Irregular Ear Clicking or Vibration Noise
Every once in awhile, I see a patient who complains of an irregular clicking (or vibration-like) noise in one or both ears that occurs in bursts and may last anywhere from a few minutes every few days to as long as days or weeks at a time. Just as mysteriously as they begin, the noise may suddenly stop only to restart weeks, months, or even years later (or never again). In the rare patient, the sound is ALWAYS there. For others, it happens only when hearing a sound.
Click.... click... click, click, click...
CLICK... click, click...
click... Click Click... click... ... ... ... CLICK
The noise occurs whether you are simply breathing without any chewing or swallowing (if it happens with opening and closing the mouth, you have TMJ). It occurs while reading, sleeping, or watching TV. There's nothing you do that consistently seems to trigger it to happen nor get it to stop. There is no pain and if anything, this issue is more annoying than anything else. If this does not quite sound like you, your problem is more likely to be due to eustachian tube dysfunction.
These irregular clicking noises in the ear should NOT be confused with tinnitus. Rather, irregular clicking noises in the ear are almost always due to muscle spasms... just like "eye twitching" or "facial twitching". BUT, instead of being able to "see" the twitching as with eye twitching (also known as blepharospasm), one hears the twitching instead since the muscles are located around or in the ear. The most common causes are:
- Palatal Myoclonus
- Tensor tympani and/or stapedius muscle spasms (middle ear myoclonus, tonic tensor tympani syndrome)
Create the ear clicking/pulsing sound you hear with an
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The first potential cause (palatal myoclonus) can be diagnosed by seeing "spasms" of the soft palate that occurs in time with the clicking. Spasms of the soft palate can be visualized by simply looking in the mouth or by nasal endoscopy. The mouth needs to open passively since actively opening the mouth will often suppress the palate spasms. Watch the videos below (click on picture).
View on Nasal Endoscopy
The reason one is able to "hear" the twitching is because the muscles of the soft palate extend up into the ear via the eustachian tube.
Treatment of palatal myoclonus is by botox injections to the muscles that are twitching. Just like botox treatment anywhere else in the body, the effects are only temporary and needs to be repeated every 3-6 months.
Tensor Tympani or Stapedius Muscle Spasms
Regarding tensor tympani and stapedius muscle spasms (middle ear myoclonus)... these muscle are not able to be visualized as they are located within the middle ear. The tensor tympani attaches to the malleus ossicle (the "hammer" of the 3 middle ear bones) and the stapedius muscle attaches to the stapes ossicle (the "stirrup").
The stapedius muscle is the smallest skeletal muscle in the human body. At just over one millimeter in length, its purpose is to stabilize the smallest bone in the body, the stapes. The tensor tympani is a muscle located in a bony canal above the eustachian tube and connects to the malleus bone. Its main role is to dampen loud sounds, such as those produced from chewing, shouting, or thunder. Because its reaction time is not fast enough, the muscle cannot protect against hearing damage caused by sudden loud sounds, like explosions or gunshots.
Just like any muscle in the body, these muscles can also "twitch" rapidly causing the clicking noise in the ear. Tensor tympani muscle spasms typically produce a clicking sound whereas stapedius muscle spasms produce more of a buzz/click sound. About 80% of patients suffering from middle ear myoclonus recall either a triggering stressful event or sudden loud noise exposure.
Middle ear myoclonus (MEM) produced noises occur completely at random without any associated correlation with external triggers. Tonic tensor tympani syndrome (TTTS) produced noises also occur randomly, BUT is associated with external triggers typically occurring with certain sounds/pitches (for example, occurs only with talking, hearing a child cry, swallowing, etc).
Unfortunately, there is no "test" one can obtain to definitively diagnose this problem with absolute certainty. One can infer there may be an issue by observing twitching of the eardrum under endoscopic magnification. Abnormalities may be seen on stapedial reflex and acoustic reflex decay. However, really the best way to diagnose is based purely on history and excluding palatal myoclonus as a diagnosis (no soft palate twitching seen even though the patient is able to hear it).
One can try to treat this condition with TriMagnesium 500mg total per day and if that fails, consider even trying muscle relaxants and anticonvulsants (ie, flexeril, neurontin, dilantin). One study found that tegretol (anti-convulsant) with baclofen (muscle relaxant) worked best.
However, ultimately the only way this problem can be definitively treated is surgical... the muscle gets cut. Botox can NOT be utilized as one needs to be able to "see" or "feel" the muscle in order to inject botox. This surgery is performed by a neuro-otologic surgeon.
See the full list of surgeons who can perform this surgery here.
Clinical characteristics and therapeutic response of objective tinnitus due to middle ear myoclonus: a large case series. Laryngoscope 2013, 123 (10): 2516-20
Stapedius muscle myoclonus. Ann Otol Rhinol Laryngol. 2003 Jun;112(6):522-4.
Middle-ear myoclonus. J Laryngol Otol. 2000 Mar;114(3):207-9.
Management of middle ear myoclonus. J Laryngol Otol. 1994 May;108(5):380-2.
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