MTD

Darn you. You and I were writing to Renee at the exact same time and I wrote a longer message than you did (wordy as I can be) regarding MTD so you got on the BB before I did!! Ha-ha. I mentioned your name in my post. Guess that means it's OK that I mentioned your name, right? Whew! Great. I'm cleared. Pretty funny...since we discussed the MTD subject last year when we got together. None of this is a contest and it never matters who educates who first or who uses someone else's information from years of research, right! Gotta keep passing the info on to the newer folks. That's the most important thing.

Hope to see you this Spring, my dear...but Renee and I will see each other in Michigan at the SD symposium in a month! If you could get there too...it would be most informative. Can you make it? It would be great if you could.

Since I know you've done your homework, I'm not going to insult you by saying..."SEARCH the BB" but, there are some things out there on MTD. Also on the web. I know...they are hard to find. Recently, Marilyn Morrison and Lloyd Pearson (and probably others, like John Dahlberg) have posted educational messages regarding MTD v. SD.

MTD is Muscle Tension Dysphonia. As SD is, MTD is a vocal disorder. It mimics SD big-time. Sounds like SD. They may sound alike but they are different in origin. Actually, alot of this stuff we see about Morton Cooper...that is really what he is talking about. MTD is caused by vocal abuse and overuse; thus, is not neurological. MTD looks and sounds like SD at a point (if all of us with SD acknowledge that our cases are very unique and respond differently to treatment) but MTD responds to speech therapy and exercises and re-training much more readily whereas a pure case of neurological-SD does not.

The interesting thing about MTD is that it can "combine" with SD, just as tremors and spasms can combine within SD. I've seen it. Actually heard it. In other words, a patient can actually have a vocal-case of dysphonia which is a combination of MTD and SD. I've known two of those types of patients. It gets rather complicated....when you combine the neurological with the structural/vocal-abuse effects.

Some of the information Goly has been posting recently is pertinent to MTD so please read her posts. I don't think she would mind me mentioning this as she mentions it herself (being open about it) and we talked about it in some regard when we got together in person last October. OK with you, Goly...hope so? The deal is...there is such a thing as "pure SD" (of all ranges) and there is such a thing as "pure MTD" (probably of all ranges even though I don't know very much about MTD) and then there is a *combination* of the two (ranges?...I don't know?). Very complicated. But, I have met people who are dealing with both so I know it happens. It truly makes our disorders difficult to discern and difficult to treat. Only a very competent speech pathologist would be able to sort the two out as well as sorting out the differences between mild-moderate-severe, etc. And, then there's the issue of a combo of AB and AD. Whoa...we all have alot to deal with.

I mean...how many combinations of all of this can we all handle? Weird, huh? Whew! I does get pretty exhausting. Thanks for asking, Renee. I would say we might be able to sort some of this out at the Michigan Symposium. Hopefully.

Kudos. You are doing exactly what everyone need(s) to do to work on your own SD/voice/dystonia case and find an appropriate solution that "fits for you." As you know by now, we're all quite different.

I NEVER portray myself as an expert but will always share my numerous years of research with whoever needs it to work on their own case. You're right that some of us on the BB are more knowledgable (or have "greater perspective"...let's put it that way) than the docs who may SPECIALIZE in "the voice" but may never have met and dx'd people with SD. So...hey!...I'm not a doc but I've definitely talked to and met (online and in person) many more SD'ers than most docs. 100-plus?

I claim NO expertise. But...I do claim many years of research and many great face-on experiences with our fellow SD'ers which have all been so positive. Listening to other folks' voices and supporting each other. Trying to figure this whole thing out? So many cool SD'ers in person? It's staggering to think about it.

So...beat my head against the wall...(am I crazy?)...I still think the best "SD-solution" is to research-like-crazy, figure out your own case and meet every single person with SD you can find. That gives us perspective and knowledge. It gives us options and ideas. It helps all of us to bounce ourselves off each other and discuss SD in the process. That's why the symposiums are so valuable. And (if she isn't too embarrassed), my inspiration in much of this BB-stuff is still Kristina Gomez. Way younger than me but my friend. She got me going on the BB over two years ago. Not sure I would have stayed so active on the BB, trying to help folks, without Kristina. A researcher to the max.

Long story, Renee. I'll explain at the symposium. Thanks for this neat message...we will share so much SD-info in Michigan! Looking forward to meeting you there. And, you're right...you can definitely learn something new every day on this BB if you're out there looking, as you are!

Like I said to Kristina, I really appreciate and admire your work and contribution to this BB, and also am aware and value your knowledge and perspective of SD, but as Kristina said: "through questioning we gain understanding", and with all my respect, I would like to question you:

I don't think that it is possible to be completely sure that there's an MTD and a neurological SD, because there hasn't been found any precise way to diagnose them. In an article at the Center for Voice Disorders of Wake Forest University about the diagnostic approach to the patient with a voice disorder, they conclude that stroboscopy is not useful in differentiating laryngeal dystonia from muscle tension dysphonia. Also in a Dr. James P. Thomas post here in this BB he said: "listening to the voice is a more important method of confirming SD", and "Certainly until we find a cause or causes of SD it will likely be impossible to find a cure".

