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What is Muscle Tension Dysphonia, and Can it be Treated? (A Crib Sheet)

Updated: Dec 7, 2022

Muscle Tension Dysphonia, or MTD, is fairly common; in the vocal pathology sense of the word. A couple of new students told me they’ve been diagnosed with it, so I decided to spend some time reading up on the pathology.

Luckily, now you don’t have to, because what follows is a 500-word crib sheet. I also included a few helpful links at the end.

According to Crystal Barron, an integrative voice pro in Los Angeles, MTD is a "diagnosis of exclusion," which means that it is commonly used when no other reasons for vocal dysfunction can be identified. It's typically a presentation that is the result of two-or-more factors, and is often seen in singers with a "high vocal load," such as professional singers or classroom teachers.

In general…

  • MTD can happen to anyone.

  • It can happen as a result of another pathology, or it can be a free-standing pathology. .

  • It’s almost impossible to tell where it came from once someone has it.

  • It can be either MT – muscle tension – in which the muscles are over-contracting, or...

  • it can be D – dysphonia – in which the muscles lack coordination, leading to a mistiming of vocal fold vibrations.

  • Other conditions such as acid reflux or anxiety over MDT itself can exacerbate the symptoms.

Once a singer is warmed up, MTD seems to go away. That makes it easy to ignore, and that may be ok. Sometimes it doesn’t get any worse. But sometimes it does.

When I cruised cyberspace looking for answers, I could not find any studies that show how people acquire MTD, but I did find suspicions.

For instance, teachers are the biggest group of people who get it. That makes voice people think that it’s either from overuse because teachers talk a lot and often loudly, or from misuse, because teachers talk even when they shouldn’t (laryngitis, overuse, fatigue), or both.

Here’s a list that will narrow it down for you. But not much.

  • You can acquire MTD as a response to external stimuli, like excessive talking, second-hand smoke, or excessively dry conditions.

  • You can acquire MTD as a response to internal situations, like acid reflux, stress, lack of sleep, or upper respiratory infections.

  • MTD can be a response to an underlying vocal fold problem.

  • MTD can be the result of a single acute event or on ongoing, low-grade stress.

Here’s a list of symptoms. This list makes me think that the reason MTD doesn’t get diagnosed early is that these symptoms could apply to many other things as well.

  • A fluttery sound in your singing when you start to warm up or sing “cold.”

  • Hoarse or raspy voice

  • Whispery or breathy voice

  • “Holes” in your sound, where your voice cuts out for a second

  • Feeling you have to speak higher or lower than normal

  • Feeling dry or scratchy

  • Feeling your voice is tired or aching after you’ve been speaking or singing

  • A feeling that you’re having to work hard to make sound

MTD is especially bad for singers. We’ll only notice it when our voices are “cold.” Once we’re warmed up it seems to go away. That makes it easy to ignore, of course, and that may be ok. Sometimes it doesn’t get any worse. But sometimes it does. Better to get scoped by an ENT who specializes in singers if you even suspect anything.

One thing health professionals in the World-of-Voice agree on; the sooner you can start treating MTD, the easier it will be to fix. Once it’s set in, it’s more difficult to change the behavior. They also agree that any other voice problem will very often result in a greater or lesser degree of MTD.

Treatment for MTD, it seems, is the same for the treatment of any other type of condition that cannot be fixed in the typical Western medicine way - with a pill or surgery - you have to try stuff until you find something that works.

I know you didn't ask, but I'd strongly recommend that you work with a very knowledgeable integrative voice specialist. It's your voice. You're worth it.



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