Primary and Secondary Muscle Tension Dysphonia (MTD)
Muscle Tension Dysphonia is term used to describe a a functional voice disorder, meaning the vocal structures are free of things like nodules and lesions, but the voice doesn't sound normal. It's characterized by a muscle tension imbalance in the laryngeal area, neck, jaw, tongue, and can even include the upper torso. Primary MTD is diagnosed when there is no obvious cause, and secondary MTD develops as a reaction to another voice issue, like working hard to speak with nodules, reflux symptoms, or a paralyzed vocal fold.
Symptoms can include hoarseness, vocal strain, increased effort to speak, decreased loudness, vocal fatigue, throat pain at rest and while speaking, breathiness, pitch changes, and even aphonia. These symptoms can come and go, and even vary throughout the day and between activities.
The patient should be evaluated by an ENT/laryngologist and speech pathologist who complete videostroboscopy, aerodynamic assessment, and behavioral voice evaluation to make an accurate diagnosis. The SLP leads the patient in various therapeutic techniques and strategies to offload laryngeal tension and help learn new motor patterns for efficient, resonant phonation.
Effective treatment options include myofascial release/manual therapy, laryngeal reposturing, and behavioral voice therapy to balance vocal subsystems for resonant, easy speech. They may target breathing and upper-body relaxation techniques to further enhance vocal efficiency. Sometimes referrals to physical therapy, massage therapy, and GI are also warranted.
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References:
Roy, N., Peterson, E. A., Pierce, J. L., Smith, M. E., & Houtz, D. R. (2017). Manual laryngeal reposturing as a primary approach for mutational falsetto. The Laryngoscope, 127, 645–650. https://doi.org/10.1002/ lary.26053
Cohen, S. M., Lee, H.-J., Roy, N., & Misono, S. (2017). Chronicity of voice-related health care utilization in the general medicine community. Otolaryngology—Head & Neck Surgery, 156, 693–701. https://doi.org/ 10.1177/0194599816688203
van Leer, E., & Conner, N. P. (2015). Predicting and influencing voice therapy adherence using social–cognitive factors and mobile video. American Journal of Speech-Language Pathology, 24, 164–176. https://doi.org/ 10.1044/2015_AJSLP-12-0123
van Mersbergen, M. (2011). Voice disorders and personality: Understanding their interactions. Perspectives on Voice and Voice Disorders, 21, 31–38. https://doi.org/10.1044/vvd21.1.31
Van Stan, J. H., Roy, N., Awan, S., Stemple, J., & Hillman, R. E. (2015). A taxonomy of voice therapy. American Journal of Speech-Language Pathology, 24, 101–125. https://doi.org/10.1044/2015_AJSLP-14-0030
Leslie Wegner, M.S., CCC-SLP, is a speech pathologist and voice teacher specializing 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.