Trembling Cords

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Colds, which are caused by viruses, are the most common cause of laryngitis. Although rare, bacterial infections, such as diphtheria, can also cause laryngitis. Certain activities may strain the vocal cords to cause inflammation and lead to laryngitis. Examples of these types of activities include yelling at a sporting event or concert and working as a professional singer. Silvers points out that all causes of laryngitis cause hoarseness, but not all hoarseness is laryngitis. Vocal polyps seen in smokers and people with chronic acid reflux , nodules from years of improper vocal use , tumors benign or malignant and trauma to the outside of the neck can cause inflammation or fracture of the laryngeal cartilage, leading to hoarseness.

Patients can have vocal neurological issues, as well, that can lead to parasthesia or vocal weakness. For example, Parkinson's patients often have hoarseness, with vocal tremor and nerve paralysis. Anything that irritates, inflames, blocks or weakens the vocal bands cords , will lead to hoarseness, Silvers said. When laryngitis persists for three or more weeks, it is considered chronic. Bulimia , alcohol abuse and smoking, gastroesophageal reflux disease GERD or acid reflux and sinusitis cause chemicals to come in repeated contact with the vocal cords, which damages the cords over time.

Symptoms such as fever, difficulty swallowing, high-pitched breathing noises and more drooling than normal in children should be taken seriously.

They may be signs of croup, which is a life-threatening condition. Parents should get the child immediate medical attention, according to the Mayo Clinic.

Laryngitis is diagnosed through a physical examination. A physician will listen to the sound of the voice, and in a technique called laryngoscopy, she will use a small mirror and a light to peer at the back of throat. Redness and swelling are typically visible. A newer, slightly more invasive procedure called endoscopy is sometimes used to make a diagnosis.

Free Your Voice - How to Sing without Tension - Felicia Ricci

Endoscopy allows the physician to view the vocal cords in motion. In this procedure, a doctor uses a skinny, bendable tube called an endoscope that is equipped with a mini camera and light at its end. The physician inserts the endoscope in the nose or mouth and it extends into the throat. Orthostatic myoclonus is characterized by slowly progressive unsteadiness when standing that is relieved by walking or sitting. Some affected individuals experienced bouncing stance and recurrent falls.

More research is necessary to determine when orthostatic myoclonus and primary orthostatic tremor are the same disorder or similar, yet distinct, disorders. In rare cases, orthostatic myoclonus may be associated with underlying neoplasm. Essential tremor is a common movement disorder characterized by an involuntary rhythmic tremor of a body part or parts, primarily the hands, arms, and neck.. In many affected individuals, upper limb tremor may occur as an isolated finding. However, in others, tremor may gradually involve other anatomic regions, such as the head, voice, and tongue, leading to a quiver in the voice or difficulties articulating speech.

Less commonly, tremor may affect muscles of the trunk or legs.

Essential tremor - symptoms, diagnosis, treatment - Southern Cross NZ

Patients with essential tremor involving the legs are often misdiagnosed as having orthostatic tremor, but in the latter condition the tremor is much more frequent Hz than in essential tremor Hz. Although tremor is typically absent with rest—i. Essential tremor may appear to occur randomly for unknown reasons sporadically or be transmitted as an autosomal dominant trait. Researchers suggest that changes mutations of different genes may be responsible for the disorder genetic heterogeneity.

Degenerative changes occur in areas deep within the brain substantia nigra and other pigmented regions of the brain , causing a decrease in dopamine levels in the brain. Dopamine is a neurotransmitter, which is a chemical that sends a signal in the brain. Parkinsonian symptoms can also develop secondary to degenerative diseases such as multiple system atrophy, hydrocephalus a condition in which areas of the brain accumulate excessive fluids, resulting in an increase in pressure on the brain , head trauma, inflammation of the brain encephalitis , circulatory disturbances infarcts or tumors deep within the cerebral hemispheres involving the area just above the brain stem basal ganglia , or exposure to certain drugs and toxins.

A diagnosis of primary orthostatic tremor is based upon a thorough clinical evaluation, a detailed patient history, and supported by specialized tests such as a surface electromyogram EMG.

Progressive Supranuclear Palsy (PSP)

Misdiagnosis is common. Many individuals may be initially suspected of having a psychogenic disorder a disorder caused by a psychological cause rather than a physical one. A surface EMG measures the electrical impulses of muscles at rest and during contraction. A surface electromyogram can often rapidly establish a diagnosis of primary orthostatic tremor by reproducing the characteristic tremor in the legs.


With a surface electromyogram electrodes are placed on the skin overlying the muscles that are to be tested. Various medications may help relieve symptoms associated with primary orthostatic tremor. Most affected individuals are treated with a drug called clonazepam Klonopin. However, some affected individuals do not respond to this first-line drug treatment. Some affected individuals responded favorably after being treated with an anti-seizure anticonvulsant drug called gabapentin Neurontin.

A very small double-blind, placebo controlled study demonstrated that affected individuals experienced a sustained improvement when treated with the drug. Authors of the study suggested that gabapentin be considered a first-line therapy for individuals with primary orthostatic tremor.

Essential tremor - symptoms, diagnosis, treatment

Additional drug therapies that have been used to treat individuals with primary orthostatic tremor include primidone Mysoline , chlordiazepoxide Librium , pregabalin Lyrica , pramipexole Mirapex , phenobarbital and valproic acid Depakote. Botulinum toxin injections into the leg muscles may be helpful. Surgical treatments such as spinal cord stimulation or deep brain stimulation should be reserved only for the most disabling cases that do not respond adequately to medical therapy.

Additional treatment is symptomatic and supportive. The medical literature details several cases of individuals with primary orthostatic tremor who have been treated by thalamic deep brain stimulation. Thalamic refers to the thalamus, a portion of the brain that relays sensory information. It is believed that some types of tremors occur due to abnormal brain activity that is processed in the thalamus. During this procedure, an electrode is placed into the thalamus and a thin wire is passed under the skin is connected to a small battery pack which is also placed underneath the skin.

The electrode is used to send electrical impulses stimulate to the brain and interrupt aberrant nerve signals that contribute to tremors. In some cases reported in the medical literature, tremors of individuals with primary orthostatic tremor were successfully controlled with thalamic deep brain stimulation. However, more research is necessary to determine the long-term safety and effectiveness of this potential therapy for primary orthostatic tremor. Information on current clinical trials is posted on the Internet at www.

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All studies receiving U. For information about clinical trials sponsored by private sources, contact: www. RareConnect offers a safe patient-hosted online community for patients and caregivers affected by this rare disease.

New discovery into causes of tremor

The long-term outcome of orthostatic tremor. J Neurol Neurosurg Psychiatry. Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in patients. Orthostatic tremor: a cerebellar pathology? Thenganatt MA, Jankovic J. Parkinsonism Relat Disord. Lotia M, Jankovic J. Botulinum Toxin for the Treatment of Tremor and Tics. Semin Neurol. Orthostatic myoclonus associated with Caspr2 antibodies. Long-term course of orthostatic tremor in serial posturographic measurement.