Muscle Tension Dysphonia, Fun #dayinthelife Video, and PYV with SOVTE!

Muscle Tension Dysphonia...

I’ve had A LOT of people ask me questions about this, & it’s something I see EVERYDAY… So here’s a full-of-info post for ya… AND CHECK OUT THE VIDEO that goes with this post for some visual examples via stroboscopy...

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MTD is an imbalance in the subsystems of voice (because of inefficient &/or hyperfunctional use of the intrinsic & extrinsic laryngeal & facial musculature). It’s often prevalent in occupational voice users because of 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 (VanHoutte et al., 2011). 

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It is important to differentiate between Primary MTD & Secondary MTD. Primary MTD is muscle tension-related dysphonia only (the imbalance in the vocal subsystems can be seen WITHOUT any anatomical abnormality)…the muscles can “work against” each other & there could even be what is termed a muscle tension gap. Often primary MTD can be associated with stress/anxiety, significant stressful life events, &/or following an upper respiratory illness. Secondary MTD is when the muscle tension/imbalance is BECAUSE of an anatomical abnormality. In this case, MTD will occur because the brain has told the body to overcompensate &/or “push harder” to “work” for vocal production; it is thought to be the body‘s natural compensatory process to adjust for the vocal injury. This can often happen because the VFs are inflamed & vibration may be impaired, or there may be glottic insufficiency (VFs don’t touch), or there may be a laryngeal dystonia, or there could be a pathology or lesion (& it’s presence can hinder efficient vibration).

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The most common symptoms of MTD are changes in vocal quality, pain or discomfort while speaking, increased effort to talk, &/or subsequent vocal fatigue with continued voice use. Some people experience globus sensation,& even changes in swallowing because of tension in the throat region. 

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There are several effective ways to manage MTD… Some include massage, myofascial release, manual therapy, prolonged stretching, laryngeal manipulation, &/or facial cupping. Other research-based voice therapy techniques include a variety of SOVTEs, VFEs, stretch and flow, resonance training, gargle technique, & CTT.  

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Occupational, recreational, & home environments may contribute to the development of MTD — extended phone use, consistent projection/command of the voice, singing, public speaking, & voice use in background noise are commonly reported in this population (Clary et al., 2014).

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Voice therapy is considered the gold standard treatment for primary MTD. It CAN also be helpful for secondary MTD (but, remembering the focus in this case should be on the anatomical abnormality that is causing the MTD). Therapy focuses on restoring the muscle balance in the vocal mechanism/re-coordinating the subsystems of voice, reducing vocal hyperfunction, & generally helping the patient understand a more efficient & healthier pattern of voice use. In very severe cases Botox can be helpful.

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Patients with MTD experience deviations in head/neck posture with hyperextension, short/compressed, respiration, a relatively high larynx position, & facial tension (Dehqan & Scherer, 2019). Stress & anxiety can lead to muscle tension in the anterior neck (Ng et al., 2013). 

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A HEALTHY, ACTIVE/mobile, & FREE body and mind will work the best, & it is important to release anything built up inside your body so that it does not “reveal itself” in your voice. Dehqan & Scherer (2019) found that manual circumlaryngeal therapy can be an effective treatment method for MTD, with the changes (because of the therapy) occurring immediately and persisting over a six month duration. They also found that voice therapy can create positive changes in vibration regularity, and that there can be a decrease in dysphonia and excess action of the paralaryngeal muscles.

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Additionally, Craig et al. (2015) found that the addition of manual therapy and circumlaryngeal massage to voice therapy has prompted evolution towards a more holistic hands-on therapy approach to the entire vocal mechanism including the neck, back, shoulders, diaphragm, and abdomen.

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Savareh et al. (2021) found statistically significant results that display positive changes in EMG & acoustic measurements, suggesting the results of SOVTE’s through VOCAL ECONOMY lead to a reduction to the load applied to the phonatory system. Meerschman et al. (2021) found that straw phonation in air led to significantly reduced medial compression both during the task & after, & that straw phonation in water led to reduced vibrational amplitude, suggesting decreased VF impact stress.

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Maxfield et al. (2015) ranked 13 SOVTEs, and found that “straw in water (& the related water bubbling produced) has been linked to a massage like effect on the VFs…Patients  normally report this improves voice production because of the relaxing effect in the larynx & pharynx…& this effect could be ideal in patients with vocal fatigue, vocal effort, &/or muscle tension”.

