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Loud Clicking Sounds Associated With Rapid Soft Palate Muscle Contractions

Schwartz, Richard H. MD*; Bahadori, Robert S. MD; Myseros, John S. MD

doi: 10.1097/PEC.0b013e3182443000
Illustrative Cases

An 8-year-old boy was seen by his primary care pediatrician with a chief complaint of “intermittent rapid vibrations of the epiglottis” that began several weeks prior. Intraoral examination revealed rapid, symmetrical bilateral contractions of the soft palate muscles (velum), accompanied by clicking sounds audible to physician (objective tinnitus) and patient. The patient was able to volitionally control the initiation and cessation of the palatal movements. The child’s mother stated that there had been no clicking noises heard while the boy was sound asleep. Palatal “clonus” was tentatively diagnosed as the cause of the problem. A normal magnetic resonance imaging study with contrast enhancement confirmed that there was no anatomical basis for the localized movement disorder.

Palatal myoclonus is an uncommon localized intraoral movement disorder. There are 2 distinct types, and our patient was diagnosed with the essential palatal myoclonus type. This type is characteristically associated with clicking tinnitus, heard by the affected person as well as those in close proximity. The clicking noise is not continuous, ceases during sleep, and is not lifelong.

From the Departments of *Pediatrics and †Surgery, Section of Pediatric Otolaryngology, Inova Fairfax Hospital for Children, Falls Church, VA; and‡Department of Neurosurgery, Children’s National Medical Center, Washington, DC.

Disclosure: The authors have no conflict of interest to declare.

Reprints: Richard H. Schwartz, MD, 100 E St, SE, Suite 301, Vienna, VA 22180 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.