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dr.g

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Hello Dr. Nagler,

I searched through your previous Q&As and did not find this topic so thought I would pose it, after a quick update.

I had my 3 week ENT F/U since onset of tinnitus. Have been having a rough go of it -- the last week or so have had a string migraines (every other day) when I usually only have 1 or 2 per year, tops. One necessitated a visit to the ED it was so severe. I am trying to live my life as usual but struggling. I find myself reacting to the tinnitus with panic attack and overall anxiety/depression. I am in the process of credentialing for a new job and really having a rough time proceeding with these health issues. Will be seeing my GP this next week to discuss SSRIs, therapy options. As of now, Xanax has been the most helpful treatment. I downloaded the Henry and Wilson book and will start working through it when my headache allows. 

My ENT ordered a brain MRI, with and without contrast, and is referring me to a neuro-otologist. Given that I have bilateral tinnitus without hearing loss, the pre-test probability is pretty low for finding anything abnormal (tumor, vascular abnormality, etc) though the combination of severe migraine with tinnitus drove the equation. I am a curious person by nature and do wonder if there may be some inflammatory process behind this, however unlikely. I think it will be reassuring to know there is nothing sinister. As we discussed in my prior thread, I have tinnitus that is sound-sensitive and decreased sound tolerance. I have had many MRIs in past, including brain, yet none while having hearing problems. I do recall the brain scan being the loudest of the lot. I am nervous about making my already miserable situation worse with this MRI. I have NRR 33 rated earplugs that I plan to wear during the scan and am curious to know your opinion as to whether the ear plugs, properly fitted, will be sufficient to prevent any noise-related damage and exacerbate the tinnitus/DST?

Best,

Dr. G
Dr. Nagler

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 #2 
Quote:
Originally Posted by Dr. G
I had my 3 week ENT F/U since onset of tinnitus. Have been having a rough go of it -- the last week or so have had a string migraines (every other day) when I usually only have 1 or 2 per year, tops. One necessitated a visit to the ED it was so severe. I am trying to live my life as usual but struggling. I find myself reacting to the tinnitus with panic attack and overall anxiety/depression. I am in the process of credentialing for a new job and really having a rough time proceeding with these health issues. Will be seeing my GP this next week to discuss SSRIs, therapy options. As of now, Xanax has been the most helpful treatment. I downloaded the Henry and Wilson book and will start working through it when my headache allows.

I really want to restrict this board to a Q&A format. But as far as your last comment goes, all I can say is that if you are unable spend 15-30 minutes a day working through a book, then with all due respect the problem is not your every-other-day migraines. Rather, the problem is that working your way through the book is not high enough on your priority list. And that is perfectly fine - please just be honest with yourself about it.

Quote:
My ENT ordered a brain MRI, with and without contrast, and is referring me to a neuro-otologist. Given that I have bilateral tinnitus without hearing loss, the pre-test probability is pretty low for finding anything abnormal (tumor, vascular abnormality, etc) though the combination of severe migraine with tinnitus drove the equation. I am a curious person by nature and do wonder if there may be some inflammatory process behind this, however unlikely. I think it will be reassuring to know there is nothing sinister. As we discussed in my prior thread, I have tinnitus that is sound-sensitive and decreased sound tolerance. I have had many MRIs in past, including brain, yet none while having hearing problems. I do recall the brain scan being the loudest of the lot. I am nervous about making my already miserable situation worse with this MRI. I have NRR 33 rated earplugs that I plan to wear during the scan and am curious to know your opinion as to whether the ear plugs, properly fitted, will be sufficient to prevent any noise-related damage and exacerbate the tinnitus/DST?

The ear plugs will certainly be sufficient to prevent any noise-related damage. As to whether they will prevent an exacerbation of tinnitus or DST, no way to know for sure, but I honestly wouldn't give it another thought. Why? Because if you start conducting your life trying to avoid anything and everything that while not causing auditory damage might still possibly result in an exacerbation of your tinnitus or DST, you will be slowly painting yourself into a corner from which there is no escape. As I see it, anyway.

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.
- Mahatma Gandhi
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