Palatal Tic Disorder Causing Objective Clicking Tinnitus in an 8 Years Old

Abstract

Palatal tremors including myoclonus are well-known causes of objective tinnitus. Essential palatal tremors and tic disorders are recognized but rarer causes of objective pulsatile tinnitus. An 8-year-old boy presented with a chief complaint of clicking sounds in both the ears for 1 month, intermittent, occurs frequently in episodes, wherein intraoral examination revealed bilateral rhythmic, low frequency, symmetrical contractions of the soft palate muscles accompanied by clicking sounds audible to physician as well (objective tinnitus). The child's mother stated that the clicking sounds were not present when he was asleep. When the child was distracted by tuning fork sound, the palatal movements stopped. CNS examination, developmental history, birth, and growth history were all normal. Magnetic resonance imaging study with contrast enhancement was normal. The child was started on clonazepam and clonidine and follow-up was done after 1st and 2nd months. The tinnitus reduced but did not resolve completely. Clinical features of a patient with palatal tremor should be carefully assessed with prior knowledge of possible etiopathologies to guide the investigations and management. We highlight a case of palatal tic disorder to bring the possibilities quickly to the reader's mind.