What Is Muscle Tension Dysphonia, and How Is It Treated?
Abby Barnes, M.S., CCC-SLP
Muscle tension dysphonia (MTD) is a common type of voice disorder that occurs when a person puts too much pressure on their laryngeal muscles (or “voice box”). This causes the voice to sound tight or strained. MTD is often misdiagnosed, but it can be identified and treated by a licensed speech-language pathologist.
Key takeaways
Muscle tension dysphonia (MTD) is a common voice disorder that occurs when a person exerts too much pressure on the muscles around the larynx.
Possible causes of MTD include acid reflux, exposure to smoke, excessive demand on the voice, a cold or flu, or stress.
Symptoms of MTD may include a strained, hoarse, or breathy voice; a feeling of tightness or a "lump" in the throat; or sudden breaks in the voice when speaking.
There are two types of MTD. In primary MTD, the muscles in the neck become tense when speaking, but there is no visual sign of problems in the larynx. In secondary MTD, there is a visual sign that something is wrong, and other muscles compensate for it to produce speech.
MTD can be diagnosed by a speech-language pathologist and treated with voice therapy. Therapy includes techniques and exercises to relax your throat muscles and improve your breath support for speech.
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Get startedWhat is muscle tension dysphonia?
Muscle tension dysphonia (MTD), also called muscle misuse dysphonia, is more common than many people realize. It's a voice disorder that happens when a person puts too much pressure on the muscles around the larynx. This affects the voice box, causing the voice to sound tight, hoarse, or strained.
MTD occurs more often among 40- to 50-year-old adults, especially women. MTD is often misdiagnosed, as there is no direct test for this condition. "Many people who have MTD will visit several doctors and other specialists before stumbling upon the right speech-language pathologist, who can diagnose MTD with a thorough examination," says Alexis Irazoque, M.S., L/SLP, a speech-language pathologist with Expressable.
What causes muscle tension dysphonia?
The cause of MTD is often unknown, and it typically starts without any warning. Research has shown that it could be caused by acid reflux, exposure to smoke, or an upper respiratory infection like a cold or flu. MTD can be associated with stress and anxiety. Studies show that when people are under periods of stress, the muscles that control the voice box can become tense. MTD can also be caused by excessive demand on the voice. Many jobs require high use of the voice, such as teaching, coaching, and working in loud environments.
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What are the symptoms of muscle tension dysphonia?
MTD has an array of symptoms, including:
Strained voice
Hoarse, breathy, and/or rough-sounding voice
Tightness and even muscle aches in the throat
Sudden breaks in the voice when speaking
Neck that is tender to the touch
Feeling the need to clear the throat frequently
Feeling a lump in the throat
The two types of muscle tension dysphonia
There are two forms of muscle tension dysphonia, called primary and secondary.
Primary muscle tension dysphonia
Primary MTD is when the muscles in the neck become quite tense when speaking, but there is no visual sign that anything is wrong in the larynx, or voice box.
Secondary muscle tension dysphonia
Secondary MTD occurs when there is a visual sign that something is wrong, and other muscles compensate for the problem to produce speech. In doing so, these muscles become overused, since they’re not typically involved in producing speech.
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How is muscle tension dysphonia diagnosed?
If left untreated, MTD is likely to grow worse with time. Constant increased muscle tension can lead to painful muscles and the inability to produce a voice. In very rare and severe MTD cases, the vocal fold can be damaged, causing nodules or cysts to form.
"Mild cases of MTD can resolve if the person learns to manage the root of the problem, such as stress or voice overuse," Irazoque says. That's why it's important to contact a speech-language pathologist, also known as a speech therapist, if you're noticing voice changes.
A speech therapist diagnoses MTD through the following process:
Obtaining the patient’s medical history: how and when the voice problem began and the current ways the person is taking care of their voice
Performing a comprehensive voice evaluation consisting of an examination of the person’s head, neck, and larynx
Assessing the person's voice use patterns and how much and how loudly they speak—essentially, what their voice sounds like
A video-laryngostroboscopy (a mouthful of a word!) may also be recommended as part of the diagnosis process. This is a visual exam of how your vocal folds vibrate to create sound. It helps find any lesions, stiffness, paralysis, muscle strain, and abnormal movements. A video-laryngostroboscopy can be performed by a licensed speech therapist, an otolaryngologist, or an ENT doctor. A tiny camera attached to a small tube called an endoscope is inserted through your nose. The camera takes slow-motion video images of your vocal folds and larynx. "The exam only takes one or two minutes, and you may receive anesthetic nose spray to make the experience more comfortable," Irazoque says.
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Muscle tension dysphonia treatment
Voice therapy with a skilled speech therapist is usually recommended as treatment for muscle tension dysphonia. Voice therapy for MTD includes breathing and vocal exercises. You will learn how to:
Relax your throat muscles
Improve your breath support to produce speech efficiently
Use the the right oral resonance, which is the air that flows through your mouth and nose while speaking
As part of your treatment, your speech therapist will teach you breathing and voice exercises. These exercises will help you decrease throat strain and find the best pitch and volume to speak with a strong and healthy voice. The main objective is to speak with minimal vocal effort.
Your speech therapist will teach you breathing and voice exercises to help you decrease throat strain and find the best pitch and volume.
During speech therapy, your speech therapist may recommend laryngeal massage and myofascial release. This consists of gentle stretching and massaging in the head, neck, and chest area where there is tension. "Many people report relief of throat strain and discomfort after these massages," Irazoque says. "And your speech therapist will teach you how to do them yourself to relax the muscles even more."
MTD exercises you can try at home
Home exercises to help with muscle tension dysphonia should be done under the guidance of your speech therapist. Your therapist might teach you techniques such as:
Straw phonation: This exercise helps you stretch and “unpress” the vocal cords. This can provide relief from vocal tension, vocal fatigue, or throat pain.
Lip trills: This exercise can help you relax and use your voice more efficiently.
Laryngeal massage (described above)
MTD can be painful and frustrating, but there is treatment for it, and you can recover. A speech therapist can provide the right exercises and relaxation techniques to get your voice back to good health. If you think you may have MTD, contact a speech therapist for an evaluation.
Frequently asked questions (FAQs)
There are two types of muscle tension dysphonia. Primary MTD is when the muscles in the neck become tense when speaking, but there’s no visual sign of a problem in the larynx, or voice box. In secondary MTD, there is a visual sign of a problem, and other muscles compensate for it in order to produce speech. In doing so, these muscles become overused.
No, muscle tension dysphonia is not permanent. You can recover your voice through voice therapy with a speech-language pathologist. In therapy, you’ll learn exercises and healthy vocal habits that can restore and preserve your vocal function.
The best treatment for muscle tension dysphonia is voice therapy with a speech-language pathologist. Your speech therapist will develop a personalized treatment plan that may include vocal and breathing exercises, as well as techniques such as laryngeal massage. It’s important to practice these exercises at home, but following the guidance of your speech therapist.
With regular voice therapy, many people see improvements within one to three months. But your recovery timeline depends on the cause of your MTD and how severe your symptoms are. With more severe symptoms, it may take several months of voice therapy to restore your voice.
Yes, stress and anxiety can cause muscle tension dysphonia. Research shows that the muscles that control the voice box can become tense when people are under stress.
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