Silencing middle ear myoclonus (Part two)

Written by: Professor Manohar Bance
Published:
Edited by: Karolyn Judge

People with middle ear myoclonus may struggle deeply with the associated symptoms it brings. How can they address it?

 

Esteemed otologist Professor Manohar Bance has put together a two-part series about this condition. Here, he discusses the diagnosis process and treatment for middle ear myoclonus, as well as providing useful advice for its’ management.

 

In part one, this expert practitioner discusses the ins and outs of middle ear myoclonus in expert detail.

 

Ear procedure for middle ear myoclonus

 

How is it diagnosed?

Primarily this middle ear myoclonus is diagnosed by the patient’s typical history. Sometimes the sounds can be heard as well by the examiner, and sometimes the contractions can be recorded on a tympanometer.

 

A tympanometer is an instrument that audiologists use to measure middle ear pressure, but can record sound from ear canal as well.

 

Normally, we would test you with a variety of different triggers to see if they caused clicking sounds, and also exclude palatal myoclonus by examining the back of your throat with a fibreoptic camera.

 

 

How is middle ear myoclonus treated?

There is not consistently reliable pharmacological treatment. Different patients try many different types of middle ear myoclonus treatment, and some may work for some, but not for others. In general, for severe cases, the only consistently effective treatment is surgical sectioning of the tendons in of the muscles in the ear. There are early reports of Botox© working as well, but this is usually temporary for most Botox© treatments, and I would say is still investigational.

 

I usually section both muscles, as it is never 100 per cent clear if one or the other is involved, and they can also both be involved.  It can be difficult to completely section the tensor tympani, as it can be hard to see, and often I will use an endoscope to verify that it is completely cut.

 

 

How can people manage their symptoms in their day-to-day lives? 

If mild, most people can live with the symptoms of middle ear myoclonus. When severe, they can be very disturbing. 

 

Some people may be able to stop the sounds using a deep earplug, or learn to live with them with relaxation therapy or cognitive behavioural therapy. There are very few other options that seem to work consistently, very sadly.

 

In general, cutting the middle ear muscle tendons seems to help those people with true middle ear myoclonus most of the time.  

 

 

References to Professor Bance’s work here:

1: Wickens B, Floyd D, Bance M. Audiometric findings with voluntary tensor tympani contraction. J Otolaryngol Head Neck Surg. 2017 Jan 5;46(1):2. doi:10.1186/s40463-016-0182-y. PMID: 28057076; PMCID: PMC5217611.


2: Aron M, Floyd D, Bance M. Voluntary eardrum movement: a marker for tensor tympani contraction? Otol Neurotol. 2015 Feb;36(2):373-81. doi: 10.1097/MAO.0000000000000382. PMID: 24751734.


3: Bance M, Makki FM, Garland P, Alian WA, van Wijhe RG, Savage J. Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle. Laryngoscope. 2013 Apr;123(4):1021-7. doi: 10.1002/lary.23711. Epub 2012

Nov 20. PMID: 23169583. –++

 

 

Visit Professor Bance’s Top Doctors profile to arrange an appointment for any concerns you may have regarding middle ear myoclonus.

By Professor Manohar Bance
Otolaryngology / ENT

Professor Manohar Bance is one of the UK’s leading otologists. Practising in Cambridge at Spire Cambridge Lea Hospital, he has been a subspecialist in diseases and surgery of the ear for 23 years, during which time he has performed thousands of major ear surgeries.
 
Professor Bance’s practice covers the management of all diseases of the ear including otosclerosischronic ear diseaseeardrum perforationgenetic hearing losscholesteatomatumours of the middle and inner ear. He also treats vertigo caused by a number of different diseases of the ear, such as Meniere´s disease, vestibular migraine and BPPV.
 
Professor Bance also specialises in Eustachian tube disorders such as balloon dilatation of the Eustachian tube, and patulous Eustachian tube. He has run a Eustachian tube disorders clinic for 12 years. Professor Bance is an expert in the selection and the fitting of cochlear implants, and collaborates closely with engineers to produce the next generation of machine-neural interfaces.
 
Professor Bance originally qualified from the University of Manchester before pursuing training in Canada. His residency was at the University of Toronto, and he practised as a consultant there for six years. He also received his MSc in Neurophysiology from the University of Toronto.  He then moved on to Dalhousie University, where he became Professor and Head of the Division of Otolaryngology-Head and Neck Surgery at Dalhousie University in Canada, and Director of the EAR Lab.
 
After a 21-year career at Dalhousie, Professor Bance moved back to the UK where he became the inaugural Professor of Otology and Skull Base Surgery at the University of Cambridge and was Fellowship trained in Otology and Neurotology. He has over 220 peer reviewed publications and 9 book chapters as well as being a co-editor of two books. Much of Professor Bance´s research has been on middle ear surgery, as well as how to optimize hearing results. His current research is on the optimization of cochlear implant and middle ear implant hearing results.  
 
Professor Bance is a board member of the Politzer Society, a member of the American Otology Society, the American Neurotology Society, the Triological Society and the Collegium Otorhinolaryngologica Amicitiae Sacrum. He is also president of the RSM Otology section and chair of the British Cochlear Group. Professor Bance is also a council member of the British Society of Otology and is Academic lead in Otology and Neurotology at Cambridge University Hospitals Trust. He has been invited to speak at hundreds of meetings worldwide.

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