The speakers in the direct-voice medium seances often state that they have great difficulty speaking through the voicebox that is created. They describe it as focusing their thoughts on the box and having sound come out, but they can't hear the sound well, so they're not sure they are communicating.
They also describe knowing the sitter's questions before they're asked. The afterlife is the world of thought, where people communicate by thought. We are spiritual beings having a physical experience, so our thoughts communicate to them just as theirs do to each other.