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Voice Disorders - Muscle Tension Dysphonia

Where To Seek Treatment
Singapore General Hospital
Contributed by Dept of Otolaryngology
Singapore General Hospital


Muscle tension dysphonia refers to hoarseness and difficulty in using the voice due to excessive tightness or imbalance of the muscles in and around the voice box. It can be due to habitual misuse of the voice muscles or can result from voice muscles trying to compensate for an underlying inflammatory or neurological condition, or growth on the vocal fold.


  • Direct problem with voicing technique and voice muscle misuse
  • Acid reflux from the stomach
  • Underlying inflammatory or neurological condition, or growth on the vocal fold.


  • Hoarseness
  • Strained voice
  • Pain or sore throat when talking
  • Voice fatigues easily
  • Difficulty controlling pitch


As with other voice disorders, examination of the vocal folds with nasoendoscopy or videostroboscopy may be required. This may be carried out in the specialist voice clinic together with a speech therapist. Evaluation of underlying conditions such as acid reflux may also be recommended.


Typically treatment is multi-faceted, and involves correcting all underlying causes. Speech therapy may be necessary to improve voicing techniques and overcome bad vocal habits which put unnecessary strain on the voice. Often lifestyle changes are necessary including dietary changes and stress reduction. Avoiding unnecessary voice use can sometimes allow the voice muscles to relax and rest. Medication to treat acid reflux may also be prescribed.

Spasmodic dysphonia is a specific condition that can produce similar symptoms to muscle tension dysphonia, in particular strained voice. Careful diagnosis is required to distinguish these conditions as botulinum toxin injection may be helpful in spasmodic dysphonia.

Good habits for heavy voice users:

  • Hydrate regularly
  • Warm up your voice before doing a lot of talking
  • Use a microphone when talking to large groups of people
  • Avoid lozenges (they sometimes have a drying effect on the throat)
  • Rest your voice when you don’t need to use it.

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