Feasibility of endoscopic treatment of middle ear myoclonus: a cadaveric study.

Natasha Pollak,Sidrah Ahmad,Roya Azadarmaki

doi:10.1155/2014/175268

Abstract

Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope.

Highlights

Middle ear myoclonus is an infrequent but well-known cause of pulsatile tinnitus
The stapedius tendon was visualized with a 2.7 mm 0∘ endoscope and in contrast to microscopic procedures, curetting of the scutum was never needed for exposure
We suggest the following steps for endoscopic tensor tympani section based on our experience with 10 cadaveric temporal bones

Summary

Introduction

Middle ear myoclonus is an infrequent but well-known cause of pulsatile tinnitus. Sometimes middle ear myoclonus is described as a sound slowly escalating over several minutes, only to stop abruptly. This cycle may repeat and these slowly waxing and abruptly stopping episodes may occur frequently throughout the day. The etiology of this condition is attributed to the myoclonic contraction of one of the two middle ear muscles, namely the stapedius and/or tensor tympani muscles [1,2,3]. In 2013, Park et al [4] reported the largest known series with 58 patients treated for middle ear myoclonus

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Conclusion