PROFESSIONAL VOICE DISORDERS (G GARRETT, SECTION EDITOR) Primary Muscle Tension Dysphonia Melda Kunduk 1 • Daniel S. Fink 2 • Andrew J. McWhorter 2 Published online: 13 July 2016 Ó Springer Science+Business Media New York 2016 Abstract Purpose of Review Primary muscle tension dysphonia (PMTD) is a voice disorder of indeterminate cause, thought to be multifactorial. Emerging research is improving its diagnosis, but the lack of standard diagnostic testing for PMTD still creates challenges in accurate diagnosis and treatment. Recent Findings Review of the recent literature demon- strates the scarce validity and reliability of subjective laryngeal palpation measures, which are commonly used to assess the presence of intrinsic and extrinsic laryngeal tension in PMTD. An initial study with transcranial mag- netic stimulation shows promise in the differential diag- nosis between adductor spasmodic dysphonia and PMTD. Summary Current and past review of the literature con- tinues to demonstrate the need for future investigation to determine the true pathophysiology of PMTD and its accurate differential diagnosis. Keywords Primary muscle tension dysphonia Á Laryngeal palpation techniques Á Differential diagnosis Introduction Primary muscle tension dysphonia (PMTD) is a nonorganic voice disorder characterized by abnormal laryngeal pos- turing during phonation. As a disorder that can present with many different vocal characteristics, accurate diagnosis can be challenging and lead to misdiagnosis by a patient’s primary medical care team. The potential for misdiagnosis, or failure to diagnose PMTD results in delay in delivering accurate, timely, and effective treatment approaches. The classification manual for voice disorders describes PMTD as the presence of excessive, atypical and abnormal laryngeal movements during phonation, in the absence of any obvious structural and neurological etiology [1]. PMTD differs from the diagnosis of secondary/adaptive muscle tension dysphonia (sMTD) where the excessive/ abnormal laryngeal movements are considered to be due to the need for alleviating the original organic and/or neuro- logic causes [1]. Primary and secondary muscle tension dysphonia are common referrals to a voice center, report- edly forming 10–40 % of referrals [2, 3]. Despite the absence of organic or neurologic causes in primary muscle tension dysphonia, it can lead to the same emotional, social, financial and occupational hardships that any other organic and neurologic voice disorder can. This paper will focus on the current understanding of primary muscle tension dysphonia and a review of the current literature of the perceptual, acoustic, endoscopic, aerodynamic, and radiographic characteristics of PMTD to aid in its diagnosis and treatment. This article is part of the Topical Collection on Professional Voice Disorders. & Andrew J. McWhorter andrew.mcwhorter@ololrmc.com Melda Kunduk mkunduk@lsu.edu Daniel S. Fink daniel.fink@ololrmc.com 1 The Department of Communication Sciences and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA 70803, USA 2 Department of Otolaryngology-Head and Neck Surgery, Our Lady of the Lake Voice Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA 123 Curr Otorhinolaryngol Rep (2016) 4:175–182 DOI 10.1007/s40136-016-0123-3