MIOCLONIA PALATINA COMO CAUSA DE ACÚFENO OBJETIVO: A PRPÓSITO DE UN CASO

Abstract

Introduction: Palatal myoclonus is a rare syndrome characterized by the appearance of involuntary rhythmic contractions of the palate muscles, usually bilaterally. It is classified as symptomatic, if a lesion is objectifiable at the level of the connections between the dentate nucleus, the Red nucleus, the inferior olivary nucleus and the Central Tegmental tract (Guillain-Mollaret triangle), or Essential if there is no apparent cause.The rhythmic click occurs more frequently in the essential form, but the cause of its production continues to be discussed. Some authors relate it to contractions in the tympanic tensor muscle, or in the stapedium muscle and even in the tensor and levator muscles of the palate; but nevertheless it also seems possible that the noise is due to the opening and closing of the eustachian tube.There is no unanimity regarding the treatment. Normally and in case of symptomatic cases, it is usually started with pharmacotherapy. The infiltration of botulinum toxin in the tensor muscle of the soft palate has been shown to be effective.Case report: 6-year-old girl who comes to the Emergency Department for a two-day evolution consisting of a sound that she describes as "crunching, as if squeezing plastic bubbles" in the left ear, rhythmic, continuous , with a frequency of about 60 / minute and without other associated symptomatology or apparent triggering cause. That tinnitus stops with the buccal opening and restarts with the closure. It is objectifiable when we bring our ear to the ear canal of the patient.Results: on ORL exploration, the oral cavity is normal, without appreciating asymmetries or muscle movements. Otoscopy is normal in both ears, with intact eardrums, which do not reveal apparent oscillations. The nasofibroscopy shows, at the level of the rhinopharynx, the presence of rhythmic contractions of the soft palate that coincide with the auditory clicks that the patient marks upon perceiving them. With a double stethoscope, we can perfectly hear the tinnitus, which can be recorded with a mobile phone. Using Reflex Decay test we tried without succeeding, to reveal some tympanic movement.To rule out lesions at the level of the brainstem and cerebellum, the patient is referred to the Neuropaediatric service for assessment, which requests Cerebral Angio RMN to rule out organic pathology.The video that we present shows what was observed during the performance of the nasofibroscopy, at the same time that we heard the click that the patient perceives. Conclusions: Palatine myoclonus is a rare entity, whose etiology is variable according to whether or not there is an organic lesion. It is one of the possible causes of the appearance of objective tinnitus, in the form of a rhythmic click, whose production mechanism is not clear, and there are many theories about it.Likewise there is no unanimity in the treatment of choice, being able to choose at first ph