From the Research
Muscle tension dysphonia (MTD) should be graded on a scale from mild to severe based on the degree of excessive laryngeal muscle tension and its impact on voice quality, with a focus on somatosensory symptoms such as vocal effort, fatigue, and discomfort, as identified in the most recent study 1.
Grading System
A common grading system includes four levels:
- Grade 1 (mild) shows minimal tension with occasional voice breaks or strain
- Grade 2 (moderate) presents with noticeable tension, frequent voice breaks, and reduced vocal range
- Grade 3 (moderately severe) demonstrates significant tension with consistent voice strain and substantial impact on communication
- Grade 4 (severe) exhibits extreme tension with severely compromised voice quality and significant communication difficulties
Assessment
Assessment should include:
- Laryngoscopic examination to visualize laryngeal posture and movement
- Perceptual voice evaluation using tools like the GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain)
- Acoustic analysis measuring parameters like jitter and shimmer
- Patient self-assessment using validated questionnaires such as the Voice Handicap Index This comprehensive grading approach helps clinicians determine appropriate treatment strategies, which may include voice therapy focusing on relaxation techniques, breathing exercises, and vocal function exercises, as supported by studies 2, 3.
Importance of Grading System
The grading system is important because muscle tension patterns directly affect treatment approaches, with higher grades typically requiring more intensive and prolonged therapy interventions. The most recent study 1 highlights the importance of considering somatosensory symptoms in the diagnosis and treatment of MTD, which can inform the development of effective treatment plans.
Key Considerations
- Anteroposterior and lateral compression of the larynx are key laryngoscopic features associated with MTD, as identified in study 4
- Voice therapy can be effective in reducing vocal tract discomfort and improving voice quality in patients with MTD, as shown in study 3
- A multidisciplinary approach, including close cooperation between a laryngologist and a speech-language pathologist, is essential for the diagnosis and treatment of MTD, as emphasized in study 5