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Abstract: A 21-year-old white female was referred to us complaining of a high frequency continuous objective tinnitus emanating from her left ear since childhood. For lhe last two years, since she entered the university, it had been tremendously bothersome, disturbing sleep, concentration in study and aggravating emocional conditions. She denied inhibition of tinnitus with sleep, drugs, head rotation and slight pressure over the jugular vein.The audiometry revealed amild high- frequency sensorineural hearing loss and the tinnitus was masked by a 55dB-8KHz external tone. All radiologic evaluation was normal, including cranial and mastoids computed tomography, MRI and MRA, as well as CSF puncture (initial pressure). With no further clues, and because of the tremendous distress caused by the tinnitus, we decided to perform an exploratory tympanomastoidectomy with a small sterile microphone and try to find more accurately the real source of tinnitus, but during the anaesthetic induction, the tinnitus was completely gome. Thus, we realized that the real cause of tinnitus should have been a muscular mioclonus in the middle ear and tenotomy of both tensor tympani and stapedial muscle were performed. The patient recovered thoroughly asymptomatic and she is still doing well after 8 months of follow-up. The authors would like to present this very unusual case and show the important role of the otolaryngologist in auscultating the external auditory cannal to confirm an objective tinnitus, once the patient might have his/her tinnitus appropriately diagnosed and treated, improving the quality of life.
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