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appointments

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Dr. Nagler,

I have had tinnitus with hyperacusis for about a week. I find it to be intrusive but not completely disabling. I'm an Atlantan, so am interested in seeing you as a patient. My question is this: how backed up are you typically with appointments? I'm hoping this will resolve on its own, but don't want to wait till it is intolerable and find there is a six month wait to see you. 

Thanks for all you do for tinnitus sufferers. 

Category: Questions and Answers


Setback after Habituation; Concerts, Congestion, Travel

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Hi Dr. Nagler,

First, thank you for continuing to correspond online. I first came across your name in 2011 and your words were very helpful in getting me back on track. I tend to avoid the tinnitus forums, but a little support here will I think help me out of this funk.

I say this because I first came down with tinnitus (and, for a few months, hyperacusis) in 2011 after a couple of ear infections. I visited various ENTs, and the answer was always the same: tinnitus, no hearing loss, and best of luck. After a few months of hearing the high pitched ringing / squealing over everything, I tried TRT. After just a couple of months, I was suddenly fine. I moved on, and didn't think back. I'm however unsure if the ringing was always there or I was just no longer noticing it. This after six or so months of hearing the ringing over literally everything. Hence, I have no idea if I habituated or it went away. Maybe that's habituation though.

Anyway, I moved on with my life. Part of that included going to sporting events, concerts, but just as before the tinnitus, wearing earplugs. I always carry 32db earplugs with me and pop them in when the noise is just too much. And for years, I was fine; no noticeable increases, nothing. I couldn't hear the tinnitus over the tv, or at work during meetings; I basically wasn't noticing it 99% of the time.

Fast forward to three weeks ago. I took my first vacation from work to go to Austin for a big music festival; the second time heading down there (and the second time since coming down the tinnitus). I saw lots of bands over about a week, and in general, just had a great time. I wore earplugs to everything, but I do know there were times when I was perhaps too close to speakers in smaller rooms, though it was really no different than the many years worth of shows I'd attended prior since feeling fine with the tinnitus toward the end of 2011. Let me note that while I was down in Austin, I had a decent headcold with congestion, and was taking sudafed each day. I had also flown in about ten planes in a span of two months, if that matters.

Three days after returning home, I began to notice a new chirping noise in my left ear. The chirping noise could be heard above everything else -- and frankly, it just scared the heck of me, and still does. Two days later, I started noticing the tinnitus over everything again, the exact same frequencies / tones I heard back in 2011 are now again above the television, above conversation, etc. I can hear it when walking the busy city streets.

So I went to a general practitioner, who noticed my left ear, the ear where the ringing seems to be at its worst, was congested (said at an 8 on a scale of 1-10). He put me on amoxicillin and zyrtec. He suggested that the noises would likely subside in five days. Unfortunately, they have not. If five days have passed, he then suggested I go see an ENT. At this point, I'm not sure if that's really worth my while given the many, many ENTs I've seen in the past that really haven't offered anything incredibly helpful here.

Basically, I have no idea if this is a new thing or I really went all these years without noticing it and because I'm now anxious over the new chirping, I'm hearing the hissing/buzzing all over again like I did back in 2011. And yes, it's true that I'm very nervous; I did spend the first new weekend with this mostly afraid to do anything, feeling kicked in the gut after being alright for such a long time, knowing that it took about 8 or so months before I felt "normal" again, and that I'm heading for that again perhaps, assuming I haven't done any new damage? I'm also really nervous that I will have to give up concerts, which is something I truly love in life.

Anyway, if anything, I hope you can set my mind back at ease that this is just a setback and that since I overcame this back in 2011 I can overcome this again, and if you have any suggestions of things I can be doing right now to help as I'm dealing with this setback. My dad (who suffers from tinnitus from an acoustic neuroma, so he understands at least) made the point that it's a lifelong condition which makes me concerned I'm going to be dealing with this every so often. I just really hope to get back to where I was, and I'm also kicking myself that the music down in Austin did this to me (knowing that searching for the reason doesn't really help, I know).

Thanks.

Category: Questions and Answers

Spikes and progress

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Hi Dr. Nagler,

Hope you are continuing to feel better. Dr. Rohe asked that I tell you hello.

