You have accessThe ASHA Leader ArchiveFeature1 Feb 2016

Totally Fried

What do you need to know about vocal fry? Speech-language pathologists and a linguist weigh in on where cultural influence ends and clinical intervention begins.

    Vocal fry: Maybe you hate it. Maybe you don’t notice it. Or maybe it just makes you think of the Kardashians.

    A barrage of articles and op-eds about the gravelly, creaky vocal quality—some warning of an epidemic of lazy, annoying speech patterns used by young women, others rejecting the idea that women should have to change their voices to please other people—have flooded the media in the past year, making it likely you’ve encountered “vocal fry” even outside your work as a speech-language pathologist.

    There’s feminist writer Naomi Wolf in the Guardian, advising “the most empowered generation of women ever” to stop using vocal fry for its own good. There’s the VICE reporter who recounted taking his girlfriend to an SLP because he was annoyed by her vocal fry. There’s journalist Ann Friedman writing for New York magazine, calling for an end of prescribing how women—specifically young women—should speak.

    Amateur speech police/vigilantes can discuss their hatred of or pride in vocal fry in the comments section ad nauseam—but with a topic as controversial and complex as vocal fry, SLPs know they have a responsibility to approach vocal fry carefully and appropriately, with evidence to back it up.

    But defining “appropriate” in this situation isn’t so easy. It’s requiring SLPs to navigate different underlying causes, the person’s opinion of his or her own voice, and how to handle the sometimes tricky area of billing. Add in perceptions of potential harm caused by vocal fry and the social issue of whether overwhelming focus on its use by young women is sexist, and the territory can get rocky.

    Figuring out the fry

    First, a terminology refresher. When news articles cover vocal fry, they’re usually referring to the use of a creaky pitch at the end of sentences, or sometimes consistently throughout someone’s speech. SLPs, however, more often use the term “glottal fry,” says SLP Starr Cookman, assistant professor at University of Connecticut Health’s Voice and Speech Clinic, to describe the lowest register under the modal register of normal speech.

    Linguists will often call it “creaky voice,” “laryngealized voice” or “glottalized voice,” says Patricia Keating, a linguistics professor who specializes in phonetics at the University of California, Los Angeles (UCLA), and president of the International Phonetic Association.

    Regardless of the terms, vocal fry can appear in a person’s speech for two reasons. The staccato, irregular vibrations of the vocal folds can occur because of pathological issues, Cookman says, such as vocal-fold lesions, hyperfunction of the larynx (muscle tension dysphonia), respiratory pathology and neurological issues. In these situations, vocal fry is likely to be persistent throughout an utterance, rather than appearing only at the end, and is treated as part of a “constellation of signs and symptoms,” including vocal fatigue and/or laryngeal pain.

    Vocal fry also can appear as a linguistic style that is a standard part of language, usually at the end of sentences to mark the completion of a speaker’s thought, says Bruce Gerratt, director of UCLA’s audiology and speech pathology clinics and professor of head and neck surgery. “Vocal fry is not normally considered a vocal deviation,” he says.

    In either case, a person who has or uses vocal fry speaks with a low pitch and suboptimal airflow, with the vocal cords in a relatively lax position.

    But this isn’t a new thing. Contrary to media reports describing a “phenomenon,” all of the SLPs and linguists interviewed for this article say it’s long existed in the English language.

    “Vocal fry has always been there,” says Laura Purcell Verdun, a Washington, D.C.-based SLP who takes medical and professional caseloads of voice disorders, including vocal fry. “This didn’t just crop up in 2010. It’s always been a component of American English,” as well as of other English dialects, including Australian and British.

    “It predated the Kardashians—they didn’t invent vocal fry,” says Verdun.

    In her hospital setting, Cookman says she hasn’t seen complaints of pathological vocal fry—which she treats in about 15–20 percent of her medical cases—increase over her 20-year career.

    But is it on the increase as a fashionable—not biological—speech pattern, as some in the media have charged? Both Keating and Verdun say it is possible that the use of vocal fry as a style of speech has spread.

    “It’s not just at the ends of sentences, it’s not just in the aid of low pitch—it’s now on longer stretches of words,” says Keating. “And so now people notice it because it doesn’t seem to be part of a general strategy for lowering pitch; it’s just a more pervasive quality that identifies younger people.”

    Interest in and awareness of vocal fry has increased over the last five years, says Verdun, who thinks more access to new types of entertainment like podcasts and reality television may have given the vocal style more exposure. “There’s definitely increased interest,” she says, “with this overwhelming trend toward criticism, whether it’s warranted or not. It’s really coming from a place of judgment and questionable prejudice.”

    Prior to a 1966 paper by Harry Hollien in the Journal of Speech, Language, and Hearing Research, vocal fry was considered a “vocal disorder.” However, Hollien and his colleagues suggested that because many people speak with this quality in everyday speech, its use should not exclusively be considered abnormal, but rather, in nonpathological cases, as a normal register—below modal—that exists as “a physiologically normal laryngeal capability.”

