Narcolepsy with tinnitus aura: interpretation.

A fifty-five year old man was admitted to our ward for evaluation of narcoleptic-cataplectic attacks which were signaled by a "hissing sound like high pressure steam leaking out of a pipe." This tinnitus was exclusively localized to the right ear. It started about sixty-to-ninety seconds before the cataplectic episode (affecting mostly the jaw muscles) and lasted through part of it as it became progressively louder toward the end and ceased abruptly. It is postulated that, along with the collapse of tonic musculature of the mandible, a decrease of proprioceptive tone also affected the tensor tympani muscle leaving the middle ear vulnerable to internally generated noise. We further postulate that tinnitus was finally arrested by the generation of phasic bursts of contraction of the tensor tympani and/or the stapedius muscle at a later stage of cataplexy.