腭肌电图引导下治疗腭肌阵挛性耳鸣

目的 观察腭部肌电图引导下注射A型肉毒毒素治疗腭肌阵挛性耳鸣的临床疗效。方法 回顾双侧腭肌阵挛性客观性耳鸣患者资料3例,先将一次性使用肉毒毒素电极针通过鼻内镜辅助分次经鼻腔插入腭帆张肌起始部位、腭帆提肌起始部位、腭帆提肌终止部位,再通过肌电图的引导来确定注射点,注射A型肉毒毒素,每个注射点各注射5U,共30U。复诊至注射后6个月,观察治疗效果及不良反应。 结果 ①疗效:3例患者分别在注射后26、25、28 h耳鸣完全消失。注射后5个月内每月行鼻内镜、腭肌电图、声导抗检查均未见阳性表现。注射后6个月,仅有1名患者复发单侧耳鸣。②不良反应:随耳鸣逐渐消失出现开放性鼻音、轻度鼻腔反流及轻度耳闷感。治疗后约2周不良反应消失。结论 腭肌电图在A型肉毒毒素注射过程中能够精确定位靶肌肉注射点,延长药效作用时间,减少不良反应,取得了良好疗效。     

咽鼓管导声测量法应用于客观耳鸣和腭肌阵挛研究——一种证明咽鼓管开放法

腭肌阵挛引起一耳或两耳客观性耳鸣已是众所周知。早在1862年Politzer首先描述了这种耳鸣,认为它是由咽鼓管肌肉阵挛所引起。晚近又出现了更多关于耳鸣起因的理论。一些学者认为耳鸣是由鼓膜张肌、镫骨肌、腭帆张肌、腭帆提肌收缩所致;还有人(Pulee和Simonson,1961)认为引起耳鸣的原因是咽鼓管本身的节律性开放与关闭。作者通过腭肌阵挛伴有客观性耳鸣的3例病人的咽鼓管导声测量,对客观性耳鸣的起因进行探讨。这3例病人都做了纯音测听、阻抗测听、听反射及听反射衰减检查,其中2例还做了电反应测听。上述检查     

腭肌阵挛与他觉性耳鸣

肌阵挛为肌肉或肌肉群短时的、相继的、痉挛性的、不自主的收缩。常见于四肢及躯干,两侧对称,但亦可单独累及部份肌肉(如软腭),称之为腭肌阵挛(palatal myoclonus)或腭肌震颤(palatal nystagmus),此病临床少见,Pulec等(1961)在以往文献中只找到170例。腭肌阵挛的临床特征为腭部肌群单侧或双侧节律性收缩,频率每分钟50—240次,有时波及咽弓及咽侧壁,少数病例还可延及咽、喉、眼及横隔,称之为腭-咽-喉-眼-横隔肌阵挛。腭肌阵挛常出现耳鸣及他觉性耳鸣。本文报导两例并加以讨论。     

腭肌阵挛性客观性耳鸣一例并文献复习

咽鼓管周围的肌肉阵挛尤其是腭部肌肉阵挛(palatal myoclonus,PM)多可导致客观性耳鸣(palatalmyoclonus objective tinnitus,PMOT),其发病率非常低,常常容易被漏诊和误诊,而且治疗较为困难。国内外,相关的临床病例报道少见,尤其是手术治疗的病例国内未见报道。我科最近收治1例,并经腭帆张     

用Carbamazepine治疗客观肌阵痉性耳鸣

约在一个世纪以前Bigelow等首先报告肌阵痉伴有客观耳鸣。其后陆续报道共200多例。外部听到的音响多认为来源于镫骨肌、鼓膜张肌、腭帆张肌、腭帆提肌收缩的结果,或与咽鼓管开闭有关。客观性耳鸣诊断并不困难,但肌阵痉却不易看到。其节律多数为1—2次/秒,但也并不尽相同。音响用声阻抗能够测出,每音响一次在基线上出现一次高峰,表示鼓膜活动一次。裸眼看不到腭肌阵痉,而用肌电图将电极放入鼻咽部可记录出腭肌的活动情况。如确定腭肌有阵痉现象,则应针对腭肌进行治疗,分离镫骨肌和鼓膜张肌无效。     

咽鼓管周围肌阵挛引起的客观性耳鸣

肌源性客观性耳鸣的病因是咽鼓管或鼓室的肌肉阵挛,为锥体外系病变所致,常有橄榄核肥大或假性肥大以及小脑的改变。从病理生理角度来看肌阵挛是较高级的神经中枢对延髓网状结构抑制减弱或解除所致,也有人认为是5羟色胺系统功能下降。大多数的肌源性客观性耳鸣是所谓的“腭帆咽喉震颤”的一部分,是咽喉肌的波动性或摆动性非自主节律性运动,多为双侧性。     

