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Tinnitus Library

Ask Barry Questions on Tinnitus - July 2014

Do you have questions about tinnitus, our products or specific treatments? Ask Barry. Arches President and tinnitus authority, Barry Keate, will select the most representative questions each month for publication. Regardless all questions will receive a personal reply from Barry.

ASK BARRY Tinnitus expert, Barry Keate, answers your questions about Tinnitus Send your question to:  Ask Barry

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Clicking and Snapping Sounds in Ear

Dear Barry,

I've been struggling with a form of Middle Ear Myoclonus that produces a clicking, snapping sound in my right ear. It's been going on every day for four months. Some days it clicks every few minutes, some days every couple of hours. It's most anxiety provoking.

I struggled with "subjective tinnitus" (hissing sound in the same ear for five years). I have high-frequency hearing loss in that ear as well. Do you think it's all related? I had an MRI withcontrast, EEG and VEP all are normal. I've seen two ENTs, a neuro-otologist and a neurologist (who gave me Valium, which didn't help). I'm despondent and desperate that this will never end. Any help, tips, suggestions would be greatly appreciated.

Thanks, Steve

Dear Steve,

Thanks for sending this question to me. I hope I can help you to manage or eliminate this condition.

Middle Ear Myoclonus (MEM) is a form of objective tinnitus that can be heard by others listening closely to your ear. Myoclonus refers to a brief twitching of a muscle or group of muscles. In the middle ear it is usually the tensor tympani muscle which connects to the ear drum and/or the stapedius muscle which attaches to the stapes bone. In the illustration below the tensor tympani is the longer black muscle running up to the back of the eardrum and the stapedius is the short red muscle attaching to the horseshoe shaped stapes bone.


The tensor tympani and stapedius muscles are protective. Their role is to reduce the amount of sound that gets into the inner ear. They can be triggered by loud noise, stress or other conditions. If the tensor tympani muscle is in spasm, an observer can see the twitching of the ear drum. If the stapedius is in spasm twitching is not visible. Spasm in the tensor tympani usually results in a "thumping" noise like a tympani drum. It can also be heard as a clicking sound. Spasm in the stapedius muscle is usually heard as a buzzing, rumbling or crackling sound. Descriptions of the sound can vary widely among patients.

Stress can be an important part of MEM and controlling this can be very helpful. In that sense this may be related to your subjective tinnitus. That is why your neurologist gave you valium. Many therapies have been tried and they seem to work with some people. Hypnosis, sedatives, acupuncture and biofeedback have all been attempted with varying degrees of success. When benzodiazepine anti-anxiety medications are used they generally start at a low dosage and are gradually increased until the patient improves or side effects become harmful. This may be why your dosage didn't work; it was the beginning dose. On the negative side there is the issue of becoming dependent on benzo medications. They can be very dangerous this way.

My personal favorites in the class of treatments are acupuncture and biofeedback. I have seen people after an acupuncture session being so totally relaxed they can barely move. Biofeedback teaches people how to control the involuntary actions of the nervous system.

Another type of clicking tinnitus is known as typewriter tinnitus. This is attributed to irritability of the 8th cranial nerve. It is intermittent and has a staccato quality like a typewriter, popping corn or Morse code. This type is responsive to carbamazepine (brand name Tegretol). This medication is an anti-convulsant and mood stabilizing drug commonly used for epilepsy and some other conditions.

I suggest you try these therapies for a few months and give them a good chance to work. If they don't there are other therapies to try. Botox injections have frequently been used for MEM. Botox will paralyze the muscles and stop the MEM. It can be injected into the wall of the eustachian tube. This treatment is reasonable but needs an individual who is very good at understanding the anatomy of the tensor tympani muscle to administer the injection. Also, Botox wears off in three months.

The final therapy, if nothing else works, is surgery. Surgical sectioning (cutting) of the tensor tympani and/or stapedial muscle tendons is a straightforward and effective procedure. This is called tympanotomy and refers to a tiny incision in the ear drum through which the surgery is accomplished. The procedure immediately cures the condition and those who have had it become symptom free even after a follow-up one year later.

I hope this is helpful for you.

Wishing you quiet times,

Barry Keate

Can Arches help tinnitus caused by hearing loss?


I have sudden hearing loss and tinnitus. I read your newsletters faithfully and would like to try 4 Tinnitus Formula.

I was diagnosed with sudden sensorineural hearing loss November of 2013 and as a result of the hearing loss, my tinnitus is so loud. I cried a lot; it’s so bothersome, but I think of a lot of other people that are worse off than me. I have previously tried Lipoflavonoid and other tinnitus vitamins, but nothing seems to quiet it down.  I was wondering if 4 Tinnitus Formula would work for someone who has sensorineural hearing loss, and not just from noise induced tinnitus. I would try anything just to quiet it down a level.

Thank You!

Joanne D.

Dear Joanne,

Noise exposure always results in sensorineural hearing loss but sensorineural hearing loss is not always from noise exposure. What I'm trying to say is they are essentially the same thing; hair cells in the cochlea are damaged which results in hearing loss. Whether this is the result of noise or other cause is immaterial. The result is the same.

Arches Tinnitus Formula® works effectively for the great majority of people with sensorineural hearing loss, whether noise induced or not. One prominent ENT physician in New York City states that among those patients with hearing loss as the cause of their tinnitus, approximately 75% to 80% have a reduction in the sound level of their tinnitus. The amount of reduction varies by the individual.

Many researchers believe sudden sensorineural hearing loss can result from interrupted blood flow to the cochlea. In this regard, Arches Tinnitus Formula is helpful because it increases blood flow to the capillaries in the inner ear. Also, because your hearing loss is fairly recent, I believe the potential for improvement is very high.

I hope this helps and you are able to reduce the noise level.

Wishing you quiet times,

Barry Keate

Law Enforcement Brings 24/7 Tinnitus

Greetings Barry,

I have had tinnitus symptoms for well over 40 years, due to being in law enforcement, and although I used good ear protection during firearm training, I still suffered some of the negative effects of an inner ear injury from constant firearm discharge close to my ears.

This tinnitus manifests itself just in having a low humming noise 24/7, does not interfere with sleep, or otherwise get in my way. I’ve had numerous tests, and all confirm slight loss of my "fine hearing". Sometime I forget about the humming noise, because of having this as my constant companion, I just ignore it.

Does your product treat the symptoms, ie, cause them to go away as I described my case?

Thank you in advance William S.

Dear William,

In the grand scheme of things you are very lucky your tinnitus isn't worse. I have the same type, due to noise exposure from firing weapons in the Armed Services. I was in the US Army in the days before they wore hearing protection on the firing range. My tinnitus developed into something that definitely changed my life for the worse.

Our product, Arches Tinnitus Formula® (ATF), does treat the symptom you are describing however it does not cause it to go away. There is no cure for tinnitus and that's true for our products (or any other as well). ATF helps reduce the noise level for about 75% of those who have tinnitus caused by noise-induced hearing loss, such as you and me. You can see what some top doctors think of Arches Tinnitus Formula.

Wishing you quiet times,

Barry Keate

NOTE: Ask Barry is pleased to be able to answer your questions based upon the information we have available. Our answers to your email inquiries are not substitutes for a physician's advice nor are they reviewed by a physician. We encourage you to share any suggestions you have received from Ask Barry with your doctor.