Ear Fluttering Conditions Explained

The “fluttering in ear” sensation—sometimes described as ear rumbling, ear thumping, ear twitching, or ear ticking—is typically related to a muscle spasm in the middle ear muscles; the tensor tympani and stapedius muscles.

The key insight is that ear fluttering usually reflects a broader neurological process rather than a simple middle ear issue. In many patients, the ear symptoms are actually downstream effects of brain-based hyperexcitability, altered sensory gain, or migraine-related circuitry. This makes it a neurological problem amenable to a medical approach.

Table of Contents:

• What Does “Ear Fluttering” Actually Mean?
• What Is Middle Ear Myoclonus?
• What Is Tonic Tensor Tympani Syndrome?
• What Is Typewriter Tinnitus?
• How Do You Treat Eardrum Fluttering?

What Does “Ear Fluttering” Actually Mean? Or “Ear Rumbling” or “Ear Thumping”?

People use a wide range of descriptions for the “fluttering in ear” sensation. Invariably, they are describing the result of a muscle spasm in the ear. The muscles in question are the smallest muscles in the body, the stapedius and tensor tympani muscles. These muscles attach to the bones of hearing and partially control sound transmission. When they spasm, people experience it as ear fluttering, or ear vibrating, or ear thumping.

Here are the most common variations that people describe:

Descriptions of Internal Ear Sounds and Variations

Patient Description	Variations / Synonyms
Eardrum fluttering	Fluttering in eardrum, fluttering noise in ear, fluttering in ear
Thumping sound in ear	Ear thumping, random thumping in ear, thudding sensation
Ticking sound in ear	Typewriter tinnitus, machine-gun tinnitus, staccato tinnitus, Morse code tinnitus
Low rumble in ear	Ear rumble, rumbling in ear, low rumble in ear, ears rumbling
My eardrum vibrates	Purring vibration in ear, eardrum vibrating

The first step in understanding what these descriptions might mean is to review the medical terminology that describes involuntary muscle contractions in general:

Medical Terms Related to Ear Muscle Spasms

Term	Definition
Myoclonus	A sudden, brief, involuntary muscle jerk. Can be phasic (single or in short bursts), irregular or rhythmic.
Clonic	Repetitive, rhythmic muscle contractions and relaxations (a subtype of phasic activity).
Tremor	Involuntary, rhythmic oscillation of a body part due to alternating contractions of opposing muscles.
Spasm	A sudden involuntary muscle contraction, which may be isolated or occur in a brief burst.

If we were to match descriptions of these medical terms to common descriptions like “fluttering in ear” or “ear rumbling”, we get something like this:

Mapping Eardrum Spasm Descriptions to Medical Terms

Ear Descriptor	Likely Medical Term	Explanation
Ear fluttering	Myoclonus / Clonic	Brief or rhythmic internal flapping or fluttering, as in tensor tympani or stapedius spasm.
Ear thumping	Clonic	Repetitive low-frequency contractions, often tied to chewing, speaking, or stress.
Ear vibrating	Tremor / Clonic	Perceived as buzzing or oscillation—usually rhythmic and continuous.
Ear spasm	Spasm / Myoclonus	Sudden or short burst of muscle tightening—may feel like twitch or click.
Ear clicking	Myoclonus	Repetitive single clicks, can be spontaneous or triggered (e.g., blinking, speaking).
Ear rumbling	Tremor	Low-frequency, oscillatory movement, often triggered by sound or movement.

Why Ear Spasm Descriptors Fall Short

Even though people describe their symptoms in ways that sound very specific—like fluttering, thumping, or rumbling—these words don’t always tell us exactly what’s going on inside the ear.

For example, “fluttering in ear” could be caused by either of the two tiny middle ear muscles or both. In fact, doctors usually can’t know for sure without using special equipment that’s not available in regular clinics or seeing it themselves using an operating microscope.

What are eardrum spasms?

The term “eardrum spasms” is a lay term for involuntary contractions of the middle ear muscles. The eardrum itself is not spasming. Rather, the muscles that attach to the bones of hearing are spasming and this affects sound transmission.

