Intermittent Tapping in My Ear — Treatment: Muscle Relaxers or Surgical Intervention

[Frances Smith]

I was literally tortured by an intermittent low pitched tapping on my ear. The only relief I got was from activity. Sleep was very difficult as was reading.

I finally got in to see an ENT. He explained what was happening in my middle ear. The tendon that attaches to the muscle which produces the protective acoustic reflex was making the tapping sound. The muscle to which it is attached was having frequent spasms.

Treatment? Muscle relaxers, and if it gets really bad the tendon can be cut (endoscopic stapedius and/or tensor tympani section). You are left without an acoustic reflex but I'll take that over torture by tapping!

I hope this helps someone else. It was truly awful. Tinnitus is bad enough, but this. Aarrgh!

Franny

 

[Psych]

I was literally tortured by an intermittent low pitched tapping on my ear. The only relief I got was from activity. Sleep was very difficult as was reading.

I finally got in to see an ENT. He explained what was happening in my middle ear. The tendon that attaches to the muscle which produces the protective acoustic reflex was making the tapping sound. The muscle to which it is attached was having frequent spasms.

Treatment? Muscle relaxers, and if it gets really bad the tendon can be cut (endoscopic stapedius and/or tensor tympani section). You are left without an acoustic reflex but I'll take that over torture by tapping!

I hope this helps someone else. It was truly awful. Tinnitus is bad enough, but this. Aarrgh!

Franny

Sorry that happened to you! Glad you found some answers.

 

[Bluemoon]

Hi Franny, I have pretty bad tinnitus and now I have developed exactly what you have described. I was given Diazepam, short dose by GP but it hasn't worked... I felt the GP had no idea what I was talking about and basically diagnosed myself. I have no idea what to do next. But it did help hearing from someone with the same condition...

 

[Kriszti]

Hi Franny, I have pretty bad tinnitus and now I have developed exactly what you have described. I was given Diazepam, short dose by GP but it hasn't worked... I felt the GP had no idea what I was talking about and basically diagnosed myself. I have no idea what to do next. But it did help hearing from someone with the same condition...

You could look up middle ear myoclonus (MEM) . That's the umbrella term for stapedial spasms and TTTS. Muscle relaxers help some, and tenotomy as a last resort also could be helpful.

 

[Pulsing Ear]

I developed this too, about 3 weeks ago. Mine comes on bad around 6 pm and goes on until I go to sleep. I wake up and it's still there louder than ever. So sleep seems to make it worse, at least at the time. About an hour later it diminishes until it slowly goes away. Then it's back again at 6 pm.

Mine is not synchronized to my heartbeat. Its also only in my left ear. How about yours? The tinnitus I already had is worse in that ear now. Its horrible. I can actually feel the vibrating in my ear. Feels like a bug crawling around in there.

Exercise seems to help mine go away.

 

[Pulsing Ear]

When they sever the muscle in the ear, are there any long term side effects to worry about?

I read about it on the web but can't seem to find anything negative about the surgery, all I see is that it is supposed to work. I did read where one lady had trouble healing her eardrum up, and has a hole now that won't heal.

I'm thinking if they basically render that muscle useless, then there has got to be some kind of negative consequence. It's not like the muscle does nothing to begin with. Patients claim there is no hypersensitivity to sounds etc.

 

[Kriszti]

When they sever the muscle in the ear, are there any long term side effects to worry about?

I read about it on the web but can't seem to find anything negative about the surgery, all I see is that it is supposed to work. I did read where one lady had trouble healing her eardrum up, and has a hole now that won't heal.

I'm thinking if they basically render that muscle useless, then there has got to be some kind of negative consequence. It's not like the muscle does nothing to begin with. Patients claim there is no hypersensitivity to sounds etc.

On Facebook I mainly see positive experiences about the surgery. I thought and read that these muscles are supposed to protect the inner ear from loud noises, but some said in the group that this idea is only hypothesized, because the stapedial muscle is not quick enough. I don't really know what to believe. They are cut normally for many other ear surgeries as well.
Some experience the cut muscles regrow together and the spasms start again.

I think I have atypical MEM, which is on/off, so I consider the surgery as a last resort.

 

[Bluemoon]

For me too it would be a last resort, but it's good to know there is some treatment. I might see if I can get another muscle relaxant. Thanks for all the help and support.

I'm not sure how to work the site or answer individual questions...

 

[Pulsing Ear]

On Facebook I mainly see positive experiences about the surgery. I thought and read that these muscles are supposed to protect the inner ear from loud noises, but some said in the group that this idea is only hypothesized, because the stapedial muscle is not quick enough. I don't really know what to believe. They are cut normally for many other ear surgeries as well.
Some experience the cut muscles regrow together and the spasms start again.

I think I have atypical MEM, which is on/off, so I consider the surgery as a last resort.

