Muscle Tension Dysphonia Research Articles

An Update on Speech Pathology Management of Chronic Refractory Cough

Chronic cough is a common, debilitating condition that can persist for years with little relief from medical treatment. Speech pathology treatment is an effective treatment option for patients with chronic cough. This review outlines current speech pathology assessment and treatment for chronic cough and describes the evidence supporting the intervention. The rationale for speech pathology intervention is described with reference to speech pathology training and expertise that are relevant for this condition. Despite the efficacy and advantages of speech pathology intervention, there is limited guidance in the literature on when patients should be referred for treatment. Patients suitable for speech pathology intervention are those whose cough has persisted despite medical management. Speech pathology intervention may be particularly beneficial for patients with coexisting laryngeal disorders such as muscle tension dysphonia or inducible laryngeal obstruction. Limited information is available regarding current speech pathology training, practice, and service delivery for chronic cough internationally. Timely referral for speech pathology intervention could reduce the disease burden for individuals with chronic cough and decrease the economic burden of this complex condition.

Detection of Muscle Tension Dysphonia Using Eulerian Video Magnification: A Pilot Study

To determine whether Eulerian Video Magnification software is useful in diagnosis of muscle tension dysphonia (MTD). Prospective. Adult patients scheduled in a tertiary care laryngology practice for evaluation of dysphonia were recruited between November 2016 and March 2017. Demographic and clinical data were extracted from patient charts. Diagnosis of MTD was confirmed with videostroboscopic and physical exam and by a speech-language pathologist. Eighteen MTD patients were video recorded while at rest and with phonation. Five patients without MTD also were analyzed as controls. Videos were analyzed using Eulerian Video Magnification software (Massachusetts Institute of Technology) to assess change in blood flow at the forehead, infrahyoid muscles, and sternocleidomastoid muscles, while using the values of the background wall as a control value. Patients with MTD demonstrated little change in perfusion to the infrahyoid muscles of the neck while phonating (+1% ± 55%). Control subjects demonstrated an increase in perfusion to the infrahyoid muscles while phonating (+102% ± 164%), with this change being significant when comparing the two groups (P = 0.04, t = 2.189, df = 21). A change in perfusion of 0% or less to infrahyoid muscles was 75% sensitive and 70% specific for diagnosis of MTD. No differences in perfusion were found between other regions assessed. Patient age and gender did not correlate with any change in perfusion between rest and phonation. Our data suggest that Eulerian Video Magnification can be used in the diagnosis of MTD by focusing on the difference in perfusion to the infrahyoid muscles between rest and phonation.

Intervention Outcomes of Two Treatments for Muscle Tension Dysphonia: A Randomized Controlled Trial.

Purpose The aim of this study was to test the hypothesis that stretch-and-flow voice therapy (SnF) is noninferior to resonant voice therapy (RVT) for speakers with muscle tension dysphonia. Method Participants with primary muscle tension dysphonia were randomly assigned to 1 of 2 treatment groups. Participants received 6 sessions of either SnF or RVT for 6 weeks (1 session per week). Pretreatment and posttreatment audio recordings of sustained vowels and connected speech were acquired. Response to treatment was assessed using the voice handicap index (VHI) as the primary outcome measure. Secondary outcome measures included the acoustic voice quality index, the smoothed cepstral peak prominence, and scales from the Consensus Auditory-Perceptual Evaluation of Voice instrument. Data were analyzed for 21 participants who completed the study (12 in the SnF group, 9 in the RVT group). Results Direction of change for the primary outcome measure and all 3 secondary outcome measures at posttreatment was in the direction of improvement for both SnF and RVT. Confidence intervals for VHI measures did not cross the null effect line on forest plots, suggesting significant effects for both treatments on the primary outcome measure. The effect sizes for pretreatment to posttreatment changes in VHI were large for both treatment groups. Similar results were found for the secondary acoustic outcome measures. There were statistically significant pretreatment to posttreatment changes in the primary and secondary outcome measures for patients receiving both treatments, indicating significant improvement in response to both RVT and SnF. There were no statistically significant differences in pretreatment to posttreatment changes in the primary outcome measure or any secondary outcome measure between the two groups. The within-group pretreatment to posttreatment changes in Consensus Auditory-Perceptual Evaluation of Voice scales did not reach statistical significance for either RVT or SnF. Conclusions Both SnF and RVT produced positive treatment response in speakers with muscle tension dysphonia, with no statistically significant difference in the outcome measures between the two treatments. This suggests that SnF is noninferior to RVT and that both are effective options for treating vocal hyperfunction. Results from this study also support previous findings documenting the sensitivity of multidimensional acoustic measurements to treatment response.

