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Presentation on MTD and Laryngeal Massage
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THE USE OF LARYNGEAL MASSAGE IN TREATING PRIMARY MUSCLE TENSION DYSPHONIA (“MTD”)
Felicity Graham
Voice Disorders – BBSQ 5113
March 7, 20111
INTRODUCTION: WHAT IS MTD?
FUNCTIONAL VOICE DISORDER:
Hyper-adduction, constriction or bowing of the vocal folds
FUNCTIONAL DYSPHONIA:Umbrella diagnosis for vocal impairment
without structural change or neurogenic disease of the larynx
TWO FORMS OF MTD:
Primary: no predominantly ORGANIC cause or abnormality of the structures/laryngeal function other than MTD
Secondary: abnormality is a result of another, underlying disorder,
such as paralysis, vocal fold atrophy or a benign lesion2
Qualit
ies
Poor control of the breath stream
Abnormally low-pitched speaking
voice
Increased frequency of hard
glottal attacks
Higher prevalence in female patients
WHAT IS MTD? CONT’DS
ym
pto
ms
Very high shoulder position
Laryngeal elevation
Reduced cricothyroid space
Painful palpation of laryngeal
musculature
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RATIONALE: TENSION & MTD
Tension degrades resonance
Subject’s voice is
becomes fuzzy, loses
intensity
Subject attempts a
clearer sound using more air pressure
With higher subglottic pressure, larynx is
destabilized
Compensatory behavior,
causing tension
All patients with voice disorders, regardless of etiology, should be tested for excess musculoskeletal tension, either as a primary or as a secondary cause of
the dysphonia.(Aronson, 1990)
Circular Nature of Tension on Phonation
Effective Therapy?
…indirect (i.e., non-manual) tension reduction
techniques often fail because of the stubborn
nature of excess laryngeal musculoskeletal tension
(Roy, 2008).
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TREATMENT: PRINCIPLES
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Reducing musculoskeletal tension releases the inherent capability of the larynx to produce normal voice
When gently rubbed or kneaded, muscles relax and
become less painful
Lowering laryngeal position in the neck permits more
normal phonation (Aronson, 1990)
The primary aim of manual therapies in the perilargyneal and laryngeal area is to relax the excessively tense
musculature which inhibits normal phonatory function… (Mathieson, et al., 2009).
LARYNGEAL MANUAL THERAPY
(“LMT”)
• Palpatory exam before• Uses both hands• Vocalization after
MANUAL CIRCUMLARYNGEAL THERAPY (“MCT”)
• Palpatory exam during • Uses one hand• Vocalization during
Why is vocalization so important?
TREATMENT: MANUAL THERAPY
“In some cases of muscle misuse, the larynx abnormally contracts during voicing, but returns to normal during rest.
The clinician is encouraged to manually assess not only resting muscle tone, but also contracted muscle tone and laryngeal position observed during voicing attempts (Roy, 2008).”
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TREATMENT: STEPS
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Massage Techniques
The medial suprahyoid musculature is palpated at rest and during phonation. Stiffness, tension, and sites of focal tenderness signal excessive muscle activity. Begin peripherally to the sites of intense tenderness.The hyoid bone is encircled with the thumb and index finger, which are worked posteriorly until the tips of the major horns are felt. Use circular movement with the fingers over the tips of the hyoid bone and within the thyrohyoid space, light pressure.
Circular movement is repeated beginning from the thyroid notch and working posteriorly. Then, with the fingers over the superior borders of the thyroid cartilage, the total larynx is worked downward, and moved laterally at the same time.
Phonation
During the steps outlined above, patients may be asked to sustain vowels, produce syllables, or to speak or sing words or phrases. Roy (2008) suggests having the patient begin with humming , then sustaining /α/ or /u/, eventually moving to serial speech, sentences/recitation, and finally to conversation.
According to Roy (2008), the patient should be considered an active participant, and encouraged to become aware of and monitor the changes in vocal quality during treatment, in order to transfer their progress into daily conversation.(Sources: Roy, 2008; Van Lierde, et al., 2010; Mathieson, et al., 2009; Aronson, 1990)
TREATMENT: CAUTIONS
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Skills must be acquired under the supervision of a skilled practitioner!
The process can be very painful for patients with higher levels of dysfunction: tenderness may persist for up to 48 hours after an intense session!
Although the procedure is extremely safe when practiced correctly, care should be taken to avoid sustained or vigorous carotid compression.
Additionally, MCT should be used with caution on patients with laryngeal, thyroid or vascular disease, or who previously have had anterior neck surgery or pathology.
Finally, if changes do not occur within two treatment sessions, it is unlikely that extra-laryngeal muscle tension is the primary or sole explanation for the observed dysphonia
…perhaps the most important step in preventing muscle tension is becoming conscious of the sensory […] experience (Deeter,
2005).
Allows therapist to observe patient’s
phonation habits more closely
Allows therapist aural and tactile
feedback simultaneously
Often offers immediate
improvement in phonation (and/or
relief of discomfort)
Allows patient an active role in their own recovery
Awareness is the key to prevention!
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SUMMARY
(See handout for notes and bibliography)
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