are also criticized when their voices go into lower, vocal fry/creaky voice registers. They’re called irritating.

Hmmm…what’s going on? Could it be that some people don’t want to hear women’s voices at all?

Lucky Christina. Tarek listens to her.

2018 update: Oh, dang! Christina and Tarek have had a very public and very messy breakup. So much for good communication.

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• Childhood apraxia of speech

Childhood apraxia of speech (CAS) is a rare speech disorder. Children with this disorder have trouble controlling their lips, jaws and tongues when speaking.

In CAS , the brain has trouble planning for speech movement. The brain isn't able to properly direct the movements needed for speech. The speech muscles aren't weak, but the muscles don't form words the right way.

To speak correctly, the brain has to make plans that tell the speech muscles how to move the lips, jaw and tongue. The movements usually result in accurate sounds and words spoken at the proper speed and rhythm. CAS affects this process.

CAS is often treated with speech therapy. During speech therapy, a speech-language pathologist teaches the child to practice the correct way to say words, syllables and phrases.

Children with childhood apraxia of speech (CAS) may have a variety of speech symptoms. Symptoms vary depending on a child's age and the severity of the speech problems.

CAS can result in:

• Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months.
• Speaking first words late, typically after ages 12 to 18 months old.
• Using a limited number of consonants and vowels.
• Often leaving out sounds when speaking.
• Using speech that is hard to understand.

These symptoms are usually noticed between ages 18 months and 2 years. Symptoms at this age may indicate suspected CAS . Suspected CAS means a child may potentially have this speech disorder. The child's speech development should be watched to determine if therapy should begin.

Children usually produce more speech between ages 2 and 4. Signs that may indicate CAS include:

• Vowel and consonant distortions.
• Pauses between syllables or words.
• Voicing errors, such as "pie" sounding like "bye."

Many children with CAS have trouble getting their jaws, lips and tongues to the correct positions to make a sound. They also may have a hard time moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or trouble with word order.

Some symptoms may be unique to children with CAS , which helps to make a diagnosis. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's hard to diagnose CAS if a child has only symptoms that are found both in CAS and in other disorders.

Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those associated with CAS include:

• Trouble moving smoothly from one sound, syllable or word to another.
• Groping movements with the jaw, lips or tongue to try to make the correct movement for speech sounds.
• Vowel distortions, such as trying to use the correct vowel but saying it incorrectly.
• Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh."
• Using equal emphasis on all syllables, such as saying "BUH-NAN-UH."
• Separation of syllables, such as putting a pause or gap between syllables.
• Inconsistency, such as making different errors when trying to say the same word a second time.
• Having a hard time imitating simple words.
• Voicing errors, such as saying "down" instead of "town."

Other speech disorders sometimes confused with CAS

Some speech sound disorders often get confused with CAS because some of the symptoms may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.

A child with an articulation or phonological disorder has trouble learning how to make and use specific sounds. Unlike in CAS , the child doesn't have trouble planning or coordinating the movements to speak. Articulation and phonological disorders are more common than CAS .

Articulation or phonological speech errors may include:

• Substituting sounds. The child might say "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup."
• Leaving out final consonants. A child with CAS might say "duh" instead of "duck" or "uh" instead of "up."
• Stopping the airstream. The child might say "tun" instead of "sun" or "doo" instead of "zoo."
• Simplifying sound combinations. The child might say "ting" instead of "string" or "fog" instead of "frog."

Dysarthria is a speech disorder that occurs because the speech muscles are weak. Making speech sounds is hard because the speech muscles can't move as far, as quickly or as strongly as they do during typical speech. People with dysarthria may also have a hoarse, soft or even strained voice. Or they may have slurred or slow speech.

Dysarthria is often easier to identify than CAS . However, when dysarthria is caused by damage to areas of the brain that affect coordination, it can be hard to determine the differences between CAS and dysarthria.

Childhood apraxia of speech (CAS) has a number of possible causes. But often a cause can't be determined. There usually isn't an observable problem in the brain of a child with CAS .

However, CAS can be the result of brain conditions or injury. These may include a stroke, infections or traumatic brain injury.

CAS also may occur as a symptom of a genetic disorder, syndrome or metabolic condition.

CAS is sometimes referred to as developmental apraxia. But children with CAS don't make typical developmental sound errors and they don't grow out of CAS . This is unlike children with delayed speech or developmental disorders who typically follow patterns in speech and sounds development but at a slower pace than usual.

Risk factors

Changes in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop. Researchers continue to study how changes in the FOXP2 gene may affect motor coordination and speech and language processing in the brain. Other genes also may impact motor speech development.

Complications

Many children with childhood apraxia of speech (CAS) have other problems that affect their ability to communicate. These problems aren't due to CAS , but they may be seen along with CAS .

Symptoms or problems that are often present along with CAS include:

• Delayed language. This may include trouble understanding speech, reduced vocabulary, or not using correct grammar when putting words together in a phrase or sentence.
• Delays in intellectual and motor development and problems with reading, spelling and writing.
• Trouble with gross and fine motor movement skills or coordination.
• Trouble using communication in social interactions.

Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, have a speech-language pathologist evaluate your child as soon as you notice any speech problems.

Childhood apraxia of speech care at Mayo Clinic

• Jankovic J, et al., eds. Dysarthria and apraxia of speech. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed April 6, 2023.
• Carter J, et al. Etiology of speech and language disorders in children. https://www.uptodate.com/contents/search. Accessed April 6, 2023.
• Childhood apraxia of speech. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/. Accessed April 6, 2023.
• Apraxia of speech. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx. Accessed April 6, 2023.
• Ng WL, et al. Predicting treatment of outcomes in rapid syllable transition treatment: An individual participant data meta-analysis. Journal of Speech, Language and Hearing Research. 2022; doi:10.1044/2022_JSLHR-21-00617.
• Speech sound disorders. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/. Accessed April 6, 2023.
• Iuzzini-Seigel J. Prologue to the forum: Care of the whole child — Key considerations when working with children with childhood apraxia of speech. Language, Speech and Hearing Services in Schools. 2022; doi:10.1044/2022_LSHSS-22-00119.
• Namasivayam AK, et al. Speech sound disorders in children: An articulatory phonology perspective. 2020; doi:10.3389/fpsyg.2019.02998.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
• Ami TR. Allscripts EPSi. Mayo Clinic. March 13, 2023.
• Kliegman RM, et al. Language development and communication disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 6, 2023.
• Adam MP, et al., eds. FOXP2-related speech and language disorder. In: GeneReviews. University of Washington, Seattle; 1993-2023. https://www.ncbi.nlm.nih.gov/books/NBK1116. Accessed April 6, 2023.
• How is CAS diagnosed? Childhood Apraxia of Speech Association of North America. https://www.apraxia-kids.org/apraxia_kids_library/how-is-cas-diagnosed/. Accessed April 13, 2023.
• Chenausky KV, et al. The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: A conceptual review. Journal of Neurodevelopmental Disorders. 2022; doi:10.1186/s11689-022-09443-z.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
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You know when you sit down for a meal in front of the computer and you just need something new to watch for a bit while you eat? If you search /r/videos or other places, you'll find mostly short videos. But while you're eating, you don't want to be constantly fumbling around with the mouse, loading video after video. You just want to **Click and Consume**. Discord: https://discord.gg/AXXVVgZVSN

Vocal Fry: what it is, who does it, and why people hate it! [27:17]