[Editor’s note] Today’s post is contributed by one of our three amazing expert panelists, Julian Rivera!  With a truly impressive wealth of knowledge in the health, fitness, and medical fields, Dr. Rivera is an asset to the OPERATHLETIC team. Learn more about Julian by reading his bio page here.

I want to welcome you all to OPERATHLETIC and to my first post. Today, I will be writing about Muscular Tension Dysphonia (MTD). My main goal overall is to bring awareness, synthesize the current available research articles, and provide you with a cohesive, down-to-earth understanding of this very common issue that plagues many individuals from non-professional to professional singers.

In general, we take our voice for granted. The voice is a beautiful instrument that is completely unique in each individual person. No one voice is the same, but we all possess three main components that allow us to speak: sound activation, a vibrator for desired frequencies, and a resonator for sound uniqueness.1 Even though we all possess these three components, voice production entails a precise interaction between many different systems in our body. If any one of these variables is out of place, it can then effect phonation, which can lead to MTD.

What is MTD?

Muscular Tension Dysphonia, also known as hyperfunctional dysphonia, is a voice disorder caused by repeated contraction of one’s throat musculature due to overuse or improper use.2 This simply means that the once in sync muscles that help create voice production are now out of sync, which places great unnecessary stress on one’s voice. The subjective symptoms of MTD can include strained or effortful voice quality, aberrant pitch, breathiness, and vocal fatigue.3 Some physiologic features can include elevated hyolaryngeal position, decreased space between hyoid and larynx, and increase throat musculature tightness.3

Doctor - Young female doctor or ENT specialist - with a patient

Treatment options

Now, how do you fix it? If you feel like you have MTD, I recommend that you seek professional assistance either via an ear, nose, and throat specialist, speech pathologist, physical therapist that specializes in neck and throat musculature, or a voice specialist. There are many different causes of MTD, some of which that are physical, neurological, psychological, extrinsic, or intrinsic. Hence why it is important for one to seek a professional opinion to rule out other pathologies and to find the site of the problem. Following that disclaimer, for simplicity purposes, I will focus on explaining self-treatment for general throat musculature tightness.

There are two main methods to self-treat MTD, either directly or indirectly. Direct treatment includes postural education, breathing, and/or soft tissue massage.4 For postural education, one should work on having relaxed shoulders and ensure that their head is in line with their shoulders to prevent a forward head posture. As for breathing, the singer should ensure that they have a relaxed diaphragm to allow proper lowering of the diaphragm. During proper breathing, one’s shoulders should not rise during each inspiration. Lastly, for soft tissue massage, try to focus on tender spots within the neck region. While starting the massage, first apply a small amount of lotion to decrease friction. Start softly and superficially and progress with depth, pressure, and duration. While performing the massage, try sustaining vowels or a hum because you may be able to notice a positive change in vocal quality.4 Remember this is not a quick fix, and that improvement will be noticed via vocal quality and reduction in pain.

Indirect treatment includes singer education and vocal hygiene, which fall hand in hand with each other.4 As a singer, it is important to take care of your instrument and understand what helps as well as what hurts your voice. There are three subgroups for indirect therapy:

  1. Environmental – avoid speaking with a lot of background noise;
  2. Vocal use – avoid yelling, screaming, or shouting, and
  3. Personal behavior – avoid alcohol, caffeine, smoke, and any foods that cause acid reflux.4

Again, if you feel as though you have MTD, talk to your medical provider for more specific medical advice and treatment. Although this article includes a very simplified definition and self-treatment plan for Muscular Tension Dysphonia, it is my hope is that this post will bring further awareness to MTD and increase the standard of care for singers.

Sing with heart,
Julian Signature


1 Benninger MS. The professional voice. J Laryngol Otol. 2011;125:111-116.

2 Liang F, Yang J, Mei X, et al. The vocal aerodynamic change in female patients with muscular tension dysphonia after voice training. J Voice. 2014;28(3):393.e7-393.e10.

3 Lowell SY, Kelley RT, Colton RH, Smith PB, Portnoy JE. Position of the hyoid and larynx in people with muscle tension dysphonia. 2012;122:370-377.

4 Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice. 2011;25(2):202-207.



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