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Use of Botulinum Toxin: A Case Report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "391" "paginaFinal" => "392" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Noemi Conill Tobías, Carlos de Paula Vernetta, Francisco Javier García Callejo, Jaime Marco Algarra" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Noemi" "apellidos" => "Conill Tobías" "email" => array:1 [ 0 => "noeconill@hotmail.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlos" "apellidos" => "de Paula Vernetta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "García Callejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Jaime" "apellidos" => "Marco Algarra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio Otorrinolaringología, Hospital Clínico Universitario, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio Otorrinolaringología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mioclonía palatal como causa de acúfeno objetivo. Uso de toxina botulínica: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 870 "Ancho" => 938 "Tamanyo" => 106520 ] ] "descripcion" => array:1 [ "en" => "Points of injection at the levator (front) and tensor (back) veli palatini muscles. Endoscopic view of the right nasal fossa." ] ] ] "textoCompleto" => "Case ReportWe present the case of a 78-year-old female patient with a history of arterial hypertension and depressive symptoms, in the context of chronic objective tinnitus.We performed oropharyngeal inspection, otoscopy, nasofibroscopy, liminal tone audiometry, tinnitometry, tympanometry and distortion-product otoacoustic emissions (DPOAE), leading to the diagnosis of palatal myoclonus. The patient had previously been examined by computed tomography (CT) and magnetic resonance imaging (MRI) tests at the Neurology Service, and both assessments were within normal limits.The patient was intervened under local anaesthesia and direct vision with a 0° rigid endoscope. We injected 10units (U) of botulinum toxin, subtype A (5U in the tensor of the soft palate [tensor veli palatini] and 5U in the elevator of the soft palate [levator veli palatini], bilaterally) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). We performed weekly controls during the first month and then after 3 and 6 months. Tinnitus disappeared after 7 days. On the 15th day we observed bilateral paralysis of the tensor and levator veli palatini muscles, noting only a slight contraction of the left soft palate, without associated symptoms. As a side effect, we observed open rhinolalia during the first week of treatment, which generated nasal fluid reflux on 2 occasions. There was no evidence of otalgia or increase of hearing loss (bilateral, moderate, and mixed hearing loss). Neither did we observe episodes of dysphagia or aspiration. Correct laryngeal function after injection was also observed during follow-up.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Tinnitus reappeared after 5 months, although its intensity was less than the initial, so we decided to administer a second dose of type-A botulinum toxin (30U).<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>DiscussionObjective tinnitus can present various aetiologies, with palatal myoclonus being one of the most unusual. This rare pathology<a class="elsevierStyleCrossRef" href="#bib0020">4</a> is generated by a rhythmic, involuntary contraction of the soft palate.Botulinum toxin subtype A is indicated in all those pathologies resulting from muscular hyperfunction and autonomic dysfunction. It binds to cholinergic nerve endings, resulting in flaccid muscular paralysis.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Its peak effect occurs within 7–14 days, and muscular function is re-established within 3–6 months. Its repeated use does not result in muscle atrophy or permanent degeneration.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In the present case, the patient suffered objective tinnitus which had intensified to the point of significantly affecting her daily activities. In the diagnosis, we highlighted the repeated presence of a notch in the impedance curve which corresponded to the tinnitus observed in the patient. Oropharyngeal examination and nasofibroscopy were also consistent with the diagnosis. In order to calculate the dose, we began by using the lowest effective dose published in the literature,<a class="elsevierStyleCrossRefs" href="#bib0025">5–9</a> noting minimal side effects. We subsequently decided to increase the dose (30U), without observing a significant increase in its duration of effect.The use of botulinum toxin for the treatment of palatal myoclonus in our case obtained optimal results with minimal side effects. The only inconvenient was the temporary effect of the toxin, which required repeated injections every 5–6 months.Conflict of InterestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres95049" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82201" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95048" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82200" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of Interests" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82201" "palabras" => array:3 [ 0 => "Objective tinnitus" 1 => "Palatal myoclonus" 2 => "Botulinum toxin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82200" "palabras" => array:3 [ 0 => "Acúfeno objetivo" 1 => "Mioclonía palatal" 2 => "Toxina botulínica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Objective tinnitus can have many different etiologies, palatal myoclonus being one of the less frequent. This type of tinnitus is generated by involuntary rhythmic contraction of the soft palate, which generates an audible click for the patient and for the explorer.Botulinum toxin achieves temporary muscle paralysis through presynaptic inhibition of the acetylcholine level at the neuromuscular union.We present a patient with long-term objective tinnitus, along with this patient's response to botulinum toxin injection." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El acúfeno objetivo o somatoacúfeno puede presentar múltiples etiologías, siendo una de las más infrecuentes la mioclonía palatal generada por la contracción rítmica e involuntaria del paladar blando que genera un click audible por el enfermo y el explorador.La toxina botulínica genera una parálisis temporal a nivel muscular mediante la inhibición presináptica de la acetilcolina a nivel de la unión neuromuscular.Presentamos el caso de una paciente con un acúfeno objetivo de larga evolución y su respuesta a la inyección con toxina botulínica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Conill Tobías N, et al. Mioclonía palatal como causa de acúfeno objetivo. Uso de toxina botulínica: a propósito de un caso. Acta Otorrinolaringol Esp. 2012;63:391–2." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 870 "Ancho" => 938 "Tamanyo" => 106520 ] ] "descripcion" => array:1 [ "en" => "Points of injection at the levator (front) and tensor (back) veli palatini muscles. Endoscopic view of the right nasal fossa." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 707 "Ancho" => 942 "Tamanyo" => 118897 ] ] "descripcion" => array:1 [ "en" => "Material for injection of botulinum toxin." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of clostridium botulinum toxin in palatal myoclonus. A preliminary report. A preliminary report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Saaed" 1 => "G.B. 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Gürkov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mao.0000224085.08344.50" "Revista" => array:6 [ "tituloSerie" => "Otol Neurotol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "672" "paginaFinal" => "675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16868515" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of autophonia with botulinum toxin: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Olthoff" 1 => "R. Laskawi" 2 => "E. 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ISSN: 2173-5735

Acta Otorrinolaringológica Española, the official publication of the Spanish Society of Otolaryngology and Head and Neck Surgery and the Ibero-American Society of Otorhinolaryngology, is the most important journal in Spanish dedicated to Otorhinolaryngology, which reflects the continuous scientific and technical progress of the specialty. It has become an important tool to be kept up to date. The Journal publishes Original Articles (articles on basic research and clinical investigation), reviews, brief communications, case studies and images, which are subjected to a rigorous peer review process.

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Acta Otorrinolaringológica Española has received its first journal Impact Factor (JCR) in 2023. Instructions for authors - Submit an article

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Impact factor

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Impact factor 2023

0.9

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Citescore 2023

1.4

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SJR 2023

0.326

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SNIP 2023

0.54

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