Pharyngeal speech represents one of several types of alaryngeal speech; however, its use as a primary method of communication is rare. This report relates the principal findings of an intensive study of a 12-year-old girl with laryngeal papillomatosis who has used pharyngeal speech as an exclusive method of oral communication since age two. The unique physiologic mechanisms of pharyngeal speech are described and differentiated from other forms of alaryngeal speech. This girl’s reduced pharyngeal speech intelligibility for consonant and vowel rhyme-test words, her unfavorable phonation time and maximum phonation duration characteristics, her low average fundamental frequency, and her markedly hoarse pharyngeal voice quality all are distinct vocal liabilities. These findings lend strong support to the hypothesis that pharyngeal speech should not be regarded as a desirable or practical primary method of alaryngeal speech.