Treating Muscle Tension Dysphonia

PART ONE

Walking the streets in a stupor getting news that was too tremendous to comprehend, I sat on the curb of a city street and wept.  Later dumbfounded in a suite high above the city I sat in complete and utter disbelief after visiting one of the world’s foremost authorities on voice.  Afraid to tell anyone about this new turn of events I sat there looking blankly at the walls.  The setting sun of early fall slowly turned to night but my shock and disbelief had not subsided.

Too excited to sleep I extinguished the lights, turned down the bed and proceeded to lay there alone in the dark for most of the night.  Eventually the bright early morning sunlight filled the room and stole the few hours of slumber that had managed to find me.  Giving a yawn and a deep stretch opening my mouth, “I could talk”.   After five long pain filled years of pursuing treatment for Spasmodic Dysphonia it was determined that I had Muscle Tension Dysphonia, a completely different beast regardless of sounding the same.    

Who to call first?  Of course mom was first then my best friend and then a long list of others; loving family members and friends that looked at me with pity as I tried to speak but could not.  As the first phone calls were made I had a nagging feeling that this newly found voice would not last.  I spoke with a loud clear voice but something inside said this was not real and not to be shared with the rest of the world.

Returning to the sleepy hills of eastern Pennsylvania staring out of the bus window the sudden change was too much to comprehend after five years of becoming near mute.  My voice remained strong over the next 6 days as I made sure not to strain while speaking, I only spoke when needed.  The psychology had not caught up with the reality just yet, as I was still unsure of what was going to leave my mouth when trying to speak.   Sadly, by day five into day six I could feel the familiar heart breaking hands weaving around my throat, choking me, taking my breath and stealing my words.  The feeling inside my heart was right; this was not meant to last.

PART TWO

After reaching into my purse to fish out the business card for the speech language pathologist I then called the number and made the first appointment for evaluation and treatment.   Gearing up in the old learned behavior, I rasped out my request, “I need to see Dr. Stewart”.   Accepting the fact that I was unable to talk once again I had to start the painful process of learning to speak with a qualified speech therapist.  There was no denying the fact that my only hope to recover my voice was through speech therapy.

Week One

In an attempt to release my perpetually tense body; to release the ever present pain that lived in my throat, neck, shoulders and back the doctor’s orders were to WIGGLE!   Imagining my spine as a jointed girder connecting the back, neck and head wiggling started to release all of the tension that had accumulated from the strain of speaking. 

Being in disbelief how this could ever help me to speak I continued to follow the doctor’s orders as the subtle motion did feel good.  For the next week every hour for a minute I wiggled without speaking.  Eventually the painful knots underneath each shoulder blade started to melt away; the tension that had been present for literally 5 years started to untwist. 

There is so much involved in the production of speech; body mechanics and neuromuscular coordination of the physical mechanisms of the throat all coordinating the production of speech.  To think so intensely about a skill that was acquired so easily as a child was overwhelming.  It is amazing that anyone speaks at all!

Week Two

More of the same wiggle and release the jaw and say “um-hmm” while feeling the vibrations travel from the lungs over the larynx and escaping the mouth.   The therapist cautioned, never ask the larynx to do for more than it is capable of giving.  Through the struggle of trying to produce voice over the past five years terrible habits of pushing my voice developed.  I learned compensatory strategies that were destroying my throat as well as my chances of ever speaking again.

The harder I tried to speak the greater the strain became, the greater the strain the harder it was to speak.  In other words the body’s initial reaction is counter intuitive, straining was not improving the situation.  The only way to recover was to release, relax without pushing and torqueing the musculature of the neck.  Seeing now the difference between this approach and past failed attempts; less is more. 

Prior therapists ordered me to push and use a full voice compared to the gentle efforts being used now.  The other therapists neglected to educate me about using the voice at the smallest possible range.   A voice without pushing, without straining, a voice that was used with practice and control allowed no effort voicing.  Voice and speech are different in the sense that voice are the sounds produced by humans and other vertebrates using the lungs and vocal folds.  Voice, it is not always speech, as it includes laughing, crying, singing, and babbling.  Speech is a series of complex oral movements used to express one’s self with the use of decodable sounds.

Week Three and Beyond

Finally permitted to speak, the shortest simplest phrases proved to be near impossible with the initiation of speech being the most difficult.  Being near tears wanting to speak so badly fighting the natural instinct to push I had only allowed what the larynx was willing to produce.  Hearing the words “dial it down” from the therapist, seeing those words pass by as if they were a cloud, the goal was to produce speech with as little effort as possible. 

As the weeks progressed and the outside temperatures began to dip into eventual winter I faithfully kept each appointment with the speech therapist.   There were more than a few sessions where crying was all that could be accomplished as there was such an enormous dam holding back all of the pain and frustration locked deep inside.  Being so highly educated with almost twelve years of college to my credit and 4 advanced degrees counting to three proved to be a monumental challenge. 

Over what seemed to be an eternity gradual improvements were noticeable such as the growing ease of initiation, the lengthening periods of “good” voice and the slow but eventual raising of the volume of my voice.  The entire process took about ten months to go from silence to speaking.   There are still good days mixed with bad, at times I still have trouble when I am tense, stressed or tired.  I have learned a great deal about vocal and muscular control and still fight to be heard at times.  

The key to curing and treating Muscle Tension Dysphonia is never giving up and staying the prescribed course of action regardless of how long it takes to recover.   The other key component is finding a speech therapist that has experience in treating this condition.  The patience, the will and the drive to recover are part of my inherent nature so giving up was never an option.