# Biography of Muscle Tension Dysphonia: A Scoping Review
## 3 Results
### Treatment
\begin{tabular}{c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** & \begin{tabular}{c} **Treatment** \\ **Measure** \\ \end{tabular} & **Oukcome Measure** & **Conclusions** \\ \hline \multirow{4}{*}{13} & \multirow{4}{*}{Stepp} & \multirow{4}{*}{2011} & \multirow{4}{*}{\begin{tabular}{c} Effects of Voice Therapy on \\ Relative Fundamental \\ Offset and Onset in Patients \\ With Vocal Hyperfunction \\ \end{tabular} } & \multirow{4}{*}{Longitudinal} & \multirow{4}{*}{16} & \multirow{4}{*}{Voice therapy} & \multirow{4}{*}{RFF} & \multirow{4}{*}{After successful completion of voice therapy, } \\  & & & & & & & & \\ \cline{4-7}  & & & & & & & & & \\ \hline \multirow{4}{*}{14} & \multirow{4}{*}{Kandogm} & \multirow{4}{*}{2012} & \multirow{4}{*}{\begin{tabular}{c} Effects of Onemrazole Over \\ Voice Quality in Muscle \\ Tension Division Patients \\ with Lymphropharyngeal \\ \end{tabular} } & \multirow{4}{*}{Longitudinal} & \multirow{4}{*}{9} & \multirow{4}{*}{Omeprazole} & \multirow{4}{*}{\begin{tabular}{c} Objective and \\ subjective voice \\ parameters showed an improvement in voice \\ quality; however, only YHI and shimmer were \\ statistically significant. \\ \end{tabular} } & \multirow{4}{*}{\begin{tabular}{c} After successful completion of voice therapy, \\ RFF values increased toward patterns seen \\ previously in individuals with healthy typical \\ voice. \\ \end{tabular} } \\  & & & & & & & \\ \hline \multirow{4}{*}{15} & \multirow{4}{*}{Guzmin} & \multirow{4}{*}{2012} & \multirow{4}{*}{\begin{tabular}{c} Therapeutic Effect of \\ Semi-Occluded Vocal Tract \\ Exercises in Patients with \\ Type I Muscle Tension \\ Dyspnonia \\ \end{tabular} } & \multirow{4}{*}{11} & \multirow{4}{*}{\begin{tabular}{c} Semi-occluded \\ postures of the \\ vocal tract and \\ phonotion into \\ resonance tubes \\ \end{tabular} } & \multirow{4}{*}{\begin{tabular}{c} Flexible \\ laryngoscopy and \\ acoustic analysis. \\ \end{tabular} } & \multirow{4}{*}{\begin{tabular}{c} The results indicate that the use of resonance \\ tubes and semi-occluded postures of the vocal \\ tract can have a therapeutic effect in patients with \\ with type I Muscle Tension Dyspnonia. \\ \end{tabular} } \\  & & & & & & & \\ \hline \multirow{4}{*}{16} & \multirow{4}{*}{Qgawa} & \multirow{4}{*}{2013} & \multirow{4}{*}{\begin{tabular}{c} Immediate Effectiveness of \\ Humaning on the Supangkoptic \\ Compression in Subjects with \\ Muscle Tension Dyspnonia \\ \end{tabular} } & \multirow{4}{*}{Cross-sectional} & \multirow{4}{*}{23} & \multirow{4}{*}{Hamming} & \multirow{4}{*}{\begin{tabular}{c} Huntington corrects both the lateral and AP \\ components of supraplotic compression in most \\ MTD patients. \\ \end{tabular} } \\  & & & & & & & \\ \hline \multirow{4}{*}{17} & \multirow{4}{*}{Guzmin} & \multirow{4}{*}{2013} & \multirow{4}{*}{\begin{tabular}{c} Laryngeal and Pharyngeal \\ Activity During \\ Semi-occluded Vocal Tract \\ Postures in Subjects \\ Disapposed With \\ Hyperfunctional Dyspnonia \\ \end{tabular} } & \multirow{4}{*}{20} & \multirow{4}{*}{\begin{tabular}{c} Semi-occluded \\ vocal Tract \\ Postures in Subjects \\ Postures \\ \end{tabular} } & \multirow{4}{*}{20} & \multirow{4}{*}{\
