Department of Otorhinolaryngology, Weill Cornell Medical College, New York, New York 10021, USA.
Laryngoscope. 2010 Mar;120(3):516-28. doi: 10.1002/lary.20702.
OBJECTIVES/HYPOTHESIS: To describe and characterize essential voice tremor, including signs, symptoms, and severity, and its relation to other manifestations of essential tremor. Description of aspects of treatment is a secondary goal.
Descriptive clinical cohort study.
Thirty-four patients with essential voice tremor were identified over 40 months. Historical information regarding duration, family history, ethanol effect, arm tremor, and prior diagnosis was collected and examination was performed. Laryngeal and pharyngeal signs were graded using the Vocal Tremor Scoring System (VTSS); arm tremor was scored using the Washington Heights Inwood Genetic Study of Essential Tremor Rating Scale (WHIGET). Patients rated vocal disability using the Voice Handicap Index (VHI). Information regarding treatment was collected both historically and prospectively.
Ninety-three percent of patients were female. Voice tremor typically began in the seventh decade (62.9 +/- 15.0 years), and had been present for a mean of 6.7 +/- 13.4 years at the time of presentation. Tremor was present in a first-degree relative in 13 patients (38.2%); nine (26.5%) reported a beneficial effect of ethanol. Only 11 (32.3%) were aware of an arm tremor. Seven patients (20.6%) had been correctly diagnosed prior to evaluation; 16 (47.1%) were undiagnosed, and 10 (29.4%) had been misdiagnosed as spasmodic dysphonia. Clinical features were scored as follows: VTSS = 7.7 +/- 3.3, range 1 to 14; WHIGET = 8.5 +/- 7.5, range 0 to 31; VHI = 71 +/- 28, range 2 to 115. VTSS did not correlate with WHIGET, but did correlate with VHI. Only 56% of treated patients found botulinum toxin helpful.
Essential voice tremor appears to affect more women than men. One third to one half of affected individuals have a family history of tremor. About one half of cases occur with upper extremity tremor no more severe than that seen in similarly aged normal individuals, contrary to what has been thought to date. Essential voice tremor is probably more common than is generally suspected, and many cases appear to be undiagnosed many years after onset or are misdiagnosed, most often as spasmodic dysphonia. The key feature is kinetic laryngeal tremor which usually extends beyond the larynx to involve the phonatory apparatus globally. Botulinum toxin may be helpful, but benefit is typically incomplete and not universal. Prolonged postinjection breathiness is the most common barrier to useful treatment.
目的/假设：描述和表征基本性声音震颤，包括体征、症状和严重程度，以及其与其他特发性震颤表现的关系。描述治疗方面是次要目标。
描述性临床队列研究。
在 40 个月期间确定了 34 例特发性声音震颤患者。收集了有关持续时间、家族史、乙醇效应、手臂震颤和先前诊断的历史信息，并进行了检查。使用嗓音震颤评分系统（VTSS）对喉部和咽部体征进行分级；使用华盛顿高地因伍德特发性震颤遗传研究的震颤评分量表（WHIGET）对手臂震颤进行评分。患者使用嗓音障碍指数（VHI）评估嗓音障碍程度。同时从历史和前瞻性两个方面收集有关治疗的信息。
93%的患者为女性。声音震颤通常始于 70 岁（62.9 ± 15.0 岁），在就诊时已存在 6.7 ± 13.4 年。13 例患者（38.2%）存在一级亲属震颤；9 例（26.5%）报告乙醇有有益作用。只有 11 例（32.3%）患者知晓手臂震颤。7 例（20.6%）在评估前已正确诊断；16 例（47.1%）未诊断，10 例（29.4%）误诊为痉挛性发音障碍。临床特征评分如下：VTSS = 7.7 ± 3.3，范围 1 至 14；WHIGET = 8.5 ± 7.5，范围 0 至 31；VHI = 71 ± 28，范围 2 至 115。VTSS 与 WHIGET 不相关，但与 VHI 相关。只有 56%接受治疗的患者认为肉毒毒素有帮助。
特发性声音震颤似乎比男性更常见于女性。三分之一到一半的受影响个体有震颤的家族史。与迄今为止的观点相反，大约一半的病例发生在上肢震颤，其严重程度并不比年龄相似的正常个体更严重。特发性声音震颤可能比一般怀疑的更为常见，许多病例在发病多年后仍未被诊断或被误诊，最常见的是痉挛性发音障碍。关键特征是通常延伸至喉外的动力学性喉震颤，累及发音器官。肉毒毒素可能有帮助，但益处通常不完整且并非普遍。注射后长时间的呼吸急促是有用治疗的最常见障碍。
