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What is Muscle Tension Dysphonia?

Article written by Kari A. Krein, M.S., CCC-SLP, Speech-Language Pathologist at St. Cloud ENT

What is a voice disorder?

A voice disorder is defined as a change from one’s baseline vocal quality to something different or inappropriate in quality, pitch or loudness, impacting an individual’s professional or personal/social life.

Kari A. Krein, M.S., CCC-SLP, Speech-Language Pathologist at St. Cloud ENT. Contributed photo

There are two main categories of voice disorders—organic and functional. Organic voice disorders result from anatomical abnormalities and can be structural in nature or neurogenic, affecting breathing, the laryngeal mechanism (including the vocal folds themselves) or the remaining vocal tract mechanism (everything above the vocal folds). Functional voice disorders, on the other hand, result from inefficient use of an otherwise normal vocal mechanism. Examples include vocal fatigue and muscle tension dysphonia (MTD).

What is Muscle Tension Dysphonia (MTD) and what are its symptoms?

MTD involves a change in the sound or the feel of your voice caused by excessive muscle tension in and around the voice box (larynx) that may involve the vocal folds themselves or the several surrounding accessory muscles of the larynx. This excessive tension can cause an imbalance of the subsystems required for efficient voice production. This ‘functional dysphonia’ occurs over short or long periods of time following a muscle-use pattern that may have been caused by exposure to irritants, a bout of laryngitis or other URI infections, stress or prolonged overuse.

MTD symptoms may include rough, raspy or hoarse vocal quality; poor or breathy vocal quality, or only the ability to whisper; strained or pressed vocal quality with a feeling of having to ‘push’ the voice out; pitch changes, or a voice that cuts out or fades away; the pitch of the voice may be too high or too low; vocal range may be reduced, especially in the upper registers during singing; pain or discomfort around the voice box on both sides, or even just one side, when speaking or singing; the throat can feel ‘tired’ after a period of speaking/singing.

How do you diagnose and treat MTD?

The diagnosis of MTD requires a complete clinical evaluation and an instrumental evaluation with a speech-language pathologist (SLP) specializing in voice disorders. The clinical evaluation includes taking a thorough history of the onset and progression of symptoms in addition to one’s pertinent medical/surgical history. The instrumental evaluation involves the direct visualization of the throat, including the larynx and vocal folds, with a long, thin camera placed through the nose and into your throat. The examination typically involves using a decongestant and topical numbing agent for comfort and is generally very well tolerated.

MTD is treated with a course of voice therapy with an SLP. Treatment focuses on reducing throat tension to maximize vocal efficiency through direct and indirect methods. Direct methods include training on various voice exercises/techniques as well as manual laryngeal massage to aid in the reduction of excess laryngeal tension. Indirect methods may include vocal hygiene (such as ensuring adequate hydration), acid reflux treatment and identifying and reducing vocal misuse behaviors contributing to the tension. Additional treatments outside of voice therapy that can be beneficial may include massage, acupuncture, psychotherapy or physical therapy (PT).

Find out more

If you would like to learn more about voice disorders, St. Cloud ENT, or the services provided by Kari A. Krein, M.S., CCC-SLP, contact (320) 252-0233 or (800) 450-3223, or visit

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