Vibration in Ear

Much like “fluttering,” the phrase vibration in ear is another way people try to describe the strange internal sensations caused by middle ear muscle contractions. Terms like ear vibration, buzzing in the ear, or feeling vibrations in the ear are often used interchangeably—even though the sensation isn’t technically a vibration, but a spasm affecting how sound is perceived.

How to Stop Fluttering In Ear

Ear fluttering can have several causes, but it often starts with the middle ear muscles. To get real relief, we need to look closer at how these muscles behave and what might be triggering them. Identifying the root cause of the ear muscle spasms is key to finding lasting solutions and preventing it from coming back.

What do the Stapedius and Tensor Tympani Muscles Do?

Your middle ear contains two of the smallest muscles in the body: the stapedius and tensor tympani. These muscles play an essential role in hearing protection, sound modulation, and sensory reflexes. Muscle spasms in the ear can occur in one or both muscles and when this happens, people sense it as an ear fluttering or ear vibrations. 

Both of these muscles act as sound dampeners, modulating the movement of the bones of hearing to regulate how sound vibrations reach the cochlea (hearing part of the inner ear). Their primary role is protective, helping to spare inner ear structures from damage caused by loud or abrupt sounds.

The Tensor Tympani Muscle and Stapedius Muscle Compared

Feature	Tensor Tympani Muscle	Stapedius Muscle
Attachment	Malleus (the bone attached to the eardrum)	Stapes (bone attached to the inner ear)
Nerve supply	Trigeminal nerve	Facial nerve
Function	Tenses the ear drum by holding the malleus still	Dampens sound by reducing stapes motion
Primary Reflex	Startle reflex	Stapedial reflex (“acoustic reflex”)
Activation Triggers	Internal body sounds or loud sounds	Sudden loud noises
Voluntary Control	Partial voluntary control	Involuntary only
Clinical Syndromes	Tonic Tensor Tympani Syndrome	Stapedius Myoclonus

The Tensor Tympani Muscle

The tensor tympani muscle attaches to the malleus, the bone of hearing that’s directly attached to the eardrum. When the tensor tympani contracts, it partially immobilizes the malleus, which in turn stiffens the ear drum.

The tensor tympani helps to dampen internal sounds like chewing or the resonance of one's own voice (this is called “autophony”). The tensor tympani innervation is by the trigeminal nerve, which makes sense, as internal sounds are often generated by muscles related to the trigeminal nerve.

The other main function of the tensor tympani is anticipatory and protective. It’s involved in the “startle reflex”—a rapid, full-body reaction to threatening stimuli. In this context, the tensor tympani may contract in anticipation of a loud noise, especially if the sound is associated with discomfort. This is different from the stapedial reflex, which we will describe below.

Because it is part of the startle reflex, contraction of tensor tympani is influenced by the fight-or-flight center of the brain. It can activate to perceived threats, emotional distress, or anxiety, not just actual sounds. This explains why some people can experience ear fluttering without any external noise at all.

Tensor Tympani—Key Functions

• Shields the inner ear from internally generated sounds.
• Activates as part of the startle response.
• Contracts during jaw movement—chewing, clenching, swallowing.

Tensor Tympani—Overactivity Symptoms

• Sensation of pressure or fullness in the ear
• Ear fluttering, ear rumbling, or ear thumping sounds
• Ear fullness, ear pressure, pain or facial burning (via trigeminal nerve sensitization)

The Stapedius Muscle

The stapedius muscle is the smallest skeletal muscle in the body. Its main job is to limit the movement of the stapes bone, which is directly attached to the inner ear. When the stapedius contracts, it dampens transmission of sound energy that reaches the inner ear.

Stapedius innervation is by the facial nerve (CN VII), which controls facial expression among other things. Because of this connection, issues affecting the facial nerve—such as Bell’s palsy or facial nerve irritation—can sometimes lead to involuntary stapedius contractions. This explains how ear clicking or fluttering can occur with blinking, smiling, or other facial movements.

