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HNO 2021 Jun 14. Epub 2021 Jun 14.

Klinik für HNO-Heilkunde/Plastische Operationen, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Deutschland.

Neurological and neurophysiological knowledge of neuromuscular diseases is combined in neurolaryngology with experience from laryngology. Laryngeal electromyography (LEMG) is the most important diagnostic and prognostic tool in neurolaryngology. It can be combined with diagnostic electrostimulation. Read More

J Voice 2021 Jun 7. Epub 2021 Jun 7.

Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois.

Introduction: Hyperkinetic dysarthria is characterized by atypical involuntary movements within the speech mechanism that may affect the respiratory, laryngeal, pharyngeal-oral, or velopharyngeal-nasal subsystems and may alter speech production. Although articulatory impairments are commonly considered in hyperkinetic dysarthria, speakers with hyperkinetic dysarthria may also present with changes in voice quality, pitch, and loudness. In approximately 70% of speakers with hyperkinetic dysarthria, these voice alterations are associated with tremor or dystonia. Read More

Laryngoscope Investig Otolaryngol 2021 Apr 9;6(2):261-276. Epub 2021 Mar 9.

Division of Otolaryngology - Head and Neck Surgery University of Utah Salt Lake City Utah USA.

Objectives: This study characterized the clinical phenotypes of individuals with vocal tremor (VT) using tremor classification criteria published by the International Parkinson and Movement Disorder Society (IPMDS) including laryngeal features from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

Methods: VT phenotypic descriptors were extracted from participant medical records from 2017 to 2019. Clinical phenotype descriptors included the: (a) chief complaint and discipline for the first appointment, (b) demographics, (c) tremor body distribution, condition, frequency, and progression, (d) exacerbating/alleviating factors, (e) treatment approaches, and (g) neurologic comorbidities. Read More

J Voice 2021 Feb 9. Epub 2021 Feb 9.

Speech Pathology and Audiology, Apollo Hospital, Jayanagar, Bangalore, 560029, India.

Essential voice tremor (EVT) is a voice disorder resulting from dyscoordination within the laryngeal musculature. A low-frequency fluctuations of fundamental voice frequency or the strength of excitation amplitude is the main consequence of the disorder. The automatic classification of healthy control and EVT is useful tool for the clinicians. Read More

Tremor Other Hyperkinet Mov (N Y) 2020 12 31;10:60. Epub 2020 Dec 31.

Mayo Clinic Arizona, Phoenix, Arizona, US.

Background: To date, there are only six published reports of adductor spasmodic dysphonia (SD) responding to awake thalamic deep brain stimulation (DBS).

Methods: We retrospectively reviewed cases of Essential Tremor (ET) with SD that were seen in our center from 2012 to 2020. We further identified those that have undergone thalamic DBS, and had a blinded laryngologist rate first the audio voice recordings before and after DBS using the Unified Spasmodic Dysphonia Rating Scale (USDRS), and the video recordings last to rate the related movements and facial grimacing. Read More

Adv Otorhinolaryngol 2020 9;85:25-44. Epub 2020 Nov 9.

Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine, New York, New York, USA,

Videostroboscopy and high-speed imaging is now an accepted way to evaluate laryngeal function in patients with voice disorders. In patients with neurolaryngological diseases such as tremor, laryngeal spasm, and paralysis, having an objective way to evaluate vocal function is desirable. Using digital imaging and analysis, both the videostroboscopy and the high-speed video can be analyzed to obtain relevant measures of vocal function. Read More

Adv Otorhinolaryngol 2020 9;85:10-17. Epub 2020 Nov 9.

Voicedoctor.net, Portland, Oregon, USA,

Visual diagnosis of laryngeal neurologic impairments is not only possible but is perhaps the most accurate method for evaluating the neurologic status of the upper airway. Precise assessments may lead to appropriate treatment without an EMG study. Principles of the neurolaryngology examination include: (1) each muscle has a single action; (2) that action can be elicited and to some degree isolated and visualized; (3) each muscle has an appropriate time to contract; (4) that timing can be compared to the opposite side; (5) inappropriate timing represents reinnervation; (6) inappropriate degree of motion represents reinnervation; (7) patients naturally compensate for any loss; (8) removing compensation during an exam reveals pathology. Read More

Parkinsonism Relat Disord 2020 12 13;81:106-112. Epub 2020 Oct 13.

Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address:

Objective: EVT is a refractory voice disorder that significantly affects quality of life. This work aims to conduct a multiparametric assessment of the effect of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) on essential vocal tremor (EVT) and investigate the relation between DBS lead location and EVT outcomes.

Methods: Nine participants underwent DBS for essential tremor and were diagnosed with co-occurring EVT in this prospective cohort study. Read More

Mov Disord 2020 12 25;35(12):2290-2300. Epub 2020 Sep 25.

Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.

