The Impact of Vocal Tremor on Deglutition: A Pilot Study
Objective Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor‐related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing re...
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| Veröffentlicht in: | The Laryngoscope 2024-11, Vol.134 (11), p.4599-4603 |
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| creator | Gartling, Gary Balou, Matina Amin, Milan Molfenter, Sonja Jones‐Rastelli, Brynn Ezeh, Uche C. Achlatis, Stratos Johnson, Aaron Gherson, Shirley Chiappetta, Natalie Barkmeier‐Kraemer, Julie Branski, Ryan C. |
| description | Objective
Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor‐related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology.
Methods
Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL‐QOL) questionnaire.
Results
Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL‐QOL or PAS between tremor phenotypes. SWAL‐QOL scores revealed that these patients rarely reported dysphagia symptoms.
Conclusions
Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population.
Level of Evidence
4 Laryngoscope, 134:4599–4603, 2024
This study investigates the impact of vocal tremor phenotypes, isolated vocal tremor (iVT), and essential tremor‐related voice tremor (ETvt) on upper aerodigestive tract physiology during swallowing. Distinct biomechanical patterns were observed, suggesting potential adaptive mechanisms contributing to faster pharyngeal bolus transit. Despite these differences, most individuals with vocal tremor did not report dysphagia symptoms, indicating the potential presence of compensatory strategies influencing swallowing patterns without perceived impairment. |
| doi_str_mv | 10.1002/lary.31581 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3075704683</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3075704683</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2461-fef7034c04a69064bcfde741701a2749502b5152f9ccdb03e76fdcba4814e9de3</originalsourceid><addsrcrecordid>eNp9kM9LwzAUgIMobk4v_gES8CJC50uT9Ie3MX8NBopO0VNo00QrbTOTFtl_b2anBw-e3uF9fLz3IXRIYEwAwrMqs6sxJTwhW2hIOCUBS1O-jYZ-SYOEh88DtOfcOwCJKYddNKBJGtGQwhAlizeFZ_Uyky02Gj8ZmVV4YVVtLDYNvlCvVdeWbWmaczzBd2VlWvzQdsVqH-3orHLqYDNH6PHqcjG9Cea317PpZB7IkEUk0ErHQJkElkUpRCyXulAxIzGQLIxZyiHMOeGhTqUscqAqjnQh84wlhKm0UHSETnrv0pqPTrlW1KWTqqqyRpnOCQoxj4FFCfXo8R_03XS28dcJSghL_MNR5KnTnpLWOGeVFktb1j6hICDWPcW6p_ju6eGjjbLLa1X8oj8BPUB64LOs1OoflZhP7l966RcaYn2O</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3114823066</pqid></control><display><type>article</type><title>The Impact of Vocal Tremor on Deglutition: A Pilot Study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Gartling, Gary ; Balou, Matina ; Amin, Milan ; Molfenter, Sonja ; Jones‐Rastelli, Brynn ; Ezeh, Uche C. ; Achlatis, Stratos ; Johnson, Aaron ; Gherson, Shirley ; Chiappetta, Natalie ; Barkmeier‐Kraemer, Julie ; Branski, Ryan C.</creator><creatorcontrib>Gartling, Gary ; Balou, Matina ; Amin, Milan ; Molfenter, Sonja ; Jones‐Rastelli, Brynn ; Ezeh, Uche C. ; Achlatis, Stratos ; Johnson, Aaron ; Gherson, Shirley ; Chiappetta, Natalie ; Barkmeier‐Kraemer, Julie ; Branski, Ryan C.</creatorcontrib><description>Objective
Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor‐related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology.
Methods
Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL‐QOL) questionnaire.
Results
Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL‐QOL or PAS between tremor phenotypes. SWAL‐QOL scores revealed that these patients rarely reported dysphagia symptoms.
Conclusions
Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population.
