A man in his 30s presented with a 1-year history of recurrent episodes of unilateral high-pitched “clicking” in his right ear followed by vertigo that lasted 3 to 4 seconds. He reported no perceived association between these episodes and breathing and head position, and denied precipitation of symptoms with exposure to loud sound or pressure change. He had not experienced hearing loss, aural fullness, autophony, or headache. On physical examination, objective, intermittent, clicking tinnitus at a frequency of 1 click per second was noted on placement of a stethoscope in close proximity to the right ear. The tinnitus coincided temporally with the patient’s complaints but was nonsynchronous with pulse. Results from prior imaging including a computed tomographic (CT) scan of the head with multiplanar reconstruction (Figure, A, C, and D), were normal. Steady state tympanometry showed mildly decreased compliance of the tympanic membrane when the patient reported hearing the clicking sensation. The patient was tentatively diagnosed as having tensor tympani and stapedius myoclonus and after discussion of treatment options, he decided to undergo middle ear exploration for muscle sectioning. The incidental findings observed during middle ear exploration are shown in the Figure, B.
Kong DK, Schutt CA, Michaelides E. Incidental Finding in a Man With Objective Tinnitus. JAMA Otolaryngol Head Neck Surg. Published online June 02, 2016. doi:10.1001/jamaoto.2016.0997