The Medical Consumer's Advocate
"Popping" ear noises
tensor tympani myoclonus; patulous Eustachian tube
dysfunction
Q: 
I have a problem with my ears
popping loudly. My ears pop when I swallow, on varying
audible degrees. Sometimes they pop softly and sometimes
loud enough for people to hear, or sometimes my ears
don't pop but the act of swallowing is abnormally loud. I
have also noticed I can make my ears pop by putting
pressure into them without having to pinch my nose or
anything. I have been to see about 4 ENT specialists
and they have put me through decongestants, allergy
treatment, I had my nose cartilage straightened and also
had a ventilation tube in my right ear, none of these
techniques worked.
Generally I have been appalled at the doctor's
seriousness of the situation, one of them even saying
"what a great party trick". To him it may be a
laugh, but it is a very serious situation for me as it
has affected my self-esteem and confidence. I dread
sitting in the quiet with people due to my condition.
I've had this problem for about 2 years now and I don't
recall how it started, but it is ruining my life. I was
just after an opinion from you as to what it could be,
something to do with the middle ear, eustachian tubes,
balance of pressure, roof of mouth (palate?) Apart from
this problem I am in good health , I also have good
hearing. What do you think is causing it? Thank you for
your time.
A: When the popping occurs, is it just a few
pops, or is it a regular, rapid-fire series of pops?
What sound do you make when you swallow? Does it happen
every time you swallow, or just sometimes?
Do any other odd sensations, either in your ear, mouth or
throat, accompany these sounds?
Please answer these questions; I do have a few ideas on
this one.
Finally, I hope you won't be offended, but here goes:
Are you depressed, and if so, have you sought help for
your depression? The reason I ask is that your reaction to
your symptoms is very severe. This is a very common symptom
of depression; if an individual is depressed, relatively
minor problems become greatly magnified. It is also extremely
common for the depressed individual to turn things around,
i.e., "I am depressed because I have this problem,"
where in fact, a truer statement would be, "I am
depressed, and I also have this problem." Your problem
may or may not be treatable (but it sounds like it's been a
difficult one to solve thus far) but depression is
*definitely* treatable.
Q: It's strange because the popping seems to vary.
When I swallow sometimes my right ear pops, sometimes my
left and sometimes both, but I'd have to say it's mainly
the right. The pop comes in conjunction with when I
swallow, in other words as soon as I swallow my ear(s)
pop. Sometimes my ears don't pop but then the act of
swallowing is too loud.
But I noticed when I had a cold recently I'd swallow
and it's perfect, and then there is about a 3-4 second
delay and my ear pops but it's more of a gradual, rapid
fire series of pops. This might last for a while and then
sometimes I would actually swallow with no noise in my
ears or my swallow wouldn't seem loud, it felt nicely
lubricated and pressurized just like it should be. This
only happened when I had the cold.
Another thing I just remembered was that a few times
my right ear popped when there was a loud noise quite
close to my ear, but this has only happened a couple of
times. (i didn't have the cold at this time)
I know I'm going into real detail but I am just
trying to describe as best as I can what happens so you
have a clearer idea.
As for the depression theory, I can see how
pessimistic people or people with heaps of troubles would
magnify their problems but I am not depressed. I mean I
am studying, I have a job I have friends with whom I go
out with regularly I have lots of interests and I have
ambitions. But this problem that I have can be bad in
certain situations and I hope you may shed some light as
to what you think may be causing it.
A: Two ideas for you, and the first one is the one I am
betting on:
1. Tensor tympani myoclonus. The tensor tympani is a
muscle within the middle ear; myoclonus is the medical term
for repetitive muscle spasm. A similar problem, which may
also be afflicting you, is palatal myoclonus.
Let's take them one at a time. In tensor tympani
myoclonus, the popping (as you call it) is rapid fire; some
people say it's like having an insect beating its wings in
their ear. It is often touched off by loud noises. Palatal
myoclonus is repetitive spasm of one of the muscles of the
soft palate. It can be triggered by swallowing or talking,
and may be associated with auditory symptoms.
Tensor tympani myoclonus is treated by muscle relaxants
(such as Baclofen/Lioresal; Valium can also work), and if
this fails, an ENT surgeon can cut the fibers of the muscle.
Palatal myoclonus is treated by injection of the offending
muscle with Botox (Botulinum toxin, which weakens the muscle
for a few months; repeat injections are necessary.)
2. Patulous Eustachian tube. In this condition, the
Eustachian tube is abnormally open ("patulous").
Normally, the ET is closed at rest and only opens
occasionally, when necessary. People with patulous ET often
state that the sound of their voice is distorted (since they
are hearing it slightly out of phase from two different
sources), and they may hear themselves swallow more than they
ordinarily would.
Your observation that your symptoms improved when you had
a cold recently suggests patulous ET. Patulous ET is
difficult to treat, but some folks treat this with ingestion
of a potassium iodide solution (how this works has never been
explained to me.)
The fact that all of the conventional treatments have
failed is consistent with either diagnosis 1 or 2; people
with patulous ET do not often improve with ventilation tube
placement, and tube placement is never helpful for myoclonus
patients.
You should discuss these possibilities with an ENT. Not
all ENTs are aware of myoclonus, so if you draw a blank stare,
you may need to talk to another ENT.
Hope this helps. Keep me posted.