Medical Reviewer: Dhira Khosla D.O.
As we age, our bodies undergo a myriad of changes from intermittent aches and pains to more consistent issues that can become a daily struggle. Essential voice tremor is a common issue that impacts the vocal cords and alters the sound production, volume, and stability of speech, most often resulting in a shaky voice.
Voice tremor generally affects older adults between forty-seven and seventy-seven years old, with females accounting for nearly 93% of cases. While there is no official cure for essential tremor voice disorder, it’s important to know that you’re not alone in this battle.
In this article, we’ll define essential voice tremor, its signs and symptoms, how essential tremor-related vocal tremors are diagnosed, and what treatment options are available for managing symptoms. Read on for a full explanation of essential voice tremor, or use the links below to skip ahead to the section that best answers your query.
What is Voice Tremor Associated with Essential Tremor?
Voice tremor due to essential tremor occurs when involuntary movement impacts the larynx, vocal folds, and throat, causing the voice to tremble, fluctuate in volume, or disrupt sound production. This tremor generally impacts older adults and disproportionately affects females.
Voice tremor is typically associated with essential tremor, a neurological involuntary and rhythmic movement that impacts the hands, torso, head, arms, legs, and can manifest in the voice as a voice tremor. Sean Parker Institute for the Voice says voice tremor is often misdiagnosed as spasmodic dysphonia which is non-rhythmic and only affects certain vocal tasks. Voice tremors, on the other hand, are generally present during all vocal tasks, including, singing, speaking, and breathing.
What causes essential vocal tremor?
The official cause of essential vocal tremor is unknown, however, studies have found that almost half of those diagnosed with voice tremor had a first-degree relative with the same essential tremor condition. According to Columbia University’s Department of Otolaryngology Head and Neck Surgery, essential vocal tremor has a gradual onset and most often appears in the 50’s and 60’s.
What are the symptoms of essential voice tremor?
How does essential tremor affect the voice? Vocal tremor is characterized by symptoms, including:
- Changes in volume and/or voice pitch
- Interruptions in voice production
- Shaky voice
Voice tremor is rhythmic and always present no matter the type of vocal task at hand, including breathing and speaking. The constant presence of vocal tremor symptoms causes some patients to whisper as a way to minimize the appearance of their tremor.
Diagnosing Vocal Tremor Associate with Essential Tremor
According to Cornell’s Sean Parker Institute for the Voice, there is not a specific diagnostic test for voice tremor associated with essential tremor, but the presence of essential tremor in the head, hands, and other body parts is suggestive of the condition.
In general, a visit with your physician regarding vocal tremor symptoms would include:
- A discussion of your symptoms
- A physician examination
- A review of your and your immediate family’s medical history
Following these steps, your doctor may recommend additional testing to help identify and treat your symptoms. Tests that are associated with vocal tremor include:
- Laryngoscopy: An exam using a narrow tube with a light and camera, inserted through the nose.
- Videostroboscopy: A telescope-like camera that provides a magnified, slow-motion view of the vocal cords as they vibrate.
- Sound (acoustic) analysis: Computer analysis that identifies abnormalities in the sounds produced by the vocal cords.
Physiological impact of voice tremor due to essential tremor
Physiologically, vocal tremors cause rhythmic changes in volume, quivering, and in more severe cases, disruptions in sound production. Tremors in the voice vary in severity and may cause individuals to alter their voice in order to minimize the appearance of their symptoms.
Beyond the physiological manifestations of vocal tremor, it can be a seriously frustrating and confidence-curbing condition to deal with. If you suffer from voice tremors, it’s important to know that you’re not alone and that there are plenty of treatment options and informational resources available to you. In this next section, we’ll discuss how essential voice tremor is treated and the range of resources that are out there to help you navigate this condition.
How Essential Voice Tremor is Treated
Unfortunately, there is no official cure for essential voice tremor but there are several treatment options that can help you manage your symptoms, and hopefully, restore your confidence when handling vocal tasks. Treatment for voice tremor typically breaks down into three categories: oral pharmaceutical medications, botox injections, and voice therapy.
Because essential voice tremor is often associated with other physiological essential tremors, it is sometimes responsive to the same medications, including propranolol, used to control blood pressure, and primidone, an anti-seizure medication. Before beginning medication for voice tremor treatment or any other condition, it’s important to discuss the potential side effects.
Botulinum toxin (botox) injections
Botulinum toxin (botox) injections into the vocal folds can be helpful with severe cases of essential vocal tremor. Treatment with botox injections can temporarily even out the voice and make speaking easier. Because botox injections only temporarily curb symptoms, the procedure needs to be repeated every three to four months.
Voice therapy is another option patients may consider, but its effectiveness is not always substantial because voice tremors are caused by involuntary movement in the vocal folds.
Finding your ideal treatment
For many patients, treating essential voice tremor involves trial and error. Because symptoms vary so much in severity and characteristics, it’s important to know that there’s not a one-size-fits-all approach when it comes to treating voice tremor, which is why it’s always a good idea to consider all treatment options available to you.
MKG-1120 Rev A Dec 2020