Laryngeal Tremor Workup

Updated: Oct 06, 2017
  • Author: Thomas L Carroll, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Approach Considerations

Workup in laryngeal tremor includes the following:

  • Laboratory tests - A complete blood count (CBC) and chemistry panel, thyroid function test, erythrocyte sedimentation rate, liver function test, and serum ceruloplasmin are indicated studies but are often low yield
  • Flexible laryngoscopy with videostroboscopy - Enables an assessment of the extent of the tremor and its location in the pharynx and larynx; videostroboscopy may demonstrate the vibratory function and architecture of the vocal folds but is often difficult to obtain in severe tremor cases due to supraglottic compensatory hyperfunction
  • Electromyography - May reveal tremor or increased muscle activity in patients with a confusing vocal picture and when spasmodic dysphonia is suspected in addition to tremor

Imaging studies

Imaging studies are not likely to be needed. 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 spasmodic dysphonia have higher than normal subglottic pressures and lower airflow rates, and aerodynamic analysis may help to differentiate ETV from a mixed case. Greater than normal airflow rates are seen during abductor spasms.