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Birkenbeuel JL, Tawk K, Martin EC, Abouzari M, Djalilian HR. Treatment of Stapedial Myoclonus as a Migraine-Related Phenomenon. Otol Neurotol 2023; 44:388-391. [PMID: 36843031 PMCID: PMC10049888 DOI: 10.1097/mao.0000000000003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To describe a case series of patients with stapedial myoclonus (SM) whose conditions improved after prophylactic migraine treatment. PATIENTS We present seven cases of SM reported from a tertiary care neurotology clinic. All seven patients reported SM triggers similar to those of migraine headaches and suffered from concomitant headaches and/or vertigo, and were thus treated with a standard migraine protocol used at this neurotology clinic. INTERVENTION Prophylactic migraine treatment. MAIN OUTCOME MEASURES Reduction or resolution of SM. RESULTS In this series, seven patients with SM were included. Six of seven subjects were male (86%), with a mean age at presentation of 44 years. Four patients noted significant improvement in their symptoms, with a reduced frequency, duration, and intensity of their symptoms with the migraine regimen. Three patients experienced complete resolution of SM with their migraine treatment. CONCLUSION We report that treatment with prophylactic migraine treatment can provide long-term relief for patients with SM, which may suggest an etiological association between migraine and SM as well as a possible treatment for SM.
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Affiliation(s)
- Jack L. Birkenbeuel
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Karen Tawk
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Elaine C. Martin
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Wong WK, Lee MFH. Middle ear myoclonus: Systematic review of results and complications for various treatment approaches. Am J Otolaryngol 2022; 43:103228. [PMID: 34537509 DOI: 10.1016/j.amjoto.2021.103228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To perform a systematic review of the diagnosis and treatment of patients with pulsatile tinnitus secondary to middle ear myoclonus. DATABASES REVIEWED PubMed, EMBASE, and Scopus. METHODS A systematic review was performed using standardized methodology. Computerized and manual searches were performed to identify studies of all ages (patients) who had middle ear myoclonus (intervention). All study designs were assessed. Extracted data included demographics, clinical features, duration of followup as well as the diagnosis and reversibility of symptoms with medical or surgical intervention. Studies were included if they included subjects with middle ear myoclonus. Exclusion criteria included letters/commentaries and reviews. RESULTS Twenty articles representing 115 subjects with middle ear myoclonus were included. The mean age was 29.7 (range 6-67). The follow-up period ranged from 5 weeks to 36 months. Primary treatment consists of medical therapy utilising anxiolytics, antiepileptics, botulinum toxin and surgical treatment involving division of middle ear muscular tendon(s). In total, 60 patients underwent middle ear muscular tenotomies, with division of both stapedius and tensor tympani tendons being the most prevalent (88%). Limitations in the data arose from study design, related comorbidities such as palatal myoclonus, and concomitant drug administration. No study provided any objective criteria to diagnose this condition or evaluate post-treatment outcome. CONCLUSION Middle ear myoclonus is an entity that is poorly assessed in the literature. There is a lack of consensus regarding the criteria and strategies for both diagnosing and treating this condition. Although level of evidence of current studies remains modest, it is felt that a stepwise approach is deemed best, with therapeutic decisions being made on an individual basis, evaluating each patient's specific circumstances and priorities.