The stapedius muscle also plays a central role in the “stapedial reflex” (also called the “acoustic reflex”), an involuntary response to loud sounds. When exposed to sudden, intense noise, the stapedius contracts reflexively to dampen the movement of the stapes bone, and thus sound transmission.

Unlike the tensor tympani, which can contract in anticipation of sound, the stapedial reflex is purely reactive and does not involve conscious input or emotional centers like the limbic system.

Stapedius—Key Functions

• Contracts reflexively to loud noises (the stapedius reflex).
• Stabilizes the stapes to prevent hypermobility and protect against mechanical trauma

Stapedius—Overactivity Symptoms

• Repetitive, involuntary contractions (myoclonus) cause sensations of ear clicking or ear twitching
• Can be associated with neurovascular compression, facial nerve irritation, or atypical migraine

Summary: Stapedius and Tensor Tympani

These muscles don’t just respond to sound—they respond to stress, neurosensory inputs, and even emotional states. Their dysfunction lies at the intersection of audiology, neurology, and psychiatry.

What Is Middle Ear Myoclonus?

Middle ear myoclonus (MEM) is the medical term for involuntary, repetitive contractions of the stapedius or tensor tympani muscles. These spasms can occur independently or together and often result in auditory sensations that are sometimes loud enough to be heard by others.

How common is middle ear myoclonus?

Middle ear myoclonus is considered rare, with exact incidence unknown due to underdiagnosis. However:

• MEM may account for 1–2% of all tinnitus presentations
• Most often affects young to middle-aged adults
• Can be on one or both sides and can involve one or both muscles

What causes middle ear myoclonus?

The exact cause of MEM isn't fully understood, but several patterns have emerged from clinical studies. In one study, nearly 80% of patients reported either emotional stress or loud noise exposure shortly before the onset of myoclonus symptoms [1]. This suggests that MEM is a neurofunctional response, triggered by a combination of sensory overload, heightened emotional reactivity, central (brain) sensitivity, or prior acoustic trauma.

In some cases, the condition may be linked to facial nerve irritation, especially if the stapedius is involved. Others may be related to increased brain sensitivity (central sensitization), which helps explain why myoclonus often co-occurs with tinnitus, hyperacusis, or migraine-like symptoms.

Middle Ear Myoclonus and Tinnitus Severity

Although MEM is considered relatively rare, it can cause a disproportionate amount of distress compared to its objective severity. Several factors may explain this increased tinnitus distress:

• Noise trauma: Acoustic trauma is a massively inflammatory event. It primes the middle ear reflexes to fire more easily and inappropriately. Acoustic trauma can be associated with tinnitus.
• Sensory hypersensitivity: Many cases of severe tinnitus involve an atypical migraine process that leads to central sensitization—where the brain becomes overly reactive to sound and other sensory stimuli.
• Hypervigilance: The limbic system (the fight-or-flight center) can become overactive, keeping the auditory system on high alert and triggering muscle reflexes. High limbic drive and tinnitus severity are connected.
• Hyperacusis: Increased sound sensitivity (hyperacusis) can lead to middle ear reflex overactivation. Hyperacusis is closely tied to tinnitus severity.

In short, the subjective burden of MEM can be significant, especially in individuals already sensitized by trauma, brain sensitization, anxiety, or hyperacusis. This likely explains why these symptoms are more frequently seen at specialty tinnitus clinics.

What is stapedial myoclonus?

Stapedial myoclonus is the involuntary contraction of the stapedius muscle. These contractions create ear clicking, ear thumping, or ear fluttering sensations that may be heard by the patient and others, depending on severity. It is a form of MEM, but when it affects the stapedius alone, there are some distinctive features.

Triggers and Contributing Factors

Stapedial myoclonus may appear spontaneously, but it often fluctuates with internal or external stressors:

• Sound exposure, especially high-frequency or sudden noises
• Facial movements like blinking or smiling
• Psychophysiological triggers such as anxiety, fatigue, poor sleep, fatigue, or stress
• Some report worsening with screen use, bright light, or vestibular overload—suggesting overlap with migraine-related sensory hypersensitivity

In certain patients, facial nerve irritation or mild hemifacial twitching may accompany or precede the auditory symptoms, hinting at a shared neurogenic mechanism.

