Voice: Neuromuscular

Muscle Tension Dysphonia (MTD) is a voice disorder caused by excessive tension in the muscles around the voice box (larynx). This tension affects the way the vocal cords vibrate, leading to voice changes such as hoarseness, strain, or discomfort when speaking. It can occur in people who use their voice extensively, such as teachers, singers, and public speakers, but it can affect anyone.

• Hoarseness or a rough voice
• A weak, breathy, or strained voice
• Voice fatigue or loss of voice after talking
• Throat discomfort or pain
• Difficulty projecting the voice
• Sensation of a lump or tightness in the throat
• Increased effort required to speak

MTD can develop due to various factors, including:

• Excessive voice use (e.g., prolonged speaking, singing, or shouting)
• Stress and anxiety, which can lead to tension in the neck and throat muscles
• Poor voice habits, such as speaking at an unnatural pitch or excessive throat clearing
• Respiratory infections or allergies, which can affect the vocal cords
• Reflux (acid reflux or GERD), which can irritate the throat and voice box
• Incorrect vocal technique in professional voice users
• Previous voice disorders, such as laryngitis, that lead to compensatory muscle tension

A specialist, such as an ear, nose, and throat (ENT) doctor or a speech-language therapist, will evaluate your symptoms. Diagnosis typically involves:

• A thorough medical history and voice assessment
• Laryngoscopy (a procedure to examine the vocal cords using a small camera)
• Voice analysis to assess pitch, loudness, and quality

Treatment for MTD focuses on reducing muscle tension and improving voice function. Common approaches include:

1. Voice Therapy

A speech-language therapist can guide you through exercises to:

• Reduce throat tension
• Improve breath support
• Develop healthy voice production techniques
• Prevent vocal strain
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2. Lifestyle and Voice Care Tips

• Stay hydrated by drinking plenty of water
• Avoid caffeine and alcohol, which can dry out the vocal cords
• Reduce throat clearing and coughing, as these can strain the vocal cords
• Practice good posture to reduce tension in the neck and shoulders
• Use a microphone if speaking loudly or for long periods
• Take regular voice breaks to prevent overuse
• Manage stress through relaxation techniques, such as deep breathing or yoga
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3. Medical Treatment

If underlying conditions such as acid reflux or allergies contribute to MTD, your doctor may recommend medications to help manage these issues.

4. Manual Therapy

Some patients benefit from physical therapy, massage, or myofascial release techniques to ease tension in the neck and throat muscles.

• If you experience persistent voice problems lasting more than two weeks, or if your voice issues interfere with your daily life, it is important to see a specialist. Early intervention can help prevent further complications and improve voice function.

Muscle Tension Dysphonia is a common but manageable voice disorder. With the right treatment and vocal care, most people can restore their natural voice and reduce discomfort. If you suspect you have MTD, consult a healthcare professional for an assessment and personalized treatment plan.

For more information, contact your ENT specialist or speech-language therapist.

Vocal Fold Atrophy is a condition where the vocal folds (also known as vocal cords) become thinner and weaker due to aging or other factors. This weakening reduces their ability to close properly, leading to voice changes such as breathiness, reduced volume, and vocal fatigue. It is most commonly seen in older adults but can also occur due to other medical conditions.

• Hoarseness or breathy voice
• Reduced vocal strength and projection
• Vocal fatigue or tiredness after speaking
• Difficulty being heard in noisy environments
• Increased effort required to speak
• A weak or unstable voice
• Frequent throat clearing
• Sensation of air escaping while speaking

Vocal Fold Atrophy occurs due to:

• Aging (Presbyphonia) – Natural thinning of the vocal folds as part of the aging process.
• Hormonal changes – Decreased levels of hormones that affect muscle strength (e.g., menopause, testosterone deficiency).
• Neurological conditions – Diseases like Parkinson’s disease or nerve damage affecting vocal fold function.
• Prolonged voice underuse – Lack of vocal exercise can lead to muscle weakening.
• Chronic illness – Conditions like chronic obstructive pulmonary disease (COPD) or neuromuscular disorders.
• Previous vocal fold injury – Surgery, intubation, or trauma to the voice box.

A specialist, such as an ear, nose, and throat (ENT) doctor or a speech-language therapist, will evaluate your symptoms. Diagnosis typically involves:

• A voice assessment to analyse pitch, loudness, and quality.
• Laryngoscopy or videostroboscopy – A small camera is used to examine vocal fold movement and structure.
• Acoustic analysis – Measuring voice quality, frequency, and airflow.

