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Growls can be obtained with various voice effects, but the effects are usually used to enhance rather than create, if they are used at all. Voice teachers teach different techniques, but long-term use eventually wears the voice out, so any technique is actually for "less harm", not for harmless vocalization.[未記出處或冇根據] The University Medical Center St Radboud in Nijmegen (The Netherlands) reported in June 2007 that, due to the increased popularity of growling in the region, it was treating several patients for edema and polyps on the vocal folds.Most "correct" growls use either a variation of vocal fry or false vocal cords, both with the use of the diaphragm. Death growls are often referred to as an overtone style of singing. Whilst supporters of more traditional vocal styles claim that this is not real singing, the majority of "good" growling techniques apply the same principles that are witnessed in "clean" vocals.
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The advent of the growl as it is used today coincided roughly with the gradual emergence of death metal, and it is thus difficult to pinpoint a specific individual as the inventor of the technique. Different vocalists likely developed the style over time. The band Death (and its precursor Mantas) with its two vocalists — initially Kam Lee and subsequently Chuck Schuldiner — have been cited as the first (although Schuldiner would eventually switch to a more high-pitched screeching). Possessed are also considered by some to be one of the earliest bands to employ growls, as are Necrophagia and Master. Around the same time, bands such as Hellhammer, with Tom G. Warrior on vocals, and seminal act Massacre also employed a variation of the growl.
The vocalists from the British grindcore band Napalm Death — consecutively Nic Bullen, Lee Dorrian and Mark "Barney" Greenway — further developed the style in the late 1980s, adding more aggression and deeper guttural elements to it, while also speeding up delivery of the lyrics.In Brazil, the band Sarcófago, with Wagner Lamounier who also did some low guttural vocals and backing vocals. Around the same time, in the United States, Chris Reifert (from Autopsy) began combining shrieks with his deep grunts.
Some death metal bands such as Carcass, Exhumed, Vital Remains, Dying Fetus and Deicide have experimented using two vocal tracks, alternating between growling grunts and pitch shifted vocals. Vocalists of doom metal bands tend to put more emphasis on adding atmospheric and emotional overtones to their growls. Nick Holmes (from Paradise Lost), Darren White (from Anathema) and Aaron Stainthorpe (from My Dying Bride) were the main developers of growls within this context, in the early 1990s. Stainthorpe was one of the first to utilize both growls and "clean" vocals in death metal.
Funeral doom metal bands have taken a different approach to growls. Deep guttural vocals are often replaced by hoarser, almost whispered growls. Examples of vocalists which make use of the technique are "Matti" (from Skepticism) and John Paradiso (from Evoken).
There are other genres which have their own approach to death growls, such as deathgrind and brutal death metal. In those styles, the vocals often attempt to be as guttural and indecipherable as possible without the use of effects, sometimes inhaling the growl. Examples are Frank Mullen of Suffocation and John McEntee of Incantation.
There are a number of symphonic and goth metal bands that combine operatic clean female vocals (often classically-trained sopranos) with a male growl/grunt. For example Cradle of Filth, After Forever, Epica, and Leaves' Eyes all employ this technique in a significant portion of their songs.