Coverage and Coding for Transgender Voice Treatment

Coverage and Coding for Transgender Voice Treatment

Aetna to Cover Voice Therapy for Muscle Tension Dysphonia

Aetna to Cover Voice Therapy for Muscle Tension Dysphonia

The Role and Limitations of Speech-Language-Hearing Therapists in Discrimination between Muscle Tension Dysphonia and Adductor Spasmodic Dysphonia

The Role and Limitations of Speech-Language-Hearing Therapists in Discrimination between Muscle Tension Dysphonia and Adductor Spasmodic Dysphonia

Guía para el fonoaudiólogo en evaluación e intervención de la disfonía por tensión muscular: Revisión y caso

La disfonía por tensión muscular es uno de los diagnósticos comunes en la clínica de voz y el fonoaudiólogo o vocólogo es parte fundamental del equipo multidisciplinar encargado de su manejo. El propósito de este artículo es realizar una descripción de la disfonía por tensión muscular dentro del espectro de las denominadas disfonías funcionales. En la primera parte se presentan las diversas denominaciones, clasificaciones y características de las disfonías por tensión muscular que pueden servir como guía para el terapeuta en el proceso de evaluación e intervención terapéutica de las personas con alteraciones vocales por tensión muscular. En la segunda parte se presenta un caso para el cual se describe la intervención terapéutica realizada analizando los factores asociados, se discuten los resultados y la eficacia del tratamiento. La terapia basada en la coordinación y balance de los sistemas fisiológicos vocales puede ser una herramienta efectiva en la resolución de casos de disfonía por tensión muscular

Vibratory Onset of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia: A High-Speed Video Study✰

Adductor spasmodic dysphonia (AdSD) is a challenging voice disorder to diagnose, often erroneously diagnosed as muscle tension dysphonia (MTD) or vocal tremor, due to its similarity in auditory and perceptual presentation. Assessments using laryngoscopy or strobolaryngoscopy procedures have demonstrated limited utility in the diagnosis of spasmodic dysphonia. High-speed videoendoscopy (HSV) provides visualization of the precise vibratory pattern of phonatory onset and thus, offers an alternative to previous diagnostic strategies for visual diagnosis of AdSD. The purpose of this study was to examine vibratory onset of patients with AdSD and patients with MTD using HSV methodology. HSV of six adults with AdSD and five adults with MTD were captured during sustained phonation. Digital kymography was used to obtain precise vibrogram data at the mid-membranous region of the vocal fold prior to and at the onset of phonation. Voice onset delay was examined by (1) quantifying timing of prephonatory delay and steady state delay and (2) describing vocal fold onset movements qualitatively in each diagnosis. HSV adequately captured the phonatory onset of the vocal folds. Voice onset delay was not significantly different between AdSD and MTD. However, there were distinct differences in voice onset gestures. Both AdSD and MTD patients presented with vocal hyperfunction during the onset of phonation. In a subset of AdSD patients, a rapid sustained adduction occurred following the initial vibratory motion. Vocal fold vibration then continued until steady phonation was achieved. This oscillatory break pattern was not observed in patients with MTD. Therefore, there appears to be differences in vocal fold vibratory onset motion between MTD and AdSD. HSV captures the precise vibratory onset in patients with MTD and AdSD. Differences were most notable after vibratory onset as opposed to vibratory delay measurements. Examination of voice onset gesture may offer an additional laryngeal parameter to assist in the differential diagnosis of spasmodic dysphonia.