Diagnostic Workup

Diagnosing stapedial myoclonus requires careful exclusion of other causes. Typical findings include:

• Normal eardrum tests (tympanometry) between episodes
• Long-term tympanometry may reveal a “sawtooth” compliance pattern during clicking episodes
• Otoscopy is typically normal, with no tympanic membrane movement unless myoclonus is observed
• Palatal myoclonus and patulous Eustachian tube must be ruled out via examination of the ear, nasopharyngoscopy or manometric testing

Because stapedial myoclonus is often episodic, patients may go undiagnosed for years or be misdiagnosed with Eustachian tube dysfunction (ETD) or TMJ issues.

Treatment Approaches

Treatment is often empirical and begins with medical options:

• Migraine prophylaxis protocols (like the ones used at NeuroMed) have shown excellent results in stapedial myoclonus
• Stress management and cognitive behavioral therapy may help break the reflex arc in patients with heightened nervous system activation

In our clinical case series “Treatment of Stapedial Myoclonus as a Migraine-Related Phenomenon“, we treated seven patients with stapedial myoclonus (SM) using a prophylactic migraine regimen. All patients showed improvement—either a significant reduction or complete resolution of symptoms—after following our multimodal medical protocol.

For cases that don’t respond to medical treatments, muscle relaxants, botulinum toxin injections, or rarely, surgical stapedius tenotomy (cutting of the stapedius tendon) may be considered.

What Is Tonic Tensor Tympani Syndrome (TTTS)?

Tonic Tensor Tympani Syndrome (TTTS) is a proposed condition involving abnormal activation of the tensor tympani that presents with a cluster of other ear related symptoms. The term “tonic” suggests sustained muscle contraction of the tensor tympani, but recent studies using special eardrums testing failed to find any evidence of tonic contraction in patients with TTTS [2].

Importantly, TTTS is classified as a syndrome, meaning it refers to a recognizable cluster of symptoms, not just eardrum spasms alone. These symptoms typically include sensations of ear pressure, mild pain, intermittent ear fluttering or clicking, and hypersensitivity to sound. These symptoms often arise without visible middle ear pathology and tend to be triggered by stress, anxiety, or exposure to sudden or emotionally disturbing sounds.

Tonic tensor tympani syndrome is therefore best understood as a neurofunctional reflex disorder—involving central sensitization, limbic system reactivity, and a heightened startle response, frequently overlapping with tinnitus, hyperacusis, and somatosensory disorders.

What Is Acoustic Shock?

Acoustic shock refers to when a sudden, unexpected loud sound triggers a pattern of sensory and auditory symptoms that persist long after the sound is gone. These symptoms can include ear pain, fullness, tinnitus, hyperacusis, and anxiety or startle responses—often without any measurable damage to the ear itself.

Tonic tensor tympani syndrome is believed to be the physiological mechanism behind this phenomenon—a dysregulated reflex arc linking the initial acoustic trauma to a longer-lasting cluster of symptoms. In fact, TTTS emerged as a syndromic finding to help explain the recurring symptom pattern observed in patients following acoustic shock incidents.

Noise trauma (acoustic shock) can act as the initiating event for TTTS, particularly in individuals with preexisting anxiety or stress vulnerability. This then leads to a form of “learned reflex” sensitization in which:

• The tensor tympani contracts defensively during the noise exposure
• This contraction becomes hyperreflexive to future sound input
• Somatosensory and trigeminal symptoms emerge due to neural crosstalk

Clinical observations show that patients with acoustic trauma and subsequent hyperacusis are more likely to exhibit TTTS symptoms, especially when the trauma is sudden and emotionally charged.

What are the symptoms of tonic tensor tympani syndrome?

