Muscle Tension Dysphonia Part One

May 19, 2020

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Muscle tension dysphonia (MTD) is a condition defined by increased tension in the intrinsic & extrinsic muscles of the larynx that results in a pathological disturbance of voice.

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Several studies report that MTD accounts for at least TEN TO FORTY PERCENT of visits to voice centers. SYMPTOMS typically include: hoarseness, vocal fatigue (worse at the end of the day & exacerbated by prolonged voice use), throat discomfort/tightness, chronic throat clearing (worse with voicing), effortful voice production, change in habitual pitch, reduced vocal range, muscular cramping/stiffness, & variable globus sensation (Clary, Schneider, & Coury, 2014; Craig et al., 2015). Of note, Perera et al. found a significant increase in upper esophageal pressure in patients during phonation (which can explain this globus &/or laryngopharyngeal reflux/LPR).

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MTD is divided into two different subtypes—Primary & Secondary. Primary is characterized by dysphonia in the absence of concurrent organic vocal fold pathology and is associated with excessive, atypical, or abnormal laryngeal movements during phonation without obvious psychogenic or neurologic etiology.  Secondary is characterized by excess muscle contraction that develops in association w/or as a presumed response to an identifiable organic lesion that impairs glottal function. The response of the body to the glottal malfunction is to attempt to regain “normal” function through increased activity in the intrinsic & extrinsic laryngeal musculature. Due to this increased activity, patients with long-standing primary MTD may have an increased propensity to develop organic lesions, thus creating a self-reinforcing cycle (Clary, Schneider, & Coury, 2014).

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The data that exist show a STRONG CORRELATION WITH VOICE USE. As a result, OCCUPATIONAL VOICE USERS (those whose jobs require daily intensive voice use—fitness professionals, singers, teachers, salespeople, etc.) are MUCH MORE LIKELY to be diagnosed w/MTD. High stress levels, LPR, recurrent respiratory illness, exposure to inhaled irritants, female gender, & advanced age have all been associated w/greater risk of developing MTD as well. 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, Schneider, & Coury, 2014). In addition, STRESS & ANXIETY can lead to muscle tension in the anterior (front of) neck (Ng, Lo, Lim et al., 2013). In combination w/dysregulated muscle activity, patients w/MTD experience deviations in head/neck posture w/hyperextension, short & compressed respiration, a relatively high position of the larynx, & tension of the muscles of the face. Dehqan & Scherer (2019).

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Stay tuned for more MTD info TOMORROW & a BIG announcement Friday!!

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