Middle Ear Myoclonus

Middle ear myoclonus (MEM) is a rare type of tinnitus that can cause clicking or buzzing sounds in your ear. Like other forms of tinnitus, the noise doesn’t come from your environment. It comes from inside your body. With MEM, a muscle twitch (myoclonus) inside your ear causes the unwanted sounds.

MEM happens when either of two tiny muscles in your middle ear repeatedly contract:

• Tensor tympani
• Stapedius

For some people, symptoms are mild and don’t cause issues. For others, the sounds and sensations are strong enough to keep them up at night. If MEM is causing you stress or harming your well-being in general, there are treatments that can help.

Symptoms of middle ear myoclonus

People with MEM describe the experience in different ways. The twitchy muscles may sound like:

• Buzzing
• Clicking
• Crackling
• Fluttering
• Rumbling
• Thumping

The sounds are usually rhythmic, but not in time with your pulse (like pulsatile tinnitus). The spasms can come and go without warning and affect one or both ears.

In some cases, people nearby may hear the sounds, too. For instance, your partner may be able to hear the buzzes, clicks, crackles or rumbles while they’re lying in bed next to you.

Middle ear myoclonus causes

Experts don’t know what causes it. Research is ongoing to learn more.

One recent study shows that having middle ear muscles that are longer-than-normal may play a role. Other research found that long-term exposure to noise may trigger symptom flare-ups, suggesting a link.

This condition is so uncommon that there’s still lots to learn about why it happens and who it impacts most.

How doctors diagnose this condition

Healthcare providers diagnose MEM by considering your medical history and symptoms. They’ll also do a physical exam. They’ll use an otoscope to check your ear canal and eardrum. (An otoscope is a simple lighted tool that providers use to look inside your ears during check-ups.) Sometimes, they can see your eardrum move in time with the buzzing or clicks. But this isn’t always the case.

You may also need:

• Hearing tests
• Imaging tests, like a CT scan or MRI
• Tympanometry

These tests can help providers zero in on a diagnosis. They can help rule out other conditions that affect your hearing.

How is it treated?

There isn’t one standard treatment for middle ear myoclonus. Instead, your healthcare provider will tailor treatment for you. Usually, they try conservative treatments, like medications, before surgery.

Treatments include:

• Medicines you take by mouth: Medications can relax your middle ear muscles, so they don’t spasm. Your provider may prescribe antiseizure meds, anxiolytics or muscle relaxers.
• Botox® injections: While Botox has been around for a while, its use in MEM treatment is still new. Your provider will make a tiny hole in your eardrum so they can inject the medicine. It paralyzes the nerves that cause the twitching.
• Surgery: Surgery is an effective last resort if other treatments don’t help enough. During the procedure, your surgeon cuts the tendons in your middle ear muscles. This stops the twitch.
• Therapy: Approaches like cognitive behavioral therapy (CBT) help some people spot symptom triggers (like noise exposure) so they can avoid them. Your provider may suggest therapy alone or along with other treatments.

When should I see my healthcare provider?

Reach out to your provider if you’re hearing sounds that interfere with your well-being. It can be unsettling to hear sounds from inside your body that you can’t control. But don’t dismiss it as being “all in your head.” MEM is a real condition that affects your ears. And it’s not just something you have to get used to.

There are treatments that can help.

What can I expect if I have this condition?

Treatment either gets rid of or greatly improves symptoms for most people. Often, medications do the trick. But if they’re not helping enough, surgery can help.

There are risks that come with surgery. For example, some people find that their hearing is sensitive to the point of discomfort afterward. This is called hyperacusis. In other people, the tendons reattach after being cut. As a result, the muscles may spasm again. If this happens, you may need another surgery.

These complications are very rare. For most people, surgery gets rid of the unwelcome noise without harming their hearing in any way.