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Affiliation(s)
- Wai Keat Wong
- Department of Otolaryngology, Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand; Department of Ear, Nose and Throat, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Michael Fook-Ho Lee
- Department of Ear, Nose and Throat, Royal Prince Alfred Hospital, Sydney, Australia
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Abstract
BACKGROUND Stapedial myoclonus is an uncommon condition involving the rhythmic contraction of the stapedial tendon that may result in a host of symptoms, including tinnitus . There is a dearth of robust diagnostic modalities to diagnose stapedial myoclonus, and most patients are treated without definitive diagnosis. Herein, we hypothesize that stapedial myoclonus can be readily diagnosed by awake otoendoscopy (see Video, Supplemental Digital Content 1, http://links.lww.com/MAO/A997). CASE REPORT A 21-year-old healthy male professional singer presented with a rhythmic "thumping sound" heard in both ears for 5 years. Symptoms were triggered by singing and were worse on the right side. Work-up, including otologic exam, audiologic testing, and high resolution imaging, was unrevealing. Given symptomatology, stapedial tendon myoclonus was suspected.While awake in the operating room, an inferior myringotomy was made, and both 1.9 mm 0 and 30 degree 3-CCD Hopkins rod endoscopes were used to visualize the middle ear space using a transcanal approach. There was robust movement of the tendon with patient vocalization that corresponded precisely with the timing of tinnitus. The patient subsequently underwent transection of the right stapedial tendon under general anesthesia using otoendoscopic visualization. The pyramidal eminence was also removed to avoid future regeneration. The patient underwent an identical procedure on the contralateral ear 3 months later with complete resolution of symptoms bilaterally. CONCLUSION Stapedial myoclonus was diagnosed by transtympanic otoendoscopy in an awake patient. This approach may be readily applied in awake patients suspected of having stapedial myoclonus. Transection of the stapedial tendon in these patients resolves tinnitus.
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Xu Y, Shi Y, Yao J, Yang H, Ding Z, Chen QQ, Liu Y, Chen W. Altered brain functional connectivity and correlation with psychological status in patients with unilateral pulsatile tinnitus. Neurosci Lett 2019; 705:235-245. [PMID: 31042571 DOI: 10.1016/j.neulet.2019.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
The study investigated the alteration of brain functional connectivity (FC) patterns and analyzed the relationship between FC and psychological statue in pulsatile tinnitus (PT) patients by resting-state functional magnetic resonance imaging. The eligible PT patients (29) and healthy subjects (29) were enrolled. Brain activity, FC and clinical characteristics, including tinnitus handicap inventory, duration, sleep quality, anxiety, and depression were evaluated. A significantly increased brain activity in the left cerebellum and left inferior temporal gyrus was observed in PT patients. An abnormally increased FC was focused on the left cerebellum and left inferior temporal gyrus, right superior temporal gyrus, and right occipital gyrus, as well as, the inferior temporal gyrus and thalamus, the putamen and caudate nucleus. Decreased FC was demonstrated between the left cerebellum and bilateral angular gyrus, as well as, the left inferior temporal gyrus and orbital gyrus of the medial prefrontal lobe. A negative correlation was established between the scores of sleep quality and anxiety and the values of FC (in the inferior temporal gyrus and bilateral thalamus). These results suggest an abnormal activity of non-auditory cortex (the cerebellum and inferior temporal gyrus), and the alteration of FC patterns are responsible for PT. Some psychological factors may not be correlated with FC in PT patients.
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Affiliation(s)
- Yaping Xu
- Department of Otorhinolaryngology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China.
| | - Yanhui Shi
- Department of Otorhinolaryngology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China
| | - Jie Yao
- Department of Otorhinolaryngology, The Second Hospital affiliated to Zhejiang traditional Chinese Medicine University, 318(#) Chao Wang Street, Zhejiang, China
| | - Hong Yang
- Department of Radiology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261(#) Huansha Rd, Hangzhou, 310006, Zhejiang, China
| | - Qiong Qiong Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China
| | - Ya Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China
| | - Wei Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Medical College in Zhejiang University, 79(#) Qingchun Street, Hangzhou, Zhejiang, China
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Diab KM, Naumova IV, Balakireva OA, Sokolova VN, Terekhina LI. [Myoclonus of the middle ear]. Vestn Otorinolaringol 2018; 83:63-66. [PMID: 29697659 DOI: 10.17116/otorino201883263-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to overview the foreign literature concerning middle ear myoclonus (MEM) known to be the most common cause of the manifestations of objective tinnitus. The authors reports two typical clinical cases of myoclonus of the middle ear. The present article is aimed at the enhancement of the awareness of the otorhinolaryngologists, audiologists, and neurologists of the condition of interest as a way to promote the further progress in its treatment.
