Muscle Tension Dysphonia - Long Recovery.

[sunmoonstars]

 

Hi, I'm new to the forum. I would like to stay anonymous, so let's just call me "Lyra" (from the Philip Pullman books).

Fall of 2012, I woke up one day feeling the bottom half of my voice was gone. Went to my local ENT and was diagnosed with acid reflux and told reflux medications were the devil, especially for someone as young as I (I'm a 25 yr old female). Tried to follow strict diet and failed.

March 2013, got an appointment with a real singers' laryngologist who turned out to be kind of nuts. Was told I had acid reflux, told I had muscle tension dysphonia as a result of the reflux, told again that acid blocking medications were the devil and put on a ridiculous vegan diet that made me loose 20 lbs in a month. His voice therapist did help me, however. He had me do the blowing on the tissue on "oooh" and "ol-ooooh." It got me back to speaking comfortably, which was a miracle, but the minute I'd sing anything with any kind of oomph, my throat would tighten up again. It appears to me that this voice therapist helped soothe my voice at the time, but did not strengthen it as was needed to take on repertoire with any substance.

 

At some point during this time, my chest voice returned, although it was not as strong as it had been. Was treble-heavy and lacking in bottom end.

 

July 2013, went to another prominent singers' laryngologist, this time in NYC. I was speaking comfortably at this point, but I could not project my singing voice to have real power, which was my major complaint along with wanting to get a freaking acid blocking medication prescribed so I didn't have to eat like I was in a nursing home at age 25. Was told I did NOT have acid reflux, that it was a common bull{censored}/excuse diagnosis. Was diagnosed instead with a paresis (weakness) of my left vocal cord, but not full paralysis, blamed on a mysterious "viral infection," possibly the silent Lyme's they found antibodies for in my Fall bloodwork for something else. Muscle tension dysphonia was also diagnosed, this time as a byproduct of the paresis, not the reflux.

Saw their voice therapist. Blew bubbles into a cup with a straw. After every 10 minutes I spent blowing bubbles into a cup, I'd feel so god awful, worse than I had ever felt my voice feel. I understand muscle tension dysphonia occurs when the muscles become too tense. Ironically, these exercises made my throat feel so damn tense and tight I'd cry hysterically about it. I was told to keep doing them, that I had to do them to "strengthen" my weak vocal cord. This went on for about 5 months until I gave up, and my voice therapist changed her story. She said something like, "Actually, the voice doesn't grow in bulk like the muscles in other organs (referring to when I went to physical therapy for an inherently weak trapezius muscle that had been giving me problems when I played guitar or lifted anything over 20 lbs)." So I said to her, "Okay, so what is this 'strengthening' of the voice about? What does that mean, then?" And she said my vocal cord was permanently weakened from the paresis and the exercises were designed not to literally strengthen my cord, but to prevent me from tensing up my muscles in an attempt to compensate. Basically, she said we could work around my weakness, but not strengthen it. I couldn't believe what I was hearing after months of being told I had to "strengthen" my voice by putting it through such unbearable discomfort!!

 

Fed up (and still waiting for my insurance to pay the thousands of dollars spent that it promised it would pay), I emailed a former Classical voice teacher of mine and she recommended another prominent laryngologist who works with professional Opera singers. I went to him, and got another mindf**k diagnosis shock.

Also, at this point, I could sing loud and full again. Strong chest voice returned, and I can hit every note and nobody ever hears a problem with my voice. I am just in SO MUCH PHYSICAL DISCOMFORT that I don't even want to speak to people, and singing is more comfortable than speaking, but I usually feel more discomfort when SPEAKING after I am DONE singing. I can't work a normal full-time job because my throat gets so damned tight I have to be able to stop speaking if I need to. I feel so f**king handicapped. I want my life back! Try finding a full-time job that doesn't require you to speak throughout the day!

 

Opera doctor examined me thoroughly. Unlike the other doctors, who had used only the scope test (through the nose), he did another test with a long metal rod, I think it was the test to check my gag reflex on each side. He told me I not only didn't have reflux, I also did NOT have paresis! He said I very well could have had a paresis when I woke up with half my voice missing during the Fall, but that these things often fix themselves as the nerves regenerate. So, either I never had true paresis, or I had it and the nerves regenerated. Thinking about it, it makes sense and it is possible that my nerves regenerated because I DID get my chest voice back. He also said I didn't have enough muscle tension dysphonia to qualify for a true MTD diagnosis (I didn't have my larynx locked in a high position, just a lot of discomfort when speaking, and according to my past doctors I was squeezing my false cords). "Okay, what do I do?" I asked him. He replied, "Well, we have to explore." He sent me to the voice therapist who worked with HIM.

