Expert: Harriet B Jacobster, Au.D. - 9/22/2009

Question
Dear Dr Jacobster,
I am a 58 year old male.  No underlying health conditions and in very good health except for Hashimoto's hypothyroidism for which I take 125 mcg Levothyroxine each day.  I do have what I would call sort "tonal" tinnitus (background noise) which I have lived with for 7 years - coincidentally 1 year after the Hashimoto diagnosis.  The problem is that for the last 7 months, irregularly, without any apparent external stimulus, my right ear appears to make an intermittent rythmic fluttering noise (not what I would call a distinct click - but rather a softer and rounder noise).  The rate in beats per minute varies but has been as high as about 150 BPM (maybe more). It is asynchronous with my heart beat.  I have been to see 3 ENT's and have no diagnosis.  I had two tests - one was the usual hearing test and the other some sort of tympanic pressure tests. Both were normal.  The ENT's seemed to say that this is something you have to live with.  My questions are: 1)What do you think this is? 2)Is it something that I should just live with or is it something that could be a symptom of a more serious problem that I should get to the bottom of? 3) If you think should pursue it, which is best type of doctor to see? 4) If you have some ideas as to what it might be, what treatments might I be able to choose from in case I find the noise is keeping me from sleep etc?  Thanks in advance for taking my question and your help.
Sincerely,
Joe

Answer
Hi Joe,
It sounds as if you may have something called myoclonus.  Myoclonus is simply a very fast rhythmic contraction of a muscle.  In the middle ear, there are several little muscles, e.g., the stapedial and the tensor tympani, that can contract and cause this "fluttering" sound.  Myoclonus does not show up on regular hearing tests or tympanometry.  There is one test that can be done, but it usually works only when the muscle is contracting.  The usual treatment is muscle relaxants.  If it gets bothersome, sometimes surgery is performed to cut the offending muscle.  Although stapedial/tympanic myclonus is usually benign, it may be symptomatic of another neurological or muscular disorder. You may wish to consult a neuro-otologist - an ear doctor specializing in the auditory nervous system - or a neurologist.

Hope this helps.
Dr. Harriet B. Jacobster, AuD
Board Certified in Audiology