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SC

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 #1 
Hi Dr. Nagler

I live in a rural city in Australia about a 2 hour trip from Melbourne, I first got tinnitus about 10 years ago, when it started i would rate the volume at about a 5- 6, it was 24/7 and i could hear it all the time, i employed tactics like sound enrichment and guided relaxation which eventually lead to the tinnitus getting to the point where it no longer bothered me too much.
For years the tinnitus was at a point where i could go for days without noticing it and the volume seemed to have reduced from a 5-6 to about a 3-4, it could still be a minor annoyance at times.

Move to late Feb 2017 and my tinnitus got excruciatingly loud while on oral and topical antbiotics for an ear infection which it turns out was a misdiagnosis by my GP, i found out it was a misdiagnosis because i insisted on a referral to an ENT who told me i did not have an ear infection, my GP had once again that same day told me that i still had an ear infection in both ears.

My tinnitus at the start of march i rated 10/10 when seen by an audiologist who told me to give it 3 or 4 months and you'll hardly notice it, move forward 4 months to now and i realise that rating of 10 was wrong because it has gotten even louder now, it is so loud and distressing that i am having immense trouble sleeping and the tinnitus is causing a massive ammount of anxiety.
My hearing has also deteriorated and the ENT said the audiogram i recently had done showed i have nerve damage most likely caused by the antibiotics.

I have some hearing aids that i got from the audiologist that also work as tinnitus maskers, when i started using them 3 months ago they did a good job of reducing the tinnitus distress when i wore them with the level set just below the tinnitus, but now they don't work well anymore because the tinnitus has gotten louder and the pitch has increased enough that the sound they make just doesn't do anything to reduce the perception of the tinnitus, it's basicaly just adding more noise.
The maskers also make my right ear ache after about 15 minutes now, and when i remove them the right ear feels sort of dull and muffled.
The audiologist has told me that the maskers can't do any damage but i'm now scared to wear them since my hearing is still deteriorating and the tinnitus getting ever louder.
I kept telling my audiologist how loud it is and she asked if i could hear it under the shower and when i told her i could easily hear it under the shower she was shocked. 


I have seen a psychologist who said that she had experience working with tinnitus sufferers but that did not work out, i felt i was getting no benefit from her therapy which entailed her advising me to play some golf or go to a movie or go for a walk and say hello to 10 people.
She also wanted me to believe that my tinnitus was being caused by not doing enough things that i enjoy, and not the antibiotics and hearing damage, she told me if i believe the tinnitus is caused by damage to my auditory system then her CBT wont be able to help me. 

I am realy struggling to cope with this tinnitus it is so much worse than the tinnitus that i lived with for 10 years, it moves around in my ears and head somedays louder in the head and some days louder in the ears.
it is so loud, high pitched and intrusive, nothing blocks the sound out anymore, i never used to be able to hear my tinnitus in the shower but now i can clearly hear it in the shower with the exhaust fan and the radio going, i was mowing the lawn the other day and i took my ear muffs off just for a few seconds and yep i could hear it over the lawn mower too.

I would appreciate any advice, i never thought after 10 years of living with and for the most part being on top of my tinnitus that i would ever be in this constant state of distress, only sleeping 1 to 5 hours per night and waking multiple times, unable to relax or even enjoy watching a movie, i never thought my tinnitus could get this loud, after about 8 years of no change in volume or pitch i was so unprepared for such an enormous change from a 3-4 to where it is now maybe a 10, i certainly hope it can't get any louder.

Scott.
Dr. Nagler

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 #2 
Hello Scott -

Thank you for your inquiry.

And, strange as it might seem at first, yours is one of the easier posts to answer that I have come across in a long time - not by virtue of the obviously complex and frustrating nature of your problem, but rather by virtue of where you live!

I am sure that there are many fine audiologists in Australia, and some of them likely know a fair bit about tinnitus. But there is one and only one Myriam Westcott, and her clinic is a mere two hours from your home.

Myriam is not merely knowledgeable about tinnitus, she is extraordinarily knowledgeable about tinnitus. And as a bonus, she is totally delightful. 

In my opinion you need a fresh look and a thorough tinnitus assessment. And you need a sensible and effective protocol to follow based upon that thorough tinnitus assessment. There is no finer person around in that regard than Myriam Westcott - so my recommendation would be for you to CLICK HERE, and make an appointment to see her. You will not be sorry, I promise you!

Hope this helps.

Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC

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The best way to find yourself is to lose yourself in the service of others.
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SC

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 #3 
Thanks for the reply Dr Nagler,

I have spoken to Myriam and she is cautiously optimistic that she may be able to help, she sent me info about dealing with tinnitus and told me to give it a few weeks and contact her again if i need to.
Unfortunately the info she sent me is stuff that i already knew from living with tinnitus for 10 years so i'm probably going to be going to see her soon.

I had an appointment with an ENT who "specialises in ears" yesterday and he couldn't have been less interested, i was in and out of his office in 10 minutes.
He told me i have TMJ which is strange because the ENT i've been seeing said i don't have TMJ and my tinnitus is tonal and doesn't seem to match to the sound i've read TMJ causes, i also told him that Myriam Westcott told me she thinks i may have TTTS, he told me he doesn't know who Myriam is or what TTTS is but she must mean i may have TMJ.

He referred me to the audiologist who is next to his practice for a tinnitus assessment and management plan, the audiologist tested my tinnitus for loudness and said it was very severe (i didn't need anyone to tell me that) measuring 40db sl.
I saw in another thread you said that tinnittus loudness never goes above 16db sl so i'm guessing the audiologist didn't measure it properly.
The audiologist hasn't made any plans for tinnitus management as i mentioned i may be going to see Myriam and she immediately knew who i was talking about.


Thanks scott.
Dr. Nagler

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 #4 
Quote:
Thanks for the reply Dr Nagler,

You are welcome, Scott.

Quote:
I have spoken to Myriam and she is cautiously optimistic that she may be able to help, she sent me info about dealing with tinnitus and told me to give it a few weeks and contact her again if i need to.
Unfortunately the info she sent me is stuff that i already knew from living with tinnitus for 10 years so i'm probably going to be going to see her soon.

Rest assured that with Myriam Westcott you will be in the very best of hands.

Quote:
I had an appointment with an ENT who "specialises in ears" yesterday and he couldn't have been less interested, i was in and out of his office in 10 minutes.
He told me i have TMJ which is strange because the ENT i've been seeing said i don't have TMJ and my tinnitus is tonal and doesn't seem to match to the sound i've read TMJ causes, i also told him that Myriam Westcott told me she thinks i may have TTTS, he told me he doesn't know who Myriam is or what TTTS is but she must mean i may have TMJ.

As I see it, any ENT who supposedly "specialises in ears" but who has never heard of TTTS (Tonic Tensor Tympani Syndrome) isn't much of an ear specialist after all. So regardless of whether you were in his office for 10 minutes or for 10 hours, you are better off elsewhere. In my opinion, anyway.

Quote:
He referred me to the audiologist who is next to his practice for a tinnitus assessment and management plan, the audiologist tested my tinnitus for loudness and said it was very severe (i didn't need anyone to tell me that) measuring 40db sl. I saw in another thread you said that tinnittus loudness never goes above 16db sl so i'm guessing the audiologist didn't measure it properly.

Well first of all one's tinnitus loudness match and the severity of one's tinnitus are two different things. You can have extremely loud tinnitus that is not at all severe, and you can have have relatively soft tinnitus that is incapacitating, and you can have all sorts of combinations and permutations in between. Regarding what I said about loudness matching in another thread, I believe I wrote that I do not recall ever seeing a loudness match greater than 16dB SL in my own clinic. I have since checked my records and found a couple at 18dB SL and one at 20dB SL. But your reading of 40dB SL? I agree with you that likely it wasn't measured properly.

All the best -

Stephen M. Nagler, M.D.

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

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 #5 
Hi Dr Nagler,

I had been as i said in my last post using the information sent to me by Myriam to see if it would help but unfortunately it hasn't, while i was using the around the clock sound therapy my T got even louder so i have had to stop that because i'm now scared of it.
I was told that if mt T got louder because of the sound therapy them means i probably have Hyperacusis and thats why it made the T louder.
I don't realy understand how H could cause T to get louder with sound therapy.

I contacted Myriam and she said i could come to see her if i want to, i'm not sure that it will help though as i don't seem to be able to get her to understand how bad my T is, she has told me i'll probably only need to see her once as that's usualy enough for most people.
I have tried to explain to her that my T is not what most people have. 

I also have a dentist appointment this week that is going to be about 3 hours long with a lot of grinding and shaping with the drill, the ëar specialist ENT" that i mentioned earlier said that much exposure has the potential to cause the T to get worse.
I have asked the dentist if the work could be done over multiple appointments but he says it has to be done at 1 appointment.
Is there anything that you know of that could reduce the risk of making the T worse, would ear muffs help or would bone conduction make them useless.

