SLPCohortJournal of voice : official journal of the Voice Foundation2025

Estimating Pressed and Breathy Phonation From Cepstral and Spectral Measures.

Laura E Toles, Olivia Murton

PMID 40021420

WHAT IT FOUND

In healthy voices, pressed phonation raises CPP and lowers H1-H2, while breathy phonation does the opposite.

Higher CPP is not always better: it can signal hazardous pressed voice. H1-H2 discriminated pressed from typical voice across tasks, especially in women, though men showed less consistent vowel results.

Key findings

01Pressed phonation produced higher CPP and lower H1-H2 than typical phonation, while breathy phonation produced lower CPP and higher H1-H2.

02H1-H2 was the only variable that significantly discriminated typical from pressed phonation across both sustained vowels and connected speech.

03The expected acoustic differences between pressed and typical phonation were significant for women but not for men during sustained vowel tasks.

STILL TO COME

How it was doneWhat they foundWhat it means for SLPs

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What it does not show

The study used only healthy participants, so it is unknown whether these acoustic patterns hold true in people who already have voice disorders or vocal fold lesions. Laryngeal imaging was not performed during the recordings, so the assumption that pressed voice equals increased vocal fold closure is inferred from theory rather than directly observed in this dataset. There are no established minimal detectable change or clinically important difference values for these measures, so a 2 dB shift in CPP cannot yet be interpreted as a true therapeutic success or failure. Only one speech-language pathologist rated the voice samples, and nasality was not assessed, which could have influenced the acoustic results. The microphone used does not have a flat frequency response in low frequencies, meaning results may not transfer directly to different recording setups.

Declared interests

The authors declared no conflicts of interest.

The easy way to misread this

Do not assume that a higher CPP score indicates a healthier voice. This study showed that pressed phonation, which is associated with vocal strain and potential tissue damage, actually raises CPP values. A patient with a high CPP may be using hazardous voice behaviors that are not audible as hoarseness.

Read it on PubMed →