An experienced Vocal Physiotherapist can assist in the treatment of dysphonia. Dysphonia is a symptom not a condition. It refers to an abnormal or hoarse voice, causing difficulty in voice production.
Muscle Tension Dysphonia (MTD) is a “functional dysphonia,” where a pattern of muscle over-use/ excessive phonatory effort can develop. This can be caused by irritants or allergies, laryngitis, stress, global muscle over-use, poor voicing technique, among other conditions including post Covid-19 and Long-Covid.
Excessive phonatory effort over a sustained period of time can stress the anatomy of the vocal tract. In some cases, leading to long-term changes in function of the vocal folds and vocal fold injury. Therefore, seeking treatment early can prevent the progression of symptoms.
People with Muscle Tension Dysphonia may report:
- Hoarseness
- Vocal fatigue or strain
- Anterior neck pain and tension
- Pain with voice use
- Voice breaks or pitch changes
- Voice loss
- A weak or breathy voice
- Restriction or difficulty reaching the upper voice register
To add to this, early research indicates that up to 25% of mild to moderate Covid-19 cases may experience dysphonia symptoms (Lechien et al., 2020).
An initial Covid-19 may contribute to voice symptoms:
- Intubation injury
- Persistent coughing
- Upper chest breathing pattern
- Working from home – change to volume of vocal use
- Increased vocal demands with return to work
- Return to voicing after significant rest
It’s been reported that 1 in 20 may experience longer term Covid symptoms of Long Covid.
Long Covid symptoms that particularly effect the voice:
- Breathlessness
- Persistent cough
- Fatigue and loss of muscular endurance
- Depression and anxiety
- Sore throat
- Joint pain
Many of these symptoms can exacerbate MTD and voice symptoms, therefore it is important to address the underlying symptoms, with the appropriate care. This may be an experienced Vocal Physiotherapist for Laryngeal Manual Therapy, a Respiratory Physiotherapist for breathing support, Therapy support, Speech Therapy, and an experienced Vocal Rehabilitation Specialist/ Coach etc.
In the meantime, some suggestions of vocal first aid;
- SLOWLY build up vocal endurance and practice – frequency before length of time
- Steam inhalation
- Hydration: sip don’t glug!
- Ventilation and humidification of the workspace or home
- Avoid throat clearing – sip water instead
- Avoid smoking, caffeine, excessive alcohol and dusty environments
- Avoid throat lozenges
- Rest the voice – take regular breaks from talking
- Appropriate Voice ‘warm-up’ AND ‘warm-down’
- Gentle shoulder and neck stretches
- Guided deep neck flexor exercises
Please do get in touch if you require some guidance.
Lechien J, Chiesa-Estomba C, Cabaraux P et al. Features of Mild-to-Moderate Covid-19 Patients With Dysphonia. Journal of voice : official journal of the Voice Foundation 2020
Mathieson L., Hirani SP., Epstein R., Baken RJ. Wood, G. Rubin, JS. (2009) Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia. Journal of Voice. 23:353-366.
Naunheim M, Zhou A, Puka E et al. Laryngeal complications of Covid-19. Laryngoscope Investigative Otolaryngology 2020;5:1117-24
NICE. Covid-19 rapid guideline: Managing the long-term effects of Covid-19 NG 188. In: Excellence NIfHaC, ed2020
Opinion. We need to do more to understand chronic vocal symptoms of covid-19. BMJ 2021 tinyurl.com/42de3twj
Van Lierde, KM. De Bodt, M. Dhaeselaer, E. Wuyts, F. Claes, S. (2010) The treatment of muscle tension dysphonia: a comparison of two treatment techniques by means of an objec5ve mul5parameter approach. Journal of Voice. 24;294-301