Palatal and middle-ear myoclonus: a cause for objective tinnitus

The cause of objective tinnitus provoked by palatal and middle-ear myoclonus may be identified by magnetic resonance imaging of the central nervous system in the Guilliain-Mollaret triangle or it may be idiopathic. The idiopathic cases are rare. From the literature, one can perceive the following unanswered questions: (1) Are palatal and middle-ear myoclonus different entities or do they usually appear together? (2) Are the clicks being produced by the palatal myoclonus (walls of the eustachian tube slapping together) or by the tensor tympani muscle contractions or by both? (3) Is stapedius muscle myoclonus important in the production of the clicks? (4) What should be the treatment for palatal and middle-ear myoclonus? We present two cases of idiopathic palatal and middle-ear myoclonus and discuss these cases in light of the literature and of some ideas of our own.