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Affiliation(s)
- Kh M Diab
- Federal state budgetary institution 'Research and Clinical Centre of Otorhinolaryngology', Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - I V Naumova
- Federal state budgetary institution 'Research and Clinical Centre of Otorhinolaryngology', Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - O A Balakireva
- Federal state budgetary institution 'Research and Clinical Centre of Otorhinolaryngology', Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - V N Sokolova
- Federal state budgetary institution 'Research and Clinical Centre of Otorhinolaryngology', Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - L I Terekhina
- Federal state budgetary institution 'Research and Clinical Centre of Otorhinolaryngology', Russian Federal Medico-Biological Agency, Moscow, Russia, 123182
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Ueberfuhr MA, Wiegrebe L, Krause E, Gürkov R, Drexl M. Tinnitus in Normal-Hearing Participants after Exposure to Intense Low-Frequency Sound and in Ménière's Disease Patients. Front Neurol 2017; 7:239. [PMID: 28105023 PMCID: PMC5215134 DOI: 10.3389/fneur.2016.00239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/12/2016] [Indexed: 11/13/2022] Open
Abstract
Tinnitus is one of the three classical symptoms of Ménière’s disease (MD), an inner ear disease that is often accompanied by endolymphatic hydrops. Previous studies indicate that tinnitus in MD patients is dominated by low frequencies, whereas tinnitus in non-hydropic pathologies is typically higher in frequency. Tinnitus of rather low-frequency (LF) quality was also reported to occur for about 90 s in normal-hearing participants after presentation of intense, LF sound (120 dB SPL, 30 Hz, 90 s). LF sound has been demonstrated to also cause temporary endolymphatic hydrops in animal models. Here, we quantify tinnitus in two study groups with chronic (MD patients) and presumably transient endolymphatic hydrops (normal-hearing participants after LF exposure) with a psychophysical procedure. Participants matched their tinnitus either with a pure tone of adjustable frequency and level or with a noise of adjustable spectral shape and level. Sensation levels of matching stimuli were lower for MD patients (mean: 8 dB SL) than for normal-hearing participants (mean: 15 dB SL). Transient tinnitus after LF-exposure occurred in all normal-hearing participants (N = 28). About half of the normal-hearing participants matched noise to their tinnitus, the other half chose a pure tone with frequencies below 2 kHz. MD patients matched their tinnitus with either high-frequency pure tones, mainly above 3 kHz, or with a noise. Despite a significant proportion of MD patients matching low-pass (roaring) noises to their tinnitus, the range of matched stimuli was more heterogeneous than previous data suggested. We propose that in those participants with noise-like tinnitus, the percept is probably generated by increased spontaneous activity of auditory nerve fibers with a broad range of characteristic frequencies, due to an impaired ion balance in the cochlea. For tonal tinnitus, additional mechanisms are conceivable: focal hair cell loss can result in decreased auditory nerve firing and a central auditory overcompensation. Also, normal-hearing participants after LF-exposure experience alterations in spontaneous otoacoustic emissions, which may contribute to a transient tonal tinnitus.
