Tic-Like Repetitive Ear-Popping Behavior With Objective Eustachian Tube Opening in an Adult With Tourette Syndrome

Tourette syndrome presents with diverse motor and vocal tics, yet involvement of Eustachian tube dynamics has not been previously described. We report the case of a 31-year-old woman who developed an unusual symptom she described as an "ear-popping tic," characterized by a strong premonitory urge to release air from the ears and clicking sounds. Her long clinical history included childhood-onset tics, emotional instability, psychiatric hospitalizations, and fluctuating tic severity. At age 31, she reported repetitive ear-popping sensations accompanied by voluntary suppression to some extent. Ear, nose, and throat examination revealed normal tympanic membranes and hearing thresholds. Acoustic Eustachian tube function testing objectively demonstrated repetitive Eustachian tube opening independent of swallowing, a finding not previously documented in tic disorders. The patient described a strong urge to engage in ear-popping and partial suppressibility, although the temporal relationship between the auditory sensation and the urge was unclear. Differential diagnoses included voluntary ear-popping behavior, palatal myoclonus, middle ear myoclonus, and tensor tympani syndrome. The repetitive non-swallow-related tube opening was considered most consistent with tic-like contractions of the tensor veli palatini and levator veli palatini muscles, although voluntary components could not be fully excluded. One month later, she adopted lifestyle practices inspired by traditional East Asian medicine, leading to gradual psychological stabilization. The ear-popping tic became less intrusive, and all medications were eventually discontinued. This case highlights the importance of objective assessment in distinguishing tic-like phenomena from other causes of Eustachian tube opening.