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What is Muscle Tension Dysphonia?

So you've been having trouble with your voice and you've gone to see your ENT. They've diagnosed you with Muscle Tension Dysphonia (MTD). But what is Muscle Tension Dysphonia? And what can you do to help yourself?

MTD presents as voice quality change without structural or neurological laryngeal change. It is characterised by excessive extrinsic or intrinsic laryngeal muscle activity resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production

There are two types:

  • Primary Muscle Tension Dysphonia: no lesion or paralysis but there is excessive muscle overactivity.

  • Secondary Muscle Tension Dysphonia: changes to muscle activity secondary to an underlying issue with the vocal folds or weakness.

Other names for MTD also include:

  • Hyperfunctional dysphonia

  • Muscle Misuse dysphonia

  • Hyperkinetic dysphonia

  • Mechanical voice disorder

  • Functional hypertensive dysphonia

  • Laryngeal tension-fatigue syndrome

  • Laryngeal isometric dysphonia

To understand MTD, it is probably best to begin thinking about how the voice works. There are lots of difference muscles that work to produce your voice. Speech occurs when air flows from the lungs, up the windpipe (trachea) and through the voice box (larynx). This causes the vocal cords to vibrate, creating sound. Sound is shaped into words by the muscles controlling the soft palate, tongue and lips.

In order for the voice to work, there should be some tension in these muscles. If they are too floppy, the voice can be weak. If the muscles are too tight, the voice will become strained and can even be painful. It is also important to consider the role of the diaphragm and posture. A person's breathing pattern can have a significant impact on their voice as well.

Muscle Tension Dysphonia Anatomy

What causes MTD?

There are a few things which can cause MTD:

  1. Irritants

  2. Compensation post laryngitis/flu/sickness

  3. Stress

  4. Technical misuse of voice

  5. Over compensation for minor glottic insufficiency

  6. Psychogenic factors

While the initial cause may go away, the voice changes remain because of the change in the muscle activation pattern.

What are the symptoms of muscle tension dysphonia?

The most common symptoms of muscle tension dysphonia include:

  • Voice that sounds rough, hoarse, gravelly or raspy.

  • Voice that sounds weak, breathy, airy or is only a whisper.

  • Voice that sounds strained, pressed, squeezed, tight or tense.

  • Voice that suddenly cuts out, breaks off, changes pitch or fades away.

  • Voice that “gives out” or becomes weaker the longer the voice is used.

  • Pitch that is too high or too low.

  • Difficulty singing notes that used to be easy.

  • Pain or tension in the throat when speaking or singing.

  • Feeling like the throat is tired when speaking or singing.

How is muscle tension dysphonia diagnosed?

Muscle tension dysphonia is primarily diagnosed through the evaluation of your voice and vocal folds with a Videostroboscopy. That is the process of using a special camera and light to observe the vocal folds vibrating in apparent slow motion. In Australia, this is usually done by an ENT.

Muscle Tension Dysphonia Treatment

Treatment for muscle tension dysphonia primarily includes voice therapy with a speech therapist to reduce throat tension and maximise vocal efficiency. Other treatments that help to decrease tension such as massage, acupuncture, or Physiotherapy, can help compliment your voice therapy.

There is positive research supporting the use of manual therapy from a trained Physiotherapist to help recover from MTD. Unsurprisingly, a 2021 study on those with MTD and neck pain found that a holistic approach to manual therapy for MTD patients was best. It is preferred to find a Physiotherapist who can assess and treat muscle imbalances and substitution patterns in the scalenes and diaphragm, supra and infrahyoids and transverse abdominis/rhomboids as well as anterior neck tissue restrictions.

If you suffer from MTD and are looking for other treatment options that support the work you are already doing with your speech therapist or vocal coach, please reach out or read more vocal physiotherapy here.


D'haeseleer E, Claeys S, Van Lierde K. The effectiveness of manual circumlaryngeal therapy in future elite vocal performers: a pilot study. Laryngoscope. 2013 Aug;123(8):1937-41. doi: 10.1002/lary.24050. Epub 2013 Apr 5. PMID: 23564361.

Tate AD, Tomlinson CA, Francis DO, et al. Physical Therapy for Muscle Tension Dysphonia with Cervicalgia. Ear, Nose & Throat Journal. 2021;0(0). doi:10.1177/01455613211063239

Tomlinson CA, Archer KR. Manual therapy and exercise to improve outcomes in patients with muscle tension dysphonia: a case series. Phys Ther. 2015 Jan;95(1):117-28. doi: 10.2522/ptj.20130547. Epub 2014 Sep 25. PMID: 25256740; PMCID: PMC4295082.

Van Lierde KM, De Bodt M, Dhaeseleer E, Wuyts F, Claeys S. The treatment of muscle tension dysphonia: a comparison of two treatment techniques by means of an objective multiparameter approach. J Voice. 2010 May;24(3):294-301. doi: 10.1016/j.jvoice.2008.09.003. Epub 2009 Jun 4. PMID: 19497709.


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