I'd like to ask to additional unrelated questions. The first, do you have any general suggestions for tinnitus sufferers when dealing with spikes or particularly bothersome days?


Second, are there "mileposts" which indicate patients are progressing towards habituation?


I have only had my initial consultation and the first session with Dr. Rohe, but I have noticed over the past few weeks it seems my ups and downs appear to be evening out a bit. The "good days" are still good, and the "bad days" tend not to be quite as bad. For now, this seems to be progress.

 

Again, hope you continue to recover. All the best.

Category: Questions and Answers

TRT chance?

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Dear Dr. Nagler.

First of all, thank you and recognize the time you spend unselfishly to improve the lives of tinnitus sufferers.

I read him once in tinnitustalk, but you disappeared.
 I have to tell you that it is much more constructive, realistic and hopeful than tinnitustalk.

Excuse my writing and grammar, but my language is not English.

I am 49 years old and I have had tinnitus for 4 years, it is 24/7 very sharp. it´s idiopathic according to two doctors who gave me the necessary tests. I have no hearing loss. Since then my life has changed for the worse, it has become a pilgrimage of therapies (drugs, neurofeedback, rtms, acupuncture, psychological therapy, supplements, mindfulnes, etc ...) and my mood is very low and sad, being the Tinnitus in 95% of my time (except when this very entertaining and focusing). I live it very intrusively. I am aware that the solution is within me, and if my brain can ignore it 5% of the time, it could do 90%.
I do not want and can not continue to lose my life because of a noise. Fortunately it has not affected my work, and I am still taking care of myself, but with total apathy, without illusions, I just want to stop tormenting myself with tinnitus.
I have now started Cognitive Behavioral Therapy and I occasionally perform relaxation. But it is not enough, much less. I am seriously considering the TRT.  Do you know any colleagues in Spain?
If TRT can make me no to bother about tinnitus and accepted it, it would be a miracle! I want to live again with peace and illusion. Not to think and suffer about tinnitus 90% of my time...

Do you think it is time to give TRT a chance?

Best regards

Category: Questions and Answers

TRT Ohio and is 5 mos. too soon for TRT

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Hello again. I thought I was doing better but find myself having a rough time.



Is 5 or 6 months after onset of T too soon for TRT? I was going to try and give it a year but I just want to live a normal life again.



I know of the un-TRT clinic at The Cleveland Clinic but where is the nearest TRT clinic to Columbus Ohio that you would recommend?



Are you taking on new patients?



As usual, thanks for being here for us 👍😃

Category: Questions and Answers

New Tinnitus sound starting TRT

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Hi Dr. Nagler,

I'm glad to hear you are doing much better.

I have a question for you.

About 3 1/2 weeks ago I met with a TRT practitioner whom you know well and recommend.  I'm waiting to get a response back from that person on this, but wanted to run it by you.

I've been wearing the noise generator earpieces since visiting the person pretty much every waking hour.  In bed, I just use a tabletop device, of course.

After about 10 days using the earpieces, I started noticing a new Tinnitus sound in my right ear IN ADDITION to my existing Tinnitus sound which started about 2.5 years ago.  I will call the new sound "secondary" for the sake of writing since it's new and much quieter than my existing.  The new, secondary sound sometimes sounds like a very quiet morse code beeping and then will change at times almost to a very quiet whistling noise that reminds me of something stuck in a vent.  

The odd and non-intuitive thing is, I hear this secondary T noise more with the sound generator in the ear vs without it - but it's still there without it.

I went to the dentist a couple of days ago and during the cleaning, one of the devices used gave a very loud, brief high pitched sound which I think caused this secondary T sound to spike.  

I do recall you stating about 1/3 of your patients see a temporary spike when starting TRT by the 3rd month so I wonder if what I am experiencing it related to this or not even though I am just entering the 4th week.

The only other change is, I had a sinus infection at the onset of starting my TRT which is now cleared up and my doctor prescribed Cefdinir.  I do still have a little drainage though which is not uncommon for me this time of year.  He had checked my ears and said they looked fine.

1) I wanted to know if you could give me any feedback or suggestion on what may be happening.  Hopefully I will habituate to this new secondary Tinnitus sound along with my regular Tinnitus.  It's a bit disappointing experiencing yet another new Tinnitus sound in addition to what I already have as that's two sounds at once I am now hearing.  But such is life.

