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Is TETRACYCLINE ototoxic?


Habituation with increased level of tinnitus

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Hi Dr. Nagler,

Thank you for the effort and time you put in helping all tinnitus sufferers.

My name is Cristian, I am 34 years old and I live in Romania. Have tinnitus since 2011 from going to a loud club music. First months were very hard for me, I visited several ENT's, all told me that I have to live with it, one of them prescribed me Betaserc 24. When the panic and anxiety disappeared I started to feel better, the level of tinnitus went down so much that I barely hear it in a silence room. I continued to live my life, going to work, listen music, going to gym, travel, reading.

First bad spike was in 2014 after going to a loud bar without wearing earplugs my tinnitus increased to a level that stayed highed more than 2-4 days that I used to. It was  masked most of the time by ambient noise at work and out. The challenge was at night because was very loud in both ears. I was very tired but unable to fall asleep for 4 days. I tried with TV and radio on, white noise, falling water, rain. Nothing worked to masked it because I like to sleep in silence. My doctor prescribed me some lorazepam meds and I could sleep a few days. I don't know if i call it habituation but after 3 months a miracle happened, my negative reaction disappeared and wasn't bothered by tinnitus again. I stopped to read tinnitus forums. I was able to sleep in silence and do usual activities like before. 

On 31 July 2016, I invited a girl to have a drink to an outdoor restaurant. Near the restaurant was an outdoor wedding, loud music. To get into restaurant we had to walk on a road that was 30 m away from the wedding place. I thought it was a safe distance and being embarrassed to protect my ears with my hands I walked like that. Next day in the morning  I noticed a high pitch different from what I had before. I thought it wil go back to the usual volume I'm used to but after two months it doesn't get better. I can hear it now almost all the time. The only good thing  is that I can sleep with sleep application on my phone that makes crickets noise. Strange think is that I went to a walk in the forest in silence, in august and barely hear the tinnitus. 
I am frustrated now for making such huge mistake and  frightened that I will not be able to habituate again.

It's possible this short exposure (about one minute) to damage my hearing?

You said in a post: That said, some groups of individuals tend not to do as well as others with TRT. Many of these individuals do, indeed, succeed in TRT; it is just that their success rate is not as high. People whose tinnitus markedly increases in intensity upon exposure to noise do not do as well if that marked increase in intensity lasts more than 24 to 48 hours.

I don't have acces to TRT but what you said means it's harder for me to natural habituate if my tinnitus increased due to noise exposure? It scares me a lot.

Category: Your Questions and My Answers

Momentarily loud headphone exposure

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I accidentally blared a 16khz test tone from my headphones for a few seconds. My tinnitus sound has increased a bit afterwards. I can deal with this fact and accept the stupidity of stumbling into this situation, however I'm wondering if this act also laser fried my ears and wrecked anything else besides more cochlear hairs due to the frequency. The headphones have a SPL of 112 dB (1 kHz/1 Vrms).

Needless to say, I have stopped looking at frequency tones and also stopped using headphones.

Thanks.

Category: Your Questions and My Answers

Tinnitus & Neck Issues

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Hi. I am a 37 year old female with recent tinnitus. When I say recent, it has been about a year. I also have 2 herniated discs in my neck(c3c4 and c5c6) and another bulge. I have degenerative disc disease. I wondered if this could cause T. I have gone to PT and done traction and soft tissue massage and I swear it helped. But, my doctor bluntly told me my neck issues had nothing to do with my tinnitus, while my PT said it absolutely could cause ringing in the ears. I do not have any hearing loss and often experience fullness in my ears. I have also had a few epidurals in my neck to relieve pain but it did not relieve the tinnitus. I also feel like masking devices sometimes make it worse as it is such a high pitched hissing. Either way it is driving me to the point of insanity. I am trying to manage my anxiety as I know it makes it worse, but it's been tough. Any thoughts on this?

Category: Your Questions and My Answers

Your second recovery?

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Hi,

First off, thanks again for the rather lengthy thread we had about "the barn" a few months back.  Fortunately, my "horse" wanders back in from time to time (especially after 2 glasses of wine).  Unfortunately, he wanders back out frequently also.

Overall I'm doing a lot better - both mentally and physically.  My symptoms have resolved ~75%.  My ears hurt less, my ringing is much lower in intensity, and my bad days are fewer and further between. 

I still have tinnitus.  I've accepted I always will.

