Transcription
Muscle tension dysphonia. What is it? What are the causes and how can you tell if you have muscle tension dysphonia? That is exactly what I am going to talk about in this video. Keep on watching and I will be right back.
Hi! I am Katarina, speech language pathologist from How 2 Improve Singing and here on this channel, I share practical tips about using your voice in a healthy way. So, if this is a topic that interests you, consider subscribing to this channel and hitting that bell notification icon so that you don’t miss any of my videos.
Muscle tension dysphonia or MTD for short. You may know MTD under other names, such as hyperfunctional voice disorder, spastic dysphonia or functional dysphonia, or even muscle misuse or abuse disorder.
So, what is muscle tension dysphonia? It is a voice disorder in the absence of other structural or neurological disorders, which simply means that there are no other findings or abnormalities of vocal folds, for example there are no vocal nodules. When there are no other structural changes present, we talk about primary MTD. But you know, as usual with our bodies and health, it’s never straightforward. People can develop muscle tension dysphonia as a result of having vocal fold abnormalities and we would recognize this as a secondary MTD. So, you can have muscle tension dysphonia and vocal nodules at the same time. In this case, muscles tension develops as a compensatory strategy.
Anyway, as the name says – muscle tension dysphonia - there is some muscle tension present in the vocal mechanism. You may be surprised to know that according to current understanding of this disorder, this tension may be located not only in the laryngeal area but also in the chest or abdominal areas, or in several areas at the same time.
MTD is quite a common voice problem. Very often more than 50% of voice clinic clients suffer from this condition. In spite of that, we really don’t quite understand the causes of MTD. The good news is that voice professionals agree at least on something: there are many causes of MTD and they include psychological factors as well as physiological factors, so for example stress, anxiety, significant emotional trauma, acid reflux, glottal insufficiency (that’s when your vocal folds don’t close properly), viral infections, muscular discoordination, allergies, environmental irritants or increased vocal demand. By the way, if you want to know if you are misusing your vocal instrument, you can click here and download a checklist with abusive vocal behaviours to help you recognize them and avoid them.
Here are some common complaints of people with MTD: Vocal fatigue is a common complaint. As the day progresses, the fatigue worsens and people with MTD may have difficulty using their voice at the end of the day. If you want to learn more about vocal fatigue and how to deal with it, you can watch my other video on this topic.
Another symptom is pain when speaking. This pain can be felt even when not talking or can worsen with swallowing. Some people may even think that they have a problem with swallowing, not MTD. This pain can be often felt on one side, and it can be felt around the ear and again some people may think that they have an ear problem.
Another symptoms is hoarseness and it is a very common complaint. Reduced vocal range, or inability to sing in either high or low ranges. A feeling of a lump in the throat, so called globus sensation, a feeling that something is stuck in the throat. Shortness of breath when speaking is also quite a common complaint.
The symptoms of MTD can be really varied and every person with MTD sounds differently. Their voice can have various degrees of hoarseness from mild to very severe hoarseness. They may be speaking at an unusual pitch, which means that their voice may sound too low or too high for their age and gender. Their voice can be inconsistent throughout the day or even throughout a sentence and can go in and out. It may be very breathy or not breathy at all. It may be impossible to increase the volume or sing with good dynamics. The voice may sound weak, constricted, harsh, tense or croaky. It may feel like speaking or singing takes a lot of effort. Or it can be very painful to talk or swallow or there may be no pain at all. And some people with severe MTD may not be able to use their voice at all.
It is also interesting to know that some people with MTD have different breathing patterns than people without this disorder. When a healthy person speaks, he or she starts speaking at about 60% of their lung capacity and takes another breath at about 40%. However, some people with MTD usually start talking at 40% of their lung capacity and talk down to 10% of their lung volume. So, they basically talk towards the end of the breathing cycle. And you can only imagine that this requires a lot of muscle work, especially the work of the expiratory muscles. Also, with this extra muscle work, a person with MTD may not have enough airflow for speaking or singing.
Another sign of MTD that is quite common is a high laryngeal position. This is caused by tension in the superficial neck muscles that move the larynx upward. These would be muscles that are above the hyoid bone or above the thyroid cartilage. You may either see tension in that area, the area under your chin – the base of the tongue – it may feel very hard or it may be even painful when these muscles are touched. Some people with MTD may have habitual forward head position, which of course impacts voice production and breathing too.
As you can see, the symptoms and signs are really wide-ranging. So, how do you know if you have MTD? There are three important components in the process of making the diagnosis of MTD. Symptoms, which I just described, cannot be the only measure to determine if you have or have not muscle tension dysphonia. So, don’t try to self-diagnose based on your signs and symptoms. This diagnosis requires a team of voice professionals, including a physician, speech-language pathologist and potentially other medical professionals.
#1 The first component is very detailed history of the voice problem. Knowing how voice difficulties started and how they developed or changed over time may be an important indicator for this diagnosis.
#2 Perceptual voice evaluation, meaning how your voice sounds, palpation so touching to assess muscular tension, and careful observations of the whole body by a speech-language pathologist is another important part of the diagnostic process.
#3 Finally, laryngoscopy, and more specifically videostroboscopy, is absolutely crucial in confirming the diagnosis of MTD. A laryngologist has to see and evaluate the structures and function of the vocal folds and other laryngeal structures. Other tests and examination may be also necessary to map the whole picture.
Making the diagnosis of MTD is not easy and it may take some time. If you experience voice changes or hoarseness for more than two weeks without the presence of an acute infection, speak to your doctor and see a specialist. The sooner, the better.
In the comments below, let me know if you have been suffering from muscle tension dysphonia. Now, once you have the diagnosis of MTD, what do you do? How do you treat MTD? I will be answering these questions in my next video so don’t go away. And check out my other videos right here below. I will see you soon.