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Middle ear myoclonus occurs in the muscles of the middle ear. These muscles may include the tensor tympani and stapedius muscles. It can involve the muscles surrounding the Eustachian tube, which include the tensor veli palatini, levator veli palatini, and salpingopharyngeus. Those affected describe it as a thumping sound or sensation in the ear.
One end of malleus is connected to the tympanic membrane, and the other end is connected to the two other ossicles, the incus and stapes, which connects to the inner ear. The purpose of the middle ear is to deliver the sound waves from the outer ear to the cochlea of the inner ear. When external sound contacts the eardrum, the ossicles vibrate.
The acoustic reflex (also known as the stapedius reflex, [1] stapedial reflex, [2] auditory reflex, [3] middle-ear-muscle reflex (MEM reflex, MEMR), [4] attenuation reflex, [5] cochleostapedial reflex [6] or intra-aural reflex [6]) is an involuntary muscle contraction that occurs in the middle ear in response to loud sound stimuli or when the person starts to vocalize.
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In many people with hyperacusis, an increased activity develops in the tensor tympani muscle in the middle ear as part of the startle response to some sounds. This lowered reflex threshold for tensor tympani contraction is activated by the perception/anticipation of loud sound, and is called tonic tensor tympani syndrome (TTTS).
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