Thanks for your input @100Hz and @GoatSheep for initiating this discussion about the workings and malfunctioning of mechanisms in the middle ear. Sorry for the digression FX-322 fans, but we've got a lot of time on our hands, 8 months at least.The tensor tympani muscle doesn't get injured by sound itself. According to the paper it's the way it reacts to the sound that causes its own damage. It's like it goes into meltdown under the right conditions. I've quoted some bits from it,
It has been suggested that an acoustic shock (or trauma), potentially coupled to a particular emotional state, can cause a TTM hypercontraction (overuse) triggering a cascade of events leading to the symptom cluster
The resulting effect of this hypercontraction could be even more important if it occurs in the case of TTM vulnerability (muscle fatigue, chronic hypoxia), namely, during times where the TTM is under particular strain due to overload, stress and noisy and loud environments. Call centers, where many cases of acoustic shock have been reported, may combine all of these elements, including prolonged stress and strong focused auditory attention.
The hypercontraction linked to an acoustic shock or trauma could lead to a more or less severe musculoskeletal disorder of the TTM, from a simple stiffening of the muscle to a more severe and pathologic condition such as tear, chronic, and spasmodic contraction. The feeling of ear fullness may result from the deformation of the tympanum detected by the mechanoreceptors inside the tympanic membrane due to TTM contraction and the dysfunction of the TTM-tensor veli palatini muscle functional unit. I find this interesting because these 2 muscles (tensor tympani and tensor veli palatini) share a tendon and even work together and the pic of the tensor veli palatini shown below is a good example of a location where the facial pain occurs.
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Injury of the TTM can be associated with many other adverse consequences. The main detrimental consequence of excessive and prolonged muscle contraction (muscle overload) is blood vessel compression. Importantly, this can result in a reduction in the local oxygen supply to the affected muscle. This phenomenon, in addition to a higher metabolic demand due to the prolonged contraction, can result in a reduction in the production of adenosine triphosphate (ATP) also called "ATP energy crisis". In this circumstance, the muscle switches to an anaerobic glycolysis state to provide the muscle with adequate ATP. Lactic acid is then produced and accumulates in the muscle which increases the local acidity. This decrease in pH (increase of extracellular protons) can activate acid-sensing ion channels of nociceptors, thereby exciting these neurons. A low pH can also downregulate acetylcholinesterase, increase the efficacy of acetylcholine, and maintain muscle contraction. Moreover, free Ca2+, needed for muscular contraction, has to return to the sarcoplasmic reticulum by the calcium pump for muscular relaxation. This process, however, is costly in ATP and cannot be properly done in case of severe energy depletion. The muscle thus stay contracted (until enough ATP is available), which could lead to further muscle injury.
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Once the muscle enters this contraction/spasming cycle, the end result of how much damage there is depends on how quickly you remove yourself from the noise situation/how long it goes on for. And this is just the start of it. What it suggests happens next is that the middle ear damage starts generating proinflammatory molecules like ATP, and the nerves (trigeminal mainly) become sensitized, this sounds to me like the familiar inner ear type II afferent sensitization theory except it's happening in the middle ear.
TTTS also typically starts after an acoustic shock, it's another indicator that the middle ear has an ongoing problem now. The TTTS is apparently protecting the inner ear at a much reduced noise threshold and startle response. It is putting itself under undue strain, whilst still presumably not recovered, even for moderate noise so it makes sense that it doesn't take much more for this muscle to go into the above cycle even more easily with repeat setbacks. Not to say inner ear pain isn't also at play, but I can't ignore the amount of seemingly linked causes and symptoms in the middle ear and face anymore.
When I had an acoustic trauma I experienced muscle spasms, TTTS I think, that shot pain into my brain. It was like the spasms led to a stabbing sensation... ouchh. I have improved a lot, no more spasms and hyperacusis in check granted my noise thresholds are no where near normal and I do protect regularly from noise. So yeah, my bad ear is where the tinnitus rages and there's lots of clicking and muscle issues.
I noticed something, it wasn't a miracle, but it does help. I was searching through YouTube ages ago and found a stretch, where your lying down and raise and put your legs over your head. Is hard to do and your stomach ends up in your face. This stretch actually pulls muscles in the ear, you can literally feel it. It may help a few folks here to give some relief to stressed muscles and retrain them. I will find a link and post if anybody is interested.
Valium also helped relax muscles but I wound up crying half the day and was popping them like candy, it was unsustainable. Benzos do seem to help a lot of people here with ear muscle spasms.
I don't think FX-322 will help this kind of damage, but better hearing and less tinnitus would be a miracle. I can't wear hearing aids because of my hyperacusis and nerve damage even though my ski slope hearing loss makes me an excellent candidate. Thus my love affair with FX-322.