Voice Tremor and Postural Tremor Co-occurrence
Yes, voice tremor and postural tremor frequently occur together, particularly in essential tremor, where up to 93% of patients with laryngeal tremor have co-occurrence of other movement disorders. 1
Essential Tremor as the Common Link
Essential tremor is fundamentally a bilateral postural and kinetic tremor disorder that can affect multiple body regions simultaneously. 2, 3 The condition manifests primarily as action tremor of the arms and hands, but commonly extends to involve the head and voice. 4, 5
- In patients with essential tremor, voice tremor is characterized by abnormal oscillatory activity at 2-6 Hz frequency. 6
- Postural tremor of the hands and forearms represents the hallmark feature, while voice tremor occurs as an additional manifestation in many patients. 3, 7
Clinical Evidence of Co-occurrence
A retrospective review of 29 laryngeal tremor patients revealed striking patterns of co-occurrence:
- 93% of patients with laryngeal tremor had at least one other concurrent movement disorder. 1
- 38% specifically had essential limb tremor (postural tremor) occurring alongside their voice tremor. 1
- 41% had oropharyngeal tremors and 24% had essential head and neck tremor, demonstrating the multi-regional nature of the condition. 1
Distinguishing from Other Tremor Disorders
Parkinsonian tremor differs fundamentally—it occurs predominantly at rest (4-6 Hz) and may have postural components, but voice tremor is less characteristic. 4, 8 Only 3% of laryngeal tremor patients in one series had Parkinson's disease. 1
Intentional (cerebellar) tremor becomes more pronounced during goal-directed movements and is associated with dysarthria and ataxic gait, representing a different pathophysiology. 8, 2
Clinical Implications
When evaluating a patient with voice tremor, actively assess for postural tremor in the hands, head, and other body regions, as isolated laryngeal tremor is uncommon. 1 The presence of both tremor types supports the diagnosis of essential tremor rather than other neurological conditions. 3
First-line treatment with propranolol (80-240 mg/day) or primidone can address both voice and postural tremor components simultaneously in essential tremor. 4, 2 For medication-refractory cases, MRI-guided focused ultrasound thalamotomy targeting the VIM nucleus can provide sustained improvement (56% tremor reduction at 2-4 years) for both manifestations. 9, 2
Important Caveat
Voice tremor involves laryngeal motor neuron firing abnormalities, but the diagnostic validity of laryngeal electromyography for vocal tremor remains unknown. 9 Clinical examination and observation of tremor characteristics across multiple body regions remain the primary diagnostic approach.