Is laryngeal tremor a component of Essential Tremor (ET)?

From the Guidelines

Laryngeal tremor is indeed a component of Essential Tremor (ET), affecting approximately 20-30% of ET patients and manifesting as a tremulous or shaky voice. The relationship between essential tremor and laryngeal tremor is supported by the fact that essential tremor can affect various body parts, including the voice box (larynx), leading to vocal tremor 1. When essential tremor affects the laryngeal muscles, patients may experience voice quivering, breaks in phonation, or a wavering quality to their speech. Key characteristics of laryngeal tremor in essential tremor include:

• Rhythmic oscillations of the laryngeal muscles at the same frequency (typically 4-12 Hz) as tremor in other affected body parts
• Voice symptoms often worsen during periods of stress or fatigue, similar to tremor in other locations
• Treatment options for laryngeal tremor include oral medications, such as propranolol or primidone, and in severe cases, botulinum toxin injections into the laryngeal muscles or deep brain stimulation may be considered, as botulinum toxin has been shown to improve self-perceived dysphonia, mental health, and social functioning in patients with spasmodic dysphonia 1. It's worth noting that while botulinum toxin is considered the "treatment of choice" for adductor spasmodic dysphonia, its use in essential voice tremor and other disorders of excessive or inappropriate muscular contraction has also been reported, highlighting its potential benefits in managing laryngeal tremor associated with essential tremor 1.

From the Research

Laryngeal Tremor and Essential Tremor

• Laryngeal tremor, also known as essential vocal tremor (EVT), is a condition that affects the voice, causing tremors or shakes in the vocal cords 2.
• Research suggests that EVT may be a component of Essential Tremor (ET), a common condition associated with action tremor in the upper limbs and other parts of the body 2, 3.
• A study found that 42% of patients with EVT had a family history of ET, and 58% noted improvement in tremor after consuming alcohol, which are common characteristics of ET 2.

Characteristics of Laryngeal Tremor

• Laryngeal tremor can present as an isolated symptom, without associated limb tremor, and may be more common in women 2.
• The average age of onset of vocal symptoms is around 64 years, and patients may experience symptoms for an average of 6 years before seeking medical attention 2.
• Laryngeal tremor can be challenging to manage, and treatment options may include medications such as primidone and propranolol, as well as alternative therapies like botulinum toxin injections and deep brain stimulation 4, 5, 6.

Treatment Options

• A scoping review of evidence-based treatments for EVT found that bilateral deep brain stimulation and octanoic acid may be effective in reducing tremor severity 4.
• Other treatment options, such as botulinum toxin injections and methazolamide, may not be as effective, and further research is needed to determine the best treatment approaches for EVT 4.
• Current treatment guidelines for ET recommend a stepped approach, starting with mild to moderate tremor severity, and progressing to more invasive treatments like deep brain stimulation for severe cases 5, 3.