One of the earliest descriptions of TTTS came from a 1979 paper describing the “tonic tensor phenomenon” [3]. The researchers noted a broad pattern of overlapping symptoms among affected individuals:

• 83% reported ear fullness
• 62% experienced tinnitus
• 42% had dysacusis (distorted or uncomfortable hearing)
• 88% reported tension headaches
• 80% experienced dizziness or disequilibrium

This early data helped define the complex and multi-sensory nature of the syndrome. A more recent large multi-clinic study [4] defined TTTS as the presence of one or more of the following symptoms:

Tonic Tensor Tympani Diagnostic Criteria

Symptom Location	Symptom Descriptor
Ear-Related Symptoms	– Sharp pain in the ear – Dull ache in the ear – A sensation of aural fullness or “blockage” – A sensation of fluttering in ear – A sensation of numbness around the ear – A burning sensation around the ear
Hearing Symptoms	– “Muffled” hearing – Distorted hearing or fluctuating hearing changes
Facial Symptoms	– Pain in the cheek – Pain in the TMJ area – Pain, tingling, or numbness along the neck or temple
General Symptoms	– Imbalance or vertigo – Nausea – Headache

To qualify as TTTS, symptoms should cluster around the ear, fluctuate with sound exposure or emotional triggers, and not be explained by other causes.

TTTS: More Than Just Ear Fluttering

Note that a diagnosis of TTTS does not require evidence of actual tensor tympani contraction, either the tonic type of contraction or ear twitching sensations. Rather, it is a loosely-related cluster of symptoms that may or may not directly involve the tensor tympani muscle.

This is problematic as these same symptoms are common in atypical migraine. For instance, vestibulocochlear migraine can also cause nausea, imbalance, headache, facial symptoms, and pressure sensations in or around the ear. I’ll explain more on this issue below.

How common Is tonic tensor tympani syndrome?

Tonic tensor tympani syndrome is often misdiagnosed due to symptom overlap with Eustachian tube dysfunction, TMJ, or somatic tinnitus. One recent study found that 13% of tinnitus clinic patients had symptoms suggestive of TTTP [5]. 

If you drill down with specific criteria, the prevalence can be even higher. According to the multicenter study above:

• 60% of tinnitus/hyperacusis patients had at least one TTTS symptom
• 80% of patients with hyperacusis experienced TTTS-like symptoms
• 68% of patients with severe tinnitus reported TTTS symptoms
• Over 90% of those with acoustic shock reported TTTS features

These findings suggest TTTS may be highly prevalent in the context of severe tinnitus and/or hyperacusis and would be seen more in specialty tinnitus clinics.

Tonic Tensor Tympani Syndrome and Central Sensitization

An acoustic shock can trigger an inflammatory response in the middle ear. This irritation releases chemicals like substance P and CGRP, which make the nerves more sensitive to sound and touch. This is called peripheral sensitization.

• Normal sounds may start to feel painful or uncomfortable
• The ear might feel full, sore, or overly reactive
• Even minor triggers can now cause discomfort

Over time, the brain's pain centers—especially in the trigemino-cervical complex (TCC)—can become hypersensitive too. This is central sensitization, where:

• The brain starts overreacting to small signals
• Sensitivity spreads to the jaw, neck, or head
• Tinnitus and ear pain can persist even without injury

Once this feedback loop starts, symptoms may continue long after the original event, driven by sensory hypersensitivity.

Is tonic tensor tympani syndrome really an atypical migraine variant?

Since the term was first coined, TTTS has since been disproved as a “tonic muscle contraction condition”, with the authors of the original team suggesting that the term TTTS “be abolished” for something more neutral to reflect a hyper-reactive middle ear muscle syndrome [9]. This opens the door for alternate explanations of the cluster of symptoms now known as TTTS.

Our team believes that TTTS belongs on the atypical migraine spectrum, rooted in central sensitization. This helps explain why TTTS often presents without obvious injury, but with profound symptoms that typically fluctuate in intensity.

