You ever wonder about the popping noise your ears? You know—that “pop” or “crack” whenever you
open and close your mouth or swallow? Or
maybe you’ve noticed (or maybe not) a peculiar noise whenever you turn your
head, yawn, fly in a plane or travel up and down in changing altitudes. If you don’t, then don’t bother reading this;
your life obviously is far more exciting than mine, removing you from such
trivial concerns. If however you do
notice these noises and they’re driving you crazy, take solace knowing that
you’re not going insane, it’s not simply “in your head,” and you will not die
of some hideous tumor brewing deep within the squishy gray matter between your
ears.
There are a number of natural causes for those noises. I personally noticed this one day smack dab
in the prime of life—as a worldly 11 year-old who thought he knew everything
under the sun, or everything worthwhile to know. I happened to be swallowing one day in
class. I wasn’t eating or drinking
anything, because in those days eating or drinking in class was forbidden. Even chewing gum was a violation of universal
school rules, an ultimate act of disobedience, punishable by death, or a trip
to the principal’s office which was worse than death. Anyway, there I was, minding my own business,
being a good student and taking notes when I swallowed. It was a seemingly normal swallow, something
one does spontaneously to prevent saliva pooling and drooling down the face
like the guy on my left, deep asleep right there during the most phenomenal math lecture
of the decade.
I wanted to kick him because sleeping in class, we were indirectly
told, was right there behind gum-chewing as one of the deadly sins. But I was worried by the unusual noise in my
ears to be concerned about my dozing classmate.
I heard a “pop” or “click” or “smack,” or a combination of all
three. I swallowed again. There it was again. I swallowed again and again. Yep, there it was again and again. I began to freak out, just a little, mind
you; for having a bona fide freak-out session right there in front of the
entire class of eleven year-olds would’ve been an everlasting source of
embarrassing jokes for years to come.
I don’t like unknowns and this weird unknown triggered a wave
of anxiety. I perseverated on that
swallowing noise. There it was again,
with each swallow. What gives? I turned my head, swallowed at different
rates, allowed more saliva to build up in the throat to swallow, swallowed while
holding my head down, then up, left and then right. There it was again and again and…oh my
God! I have a tumor!
Whoa! Hold onto your
horses! Don’t panic!--self-talk meant to
allay the cold sweats and palpitations.
The teacher gave me an odd look, then tapped my buddy on the left with a
yard stick, waking him with a jolt. The
burst of laughter from the class diverted me from my predicament…for about ten
seconds.
Anyway, to make a long story short, I eventually came to
grips with my predicament after my not-so-sympathetic dad told me I was crazy
and my more sympathetic mom said I was not going to die because she’s heard the
same noises for years and years. And she
wasn’t dead.
Later as I became a grown-up
(and an ENT doctor), I recalled the silliness of my youth, and in fact share
this story with some of my patients presenting with the same complaint. These usually are teenagers and young adults,
some with a history of anxiety issues and some without. After taking their history and providing
there is nothing unusual on their physical exam (or other testing such as a
microscope exam of the ears, tympanograms to check the middle ear pressure
problems and hearing tests), I usually find and then explain one of four causes,
which for the most part are natural and normal phenomena. Note: this is different from ear ringing or
ear noises known as tinnitus, and you can check the post, Tinnitus: Ringing in the Ears or “What are those Noises in My Head?” for more on that topic.
1. Eustachian tube function
This was the phenomenon that tortured me in grade school
during that math class. This is not a
dysfunction, but an actual normal function of the eustachian tube opening and
closing. Sometimes a person becomes more
aware of it, and as you can imagine, if you keep on thinking about something,
it can be distracting. But you need to eustachian
tube to do its thing, that is, open and close in order to equalize the pressure
in the space behind the eardrum known as the middle ear space. This is important during environmental pressure
changes, such as travelling through altitudes, flying in a plane or during barometric
changes that occur with changes in the weather.
In an attempt to remedy this phenomenon--mistakenly
believing this to be a “problem”--many patients try to clear their ears by
manipulation their jaw in such a way that an audible “pop” is experienced. They’ll open and close their mouth or move
the jaw forward to create that sound. Don’t do this! It doesn’t help. Though you may feel this popping is equalizing
ear pressure (i.e, letting air into the middle ear space) this is a false
premise. You’re actually moving the
condyle of the mandible (the jaw) within the socket that sits right in front of
the ear. And since it is close to the
ear, it is easily heard. Doing his
maneuver repeatedly eventually becomes habitual, and leads to more ear
aggravation, even ear pain. This is
leads us to the next cause of ear popping:
2. Temporal mandibular joint (TMJ)
You ever notice a pop or click upon opening the mouth? I first noticed this sometime in my teenage
years. It freaked me out. I hadn’t notice that sound before. . . or did
I? I had another anxiety-provoking experience
similar to the one when I first became acquainted with the sound of the eustachian
tube function. I perseverated on this
for a while until I was distracted by something else, the details which have
been lost forever, and I notice this only when I think about it. Yep, there it is again, whenever I open and
close my mouth, even normally.
