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  • Head and Neck Institute

Voice Pain and Muscle Tension Dysphonia

Updated: Mar 14, 2022

Question: I am a trained singer and have never had a voice problem. However, ever since having a cold a few weeks ago, it hurts when I sing or speak. I have tried to go on vocal rest and this helps for a short time. But when I use my voice, it hurts again. What is wrong and what can I do?


Often after having a cold or upper respiratory infection, the vocal cords can become swollen, commonly known as laryngitis. When this happens, the muscles around the larynx (paralaryngeal muscles) and neck muscles engage when you vocalize.

These muscles are not typically used for voice production, but to compensate for laryngitis, they begin to participate in voice support. The problem arises, after the upper respiratory infection has resolved, and a “habit” forms where the paralaryngeal muscles continue to remain tense and engaged, even when not in use.

This tension is a type of Muscle Tension Dysphonia (MTD). Associated symptoms include throat pain, vocal fatigue, hoarseness, decreased vocal range, or effortful phonation. There is often an accompanying loss of vocal agility, where singing simply feels more difficult. Patients may also complain of a feeling of something being stuck in their throats, effortful swallowing, or painful swallowing. These symptoms can persist for days, or even years, if not addressed with intensive and targeted muscular therapy.

Treatment of MTD includes voice therapy by a certified Speech-Language Pathologist with additional fellowship training in voice therapy. Timely treatment is critical because if left untreated, complications such nodules, polyps, cysts, hemorrhage, and chronic laryngitis can develop. Untreated MTD results in excessive force being applied to the vocal folds, resulting in these types of injuries. Treatment and recovery is more effective when MTD diagnosed early, before complications develop. The only way to diagnose MTD is to seek evaluation if you have symptoms that have not been explained.

All cases of voice pain should be evaluated by a qualified laryngologist and voice therapist team. Proper examination should also be obtained through videostroboscopy when diagnosing voice pain. Once definitive diagnosis has been made, a trained voice therapist should initiate specialized therapy.


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