# Biography of Muscle Tension Dysphonia: A Scoping Review
###### Abstract  
**Background**: Muscle Tension Dysphonia is a relatively new clinical entity that, despite being one of the most frequent causes of functional dysphonia, is little-known by many otolnohia-laryngologists. **Objective**: The objective of the current work is to describe the evolution of Muscle Tension Dysphonia--the concepts and the ways it has been diagnosed and treated--from its first descriptions to our current knowledge. **Design**: A scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A search of three bibliographic databases was performed to identify original articles on Muscle Tension Dysphonia. Study selection and characterization was conducted by three independent reviewers and was further reviewed by a fourth individual. In case of relocating any of the studies, it was performed by agreement of two reviewers. We excluded articles not written in English or Spanish, letters to the editor, review articles, studies of the pediatric population, articles related to dysphagia, and other publications that were not relevant. **Results**: The search identified 1144 articles published from 1983 to December 2022. A total of 581 studies were repeated and another 462 were excluded because they were not written in English or Spanish, were not original articles, or were not relevant to the objective of the study. Finally, 101 articles were included in the review. The articles included in the review were divided into three groups considering the objective and conclusions of each study: 21 articles were classified as \"Etiology and Physiopathology\", 29 articles as \"Diagnosis\", and 51 articles were included in the \"Treatment\" group. **Conclusions**: The concept of Muscle Tension Dysphonia has been developed during the last forty years. For its diagnosis, endoscopic visualization of the larynx is crucial, but must be combined with the patient's clinical history and other methods can also be useful. This entity should be addressed in a multidisciplinary approach, with the active participation of speech therapists. Most therapeutic options include voice education, vocal hygiene, and rehabilitation of the voice.  
muscle tension dysphonia; speech therapy; hyperfunction +
Footnote †: journal:glottic closure during phonation, resulting in changes in qualities of the voice. A decade ago, it comprised approximately 10-40% of clinical cases in voice centers [2; 3].  
Based on the mechanism that unleashes this increase in muscular tension, MTD is classified in the \"Classification manual for voice disorders-I, 2006\" into primary or secondary types. Primary MTD is characterized by an increase in tension that is independent of any external mechanism: it is an alteration of the phonation mechanism itself. In secondary MTD, the mechanism responsible for the increase in muscular tension is a compensatory reaction to a mechanism that alters the function or structure of the glottis [4].  
Thanks to new diagnostic methods, it is possible to achieve a better comprehension of dysphonia caused by excessive muscle tension. The aim of this scoping review is to provide a historical review of Muscle Tension Dysphonia, including definition, assessment methods, and treatment approaches, as these have evolved over the years. Knowledge of them will undoubtedly help voice specialist to understand the process that each patient is undergoing and to propose specific treatments in order to improve their situation.