Treatment of objective tinnitus with transpalatal Botox® injection in a pediatric patient with middle ear myoclonus: A case report.

We describe a case of bilateral middle ear myoclonus (MEM) that was treated with trans-palatal Botox® injection after failing surgery to section the tensor tympani and stapedial tendons. MEM is a rare disorder resulting from rhythmic contraction of middle ear muscles. An 8-year old girl presented with audible clicking tinnitus, and resultant inability to focus in school. Her parents declined medical therapy, and she underwent surgeries for tendon lysis, with only temporary relief. She had successful response to trans-palatal Botox® injection to the tensor veli palatini aponeurosis. Trans-palatal Botox® injection is a safe and reasonable alternative for treatment of MEM.