The human voice is produced when exhaled air passes through the closed vocal cords, causing the vibration of the folds. The vibrations are then amplified by various structures of the oral cavity. The tongue along with the teeth plays a very important part in converting these vibrations to words.
Muscle tension dysphonia is often defined as alteration in a person's voice due to increased tension in the muscles of the voice box/ larynx, thereby limiting the ability of the vocal cords to adduct( move towards the midline) and abduct( move away from midline). A functional voice dysphonia is often suspected when there isn't any significant anatomical or neurological finding and the disorder is limited to function of the muscles of phonation.
Causes of muscle tension dysphonia
The etiological factors are classified under three major categories.
Psychological/ personality disorder- for instance when the person is under stress the muscles of the voice box become tense. Sometimes it can also occur following emotional trauma.
Vocal misuse/ abuse- yelling, screaming, excessive throat clearing, speaking in a pitch too low or too high.
Due to some underlying cause like cold, flu, acid reflux, smoking, or any upper respiratory tract infection.
"Voice disorders were reported to be significantly more prevalent in male children than in female children. In adulthood, however, prevalence was higher in female adults than in male adults, with a reported ratio of 1.5:1.0."
Symptoms of muscle tension dysphonia
Few common symptoms are-
Weak, airy, breathy voice like a whisper.
Hoarse, rough, raspy, or fatigued voice.
Sudden change in the pitch of the voice,
Strained, stressed, tense, or, pressured voice.
Voice fatigue or voice may become weak with longer use.
Altered pitch, either too high, or too low.
Difficulty in speaking due to pain in the throat.
Difficulty in singing previously easy notes.
Extra force needed for a loud voice.
How is muscle tension dysphonia diagnosed?
Muscle tension dysphonia is often diagnosed by a Speech therapist or an ENT specialist. A thorough systematic evaluation of the voice of the patient along with the laryngeal structures is vital for preparing an appropriate treatment plan for the patient.
The specialist often uses a laryngoscope or a stroboscope to assess the condition and functioning of the vocal cords.
Being a diagnosis of exclusion, muscle tension dysphonia is often diagnosed by full history, including medical, surgical, psychological or any traumatic information, complete physical examination and exclusion of any other possible causes of the voice disorder.
Treatment of muscle tension dysphonia-
First step is the correct diagnosis of muscle tension dysphonia. There are various treatment modalities based on the cause and severity of the disorder. Most cases can be treated by simply identifying the underlying etiology and modification in the patient's behavior.
Speech therapy is the standard care for the condition. A speech language pathologist/ speech therapist employs a holistic approach to the treatment. The aim is to establish a balance in breathing, phonation, and resonance.
The speech therapist helps the person understand the correct positioning, and relaxation of the vocal cords by appropriate exercises in order to speak with minimal vocal efforts. Several speech therapists also recommend laryngeal massage, consisting of gentle stretching and massaging the muscles of the neck.
They also counsel and educate the patient in understanding their condition better, along with appropriate behavioral modification, in order to halt further progression of the condition. Voice therapy often requires multiple sessions, the number of the sessions vary person to person based on the severity of the condition.
The results of the various studies have shown that voice therapy is very effective in reducing the frequency and severity of the VTD in patients with MTD in addition to improving voice quality.
Exercises for muscle tension dysphonia
Here are a few exercises to reduce the tension of the vocal tract.
Lips -
Lip stretches- alternate between smiling and pursing your lips( pushing them forward), hold each position for 5 seconds.
Silently position your lips as producing 'oo' and 'ee' vowels, and repeat with strong lip movements, followed by adding sound.
Jaws-
Jaw massage- open your jaw slightly and place the balls of your hands just under your cheekbones. Rub firmly while letting your jaw open further. Repeat 3 times.
Tongue
Protrusion- protrude your tongue out of your mouth as far as it will go, you will feel a pull at the base of your tongue. Hold it in the position Throat
Silent laughing- imagine someone has told you a joke and you aren't allowed to laugh out loud. Try laughing with a closed mouth and you can feel your throat widen. Try breathing in the position.
Closed yawn- try yawning with your lips closed, letting the air collect in your mouth and throat. Repeat 5 times.
Throat
Silent laughing- imagine someone has told you a joke and you aren't allowed to laugh out loud. Try laughing with a closed mouth and you can feel your throat widen. Try breathing in the position.
Closed yawn- try yawning with your lips closed, letting the air collect in your mouth and throat. Repeat 5 times.
Even though it is said that muscle tension dysphonia is an untreatable condition, with timely diagnosis, treatment and lifestyle modification you can overcome the condition.
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