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Understanding Muscle Tension Dysphonia: Causes, Symptoms, and Treatment

Muscle Tension Dysphonia (MTD) refers to a voice disorder arising from strained or excessive muscle tension in the voice-producing mechanism, even in the presence of healthy vocal cords. This common condition can lead to a voice that sounds stressed or raspy, causes discomfort when talking, and may often coincide with other voice-related issues.


MTD might occur after a vocal cord injury, such as laryngitis or vocal cord inflammation, typically following an illness. A typical response to such an injury relies on auxiliary muscles in the throat for voice production. Even after the vocal cords recover post-illness, this muscle misuse may persist.


Other contributing factors to MTD include extended periods of speaking without breaks, yelling, conversing loudly in loud settings, or habitually utilizing a pitch that's too high or too low. MTD is particularly prevalent among the 40- to 50-year age group, especially among women.


There are two types of MTD:


  • Primary MTD: Here, the neck muscles tense up when using the voice, but the larynx (or voice box) shows no abnormality.


  • Secondary MTD: In this form, an exception in the larynx causes the overuse of other muscles to aid voice production.


Another name for MTD is muscle misuse dysphonia, reflecting muscle tension's central role in this disorder.


Origins and Contributing Factors

The exact causes of muscle tension dysphonia remain a mystery, often appearing suddenly and without apparent reason. However, some factors can contribute to or trigger MTD.


These include irritants like upper respiratory infections, passive smoking, acid reflux, or excessive vocal strain. In many instances, MTD arises when multiple such factors are present.


asian woman suffering fromMuscle Tension Dysphonia


Identifying Muscle Tension Dysphonia: Signs and Symptoms

Symptoms of muscle tension dysphonia can range from vocal changes to physical discomfort, including:


  • A husky, hoarse, breathy, and rough voice

  • Muscle aches and tightness in the throat

  • A voice that sounds strained or tight

  • Weak or airy voice

  • A sudden voice breaks or fades

  • Neck pain or tenderness

  • Decreased vocal range when singing

  • Frequent throat-clearing

  • The sensation of a lump in the throat


Diagnosing Muscle Tension Dysphonia

Diagnosing MTD can be challenging, and the condition is often misdiagnosed. It tends to mimic other states, and there's no definitive test. Accurate diagnosis calls for an in-depth evaluation by an experienced team of voice specialists. The following steps are typically involved in diagnosing MTD:


  • Patient History: Understanding the onset and evolution of the voice problem is crucial.

  • Speech-Language Pathology Evaluation: Speech-language pathologists play a pivotal role in analyzing MTD and evaluating the patient's speech and voice behaviors.

  • Laryngoscopy and Stroboscopy: Detailed examination of the vocal folds is crucial to rule out anatomical abnormalities. This involves flexible laryngoscopy for observing muscle patterns during speech and stroboscopy to assess vocal fold vibration.

  • Investigation for Other Associated Abnormalities: The diagnostic process also involves checking for associated factors such as reflux, allergies, medication side effects, and hormonal imbalances.


Treating Muscle Tension Dysphonia

The primary treatment for MTD involves voice therapy sessions with a speech-language pathologist. This aims to alleviate throat tension and optimize vocal efficiency. Complementary treatments, like massage, acupuncture, psychotherapy, or physical therapy, might be recommended alongside voice therapy to help release tension.

Moreover, medical or surgical treatments might be necessary to address any underlying causes of MTD. The gold standard treatment, voice therapy, is typically delivered over multiple sessions to reduce the pattern of muscle tension.


Voice therapy for MTD typically includes:

  • Breathing techniques: Teaching patients how to control their breathing can help reduce muscle tension in the throat.

  • Voice relaxation exercises help relieve muscle tension and improve voice quality.

  • Voice Use Education: Teach patients how to use their voice correctly to reduce strain and improve vocal efficiency.

  • Voice and Posture Alignment: Ensuring that posture and voice are aligned can help reduce tension in the muscles surrounding the voice box.


