Muscle Tension Dysphonia Treatment

Posted by | May 19, 2013 | Voice Treatment

Exercises to Relieve Supraglottic Tension ( Throat Constriction Above the Vocal Folds)


Circumlaryngeal Massage Technique:-  The SLP will massage the laryngeal area between the hyoid and thryoid to relax the laryngeal muscles and reduce tension. It is a “hands-on” approach in which patients are trained to massage their neck area while observing different changes in their voice quality.  When gently rubbed or kneaded the area becomes less painful.

The technique begins by the clinician encircling the client’s thyrohyoid space with her thumb and index finger and moving the fingers in a posterior direction until the major horns of the hyoid were located. Light to moderate pressure was exerted in a circular motion over the tips of the hyoid bone. Then this same movement was administered to the thyrohyoid space downward toward the thyroid notch, intending to open the space and essentially reduce the suprahyoid muscular tension responsible for elevating the larynx in a hypertensive state. Lowering laryngeal positioning in the neck permits more normal phonation (Aronson, 1990).  While manipulating the larynx, the patient is asked to hum, sustain vowels, produce words or phrases.  Monitor changes and once a ‘good voice quality’ is made, attempt to repeat.

Before attempting circumlaryngeal massage, physiological markers should first be witnessed.  First, the height of the larynx in the neck should be assessed as well as palpation of the suprahyoid muscles that suspend the larynx, such as the mylohyoid, stylohyoid, geniohyoid, hyoglossus, and digastric muscles. If these muscles are found to feel taut, and the larynx is being held in a high position in the neck, then muscle hyperactivity is likely (Rubin et al., 2000).  Also determine the ease of moving the larynx laterally.

Most patients with muscle tension dysphonia will see improvement after effective circumlaryngeal massage (Roy, et. al 1993).

Exercises for MuscleTension Dysphonia:

1. Tongue Stretch: Open your mouth and stick your tongue out as far as possible. You should feel stretching at the back of the tongue where it connects to your throat, below and behind your lower teeth. Relax and bring the tongue back to normal position. Repeat this 4 times.

2. Yawn: The yawn serves to expand the pharynx and to stretch and then relax the extrinsic laryngeal muscles, thus lowering the larynx in the neck to a more neutral position and permit a more forward placement of the tongue in the oral cavity.

Open your mouth as wide as possible and stretch deeply into the back of your throat. Lift your chest while you keep inhaling and keep stretching your mouth until you yawn “for real.” A true yawn is a powerful relaxer once it’s learned to triggered on command. Repeat this 4 times.

3. Big Sniff: With your mouth closed, take a deep breath in through your nose, as if smelling something such as a flower. Try to feel your throat get wide from behind the nose and down. When you have fully inhaled at a comfortably level, immediately release the exhalation. Do not hold your breath. Take a normal breath in and out before repeating. Repeat 4 times.

4. Chuckle: Keep your mouth closed, smile a tiny bit, press your chin slightly back, then laugh silently inside your throat. The goal is to feed your throat get wide on the inside, just below the back of the tongue and lower teeth. Repeat 4 times. You should feel the wideness in the same place as in the big sniff exercise.



Aronson, A. E. (1990). Clinical voice disorders: An interdisciplinary approach (3rd ed.). New York, NY: Thieme.  

Rubin, J. S., Lieberman, J., & Harris, T. M. (2000). Laryngeal manipulation. Otolaryngologic Clinics of North America, 33(5). 1017–1033.




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2 Responses to “Muscle Tension Dysphonia Treatment”

  1. Comment made by Liam on Nov 4th 2013 at 15:06: Reply

    after 9mthsof my voice getting worse and worse have finally been told I have MTD, now after 3 sessions of voice therapy and many hrs
    of practice with breath exercises still no improvement. Just read this and happy to try this system tongue stretch/ yawn etc. ( will try anything) Have stopped smoking/ no alcohol/ and no caffeine now for 6weeks.
    Any tips? Willing to attend private clinic with genuine recommendations


  2. Comment made by Anonymous on Nov 29th 2013 at 10:48: Reply

    I have had relief in the past using an electric hand held massager while doing voal exercises. I suffered with this problem for almost 5 months this spring and it has recurred a few days ago. I am now convinced it is related to stress in my life and am working to correct that in addition to revisiting the exercises and using the massager.

    Best of Luck,

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