Now - on to the real reason I'm contacting you.  I read a thread filled with much vitriol on another forum in which you indicate a serious increase in your own symptoms after years of habituation (mid 2015?).  As these increases are probably the biggest fear for all of us, I'm curious if/how you recovered.  Also, I'm curious what "recovery" is defined as in your case.  Did you return to a baseline?  Did you habituate to a new normal?

Thanks,
Tom

Category: Your Questions and My Answers

What is the relationship between Eustachian Tube Dysfunction and Tinnitus?

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I've read that tinnitus can often be caused by Eustachian tube dysfunction.  What exactly is happening in the ear that is causing this to happen?  My understanding is that tinnitus is generally caused by damage of some sort to the inner ear.  Does the constant pressure in the middle ear from Eustachian tube dysfunction somehow irritate or damage the inner ear? Or is it simply that the infection that caused the Eustachian tube dysfunction also infected the inner ear? When Eustachian tube issues are resolved, does the tinnitus generally resolve as well?

I ask this because I think that I am having problems with my Eustachian tubes (my ears always feel stuffed, even after I pop them).  I am also having tinnitus, though it's not steady tone... it sounds more like how I would imagine irritation to sound, if that makes any sense.

Thanks.

Category: Your Questions and My Answers

When to move on from investigating the cause

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Dear Dr Nagler,

I am an Otologist from the UK. I developed a left sided sudden sensorineural hearing loss 3 months ago. I had early oral steroids, intratympanic injections and hyperbaric oxygen and my hearing returned to normal. MRI was normal aside bilateral vascular loops. No obvious cause has been found for my sudden loss. Cochlear hydrops is a possibility as I had a lot of aural fullness and considerable low frequency loss. No vertigo. I also took betahistine for 4 weeks which I think made no difference.

Unfortunately I have had worsening left sided tinnitus since then (24/7 and perceived as loud - I cannot mask it at all). I also now have quite a lot of somatic modulation with neck and jaw movement as well as the fact that the tinnitus is now often also modulated by my pulse (i.e constant tone but throbbing exactly in time with my pulse).

I am at the stage where I have accepted that it may not improve and have started CBT, mindfulness and general relaxation exercises. I feel though that I am held back by wanting to continue to explore what caused this and how I can medically improve it. I am generally out of panic mode regarding this but it has left me very low emotionally and felling I cannot enjoy my life as I hear it constantly. My sleep is now good, but every morning is TERRIBLE. It tends to get better as the day goes on and by the evening is usually manageable. I find that any attempt to mask/blend with my tinnitus seems to drive the noise higher (including sound therapy at night) and so at present I have abandoned this. 

I feel rather stuck at the moment. Any advice much appreciated. Have you seen many people with somatic pulsatile modulation of constant tone tinnitus? I am hoping it has no more significance than any other somatic modulation but I am not sure.

Kind Regards

Category: Your Questions and My Answers

Simple question: can you guarantee success?


Single best piece of advice ...

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Hello All -

So here's a question to think about ...

What is the single best piece of advice you could offer to any tinnitus sufferer who approached you in search of information and support?



stephen nagler

Category: My Questions and Your Answers

Do I ask for referral to ENT?

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Hi again Dr Nagler



I posted a few weeks ago regarding the return of my tinnitus after some 15 years. Whilst my horse hasn't returned to the barn, I can say that tinnitus is now not bothering me for around 80% of the time, I am sleeping ok and good/bad days no longer depend on what my tinnitus is doing, but rather on what "I" am doing. I no longer feel the need to have the TV on constantly in the bedroom, and I use the Simply Rain app (recommended by Frosin on here) on my iPad throughout the night. My husband occasionally asks me to turn it up a little as he can't hear it; he finds it soothing too. Cool.



When I first got the tinnitus all those years ago, I did all the things that I imagine most people do if their tinnitus is intrusive and bothersome to them. I saw the doctor to check for wax. I was referred to ENT and also for an MRI scan as the tinnitus was one sided. ENT appointments showed nothing specific & the MRI came back "reassuringly normal".



In my initial panic this time (just under 3 months up to now) I saw the doctor who ruled out wax. He said to give it some time and to go back for referral to ENT if my tinnitus didn't "clear up".



I'll be honest, I don't really feel any inclination to go back. I am worried that it will bring about a sense of trying to find a reason, that could maybe set me back a bit in my habituation journey.



So that's my question really. Am I supposed to rule out physical causes via doctors/ENT? Would I be foolish to assume that what happened in the past will likely dictate what happens this time?