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Gillespie et al. (2019) found that conversation training therapy (CTT) has demonstrated efficacy in patients with MTD & benign VF lesions. Additionally, Watts et al. (2015) found significantly greater improvement in vocal handicap, maximum phonation time, & acoustic measurements of vocal function after stretch & flow voice therapy. Jafari et al. (2017) provided evidence regarding the efficacy of vocal function exercises (VFEs) in the treatment of patients with MTD.

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Watts et al. (2019) found that both stretch & flow & resonant voice therapy produced positive treatment response in speakers with MTD with no statistically significant difference in the outcome measures between the two treatments (which suggests that both are effective options for treating vocal hyperfunction & one is not superior to the other. These are just the tip of the iceberg related to the research supporting the benefits of voice therapy for MTD.

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#voxfit #voice #prioritizeyourvoice #pyv #videostroboscopy #healthyvoice #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #mtd #muscletensiondysphonia #voicetherapy #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #rebalancethevocalsubsystems 

A Day in the Life...

Check out the video at this LINK... 

#adayinthelife

Research article upon research article upon research article. (Because we love them. And it’s so important to stay up on all the new research! #ifyouarentlearningyouarentgrowing)

Pharynx and Larynx LOVE
(Because, duh..)

EMST-150 @emst150 (strengthen the expiratory muscles)

VocalMist @vocalmist (directly hydrate your VFs, reduce vocal effort, reduce effects of allergies)…

Videostroboscopy (always use a laryngeal mic and ensure it’s properly positioned to capture appropriate frequency and tracking)

Straw Phonation using the SingRing by @oovostraw (SOVTE, vocal reset, healing, rebalancing, variable occlusion, etc etc etc)

Manual therapy (using Dycem for prolonged stretching and “lingering”)

Steam (directly hydrating the mouth, nose, and upper throat.. and creating a soothed oral cavity and laryngeal region)

ARK-J device (targeting prevention of trismus related to the consequential effects of radiation therapy)

Anddd my favorite, videostroboscopy (rigid scope shown here..)

Also featured, my graduate student @kaylanicolei … we decided to have a “slight breather” of “fun” during our last (long & crazy) day together! I’m wishing her alllll the best and know she will do GREAT things as a speech pathologist!

And hey everyone.. remember to #prioritizeyourvoice today and everyday!!!

#voxfit #voice #prioritizeyourvoice #videostroboscopy #healthyvoice #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #strobe #laryngealimaging #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #headandneckcancer #trismus #pharynx #larynx #larynxlove #emst #ultrasonicnebulizer #strawphonation #steam #manualtherapy 

Anddd of course, always REMEMBER to PRIORITIZE YOUR VOICE!  

Tell me something I don’t know!  Buuuut for real, I LOVE it when (new) research proves it time and time again! SOVTEs (always) for the win! 

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“The primary goal of voice clinicians is to help clients in developing a voice which is self-perceived as more COMFORTABLE , EASIER and STRONGER; therefore, SOVTE could be an easy means to warm up the voice before the show and the rehearsals for performing actors. Further, there are few doubts that self-confidence is important in performing artists” (Di Natale et al., 2022). 

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I believe this finding can be translated to a variety of different occupational and professional voice users as well. We know that SOVTEs are beneficial warm-ups before high vocal demand and we also know they provide vocal resets and VF tissue healing, as well as a rebalancing of the vocal subsystems.

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FYI— This study’s SOVTE protocol included a series of 10 minutes of SOVTEs progressing from high to low resistance using tube in water (LaxVox) with an immersion of 3 cm in water (35cm tube length, 1 in diameter; /u/ vocalizations x20), straw phonation (10cm in length, 3mm diameter; /u/ vocalizations x20), lip trills (x10), tongue trills (x10) and humming (x10).

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It’s #prioritizeyourvoicefriday !!! Don’t forget to PRIORITIZE YOUR VOICE!!! 

How are YOU prioritizing your voice today? And everyday? As an OCCUPATIONAL VOICE USER, it should be one of your top priorities! 
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What do you need to know to keep your voice healthy?  You should understand how the voice works, how to protect and care for your voice, and how to use your voice and entire vocal mechanism in the most efficient, effective, and dynamic ways possible.  
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I’m super PASSIONATE about this population of voice users (I’m one and most of you are too!), and am HERE TO HELP! Reach out with any questions, concerns, or if you’d like to work together. Email me at [email protected] 

#voxfit #voice #prioritizeyourvoice #videostroboscopy #healthyvoice #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #sovte #semioccludedvocaltractexercises #vocalwarmup