 

So now here I am, on voice therapist number 3. She is a big name in the classical singing and voice recovery world, and she sees patients who have had little to no success with other voice therapists before her. She says I do have MTD, but mild. My impression is the doctor probably didn't consider it enough MTD for an official diagnosis because so many people have it WAY worse, and mine is "mild." So this new voice therapist, the first time I met with her, she said she had been dealing with MTD for years, and that first it was blamed by the medical community on allergies, then on reflux, and all along it was from neither. She also said that even paresis now is misdiagnosed/overdiagnosed, and that even if I did have it it is very likely I have recovered now, that "it's more common than you think, and many people spontaneously recover." If that is the case, my guess is I still have the muscle tension dysphonia leftover from when the paresis happened. She seems to know her ****, but I am having a really hard time understanding why, when my voice is feeling so sh*tty and tense and TIGHT TIGHT TIGHT in the throat, she wants me to sing for an hour a day every day with no rest days in between. After 2 days in a row of real singing, my throat is so tight I feel like I can barely talk to anybody for 2-3 days after without real discomfort.

1) I don't understand - with every other form of physical therapy there is recovery time after exercising, is there not? Why should the voice be different, especially when it feels so knocked out after I work it?

 

2) And her opinion is different. She says we CAN strengthen my (very slightly) bowed left vocal cord (not what voice therapist #2 said which was that we could merely "work around it.") How the hell do I know what's true?

 

3) I'm a soprano and I spent years trying to sing with a darker, more mezzo-like tone, unaware that it was bad for me. Could this have contributed to my MTD?

 

4) I have been told by every doctor and voice therapist I have seen that what I have is a "very mild" problem, an opinion that has been consistent in spite of their differing diagnosis. And nobody hears anything wrong with my voice when I sing, in fact, I sound good. I can still hit all the high notes, voice never breaks or cracks, etc. AND I can PROJECT again! It is just the remaining physical discomfort that is making me miserable, moreso when I speak than when I sing. Singing has little discomfort compared to speaking, but it will be more uncomfortable for me to speak after I have been singing.

 

Some days I just cry so hard because I fear this physical discomfort could be permanant, and sometimes I think my second voice therapist made me permanantly worse. But I think that is just my anxiety-related fear, because if MTD is learned behavior, it can be unlearned, right? It's all muscle activity patterns from what I understand. I don't have ANY nodes or lesions of any kind! What seems most logical to me is (and this may or may not have been caused by my second voice therapist's treatment plan) my muscles were driven more deeply into bad habits over the months, so now it's even harder to undo the bad habits, though I'd imagine they must still be reversible.

 

It seems that although voice therapy gave me my good sound and projection back, the therapy has made my voice more physically uncomfortable and not being able to have long conversations with people I love is absolutely heartbreaking!! I can't understand why I SOUND better but FEEL worse!

 

5) I've divided my treatment plan (I did this on my own) into 2 subcategories:

   1) Strengthen the bowed cord with these types of exercises http://www.livestrong.com/article/344369-damaged-vocal-cord-exercises/, soothe and stretch with "ooooooh" slides, humming, etc.

 

   2) Avoid reinforcing bad muscle habits. Which means no true belting (for now), and checking all the notes of a song on the piano before I sing to make sure I am not pushing my chest voice higher than D4.

 

I've been avoiding everything above B4 right now because singing higher than that feels (AND sounds!) fine in the moment, but makes my throat muscles tighten up all over again after. I don't think I ever properly learned how to lower my larynx to sing higher notes in a pure head voice. despite being a soprano, I've mostly lived in my middle and chest voice. I sing pop/rock like Avril Lavigne, Michelle Branch, etc.

 

 Any insight would be appreciated. I like my new voice therapist because she does not make me feel like my voice is permanantly broken. She makes me feel empowered like I can strengthen it and be able to do everything normally again (as far as my attitude).

I just can't understand why this fast recovery pace is desirable. I feel like I've badly sprained my ankle and I'm being asked to run a marathon right away without walking, jogging and building up to it first.

   

[davie]

Hi Lyra, welcome to the forum.

