Voice tremor: dysregulation of voluntary expiratory muscles

We studied three patients: two with voice and hand tremor, and one with voice tremor. Voice tremor was associated with synchronous rhythmic contraction of cricothyroid and rectus abdominis muscles, but not always vocalis muscle. Voice tremor was manifested only in voluntary phonation or expiration, not in involuntary phonation, voluntary inspiration, or involuntary expiration and inspiration (breathing at rest). Impaired regulation of the CNS programs innervating the voluntary expiratory muscles probably causes voice tremor. Clonazepam and propranolol were helpful in blinded studies.