If MTD is supposed to be milder than SD, I can say that at the onset of my SD, I could barely talk at all, during one whole year. Also, this last 5 years, even with the knowledge I already had, I sometimes had some control of it, but not always, and my SD could fluctuate between mild, moderate and severe in a day or week period. Fighting this, was the most difficult and challenging thing I've ever experienced.

My father has a very rare neurological disorder that also has affected his speech, and it is hard to understand him all the time. This is also true in Parkinson's patients. How come almost all of us have "experienced being able to speak almost normally in some circumstances and not others", as Don Nesbitt recently said? And why, with some tricks like speaking in another language or accent or not hearing your voice, many of us have also experienced a good voice?

I do agree with something that John S. Beeman wrote: "I would say that addressing the condition and treating it as SD might be more beneficial that "under" diagnosing the condition and continuing the patient frustration".

But, why can't SD be a real complex mechanical problem and a few of us with the help of speech therapy (and some luck) have found a way in which it can be fixed?

And if there really is a neurological SD, I think you could only be sure of it, after having tried a proven effective therapy, which hasn't been developed yet.

Stuttering was also thought to be neurological for a long time and now Dr Martin F. Schwartz has discovered a physcial cause for it and developed a succesful treatment. He says: "So stuttering is a set of learned responses to a unique pattern of nerve impulses from the vocal cords. It follows, then, that to treat the problem, one must prevent this pattern from reaching the brain." Maybe SD could be something similar, or could you say there are some muscle tension stutters and some neurological?

Isn't this MTD vs. SD thing creating more confusion and disconcert to an already difficult to diagnose disorder? It turns out to be that if we are lucky enough we may get an accurate SD diagnosis, but it is possible that we can never find a specialist that can tell us for sure if ours is MTD or SD, thus making it extremely difficult to find the appropriate solution.

But even if you are right, and I am wrong, wouldn't it be better to be open-minded until we can know for sure?

Although we don't know each other, we are fighting the same battle (like Kristina also said), and I'm sure that we both have the best intentions in our assumptions, and the really important thing is not who's right or who's wrong, but finding the truth from which we might all benefit.

Thanks for being there for all of us,

Tatiana.

I have been told that my condition is a combination of SD and MTD. You are right in that there doesn't seem to be a conclusive test to differentiate between the two but one speech therapist told me that if one's symptoms are lessened with botox, chances are it's SD. I can say this: I have tried speech therapy and it did not help. During the past 1.5 yrs. on botox, I have my voice back. Although not at 100%, it is far better than it was prior to injections. I recall at times, pre botox, not being able to talk at all. At least now I talk without tremor...volume isn't the greatest but all in all, I have a voice.

(And HELLO to Goly, Lynne, Lloyd and the many others I have met and communicated with.) I haven't been here for quite some time. Most of my internet time is spent going to my orthognathic surgery support sites. I was interested in something Tatiana said about not really being able to tell for sure if someone has SD or MTD. I tend to think that may be true. I suppose the true test is what therapies work - or is it?

The botox injections did help me to speak and breathe. (I had a breathing component as well.) But I don't think that was confirmation of SD. I think each person with a voice disorder needs to be very careful about accepting diagnoses. I accepted the SD diagnosis and ended up taking injections in my jaw muscles because my neurologist told me I had a bit of oromandibular dystonia as well (and some ST, too!)

I don't really blame the neuro. From his perspective that is what it looked like. And I was easily led. I wish I had had my husband with me that day. I don't think I would have accepted the jaw injections and I must say in all honesty there was no pressure for me to take them. I didn't even ask about the extra cost for the jaw injections and was very surprised when I went to pay the bill! I must have been having one of my fuzzy brain moments to have agreed to it. I wish the doctor had pointed out the extra cost to me... but that is past now.

My dentist who was treating me for TMJ was very upset when I told him that the neuro had injected my jaw muscles. I was in the beginning stages of my TMJ treatment and it really hadn't been given a chance to work. The dentist was distressed that good muscle had been injected with toxin for no purpose.

I have not had a botox injection for almost five years. My voice began to improve after I began wearing a bite guard designed especially for me. The muscles in my face, neck and shoulders began to relax. I had not realized that I was carrying so much tension. So for me I think successful treatment has been an indicator that I had MTD and not SD. I would say I have a normal voice now. I hope to have a better voice and one that doesn't tire as easily as I train my voice in the coming months. I hope to return to music teaching next fall.

In December of last year I had orthognathic surgery (jaw realignment) to correct the poor bite/jaw misalignment that I now believe was the cause of the muscle tension and larynx spasms. I am only about 10 and a half weeks post-op now so it is too soon to tell what the surgery will do for me. I still have a lot of soreness and numbness from the surgery and I think I need time to adjust to the jaw position that is so different. But I have high hopes!

