Ask the patient to cough, followed by a clearing of their throat.
These tasks can be helpful, like yelling, in sorting out weakness of the glottis or psychogenic / nonorganic vocal problems. For instance, if a patient could only whisper up to this point in the exam, but can produce a robust cough, then the vocal cords or some portions of the glottis have the capacity to come together, hold back air and then on release, generate sound. Notation is made whether the patient can or cannot produce sound on this task and whether it is normal, soft, seal-like bark quality or strained.
It is a different way of assessing occlusion capacity of the larynx under a condition of high subglottic pressure.