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Muscle Tension Dysphonia: What is it and what can I do?

What is it?


Muscle Tension Dysphonia is a condition that affects the voice, it occurs when the extrinsic and intrinsic muscles that affect the larynx and vocal folds become either overly tight this can be through overuse or weaker through underuse. This affects the balance of muscle system of the voice and can cause problems with the voice. It will normal present as a hoarse voice, but can progress to loss of range, issues with pitch, a tight sensation, problems with swallowing, an pain in the throat.

Symptoms?

  • Rough, hoarse or develop a raspy quality

  • Tight, tense, strained with a constricted or 'squeezed' quality

  • Breathy, weak and quiet, fading out towards the end of sentences

  • Intermittent with voice 'breaks' where the sound cuts out briefly or where voice is slow to start vibrating

  • Too high or low in pitch, or the pitch may be unstable

Changes in sensation when speaking or singing may occur including:

  • Tiredness, aching or pain especially when speaking/singing loudly against noise or for long periods

  • Dryness or scratchiness

  • A sense that talking is effortful and hard work


Symptoms can range in severity and for many will normally increase as we use our voices with them becoming fatigued through heavy use, and resulting in any if the symptoms described.

How is it diagnosed?

It can be initially diagnosed through an assessment taking a detailed history of your symptoms and a physical examination of posture, movement and through palpation of your extrinsic vocal muscles by a skilled and knowledgeable physio. If further examination is required then a referral can be arranged to an Ear, Nose and Throat Consultant and/or Speech and Language Therapist where further investigations can be carried out such as a laryngoscopy (camera investigation), for singers this should be carried out under stroboscopy for a more detailed examination of the function of the vocal folds.

How is it treated?

The underlying causes of the muscle tension dysphonia need to be treated, this may be through a combination of treatments and changes. Some lifestyle factors may need to be altered to improve vocal health, vocal technique may also need to be improved to improve muscle function and activity. From a physical perspective we can also address any postural issues that may be present helping to improve muscle strength and tension. Massage to key vocal muscles can also be carried out, this is know as laryngeal manual therapy or a vocal massage. It focusses on restoring mobility to the extrinsic vocal muscles to improve the intrinsic muscle activity of the vocal folds.

What causes muscle tension dysphonia?

It is commonly a combination of factors such as:

  • Long-term patterns of ineffective voice use

  • Sudden changes in voice production associated with a period of vocal overuse, an infection or emotional stress

  • Compensation for an underlying vocal fold problem such as a cyst, paresis, or fatigue in the vocal muscles

  • A 'guarding' response to acid reflux or some other irritant

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