Middle ear myoclonus is a rare cause of tinnitus in which tiny muscles in the middle ear, or the soft palate, spasm rhythmically, producing clicking or buzzing that a clinician can sometimes hear too.
Almost all tinnitus is "subjective" — only the person experiencing it can hear it. Middle ear myoclonus is one of the exceptions, and a 2025 review describes it as rare and under-recognised, which is a good reason to know what it sounds like.
What is happening
The condition involves involuntary, rhythmic spasms of one or both of two tiny muscles in the middle ear — the tensor tympani and the stapedius — or, in a related condition, the muscles of the soft palate at the back of the throat (palatal myoclonus). People describe the sound in many ways: buzzing, clicking, crackling, fluttering, rumbling or thumping. A 2016 review draws one distinction between the two sites, describing palatal myoclonus as mostly irregular, non-continuous clicking and middle ear myoclonus as a softer crackling or buzzing. What causes middle ear myoclonus is not known — Cleveland Clinic states plainly that experts don't know. The 2016 review describes the middle ear spasms as thought to be a form of segmental myoclonus: involuntary jerking of muscles supplied by nerves from the brainstem.
How it's different from ordinary tinnitus
Two features set middle ear myoclonus apart from noise-induced or hearing-loss-related tinnitus:
- 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. Objective versus subjective tinnitus explains why that distinction matters.
- 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.
A 2022 systematic review adds a caution worth knowing: across the 20 articles and 115 patients it found, no study used objective criteria to diagnose the condition or to judge the result of treatment. Much of what is known comes from case reports and small series.
Treatment
This is one of the more directly treatable causes of tinnitus, because the source is a specific, identifiable muscle rather than a diffuse neural process. The 2022 review found the level of evidence modest and recommends a stepwise approach, decided case by case:
- Conservative management first — reassurance, behavioural approaches, and medicines such as muscle relaxants, anticonvulsants or anti-anxiety medications. In palatal myoclonus, the 2016 review's own clinic data showed satisfactory results in over 80% of patients after three months of this kind of treatment; that figure is for the palatal form, not for middle ear myoclonus itself. A 2025 review names clonazepam, carbamazepine and piracetam as the main drugs used.
- Botulinum toxin (Botox) injections for cases that don't respond. In palatal myoclonus, the 2016 review describes patients with otherwise intractable tinnitus completely cured without significant lasting side effects; the 2025 review reports early safety and efficacy data for injecting it through the eardrum in middle ear myoclonus.
- Surgery to cut the tendons of the affected middle ear muscles, for severe, resistant cases. In the 2022 review, 60 of the 115 patients had this operation, most often dividing both tendons. The 2025 review calls the results highly encouraging, with two risks to weigh: hyperacusis, and symptoms returning if the tendon reattaches.
What to describe at an appointment
If your tinnitus is a distinct clicking or buzzing — rather than a steady tone or hiss — and especially if it comes and goes in bursts rather than staying constant, or if someone else has ever mentioned hearing a faint clicking near your ear, that is a specific enough pattern to describe precisely at your first audiology appointment. Middle ear myoclonus is rare, but it is also one of the few tinnitus causes with a clearly identifiable source and a real chance of 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.