I am comfortable enough right now to accept that if the tinnitus is present throughout the rest of my life, then that's ok. My day to day behaviour now is no different to pre-tinnitus with the exception of one thing; I am mindful of noise that could damage my hearing. I don't avoid anything that only exacerbates the tinnitus, but I am cautious about anything that could potentially harm my ears (or anyone else's for that matter).



Thank you once again for your support on here, and apologies for the long post to get to a two line question!



Zippy.

UK.







Category: Your Questions and My Answers

Spike ?

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Hi Dr. Nagler, thank you so much for this site.

I developed tinnitus ten years ago following an ear infection in my left ear.  The first year or so was very rough but I feel like I have habituated for the most part to my normal sound of T (tea kettle).  I did use sound generators for a few months but eventually found them to be more annoying than helpful.   I have had a few "episodes" over the years where the sound changes, a beeping sound sort of like a back up horn, one episode lasting a few weeks and one lasting a few days.  Although the beeping was extremely annoying, I didn't hear most of the time (with tv or music on)..  However, last week the volume of my normal tea kettle T increased to a level that it has never been and can be heard over about everything.  In a silent room, it does sound like it is coming from the top of my head but with other noise around, it is mostly screaming from my right ear.  I've searched for information on "spikes" and I know that there is no way to know if a new sound level is permanent or not.  I would just like to ask, with your experience does this sort of increase in volume return to baseline for most people? Over the years, there may have been a slight increase in volume, just enough to remind me of T, after mowing the lawn or loud situations but I've never experienced it being this loud for over a week.  Should I see my ENT to see if there is any hearing loss and since I can't really notice a difference in my hearing would that even matter?

Thank you so much

Category: Your Questions and My Answers

SWIMMING

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Dear Dr. Nagler,
     Thank you for all you do to alleviate suffering and for providing accurate and timely advice.  I have a simple question.  Can swimming cause a tinnitus spike?  I have had T for about a year and am making good progress with a CBT therapist who recommended swimming.  I went on a tinnitus support board and am now scared to death to put my head under water based upon what I read there.  Perhaps the lesson is to simply take the plunge literally and figuratively and not read anything on so-called support boards.  My CBT therapist has now expressly forbidden me to look at them as long as I am his patient.  Thank you again for your compassion and sincerity.  JPN77

Category: Your Questions and My Answers

Ototoxic IV antibiotics and antidepressants

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Dr Nagler,



I saw you back in 2002 when my tinnitus first began. You were so helpful!

I have habituated well, save for spontaneous occasional spikes. My T is very sensitive to certain medications, such as aspirin and ibuprofen.



My question involves prophylactic IV antibiotics that are administered during surgery. I have a tear in my shoulder that may require surgery, but it is not a life or death issue. Are you aware of cases where these antibiotics have worsened T? I have visited otolologists (not a regular ENT) to ask about ototoxic drugs and I was so surprised at their lack of knowledge on the matter.



Also, I may need a medication for nerve pain. Does Lyrica (or similar medications) worsen T?



Is there a go-to antidepressant for T nowadays? Last time I investigated this, Zoloft seemed to be most popular .



Thank you for your time!

Category: Your Questions and My Answers

Fullness

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Thank you for the forum. I've been to the other place but it's so negative it makes one feel down, I've given up there.



My tinnitus is loud, very loud, and fluctuates a lot, some better, though never quiet days. I can and do cope with all this monsterous buzzing/ringing but I'm finding the ear fullness worse. I had all the tests, I don't have meniers, and the pressure test was ok. I had SSHL 4 years ago. I have hearing aid now.



I get migrainous headaches frequently, though can't take anything but paracetamol as I'm on warfarin. Can I ask if migraine can make the tinnitus and fullness worse?

Category: Your Questions and My Answers

Tonic Tensor Tympani Syndrome

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Dear Dr Nagler,

I am unfortunately still in the "trying to figure my tinnitus out" stage.  As you have likely gathered from my past thread (and I hope it is okay to make a separate one), I am quite a neurotic individual, and that certainly does not help matters.  But new problems are starting to surface, asides from just the tinnitus, and I would like to get your thoughts.

