What is tonic tensor tympani syndrome?
Tonic tensor tympani syndrome (TTTS) is abnormal activity of the tensor tympani muscle of the middle ear that is responsible for protecting the inner ear from loud sounds.
The tensor tympani muscle (in combination with the stapedius muscle) is a reflexive, involuntary muscle contraction that occurs when you speak, when you chew food, and when an external loud sound occurs, to protect your ears from hearing those sounds at damaging levels.
When the muscles contract in response to the potentially damaging sound, the tiny bones of the middle ear (ossicles) move to tighten the eardrum (hence the name tensor tympani), which in turn reduces the level of transmission of the sound to the inner ear. It is a protective reflex used to protect the ear from sudden loud noise.
When the tensor tympani muscle is reacting properly to sounds, you don’t even know it exists. The word “tonic” in the description of this syndrome refers to continuous muscle contraction. With tonic tensor tympani syndrome, the reflex threshold for the muscle contraction is reduced and you become aware of the muscle’s frequent spasms (hypercontraction). The increased activity of the tensor tympani muscle is activated by the perception, or even anticipation of loud sounds and is anxiety-driven.
What causes tonic tensor tympani syndrome?
Tonic tensor tympani syndrome is an anxiety-based condition. People who experience tinnitus and/or decreased sound tolerance (hyperacusis, misophonia, or phonophobia) are at greater risk for developing TTTS.
When someone experiences decreased sound tolerance, everyday sounds seem too loud. Following exposure to triggering sounds, an increase in tinnitus and/or hyperacusis may occur, as well as increased anxiety. This increase in anxiety in response to sound can lead to increased activity of the tensor tympani muscle.
In some people with severe hyperacusis/misophonia, they don’t even need to hear a sound in order for their tensor tympani muscle to contract. The tensor tympani muscle will be activated by the perception or anticipation of loud sound and can contract just by thinking about a loud or specific sound.
There is also some evidence that indicates TTTS can be the result of TMJ problems or upper cervical spine problems caused by whiplash. If TTTS is experienced following a trauma to the jaw, neck, or upper back then you should seek proper treatment from a dentist or chiropractor.
What are the symptoms?
- Feeling of fullness or pressure in the ear
- Otalgia (either a sharp pain or dull ache)
- Fluttering sensation in the ear
- Headache or neck/jaw pain
- Numbness or tingling sensation of the ear, neck, or jaw
- Tinnitus in the form of clicking
- Muffled or distorted hearing sensation
- Vertigo or imbalance
How is tonic tensor tympani syndrome diagnosed?
It can be very difficult to be diagnosed with TTTS because few people have ever heard of it, including physicians.
Often times, other otologic conditions will be ruled out first before tonic tensor tympanic syndrome will be diagnosed.
How is it treated?
Once sound acquires a negative reaction, such as with tinnitus, hyperacusis, misophonia, or phonophobia, the limbic system and autonomic nervous system becomes heightened when a triggering sound is heard, initiating the fight or flight reaction.
Treatment of tonic tensor tympani syndrome is accomplished by managing the tinnitus and/or hyperacusis. The aim of treatment is to provide information, counseling, and desensitization to everyday sound through sound therapy. Once the hyperacusis and tinnitus becomes under control, the TTTS is likely to resolve.
Does tonic tensor tympani syndrome cause lasting problems?
TTTS itself does not harm the ear, but it can be painful and uncomfortable to experience for any extended time period.
TTTS can cause high levels of anxiety if left unmanaged. It is important to seek treatment for tinnitus, hyperacusis and misophonia to reduce the risk of tonic tensor tympanic syndrome.