I'm sitting now in the waiting room of my ENT. Of course once again my ear isn't having the problem. Same thing happened last time. It's becoming less common now, so that's good. Tinnitus in that ear is louder now though.

 

[Bluemoon]

Hi Pulsing Ears, how did it go with ENT? Hope it went well.

 

[Pulsing Ear]

Hi Pulsing Ears, how did it go with ENT? Hope it went well.

Yes, I had a good talk with the doctor. He confirmed the stapedial myoclonus diagnosis based on my symptoms. He did tell me that the problem usually goes away after some time, so I will just have to deal with it. Not really any way to treat it with drugs.

He does the surgery himself if it comes to that. They sever the muscle and then even install some kind of apparatus inside the middle ear. Sounds like The Bionic Man! He said the surgery is straightforward, simple, and effective.

Since the problem for me comes and goes, I'm confident that it will go away eventually. I went most of yesterday without it. He didn't think any of my many medications caused it. I'm still suspicious of the higher dose of Bisoprolol I took, but it seems unlikely. These things are hard to pin down a cause on. He mentioned viruses can cause it. He reassured me that its not a harbinger of bad health problems for me. He said when he was at Harvard Medical School there was a theory on that, but he hasn't seen any evidence to back it up.

Now the main thing that is bothering me is my high pitched tinnitus ringing I've had for decades. The bad thing, it seems about 2x as loud in my left ear as it used to be. The left ear is the one that has the myoclonus. It's like it stirred up the volume of the ringing and I'm scared it will stay this way. The doctor did not have much to say about the increased tinnitus. I asked him if he thinks I'm in danger of losing my hearing in that ear and he said no.

 

[Bluemoon]

Well in many ways it seems positive. And just knowing you have some control helps i.e. last resort surgery. It is so hard to pin these things down... My tinnitus too is all over the place but all these things are connected in our brain and auditory system. And of course it makes you anxious which exacerbates everything. Vicious circle. I've got a feeling things will start to calm down for you and hopefully for me too. We need a lot of patience, which is even more difficult in these times with COVID-19 and lockdown...

I wish you all the best. And will keep track of your posts....

 

[Pulsing Ear]

Well in many ways it seems positive. And just knowing you have some control helps i.e. last resort surgery. It is so hard to pin these things down... My tinnitus too is all over the place but all these things are connected in our brain and auditory system. And of course it makes you anxious which exacerbates everything. Vicious circle. I've got a feeling things will start to calm down for you and hopefully for me too. We need a lot of patience, which is even more difficult in these times with COVID-19 and lockdown...

I wish you all the best. And will keep track of your posts....

Thanks. I agree that being shut up all day and night makes it harder. Since I have heart failure, I take the COVID-19 threat seriously.

Right now it's the high pitched ringing in my left ear that bothers me. It's weird because it feels like my right ear is normal with no ringing but I know that's not the case. The left is overpowering the right.

The myoclonus is still gone!

 

[Bluemoon]

Hope your myoclonus stays away! Tinnitus is a strange thing, does whatever it wants which makes it so unnerving... Plus we have zero control.

My tinnitus has been terrible during lockdown but has calmed down a bit, giving way to the horrible myoclonus. Our brain is chief executive of our whole body, everything goes there, everything inside it is affected by stress, making the neurons far less peaceful.

I think your bad tinnitus will calm down as things calm down.

All the best!

 

[Pulsing Ear]

Hope your myoclonus stays away! Tinnitus is a strange thing, does whatever it wants which makes it so unnerving... Plus we have zero control.

My tinnitus has been terrible during lockdown but has calmed down a bit, giving way to the horrible myoclonus. Our brain is chief executive of our whole body, everything goes there, everything inside it is affected by stress, making the neurons far less peaceful.

I think your bad tinnitus will calm down as things calm down.

All the best!

Thanks. So the myoclonus was gone all day yesterday until I woke up in the middle of the night to use the bathroom. It was banging away then. It was about 3:30 am. When I woke up it was gone! What a pleasant surprise. So far today it isn't back and it is after sundown too. Hoping this is a good trend that continues until it just goes away.

The tinnitus in that ear is still louder than normal but I think it has gone down too.

I'm going on about 1 month now that I have had the stapedial myoclonus.

 

[Bluemoon]

Hope your tinnitus has calmed down a bit. I've been to two GPs and both have never heard of MEM, showed zero interest. Think it will be a long haul trying to get some help. It's so exhausting and disheartening.

 

[Kriszti]

Hope your tinnitus has calmed down a bit. I've been to two GPs and both have never heard of MEM, showed zero interest. Think it will be a long haul trying to get some help. It's so exhausting and disheartening.

Try to find an ENT who has interest and expertise in middle ear issues. They at least must have heard of the condition.

 

[Bluemoon]

Thanks Kriszti!