Level of Evidence
4 Laryngoscope, 134:4599–4603, 2024
This study investigates the impact of vocal tremor phenotypes, isolated vocal tremor (iVT), and essential tremor‐related voice tremor (ETvt) on upper aerodigestive tract physiology during swallowing. Distinct biomechanical patterns were observed, suggesting potential adaptive mechanisms contributing to faster pharyngeal bolus transit. Despite these differences, most individuals with vocal tremor did not report dysphagia symptoms, indicating the potential presence of compensatory strategies influencing swallowing patterns without perceived impairment.</description><identifier>ISSN: 0023-852X</identifier><identifier>ISSN: 1531-4995</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.31581</identifier><identifier>PMID: 38963230</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Deglutition - physiology ; Deglutition Disorders - physiopathology ; Dysphagia ; dysphagia/swallowing/laryngeal anatomy and physiology ; Essential Tremor - complications ; Essential Tremor - physiopathology ; Female ; Humans ; laryngeal dystonia/tremor ; Male ; Middle Aged ; Physiology ; Pilot Projects ; Quality of Life ; Swallowing ; Tremor (Muscular contraction) ; Tremor - physiopathology ; Voice Disorders - diagnosis ; Voice Disorders - etiology ; Voice Disorders - physiopathology</subject><ispartof>The Laryngoscope, 2024-11, Vol.134 (11), p.4599-4603</ispartof><rights>2024 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2461-fef7034c04a69064bcfde741701a2749502b5152f9ccdb03e76fdcba4814e9de3</cites><orcidid>0000-0002-8860-6319 ; 0000-0002-1494-661X ; 0000-0002-5037-3070 ; 0000-0002-7577-0267 ; 0000-0002-5362-0866</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.31581$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.31581$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38963230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gartling, Gary</creatorcontrib><creatorcontrib>Balou, Matina</creatorcontrib><creatorcontrib>Amin, Milan</creatorcontrib><creatorcontrib>Molfenter, Sonja</creatorcontrib><creatorcontrib>Jones‐Rastelli, Brynn</creatorcontrib><creatorcontrib>Ezeh, Uche C.</creatorcontrib><creatorcontrib>Achlatis, Stratos</creatorcontrib><creatorcontrib>Johnson, Aaron</creatorcontrib><creatorcontrib>Gherson, Shirley</creatorcontrib><creatorcontrib>Chiappetta, Natalie</creatorcontrib><creatorcontrib>Barkmeier‐Kraemer, Julie</creatorcontrib><creatorcontrib>Branski, Ryan C.</creatorcontrib><title>The Impact of Vocal Tremor on Deglutition: A Pilot Study</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objective
Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor‐related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology.
Methods
Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL‐QOL) questionnaire.
Results
Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL‐QOL or PAS between tremor phenotypes. SWAL‐QOL scores revealed that these patients rarely reported dysphagia symptoms.
Conclusions
Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population.
Level of Evidence
4 Laryngoscope, 134:4599–4603, 2024
This study investigates the impact of vocal tremor phenotypes, isolated vocal tremor (iVT), and essential tremor‐related voice tremor (ETvt) on upper aerodigestive tract physiology during swallowing. Distinct biomechanical patterns were observed, suggesting potential adaptive mechanisms contributing to faster pharyngeal bolus transit. Despite these differences, most individuals with vocal tremor did not report dysphagia symptoms, indicating the potential presence of compensatory strategies influencing swallowing patterns without perceived impairment.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Deglutition - physiology</subject><subject>Deglutition Disorders - physiopathology</subject><subject>Dysphagia</subject><subject>dysphagia/swallowing/laryngeal anatomy and physiology</subject><subject>Essential Tremor - complications</subject><subject>Essential Tremor - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>laryngeal dystonia/tremor</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Physiology</subject><subject>Pilot Projects</subject><subject>Quality of Life</subject><subject>Swallowing</subject><subject>Tremor (Muscular contraction)</subject><subject>Tremor - physiopathology</subject><subject>Voice Disorders - diagnosis</subject><subject>Voice Disorders - etiology</subject><subject>Voice Disorders - physiopathology</subject><issn>0023-852X</issn><issn>1531-4995</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM9LwzAUgIMobk4v_gES8CJC50uT9Ie3MX8NBopO0VNo00QrbTOTFtl_b2anBw-e3uF9fLz3IXRIYEwAwrMqs6sxJTwhW2hIOCUBS1O-jYZ-SYOEh88DtOfcOwCJKYddNKBJGtGQwhAlizeFZ_Uyky02Gj8ZmVV4YVVtLDYNvlCvVdeWbWmaczzBd2VlWvzQdsVqH-3orHLqYDNH6PHqcjG9Cea317PpZB7IkEUk0ErHQJkElkUpRCyXulAxIzGQLIxZyiHMOeGhTqUscqAqjnQh84wlhKm0UHSETnrv0pqPTrlW1KWTqqqyRpnOCQoxj4FFCfXo8R_03XS28dcJSghL_MNR5KnTnpLWOGeVFktb1j6hICDWPcW6p_ju6eGjjbLLa1X8oj8BPUB64LOs1OoflZhP7l966RcaYn2O</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Gartling, Gary</creator><creator>Balou, Matina</creator><creator>Amin, Milan</creator><creator>Molfenter, Sonja</creator><creator>Jones‐Rastelli, Brynn</creator><creator>Ezeh, Uche C.