• 말소리와 음성과학
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• 제5권4호
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• pp.63-70
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• 2013

The purpose of this study is to show the aerodynamic characteristics and differences in muscle tension dysphonia and adductor spasmodic dysphonia to predict factors which will provide additional information while preparing for the objective examination standard to distinguish the two dysphonias. Forty-eight individuals diagnosed with muscle tension dysphonia and adductor spasmodic dysphonia participated in this study. PAS was used in order to find the aerodynamic characteristics for the two dysphonias. The outcomes of this study show that the airflow variation and glottal resistance of the two groups showed noticeable differences. This study concludes that the aerodynamic characteristics may be used as additional information on diverse evaluations to classify muscle tension dysphonia and adductor spasmodic dysphonia.

• 음성과학
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• 제3권
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• pp.5-17
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• 1998

Botulinum toxin, a neurotoxin derived from Clostridia Botulinum, has been injected into the target muscle(s) for the treatment of several kinds of voice and speech disorders at the Voice Clinic, Yonsei Institute of Logopedics and Phoniatrics since December 1995. Criteria for the diagnosis and method of injection for spasmodic dysphonia, mutational dysphonia, muscle tension dysphonia, dysphonia after total laryngectomy, and stuttering were summarized. Among 144 patients with adductor type spasmodic dysphonia, who were injected one time to maximum 8 times during the 27 months, 90% were recognized as having better than slight improvement. Even though the injected cases were small, not only the abductor type spasmodic dysphonia, but also the intractable mutational dysphonia or muscle tension dysphonia resistant to voice therapy revealed that botulinum toxin injection would be another options for treatment. Patients who cannot phonate after total laryngectomy and some forms of adulthood stutterers can also be candidates for the injection of botulinum toxin.

• 대한후두음성언어의학회지
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• 제25권2호
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• pp.75-78
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• 2014

기능성 음성장애는 후두에 구조적 혹은 신경학적 병변이 없이 음성발성에 장애가 있는 질환으로, 의학적인 부분만으로 설명하기가 어려운 장애 요소들을 내포하고 있기 때문에 진단에 많은 혼란이 있을 수 있는 논쟁의 여지가 많은 음성질환이다. 기능성 음성장애의 중요한 부분 중의 하나인 muscle tension dysphonia는 후두 근육과 후두 주변 근육의 지나친 긴장에 의해서 발생하는 음성장애로, 비록 후두 내/외근의 운동이 제대로 조절되지 않는 것이 muscle tension dysphonia의 가장 첫 번째 원인이라고 알려져 있고, 특정의 개인적인 인성의 특징(personality traits)들도 발생에 있어서 상당히 중요한 부분을 차지 하는 것으로 연구되고 있지만, 이들 근육이 도대체 어떻게 문제가 되는 지에 대해서는 사실 아직까지 완전하게 설명하기에는 곤란한 점이 많다. 또한 최근 들어서는 muscle tension dysphonia를 하나의 질환으로 보기보다는 기능성 음성장애의 문제점들을 설명하는 진단적 지표(diagnostic label)로 보는 경향이 많으며, 기능성 음성장애와 기질적 음성장애(organic voice disorder)를 아우르는 위치에 있는 것으로 해석하는 경향도 있다. 따라서 기능성 음성장애에 대한 분류나 발생기전에 대한 의견들은 아직까지 논란이 되는 부분들이 많은 상태이고, 기능성 음성장애를 더 잘 이해하고 이 질환을 성공적으로 치료해 나갈 수 있는 중요한 요인들을 찾아낼 수 있도록 더 많은 연구들이 이루어 져야 할 것으로 생각된다.

• 대한후두음성언어의학회지
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• 제25권2호
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• pp.79-81
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• 2014

Spasmodic dysphonia (SD) is a chronic, focal, speech-induced, action-specific dystonia, resulting strained voice. Muscle tension dysphonia (MTD) may also result in a strangled, strained voice quality, usually as a result of compensation for underlying laryngeal disease such as glottal insufficiency. Patients with SD and MTD were suffered from the severely limiting people's communication, especially via telephone and in noisy backgrounds. SD is usually of the adductor type characterized by glottic contractions causing tightness and voice breaks, which is difficult to distinguish from MTD. In this review article, we present the characteritics and management of SD and MTD.

