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Vocal tremor subjective and quantitative evaluation in laryngeal dystonia (Lin et al., 2026) Dexun Lin (25303170) Li Zhou (54356) Lu Wang (45927) Lihua Li (1408309) Desheng Wang (196022) Xiaojue Chen (20561586) Xinlin Xu (677269) Otorhinolaryngology Speech pathology subjective and quantitative assessment vocal tremor patients adductor laryngeal dystonia video feature tracking stroboscopic laryngoscopy recordings tremor directionality kinematic parameters intermittent dystonia tremor dystonia tremor stroboscopic videos spasmodic dysphonia larynx phonation tremor patterns pathophysiology voice disorders <p dir="ltr"><b>Purpose: </b>The aims of this study were to subjectively and quantitatively analyze vocal tremor (VT) in patients with adductor laryngeal dystonia (ADLD) using video feature tracking of stroboscopic laryngoscopy recordings, to observe the VT incidence and characterize tremor directionality and kinematic parameters, and to identify differences between the patients with intermittent dystonia tremor (iDT) and regular dystonia tremor (rDT).</p><p dir="ltr"><b>Method: </b>A retrospective analysis included 55 clinically diagnosed ADLD patients (ADLD group) and 10 normal-voiced controls (normal group). Two blinded laryngologists assessed stroboscopic videos and classified ADLD patients with VT into iDT group and rDT group based on tremor regularity. Video tracking was used to quantitatively measure tremor amplitude, period, and velocity of the epiglottis, bilateral vestibular folds, and bilateral arytenoids in horizontal and anteroposterior directions.</p><p dir="ltr"><b>Results: </b>VT was detected in 61.82% (34/55) of ADLD patients, all of whom were female (34/49). This incidence was statistically different than for controls (0/10) and for male patients with ADLD (0/6; <i>p</i> < .001). Predominant tremor types were horizontal (52.94%, 18/34) and mixed (41.18%, 14/34). Horizontal tremor parameters did not differ significantly within the ADLD group or between the iDT and rDT groups (<i>p</i> > .05). Mean horizontal amplitudes were epiglottis, 0.21 vocal fold widths; left/right vestibular folds, 0.14/0.12 vocal fold widths; and left/right arytenoids, 0.16/0.13 vocal fold widths. In the anteroposterior direction, only arytenoid amplitude and velocity showed intergroup differences (<i>p</i> < .05). The iDT group had smaller epiglottic and bilateral arytenoid oscillation amplitudes than the rDT group (<i>p</i> < .05). Mean anteroposterior amplitudes were epiglottis, 0.33 vocal fold widths; left/right vestibular folds, 0.12/0.16 vocal fold widths; and left/right arytenoids, 0.17/0.22 vocal fold widths.</p><p dir="ltr"><b>Conclusions: </b>VT is a key phenotype in female ADLD patients. Video tracking enables quantitative characterization of tremor kinematics and reveals objective amplitude differences between the rDT and iDT, providing a methodological basis for objective diagnosis, subtyping, and treatment evaluation of ADLD.</p><p dir="ltr"><b>Supplemental Material S1. </b>Representative stroboscopic recording of intermittent dystonia tremor.</p><p dir="ltr"><i>Note</i>. This video captures the characteristic intermittent, periodic laryngeal oscillations during sustained /i/ phonation in a patient with adductor laryngeal dystonia. Quantitative kinematic analysis indicated that the intermittent dystonia tremor group exhibits significantly reduced anteroposterior oscillation amplitudes of the epiglottis and bilateral arytenoids relative to the regular dystonia tremor group (<i>p</i> < .05), characterizing this subtype by its lower tremor magnitude.</p><p dir="ltr"><b>Supplemental Material S2. </b>Representative stroboscopic recording of regular dystonia tremor.</p><p dir="ltr"><i>Note. </i>This video demonstrates the continuous and rhythmic laryngeal oscillations characteristic of the regular dystonia tremor subtype in adductor laryngeal dystonia. Kinematic measurements revealed significantly greater anteroposterior oscillation amplitudes in the epiglottis and arytenoids for the regular dystonia tremor group (<i>p</i> < .05), suggesting a potential clinical association between tremor regularity and higher oscillatory intensity in this patient cohort.</p><p dir="ltr"><b>Supplemental Material S3. </b>Connected speech of the patient with intermittent dystonia tremor.</p><p dir="ltr"><b>Supplemental Material S4. </b>Sustained vowel /a/ production of the patient with intermittent dystonia tremor.</p><p dir="ltr"><b>Supplemental Material S5. </b>Connected speech of the patient with regular dystonia tremor.</p><p dir="ltr"><b>Supplemental Material S6. </b>Sustained vowel /a/ production of the patient with regular dystonia tremor.</p><p dir="ltr">Lin, D., Zhou, L., Wang, L., Li, L., Wang, D., Chen, X., & Xu, X. (2026). Subjective and quantitative assessment of vocal tremor in patients with adductor laryngeal dystonia. <i>Journal of Speech, Language, and Hearing Research</i>. Advance online publication. <a href="https://doi.org/10.1044/2026_JSLHR-25-00990" target="_blank" rel="noreferrer">https://doi.org/10.1044/2026_JSLHR-25-00990</a></p> 2026-10-05T17:01:28Z Dataset Media 10.23641/asha.34057596.v1 https://figshare.com/articles/media/Vocal_tremor_subjective_and_quantitative_evaluation_in_laryngeal_dystonia_Lin_et_al_2026_/34057596 CC BY 4.0