Muscle Relaxers & TTTS

[nicole76]

Dr. Nagler,

I would love to hear your thoughts on muscle relaxers in relation to our ears.

Background: I've been having bad muscle pain in my neck and shoulders and was prescribed Flexeril. I took one pill which helped me sleep. I took another the following evening but it didn't help me sleep at all. Not only that, but I woke up with a new tone in my ear that builds on certain fan/motor noises. The new tone also increases when I yawn and is loudest when I'm lying down.

Since then, I've had instances where the muscle in my ear would flutter or thump. In the right ear it mostly does this at night so I believe it's posture related whereas the left ear does it after certain sounds. It's important to note this isn't a daily occurrence. However, if I take Soma (a different muscle relaxer) the night before, I am guaranteed to get far more thumping the next day and usually the day after before things calm down again.

I mentioned this to my pain doctor and he didn't believe the medication was causing these issues but the timing is quite suspicious. Plus the situation with the Soma has happened more than once.

I'm just confused how a muscle relaxer could be causing this. Wouldn't it make the muscles in the ear better and not more tight and prone to irritation? And is this causing lasting damage? I guess I just don't really understand how muscle relaxers work.

Thanks for your time.

 

[Dr. Nagler]

Dr. Nagler,

I would love to hear your thoughts on muscle relaxers in relation to our ears.

Background: I've been having bad muscle pain in my neck and shoulders and was prescribed Flexeril. I took one pill which helped me sleep. I took another the following evening but it didn't help me sleep at all. Not only that, but I woke up with a new tone in my ear that builds on certain fan/motor noises. The new tone also increases when I yawn and is loudest when I'm lying down.

Since then, I've had instances where the muscle in my ear would flutter or thump. In the right ear it mostly does this at night so I believe it's posture related whereas the left ear does it after certain sounds. It's important to note this isn't a daily occurrence. However, if I take Soma (a different muscle relaxer) the night before, I am guaranteed to get far more thumping the next day and usually the day after before things calm down again.

I mentioned this to my pain doctor and he didn't believe the medication was causing these issues but the timing is quite suspicious. Plus the situation with the Soma has happened more than once.

I'm just confused how a muscle relaxer could be causing this. Wouldn't it make the muscles in the ear better and not more tight and prone to irritation? And is this causing lasting damage? I guess I just don't really understand how muscle relaxers work.

Thanks for your time.

Hello @nicole76 -

I am not aware of any established relationship between muscle relaxants and TTTS-type symptoms. The important thing to understand is that the fluttering/thumping you describe does not represent any pathology of significance - nothing has been damaged to cause it, and it causes no damage itself. Since it is not a sign of anything "wrong," what you do about it really depends on how much of a nuisance it is. Some folks have had success eliminating coffee and other caffeine products from their diet. I experience fluttering every once in a while, and there is simply no way that I'd give up coffee even on a trial basis - but yours might be more bothersome than mine is. If it is a huge problem, you might want to see an otologist. I am aware of some reports of success with Botox injections. And in extreme cases, the tensor tympani muscle can be cut. Most of the time, however, it just seems to settle out on its own - or you get so used to it, that it ceases to be an issue.

In your case, of course, you might see what happens when you stop the muscle relaxants (if your doctor approves). Just because there is no "established relationship," that doesn't mean it's impossible!

Hope this helps.

All the best -

Stephen M. Nagler, M.D.