by Barry Keate
Middle Ear Myoclonus (MEM) is a rare form of objective tinnitus that can actually be heard by another person. It sounds pretty scary and unfathomable, but it’s not that difficult to understand.
Myoclonus refers to the spasmodic jerky contraction of a muscle or group of muscles. Hiccups are a form of myoclonus. In the middle ear, myoclonus can occur in the very small muscles behind the eardrum and in front of the cochlea.
There are two such muscles in the middle ear. The tensor tympani muscle attaches to the malleus bone in back of the eardrum. The stapedius muscle attaches to the stapes bone, that conducts sound to the cochlea. Both of these muscles are protective. They act to dampen sound levels coming into the ear and to reduce the sound of chewing and our own voice.
In the illustration below, the tensor tympani is the long dark muscle connected to the malleus bone inside the eardrum. The stapedius is the short red muscle attached to the stapes bone, the horseshoe shaped object.
When the tensor tympani muscle is in spasm, it creates a thumping sound like a tympani drum. It can also be heard as a clicking sound. The thumping or clicking can produce a frequency as high as 90-100 times per minute. A doctor can actually see the eardrum vibrating and can hear the sound from 10-20 cm away.
When the stapedius muscle is in spasm is usually heard as a buzzing, rumbling or crackling sound. It cannot be observed affecting the eardrum but can sometimes be heard outside the ear.
MEM is quite rare, occurring in only about 6 in 10,000 people. But it can be maddening to have the thumping, clicking or buzzing sounds that will not stop.
Causes of MEM include being subject to loud sounds such as artillery fire or nearby firecracker explosion. Stress can also bring it on. It can be caused by spasm in the facial nerve or the palate. When spasms start, they can often include both ears. Stress can play a major role, increasing the discomfort of the spasms.
MEM Treatment Options
Typical treatments include coping strategies and counseling, relaxation and anxiety reduction. Hypnosis and sedatives are sometimes used. Acupuncture and biofeedback can be helpful. Botox injections in the wall of the Eustachian tube will paralyze the muscles and stop the spasms. But Botox is very expensive and wears off in 3 months. When benzodiazepine anti-anxiety medications are used, they generally begin at a low dosage and are slowly increased until the patient improves or side effects become harmful. (1)
There is a similar situation associated with “typewriter tinnitus”. This tinnitus is intermittent and has a staccato quality like a typewriter in the background or Morse code. This type of tinnitus is usually associated with irritability of the 8th cranial nerve, the auditory nerve. It is usually responsive to the drug carbamazepine. This medication is commonly used to treat seizures or nerve pain.
When other methods fail to reduce MEM, surgery can be employed. A tympanotomy is used to cut the stapedial and/or the tensor tympani muscles. Care must be taken because the facial nerve can be damaged during the surgery. Case reports have shown that surgery is very effective, immediately and permanently stopping the spasms, (2)
Zygomatic Hand Pressure Technique
A very simple, non-invasive treatment has been found that helps some people with irregular MEM. It involves lacing the fingers together and applying pressure from the palms over the zygomatic bones (cheekbones). A pressure of about two pounds is applied for 30 seconds or until the clicking stops. In two case reports, MEM was brought under control and episodes diminished. (3)
If this technique does not help, I recommend acupuncture and biofeedback for this condition. 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 and reduce stress.
1 – Tensor Tympani and Stapedius Myoclonus Tinnitus
2 – Golz A, Fradis M, et. al. Bilateral tinnitus due to Middle-Ear Myoclonus. The International Tinnitus Journal, Vol. 9, No. 1; Jan/June, 2003.
3 – Chan C, Palaniappan R. Middle Ear Myoclonus: A New Technique For Suppression Of Spontaneous Clicking Tinnitus, The International Tinnitus Journal, Vol. 16, No. 1; Jan/June, 2010.