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AndyA

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 #1 

Dear Dr. Nagler,

About one month ago, which was 4 months after onset of noise induced hearing loss and tinnitus; I started TRT with an experienced TRT audiologist of my area.

At onset tinnitus was a very intrusive torture with dozens of randomly alternating tones, but after a month I lost many of those tones and the tinnitus started getting somewhat more tolerable. Two month after onset even more improvement set in and I kept getting better and losing tinnitus tones weekly, until a strong relapse around month 3, which coincided with a very emotional verbal argument with my wife. After that relapse, I started with TRT.

However it appears that since the start of TRT my condition may have gotten even worse. Actually that is the reason for my question. When I say worse, I mean TRT so far seemed to have chased my tinnitus to higher frequencies and louder. Given my steady improvements of the past (except my relapse) and given my feeling that since the start of TRT I may have gotten worse, would you say that I would possibly heal better on my own as with the help of TRT?

I just want to make sure that TRT does not exclude my natural healing.

Many thanks,

Andy

Dr. Nagler

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 #2 
Hi AndyA -

Thank you for your interesting question.

I would have to say that TRT done properly cannot interfere with anything. Sometimes it might be less than optimally effective in facilitating habituation, but in any event it does not slow things down.

I am somewhat troubled, though, by your references to "healing." It is a very basic concept in TRT that nothing is broken. And that being the case, there is nothing that needs to heal at all. If you do not understand this crucial principle, I think you should discuss it with your TRT clinician.

All the best -

sp

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The best way to find yourself is to lose yourself in the service of others.
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No bird ever soared in a calm. Adversity is what lifts us.
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David McCullough quoting Wilbur Wright
AndyA

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 #3 

Hello Dr. Nagler,

Thank you for your response.

Yes, I realize my way of using “healing” looked as if I was misleading myself. I meant it in ways of tinnitus getting better or certain sounds going away, which is what I was referring to used to happen before I started TRT.

Since I started TRT, my tinnitus (of complex sounds) seems changing a lot more than it did before TRT. Notably my tinnitus is changing not only during the periods of time that I wear the WNG, there is even a noticeable change to tinnitus once I take the WNG off. So there is a difference of tinnitus pattern between wearing WNG device and not wearing WNG device. Is that normal?

My concern is that if habituation means getting used to a certain tinnitus including all of it's patterns, then wouldn’t I have more difficulty habituating if my tinnitus pattern is different while wearing WNG device vs. without wearing a WNG device at all?

Is habituation even possible for me as long as my tinnitus patter is ever evolving, as it still does now? Or is habituation only possible for someone with an established tinnitus sound pattern?

Many thanks,

Andy

Dr. Nagler

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 #4 

Quote:
Originally Posted by Andy
Thank you for your response.

You are welcome.

Quote:
Yes, I realize my way of using “healing” looked as if I was misleading myself. I meant it in ways of tinnitus getting better or certain sounds going away, which is what I was referring to used to happen before I started TRT.

There are a number of ways to look at it, but I sort of see habituation as the process whereby you care less and less about your tinnitus regardless of what it might be doing.

Quote:
Since I started TRT, my tinnitus (of complex sounds) seems changing a lot more than it did before TRT. Notably my tinnitus is changing not only during the periods of time that I wear the WNG, there is even a noticeable change to tinnitus once I take the WNG off. So there is a difference of tinnitus pattern between wearing WNG device and not wearing WNG device. Is that normal?

The older I get, the less I think in terms of what "normal" is. In fact, the only thing I know for sure about "normal" is that it's boring! :-)

If it helps, though, what you describe is not particularly uncommon within the first six to eight weeks of TRT. In fact, it might even be considered to be a variation of what (in TRT) is sometimes called "Six Week Syndrome." Best to discuss it with your TRT clinician, who clearly knows you better than I, to see if he or she might (or might not) suggest a tweak or two.

Quote:
My concern is that if habituation means getting used to a certain tinnitus including all of it's patterns, then wouldn’t I have more difficulty habituating if my tinnitus pattern is different while wearing WNG device vs. without wearing a WNG device at all?

Habituation really has nothing to do with getting used to something. It has to do with reacting less and less over time. There really is a difference. I mean, if you don't react to something, there is no need to get used to it! Again, something best discussed with your own TRT clinician.

Quote:
Is habituation even possible for me as long as my tinnitus patter is ever evolving, as it still does now? Or is habituation only possible for someone with an established tinnitus sound pattern?

Tinnitus is an ever-evolving phenomenon. It is rarely static, which is why (I presume) your TRT clinician has instructed you to re-set your devices each morning. You do not habituate to any particular tinnitus sound; rather, you might consider the process as akin to gradually decreasing your reason to tinnitus as a concept!

Hope this helps more than confuses or frustrates.

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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