Muscle Tension Dysphonia

One of the most common voice disorders we treat in speech therapy is muscle tension dysphonia (MTD). The term dysphonia means there is something wrong with the voice. However, muscle tension dysphonia can also refer to a voice that sounds normal, but causes pain, discomfort, or fatigue to the speaker. MTD is known as a functional disorder, meaning that there is nothing structurally wrong with the voice such as nodules, polyps, paralysis, etc. Instead, the muscles do not function properly, which causes poor sound, discomfort, or a sensation of increased effort.  Different individuals may have very different symptoms of MTD. In fact, MTD can mimic most structural voice disorders.

Possible vocal characteristics:

  • rough, hoarse, gravely, or raspy
  • weak, breathy, airy, or leaky
  • strained, pressed, squeezed, tight, tense, choked, or effortful
  • jerky, shaky, or halting
  • suddenly cutting out, squeezing shut, breaking off, changing pitch, or fading away
  • giving out gradually, or becoming weaker or more tense as voice use continues
  • excessively high or low pitch
  • inability to produce a loud or clear voice
  • inability to sing notes that they used to

Possible sensations:

  • pain or discomfort in the throat area associated with voice use
  • a tight choking sensation associated with vocal use
  • a sensation of fatigue or effort that increases with vocal use
  • an area of the neck is tender to the touch
  • a feeling of the need to clear the throat frequently
  • a feeling of a lump in the throat

Common causes:

  • prolonged illness
  • continued vocal use during laryngitis due to illness
  • overuse
  • under use (such as after a surgery)
  • trauma, such as an injury, chemical exposure, or an emotionally traumatic event

These common causes may lead to an abnormal vocal response, causing the individual to compensate by using extra effort while talking. The onset of MTD can be very subtle. The individual is usually unaware of the extra effort, but this extra effort typically recruits muscles that are not part of the larynx itself. The result may or may not be a stronger voice, but it usually starts a “snowball effect” where more and more effort is required. This may continue for months or even years before the individual becomes aware that his or her voice is abnormal.

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