Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-19T13:42:54.815Z Has data issue: false hasContentIssue false
  • English
  • Français

The stapedial reflex in cephalic tetanus

Published online by Cambridge University Press:  29 June 2007

Chris de Souza ,
Dilip Karnad ,
Rosemarie de Souza ,
A. Raje ,
K. Mansukhani  and
G. H. Tilve
Chris de Souza*
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
Dilip Karnad
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
Rosemarie de Souza
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
A. Raje
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
K. Mansukhani
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
G. H. Tilve
Affiliation:
Departments of Medicine, Audiology and Neurology, KEM Hospital, Parel, Bombay 400 012, India.
*
Chris de Souza, St Peter's Colony, 16 Xavier House, Manuel Gonsalves Road, Bandra, Bombay 400 050, India.
Get access Rights & Permissions [Opens in a new window]

Abstract

Three patients are presented with cephalic tetanus following injuries to the face. Two were adults and one a child. All three had bilateral VIIth cranial nerve involvement and one patient also presented with involvement of the IIIrd, IVth and VIth cranial nerves. The patients initially an ipsilateral VIIth cranial nerve weakness which later in the course of the illness developed into hyperactivity of the VIIth cranial nerve. The contralateral VIIth cranial nerve demonstrated a similar pattern. The stapedial reflex was tested serially. The stapedius muscle activity preceded that of the muscles of the face thus serving as an indicator of improvement or impending deterioration. Deflections measuring more than 1 cm, on stapedial reflex threshold testing, were indicative of stapedial reflex spasm. In the stapedial reflex decay test, both ill-sustained (intermittent) and sustained spasms of the stapedius muscle were seen.