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Affiliation(s)
- Margarete Anna Ueberfuhr
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians Universität München, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Lutz Wiegrebe
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany; Division of Neurobiology, Department Biology II, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Eike Krause
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians Universität München, Munich, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig-Maximilians Universität München, Munich, Germany
| | - Robert Gürkov
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians Universität München, Munich, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig-Maximilians Universität München, Munich, Germany
| | - Markus Drexl
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Ludwig-Maximilians Universität München , Munich , Germany
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Thiede O, Stoll W, Schmäl F. Clinical and Experimental Investigations of Spontaneous Impedance Changes of the Middle Ear. Ann Otol Rhinol Laryngol 2016; 113:577-81. [PMID: 15274420 DOI: 10.1177/000348940411300712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The major symptoms of glomus tympanicum tumors are pulsatile tinnitus and spontaneous impedance changes (SICs) of the middle ear. On the other hand, SICs often occur even in the absence of pathological findings. The aim of this study was to analyze the occurrence of SICs in patients and healthy volunteers. We retrospectively evaluated 184 patients with SICs and/or complaints of periodic tinnitus. Most of them (n = 134) showed pulse-synchronous SICs. Pathological findings were recorded in only 66 patients. Binaural SICs were registered significantly (p = .03) more frequently in patients with arterial hypertension (63% versus 18%). Because of the positive correlation between arterial hypertension and the occurrence of SICs, the influence of increasing blood pressure (systolic blood pressure > 160 mm Hg after physical activity) on the occurrence of SICs was investigated in a prospective trial in healthy test subjects (n = 42). In 17 of them, pulse-synchronous SICs occurred for the first time or were registered at a lower sensitivity level after an increase in blood pressure. In summary, only half of the patients with pulse-synchronous SICs showed pathological findings. a significant correlation between high blood pressure and binaural pulse-synchronous SICs was demonstrated in patients with arterial hypertension and healthy volunteers after physical activity.
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Affiliation(s)
- Oliver Thiede
- Department of Otorhinolaryngology-Head and Neck Surgery, University of MOnster, Münster, Germany
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Abstract
HYPOTHESIS Voluntary eardrum movement (VEM) and resultant tympanometric changes reflect tensor tympani (TT) contraction. BACKGROUND TT contraction has been hypothesized to cause symptoms of aural fullness, tinnitus, clicking, and even vertigo despite the lack of understanding of how it functions or what causes it to contract. Identifying tympanometric changes unique to TT contraction can provide a diagnostic tool for identifying its role in pathologic conditions. METHODS Various tympanometric measurements were performed on human subjects who could voluntarily move their eardrums. These were compared with similar tympanometric measurements performed on cadaveric temporal bones while manually tensing the TT and stapedius muscles individually. RESULTS Eight subjects (14 ears) who could cause VEM were identified. Compared with baseline, VEM resulted in significantly decreased middle ear compliance (p < 0.01) and middle ear pressure (p < 0.01) measurements. The compliance changes seen with VEM were larger than those seen with acoustically stimulated stapedius contraction. Finally, the direction of compliance change with VEM was dependent on the pressure applied to the external auditory canal (EAC), with compliance increasing with positive EAC pressure. This was not seen with stapedius contraction. These findings were reproduced using the cadaveric temporal bone model: larger compliance changes with pull on TT as compared with stapedius with neutral EAC probe pressure; change in direction of compliance changes with varying EAC probe pressure with TT pull, not with stapedius pull. CONCLUSION TT contraction produces distinctive tympanometric findings that can be used to support its abnormal contraction in ears with symptoms compatible with TT syndrome.
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Han L, Zhaohui L, Fei Y, Pengfei Z, Ting L, Cheng D, Zhenchang W. Disrupted neural activity in unilateral vascular pulsatile tinnitus patients in the early stage of disease: evidence from resting-state fMRI. Prog Neuropsychopharmacol Biol Psychiatry 2015; 59:91-99. [PMID: 25645870 DOI: 10.1016/j.pnpbp.2015.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
Numerous studies have shown that neurological changes are important findings of tinnitus patients. Previous studies on tinnitus have indicated that patients with pulsatile tinnitus (PT) often show altered baseline brain activity in the resting state. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to investigate changes in spontaneous brain activity among patients with unilateral pulsatile tinnitus in the early stage of disease (less than forty-eight months) and determined the relationship of these changes with clinical data. The PT patients (n=34) and matched normal control subjects (n=34) were enrolled in this study. Spontaneous brain activity was revealed by the regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) values. Compared with normal controls, the patients with PT had significantly increased ReHo and ALFF in the posterior cingulate cortex, right inferior parietal lobule (IPL) and right cerebellum posterior lobe. The PT group showed increased ReHo in the posterior cingulate cortex (PCC), precuneus, right IPL, right superior frontal gyrus, some occipital areas and part of the right cerebellum posterior lobe. For ALFF, the increased clusters were in the PCC and precuneus and in some areas of the cerebellum posterior lobe, bilateral IPL and inferior frontal gyrus (IFG). Increased PT duration was correlated with increased ALFF in the bilateral inferior frontal gyrus (IFG) and precuneus. An increased THI score was correlated with ReHo and ALFF values in the precuneus. Taken together, the combined study of ReHo and ALFF measurements may yield a more comprehensive neurological pathophysiology framework for PT patients in the early stage of the disease.
