Dear Dr. Nagler,
I have had tinnitus for nearly 3 weeks. The ringing started during a time of considerable stress. While working on a looming deadline, I got a Group A Strep infection in my left leg, and I strained my right leg while walking funny because of the pain. They gave me two of the 800 mg Bactrim per day for the infection, and 800 mg Ibuprofens for pain. The Bactrim gave me terrible insomnia. On the 9th day, my ears started ringing and they haven't let up since. It seems to be a symmetrical ringing. I think it became a bit quieter after the first day, but has been rather steady since then. My means of comparison is that when I hold my jaw completely open, it produces a similar high pitched tone of a certain loudness. On the 1st day, the "tinnitus" sound was comparable to the "jaw" sound. After that it has been somewhat fainter, although it's very hard to say whether it is generally improving or not. Of course, I don't know if this is an accurate means of "measuring" it. Maybe it is unhelpful to measure it at all, but I am a scientist so my first instinct is always to measure.
This situation has caused me a great deal of anxiety which has been ratcheting up gradually as the ringing has persisted. My PCP initially said he thought the ringing was likely a side effect of the Bactrim and that it would subside after a week or so. Another doctor I talked to said it would likely take more than 2 weeks before I would see improvement, if Bactrim was the cause.
When I complained of the anxiety, my PCP gave me a prescription for 0.5 mg Klonopin to use "as needed". I've taken 0.25 mg in the last few days before bed. It initially made me feel calmer, so I was able to get to sleep. However, both times I woke up in a few hours, and the tinnitus seemed like it was possibly louder, which led me to panic. I was able to eventually calm down and get more sleep, but it wasn't easy. I really don't know if it's actually louder or not. Today I was feeling consumed by anxiety so I took my third half-pill about an hour ago. I feel somewhat less anxious, but I'm not sure of its effect on the tinnitus itself. Of course I have a great fear of making it permanently louder.
The other problem I continue to have is sleep. So far, I've gotten to sleep using Benadryl, but last night that didn't work, in fact, it seemed to have the opposite effect! Seems like that happens every once in a while. I've been thinking of trying Melatonin for sleep. Any thoughts?
I've done a course of SSRIs in the past (about 1.5 years before this tinnitus business began), which was because of a problem with obessive worrying about certain things in life. This episode with tinnitus has seemed to enlist those obsessive tendencies and made it much worse than it probably needed to be. I wonder if I should seek an SSRI type answer to this rather than anti-anxiety meds... Of course, SSRIs also seem to be associated with tinnitus so I have great trepidation about that path as well.
The bottom line is, every possible course of action seems to have some risk of making my situation worse. But my present situation also seems kind of hopeless. I feel like this tinnitus is never going to leave and it's hard to see how it can get better or how I can possibly get used to this noise. I've masked the sound with some white noise generators on my phone but it seems hard to get the right volume and sound to do so... lately it seems like it may have some "interaction" with the tinnitus... perhaps this is what you called "stochastic resonance" in your TRT article.
On top of all this, I have to go to two meetings out of town this month, each for several days in a row. I was really looking forward to it before this happened. I really feel like this situation has sucked all of the joy out of my life and threatens to utterly destroy it. I've started taking a look at the Henry and Wilson book, and I started doing some of the CBT exercises. It seems like a very long road. Especially with the fear that the tinnitus could worsen and that I might do it to myself... either with the Klonopin or by being unable to wrestle my attention away from it. Are such fears warranted? Or perhaps I have poisoned my expectations by reading too much about the subject.
At this point I don't really know what to do. I have an ENT appointment in two days, but I don't expect that they will find any hearing loss. I'm 35 years old.
Any guidance would be appreciated. I'm located near Indianapolis (Chicago is also doable). If you know any professionals in my region let me know. Perhaps I may be lucky and my tinnitus will spontaneously resolve, but if it does not, I believe I will need competent help to overcome it.
I'm sorry this ended up being so long-winded, but then, I've been at home thinking about this for 2 weeks during a university break (I work there as a researcher). Thanks so much for your time.
Chris
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