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Slide 09 Common Voice Disorders Muscle Tension Dysphonia

last modified on: Tue, 03/06/2018 - 13:41

return to: Botulinum Toxin Protocols;  Videos for Common Voice Disorders Mary Greeley Medical Center Grand Rounds August 12, 2015 Hoffman

Slide 01 Common Voice Disorders Dysphonia What is your diagnosis

Sudden onset of dysphonia beginning 8 months ago upon awakening in the morning with a severely raspy voice. Two month trial of voice therapy unsuccesful. Voice is hoarse "90% of the time" with occasional period of clearer voicing lasting minutes to hours.


Evaluation with trans-oral videostroboscopy and application of therapeutic probes in the voice clinic:

Common Voice Disorders mtd treatment sequence

Teaching points:

  1. Voice Therapy is the primary management strategy for muscle tension dysphonia. While a diagnosis of MTD is made more likely with an immediate positive response to voice therapy probes, as in the case above, a diagnosis of MTD should not be excluded based on lack of improvement from a single trial session of voice therapy. Often 3-4 therapy sessions are required to sufficiently address issues such as breath support, appropriate speaking pitch, and body position that may be contributing to the functional dysphonia.
  2. Not all Speech Pathologists are similarly equipped with the appropriate management skills in that some focus on childhood disorders (e.g.stuttering), others on elderly stroke patients (e.g.swallowing) and still others on professional voice (vocology).
  3. Anxiety, depression and other stressors may be associated with muscle tension dysphonia and may require the interventions of a family practice doctor, psychiatrist, psychologist, social worker, or other health care professional skilled this type of management.
  4. Refractory cases of muscle tension dysphonia may (in selected cases) benefit from laryneal botulinum toxin (Botox) injection.
  5. Muscle tension in voicing may be primary (as above) or - less commonly - adaptive to incomplete glottic closure (such as occurs with vocal cord paresis or bowing). Management of the incomplete glottic closure (such as by augmentative injection laryngoplasty) may be successful in these cases.
  6. The differential diagnosis of muscle tension dysphonia includes other movement disorders that can present in a similar fashion including spasmodic dysphonia and vocal tremor.

    return to: Common Voice Disorders Videos April 6 2010 Hoffman