What are the vocal cords?

The vocal cords are two small muscles located in the larynx (voice box) that are responsible for voice production. They are found above your trachea (windpipe) at the level of the Adam’s apple. Your vocal cords are very small, about 1.8cm for men and 1.1cm for women.

How is voice/speech usually produced?

When you are not speaking the vocal cords lie apart, allowing air to pass in and out of your lungs. During speech they come together and as air from your lungs pushes up through them, they vibrate and produce sound. Movement of your lips and tongue shape vibrations into individual sounds.

What is muscle tension dysphonia?

Muscle tension dysphonia is too much tension in the voice box when you talk.  The tissues above your vocal cords can squeeze too much and make talking very effortful. Tension in your voice box will affect how your vocal cords vibrate and can cause your voice to sound strained. You may have to use more effort to speak and talking for a long time may make your voice tired and sore.

What are the symptoms?

  • Tiredness, aching or pain when speaking or singing
  • A dry throat, particularly if speaking for long periods of time
  • A change in voice quality, possibly worsening towards at the end of the day
  • A change in the pitch of your voice (too high, too low or unpredictable), or experiencing voice breaks where the sound ‘cuts out’.

Your voice may sound:

  • Rough, hoarse or croaky
  • Tight, strained or tense
  • Breathy or weak

What causes muscle tension dysphonia?

Muscle tension can be caused by factors such as:

  • A throat infection
  • An emotional event such as loss of a loved one, life stress or traumatic event
  • Long term misuse of your voice such as shouting or yelling or not looking after your voice
  • A problem with your vocal cords such as a cyst or polyp, or fatigue in the vocal muscles
  • Your body trying to protect your vocal cords from acid reflux

How is muscle tension diagnosed?

Diagnosis of muscle tension usually requires looking at your vocal cords with a camera. This is carried out by an Ear, Nose and Throat (ENT) specialist and often a Speech Pathologist. You will be asked about the history of your voice and anything that happened at the start of your voice problems.  The flexible camera is placed into your nose and looks down into your voice box.  We can see how the vocal cords are moving, and if there is any tension in your voice box when you talk.

How is muscle tension dysphonia treated?

Treatment for muscle tension dysphonia is usually through voice therapy sessions with a Speech Pathologist. These sessions help to work through any causes and provide you with exercises and techniques to help you reduce the tension in your voice box.  You will usually have to practice these at home between sessions.

In most cases, muscle tension does not cause damage to the vocal cords. However, with prolonged muscle tension and forcing your voice, it may cause some swelling and irritation.

If your muscle tension dysphonia is caused by a problem with your vocal cords the ENT specialist will discuss medical or surgical options. We usually advise that you attend voice therapy sessions as well as any medical/surgical intervention to help your recovery.

Ways to help reduce tension:

  • Do something every day that you find relaxing such as:
    • reading,
    • walking or
    • listening to music
    • meditation or yoga
  • Avoid shouting, yelling, screaming and whispering
  • Do not speak or sing over background noise
  • Avoid too much throat clearing or coughing
  • Sip water regularly
  • Inhale steam to relax and hydrate your voice box

If you have any concerns or questions, please talk to your ENT Doctor or Speech Pathologist.

Disclaimer This document describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Royal Victorian Eye and Ear Hospital makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.

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  • Muscle Tension Dysphonia #136
  • Owner: Speech Pathology
  • Last Reviewed: March 16, 2023
  • Next Review: March 16, 2028