A 12-year-old girl presented with a one-week history of clicking sounds in her ears following an upper respiratory infection. Her parents also reported hearing the sound, which was metallic and intermittent, disappearing during sleep. It was not pulsatile and was unaccompanied by auditory or visual symptoms. She had no history of chronic illness or medication use.

Physical examination revealed rhythmic and involuntary movements of the soft palate, visible in the oropharynx, producing the characteristic sound (video). Swallowing and speech were unaffected. The remainder of the general and neurological physical examination and laboratory tests, including a throat swab for viruses, were nonspecific. Brain MRI and MR angiography revealed no abnormalities, including vascular loops.

A diagnosis of essential palatal myoclonus (EPM) was made. Treatment with piracetam did not result in clinical improvement, and symptoms persisted at the last follow-up after six months of evolution. EPM in children is exceptional and is characterized by rhythmic contractions of the soft palate and, occasionally, of the pharyngeal muscles.1–3 It is part of the differential diagnosis of objective tinnitus and, unlike symptomatic palatal myoclonus, which is associated with brainstem lesions in the Guillain-Mollaret triangle, EPM is idiopathic and shows no radiological abnormalities.