\begin{tabular}{c} Semi-occluded \\ endoscopy during \\ phonotion \\ \end{tabular} } & \multirow{4}{*}{
\begin{tabular}{c} Laryngeal and vocal tract \\ prolongation \\ \end{tabular} } \\  & & & & & \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & &  
\begin{table}
\begin{tabular}{c c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** & **Treatment Measure** & **Oukcome Measure** & **Conclusions** \\ \hline
19 & Zegler & 2014 & \
\begin{tabular}{c} Perceptions of Voice Therapy \\ From Patients Diagnosed \\ with primary Muscle Tension \\ \end{tabular} & Cross-sectional & 45 & Voice therapy &
\begin{tabular}{c} Patient Perception \\ of Voice Therapy \\ questionnaire, \\ VH-10 \\ \end{tabular} & In this study, patients valued direct voice therapy in which they worked on altering vocal behaviors more than indirect voice therapy that aimed to educate patients about their voice. \\ \hline
20 & Watts & 2015 & \begin{tabular}{c} A Randomized Controlled \\ Trial of Stretch-and-Flow \\ Voice Therapy for Muscle \\ Tension Dysphonia \\ \end{tabular} & \begin{tabular}{c} Randomized \\ controlled trial \\ \end{tabular} & 20 & \begin{tabular}{c} Stretch-and-flow \\ voice therapy \\ \end{tabular} & \begin{tabular}{c} VHL, GRBAS, \\ Acoustic analysis, \\ Acoustic analysis, \\ \end{tabular} & \
\begin{tabular}{c} VHL, GRBAS, \\ Acoustic analysis, \\ maximum phonatory performance and \\ phonatory physiology. \\ \end{tabular} &
\begin{tabular}{c} Application of Snf’ to patients with MTD for six \\ treatment sessions over a week period \\ resulted in a significant reduction in vocal \\ handicap and improvement in measures of \\ maximum phonatory performance and \\ phonatory physiology. \\ \end{tabular} \\ \hline
21 & Craig & 2015 & \begin{tabular}{c} Combining Voice Therapy \\ and Physical Therapy: A \\ Novel Approach to Treating \\ Muscle Tension Dysphonia \\ \end{tabular} & Retrospective & 153 & \
\begin{tabular}{c} Physical therapy \\ with voice therapy \\ \end{tabular} & VHI &
\begin{tabular}{c} Voice therapy alone had significantly greater \\ median improvement in VHI than those treated \\ with physical therapy. \\ \end{tabular} \\ \hline
22 & Pacheco & 2015 & \begin{tabular}{c} False vocal Cod botulinum \\ Toxin Injection for Refactory \\ Muscle Tension Dysphonia: \\ Our Experience with Seven \\ Patients \\ \end{tabular} & Cross-sectional & 7 & \
\begin{tabular}{c} False vocal cord \\ botulinum toxin \\ injection \\ \end{tabular} &
\begin{tabular}{c} FVC Botox offers benefit to patients with \\ refractory MTD. The best results are obtained \\ with continued voice therapy following \\ injection. \\ \end{tabular} \\ \hline
23 & Tomlinson & 2015 & \begin{tabular}{c} Manual Therapy and Exercise \\ to Improve Outcomes in \\ Patients With Muscle Tension \\ Dysphonia: A Case Series \\ \end{tabular} & Longitudinal & 9 & \begin{tabular}{c} Manual therapy, \\ exercise, and stress \\ management \\ education \\ \end{tabular} & \