The condyle of the
mandible normally sits in a socket in front of the ear. The condyle allows the mandible (jaw) to articulate—to move in a rotating fashion
to open and close the mandible for things such as chewing and talking. The condyle naturally moves forward slightly
out of the socket with wider mouth-opening, almost a disarticulating action
which allows the mouth to open wider. These
actions create the sound which can be characterized as a pop, click or even a
grinding type noise. This is common. However, by opening and closing the mouth
repeatedly (i.e., when trying to “clear” the ears) inflammation can occur
between the condyle and the socket, leading to ear pain, jaw pain, and often
headaches. Repeated chewing (i.e., gum
chewing), clenching the teeth and grinding the teeth also can lead to pain and
discomfort. When this occurs, it is
known as a temporal mandibular joint (TMJ) disorder. So avoid doing those things that will aggravate
your TMJ.
3. Cervical spine
Once in a while a patient will notice a crackling sound or a
pop whenever they move their neck a particular way. This arises from the cervical vertebrae, the
column of bone that surrounds your spinal cord as it leaves the bottom of your
skull. Each vertebra (where vertebrae is the fancy doctor-word for more than
one vertebra, i.e., the plural form) is bony unit stacked one upon another,
separated by a softer disk allowing for articulation
(movement). Sometimes a popping or
crackling is felt and heard when the neck is moved a particular way, usually
the result of one vertebra articulating upon another (and sometimes related to
developing arthritis of those vertebrae), a ligament sliding along the
vertebra, or from a bony vertebral spur that forms in some patients as they
age. The sound radiates upwards along
the vertebral column to the skull and is picked up by the cochlea (inner
ear). This typically is a natural
phenomenon, usually occurring in older folks like me.
4. Laryngeal cartilage crepitus
On occasion I’ll see a patient, often in young adults, who
is really freaked-out by this problem. Whenever
they swallow or move their neck in a particular manner, they hear a pop or
click. Sometimes they’ll even localize
it to one area in the neck. This often
occurs with dry swallowing and is less prevalent or noticed not at allow when
eating or drinking something.
Again, personal experience should help ease with this freakish-like
symptom (notice how often I’ve been “freaked-out” in my younger days in the
examples above—almost too many to count).
I was in my early 20s, trying to keep my eyes open during another
earth-shattering lecture about life-changing topics I’ve long forgotten, when I
heard a pop that seemed to arise from the upper left side of my neck. I believe I simultaneously swallowed and
turned my head to the right when this freaky episode caught me off guard. I don’t rightly recall why my gaze was diverted
from the somnolence-inducing professor, but my guess is an attractive fellow
student of the opposite sex caught my attention.
To make a long story short, I perseverated on that odd
sensation to the point where I stopped taking notes altogether and completely
lost track of the rest of the lecture (later, I had to listen to a taped
recording of that lecture in the tape library on campus—yes indeed, they had
one of those way back in the day). I repeated
the circumstances that caused my dilemma and noticed the popping sensation
sometimes, but not always. It discovered
eventually it occurred with a specific neck position. Fears of tumors invading my brain, a parasite
in my neck or of being possessed by an evil spirit loomed in my head. I also couldn’t reproduce it when I was actually
eating or drinking something.
This particular symptom arises when the back of the hyoid
bone or thyroid cartilages rub along the vertebral column. Notice in the drawing above structures called
cornu, which is Latin for
“horn”. Both the thyroid cartilage and
hyoid bone have corni (plural for cornu)
that project backwards. There is soft
tissue covering the cornu, but they still can rub onto the front
(anterior) part of the vertebral column,
causing a crackling or popping sound that also can be felt. If you move your larynx (or “Adam’s Apple”)
side to side, you will feel and hear a crackling sensation we call crepitus. This is an expected and normal phenomenon. The
thyroid cartilage calcifies as one ages, usually starting in early adulthood,
and calcification typically occurs first along the back side (posterior) of the
cartilage, of which the cornu is one.
This firms up the structure and creates the natural crepitus. You often will not notice this sensation when
eating food or drinking a beverage or water, since the bolus (the lump or mass created by the food or liquid) pushes the
larynx slightly forward (anteriorly) and away from the vertebral column.
In my personal predicament, this issue later seemed to
resolve or more likely I forgot about it.
To this day when I swallow, I still hear crackling and popping and by
the life of my I’m not sure if it’s my eustachian tubes or my neck.
Take solace if you experience any of the above, as these are
natural phenomena. Hopefully, after the
above discussion and my own youthful tales of woe, you may rest assured that
you are not going crazy.
©Randall S. Fong, M.D.
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