Transcutaneous Electrical Nerve Stimulation Combined With Voice Therapy in Women With Muscle Tension Dysphonia

The purpose of the present study was to investigate the effect of Voice Therapy (VT) with and without Transcutaneous Electrical Nerve Stimulation (TENS) in women with Muscle Tension Dysphonia (MTD). A total of 20 women with MTD participated in the study. Participants underwent evaluation of auditory-perceptual assessment, acoustic voice analysis, Vocal Tract Discomfort (VTD), and musculoskeletal pain before and after the treatment. The participants were divided into two groups: (1) TENS + VT group (10 participants) and (2) VT group (10 participants). Both groups received 10 sessions of treatment, twice a week, each lasting 50 minutes. The statistical analysis was performed using Wilcoxon signed ranked and Mann-Whitney U tests (P < 0.05). After VT, significant improvements were observed in all auditory-perceptual parameters and all VTD items except for the tickling frequency and severity. The VT caused significant reduction in the frequency of pain in anterior neck, posterior neck, and the larynx. Also, VT resulted in a significant reduction in pain intensity only in the larynx. After VT + TENS, significant improvements were observed in all auditory-perceptual parameters, shimmer, and all VTD items. Moreover, the VT + TENS led to a significant decrease in the frequency and intensity of pain in anterior neck, posterior neck, the larynx, masseters, shoulders, and upper back. The findings of between-group comparison after treatment showed significantly more reduction in the frequency (dry and pain items) and severity (tight and pain items) of the VTD in VT + TENS group compared with VT group. Regarding the musculoskeletal pain, significantly more reduction in the frequency and intensity of pain in anterior neck and the larynx was observed in VT + TENS group compared with VT group. The VT and VT + TENS could lead to positive outcomes in auditory perceptual assessment, acoustic voice analysis, the VTD, and assessment of musculoskeletal pain. In some items of frequency and severity of VTD scale and assessment of musculoskeletal pain, VT + TENS also produced better results compared with VT. As a result, TENS was recommended as a complementary therapy for patients with MTD, especially when these patients had more complaints about VTD and musculoskeletal pain.

Comparison of Maximum Oxygen Uptake and Rating Perceived Exertion in Woman's Kabaddi Athletes (Without Breathy Voice to Severe Breathy Voice)

There is limited research on voice problems of athletes, especially Kabaddi athletes who use their voice during Kabaddi exercises and may damage their vocal folds and impair their voice quality. The present study aimed to compare maximum oxygen uptake (VO2max) and rating perceived exertion (RPE) in Woman's Kabaddi athletes without breathy voice (BV) to severe BV. Seventy woman's Kabaddi athletes (mean age of 20.5 ± 2.7 years, height of 163 ± 3.6 cm, weight of 61.4 ± 5.4 kg) at the club and national team level (without BV to severe BV) were compared in this study. Data were collected by imaging the larynx by a stroboscopic device (there is gap and asymmetry between vocal folds, presence of mass on vocal folds, muscle tension dysphonia, hoarseness, and harshness), evaluating the voice parameters by Vocal Assessment software (mean F0 (Hz), F0SD (Hz), jitter (%), shimmer (%), Normal Noise Energy (NNE) (dB)), and calculating VO2max by Bruce treadmill test. RPE was calculated by a 15-point (6-20) Borg test. The results showed that 39 (55.17%) subjects had moderate and high BV symptoms and 31 (44.28%) had no symptoms of BV and low BV. The mean fundamental frequency in the group with moderate and severe BV was equal to 2.59 Hz opposite the mean fundamental frequency in the group without BV and low BV was equal to 0.65 Hz, and in contrast, the jitter (0.47%) opposite (0.19%) and the shimmer was equal to (6.64%) opposite (0.67%) and the NNE was equal to (-3.08 dB) In front of (-11.95 dB). There was no significant difference between VO2max in two groups of Woman's Kabaddi athletes as well as RPE in two groups of Woman's Kabaddi athletes at significant level of P ≤ 0.05. Severe BV is affected by voice abuse. Voice abuse during Kabaddi is negatively affecting the quality of voice. After Kabaddi sport, athletes are complained from obstruction, hoarseness, and harshness due to disturbances in vocal folds and throat dryness. According to the data obtained from this study, abuse has a negative effect on vocal folds, which is followed by BV in various degrees in Kabaddi athletes.

Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints.

Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI-10 scores in patients with voice complaints not responsive to antireflux medications. Retrospective cohort study. A study of patients was conducted at a single tertiary-care center over 1 year (January 2012-January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice-therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow-up visits with a laryngologist. A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow-up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5-22.8] vs. 10.5 [IQR, 4.5-14]; P = .02) and median VHI-10 score (25.5 [IQR, 11.3-30.0] vs. 13.5 [IQR, 9.5-20.8]; P = .03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = -0.4; P = .05). In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI-10 scores improved following voice therapy. Results suggest that self-reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy. 4 Laryngoscope, 129:1169-1173, 2019.

