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Judgments are made relative to the degree of vocal tension/harshness in the speaker's voice. Vocal tension and harshness indicate that phonation is being produced with excessive strain in the laryengeal musculature. This may result in over adduction of vocal folds which creates disturbances in the vibratory pattern of the folds.

Rating Comments Sample
Level 1Vocal tension is too great to sustain tone. no sample
Level 2Severe tenseness. The predominant feature in this sample is severe tenseness in voice quality with a coexisting quality of nasality also identified with the generalized inability to control respiration and phonation. The speaker does have a few intelligible words and some consonants. However, the major problem is the speaker’s inability to control the breath stream at the level of the larynx. For this reason, voice training would be recommended, preparatory to any work on consonant production. (Female)
Level 3Moderate tenseness. Moderate harshness associated with severe nasality is apparent in this speech sample. The unpleasantness and monotony of the tonal speech pattern is accentuated by a flat inflection and a rather uniform pattern of stress and rate of syllable utterance. (Female)
Level 4Mild tenseness. This speech sample demonstrates a mild tense and harsh quality of voice. (Female)
Level 5Normal quality. no sample