Effects and Differences of Voice Therapy on Spasmodic Dysphonia and Muscle tension dysphonia: A Retrospective Pilot Study

Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO2 laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.

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Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

10.2310/ot.7065 ◽

2021 ◽

Author(s):

Elizabeth Erickson-DiRenzo ◽

Christine M. Kim ◽

C. Kwang Sung Sung

Keyword(s):

Muscle Tension ◽

Voice Disorders ◽

Neuromuscular Control ◽

Vocal Folds ◽

Voice Therapy ◽

Type I ◽

Muscle Tension Dysphonia ◽

Functional Dysphonia ◽

Age Related ◽

Type I Thyroplasty

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

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Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age

Otolaryngology ◽

10.1177/0194599820978435 ◽

2020 ◽

pp. 019459982097843

Author(s):

Amy Jacks ◽

Hannah Kavookjian ◽

Shannon Kraft

Keyword(s):

Vocal Cord ◽

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Muscle Tension ◽

Voice Handicap Index ◽

Voice Therapy ◽

Old Patients ◽

Presenting Symptoms ◽

Muscle Tension Dysphonia ◽

Significant Relationships

Objective To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. Study Design Retrospective cohort study. Setting Tertiary care voice center between January 2011 and June 2016. Methods A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. Results The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia ( P = .006) and vocal cord atrophy ( P < .001) but were less likely to have laryngopharyngeal reflux ( P = .001), benign vocal cord lesions ( P < .001), or muscle tension dysphonia ( P < .001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery ( P = .001) and voice therapy ( P = .034), as did the <65 cohort (surgery, P < .001; voice therapy, P = .015). Adult surgical patients <65 reported greater improvements than patients ≥65 ( P = .021). Conclusions There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy.

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Adductor Spasmodic Dysphonia versus Muscle Tension Dysphonia: Examining the Diagnostic Value of Recurrent Laryngeal Nerve Lidocaine Block

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600301 ◽

2007 ◽

Vol 116 (3) ◽

pp. 161-168 ◽

Cited By ~ 9

Author(s):

Nelson Roy ◽

Marshall E. Smith ◽

Brynn Allen ◽

Ray M. Merrill

Keyword(s):

Recurrent Laryngeal Nerve ◽

Muscle Tension ◽

Diagnostic Value ◽

Laryngeal Nerve ◽

Spasmodic Dysphonia ◽

Muscle Tension Dysphonia ◽

Adductor Spasmodic Dysphonia

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Voice Therapy for Muscle Tension Dysphonia (MTD)

The Japan Journal of Logopedics and Phoniatrics ◽

10.5112/jjlp.54.40 ◽

2013 ◽

Vol 54 (1) ◽

pp. 40-44

Author(s):

Yukiko Yanagi ◽

Daigo Komazawa ◽

Michiko Kanno ◽

Michi Aikawa ◽

Chiho Ozaki ◽

...

Keyword(s):

Muscle Tension ◽

Voice Therapy ◽

Muscle Tension Dysphonia

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Phonatory Air Flow Characteristics of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia

Journal of Speech Language and Hearing Research ◽

10.1044/jslhr.4201.101 ◽

1999 ◽

Vol 42 (1) ◽

pp. 101-111 ◽

Cited By ~ 29

Author(s):

Maureen B. Higgins ◽

David H. Chait ◽

Laura Schulte

Keyword(s):

Air Flow ◽

Muscle Tension ◽

Flow Characteristics ◽

Spasmodic Dysphonia ◽

Potential Contribution ◽

Intrasubject Variability ◽

Muscle Tension Dysphonia ◽

Adductor Spasmodic Dysphonia ◽

Coefficients Of Variation ◽

Significant Difference

The purpose of this study was to determine if phonatory air flow characteristics differed among women with adductor spasmodic dysphonia (AdSD), muscle tension dysphonia (MTD), and normal phonation. Phonatory air flow signals were gathered during [pα] syllable repetitions. Mean phonatory air flow, coefficients of variation, and the presence of large air flow perturbations (75 ml/s or more) were examined for the three groups of speakers. There was no significant difference in mean phonatory air flow across groups, and very large intersubject variation in mean phonatory air flow occurred for both the AdSD and MTD groups. Coefficients of variation were similar for the groups of women with MTD and normal phonation but were significantly larger for the group with AdSD. Air flow perturbations were common with AdSD and rare with MTD. Relatively large coefficients of variation and air flow perturbations of at least 75 ml/s did occur for some women with normal voices who were 70 years of age or older. It appears that intrasubject variability in phonatory air flow may aid in the differentiation of AdSD and MTD when used in conjunction with other elements of a thorough voice evaluation. However, the potential contribution of aging to increased intrasubject variability in phonatory air flow must be considered when interpreting findings.

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