Abstract

To work towards homogenous assessment, and compatible, consistent, charted progress of the singer diagnosed with muscle tension dysphonia (MTD) across the voice care team, there is a need for further research into the treatment of MTD in the singing voice. High quality continued support for the singing voice after an MTD diagnosis requires accessible, practical knowledge to allow a coherent link between initial speech and language therapy (SLT) treatment, ongoing clinical research and the informed singing teachers who continue to support the next stages of treatment and recovery.

While some treatment approaches may initially be based in spoken voice work, with it assumed that singers “would know how their laryngeal mechanisms work” and be able to consciously associate techniques and principles for speaking with those for singing (Stemple & Fry, 2010, p. 311), Leborgne and Rosenberg (2014) continue to highlight the value of input from, and collaboration with, singing teachers during the therapy process. There is inconclusive evidence about how MTD should be best treated in singers as professional voice users and few studies have attempted to measure the success of individual treatments with the singing voice. Furthermore, there is little literature that explores MTD
and the musical theatre singing voice, despite earlier recommendations by Scearce (2016) that treatment should be designed with the vocal physiology and multiple vocal approaches required in the musical theatre singing voice in mind. The physical demands, instrumental elements, and additional spoken aspects of musical theatre performance are not routinely considered or evidenced in detail within current literature.

The body of work which makes up this thesis explores MTD in the singing voice, leading to the development of resources to connect therapeutic interventions with vocal use in performance. The thesis begins with the creation of an illustrated guide to The Muscles of Singing Voice Production (Supplementary Resource One) (Thomas, pre-publication), followed by an investigation of current approaches to the measurement of laryngeal tension (Thomas et al., 2023), causes and impacts of MTD, current treatment approaches for MTD in singers, and considers the additional demands on the musical theatre performer and their potential links to laryngeal tension. The thesis then presents chapters which
capture a voice practitioner questionnaire and several case study reports to provide data that illustrates current approaches with regards to the treatment of MTD, and additional consideration of the musical theatre singing voice. Collectively the investigations and findings in the current body of work provides the basis for the design of an accessible resource (resource two) of adaptable therapeutic exercises for the singing teacher/vocal coach to ensure a shared knowledge and understanding of the process involved, alongside evidence-based approaches to enable continued progression for the singer.

The thesis concludes that there is still a need for more objective and standardised practical methods to accurately diagnose and monitor the rehabilitation of MTD in the singing voice. Given the person-centred nature of vocal treatment and training, a team-based approach, grounded in shared knowledge and gradual progression, may be the most effective. Further research into the specific physiological and acoustic effects of MTD on musical theatre singing could help tailor diagnosis and individualise treatment, enabling voice care teams to track recovery more precisely. The final chapter concludes the research, linking to contemporary treatment approaches and recommendations for future
research. These elements have informed the development of a supportive resource designed to facilitate a progressive transition from therapeutic intervention to the resumption of performance-level vocal function.