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University Of Pittsburgh

Dapartemen Of Otolaryngologi
Muscle Tension Dysphonia

Understanding the Disorder


Muscle Tension Dysphonia (MTD)
The term “muscle tension dysphonia” is a general term for an
imbalance in the coordination of the muscles and breathing patterns
needed to create voice. This imbalance can be seen without any
anatomical abnormality (primary MTD) or in the presence of an
anatomical abnormality (secondary MTD). In the case of secondary
MTD, the muscle tension is thought to be the body’s natural
compensatory process to adjust for the vocal injury. This section will
discuss primary MTD.

Stress and Anxiety


Primary MTD can be associated with stress and anxiety. Recent
research has shown that under periods of stress, the muscles that
control the voice box become tense. Periods of prolonged muscle
tension in the voice box can lead to an incoordination of the vocal
control system.

Causes
Primary MTD often occurs following an upper respiratory illness, such
the cold or flu. In the case of an upper respiratory tract infection, the
muscular imbalance is not thought to be connected to stress and
anxiety. Significant stressful life events, such as the loss of a loved
one, can cause muscle tension dysphonia as well.

Symptoms
Muscle tension dysphonia is a highly variable condition. The most
common symptom of primary MTD is a change in voice quality,
ranging from mild to severe and it is often associated with pain or
discomfort while speaking. The voice can be affected during speaking,
singing or both. Often, hoarseness will be associated with an
increased effort to talk and subsequent fatigue or tiring of the voice
with continued use.

Common Symptoms Associated with MTD


University Of Pittsburgh
Dapartemen Of Otolaryngologi
 Vocal fatigue
 Unreliable voice
 Low, gravely voice
 Voice breaks
 Airy or breathy voice
 Inability to sing
 Hoarse and rough quality
 Extra force needed for loud voice
 Vocal symptoms worsen with stress
 Inconsistent voice
 Voice sometimes returns to normal

Diagnosis
How is the diagnosis of MTD made?
1. Patient History: A history of how the voice problem started and an
evaluation of voice and speaking behaviors are important steps in the
diagnosis of primary MTD.
2. Speech-Language Pathology Evaluation

 Examination by a speech-language pathologist is very important


in the diagnosis of muscle tension dysphonia.
 Improvement in voice through trial voice therapy techniques is
key to determining that the vocal disorder is due to a muscular
imbalance.
 Acoustic and aerodynamic measurements are also valuable
assessment tools to determine normal voice and breathing
behaviors.

3. Laryngoscopy and Stroboscopy

 Careful examination of the vocal folds is essential for making the


diagnosis of primary MTD. It is a diagnosis of exclusion;
therefore, careful examination of the vocal folds is necessary to
rule out anatomical abnormalities.
 Flexible laryngoscopy allows the clinicians to observe some
muscular patterns during speaking.
 Stroboscopy allows the examiner to assess the mucosal wave as
a marker for vocal fold vibration.

4. Investigation for Other Associated Abnormalities


University Of Pittsburgh
Dapartemen Of Otolaryngologi
 The diagnostic process should also focus on looking for
important associated factors, such as:
o Reflux
o Allergies
o Side effects of medications (e.g., diuretics and
antihistamines)
o Hormonal Imbalance

Treatment
Voice Therapy
Voice therapy is the gold standard treatment for primary MTD. There
are no other treatments that can restore the muscle balance in the
vocal mechanism. Voice therapy helps the patient improve vocal
symptoms through exercises and techniques geared at improving the
way the body (muscles, lungs etc.) work together to create voice.

Behavioral Counseling
In cases of primary MTD associated with stress or anxiety, it can be
very helpful for the patient to work with a counselor to reduce stress in
addition to completing voice therapy.

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