Dr. Nagler's Tinnitus Corner
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theclagster

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 #1 
Hi Dr N,

I am a huge admirer of you and your dedicated support to Tinnitus sufferers. You are a true altruist and humanitarian.

I have had T for 4 years and have adjusted well. 5 weeks ago I too my best friends nephew to a darts exhibition with Gary Anderson 2 time world champ. He's 14 and autistic but loves darts so I was doing my bit.

I am always careful around sound and wore my earplugs ( I have T in the left ear only)

I was in there for roughly 25 mins and the MC was announcing scores through a loud speaker.

Since then and for last 5 weeks my Tinnitus has shot up in loudness and reaches very high levels when driving in the car etc. It wasn't doing this before. The last 5 weeks have been very tough for me. 

I know I wasn't there long enough to damage my auditory system but the Neurons firing the Tinnitus were aggravated and are now doing twice the work they were.

I am not thinking too emotionally here I am just wondering in your vast experience if such increases eventually come back down?

Many thanks in advance

Robert (Dublin Ireland)
Dr. Nagler

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 #2 
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Originally Posted by Robert
I am a huge admirer of you and your dedicated support to Tinnitus sufferers. You are a true altruist and humanitarian.

Thank you for the kind words. I am glad to be in a position to make some small difference in people's lives. But that said, I wish I'd never heard of the word "tinnitus," not unlike everybody else who visits this site, I suppose.

Quote:
I have had T for 4 years and have adjusted well. 5 weeks ago I too my best friends nephew to a darts exhibition with Gary Anderson 2 time world champ. He's 14 and autistic but loves darts so I was doing my bit.
I am always careful around sound and wore my earplugs ( I have T in the left ear only)
I was in there for roughly 25 mins and the MC was announcing scores through a loud speaker.
Since then and for last 5 weeks my Tinnitus has shot up in loudness and reaches very high levels when driving in the car etc. It wasn't doing this before. The last 5 weeks have been very tough for me. 
I know I wasn't there long enough to damage my auditory system but the Neurons firing the Tinnitus were aggravated and are now doing twice the work they were.
I am not thinking too emotionally here I am just wondering in your vast experience if such increases eventually come back down?

Well, there are several variables at play, but since there is no way that you suffered any auditory damage, I would say that the chances are decent that in time things will settle back down for you. And even if they don't, you will likely accommodate to your new level of tinnitus in the same manner you did to your "pre-dart" tinnitus.

Let me ask you these questions: How long was it after you left the darts exhibition that you noticed the increase in tinnitus loudness? Is your tinnitus still in one ear or is it in both ears? How long did you keep the earplugs in after you left the exhibition? Did you plug both ears or only your tinnitus ear during the exhibition?

Also, I am not all that sure that the "Neurons firing the Tinnitus" are doing any more work than they were before. But more about that after you answer my questions above.

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
Dr. Nagler

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 #3 
Robert's responses [sent to me via e-mail and posted with his permission]:

How long was it after you left the darts exhibition that you noticed the increase in tinnitus loudness?

I instantly noticed - The T had increased in speed and was producing electrical sounds like crazy.  The best way that I can describe it is that the ear seemed really mad and was producing all this sound in outrage. It still feels like this.

Is your tinnitus still in one ear or is it in both ears? 

1 ear

How long did you keep the earplugs in after you left the exhibition? 

An hour or so

Did you plug both ears or only your tinnitus ear during the exhibition?

Both ears plugged

 
...................

So here is my thinking ...

No damage was done to your auditory system. That is for sure.

I believe that the most likely scenario is that you had a lingering concern (possibly subconscious) about the noise level at the dart exhibition that resulted in a reflex increase in tinnitus loudness. Leaving your ears plugged for an hour after you left was well-intended but unfortunate - because that forced you to listen to your exacerbated tinnitus in a relatively silent environment, thereby compounding the problem. And once that happened, your emotional and fight-or-flight pathways took over. That's my best guess, anyway.

My suggestion would be to avoid very quiet environments just as compulsively as you avoid very noisy environments. Avoid plugging unless the sound in the environment is so loud that you must raise your own voice in order to be heard by a person standing next to you.

Remember: How loud your tinnitus sounds to you is a function not only of those "Neurons firing the Tinnitus" (to use your phrase) but also of the manner in which the non-auditory pathways (emotion, fight-or-flight, etc.) act upon the signal emitted from those neurons. I honestly think that the latter is a greater factor at this point than the former, and I suspect all will return to baseline in time as long as you avoid the temptation to overprotect your ears.

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
theclagster

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 #4 
Hi D Nagler,

Just a quick replay to whats been going on these passed few weeks. The Tinnitus has remained the same - However daily I seem to feel a bit better each day about it. My question is one about protection. As I work in a capital city (Dublin) there are a multitude of noises that could catch me by surprise therefore when I am out an about I usually wear foam earplugs. I was thinking of switching to musicians earplugs as the foam ones may be OTT.

Could you please comment. Sounds can instantly appear at dangerous levels in the city so when going from A to B i do protect. Will musicians earplugs suffice.

