Dr. Nagler,
Hope you are doing well. I've have read/searched through much of your forum history, FAQ materials, and worked through the PDF book. The resources you've provided are very helpful, thanks for providing such open access to your expertise. I'm analytical, so apologies in advance for the amount of detail below.
I'm not new to tinnitus as my ears have had a slight ring to them for as long as I can remember (at least >30 years, I'm in my 40s now), but I'm new to suffering from it. In fact, in my current state, I have to wonder if I ever really had real ringing in the first place or if I just broke 30 years of habitation and only now realize the sound at its worst level -- it'd been years since I thought about it.
About 3.5 months ago, I blew the doors off the barn with the shots of a 9mm handgun at an indoor range. I wish I'd just shot the damn tinnitus horse instead. I was wearing in-ear foam protection, but that protection was soundly defeated with the shots and my right ear rung out hard. I wager they did not expand enough. As someone who is not a huge gun fan to begin with, the whole experience proved to be a costly mistake. My ENT found that there was more damage to my left ear than right (even though the right rang out), and that I was still hearing within "normal range." I had a slight dip from the baseline in my most recent hearing test in a few frequencies. She put me on a couple courses of prednisone, first at 60mg for a week then a 8 day 30mg taper -- and those weeks were simply awful. The meds put me in orbit -- never knew what true anxiety was like before that -- and I don't know if they actually helped at as my hearing recovery in my post-treatment tests was clinically insignificant.
Since then, I've been struggling most with the inconsistent nature of the sounds that remain in both ears. Three weeks after onset I developed a Somatic Modulation nature to the tinnitus in my damaged left ear -- the sound with movement is a "trigger" for me as the sound pitches (up to 3x as loud) with most steps, every bite, and with most movements of my head -- breaking through concentration grabbing attention from what I'm doing. I am a grinder, and my jaw clicks and has some form of TMJ, so I'm sure that does not help. I do wear a night guard.
I find my life with tinnitus is on a sliding scale, on intrusive days it's hard concentering on work (or do much of anything else), though I do my best to bull through it, on non-reaction days it does not bother me much even with omnipresence and I'm able to get by (though not thrive). Today is one of those very intrusive days, probably what prompted me to finally write you after a couple months of lurking.
There is no telling how I will be one day to the next, no rhyme or reason to it, the tinnitus just is (though stress and fatigue do seem to factor). That alone is a pain in the neck, though I have 3 main flavors of sound.
- Days that just ring easiest to ignore - these are the days I feel closest to normal and may be nearer to what may have been my original baseline.
- Days that are very Somatic are at risk of going south due to the trigger factor, a day where movement bothers me can go bad and turn in to a hiss day (or string of them).
- Days that hiss are the usually most intrusive and highest risk of reacting from the moment I wake up
… In the interest of getting to the point (too late), my questions are basically: "Now what? And does it matter?"
How common is this intrusive inconsistency and somatic complaint, and how do folks manage? If my head just picked a sound and stuck with it, I feel I'd be further along. At my quiet desk gig there are some days where I can't help but "pick" at the noise coming from my left side and neck -- and that can send me into a spiral for the day. It reminds me of an aggravated pain response, it's aggravated, so you check it, which aggravates it more -- but "leaving it alone" is a challenge.
Should I just be patient and just give it more time? While I found the CBT.PDF book helpful and it made a difference in turning a corner (positive thinking, etc.), I want to spend less time thinking about my tinnitus, not more, so I'm not wholly sold on the philosophy. Yes, I'm tuning it out more and reacting less, but I'm still reacting far too often and it interferes with day to day. I've about given up that this might go away, though I hang on to slim hope while I await habitation.
In your experience, does the intolerance, inconsistency, or somatic nature of tinnitus tend to fade with time and habituation? Can TRT help with this? My gut says it's still "too soon" at 3.5 months to go down the TRT path, and I have improved, but I'm growing impatient for the next s-curve. I miss "normal" but I don’t remember what normal was except quiet enough that it never bothered me. I've been able to string together days (up to 3) where I don't think about tinnitus as much, but that seems to be the cap before I get a hiss day snuck in.
Should I continue to look for an additional factor (TMJ, etc) for the Somatic component or does it even matter since I have a trauma event? I guess since it came up weeks after onset, and I'm not convinced the issues are completely dependent, or if that the drug treatment made it worse. For the most part you tell folks to move on -- but I wonder if I've left a stone unturned.
In that regard, can chiropractic or back exercise help the somatic component since this sound doesn't seem to be originating in the ear, or do I likely just have nerve damage as part of the deal? If it were estuation tube issues my assumption is my ENT would have said something. My posture is meh as years of deskwork has taken its toll, but I've never been a real believer in chiropractic in general. I read there were some studies about exercise therapy, but found few results.
Out of curiosity, on your barrier removal, how do you reconcile "tinnitus logs" with the "Daily Diary" reaction tracking exercises in the book? They seem to me one in the same. I'm not doing much of either any more, simply noting if something of interest happens during the day, what form of day it was, and how I reacted. In the beginning I had bullets for hours each day.
Realize this was long, so any thoughts are appreciated and will help me in working through next steps. Again, I'm a bit stuck on What Now? Hopefully some of your answers will help others as well, I know I benefited from other posts along the way (though I'm staying off boards as much as possible).
Regards,
JP
Category: Questions and Answers