肉毒杆菌毒素注射治疗腭肌阵挛

腰肌阵挛乃罕见的软聘或其他口咽部肌肉的不自主、不规则或节律性的快速收缩，每分钟可达40～240次，伴有同步的客观性耳鸣，常见受累肌为跨帆张肌和提肌，亦可累及鼓膜张肌、咽鼓管咽肌、咽上缩肌、面、喉、隔、前曾肌、常因耳鸣就诊。病因不明，常认为是齿状核及下橄榄核间、经红核通道的病损，表现为退变或微梗塞，曾用抗胆碱能、抗抑郁、抗痉挛药等治疗及手术凿断翼钩和切断腰肌治疗，因副作用多或疗效差，尚不令人满意。肉每杆菌毒素作用于神经肌肉接头前的突触部，抑制神经递质乙酸胆碱的释出，抑制作用靠毒素与突触前表面上受体发生…     

腭肌阵挛为他觉性耳鸣的一种原因

腭肌阵挛 ( PM)是一种由于不规则的腭肌痉挛收缩所引起的少见疾病。好发年龄为 4 0～ 70岁之间 ,肌肉阵挛频率约在 10～ 2 4 0次 /min,大多数 PM可引起不同程度的他觉性耳鸣 ,主要是由于咽鼓管闭合拍击造成的 ,即使睡觉或在全身麻醉时也不停止 ,有些病人则在发音和吞咽时有一过性停止。该作者通过对 5例PM(其中 1例经历 4个月后 ,PM自然停止 )和 1例能够随意产生 PM的病人进行全面体格检查及其疗效进行分析 ,并探讨了引起腭肌痉挛的发病机理以及腭肌痉挛与他觉性耳鸣的关系。 PM的产生被认为是由于Guillian- Mollaret三角 (肌阵挛三角…     

乙状窦骨壁缺失/憩室致他觉性搏动性耳鸣两例

搏动性耳鸣(pulsatile tinnitus ,PT )约占耳鸣患者的4％[1 ,2 ].临床中,偶见腭肌阵挛、鼓膜张肌阵挛等导致的搏动性耳鸣,乙状窦骨壁缺失或憩室导致的博动性耳鸣有较多文献报道,而他人也能听见的(他觉性)静脉源性搏动性耳鸣罕见[3～5 ].本文报告两例他觉性乙状窦骨壁缺失/憩室导致的搏动性耳鸣.     

他觉性咽鼓管性耳鸣二例报告

他觉性耳鸣是患者自己及检查者都能听到来自外耳道及其周围组织的声音。较少见。病因分为血管及肌肉型。前者是头颈部或颅底血管异常引起的高调耳鸣,后者是腭肌阵挛产生的“哒哒”声耳鸣。迄今认为“哒哒”声耳鸣与咽鼓管壁急剧靠在一起、张鼓膜肌及镫骨肌痉挛、咽鼓管开放有关。     

Objective tinnitus caused by myoclonus of the musculus tensor veli palitini

Objective tinnitus is often caused by palatal myoclonus. We report a 15 years old boy with objective tinnitus in both ears and palatal myoclonus. He had myorhythmic movements of both tensor veli palatini muscles asynchronous with the objective tinnitus. The frequency of the clonus was 120 contractions a minute. The myoclonus and the objective tinnitus disappeared after division of the bilateral tensor veli palatini muscles.     

Objective tubal tinnitus: a report of two cases

Two patients with objective tinnitus due to continuous tubal opening are presented. The objective tubal tinnitus was found to be due to clonic spasm of the muscles of the pharynx and eustachian tube and it can be easily differentiated by means of sonotubometry alone. The acoustic events occurring during the clicking sound were analyzed and were similar to the swallowing sound. Movements of the tympanic membrane were not seen in any of these ears. However, the close relationship of the tensor tympani and tensor palati muscles could explain the movement of the tympanic membrane in some cases. I believe that stapedius muscle spasm or a patulous tube as such does not cause the clicking sound, but it can occur in association with palatal myoclonus. The objective tubal tinnitus is heard as a result of the walls of the eustachian tube snapping together. Transection of the tensor veli palatini muscle tendon may be a useful method of treatment if the patient experiences objective tinnitus which is very distressing.     

Objective tinnitus secondary to palatal tremor: Two case reports and brief literature review

Objective tinnitus is defined as a type of tinnitus perceived by both the patient and external observer. This paper presents two cases of objective tinnitus related to palatal tremor, along with a literature review. Palatal tremor is a condition characterized by soft palate involuntary contractions. Two types of palatal tremor have been described: symptomatic palatal tremor and essential palatal tremor, with different clinical manifestations. Diagnostic workup is based on medical history and physical examination, including direct oropharynx exploration and cavum visualization through nasopharyngoscopy. Brain MRI is mandatory in all cases. If a secondary origin is suspected, additional lab tests should be performed based on clinical suspicion. First-line treatment is botulinum toxin injection into the levator veli palatini and tensor veli palatini muscles, with velopharyngeal insufficiency being its main adverse effect. Other medications have not been shown to be effective.     