Note, my right ear does have more hearing loss than my left and I do sometimes hear my general T more in the right ear where this secondary sound is occurring.

2) Another thing I notice while wearing the noise generator devices is once in a while it feels like the broadband noise travels from my right to my left ear for a split second.  They are in well and seem to be working fine with balanced levels, but just curious if that effect is normal.

Thank you,
-D

Category: Questions and Answers

Ear slap

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Good day Dr. Nagler

I first read a couple of your posts on tinnitus talk and was disappointed when you left, I thought I was out of luck until I came across your site. Thanks for being here, and sorry about tinnitus talk.

Here is my issue.

Jan. 21 2017, I received an ear slap on my left ear, heard a pop and instant pain. The hit wasn’t that hard just his palm covered my ear perfectly. I seen a nurse practitioner on Jan. 27 and diagnosed me with a red and swollen eardrum but not ruptured. I was given meds ( azithromax, I believe) for four days to clear up the head cold, back of the throat drainage and if the ear didn’t feel better come back the following week.

 After the ear slap my hearing was definitely affected for several days but I had no dizziness or nausea. I went back in Jan. 31st and seen my Doctor who said the eardrum ruptured, probably happened over that weekend when I heard popping and felt some relief. I was prescribed Ciprodex drops to be taken twice a day/two drops in left ear for one month. I noticed when I was with the Doctor I had very very low level of tinnitus, in fact I had just noticed it. I went back in fourteen days later for a checkup and was told all was looking good it was healing up nicely and continue to use the drops. A day or so prior to Feb. 28 my tinnitus that was very very low became a little more noticeable but still very low. Feb. 27 put the drops in but didn’t hear the normal fizzle that usually accompanied it. Ah, the eardrum must be closed up.

 Awoke 0300 on Feb. 28 to extremely loud whole head tinnitus, so loud in fact the television in my bedroom, I could double the volume and still hear it clearly. This lasted for about 48 hrs, during this time I had another hearing test done at my place of employment.  No real changes, actually slightly better at 8khz, than 7 months prior. I also had a Chiropractor adjust my neck and head to perhaps alleviate the ringing. I also saw my Doctor who made an appt. with the local ENT office for March 2 at 0900. March 2nd I awoke at 0320 to the same loud tinnitus and sat up in bed only to hear it begin to subside and by 0330 it was gone. Went to the ENT appt. where I explained everything and she looked and said there were still microscopic holes in the eardrum and wanted to place a 1mm paper patch over the area. I was assured it would not cause the tinnitus to return and I was instructed to stop using the drops.  

Well it did come back very strong about twelve hrs later. Of course called the ENT and scheduled another appt. March 8, no issues patch was still there and basically live with it or get a hearing aid to help mask it. I did meet with an audiologist about getting a hearing aid, receiver in canal type but she felt we should wait a couple of months and see how this progresses. My hearing loss at the normal speech range is 10 to 15db. Also on March 8th I had another hearing test done at the ENT office which was identical to my workplace test.

  Then I started thinking, were those Ciprodex drops ototoxic? I never experienced any side effects while taking them, my Doctor never heard of them being ototoxic and my ENT simply said they’re not. Then I thought about it more and perhaps my Eustachian tube was plugged. A little history I have had Eustachian tube issues as a young child at least six surgeries (tubes) and had the last “T” type tubes removed when I was 22 yrs old. I’m now 47. Over the last several years I have had head colds accompanied by on and off ear infections.  I called my doctor and asked what I could take if this could be the issue. He instructed me to take generic Sudafed 3/day 30mg along with Nasacort 2 shots each nostril 2/day. Do this for at least a week.

