Department of Otolaryngology and Head and Neck Surgery, University Hospital Ghent, Belgium.
J Voice. 2011 Mar;25(2):202-7. doi: 10.1016/j.jvoice.2009.10.009. Epub 2010 Apr 18.
Muscle tension dysphonia (MTD) is a clinical and diagnostic term describing a spectrum of disturbed vocal fold behavior caused by increased tension of the (para)laryngeal musculature. Recent knowledge introduced MTD as a bridge between functional and organic disorders. This review addresses the causal and contributing factors of MTD and evaluates the different treatment options.
We searched MEDLINE (Pubmed, 1950-2009) and CENTRAL (The Cochrane Library, Issue 2, 2009). Studies were included if they reviewed the classification of functional dysphonia or the pathophysiology of MTD. Etiology and pathophysiology of MTD and circumlaryngeal manual therapy (CMT) were obligatory based on reviews and prospective cohort studies because randomized controlled trials (RCTs) are nonexisting. Concerning the treatment options of voice therapy and vocal hygiene, selection was based on RCTs and systematic reviews.
Etiological factors can be categorized into three new subgroups: (1) psychological and/or personality factors, (2) vocal misuse and abuse, and (3) compensation for underlying disease. The effective treatment options for MTD are (1) indirect therapy: vocal hygiene and patient education; (2) direct therapy: voice therapy and CMT; (3) medical treatment; and (4) surgery for secondary organic lesions.
MTD is the pathological condition in which an excessive tension of the (para)laryngeal musculature, caused by a diverse number of etiological factors, leads to a disturbed voice. Etiological factors range from psychological/personality disorders and vocal misuse/abuse to compensatory vocal habits in case of laryngopharyngeal reflux, upper airway infections, and organic lesions. MTD needs to be approached in a multidisciplinary setting where close cooperation between a laryngologist and a speech language pathologist is possible.
肌肉紧张性发声障碍（MTD）是一个临床和诊断术语，用于描述由（副）喉肌张力增加引起的一系列声带功能紊乱。最近的研究知识将 MTD 视为功能性和器质性障碍之间的桥梁。本综述旨在探讨 MTD 的病因和促成因素，并评估不同的治疗选择。
我们检索了 MEDLINE（PubMed，1950-2009 年）和 CENTRAL（The Cochrane Library，第 2 期，2009 年）。如果研究综述了功能性发声障碍的分类或 MTD 的病理生理学，我们将其纳入。基于综述和前瞻性队列研究，我们必须探讨 MTD 的病因学和病理生理学以及环甲膜手动疗法（CMT），因为不存在随机对照试验（RCT）。关于嗓音治疗和嗓音保健的治疗选择，我们根据 RCT 和系统综述进行选择。
病因可分为三个新亚组：（1）心理和/或人格因素；（2）发声误用和滥用；（3）代偿潜在疾病。MTD 的有效治疗选择包括：（1）间接治疗：嗓音保健和患者教育；（2）直接治疗：嗓音治疗和 CMT；（3）药物治疗；（4）继发器质性病变的手术治疗。
MTD 是一种病理状态，由多种病因引起的（副）喉肌过度紧张导致发声障碍。病因包括心理/人格障碍、发声误用/滥用、胃食管反流、上呼吸道感染和器质性病变等代偿性发声习惯。MTD 需要在多学科环境中进行治疗，喉科医生和言语语言病理学家之间需要密切合作。
