The perception of a tapping sound inside the ear, without any corresponding external noise, is often confusing and distracting. This symptom is a form of tinnitus, which describes any sound perceived in the head or ears. Unlike the common steady ringing or buzzing, a distinct tapping or clicking suggests a physical, mechanical event occurring within the ear or surrounding structures. Investigating the source usually points to muscle activity or blood flow near the auditory system.
Understanding the Types of Tinnitus
Tinnitus is generally categorized into two main types based on whether the sound can be heard by an examiner. The vast majority of cases are known as subjective tinnitus, where the sound is perceived only by the patient. Subjective tinnitus typically originates from an issue with the auditory nerve or the brain’s processing of sound, and it is usually described as a constant ringing, hissing, or buzzing.
In contrast, objective tinnitus is a rare form where the noise is produced by a physical source within the body and can sometimes be detected by a medical professional using a stethoscope. A tapping or clicking sound is frequently a sign of objective tinnitus because it often results from mechanical movements like muscle spasms or turbulent blood flow. This distinction is important because objective sounds often have an identifiable and treatable physical origin.
The classification of the tapping noise helps guide the diagnostic process. If the tapping is a rapid, irregular clicking, the cause is likely muscular or mechanical. If the tapping is a steady, rhythmic thumping, the investigation often shifts toward vascular considerations.
Benign Muscular and Mechanical Origins
The most common cause for an irregular, non-rhythmic tapping or clicking sound is involuntary muscle contraction, known as myoclonus, occurring in the middle ear. This condition is specifically termed middle ear myoclonus (MEM) and involves the tiny muscles that regulate sound transmission. The two muscles involved are the tensor tympani and the stapedius muscle, which normally contract to protect the inner ear from loud noise.
When these muscles spasm involuntarily, their rapid contractions are perceived as a clicking, popping, or fluttering sound in the ear. The tensor tympani muscle, attached to the eardrum, can cause a distinct thumping or clicking when it twitches. This muscle activity is usually benign, though it can be triggered or worsened by anxiety, stress, or exposure to loud noise.
Another mechanical source of tapping can be found in the Eustachian tube, which connects the middle ear to the back of the nose and throat. Eustachian tube dysfunction (ETD) can cause clicking or popping as the tube struggles to open and close to equalize pressure. Palatal myoclonus involves rhythmic spasms of the muscles in the soft palate, which can repeatedly yank open the Eustachian tube, resulting in an audible clicking noise.
Finally, the simple presence of material resting against the eardrum can cause a tapping sensation with movement. Excessive earwax, or a small hair or foreign body touching the tympanic membrane, can create a tapping or rustling noise when the head moves or the jaw is clenched. Removing the obstruction often resolves this mechanical symptom immediately.
Rhythmic Tapping and Vascular Considerations
When the tapping sound is perceived as a steady thumping, whooshing, or pulsing that aligns precisely with the heartbeat, it is classified as pulsatile tinnitus. This rhythmic sound indicates a vascular source, meaning it is related to blood flow near the ear’s delicate structures. The sound is essentially the audible perception of blood moving through nearby arteries or veins.
Pulsatile tinnitus often arises from turbulent blood flow, which can be caused by various conditions that alter the speed or volume of blood. For instance, atherosclerosis, a condition where plaque narrows the arteries, forces blood to flow with greater force and turbulence, creating a louder sound near the inner ear. High blood pressure can also increase the force of blood flow, making the pulse more noticeable in the ear.
Other vascular sources include certain anatomical variations or conditions that affect the large blood vessels in the neck and head. Narrowed neck arteries, known as carotid artery stenosis, can generate an audible sound due to the constricted passage of blood. Conditions like anemia or an overactive thyroid gland (hyperthyroidism) can also increase blood flow velocity, causing the rhythmic sound to become more prominent. If the tapping is truly rhythmic and persistent, it warrants a thorough medical investigation to rule out these underlying cardiovascular causes.
Diagnosis and When to Consult a Specialist
A persistent tapping sound in the ear requires evaluation to determine if the source is muscular, mechanical, or vascular. The diagnostic process typically begins with a physical examination of the ear, head, and neck by an otolaryngologist, often including an audiogram to check for any associated hearing loss. The specialist may listen over the ear, neck, and skull with a stethoscope to determine if the sound is objective.
Movement tests are also performed, where the patient is asked to clench the jaw or move the neck, as these actions can sometimes change or worsen the tapping sound, pointing toward a muscular or temporomandibular joint issue. If a vascular cause is suspected, especially with rhythmic tapping, imaging tests like a CT scan or MRI may be ordered to visualize blood vessels and surrounding structures.
Consult a specialist if the tapping sound is strictly synchronized with your heartbeat, as this pulsatile form can sometimes signal a treatable vascular condition. Immediate medical attention is also recommended if the tapping is accompanied by other symptoms:
- Sudden hearing loss
- Dizziness
- Severe pain
- Neurological changes
Treatment focuses entirely on the underlying cause, which might involve medication for muscle spasms, a procedure to clear earwax, or management of a cardiovascular condition.