No differential diagnosis of stapedius muscle contraction from tensor tympani contraction has yet been described, and, currently, no objective method exists by which the two conditions may be distinguished.
The tremor may be recorded (for later evaluation) during conduct of acoustic reflex testing or impedance audiometry. Periodic movements of the tympanic membrane can often be seen upon otomicroscopy, and a rhythmic tremor of the soft palate may be noted upon flexible nasopharyngoscopic examination. In our patient, both tympanic membranes moved upon blinking, but she did not complain of right-side tinnitus. Rock believed that the sounds were not intrusive in most subjects, being easily ignored awareness of sound was closely associated with individual sensitivity. Sound may also be caused by snapping or cracking of mucous membranes of the eustachian tube in response to peritubal muscle contraction, although the most frequent symptom is autophony. Stapedius muscle contraction is thought to produce a buzzing sound, and tensor tympani contraction a clicking. Middle-ear muscular tinnitus is highly variable in nature, being most commonly described as crackling, but also as clicking, tapping, thumping, pulsatile, "(like a) fluttering moth", mechanical rumbling, buzzing, gushing, and whooping. Occasionally, a causative lesion can be identified in the brainstem or cerebellum via magnetic resonance imaging however, most cases are idiopathic. Neither direct examination nor fiber-optic nasopharyngoscopy revealed any sign of palatal myoclonus ( Supplementary Videos 1 and 2 in the online-only Data Supplement).Īmong objective tinnitus, muscular tinnitus is rare and the precise mechanism poorly understood. Thus, we recorded left-side tinnitus that was not audible when a stethoscope was placed on the outer ear. Interestingly, she did not complain of rightside tinnitus however, the right-side tympanic membrane also moved when she blinked ( Fig. On otoendoscopic examination, the auricles, external auditory canals, and tympanic membranes of both ears were normal, but, whenever the patient blinked, to-and-fro movements of both tympanic membranes were evident, especially the posterior halves. She did not complain of facial pain or headache. She had no history of any systemic illness, head trauma, or exposure of the ear to noise or any toxic drug. No other ear symptom, such as otalgia, otorrhea, vertigo, or facial palsy, was evident. The noise could not be easily characterized it was a "combination of a buzz and chewing gum-like sound".
The sound was present only when she blinked or closed her eyes, and occurred on every blink. She had become increasingly worried when the tinnitus did not subside over time. A 45-year-old female presented complaining of low-pitched unilateral left-ear tinnitus 2 months in duration, which commenced during descent of an aircraft in which she was travelling.
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