Muscle Tension Dysphonia

If your voice is tired, your throat feels tight, or it hurts to talk, you may have voice strain caused by muscle tightness. This is called muscle tension dysphonia. This common voice problem occurs when the muscles in your throat are working inefficiently, even if your vocal cords are normal. Muscle tension dysphonia often accompanies another voice problem. Muscle tension dysphonia is caused by not using the power of your breath to energize your voice, or forcing your throat muscles to work too hard when you speak. Muscle tension dysphonia can make your voice sound strained or hoarse and can cause discomfort when you talk.

Muscle tension dysphonia can happen when you’ve been sick or developed a temporary vocal cord injury, such as laryngitis or swelling of the vocal cords. Even after your vocal cords have healed, you can get stuck engaging the wrong muscles to use your voice in a way that causes strain.

Other factors that may contribute to muscle tension dysphonia include excessive talking, loud talking or yelling, or regularly speaking at a pitch that is too high or too low for you.

Comprehensive Voice Evaluation
We will examine your head, neck, and larynx (voice box) as part of a comprehensive voice evaluation. We also assess your voice use patterns -- how much and how loudly you speak or sing -- and what your voice sounds like. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illnesses.

Videolaryngostroboscopy
Often with muscle tension dysphonia, the vocal cords may appear normal, and only detailed examination using videolaryngostroboscopy can identify minor muscle inefficiencies. This test is typically only available at ENT clinics that specialize in voice disorders, like those at Duke.

Videolaryngostroboscopy is the gold standard for vocal cord and voice box evaluation. This detailed visual exam enables your provider to observe how your vocal cords vibrate while you speak or sing and to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords, or other physical contributors to your voice problem.

A tiny camera attached to a small tube called an endoscope is inserted through your nose, allowing your provider to see your vocal cords and larynx (voice box). The camera records while a flashing strobe light simulates slow motion video capture of your vocal cords moving. Compared to a still photo, this video allows your provider to see subtle changes in how your voice box and throat function when you make different sounds. It takes only about a minute, and your nose may be sprayed with topical anesthetic to numb and open the nasal passages to make it more comfortable for you. After the exam, your team will review the recording with you to determine an accurate diagnosis and treatment plan.

Voice Therapy
Voice therapy helps you learn to relax your throat muscles, use your breath to power your voice efficiently, and use good oral resonance (how air flows through your mouth and nose when you speak). You’ll work with a speech pathologist who will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. The goal is to teach you to speak (or sing) with minimal vocal effort.

Manual Therapy, Stretches, and Massage
Targeted manual therapy performed by a speech pathologist can reduce excess muscle strain involved with voice use. This may involve gentle stretching or massage in areas of the head, neck, and torso where muscle tension is present. People often experience dramatic relief of discomfort and throat strain after these treatments. You may also learn stretches and self-massage techniques to use at home.

Skilled Voice Therapists
We are one of only a few dedicated voice care centers in the Southeast providing expert voice therapy, the treatment of choice for muscle tension dysphonia. Our team of speech pathologists has advanced training in voice problems and years of experience in providing relief for this condition.

Specialty Care for Singers and Professional Voice Performers
If you are one of the many singers affected by muscle tension dysphonia, you’ll benefit from the expertise of our clinical singing voice specialists.

Coordinated Care
If you have other medical conditions that may contribute to your voice strain -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from a comprehensive team.