The authors have no funding, financial relationships, or conflicts of interest to disclose.
Article first published online: 9 JUL 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 9, pages 2071–2075, September 2012
How to Cite
Lee, G.-H., Bae, S.-C., Jin, S.-G., Park, K.-H., Yeo, S.-W. and Park, S.-N. (2012), Middle ear myoclonus associated with forced eyelid closure in children: Diagnosis and treatment outcome . The Laryngoscope, 122: 2071–2075. doi: 10.1002/lary.23420
Guen-Ho Lee and Seong-Cheon Bae are equally contributed to this paper and will be designated as co-first authors.
- Issue published online: 23 AUG 2012
- Article first published online: 9 JUL 2012
- Manuscript Accepted: 18 APR 2012
- Manuscript Revised: 20 MAR 2012
- Manuscript Received: 31 DEC 2011
- Middle ear myoclonus;
- forceful eyelid closure syndrome;
- Level of Evidence: 4
Forceful eyelid closure syndrome (FECS) was first reported at the Proceedings of the Second International Tinnitus Seminar in 1983. The main symptom of this syndrome is a spontaneous muscular tinnitus related only to forced eye closure, specifically the voluntary contraction of the periorbital muscles. Although investigation of the syndrome was initiated >100 years ago, only four cases have been published in the past 20 years. We report six cases of middle ear myoclonus tinnitus diagnosed as FECS in children and discuss issues surrounding the diagnosis and treatment of this syndrome.
Retrospective case series.
From 2009 to 2011, six children complaining of clicking or crackling sounds in their ears presented at Seoul St. Mary's Hospital. Endoscopic examination and recording of the tympanic membrane were performed while the patients were asked to close their eyes forcefully. Audiologic studies including acoustic reflex decay and static compliance were performed for documentation of the movement of the tympanic membrane. Triggering factors of FECS in the children were carefully evaluated.
Synchronous movement of the tympanic membrane in response to forced eye closure on endoscopic examination was the most reliable finding to diagnose FECS. Acoustic reflex decay and other impedance audiogram findings showed irregular perturbations during forced eye closure, which led to diagnosis of the tinnitus as middle ear myoclonus. Most of the patients had triggering factors for FECS. Reassurance and removal of the triggering or causal factors with or without medication improved clicking sounds coming from middle ear myoclonus.
FECS is a rare clinical entity and can be easily missed in routine clinical examination. We suggest that patients, especially children, with clicking or crackling tinnitus should be evaluated for FECS using proper diagnostic tools. A possible mechanism of FECS in children postulated from our case review is suggested. Laryngoscope, 2012