Beyond observing obvious problems in breathing, the clinician should note the amount of neck tension. The accessory neck muscles and the supralaryngeal strap muscles in some patients literally stick out like bands as the patient speaks (this is also observed in untrained singers). Often, mandibular restriction is closely associated with neck tension; affected patients speak with clenched teeth, with little or no mandibular movement. Such restricted jaw movement places most of the burden of speech articulation on the tongue, which must make fantastic adjustments to produce the various vowels and diphthongs in connected speech if no cavity-shaping assistance from the mandible is forthcoming. Any excessive elevation or lowering of the larynx as well as the tipping forward of the thyroid cartilage in the production of high pitches should be noted as possible hyperfunctional behavior (Guzman et al., 2013; Lowell et al., 2012). The angle of the thyroid cartilage may be digitally palpated as the patient sings a number of varying pitches; typically, the fingertips feel little discernible change in the thyroid angle as the patient sings up and down a scale. Sometimes, however, the thyroid cartilage can be felt to rock forward slightly in the produc­tion of high pitches, as it sweeps upward to a higher position toward the hyoid bone. One should gently move the larynx manually from side to side to note the degree of tension with which the strap muscles of the neck hold the larynx in place. We also ask patients to move their larynx manually from side to side and to observe how fixed it appears compared with the clinician’s own larynx.