A clicking noise heard inside the head, particularly when lying down, is a form of somatic or objective tinnitus. It often originates from physical structures near the ear rather than being a purely auditory nerve phenomenon. The sound being triggered by a change in body position suggests a mechanical or circulatory mechanism. While this symptom is frequently benign, any new or persistent noise in the head or ear warrants a discussion with a healthcare provider for proper evaluation.
Why Position Triggers Inner Ear Noises
Transitioning from a vertical to a horizontal position fundamentally alters the distribution of fluids and pressure within the head and neck. Gravity is neutralized, leading to an immediate increase in blood flow and pressure within the cranial and inner ear vasculature. This increase in blood pressure and volume can cause small, sensitive blood vessels near the auditory structures to expand slightly.
This positional change also affects the pressure equalization system of the middle ear. The inner ear fluid and surrounding tissues are sensitive to these subtle shifts in pressure and flow dynamics. An increase in intracranial pressure (ICP) is a known physiological response to lying down, which can sometimes be perceived as amplified internal sounds by the auditory system.
Common Sources: Ear and Muscular System
The most frequent causes of positional clicking relate to the ear’s pressure system or the muscles surrounding the jaw. Eustachian Tube Dysfunction (ETD) is a common culprit, where the tube connecting the middle ear to the back of the throat fails to open or close properly. When the tube attempts to equalize pressure, a blockage from fluid, mucus, or inflammation—common with allergies or a cold—can result in an audible click. When lying down, fluid dynamics shift, making it more difficult for the tube to drain or equalize pressure, thus making the clicking more noticeable.
Another widespread source is the Temporomandibular Joint (TMJ), which is located immediately adjacent to the ear canal. Issues with this joint, such as displacement of the articular disc or muscle tension, can generate clicking sounds that are transmitted directly into the ear. Lying in certain positions, especially on one side, can place mechanical strain on the jaw joint and its associated musculature, potentially exacerbating the clicking sound. Teeth clenching or grinding (bruxism) often occurs unconsciously during sleep, further stressing the TMJ and leading to positional clicking upon relaxing or shifting position.
A less common, though still benign, possibility involves involuntary muscle spasms known as palatal myoclonus. This condition involves rapid, rhythmic contractions of the muscles in the soft palate. The quick snapping motion of these muscles can be transmitted up the Eustachian tube into the middle ear, producing an objective clicking sound that can sometimes be heard by others. This sound is often noticed most when the person is relaxed or lying down, although the clicking typically stops during sleep.
Addressing Vascular and Neurological Possibilities
While muscular and pressure-related causes are more common, the clicking noise may occasionally stem from vascular or neurological sources, particularly if the sound is rhythmic. Pulsatile tinnitus is perceived as a whooshing or thumping noise that beats in time with the person’s pulse. Positional changes, such as lying down, affect this noise because the head’s horizontal position increases blood flow and can create more turbulent flow in the vessels near the ear. Causes of turbulent flow range from benign conditions like a venous hum to more serious issues like atherosclerosis, which involves the narrowing of arteries.
A rare but significant neurological and bony cause is Superior Canal Dehiscence (SCD). This condition involves a thinning or absence of the bone covering one of the inner ear canals, creating a “third window” for sound transmission. This bony defect causes an amplification of internal bodily sounds, such as the person’s own heartbeat, eye movements, or joint movements. The symptoms of SCD can be sensitive to pressure changes, and while not strictly a clicking noise, the amplification of internal sounds is often noticeable when changing position.
When to Seek Professional Medical Guidance
While many causes of positional clicking are harmless, certain accompanying symptoms should prompt a consultation with a physician, such as an Otolaryngologist (ENT). Any instance where the clicking noise is accompanied by a sudden or noticeable loss of hearing requires prompt medical attention. Similarly, the onset of dizziness, vertigo, or issues with balance alongside the clicking noise are considered warning signs.
Other indications for a medical workup include persistent, severe ear pain or any discharge from the ear canal. If the sound is rhythmic, like a pulse, and does not resolve quickly, investigation is required to rule out a vascular issue. A medical professional can conduct specific tests, such as an audiological exam, to determine the exact origin of the sound and provide an accurate diagnosis.