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J Voice 2018 Dec 27. Epub 2018 Dec 27.

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 2018 Dec 27. 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 2018 Dec 24. 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

Expert Rev Neurother 2018 Dec 1. Epub 2018 Dec 1.

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

Introduction: This paper reviews studies that have assessed the treatment of psychiatric disturbances in dystonia, tic disorders, Tourette syndrome, Huntington's disease and essential tremor. Areas covered: 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. Expert commentary: Although psychiatric disturbances are frequent in hyperkinetic movement disorders, few controlled studies have assessed the treatment of psychiatric disturbances in such disorders. Read More

Laryngoscope 2019 Jan 13;129(1):170-176. Epub 2018 Nov 13.

Division of Otolaryngology, Wisconsin Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.

Objective: To compare presenting characteristics of patients with adductor spasmodic dysphonia (ADSD), ADSD with laryngeal tremor (ADSD + LT), and laryngeal tremor without ADSD (LT).

Design: Cross-sectional analysis.

Methods: Patients treated for laryngeal movement disorders (1990-2016) were included. Read More

JAMA Otolaryngol Head Neck Surg 2018 Oct 25. Epub 2018 Oct 25.

Division of Otolaryngology, Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison.

Importance: Essential vocal tremor (EVT) is a neurologic voice disorder characterized by periodic fluctuations in pitch and loudness that can hinder intelligibility. Defining the normative range of vocal tremor frequency may assist in diagnosis and provide insight into disease mechanisms.

Objective: To characterize the normative voice tremor frequency in EVT (in hertz). Read More

Neurology 2018 Nov 19;91(21):e2020-e2026. Epub 2018 Oct 19.

From the Institute of Neurogenetics (J. Junker, V.B., A.W., N.B.) and Department of Neurology (J. Junker, N.B.), University of Luebeck, Germany; Department of Psychology (V.B.), Centre for Innovation in Mental Health, University of Southampton, UK; Department of Neurology (B.D.B.), University of Colorado Anschutz Medical Campus, Aurora; Neurology Section (B.D.B.), Denver VA Medical Center, CO; Département de Neurologie (M.V., E.R.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris; Sorbonne Universités (M.V.), Pierre Marie Curie Paris-6, Institute of Brain and Spine (ICM), Inserm U 1127, Paris, France; Department of Neurology (C.C.), Rush University Medical Center, Chicago, IL; Department of Neurology (I.A.M.), Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville; Department of Neurology (J. Jankovic), Baylor College of Medicine, Houston, TX; Department of Neurology (M.S.L.), University of Tennessee Health Science Center, Memphis; Neuromed Institute (IRCCS) (A.B.), Pozzilli (IS), and Department of Neurology and Psychiatry, Sapienza University di Roma, Italy; Department of Neurology (R.B.), University of Rochester Medical Center, NY; Department of Neurology (S.G.R.), University of Maryland Medical Center, Baltimore; Department of Neurology (J.S.P.), Washington University in St. Louis, MO; and Department of Neurology and Human Genetics (H.A.J.), Emory University, Atlanta, GA.

Objective: To determine predictors of alcohol responsiveness in a large cohort of patients with dystonia.

Methods: A total of 2,159 participants with dystonia were prospectively enrolled in the cross-sectional Dystonia Coalition multicenter study. Patients with secondary, combined, or confirmed genetic dystonia (total n = 164) or unknown alcohol responsiveness (n = 737) were excluded. Read More

Laryngoscope 2019 Jan 16;129(1):E21-E25. Epub 2018 Oct 16.

Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.

Objectives: Laryngeal function requires neuromuscular activation of the intrinsic laryngeal muscles (ILMs). Rapid activation of the ILMs occurs in cough, laughter, and voice-unvoiced-voiced segments in speech and singing. Abnormal activation is observed in hyperfunctional disorders such as vocal tremor and dystonia. Read More

Clinics (Sao Paulo) 2018 07 16;73:e87. Epub 2018 Jul 16.

Departamento de Otorrinolaringologia e Cirurgia de Cabeca e Pescoco, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR.

