Middle ear myoclonus associated with forced eyelid closure in children: Diagnosis and treatment outcome

Abstract

FECS is a rare clinical entity and can be easily missed in routine clinical examination. We suggest that patients, especially children, with clicking or crackling tinnitus should be evaluated for FECS using proper diagnostic tools. A possible mechanism of FECS in children postulated from our case review is suggested.

Objective Tinnitus

“…Tinnitus secondary to middle ear myoclonus is very rare, and consequently there are very few reports of it in the English literature [8][9][10][11][12]. It has been suggested that the crackling or buzzing sounds reported are caused by repetitive and abnormal tensor tympani and stapedial muscles contractions [11].…”

“…It has been suggested that the crackling or buzzing sounds reported are caused by repetitive and abnormal tensor tympani and stapedial muscles contractions [11]. These myoclonic movements are thought to be a form of segmental myoclonus involving brainstem innervated muscles.…”

“…These myoclonic movements are thought to be a form of segmental myoclonus involving brainstem innervated muscles. Vascular, infectious and demyelinating disorders as well as anxiety, trauma and neoplastic disease have all been implicated in the etiology of segmental myoclonus [9,11,12]. In a previous report of the largest case series of middle ear myoclonus, 58 enrolled patients had a mean age of 29.8 years (range, 6-70 years) and 20.7% (n=12) were less than 10 years old [12].…”

Palatal botulinum toxin as a novel therapy for objective tinnitus in forced eyelid closure syndrome

“…Forced eyelid closure syndrome (FECS) is an exceedingly rare form of objective tinnitus, with only 11 cases reported in the literature since 1983 . Objective tinnitus is often associated with underlying pathologies such as myogenic dysfunction, vascular abnormalities, temporomandibular joint disease, and patulous Eustachian tube dysfunction .…”

“…Objective tinnitus is often associated with underlying pathologies such as myogenic dysfunction, vascular abnormalities, temporomandibular joint disease, and patulous Eustachian tube dysfunction . Myogenic objective tinnitus is thought to result from abnormal contractions of the palatal and middle ear muscles, namely the tensor veli palatini, stapedius, and/or tensor tympani muscles . Palatal tremor and middle ear myoclonus (palatal tinnitus) are more common causes of myogenic objective tinnitus but lack the involvement of the periorbital muscles seen in FECS .…”