\begin{tabular}{c} MSR, PSYS, and \\ VHL. Cervical and \\ jaw range of \\ motion \\ \end{tabular} &
\begin{tabular}{c} Most of the patients had no pain after treatment. \\ all of the patients demonstrated an \\ improvement in FSPS score, and some of them \\ also had a clinically meaningful change in VHI \\ scores. All of them demonstrated improvement \\ in cervical flexion, lateral flexion, and jaw \\ opening. \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table}
Table 3: _Cont._  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** &
\begin{tabular}{c} **Treatment** \\ **Measure** \\ \end{tabular} & **Outcome Measure** & **Conclusions** \\ \hline
24 & Rangarathnam & 2015 & \begin{tabular}{c} Telepractice Versus In-Person \\ Delivery of Voice Therapy for Primary Muscle Tension \\ Dysphonia \\ \end{tabular} & Prospective cohort & 14 & \begin{tabular}{c} Telepractice for \\ delivering flow \\ promotion \\ exercises \\ \end{tabular} & \
\begin{tabular}{c} Auditory- \\ perceptual, \\ acoustic, \\ quality-of-life \\ measures \\ \end{tabular} &
\begin{tabular}{c} The results of this study indicate that flow \\ phonation exercises can be successfully used for \\ patients with MTD using telepractice. \\ \end{tabular} \\ \hline
25 & Zuide & 2017 & \begin{tabular}{c} Changes in Abnormal Muscle \\ Tension Pattern After \\ Fiberoptic Injection \\ Laryngoplasty \\ \end{tabular} & Longitudinal & 16 & \begin{tabular}{c} Fibeptic \\ injection \\ laryngoplasty \\ \end{tabular} & \
\begin{tabular}{c} Stroboscopic \\ frames \\ \end{tabular} &
\begin{tabular}{c} The mean percentage of frames showing MTP in \\ patients with MTP significantly decreased 1 \\ month after the injection. \\ \end{tabular} \\ \hline
26 & \begin{tabular}{c} Stelska- \\ Badurek \\ \end{tabular} & 2017 & \begin{tabular}{c} Combined Functional Voice \\ Therapy in Smgers With \\ Muscle Tension Dysphonia \\ Singing \\ \end{tabular} & Prospective cohort & 40 & \begin{tabular}{c} Combined \\ functional voice \\ functionally varying \\ singing voice \\ \end{tabular} & \
\begin{tabular}{c} Videalaryngo- \\ functional voice \\ functional voice \\ therapy \\ \end{tabular} &
\begin{tabular}{c} After combined functional voice therapy in the \\ temporal \\ spreading and singing voice \\ analysis of SIganda. \\ \end{tabular} \\ \hline
27 & Lemos & 2017 & \begin{tabular}{c} Effects of a Voice Therapy \\ Program for Patients with \\ Muscle Tension Dysphonia \\ \end{tabular} & Longitudinal & 30 & \
\begin{tabular}{c} Perceptual- \\ auditory protocol \\ GRASEL, measures \\ of maximum \\ phonation times, \\ \(s/z\) ratio, and \\ acoustic voice \\ analysis \\ \end{tabular} &
\begin{tabular}{c} All parameters assessed using the CRBASI \\ averaged NOTF increased. A positive \\ difference was observed for vocal jitter and \\ shimmer. Speech therapy favored lower \\ photonation effort, lowered vocal strain, and \\ adequacy of adjustment of laryngeal muscles. \\ \end{tabular} \\ \hline
28 & Jafari & 2017 & \begin{tabular}{c} Vocal Function Exercises for \\ Muscle Tension Dysphonia: \\ Auditory-Perceptual \\ Evaluation \\ \end{tabular} & Longitudinal & 15 & \
\begin{tabular}{c} Vocal function \\ exercises (VFEs) \\ \end{tabular} &
