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Post by Lisa on Jan 20, 2004 11:57:08 GMT -5
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Post by arthur on Jan 26, 2004 12:06:06 GMT -5
Sorry. I was very busy the last couple of days.
No, he is at Mass General in Boston. Will get back to you more on this.
Check also these articles
"R A Levine, Diagnostoc Issues in Tinnitus: a Neuro-otological Perspective"
"Tinnitus
Alan H. Lockwood, M.D., Richard J. Salvi, Ph.D., and Robert F. Burkard, Ph.D."
"Marja Estola-Partanen, Muscular Tension and Tinnitus"
"Robert Trotic et al, Tinnitus State of the Art ..."
"Gordon Shields, Tinnitus Grand Rounds .."
This following next is a good summary I believe I copied from one of the articles, but I don't have the exact source.
Palatomyoclonus
The myoclonus form of tinnitus is described as an irregular clicking sound heard within the ear. The sound is rapid (20 to 400 beats per minute) and occurs intermittently. It is caused by the mucous membranes of the eustachian tube snapping together in response to the movement of the palatal musculature. Patients may also complain of fullness in the ear and distortion of hearing, and may have histories of other muscle spasm, including postoccipital spasm, temporomandibular joint problems, and blepharospasm. Diagnosis is made by auscultating the ear canal with a Toynbee tube for audible clicking.
Tympanogram may show recording movement synchronous with the contraction, and electromyographic studies of the palatal musculature may confirm the diagnosis. Observable palatal fasciculation is associated with a CNS lesion in which there is hypertrophic degeneration of the inferior olive; these patients warrant an MRI to search for this lesion. Palatomyoclonus must be differentiated from tensor tympani spasm, which will have similar symptoms and findings except without palatal muscle contraction; tensor tympani spasm is usually transient. Treatment of palatomyoclonus initially consists of medications that include muscle relaxants such as clonazepam or diazepam, warm liquids, and stress management. Botulinum toxin injection into the active muscle may help in severe cases.2,4
Idiopathic stapedial muscle spasm
This condition, in contrast to palatomyoclonus, tends to be a rough, rumbling, or crackling noise often accentuated or triggered by external noises such as voices, rattling of paper, or running water. The symptoms generally follow this exposure, are brief and intermittent, and rarely become disruptive and prolonged. Diagnostic studies include variable-intensity tympanometry in an effort to stimulate the spasm and aid diagnosis, and acoustic reflex testing which may demonstrate a prolonged, continued increased impedance during and after the sound stimulus.5 Primary treatment consists of muscle relaxants, clonazepam or diazapam. Because the symptoms may last only 2 or 3 months and then disappear for long periods, the use of surgery to divide the stapedius tendon should be used very conservatively.4
Ojective tinnitus also has nonvascular sources. Unilateral sounds may be associated with debris against the tympanic membrane. Crackling sounds following an upper respiratory infection may represent a resolving middle ear space effusion or eustachian tube dysfunction. Crunching sounds may reflect temporomandibular joint dysfunction. Rhythmic clicking can be associated with voluntary or involuntary muscular contractions of middle ear and eustachian tube structures and, rarely, palatal myoclonus. Reports of echoing sounds, distortion of one's own voice (autophonia) and recent weight loss suggest a patulous eustachian tube. Spontaneous oto-acoustic emissions, thought to be produced by vibrating cochlear hair cells, are considered a relatively rare type of objective tinnitus. Treatment of objective tinnitus depends upon identifying and modifying the underlying condition (Levine, 2000).
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