Objectives: Voice tremor is a common movement disorder that manifests as involuntary oscillations of laryngeal muscles, leading to rhythmic alterations in voice pitch and loudness. Differential diagnosis of essential tremor of voice (ETv) is often challenging and includes dystonic tremor of voice (DTv), which is characterized by irregular, isometric contractions of laryngeal muscles during dystonic activity. Although clinical characteristics of voice tremor are well described, the pathophysiology underlying its heterogeneous phenomenology remains limited. Read More

Parkinsonism Relat Disord 2020 09 6;78:129-133. Epub 2020 Aug 6.

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

Introduction: Myoclonus-dystonia is a rare syndrome typically occurring during childhood or adolescence, mainly due to SGCE pathogenic variants. Early-onset, atypical presentations of myoclonus-dystonia have recently been associated with KCTD17 variants. In these cases, laryngeal involvement was reported in the advanced stages. Read More

Acta Otorhinolaryngol Ital 2020 Jun;40(3):198-203

Department of Otorhinolaryngology/Audiology, Mayo Clinic, Jacksonville, FL, United States.

Front Neurosci 2020 8;14:647. Epub 2020 Jul 8.

Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.

Background: The primary motor cortex (M1) is a critical node in Parkinson's disease (PD)-related motor circuitry; however, the functional roles of its subregions are poorly understood. In this study, we investigated changes in the functional connectivity patterns of M1 subregions and their relationships to improved clinical symptoms following levodopa administration.

Methods: Thirty-six PD patients and 37 healthy controls (HCs) were enrolled. Read More

Am J Med Genet A 2020 10 5;182(10):2369-2371. Epub 2020 Jul 5.

Department of Neurology, University of Rochester, Rochester, New York, USA.

Genetic variations in the ASAH1 gene are associated with a spectrum of disorders ranging from Farber disease (FD) to spinal muscular atrophy with or without progressive myoclonic epilepsy (SMA-PME). FD presents most commonly in infants with subcutaneous joint nodules, progressive arthritis and granulomas of the larynx and epiglottis leading to a hoarse cry. SMA-PME is characterized by childhood onset progressive weakness due to motor neuron disease followed by progressive epilepsy, tremor, and sensorineural hearing loss. Read More

J Voice 2020 Jun 15. Epub 2020 Jun 15.

Department of Otolaryngology and Head & Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA. Electronic address:

Objectives: Laryngeal Botulinum Toxin injection (LBTX) in the adductor musculature is the current therapy for Adductor Spasmodic Dysphonia. This study explores nonbiological factors that can affect the patient experience during this procedure and their association with better or worse self-reported effectiveness.

Methods: A 14 item survey was used to evaluate the patient experience in patients who had undergone LBTX in Mayo Clinic Jacksonville, Florida, during 2019. Read More

J Voice 2020 May 26. Epub 2020 May 26.

Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.

Laryngeal botulinum toxin injection is an important treatment modality for spasmodic dysphonia and other laryngeal disorders. We sought to compare usage patterns of laryngeal botulinum toxin injections for voice disorders and to identify and quantify inefficiencies and barriers in providing this treatment. A 26 item survey was written and approved for distribution by the American Academy of Otolaryngology-Head and Neck Surgery and the National Spasmodic Dysphonia Association. Read More

J Acoust Soc Am 2020 03;147(3):1822

Department of Physics and Astronomy, Ohio University, Athens, Ohio 45701, USA.

Vocal wow and tremor are slow modulations of the voice presumed to result from integration of auditory and somatosensory feedback, respectively. This distinction has important implications for diagnosis and treatment of neurological disorders that may differentially impact these systems, but the underlying mechanisms remain poorly understood. An important contribution on this matter is the reflex resonance model [Titze et al. Read More

J Neuroimmunol 2020 04 13;341:577192. Epub 2020 Feb 13.

Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.

Stiff person spectrum disorders (SPSD) are a broad group of immune-mediated disorders. Clinical presentations include classical stiff person syndrome (SPS), focal SPS, and progressive encephalomyelitis with rigidity and myoclonus (PERM). The most frequently associated antibodies are anti-GAD65, anti-GlyR, anti-amphiphysin, and anti-DPPX. Read More

Tremor Other Hyperkinet Mov (N Y) 2020 23;10. Epub 2020 Jan 23.

Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.

Background: The consensus statement by the Task Force on Tremor of the International Parkinson and Movement Disorder Society excludes individuals with "isolated voice tremor" as a clinical variant of essential tremor (ET). This clinical viewpoint presents a rationale for reconsideration of "isolated voice tremor" as a clinical variant of ET.

Methods: Evidence from the literature was extracted to characterize the clinical phenotype of "isolated voice tremor," or essential vocal tremor (EVT). Read More

Laryngoscope 2020 11 14;130(11):2659-2662. Epub 2019 Dec 14.

Division of Otolaryngology, The George Washington University, Washington, DC, U.S.A.

Objectives/hypothesis: The primary treatment of adductor spasmodic dysphonia is repeated injections of botulinum toxin type A (Botox) into the thyroarytenoid muscles. Dosing can be performed into either one or both thyroarytenoid muscles. The objective of this study was to evaluate the treatment effect and side effect profile across a large number of injections. Read More

J Speech Lang Hear Res 2019 10 17;62(10):3689-3705. Epub 2019 Oct 17.

