Reconsidering the Management of Middle Ear Myoclonus: A Case Series Presentation and Systematic Review of Surgical Outcomes Following Lysis of the Tensor Tympani and Stapedial Tendons

OBJECTIVE: To present a two patient case series and systematically review clinical characteristics and outcomes of middle ear myoclonus (MEM) and to evaluate whether lysis of the tensor tympani (TT) and/or stapedial tendon (ST) should be considered as an alternative to medical therapy to treat this condition. DATABASES REVIEWED: MEDLINE, Embase, CENTRAL, and Web of Science. METHODS: Two institutional cases (3 ears) operated on from March through August 2025 were retrospectively analyzed. We then systematically identified English-language studies published before August 2025 and screened them using predefined criteria. Two independent reviewers (C.Z., D.S.) extracted data on demographics, symptom duration, prior medical therapy, surgical procedure (TT and/or ST lysis), technique, laterality, and outcomes. We then used descriptive statistics. RESULTS: Both patients (3 ears) in the case series achieved complete symptom resolution. Of 756 screened articles, 17 met criteria for full-text review, contributing 70 patients. Combined with the case series, the total cohort comprised 72 patients, of whom 60 (83.3%) had previously tried anticonvulsants, antispasmodics, tranquilizers, sedatives, and/or muscle relaxants, while 12 (16.7%) underwent surgery as initial treatment. Complete symptom resolution occurred in 67 patients (93.1%), partial improvement in 4 (5.5%), and symptom recurrence in 1 (1.4%). CONCLUSION: TT and/or ST lysis is a safe and effective treatment for MEM with high rates of symptom resolution. Surgical intervention should be considered early in appropriate patients, and patients should be appropriately counseled regarding the high likelihood of complete symptom resolution with surgical intervention.