title: Laryngoscopy evaluation protocol for the differentiation of essential and dystonic voice tremor.
abstract: BACKGROUND
  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. The transnasal fiberoptic laryngoscopy protocol, which consisted of the assessment of palate, pharynx and larynx tremor during the performance of several vocal and non-vocal tasks with distinct phenomenological characteristics, was applied to 19 patients with voice tremor. Patients were diagnosed with essential or dystonic tremor according to the phenomenological characterization of each group. Once they were classified, the tasks associated with the presence of tremor in each syndrome were identified.
  
  
  RESULTS
  The tasks that significantly contributed to the differential diagnosis between essential and dystonic tremor were /s/ production, continuous whistling and reduction of tremor in falsetto. These tasks were phenomenologically different with respect to the presence of tremor in the two syndromes.
  
  
  CONCLUSIONS
  The protocol of specific tasks by means of transnasal fiberoptic laryngoscopy is a viable method to differentiate between essential and dystonic voice tremor syndromes through the following tasks: /s/ production, continuous whistling and reduction of tremor in falsetto.
authors.affiliation: Department of Otorhinolaryngology, Health Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Otorhinolaryngology, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. Electronic address: moraesbruno.orl@hotmal.com.
authors.forename: Bruno Teixeira de
authors.initials: BT
authors.lastname: Moraes
authors.affiliation: Department of Otorhinolaryngology, Health Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Noemi Grigoletto de
authors.initials: NG
authors.lastname: Biase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D020821:Dystonic Disorders / Q000175:diagnosis*; D020329:Essential Tremor / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D014202:Tremor / Q000145:classification / Q000175:diagnosis*; D014832:Voice Disorders / Q000175:diagnosis*; D014833:Voice Quality; D055815:Young Adult
keywords: Distonia; Dystonia; Essential tremor; Laringoscopia; Laryngoscopy; Tremor; Tremor essencial