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Case Reports in Otolaryngology
Volume 2013, Article ID 231505, 3 pages
http://dx.doi.org/10.1155/2013/231505
Case Report

Treatment of Palatal Myoclonus with Botulinum Toxin Injection

Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Philadelphia, PA 19140, USA

Received 22 May 2013; Accepted 1 August 2013

Academic Editors: A. Casani and G. J. Petruzzelli

Copyright © 2013 Mursalin M. Anis and Natasha Pollak. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Palatal myoclonus is a rare cause of pulsatile tinnitus in patients presenting to the otolaryngology office. Rhythmic involuntary contractions of the palatal muscles produce the pulsatile tinnitus in these patients. Treatment of this benign but distressing condition with anxiolytics, anticonvulsants, and surgery has been largely unsuccessful. A few investigators have obtained promising results with botulinum toxin injection into the palatal muscles. We present a patient with palatal myoclonus who failed conservative treatment with anxiolytics. Unilateral injection of botulinum toxin into her tensor veli palatini muscle under electromyographic guidance resolved pulsatile tinnitus in her ipsilateral ear and unmasked pulsatile tinnitus in the contralateral ear. A novel method of following transient postinjection symptoms using a diary is presented in this study. Botulinum toxin dose must be titrated to achieve optimal results in each individual patient, analogous to titrations done for spasmodic dysphonia. Knowledge of the temporal onset of postinjection side effects and symptomatic relief may aid physicians in dose titration and surveillance. We present suggestions on titrating the botulinum toxin dose to optimal levels. A review of the literature on the use of botulinum toxin for palatal myoclonus and some common complications are discussed.