Best of five
- A. Patulous Eustachian tube
- B. Glomus tumour
- C. Tensor tympani or stapedius myoclonus
- D. Superior canal dehiscence
- E. Ménière disease
FRCS (ORL-HNS) · SECTION 1 SBA
Middle-ear myoclonus
A patient describes irregular objective clicking in one ear. Otoscopy intermittently shows rhythmic tympanic-membrane movement, hearing is normal and vascular imaging is unremarkable. What is the most likely mechanism?
C. Tensor tympani or stapedius myoclonus
Intermittent contraction of middle-ear muscles can generate audible non-pulsatile clicks and visible drum movement. Diagnosis is clinical and treatment ranges from reassurance to selected muscle tenotomy.
Why every option is right or wrong
A. Patulous Eustachian tube: This typically causes autophony of breathing and voice rather than irregular clicking.
B. Glomus tumour: A vascular tumour causes pulse-synchronous tinnitus and a retrotympanic mass.
C. Tensor tympani or stapedius myoclonus: Intermittent contraction of middle-ear muscles can generate audible non-pulsatile clicks and visible drum movement. Diagnosis is clinical and treatment ranges from reassurance to selected muscle tenotomy.
D. Superior canal dehiscence: This causes sound- or pressure-induced vertigo and autophony, not visible rhythmic drum movement.
E. Ménière disease: Ménière disease causes episodic vertigo, fluctuating hearing loss and tinnitus.
What if the scenario changed?
If the sound were exactly pulse-synchronous, vascular and intracranial causes would require renewed evaluation.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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