Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia

Katherine L. Marks, Manuel E. Díaz Cádiz, Laura E. Toles, Daniel P. Buckley, Lauren F. Tracy, J. Pieter Noordzji, Gregory A. Grillone, Cara E. Stepp

Research output: Contribution to journalArticlepeer-review


Objective: The purpose of this study was to determine whether automated estimates of vocal creak would differentiate speakers with adductor laryngeal dystonia (AdLD) from speakers with muscle tension dysphonia (MTD) and speakers without voice disorders. Methods: Sixteen speakers with AdLD, sixteen speakers with MTD, and sixteen speakers without voice disorders were recorded in a quiet environment reading aloud a standard paragraph. An open-source creak detector was used to calculate the percentage of creak (% creak) in each of the speaker's six recorded sentences. Results: A Kruskal-Wallis one-way analysis of variance revealed a statistically significant effect of group on the % creak with a large effect size. Pairwise Wilcoxon tests revealed a statistically significant difference in % creak between speakers with AdLD and controls as well as between speakers with AdLD and MTD. Receiver operating characteristic curve analyses indicated that % creak differentiated AdLD from both controls and speakers with MTD with high sensitivity and specificity (area under the curve statistics of 0.94 and 0.86, respectively). Conclusion: Percentage of creak as calculated by an automated creak detector may be useful as a quantitative indicator of AdLD, demonstrating the potential for use as a screening tool or to aid in a differential diagnosis. Level of Evidence: 3 Laryngoscope, 133:2687–2694, 2023.

Original languageEnglish (US)
Pages (from-to)2687-2694
Number of pages8
Issue number10
StatePublished - Oct 2023


  • acoustics
  • creak
  • laryngeal dystonia
  • muscle tension dysphonia
  • speech-language pathology
  • voice disorders

ASJC Scopus subject areas

  • Otorhinolaryngology


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