Methods of Measuring Laryngeal Muscle Tension in Patients with Muscle Tension Dysphonia: A Scoping Review

Abstract

Background: In clinical practice and research relating to Muscle Tension Dysphonia (MTD), several laryngeal muscle tension measurement methods are used to diagnose, to identify specific muscle strengths and deficits, and to measure therapeutic outcomes. The variety and reliability of available measurement methods presents challenges within diagnosis and treatment. The lack of methodical standardisation presents a barrier to homogeneous practice in this area. There is a need for a comprehensive scoping review of laryngeal muscle tension measurement methods.

Study Design: Scoping review.
Objectives: (1) To identify current methods of laryngeal muscle measurement which have been developed or tested with people with MTD; and (2) To identify the construct/s measured, reliability, validity, ability to detect change, efficiency and accessibility of identified methods.

Method: This scoping review was conducted using the Arksey and O’Malley framework. Studies were identified through searches of 4 major databases. The reviewer independently assessed titles, abstracts, and full-text articles.

Results: 27 papers published from 2000 to 2022 that satisfied the inclusion criteria were selected from 194 studies. The papers showed a variety of approaches with regards to the measurement of laryngeal activity and tension in subjects with MTD. Just over a quarter (25.9%) were reviews of the validity of assessment methods of MTD, including surface electromyography (sEMG), while 22.2% discussed surface electromyography as a measurement of muscle activity in subjects with MTD. 96.3% used a published methodological framework.

Conclusions: Assessment methods for Primary MTD are multi-faceted, including patient history, laryngoscopic examination, and voice-related musculoskeletal features. Potential use of objective measurement methods, including sEMG, Real Time Elastosonography, Magnetic Resonance Imaging was noted. Due to variability in assessment methods and results, there is a need for greater objective practical methodological standardisation to ensure accurate diagnosis, appropriate care, and chart patient progress.