by Neil Bauman, Ph.D.
A man asked,
How do I know if I have Tonic Tensor Tympani Syndrome?
Tonic Tensor Tympani Syndrome (TTTS) is probably not a familiar condition to most people. In fact, few people have ever heard of it.
The tensor tympani muscle, from which Tonic Tensor Tympani Syndrome gets its name, is one of the two tiny muscles in your middle ears. (The other is the stapedius muscle.)
The tensor tympani muscle reacts to sudden loud sounds—called the startle reflex. This startle reflex is made worse if you are particularly stressed or anxious. (1) The job of the tensor tympani muscle is to pull the tiny malleus (hammer) bone away from the eardrum (tympani), thus tensing the eardrum (hence its name tensor tympani). This reduces the volume of sounds that are transmitted to the inner ear, which helps protect the delicate inner ear structures from noise damage.
The tensor tympani muscle also has other functions. For example, it also contracts (tenses) immediately before you begin talking. This reduces the sound of your own voice so it doesn’t “deafen” you. (1) It also tenses to reduce the volume of sounds produced when you chew your food. (2) (Aren’t you glad it does this?)
The word “tonic” in this syndrome name describes the continuous or pulsing action of the tensor tympani muscle. Quite often the word “tonic” is omitted and people just refer to this syndrome as “Tensor Tympani Syndrome”.
When everything is working properly, you aren’t even aware you have two tensor tympani muscles working for you. Their actions are totally automatic. However, when something disturbs their normal functions, you may become painfully aware of their existence.
In numbers of people who have hyperacusis (where normal sounds are now abnormally loud), and who also typically have misophonia (where you have negative emotional reactions to certain specific sounds) increased (abnormal) activity develops in the tensor tympani muscle as part of the startle response to some sounds. This is called Tonic Tensor Tympani Syndrome.
“Tonic tensor tympani syndrome is an involuntary, anxiety-based condition where the reflex threshold for tensor tympani muscle activity is reduced, thus causing frequent spasms.” (4)
Since TTTS is an involuntary reaction, some people with hyperacusis/misophonia don’t actually even need to hear a loud sound in order to send their tensor tympani muscles into spasms. (2) This can happen when they just think about about specific sounds to which they have an aversion. Thus this condition is not really due to the hyperacusis as much as it is due to misophonia.
Misophonia frequently results in some degree of Tonic Tensor Tympani Syndrome. The good news is that when you successfully treat misophonia, typically the TTTS also goes away. (3)
If you have Tonic Tensor Tympani Syndrome you will experience one or more of the following symptoms. Typically, the worse your hyperacusis/misophonia, the more symptoms of TTTS you will exhibit. Also, you are more likely to have more TTTS symptoms if you have both tinnitus and hyperacusis.
Classic Tonic Tensor Tympani Syndrome symptoms include:
Pain: You may experience a sharp pain in your ear when the tensor tympani muscle tightens and stretches your eardrum, or you may experience a dull ache in your ear. You may also experience pain in your cheek, pain in your temporomandibular joint (TMJ) area or pain along the side of your neck due to irritation of the trigeminal nerve that activates the tensor tympani muscle. In addition, you may have a headache.
Numbness and/or burning sensation: Irritation of the trigeminal nerve can also lead to numbness and burning sensations in and around your ear, along your cheek, the side of your neck and in the temporomandibular joint area.
Tinnitus: This may sound like a series of clicks as your tensor tympani muscle rapidly contracts and relaxes.
Fluttering sensation: You may experience rhythmic sensations such as your eardrum fluttering. This occurs when the tensor tympani muscle continually and rhythmically contracts and relaxes.
Feeling of fullness: You ear may feel “full” or blocked. As a result, you may frequently experience a popping sensation.
Muffled hearing: You may feel your hearing is fluctuating or is muffled although typically neither is true. Your hearing may also seem distorted.
Balance problems: You may have mild vertigo or “disordered” balance—often described as “swaying” like being on a boat. This may lead to feelings of nausea. (1)
In one study, “the most common symptoms were aural fullness (33.0%); headache (21.2%); disordered balance (20.3%); TMJ pain (20.0%); pain along the side of the neck (20.0%); tympanic flutter (19.1%); dull ache in ear (19.1%); sharp pain in ear (17.7%); “muffled” hearing (12.5%); and “distorted” hearing (11.0%).” (1)
In people with either hyperacusis, or both tinnitus and hyperacusis, the most common symptoms which developed or were made worse by exposure to loud/intolerable sounds were: “distorted” hearing 78.6%, “muffled” hearing 75.9%, dull ache in ear 74.0%, sharp pain in ear 66.7%, tympanic flutter 59.2% and aural fullness 53.3%. (1)
Other things to consider when determining whether you might have TTTS include: Are your symptoms constant as opposed to occurring relatively infrequently? Do your symptoms appear after you have exposed your ears to loud/ intolerable sounds. If you have TTTS symptoms all the time, are they made worse when you expose your ears to loud/intolerable sounds? (1)
If you answered yes to these above questions, this indicates that you likely have TTTS.
Here are several interesting findings related to Tonic Tensor Tympani Syndrome.