• 대한후두음성언어의학회지
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• 제28권2호
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• pp.71-78
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• 2017

Voice disorder is classified into three categories, structural, neurogenic and functional dysphonia. Neurogenic dysphonia refers to a disruption in the nerves controlling the larynx. Common examples of this include complete or partial vocal cord paralysis, spasmodic dysphonia. Also it occurs as part of an underlying neurologic condition such as Parkinson's disease, myasthenia gravis, Lou Gehrig's disease or disorder of the central nervous system that causes involuntary movement of the vocal folds during voice production. Functional dysphonia is a voice disorder in the absence of structual or neurogenic laryngeal characteristics. A near consensus exist that Muscle tension dysphonia (MTD) is functional voice disorder wherein hyperfunctional laryngeal muscle activity whereas Spasmodic dysphonia (SD) is neurogenic, action-induced focal laryngeal dystonia including several subtype. Both Adductor type spasmodic dysphonia (AdSD) and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. It makes these two disorders extremely difficult to differentiate based on clinical interpretation alone. Because treatment for AdSD and MTD are quite different, correct diagnosis is important. Clinician should be aware of the specific vocal characteristics of each disease to improve therapeutic outcome.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.91-94
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• 2016

Voice is a physical phenomenon, generated by vocal fold and expiratory airflow. Dysphonia should come from abnormal vocal fold and airflow. Occassionally larynx looks normal in show, but it is actually not. There should be undetected structural or functional abnormalities. So when ENT doctors face dysphonia patients who looks normal larynx, should make a diagnosis through close observation. In this review article we present some dysphonia diseases which looks normal larynx. For example vocal fatigue, vocal fold paresis, posterior glottic diastasis, muscle tension dysphonia and psychogenic dysphonia.

• 말소리와 음성과학
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• 제3권3호
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• pp.133-140
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• 2011

Muscle misuse dysphonia (MMD) is defined as a behavioral voice disorder resulting from inappropriate contractions of intrinsic and/or extrinsic laryngeal muscles. The purpose of this study was to investigate the effect of motor learning guided laryngeal motor control therapy (MLG-LMCT) which is designed to improve an existing LMT and further the effective voice treatment on people with muscle misuse dysphonia. Forty-six people with MMD (M:F=16:30) participated in this study. The voice samples of the participants were recorded to investigate the effect of MLG-LMCT before and after the voice therapy. Voice samples were analyzed via electro-glotto-graph (EGG). Contact quotient (CQ), speed quotient (SQ), and waveform were reported. In addition, perceptual and acoustical evaluation were conducted to determine the change of voice improvement after treatment. The experimenter massaged the tensioned muscles around the neck. In order to find more proper phonation the experimenter showed the subjects their EGG wave forms as to whether or not they are moving the vocal folds to the appropriate position. Therefore, the EGG wave forms were used as a type of visual feedback. With the wave form, the experimenter helped subjects move the vocal folds and laryngeal muscles to find more proper voice production. The sensory stimuli from the experimenter gradually faded out. A paired dependent t- test revealed that there was significant differences in CQ between pre- and post-therapy. Perceptually, overall, rough, breathy, strain, and transition were significantly reduced. Acoustically, there were significant differences in Fo, jitter, shimmer, and NHR. After using MLG-LMCT, most of the subjects showed improvements in voice quality. The results from this study led us to the following conclusions: Motor learning guided laryngeal motor control therapy (MLG-LMCT) has reduces muscle misuse dysphonia. These results may occur because a visual feedback from EGG wave form can maintain the effect of the muscle tension reduction from laryngeal manual therapy. In case of people with MMD who reduced muscle tension from the therapy (LMT) but, not appropriately manipulating the location of larynx or adducting the vocal folds, MLG-LMCT might be an alternative therapy approach.

• 대한후두음성언어의학회지
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• 제30권1호
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• pp.12-14
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• 2019

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient's voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.

• 대한후두음성언어의학회지
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• 제32권2호
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• pp.94-97
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• 2021

Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO₂ laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.

• 대한후두음성언어의학회지
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• 제32권2호
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• pp.64-74
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• 2021

Background and Objectives This study was to investigate the voice quality and articulation effects of laryngeal massage on muscle tension dysphonia (MTD). Materials and Method A systematic review of articles published between January 2000 and December 2020 in Cochrane, PubMed, ScienceDirect, SpingerLink, ERIC, and Naver Academic was conducted. From the total of 2094 articles identified, 10 peer-reviewed articles were included in a meta-analysis. Mean effect sizes of the variables related to voice quality (jitter, shimmer, harmonic to noise ratio or noise to harmonic ratio, high-F0, low-I, cepstral peak prominence) and articulation (F1, F2, F1 slope, F2 slope) were calculated by Hedges'g. Results Meta-analysis of the selected articles showed that laryngeal massage had medium to large effects on all variables of voice quality and articulation except F0-high and F1 slope in the MTD patients. Conclusion This study provided comprehensive clinical evidence that it is highly desirable to apply laryngeal massage to MTD patients.