Backstreet’s back, all right.
The Backstreet Boys kicked off their their highly-anticipated 21-concert ‘Into The Millennium’ Las Vegas Sphere residency this weekend.
But fans of the famous fivesome couldn’t help but notice that one of its beloved harmonizers, Brian Littrell, sounded a little different.
The singer, 50, recently opened up about a crippling vocal chord condition that’s been haunting him for years.
“I’m seeing a vocal therapist in California, so you know, it’s starting to come out,” he told Parade.
“It’s starting to feel a little more natural. But, yeah, it’s a work in progress. It always will be.”
Littrell has been struggling with muscle tension dysphonia (MTD) since 2012.
“That’s part of it, just managing it,” he told the outlet.
What is muscle tension dysphonia?
Muscle tension dysphonia (MTD) is a voice disorder caused by abnormal muscle activity around the voice box (larynx).
Unlike structural issues like nodules or polyps, MTD isn’t the result of damaged tissue — instead, it’s caused by excessive tension in the muscles that control speech.
This tension interferes with normal vocal cord vibration and can make speaking or singing feel difficult, strained or unnatural.
There are two main types:
- Primary MTD, which happens without any underlying vocal cord abnormality
- Secondary MTD, which develops as a response to another vocal issue, such as inflammation, injury or overuse
Symptoms of muscle tension dysphonia
The hallmark of MTD is a voice that sounds off — but the signs can vary depending on the person.
Common symptoms include:
- A hoarse, rough, raspy or breathy voice
- Vocal fatigue, especially after talking for long periods
- Difficulty projecting or controlling pitch and volume
- A strained or tight sensation in the throat when speaking or singing
- Voice breaks or a feeling of running out of air mid-sentence
Risk factors and frequency
MTD can affect anyone, but it’s most commonly seen in people who rely heavily on their voice, such as singers.
Factors that can increase the risk of MTD include:
- Vocal overuse or misuse
- Stress or anxiety, which can contribute to muscle tension
- Upper respiratory infections
- Gastroesophageal reflux (GERD)
- Poor posture or neck tension
MTD is a common voice disorder, with estimates suggesting it accounts for up to 40% of all disorders seen in voice clinics.
It’s especially common in women and people who are between 40 and 50.
Diagnosis and treatment
Diagnosis of muscle tension dysphonia typically involves an ear, nose and throat specialist (ENT) performing a voice evaluation and physical exam.
They would also go over the patient’s medical history and vocal habits.
Treatment focuses on relaxing the muscles around the larynx and retraining vocal technique.
The mainstay is voice therapy, often with a speech-language pathologist who specializes in voice disorders.
In rare or severe cases, botox injections into the laryngeal muscles may be considered to reduce excessive tension.
With consistent treatment, many people with MTD can return to full voice, though it often requires ongoing maintenance, especially for high-demand vocal professionals.
