Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 25.
doi: 10.1002/lary.32447. Online ahead of print.

Efficacy and Safety of Intratympanic Botulinum Toxin Injection on Middle Ear Myoclonic Tinnitus

Ji Hyung Lim  1 , Dowoon Han  1 , Gianfranco C Velasco  1   2 , Young Jun Seo  1 , Jae Sang Han  1 , Jung Mee Park  3 , Jae Hyun Seo  1 , So Young Park  4 , Shi Nae Park  1
Affiliations

Efficacy and Safety of Intratympanic Botulinum Toxin Injection on Middle Ear Myoclonic Tinnitus

Ji Hyung Lim et al. Laryngoscope. .

Abstract

Objectives: Investigating the efficacy and safety of intratympanic Botulinum toxin (IT-BTX) injection as a novel treatment for middle ear myoclonic tinnitus (MEMT).

Methods: Medical records and tinnitus questionnaires of the patients with MEMT who underwent IT-BTX were retrospectively reviewed. The efficacy of IT-BTX on MEMT as well as its safety were evaluated by audiology tests and tinnitus questionnaires.

Results: A total of 57 patients who completed the questionnaires at pre- and post-IT-BTX were enrolled. Tinnitus handicap inventory (THI) scores decreased significantly from pre-IT-BTX (44.31 ± 26.8) to 31.42 ± 23.6 (p < 0.001), 32.92 ± 24.9 (p = 0.004), and 25.71 ± 22.9 (p < 0.001) at 1-, 3-, and 6-months post-IT-BTX, respectively. Additionally, visual analog scales (VAS) of loudness (LD), awareness (AW), annoyance (AN), and effect on life (EF) significantly decreased post-IT-BTX (p < 0.05): LD from 4.19 ± 2.4 to 2.47 ± 2.0, 2.89 ± 2.2, and 2.38 ± 1.9 at 1-, 3-, and 6-months; AW from 41.75 ± 29.5 to 24.38 ± 23.3, 26.94 ± 23.3, and 22.10 ± 21.7; AN from 5.00 ± 2.8 to 2.82 ± 2.1, 3.47 ± 2.4, and 2.78 ± 2.2; EF from 4.82 ± 2.8 to 2.89 ± 2.2, 3.28 ± 2.4, and 2.73 ± 2.2 at 1-, 3-, and 6-months post-IT-BTX. Notably, 40.3% of the IT-BTX patients experienced a complete cure of their MEMT symptoms, while 50.8% demonstrated partial resolution after IT-BTX. There were no side effects or complications after IT-BTX during their follow-up period. Comparing delta values between the single injection group and multiple injection group revealed significant differences in VAS LD at the post-1-month time point and between the 1-month and 6-month intervals.

Conclusion: IT-BTX is an effective, safe treatment for MEMT, significantly improving symptoms without complications, and offers a promising alternative before middle ear tendon resection.

Keywords: botulinum toxin; intratympanic injection; middle ear myoclonic tinnitus.

PubMed Disclaimer

References

    1. T. E. Zipfel, S. R. Kaza, and J. S. Greene, “Middle‐Ear Myoclonus,” Journal of Laryngology and Otology 114 (2000): 207–209.
    1. N. Pollak, R. Azadarmaki, and S. Ahmad, “Feasibility of Endoscopic Treatment of Middle Ear Myoclonus: A Cadaveric Study,” International Scholarly Research Notices 2014 (2014): 175268.
    1. S. K. Bhimrao, L. Masterson, and D. Baguley, “Systematic Review of Management Strategies for Middle Ear Myoclonus,” Otolaryngology–Head and Neck Surgery 146 (2012): 698–706.
    1. D.‐K. Kim, J. M. Park, J. J. Han, et al., “Long‐Term Effects of Middle Ear Tendon Resection on Middle Ear Myoclonic Tinnitus, Hearing, and Hyperacusis,” Audiology and Neurotology 22 (2018): 343–349.
    1. J. Hornibrook and A. Keast, “Bilateral Clicking Tinnitus due to Myoclonus of Middle Ear Muscles,” New Zealand Medical Journal (Online) 132 (2019): 67–69.

LinkOut - more resources