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Diagnosis and Treatment of Therapy-resistant Muscle Tension Dysphonia

CITATION:  Bhalla, R.K., Wallis, J., Kaushik, V., & de Carpentier, J.P. (2005).  How we do it: adjunctive intravenous midazolam: diagnosis and treatment of therapy-resistant muscle tension dysphonia.  Clinical Otolaryngology, 30, 364–383.

ABSTRACT:  Muscle tension dysphonia is a voice abnormality characterized by increased muscular tension in the laryngeal framework, and in the pre- and paralaryngeal neck musculature. The subsequent effect is to palpably increase phonatory muscle tension in the anterior neck, to elevate the larynx causing an increase in vocal pitch, a posterior phonatory gap, and vocal fold mucosal changes secondary to abnormal points of contact. Vocal tract discomfort is a common feature. Sufferers are extremely reliable in identifying types of discomfort to their therapist.1 This is distinct from spasmodic dysphonias, where excessive or uncontrolled closing of the vocal folds (adductor), or prolonged vocal fold opening for breathless sounds (abductor) or vocal fold tremor, produces involuntary changes in pitch, the inability to maintain speech without intermittent glottal catches or breathy breaks.2 Although both abnormalities feature varying degrees of increased muscular tension in the muscle groups discussed, spasmodic dysphonias are thought to be involuntary whereas muscle tension dysphonia is felt to be a psychogenic disorder of muscle misuse. 


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dystonia. Arch. Otolaryngol. Head Neck Surg. 127, 389–392

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5 Dworkin J.P., Meleca R.J., Simpson M.L. et al. (2000) Use of
topical lidocaine in the treatment of muscle tension dysphonia.
J. Voice 14, 567–574