Can stress and anxiety cause hoarseness? Understanding Muscle Tension Dysphonia (MTD).
Your voice feels hoarse, scratchy, or tired — not just once, but every day, especially in the evenings after a long day of teaching, talking, singing, or leading online meetings on Zoom. Maybe it happens even more when you’re feeling stressed or anxious. It can be frustrating, and it might make everyday conversations feel like hard work.
Chronic hoarseness is often a sign that your body is carrying tension, stress, or anxiety — and your voice is simply showing it. You’re not alone, and experiencing this is completely normal.
What is Muscle Tension Dysphonia (MTD)?
Muscle Tension Dysphonia (MTD) is a voice disorder caused by excessive tension in the muscles around the larynx (voice box), neck, jaw, and shoulders. It can make your voice feel strained, hoarse, or fatigued, and it often worsens with prolonged voice use (Mathieson & Morrison, 2018).
How does stress or anxiety cause Muscle Tension Dysphonia (MTD)?
Stress and anxiety can affect your voice in multiple ways:
Muscle tension: Stress naturally tightens the muscles of the throat, neck, jaw, and larynx, making speaking or singing harder and uncomfortable — a hallmark of MTD (Behrman & Epstein, 2001).
Breathing changes: Anxiety often causes shallow, upper-chest breathing, raising your shoulders and taking in less air. Over time, this reinforces tension in the throat and neck, contributing to Muscle Tension Dysphonia (MTD) (Verdolini et al., 1994).
Vocal fatigue: Chronic stress can make your voice tire more quickly. Even short periods of talking may leave you hoarse, and prolonged use worsens Muscle Tension Dysphonia (MTD) symptoms (Roy et al., 2004).
Work-related stress: When Muscle Tension Dysphonia (MTD) affects your voice, it can become unreliable, which is stressful at work. You may worry about straining your voice, performing well, or the financial impact of time off, especially when using your voice heavily for teaching, meetings, or online calls.
Emotional signaling: Hoarseness or tightness often reflects the stress or emotions you’re carrying. Your body is signaling it’s overloaded and needs help (Behrman & Epstein, 2001).
How is Muscle Tension Dysphonia (MTD) diagnosed?
Muscle Tension Dysphonia (MTD) is usually diagnosed by a voice specialist or ENT (Ear, Nose, and Throat doctor). During an examination, an ENT may use laryngoscopy or endoscopy to look at your vocal folds. In most cases of MTD, the vocal folds appear normal structurally, even though you experience hoarseness, strain, or vocal fatigue. This is why MTD is often described as a functional voice disorder, meaning the problem is in how the voice is being used, not in the anatomy itself (Mathieson & Morrison, 2018).
What are the symptoms of Muscle Tension Dysphonia (MTD)?
The most common symptoms of muscle tension dysphonia include:
Voice that sounds hoarse or strained
Voice becomes weaker and more effort the longer your voice is used.
Difficulty singing notes that used to be easy.
Pain or tension in your throat
Feeling like there is something in your throat that needs to be cleared.
How common is Muscle Tension Dysphonia (MTD)?
Muscle Tension Dysphonia (MTD) is surprisingly common, especially among people who use their voices a lot:
Teachers: About 1 in 5 report work-related voice problems (Roy et al., 2004).
Singers: Around 46% notice dysphonia at some point (Roy et al., 2005).
Other professional voice users: Actors, broadcasters, and public speakers — nearly 4 in 10 experience similar issues (Roy et al., 2004).
In voice clinics, Muscle Tension Dysphonia (MTD) is one of the most frequently diagnosed voice disorders. Many patients seeking help for chronic hoarseness, strain, or vocal fatigue are found to have Muscle Tension Dysphonia (MTD) as a primary or contributing factor (Mathieson & Morrison, 2018).
Can Muscle Tension Dysphonia (MTD) be treated?
Yes! Voice therapy is the treatment for muscle tension dysphonia.
Release tension in the larynx, neck, jaw, and shoulders
Improve breath support and posture
Teach strategies to manage stress and prevent vocal strain
Make your voice more reliable and comfortable for work, teaching, or online meetings (Mathieson & Morrison, 2018)
Do you have a waiting list?
No- most people are seen within one week on the free consultation.
How long does Muscle Tension Dysphonia (MTD) last?
Muscle Tension Dysphonia if untreated can last for months or years for some people. This is because they may be in a high voice use occupation such as a teacher, manager or call center and continue to abuse their voices without treatment. The treatment for Muscle Tension Dysphonia is Voice therapy. Typically people require 6-8 sessions following an assessment.
Why choose The Speech Network for Voice Therapy?
Our UK-based private voice therapists are all Clinical Specialists in Voice, each with a minimum of 15 years’ experience. They currently work, or have previously worked, as Senior Voice Therapists within the NHS.
All our therapists are fully registered and accredited, including:
Health and Care Professionals Council (HCPC)
Royal College of Speech and Language Therapists (RCSLT)
Association of Speech and Language Therapists in Independent Practice (ASLTIP)
Our private voice therapy team is highly rated, with outstanding 5-star Google reviews and recognition as a 2024 Quality Business Award winner.
Our UK based Private Voice Therapists are Clinical Specialists in Voice with a minimum of 15 years experience Specialising in Voice Therapy. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.
References
Behrman, A., & Epstein, R. (2001). Effects of stress and anxiety on voice production. Journal of Voice, 15(2), 214–228.
Mathieson, L., & Morrison, M. (2018). Muscle Tension Dysphonia: Assessment and Management. Current Opinion in Otolaryngology & Head and Neck Surgery, 26(6), 441–447.
Roy, N., Merrill, R. M., Gray, S. D., & Smith, E. M. (2004). Voice disorders in teachers and the general population: Effects on work performance, attendance, and future career choices. Journal of Speech, Language, and Hearing Research, 47(3), 542–551.
Roy, N., et al. (2005). Prevalence of voice disorders among singers: A literature review. Journal of Voice, 19(3), 478–493.
Verdolini, K., Titze, I. R., & Fennell, A. (1994). Dependence of phonatory effort on respiratory drive. Journal of Speech and Hearing Research, 37(4), 749–756.