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The Influence of Botulinum Toxin on Auditory Disturbances in Hemifacial Spasm Wp³yw Toksyny Botulinowej Na Zaburzenia S³uchu W Po³owiczym Kurczu Twarzy

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The Influence of Botulinum Toxin on Auditory Disturbances in Hemifacial Spasm Wp³yw Toksyny Botulinowej Na Zaburzenia S³uchu W Po³owiczym Kurczu Twarzy ORIGINAL PAPER/ARTYKU£ ORYGINALNY The influence of botulinum toxin on auditory disturbances in hemifacial spasm Wp³yw toksyny botulinowej na zaburzenia s³uchu w po³owiczym kurczu twarzy Monika Rudziñska1, Magdalena Wójcik1, Katarzyna Zajdel2, Karolina Hydzik-Sobociñska2, Michalina Malec1, Marcin Hartel3, Jacek Sk³adzieñ2, Andrzej Szczudlik1 1Katedra i Klinika Neurologii, Collegium Medicum Uniwersytetu Jagielloñskiego, Kraków 2Klinika Otolaryngologii, Collegium Medicum Uniwersytetu Jagielloñskiego, Kraków 3Medyczne Centra Diagnostyczne Voxel, Zabrze Neurologia i Neurochirurgia Polska 2012; 46, 1: 29-36 DOI: 10.5114/NINP.2012.27451 A bstr act Streszczenie Background and purpose: Hemifacial spasm (HFS) is fre- Wstêp i cel pracy: Po³owiczemu kurczowi twarzy (hemifacial quently accompanied by other symptoms, such as visual and spasm – HFS) czêsto towarzysz¹ inne objawy, takie jak zabu- auditory disturbances or pain. The aim of the study was to rzenia widzenia, s³uchu czy ból. Celem pracy by³a ocena assess the occurrence of auditory symptoms accompanying wystêpowania zaburzeñ s³uchu i analiza ich zwi¹zku z inny- HFS using subjective and objective methods, their relation mi objawami choroby, a tak¿e ich zmiana pod wp³ywem tok- with other HFS symptoms, and their resolution after botu- syny botulinowej (BTX-A). linum toxin (BTX-A) treatment. Materia³ i metody: Obecnoœæ i nasilenie niedos³uchu oraz Material and methods: The occurrence of hypoacusis, ear kliku i szumu usznego oceniono na podstawie wywiadu clicks and tinnitus was assessed by questionnaire in 126 HFS u 126 chorych na HFS zarejestrowanych w elektronicznej patients from an electronic database which included medical bazie danych, która zawiera m.in. ocenê nasilenia HFS w od - data such as severity of HFS rated by clinical scale and powiednich skalach oraz ocenê konfliktu naczyniowego z ner- magnetic resonance imaging focused on the presence of vas - wem VII i VIII w badaniu za pomoc¹ rezonansu magne- cular nerve VII and VIII conflict. Forty consecutive patients tycznego. Czterdziestu kolejnych pacjentów leczonych BTX-A treated with BTX-A and 24 controls matched by sex and age oraz 24 osoby tworz¹ce grupê kontroln¹ poddano szcze- underwent laryngological examination including audiometry, gó³owej ocenie laryngologicznej z badaniem audiometrycz- tympanometry and acoustic middle ear reflex before injection nym i tympanometrycznym przed wstrzykniêciem BTX-A and two weeks later. i po 2 tygodniach od jej podania. Results: About 45.2% of patients complained of auditory Wyniki: Spoœród chorych na HFS 45,2% skar¿y³o siê na disturbances (31.7% hypoacusis, 30.2% ear clicks and 7.1% zaburzenia s³uchu [31,7% na niedos³uch, 30,2% na trzask tinnitus) on the side of HFS. Auditory disturbances correla- („klik”) uszny i 7,1% na szum uszny] po stronie HFS. Zabu- ted with severity of HFS symptoms but not with age, dise- rzenia s³uchu czêœciej wystêpowa³y u chorych z nasilonymi ase duration, or neurovascular conflict with nerves VII and objawami HFS, ale nie mia³y zwi¹zku z wiekiem chorych, VIII. We did not find abnormalities in audiometric and tym- czasem trwania choroby czy wystêpowaniem konfliktu naczy- panometric assessment in patients in comparison with con- niowego z nerwem VII i VIII. Nie stwierdzono ró¿nic w ba - Correspondence address: dr n. med. Monika Rudziñska, Katedra i Klinika Neurologii, Collegium Medicum Uniwersytetu Jagielloñskiego, ul. Botaniczna 3, 31-503 Kraków, Poland, tel. +12 424 86 00, fax +12 424 86 26, e-mail: [email protected] Received: 26.01.2011; accepted: 21.09.2011 Neurologia i Neurochirurgia Polska 2012; 46, 1 29 Monika Rudziñska, Magdalena Wójcik, Katarzyna Zajdel, Karolina Hydzik-Sobociñska, Michalina Malec, Marcin Hartel, Jacek Sk³adzieñ, Andrzej Szczudlik trols. No abnormalities were detected in brainstem evoked daniu audiometrycznym i tympanometrycznym miêdzy grup¹ potentials comparing the sides with and without HFS symp- chorych i grup¹ kontroln¹, jak równie¿ istotnych odchyleñ toms. Tinnitus and absence of ipsilateral acoustic middle ear od normy w badaniu s³uchowych potencja³ów wywo³anych reflex occurred more often in patients with auditory symp- z pnia mózgu miêdzy stron¹ z objawami s³uchowymi a stron¹ toms than those without them. BTX-A treatment caused reso- zdrow¹. U chorych ze skargami na zaburzenia s³uchu w po - lution of subjective acoustic symptoms without any improve- równaniu z chorymi bez zaburzeñ s³uchu czêœciej stwierdza- ment in audiometric assessment. no obecnoœæ szumu usznego i zniesiony ipsilateralny odruch Conclusions: Auditory disturbances