This letter originally appeared in Dr. Hoffman's column on allHealth.com. |
Q: I can hear clicking in my right ear most of the time . . . especially when I swallow. Can you please tell me what may be causing this?
A: There are two good possibilities to explain this clicking noise. Is it only a brief "click-click"? This sound originates in the Eustachian tubes. The Eustachian tubes are primarily muscular tubes which extend from high in the back of the throat up to the middle ear space on each side. When you swallow, some of your throat muscles tug on the Eustachian tubes (this is one way we "pop" our Eustachian tubes). When this happens, the walls of each tube can come together, and then pull apart. This produces sound, just as you can produce sound by touching your lips together. Since the Eustachian tubes are continuous with the middle ear space, you can hear even very quiet noises that are produced by the tubes. If this is the source of your "click-click" noise, I am afraid you are going to have to just live with it.
Another possibility is myoclonus. If you have ever had a muscle twitch in your leg, then you have experienced myoclonus, which is simply a repetitive contraction/relaxation of a particular muscle. There are two tiny muscles in the middle ear space which attach to the ossicles (little bones) that conduct sound. If either muscle develops such a twitch, it makes the ossicles vibrate, much as sound makes the ossicles vibrate. You hear, rather than feel, the twitch. The result is a very regular, rapid, repetitive "click click click click click....." You get the idea.
Palatal myoclonus is a very similar problem. In this disorder, myoclonus of a muscle in the soft palate (which attaches to the Eustachian tube) produces sound.
Myoclonus does not necessarily require treatment. If this sound is driving you crazy, and if your doctor confirms the diagnosis of myoclonus, then a variety of treatment options are available. Muscle relaxants can be effective, but most are also sedating. Palatal myoclonus can be treated by injecting the twitching muscle with Botox, a drug which paralyzes the muscle for weeks to months at a time. For myoclonus of the middle ear muscles, surgical intervention (to sever the offending muscle) is possible, but is rarely necessary.
Why do you only hear this noise on the right side? Well, we are not symmetric creatures. I have given up trying to explain unilateral symptoms. If there is no obvious explanation (such as a tumor or an infection), I chalk it up to anatomical asymmetry. This is the sort of reassurance that you can only receive by visiting an ear, nose and throat doctor. Obviously, if you are concerned enough to write to this column, you ought to see an ear, nose and throat doctor for a complete examination of your ears and throat.