Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy

Objective: The main object of this study is to elucidate the voice characteristics and the efficacy of voice therapy in children with muscle tension dysphonia (MTD). Methods: A retrospective file review was undertaken of eight Korean male children diagnosed as having MTD. All subjects received perceptual, acoustical and laryngoscopic evaluation before and after the treatment. Results: Markedly strained and breathy voices were detected in all patients. Pitch breaks and/or inadequately high or low speaking fundamental frequencies were noticed in five subjects. Laryngoscopic evaluation revealed anteroposterior contraction, false vocal fold approximation, decreased vibration of true vocal folds and incomplete glottal closure. Notably, seven out of eight subjects had bilateral vocal nodules. Voice therapy was focused on the awareness, relaxation, respiration and easy-onset phonation to reduce the tension around the laryngeal muscles. A few sessions of voice therapy resulted in dramatic improvement of their voice quality and pitch adjustment. Hyper-contraction of the supraglottic structures was also relieved. Conclusions: These findings suggest that the proper diagnosis of MTD in children warrants prompt and favorable responses to voice therapy regardless of coexistence of vocal nodules.