Vocal Tremor

Description and Etiology

The cause of essential voice tremor is unknown.  It is considered the most common movement disorder and is more come in people of advanced age. The symptoms are thought to worsen with increased anxiety, fatigue, and excitement.  Tremor is also often seen in the hands and limbs. It has been reported that alcohol intake provides some symptomatic relief.

  • Perceptual Signs and Symptoms

o      Easy to identify perceptually during vowel prolongation

o      Audible and rhythmic cycles of the tremor occurring every 4 to 6 tremors per second

o      Also characterized by

§       Pitch

§       Voice breaks

o      Difficulty differentiating essential voice tremor from adductor spasmodic dysphonia

o      Laryngeal EMG can help differentiate between the two

  • Features of Visual Assessment

o      Bilateral(both sides) tremor of the true vocal folds

o      Accompanying tremor

§       Soft palate

§       Tongue

§       Pharyngeal wall

§       False vocal folds

o      The larynx(voice box) moves both at rest and increases during phonation

§       With ADSD, spasms are not seen when the larynx is at rest

  • Management

o      Pharmacologic management:

§       Beta-blockers

§       Propranolol

§       Metoprolol

§       Other drug treatments include:

  • Anticonvulsants
  • Benzodiazepines
  • Calcium channel blockers
  • Botox

o      Deep brain stimulation