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.