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Oreille

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 #1 
Hello Dr. Nagler.

My neurotologist wants me to get an ECOG test (Electrocochleography). I read that the sound, albeit short in duration, can get loud (100 dB!!??) in this test.

What is your take on this test, its intrusiveness and its ‘risk’ for somatic/physical/emotional aggravation of pulsatile and buzzing tinnitus like I am experiencing?

Unfortunately, a “ECOG and tinnitus” internet search brings to the forum-we-shall-not-name with its usuall apocalyptic stories.

Thank you!
Dr. Nagler

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 #2 
You are correct in that ECOG can get loud - briefly. The loudness and duration of loudness are not enough to cause actual auditory damage, but in terms of temporarily aggravating tinnitus and in terms of its emotional effect, that is hard to predict.

But there is a greater issue. And that greater issue has to do with precisely why your neurotologist wants to order the test in the first place. In other words, what decisions or recommendations is your neurotologist going to make based on the results of the test? If the results of the test are not going to contribute in a truly meaningful way to an actual treatment recommendation, then I wouldn't have the test done even if it carried no risk at all! So I would tell your neurotologist that you are concerned about unnecessary noise exposure and therefore want to know exactly how necessary the test is to establishing a diagnosis and treatment recommendation.

Hope this helps.

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

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

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 #3 
Thank you Dr Nag;er.
May I ask why you think the test should be avoided without a clear treatment strategy around it? Is it because it reinforces the obsession/hyper vigilance and prevents ‘letting go’? I find that trusting the clinician is actually soothing, I am not really looking for a specific diagnostic, if something shows up ok, if not, also ok. But I actually find ‘arguing’ , so to speak, with the clinician to be more upsetting and anxiogenic for me.

Thank you
Dr. Nagler

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 #4 
Quote:
May I ask why you think the test should be avoided without a clear treatment strategy around it? Is it because it reinforces the obsession/hyper vigilance and prevents ‘letting go’?

It has absolutely nothing to do with reinforcing anything! I have been a licensed medical doctor for over 40 years now. And I can tell you that physicians - some very good ones, in fact - order tests for any number of reasons. But that said I have never understood why any doctor would ever order a test if the result would not help him or her make a decision or recommendation.

Quote:
I find that trusting the clinician is actually soothing, I am not really looking for a specific diagnostic, if something shows up ok, if not, also ok. But I actually find ‘arguing’ , so to speak, with the clinician to be more upsetting and anxiogenic for me.

I would never go to a doctor I didn't trust. But there is a difference between trusting somebody and having blind faith in that person. Moreover there is a difference between respectfully asking a question and arguing. I did not suggest that you argue with your doctor, but it is totally appropriate for if you to ask a question about why he or she is ordering this test or that - especially one that you understand can be uncomfortably loud.

You mentioned earlier about how important it is to you to be able to trust your doctor. I totally understand. And the way I see it, my patients' willingness to ask me questions about issues of concern to them is a reflection of the trust they have in me!

All the best -

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
Oreille

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 #5 
I entirely understand your point Dr. Nagler.

I went ahead with the ECOG test, partly out of hope (that it would be usefull), partly out of fear (that I couldn’t do something that was scaring me), partly out of courage (I give myself brownie points for not having stayed in bed with excuses). It was unpleasant, but I do not experience hyperacousis. It was mostly a very anxious time because ‘I hope it doesn’t go worst, like some guys on tinnitus talk said it did for him’. But it has not really changed my condition, proving to myself that the fearmongering of tinnitus talk is also just an illusion. I will see the neurotologist Monday for results, so far I have seen only his nurses practitioners/audiologists. This neuro is booked months in advance, and I think that forcing myself to a docile behavior with this additional test he requested was also - at least that’s what my confused self thinks- the condition for seeing him quickly. It’s a shame maybe, but I did what I could to manage what I think was a ‘damn if you do, damn if you dont’ situation.

I’m still in the process of ‘figuring out my pulsative T”, because a nurse practitioner said he could hear it over the mastoid bone. In a way I’m kind of hoping that there’s nothing that can be done so I can advance to the next step of letting tests go and accept. I feel I must go with all the tests requested, but it’s kind of dragging me behind in a way.

So thank you for your honest, no-nonsense reply to my ECOG concerns. I’m still glad I did it, because I don’t want to discount the positive of having been able to get out of bed to follow a medical request that scared me.

Very gratefully,
Dr. Nagler

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 #6 
Oreille, if you are glad you did it, then I am glad for you.

I'll just add a couple of points - for general information.
  • In your post directly above you mention that "a nurse practitioner said he could hear it over the mastoid bone." If that is the case, then what you are referring to as your pulsatile tinnitus is actually a somatosound, and ECOG is typically not considered to be part of the work-up for somatosounds.
  • You only need to submit a post once to this board. [You submitted the post above four times.] It can take up to a few days for me to get around to reading a post, and nothing appears on the board before I have read it.

All the best -

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
Oreille

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Posts: 11
 #7 
Yes, my apologies for the multiple submissions. That was not intentional. My iPad was not working properly and I wasn’t sure i was clicking the right button :-)

Than you again.
Dr. Nagler

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 #8 
Not a problem. It happens quite a lot actually - and every once in a while I post about it as a reminder to all!

Be well -

Stephen M. Bagler, 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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