By: Kathy Hubbard
Muscle tension dysphonia (MTD) is a change in the sound or feel of your voice due to excessive muscle tension in and around the voice box, and globus sensation is when you feel like there’s something stuck in your throat.
Muscle tension dysphonia often happens to singers, preachers and teachers. But it can happen to anyone. Johns Hopkins Medicine describes the voice as becoming rough, hoarse, gravelly, raspy, weak, breathy, airy or only a whisper. Or the voice could sound strained, pressed, squeezed, tight or tense. It can suddenly cut out, break off, change pitch or fade away. You get the picture.
MTD can make it difficult or painful to sing or speak. It can make it difficult to sing notes that used to be easy. The voice can “give out” or become weaker the longer it’s used, or one could feel like their throat is tired when speaking or singing.
Cadie Archer holds a master’s degree in clinical speech language pathology and is a long-time speech therapist at Performance Therapy Services. When I asked her what she could do to help this condition she said that “treatment involves increasing awareness of muscular tension, particularly laryngeal tension, and alleviating that tension through circumlaryngeal massage, relaxed throat breathing using diaphragmatic breathing techniques, stretching of the tongue, neck, jaw, and relearning how to optimally use the voice so as to not continue bad habits that may increase laryngeal tension.
“I provide education and training on the optimal use of the voice,” she said. “After therapy, patients typically report that they are able to sing in church again or they experience less fatigue with voicing at the end of the day.”
Archer said that she typically introduces a six to twelve week vocal exercise program that includes use of semi-occluded vocal tract exercises. These are exercises that involve partially closing the mouth to create back pressure on the vocal folds, like singing through a straw. She follows these up with “vocal functional exercises to strengthen laryngeal musculature.”
Globus sensation is mostly more annoying than anything else. It’s a painless result of several different health conditions including acid reflux, esophageal issues and chronic sinusitis. Cleveland Clinic says, “Globus sensation usually isn’t dangerous, and it often goes away on its own. But some people need treatment to correct it.”
Bear in mind, they also say that “it’s normal to get a lump in your throat from time to time, especially when holding back strong emotions.” You know, like when you’re watching a sappy movie.
“After a diagnosis is made regarding the etiology (cause) of the globus sensation, a speech language pathologist can develop a plan of care to help manage symptoms.” Archer said. “While it may begin as simply being uncomfortable, if left untreated, globus sensation has the potential to progressively worsen, negatively impacting a person’s vocal quality and/or swallowing function.”
So of course, I asked her what the treatment involved. She said, “Due to the wide range of possible causes of globus sensation, there are many different treatment approaches I may employ. If the etiology is esophageal dysmotility (muscles of the esophagus don’t function properly) or stasis (food gets stuck), I have been trained on the DIEZ approach.
DIEZ stands for dysphagia intervention for the esophageal zone. “This uses high lung volumes at swallow onset to manipulate the pressure gradient and improve esophageal bolus transport (moving food through the mouth, pharynx and esophagus). I’ve seen amazing outcomes by simply changing breathing patterns during the swallow to help alleviate globus sensation,” Archer explained.
And finally, I wanted to know what if it’s caused by reflux. She answered, “I will provide education regarding dietary and lifestyle modifications to help manage reflux, this includes use of alginate therapy (plant based), alleviating laryngeal tension through use of circumlaryngeal massage and/or re-learning how to use one’s voice when speaking can also help improve symptoms of globus sensation.”
I don’t know about you, but I find it fascinating how much more therapy can do for our bodies beyond helping with mobility issues. If you think or know you have one of the above conditions, ask your primary care provider if speech therapy is right for you. If so, get a referral to see one of our experts.
Kathy Hubbard is a member of the Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com. This article was written for publication in the Bonner County Daily Bee on February 19, 2025.