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Affiliation(s)
- Lv Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liu Zhaohui
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yan Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhao Pengfei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li Ting
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Dong Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wang Zhenchang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Ward J, Vella C, Hoare DJ, Hall DA. Subtyping Somatic Tinnitus: A Cross-Sectional UK Cohort Study of Demographic, Clinical and Audiological Characteristics. PLoS One 2015; 10:e0126254. [PMID: 25996779 PMCID: PMC4440784 DOI: 10.1371/journal.pone.0126254] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus.
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Affiliation(s)
- Jamie Ward
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
- * E-mail:
| | - Claire Vella
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
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Feasibility of endoscopic treatment of middle ear myoclonus: a cadaveric study. ISRN OTOLARYNGOLOGY 2014; 2014:175268. [PMID: 24734199 PMCID: PMC3964766 DOI: 10.1155/2014/175268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/12/2014] [Indexed: 11/17/2022]
Abstract
Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope.
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Abel MD, Levine RA. Muscle Contractions and Auditory Perception in Tinnitus Patients and Nonclinical Subjects. Cranio 2014; 22:181-91. [PMID: 15293775 DOI: 10.1179/crn.2004.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Evidence has been accumulating linking subjective tinnitus to the somatosensory system. Most subjective tinnitus patients can change the psychoacoustic attributes of their tinnitus with forceful head and neck contractions. This study assessed the significance of such somatic modulation of tinnitus by testing nonclinical subjects. Like tinnitus patients, about 80% of nonclinical subjects, who had ongoing tinnitus at the time of testing (whether or not they were previously aware of it), could modulate their tinnitus with head and neck contractions. Over half of those with no tinnitus at the time of testing could elicit a tinnitus-like auditory perception with head and neck contractions. The finding that forceful head and neck contractions, as well as loud sound exposure, were significantly more likely to modulate ongoing auditory perception in people with tinnitus than in those without tinnitus supports the concept of a neural threshold for tinnitus. Somatic influences upon auditory perception are not limited to tinnitus sufferers but appear to be a fundamental property of the auditory system.
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Affiliation(s)
- Mark D Abel
- Department of Oral and Maxillofacial Surgery, Philadelphia, PA 19104, USA.
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Han L, Zhaohui L, Fei Y, Ting L, Pengfei Z, Wang D, Cheng D, Pengde G, Xiaoyi H, Xiao W, Rui L, Zhenchang W. Abnormal baseline brain activity in patients with pulsatile tinnitus: a resting-state FMRI study. Neural Plast 2014; 2014:549162. [PMID: 24872895 PMCID: PMC4020302 DOI: 10.1155/2014/549162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/10/2014] [Accepted: 04/06/2014] [Indexed: 02/07/2023] Open
Abstract
Numerous investigations studying the brain functional activity of the tinnitus patients have indicated that neurological changes are important findings of this kind of disease. However, the pulsatile tinnitus (PT) patients were excluded in previous studies because of the totally different mechanisms of the two subtype tinnitus. The aim of this study is to investigate whether altered baseline brain activity presents in patients with PT using resting-state functional magnetic resonance imaging (rs-fMRI) technique. The present study used unilateral PT patients (n = 42) and age-, sex-, and education-matched normal control subjects (n = 42) to investigate the changes in structural and amplitude of low-frequency (ALFF) of the brain. Also, we analyzed the relationships between these changes with clinical data of the PT patients. Compared with normal controls, PT patients did not show any structural changes. PT patients showed significant increased ALFF in the bilateral precuneus, and bilateral inferior frontal gyrus (IFG) and decreased ALFF in multiple occipital areas. Moreover, the increased THI score and PT duration was correlated with increased ALFF in precuneus and bilateral IFG. The abnormalities of spontaneous brain activity reflected by ALFF measurements in the absence of structural changes may provide insights into the neural reorganization in PT patients.