Division of Otolaryngology and Head & Neck Surgery, University of Utah, Salt Lake City.

Purpose This study compared auditory-perceptual measures of presence/absence and severity of vocal tremor to acoustic markers of vocal tremor. The validity (both concurrent and diagnostic) of various acoustic markers of vocal tremor was also assessed. Method Fifty-six midvowel sustained [a:] recordings were selected to yield a representative convenience sample of vocal tremor. Read More

Neurogenetics 2019 08 13;20(3):161-164. Epub 2019 Jun 13.

Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Autosomal dominant spinocerebellar ataxia (SCA) type 12 is a rare SCA characterized by a heterogeneous phenotype. Action tremor of the upper limbs is the most common presenting sign and cerebellar signs can appear subsequently. In many cases, minor signs, like dystonia, can be predominant even at onset. Read More

Otolaryngol Clin North Am 2019 Aug 7;52(4):759-767. Epub 2019 May 7.

University of Maryland School of Medicine, 16 South Eutaw Street, Suite 500, Baltimore, MD 21201, USA. Electronic address:

The primary movement disorders affecting the voice are laryngeal dystonia (including spasmodic dysphonia), essential voice tremor, and Parkinson disease. Diagnosis of these conditions is clinical and based on a detailed history, voice evaluation, and physical and laryngoscopic examination. Laryngeal dystonia and essential voice tremor are hyperfunctional disorders and are treated most commonly with botulinum toxin injections. Read More

J Voice 2020 Sep 20;34(5):720-731. Epub 2019 Feb 20.

Immunology Department, Edgard Santos University Hospital of the Federal University of Bahia-UFBA, Salvador, Bahia, Brazil.

Purpose: To characterize the voice before and after speech-language intervention, with Humming nasal sound in patients with sequelae Mucosal Leishmaniasis (ML) and Cutaneous Leishmaniasis (CL).

Methods: Collection of phonation /a:/ from 44 patients with ML and CL for perceptual voice analysis and computed acoustic. The Wilcoxon nonparametric test and Fisher's exact test were used, with significance level of 5%. Read More

J Voice 2020 Jul 28;34(4):598-603. Epub 2018 Dec 28.

Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California.

Objective: Adductor spasmodic dysphonia (AdSD) is a challenging voice disorder to diagnose, often erroneously diagnosed as muscle tension dysphonia (MTD) or vocal tremor, due to its similarity in auditory and perceptual presentation. Assessments using laryngoscopy or strobolaryngoscopy procedures have demonstrated limited utility in the diagnosis of spasmodic dysphonia. High-speed videoendoscopy (HSV) provides visualization of the precise vibratory pattern of phonatory onset and thus, offers an alternative to previous diagnostic strategies for visual diagnosis of AdSD. Read More

Laryngoscope 2019 06 27;129(6):1433-1437. Epub 2018 Dec 27.

Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

Objectives/hypothesis: Vocal tremor is a neurologic disorder that can be treated with laryngeal botulinum toxin injections (LBTX). We sought to describe our experience with thyroarytenoid and concurrent strap muscle injection.

Study Design: Retrospective chart review. Read More

Laryngoscope 2019 07 24;129(7):1627-1633. Epub 2018 Dec 24.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

Objective: Spasmodic dysphonia (SD) is a neurological disorder characterized by involuntary spasms in the laryngeal muscles. It is thought to selectively affect speaking; other vocal behaviors remain intact. However, the patients' own perspective on their symptoms is largely missing, leading to partial understanding of the full spectrum of voice alterations in SD. Read More

J Voice 2020 May 30;34(3):471-476. Epub 2018 Nov 30.

Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address:

Objective: Vocal fold injection augmentation (VFIA) is employed diagnostically for patients with subtle glottic insufficiency. Its use in patients with both vocal fold atrophy and benign essential voice tremor (EVT) has been reported but not after durable augmentation. This study intends to evaluate the success of durable VFIA using either autologous fat or calcium hydroxylapatite in patients with both vocal fold atrophy and comorbid EVT. Read More

Expert Rev Neurother 2019 01 10;19(1):55-65. Epub 2018 Dec 10.

b Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy.

: This paper reviews studies that have assessed the treatment of psychiatric disturbances in dystonia, tic disorders, Tourette syndrome, Huntington's disease, and essential tremor. : We searched for papers in English in Pubmed using the following keywords: blepharospasm, cervical dystonia, arm dystonia, laryngeal dystonia, spasmodic dysphonia, tic disorders, Tourette syndrome, Huntington's chorea, essential tremor, depression, anxiety, obsessive compulsive disorders, attention deficit hyperactivity disorders, psychosis, apathy. : Although psychiatric disturbances are frequent in hyperkinetic movement disorders, few controlled studies have assessed the treatment of psychiatric disturbances in such disorders. Read More