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Dr. Nagler

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Four Keys To Overcoming Tinnitus
Stephen M. Nagler, M.D.

As I have come to see it over time, there are four basic keys to overcoming tinnitus:

Strategy

Determination
Flexibility
Insight

Strategy is the overall approach: Tinnitus Retraining Therapy, Cognitive Behavioral Therapy, Progressive Tinnitus Management, masking, Mindfulness Based Tinnitus Stress Reduction, various medications, etc. We can even include the alternative therapies that seem to appeal to some. Please note that giving it time is not a strategy. Giving it time is what is left when you do not have a strategy. So you start by researching the problem and choosing a Strategy that seems best to suit your tinnitus, your situation, and your philosophy.

Now with any of these approaches there will inevitably be bumps along the road. Improvement is never a straight line type of thing. So it takes some degree of persistence and Determination to appreciably free yourself from suffering. (Although to be frank with you, if you are going the alternative therapy route, I really wouldn't push the Determination piece. There's a reason it's called "alternative.")

Just as important as is the role of Determination, is the role of Flexibility. At some point you must be prepared to acknowledge that in spite of your being determined, your Strategy is not getting you where you want to go. It is often very hard to recognize that point. It is even harder to acknowledge it. And it is harder still to be flexible enough to back off and initiate another Strategy consistent with your philosophy. But sometimes that is exactly what is called for.

Above I wrote that you select a Strategy consistent with your philosophy; to me that step is very important. It can take considerable Insight, however, to come to the realization that the barrier may lie in your philosophy itself. And it can take a good deal of courage to go back to square one and do a total reboot based on that realization, so much so that in some cases (I personally know of several) folks wind up truly suffering needlessly for years and years. The most common example of what I am talking about is the (quite understandable) insistence of many on focusing their efforts towards finding a way to effectively address their tinnitus itself. The logic here is: "If I didn't have tinnitus, then I wouldn't have a problem. And if I had less tinnitus, then I'd have less of a problem." And who can argue with that logic? I sure can't. The difficulty lies not in the logic, but in its practical application. Why? Because at present we simply do not have a predictably effective surgical, pharmacological, psychological, neurological, or audiological method of ablating or even lastingly mitigating the intensity ones tinnitus. The best we have been able to come up with so far are the suppression of tinnitus through masking, the temporary suppression of tinnitus through residual inhibition, the possible partial suppression of tinnitus through various poorly understood and poorly documented pharmacological effects, and, of course, the seemingly endless anecdotal reports of various shapes and sizes. For argument's sake, let's also include all the investigational treatments that typically generate so much excitement on Internet boards but have yet to be demonstrated to be effective - or they would no longer be "investigational." So if your focus is on your tinnitus, and it is getting you where you want to go (for instance, if you are happy and content with what masking can do for you), then I think that's wonderful. But if focusing on your tinnitus is not getting you where you want to go, then in order to succeed you may need to adopt a totally different philosophy and consider addressing your reaction to your tinnitus rather than your tinnitus itself. Why consider reaction at all? Because if you did not react to your tinnitus, your tinnitus couldn't possibly bother you or make you feel bad in any way - because being bothered by your tinnitus is a reaction. And that's true no matter how loud your tinnitus might be. Moreover, even if you do react to your tinnitus, the less you react to your tinnitus, the less bothersome it will be. Nobody wants to have tinnitus, but if you do not react to your tinnitus - if it causes you no distress at all - what's wrong with that??!! The problem here is that you cannot make yourself not react to your tinnitus, but there are indeed a variety of effective ways to indirectly accomplish just that. Of course, if you have invested a lot of yourself in one philosophy, totally switching gears and adopting another philosophy can be a very daunting task indeed.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC

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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.