\begin{tabular}{c} Significant improvement after therapy for \\ participants was observed by the aid of \\ auditory-perceptual rating of voice quality and \\ the patient’s self-assessment ratings \\ measurements. \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table}
Table 3: _Cont._  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** &
\begin{tabular}{c} **Treatment** \\ **Measure** \\ \end{tabular} & **Outcome Measure** & **Conclusions** \\ \hline
29 & Rad & 2018 & \begin{tabular}{c} Efficacy of Manual \\ Circumaryngeal Therapy in \\ Patients With Muscle Tension \\ Dysphonia \\ \end{tabular} & Cross-sectional & 20 & \
\begin{tabular}{c} Manual \\ circuitry/nrygeal \\ therapy \\ \end{tabular} & Acoustic analysis &
\begin{tabular}{c} Following MCI, jitter and shimmer showed a significant reduction, while HNR improved \\ significantly versus pretreatment. \\ \end{tabular} \\ \hline
30 & Khattoonbaldi & 2018 & \
\begin{tabular}{c} Patient-Based Assessment of \\ Effectiveness of Voice \\ Therapy in Vocal Mass \\ Lesions with Secondary \\ Muscle Tension Dysphonia \\ \end{tabular} & Longitudinal & 33 & Voice therapy & VHI &
\begin{tabular}{c} The findings of this study indicate a statistically significant improvement after the voice therapy protocol, and they recommend a combination of \\ direct and indirect voice therapy in the vocal \\ rehabilitation of patients with secondary MTD and vocal mass lesions. \\ \end{tabular} \\ \hline
31 & Dehapan & 2019 & \begin{tabular}{c} Positive Effects of Manual \\ Circumaryngeal Therapy in \\ The Treatment of Muscle \\ Tension Dysphonia (MTD): \\ Long Term Treatment \\ Outcomes \\ \end{tabular} & Longitudinal & 28 & \begin{tabular}{c} Manual \\ Circumaryngeal \\ Therapy \\ \end{tabular} & \
\begin{tabular}{c} CAFE-V, Acoustic \\ analysis \\ Therapy \\ \end{tabular} &
\begin{tabular}{c} Improvements in the acoustic analysis and \\ CAFE-V were persistent over a \\ 6-month-duration follow-up. \\ \end{tabular} \\ \hline
32 & Mansuri & 2019 & \begin{tabular}{c} Effects of Voice Therapy on \\ Vocal Tract Discomfort in \\ Muscle Tension Dysphonia \\ \end{tabular} & Longitudinal & 25 & Voice therapy & \
\begin{tabular}{c} Acoustic voice \\ analysis, auditory- \\ perceptual \\ assessment and \\ VTD \\ \end{tabular} &
\begin{tabular}{c} After voice therapy, significant improvements \\ were observed in the acoustic characteristics. \\ \end{tabular} \\ \hline
33 & Gillespie & 2019 & \begin{tabular}{c} Efficacy of conversation \\ training therapy for patients \\ with benign vocal fold lesions \\ and Muscle Tension \\ Dysphonia compared to \\ historical matched control \\ patients \\ \end{tabular} & 96 & \
\begin{tabular}{c} Conversation \\ Training Therapy \\ \end{tabular} &
\begin{tabular}{c} VII-10, acoustic, \\ participant reporting of voice handicap and \\ acoustic, aerodynamics, and \\ aerodynamics-perceptual voice outcomes. \\ outcomes \\ \end{tabular} \\ \hline
34 & Watts & 2019 & \begin{tabular}{c} Intervention Outcomes of \\ Two Treatments for Muscle \\ Tension Dysphonia: A \\ Randomized Controlled Trial. \\ \end{tabular} & Randomized & 21 & \
