Palatal myoclonic tinnitus (PMT) is a rare condition caused by rhythmic voluntary or involuntary movements of the soft palate, mainly the tensor veli palatini and levator veli palatine muscles. Patients usually present with a ‘clicky’ noise in the ear. Oral or nasal endoscopy showing rhythmic contraction of the palatal muscles is a main diagnostic clue to PMT. Management includes reassurance, behavioural therapy, and use of oral systemic medications with anticholinergics, anxiolytics. Botulinum toxin injection into the palatal muscles is used in intractable cases. The senior author reports his 15 years’ experience in managing this rare condition. In his series of 54 patients diagnosed with PMT, he used Visual Analog Scales (VAS) of tinnitus annoyance, awareness, loudness, and effect on life, Tinnitus Handicap Inventory (THI), Brief Encounter Psycho-Social Instrument (BEPSI), and Beck’s Depression Inventory (BDI) scores for evaluation and assessment at each point of follow-up. The author reports complete resolution in 25% of patients to reassurance and behaviour therapy, 44% to systemic medications and the remaining one third of patients to Botulinum toxin injections. This is a useful paper to read as it outlines a systematic approach to manage this rare condition. This is the longest series published in the literature. It would have been be useful if the senior author had included the long-term outcome of these patients.
Stepwise approach to manage palatal myoclonus successfully
Reviewed by Sangeeta Maini & Bhaskar Ram
Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study.
CONTRIBUTOR
Sangeeta Maini
FRCS ORL-HNS, Aberdeen Royal Infirmary, Forresterhill, Aberdeen, AB25 2ZN.
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