    Who has vocal fry?

    Fifty years after the Hollien paper, young women are finding themselves the target of negative attention for their use of vocal fry—typically from older men, but also from some women, including Naomi Wolf, the feminist writer whose July 2015 column in the Guardian (U.K.) most recently revived the vocal-fry debate in the press. The headline: “Young Women, Give Up the Vocal Fry and Reclaim Your Strong Female Voice.”

    Although Wolf has fervent supporters, other feminists argue that Wolf herself is telling women how to behave, railing against the point of feminism itself. And hey, Wolf’s critics wonder, what about men?

    Men use vocal fry, as well as other speech styles, such as “uptalk,” that are usually associated only with women.

    “I hear people complaining about [women using vocal fry] all the time,” Gerratt says. “I don’t know why they pick on the women and not the men, because this occurs in men, too.”

    “I don’t know why they pick on the women and not the men, because this occurs in men, too.”

    A popularly cited 2011 study by Lesley Wolk in the Journal of Voice studied the use of vocal fry in female college students. They found that two-thirds of female college students ages 18 to 25 used vocal fry, usually at the end of sentences. In a 2014 follow-up study, Wolk and her team studied the prevalence of vocal fry in male college students, finding that they, too, used vocal fry at the end of sentences, though at a significantly lower rate than that of females.

    Verdun, who treats vocal fry for a professional client list that includes male and female attorneys, executives, politicians, and radio and TV personalities, says she finds Wolf’s argument prejudicial. “It was perhaps a little overly dramatic. … It’s a matter of the individual, versus making these overarching generalizations to women under their 30s or all women professionals. There’s nothing to be gained by that because you’re continuing to reinforce the older white male perspective of the female voice.”

    Another vocal fry study by Duke University researchers, led by Rindy Anderson and published in PLOS One in 2014, looked at how vocal fry affects women’s job prospects. The answer? Not in a good way. The authors found that women who used vocal fry were less likely to appear “hirable” than their counterparts without vocal fry, and they were also seen as less attractive, competent, educated and trustworthy. Men, with and without vocal fry, were also studied—and although the men with vocal fry were also perceived more negatively, they were still rated more highly than their female counterparts.

    Ira Glass, who speaks to an enormous audience each week as host of the “This American Life” podcast/radio show, uses vocal fry. But of the many complaints (or “hate mail,” he says) the show has received over the years regarding voice quality, none has been directed at Glass. The subjects of all of the complaints were women who had worked on the show. (NPR’s “Fresh Air” has also recently dedicated a fair amount of airtime to the debate surrounding vocal fry and women’s voices.)

    Noam Chomsky also has a distinct vocal fry, and Ann Hepperman, a producer of the Slate podcast Culture Gabfest, recently cut a mix of many prominent male podcasters using vocal fry. And the list goes on.

    But still, young women catch most of the flack, which may be because of an inherent difference between men’s and women’s voices. “It may be that people are accustomed to the sound in men’s voices because they’re already at a lower pitch,” says Gerratt.

    Vocal fry also may be considered annoying in any gender for other reasons. Verdun notes that a 2014 study by Sei Jin Ko in the journal Psychological Science showed that listeners found authoritative, hierarchical voices to be “steady in pitch, more varied in volume and less strained,” whereas the creakiness of vocal fry does not maintain a regular pitch.

    It also may just come down to people not liking a perceived change.

    “Some people are annoyed when they notice that something about the way their language is spoken changes,” Gerratt offers. “They were taught to speak in a certain way, and they consider this new way to be not good. They don’t like to see things change.”

    Research and anecdotal evidence indicate that vocal fry most greatly offends older listeners. A study by Stanford University linguist Penny Eckert found that while those older than 40 thought a radio reporter with vocal fry did not sound authoritative, those younger than 40 actually thought the creaky-voiced reporter, in fact, sounded authoritative. Another study by Ikuko Patricia Yuasa, published in 2010 in the journal American Speech, showed that although college-age Americans say that creaky voice makes a speaker sound “hesitant, nonaggressive and informal,” they concurrently thought it made the speaker sound “educated, urban-oriented and upwardly mobile.”

    If the style persists as young people become middle-age people, “all of a sudden everyone uses it, and it’s standard again,” Gerratt says.

    Maybe it’s mostly a matter of perspective, posits linguist Keating. “As a linguist, I’d say, ‘Speech patterns change and this is what they’re doing now—whatever.’ But as an older person, I think, ‘Oh, those nice, smooth voices—that’s so much better,’” she says with a laugh.

    What it means for SLPs

    With such a loaded topic, how should SLPs approach the treatment of vocal fry?

    Although some people with vocal fry argue that it’s just the way they talk—it’s not a choice they make—SLPs Gerratt and Verdun say that unless vocal fry is present throughout every syllable of every sentence spoken, it’s more than likely a choice—albeit a subconscious one.