</creator><creator>Achlatis, Stratos</creator><creator>Johnson, Aaron</creator><creator>Gherson, Shirley</creator><creator>Chiappetta, Natalie</creator><creator>Barkmeier‐Kraemer, Julie</creator><creator>Branski, Ryan C.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8860-6319</orcidid><orcidid>https://orcid.org/0000-0002-1494-661X</orcidid><orcidid>https://orcid.org/0000-0002-5037-3070</orcidid><orcidid>https://orcid.org/0000-0002-7577-0267</orcidid><orcidid>https://orcid.org/0000-0002-5362-0866</orcidid></search><sort><creationdate>202411</creationdate><title>The Impact of Vocal Tremor on Deglutition: A Pilot Study</title><author>Gartling, Gary ; Balou, Matina ; Amin, Milan ; Molfenter, Sonja ; Jones‐Rastelli, Brynn ; Ezeh, Uche C. ; Achlatis, Stratos ; Johnson, Aaron ; Gherson, Shirley ; Chiappetta, Natalie ; Barkmeier‐Kraemer, Julie ; Branski, Ryan C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2461-fef7034c04a69064bcfde741701a2749502b5152f9ccdb03e76fdcba4814e9de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Deglutition - physiology</topic><topic>Deglutition Disorders - physiopathology</topic><topic>Dysphagia</topic><topic>dysphagia/swallowing/laryngeal anatomy and physiology</topic><topic>Essential Tremor - complications</topic><topic>Essential Tremor - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>laryngeal dystonia/tremor</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Physiology</topic><topic>Pilot Projects</topic><topic>Quality of Life</topic><topic>Swallowing</topic><topic>Tremor (Muscular contraction)</topic><topic>Tremor - physiopathology</topic><topic>Voice Disorders - diagnosis</topic><topic>Voice Disorders - etiology</topic><topic>Voice Disorders - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gartling, Gary</creatorcontrib><creatorcontrib>Balou, Matina</creatorcontrib><creatorcontrib>Amin, Milan</creatorcontrib><creatorcontrib>Molfenter, Sonja</creatorcontrib><creatorcontrib>Jones‐Rastelli, Brynn</creatorcontrib><creatorcontrib>Ezeh, Uche C.</creatorcontrib><creatorcontrib>Achlatis, Stratos</creatorcontrib><creatorcontrib>Johnson, Aaron</creatorcontrib><creatorcontrib>Gherson, Shirley</creatorcontrib><creatorcontrib>Chiappetta, Natalie</creatorcontrib><creatorcontrib>Barkmeier‐Kraemer, Julie</creatorcontrib><creatorcontrib>Branski, Ryan C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gartling, Gary</au><au>Balou, Matina</au><au>Amin, Milan</au><au>Molfenter, Sonja</au><au>Jones‐Rastelli, Brynn</au><au>Ezeh, Uche C.</au><au>Achlatis, Stratos</au><au>Johnson, Aaron</au><au>Gherson, Shirley</au><au>Chiappetta, Natalie</au><au>Barkmeier‐Kraemer, Julie</au><au>Branski, Ryan C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Vocal Tremor on Deglutition: A Pilot Study</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2024-11</date><risdate>2024</risdate><volume>134</volume><issue>11</issue><spage>4599</spage><epage>4603</epage><pages>4599-4603</pages><issn>0023-852X</issn><issn>1531-4995</issn><eissn>1531-4995</eissn><abstract>Objective
Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor‐related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology.
Methods
Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL‐QOL) questionnaire.
Results
Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL‐QOL or PAS between tremor phenotypes. SWAL‐QOL scores revealed that these patients rarely reported dysphagia symptoms.
Conclusions
Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population.
Level of Evidence
4 Laryngoscope, 134:4599–4603, 2024
This study investigates the impact of vocal tremor phenotypes, isolated vocal tremor (iVT), and essential tremor‐related voice tremor (ETvt) on upper aerodigestive tract physiology during swallowing. Distinct biomechanical patterns were observed, suggesting potential adaptive mechanisms contributing to faster pharyngeal bolus transit. Despite these differences, most individuals with vocal tremor did not report dysphagia symptoms, indicating the potential presence of compensatory strategies influencing swallowing patterns without perceived impairment.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>38963230</pmid><doi>10.1002/lary.31581</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-8860-6319</orcidid><orcidid>https://orcid.org/0000-0002-1494-661X</orcidid><orcidid>https://orcid.org/0000-0002-5037-3070</orcidid><orcidid>https://orcid.org/0000-0002-7577-0267</orcidid><orcidid>https://orcid.org/0000-0002-5362-0866</orcidid></addata></record> |
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| ispartof | The Laryngoscope, 2024-11, Vol.134 (11), p.4599-4603 |
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| subjects | Aged Aged, 80 and over Deglutition - physiology Deglutition Disorders - physiopathology Dysphagia dysphagia/swallowing/laryngeal anatomy and physiology Essential Tremor - complications Essential Tremor - physiopathology Female Humans laryngeal dystonia/tremor Male Middle Aged Physiology Pilot Projects Quality of Life Swallowing Tremor (Muscular contraction) Tremor - physiopathology Voice Disorders - diagnosis Voice Disorders - etiology Voice Disorders - physiopathology |
| title | The Impact of Vocal Tremor on Deglutition: A Pilot Study |
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