Dr. Nagler's Tinnitus Corner
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Isabelle

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 #1 

Dear Dr Nagler,

Two months ago I went to the cinema to see the movie Babydriver. The lead player has tinnitus and after watching the movie I was lying in bed and wondering what that would be like. And then all of the sudden I heard a high pitched tone. It hasn't left me ever since. Although now it has become more of a high pitched hiss. I can hear it everywhere I go.

I could say that it absolutely terrified me and since that day I spend my days reading and reading about tinnitus. After a month I thought I had a pretty good concept of tinnitus and what I would strive for: habituation. I went on two holidays and tried to enjoy it as much as possible, but my thoughts were almost 24/7 with tinnitus. So far for distraction.

My greatest fear is that I won't be able to overcome my obsession (and forget about tinnitus) and thus will be bothered by tinnitus forever. This because of an obsession I had in the past with a globus feeling in my throat. That obsession faded within time (2 years approx). But 2 years (or maybe even many more) for tinnitus suffering feels so exhaustingly long. Cause I already feel like I can't live like this for much longer. I already made an appointment with a special tinnitus psychologist where I live (Netherlands), but I know this won't be some quick fix. What are your insights to this? I am so scared.

Kind regards,

Isabelle

Dr. Nagler

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 #2 
Hello Isabelle ... and welcome.

I am sorry to see that you are having a difficult time of it.

You ask for my insights. So here goes ...

Your auditory system (by which I mean your ears, your two auditory nerves that connect your ears to your brain, and all of the auditory pathways within the brain) does not just detect, process, and evaluate sounds that originate in the environment; your auditory system also makes sounds of its own (i.e., your tinnitus). Those sounds do not originate as sound waves (which is why nobody else hears your tinnitus), but they are real sounds nevertheless. And sometimes - for any of a number of reasons - your brain can latch on to those sounds. When that happens, usually your brain quickly recognizes them as unimportant (i.e., neutral) and lets go. But occasionally, through no fault or weakness of your own, your brain labels them as "foreign."

Now there's a part of your brain called your autonomic nervous system (ANS) whose job it is to protect you. It is your ANS that makes the pupils of your eyes dilate in a dark room (to let in as much light as possible to protect you). Well, your auditory system has no pupils. And as far as your ANS is concerned, when your brain labels its internally-generated sounds as foreign, you need protection. So, since your auditory system has no pupils, the only strategy your ANS has at its disposal to do its job is to monitor those sounds, which is about the last thing you want to be doing. Problem is ... you cannot will your ANS to stop monitoring your tinnitus any more than you can will your pupils to contract in a dark room. But that is precisely what you try to do, which invariably fails, thereby invoking all sorts of emotional responses that serve only to compound the problem.

In other words, the difficulty isn't that there is something wrong with your brain. The difficulty is that your brain is doing precisely what it is supposed to be doing, but it's doing it too well!

To complicate matters, in spending your days "reading and reading about tinnitus," you likely came across the Tinnitus Talk website, which is basically a cesspool of terrible and grossly misleading postings masquerading as "support." And gradually, through no fault of your own, Tinnitus Talk pretty-much sealed the deal, hammering the nails of misery, desperation, and sorrow one-by-one into your coffin of distress, thereby further engaging your emotions and reinforcing the vicious circle that has brought you to this point.

Moreover, it is this vicious circle - comprised of your auditory cortex (perception and evaluation of sound), your ANS (protection), and your limbic system (emotion) - that serves to reinforce the intrusiveness of your tinnitus and can make it sound incredibly loud even though the magnitude of the tinnitus signal itself might be rather small.

That's how I have come to see it anyway.

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

__________________

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

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 #3 
Dear Dr Nagler,

Thanks for your reply. It is true that I came across Tinnitus Talk and I indeed spend most of my hours there. I know I shouldnt but it is so addictive because all I can think about is tinnitus. Also I said thinking to have a good concept of T, but I'm still trying to figure out some things. Cause there are so many different stories and I dont know yet which one will be mine. I try to endure this hard time and focusing on therapy and continuing life as best as I can. Just hoping for some peace of mind in the future. I am doing med school myself and was just in my gap year waiting for my internships. Since I read your story I became a little frightened that I won't be able to perform my internships anymore and maybe even not become a doctor if things stay the same. Because someone said to me that I should avoid stress as much as possible. Do you think it is still possible once my brain will be more hardened to the sound?

Isabelle
Dr. Nagler

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 #4 
Quote:
Originally Posted by Isabelle
Thanks for your reply.

You are welcome.

Quote:
It is true that I came across Tinnitus Talk and I indeed spend most of my hours there. I know I shouldnt but it is so addictive because all I can think about is tinnitus.

Right. The folks who run Tinnitus Talk know exactly how addictive it is - and they take advantage of it. The last thing they are interested in is getting folks to the point where they no longer depend on that board. Their M.O. is to retire on the income they generate from the advertising space they plan to start selling. And the fewer the number of hits, the less the advertising space is worth. Nauseating. Don't get me started.

Quote:
Also I said thinking to have a good concept of T, but I'm still trying to figure out some things.

And you are turning to Tinnitus Talk for answers, a site populated predominantly by individuals who have not yet been able to figure out for themselves what you are trying to figure out for yourself? What kind of a resource is that?

Quote:
Cause there are so many different stories and I dont know yet which one will be mine.

