Endoscopic Treatment of Middle Ear Myoclonus with Stapedius and Tensor Tympani Section: A New Minimally-Invasive Approach
Natasha Pollak *
Department of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Roya Azadarmaki
Metropolitan NeuroEar Group, Rockville, Maryland, USA.
Sidrah Ahmad
Department of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
*Author to whom correspondence should be addressed.
Abstract
Aims: We describe a new, entirely endoscopic surgical technique for treatment of middle ear myoclonus.
Case Presentation: In our patient, the stapedius and tensor tympani tendons were sectioned to control chronic middle ear myoclonus. The procedure was performed using endoscopic ear surgery techniques, with the aid of rigid Hopkins rod endoscopes. Control of the pulsatile tinnitus was achieved after endoscopic tenotomy of the stapedius and tensor tympani, without any complications.
Discussion and Conclusion: Endoscopic tensor tympani and stapedius tendon section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as a first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize dissection of healthy tissue for exposure. The entire operation, including raising the tympanomeatal flap and tendon section can be safely completed under visualization with a rigid endoscope with good control of the pulsatile tinnitus.
Keywords: Middle ear myoclonus, stapedius myoclonus, tensor tympani myoclonus, pulsatile tinnitus, endoscopic ear surgery, functional endoscopic ear surgery, minimally-invasive surgery.