Muscle tension dysphonia

What is muscle tension dysphonia

Muscle tension dysphonia (MTD) is a voice problem involving excessive or poorly coordinated muscle activity around the voice box. It can occur on its own or as compensation for another vocal-cord problem. The voice may sound hoarse, tight, strained or weak.

What causes it

MTD can be triggered by a number of factors, including:

• Vocal overuse or misuse (e.g. shouting, singing, excessive talking).
• Stress or anxiety.
• Poor posture or breathing technique.
• Reflux (acid coming up from the stomach).
• Recovery after a cold or laryngitis.
• Underlying voice conditions or compensatory patterns.

Symptoms

• Hoarse or breathy voice.
• Strained or tight voice.
• Throat discomfort or a sensation of a lump.
• Vocal fatigue – voice tires easily.
• Variability in voice quality throughout the day.
• Difficulty projecting the voice.

Diagnosis

Assessment usually involves an ENT or voice specialist and a speech and language therapist. A camera examination of the voice box is important to look for other causes and guide treatment.

Treatment

The main treatment for MTD is speech and language therapy. This focuses on:

• Reducing muscle tension.
• Improving voice technique.
• Teaching better breathing and posture.
• Managing contributing factors like stress or reflux.

You may be referred for therapy after review by an ENT specialist.

Self-help tips

• Avoid shouting or whispering.
• Rest your voice if it feels tired.
• Stay well hydrated.
• Practise good posture.
• Manage stress through relaxation or breathing techniques.
• Avoid throat clearing – sip water or swallow instead.

When to seek help

Arrange a GP review if hoarseness lasts more than 3 weeks, keeps returning or affects your work or daily life. Seek advice sooner if it is worsening or you have a neck lump, pain on swallowing, coughing up blood or unexplained weight loss.

Call 999 if you have severe breathing difficulty or noisy breathing with distress.