Hearing a clicking sound that seems to originate from the back of the head is a form of objective or somatic tinnitus. Tinnitus is the perception of sound when no external sound is present, and a clicking noise indicates a physical movement or process within the body is creating the sound. While often benign, this sensation warrants investigation to determine the exact mechanical or physiological source. The clicking sound is often a vibration transmitted through bone and tissue to the inner ear, making the exact location difficult to pinpoint.
Musculoskeletal and Ear-Related Causes
The most frequent sources of internal clicking are mechanical, often involving structures near the ear and skull base. The temporomandibular joint (TMJ), which connects the lower jawbone to the skull, is a common culprit. Clicking or popping occurs when the soft cartilage disc cushioning the joint shifts or is displaced during movements like chewing, talking, or yawning. This mechanical joint noise is easily transmitted through the skull bone, leading to the perception of sound near the ear or the back of the head.
The Eustachian tube, a narrow passageway connecting the middle ear to the upper throat, is another frequent cause of clicking or popping sensations. This sound, often described as a crackle, usually occurs when the tube opens to equalize pressure between the middle ear and the environment. Dysfunction, often due to inflammation from allergies or a cold, prevents smooth pressure equalization, resulting in an audible click or pop when the tube finally snaps open.
Another possibility involves the tiny muscles within the middle ear itself, a condition known as middle ear myoclonus (MEM). This involves involuntary, rapid contractions or spasms of the tensor tympani or stapedius muscles, which normally dampen loud sounds. The irregular twitching of these muscles creates a brief, repetitive sound, often described as a rapid clicking, tapping, or fluttering noise.
Sounds can also arise from the cervical spine, or neck, and be transmitted to the ear. Movements of the head may produce a grinding or cracking sound, known as crepitus, originating from the neck joints. This sound can be caused by the collapse of gas bubbles within the joint fluid or by degenerative changes in the spinal vertebrae. When these structural noises occur, the vibrations travel up the neck bones and are perceived as an internal sound.
Vascular and Blood Flow Explanations
A different category of sound involves the movement of blood, leading to pulsatile tinnitus. This sound is often described as a rhythmic whooshing, thumping, or rushing noise that is synchronous with the heartbeat. Unlike a sharp click, this sound is a direct consequence of turbulent blood flow in arteries and veins near the ear structures.
Turbulence in blood vessels can be caused by several factors, including increased blood flow due to conditions like anemia or an overactive thyroid. Structurally, the sound may signal a narrowing of a blood vessel, such as from atherosclerosis in the carotid arteries, or irregularities in the large veins near the skull base. These changes force blood to flow more quickly and noisily past the auditory system.
A key method to determine if the sound is pulsatile is to check your pulse while the sound is present; if the internal rhythm matches your heartbeat, it suggests a vascular origin. Pulsatile sounds may also change in intensity when lying down or turning the head, as these actions affect blood flow dynamics in the neck and head. While many causes are benign, this symptom warrants immediate medical evaluation because it can indicate a vascular change or condition affecting blood flow.
Neurological and Rare Anatomical Issues
In rare instances, the clicking sound can be traced to involuntary muscle contractions in the throat and palate, a condition known as palatal myoclonus (PM). This involves rhythmic spasms of the muscles in the roof of the mouth and throat, including the tensor veli palatini, causing an audible, repetitive clicking or thumping sound. Since these muscles attach near the opening of the Eustachian tube, their rapid contraction generates a noise often loud enough to be heard by a doctor during an examination.
Palatal myoclonus is typically diagnosed by a specialist who can visually observe the rhythmic movements of the soft palate. The underlying cause is sometimes neurological, related to lesions in brainstem pathways that control muscle coordination, but it can also occur without an identifiable structural abnormality. Rare anatomical considerations include bone or dural defects that might allow normally muffled internal sounds to be transmitted more clearly to the inner ear.
When to Seek Medical Consultation
While many sources of clicking in the head are benign, certain associated symptoms indicate the need for prompt medical attention. Any clicking sound synchronous with your heartbeat should be reported immediately, as it suggests a vascular issue requiring specialist investigation. Similarly, a sudden onset of the clicking noise, especially if accompanied by other neurological symptoms, requires a timely evaluation.
Other concerning signs that warrant a medical visit include:
- Dizziness or vertigo.
- Facial weakness or numbness.
- Any noticeable change in hearing acuity, such as sudden hearing loss.
The best starting point for an evaluation is a primary care physician or an Otolaryngologist (ENT doctor).
To prepare for the appointment, keep a detailed log of your symptoms, noting the frequency, duration, and loudness of the clicking. Track whether the sound is regular or irregular, if it correlates with movement of your neck or jaw, and whether it is affected by your pulse. Providing these specific details helps the doctor narrow down potential causes and determine if further diagnostic tests, such as imaging or specialized hearing exams, are necessary.