Voice therapy is usually very effective, with patients noticing improvement within a few sessions. However, complete recovery might take several weeks or months, depending on the severity of the condition and individual responsiveness to therapy.


Asian woman with Muscle Tension Dysphonia or neck pain or thyroid gland against gray background


Prevention of Muscle Tension Dysphonia

While it's essential to understand how to manage muscle tension dysphonia (MTD), it's equally necessary to delve into strategies for preventing its onset. 


The adage "prevention is better than cure" applies to vocal health. 


Certain lifestyle modifications and vocal hygiene practices can reduce the risk of developing MTD or help manage its symptoms if already present.


Cultivate Healthy Vocal Habits

Your voice is an instrument; like any instrument, it needs proper care to perform at its best. Here are some vocal hygiene tips to consider:



Keeping your body well-hydrated is crucial for the health of your vocal folds. Aim for the recommended 8-10 glasses of water daily. Avoid dehydrating substances such as caffeine and alcohol.


Proper Breathing:

Breathing exercises play a vital role in maintaining vocal health. Breathing correctly can help regulate muscle tension, reduce stress, and optimize voice production. Techniques such as diaphragmatic breathing can be beneficial.


Avoid Vocal Strain:

Steer clear of behaviors that put a strain on your voice. These include shouting, whispering, speaking for extended periods without rest, and speaking in noisy environments where you might be tempted to raise your voice.


Warm-Up Your Voice:

Just as athletes warm up their muscles before exercise, so should you before extensive voice use. Simple vocal warm-ups can prepare your voice for the task ahead and reduce the risk of vocal strain.


Adopt a Healthy Lifestyle

Lifestyle modifications can also significantly impact your vocal health. These include:


Balanced Diet:

A balanced diet supports overall health, including your voice. Foods rich in vitamins A, E, and C, alongside adequate hydration, can help maintain healthy vocal cords.


Reflux Management:

If you're prone to acid reflux, managing it effectively can prevent potential damage to your vocal cords. This often involves dietary changes and sometimes medication.


Stress and Anxiety Management:

As muscle tension dysphonia is closely related to stress and anxiety, developing coping strategies such as relaxation techniques, mindfulness, or yoga can be beneficial.


Regular Exercise:

Physical activity promotes overall muscle health and can help manage tension. Furthermore, exercises targeting posture can also assist in optimizing voice production.


While these preventative measures can reduce the risk of developing MTD, they're not foolproof. If you're experiencing persistent voice changes or difficulties, seeking medical attention promptly is crucial. Early diagnosis and treatment are paramount in managing muscle tension dysphonia effectively.


A young girl has a sore throat. Muscle Tension Dysphonia


Medicinal Potential of CBD and Marijuana for Muscle Tension Dysphonia

As we journey deeper into understanding muscle tension dysphonia (MTD), we must consider emerging therapeutic approaches. Some intriguing prospects lie in the potential use of CBD and medical marijuana. 


While voice therapy and other conventional interventions remain at the forefront of treatment for MTD, there's an increasing curiosity about the potential role of these alternative treatments.


But what is the connection between CBD, marijuana, and vocal health? And could these substances hold the key to better managing MTD? Let's explore the possibilities and current understanding of CBD and medical marijuana in the context of muscle tension dysphonia.


Pharmacological Approaches and the Role of CBD and Medical Marijuana

To date, oral medications have not been proven to consistently alleviate the symptoms of dysphonia. While no specific drug is indicated for treating dysphonia, several products are known to calm hyperactive muscles or nerves, potentially reducing vocal tension. 


These include medications such as carbidopa/levodopa, lorazepam, clonazepam, gabapentin, and diazepam. These are often prescribed to alleviate symptoms of various types of dystonia, characterized by involuntary muscle contractions.


In recent years, CBD oil and medical marijuana have drawn attention as potential alternatives for symptom management. 