 I started this regimen on April 4, by 2300hrs my left ear was popping quite a bit and the tinnitus seemed to subside, difficult to tell exactly how much but it did decrease very exhausted at that point. The popping subsided and now hardly happens at all but the ear doesn’t feel as full as it used too. The tinnitus went from a solid tone to a tonal hiss about three weeks after it initially went so loud. Currently, I feel it has decreased from where it was at when I started the Sudafed/Nasacort routine but is still fairly loud and can hear it over normal conversation some of the time. Perhaps I’m becoming habituated to some degree. There are times where the tinnitus is just in my left ear but most of the time it is in my left ear and entire head. I have had about eight hours of actual silence since March 2nd, sometimes in the morning when I first wake up and sometimes mid afternoon. During nighttime it usually settles down quite a bit. At times I simply realize it isn’t there then begin to actively listen for it and it really it is gone. I would continue with what I was doing then it would come back on its own without me actively listening. Just for my own test when I do hear it I really listen for it and it does get louder. Very unique this tinnitus affliction.

  I see a different ENT on Good Friday. My hearing tests show 60 at 6khz and 65 at 8khz so there is hearing loss and my ENT feels that this is the cause for the tinnitus. She never measured the frequency of the tinnitus. When my tinnitus was a tone I played a tone generator and found it to be mid ~4khz difficult to say exactly.  Do you have any thoughts/advice on this? What can I expect?  I have kept a log every day and now up to 17 pages with #12 font, I summarized a lot for you. Lol I have been taking Lipo Flavonoid since March 1, and Magnesium and NAC both sparingly. I never really had tinnitus prior to the ear slap, just the occasional tone for a few seconds then it would subside. Had that my entire life it was never an issue.

I have the same user name on tinnitus talk if you would like to look up a few more details than what I have written here. Thanks so much for being such a great resource.

Category: Questions and Answers

Benzodiazepines

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Dr. Nagler,

Glad you're back on the air, I look forward to reading your answers here in my quest to reconquer my tinnitus, I say reconquer because I spent well over a year in blissful habituation and honestly can't say if it was gone or I learned to tune it out but in any case I'm a little over two months into a spike that was quite trying and reignited all the anxiety, depression and the full battery of the misery it can bring.

I see you successfully used Xanax and I have as well first time around. Seems every doc I have seen has no problem prescribing but at some point they all recommended clonzepam which I am currently taking very sparingly. I am allowed .5mg 2x a day but found I can get along on one cut in half and I have been holding myself to every other day.

Am I being over cautious? They are quite effective and I don't want to spoil that benefit by building tolerance, assuming there is such a thing since a lot of what I know comes from the internet and as we all know it's filled with bad information. 

In any case the inserts do all seem to feel it's a short term emergency medication but I am also aware it's frequently used to treat seizures and some other issues and that would seem to be to be long term.

First time around I was taking .5mg twice a day and did experience some withdrawal, down feeling, depression, anxiety but since that's what I deal with without the drug the risk is worth the reward and it's temporary. 

Do you have an opinion on a more long lasting medication like buspirone? For me reducing anxiety leads to better sleep and that translates into a tolerance for my tinnitus that makes it almost a non issue.

Finally I know you're a long time patient and wonder if you've experienced spikes and if this is just a normal course and to expect periodic spikes.

I think mine might have been self imposed by exposure to a sound level in the mid to high 70db range for a couple hours. I thought that's safe but perhaps not for a tinnitus patient.

Thanks again for all you do, I have more questions but I know you're time is limited and I don't want to abuse my privileges here.


Category: Questions and Answers


Poor man's TRT

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Doctor,

I feel like I'm monopolizing your time here but I can't help myself, having a quality source for information is just too tempting.

I've been doing a lot of sound enrichment and wonder if it can be over down in time listening. Do the ears benefit from a period of rest? I listened all day yesterday at a very low level and slept for a few hours streaming into my Phonaks but finally removed them in the middle of the night.

This morning I was disappointed in the level, quite loud and intrusive. I find as the day progresses, I have not been listening to any enrichment and things seem to be calming down.

So, I wonder, does tinnitus get worse before it gets better? Does our hearing benefit from brief periods of rest?

Thanks again for all you do.
Dave




Category: Questions and Answers

Questions about Habituation

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Hello Dr Nagel, my names Simon and I've really benefited from reading your posts.

My story about Tinnitus is pretty typical. Sudden tinnitus out of nowhere despite no history of loud music, all tests negative for symptoms , sleepless nights and wagons of despair on me as I browsed certain tinnitus forums for cures until I found this forum. I really enjoyed reading your posts about confronting how Tinnitus makes you feel over agonizing over Tinnitus itself. The first week of my Tinnitus I was certain I couldnt go on another day until I realized about a month passed and I wasn't dead so clearly the Tinnitus cant be all that bad for me and that I could overcome this.