Many thanks

Robert
Dr. Nagler

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 #5 
Quote:
Originally Posted by Robert
Just a quick replay to whats been going on these passed few weeks. The Tinnitus has remained the same - However daily I seem to feel a bit better each day about it. My question is one about protection. As I work in a capital city (Dublin) there are a multitude of noises that could catch me by surprise therefore when I am out an about I usually wear foam earplugs. I was thinking of switching to musicians earplugs as the foam ones may be OTT.

Could you please comment. Sounds can instantly appear at dangerous levels in the city so when going from A to B i do protect. Will musicians earplugs suffice.

Thank you for your very good question, Robert.

Please clarify something for me. Are you using plugs for the purpose of avoiding auditory damage or for the purpose of avoiding an increase in the loudness of your tinnitus?

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
theclagster

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 #6 
Hi Dr Nagler - I suppose both. Firstly to avoid an increase in Tinnitus - Which has happened to me from noise which could no way be damaging before and secondly auditory damage which would happen at higher sound levels.  

Many thanks

Robert
Dr. Nagler

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 #7 
This issue is a bit complex, Robert.

Let me start by telling you the obvious: your auditory system exists to hear.

And now perhaps the not-so-obvious: everything you do that causes it to hear less - like wearing earplugs when they are not absolutely necessary - makes your auditory strain to hear more. The unfortunate consequence of this straining lies in the fact that when you remove the earplugs. sounds that were moderately loud before now tend to sound intolerably loud ... so you naturally want to put your earplugs back in. The result over time of this pattern of overprotection is hyperacusis. And more than that, overprotection tends to make your tinnitus sound louder because you lose the partial masking effect provided by those external sounds that are no longer accessible because of the earplugs.

So the use of earplugs comes at a price!

Given that earplugs should not be worn with impunity, we now turn to the question of when they should be worn - in other words when the advantages of wearing them outweigh the disadvantages.

So first let's look at the use of earplugs to avoid auditory damage. Well, I've already given you that guideline: "Avoid plugging unless the sound in the environment is so loud that you must raise your own voice in order to be heard by a person standing next to you." And regardless of where you live - Dublin, Atlanta, New York City, wherever - it is rare that you encounter sounds that lastingly exceed that threshold. Sure, if you are a riveter or if you are using a power mower, you should be using ear protection. But how about as you walk around in the city? Given the downside to unnecessarily plugging, I would not recommend inserting plugs "just in case" you encounter a sound that exceeds the threshold. Rather, if you find yourself on a street corner with a fire engine screaming by (or some such thing), simply cover your ears until the fire engine passes. Remember, auditory damage is a function of both the dB level of the offending noise and the length of time you are exposed to that noise. What about those sounds that do not exceed the threshold but that are uncomfortably loud to you? The reason they are uncomfortably loud is likely because of the hyperacusis you have developed over time by virtue of your overprotecting your ears! My suggestion? Gradually wean yourself off of using earplugs unnecessarily. Now I am about ready to leave my home and head to the Atlanta United vs NY Red Bulls soccer match where there will be some 70,000 screaming fans - and, of course, I will be wearing my earplugs. But it will be my first time wearing plugs in at least six months! Why wear them at the game? Because I know that if I don't, I will be exposing my auditory system to prolonged noise above the threshold!

......

Hooray!!! Atlanta United won 3-0 in front of just over 70,000 fans. The dB rating was often over 105 and was consistently over 95, but I was totally fine with my earplugs - both from a comfort standpoint and from the standpoint of knowing that the crowd noise would not be causing any auditory damage. I brought some extras for those around me as well! What about all the folks in the stadium who did not wear earplugs? I figure I can't fix the world. I just do my best to improve a little part of it!

Now, to your question about the effect of unexpected city noises on your tinnitus. And I'm not sure you are going to care for this response, Robert, but here goes anyway ...

It is virtually impossible to live a fulfilling, productive, and enjoyable life if you are going to conduct your day trying to avoid anything and everything that might - just might - exacerbate your tinnitus. That would include various foods, that would include fatigue, that would include stress, that would include atmospheric changes, and that would also include the sudden noises you might encounter in public. My friend, when you conduct your life around your tinnitus, you are giving your tinnitus far more credit than it deserves. If you treat your tinnitus like it is more than "just a sound," well that is what makes it more than just a sound. I know, I know. Your tinnitus IS more than just a sound to you. I totally understand that. Your tinnitus has incredible power over you at this point in time. But the fact of the matter is that 100% of the power your tinnitus has over you comes from you. Your tinnitus is not associated with a sound wave, which means that no matter how loud your tinnitus sounds, it cannot possibly cause you any physical harm. So since all of the power your tinnitus has comes from you, I respectfully suggest that it might be time for you to gradually take that power back. It is certainly not your fault that you gave it away - you did that unwittingly - but you can absolutely take it back.

What type of earplugs should you wear in the streets of Dublin? Eventually I hope it will be none! Unless you're a riveter, that is. :-)

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
theclagster

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Posts: 12
 #8 
Many thanks Dr. Much appreciated
Dr. Nagler

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Posts: 1,599
 #9 
Quote:
Many thanks Dr. Much appreciated

Glad to help.

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.