Diagnosis of Stapedial Myoclonus Using Endoscopic Visualization

Area of Science:

• Otolaryngology
• Neuroscience

Background:

• Stapedial myoclonus is an uncommon condition characterized by rhythmic stapedial tendon contractions, often leading to tinnitus.
• Current diagnostic methods for stapedial myoclonus are limited, hindering definitive diagnosis and treatment.
• Awake otoendoscopy is proposed as a readily applicable diagnostic tool for stapedial myoclonus.

Observation:

• A professional singer presented with bilateral rhythmic "thumping" tinnitus triggered by vocalization.
• Standard otologic examination, audiology, and imaging were inconclusive.
• During awake otoendoscopy, rhythmic stapedial tendon movement was observed, correlating with tinnitus timing.

Findings:

• Awake otoendoscopy successfully diagnosed stapedial myoclonus by visualizing rhythmic stapedial tendon movement.
• Surgical transection of the stapedial tendon, with pyramidal eminence removal, led to complete symptom resolution.
• The procedure was performed bilaterally with sustained positive outcomes.

Implications:

• Awake otoendoscopy offers a practical diagnostic approach for suspected stapedial myoclonus.
• Stapedial tendon transection is an effective treatment for resolving tinnitus associated with stapedial myoclonus.
• This minimally invasive technique may improve patient outcomes for this rare condition.