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Vocal tremor

MedGen UID:
868495
Concept ID:
C4022889
Finding
Synonym: Shakey voice
 
HPO: HP:0012477

Definition

A wavering, unsteady voice that reflects involuntary and approximately sinusoidal oscillation of motor unit firings of laryngeal muscles. Vocal tremor results in low frequency modulations of voice frequency or amplitude and intermittent voice instability. [from HPO]

Term Hierarchy

Conditions with this feature

Tremor, hereditary essential, 6
MedGen UID:
1711112
Concept ID:
C5394329
Disease or Syndrome
Hereditary essential tremor-6 (ETM6) is an autosomal dominant neurologic disorder characterized by adult-onset kinetic and/or postural tremor usually affecting the upper limbs. Some patients may have involvement of the head, trunk, lower limbs, and/or voice. Additional neurologic features, such as cognitive impairment or pyramidal signs, are usually not observed. Brain imaging does not show cerebellar atrophy or leukodystrophy. Skin biopsy shows intranuclear eosinophilic inclusions in fibroblasts and sweat gland cells, which may be used for diagnosis. There is evidence of genetic anticipation, with progressive earlier age at onset in younger generations. In rare cases, the phenotype may convert to NIID over time (summary by Sun et al., 2020; Ng et al., 2020). For a phenotypic description and a discussion of genetic heterogeneity of hereditary essential tremor, see ETM1 (190300).

Professional guidelines

PubMed

Khoury S, Randall DR
J Voice 2024 Jul;38(4):922-930. Epub 2022 Jan 10 doi: 10.1016/j.jvoice.2021.12.009. PMID: 35022154
Mittal SO, Lenka A, Jankovic J
Parkinsonism Relat Disord 2019 Jun;63:31-41. Epub 2019 Jan 26 doi: 10.1016/j.parkreldis.2019.01.023. PMID: 30709779
Barkmeier-Kraemer JM, Clark HM
Tremor Other Hyperkinet Mov (N Y) 2017;7:489. Epub 2017 Sep 21 doi: 10.7916/D8Z32B30. PMID: 28983422Free PMC Article

Recent clinical studies

Etiology

Tykalová T, Rusz J, Švihlík J, Bancone S, Spezia A, Pellecchia MT
J Neural Transm (Vienna) 2020 Sep;127(9):1295-1304. Epub 2020 Jul 10 doi: 10.1007/s00702-020-02229-4. PMID: 32651925
Hopewell BL, Paige C, Francis DO
J Voice 2019 Sep;33(5):730-731. doi: 10.1016/j.jvoice.2018.03.007. PMID: 29778327
Guglielmino G, Moraes BT, Villanova LC, Padovani M, Biase NG
Clinics (Sao Paulo) 2018 Jul 16;73:e87. doi: 10.6061/clinics/2018/e87. PMID: 30020342Free PMC Article
Richards AL
Curr Opin Otolaryngol Head Neck Surg 2017 Dec;25(6):475-479. doi: 10.1097/MOO.0000000000000412. PMID: 28937519
Hintze JM, Ludlow CL, Bansberg SF, Adler CH, Lott DG
Otolaryngol Head Neck Surg 2017 Oct;157(4):551-557. Epub 2017 Aug 29 doi: 10.1177/0194599817728521. PMID: 28850801

Diagnosis

Paige C, Hopewell BL, Gamsarian V, Myers B, Patel P, Garrett CG, Francis DO
JAMA Otolaryngol Head Neck Surg 2018 Dec 1;144(12):1169-1173. doi: 10.1001/jamaoto.2018.2566. PMID: 30422171Free PMC Article
Richards AL
Curr Opin Otolaryngol Head Neck Surg 2017 Dec;25(6):475-479. doi: 10.1097/MOO.0000000000000412. PMID: 28937519
Hintze JM, Ludlow CL, Bansberg SF, Adler CH, Lott DG
Otolaryngol Head Neck Surg 2017 Oct;157(4):551-557. Epub 2017 Aug 29 doi: 10.1177/0194599817728521. PMID: 28850801
Ho AL, Erickson-Direnzo E, Pendharkar AV, Sung CK, Halpern CH
Neurosurg Focus 2015 Jun;38(6):E6. doi: 10.3171/2015.3.FOCUS1537. PMID: 26030706
Imamura R, Tsuji DH
Braz J Otorhinolaryngol 2006 Jul-Aug;72(4):434. doi: 10.1016/s1808-8694(15)30985-x. PMID: 17143419Free PMC Article

