Muscle Tension Dysphonia Treatment

In my last video, I was talking about muscle
tension dysphonia, causes, common symptoms and the diagnostic process. In this video, I am going to talk about muscle
tension dysphonia treatment options. Stick around and we’ll start right after
this. 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. So how do you treat muscle tension dysphonia
or MTD for short? The good news is that primary MTD responds
really well to voice therapy, which should be the gold standard for treating this condition. The length of therapy depends on several factors
and can last from a few weeks to several months or longer. The goal of therapy is to decrease or eliminate
tension so that the laryngeal muscles can work efficiently again. It is important to know that this video offers
just an overview of possible treatment options and should not be replaced for an individualized
and personal treatment plan developed by an experienced speech-language pathologist. As I said in my previous video, people with
muscle tension dysphonia have very different manifestations of this disorder and their
treatment needs have to be developed based on their individual needs. It may be necessary to treat underlying or
contributing factors as well as the voice itself. For example, if MTD developed secondary to
vocal fold lesions, the ENT specialist may suggest other treatment options, such as medication
or surgery. Or if acid reflux or emotional stress is a
contributing factor to MTD, then these conditions should be treated appropriately. The role of a speech-language pathologist
is important in the therapy process. I personally like to use the ALERT framework. Each letter of this word stands for an area
addressed in voice therapy. Let’s go through the letters together:
A STANDS FOR ANATOMY During the diagnostic process of MTD, the
voice specialist should get a very clear picture about the anatomy and function of the vocal
instrument. This is done through a videostroboscopic examination. Based on the findings, it may be necessary
to consider medication or surgery in some cases. L STANDS FOR LIFESTYLE
In this area, you need to identify behaviours and lifestyle factors that contribute or are
responsible for MTD. This may include adjusting your daily schedule
to decrease vocal use, get enough sleep, eat healthy diet including sufficient hydration,
improve overall vocal health, or identify and eliminate harmful vocal behaviours. The most dangerous vocal behaviours are those
that we don’t know we are using in our every day lives. And, you can discover some of these behaviours
by clicking this link and downloading a checklist of vocal abusive behaviours. E STANDS FOR EMOTIONS
Emotional stress and anxiety are well recognized causes of MTD in many people. The speech-language pathologist may help you
identify these factors, she or he may offer some relaxation, breathing and mindfulness
techniques to deal with some of them. Sometimes, it may be necessary to work with
other professionals to treat them. R STANDS FOR REFLUX
Reflux can be a triggering factor of MTD. LPR or laryngo-pharyngeal reflux is very common
in people with voice disorders and therefore it has its own special letter in this voice
treatment framework. So, in order to eliminate tension, you need
to start managing acid reflux with the help of your doctor. AND FINALLY T STANDS FOR TECHNIQUE. This is the core of voice therapy. The speech-language pathologist may use different
approaches and techniques to eliminate tension from the vocal mechanism and establish and
promote more efficient ways of sound production. Here are three examples:
#1 Establishing optimal body and head and neck alignment. Body and neck misalignment can lead to MTD
because the muscles have to work from a mechanical disadvantage. Simply, muscles have to work harder if your
posture is not optimal. #2 Improving breathing patterns and coordination
of breathing with the phonatory system. People with MTD are known to have altered
breathing patterns and inefficient breath control. Therefore, a huge part in voice rehabilitation
is working on developing good breathing habits. My channel has many videos on this topic so
make sure to watch them. #3 Vocal exercises to establish and strengthen
healthy voice use. Some examples of very specific techniques
are Vocal Function Exercises first developed by Dr. Stemple, Stretch and Flow Phonation
exercises first introduced by Dr. Stone, Resonant Voice Therapy or semi-occluded vocal tract
exercises and more specifically, straw exercises or tube phonation exercises. If you know me a little bit, you know that
I am a big fan of straw exercises and you will find more videos with these type of exercises
on my channel. So, don’t forget to check them out. Bonus tip
Muscle tension dysphonia massage is a very popular and common approach to therapy of
MTD. The goal is to reduce tension from the superficial
laryngeal muscles, which in turn reduces tension from the muscles inside your larynx. This technique has many names, such as laryngeal
massage, manual therapy, circumlaryngeal massage and many other names. I made a whole video on this topic so feel
free to watch it. I will link to it at the end of this video. Even though these techniques are very different,
they have many things in common. The goal is to take away pressure from the
vocal folds and re-distribute vocal effort to all participating structures. These techniques use vocal exercises like
humming, buzzing, phonating on the vowels /i/ or /o/, on fricatives Z or V or phonating
on NG like in the word sing. And they start in the most comfortable range
and slowly progress to include a wider vocal range through stretching vocal exercises such
as slides or glides. Many of these techniques work directly with
breath management in coordination with laryngeal muscle use. And that is all for this video. Check out my other videos right here below
and don’t forget to subscribe for more videos about healthy voice use. I will see you soon.


  1. Thank you for watching. Which area of the A.L.E.R.T. framework are you going to explore more to deal with your voice problem? Let me know in the comments below!

  2. I'm a man. I used to reject my process of puberty and I used to talk like a child because I was frightened of being an adult, not to mention my problems of anxiety.Now I've been forcing myself to sound like a man, but it has been kinda frustrating… What would you recommend me? Please and thank you!

  3. I've suffered with my voice for 22 years now, since I was 11 and my voice changed. I've had vocal therapy and vocal coaching. This had helped a little but I still have a lot of issues. I've had chiropractic and massage therapy also. I eat well, drink only water and dont drink or smoke. My natural speaking voice is fairly low, but if I go too low my voice cracks. If I go high I generally tighten up and cant produce any sound at all. Feels like I'm being strangled and every now and then, a weak high pitched noise will leak out. I have had extremely rare days maybe 10 over 22 years where I've had full access to my voice, approximately 5 octaves. My goal is to sing, I used to sing as a child and had a strong well balanced voice. I have noticed, on the odd occasion when I've had a cold or sinus infection, my voice is free and I can access all of it with ease. As soon as I get well I'm back to 'normal' so frustrating. Any help or advice would be greatly appreciated. Thanks.

  4. Very nice video. I am also an slp and i suffered from acid reflux. I started medication 5 months after. My neck at that time was felt to be tight and swallen. I could not utter a sentence without feeling pain. I was so sad at that time. Later i took medication but the tightness in my neck and the severe pain when i was swallowing was driving me mad. Later i figure it out that i must have developed MTD. Massage to the neck myscles made all the difference to me. The first time i did it, all outer skin of my neck became deep red, which means that they were extremely tight

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