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Affiliation(s)
- Lv Han
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Liu Zhaohui
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yan Fei
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li Ting
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Zhao Pengfei
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Du Wang
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Dong Cheng
- 2Department of Radiology Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guo Pengde
- 1Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Han Xiaoyi
- 2Department of Radiology Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wang Xiao
- 2Department of Radiology Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li Rui
- 2Department of Radiology Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wang Zhenchang
- 2Department of Radiology Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- *Wang Zhenchang:
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Kim BG, Bang MY, Kim DH, Moon IS. Tinnitus related to eyelid blinking. Auris Nasus Larynx 2012; 40:518-20. [PMID: 23260344 DOI: 10.1016/j.anl.2012.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/16/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
Abstract
Tinnitus can be generated by various causes, including vascular or myogenic factors and sensorineural auditory structures. Tinnitus due to repetitive contraction of the paraauditory muscles is a rare condition. We present a case of bilateral tinnitus concomitant with eyelid blinking. Otoscopy revealed normal tympanic membranes; however, inward movement of the tympanic membrane was visible whenever the patient blinked. Long-time-based tympanometry measuring static compliance revealed a cogwheel or saw-toothed pattern associated with movement of the tympanic membrane related to eyelid blinking. The patient was managed with pharmacological treatment combined with assurance and was relatively well controlled.
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Affiliation(s)
- Bo Gyung Kim
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, Republic of Korea
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17
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Abstract
OBJECTIVE To describe 2 patients presenting with idiopathic tinnitus concomitant with eye closure. STUDY DESIGN Clinical capsule report. SETTING University hospital. PATIENTS Two patients presented with intermittent tinnitus synchronous with eye closing or blinking. Otoscopic examination revealed inward movement of tympanic membranes concomitantly with eye blinking or eye closure in 1 patient. Neither patient had facial nerve disease or myoclonus. INTERVENTIONS Compliance in impedance audiometry was recorded. RESULTS Compliance in impedance audiometry was reduced during eye blinking and eye closure in both cases. The tinnitus was attributed to muscular tinnitus via stapedial muscle contraction during eye closure. CONCLUSION These are the rare 2 reported patients presenting with idiopathic muscular tinnitus concomitant with eye closure. The reductive change of compliance in impedance audiometry during tinnitus coincident with eye closure is a feature of this form of tinnitus. We suggest evaluation of compliance change in impedance audiometry to be a key examination in patients with stapedial muscular tinnitus concomitant with eye closure.
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Affiliation(s)
- Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama, Japan.
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18
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Bhimrao SK, Masterson L, Baguley D. Systematic Review of Management Strategies for Middle Ear Myoclonus. Otolaryngol Head Neck Surg 2012; 146:698-706. [DOI: 10.1177/0194599811434504] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. Middle ear myoclonus is a rare condition with distinct characteristics at presentation. Diagnosis is based primarily on history, clinical examination, and long-time-based tympanometry. No consensus exists regarding treatment at present. This review was designed to identify relevant studies on current investigation and management. Data Source. A systematic electronic literature search of MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Trials register, and Web of Science was conducted for articles describing middle ear myoclonus through to May 2011. English- and non-English-language articles that focused on investigation and treatment were considered for review. Review Method. Two authors independently reviewed the articles for study design, treatment, intervention, and outcome. Data from human and experimental studies were considered. Results. A total of 21 articles were identified for this review. Most studies were found to be case reports or small case series. In general, there was no evidence of a conclusive diagnostic test or treatment for middle ear myoclonus. Conclusion. There is a need for high-quality prospective controlled trials to determine the most effective management of middle ear myoclonus. The authors describe a treatment algorithm based on the data available and clinical knowledge.
