Vocal tremor is a benign neurologic voice condition that is characterized by involuntary ryhthmic movements of the vocal folds during speech. Patients experience an "unsteady" or "shaky" vocal quality that can be debilitating. In some cases, the tremor may impact the surrounding muscles in the mouth and the throat. Vocal tremor may also co-occur in patients with essential tremor of the head and upper extremities.

Essential Tremor of the Voice Causes

There is no known underlying condition that triggers the onset of this neurologic voice condition. Vocal tremor can affect patients of any age, but most commonly affects people beginning in their 50s or 60s. It is inherited in almost half of all cases and can worsen with age.

Symptoms of Voice Tremor

The main symptom of vocal tremor is a rhythmic wavering of the voice. You may notice that it takes more effort to speak and that people may have difficulty understanding you. Your voice can sound strained or tight and fatigue easily with use. 

Essential Tremor of the Voice Diagnosis 

Our voice care team at the Voice and Swallowing Center has the advanced training and skills necessary to diagnose this voice condition. During the initial visit, you will be assessed by one of our laryngologists and likely, an additional session with one of our voice pathologists. We use cutting-edge diagnostic tests to determine the cause of your voice disorder and to develop your plan of care. Following a thorough discussion of your symptoms and medical history, be expected to undergo the following assessments: 

  • Video Laryngostroboscopy: Using a small camera inserted through the nose or mouth, our specialists are able to assess the health and function of your larynx (voice box) and determine the presence of any vocal fold growths or abnormalities characteristic of vocal fold leukoplakia.

Treatment of Voice Tremor

Patients with essential tremor of the extremities are often treated with oral medications such as propranolol and primidone; however, in our experience, essential tremor of the voice does not respond well to these medications. Patients who exhibit compensatory muscle tension/vocal strain when speaking, even after undergoing Botox treatment, may benefit from a trial of voice therapy.

Botulinum toxin (e.g., Botox®) injection into the affected muscles has been shown to be effective at symptomatic relief for vocal tremor. This quick procedure can be carried out easily at our Voice Center. The impact of botulinum toxin typically last months and will be repeated when the effect starts to wear off. While this treatment is beneficial for many patients, it can take a few injections before getting the “right” dose specifically for you. You may need to discuss adjustments in the dose with your laryngologist if you do not get the ideal outcome. We will work to provide an individualized treatment plan for you.