Muscle Tension Dysphonia

Muscle Tension Dysphonia or MTD is a rather newly labeled diagnosis of vocal function aberrant behavior. It is common in those who are professional level singers, sometimes very high level singers with long successful careers.

The symptoms of MTD are wide ranging. It can be hard to get this diagnosis if you are seeing an ENT who is not familiar with professional voice users or the demands and requirements of professional level singing. A typical issue is the loss of the ability of the voice to match pitch. Sometimes the singer can be a full half step flat. This can be very unsettling, in that the person is clearly hearing the pitch and striving to reproduce it, but it just won’t come out accurately. Further, sometimes the voice just “shuts off” at a specific pitch, meaning that it no longer goes above or below certain notes, no matter how much effort the vocalist exerts. This can cause all kinds of compensatory behavior including pushing, forcing and ensuing vocal fatigue.

If the problem causes other issues like instability of vibrato, inability to sustain pitches, loss of control over volume, or loss of range, it could incorrectly be assumed that the singer is experiencing vocal technique problems. In the case of a very experienced singer, however, with lots of career success and life experience, the likelihood that the person will somehow “forget” how to breathe or “match pitch” or “create resonance” is small.

Because this condition was recognized by the medical profession not that long ago, it can go undiagnosed and that can cause the vocalist to believe that he or she is a hypochondriac or that he has experienced some kind of mental/emotional breakdown. The lack of ability to sing, when one’s identity has been intricately wrapped up in singing, is highly distressing. The complete lack of explanation for this situation having biological or neurological roots is even worse. Further, because the vocal folds generally look normal in MTD, if the ENT does not have the instruments to examine microscopic vocal fold irregularities, which requires expensive equipment and a very skilled eye, just visiting just any ENT may be no help. They must also examine the pharyngeal behavior for squeezing and compensation, and that means they must look not just at the folds but at the entire vocal tract. We have a growing number of throat specialists who understand these vocal function syndromes but they are not necessarily to be found just anywhere. Further, if the vocalist with the problem does not explain it well or understand that MTD could be a possible diagnosis, he or she might not ask useful questions of the MD or provide vital information that could lead to a correct evaluation of the problem. Medical tests pinpointing what’s wrong and where it shows up can be very helpful, but it might take a while to find someone who can provide this kind of diagnosis.

And, if you are given the diagnosis of MTD, you should be sent to a qualified Speech Language Pathologist who has experience dealing with professional singers with this problem. Not all SLPs have that kind of training and experience and without it, things could be very difficult indeed, in that many times singers can speak well enough, but they cannot sing. It’s not really clear why this would be so but my guess is that singing requires a much higher level of function than does conversational speech. In a sense, you can walk, but you can’t run. If you do not have assistance with speaking you really do not know if the way you are using your speaking voice is having a negative impact on how you are attempting to sing. If the SLPs is not familiar with singing, however, the sessions could be limited only to speech and that may not ultimately get the person back to singing again.

Therefore, if you or anyone you know has any kind of similar symptoms and they do not seem to respond to normal vocal technique training, and the person was functioning at a relatively high level for quite some time before the problem existed, you should yourself or they should be diligent in getting the right kind of help. It is very possible to encourage the vocal folds to return to normal function, as long as you know what you are doing, but it takes time, patience and perseverance. Looking for a Singing Voice Specialist who has successful experience helping to resolve MTD is very important.

I have had great success with some very recalcitrant vocal fold issues in singers at a high level who “just lost” their ability to sing and were totally distraught at this development. (Who wouldn’t be?) How I learned to be helpful was through trial and error, observation of SLPs, work with medical doctors and lots of years of life experience singing and teaching. I also have a good deal of “intuition” that helps me and that was cultivated deliberately as well, although I had some strong natural tendencies at the outset. Please help spread the word that MTD is real and that is can be addressed by a team of skilled and experienced voice care professionals.

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5 thoughts on “Muscle Tension Dysphonia”

  1. I have been diagnosed with MTD and have been suffering with the condition since 2008. It’s amazing how quickly one can go from professional level singing to literally singing 1/2 step under pitch at times. Thank you Jeanie for heping spread awareness about this, and many other voice issues.
    Jeff Costello

    1. So did your voice ever get back to pro level? I’m in the same position. I know it’s been 5 plus years…

      1. If you listened to the recorded examples on the Somatic Voicework™ website, you wouldn’t have to ask me if it got back to professional levels. It is obvious that it did, but the vocal fold is still not functioning normally and I am singing anyway. Something to think about, no?

  2. What is usually the cause of zig-zagging resonance (the feeling that notes alternate coming out the right or left side instead of down the center?) Can this be corrected?

    1. The resonance is not zig-zagging, Jill, it is your vocal production which is unstabile. There are many causes for that kind of instability. You have to work on making the vocal production, across the board, more solid.

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