Laryngeal Tremor Workup

  • Author: Monika I Sidor, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 1, 2012
 

Approach Considerations

Workup in laryngeal tremor includes the following:

  • Lab tests - A complete blood count (CBC) and chemistry panel, thyroid function test, erythrocyte sedimentation rate, liver function test, and serum ceruloplasmin are indicated studies
  • Video stroboscopy - Enables an assessment of the vibratory function and architecture of the vocal folds
  • Electromyography - May reveal tremor or increased muscle activity in patients with adductor dysphonia

Imaging studies

The use of computed tomography (CT) scanning or magnetic resonance imaging (MRI) of the brain should be reserved for patients who present with focal neurologic findings or acute onset and stepwise progression.

Acoustic analysis

Acoustic analysis may be used to monitor the patient’s response to treatment. The following components of the voice are analyzed (patients with laryngeal dystonias usually have higher frequency, amplitude, and voice breaks):

  • Fundamental frequency changes
  • Jitter
  • Voice breaks
  • Shimmer
  • Signal-to-noise ratio

Aerodynamic analysis

Aerodynamic analysis is used to evaluate airflow and air pressure during voice production. Patients with adductor dysphonia have higher than normal subglottic pressures and lower airflow rates. Greater than normal airflow rates are seen during abductor spasms.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Monika I Sidor, MD  Resident Physician, Department of Surgery, University of Michigan at Ann Arbor Medical School

Monika I Sidor, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Soly Baredes, MD  Professor of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Soly Baredes, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Society for Head and Neck Surgery, New York Head and Neck Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Nothing to disclose.

Brian E Benson, MD  Chief, Division of Laryngeal Surgery and Voice Disorders, Director, The Voice Center, Clinical Assistant Professor, Department of Otolaryngology, Hackensack University Medical Center; Attending Physician, Department of Otolaryngology, St Luke's-Roosevelt Hospital Center

Brian E Benson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

Additional Contributors

Lanny Garth Close, MD Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons

Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: GE Healthcare Honoraria Review panel membership

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

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  2. Merati AL, Heman-Ackah YD, Abaza M. Common movement disorders affecting the larynx: a report from the neurolaryngology committee of the AAO-HNS. Otolaryngol Head Neck Surg. Nov 2005;133(5):654-65. [Medline].

  3. Woodson GE, Blitzer A. Neurologic Evaluation of the Larynx and the Pharynx. In: Cummings CW, et al., eds. Otolaryngology Head and Neck Surgery. 4th ed. Philadelphia, PA: Mosby; 2005:2054-2064.

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  5. Perez KS, Ramig LO, Smith ME. The Parkinson larynx: tremor and videostroboscopic findings. J Voice. Dec 1996;10(4):354-61. [Medline].

  6. Korn GP, Moraes M, Vilanova LC, de Moraes BT, Madazio G, Padovani M, et al. Comparison of clinical characteristics of patients with adductor laryngeal dystonia in the focal and segmental types. Braz J Otorhinolaryngol. Jul-Aug 2011;77(4):413-7. [Medline].

  7. Bove M, Daamen N, Rosen C, et al. Development and validation of the vocal tremor scoring system. Laryngoscope. Sep 2006;116(9):1662-7. [Medline].

  8. Adler CH, Bansberg SF, Hentz JG. Botulinum toxin type A for treating voice tremor. Arch Neurol. Sep 2004;61(9):1416-20. [Medline].

  9. Busenbark K, Ramig L, Dromey C, Koller WC. Methazolamide for essential voice tremor. Neurology. Nov 1996;47(5):1331-2. [Medline].

 
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