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Oculostapedial synkinesis

H P Schwarze1, B E Hirsch, P C Johnson

  • 1Division of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|December 1, 1995
PubMed
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Persistent ear symptoms like tightness and drumming can occur after facial nerve surgery for hemifacial spasm. Transmeatal division of the stapedial tendon offers immediate relief for this specific oculostapedial synkinesis.

Area of Science:

  • Neurology
  • Otolaryngology
  • Neurosurgery

Background:

  • Hemifacial spasm often presents with auditory symptoms, including low-pitch rumbling, ear fullness, and reduced hearing acuity.
  • Ephaptic neural transmission is the leading hypothesis for the pathophysiology of hemifacial spasm.
  • Microvascular decompression is a common surgical treatment for hemifacial spasm affecting the facial nerve.

Observation:

  • This case presents a 51-year-old woman with persistent oculostapedial synkinesis following successful microvascular decompression.
  • The patient experienced bothersome auditory symptoms, specifically ear tightness and a "drumming" sensation.
  • These auditory symptoms were exacerbated by voluntary eye closure and blinking.

Findings:

  • Oculostapedial synkinesis can manifest as persistent auditory symptoms even after effective treatment of the underlying hemifacial spasm.

Related Experiment Videos

  • The exacerbation of auditory symptoms suggests a role for ephaptic transmission and/or aberrant nerve regeneration.
  • Transmeatal division of the stapedial tendon effectively resolved the patient's persistent stapedial muscle dysfunction.

    • Implications:

    • Persistent stapedial muscle dysfunction requires consideration in patients with residual auditory symptoms post-hemifacial spasm surgery.
    • Surgical division of the stapedial tendon is a viable and immediate treatment option for refractory oculostapedial synkinesis.
    • Understanding ephaptic transmission and aberrant regeneration is crucial for managing complex facial nerve disorders.