[Objective tympanophonia caused by myoclonus of the auricular muscles]

The objective of the present literature review was to systematize the available data on the etiology, pathogenesis, clinical features, diagnostics, and treatment of muscular tympanophonia. The commonest source of muscular tympanophonia is the tremor (myoclonus) of the soft palate or the middle ear; sometimes this condition can be a consequence of myoclonus of the external ear muscles or head muscles. Pharmacotherapy of muscular tympanophonia does not invariably result in the favourable outcome. The author describes a rare observation of objective tympanophonia attributable to myoclonus of the auricular muscle. The patient complained of sensation of clicking sounds in the affected right ear in synchrony with involuntary contractions of the muscles above the auricle and in the postaural region. The contractions of these muscular groups were palpable at the moments when the patient felt snaps in the ear. The presence of myoclonus of the auricular muscles was confirmed in the electromyographic studies. Multispiral computed tomography did not reveal pathological changes in the brain stem structures. The patient took the prescribed doses of clonazepam and baclofen during 5 weeks; however, this treatment failed to substantially improve his condition. Tympanophonia was eliminated by means of administration of botulinum toxin into the m. auricularis posterior and m. temporalis region.