Review Article

The Assessment Methods of Laryngeal Muscle Activity in Muscle Tension Dysphonia: A Review

Table 1

Summaries of studies using surface electromyography.

AuthorsDesignParticipantsTasksType of electrodesElectrode
positioning
Outcome measureResults

Redenbaugh and Reich 1989 [31]Case-control7 normal and
7 patients with vocal hyperfunction
At rest, phonation, and reading
UnipolarThyrohyoid membraneRMS(i) EMG levels in MTD significantly higher than normal
(ii) Moderately high correlations between clinical measures and speech EMG values

Hočevar-Boltežar et al. 1998 [32]Case-control5 normal and
11 patients with
MTD
At rest,
phonation
UnipolarPerioral area and
anterior neck
RMS(i) Increases of EMG activity in the perioral and supralaryngeal muscles before and during phonation
(ii) Same sEMG level for both groups at rest

Stepp et al. 2010 [26]Pretest-posttest13 patients with
vocal folds paralysis
(before and after thyroplasty injection)
Phonation,
reading, and
spontaneous speech
Double-differential (1) Thyrohyoid, omohyoid, and sternohyoid
(2) Cricothyroid and sternohyoid
(3) SCM
RMS(i) No significant reductions in RMS after injection
(ii) No significant effects of after vocal tasks
(iii) The largest changes associated with the electrode position 1

Stepp et al. 2011 [33]Case-control10 normal and
18 patients with
vocal nodules (10 singers and 8 nonsingers)
Phonation,
reading, and
spontaneous speech
Double-differential (1) Thyrohyoid, omohyoid, and sternohyoid
(2) Cricothyroid and sternohyoid
(3) SCM
RMS(i) No significant difference between groups
(ii) Significant effect of vocal tasks
(iii) Useful for assessing inappropriate phonatory behaviors in nodules

Stepp et al. 2011 [19]Pretest-posttest16 patients with vocal hyperfunction
(before and after one session voice therapy)
Phonation,
reading, and
spontaneous speech
Double-differential (1) Thyrohyoid, omohyoid, and sternohyoid
(2) Cricothyroid and sternohyoid
(3) SCM
RMS(i) No reliably changes over one session voice therapy
(ii) Stronger relationship in suprahyoids in a smaller set of patients with vocal nodules

Van Houtte et al. 2013 [34]Case-control44 normal and
18 patients with MTD
At rest,
phonation, and
reading
Bipolar(1) Mylohyoid, geniohyoid, and digastric
(2) Sternohyoid and omohyoid
(3) SCM
RMS(i) Not able to discriminate between MTD and normal subjects
(ii) Type of electrodes, nature of primary MTD, and emotional state of the subjects as important factors

Stepp et al. 2010 [35]Case-control18 normal and 18 patients with vocal nodulesReading,
spontaneous speech
Double-differential(1) Thyrohyoid, omohyoid, and sternohyoid
(2) Cricothyroid and sternohyoid (contralateral)
NIBcohSignificant decrease in NIBcoh in patients compared to healthy speakers

Stepp et al. 2011 [40]Repeated measures10 normalReading,
spontaneous speech
Double-differential(1) Thyrohyoid, omohyoid, and sternohyoid
(2) Cricothyroid and sternohyoid (contralateral)
NIBcohSignificant reduction of NIBcoh during mimicking hyperfunctional voice

RMS: root mean squared; MTD: muscle tension dysphonia; EMG: electromyograghy; sEMG: surface electromyograghy; SCM: sternocleidomastoid; NIBcoh: neck intermuscular beta coherence.