These images show the laryngeal inlet appearance upon phonation in muscle tension dysphonia (MTD). In this condition, there is imbalance or excessive activity of extrinsic and/or extrinsic muscles of the larynx. The typical features of Type III MTD is shown as in which there is extreme antero-posterior supraglottic contraction [Morrison-Rammage classification of MTD (1986)]. The resulted voice became strained and strangled with tightness often felt at upper neck area surrrounding the hyoid cornua areas (palpation may reveals a localized tenderness). Secondary form of MTD is commoner and usually mangeable by most speech language pathologist/therapist. Flexible transnasal laryngoscopic examination is the preferred in-the office evaluation of any forms of functional dysphonia including MTD.