Dr. Nagler's Tinnitus Corner
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dougwarby

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 #1 
Hello Dr Nagler, thank you for this excellent site.

I am a medical practitioner (General practice) who has had tinnitus in my Right ear for 6 weeks.
I have seen an ENT specialist and audiologist. I have no asymmetric hearing loss, just some higher frequency drop off. The cause is an adverse drug reaction.
I have taken on board a lot of what you have said on your website and I am mostly dealing with my tinnitus by trying not to react to it emotionally and find meditation, soft white noise and distraction all help. Also have stopped reading tinnitus posts which can be quite scary.
However there are times when I still become quite anxious by it.

I wonder if you might have any knowledge of TRT in Melbourne, Australia?

Also do you have any recommendation for in ear or wireless sound devices that I could wear in my Right ear as I find some phone apps with soft white noise or nature sounds quickly relieve my anxiety but are a bit awkward to use.

many thanks, Doug
Dr. Nagler

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 #2 
Hello Doug ... and welcome.

I will get to your questions in just a moment, but kindly allow me to make a couple of observations first.

(1) I see that you identify the cause of your tinnitus as an "adverse drug reaction." While you may, indeed, be 100% correct in your assumption, many individuals develop tinnitus with no identifiable precipitating cause. That being the case, it is quite possible that had you not taken the drug you believe to be the culprit, you may have developed it anyway!

(2) As a physician I am sure you are aware that there can be considerable variability in what is considered to be the appropriate work-up of various conditions. For persistent unilateral tinnitus (even in the presence of a symmetrical audiogram) typically the recommendation here in the US would be an MRI of the brain and IACs with and without contrast to rule out a CPA lesion. The exception would be in the case where there is a clear explanation for the unilateral tinnitus - like in the right ear of a left-handed rifle enthusiast, where the left ear would be largely protected by the shoulder but the right ear would be exposed to the barrel of the gun. Absent such an explanation for one's unilateral tinnitus, in the US the recommendation would usually be an MRI. (Note: The overwhelming majority of MRIs done under such circumstances are unremarkable, but you would hate to miss an acoustic neuroma or the like.) Also, if you and your ENT do decide at some point to go ahead with an MRI, please keep in mind that the machine can be quite loud, and earplugs are a must!

OK, now on to your questions.

As you may know, I am a strong proponent of TRT for individuals with severe intrusive tinnitus. I realize that the term "severe intrusive tinnitus" is rather nebulous - so I have developed a very crude scale that at least gives me a general idea of things without going through any lengthy questionnaires. Basically, I ask the following question:

On a scale of 1 to 10 where 1 is "I have tinnitus and I'd prefer not to have tinnitus but in the grand scheme of things I do not care much one way or the other because my tinnitus does not affect my life," and 10 is "I have tinnitus and my tinnitus has totally, completely, permanently, and irrevocably destroyed my life," where would you place yourself along that huge continuum these days? Please just give me one overall average number.

When I was in clinical practice and people with tinnitus would contact me expressing an interest in TRT, I generally offered it to those who scored 8, 9, or 10. I encouraged those who scored 7 or below (and even some who scored 8) to consider other approaches. I realize that many TRT clinicians are more liberal in the above regard than I, but I really tried to reserve TRT for the most severe cases.

Regarding your question about practicing TRT clinicians in Melbourne, I can unconditionally recommend Myriam Westcott. Myriam is one of the smartest, most knowledgeable, most experienced, and most dedicated tinnitus clinicians I know. Let me make one clarification: Myriam has taken TRT courses and understands TRT quite well, but I am not sure she actually identifies herself as a TRT clinician. Regardless, I assure you that you will be in good hands with Myriam Westcott - TRT or no TRT!  So CLICK HERE.

In terms of devices, my suggestion would be to see Myriam first and follow her recommendations regarding wearable broadband sound generators.

Hope this helps.

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
dougwarby

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 #3 
That is a difficult question as the intrusiveness varies during the day. Overall I would give it an 8 in that I have been off work for 5 weeks and struggled with anxiety. I had pre-existing depression which the tinnitus has aggravated. I am taking Mirtazapine.  Sometimes my T is barely noticeable if I am occupied or watching TV. I am doing meditation several times a day, watching my diet and exercising. Sleep is most impacted, I get off to sleep fine but the worst time is in the morning when I wake early and I need to using sounds on my phone to reduce its impact.

I will try to get an appointment with Miriam, thank you for the suggestion.
Dr. Nagler

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 #4 
Got it. I am so glad that you will be seeing Myriam. Be sure to say hi to her for me.

Intrusive tinnitus superimposed on depression or dysthymia can be a challenge. After all, intrusive tinnitus represents two great losses - the loss of silence and the loss of control. So if you are feeling a bit overwhelmed in your current situation, that is totally understandable. Depression is tough enough without additional losses of such magnitude. I do hope you are not trying to "go it alone" and self-prescribing the mirtazapine. Remember, a doctor who self-prescribes has a fool for a patient. Seek appropriate counseling if you have not already done so - and after Myriam evaluates you, hopefully she can connect with your therapist.

While you are waiting to get in to see Myriam, you might check out the Tinnitus Association of Victoria's website HERE - and order the DVD advertised on the bottom left of the home page. Also, perhaps take a look at my Letter to a Tinnitus Sufferer.

I will keep a good thought for you.

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
dougwarby

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Posts: 4
 #5 
Thank you.

I am certainly not self prescribing. I am under a psychiatrist.
My audiologist who I have seen (not Myriam) did an approximate measure of T loudness (as assessed by a tone in my left ear, which is normal) and said it was actually very soft. I don't know how valid that is but I suspect it is my hyper vigilance and anxiety which is causing most of my problems.

My T is easily masked by being active or having background sounds such as TV.

many thanks again for your help

regards Doug
Dr. Nagler

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 #6 
Excellent. Sounds like you have all of your ducks in a row.

All the best with it -

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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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.