More on Muscle Tension Dysphonia...

May 21, 2020

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Muscle Tension Dysphonia Part Two: The Importance of a Whole Body, Mind, and Voice Treatment Approach...

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Inefficient &/or hyperfunctional use of the muscles of the larynx, pharynx, jaw, tongue, neck & respiratory system can contribute to an imbalance in the subsystems of voice. This is often seen in professional voice users (fitness instructors, teachers, salespeople, singers, etc.) w/higher vocal demands, as they not only have daily prolonged voice use but also RELY ON THEIR VOICE to CONTROL, ENTERTAIN, or CONVINCE their audience (Van Houtte, Van Lierde, & Claeys, 2011).

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It is speculated that muscular restrictions occur when connective tissue remodels in response to tension & stress. Therapy aims to decrease such restrictions w/in muscle groups & surrounding structures to improve function. Voice therapy has been strengthened by the inclusion of circumlaryngeal massage/manual therapy: this has prompted evolution towards a more holistic hands-on therapy approach to the entire voicing mechanism including the neck, back, shoulders, diaphragm, & abdomen (Craig, et al, 2015).

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The STRETCHING & RELEASE of musculature outside of just the laryngeal muscles is important as dysphonia can arise from muscle tension that extends beyond this focused region (Craig et al., 2015) & it has been proposed that a proportion of voice therapy failures in patients w/MTD relate to inadequate reduction of muscle tension (Aronson, 1990). Manual circumlaryngeal therapy aims to correct laryngeal position & relax paralaryngeal & cervical muscles resulting in improved voice quality. Dehqan & Scherer (2019) found that this therapy can be an effective method for voice rehabilitation in patients w/MTD & the changes due to therapy were immediate AND persistent over a 6 month duration following termination of treatment sessions (relative to both objective & subjective measures). They also found that voice therapy can create positive changes in vibration regularity & that there can be a decrease in hoarseness & excessive action of paralaryngeal muscles.

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Voice production requires whole-body muscular engagement: posture related to the spine, shoulders, & hip position can impact voice as can expiratory muscles via maintenance of adequate pressure for voicing. Resonance is also impacted by muscles, as it is affected by the intricate coordination of the muscles that alter tongue position, larynx height, & mouth opening. Therefore, muscle imbalances can disrupt any & all aspects of the mechanism—respiration, phonation, resonance/articulation—& produce symptoms of MTD.  (Craig et al,. 2015).

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Treatment of MTD focuses on rebalancing the subsystems of voice (respiration, phonation, resonance, articulation), ultimately resulting in restoration of proper vibratory parameters & improved efficiency of voice production (Roy et al., 2009; Roy & Bless, 1998). 

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