Objective Tinnitus of Nasopharyngeal Origin

Area of Science:

• Otolaryngology
• Neurology

Background:

• Objective tinnitus is a rare condition where the patient can perceive sounds originating from within their own body.
• Common causes include vascular abnormalities, palatal myoclonus, and patulous Eustachian tube.

Purpose of the Study:

• To report a novel case of objective tinnitus.
• To describe the unique mechanism of sound generation in this specific patient.
• To emphasize the role of physical examination in diagnosing unusual tinnitus etiologies.

Main Methods:

• Case report of a 49-year-old female patient presenting with objective tinnitus.
• Detailed physical examination of the nasopharynx, including observation during phonation and swallowing.
• Assessment of anatomical structures involved in sound production.

Main Results:

• The patient exhibited unintentional sounds from the nasal cavity during talking and swallowing, resembling lip-smacking.
• Physical examination revealed a hypertrophic posterior nasopharyngeal wall and torus tubarius.
• Voluntary muscle effort caused the posterior pharyngeal wall to protrude, collide with the torus tubarius, and generate sound upon separation.

Conclusions:

• Nasopharyngeal muscle constriction can induce a novel type of objective tinnitus.
• This case underscores the importance of a comprehensive physical examination for diagnosing rare causes of tinnitus.
• While Botox injection was offered, the patient declined treatment, necessitating further management strategies.