Muscle Tension Dysphonia

A dysphonia (diss-PHONE-nee-ah) is the medical term for a voice disorder. 

Muscle tension dysphonia (MTD) is one of the most common voice disorders. It occurs when the muscles around the larynx (voice box) are so tight during speaking that the voice box does not work efficiently. 

MTD is more prevalent among people in the 40- to 50-year-old age group, especially women. 

There are two types of MTD:

  • Primary MTD — In this type, the muscles in your neck are tense when you use your voice but there is no abnormality in the larynx (voice box).
  • Secondary MTD — In this type, there is an abnormality in the voice box that causes you to over-use other muscles to help produce your voice. 

Muscle tension dysphonia is also referred to as muscle misuse dysphonia. 

Causes or Contributing Factors

No one fully understands what causes MTD. It usually begins without warning or explanation. It may be caused by irritants such as an upper respiratory infection, passive smoking, acid reflux or excessive demand placed on your voice. Sometimes, more than one of these factors are present when MTD begins. 

Signs and Symptoms

Muscle tension dysphonia has several signs and symptoms, including:

  • Husky, hoarse, breathy and/or rough voice
  • Tightness and even muscle aches in the throat
  • Strained or tight voice
  • Weak or airy voice
  • Sudden breaks or fading of the voice
  • Neck that is tender or sore to the touch
  • Loss of vocal range when singing
  • Feeling the need to clear the throat often
  • Feeling a lump in the throat


The condition is hard to diagnose and is often misdiagnosed. It frequently mimics other illnesses, and there is no definitive test for the condition. An appropriate diagnosis requires a thorough examination by an experienced team of voice specialists. 

At the University of Michigan Vocal Health Center, we will:

  • Take a complete history of your voice problem 
  • Evaluate your speaking method
  • Examine your vocal cords 


We offer several different treatments for muscle tension dysphonia (MTD):

  • Voice therapy — This is the most common treatment for MTD. It may include resonant voice techniques and massage. 
  • Botox injections — Botox is sometimes used along with voice therapy to get the voice box to stop spasms.

Make an Appointment

Schedule an appointment by calling us at (734) 936-8051.