One thing that I want to say is that failed speech therapy might not mean that a person has SD and not MTD. In my case I believe that speech therapy was limited in its effectiveness because of the underlying physical problem. I think I will still need to work on relaxing the muscles and retraining my voice, but I think the work will be much easier! I guess what I have learned is that (at least for me) there are no easy answers. And even when you find an answer you still have to keep an open mind. My faith in God and prayer have been very important in my search for an answer - probably the most important factors.

Also input from others has been a great help. Please e-mail me if you think I can be of help to you. If you use my aol address I am more likely to see your e-mail. My husband gets a lot of e-mail from his own support groups (he is a recently diagnosed diabetic) and an e-mail to me from an unfamiliar name from could easily be deleted by mistake!

If there is anyone I have met on the Internet and in person while I've done "the-SD-dance" who I admire for doing all the extensive research and figuring out what works for a particular case (my mantra...as you know..."Whatever Works"), it is you. That's all I've ever said to people..."lo, all these years"...research to the ultimate, leave no stone unturned and figure out your own case.

So glad things are going well. Sorry to hear George has new physical problems though. Darn. Say HI to him for me and do you think there is ANY way you could put those Before-After pics out on the Internet for the world to see...or at least the "world" that might be doing a similar search to yours? The difference is incredible; and, obviously, it speaks volumes for what you have gone through in determining the details of your own case. We all can throw out acronyms: SD, AB, AD, MTD (and every combination of them) but those pictures tell a story beyond belief. My hope is that you continue to heal and that the surgery you had in December provides continual relief. My mind was blown...with the difference.

Thanks for continuing to share on the SD-BB. I've learned so much, over the years, from you.

--Lynne

I have posted a couple of my pictures on the "Yahoo"! site but only members can view the photos. I'm not sure if that is members of "Yahoo!" in general or only members of the club. You might want to try it and see if you can see them. It is easy to join Yahoo. The web site is www.yahoo.com and you need to click on the "clubs" link. The club is "orthognathic surgery support."

There are lots of clubs on the site. My husband has found some diabetes clubs, too. There are also message boards in the clubs where you can find a lot of information. As it was with SD, having an internet site to go to has been such a blessing to me. It is really helpful to read the posts and even ask questions.

Your encouragement has meant a lot to me. Thank you, Lynne!

I was fascinated to read about your experience with SD. I am new to this group and am in the pre-treatment phase of SD in the sense that I haven't yet had a Botox injection. I am at the point where my doctors believe I have SD...though it could be MTD etc. etc. I was originally treated for reflux (with medication) and voice therapy (which I'm still doing) but neither seemed to have made a difference.

What intrigued me about your situation was the potential link between MTD and a jaw problem. Last week my dentist fixed the bottom of my two front-top teeth because they were chipping. He felt this was caused by grinding my teeth at night and general tension held in my jaw. He also suggested that a mouth guard might be useful if this tooth chipping pattern persisted. When I was a kid I had braces for an eye tooth problem. I remember the orthodontist telling my father at the time that he should consider fixing "my overbite" at the same time which I presume would call for a more radical treatment. I was upset at the time to have to have braces at all (I was 14) so I insisted that we go with the minimum treatment...so I still have a mild overbite.

I just wondered if you thought this was a potential "cause" I should look into and whether you had any other suggestions.

Thanks so much for your input.

My dentist was trained at the Pankey Institute and I would highly recommend you see a dentist who has had a substantial amount of training there. It was not his dental school, but rather training he received after becoming a dentist. He goes for a week or two at a time I think. At the institute (I think it is in Florida) he learned how to make a special splint specifically designed for the patient to create a comfortable bite. He explained to me that when a person clenches and grinds he/she is trying to find a bite that feels right. The splint reduces the need to clench and grind. There are a lot of things about the bite the dentists look at and the splint is carefully designed and adjusted regularly.

I did an internet search and found information on the Pankey Institute on the web. You can find dentists in your area with Pankey training and I think you can even find out what level they have been trained to. I definitely think it is worth you checking into. Be aware that not all dentists who build splints design them like this.

Forgive me if I am repeating things you already know from previous posts. I forgot what I said here and I am not taking the time to look right now. I have also been treated for reflux and have had speech therapy. The speech therapy was helpful, I think, but it did not solve the problem. The reflux medications helped me not wake up at night not breathing from laryngeal spasms. My surgeon speculates the my reflux was caused by poor chewing of food due to the poor bite.

I am 2 1/2 months post op from my jaw surgery and I feel it is too soon to tell what long term benefits I will have, but I am very hopeful.

Feel free to email if you like. Be sure and put something about SD or this bulletin board in your subject so I will not miss it. My husband gets lots of emails from a support group BB and I could miss an email. I also have an aol address: MarilTX@aol.com