PROJECT SUMMARY/ABSTRACT Tremor affects ~1% of the global population or nearly 80 million people. In spite of this staggering figure, both nomenclature and treatment approaches are inconsistent. Many patients present with tremor affecting the voice, either in isolation or in combination with tremor of the limbs. Isolated vocal tremor was historically considered a clinical variant of essential tremor (ET). Recently updated classification criteria, however, exclude isolated voice tremor from ET classification. This controversy provides an ideal platform for meaningful patient- oriented research with the potential to substantively address issues related to communication-related disability. In addition, this K24 midcareer award will allow me to enhance the quantity and quality of mentoring I provide to students, residents, fellows, and junior faculty. My research focus for this award will be on understanding differences in the clinical phenotypes between these two patient populations and the impact of voice tremor on structures of the upper aerodigestive tract and deglutition. In addition, foundational efficacy data regarding pharmacological therapy for patients with voice tremor will be collected. Both Career Goals and Research Aims, consistent with the mission of the National Institute on Deafness and Other Communication Disorders, are proposed for this K24 midcareer award. With regard to career development and mentorship, the following Career Goals are proposed: Career Goal 1. To evaluate the quality of my mentoring and implement a plan for improvement through a formalized training plan Career Goal 2. To mentor junior students, post-doctoral scholars, residents, fellows, and faculty in translational science to enhance patient care through scientific discovery In addition, a multi-disciplinary team has been assembled to address the following Research Aims: Aim 1. To characterize overlapping and/or distinguishing clinical phenotypes of patients with ETVT and iVT. Aim 2. To correlate VT severity with altered deglutition in ETVT and iVT. Aim 3 (Exploratory). To compare systemic and locally administered pharmacological treatment effects for ETVT and iVT.