Bilateral muscular tinnitus due to myoclonus of extrinsic auricular muscles

Dimensions, Function and Applications of the Auricular Muscle in Facial Plastic Surgery

PURPOSE

To determine the dimensions and function of the auricular muscle and to consider applications of this muscle in facial plastic surgery.

METHODS

Nonpreserved fresh frozen human cadaver dissections from the (HOSPITAL-Blinded) Body Donation program were dissected. The length and width of the superior auricular muscle were measured. One surgeon performed all dissections and measurements.

RESULTS

A total of seven left and five right hemifaces were studied. The average central height of the superior auricular muscle was 4.7 cm, and an average width was 5.0 cm. There was no significant difference between the average values of the left versus the right hemiface measurements. The muscle originated in the fibers of the galea and temporal fascia and inserted into the conchal cartilage in each specimen. Engaging the muscle in its line of action yielded slight elevation of the forehead and prevented movement of the galea along the vertex of the scalp.

CONCLUSIONS

The auricular muscle acts as an occipitofrontalis stabilizer and a weak brow elevator.

LEVEL OF EVIDENCE IV

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[The diagnostics and treatment of tympanophonia]

Tympanophonia can be a consequence of a variety of diseases and pathological conditions diagnostics of which encounters difficulties. The comprehensive clinical examination of the patient is necessary to determine the cause of tympanophonia including elucidation of the following characteristics: initial (acute or gradual) sensation of sound in the ear(s), duration of persisting clinical manifestations, the presence of an acoustic or craniocerebral injury, characteristics of the noise, viz. continuous or intermittent, clicking sounds, paroxysmal or pulsed noise (synchronous with the heart beating), fluctuating, audible to the patient alone or to the surrounding people as well, unilateral and bilateral noises (either symmetric or asymmetric), perception of noise in the head rather than ears., high- and low-pitched noise together with the accompanying neurological symptoms. The analysis of these characteristics makes it possible to differentiate between objective and subjective sensation of noise in the ear(s), determine the amount of additional studies needed for the evaluatio of the conditions of a given patient, identify the possible cause of tympanophonia, establish the nosological diagnosis, and distinguish a group of the patients in need of emergency otological management.

Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review

INTRODUCTION

In contrast to subjective tinnitus, objective tinnitus can be heard by the examiner as well as by the patient. It can be triggered by, among many other etiologies, idiopathic muscular tremor in the soft palate, the essential palatal tremor (EPT). Many treatment modalities have been investigated, of which only Botulinum toxin (BT) injections have shown promising results.

GOAL

The aim of this study was to evaluate the effect of BT treatment on objective tinnitus due to EPT by a systematic review of the literature.

METHODS

In accordance with PRISMA guideline a systematic literature search in three databases was performed.

RESULTS

Twenty-two studies fulfilled the inclusion criteria, mainly case reports and case series. A total of 51 BT treated patients diagnosed with EPT were identified in the literature. The studies were evaluated with focus on diagnostics, injection technique and BT dose, follow-up, effect on objective tinnitus, complications, and adverse effects.

CONCLUSIONS

The included studies suffer from an extremely low evidence level with several sources of bias. When optimally injected, BT seems to be an effective treatment of objective tinnitus due to EPT, with few adverse effects and complications. We suggest BT injections as first choice in case of EPT and present a guideline regarding diagnostics, treatment, and follow-up.