I'm approaching my second month of Tinnitus now and I like to think I'm on stage 2.5 out of 4 on the stages of Habituation (I forgot where I found these arbitrary stages or what they even mean anymore) and I'm dealing with my barriers to Habituation which was mostly my anxiety. I took Xanax to help me sleep the first week but I've actually been sleeping perfectly fine through my Tinnitus with no sleep medication since I'm not scared of my Tinnitus anymore. I have a white noise generator that I used for the first month but I realized that I am able to sleep comfortably with no noise now that my anxiety at night has been dealt with and that this is my preferred method of sleep. What I'm wondering now is if its okay to just sleep in silence minus the fridge against my wall since in one of your FAQ you mention how its beneficial to sleep some sort of noise since your ears will ramp up to hear the Tinnitus. I also understand that everyone has their own situation and that if something works for me then I shouldn't knock it but I've also learned that something "working" doesn't necessarily mean its good for me which is why I'm consulting the advice of an expert. Same question goes for normal day, I spend my days in front of a laptop with a pretty quiet fan, the only noise is from streaming videos but its mostly quiet in my room. Do I need more sound enrichment or is what I'm doing fine? Is habituation slower without sound enrichment?

One last thing that has been really on my mind this past week which is probably something you cant answer on just a forum without any medical information but my Tinnitus is only in my left ear and it feels like one distinct tinnitus sound (out of the three sounds I have) makes the left temple throb when I hear it. Its a high pitch sound, kind of like a small bell jingle. From what I understand, Tinnitus cant physically hurt you but this pain only happens for one distinct sound which isnt always there and sometimes I get a bit of a headache from it. I had thought it was TMJ since it was literally on top of it but my jaw itself doesn't lock or have any real discomfort, maybe just a little stiffness. I do plan to see my doctor about this later but I just wanted to see if this sounds like anything you know about.

Thanks for reading


Category: Questions and Answers

Sleep changes and Hearing Tests

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Dr. Nagler

I hope your illness from this past couple of months is all behind you now. Seems like I know so many people who have had a rough season for one reason or another, including me. Even our poor city Atlanta has been having a time of it. I had a couple of follow up questions and hope others might get some benefit from. I think at some point I am going to have to see you personally, I think it may help me navigate this and I have heard a few people say it is well worth it to see you!

1. After a difficult month with some stress, partly due to a physical issue my T has, of course, acted up. I guess I am not surprised. This new little spin is that I wake up in the morning with it being elevated, and then other times lowered. I really never noticed this happening before and of course it challenges me. Do you know of any reason why changes, or spikes might happen while we are asleep? Is that a known phenomenon with this? I now feel like I never know what I will wake up to when I go to bed and that has not been a trend before, I never worried about it. Just something else to drive me nuts. 

2. Another, perhaps redundant question. Do you see any problem with listening to ear phones? Not loudly of course. I sometime due while I am working. Maybe music - not loud - or podcasts. Most others I know with T don't even worry about it, and I don't want to be neurotic, or act like I have to handle my ears with kid gloves. I have even wondered about ear buds while running - as long as they are low volume.

3. Lastly, a question about hearing exams. As people with tinnitus, should we be getting hearing exams once every year or so to see if there are any changes and to monitor our situation. I guess it can't hurt anything but wondered if there was a standard, or is it just a personal choice. I never really understand what the report means. I think mine is mild to maybe moderate hearing loss I guess. I attached copies of the 2 I had done a couple of years ago if you are able to give just a general idea. If not, no worries if you prefer to do that sort of thing in person.

Thank you again for all you do for us!!

Category: Questions and Answers

Last question on masking and or sound enrichment

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Dr. Nagler,

Sorry to beat this horse again but as previously mentioned I as well as many of us use masking and all sorts of sound to help us cope.

I know TRT has a sound component and I've perhaps not been using the correct terminology when asking my questions. I know sound without therapy it's not TRT.

I read a paper you co-wrote in 2002 regarding this and the conclusion mentions a best of both worlds  using sound protocol.

