What is muscle tension dysphonia (MTD)?

May 31, 2013 Swedish Health Team

a woman holding her sore throat


In this article:

  • MTD is a condition in which the throat muscles are out of balance with the rest of the vocal system.

  • Symptoms can include a gravelly, whispery or weak voice.

  • Swedish clinicians can help with recovery, which can include voice therapy and counseling.

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. A 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 in 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:

  • A rough, hoarse, gravelly or raspy voice

  • A weak, breathy or airy voice or one that is only a whisper

  • A voice that sounds strained, pressed, squeezed, tight or tense

  • The voice suddenly “gives out,” breaks off, changes pitch, fades away or becomes weaker the longer it 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

  • Normal voice sounds occasionally, 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.

Find a doctor

If you have questions about your voice or MTD, contact Primary Care or Otolaryngology at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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