What Is Middle Ear Myoclonus?

When most people think of Tinnitus, they imagine a constant ringing or hissing. But a distinct and often startling form of tinnitus arises from the middle ear itself—specifically from involuntary contractions of the tensor tympani and stapedius muscles. This condition, known as middle ear myoclonus (MEM), produces objective clicks, creaks, or thumping sounds that can sometimes even be heard by an examiner.

The Two Key Muscles: Tensor Tympani and Stapedius

The tensor tympani attaches to the malleus (hammer) bone. When it contracts, it pulls the eardrum inward, dampening loud sounds. The stapedius attaches to the stapes (stirrup) bone and stabilizes it during loud noise. Both muscles normally work reflexively, but when they spasm rhythmically or continuously, patients hear annoying, repetitive sounds.

Key symptom: Rapid clicking, popping, or thumping in one ear that may be triggered by sound, movement, or stress. Some describe it as the sound of a typewriter or a sewing machine.

Typewriter Tinnitus: A Unique Auditory Phenomenon

Typewriter tinnitus is a specific form of MEM where the tensor tympani or stapedius muscle fires erratically, producing rapid, percussive beats that resemble a mechanical typewriter or a woodpecker. Patients often report that the clicking can be voluntarily stopped by yawning, swallowing, or changing head position—clues that suggest a muscular origin within the middle ear.

Thumping and Tubal Tinnitus

A slower, more rhythmic thumping (often synchronized with the pulse) may indicate tubal tinnitus—a condition where contractions of the tensor veli palatini (a palatal muscle) cause the Eustachian tube to snap open and shut. This can sound like a low-frequency heartbeat or a distant drum. Unlike typewriter tinnitus, tubal tinnitus often responds to muscle relaxants or specific maneuvers that alter middle ear pressure.

Diagnosis and Differentiation

Diagnosing middle ear myoclonus requires ruling out vascular tumors, patulous Eustachian tube, and neurological disorders. Otoscopy may reveal visible twitching of the tympanic membrane. Audiometry, tympanometry, and sometimes MRI are used. Because tensor tympani and stapedius spasms are often stress-related, a subset of patients improve with biofeedback, antianxiety medication, or benzodiazepines.

Treatment Options for Clicking and Thumping Tinnitus

For bothersome MEM, treatments range from simple observation to surgical intervention. Mild cases may respond to sound therapy or muscle relaxants. When clicking or thumping becomes disabling, injection of botulinum toxin into the tensor tympani or stapedius has shown promise. In severe, refractory cases, surgical division (tenotomy) of the involved muscle can provide lasting relief—though it carries risks of hearing loss or hyperacusis.

Living with Middle Ear Myoclonus

Many people with tensor tympani or stapedius myoclonus feel isolated because their tinnitus sounds mechanical rather than tonal. However, recognizing that these middle ear muscles can misbehave empowers patients to seek specialized care. If you hear persistent clicking, popping, or rhythmic thumping in your ear—especially if it changes with jaw movement or sound—consult an otologist experienced with MEM.

Bottom line: Not all tinnitus is neurological. Sometimes the source is right inside your middle ear, where tiny muscles produce very real, very audible chaos.