I am so worried about my T it has been almost 7 months now since it got to this insane level and it's not getting better nor am i anywhere near getting to a point where it doesn't bother me.
Dr. Nagler

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 #6 

Quote:
I had been as i said in my last post using the information sent to me by Myriam to see if it would help but unfortunately it hasn't, while i was using the around the clock sound therapy my T got even louder so i have had to stop that because i'm now scared of it.
I was told that if mt T got louder because of the sound therapy them means i probably have Hyperacusis and thats why it made the T louder.
I don't realy understand how H could cause T to get louder with sound therapy.

The reason you do not understand how hyperacusis can cause tinnitus to get louder with sound therapy is because it can't. Hyperacusis has nothing to do with tinnitus loudness. And whoever told you otherwise is wrong.

Quote:
I contacted Myriam and she said i could come to see her if i want to, i'm not sure that it will help though as i don't seem to be able to get her to understand how bad my T is, she has told me i'll probably only need to see her once as that's usualy enough for most people.
I have tried to explain to her that my T is not what most people have.

Scott, I have told you that with Myriam Westcott you will be in the best of hands. I did not say "perfect" hands, but I did say the best. And I continue to believe that. Now without the benefit of her actually seeing you in person and evaluating you, she can only speak in generalities. And given what you feel is the unique nature of your condition, I think that's asking an awful lot.

You live a mere two hours from Myriam's office. Go see the lady. At least that's what I would do were I in your shoes.

Quote:
I also have a dentist appointment this week that is going to be about 3 hours long with a lot of grinding and shaping with the drill, the ëar specialist ENT" that i mentioned earlier said that much exposure has the potential to cause the T to get worse.
I have asked the dentist if the work could be done over multiple appointments but he says it has to be done at 1 appointment.
Is there anything that you know of that could reduce the risk of making the T worse, would ear muffs help or would bone conduction make them useless.

Dr. Jack Vernon (1922 - 2010) used to recommend asking the dentist to give you a ten second break after every five seconds of drilling. He never found a dentist who would not comply with that very simple request. Ear plugs or muffs can be helpful to a degree, but they do not affect bone conduction (i.e., transmission of sound waves to your cochlea via your teeth and facial bones). So while there are no guarantees, Dr. Vernon's approach is the way I'd go.

Quote:
I am so worried about my T it has been almost 7 months now since it got to this insane level and it's not getting better nor am i anywhere near getting to a point where it doesn't bother me.

... which is why I think you should make an appointment to see Myriam.

Best regards -

Stephen M. Nagler, M.D.


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

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 #7 
This is what i was told about the tinnitus possibly being louder because of sound therapy and hyperacusis.

 "If the tinnitus was stirred up by you using sound therapeutically – then that suggests you may have developed hyperacusis. Generally when patients have both tinnitus and hyperacusis, the hyperacusis is tackled first and the tinnitus tends to settle down as a result."

Dr. Nagler

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 #8 
Quote:
Originally Posted by Scott
This is what i was told about the tinnitus possibly being louder because of sound therapy and hyperacusis.

"If the tinnitus was stirred up by you using sound therapeutically – then that suggests you may have developed hyperacusis. Generally when patients have both tinnitus and hyperacusis, the hyperacusis is tackled first and the tinnitus tends to settle down as a result." 

Hyperacusis is a condition wherein external sounds well-tolerated by the general population sound uncomfortably loud to the person with the condition. Period. In other words, in hyperacusis the issue is loudness discomfort.

Now it is true that some individuals with tinnitus find that certain external sounds seem to aggravate their tinnitus, but to the very best of my knowledge whether or not those individuals happen to also have hyperacusis has no bearing on it.

The reason that we address hyperacusis first when people have both hyperacusis and tinnitus has to do with the fact that hyperacusics tend to avoid a variety of sounds because of the discomfort that those sounds cause, not because of whatever effect those sounds might or might not have on their tinnitus. Hyperacusics quite naturally prefer quieter environments because in quieter environments they experience less discomfort! Once the hyperacusis has been effectively addressed (and hence once those folks are comfortable in the presence of the entire spectrum of non-ototoxic environmental sounds), then the tinnitus often simply takes a back seat and becomes less of an issue for the same reason that tinnitus tends to become more of an issue in very quiet environments whether or not a person has hyperacusis.

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi
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Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.