Oculostapedial synkinesis.

A 51-year-old woman with persistent oculostapedial synkinesis after successful microvascular surgical decompression of the facial nerve in the cerebellopontine angle is presented. Auditory symptoms are common in patients with hemifacial spasm manifested by a low-pitch rumbling noise, ear fullness or stuffiness, subjective reduction of hearing acuity, and as described in this case, ear tightness and "drumming." Ephaptic neural transmission is the proposed cause of hemifacial spasm. The exacerbation of auditory symptoms with voluntary blinking and eye closure can be explained by ephaptic transmission and/or aberrant regeneration. Should the aggravating and annoying symptoms of stapedial muscle dysfunction persist in the face of successful treatment of hemifacial spasm, transmeatal division of the stapedial tendon provides immediate relief.