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The objective of this study was to objectively examine voice tremor and its response to symptomatic pharmacological treatment in patients with essential tremor using voice analysis consisting of power spectral analysis and machine learning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We investigated 58 patients (24 men; mean age\u2009\u00b1\u2009SD, 71.7\u2009\u00b1\u20099.2\u2009years; range, 38\u201385\u2009years) and 74 age\u2010 and sex\u2010matched healthy subjects (20 men; mean age\u2009\u00b1\u2009SD, 71.0\u2009\u00b1\u200912.4\u2009years; range, 43\u201395\u2009years). We recorded voice samples during sustained vowel emission using a high\u2010definition audio recorder. Voice samples underwent sound signal analysis, including power spectral analysis and support vector machine classification. We compared voice recordings in patients with essential tremor who did and did not manifest clinically overt voice tremor and in patients who were and were not under the symptomatic effect of the best medical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Power spectral analysis demonstrated a prominent oscillatory activity peak at 2\u20136\u2009Hz in patients who manifested a clinically overt voice tremor. Voice analysis with support vector machine classifier objectively discriminated with high accuracy between controls and patients who did and did not manifest clinically overt voice tremor and between patients who were and were not under the symptomatic effect of the best medical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with essential tremor, voice tremor is characterized by abnormal oscillatory activity at 2\u20136\u2009Hz. Voice analysis, including power spectral analysis and support vector machine classification, objectively detected voice tremor and its response to symptomatic pharmacological treatment in patients with essential tremor. \u00a9 2021 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.28508","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T16:07:19Z","timestamp":1612454839000},"page":"1401-1410","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Voice Analysis with Machine Learning: One Step Closer to an Objective Diagnosis of Essential Tremor"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5612-7965","authenticated-orcid":false,"given":"Antonio","family":"Suppa","sequence":"first","affiliation":[{"name":"Department of Human Neurosciences Sapienza University of Rome  Rome Italy"},{"name":"IRCCS 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