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Occlusion effect

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Dr Nagler - It appears I may need to get a filling. I understand that you do not wear earplugs at the dentist but have recommended to people if they are concerned to wear plugs and provide some to their dentist (as well as the 5 seconds on, 10 seconds off method from Dr. Vernon). Is the occlusion effect something to be concerned about when wearing plugs? Would over the ear protection be more effective and reduce the occlusion effect? Is there any evidence that dental drills conduction causes auditory damage at the exposure consistent with a filling?

As an aside, I've read recently that your patients tinnitus matching decibel level was typically in the upper teens and maybe maxed out around 20 db. I was wondering if you have had yours measured and would mind sharing? 

I had mentioned previously that my tinnitus had improved a great deal and then worsened (I won't speculate the cause here). In your experience, have you seen fluctuations like this, can a case have gotten louder and then held steady or can I expect further worsening (or even improvements). 

I've come a long way since the onset in March 2018 and recently started cbt to hopefully address some of these concerns to reach a point where it wouldn't matter either way. 

Lastly, my ENT did not recommend that I get an MRI after discussing with a neuro-otologist (spelling?) on site. He said that he had not seen an acoustic neuroma in someone with unilateral tinnitus with no other symptoms. Does this make sense to you or would you recommend a second opinion? Truthfully, I feel like I have it in both ears now anyways. 

Thank you and happy new year.

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