False Vocal Fold vs EMG Guided Botox for Vocal Tremor

False Vocal Fold vs EMG-Guided Botulinum Toxin Injections for Voice Tremor (FVFIVT): Prospective Non-Randomized Comparative Clinical Trial

This is a prospective, non-randomized, two-arm comparative clinical trial evaluating outcomes of false vocal fold (FVF) botulinum toxin injections versus standard EMG-guided botulinum toxin injections in patients with essential voice tremor. Participants will receive either FVF injections or EMG-guided injections based on shared clinical decision-making between the treating laryngologist and patient. The study will assess changes in voice-related quality of life, tremor severity, and patient satisfaction over a 12-week follow-up period and compare these outcomes between the two treatment approaches.

Inclusion Criteria:

• Age ≥18 years
• Diagnosis of essential voice tremor by a laryngologist and speech pathologist
• Deemed an appropriate candidate for either FVF or EMG-guided botulinum toxin injections
• Able to provide informed consent and complete questionnaires in English

Exclusion Criteria:

• Coexisting severe neurologic disease that precludes reliable participation in follow-up
• History of laryngeal surgery or structural lesion that markedly confounds tremor assessment
• Known hypersensitivity to botulinum toxin or injectable components
• Pregnancy
• Dysphagia at baseline
• Inability to comply with follow-up schedule