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Affiliation(s)
- Sanjiv Kumar Bhimrao
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David Baguley
- Audiology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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19
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20
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Chien HF, Sanchez TG, Sennes LU, Barbosa ER. Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor. Parkinsonism Relat Disord 2006; 13:254-6. [PMID: 16828572 DOI: 10.1016/j.parkreldis.2006.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
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Affiliation(s)
- Hsin Fen Chien
- Movement Disorders Clinic, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
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21
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Abstract
In very rare cases, acute hearing loss can be caused by a fractured long process of the malleus. Such fractures can be due to head traumas, direct injuries of the tympanic membrane or barotraumas. Clinical findings are: abnormal mobility of the manubrium mallei during the Valsalva maneuvre or pneumomassage of the ear drum, conductive hearing loss, abnormal high compliance in the type A tympanigram. We report on a 48 year old female patient who showed typical symptoms and clinical findings, and discuss possible pathogenic factors. In accordance with the literature, we presume that negative pressure in the external ear canal, caused by a rapidly extracted finger (!), might be responsible. At the very onset of hearing loss, the patient noticed a high frequency tinnitus in the affected ear. Surgically, we tried to re-fix the manubrium by splinting it and the adherent parts of the tympanic membrane with cartilage.
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Affiliation(s)
- C Punke
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie Otto Körner der Universität Rostock.
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22
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Pau HW, Punke C, Zehlicke T, Dressler D, Sievert U. Tonic contractions of the tensor tympani muscle: a key to some non-specific middle ear symptoms? Hypothesis and data from temporal bone experiments. Acta Otolaryngol 2005; 125:1168-75. [PMID: 16243741 DOI: 10.1080/00016480510012408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS The results of this study show that in clinical practice it will not be easy to diagnose tonic contractions of the tensor tympani muscle and only a combination of findings will be helpful. Based on these experimental results a clinical study will be started which should clarify the diagnostic relevance of indicators of tonic tensor muscle contractions. OBJECTIVES There are indications from the literature and from personal experience that tonic contractions of the tensor tympani muscle may play a role in some ear symptoms, such as fullness, certain cases of tinnitus, slight hearing loss or Ménière's disease-like findings. In order to prove this theory we looked for indicators, either visual or functional, to help clinically diagnose the functional state of the muscle, particularly its tonic contraction. MATERIAL AND METHODS Experiments simulating tensor contractions were carried out on temporal bone specimens. Traction was applied either to the isolated muscle, to its tendon or to the malleus neck. Effects were observed either visually via an endoscope or by impedance audiometry using multiple-frequency tympanometry. RESULTS During simulated tensor traction the aspect of the tympanic membrane changed slightly, i.e. there was some inward movement of the umbo. However, such effects were only identifiable during the pulling action or by directly comparing the "contracted" and "relaxed" states. Tympanometry revealed a decrease in the peak amplitudes and a shift in the middle ear resonance towards higher frequencies during contractions.
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Affiliation(s)
- Hans Wilhelm Pau
- Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Halschirurgie, Rostock, Germany.
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23
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Henson MM, Madden VJ, Rask-Andersen H, Henson OW. Smooth muscle in the annulus fibrosus of the tympanic membrane in bats, rodents, insectivores, and humans. Hear Res 2005; 200:29-37. [PMID: 15668036 DOI: 10.1016/j.heares.2004.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Accepted: 09/09/2004] [Indexed: 10/26/2022]
Abstract
The annulus fibrosus and its attachment to the bony tympanic ring were studied in a series of mammals. In the pallid bat, Antrozous pallidus, there is an extensive plexus of large interconnected blood sinuses in the part of the annulus that borders the tympanic bone. The spaces between the sinuses are packed with smooth muscle cells. Most of the cells have a predominately radial orientation; they extend from the bony tympanic sulcus to a dense collagenous matrix (apical zone) where radially oriented fibers of the pars tensa are confluent with the annulus. The muscles and vessels constitute a myovascular zone. A structurally similar myovascular zone is also present in the European hedgehog. In rodents, the annulus lacks the large interconnected blood sinuses but many small vessels are present. Smooth muscle is concentrated in the broad area of attachment of the annulus to the tympanic bone. In the gerbil, smooth muscle seems to be concentrated in the central part of the width of the annulus where it is attached to bone and radiates toward the tympanic membrane. In humans collections of radially oriented smooth muscle cells were found in several locations. The smooth muscle in all species studied appears to form a rim of contractile elements for the pars tensa. This arrangement suggests a role in controlling blood flow and/or creating and maintaining tension on the tympanic membrane.
