Klinische Neurophysiologie 2007; 38 - P75
DOI: 10.1055/s-2007-1032263

Successful treatment of autophonia with botulinum toxin: a case report

A Olthoff 1, R Laskawi 1, E Kruse 1
  • 1Göttingen

Objectives: To treat an autophonia due to a patulous eustachian tube (PET) using botulinum toxin.

Patient and Methods: Assuming PET was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscle and salpingopharyngeus muscle), paralysis was performed via botulinum toxin (BT) type A injections in a female professional musician, 45 years old with chronic unilateral autophonia for 20 years.

In addition to a patient interview, an endoscopic examination of the nasopharynx (postrhinoscopy), ear microscopy and impedance audiometry were performed to verify the diagnosis and the outcome after treatment.

Results: The autophonia disappeared 1 week after treatment. A normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months.

Conclusions: The administration of BT type A provides a new option in the treatment of PET. The reliability of this method and the effect of repeated injections remains to be proved in future studies.

FIGURE 1 Fig 1 Anatomical picture of paratubal muscles with schematic illustration of botulinum toxin injectionLEGEND The tensor and levator veli palatini muscles (MTVP and MLVP) and the salpingopharyngeus muscle (MSP) are involved in the opening mechanism of the eustachian tube (ET). The arrow marks the localization of botulinum toxin injection.Nach: Tillmann B. Farbatlas der Anatomie. Stuttgart New York: Georg Thieme, 1997 FIGURE 2 Fig 2 Pre- and posttreatment viewLEGEND Postrhinoscopy: The right eustachian tube (ET) is unclosed in picture “a“. Photographs “a“ and “b“ are pretreatment images (“a“ right, “b“ left side). Photographs “c“ and “d“ are posttreatment images (“c“ right, “d“ left side). The white dotted lines mark the right ET ostium. FIGURE 3 Fig 3 Impedance audiometry pre- and posttreatmentLEGEND Pretreatment synchronous respiratory undulation of the right tympanic membrane compliance is shown in picture “a“. Posttreatment normalized findings are shown in picture “b“.