Treatment aims to improve voice quality and function through various approaches:

1. Voice Therapy

A speech-language therapist can help strengthen the vocal folds and improve voice control through:

• Vocal exercises to improve closure of the vocal folds.
• Breathing techniques to support better voice production.
• Postural and relaxation techniques to reduce strain.
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2. Medical and Surgical Interventions

If voice therapy alone is not effective, medical treatments may include:

• Voice Injections (Vocal Fold Augmentation) – Injectable fillers (e.g., hyaluronic acid, collagen) can add bulk to the vocal folds, improving their ability to close.
• Thyroplasty – A surgical procedure where a small implant is placed to help bring the vocal folds closer together.

3. Lifestyle and Voice Care Tips

• Stay hydrated – Drink plenty of water to keep vocal folds lubricated.
• Avoid smoking and alcohol – These can dry out and irritate the vocal cords.
• Use a microphone if needed – Reduces strain when speaking in large spaces.
• Take voice breaks – Resting the voice can help prevent overuse.
• Speak with proper breath support – Engage the diaphragm to avoid vocal strain.

• With proper treatment, most people with vocal fold atrophy can significantly improve their voice quality and function. Early intervention with voice therapy and, if necessary, medical treatments can help restore confidence in speaking.

If you experience persistent hoarseness, vocal weakness, or difficulty speaking for more than two weeks, consult an ENT specialist or speech-language therapist for an evaluation.

Vocal Fold Atrophy is a common condition, particularly in older adults, but it is manageable with the right treatment. If you have concerns about your voice, seek professional help to explore therapy or medical options that can enhance your vocal quality and daily communication.

UVFP occurs when one vocal fold fails to move as it should, affecting speech and swallowing. This can lead to a weak, breathy voice and difficulty swallowing. The condition often results from issues with the nerve controlling the vocal fold's movement. 

Common causes include:

• Surgical Complications: Injury to the recurrent laryngeal nerve during surgeries in the neck or chest, such as thyroid or cardiac procedures. 
• Neurological Conditions: Stroke or other neurological disorders affecting nerve function. 
• Tumours: Growths in the neck, thyroid, or chest that impact nerve function. 
• Trauma: Injury to the neck or chest area. 
• Idiopathic: In some cases, the cause is unknown.

• Voice Changes: Hoarseness, breathy voice, or weak voice. 
• Swallowing Difficulties: Choking or coughing when eating or drinking. 
• Breathing Issues: Shortness of breath during speech. 
• Weak Cough: Reduced ability to clear the throat.

Diagnosis typically involves:

• Medical History and Physical Examination: Assessing symptoms and potential causes.
• Laryngoscopy: Using a flexible or rigid scope to visualise vocal fold movement.
• Imaging Studies: CT or MRI scans to identify underlying causes like tumours or nerve damage.

Treatment aims to improve voice quality and swallowing function. Options include:

• Voice Therapy: Exercises to strengthen vocal muscles and improve voice function.
• Surgical Interventions:
  • Injection Laryngoplasty: Injecting substances to bulk up the paralyzed vocal fold, improving closure during speech. 
  • Medialisation Thyroplasty (Type 1 Thyroplasty): Inserting an implant to move the paralysed vocal fold towards the middle, enhancing voice quality. 
  • Reinnervation Surgery: Rewiring nerves to restore vocal fold movement, suitable for select patients.

• Voice Improvement: Many patients experience a stronger, clearer voice.
• Swallowing Function: Reduction in choking or coughing episodes during eating and drinking.
• Recovery Time: Varies depending on the treatment; your doctor will provide specific guidance.

Contact your healthcare provider if you experience:

• Worsening Voice Quality: Increased hoarseness or breathiness.
• Difficulty Breathing: Especially if it interferes with daily activities.
• Swallowing Problems: Persistent choking or coughing when eating or drinking.

Q: Will my voice return to normal after treatment?
A: While many patients see significant improvement, complete normalisation depends on the underlying cause and treatment type.

Q: Is UVFP a life-threatening condition?
A: UVFP is typically not life-threatening but can significantly impact quality of life. 

Q: Can UVFP affect both vocal folds?
A: UVFP affects one vocal fold. If both are affected, it is termed bilateral vocal fold palsy, a different condition.

For more information, contact your ENT specialist or speech-language therapist.