COVID-19-Associated Middle Ear Myoclonus in a 10-Year-Old Male – Cureus

Middle ear myoclonus is a rare condition attributed to abnormal, repetitive contractions of the middle ear muscles including the tensor tympani and/or stapedius muscles. This condition generates objective tinnitus that is characterized by a “clicking” noise that is audible to both the patient and an outside observer. No specific pathophysiologic process has been identified as the cause of middle ear myoclonus, making its diagnosis and treatment challenging. In this report, we present a presumptive case of COVID-19-associated middle ear myoclonus in a 10-year-old male.

Introduction

Tinnitus is defined as the perception of sound in the absence of a true external auditory stimulus [1]. The differential to consider when evaluating tinnitus is vast, making it rather difficult to diagnose. However, the characteristics of tinnitus, including quality, location, pitch, and variability, may point to its etiology. Tinnitus can be subjective or objective. Subjective tinnitus is only audible to the patient, while objective tinnitus is audible to the patient as well as an outside observer [2]. This observer can appreciate the tinnitus with their naked ear or through auscultation of the head and/or neck structures located close to the ear with a stethoscope.

Although rare, cases of objective tinnitus have been reported to develop due to repetitive abnormal rhythmic contractions of middle ear muscles, including the stapedius and tensor tympani, and palatal muscles [3]. Specifically, tensor tympani myoclonic contractions are characterized as “clicking,” while “buzzing” is a characteristic of stapedial contractions [4]. Tinnitus of this type is known as middle ear myoclonus.

Middle ear myoclonus accounts for only 1.5% of new tinnitus cases. With such a small number of diagnoses, data and understanding of this condition are significantly limited with most of the published literature taking the form of case reports and case series [5,6]. The definitive etiology of tinnitus produced by middle ear myoclonus is unknown. There are, however, many theories as to how this condition is produced. A variety of causes including brain tumors such as acoustic neuromas, vascular deformities, trauma, anxiety, demyelinating disease, and viral infections have been implicated [7]. Furthermore, several cases of middle ear myoclonus have been attributed to aberrant activity or irritability of the facial and trigeminal nerves and nuclei, which control the actions of both the tensor tympani and stapedius muscles [4].

In this report, we present the case of a 10-year-old male diagnosed with middle ear myoclonus after a presumed COVID-19 viral infection.

Case Presentation

A 10-year-old male, with a past medical history significant for autism and attention deficit hyperactivity disorder (ADHD), presented to the outpatient pediatric clinic reporting a popping, clicking noise that had been present in both of his ears for approximately five months. Upon entrance to the patient’s room, the child eagerly ran to the medical student, …….

Source: https://www.cureus.com/articles/94506-covid-19-associated-middle-ear-myoclonus-in-a-10-year-old-male