Your story will be your story. It is unique to you.

Quote:
I try to endure this hard time and focusing on therapy and continuing life as best as I can. Just hoping for some peace of mind in the future.

The overwhelming majority of folks in your shoes do just fine. And if you want some peace of mind - go out tomorrow and make a difference in the life of somebody less fortunate than you are. That is a 100% guaranteed way to insure that tomorrow will be a better day for you than today. It might not be a better tinnitus day - but it will be a better day nonetheless.

Quote:
I am doing med school myself and was just in my gap year waiting for my internships. Since I read your story I became a little frightened that I won't be able to perform my internships anymore and maybe even not become a doctor if things stay the same.

There are only a very few occupations that require 100% concentration 100% of the time. So unless you want to be a neurosurgeon, a diamond cutter, or a tightrope walker ... you should be just fine.

Quote:
Because someone said to me that I should avoid stress as much as possible.

And just because "someone" said it, you believe it? Please. A stress-free life is a boring life. 

Quote:
Do you think it is still possible once my brain will be more hardened to the sound?

Your brain does not need to be "hardened to the sound" for you to overcome 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
Isabelle

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 #5 

Dear Dr Nagler,

Thanks for your honesty. Much needed in times where I don't seem to judge things properly myself. I asked my boyfriend to block my acces to Tinnitus Talk on all my electronic devices. It feels scary and good at the same time.

I have a few more questions for you if you don't mind answering.

1. Do you know if a fullness of the ear sensation can subside over time when due to an acoustic trauma? 2 weeks before noticing the ringing I went clubbing without ear protection. My ENT said it probably has to do with the inner ear (since that's the place to be for acoustic trauma) but he couldn't find out because I must be dead to measure the pressure in the inner ear. Figured that's not such a good plan ;). You probably don't know the exact answer either, but I thought I could always ask because you might have seen patients with the same problem.

Side note: I've been beating myself up for this evening so much. Because normally I always wear earplugs. This time however I made an exception because it was my best friend's surprise party - to cheer her up because her mother was dying of mesothelioma. I wanted to do her a favor. But now it turns out in the end I didn't because because of my major panic attacks following the discovery of tinnitus I didn't go to her mother's funeral. I feel awful about that one stupid mistake. After the clubbing night I heard a slight ringing in my right ear (also the fullness ear, my tinnitus ear) but after some more sleep I didn't notice it/didn't think of it anymore. 

2. I think my tinnitus an sich isn't extremely loud since I only noticed it after paying attention to it after the movie. But it is now maximally amplified because of my anxiety. It has subsided a little already because my anxiety is lessening. Do you think I can manage by only doing CBT? Because my psychologist said they don't offer TRT because it is not evidence based. They do offer wearable noise generators (so maybe they kind of do the same but not call it TRT?) Since you are very much pro TRT I am so confused. Because I find you trustworthy, but I must also be confident of my therapist in order for the therapy to work. Shouldn't I? 

I am very grateful for your willingness to answer the questions asked by us sufferers.

Isabelle

Dr. Nagler

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 #6 

Quote:
Thanks for your honesty.

You are welcome. I confess, my honesty and frankness get me into trouble on occasion, but it's the only way I know how to be.

Quote:
Do you know if a fullness of the ear sensation can subside over time when due to an acoustic trauma?

The most common cause of a feeling fullness in the ears after acoustic trauma is a temporary threshold shift, the operative word there being "temporary."

Quote:
I've been beating myself up for this evening so much. Because normally I always wear earplugs. This time however I made an exception because it was my best friend's surprise party - to cheer her up because her mother was dying of mesothelioma. I wanted to do her a favor. But now it turns out in the end I didn't because because of my major panic attacks following the discovery of tinnitus I didn't go to her mother's funeral. I feel awful about that one stupid mistake.

Really? As a medical student you surely know the highly sophisticated term used to describe people who make stupid mistakes, don't you? That term is ... NORMAL. I myself make stupid mistakes around once a week. My wife would tell you that it's more like once a day. Please don't beat yourself up for being normal.

Quote:
I think my tinnitus an sich isn't extremely loud since I only noticed it after paying attention to it after the movie. But it is now maximally amplified because of my anxiety. It has subsided a little already because my anxiety is lessening. Do you think I can manage by only doing CBT?

I much prefer TRT myself, but CBT has indeed been used with considerable success.

Quote:
Because my psychologist said they don't offer TRT because it is not evidence based.

I guess that depends on how much evidence they're looking for. It was evidence-based enough for me back in the mid-1990s when I was suffering. And the evidence has only gotten stronger since then.

Quote:
They do offer wearable noise generators (so maybe they kind of do the same but not call it TRT?)

TRT is a formal protocol that is very well-defined. It is not CBT plus wearable devices. In fact, it is not CBT at all.

Quote:
Since you are very much pro TRT I am so confused.

I am pro-TRT because the data are compelling, because the model upon which TRT is based makes such good sense, and (I admit) because I am biased: TRT saved my life.

Quote:
Because I find you trustworthy, but I must also be confident of my therapist in order for the therapy to work. Shouldn't I?

Well I certainly wouldn't do TRT with a therapist who is not knowledgeable and experienced in TRT, if that's what you mean. But if you are confident in your therapist and in your therapist's approach, then he or she is a good place to start. TRT is an answer, but it is not the only answer.

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
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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.