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Tinnitus and myoclonus

OBJECTIVE tinnitus with palatal myoclonus was already described more than a century ago by Bigelow and Holmes. Up to 1961 Pulec and Simonton (6) collected 170 cases from the literature. Objective tinnitus: a noise, a murmur or clicking coming from a patient's ear and audible for the examiner, is relatively rare. Part of the case occurs with palatal myoclonus, sometimes called clonical spasm or palatal nystagmus. Another part is caused by murmurs of the arteriovenous anastomoses or aneurysms somewhere nearby the ear. Fowler (3) divides the tinnitus into vibratory and non-vibratory. To the vibratory form belong the muscular, vascular and mucous sounds. These are objectively audible. To the non-vibratory tinnitus belong those noises as found with otosclerosis, labyrinthitis, middle ear processes and irritations of the acoustic nerve. These are only subjectively audible and generally continuous. A tinnitus can be temporary, continuous, rhythmic, irregular, soft or loud. The characteristics of the vibratory tinnitus are dependent on the origin of the sound. The tinnitus that occurs with palatal myoclonus need not be equal in frequency to the number of contractions of the clonus. According to some authors this tinnitus is caused by muscular contraction (muscle sound) of the stapedius muscle, or of the tensor tympani muscle or of the bigger muscles of the Eustachian tube (tensor veli palatini muscle and levator palatini muscle).