accompanying HFS are strzemi¹czkowy. Po podaniu BTX-A zmniejszy³y siê skargi probably caused by dysfunction of the Eustachian tube, which na zaburzenia s³uchu, ale bez zmian w wynikach badañ audio- improves after BTX-A treatment. metrycznych. Wnioski: Stwierdzane zaburzenia s³uchu w HFS mog¹ byæ Key words: hemifacial spasm, auditory symptoms, botulinum spowodowane zaburzeniami czynnoœci tr¹bki Eustachiusza, toxin. które zmniejszaj¹ siê po podaniu BTX-A. S³owa kluczowe: po³owiczy kurcz twarzy, objawy s³uchowe, toksyna botulinowa. Introduction hearing threshold, accompanied by an increased thresh- old of the stapedius reflex and alterations in brainstem Hemifacial spasm (HFS) is a movement disorder auditory evoked potentials. characterized by unilateral clonic or tonic contractions The aim of the study was to assess the occurrence of of muscles supplied by the facial nerve. HFS begins subjective and objective auditory disturbances accom- most commonly in the fifth decade and is twice as com- panying HFS, their relation with other HFS symptoms, mon in women (14.5 vs. 7.4/100 000) [1]. Involuntary and their resolution after botulinum toxin (BTX-A) mo vements usually affect the orbicularis oculi muscle at treatment. first, and then spread gradually to other muscles inner- vated by the facial nerve. It is thought that the muscle Material and methods contractions in HFS are secondary to the compression of the facial nerve with the vessel within the facial nerve The study comprised 126 patients with HFS (66.6% exit zone from the brainstem and result from abnormal were women; mean age: 62.2 ± 10.8 years; mean dura- impulsation within the facial nerve due to the occurrence tion of HFS: 9.4 ± 10.6 years) who were treated in of artificial synapses between adjacent axons or due to the Movement Disorders Outpatient Clinic at the De - the reorganization of the facial nucleus [2-4]. partment of Neurology (University Hospital of Kraków) Besides the typical muscle twitching of half of the between 2004 and 2010. The diagnosis of HFS was face, many patients with HFS suffer from additional established in each case by the movement disorder spe- symptoms and signs, including abnormal tearing, sali- cialist (M.R.), according to the clinically observed uni- vation or auditory disturbances [3-5]. The most fre- lateral clonic or tonic contractions of muscles innervat- quen tly reported (13-32% of patients) [3-7] auditory ed by the facial nerve. symptoms include hypoacusis and tinnitus, sometimes Demographic and clinical data were recorded in in the form of specific intermittent crackles, called ear the dedicated electronic database. The registered vari- clicks. Unilateral tinnitus may result from the activity ables included, among others, age at onset of the dis- of the tensor tympani muscle and/or motor units of the ease, duration of the disease and its course, affected side, stapedius nerve, as its fibres travels through the facial associated symptoms, including auditory ones (tinnitus, nerve. The contractions of the stapedius muscle may and, separately, ear clicks, because those were very often evoke oscillations of the auditory ossicles within the mid- and clearly reported by the studied patients), hypoacu- dle ear. Close proximity of the facial and vestibuloco - sis, factors that exacerbate or relieve muscle contractions, chlear nerve might facilitate the occurrence of neuro- comorbidities, family history, and treatment. vascular conflict with the latter one, and this could be The severity of HFS was assessed according to the another cause of auditory disturbances. Damage of the seven-point Clinical Global Impression Scale (CGI) [8] vestibulocochlear nerve usually causes an increase of the and with the five-point scale proposed by Tan et al. 30 Neurologia i Neurochirurgia Polska 2012; 46, 1 Auditory disturbances in hemifacial spasm [9,10]. Each patient had magnetic resonance imaging in Kraków, who were treated because of upper respirato- (MRI) of the head performed with detailed assessment ry tract infections and were scheduled for tonsillectomy of the cerebellopontine angles in 3D FIESTA sequences due to chronic tonsillitis. Control subjects had no sub- to establish the presence of neurovascular conflict (com- jective or objective otological symptoms, and no clinical pression of the seventh or eighth cranial nerve or com- features of otitis media or Eustachian salpingitis. pression of the brainstem). Controls were subjected to interview, assessment of Written consent was obtained from each patient the level of tinnitus, otoscopic and audiometric testing, before the beginning of the study. with tympanometry and assessment of the stapedius A more detailed assessment of auditory disturbances reflex, similarly to the patients with HFS. was performed in 40 (out of the 57) consecutive patients Pure-tone audiometry included measurements of air with HFS who were treated with BTX-A in the last and bone conduction
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