Tonic Tensor Tympani Syndrome = Atypical Migraine

Shared Feature	Common to TTTS and Atypical Migraine
Common Triggers	Stress, fatigue, sensory overload, and loud sounds
Trigeminal Involvement	Both conditions involve the trigeminal nerve and its central pain pathways
Ear Symptoms	Tinnitus, ear fullness, middle ear muscle spasms, fluctuating hearing loss, and hyperacusis are common in both
Somatic Symptoms	Facial tingling, dizziness, nausea, imbalance, and headache may be present
Central Sensitization	Both involve heightened sensitivity and amplified sensory responses
Fluctuating Symptoms	Both feature symptoms that fluctuate in intensity
Pain Referral Pathways	Pain or tension can spread between jaw, neck, and ear via shared neural circuits

What is clear to our team is that TTTS is describing all of the features of vestibulocochlear migraine. We have publishes numerous studies over the past decade on how atypical migraine affects hearing and balance. Importantly, viewing TTTS as an atypical migraine variant isn’t just a matter of terminology—it fundamentally shifts how we treat it.

How do you treat tonic tensor tympani syndrome?

The few clinical studies on TTTS that exist show that standard tinnitus treatments—such as tinnitus counseling, sound therapy, and cognitive behavioral therapy—can significantly improve symptoms [5]. However, when we reframe TTTS as an variant of central sensitization, it opens the door to a broader range of interventions that are much more effective than previously developed treatments.

At NeuroMed, our multimodal rehabilitation plan combines these proven strategies with central sensitization-focused treatments, including medications, targeted nutraceuticals, and lifestyle interventions that optimize sleep, reduce stress, and nutrition. This integrated strategy allows for a far more comprehensive approach to the problem.

What Is Typewriter Tinnitus?

Typewriter tinnitus (also called Morse code tinnitus, staccato tinnitus, or machine-gun tinnitus) is a rare form of tinnitus where patients random clicking or popping sounds in one ear. It’s described as:

• “Popcorn in the ear”
• “A typewriter tapping”
• “A machine-gun sound in bursts”

Typewriter tinnitus is NOT caused by middle ear muscle spasms. Instead, the sound comes from abnormal nerve firing in the auditory nerve—specifically the hearing nerve (CN VIII).

What causes typewriter tinnitus?

The most widely accepted cause is neurovascular compression—where a nearby blood vessel (usually a loop of the anterior inferior cerebellar artery (AICA)) presses on the auditory nerve. This contact can:

• Damage the nerve’s insulation (demyelination)
• Create short-circuits in the nerve’s firing
• Trigger paroxysmal, click-like discharges

However, in a 2023 study [6], about 10% of patients with typewriter tinnitus had no visible nerve compression on MRI, suggesting other causes like:

• Neuroinflammation
• Autoimmune or demyelinating disease
• Central sensitization-related nerve hypersensitivity

How is typewriter tinnitus diagnosed?

There’s no single definitive test, but diagnosis involves a step-by-step process to rule out muscle-based causes, confirm nerve involvement, and evaluate treatment response.

1. Rule out MEM: Otoscopy or eardrum testing can detect rhythmic movement caused by muscle contractions (like tensor tympani or stapedius). If no movement is seen, a nerve-based cause becomes more likely.
2. MRI evaluation: High-resolution MRI can help rule out other causes and check for neurovascular compression.
3. ABR (Auditory Brainstem Response) testing: ABR measures how fast sound signals travel through the auditory nerve. A prolonged ABR signal is a strong indicator of nerve compression.
4. Empiric medication trial: A short course of antiseizure medication is often used to confirm the diagnosis. In fact, the authors of a recent article claims that response to one of these medications should be the primary diagnostic tool used for typerwriter tinnitus [7] . When you combine this with another recent study [8], 36/36 cases of typewriter tinnitus had partial or complete response to short-term antiseizure treatment.

Typewriter Tinnitus Summary:

• Typewriter tinnitus is a nerve-based (not muscle-based) condition.
• It's likely caused by vascular pressure, inflammation, or nerve damage.
• ABR testing helps confirm diagnosis and predict relapse risk.
• Certain antiseizure drugs are highly effective and can be used as a diagnostic tool.
• Thorough examination of objective tinnitus causes is called for before surgery is considered.

