Muscle Tension Dysphonia Following Adolescent Voice Change

Abstract

We report the case of a patient who experienced vocal hoarseness for a long period following attainment of a lower vocal pitch after adolescent voice change. The larynx showed no organic laryngeal abnormalities, but slit-shaped glottal closure insufficiency and supraglottic hypercontraction during phonation were observed. At the beginning of voice therapy, we employed semi-occluded vocal tract exercises, and the hoarseness improved in sustained vowel phonation. However, the hoarseness flared up again when he pronounced consonants and spoke with intonation. We then employed the Weleminsky digital manipulation method and had the patient increase his vocal loudness, a combination often used to treat mutational dysphonia, and his hoarseness improved.
In this case, muscle tension dysphonia was caused by dysregulation of the laryngeal muscles due to adolescent voice change. The slit-like glottis closure insufficiency may have occurred because of a predominance of activity of the cricothyroid muscle in comparison with the adductor muscles and excessive contraction of the supraglottic region, causing hoarseness. Therefore, we undertook a voice therapy technique that relieves hypertension of the cricothyroid muscle, moderately promotes the muscle tension of the adductor muscles, and corrects the imbalance in muscle tension between the adductor muscles and the cricothyroid muscle.