HYPOTHESIS PAPER
MIDDLE EAR MUSCLE HYPERACTIVITY AS ONE CAUSE OF TINNITUS: A PUTATIVE ROLE FOR MIDDLE EAR MECHANORECEPTORS
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Faculté de Médecine, Maïeutique et métiers de la Santé, Université de Lorraine, France
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
Submission date: 2025-11-23
Final revision date: 2026-05-31
Acceptance date: 2026-06-17
Online publication date: 2026-08-12
Publication date: 2026-08-12
Corresponding author
Nicolas CHARPENTIER
Faculté de Médecine, Maïeutique et métiers de la Santé, Université de Lorraine, 9, avenue de la Forêt de haye, 54500, Nancy, France
J Hear Sci 2026;16(2):9-20
KEYWORDS
TOPICS
ABSTRACT
Subjective tinnitus is common yet poorly understood, and existing models do not fully explain its clinical diversity. This article presents
a mechanistic hypothesis, based on existing literature, in which tinnitus may emerge not only from reduced auditory input due to inner ear
injury but also from increased activity of the middle ear muscles, which may ultimately increase extracochlear, largely somatosensory, input
to the cochlear nucleus. In this framework, auditory deafferentation is necessary but insufficient on its own.
We further hypothesise that, in some clinical contexts, somatosensory drive may be amplified by excessive stimulation of putative middle ear
mechanoreceptors (MeRs). This stimulation may originate from muscle vibration (tremor) within the tympanic cavity, associated with heightened activity of the stapedius, tensor tympani, and tensor veli palatini muscles. Clinical situations such as loud-noise exposure, temporomandibular disorders, cervical dysfunction, and ear canal irritation may be interpreted within this framework as diverse triggers converging on enhanced middle ear muscle activity and mechanosensory overstimulation.
Although hypothetical, the model yields testable predictions. Functional neuroimaging could reveal abnormal activation of somatosensory cortical areas in tinnitus not directly related to acoustic trauma; middle ear muscle activity could be assessed in animal models using electromyography; and refined impedance-based measurements may help detect and characterise middle ear vibratory phenomena. Clinically, inter-individual variability in the stapedius reflex should modulate transient tinnitus and aural fullness after exposure to loud noise. By integrating auditory deafferentation, somatosensory modulation, and middle ear biomechanics, this hypothesis aims to guide future experimental work and therapeutic strategies.
FUNDING
This research and article did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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