Successful treatment of autophonia with botulinum toxin: case report

OBJECTIVES: We sought to treat autophonia due to a patulous eustachian tube using botulinum toxin. METHODS: Because we assumed that the patulous eustachian tube was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscles and salpingopharyngeus muscle), paralysis was performed via injection of botulinum toxin type A in a 45-year-old female professional musician who had had chronic unilateral autophonia for 20 years. In addition to a patient interview, an endoscopic examination of the nasopharynx (posterior rhinoscopy), ear microscopy, and impedance audiometry were performed to verify the diagnosis and the outcome after treatment. RESULTS: The autophonia disappeared 1 week after treatment. Normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months. CONCLUSIONS: The administration of botulinum toxin type A provides a new option in the treatment of patulous eustachian tube. The reliability of this method and the effect of repeated injections remains to be proved in future studies.     

Symptomatic palatal myoclonus with ear click after tick-borne meningoencephalitis

We present a case of a 39-year-old patient, who was diagnosed and treated for a tick-borne meningoencephalitis. Three months after the treatment he started to complain of annoying, cracks-resembling, rhythmical sounds, coming from the inside of his head to both his ears. Physical examination revealed rhythmical oscillations of the soft palate with a frequency of 100–120 per minute and a clock ticking noise synchronic with the palate tremor. Electromyography revealed continuous motor unit activity at rest in the tensor veli palatini muscle. Palatal myoclonus (PM) as a result of tick-borne meningoencephalitis was diagnosed. Treatment with several medications was started with no effect, then botulinum toxin was administered under EMG guidance to both sides of the patient’s soft palate with great improvement. A 5-year follow-up and continuation of botulinum toxin injections with only minor and reversible side effects proved the treatment efficacy and safety. In the article we present a case of symptomatic palatal myoclonus with ear click and shortly discuss its aetiology, types and treatment options. We also stress the efficacy and safety of PM treatment with repetitive injections of botulinum toxin.     

Objective tinnitus from palatal myoclonus. Use of botulinum toxin: a case report

Objective tinnitus can have many different etiologies, palatal myoclonus being one of the less frequent. This type of tinnitus is generated by involuntary rhythmic contraction of the soft palate, which generates an audible click for the patient and for the explorer. Botulinum toxin achieves temporary muscle paralysis through presynaptic inhibition of the acetylcholine level at the neuromuscular union. We present a patient with long-term objective tinnitus, along with this patient's response to botulinum toxin injection.     

Palatal myoclonus: treatment with botulinum toxin

Palatal myoclonus is a rare neurological disorder, which manifests as involuntary palatal contractions. It may be related to an underlying neurological abnormality or it may be of unknown etiology. The most common symptom is objective clicking tinnitus. Systemic treatment is largely unsuccessful. The use of botulinum toxin type A has been effective in treating the symptom with limited adverse effects.     

Palatal aponeurosis and the insertion of the tensor muscle of the soft palate. An anatomic study and clinical applications

INTRODUCTION: Knowledge of the anatomy of soft palate muscles is of great interest in cleft palate surgery, in surgical correction of obstructive sleep apnea syndrome and in excision of maxillo-facial carcinomas. Some authors described the palatal aponeurosis as the expansion of the tendon of the two tensor veli palatini muscles, others stated that the palatal aponeurosis is a distinct anatomic entity. METHOD: Ten dissections of the soft palate have been performed to improve our knowledge of its anatomy. RESULTS: The palatal aponeurosis is a distinct anatomic entity continuous with the periosteum of the nasal cavity. The tendon of the tensor veli palatini terminated on the inferior side of the aponeurosis. One fifth of the tensor's tendinous fibers terminated on the posterior border of the palatine bone and the others are spreading on the anterior and inferior side of the palatal aponeurosis. DISCUSSION: In cleft palate patients, this aponeurosis is absent, the palatal muscles are attached to the posterior border of the palatine bones. So it seems to be logical to recommend a soft-palate "pushback" to create a new space between the posterior border of the palatine bones and the soft-palate muscles.     

Clinical study of otological manifestations in cases of cleft palate

Cleft palate (with or without cleft lip) occurs in about 1: 750–1: 2000 births in different societies in the world. Cleft palate individuals have a greater incidence of hearing loss than the general population. The primary cause of the ear problem in cleft patients is eustachian tube dysfunction. The cause for which is abnormal insertion of levator veli palatini and tensor veli palatini muscles into the posterior margin of the hard palate and the palatal aponeurosis and associated muscular hypoplasia.