Long-Term Effects of Middle Ear Tendon Resection on Middle Ear Myoclonic Tinnitus, Hearing, and Hyperacusis

Abstract

Objective: To evaluate the therapeutic effects of middle ear tendon resection (METR) on middle ear myoclonic tinnitus (MEMT) and to investigate its long-term effects on hearing and hyperacusis. Materials and Methods: Thirty-seven patients with MEMT with a mean age of 33.2 ± 11.8 years were included in this study. METR was performed on all 37 MEMT patients (41 ears) between November 2004 and August 2016. The mean follow-up period was 16.1 months. We examined changes in tinnitus and accompanying stress and depression in patients after surgery, and examined the hearing changes and the occurrence of complications including hyperacusis. Results: After surgery, 34 (91.9%) patients exhibited complete resolution of MEMT during their follow-up period, and 3 patients showed a partial response. The mean Visual Analog Scale (VAS) scores for tinnitus severity, the Tinnitus Handicap Inventory (THI), and stress index decreased significantly after surgery (p < 0.05, paired t test). No patient developed hearing loss or hyperacusis following surgery. Preexisting hyperacusis even improved in most of the patients with intractable MEMT after surgery. Recurrence of the symptom occurred in only 1 patient, who underwent revision surgery with improvement. We observed 1 case of postoperative delayed facial palsy with complete recovery in 2 weeks. Conclusions: METR seems to be an effective and safe treatment option for intractable MEMT, considering its high control rate of tinnitus and no long-term harmful effects on hearing and hyperacusis.

Tinnitus Concomitant With Eye Closure Treated by Tensor Tympani Tendon Resection and Cartilage Block Insertion

“…2 If conservative therapy fails, METR could be considered. [1][2][3] Park et al reported that 92% of the patients showed complete resolution after METR in their large case series. 3 To prevent recurrence due to incomplete resection or reattachment of the resected margin, they adopted a weak cauterization of the section site using the specially designed tip.…”

“…[1][2][3] Park et al reported that 92% of the patients showed complete resolution after METR in their large case series. 3 To prevent recurrence due to incomplete resection or reattachment of the resected margin, they adopted a weak cauterization of the section site using the specially designed tip. 3 However, there is a possible risk of thermal injury to the facial nerve with electrocauterization; therefore, a laser may be an alternative.…”

“…2 In patients with intractable MEM, middle ear tendon resection (METR) is a treatment of choice with a high success rate. 3 However, reattachment of the resected tendon can occur in the healing process. 3 Herein, we present the first report of an MEM concomitant with eye blinking treated by resection of the tensor tympani tendon and the cartilage block insertion, which can prevent a recurrence.…”

“…4 The perturbations on the acoustic reflex decay test and inspection of the tympanic membrane using an endoscope or microscope are the most reliable diagnostic tools. 1,3 In the case of newly developed MEM, the brain magnetic resonance imaging should be performed because the lesion of brainstem or cerebellum may be the cause. 2,4 For treatment, medications (muscle relaxant, anxiolytics, and anticonvulsants) are often used as the first therapeutic option.…”

“…3 To prevent recurrence due to incomplete resection or reattachment of the resected margin, they adopted a weak cauterization of the section site using the specially designed tip. 3 However, there is a possible risk of thermal injury to the facial nerve with electrocauterization; therefore, a laser may be an alternative. 3 Nevertheless, the problem is that not all clinics have specially designed tips or laser systems.…”