 

[hans799]

I also noticed stapedial myoclonus a few weeks back. Thankfully it's infrequent, often stays quiet for hours, and even when it comes on, the most I get are 5-10 clicks in one batch.

I think it's related to face mask use. I'm using KN95 masks with ear savers, meaning they loop tightly around my head. The myoclonus seems to be a lot more active during and following mask use. Some nerve or muscle is probably irritated by the pressure. Once I get vaccinated I'm switching to a loose cloth mask and we'll see if the myoclonus stops. Until then I'm putting up with it, much better than getting the bat fever.

 

[Pulsing Ear]

I also noticed stapedial myoclonus a few weeks back. Thankfully it's infrequent, often stays quiet for hours, and even when it comes on, the most I get are 5-10 clicks in one batch.

I think it's related to face mask use. I'm using KN95 masks with ear savers, meaning they loop tightly around my head. The myoclonus seems to be a lot more active during and following mask use. Some nerve or muscle is probably irritated by the pressure. Once I get vaccinated I'm switching to a loose cloth mask and we'll see if the myoclonus stops. Until then I'm putting up with it, much better than getting the bat fever.

I read someone else on here suspected the mask, or maybe it was you? I also wear a N95 mask because of my heart failure.

I've been in the ER to get my heart defibrillated 3 x now in the past 6 months. Each time, wearing my mask for 4 hours straight. About 1 month ago two days after the er trip my stapedial myoclonus started for the first time. Mine was really bad because it lasted about 18 hours a day or so. I got about a 4 hour break during the afternoon. It went away for 1 week and I thought it was gone, but then came back harder than ever.

Now it's mostly gone again, but still comes on while I sleep. I only have it when I get up in the night to go to the bathroom.

You might be on to something with your mask hypothesis, I don't know though. I spent 3 trips to the ER wearing it 4 hour each time and only had it occur after 1 trip. I had it come back again 2 days after my last trip, but it isn't bad now. When I'm there I am also administered a high voltage shock along with strong antiarrhythmic drugs and anesthesia. One of those could have caused mine.

I asked my ENT about those things causing this problem and he said no. He hasn't seen that happen during his entire career, and he's in his 60s or 70s. Very highly respected Harvard Medical School graduate. He even does the surgery for middle ear myoclonus. One thing that made me feel better is the fact that he himself has had stapedial myoclonus! He knows how it feels and said that almost all of the cases go away on their own. He mentioned viruses as the biggest cause I think. He said the surgery is rarely needed, but he's done quite a few over his many years of practice.

I forgot to ask him if the surgery leads to any hearing loss. I'd not want to sacrifice part of my hearing because I really enjoy music.

 

[hans799]

someone else on here suspected the mask, or maybe it was you?

I think that was also me, sadly.

almost all of the cases go away on their own

I read the same thing. It's annoying as hell, especially since you have much longer bursts than I do. But look on the bright side: it'll most probably go away on its own, and if not, there's surgery for it. Compare this to a good old fashioned tinnitus spike, which is not guaranteed to go away on its own and has no surgery. I'd much rather have the clickity click.

 

[Pulsing Ear]

I think that was also me, sadly.

I read the same thing. It's annoying as hell, especially since you have much longer bursts than I do. But look on the bright side: it'll most probably go away on its own, and if not, there's surgery for it. Compare this to a good old fashioned tinnitus spike, which is not guaranteed to go away on its own and has no surgery. I'd much rather have the clickity click.

It sucks having both, but my myoclonus has calmed down thankfully.

 

[Bluemoon]

Hi Pulsing Ear, is your myoclonus totally gone now?

 

[Pulsing Ear]

Hi Pulsing Ear, is your myoclonus totally gone now?

For the most part. It does seem to come back at night while I sleep though. I can feel it when I get up to go to the bathroom. When I get up in the morning I'm thankful that it's gone.

 

[Bluemoon]

That's great, sounds very hopeful. Mine is a bit erratic, it comes and goes, I don't see any pattern to it... Hopefully it will settle.

 

[Zeedoc]

Hi there! New member here, wanting to share my thus far unresolved journey that relates closely to this recent thread. Posting detail here to help others compare situations and working therapies or resolutions.

For background, I'm mid 50s, male, in very good health, no chronic issues, maintain my weight and exercise regularly. I live in Toronto and have a professional job.

My basic tinnitus started in late 2017. First appeared in September as a VERY loud alarm that woke me up out of a dead sleep and had me running around my condo looking for the alarm. It went away after about 30 mins. A few months later, my tinnitus came on gradually but never to that level. Probably a 6-7 level compared to the alarm sound that I would rate a 10. High pitched whistling that over time morphed into ringing. Low sound level in left ear, loud in right ear, which has historically been problematic since I was a kid with infections, etc Unable to sleep or work for months, but over time slowly got quieter. As of today it's about 25% of what it was, no longer a bother, and in fact the right ear is now quieter than left. Will likely be permanent. I sleep and work with low ambient noise but could probably function without it.

