Have you ever heard of Muscle Tension Dysphonia (MTD)? This little-known condition is actually one of the most common voice disorders treated by speech pathologists. Symptoms can include vocal hoarseness, strain, pain and voice cracks when speaking.

Diagnosis by an ENT doctor with nasendoscopy is essential to guide the correct treatment. With the help of an experienced voice professional, you can learn to manage and recover from this voice disorder. Here’s what you need to know about MTD and how voice therapy can help.

What is Muscle Tension Dysphonia?

Muscle Tension Dysphonia (MTD) is a term used for voice conditions where the vocal cords and surrounding muscles are tense and they constrict or spasm. When muscles are tense, the voice may sound rough, husky, hoarse, or strained and it is tiring to speak because it takes so much effort. Some people describe they are ‘pushing’ out the voice.

MTD is not contagious, nor a sign of being ill.

muscle tension dysphonia

Imagine a person with cerebral palsy who can’t control their arms/hands because of an extreme muscle spasm. This is the same for the muscles of the larynx, but we can’t see them, only hear the effect. When muscles are continually in spasm, it can be very tiring to speak because it is so effortful. Sometimes the voice will last for an extended period before tiring. At other times, the tension is so severe it may feel like choking.

MTD can vary greatly from one person to another, and from one situation to another. This makes it very frustrating for the speaker with MTD who may have a regular voice one moment, that rapidly deteriorates the next.

Types of MTD

There are two types of MTD and the differences between them will impact the muscle tension dysphonia treatment you need.

Primary MTD

This is when the muscles in your neck are tense while talking, but there are no structural abnormalities.

Secondary MTD

In Secodary MTD, the ENT doctor can see a structural/organic change to the larynx (voice box), and you may have been using increased muscle tension to compensate for this change.  For example, MTD can occur after a period of illness which caused the vocal cords to swell. You might whisper (which is straining) to get your voice out, which creates a habit of uncoordinated muscle movement that can continue after you are well again.

Learn more about the difference between Organic, Muscle Tension and Functional Neurological Voice Disorders here.

Contributing factors of Muscle Tension Dysphonia

MTD is more prevalent in women between 40-50 years. There is no single cause of MTD, so your Speech Pathologist will take an in-depth history about your; breathing, digestion, hearing, significant life events, family and work contexts. This allows the Speech Pathologist to provide holistic care to support contributing factors to the MTD not only the symptoms. Some contributing factors to this condition are: 

  • Repetitive and effortful voice use 
  • Continuous loud volume without amplification 
  • Organic trigger – An upper respiratory infection
  • Irritants – Reflux (GERD/ LPR)

Common Muscle Tension Dysphonia Symptoms

There are several common symptoms of muscle tension dysphonia including: 

  • Tight or strained, rough, husky, or hoarse voice 
  • Neck pain or tenderness 
  • Lack of vocal range when singing or speaking
  • Sudden voice breaks or fading when speaking
  • Weak ‘careful’ voice to avoid pain
  • Difficulty controlling volume
  • Vocal fatigue
  • Feeling as if there’s a lump in the throat
  • Frequently clearing the throat
muscle tension dysphonia symptoms

Common goals of people with MTD that show the impact on their lives are:

  • I want to be able to read a story to my children, grandchildren, students.
  • My voice will be able to last for a short phone conversation, a lesson, a full day..
  • I will be able to speak without pain, coughing or throat clearing.
  • I will sing again, even just for enjoyment by myself. 

Exercises for Muscle Tension Dysphonia

There are muscle tension dysphonia exercises a Speech Pathologist will demonstrate to reduce the laryngeal tension.  Sometimes, these exercises will work quickly. While in other cases, the muscles relax for a short time before they tense up again. With all therapy, home follow-up is required for lasting improvements to occur. A Speech Pathologist experienced in voice care will help you to identify the strategies that work best for you, and how to embed them into your routine. 

Voice exercises that can help with MTD may look a little strange, so the person will probably want to perform them alone. Some exercises that can be helpful will reduce laryngeal muscle tension, and may also increase the efficient use of breath support and resonance. It is important these are initially completed with a Speech Pathologist so you practice correctly:

  • Yawning and sighing
  • Humming the /mm-hhm/ sound or straw therapy 
  • Using abdominal breath support with a hierarchy of soft/noisy sounds
  • Speaking in a sad ‘sobbing’ tone
  • Speaking in a soft ‘confidential’ tone
    exercises for muscle tension dysphonia

    How to Support Someone with MTD

    Muscle tension dysphonia can impact your work, social life and even your personal identity. 

    The voice is a part of our identify and an ongoing voice disorder can also have psychological impacts. Some people with MTD will need adjusted work duties, or time off. Having a supporting work process (such as WorkCover) can make a positive difference to recovery and returning to work.

    If you’re working alongside someone with MTD, here’s what you can do to help: 

    • Do your research on MTD at the australiandysphonianetwork.org or at dysphonia.org to learn more about what they’re going through.
    • Know that the person’s experience, knowledge, and cognition aren’t impacted by the condition.
    • Pay attention to voice breaks and changes and suggest taking a rest.
    • Ask if you can take over if the other’s voice is noticeably getting worse. 
    • Have a ‘Plan B’ if you work with someone with this condition and their voice gives out.
    • Suggest recording repetitive scripts that they can play if possible.
    • Communicate by emails/messages/texts where possible.

    The Takeaway

    MTD isn’t easy to manage or to live with. Voice therapy exercises for muscle tension dysphonia can be very helpful, but it’s still essential for the surrounding community to offer help and support.  

    If you’re struggling with a weak or hoarse voice or find that your voice ‘breaks’ under strain, then you need to seek out expert help immediately. A speech pathologist with experience in voice therapy can collaborate with you and your team, to achieve your voice goals.