Muscular Tension Dysphonia (MTD)
The term muscular tension dysphonia (MTD) was coined by Morrison and Rammage at the University of British Columbia. This is a syndrome consisting of some or all of the following:
1) Excess tension, sometimes to the point of discomfort/ pain in the paralaryngeal and suprahyoid muscles;
2) An open posterior glottic chink during phonation;
3) High larynx position in the neck;
4) Inappropriate contraction of pharyngeal constrictors with phonation;
5) Often but not always, vibratory mucosal injury.
The vocal cord mucosal changes associated with MTD are usually fleshy vocal nodules. This syndrome is seen most often in young women.
Inappropriate Pharynx Contraction Is A Component of (MTD)
Use Different Views for MTD Than for Frequently-Associated Nodules
MTD Posturing Abnormality Transiently Corrected With Creaky Voice
Muscular Tension Dysphonia
To See MTD, You Must See Posterior Commissure and Vocal Process Mucosa Especially at High Pitch
Severe MTD With “Red Herring” Mucus Retention Cyst and “Reflux” Findings
MTD at Prephonatory Instant, and During Phonatory Blurring
Looks Like MTD, but Isn’t
Persistent MTD and Pharynx Recruitment in Young Singer After Sulcus Removal
MTD and Postoperative “Gap Memory”
MTD Briefly Abolished with Creaky Voice
Mind the GAP!
Indicator Lesions and MTD
Quasi-Muscular Tension Dysphonia: the Real Thing Is Usually Throughout the Range
Severe MTD or Bilateral LCA Weakness?
MTD: Vocal Cord Posture and Pharynx Recruitment Often Come Together
MTD at A Distance and Up Close
MTD Phonatory Gap Greater Than Required By Swelling
Released to Sing, and A Surprise Explanation for Pain
Search not Only for Nodules, but Also for Segmental Vibration and Look at the Posterior Commissure for MTD
Muscular, not Mucosal Ceiling Diagnosable Even with Distant Views
Loss of Upper Voice Caused by Lowered Muscular Ceiling (MTD)
Every voice has a natural range (from its “floor” to its “ceiling”), often 2 ½ octaves or more. Over time, some singers notice upper range loss or effortfulness (the ceiling descends). Yet there are no nodules or polyps.
When the “muscular ceiling” descends, it feels and sounds like the voice has to be pushed up to its upper range and the throat may almost ache with the effort. And pitch may sag.
A common association in women is menopause, but it can be seen in either sex at any age.