This tinnitus is intermittent and has a staccato quality 'like a typewriter in the background, pop corn, Morse code'. It is responsive to carbamazepine. In our view, this clinical picture would be difficult to distinguish from stapedius myoclonus without careful clinical examination. TT myoclonus should be associated with a visible displacement of the ear drum during the sound.
Stapedius myoclonus should be audible to the examiner, also one should be able to record it from an external ear microphone and it should be higher pitched. We do not know of anyone who has reported this however. Surgery to cut the muscle is effective, and is used as a last resort. According to Bhimrau et al , the facial nerve is often damaged during this sort of surgery. However, it is generally successful in stopping the myoclonus.
A recent report suggested using Botox to paralyze the muscles Liu et al, Botox can be injected into the wall of the eustachian tube. Of course, the TT is a small muscle and thus only a small amount of Botox is needed Botox, sold by Allergan, is extremely expensive. This treatment seems reasonable, except that one needs an individual to administer the Botox who has a very good understanding of the anatomy of the TT to administer the injection, and also Botox wears off in 3 months. Treatment of these muscle spasm syndromes is usually reassurance.
Tinnitus coping strategies of counselling, relaxation and anxiety reduction are standard practice. Hypnosis, sedatives, psychotherapy, acupuncture, biofeedback have been attempted -- as this type of tinnitus is somewhat related to stress, these strategies are sometimes helpful. As can be seen, very little treatment has been reported. While the logic of reducing muscle spasm through medication is reasonable, we ourselves have not had success. It seems to us that the TT muscle requires considerable local irritation to develop myoclonus, and medications that affect the whole body are unable to reduce such intense local spasms.
Although masking has been reported effective East et al, , it is difficult to see a reasonable rationale, and we suspect this is a placebo. Pharyngeal muscle tone alteration, swallowing, Valsalva, and grommet insertion are not effective Badia et al, We are similarly dubious that manual compression of the face as reported by Chan and Palaniappan has any general utility as it would seem to us that any relief would be necessarily brief.
What is needed is a method of selectively weakening these muscles through drops administered through a ventilation tube or grommet. Alternatively, a method of causing a longer paralysis of the TT than can be obtained using Botox. Attacking the reflex at the neural level would also seem possible -- perhaps a method of cutting the nerve to the TT muscle. Hain, MD. Anatomy of the tensor tympani and stapedius Stapedius and Tensor Tympani Muscles Cartoon of the middle ear showing muscles that attach to ossicles ear bones , and ear drum.
The stapedius is attached to the stapes of course -- horseshoe object above , while the tensor tympani is attached to the ear drum. While useful, be aware that there are multiple errors in this illustration from Loyola Medical School. On the other hand, the tensor tympani may be activated by: Tactile stimulation of EAC and face Klockhoff, ; Klockhoff and Anderson, Pneumatic pressure on eyelids Klockhoff and Anderson, , Sudden forced opening of closed eyelids Terkildsen, , or forced closing of eyelids Kaffenberger et al, Borg et al, Disorders of the tensor tympani The tensor tympani syndrome is uncommon.
Diagnosing TT myoclonus. Another middle ear tinnitus - -stapedius myoclonus syndrome. Rhythmic changes in impedance of the middle ear. Each bump was correlated with a high-pitched "tic" that can be heard from the outside, due to stapedius myoclonus. Click below to play recording of stapedius myoclonus. Your browser does not support the audio element. Treatment of TT myoclonus that may work. Treatments of TT myoclonus that probably don't work.
Medications responses were reported by Bhimrau et al Benzodiazepines too much sedation orphenadrine Norflex carbamazepine piracetam one patient botulinum toxin one patient, gelfoam in middle ear As can be seen, very little treatment has been reported. Treatments of TT myoclonus that we wish someone would develop What is needed is a method of selectively weakening these muscles through drops administered through a ventilation tube or grommet. References: Abdul-Baqi KJ. Objective high frequency tinnitus of middle-ear myoclonus.
J Laryngol Otol. Management of middle ear myoclonus. Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle. Continuous high frequency objective tinnitus caused by middle ear myoclonus. Ear Nose Throat J. Bhimrao, S. Borg, E. Theories of middle ear muscle ftmctions.
The acoustic reflex: Basic principles and clinical applications. Transitory stapedial myoclonus in a patient with benign fasciculation syndrome. Epub Mar Caviness, J. Chan CC, Palaniappan R. Int Tinnitus J. The suppression of palatal or intratympanic myoclonus by tinnitus masking device.
Palatal botulinum toxin as a novel therapy for objective tinnitus in forced eyelid closure syndrome. Anderson Klockhoff, I. A clinical and experimental study with special reference to diagnostic problems in hearing impairment. Levine, R. Botox transient treatment of tinnitus due to stapedius myoclonus: case report. Clin Neurol Neurosurg. These muscles can be a source of tinnitus. The cavity that contains the ossicles middle ear is connected to the throat through the Eustachian tube, and to the mastoid sinus.
When the ossicles are broken, missing, or otherwise not functional, hearing can be reduced by a large amount for "air" conduction, but hearing through the bone is unaffected.
This type of hearing loss is called a " conductive" hearing loss. As a general rule, conductive hearing loss can be surgically fixed, as the ossicles can be replaced with a prosthesis. In addition, bone-conduction type hearing devices can bypass the middle ear and also "fix" a conductive hearing loss, although these require some sort of device to be attached to the head.
As a general rule, ossicular problems are not associated with dizziness, but rather are associated with hearing loss or tinnitus. Ossicles Timothy C. Stapedius and Tensor Tympani Muscles Cartoon of the middle ear showing muscles that attach to ossicles ear bones , and ear drum.
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