Etiological spectrum for dysphonia in a rural Indian treatment seeking population

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Aim of the study was to identify and analyse the etiological factors for dysphonia in a rural treatment seeking population in South India.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 consenting patients presenting to the Department of Otorhinolaryngology in our rural hospital with change in voice for more than 4 weeks and undergoing detailed clinical evaluation including videolaryngoscopic examination and other relevant investigations to arrive at a definitive diagnosis, were included in a cross sectional descriptive clinical study. Descriptive and inferential statistical analysis was performed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Organic/structural and functional dysphonia constituted 87% and 13% of cases respectively. The commonest causes for dysphonia were laryngopharyngeal reflux disease (LPRD) (35%), laryngeal/hypopharyngeal malignancies (16%) and vocal palsy/paresis (12%). The mean age of the study patients was 38.71±5.82 years. Majority (65%) were aged 21–50 years. Vocal palsy was identified in children aged 1–10 years (1%), and muscle tension dysphonia in those aged 11–20 years (2%). In individuals aged 21–50 years, LPRD (28%), functional dysphonia (9%), vocal nodules (8%) and vocal palsy (7%) were the most common causes. Laryngeal/hypopharyngeal malignancy (14%) was the commonest etiology identified in individuals aged ≥51 years. Male:female ratio was 1.1:1. The most frequently observed cause for dysphonia was laryngeal/hypopharyngeal malignancy (15%) in males, and LPRD (22%) in females.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; With its vast etiology, dysphonia is often just the “tip of the iceberg” for a much greater underlying disease process. This study serves as an insight into the possible differential diagnosis based on age, gender and geographic location of patients. As observed, the most common causes for dysphonia are LPRD and laryngeal/hypopharyngeal malignancies; both of which are amenable to prevention by lifestyle modification, early detection by appropriate clinical and investigative measures, and suitable treatment. Early and correct identification of the cause for dysphonia, enables early management, thereby reducing its associated morbidity and mortality.&lt;/p&gt;

A Novel Laryngeal Palpatory Scale (LPS) in Patients with Muscle Tension Dysphonia

ObjectivesLaryngeal palpation is a routine clinical method for evaluation of patients with muscle tension dysphonia (MTD). The aim of this study was to develop a new comprehensive valid and reliable “laryngeal palpatory scale” (LPS), based on psychometric criteria. MethodsThe scale items were selected based on an in-depth analysis of the literature and an expert focus group. Scale item generation and item reduction were followed by a psychometric assessment. Qualitative and quantitative content validity (the content validity ratio (CVR), content validity index (CVI)), the qualitative face validity, and the inter-rater reliability were determined. For this purpose, 531 patients were assessed and finally 55 patients with primary MTD (26 women, mean age: 40.8 years, SD: 12.5; 29 male, mean age: 41.6 years, SD: 11.8) participated in the study. A weighted kappa (k*) statistic was used to examine the inter-rater reliability for each single item. ResultsBased on the CVR, three items were omitted because they had a score of less than 0.62. The CVI for all remaining items was greater than 0.79 and the scale CVI was equal to 0.96. The final 45 items were a result of the study. The inter-rater reliability for each single item ranged from 0.41 to 1, indicating moderate to almost perfect agreement. ConclusionsThe LPS is a reliable and valid instrument for assessing patients with MTD. However, future studies are needed to provide adequate data on sensitivity, specificity, concurrent validity, and cutoff scores.