Keywords

TetanusFacial paralysisAcoustic impedance testsStapedius muscle
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 108 , Issue 9 , September 1994 , pp. 736 - 742
Copyright
Copyright © JLO (1984) Limited 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achari, A. M. (1973) Facial palsy in tetanus. British Medical Journal 3: 543–544.CrossRefGoogle ScholarPubMed
Beaty, H. N. (1987) Tetanus. In Harrison's Principles of Internal Medicine. 11th Edition (Braunwald, C, ed.), McGraw-Hill, New York, pp 558–561.Google Scholar
Bischoff, C., Klingelhoefer, J., Conrad, B. (1989) Decay and recovery of the stapedial reflex by prolonged stimulation in the diagnosis of myasthenia gravis. Journal of Neurology 236: 343–348.CrossRefGoogle ScholarPubMed
Blom, S., Zakrisson, J. E. (1974) The stapedius reflex in the diagnosis of myasthenia gravis. Journal of Neurological Sciences 21: 71–76.CrossRefGoogle ScholarPubMed
Brooks, V. B., Curtis, D. R., Eccles, J. C. (1957) The action of tetanus toxin on the inhibition of motor neurones. Journal of Physiology (London) 135: 655–670.CrossRefGoogle Scholar
Dastur, F. D., Shahani, M. T., Dastoor, D. H., Kohiyar, F. N., Bharucha, E. P., Mondkar, V. P., Kashyap, G. H., Nair, K. G. (1977) Cephalic tetanus: demonstration of a dual lesion. Journal of Neurology. Neurosurgery and Psychiatry 40: 782–786.CrossRefGoogle ScholarPubMed
de Souza, C. E., Karnad, D. R., Tilve, G. H. (1992) Clinical and bacteriological profile of the ear in otogenic tetanus: a case control study. Journal of Laryngology and Otology 106: 1051–1954.CrossRefGoogle ScholarPubMed
Dirks, D. D. (1979) Bone conduction testing. In Handbook of Clinical Audiology. 2nd Edition (Katz, J., ed.), Williams and Wilkins, Baltimore/London, pp 110–123.Google Scholar
Duchen, L. W., Tonge, D. A. (1972) The effects of tetanus toxin on neuromuscular transmission and on the morphology of motor endplates in the mouse. Journal of Physiology 228: 157–172.CrossRefGoogle Scholar
Engel, W. K., Warmots, J. R. (1973) The motor unit. In New Developments in Elearomyography and Clinical Newophysiology. (Desmedt, J. L., ed.), Karger, Basel, pp 141–177.Google Scholar
Feldman, A. S. (1981) Acoustic impedance - admittance battery. In Handbook of Clinical Audiology. 2nd Edition. (Katz, J. ed.), Williams and Wilkins, Baltimore/London, pp 356–374.Google Scholar
Garcia-Mullin, L., Daroff, R. B. (1973) Cephalic tetanus - a case report with EMG study. Journal of Neurology, Neurosurtery and Psychiatry 36: 296–301.CrossRefGoogle Scholar
Green, D. S. (1979) Pure tone air-conduction testing. In Handbook of Clinical Audiology. 2nd Edition. (Katz, J., ed.), Williams and Wilkins, Baltimore/London, pp 98–109.Google Scholar
Guinan, J. J., Joseph, M. P., Norris, B. E. (1989) Brain stem facial motor pathways from 2 distinct groups of stapedius motor neurones in the cat. Journal of Comparative Neurology 287: 134–144.CrossRefGoogle Scholar
Hirsch., A., Anderson, H. (1980) Elevated stapedius reflex threshold and pathologic decay. Clinical occurrence and significance. Acta Otolaryngologica (Supplementum) 368: 1–15.Google Scholar
Jagoda, A., Riggio, S., Burguires, T. (1980) Cephalic tetanus: a case report and a review of literature. American Journal of Emergency Medicine 6: 128–130.CrossRefGoogle Scholar
Jerger, J., Hayes, D. (1981) Clinical use of acoustic impedance testing in audiological diagnosis. In Audiology and Audiological Medicine. Vol. 2. (Beagley, H. A., ed.), Oxford University Press, Oxford, pp 707–722.Google Scholar
Joseph, M. P., Guinan, J. J., Fullerton, B. C., Norris, B. E., Kiang, N. Y. S. (1985) Number and distribution of stapedius motor neurones in cats. Journal of Comparative Neurology 232: 43–54.CrossRefGoogle ScholarPubMed
Lyon, M. J. (1978) The central location of the motor neurones to the stapedius muscle in the cat. Brain Research 143: 437–444CrossRefGoogle Scholar
Margolis, R. H., Levine, S. C. (1991) Acoustic reflex measures in audiologic evaluation. Otolaryngologic Clinics of North America 24: 329–347.CrossRefGoogle ScholarPubMed
Oh, S. J. (1988) Electromygraphy Neuromuscular Transmission Studies. Ch. 5. Williams and Wilkins, Baltimore/Sydney/Hong Kong, pp 111–180.Google Scholar
Park, D. M. (1970) Cephalic tetanus. Journal of Neurology, Neurosurgery and Psychiatry 33: 212–215.CrossRefGoogle ScholarPubMed
Ramsden, R. T. (1987) Acoustic Tumours. In Scott Brown's Otolaryngology. 5th Edition. (Kerr, A. G. and Booth, J. B., eds.), Butterworths, London, pp 500–533.Google Scholar
Scholz, D. G., Olson, J. M., Thurber, D. L., Larson, D. E. (1989) Tetanus: an uncommon cause of dysphagia. Mayo Clinic Proceedings 64: 335–338.CrossRefGoogle ScholarPubMed
Shahani, M., Dastur, F. D., Dastoor, D. H., Mondkar, V. P., Bharucha, E. P., Nair, K. G., Shah, J. C. (1979) Neuropathy in tetanus. Journal of Neurological Sciences 43: 173–182.CrossRefGoogle ScholarPubMed
Simons, M. R. (1979) Acoustic impedance tests. In Diseases, Deafness and Dizziness. (Goodhill, V., ed.). Harper and Row, New York, London, pp 185–200.Google Scholar
Wilson, R. H., Sleekier, J. R, Jones, H. C, Margolis, R. H. (1978) Adaptation of the acoustic reflex. Journal of the Acoustical Society of America 64: 782–791.CrossRefGoogle ScholarPubMed
Wilson, R. H., McBride, I. M. (1978) Threshold and growth of the acoustic reflex. Journal of the Acoustical Society of America 63: 147–154.CrossRefGoogle ScholarPubMed