How Do You Treat Eardrum Fluttering?

Eardrum fluttering is best treated by addressing the brain’s sensory hypersensitivity. We use a combination of medications to calm overactive circuits, targeted supplements to restore neurotransmitter balance, and frontline therapies like sound therapy and stress reduction to recalibrate the system. Rather than chasing the symptom in the ear, we treat the neurological root cause.

Fluttering or vibrating sensations in the ear often signal dysfunction in the middle ear muscles, trigeminal nerve, or deeper sensory circuits in the brain. These cases frequently go undiagnosed, especially when routine tests come back normal and providers aren’t trained to recognize them.

Whether labeled as middle ear myoclonus, tensor tympani syndrome, or typewriter tinnitus, these conditions often stem from the same dynamic: neuroinflammation and central sensitization. When the brain becomes irritated by stress, trauma, or sensory overload, symptoms can persist long after the initial trigger.

At NeuroMed, we reframe these disorders as manifestations of central sensitization—a shift that enables real solutions. Our multimodal protocol blends brain-targeted medical treatment with sensory retraining, behavioral tools, and lifestyle strategies designed to normalize hypersensitive circuits and bring lasting relief.

If you’re living with unexplained fluttering, clicking, or thumping in your ear—don’t settle for being told “it’s nothing.” Book a consult with our team today and take the first step toward lasting relief.

Ear Fluttering Frequently Asked Questions

Fluttering In Ear References

[1]           S.-N. Park et al., “Clinical characteristics and therapeutic response of objective tinnitus due to middle ear myoclonus: a large case series,” The Laryngoscope, vol. 123, no. 10, pp. 2516–2520, Oct. 2013, doi: 10.1002/lary.23854.

[2]           P. Fournier et al., “Exploring the middle ear function in patients with a cluster of symptoms including tinnitus, hyperacusis, ear fullness and/or pain,” Hear. Res., vol. 422, p. 108519, Sep. 2022, doi: 10.1016/j.heares.2022.108519.

[3]           I. Klockhoff, L. Lindholm, and C. E. Westerberg, “[Spontaneous impedance fluctuation–a ‘tensor tympani syndrome’ with special reference to tension headache],” Nord. Med., vol. 85, no. 18, p. 577, May 1971.

[4]           M. Westcott et al., “Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: a multi-clinic prevalence study,” Noise Health, vol. 15, no. 63, pp. 117–128, 2013, doi: 10.4103/1463-1741.110295.

[5]           S. H. L. Tan and G. J. C. Lee, “Prevalence and management outcomes of tonic tensor tympani syndrome in an ENT audiology tinnitus clinic in Singapore,” J. Laryngol. Otol., vol. 138, no. 6, pp. 627–633, Jun. 2024, doi: 10.1017/S0022215123002141.

[6]           H. Sun et al., “Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator,” Ear Hear., vol. 44, no. 6, pp. 1430–1436, May 2023, doi: 10.1097/AUD.0000000000001382.

[7]           W. Sunwoo, Y. J. Jeon, Y. J. Bae, J. H. Jang, J.-W. Koo, and J.-J. Song, “Typewriter tinnitus revisited: The typical symptoms and the initial response to carbamazepine are the most reliable diagnostic clues,” Sci. Rep., vol. 7, no. 1, p. 10615, Sep. 2017, doi: 10.1038/s41598-017-10798-w.

[8]           J. S. Han et al., “Typewriter tinnitus: An investigative comparison with middle ear myoclonic tinnitus and its long-term therapeutic response to carbamazepine,” Auris. Nasus. Larynx, vol. 47, no. 4, pp. 580–586, Aug. 2020, doi: 10.1016/j.anl.2020.01.005.

[9] Fournier P, Paquette S, Paleressompoulle D, Paolino F, Devèze A, Noreña A. Contraction of the stapedius and tensor tympani muscles explored by tympanometry and pressure measurement in the external auditory canal. Hear Res. 2022 Jul;420:108509. doi: 10.1016/j.heares.2022.108509. Epub 2022 Apr 27. PMID: 35568596.