On rare occasions entotic sounds perceived by the patient can also be heard by the examining physician. This objective tinnitus aurium originates in one of two ways: (1) It may be caused by spasmodic, rhythmic contractions of the muscles related to the eustachian tube, or (2) the sounds may be of vascular origin. SOUNDS OF MUSCULAR ORIGIN In the first variety, the sounds have a clicking or snapping quality and are due to unilateral, rhythmic contractions of the levator palati or tensor palati muscles pulling on the eustachian tube, or they may originate in similar contractions of the tensor tympani muscle. At times the sounds are of such intensity that they can be heard at a distance of several feet from the patient. The sounds are usually associated with synchronous contractions of the soft palate. At times there may be associated movements in the eyelids or in the larynx on