It is becoming harder and harder for me to tolerate noise.  I get a flutter (mostly in my right ear, which is also the ear the tinnitus is worse in), from certain sounds.  It is very similar to the flutter I can voluntarily produce by tensing my ear muscles.  This flutter now happens in the shower, or really near any running water (I don't know if it is the change in air pressure or the sound itself).  Now even people's voices sometimes produce this effect, and there is intermittent pain in my ears.  The tinnitus also seems to be getting worse.  My ears feel more and more stuffed, and I try to relieve that pressure by crackling them, or performing the valsalva maneuver, but it doesn't get rid of that stuffed feeling.

Perhaps this is all anxiety and muscle tension based, since I keep tensing my jaw and ear muscles and popping my ears, and I am just very focused on this all the time, but I just don't know what is happening to me.  I have chronic congestion, and one ENT said there was no sign in infection and that she thinks it's allergies (based on my CAT scan), and that that's causing all of this, but then the allergist did the skin test and said I don't have any allergies, and that it's a chronic sinus infection, and prescribed me an antibiotic that I'd already been on, so that left me scratching my head.  Another ENT said I might have a patulous eustachian tube, and that I need to go in for another audiology exam to rule that out.  In the interim I have been worrying intensely about that, since from what I understand there is no effective treatment for a patulous eustachian tube.  The doctor said he didn't see any signs of it (eardrum was not moving on respiration), but that there might be "micro-vibrations" of the eardrum that can't be seen with the naked eye, and based on what I was describing it was worth checking out.  But I don't know how much of any of the above conditions could cause the symptoms I'm having in the first place!  

I really just don't know what to make of all this.  Is it likely that this worsened hypersensitivity to sound and muscle spasms are all just anxiety/muscle tension driven?  What do you recommend I do?  I mean, the tinnitus in itself is troubling, but if I can't tolerate noise anymore, that's even worse, right?

Category: Your Questions and My Answers


Adding meaning to your life

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In a post about the best advice one might give to a tinnitus sufferer in search of information and support Zug wrote :

  • So, here we go, my best advice, at least for the moment is this: Stop trying to be happy, stop longing for the good old days when you didn't have Tinnitus, stop even to trying to find a cure. Just try to do something meaningful with your life.

Zug's advice might seem like a tall order at first, but at least one part of it can be readily and quickly accomplished. 

My question to you all:

What would you consider to be a 100% guaranteed way of adding meaning to your life?

stephen nagler

Category: My Questions and Your Answers

Aspirin

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Hello, doctor! Can aspirin taken for a week (1300mg a day)cause permanent tinnitus or hearing loss? I have read that it is ototoxic. Thank you very much for your answer!



Nathalie

Category: Your Questions and My Answers

12 years of Tinnitus - now it is going nuts?

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Hi Dr. Nagler,

I am very unsure on what is  happening to me a the moment.
I have had T for 12 year - doing ok - 90% habituated is think.

Over the last year I have had som incidents of loud noise and severe stress. Got 2 spikes that lasted 4 and 2 months.

2 months ago I weaned off Zoloft (been on it for 10 years) and it has been ok actually.

BUT - last week my T went to a level I have never ever heard before. New sounds and EXTREMLY loud. Also a (not new) felling og burning in my ears.

Is it a spike? Is is the missing Zoloft or is it just the tinnitus being tinnitus?

Best regards and thanks for this forum.

Troels 

Category: Your Questions and My Answers

tinnitus and stress

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Hi Doctor Nagler, I posted a few months ago and you were very helpful

I wanted to run something by you, in the last 6 weeks I have had a very stressful period dealing with a particular event, and on top of it have experienced quite severe intermittent flu like symptoms, so a lot to deal with!

During this period my tinnitus has not bothered me at all!! yes of course its been there but I've barely noticed it, usually I sleep with a white noise device and use in-ear noise generators during the day, neither have been required.

Now, with both 'events' i.e the stressful situation and illness having abated, my tinnitus, or perception of, has returned in full force and i'm back to the same old treatments per the above-v.frustrating!

Have you ever come across it this way around, i.e stress reducing tinnitus because, presumably, I haven't got time to think about it so much, and if so does this offer any clues to treatment/habituation?

Thanks in advance

Category: Your Questions and My Answers

Ultrasound therapy

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Hello! Can ultrasound therapy (3MHz / 0,5W/cm2) cause tinnitus? Is it possible for ultrasound to damage the inner ear or any part of the ear or auditory nerves? Is it safe to get ultrasound therapy on the temporomandibular joint for TMJ disorder and facial nerve inflammation? Can ultrasound reach the inner ear? Thank you.

Category: Your Questions and My Answers

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