Middle ear myoclonus (MEM) is a rare condition involving involuntary muscle spasms within the middle ear, leading to internal sounds heard by the affected individual.
Understanding Middle Ear Myoclonus
The middle ear houses two small muscles, the tensor tympani and the stapedius, which play a role in normal hearing and ear protection. The tensor tympani muscle connects to the malleus, one of the three tiny bones in the middle ear, and its contraction tenses the eardrum. This action helps dampen loud sounds, particularly those generated internally, such as chewing, speaking, or swallowing. The stapedius muscle, the smallest skeletal muscle in the human body, attaches to the stapes bone. It acts to stabilize the stapes and reduce the amplitude of sound waves reaching the inner ear, thereby protecting against excessively loud external noises.
In MEM, these muscles contract involuntarily and rhythmically, disrupting their protective function and creating the characteristic sounds. The exact cause of these contractions is often unknown, though anxiety can sometimes lower their threshold.
Recognizing the Signs
Individuals with middle ear myoclonus experience distinct internal sounds that vary in nature. Common descriptions include clicking, thumping, buzzing, fluttering, crackling, or popping noises. These sounds are usually perceived internally, though they may sometimes be audible to an examiner, known as objective tinnitus.
The sounds can be intermittent or continuous, regular or irregular, and may affect one or both ears. Certain actions, such as swallowing, speaking, or changes in head position, can trigger or intensify them. The persistent nature of these noises can interfere with daily activities, including concentration and sleep.
Addressing the Danger Question
Middle ear myoclonus is a benign condition, not life-threatening, and does not lead to severe medical complications or permanent hearing loss. While not physically dangerous, the persistent internal sounds can be distressing and affect quality of life. The constant noise can disrupt sleep, impair concentration, and contribute to emotional challenges.
In rare instances, MEM may be associated with underlying neurological conditions. These are usually ruled out through a comprehensive medical evaluation. The primary concern with MEM is its impact on comfort and daily functioning, rather than physical health.
Pathways to Relief
Diagnosis begins with a detailed medical history and physical examination. Audiological tests, such as tympanometry, can provide objective information by detecting rhythmic eardrum movements, though this is not always definitive. Imaging studies like MRI or CT scans may rule out other potential causes. In some cases, a definitive diagnosis is made through direct visualization of muscle spasms during an examination.
Management and treatment options are individualized based on symptoms and needs. Medications like muscle relaxants (e.g., baclofen, clonazepam), anticonvulsants (e.g., carbamazepine), or anxiolytics may be prescribed to control spasms. Botulinum toxin injections directly into affected middle ear muscles also reduce activity.
Beyond medication, behavioral therapies like cognitive behavioral therapy (CBT) and sound therapy, which might involve masking devices, can offer relief. Simple lifestyle adjustments, including stress reduction, limiting caffeine intake, and improving sleep habits, may also help manage symptoms. For severe or persistent cases unresponsive to conservative treatments, surgical intervention may be considered. This procedure, tenotomy, involves cutting the tendons of the affected tensor tympani or stapedius muscle, and can be performed using minimally invasive endoscopic techniques.