Muscle Tension Dysphonia

1. Laryngeal Manual Therapy (Self-Massage)

We need to physically relax the muscles around the larynx (voice box) that are stuck in a high, tense position.

The Hyoid Release: Locate the hyoid bone (the U-shaped bone high in your neck, just under the jaw).

The Action: Using your thumb and index finger, gently massage the space between the hyoid bone and the thyroid cartilage (the Adam's apple). Use small circular motions.

The Stretch: Gently massage downward along the sides of the larynx.

Note: You may feel some tenderness or an urge to cough. This is normal, but do not press so hard that it causes sharp pain.

2. The "Yawn-Sigh" Technique

When we have MTD, the voice box often rides high in the neck. A yawn reflexively lowers the larynx and opens the throat.

Step 1: Open your mouth wide and trigger a fake yawn. Feel the back of your throat open and your Adam's apple drop down.

Step 2: As you exhale the yawn, let out a gentle, airy sigh: "Haaaaaa."

Step 3: Gradually turn that sigh into words like "Haa-llow" or "Haa-mmer," keeping that open, relaxed feeling in the throat.

3. Semi-Occluded Vocal Tract (SOVT) Exercises

These are standard practice in Mumbai clinics because they are safe and effective. They create "back pressure" from the mouth to the vocal cords, which helps the cords vibrate without strain.

A. Lip Trills (The "Brrr" Sound)

Relax your lips completely.

Blow air through them to make them vibrate (like a horse snorting or a baby making bubbles).

Add a gentle "uh" sound behind it.

Slide: Slide your pitch up and down gently like a siren.

If you struggle: Put two fingers gently on your cheeks to lift them slightly; this takes the weight off the lips.

B. Straw Phonation (Straw Bubbling)

This is excellent if your voice feels tired or painful.

Take a regular drinking straw and place it in a half-filled glass of water.

Blow bubbles steadily.

Add voice/humming while blowing bubbles. The goal is to keep the bubbles steady while making sound.

This massages the vocal cords from the inside out.

4. Diaphragmatic Breathing (Abdominal Breathing)

In MTD, patients often hold their breath or breathe using their shoulders/neck (clavicular breathing), which adds tension to the laryngeal area.

Placement: Place one hand on your chest and one on your stomach (just above the navel).

The Inhale: Breathe in through your nose. The hand on your stomach should rise. The hand on your chest should remain still.

The Exhale: Exhale through pursed lips. The stomach moves in.

Why: This takes the workload off the neck muscles during speech.

5. Resonant Voice Therapy (The "Mmm" Focus)

We want to move the sensation of voice away from your throat and into the "mask" of your face (lips and nose).

The Hum: Gently hum "Mmmm" at a comfortable pitch.

The Vibration: Focus on feeling a buzzing or tickling sensation on your lips and the bridge of your nose.

The Check: If you feel the vibration in your throat, you are pressing too hard. Lighten the sound.

Progression: Mmmm -> Mmm-one, Mmm-any, Mmm-oney.

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