Velo-pharyngo-laryngeal myoclonus: evaluation of objective tinnitus and extrathoracic airway obstruction.

Velo-pharyngo-laryngeal myoclonus, the rapid, rhythmic contraction of muscles of the pharynx and larynx, is a rare neurological manifestation of numerous disease processes affecting the cerebellum. In its most common form, palatal myoclonus, this disease frequently presents to the otolaryngologist as objective tinnitus. Impedance audiometry provides a useful means of verifying suspected palatal myoclonic activity through recorded changes in the middle ear pressure, as mediated by muscle activity at the proximal portion of the eustachian tube. A very rare case of velo-pharyngo-laryngeal myoclonic with clonic contraction of the laryngeal adductors and subsequent extrathoracic airway obstruction is presented. Tracheostomy provided immediate symptomatic relief of dyspnea.