Muscle Tension Dysphonia

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Hello Dr. Thomas!

 My name is Makena and I'm an eighteen year old female singer.  Lately I have been experiencing symptoms of MTD after/while singing, that I've never had before and I've been singing my whole life.  I had an appt. with an ear nose and throat specialist recently but she said I wasn't describing symptoms of nodules because I haven't noticed a change in my voice, just the pain is present.  She recommended a formal vocal coach and said that training would solve the problem, which I have also scheduled soon.  She saw no pictures of my larynx or anything, so I wanted to ask your advice.  Do you think surgery or injections would be necesarry? What can I do to ease the discomfort in the meantime? Is this permanently damaging to my voice? 
Thank you for your time,
James P Thomas MD's picture
Submitted by James P Thomas MD on Sat, 2012-04-07 12:41

it would be impossible for me to make a diagnosis without seeing both the vocal cords themselves as well as the actual movement of the vocal cords. In addition, there are a wide range of qualities of endoscopes with the fiber-optic endoscopes giving the dirtiest image and high definition chip endoscopes or high-definition rigid endoscopes giving a very clear view.

While pain is a symptom of muscle tension, it can certainly be a symptom of other problems which an ENT should be able to sort out. When the pain is from muscle tension, the laryngologist will see that the vocal cords are opening in the back when making sound, yet they are capable of coming completely together at other times. In other words, there is not a paralysis or joint fixation which is limiting closure of the vocal cords, rather competing muscles are tensioning and holding the vocal cords apart.


It would be impossible to jump to conclusions about treatment until an accurate diagnosis is made. If the patient is ever in doubt, a second opinion with a laryngologist can often be quite helpful. I do list a number of laryngologists on this website at “Home: physicians”.