Muscle Tension Dysphonia

Muscle tension dysphonia (MTD) is when the muscles surrounding your larynx are too tight. Your larynx, or “voice box,” contains the vocal cords that produce your voice. With MTD, an imbalance of tension in the muscles connecting to your vocal cords can make you hoarse. It’s a common type of functional voice disorder. This means that the main problem isn’t with your vocal cord anatomy. Instead, the problem is with how these muscles coordinate to make your voice.

With MTD, tight muscles keep your vocal cords from spreading apart and coming together in the carefully coordinated ways needed to produce your voice. Instead, your voice may sound weak or strained. It may hurt to speak. It may be worse at the end of the day or after vocally-demanding tasks. This can be especially difficult if you have a job that depends on you using your voice a lot, like teaching or singing.

You may need to learn how to relax these muscles before you speak easily again. You may need to retrain them, so they work correctly. For most people, voice therapy with a speech-language pathologist (SLP) fixes the issue.

Types

Determining the type of MTD helps your healthcare provider decide which treatments will work best. The types are:

• Primary: Your voice muscles tense and strain to support your voice. Your vocal cords are perfectly fine.
• Secondary: Your voice muscles tense and strain to make up for an underlying issue with your vocal cords.

Symptoms of muscle tension dysphonia

Symptoms include:

• Hoarseness
• Straining to speak
• A throat that feels sore or tight
• Tiring quickly when you try to talk
• A voice that sounds raspy, gravelly, weak, breathy or shaky
• Not having as much of a vocal range when you talk or sing
• Feeling like there’s a lump in your throat after talking

Muscle tension dysphonia causes and risk factors

Typically, the muscle tension begins when you overuse your voice or have other strain on your larynx, like a bad cough. Sometimes, MTD happens because of tension or injury in your neck, chest or shoulder muscles.

Possible causes include:

• Acid reflux
• Allergies
• Chronic laryngitis
• Respiratory infections
• Stress or anxiety
• Vocal cord disorders or injuries
• Speaking too loudly or at an uncomfortable pitch (too high or low) for too long
• Neck, back, chest and shoulder disorders
• Connective tissue disorders

MTD is a common cause of hoarseness. People who develop it often work jobs that require them to speak a lot. That means teachers, public speakers and singers are especially at risk.

Think of it this way: overuse injuries and muscle strains are common in athletes. If you use your voice for a living, you’re a vocal athlete of sorts. And this means the muscles that power your voice are more likely to experience tension and strain, just based on sheer repetition. Using muscles the wrong way repeatedly only makes things worse.

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms and how they’re impacting your life. They’ll feel your neck muscles and listen to you speak. They’ll analyze characteristics of your speaking voice that indicate problem areas.

They’ll use a flexible scope with a camera that goes down your nose to view your vocal cords up close. This is called a videostroboscopy. It shows how your vocal cords and voice box (larynx) work when you speak.

How is it treated?

Voice therapy is the main treatment for MTD. Your speech-language pathologist will teach you how to use your voice without harming your muscles. Treatment often involves in-person sessions. Your provider will identify problems with how you’re using your voice. They’ll teach you exercises to practice at home to fix them.

Therapy may involve:

• Breathing exercises to help you use more of your breath to power your voice
• Voice exercises designed to reduce or “offload” tension
• Instruction on posture, so it’s easier to use your diaphragm (the muscle under your lungs) to power your breath
• Manual therapy or massage to release tight muscles
• Relaxation techniques to help manage stress

You may also need treatments for underlying conditions related to MTD. Physical therapy may help with neck problems. Medical treatment of laryngitis may reduce the tension in your body that leads to MTD.

When should I see my healthcare provider?

You’ll see your speech-language pathologist regularly during voice therapy. It’s important that they can check on your progress so they can adjust treatment as needed. This can help you see improvements faster. You’ll need to practice at home, too. Your SLP will help you stick to a plan to get your voice back on track.

Can you fully recover from muscle tension dysphonia?

Yes. Many people recover with treatment. But your timeline depends on how severe your symptoms are and what’s causing MTD. With regular voice therapy, people with mild symptoms may recover within a matter of weeks. If symptoms are more severe, it may take several months of voice therapy before you get your old voice back.

It’s also important to treat underlying conditions that may be contributing. Even then, you’ll likely also need voice therapy to unlearn any muscle movements you’ve picked up that cause tension or injury.