title: Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report.
abstract: BACKGROUND
  In this study, we report a rare case of an adult patient with essential palatal tremors (EPT) presenting as nasal clicks, instead of otic clicks or objective pulsatile tinnitus in common EPT.
  
  
  METHODS
  Nasal endoscopic examination and EMG recordings of the soft palate muscles were performed to confirm the source of the clicks. Initial treatment with lidocaine provided symptomatic relief for four hours. The patient was then treated with four simultaneous injections of 12.5 U of botulinum toxin in four different sites of the soft palate. Palatal tremors and clicks completely disappeared within three months of treatment.
  
  
  CONCLUSIONS
  To our knowledge, this is the first case of EPT that presented with nasal clicks. We recommend that otolaryngologists should expect this rare occurrence in the clinical setting, and handle patients presenting with such symptoms with care and compassion in order not to worsen their psychological status.
authors.affiliation: ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Ye
authors.affiliation: ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Shiyu
authors.initials: S
authors.lastname: Liao
authors.affiliation: ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Baozhen
authors.initials: B
authors.lastname: Luo
authors.affiliation: ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China. nily2001@126.com.
authors.forename: Liyan
authors.initials: L
authors.lastname: Ni
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use*; D004576:Electromyography / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000503:physiopathology / Q000601:surgery*; D010160:Palate, Soft / Q000503:physiopathology*; D011788:Quality of Life; D035583:Rare Diseases; D018570:Risk Assessment; D014012:Tinnitus / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014202:Tremor / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D001905:Botulinum Toxins
keywords: Botulinum toxin; Case report; Electromyography; Inferior olive; Palatal tremors; Pulsatile tinnitus