Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia

Muscle tension dysphonia (MTD), a common voice disorder that is not often referred to physical therapy (PT), is characterized by excessive muscle recruitment resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether PT including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Nine patients with MTD were a administered a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the Numeric Rating Scale (NRS), Patient Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion were also assessed at baseline and after the intervention using standard goniometric measurements. Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients exhibited improvement in cervical flexion and lateral flexion and jaw opening, while eight of the patients improved in cervical extension and rotation post-intervention.

The findings indicate that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of PT to incorporate referrals from Voice Centers for the treatment of MTD.