Eardrum Spasm - Associated Conditions and Management

Introduction

The middle ear consists of muscles called tensor tympani and stapedius. These muscles protect the ear from sounds entering the ear from outside and also from sounds generated inside the body (chewing, own voice). When these muscles get affected, it causes eardrum spasms. It is similar to the twitch of muscles in another part of the body.

What Is an Eardrum Spasm?

Middle ear muscles are a mystery in their function. Tensor tympani and tensorveli palatine and palatal muscle open to eustachian tube. Tensor tympani and tensorveli palatine are connected, and hence when pathology is present in one, another muscle is also involved.

When there is dysfunction of the middle ear muscles occurs, changes are of two types. One is due to repeated contractions leading to clicks or other sounds, and the other is the permanent shortening of muscle length occurs, leading to the continuous pull of structures that are attached to the muscles.

What Is the Middle Ear Myoclonus?

Middle ear muscle when get affected by spasms, a rare condition is developed known as middle ear myoclonus (MEM) and also called MEM tinnitus. MEM occurs in six out of 10,000 people due to repeated and synchronized contractions taking place in muscles (tensor tympani and stapedius).

• The tensor tympani is attached to the malleus bone (hammer-shaped), which conducts vibrations to the eardrum. When the tensor tympani muscle gets spasms, it produces clicking or thumping sounds.

• The stapedius muscle is attached to the stapes bone. This bone conducts sound to the cochlea (part of an inner ear), which is spiral. When the stapedius muscle is in spasm, it creates a buzzing or crackling sound.

What Is Tinnitus?

Tinnitus is a symptom showing that something is wrong in the auditory system. The auditory system consists of

• Ear.

• Auditory nerve.

• Brain.

Tinnitus is a ringing sound in the ear. Apart from ringing even, other sounds are heard like

• Buzzing.

• Clicking.

• Roaring.

• Hissing.

What Is the Cause of Tinnitus?

Tinnitus is mainly caused by loud sounds. A sudden, extremely loud sound can be causative of tinnitus. Individuals exposed to noises at the workplace regularly and those who use types of equipment (jackhammers, chainsaws, and guns) that create loud sounds. Individuals affected with tinnitus are found to have some level of hearing loss. Conditions that cause tinnitus are

• Rupture Of the Eardrum: A hole or tear in the thin tissue that separates the ear canal and middle ear.

• Blockage Due to Ear Wax: Blockage in the ear occurs when wax buildup in the ear. It gets hardened and does not come out of the ear naturally.

• Labyrinthitis: An inner ear infection affecting the labyrinth, thereby hearing and balance.

• Meneries’s Disease: Inner ear problem causing dizziness resulting in vertigo and hearing loss.

• Concussion: It is a brain injury caused due to trauma affecting the function of the brain.

• Thyroid Abnormalities: Variations in thyroid hormones cause thyroid gland abnormalities affecting various functions of the body.

• TMJ (Temporomandibular Joint) Syndrome: It affects jaw joints, muscles, and ligaments associated, causing difficulty in mouth opening.

• Brain Tumor: Abnormal mass or growth of cells in the brain.

• Acoustic Neuroma: A benign tumor occurring in the vestibular or on the auditory nerve leading from the inner ear to the brain.

• Osteosclerosis: It is a disorder characterized by abnormal hardening of the bone and an elevation in bone density.

• Medications: Certain drugs like Aspirin, antibiotics, antidepressants, and anti-inflammatories cause eardrum spasms.

What Is Tonic Tensor Tympani Syndrome (TTTS)?

Tonic tensor tympani syndrome is an involuntary, anxiety-based condition, in which an individual can observe the reduced capacity of a muscle for its activity resulting due to frequent spasms.

The tympanic membrane (TM) or the eardrum appears similar to an acoustic drum. It is positioned 25 to 28 millimeters (mm) beyond the opening of the ear canal. The eardrum has three main layers, has an oval diameter of 8 to 10 mm, and is 0.1 mm thick. It is pinched inward at the center to get attached to the malleus bone (one of the three tiny bones) which forms a sound bridge across the middle ear cavity.

The eardrum can vibrate 20 to 20000 times per second. Air pressure needs to be equal on both sides of the eardrum to achieve maximum working efficiency. TM is supplied by many nerves which also connect to the abdomen, heart, lungs, mouth, etc. Pressure on the tympanic membrane causes referred pain in adjacent areas. Tensor tympani muscle spasm causes audible fluttering, fullness, dizziness, referred heat or pain, and distortion. Persistent spasms are associated with anxiety caused due to tinnitus and acoustic shock.

What Are the Symptoms of Tonic Tensor Tympani Syndrome (TTTS)?

TTTS can trigger symptoms from tympanic membrane tension, alteration in middle ear ventilation, nerve irritability, and symptoms of acoustic shock (incidents involving exposure to high-intensity sounds). Other symptoms include

• Pain, numbness, or burning in and around the ear.

• Aural blockage.

• Mild vertigo or nausea.

• Hearing clicking or popping sounds.

• The sensation of pressure in the ear.

• Headache.

• Impaired hearing.

What Is the Cause of TTTS?

TTTS is associated with anxiety and is especially related to anxiety due to hyperacusis (overly sensitive to sounds) and tinnitus. Constant worry and anxiety about loud sounds cause pain in the ears and also cause the tensor tympani muscle to overreact.

How To Diagnose Eardrum Spasms?

Diagnosis of the eardrum is very important. There is no definitive test available to diagnose. The following steps are involved in the diagnosis.

• Evaluation: Complete history and physical examination are done.

• Audiometry: It is not used in diagnosis, but it can aid in masking treatment.

• Tympanometry: Tympanometry will assess the pressure in the middle ear at a given movement. If tensor tympani is not contracting, then it is of no use. Hence long-term tympanometry is used to know the saw-tooth-like pattern movement observed in the tympanic membrane.

• An Impedance Audiogram: Can also be used to assess the middle ear.

• Imaging: Computed tomography (CT) and Magnetic resonance imaging (MRI) can be used to rule out other causes, if any.

What Is the Treatment for Eardrum Spasms?

Treatment varies as per the severity of symptoms and expectations of patients. There are no particular guidelines for the treatment

1. Medical Approach:

• Benzodiazepines: These are used to reduce anxiety and also as muscle relaxants.

• Orphenadrine Citrate: Acts as a muscle relaxant and can be used for eardrum spasms.

• Piracetam (GABA Derivative): Its use is limited in eardrum spasms.

• Carbamazepine: It is a sodium-channel blocker that reduces neuronal firing leading to decreased activity of innervating muscles.

• Botulinum Toxins: These are used for contractions of muscles related, and it does their work by preventing acetylcholine from neurons.

2. Surgical Approach:

Surgical removal of tensor tympani and stapedius muscles can reduce symptoms or eliminate the eardrum spasm.

Conclusion

The ear is a sensory organ and very essential for the function of hearing. Loud sounds do affect the ears, and one of those conditions is eardrum spasm. This occurs due to spasms of muscles in the ear. This affects the hearing function as well as one’s quality of life. Hence knowing in detail about the condition helps one to seek the help of a doctor. Also, help in the early diagnosis of the condition, and this, in turn, helps in the effective treatment of the disease and improves the quality of life.