Essential palatal myoclonus: the click in your ear with nothing on the scan.

A rhythmic clicking that no one else can hear and no MRI can explain. The brain may be producing it, and that is a treatable finding.

This page is about understanding the condition and the role the brain and nervous system can play in it. It is not a diagnosis. Your own clinicians know your case.

What essential palatal myoclonus is, and why imaging comes first

Your soft palate is the fleshy back part of the roof of your mouth. In palatal myoclonus it contracts in a steady rhythm, usually one to three times a second, and often keeps going during sleep. Many people notice it as a clicking or popping sound in one or both ears, caused by the small muscles that open the Eustachian tube snapping with each contraction.

There are two kinds. Symptomatic palatal myoclonus follows damage to a specific circuit in the brainstem and cerebellum, from a stroke, multiple sclerosis, injury or tumour. It usually involves different muscles, rarely causes a click, and shows a characteristic change on MRI. Essential palatal myoclonus is the label used when the click is present, the examination is otherwise normal, and the scan shows nothing wrong. Because the symptomatic form can be the first sign of a serious brain condition, the first job for your doctor is a careful neurological examination and an MRI.

The neuroplastic contribution

The ATNS Index of Neuroplastic Symptoms is specific here: when there is no evidence of disease in the brainstem or cerebellum, the person should be assessed for neuroplastic symptoms. That is exactly the situation the word essential describes.

Neuroplastic symptoms are real symptoms produced by learned pathways in the brain and nervous system rather than by structural damage. In movement disorders this is often called a functional movement disorder. The movement is real, it is not under voluntary control, and it is not pretending. The difference from a structural disorder is in the wiring: the brain has learned a pattern and runs it automatically, the way it runs a habit or a tic, often with attention and anxiety acting as the accelerator. Because the pathway was learned, it can be unlearned, which is why this diagnosis is good news rather than a dead end.

Clues that point toward a functional origin include:

• The clicking varies or stops when your attention is pulled elsewhere.
• It falls into step with another rhythm, such as tapping your finger.
• It began after a period of stress, illness or a frightening event.

What the research shows

Neurologists have been rethinking essential palatal myoclonus for more than a decade. A reappraisal of a large series of palatal tremor cases concluded that psychogenic (functional) palatal tremor may be under-recognised, and recommended that clinicians look deliberately for the positive signs of a functional movement disorder, such as variability, distractibility and entrainment, rather than assuming a structural cause.

A 2020 report described two patients with essential palatal tremor studied with EEG and EMG recordings time-locked to video. In both, the palatal movement was incongruous with any known lesion, variable, distractible and entrainable: in one, the palate fell into rhythm with the patient's finger tapping. The authors state that essential palatal tremor is now believed by many to be a functional movement disorder, and they used these recordings to make a definite diagnosis.

A 2021 clinical and imaging study of patients with palatal tremor confirmed the broad pattern: the essential form is associated with ear clicks and normal imaging, and the authors advise that a functional cause should be considered in such cases. The evidence is drawn from case reports and series rather than large trials, and some authors argue that a subset of essential cases may still be generated centrally by an unseen mechanism. But the direction is consistent, and it matches the index's position. For more on how the brain can produce real symptoms without damage, see our guide to functional neurological disorder.

Signs the brain may be part of the picture

• Your MRI and neurological examination are normal.
• The clicking comes and goes, changes speed, or disappears when you are absorbed in something.
• It started after a stressful period, a scare or an illness.
• Focusing on it, or worrying about it, makes it louder and faster.
• You have other symptoms that tests have not explained, such as tinnitus, dizziness, headaches or chronic pain.

A solution that addresses it

There is an approach that addresses the brain's role directly. Pain and symptom reprocessing, used for a wide range of neuroplastic symptoms including functional movement, begins with understanding how the brain learns and runs symptom patterns. It then builds skills: somatic tracking (noticing the sensation or sound with calm curiosity rather than alarm), reducing the sense of threat, graded return to normal activity, emotional awareness and expression, and acceptance and commitment skills (ACT) that loosen the grip of monitoring and worry. Trained clinicians deliver it, and digital programs are making it more accessible. It works best alongside the specialist care of a neurologist who is familiar with functional movement disorders.

Cindra is a daily AI companion built around these approaches, with daily check-ins, short practices and plain-language lessons for people whose symptoms have a neuroplastic component. You can join the waitlist.

What to do next

First, get the medical workup. See a neurologist, have an examination and an MRI of the brain, and make sure symptomatic palatal myoclonus has been excluded. Seek prompt attention if the clicking comes with new weakness, slurred speech, double vision, trouble swallowing, unsteadiness or numbness.

Second, if imaging is clear, ask your neurologist directly whether this is a functional movement disorder and whether your symptoms fit a neuroplastic pattern.

Third, if the answer is yes or probably, start learning and practising. The aim is not to force the click to stop but to change the brain's relationship with it, which is what allows it to fade. Our mindfulness and somatic exercises are a reasonable place to begin.

This article is for general education and is not medical advice, and it does not diagnose or treat any condition. Persistent symptoms deserve a proper medical assessment to rule out disease or injury before a neuroplastic explanation is considered. If your symptoms are new, changing, or come with red-flag signs such as fever, unexplained weight loss, numbness or weakness, chest pain, or loss of bladder or bowel control, see a clinician promptly.