Updates on Vocal Tremor and its Management Vocal tremor is a neurogenic voice disorder characterized by a nearly periodic modulation in pitch and loudness during sustained phonation. This voicing pattern is the result of tremor affecting structures within the speech mechanism, resulting in modulation of lung pressure, phonation, articulation, and resonance during speaking. Speaking patterns in these ... Article
Article  |   November 01, 2012
Updates on Vocal Tremor and its Management
Author Affiliations & Notes
  • Julie Barkmeier-Kraemer
    Department of Otolaryngology, University of California, Davis, Sacramento, CA
  • Disclosure: Julie Barkmeier-Kraemer has no financial or nonfinancial relationships related to the content of this article.
    Disclosure: Julie Barkmeier-Kraemer has no financial or nonfinancial relationships related to the content of this article.×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Articles
Article   |   November 01, 2012
Updates on Vocal Tremor and its Management
SIG 3 Perspectives on Voice and Voice Disorders, November 2012, Vol. 22, 97-103. doi:10.1044/vvd22.3.97
SIG 3 Perspectives on Voice and Voice Disorders, November 2012, Vol. 22, 97-103. doi:10.1044/vvd22.3.97

Vocal tremor is a neurogenic voice disorder characterized by a nearly periodic modulation in pitch and loudness during sustained phonation. This voicing pattern is the result of tremor affecting structures within the speech mechanism, resulting in modulation of lung pressure, phonation, articulation, and resonance during speaking. Speaking patterns in these individuals may be perceived as similar to spasmodic dysphonia or muscle tension dysphonia. The key to determining the presence of vocal tremor and distinguishing it from other voice disorders requires familiarity with the perceptual, acoustic, and physiologic patterns associated with vocal tremor during different voicing and speech contexts. Management of those with vocal tremor can be challenging because of its co-occurrence with other neurological disorders. The two most common methods for managing vocal tremor include pharmaceutical treatment, most commonly applied via injections of Botulinum Toxin Type A (Botox®), and behavioral modification of speaking patterns. The latter approach is in early clinical phases of research and has not yet been subjected to clinical trials. In this paper, I will summarize the clinical characteristics of vocal tremor in comparison to what is known about tremor in general and describe Botox® and behavioral approaches for managing individuals with this voice disorder.

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