Vocal Tract Discomfort Scale: Validation of the Argentine Version

The objective of this study was to validate the Vocal Tract Discomfort Scale (VTD) Argentine version. Nonrandomized, cross-sectional prospective study with control group. The VTD Scale was culturally and linguistically adapted to Argentinian Spanish according to the recommended requirements of translation, closely observing the methodology that was suggested (translation, summary, review and back-translation). The scale Argentine version (Escala de disconfort del tracto vocal) was administered to 107 patients with muscle-tension dysphonia (MTD) (23 men and 84 women, mean ages being: 32.30 ± 9.09 years old for MTD type I, and 31.23 ± 8.45 years old for MTD type II) and 30 volunteers with no vocal pathology (9 men and 21 women, mean ages being: 44.3 ± 8.72 years old). All patients completed the Escala de disconfort del tracto vocal before and after Mathieson Laryngeal Manual Therapy. The results of the VTD Scale administered in both patients and vocally healthy subjects were initially compared; the changes arising from pre and post therapy were also compared in the second phase. The internal consistency of the VTD Scale was assessed using Cronbach alpha coefficient. The internal consistency assessed was considered acceptable for both subscales within the VTD Scale. The values obtained for frequency, severity, and total score of the Scale were similar in patients with MTD I and MTD II, marking a difference with those obtained in the control group of healthy volunteers. A lump feeling in the throat was one of the most frequent symptoms in both MTD and vocally healthy groups. The VTD Scale shows an acceptable consistency, so it is a highly reproducible, reliable, and valuable instrument of evaluation to assess Argentinian patients with voice disorders.

Control of Fundamental Frequency in Dysphonic Patients During Phonation and Speech

PurposeThe pitch-shift reflex (PSR) is the adaptation of the fundamental frequency during phonation and speech and describes the auditory feedback control. Speakers without voice and speech disorders mostly show a compensation of the pitch change in the auditory feedback and adapt their fundamental frequency to the opposite direction. Dysphonic patients often display problems with the auditory perception and control of their voice during therapy. Our study focuses on the auditory and kinesthetic control mechanisms of patients with muscle tension dysphonia (MTD) and speakers without voice and speech problems. Main purpose of the study is the analysis of the functionality of the control mechanisms within phonation and speech between patients with MTD and normal speakers. MethodSixty-one healthy subjects (17 male, 44 female) and 22 patients with MTD (7 male, 15 female) participated following two paradigms including a sustained phonation (vowel /a/) and speech ([‘mama]). Within both paradigms the fundamental frequency of the auditory feedback was increased synthetically. For the analysis of the PSR the electroencephalogram, electroglottography, the voice signal, and the high-speed endoscopy data were recorded simultaneously. The PSR in the electroencephalogram was detected via the N100 and the mismatch negativity. Statistical tests were applied for the detection of the PSR in the physiological response within the electroglottography, voice, and high-speed endoscopy signals. The results were compared between both groups. ResultsNo differences were found between the controls and patients with MTD regarding latency and magnitude of the perception of the pitch shift in both paradigms, but for the magnitude of the behavioral response. Differences also could be found for both groups between the “no pitch” and “pitch” condition of the two paradigms regarding vocal fold dynamics and voice quality. Patients with MTD showed more vibrational irregularities during the PSR than the controls, especially regarding the symmetry of vocal fold dynamics. ConclusionPatients with MTD seem to have a disturbed interaction between the auditory and kinesthetic feedback inducing the execution of an overriding behavioral response.

Positive Effects of Manual Circumlaryngeal Therapy in the Treatment of Muscle Tension Dysphonia (MTD): Long Term Treatment Outcomes

IntroductionManual circumlaryngeal therapy (MCT) aims to correct laryngeal position and relax (para) laryngeal and cervical muscles resulting in improved voice quality. The goal of the current study was to further verify long-term effects of MCT in the treatment of Muscle Tension Dysphonia (MTD) patients based on acoustic findings and perceptual judgments. MethodTwenty-eight adult female patients who had been referred to the speech therapy clinic of Khatam Hospital, Zahedan city, participated in this study. Manual circumlaryngeal therapy was undertaken. There were 15 therapy sessions, three sessions per week, each with duration of 30 minutes. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the long-term (6-months) effects of the 15 treatment program. ResultsAcoustically, Harmonic to Noise Ratio (HNR) increased and perturbation (Jitter and Shimmer) measures decreased, and perceptually, the subjective CAPE-V ratings improved in all patients. ConclusionThese results suggest that MCT can be an effective method for voice rehabilitation in patients with MTD and the changes due to the therapy were persistent over a 6-month duration following the termination of treatment sessions.