Objectives: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. Read More

JAMA Otolaryngol Head Neck Surg 2018 Aug;144(8):657-665

Department of Neurological Sciences, Rush Medical College, Chicago, Illinois.

Importance: A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders.

Objective: To determine the agreement among experts not using standard guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert consensus attributes for classifying patients for research.

Design, Setting And Participants: From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study). Read More

Otolaryngol Clin North Am 2018 Aug 8;51(4):759-768. Epub 2018 Jun 8.

Medstar Georgetown University Hospital, 1 Gorman Building, 3800 Reservoir Road Northwest, Washington, DC 20007, USA. Electronic address:

The impact of aging is as inevitable in the larynx as on all biologic systems. The muscles of larynx have the potential to atrophy, the elastin fibers of lamina propria thin with age, and mucous production diminishes. As a result, vocal folds fail to approximate appropriately and the stress on once-robust vocal folds increases. Read More

J Voice 2018 May 16. Epub 2018 May 16.

Division of Otolaryngology and Wisconsin Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, Wisconsin.

Vocal tremor is a neurologic disorder with myriad etiologies (eg, Parkinson disease, medications, or essential tremor). Vocal tremor can limit intelligibility and social interaction and can result in isolation in nonprofessional voice users. In a professional singer whose entire career is based on voice quality, onset of a vocal tremor is devastating. Read More

Curr Treat Options Neurol 2018 Feb 24;20(2). Epub 2018 Feb 24.

Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, New Haven-CT, 31 Silver Pine Drive, Newport Coast, CA, 92657, USA.

Botulinum neurotoxins (BoNTs) are now among the most widely used therapeutic agents in clinical medicine with indications applied to the fields of movement disorders, pain disorders, and autonomic dysfunction. In this literature review, the efficacy and utility of BoNTs in the field of movement disorders are assessed using the criteria of the Guideline Development Subcommittee of the American Academy of Neurology. The literature supports a level A efficacy (established) for BoNT therapy in cervical dystonia and a level B efficacy (probably effective) for blepharospasm, hemifacial spasm, laryngeal dystonia (spasmodic dysphonia), task-specific dystonias, essential tremor, and Parkinson rest tremor. Read More

JAMA Otolaryngol Head Neck Surg 2018 Apr;144(4):293-299

Otolaryngology, Department of Surgery, Wisconsin Surgical Outcomes Research, University of Wisconsin, Madison.

Importance: The relative outcomes of onabotulinum toxin A injections for treatment of adductor spasmodic dysphonia (ADSD), ADSD with lateral laryngeal tremor (ADSD+LT), and lateral LT without ADSD are unclear.

Objective: To compare the outcomes of onabotulinum toxin A treatment on ADSD, ADSD+LT, and lateral LT without ADSD.

Design, Setting, And Participants: A retrospective cohort study was conducted from January 1, 1990, to September 30, 2016, at a tertiary referral voice center. Read More

J Clin Mov Disord 2017 13;4:20. Epub 2017 Dec 13.

Columbia University College of Physicians and Surgeons, Neurology, Icahn School of Medicine at Mt. Sinai, Center for Voice and Swallowing Disorders, 425 West 59th Street, New York, NY 10019 USA.

Background: Although considerable research has focused on the etiology and symptomology of adductor focal laryngeal dystonia (AD-FLD), little is known about the correlation between clinicians' ratings and patients' perception of this voice disturbance. This study has five objectives: first, to determine if there is a relationship between subjects' symptom-severity and its impact on their quality of life; to compare clinicians' ratings with subjects' perception of the individual characteristics and severity of AD-FLD; to document the subjects' perception of changes in dysphonia since diagnosis; to record the frequency of voice arrest during connected speech; and, finally, to calculate inter-clinician reliability based on results from the Unified Spasmodic Dysphonia Rating Scale (USDRS) (Stewart et al, J Voice 1195-10, 1997).

Methods: Sixty subjects with AD-FLD who were receiving ongoing injections of BoNT participated in this study. Read More

J Voice 2019 Jan 13;33(1):16-26. Epub 2017 Dec 13.

Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

Objectives: The main objectives of this study were to (1) examine intrarater and inter-rater reliabilities in perceptual ratings of vocal fold vibratory patterns and supraglottic characteristics for essential vocal tremor and adductor spasmodic dysphonia (AdSD) using high-speed videoendoscopy (HSV), and (2) to investigate the specificity of the parameters in differentiating these two voice disorders.

Methods: HSV recordings of 34 cases diagnosed with essential vocal tremor, AdSD, or AdSD with vocal tremor were evaluated blindly by two voice speech pathologists. The two raters examined all HSV video segments twice across nine supraglottic and vocal fold vibratory characteristics for inter-rater and intrarater reliabilities. Read More

Laryngoscope 2018 01 8;128 Suppl 1:S1-S9. Epub 2017 Dec 8.

Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, New York.

Objective: Laryngeal dystonia (LD) is a functionally specific disorder of the afferent-efferent motor coordination system producing action-induced muscle contraction with a varied phenomenology. This report of long-term studies aims to review and better define the phenomenology and central nervous system abnormalities of this disorder and improve diagnosis and treatment.

Methods: Our studies categorized over 1,400 patients diagnosed with LD over the past 33 years, including demographic and medical history records and their phenomenological presentations. Read More

Tremor Other Hyperkinet Mov (N Y) 2017 23;7:506. Epub 2017 Oct 23.

Departments of Pharmacology and Neurology, Emory University, Atlanta, GA, USA.

Background: The dystonias include a clinically and etiologically very diverse group of disorders. There are both degenerative and non-degenerative subtypes resulting from genetic or acquired causes. Traditionally, all dystonias have been viewed as disorders of the basal ganglia. Read More

Toxins (Basel) 2017 11 2;9(11). Epub 2017 Nov 2.

New York Center for Voice and Swallowing Disorders, New York, NY 10019, USA.

Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led to the use of chemodenervation for this disorder, which has since become a refined technique. Indeed, due to its safety and efficacy, BoNT has been investigated in multiple neurolaryngology disorders, including spasmodic dysphonia, vocal tremor, and muscle tension dysphonia. Read More

Laryngoscope 2018 02 8;128(2):437-446. Epub 2017 Oct 8.

Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.

Objectives/hypothesis: Botulinum toxin chemodenervation (BTX) is used to treat essential voice tremor (EVT), but results are not uniformly satisfactory. This study sought to assess the comparative utility of injection augmentation (IA) for EVT.

Study Design: Prospective crossover treatment study. Read More

Curr Opin Otolaryngol Head Neck Surg 2017 Dec;25(6):475-479

Pinnacle Voice and Swallow Centre, Epworth Richmond, The Royal Melbourne Hospital, Parkville, Victoria, Australia.

Purpose Of Review: Vocal tremor in movement disorders is often overlooked, although it has a significant impact on quality of life. Careful observation of tremor phenomenology allows for accurate diagnosis and tailored treatment.

Recent Findings: The central pathways associated with various vocal tremor-associated diseases have been further elucidated. Read More

Otolaryngol Head Neck Surg 2017 10 29;157(4):551-557. Epub 2017 Aug 29.

1 Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.

Objective The purpose of this review is to describe the recent advances in identifying possible factors involved in the pathogenesis of spasmodic dysphonia. Spasmodic dysphonia is a task-specific focal laryngeal dystonia characterized by irregular and uncontrolled voice breaks. Pathogenesis of the disorder is poorly understood. Read More

J Voice 2018 Jul 2;32(4):515.e15-515.e28. Epub 2017 Aug 2.

Department of Linguistics, Universidad Autónoma de Madrid, Madrid, Spain.

The voice of persons with Williams syndrome (WS) is described as hoarse with a deep and unstable fundamental frequency (f0). These observations may be justified by the deficit of elastin due to a haplo-insufficiency in the ELN gene characteristic of the syndrome. In view of the possible relationship between elastin deficit and dysphonia, a study of the dynamic function of WS phonation was conducted by means of biomechanical analysis. Read More

J Neurol 2017 Jul 26;264(7):1482-1487. Epub 2017 Jun 26.

Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.

Functional (psychogenic) movement disorders (FMDs) may present with a broad spectrum of phenomenology including stereotypic movements. We aimed to characterize the phenomenology of functional stereotypies and compare these features with those observed in 65 patients with tardive dyskinesia (TD). From a cohort of 184 patients with FMDs, we identified 19 (10. Read More

BMJ Case Rep 2017 Apr 23;2017. Epub 2017 Apr 23.

Department of Neuroradiology, BHR Hospitals, Romford, UK.

Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with progressive ataxia. We demonstrate for the first time that the respiratory symptoms can result from association of palatal tremor with a similar tremor of laryngeal and respiratory muscles that interrupts normal inspiration and expiration.A 60-year-old woman presented with progressive ataxia, palatal tremor and breathlessness. Read More

J Voice 2017 Sep 18;31(5):628-633. Epub 2017 Mar 18.

Department of Otorhinolaryngology, University of Oklahoma, Oklahoma City, Oklahoma.

Robotic surgery has become the standard of care for many procedures outside of otolaryngology and now is gaining momentum within our specialty. The da Vinci (Intuitive Surgical, Sunnyvale, CA) robot has several advantages to human hands, including removal of tremor and better access to lesions because of increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotic surgery because access was previously thought to be difficult because of the limitations of currently used retractors, which include poor base of tongue and oral commissure retraction resulting in lack of exposure of the glottis in many patients and lack of space for the robotic instruments to occupy. Read More

J Neurosurg 2018 Feb 17;128(2):575-582. Epub 2017 Mar 17.

Department of Surgery, Divisions of1Neurosurgery and.

Spasmodic dysphonia (SD) is a neurological disorder of the voice where a patient's ability to speak is compromised due to involuntary contractions of the intrinsic laryngeal muscles. Since the 1980s, SD has been treated with botulinum toxin A (BTX) injections into the throat. This therapy is limited by the delayed-onset of benefits, wearing-off effects, and repeated injections required every 3 months. Read More

Prescrire Int 2017 Mar;26(180):72-77

What is the best treatment for adults with Graves' disease in 2016? To answer this question, we reviewed the literature using the standard Prescrire methodology. When the symptoms of hyperthyroidism are poorly tolerated, a beta-blocker relieves tachy- cardia, anxiety and tremor. Three treatments have been shown to be effec- tive in controlling hyperthyroidism: antithyroid drugs, radioiodine, and thyroidectomy. Read More

Iran J Otorhinolaryngol 2017 Jan;29(90):47-52

Department of Neurology, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Dystonia is a disorder of movement caused by various etiologies. Laryngeal dystonia is caused by the spasm of laryngeal muscles. It is a disorder caused by vocal fold movement in which excessive adduction or abduction of the vocal folds occurs during speech. Read More

J Voice 2017 May 17;31(3):391.e7-391.e18. Epub 2016 Nov 17.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address:

Objective: The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin.

Study Design: This is a prospective cohort study.

Methods: Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Read More

Iran J Child Neurol 2016 ;10(4):75-79

Department of Neurology, Iran University of Medical Sciences, Tehran, Iran.

The basal ganglia are a group of structures that act as a cohesive functional unit. They are situated at the base of the forebrain and are strongly connected with the cerebral cortex and thalamus. Some speech disorders such as stuttering can resulted from disturbances in the circuits between the basal ganglia and the language motor area of the cerebral cortex. Read More

Laryngoscope 2017 06 3;127(6):1402-1407. Epub 2016 Nov 3.

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.

Objectives/hypothesis: Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed. Read More

J Voice 2017 May 8;31(3):366-377. Epub 2016 Jun 8.

Department of Communication Science and Disorders, University of Iowa, Iowa City, Iowa.

Background: Vocal tremor may be associated with cyclic oscillations in the pulmonary, laryngeal, velopharyngeal, or oral regions.

Objectives: This study aimed to correlate the overall severity of vocal tremor with the distribution and severity of tremor in structures involved.

