Muscle Tension Dysphonia

Muscle Tension Dysphonia

Voice Strain

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Muscle tension dysphonia, or voice strain, can occur even when there is no damage to your vocal cords. It’s often overlooked and untreated. The Duke Voice Care Center team of laryngologists -- ear, nose, and throat doctors with advanced training in voice disorders -- and highly trained speech pathologists diagnose your condition and help you learn to speak without pain.

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About Muscle Tension Dysphonia

If your voice is tired, your throat feels tight, or it hurts to talk, you may have muscle tension dysphonia, or voice strain. This common voice problem can occur even if your vocal cords are normal, but the muscles in your throat are working inefficiently. You may not have enough breath to support your voice, or your throat muscles may be too tight when you speak. Muscle tension dysphonia can make your voice sound strained and feel uncomfortable when you talk.

Muscle tension dysphonia can happen when you’ve been sick and developed an injury to the vocal cords, such as laryngitis or swelling of the vocal cords. Because of that injury, you may start relying on other muscles in your throat to force your voice out. Even when your vocal cords have healed after the illness is over, you can get stuck in a pattern of muscle strain. 

Other factors that may contribute to muscle tension dysphonia include excessive talking without breaks, screaming, talking loudly in noisy environments, or habitually speaking at a pitch that is too high or too low for you.

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Duke Health offers locations throughout the Triangle. Find one near you.

Tests and Treatments

Comprehensive Evaluation

Assesses your voice use patterns -- how much you speak, sing, or use a loud voice, and what your voice sounds like. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illness. We will perform a head and neck examination and a visual examination of your voice box.


This detailed visual exam helps us evaluate how your vocal cords vibrate while you speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow motion video images of your vocal cords. The exam takes about a minute; your nose may be sprayed with topical anesthetic for your comfort. 

The exam allows your team to look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. After the exam, your team will review the images with you to determine an accurate diagnosis and treatment plan together.

Laryngovideostroboscopy can be essential to reaching an accurate diagnosis and determining the best treatment for your voice. It is typically only available at ENT centers that specialize in voice disorders.

Voice Therapy

Voice therapy helps you learn to relax your throat muscles, use your breath to power your voice, and use good oral resonance. You’ll work with a speech pathologist who guides you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking. The goal is to teach you to speak with minimal effort. 

Laryngeal Massage and Myofascial Release

If appropriate, you may receive a targeted massage of your voice box muscles, performed by a specially trained speech pathologist. People often experience dramatic relief of throat strain and discomfort. You may also learn stretches and self-massage techniques for daily use to reduce strain and support relaxed, healthy voice use.

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Why Choose Duke

Expert Diagnosis
Often with voice strain, the vocal cords appear normal in a superficial exam. As part of our comprehensive voice evaluation, we use videolaryngostrobscopy, a highly specialized exam that can uncover the patterns of muscle strain that cause muscle tension dysphonia.

Skilled Voice Therapists
We are one of the few centers in the Southeast providing expert voice therapy, the treatment of choice for muscle tension dysphonia. Our team of speech pathologists has advanced training in voice problems and years of experience in providing relief for this condition.

Special Services for Singers
If you are one of the many singers affected by voice strain, you’ll benefit from the expertise of our singing voice specialists.

Coordinated Care
If you suffer from other medical conditions that may contribute to your voice strain -- such as allergies, asthma, and acid reflux -- we will coordinate your care with the right specialists throughout Duke Health.

Active Research to Advance Care
Our ongoing research into how voice problems affect how we feel about ourselves gives us insight into treating the whole range of voice disorders, including muscle tension dysphonia.

Duke University Hospital is nationally ranked in 10 adult specialties
Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.
Reviewed: 02/20/2018