I always have a residual effect of quiet tinnitus after using sound, very brief but noticeable.

Is there any real evidence that the use od sound has a therapeutic value in working toward habituation? Is do what's the best recommendation?

I also read something about self treatment and if this were a cardiac illness we'd all be at the best doc we could find. That's true but insurance helps. With tinnitus, we're on our own financially and sometimes money forces choices that aren't idea and that's why your guidance and advice are so important to many of us.

As always, thanks for your support.

Category: Questions and Answers

Tinnitus and transcranial magnetic stimulation

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Hello Dr. Nagler,

(sorry for my English, I’m French) I have tinnitus and hyperacusis since 2 years after an acoustic trauma in a nightclub, I’ve tried several therapies including TRT which didn’t really work on me.

I’ve read that transcranial magnetic stimulation has shown good results on tinnitus even if it’s still experimental. Would you advice to try it ?

Thanks,

Xavier

Category: Questions and Answers

Tinnitus and hyperacusis

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dr. Nagler,



Thank you for taking the time to read my post. I have had tinnitus and hyperacusis since December 6. As a background I would have tinnitus if I woke up in the middle of the night I would have ringing in my ears at bedtime periodically but it only happened a few times. At the time I was taking trazodone and Flexeril to sleep for my fibromyalgia. Two weeks before it happened I was switched from flexeril to baclofen because the flexeril wasn't helping my back. I was then getting headaches so I switched back to flexeril. I woke up the next morning with tinnitus. I thought it was one of the two drugs as it would happen after about a half an hour to an hour of taking the medicine. I went to the doctor in the middle of December she told me it could've been the trazodone. I quit cold turkey when she gave me Ambien. The tinnitus still continued. I had to quit my job as a secretary.



I have been very very depressed and have extreme anxiety and have been going to counseling. My psychiatrist has tried cymbalta, Effexor xr and now gabapentin. I'm also taking a small dose of xanax. It seems that everything is making my tinnitus worse. Im freaked out that the Meds are making me worse.



I'm also going to an audiologist and have maskers. Phonak. My tinntis is worse in the evenings after I take off the maskers. But sometimes not right away. Could I just not be a candidate for Masking maybe?



Cindy



Category: Questions and Answers

Botox Injection

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Hello, Dr. Nagler:

Last year I had major neck and ear surgery due to squamous cell carcinoma and went through subsequent proton therapy and immunotherapy treatments. As of last December, scans showed that the tumors were gone and that I was cancer free (next scans are scheduled for late May and I hope for/expect similar results). However, there are side effects to the radiation and I have been diagnosed with radiation induced fibrosis. Physical therapy is helping me regain range of motion and strength, but the doctor overseeing this effort has also suggested a botox injection as an additional treatment. I am very curious about whether such an injection can cause hearing loss or tinnitus. Would you happen to have any insights? I already have tinnitus on both sides and some hearing loss at the higher ranges in my remaining right ear (the left ear was lost to the surgery) and I am not much interested in jeopardizing the situation.

Also, you may recall that we corresponded some time ago about TRT and you provided the name of a specialist in my area. I want you to know that I after many scheduling issues, I will be seeing the specialist this coming week. I want to express my gratitude for your assistance with this.

All the best,

Denis Schreiber

Category: Questions and Answers


Habituation setback

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About six years ago I awoke with tinnitus and had several years of very bad experiences. For a couple of years I have not really been troubled by it however due to focusing again on the tinnitus I am now back to being an anxious wreck. Is this typical of habituating?

Category: Questions and Answers

Treating tinitus with hydrogen peroxide , face massage, and sensodyne toothpaste

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Hello Dr.  I got T from an ear infection.  Ear infection came right after I was using synex and nettie pot to clear up sinus congestion.  After going to Primary that prescribed antibiotics and then  ENT and audiologist (no hear loss). Going to visit my Primary in may for  new diagnosis and recommendations to other specialists.  Like everyone else,  i am trying new things. 1- Massage the inner outer jaw muscles to remove toxins, running treadmill, and now a good swig of hydrogen peroxide and ' hold air" in mouth for 2 mins and then following up with sysendydine toothpaste. 