Methods: Endoscopic and clinical examinations were completed on 20 adults with vocal tremor and two age-matched controls during sustained phonation. Read More

Auris Nasus Larynx 2017 Apr 1;44(2):182-187. Epub 2016 Jun 1.

Department of Otorhinolaryngology - Head & Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea. Electronic address:

Objective: To consider the feasibility of diagnosing intrinsic laryngeal muscle myofascial pain syndrome (MPS) in dysphonic patients who demonstrated immediate symptom and stroboscopic finding improvement after laryngeal electromyography (LEMG) without further treatment.

Methods: A chart review of patients who showed subtle vocal fold movement abnormalities on a stroboscopic examination and underwent ultrasonography (US)-guided LEMG was performed. Patients with vocal fold paralysis, mucosal lesions, spasmodic dysphonia, and vocal tremor on stroboscopic examination were excluded. Read More

Neurol Genet 2016 Jun 11;2(3):e69. Epub 2016 Apr 11.

Departments of Neurology and Anatomy & Neurobiology (M.S.L., S.R.V., J.X., M.M.T.), University of Tennessee Health Science Center, Memphis, TN; Department of Neurology (J.S.P., L.J.W.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology (A.R.R.), Human Genetics, and Pediatrics (H.A.J.), School of Medicine, Emory University, Atlanta, GA; Department of Neurology (P.H.), Vanderbilt University, Nashville, TN; Department of Neurological Sciences (C.L.C.), Rush University, Chicago, IL; Institute of Neurogenetics (A.W., J. Junker), University of Lübeck, Germany; Department of Neurology (J. Jankovic), Baylor College of Medicine, Houston, TX; Department of Neurology (R.L.B.), University of Rochester, NY; Department of Neurology (S.G.R.), University of Maryland, Baltimore, MD; Department of Neurology (R.L.R.), University of Florida, Gainesville, FL; Department of Neurology (B.D.B.), University of Colorado Denver School of Medicine, Aurora, CO; Center of Excellence in Neuroscience (S.C.), University of Montreal, QC, Canada; Mirken Department of Neurology (L.S.), Mt. Sinai Beth Israel Medical Center, New York, NY; Booth Gardner Parkinson's Care Center (P.A.), Kirkland, WA; and Department of Neurology (N.P.S.), University of Alabama at Birmingham, AL.

Objective: To characterize the clinical and genetic features of cervical dystonia (CD).

Methods: Participants enrolled in the Dystonia Coalition biorepository (NCT01373424) with initial manifestation as CD were included in this study (n = 1,000). Data intake included demographics, family history, and the Global Dystonia Rating Scale. Read More

Logoped Phoniatr Vocol 2017 Apr 15;42(1):29-38. Epub 2016 Apr 15.

b Department of Otolaryngology , Head and Neck Surgery B53, Clinical Sciences and Intervention, Karolinska Institutet, Karolinska University Hospital , 141 86 Stockholm , Sweden.

Freddie Mercury was one of the twentieth century's best-known singers of commercial contemporary music. This study presents an acoustical analysis of his voice production and singing style, based on perceptual and quantitative analysis of publicly available sound recordings. Analysis of six interviews revealed a median speaking fundamental frequency of 117. Read More

Laryngoscope 2017 02 14;127(2):411-416. Epub 2016 Apr 14.

Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, U.S.A.

Objectives/hypothesis: The purpose of this study was to determine the effects of anchors and training on intrarater and inter-rater reliability for visual-perceptual, endoscopic tremor ratings.

Study Design: Prospective cohort study.

Methods: Nasoendoscopy recordings of 10 participants with a diagnosis of essential voice tremor were evaluated by five voice specialists using the Vocal Tremor Scoring System. Read More

Vojnosanit Pregl 2016 Feb;73(2):165-8

Background/aim: The major role of larynx in speech, respiration and swallowing makes carcinomas of this region and their treatment very influential for patients' life quality. The aim of this study was to assess the importance of voice therapy in patients after open surgery on vocal cords.

