title: Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor.
abstract: Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
authors.affiliation: Movement Disorders Clinic, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil. chien.74@fmusp.org.br
authors.forename: Hsin Fen
authors.initials: HF
authors.lastname: Chien
authors.forename: Tanit Ganz
authors.initials: TG
authors.lastname: Sanchez
authors.forename: Luiz Ubirajara
authors.initials: LU
authors.lastname: Sennes
authors.forename: Egberto Reis
authors.initials: ER
authors.lastname: Barbosa
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004333:Drug Administration Routes; D005260:Female; D006311:Hearing Disorders / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D009296:Nasal Cavity; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010156:Palatal Muscles / Q000187:drug effects / Q000503:physiopathology*; D014202:Tremor / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A