A 62-year-old man with a shakiness that worsens with fatigue and improves with wine most likely has which diagnosis?

• A. Vocal tremor
• B. Spasmodic dysphonia
• C. Muscle tension dysphonia
• D. Parkinson’s disease

Answer: (A)

This pattern points to a tremor of the vocal apparatus, i.e., vocal tremor. When the voice tremor worsens with fatigue and improves with alcohol, it’s a classic sign of essential tremor affecting the laryngeal muscles. Alcohol often dampens tremor amplitude, giving temporary relief. Other disorders don’t fit this tremor pattern: spasmodic dysphonia involves dystonic, episodic voice breaks rather than a tremor that fluctuates with fatigue; muscle tension dysphonia causes a hoarse, tense voice from excessive neck and laryngeal muscle contraction rather than true tremor; Parkinson’s disease can have a tremor but is typically a resting tremor and comes with other features like bradykinesia and rigidity, not specifically alcohol-responsive vocal tremor.