My new issue started to come on around 2nd week of December 2020. We're talking some form of myoclonus in the right ear. Unsure if this is related, but I first noticed a stiff neck when I woke up, but no pain. So I changed my pillow setup and work-from-home ergonomics. Some body work (massage/chiro) has resolved that stiffness.

A week after that symptom the MEM started. Still have it. In retrospect I can say this thing takes on personalities that last from 2-7 days, roughly. There may be a high or low active day as it transitions between personalities.

The personalities are all different in terms of frequency of flare ups, duration of flare up, type of sound, speed of sounds, everything. But I do get multiple flare ups daily. No days off so far.

In terms of the actual sound, I have discovered there are 3 levels:

• loud = a thump, much like microphone tapping. Comes with a vibration sensation that no sound can mask and often can feel a muscle pulling inside my head somewhere
• medium = popcorn popping. Stocchatic, not sharp, a little muffled, just a medium thump that seems to have a little air release with each thump. No physical sensation
• soft = light, highly-muffled popcorn, almost like fluttering or a light puff of air

Key personalities in chronological order have been:

1. Onset = quiet at night, comes on about hour after waking up, highly active or midly active during day, calms in evening.
2. Worst phase = mostly loud, more on than off, runs right through the night, flareups last anywhere from 4 to 24 hours with breaks of less than an hour. No sleep, no work. This lasted about 10 days and I was absolutely mental.
3. Intermittent, mostly stimulated by burping/yawning/stretching. Medium-soft sound, 5 min duration, medium paced. When sleeping it would be quiet when on my back but activate immediately if I turned onto my right side.
4. Intermittent, medium sound (the real popcorn phase of about a week), stimulated as above by me or flares up on its own. Flareups would happen every 30 mins to 3 hours. If short duration between flareups they lasted about 5 mins, if longer duration then about 15. The sound was like muffled popcorn popping but probably 50% faster in speed.
5. Current phase. Quiet for 3-6 hours at a time then activates for 3-6 hours. When activating it's mostly medium loudness with occasional loud thumps. Very slow paced. 1-2 pops every 10 to 30 seconds. I'm on the third day of this phase.

Between Phase 4 and 5 I had a VERY quiet day (only 2 short flareups the whole day and of COURSE this was the day of my ENT appointment), then an active day then a very quiet day. Encouraging.

My ability to sleep started to return with Phase 3 because it was less loud, and I sourced two looping noise/music tracks that I could play with a headphone in my right ear and sleep with it, without it having to be too loud. Without it the noise wakes me up immediately and I can't sleep until it stops. I wake up multiple times during the night to toss and readjust the ear piece, but in total can get 6-7 hours of sleep regularly. But the sound is just so distracting it's making work extremely difficult. I teach online part time while I am starting my own business. I have had to pause my business because if I'm in an important meeting and have a flareup I completely lose my concentration and have to end the meeting. I need resolution. I'm trying to be hopeful that it'll come, as some threads say for most people it goes away on its own but if it's like my T and takes up to a year there will be consequences to my career and financial situation that I don't think I can withstand.

Doc and ENT are perplexed. ENT found no issues. I have taken magnesium, B12, melatonin, sinus meds, antibiotics, steroidal sprays and nothing. I'm not a patient person and I already have misophonia (sensitivity to sound) so waiting for months to see what happens likely isn't sustainable.

One thing I'm going to try is an anticonvulsant - carbamazepine. It's inexpensive, and in my popcorn phase I googled that word and it brought up a few small studies of successful use with a brand of tinnitus called 'typewriter' tinnitus, that can sound like a typewriter, morse code, clicking or popcorn sounds. Stocchatic in nature and occur at fairly regular intervals with periods of quiet. My sound isn't as sharp as clicking or typewriter but otherwise fits. Often associated with some irritation or compression of the cochlear nerve. Because this is so rare to begin with studies are few and small numbers but have 100% success rate with the drug. I have been referred for an MRI which I hope comes up with something along this line. Otherwise going to bother my doc to give me an Rx for the anti-convulsant. I'm not sure if I can be optimistic here but need to try something.

One other note. Three days ago while getting a massage my therapist noticed my body is twitchy, even before she began the massage. I realized she's right and I have tiny twitches about every 30 seconds in one random place in my body that is different each time. Not bothersome but now that I notice them I see they have been persistent all day/night since first pointed out.

Lots of info here - sorry. But trying to share as much to be helpful. If this situation resolves itself I will be sure to update the boards. Frustrating to read about so many people having issues and then you never hear from them again so you're unsure what happened. Praying the anti-convulsant has some sort of effect and the MRI comes up with something.

Best to all.