Muscle tension dysphonia: can stress damage your voice?

Written by: Professor Owen Judd
Published: | Updated: 12/04/2023
Edited by: Laura Burgess

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.


Read more on the symptoms of muscle tension dysphonia

By Professor Owen Judd
Otolaryngology / ENT

Professor Owen Judd is a highly-trained consultant ENT surgeon with a special interest in laryngology (voice disorders) and neurotology (disorders of the brain and ear, especially balance, dizziness and facial paralysis). Practising across clinics in Derby and Nottingham, Professor Judd provides the full range of ENT surgical procedures as well as a comprehensive paediatric service. He has particular expertise in complex ear surgery

He has particular expertise in migraine, balance disorders, and complex ear surgery, and was one of the first surgeons in the country to offer total endoscopic ear surgery - a minimally invasive ear surgery technique. He now teaches this technique nationally. He has also introduced minimally invasive laryngeal surgery under local anaesthetic for voice problems, to the Midlands region.

Originally qualifying from the University of Nottingham, Professor Judd completed his higher surgical training in London, Plymouth, Southampton and the East Midlands. He undertook a specialist Fellowship in Neurotology and Otological implantation at Queen’s Medical Centre in Nottingham and was appointed Consultant Neurotologist and Laryngologist ENT Surgeon at the Royal Derby Hospital in 2014. He has a prestigious BMJ Visiting Professorship in Balance Medicine, being a regular international speaker on vertigo and dizziness. He is also Honorary Associate Professor at the University of Nottingham and Associate Clinical Sub-Dean for the University Medical School. He is actively involved in all areas of ENT research and has published over 60 articles in peer-reviewed journals, 6 book chapters, and 2 textbooks to date.

Professor Judd is also highly experienced in facial rejuvenation without the use of surgery. He has successfully treated over 3,000 patients with a range of injectable treatments and is a pioneer of the TimeNet procedure, which is designed to stimulate collagen production over a longer period of time. Professor Judd can also provide minimally-invasive earlobe surgery and treat patients experiencing hyperhidrosis (excessive sweating).

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