Clinical characteristics and therapeutic response of objective tinnitus due to middle ear myoclonus: a large case series

Objectives/hypothesis: To evaluate the clinical characteristics and therapeutic response of tinnitus due to middle ear myoclonus (MEM) and to suggest appropriate diagnostic methods.

Study design: Retrospective chart review.

Methods: This study included 58 patients with tinnitus diagnosed with MEM, who were seen from January 2004 to July 2011. Clinical and audiological characteristics were investigated. The therapeutic responses to counseling, medical therapy, and surgical therapy were evaluated.

Results: Patients had a mean age of 29.8 years (range, 6-70 years), 20.7% (n = 12) were <10 years old, 39.7% (n = 23) were <20 years old, 74.1% (n = 43) were <40 years old, and 5.2% (n = 3) were ≥60 years old. Remembered stressful events or noise exposure were associated with the onset of MEM in 51.8% (n = 30) and 27.6% (n = 16) of patients, respectively. The most frequent nature of the tinnitus was a crackling sound. MEM associated with forceful eyelid closure was observed in 15% of patients. Impedance audiogram and otoendoscopic examinations of the tympanic membrane were helpful tools for diagnosing MEM. With medical therapy, more than 75% of patients exhibited complete or partial remission of their tinnitus. Patients with intractable MEM who underwent sectioning of the middle ear tendons had very good outcomes.

Conclusions: Tinnitus due to middle ear myoclonus seems to occur in young patients and to be related to stress or noise. Information about the clinical characteristics and therapeutic response of this less-common type of tinnitus will help to ensure early and appropriate diagnosis and treatment of these patients.

Level of evidence: 4.