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Tensor Tympani Spasm

Tensor tympani spasm causing pulsatile tinnitus in the left ear. This 55 year old woman of native american descent (Pima indian most likely), has a life long history of intermittent tinnitus in the left ear, described as "shotgun" or fluttering" sounds. The tinnitus can last for days or only a few moments and is unpredictable. She had never been diagnosed with a cause of the tinnitus and had assumed that is was normal. This video shows irregular motion of the umbo and manubrium of the malleus in the left middle ear, which is caused by dystonic contractions of the tensor tympani muscle. This rarely diagnosed condition can cause abnormal sounds and sensations in the ear. In addition, dystonias of the tensor veli palatini muscle and stapedius muscle can also cause similar symptoms. She incidentally also has a large tympanic membrane perforation on the left side and is recovering from an acute otitis media with otorrhea. Treatment potentially would include botox injection of the muscle versus simple transection of the abnormal middle ear muscle (Tensor Tympani). However, in this case, the patient was not significantly bothered by the symptoms and no intervention was needed.