\begin{tabular}{c} Stretch-and-flow \\ voice therapy and \\ resonant voice \\ therapy (RVT) \\ \end{tabular} &
\begin{tabular}{c} VH, AVU, the \\ synopsis are speakers with Muscle Tension \\ psychonia, with no statistically significant \\ difference in the outcome measures between the two treatments. \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table}
Table 3: _Cont._  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** & **Treatment Measure** & **Outcome Measure** & **Conclusions** \\ \hline \multirow{4}{*}{35} & \multirow{4}{*}{Reetz} & \multicolumn{4}{c}{Do Standard Instrumental} & \multirow{4}{*}{Longitudinal} & \multirow{4}{*}{39} & \multirow{4}{*}{Combined voice} & \multirow{4}{*}{Acoustic analysis, DSI, VHI, GRBAS} & Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. \\  & & & & & & & \\ \cline{4-7}  & & & & & & & \\ \hline \multirow{4}{*}{36} & \multirow{4}{*}{Mansuri} & \multicolumn{4}{c}{Application of} & \multirow{4}{*}{30} & \multirow{4}{*}{Transcutaneous} & \multirow{4}{*}{Antitory-} & \multirow{4}{*}{High-frequency TENS can be used in the voice treatment program of patients with MTD, MTD judgments with plain complaints reported that their VIPD and pain were decreased following the high-frequency TENS. Notably, these positive effects were obtained after a single session of pain \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & & & & & & \\ \cline{4-7}  & & & & & & & \\ \hline \multirow{4}{*}{37} & \multirow{4}{*}{Mansuri} & \multirow{4}{*}{2020} & \multirow{4}{*}{Nonrefined} & \multirow{4}{*}{Longitudinal} & \multirow{4}{*}{20} & \multirow{4}{*}{TENS with Voice Therapy} & \multirow{4}{*}{CRBAS, Acoustic analysis, VTD, and musculoskeletal patients} & \multirow{4}{*}{TENS is recommended as a complementary therapy for patients with MTD, especially when these patients have more complaints about VTD and musculoskeletal pain.} \\  & & & & & & & \\ \hline \multirow{4}{*}{38} & \multirow{4}{*}{Aghadoest} & \multirow{4}{*}{2020} & \multirow{4}{*}{A Study of Voel Facilitating Techniques Compared to Manual Circular Irregular Muscle Tension Dysproxions & Randomized clinical trial} & \multirow{4}{*}{16} & \multirow{4}{*}{Vocal facilitating techniques and manual} & The greatest improvement obtained on the ISI following VFIs and for the physical aspect of VHI after MCT demonstrated that a voice therapist can use appropriate techniques based on the voice complaints and results of voice assessments in MTD. \\ \hline \multirow{4}{*}{39} & \multirow{4}{*}{Novakovic} & \multirow{4}{*}{2020} & \multirow{4}{*}{Injection Laryngoplasty as Adjunct Treatment Method for Muscle Tension Dysproxions: Preliminary Findings.} & \multirow{4}{*}{Longitudinal} & \multirow{4}{*}{37} & \multirow{4}{*}{Injection LASSO LASSO during prolongation, VHI-10, acoustic analysis} & IL resulted in positive changes in voice-related quality of life in MTD patients with and without global insufficiency. Acoustically, only those with global insufficiency demonstrated an increase in HNR following IL. \\ \cline{4-7}  & & & & & & \\ \hline \hline \end{tabular}
\end{table}
Table 3: Cont.  
