The basis is flaccid vocal folds producing turbulence and increased volume in the glottis along with failure to develop complete closure of glottis during the cycle. Phonation is hoarse or harsh, pitch is low and monotonous, loudness is reduced. Inappropriate crying or laughter may be present. Voice quality produced by hyperadduction of the vocal folds with resultant glottic constriction. Components of both flaccid and spastic dysarthria are noted.
Phonation has a wet or gurgly quality.
Flutter or voice tremor is noted. The voice quality is monopitch, reduced loudness, with both harsh and breathy sounds. This can be the earliest sign of parkinsonism. Quavering, intermittent voice arrests during speech. Vocal folds appear normal in structure, on vowel sounds adductor-abductor oscillations synchronous with tremor are seen.