Muscle Tension Dysphagia (MTDg)
What is MTDg?
Dysphagia is a medical term used with someone who has difficulty swallowing food, liquids, pills, and/or saliva. Sometimes the reason is clear-cut (after having a stroke or surgery) but some swallowing problems don’t have an obvious underlying cause.
Muscle Tension Dysphagia is a swallowing disorder that is caused by a muscle tension imbalance in the upper body including the larynx, neck, jaw, tongue, and/or upper torso. This imbalance can be caused by irritants (reflux, toxic exposure, allergies, etc), emotional concerns and anxiety, and poor use or overuse of upper body muscles/mechanics.
Other symptoms can include:
Painful swallowing (odynophagia)
Choking or coughing while eating
Hoarse voice (dysphonia)
Feeling that something is stuck in your throat (globus sensation)
Vocal cord dysfunction
How is it diagnosed?
MTDg is a diagnosis of omission, meaning that we only look to this diagnosis when nothing else explains the symptoms. Before diagnosing MTDg, your care team should first rule out all other possible causes including:
Neurological diseases (including Parkinson’s and other dementias)
Esophageal issues (like strictures or webs)
History of head and neck cancer or radiation to the upper body
The patient should be evaluated by an ENT/laryngologist and speech pathologist. They will take a detailed history and complete various instrumental swallowing and voice assessments like a Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Modified Barium Swallow Study (MBSS), and/or videostroboscopy to make an accurate diagnosis.
How do you treat MTDg?
First identify irritants and eliminate them. Treat reflux with medication/diet changes, reduce allergies, see a psychiatrist/therapist, pulmonologist for respiratory concerns, etc.
With normal dysphagia, a patient would see a Speech Language Pathologist to strengthen and coordinate the swallow, but research has shown that traditional dysphagia treatments can actually increase symptoms of laryngeal muscle tension (Kang & Lott, 2020, p. 1596). A Speech Language Pathologist who specializes in voice can help to decrease laryngeal muscle tension with voice therapy similar to the treatment for Muscle Tension Dysphonia. Therapy can include various resonant voice tasks, breathing tasks to promote easy diaphragmatic breathing, and manual therapy designed for each patient’s specific needs.
Kang, C. H., & Lott, D. G. (2020). Muscle Tension Dysphagia Evaluation and Treatment. Perspectives of the ASHA Special Interest Groups, 5(6), 1593–1597. https://doi.org/10.1044/2020_persp-20-00069
Kang, C. H., Hentz, J. G., & Lott, D. G. (2016). Muscle tension dysphagia: Symptomology and theoretical framework. Otolaryngology Head and Neck Surgery, 155(5), 837–842. https://doi.org/10.1177/ 0194599816657013
Roy, N., Bless, D. M., Heisey, D., & Ford, C. N. (1997). Manual circumlaryngeal therapy for functional dysphonia: An evaluation of short- and long-term treatment outcomes. Journal of Voice, 11(3), 321–331. https://doi.org/10.1016/s0892-1997(97) 80011-2
Titze, I. R. (2018). Major benefits of semi-occluded vocal tract exercises. Journal of Singing, 74(3), 311–312. https://www. thefreelibrary.com/Major%20Benefits%20of%20Semi-Occluded %20Vocal%20Tract%20Exercises.-a0523609627
Watts, C. R., Hamilton, A., Toles, L., Childs, L., & Mau, T. (2015). A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia. The Laryngoscope, 125(6), 1420–1425. https://doi.org/10.1002/lary.25155
Leslie Wegner, M.S., CCC-SLP, is a speech pathologist and voice teacher who specializes in singing/professional voice, swallowing, accent modification, and AAC. She is the owner of North Texas Voice and Speech, a member of ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and is a proud Veteran of the US Army Band. Connect at www.ntxvoice.com, Instagram, and Facebook.