    “If a person can shut it off at will, that’s not a disorder,” Gerratt says.

    “The thing about glottal fry is that it’s inconsistent,” Verdun says. “It exists among otherwise normal voice production, whereas somebody who has muscle tension dysphonia clearly has excessive tension, complains of pain or soreness or tightness or constriction, and every word that comes out of their mouth [sounds] the same.”

    And unless it’s the type of vocal fry that’s pathological and appears alongside other disorders and symptoms—like in the patients Cookman treats at her hospital—it’s only something that needs to be fixed when a person decides that it needs to be fixed, they say.

    “If it’s not a concern for them, I’m not going to make it a concern,” says Verdun. “But there’s no reason that it can’t be addressed, [though] it has to be addressed from a physiological perspective, not from a judgmental, prejudicial, generational, sexist perspective. It’s all about making sure the words that you use are coming across as powerfully as you want them to.”

    “It’s all about making sure the words that you use are coming across as powerfully as you want them to.”

    Choosing to work on eliminating vocal fry is akin to choosing to modify or reduce an accent, say Gerratt and Keating. “You know, a Henry Higgins and Eliza Doolittle sort of thing,” Keating offers as an example.

    Although every professional and medical case is unique, Verdun and Cookman both use education and awareness techniques to treat vocal fry, which usually takes about two to three sessions to alter.

    “The focus is always on how to optimize or normalize vocal physiology for optimal voice production,” Verdun says. “Everyone learns differently, hears things or feels differently, so that needs to be teased out. Medical cases may be less stimulable or may warrant more patience and persistence.”

    And vocal fry could be just one aspect of the voice that male and female clients are looking to change. They may think their voices are too soft, too high-pitched, too nasal. “It’s a pretty diverse clientele,” Verdun says. Typically, “their concern is that it’s somehow getting in the way of their ability to communicate effectively at work.”

    Debating damage

    Another common charge against vocal fry is that it hurts the voice. But in the case of end-of-sentence use, no research confirms this. The authors of the 2011 Wolk study suggest vocal fry may cause damage, but did not test the suggestion.

    “There’s no evidence that shows that glottal fry, in and of itself, causes injury,” says Cookman, who adds that her patients’ vocal fry usually naturally accompanies their primary medical issue.

    Verdun echoes Cookman, adding that although she’s heard anecdotes from some otolaryngologists and other physicians who “very much suggest it’s medical, and if you don’t do something about it, it can cause nodules or polyps,” she has never personally seen it. “And I’ve practiced for a long time. I do believe that more chronic use could lead to laryngeal tension and vocal fatigue, but that’s really individual cases versus the standard expectation across the board,” she says.

    “Perhaps if the user is overusing their voice in that way, trying to project their voice loudly while maintaining that glottal fry characteristic, then that’s more likely to create an environment where there could be a secondary injury,” Cookman suggests.

    From a global perspective, linguist Keating notes that languages around the world incorporate vocal fry. In fact, Gerratt estimates there are probably more languages in the world that use creak than don’t—creak is part of one of the tones used in Mandarin Chinese, he says, which hundreds of millions of people speak. “When so many people use a phonation type commonly in their language, to me it strongly implies it is not a disorder.”

    Languages around the world incorporate vocal fry. In fact, there are probably more languages in the world that use creak than don’t.

    But in America, where English does not call for vocal fry, strong negative reactions from others can certainly make it seem like something is wrong. For example, fiancés, parents and supervisors frequently call Verdun, requesting her services for their partners, children or employees. However, she advises taking on such clients only if they themselves want to change their voices.

    And insurance companies won’t reimburse an SLP for something they don’t consider medically necessary, such as altering a speech style. Many providers also do not cover treatment for muscle tension dysphonia.

    “Insurance can only be billed if there has been a physician’s exam of the larynx and voice … and the patient has been referred for therapy with a specific diagnosis,” Verdun says. “Insurance would not be billed for professional clients” who are looking to change their voices but do not have a diagnosed voice disorder.

    But for those clients, Verdun says she can see how eliminating vocal fry could fit in with any other type of professional development.

    “How is it different than learning how to manage crisis situations or how to give bad news?” she asks. “That’s very much reasonable and may not be judgmental or prejudicial at all.”

    But she poses another perspective: If your 50-year-old boss doesn’t like your voice, “is that something [the boss] needs to adjust to, or do you need to adjust? You really have to decide that for yourself. But no matter what, you shouldn’t feel bad about yourself.”

    It’s all about bringing it back to the clients themselves, says Verdun.

    “Does your voice reflect whatever image you’re trying to project? Does your voice support whatever message you’re trying to convey? If it is, then fine. Who am I to say otherwise?”

    “It really comes down to, are you able to do with your voice what you need it to be able to do?” she says. “Does your voice reflect whatever image you’re trying to project? Does your voice support whatever message you’re trying to convey? If it is, then fine. Who am I to say otherwise?”

    Author Notes

    Haley Blum is a writer/editor for The ASHA Leader.

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