Muscle tension dysphonia (MTD) is when the voice sounds disordered due to overly-tight or tense larynx muscles, which are the tiny muscles found in the vocal cords. We’ve asked one of our top ENT surgeons Professor Owen Judd whether feeling stressed can affect your voice, if it can lead to the condition MTD, and what you can do to get your voice back!
Can muscle tension dysphonia be caused by stress?
Yes, indeed it can. Stress is one of the primary causes of MTD. When we talk about stress, one of the common phrases used is “feeling uptight”. This is exactly what is happening, as stress cause muscles throughout the body to tighten, the most common of which are around the neck and shoulders.
Stress will also lead to muscle tightness inside the neck as well as outside and can commonly precipitate MTD. Therefore neck massage and warm compresses on the external neck muscles to help them relax will also benefit the internal muscles of the larynx. Relaxation and a reduction of stress are key for treating MTD. When we get uptight, so do our voice boxes!
Can other psychological issues cause muscle tension dysphonia?
Yes. Our psychology and emotional state are very strongly linked with our voice. The area of the brain that deals with the voice is in the frontal lobe, and the area of the brain that deals with emotion and especially emotional stability is also in the frontal lobe along with an area of the brain known as the amygdala.
If you think about listening to a relative's or friend's voice on the telephone, you can tell if they are upset, sad or angry simply through the sound of their voice, even though you cannot see their face. The same applies to listening to someone who is anxious or nervous. Their voice may tremble or break up.
There is, therefore, a very strong link with psychological issues such as anxiety, stress, depression and our emotions in general, and MTD.
What happens if left untreated?
In some cases of mild MTD, it can resolve if the underlying cause such as voice overuse or stress resolves.
However, in severe cases, the voice is likely to get worse as time goes by and the constant increased muscle tension can lead to painful muscles and inability to produce a voice.
Very rarely severe untreated MTD can lead to damage to the vocal cords themselves, such as causing nodules or cysts to form, which can exacerbate the problem.
Who should I see if I have symptoms of muscle tension dysphonia?
If you have mild symptoms of MTD, you can self-treat initially by reducing stress, reducing excessive voice use, and avoiding whispering or shouting. Taking relaxation treatments such as massage and using regular steam inhalation to help soothe the tight muscles can often help.
If the symptoms worsen or are persistent for more than three weeks, you should visit your general practitioner (GP) or family doctor.
They may then refer you to see an ear, nose and throat surgeon or laryngologist. They will likely examine your larynx with a small flexible telescope passed through your nose and ask you to speak whilst doing so to watch how your vocal cords move.
Ultimately MTD is best treated with voice therapy provided by a qualified speech and language therapist. This may be coupled with treatment of the underlying initial cause such as stress relief, psychological counselling if needed, or medication in some cases.