While muscle tension dysphonia (MTD) may not be a term you’re familiar with, this voice disorder is more common than many people realize–especially in this era of COVID-19.

What is muscle tension dysphonia? Without the proper coordination of breathing and muscle movement, the vocal system doesn’t work properly. MTD occurs when a person exerts too much pressure on their laryngeal muscles (also known as the “voice box”), causing their voice to sound tight or strained.

While that may seem pretty straightforward, MTD is often misdiagnosed, as there is no direct test for this condition. Many people who have MTD will visit a slew of doctors and other specialists before stumbling upon the right licensed speech-language pathologist, who can diagnose MTD with a thorough examination.

What causes muscle tension dysphonia?

The cause of MTD is often unknown, and it typically starts without any warning. Research has indicated that it could be caused by acid reflux, exposure to smoke, or an upper respiratory infection like a cold or flu.

MTD can be associated with stress and anxiety. Research has shown that when people are under periods of stress, the muscles that control the voice box can become tense.

MTD can also be caused by excessive demand on the voice. That’s where COVID comes in. Many people have been straining their voices to be heard while wearing a mask or talking on video calls, especially those who speak often in their work, like teachers.

What are the symptoms of muscle tension dysphonia?

MTD has an array of symptoms, including:

  • Strained voice
  • Hoarse, breathy, and/or rough-sounding voice
  • Tightness and even muscle aches in the throat
  • Sudden breaks in the voice when speaking
  • Neck that is tender to the touch
  • Feeling the need to clear the throat frequently
  • Feeling a lump in the throat

The two types of muscle tension dysphonia

There are two forms of muscle tension dysphonia:

Primary MTD is when the muscles in the neck become quite tense when speaking, but there is no visual sign that anything is wrong in the larynx, or voice box.

Secondary MTD occurs when there is a visual sign that something is wrong, and other muscles compensate for the problem to produce speech. In doing so, these muscles become overused, since they’re not typically involved in producing speech.

If left untreated, MTD is likely to grow worse with time. Constant increased muscle tension can lead to painful muscles and the inability to produce a voice. In very rare and severe MTD cases, the vocal fold can be damaged, causing nodules or cysts to form. Mild cases of MTD can resolve if the person learns to manage the root of the problem, such as stress or voice overuse.

How is muscle tension dysphonia diagnosed?

A speech-language pathologist, also known as a speech therapist, diagnoses MTD through the following process:

  • Obtaining the patient’s medical history: how and when the voice problem began and the current ways the person is taking care of their voice
  • Performing a comprehensive voice evaluation consisting of an examination of the person’s head, neck, and larynx
  • Assessing the person's voice use patterns and how much and how loudly they speak—essentially, what their voice sounds like
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A video-laryngostroboscopy (a mouthful of a word!) may also be recommended as part of the diagnosis process. This is a visual exam of how your vocal folds vibrate to create sound. It helps find any lesions, stiffness, paralysis, muscle strain, and abnormal movements.

A video-laryngostroboscopy can be performed by a licensed speech-language pathologist, an otolaryngologist, or an ENT doctor.  A tiny camera attached to a small tube called an endoscope is inserted through your nose. The camera takes slow-motion video images of your vocal folds and larynx.

The exam only takes one or two minutes, and you may receive anesthetic nose spray to make the experience more comfortable.

How to treat muscle tension dysphonia

Voice therapy with a skilled speech-language pathologist is usually recommended as treatment for MTD. Voice therapy teaches you how to:

  • Relax your throat muscles
  • Improve your breath support to produce speech efficiently
  • Use the the right oral resonance, which is the air that flows through your mouth and nose while speaking
How to Find and Choose the Perfect Speech Therapist
Choosing a speech therapist isn’t a decision to take lightly. In this article, we break down several important considerations to help you find the ideal speech therapist for you and your family.

As part of your treatment, your speech therapist will teach you breathing and voice exercises. These exercises will help you decrease throat strain and find the best pitch and volume to speak with a strong and healthy voice. The main objective is to speak with minimal vocal effort.

During speech therapy, your speech therapist may recommend laryngeal massage and myofascial release. This consists of gentle stretching and massaging in the head, neck, and chest area where tension may be present. Many people report relief of throat strain and discomfort after these interventions. And your speech therapist will teach you how to complete these massages yourself to relax the muscles even more.

MTD can be painful and frustrating, but there is effective treatment for it. A speech-language pathologist can provide the right exercises and relaxation techniques to get your vocal system back to good health. If you suspect you may be dealing with MTD, contact a speech therapist for an evaluation.