Methods: This study included 21 male patients and the control group of 19 subjects. Read More

Curr Opin Otolaryngol Head Neck Surg 2016 Jun;24(3):175-82

aSpeech & Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland bFaculty of Health Sciences, Australian National Catholic University (Brisbane, Sydney, Melbourne), Australia cNewcastle University Institute for Ageing, Speech and Language Sciences, Newcastle University, Newcastle-upon-Tyne, UK.

Purpose Of Review: Voice tremor is strongly linked to the Parkinson's disease speech-voice symptom complex. Little is known about the underlying anatomic source(s) of voice tremor when it occurs. We review recent literature addressing this issue. Read More

Brain Imaging Behav 2017 02;11(1):166-175

Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, NY, 10029, USA.

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). Read More

Parkinsonism Relat Disord 2016 Feb 18;23:66-71. Epub 2015 Dec 18.

Molecular Neurogenetics Unit, IRCCS Neurological Institute C. Besta, Via L. Temolo 4, 20126 Milan, Italy. Electronic address:

Introduction: Mutations in GNAL have been associated with adult-onset cranio-cervical dystonia, but a limited number of cases have been reported so far and the clinical spectrum associated with this gene still needs to be fully characterized.

Methods: We identified an Italian family with adult-onset, dominantly-inherited dystonia whose members presented with different combinations of dystonia affecting the cervical, oro-mandibular and laryngeal regions associated with prominent tremor in some cases. Pure asymmetric upper limb dystonic tremor was present in one of the members and jerky cervical dystonia was also observed. Read More

Braz J Otorhinolaryngol 2016 Jan-Feb;82(1):88-96. Epub 2015 Dec 3.

Department of Otorhinolaryngology, Health Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Introduction: Although syndromes that cause voice tremor have singular characteristics, the differential diagnosis of these diseases is a challenge because of the overlap of the existing signs and symptoms.

Objective: To develop a task-specific protocol to assess voice tremor by means of nasofibrolaryngoscopy and to identify those tasks that can distinguish between essential and dystonic tremor syndromes.

Methods: Cross-sectional study. Read More

JAMA Otolaryngol Head Neck Surg 2016 Feb;142(2):117-21

Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson.

Importance: Essential vocal tremor is difficult to treat. An effective pharmacologic treatment could allow patients to avoid or decrease the frequency or dosage of botulinum neurotoxin injections.

Objective: To evaluate the efficacy of primidone in the treatment of essential vocal tremor. Read More

Codas 2015 Jul-Aug;27(4):392-9

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.

Objectives: To evaluate the behavior of the phonatory function and the perceived strain in Brazilian young women, before and after a test of prolonged voice use test, for a period of one continuous hour.

Methods: Twenty young women without laryngeal disorders participated in the study and were submitted to vocal acoustic analysis (MDVP-Advanced, CSL-Kay Pentax®), perceptual voice assessment, carried out by five judges, and the measurement of speech-strain level using a visual analog scale before and after a prolonged use of the voice, from the reading of a standardized text for one hour in usual vocal intensity and frequency, without breaks for hydration or vocal rest. The description and comparison between the variables and the appropriate statistical analysis were carried out. Read More

J Acoust Soc Am 2015 Aug;138(2):953-63

Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona 85721, USA.

The purpose of this study was to determine if adjustments to the voice source [i.e., fundamental frequency (F0), degree of vocal fold adduction] or vocal tract filter (i. Read More

Ann Otol Rhinol Laryngol 2015 Nov 29;124(11):859-63. Epub 2015 May 29.

Mayo Clinic, Department of Otolaryngology-Head and Neck Surgery, Phoenix, Arizona, USA.

Objective: Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies.

Methods: Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Read More

J Voice 2016 Mar 20;30(2):228-33. Epub 2015 May 20.

Department of Clinical Sciences, Umeå University, Umeå, Sweden. Electronic address:

Objectives: The present study aimed at evaluating the effect of deep brain stimulation (DBS) of the caudal zona incerta (cZi) on voice tremor in patients with essential tremor (ET).

Study Design: This is a prospective nonrandomized design with consecutive patients.

Methods: Twenty-six patients operated with cZi DBS were evaluated under two conditions: without stimulation (Stim OFF) and with stimulation (Stim ON). Read More