\begin{table}
\begin{tabular}{c c c c c c c c c c} \hline \hline
**No.** & **Author** & **Year** & **Title** & **Type of Study** & **N** & \begin{tabular}{c} **Treatment** \\ **Measure** \\ \end{tabular} & **Outcome Measure** & **Conclusions** \\ \hline \multirow{3}{*}{40} & \multirow{3}{*}{Modill} & \multirow{3}{*}{2021} & Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audir & Longitudinal & 68 & \begin{tabular}{c} Voice therapy: \\ OPT and SVO- \\ task variation and \\ NP \\ \end{tabular} & \begin{tabular}{c} Auditory- \\ perceptual \\ outcome measures, \\ acoustic outcome measures \\ \end{tabular} & Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. \\ \hline \multirow{3}{*}{41} & \multirow{3}{*}{Falah} & \multirow{3}{*}{2021} & Effect of Mathieson Laryngeal Manual Therapy in Patients with Muscle Tension Disruption Aware After a Therapeutic Course & Longitudinal & 12 & \begin{tabular}{c} Mathieson \\ laryngeal manual \\ therapy (MLT) \\ following a \\ therapeutic course \\ \end{tabular} & \begin{tabular}{c} Videostrobscopy, \\ temporal voice \\ assessment and \\ VTDp \\ \end{tabular} & \begin{tabular}{c} After MLML, the frequency of supraglotic \\ parameters significantly changed, but the VTDp \\ showed no significant difference. The MLT can remarkably improve the supraglotic activity and perceptual characteristics of the voice in primary MTD after a therapeutic course. \\ \end{tabular} \\ \hline \multirow{3}{*}{42} & \multirow{3}{*}{Wenke} & \multirow{3}{*}{2021} & Effectiveness of Intensive Voice Therapy Versus Weekly Therapy & \multirow{3}{*}{2021} & \multirow{3}{*}{\begin{tabular}{c} Hensive Voice \\ Therapy Versus \\ Weekly Therapy \\ \end{tabular} } & \multirow{3}{*}{\begin{tabular}{c} Videostrobscopy, \\ perceptual voice \\ assessment, VTDp \\ \end{tabular} } & \multirow{3}{*}{\begin{tabular}{c} After MLML, the frequency of supraglotic \\ activity decreased, and perceptual voice \\ parameters significantly changed, but the VTDp \\ showed no significant difference. The MLT can remarkably improve the supraglotic activity and perceptual characteristics of the voice in primary MTD after a therapeutic course. \\ \end{tabular} } \\  & & & & & & & \\ \hline \multirow{3}{*}{43} & \multirow{3}{*}{Tate} & \multirow{3}{*}{2021} & \multirow{3}{*}{2021} & Physical Therapy for Muscle Tension Dysphonia with Cerivalgia. & Longitudinal & 178 & \begin{tabular}{c} Specialized \\ manual physical \\ therapy (PT) \\ program \\ \end{tabular} & \multirow{3}{*}{VH-10} & \begin{tabular}{c} Among patients diagnosed with MTD with \\ correlation, treatment with a specialized PT \\ program was associated with improvement in \\ VH-10 scores regardless of whether they had \\ VT. \\ \end{tabular} \\  & & & & & & & \\ \hline \multirow{3}{*}{44} & \multirow{3}{*}{Terney} & \multirow{3}{*}{2021} & \multirow{3}{*}{\begin{tabular}{c} Characterization of \\ Functional Dysphonia: Pre- \\ and Post-Treatment Findings \\ \end{tabular} } & \multirow{3}{*}{Cross-sectional} & \multirow{3}{*}{109} & \multirow{3}{*}{Voice Therapy} & \multirow{3}{*}{VH} & Most individuals with functional dysphonia improved after specialized voice therapy once correctly diagnosed, but correct diagnosis and proper treatment were often significantly delayed. \\ \hline \multirow{3}{*}{45} & \multirow{3}{*}{Sambhu} & \multirow{3}{*}{2022} & Evaluating the Use of \begin{tabular}{c} \\ Baccón \\ Treatment for Muscle Tension \\ \end{tabular} & \multirow{3}{*}{\
\begin{tabular}{c} Prospective cohort \\ \end{tabular} } & \multirow{3}{*}{52} & Baccón and voice &
\begin{tabular}{c} VH-10, Reflux \\ Symptom Index, \\ and other survey \\ elements \\ \end{tabular} & There was no significant difference in voice psychometric outcomes between non-baclofen and baclofen groups. \\ \end{tabular} \\  & & & & & & & \\ \hline \hline \end{tabular}