Objective Tinnitus and the Tensor Tympani Muscle

Objective tinnitus (OT) may be caused by contraction of the tensor tympani muscle (TTM). The more forcefully the TTM contracts, the greater the intensity of the OT heard. Forceful closure of both eyelids can reflexively cause OT by contracting the TTM. The Forceful Eyelid Closure Syndrome (FECS) was reported at the Proceedings of the Second International Tinnitus Seminar in 1983.(1) FECS consists of several factors: (1) Objective tinnitus (2) An associated waning of hearing primarily of the lower frequencies, as much as 45 dB at 125 Hz, 30 to 40 dB at 250 Hz ascending to the patient's norm at 2000 Hz and approximately a 5 to 10 dB at 4000 Hz and 5 to 20 dB at 8000 Hz (3) Retraction of the manubrium and posterior mid-third of the tympanic membrane (TM) at the malleus-umbo area as seen under the otomicroscope (OM) in 25% (108) of 432 ears examined (4) These same ears were 75% (324) positive for increased impedance at maximum compliance with FEC. Of the patients studied, 25% had no response under the otomicroscope or by impedance audiometry.