Citation

Ensink RJH, Vingerhoets HM, Schmidt CWTH, Cremers CWRJ. Otol. Neurotol. 2003; 24(5): 714-716.

Copyright

(Copyright © 2003, Lippincott Williams and Wilkins)

DOI

10.1097/00129492-200309000-00003

PMID

14501444

Abstract

PURPOSE: 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.
PATIENT: 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.
INTERVENTION: 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.
OUTCOME: 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.

Language: en

Keywords

Bone Cements; Botulinum Toxins; Child; Eustachian Tube; Humans; Male; Myoclonus; Patient Care Team; Postoperative Complications; Reoperation; Risk; Secondary Prevention; Suicide; Suicide Prevention; Tinnitus; Treatment Failure