My theory is desensitize nerves, remove toxins in muscles with light massage. I wake up with no tinnitus but tinnitus slowly returns.   FYI:  no clicking or pain when opening jaw but T increase when chewing and yawning. 

Have you any comment on this approach?       

Category: Questions and Answers

Old, stable, mild tinnitus has suddenly turned into a 10/10. Feeling like I can't go on.

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Hello Dr. Nagler,


31 years old woman from Hungary here. I've had mild, 1/10 tinnitus in my left ear for many years now - I could hear it when I was trying to fall asleep or if I used noise-isolating headphones with nothing playing, but it was never more than an occasional small annoyance. This March, after a combination of extreme stress and a nasty viral infection, it has suddenly spiked, spread to my other ear and the spikes show no sign of stopping. There's a nasty high-pitched squeal in my right ear now and pretty much nothing masks it except for the shower. Everything sounds metallic and the sound is so sharp that it feels like my brain is being zapped. It's increased so much in a few weeks that I can hear it everywhere... and it won't stop, why won't it stop? I'm still waiting for an MRI, but the ENTs I've seen haven't found anything...

I have stopped sleeping and was nearly hospitalised due to a huge mental breakdown. I am currently on Remeron, Xanax and Ambien for sleep - I had to move back in with my parents as I'm considered a suicide risk. I will lose my job as I'm an editor who works with headphones, and I can no longer tolerate them on my head due to how they amplify my already harsh tinnitus. 

Do you think there's hope for me, Dr. Nagler? I have always prided myself on not having to rely on psychiatric medicine - and look at me now. I'm sedated out of my mind (I hope there aren't too many mistakes in this post, as I feel like a zombie...). I see no way out. I have lost my silence, I have lost my job, my sleep, my music, everything. I've looked at TRT and apparently it's practiced here in Budapest but it's very expensive and I'm not sure it would even work for me... please help me, Dr. Nagler. Is there hope? Am I just making my tinnitus increase by taking all these psych meds? I think about killing myself every minute I'm awake. I can't focus on anything, not even video games, which have always made me feel better when I was depressed. Please advise me, Doctor. Right now, I don't know if I'll make it...

Category: Questions and Answers

Looking for some insight

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Dr. Nagler,

First off, I am two months into TRT.  I email my audiologist with questions all the time but, sometimes for the information to really take root with me I like to have another source. I'm very happy with the level of care I am getting but, let's just say I'm looking for a second opinion.

A little about me: I live so close to you but so far since the I-85 debacle. Coming from Coweta there is no way I'm willingly driving through Atlanta right now. I think tinnitus is preferable! I am forty-one and a pilot for the big local airline. I've been around loud airplanes since high school and I am a musician that has played in loud bar bands for years and years. Needless to say I have abused my ears for decades.

I first heard of tinnitus not long ago. During July 4th weekend of 2015 my dad mentioned that he had had it for forty years and described it to me. When he told me I said, "Oh yeah, I have that!" I never knew there was a name for it. It was just the sounds in my head and they literally never bothered me. I couldn't remember a time when I didn't have them. If I wanted to hear it then I did and if I didn't want to then I didn't. Simple as that.

Over the next year and a half whenever I heard the sounds I could put a name to it and I started hearing the term tinnitus mentioned more and more. On January 6th I was on a trip and had an early morning pickup at the hotel in San Jose. During the van ride to the airport I joked to the other pilot that these early wake ups cause my tinnitus to act up (I think i've said this before but can't really remember) as it was slightly buzzing or squeaking.

But, as usual, I put it out of my head and forgot about it until Jan 14th while I was watching the Patriots playoff game. I was laying on the couch when I noticed that my tinnitus sounded louder than usual. This was the first time I ever googled it. But, I went to bed and forgot about it.

Sometime the following week (probably the 18th or 19th) I woke up at night and heard that my tinnitus seemed louder again. It sounded just like when I sometimes have too much to drink. I quickly fell back asleep and forgot about it again.

On Friday the 20th we went up to Atlanta for my daughters cheer competition at the World Congress Center. We got a hotel room so we wouldn't have to drive up so early from Newnan and I remember thinking to myself that I hoped that my tinnitus doesn't wake me up. Fortunately, it didn't and we went to the competition on Saturday which was very loud. I only stayed in there for my girl's routine.

