Muscle Tension Dysphonia is an extreme tightness or imbalance of the muscles in and around the vocal box leading to hoarseness and difficulty in using the voice.The muscle tension dysphonia is a disorder for an imbalance in the coordination of the muscles and breathing patterns required to create voice.This imbalance can be observed without any anatomical anomaly (primary MTD) or in the presence of an anatomical anomaly (secondary MTD).In the case of secondary MTD, the muscle tension is thought to be the body's natural compensatory process to adapt to the vocal injury.Primary MTD can be related to stress and anxiety.Recently it has been shown that under periods of stress the muscles that control the voice box become tense.Periods of prolonged muscle tension in the voice box can result in an in-coordination of the vocal control system.Muscle Tension Dysphonia often happens after an upper respiratory illness, such the cold or flu.In the upper respiratory tract infection, the muscular imbalance is not believed to be connected to stress and anxiety.Any stressful life events (e.g. the loss of a loved one) can cause muscle tension dysphonia as well.The causes of Muscle Tension Dysphonia are:1. Direct problem with the use of vocal technique2. Voice muscle habitual misuse3. Acid reflux from the stomach or laryngopharyngeal reflux4. Underlying inflammation of the vocal cord5. Growth on the vocal cord6. Neurological disorder affecting the vocal cordFrequent Symptoms Linked with MTD1. Hoarse voicea. Unreliable voiceb. Low, gravely voicec. Voice breaksd. Hoarse and rough quality2. Strained voicea. Airy or breathy voiceb. Inability to singc. Extra force needed for loud voiced. Vocal symptoms worsen with stresse. Inconsistent voice3. Pain or sore throat when talking4. Vocal fatigue easily5. Difficulty controlling pitchDiagnosis:1. A history of how the voice problem began and an evaluation of voice and speaking behaviors are steps in the diagnosis of primary MTD2. Speech-Language Pathology EvaluationEvaluation by a speech-language pathologist is very essential in the diagnosis of muscle tension dysphonia.Acoustic and aerodynamic measurements are also priceless assessment tools to find out the normal voice and breathing behaviors.3. Laryngoscopy and StroboscopyIt is a diagnosis of exclusion; careful examination of the vocal folds is required to exclude anatomical abnormalities.Flexible laryngoscopy permits the doctors to observe some muscular patterns during speaking.Videostroboscopy can help to view the vocal cords and permit the examiner to evaluate the mucosal wave as a marker for vocal fold vibration.4. CT or MRI Scanning of skull from nose to vocal box to look for underlying causes.5. Investigation for Other Linked AbnormalitiesThe diagnostic process should also direct on looking for important linked factors, such as:a. Laryngopharyngeal refluxb. Allergiesc. Side effects of medications (e.g., diuretics and antihistamines)d. Hormonal ImbalanceTreatment:Speech therapy is the best standard treatment for primary MTD.Speech therapy assists the patient to improve vocal symptoms through exercises and techniques geared at improving the way the body (muscles, lungs etc.) work together to create voice:2. Behavioral CounselingIn cases of primary MTD linked with stress or anxiety, it can be very useful for the patient to work with a counselor to decrease stress besides completing voice therapy.3. Medicine to treat acid laryngopharyngeal refluxTABLE OF CONTENTIntroductionChapter 1 Muscle Tension DysphoniaChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 LaryngitisChapter 8 Laryngopharyngeal RefluxEpilogue