Table 2 Inclusion and exclusion criteria

Inclusion criteria

 •Males and females

 •18 or above

 •Clinical diagnosis of primary MTD based on history and laryngoscopic assessment (type I–III MTD patterns) through joint assessment by a SLT-V and laryngologist

 •Current voice problems, persistent for greater than 2 months

 •Severity of disorder (a) VHI ≥ 30 and (b) patient wants therapy

 •Patient willingness to undergo treatment

 •Agree to undertake the study protocol

Exclusion criteria

 •Organic vocal pathology (1) structural/neoplastic disorders (e.g. carcinoma, cyst, polyp, papilloma, Reinke’s oedema), (2) neurological disorders (e.g. vocal cord palsy, paresis, spasmodic dysphonia) and (3) inflammation (e.g. infection, reflux (RFS > 7) or significant relevant systemic disease (e.g. severe COPD) or need for surgery

 •Significant psychological issues identified during initial assessment (with option to withdraw if discovered during the treatment periods and agreed by both patient and therapist)

 •MTD pattern (IV–VI) compatible with significant primary psychological aetiology on laryngoscopy

 •Transgender voice issues

 •Previously incompletely treated dysphonia, neurological disease or upper aerodigestive tract malignancy

 •Had previous VT or CVT training or pharmacological treatment for their voice problem (other than proton pump inhibitors or an alginate recommended for disorders of laryngopharyngeal reflux–related symptoms)

 •A hearing impairment that would prohibit or impact on telepractice treatment

 •Significant concomitant health problems affecting voice

 •Not have or be able to use a computer with video link at home or in hospital even with support

 •Not able to commit to the study protocol