Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor

Abstract Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have a...

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Bibliographic Details
Published in:Parkinsonism & related disorders 2007-05, Vol.13 (4), p.254-256
Main Authors: Chien, Hsin Fen, Sanchez, Tanit Ganz, Sennes, Luiz Ubirajara, Barbosa, Egberto Reis
Format: Article
Language:English
Subjects:
Adult
Botulinum toxin
Botulinum Toxins, Type A - therapeutic use
Drug Administration Routes
Female
Hearing Disorders - drug therapy
Hearing Disorders - etiology
Hearing Disorders - pathology
Humans
Nasal Cavity
Neurology
Neuromuscular Agents - therapeutic use
Palatal Muscles - drug effects
Palatal Muscles - physiopathology
Palatal tremor
Tinnitus
Tremor - complications
Tremor - drug therapy
Tremor - pathology
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Summary:Abstract Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
ISSN:1353-8020
1873-5126
DOI:10.1016/j.parkreldis.2006.05.004