Overview:
Benign Essential Voice Tremor causes shaking of the voice. It can affect the larynx, vocal folds or throat. This type of disorder will not harm your over all health since it is benign, but it will affect your ability to communicate confidently with others. Essential means that the tremor is not associated with any other state of a disease. It is a disorder of involuntary movement. The tremor is rhythmic and can be oscillatory. The cycle can vary in timing and occur as much as 12 times per second. The tremor may only be heard when the person speaks, unless it is present in other parts of the body such as the hands, head or other body parts.
This video shows someone with a benign essential voice tremor.
Cause:
There is no specific test to diagnose tremor, but it is caused by a central nervous system problem. or it could be hereditary. Benign Essential Tremor sometimes occurs along with Spasmodic Dysphonia, so that there are vocal fold spasms as well as continuous shaking. The reason for this is unknown.
· Poor voice quality, with "old-sounding" characteristics
· Vocal weakness and low volume
· Vocal fatigue increasing with voice use
· Embarrassment
The voice can be qualified as wobbling or a steady shaky quality, it can be gentle or harsh like a “hiccup” sound. It is rhythmic and steady, it may vary in intensity with pitch changes in volume and it can get worse in stressful situations, similar to most voice disorders.
Treatment:
There is not one specific treatment that will eliminate vocal tremor. The patient will often try to control the tremor when speaking which can do more harm to the vocal musculature and make the tremor worse.
Functional voice therapy:
This can help reduce the vocal compensation and improve the speaking voice.
Botox injections:
Injections can be helpful to reduce the strain and harsh voice quality, but the tremor will not be eliminated. Again, this depends on the severity of tremor. The patient is injected with botox into the thyroarytenoid muscle of the vocal fold which controls the strength and “hiccup” quality of the tremor. The person will have to have consistent Botox injections every 4-6 months. There are two injections, one for each side.
How does the Doctor know he is injecting into the correct muscle?
The Doctor knows he/she is injecting into the correct muscle with the help of Electromyographic (EEG) guidance. The needle is attached to a wire that sends a signal to the EEG machine that gives a signal about the activity of the muscle. The patient will be asked to say “eee or ahhh” this will cause the muscle to contract and this sends a signal through the wire to the EEG machine. A “crackling” noise is made which tells the doctor that the needle is in the correct muscle. The person is “grounded” for the electrical signal by having electrodes placed on their clavicle area.
How long does it take?
It only takes a few minutes, but they ask the patient to wait 15 minutes to be sure they feel OK!
Does it hurt?
It is a small amount of pain, like a tetanus shot. No anesthesia is used because it makes it hurt more.
How long does it take to feel the effects of the injection?
The injection can take up to three days to feel its effects, but again this depends on the person. Some people report that they feel the difference the next day.
What are the side effects?
Side effects are minimal since the amount of Botox injected is generally a small amount. Patients will notice weak and breathy voice quality for about a week and over time it should get stronger. The voice tremor will be more gentle, but it will no disappear. and only weak vocal folds are noticed.
Oral medications:
Medications such as anti-seizure drugs, beta-blockers and psychotropic drugs can help with tremor, but it depends on each individual case as well as severity of the tremor and whether it exists in other parts of the body. People with vocal tremor must consult their physician before taking any medications, because these drugs can also have a side effect of tremor as well.
References:
Gironell, G., Kulisevsky, J. (2009). Diagnosis and Management of essential tremor and dystonic temor. Ther Adv. Neurological Disorders. 2(4) 215-222.
Lester RA, Barkmeier-Kraemer, J, Story BH. (2013). Physiologic and acoustic patterns of essential voice tremor. Journal of Voice. doi:pii: S0892-1997(13)00003-9. 10.1016/j.jvoice.2013.01.002.
Stretching the muscles and taking herbal supplements sometimes helps.
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ReplyDeleteMostly no Benign Essential Tremor Treatment is needed and tremors may be relieved by some simple measures such as resting well, avoiding caffeine, avoiding stimulants present in over the counter medications and avoiding temperature extremities. Medical treatment of benign essential tremor includes beta blockers such as propranolol,atenolol,metoprolol, nadolol and aotalol, anti-seizure medications such as primidone, gabapentin and topiramate, benzodiazepines, antipsychotics such as clonazepam and alprazolam, tranquilizers and botulinum injections. Surgery is another option. There two surgical procedures that can be done. First procedure is deep brain stimulation having side effects such as motor control, problems with speech, balance, headaches and weakness. Thalamotomy is the second option. Physical therapy to improve muscle strength, control and coordination and occupational therapy to help adapt living with benign essential tremors is suggested.
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New research out of Columbia University suggests that Essential Tremor (ET), the most common form of tremor. It is important to know that Benign Essential Tremor Treatment generally provides longstanding tremor control or marked reduction, with improved hand function and ability to perform various important activities of daily living.
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