Get those butterflies back in your stomach, Susan!

Susan writes:

A couple of weeks I started getting something I call "ear flutters." It happens only in the late evening (every night now) except for one afternoon episode. My head/ears feel full, and a sound/sensation starts in my right ear. I can describe it as a rapid irregular beat with a tiny mallet, or a very muffled putt-putt from an old outboard motor.

Onset coincided with increased stress and a slight worsening of tinnitus. I'm guessing either my arteries are involved or a space alien has invaded my eardrum.

This is most likely myoclonus. Myoclonus, by the way, is a two bit medical word meaning "muscle twitch." You have two eensy weensy muscles in your middle ear, the tensor tympani, and the stapedius. Either can develop a twitch. Because of where they are located and what they are attached to, a twitch in either of these muscles produces a fluttering sound, and sometimes also a fluttering sensation.

According to this website, middle ear myoclonus can be a symptom of TMJ, multiple sclerosis, intracranial neoplasm, or cerebrovascular disease. That's news to me. In my experience, middle ear myoclonus tends to be idiopathic (no apparent explanation) and goes away with time and/or conservative treatment (muscle relaxants, for example).

Middle ear myoclonus must be distinguished from vascular tinnitus. Vascular tinnitus is a rhythmic sound which follows the pulse. This is a whole different ballgame, and requires a considerably different diagnostic approach.

Here's an interesting online discussion of middle ear myoclonus. One of the participants insists that cutting the muscle is the only cure. Again, relying upon my experience, surgery is rarely necessary (I have never had to refer anyone for this operation). If I ever met a patient with such persistent, intractable myoclonus, I suppose I would go ahead with the appropriate scans to rule out MS or tumor.

By the way, I agree with what Jambo and JoeM say in their first few posts regarding ENTs: unfortunately, there are a few ENTs who don't know about this condition.

Mind you, I haven't read all of their discussion, so I don't vouch for what they have to say. It will give you the opportunity to hear others' experiences, though.

Needless to say, you should find an ENT familiar with this condition and pursue it with him/her.

D.