Muscle Tension Dysphonia

Voice Strain

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Muscle tension dysphonia, or voice strain caused by muscle tightness, can occur even when there is no damage to your vocal cords (also known as vocal folds). It’s often overlooked and left untreated. The Duke voice care team of laryngologists -- ear, nose, and throat (ENT) doctors with advanced training in voice disorders -- and highly trained speech pathologists diagnose your condition and help you learn to use your voice more comfortably in order to speak or sing without strain.

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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 caused by muscle tightness. 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 be using your breath to effectively energize your voice, or your throat muscles may be too tight when you speak. Muscle tension dysphonia can make your voice sound strained or hoarse and can make it uncomfortable to talk. It is common to experience muscle tension dysphonia along with another voice problem.

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

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.

Our Locations

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

Tests and Treatments for Muscle Tension Dysphonia

Comprehensive Voice Evaluation

We will examine your head, neck, and larynx (voice box) as part of a comprehensive voice evaluation. We also assess your voice use patterns -- how much and how loudly you speak or sing -- 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 illnesses.


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, muscle 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.

Videolaryngostroboscopy is the best test for reaching an accurate diagnosis and determining the best treatment for your voice.

Voice Therapy

Voice therapy helps you learn to relax your throat muscles, use your breath to power your voice efficiently, and use good oral resonance (how air flows through your mouth and nose when you speak). You’ll work with a speech pathologist who will guide 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 vocal effort.

Laryngeal Massage and Myofascial Release

If appropriate, you may receive targeted manual therapy performed by a speech pathologist. This may involve gentle stretching or massage in areas of the head, neck, and torso where muscle tension is present. People often experience dramatic relief of throat strain and discomfort after these treatments. 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 muscle tension dysphonia, the vocal cords may appear normal, and only detailed examination using videolaryngostroboscopy can identify minor muscle inefficiencies. This test is typically only available at ear, nose, and throat clinics like Duke's that specialize in voice disorders.

Skilled Voice Therapists
We are one of only a few dedicated voice care 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.

Specialty Care for Singers and Professional Voice Performers
If you are one of the many singers affected by muscle tension dysphonia, you’ll benefit from the expertise of our clinical singing voice specialists.

Coordinated Care
If you have other medical conditions that may contribute to your voice strain -- such as allergies, asthma, or acid reflux -- we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team. 

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.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

This page was medically reviewed on 11/07/2022 by