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.