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Affiliation(s)
- M M Henson
- Department of Otolaryngology, The University of North Carolina, Chapel Hill, NC 27599, USA
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24
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Abstract
Myoclonus presents as a sudden brief jerk caused by involuntary muscle activity. An organisational framework is crucial for determining the medical significance of the myoclonus as well as for its treatment. Clinical presentations of myoclonus are divided into physiological, essential, epileptic, and symptomatic. Most causes of myoclonus are symptomatic and include posthypoxia, toxic-metabolic disorders, reactions to drugs, storage disease, and neurodegenerative disorders. The assessment of myoclonus includes an initial screening for those causes that are common or easily corrected. If needed, further testing may include clinical neurophysiological techniques, enzyme activities, tissue biopsy, and genetic testing. The motor cortex is the most commonly shown myoclonus source, but origins from subcortical areas, brainstem, spinal, and peripheral nervous system also occur. If treatment of the underlying disorder is not possible, treatment of symptoms is worthwhile, although limited by side-effects and a lack of controlled evidence.
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Affiliation(s)
- John N Caviness
- Mayo Clinic College of Medicine, Parkinson's Disease and Other Movement Disorders Center, Scottsdale, Arizona 85255, USA.
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25
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Abstract
Myoclonus of the middle ear is a very rare condition. We present the case of a 20-year-old soldier who was exposed to intense artillery noise during a fierce battle and immediately afterward complained of an incapacitating tinnitus in both ears. Microscopic examination of the ears demonstrated rapid rhythmic movements of the tympanic membrane coinciding with the tinnitus, which was also easily heard by the examiner. There was no evidence of palatal myoclonus, and thus the diagnosis of middle ear myoclonus was made. Exploratory tympanotomy confirmed the diagnosis of stapedial muscle myoclonus. Bilateral sectioning of the stapedial tendons brought immediate relief of the tinnitus to the patient. We review the literature of middle ear myoclonus and discuss the symptoms, evaluation, and management of this rare condition.
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Affiliation(s)
- Avishay Golz
- Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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26
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Cohen D, Perez R. Bilateral myoclonus of the tensor tympani: a case report. Otolaryngol Head Neck Surg 2003; 128:441. [PMID: 12646854 DOI: 10.1067/mhn.2003.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- David Cohen
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
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27
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Bertholon P, Convers P, Antoine JC, Mayaud R, Prades JM, Michel D, Martin C. Objective tinnitus associated with essential laryngeal myoclonus: report of two cases. Mov Disord 2002; 17:218-20. [PMID: 11835471 DOI: 10.1002/mds.1277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report on two patients with an objective tinnitus. In the first one, the objective tinnitus was unique as it was due to bilateral rhythmic contractions of the vocal cords. In the second, the objective tinnitus arose from Eustachian tube contractions and was associated with up and down movements of the larynx. In both patients, the abnormal laryngeal movement shared most of the characteristics of palatal or palatolaryngeal myoclonus and was thought to be laryngeal myoclonus. Its origin remained essential as all the investigations were negative.
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Affiliation(s)
- Pierre Bertholon
- Department of Otolaryngology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
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28
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Abstract
OBJECTIVE To discuss the various symptoms and causes of objective tinnitus in children. STUDY DESIGN Retrospective case review. PATIENTS Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma. MAIN OUTCOME MEASURE The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner. RESULTS Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus. CONCLUSION The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.
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Affiliation(s)
- M H Fritsch
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5230, USA
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