Effects of Voice Therapy Using the Lip Trill Technique in Patients With Glottal Gap

Lip trills are widely used as a voice warm-up technique among singers. However, little is known about the effects of lip trills in cases of voice disorders. We examined the therapeutic effects of lip trills in patients with glottal gap. Patients with glottal gap were classified into three groups according to the type of gap: gap-only, gap with muscle tension dysphonia (MTD), and a sulcus vocalis group. Patients underwent perceptual, acoustic/aerodynamic analyses, stroboscopic evaluations, and subjective analyses using a questionnaire before and after lip trills. The results were analyzed before and after trills and according to and between the groups. The results in 42 patients were analyzed. Most of the parameters were improved and glottal gap was significantly reduced after trills in all patients. In the gap-only group (n = 19), most of the parameters showed improvement and were within the respective normal ranges, and glottal gap was improved after trills. In the MTD group (n = 13), although many parameters were improved, the improvement was not as prominent as in the gap-only group. In the sulcus vocalis group (n = 10), only some of the parameters were improved and the improvement in glottal gap was limited. Lip trills were an effective treatment for glottal gap. The therapeutic effect was prominent in the gap-only group, followed by the MTD and sulcus vocalis groups. Trills can be used as an adjuvant treatment option in voice therapy in cases of various voice disorders.

Airflow Patterns of Running Speech in Patients With Voice Disorders

Aerodynamic measures of voice have historically been acquired using sustained phonation tasks. This study seeks to determine whether there are differences in airflow during sustained phonation (MFs), in running speech (MFrs), or during phonation in running speech (MFvrs). We also seek to determine whether these patterns are diagnostically significant. Data were collected on 40 subjects (15 men, 25 women), ages 20-79, with a mean age of 53 in this prospective study. All participants received a comprehensive videostroboscopic evaluation and were deemed appropriate for voice evaluation and trial therapy. The Phonatory Aerodynamic System 6600 was used for data collection. The Comfortable Sustained Phonation and Running Speech protocols were used for data acquisition. Patient diagnoses were divided into five subgroups: benign lesions, vocal fold paralysis or paresis, muscle tension dysphonia, edema or laryngitis, and chronic cough. Statistical methods such as analysis of variance and Tukey tests assessed pairwise differences in the airflow rate. Pairwise Tukey multiple comparisons of means testing using a 95% family-wise confidence level were completed to determine the interrelationships of the pairs. Differences were found among airflow measures (P value = 0.0152), pairwise comparisons of MFs-MFvrs pair (P value = 0.012), and diagnosis. No significance was found in MFs-MFrs (P = 0.051) or MFvrs-MFrs (P = 0.94) pairs. Mean flow rates were higher than the norms in MFs. The overall range of mean airflow was similar to those of published norms. Assumptions about mean airflow of connected speech should not be made based on sustained phonation tasks alone. No salient diagnostic characteristics were found by diagnosis.

Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem.

ObjectiveTo characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD).Study DesignRetrospective chart review performed over a 14-month period from October 2014 to December 2015.SettingVoice and swallowing center of a tertiary academic medical center.Subjects and MethodsThirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures.ResultsAmong patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia (P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia (P = .002).ConclusionsPatients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.

Efficacy of Manual Circumlaryngeal Therapy in Patients with Muscle Tension Dysphonia

Objectives: The aim of this study was to evaluate the effects of manual circumlaryngeal therapy after one session of treatment on the voice of patients with muscle tension dysphonia. Methods: A total of 20 patients with muscle tension dysphonia were evaluated by recording vowel /a/ phonation and extracting fundamental frequency (F0), first formant frequency (F1), jitter, shimmer, and harmonics-to-noise ratio (HNR). One session of manual circumlaryngeal therapy was held for these patients. Immediately after treatment, acoustic assessments were replicated. Results: Following manual circumlaryngeal therapy, jitter and shimmer showed a significant reduction (P < 0.009), while HNR improved significantly versus pretreatment (P < 0.001). The mean changes in F0 were not significant, whereas a significant reduction was observed in F1 parameter (P < 0.009). Conclusions: The reduction in jitter and shimmer and increase in HNR after therapy resulted in the patients’ vocal improvement. Reduction of F1 after treatment suggests elongation of vocal tube and elimination of vocal tract shortness in response to the descent of larynx from its high-tension status. The insignificant change of F0 was attributed to the lack of change in vibrational characteristics, as well as stretching of vocal cords.