What is Muscle Tension Dysphonia (MTD)?

May 31, 2013

Muscle tension dysphonia (MTD) is one of the more confounding and misunderstood conditions of the voice.  With this condition the vocal cords and supporting structures may be healthy but they are working too hard.  MTD is caused by the throat muscles being too tight and out of balance with the rest of the voice production system.  The person with MTD may feel that it takes more effort to talk and their voice gets worse the more they talk.  Many patients may feel a soreness of their neck, throat and often their shoulders. Sometimes MTD may develop in trying to compensate for a weak vocal fold or a vocal fold lesion.

MTD is characterized by the following:

  • Voice that sounds rough, hoarse, gravely, or raspy
  • Voice that sounds weak, breathy, airy, or is only a whisper
  • Voice that sounds strained, pressed, squeezed, tight, or tense
  • Voice that suddenly cuts out, breaks off, changes pitch, or fades away
  • Voice that “gives out” or becomes weaker the longer the voice is used
  • Pitch that is too high or too low
  • Difficulty singing notes that used to be easy
  • Pain or tension in the throat when speaking or singing
  • Feeling like the throat is tired when speaking or singing
  • Voice that may sound normal sometimes, such as during laughing or coughing

Once an otolaryngologist has examined you and diagnosed you with MTD, you will typically be referred to a speech pathologist for voice therapy.  In some cases there may be some underlying physical or emotional stress contributing to the dysphonia.  Our voices are very emotional instruments and help to convey a spectrum of emotions including happiness, sadness and anger.  “I’m all choked up” is more than just a figure of speech.  As such, you may also benefit from additional therapies such as massage or counseling services. 

Recovery from MTD can be varied.  Many patients note improvement after just a few sessions of voice therapy.  However, the longer the tense voicing pattern has been in place, the more challenging it is to change and sustain.  Recovery from MTD relies on an accurate diagnosis from an otolaryngologist, therapy with a skilled voice therapist, and of course the motivation and passion that you, the patient, bring to the process.



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I was diagnosed with this today. I have had it for three years and I am hoping that the voice therapy works for me. I also started voice therapy today. Your blog helped me to understand this better, thank you.
My voice changed after I had surgery. I have been to 3 Ent's. I received 3 different opinions. 1. Said it is from the breathing tube. 2. Another said a cyst on vocal cord. 3. The third said there is no cyst. You have Muscle Tension Dysphonia. I really don't know who to believe.