Middle Ear Myoclonus: Rhythmic Clicking You Can Hear

Almost all tinnitus is "subjective" — only the person experiencing it can hear it. Middle ear myoclonus is one of the rare exceptions: it can produce a clicking or buzzing sound genuinely audible to someone else, including a clinician listening with a stethoscope near the ear. It's uncommon — accounting for roughly 1.5% of new tinnitus cases — but distinctive enough to be worth recognizing on its own.

What's actually happening

The condition involves involuntary, rhythmic spasms of one of two tiny muscles in the middle ear — the tensor tympani or the stapedius — or, in a related condition, the muscles of the soft palate at the back of the throat (palatal myoclonus). Each produces a characteristically different sound: tensor tympani spasms are typically described as clicking, while stapedius muscle spasms tend to produce more of a buzzing sound. The exact cause of these spasms is unknown in most cases, though they're thought to be a form of segmental myoclonus — involuntary muscle twitching originating from brainstem-controlled nerve pathways, similar in category to a hiccup or an eyelid twitch, just in an unusual location.

How it's different from ordinary tinnitus

Two features set middle ear myoclonus apart from the noise-induced or hearing-loss-related tinnitus covered elsewhere on this site:

• It's objective, not subjective, in a meaningful share of cases — a clinician can sometimes hear it too, or can see the eardrum move rhythmically during examination with an otoscope.
• It's rhythmic but not tied to your heartbeat — this is the key distinction from pulsatile tinnitus. Middle ear myoclonus produces a repeating click or buzz at its own rate, set by the muscle spasm, not by your pulse.

Accompanying symptoms can include a sense of ear fullness, muffled or distorted hearing, and — for palatal myoclonus specifically — a visible rhythmic movement of the soft palate that a doctor can see on exam.

How it's diagnosed

Diagnosis relies on directly observing the muscle spasm — via otoscope for tensor tympani or stapedius involvement, or endoscopic exam of the throat for palatal myoclonus — sometimes combined with tympanometry (a hearing-related pressure test) and, for palatal myoclonus, an EMG to document the abnormal muscle activity directly. Because palatal myoclonus can occasionally be secondary to a brain lesion rather than occurring on its own, imaging and a neurological exam are typically part of a thorough workup, specifically to rule that out.

Treatment

This is one of the more directly treatable causes of tinnitus covered on this site, precisely because the source is a specific, identifiable muscle rather than a diffuse neural process:

• Conservative management first — reassurance, behavioral approaches, and sometimes medications such as muscle relaxants, anticonvulsants, or anti-anxiety medications, which case series report achieving satisfactory results in a large majority of patients over a few months.
• Botulinum toxin (Botox) injections, targeted at the specific spasming muscle, for cases that don't respond to conservative treatment — case reports describe this achieving complete resolution in patients with otherwise treatment-resistant palatal myoclonic tinnitus, without significant lasting side effects.
• Surgical options, in rare, severe, treatment-resistant cases, involving the affected middle ear muscle directly — reserved for when other approaches haven't worked.

The practical takeaway

If your tinnitus is a distinct clicking or buzzing — rather than a steady tone or hiss — and especially if it seems to come and go in irregular bursts rather than staying constant, or if someone else has ever mentioned being able to hear a faint clicking near your ear, that's a specific enough pattern worth describing precisely at your first audiology appointment. Middle ear myoclonus is rare, but it's also one of the few tinnitus causes with a clearly identifiable source and a real chance of complete resolution once properly diagnosed — which is why it appears among the exceptions on can tinnitus be cured, a page whose honest headline answer for the ordinary kind is no.