Table 1 Symptoms and clinical findings compatible with a clinical diagnosis of MTD

•The history of the presentation of the condition and its compatibility with a Primary MTD diagnosis

•Presenting vocal symptoms such as hoarseness, change in voice quality, limitations in pitch, loudness, flexibility, and/or stamina of the voice

•Absence of organic pathology such as structural abnormalities, neurological and inflammatory conditions on endoscopy

•Auditory-perceptual voice change which includes one or more of the following characteristics: having a variable or abnormal in quality (overall severity of hoarseness, roughness, breathiness, strain), having an abnormal habitual pitch with or without a restricted fundamental speaking frequency range or having abnormal loudness and loudness variability during speech

•The presence of muscle soreness, tenderness or other evidence of hyperfunction in the thyrohyoid or cricothyroid space and/or suprahyoid muscles on physical examination

•Laryngoscopic findings of laryngeal hyperfunction pattern (MTP types 1–III)