1. People with Tonic Tensor Tympani Syndrome typically ended up with their tinnitus and/or hyperacusis/misophonia as a result of exposure to loud sounds, whereas those people whose tinnitus/hyperacusis was not the result of exposure to loud sounds are unlikely to have TTTS.
2. The more severe your tinnitus and/or hyperacusis is, the more likely you are to have more/multiple symptoms of TTTS.
3. In people with Tonic Tensor Tympani Syndrome, there is a link between their emotional states and their resulting middle ear muscle contractions. Thus, if you form a negative emotional attachment to your tinnitus and/or hyperacusis, you may develop one or more TTTS symptoms. Conversely, if you don’t let your tinnitus and/or hyperacusis become a problem to you (remain emotionally neutral towards them), you are unlikely to develop TTTS. In this sense, Tonic Tensor Tympani Syndrome is a psychosomatic condition.
4. If you believe that certain loud (to you) sounds have damaged your ears (when they haven’t), you are setting yourself up for developing various TTTS symptoms. Conversely, if you treat such incidents as no big deal (no emotional involvement), you are unlikely to develop TTTS and will much more readily habituate to your tinnitus and hyperacusis if any develops.
This is borne out by the conclusions of researchers who concluded that “74.0% of hyperacusis patients with the symptom of dull ache in the ear and 66.7% of hyperacusis patients with the symptom of sharp pain in the ear reported these symptoms developed or were exacerbated by loud/intolerable sound exposure. These patients readily believe that their ears are no longer able to physically tolerate these sounds, or that these sounds are causing damage to their ears or hearing, and should be avoided. This unpleasant consequence of exposure to sounds perceived as intolerable and the threat of further exposure is likely to play a significant role in tinnitus escalation and the development, persistence and escalation of hyperacusis.” (1)
If you have Tonic Tensor Tympani Syndrome, you need to realize that it does not harm your ears, even though you might swear that it is damaging your ears. This is because you perceive the sounds as louder than they really are. The truth is that moderate, everyday sounds do not harm your ears or cause hearing loss.
5. Effective hyperacusis and misophonia therapy reduces the frequency and severity of TTTS symptoms.
6. Tonic Tensor Tympani Syndrome symptoms “are subjective and can cause high levels of anxiety. This can lead to tinnitus escalation, the development and escalation of hyperacusis, and limit the efficacy of tinnitus/hyperacusis therapy.” (1) In other words, the more you worry about your tinnitus, hyperacusis and resulting TTTS symptoms, the worse they get.
Therefore, if you have Tonic Tensor Tympani Syndrome, you need to seek effective treatment for your tinnitus, hyperacusis and misophonia. When you do that, there is a good chance that your TTTS will go away on its own.
Addendum—TTTS and TMJ and/or C1/C2 Cervical Problems
The above is the common view of TTTS and its causes. However, there is a growing body of evidence pointing to another, and totally different, cause of TTTS. Tonic Tensor Tympani Syndrome can also be the result of temporomandibular joint (TMJ) problems and/or upper cervical spine problems—specifically, your C1 and C2 vertebrae being out of proper alignment.
Often TMJ and upper cervical spine problems are related, and thus, just as often occur together. This typically happens if you get whiplash from being involved in a motor vehicle accident. You can put your neck vertebrae “out” at the same time as you damage your TMJ. Because various nerves become “pinched”, this can lead to the clicking sounds (a kind of objective tinnitus) that you perceive as TTTS.
In fact, according to Dr. Stylis,”In cases of whiplash trauma, whilst injury to the cervical spine is often blamed as the cause of tinnitus, it is usual that there is a concomitant ‘jaw lash’ injury resulting in tender temporomandibular joints which is the cause of the tinnitus. Studies have indicated that TMJ trauma occurs in figures extending from 87% to 96% of cases of whiplash injuries following motor vehicle accidents” (5)
Therefore, if you experience TTTS in the days, weeks, months or longer after you have been in a motor vehicle accident, the cause may not be due to traditional causes as explained above, but may be the direct result of your C1/C2 vertebrae being out of proper alignment and/or due to pressure being put on nerves and other body structures affecting your middle ear as a result of TMJ problems.
If this is your experience, then you want to go to a dentist or other specialist to be sure there is nothing wrong with your TMJ. At the same time, you would do well to go to a special kind of chiropractor called an upper cervical spine chiropractor to be sure your C1 and C2 vertebrae are in proper alignment. You can find an upper cervical chiropractor by going to http://www.upcspine.com/ and clicking on the “Practitioners” tab .
(1) Westcott, Myriam, et. al. 2013. Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: A multi-clinic prevalence study. Noise & Health, March-April 2013, Volume 15:63, 117-28.
(2) Tensor Tympani Muscle. Wikipedia.
(3) Jastreboff, Pawel & Margaret. Decreased sound tolerance (DST): hyperacusis and misophonia. 2012.
(4) Westcott M, et. al. 2013. Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: a multi-clinic prevalence study. PubMed.
(5) Stylis, Stan. 2012. Tinnitus and the TMJ—Australasian College of Ear, Nose and Throat Physicians.