Treatment for severe palatoclonus by occlusion of the eustachian tube.
OBJECTIVE
Surgical blocking of the eustachian tube is presented as an ultimate treatment option in a 11-year-old suicidal boy with a therapy-resistant, persistent clicking tinnitus caused by myoclonus of the levator veli palatini.


METHODS
An 11-year-old boy decompensated psychologically as a result of loud and objective tinnitus. The tinnitus could be heard easily by an examiner by bringing his own ear at a distance of approximately 20 to 30 cm to the left ear of the patient. No neurologic etiology for the tinnitus could be traced. Pediatric psychiatric evaluation resulted in a recommendation to perform, as a last resort, an experimental surgical option like blockage of the eustachian tube.


METHODS
Treatment with Tegretol (Novartis, The Netherlands) had no effect. Treatment with Dysport (Ipsen) botulin toxin with 30 to 60 U was temporarily effective. Finally, 60 U were not effective anymore. As last refugium, a surgical blockage of the eustachian tube has been performed, first with bone cement and later by a more conventional surgical blockage of that bony tube.


RESULTS
After surgical blockage of the bony part of the eustachian tube, the objective tinnitus disappeared. Blockage of the protympanum by bone cement resulted in only 1 year of successful blocking. After recurrence of the tinnitus combined with aeration of the middle ear, a second surgical transcanal approach was successful in blocking the eustachian tube. With a grommet, the hearing level remained within 10 dB for 0.5 to 8.0 kHz.
D001843:Bone Cements / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D005064:Eustachian Tube / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009207:Myoclonus / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012306:Risk; D055502:Secondary Prevention; D013405:Suicide / Q000523:psychology; D014012:Tinnitus / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D017211:Treatment Failure; D000092864:Suicide Prevention
D001843:Bone Cements; D001905:Botulinum Toxins