Sunday Jan 22nd morning I was sitting in the kitchen with my wife drinking coffee when I realized that my tinnitus seemed louder than usual. I mentioned it to my wife and started reading as much as I could. The sounds were still no different that what I'd ever heard, just louder or more noticeable. I must have forgotten about it because, later that night was the Falcons game where they stomped Green Bay. I remember that game vividly but, I do not remember noticing any tinnitus. 

Tuesday the 24th I was driving up to the airport for a pilot meeting at about 9:30am. Shortly after getting on the interstate which is ten minutes from my house I heard the ringing again. I though to myself that I'd never heard it in the car before although now I'm unsure about that. On the way back home that afternoon after just passing I-285 I wondered if I could still hear it in the car so, I looked for it, immediately found it, and couldn't get rid off it. I don't remember the rest of the day.

The next couple of days I heard it off and on. Sometimes when going to bed I heard it so, I had started using a white noise machine. Still though, I didn't think anything was really unusual and it was probably only louder because of a sinus infection that I had earlier in the month.

On Friday the 27th I started a five day trip. I got into Ft. Walton rather late and went to bed soon after getting to my room. At 2:30am I woke up with my ears screaming! I now realize that this was probably because the a/c in the room was very loud. Anyway, panic was now starting to set in. I slept better the next few nights of the trip but, the anxiety was really starting to take hold. so, on the way home from the airport I went to see my AME. He told me that yep, you've got tinnitus, its from hearing loss but, just in case here is some amoxyl and take Claritin. 

On Feb 2nd I was sitting short call reserve at my house. That was the first day I just spent all day listening to my tinnitus. It seemed to get louder and louder until I was in full blown panic mode. I called in sick and stayed out from work for the next three weeks. I lost fifteen pounds and very low blood pressure.

I saw a few more doctors such as an ENT, spinal surgeon, and my regular doc. The replies were all pretty much the same thing.  You have tinnitus so, you just have to learn to live with it.

Just by happenstance, my stepmom mentioned that she had heard of an audiologist in Fayetteville that helped an acquaintance with tinnitus. So, I made an appointment with Dr. Tim Winstead at the Hearing Doctors of Georgia on the 15th. I went into that office with my wife totally emotionally drained. But, then I met Dr. Winstead. He was the first doc that wanted to hear my full story and was truly interested in it. I could instantly tell that he really cared.

First off was a hearing test. So, I went in to the booth fully expecting to find that I had severe hearing loss. But, when the doc opened the door after the test he had a big smile on his face and said, "This is very encouraging". I about collapsed. We went in to his office and he gave me some various options but said that I was a good candidate for TRT but, it was very expensive. So, we could do watchful waiting and try some other things if I'd prefer. I threw my wallet on the table and told to shut up and take my money!

I'm two months into TRT right now listening to Zen-A. Generally speaking I am leaps and bounds better than before. I still sometimes get a little anxiety but, I find what helps that more than anything is remembering the events of January. And, this is where you come in. In theory, When I first heard it loud on the 14th (it had been exactly one month since my last band practice which had been rather loud) the volume of my tinnitus did not change. However, I was already habituated to it but, over the next two weeks I was slowly loosing that ability to block it for some reason. Those reasons could be stress, ear infection, assigning negative emotion to the sounds which I had never done before.

Does this sound plausible to you? If my tinnitus went up in volume, which I'm still not convinced it did, did I just loose the ability to habituate or block it out?

Thanks so much for your time,
Joel


Category: Questions and Answers

Ototoxicity in SSRI?

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Hi Dr. Nagler! I was wondering if there is a definitive answer concerning SSRI antidepressants and ototoxicity? Can they cause PERMANENT hearing loss? A rather sizeable number of sources list them as ototoxic (rather confusing) and i'm worried that my current medication Lexapro is going to give me permanent tinnitus and or hearing loss...I used to be on Setraline for a long period of time but never had any problems with it. I visited a dentist who said my jaw was severly out of whack so it may be TMJ idk I have also had tubes in my ears. Also i've read alot of your responses to posts and thank you for being such a help to people. Inspiring! Best Regards Adam

Category: Questions and Answers

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