Therapy

Frucht SJ, Riboldi GM
Tremor Other Hyperkinet Mov (N Y) 2020 Oct 21;10:47. doi: 10.5334/tohm.560. PMID: 33178485Free PMC Article
Mittal SO, Lenka A, Jankovic J
Parkinsonism Relat Disord 2019 Jun;63:31-41. Epub 2019 Jan 26 doi: 10.1016/j.parkreldis.2019.01.023. PMID: 30709779
Guglielmino G, Moraes BT, Villanova LC, Padovani M, Biase NG
Clinics (Sao Paulo) 2018 Jul 16;73:e87. doi: 10.6061/clinics/2018/e87. PMID: 30020342Free PMC Article
Kaye R, Blitzer A
Toxins (Basel) 2017 Nov 2;9(11) doi: 10.3390/toxins9110356. PMID: 29099066Free PMC Article
Nida A, Alston J, Schweinfurth J
JAMA Otolaryngol Head Neck Surg 2016 Feb;142(2):117-21. doi: 10.1001/jamaoto.2015.2849. PMID: 26660910

Prognosis

Richards AL
Curr Opin Otolaryngol Head Neck Surg 2017 Dec;25(6):475-479. doi: 10.1097/MOO.0000000000000412. PMID: 28937519
Rojas GVE, Ricz H, Tumas V, Rodrigues GR, Toscano P, Aguiar-Ricz L
J Voice 2017 May;31(3):391.e7-391.e18. Epub 2016 Nov 17 doi: 10.1016/j.jvoice.2016.09.029. PMID: 27866691
Hemmerich AL, Finnegan EM, Hoffman HT
J Voice 2017 May;31(3):366-377. Epub 2016 Jun 8 doi: 10.1016/j.jvoice.2016.05.004. PMID: 27289298
Anand S, Shrivastav R, Wingate JM, Chheda NN
J Voice 2012 Nov;26(6):811.e1-7. Epub 2012 Aug 24 doi: 10.1016/j.jvoice.2012.02.007. PMID: 22921293
Bové M, Daamen N, Rosen C, Wang CC, Sulica L, Gartner-Schmidt J
Laryngoscope 2006 Sep;116(9):1662-7. doi: 10.1097/01.mlg.0000233255.57425.36. PMID: 16955000

Clinical prediction guides

Karatayli Ozgursoy S, Vargas ER, Heckman MG, Rutt AL
Acta Otorhinolaryngol Ital 2020 Jun;40(3):198-203. doi: 10.14639/0392-100X-N0284. PMID: 32773781Free PMC Article
Paige C, Hopewell BL, Gamsarian V, Myers B, Patel P, Garrett CG, Francis DO
JAMA Otolaryngol Head Neck Surg 2018 Dec 1;144(12):1169-1173. doi: 10.1001/jamaoto.2018.2566. PMID: 30422171Free PMC Article
Richards AL
Curr Opin Otolaryngol Head Neck Surg 2017 Dec;25(6):475-479. doi: 10.1097/MOO.0000000000000412. PMID: 28937519
Hemmerich AL, Finnegan EM, Hoffman HT
J Voice 2017 May;31(3):366-377. Epub 2016 Jun 8 doi: 10.1016/j.jvoice.2016.05.004. PMID: 27289298
Schaefer SD
Laryngoscope 1983 Sep;93(9):1183-204. doi: 10.1288/00005537-198309000-00015. PMID: 6136880

Recent systematic reviews

Lester-Smith RA, Miller CH, Cherney LR
J Voice 2023 Jul;37(4):561-573. Epub 2021 Jun 8 doi: 10.1016/j.jvoice.2021.03.026. PMID: 34112549

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