Muscle Tension Dysphonia

What happens in muscle tension dysphonia

Normal voice uses a precise balance of muscles inside the larynx to bring the vocal cords together and vibrate them, while muscles of the neck and jaw stay relaxed. In MTD, the larynx is squeezed too tightly, the voice box may be pulled up in the neck, and the structures above the vocal cords may squeeze inward. The vocal cords cannot vibrate freely, so the voice sounds strained or rough and tires quickly.

Primary vs secondary MTD

• Primary MTD: no other problem with the vocal cords. Often follows a respiratory infection or laryngitis, when people "push" through a hoarse voice and the habit persists, or develops with stress or heavy voice use.
• Secondary MTD: tension develops to compensate for another problem, such as vocal cord nodules, a vocal cord cyst, vocal cord paralysis or age-related thinning of the cords.

Symptoms

• hoarse, rough, strained, pressed or breathy voice
• voice that worsens through the day or with use
• vocal fatigue and effort to speak
• reduced pitch range, especially for singers
• pain, tightness or aching in the throat or neck when speaking
• a lump-in-the-throat sensation
• voice breaks or loss of voice
• tension in the jaw, shoulders or neck

Causes and risk factors

• Upper respiratory infections and laryngitis
• Heavy or loud voice use: teachers, coaches, singers, actors, call-center and customer service workers, clergy
• Psychological stress and anxiety
• Acid reflux irritating the larynx
• Poor posture and neck tension
• Speaking at an unnatural pitch or volume
• Dehydration, smoking, alcohol and caffeine
• Underlying vocal cord lesions

Diagnosis

An ENT doctor (otolaryngologist) or laryngologist examines the larynx:

• Laryngoscopy: a thin flexible or rigid camera through the nose or mouth to watch the vocal cords while you speak.
• Videostroboscopy: a strobe light that shows vocal cord vibration in slow motion, helping detect small lesions.
• Voice assessment by a speech-language pathologist: listening, acoustic measures, and feeling the neck muscles (laryngeal palpation).

The diagnosis is based on signs of excess tension with no other cause, or with a cause that does not fully explain the voice change.

Doctors also consider spasmodic dysphonia, a neurological voice disorder with a strained, broken voice that is treated differently.

Treatment

Voice therapy

The mainstay of treatment, usually 4 to 8 sessions with a speech-language pathologist specializing in voice:

• laryngeal massage and manual therapy to release muscle tension and lower the larynx
• semi-occluded vocal tract exercises: humming, lip trills, phonating through a straw
• resonant voice therapy: producing voice with forward vibrations in the face rather than squeezing the throat
• breathing coordination and posture work
• vocal hygiene education

Many people notice improvement within a few sessions.

Treat contributing factors

• reflux management if laryngopharyngeal reflux is present
• stress management, counseling or CBT
• treatment of vocal cord lesions; surgery is usually only after voice therapy
• addressing allergies or postnasal drip

Vocal hygiene tips

• drink plenty of water; keep the throat moist
• use a humidifier in dry environments
• avoid shouting, whispering and prolonged throat clearing
• use amplification in classrooms and large spaces
• take voice breaks during long speaking days
• limit caffeine and alcohol; do not smoke
• warm up the voice before heavy use

Outlook

Most people with MTD improve substantially with voice therapy, often within weeks. Relapses can happen during stress or after colds, but the techniques learned help bring the voice back quickly.

Frequently asked questions

What is muscle tension dysphonia?

It is a voice disorder in which the muscles around the voice box are too tense or out of balance, causing a hoarse, strained or tired voice. The vocal cords usually look healthy. It often follows a cold, heavy voice use or stress.

What are the symptoms of muscle tension dysphonia?

Typical symptoms are hoarseness, a strained or breathy voice, a voice that tires with use, throat tightness or pain when speaking, voice breaks and reduced vocal range. Symptoms often worsen through the day.

How is muscle tension dysphonia treated?

Voice therapy with a speech-language pathologist is the main treatment. It includes laryngeal massage, breathing and resonance exercises, and good vocal habits. Treating reflux, stress or underlying vocal cord problems also helps.

Can stress cause muscle tension dysphonia?

Yes. Stress and anxiety increase muscle tension in the neck and larynx, which can trigger or worsen MTD. Combining voice therapy with stress management often gives the best results.

How long does it take to recover from muscle tension dysphonia?

Many people improve within a few weeks of starting voice therapy, typically after 4 to 8 sessions. Continuing exercises and vocal hygiene helps prevent the problem returning.