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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index

Current Evaluation and Management

Written By

D. Scott Fortune MD
David S. Haynes MD
Jay W. Hall III PhD

Neurologic Disorders
Neurologic disorders that cause objective tinnitus include palatomyoclonus and idiopathic stapedial muscle spasm. The differential diagnosis of these diseases includes other neurologic diseases, such as multiple sclerosis, cerebrovascular disease, and central nervous system neoplasms. Palatomyoclonus is characterized by an irregular clicking sound within the ear. The myoclonus is rapid with a rate between 40 and 200 beats/min and occurs intermittently. The sound is generated by the mucous membranes of the eustachian tube snapping together as the palatal musculature undergoes myoclonic contractions. Patients may also complain of aural fullness, hearing loss, or sound distortion. Symptoms are worsened by stress. Frequently a history of muscle spasm with occipital headaches or temporomandibular joint pain can be obtained. The diagnosis can be made on physical examination by listening for the noise with a Toynbee tube or viewing myoclonic jerks in the palate. Tympanometry can occasionally record movement synchronous with the palatal contractions. Rarely, electromyography of the palate is indicated to confirm the clinical diagnosis. Treatment of palatomyoclonus is medical. Antispasmodic agents and muscle relaxants, such as clonazepam or diazepam, are the mainstay of treatment. Neurologic consultation is useful for long-term management of these patients.

Idiopathic stapedial muscle spasm creates a rough, crackling, rumbling noise in the ear. External sounds, such as music tones, water faucets, and voices, are known to accentuate the spasms. Physical examination reveals a normal tympanic membrane with rhythmic contractions synchronous with the noise. History and physical examination are sufficient for diagnosis. The disease is usually self-limited and remits with time; reassurance is often sufficient. Recalcitrant cases may be treated by middle ear exploration with division of the stapedius and tensor tympani muscles. Although the operation abolishes the symptoms, it is rarely necessary. [15]

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