I'm sorry to hear about your difficulties. I think many singers have dealt voice problems at some point or another, so you're not alone. I think the best course of action is take note of the bad habits you've experienced and try your best to avoid them. Judging from what you've mentioned, I think there may have been some vocal abuse involved. If you're naturally a soprano, then trying to force a mezzo sound could be damaging. Usually when a singer tries to force a thicker sound, they're using too much breath pressure to do it. When this happens a lot of other issues may arise. The cords will have too much breath to resist against and the larynx will be high, as a result the singer will try to compensate by introducing tension from other parts like the surrounding muscles and also the tongue. So I think its best to lay off using too much chest voice and try to incorporate more head voice development. There are actually some vocal exercises that can be used to help recuperate and rebalance the voice. I hope this is helpful to you.

[sunmoonstars]

Yes, would you please point me to those rebalancing exercises? I found an article, wish I could find it, written by a classical teacher, on retraining a lyric voice that has suffered from the singer trying to add weight. The suggested exercise was the "nnnnng----->AAAAAAAH" Do you know what that does?

It seems I had two very contrasting issues. The paresis, though it seems to be gone now, made me loose my chest voice at the time, so the obvious solution was to work on my chest voice. But before I got the paresis I had been using *too much* chest voice in my mix, so if the paresis had never happened, it would have made sense to work on the head voice.

I have a full, working chest voice now, so maybe it does make sense to get more into the head voice. I am just petrified because I have noticed that working on my head voice, even though I am a natural soprano, is what causes me the most throat tightness afterwards. I need to learn how to lower my larynx for the head voice. I know I said I have MTD, but my voice therapist said I *am* able to lower my larynx. I wonder how much longer I should be in voice therapy, or if I should just get a good classical teacher. I just don't want to be in pain anymore. I don't even care so much about singing right now. I just wanna be able to speak to people again without feeling like somebody is pinching my thyro-hyoid space with tweezers, or on other days, squeezing my larynx with every word. It's absolutely awful.

[robodelfy]

Hi, I know this thread was a long time ago, but Lyra/sunmoonstars, if you read this please respond. I have been suffering with the almost identical problem as you for a year and a half. I have searched the internet and never found anyone with my exact symptoms....mainly pain and tension when talking and sing, but more when talking. Most of the time my voice sounds fine though, especially when singing, although it does get a bit rough due to tension after prolonged sessions.

 

I also take a few days to recover after talking a lot one day, and mostly I spend all my time alone now, and have to really limit conversations. I have not used the phone in so long, and barely seen any friends. Its been such a difficult time, and I have seen every specialist in the UK, had 4 endoscopies and stroboscopes, laryngeal manipualtion etc etc.

 

I do feel I am very slowly making progress, but its hard to know as sometimes it feels worse than ever. I am more accepting of it now so I dont fall into despair so easily.

 

Please get in touch with me if you read this and maybe we could talk, or email. I'd love to know if you recovered, and I really hope you have. I have also made a lot of headway following a psychosomatic approach after nothing else worked, which may interest you.

 

Message me here on the thread or privately.

 

Thankyou

[lizbills]

Hey there, I am suffering from the same exact issue as Lyra. Her story fits mine to a T, crazy! You can email me if you need to talk about it. LizBills1@gmail.com

[Pained 1]

I am also suffering almost identical issues with MTD. A voice that is ok day to day but has no power and fades at certain pitches. I can live with that. It changes my life but its something i can deal with.

 

the pain on the other hand is constant and at times unbearable. neck pain, shoulder pain, thtoat tightening so much it can be difficult to swallow or even breathe at times. Ive also developed a cough that is caused by irritants such as dust or deodorant or perfume etc. My throat tightens, and the cough starts. If it doesn't resolve pretty quickly then the chest pain begins. This is unbearable. It spreads what feels like electric shocks across my chest and its agony. I have almost called an ambulance.

i haven't been able to find a lot of documented information around the associated pains with MTD, but have noticed quite a few people talking about it on forums etc.

 

Im not sure how to make this situation any better. It is affecting my whole life. I avoid talking to people. I cant sleep and I'm in constant pain.

 

maybe we need to create a support group for those who suffer with us. ...

[lizbills]

Hey everyone I am a muscle tension dysphonia survivor. I post videos about it to help! Including my story, vocal exercises, tips and tricks! 
here is my latest video on breath and how it can help to eliminate access tension!