Although not explicitly studied for spasmodic dysphonia or MTD, anecdotal reports suggest that some patients experience temporary relief from symptoms after using CBD or medical marijuana


As we continue to explore and understand the potential of these substances, we should consider their effects on voice quality and overall vocal health.


The Impact of Marijuana Ingestion on the Voice

The question arises: "What happens to the voice when marijuana is ingested rather than smoked?" Smoking anything, including marijuana, irritates the vocal cords, inducing laryngitis and increasing the risk of vocal bruising and permanent injury. Ingestion, on the other hand, may pose fewer risks to vocal health.


It's been theorized that marijuana use, in any form, causes blood vessel dilation, potentially increasing the risk of vocal bruising. This hypothesis hinges on two assumptions:


  • When marijuana is used orally, blood vessels dilate.

  • Blood vessel dilation raises the likelihood of vocal bruising.


To verify these assumptions, extensive research is needed. Interestingly, current studies on THC (the psychoactive compound in marijuana) and its effects on blood vessels have yielded inconclusive results. 


Some research suggests THC might cause vasoconstriction or the narrowing of blood vessels, contrary to the dilation theory.


Furthermore, there is no conclusive evidence that blood vessel dilation directly increases the risk of vocal hemorrhage. Therefore, at this point, it seems unlikely that ingesting marijuana poses significant risks of vocal bleeding.


cannabis products


Final Thoughts

The connection between marijuana, CBD, and vocal health is complex and understudied. Current evidence suggests that ingesting these substances may have potential benefits in managing symptoms of muscle tension dysphonia. However, further comprehensive, fact-based research is needed to evaluate their effectiveness and safety.


Patients and voice health professionals should always rely on empirical evidence and expert opinion in making decisions about treatment methods. While it's important to continue exploring alternative treatments like CBD and medical marijuana, any potential benefits must be weighed against potential risks.


It's also essential to remember that while CBD and marijuana might aid in symptom management, the primary treatment for MTD remains voice therapy and other interventions to retrain and relax the voice muscles. These substances should not be seen as a replacement for conventional medicine but rather as potential tools within a comprehensive treatment approach.


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Can Muscle Tension Dysphonia Go Away?

Yes, muscle tension dysphonia can improve with appropriate treatment, which often includes speech therapy focused on relaxation techniques, vocal exercises, and cognitive behavioral therapy. In some cases, individuals can fully recover from MTD, while others may have recurrent or ongoing symptoms.

How Long Does Muscle Tension Dysphonia Take to Heal?

The recovery time for muscle tension dysphonia varies significantly from person to person. For some, improvement can be seen after a few weeks of dedicated speech therapy, while others may require several months. The exact timeline depends on factors such as the severity of the condition, the individual's commitment to treatment, and the presence of any underlying disorders.

Is Muscle Tension Dysphonia Mental?

While muscle tension dysphonia is a physical condition resulting from improper use of the voice muscles, psychological factors like stress and anxiety can contribute to its onset or exacerbation. It's not purely a mental condition, but mental health does play a significant role in managing and treating MTD.

Can Muscle Tension Dysphonia Come and Go?

Yes, the symptoms of muscle tension dysphonia can come and go. Factors such as stress levels, voice use, and general health can influence the presence and severity of symptoms. Additionally, some people may find their symptoms worsening during certain parts of the day or particular activities.

What Triggers Muscle Tension Dysphonia?

Several factors can trigger muscle tension dysphonia. These include excessive voice use, vocal misuse (yelling or screaming), high-stress situations, and underlying psychological issues like anxiety or depression. Physical factors such as posture and breathing techniques can also contribute to MTD.

How Do You Relax Your Throat Muscles?

Relaxing your throat muscles can be achieved through various techniques. Vocal and breathing exercises under the guidance of a speech therapist can be beneficial. Techniques may include diaphragmatic breathing, gentle humming, and neck and shoulder relaxation exercises. Regular breaks from voice use, proper hydration, and stress management strategies can also aid in relaxing the throat muscles.