TTTS usually presents with symptoms such as fluttering of the eardrum, a sensation of heat, pain, blockage and fullness in the ear, tinnitus, hyperacusis and dizziness. These symptoms are also found in other ear disorders so that the correct diagnosis is mandatory to ensure correct treatment.

The tensor tympani and the stapedial muscles are part of the ear’s natural protective mechanism. These muscles normally contract to tighten the middle ear bones (the ossicles) as a reaction to loud sounds. This protects the inner ear from damage. People who are exposed to a sudden, damaging loud noise may develop a spasm of the stapedial muscles, leaving the tensor tympani muscle in a constant state of contraction, hence the symptoms.

In many people with tinnitus, particularly if they have developed hyperacusis, an increased, involuntary activity can develop in the tensor tympani muscle in the middle ear as part of a protective and startle response to some sounds. This lowered reflex threshold for tensor tympani contraction is activated by the perception/anticipation of sudden, unexpected, loud sound, and is called tonic tensor tympani syndrome (TTTS). This response can then generalise to other types of sound and to lower sound volume levels, resulting in the development as well as the potential escalation of hyperacusis. In some people with hyperacusis it appears that the tensor tympani muscle can contract just by thinking about a loud sound.

TTTS is, in fact, an overreaction of the ear’s natural protective mechanism.

Healthy Hearing & Balance Care audiologists are experienced in diagnosing and managing TTTS and Dr Celene McNeill was part of an international epidemiological investigation of the condition.

References

Tonic Tensor Tympani Syndrome (TTTS) in Tinnitus and Hyperacusis Patients: A Multi-Clinic Incidence Study