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Gilly6864

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 #1 
hello dr nagler!  hope all is well with you and your family!  you are an inspiration and thank you for your time! 
1) i was wondering how loud can tinnitus get? has there been any data collected on the loudness? or does tinnitus have a certain cut-off point? very loud noise can rupture ear drums so i was wondering if T ever gets that loud?  i know loudness means nothing when it comes to T but i was just curious.
2)if tinnitus stays the same in volume then why does the brain trigger a response that makes it seem unbearable on some occasions? i think i remember reading somewhere that your T had changed in tone to a point where you thought it was louder than your already intrusive T but upon closer examination the volume never changed it was just the pitch. 
3) how common is fleeting tinnitus in people who don't have 24/7 T?
4) if you have hearing loss and can only hear T at 90db but you hear nothing for the first 80db would this sound loud to a T suffer as compared to someone hearing 90db w perfect hearing?  i would assume the perfect hearing guy would be in agony because he hears the full volume as compared to a person w hearing loss of 80db.  dont have a clear understanding of this.
5)when you started TRT how long did it take before your life changed for the better?

thank you for your time!!
Dr. Nagler

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 #2 
Hi Gilly -

That's quite a series of questions. I'll give it my best shot.

You wrote:

i was wondering how loud can tinnitus get? has there been any data collected on the loudness? or does tinnitus have a certain cut-off point?

When measured under controlled conditions by audiologists experienced in tinnitus pitch and loudness matching, tinnitus typically measures 10dB or less over the threshold of hearing at the tinnitus frequency. And we are talking here about a series of 1630 individuals whose tinnitus was bothersome enough for them to seek evaluation and treatment at a university tinnitus center. Now I know that intrusive tinnitus generally sounds incredibly loud, but when carefully measured it is actually a rather small signal. The mechanisms whereby such a small signal can be perceived as such a loud sound have been looked at exhaustively, but suffice it to say that they fall under the umbrella of what is known as "central auditory processing."

................

very loud noise can rupture ear drums so i was wondering if T ever gets that loud?

The reason that very loud noise from an external source can rupture ear drums has to do with the mechanical injury caused by the sound waves from which the loud noise originates. Tinnitus does not originate as a sound wave - so matter how loud it is, tinnitus can do no physical damage to any part of the auditory system.

...............

i know loudness means nothing when it comes to T but i was just curious.

Well I don't know anybody with intrusive tinnitus who wouldn't prefer it if his or her tinnitus were less loud - so I wouldn't exactly agree that loudness means nothing. That said, the primary determinant of tinnitus severity is not loudness, but rather reaction (i.e., how you react to your tinnitus regardless of its loudness). The problem is that we have no conscious control over how we react to our tinnitus; if we did, life would certainly be much simpler!

.................

if tinnitus stays the same in volume then why does the brain trigger a response that makes it seem unbearable on some occasions?

I don't think anybody knows, Gilly. If you are trying to somehow figure out your tinnitus, well good luck with that one! I have often said that the first step in overcoming your tinnitus comes when you have figured out that you can't figure it out at all ... so you stop trying and begin looking at other strategies.

....................

how common is fleeting tinnitus in people who don't have 24/7 T?

I recall attending a tinnitus conference along with a couple of hundred audiologists, ENTs, and other healthcare professionals several years ago where the speaker was interested in just that question. So first he asked how many people in the audience had tinnitus - and as you would expect around 20% of the people in attendance raised their hands. He then described "fleeting tinnitus" without calling it that (i.e., a sporadic high-pitched sound in one or both ears that completely fades away within 20-30 seconds of onset), and asked how many in the audience experienced that phenomenon. Almost every hand in the room was raised.

So the answer to your question is that fleeting tinnitus is a very common auditory phenomenon in the general population, a phenomenon that has no clinical consequence whatsoever.

..............

if you have hearing loss and can only hear T at 90db but you hear nothing for the first 80db would this sound loud to a T suffer as compared to someone hearing 90db w perfect hearing?  i would assume the perfect hearing guy would be in agony because he hears the full volume as compared to a person w hearing loss of 80db.  dont have a clear understanding of this.

In order to get a better understanding it will help to keep in mind that in tinnitus loudness matching we are talking about matching tinnitus loudness to the loudness of an external sound introduced to the audiology booth as you hear it. Thus, if it takes 90dB of external sound for a fellow with an 80dB threshold of hearing to match his tinnitus, his loudness match is actually only 10dB - more properly written as 10dB SL (10db sensory level). In your second example the perfect hearing guy would indeed have a loudness match of 80dB SL - but going back to my response to your first question, the typical loudness match is 10dB SL or less. Indeed I have never seen a properly conducted loudness match any greater than 16dB SL, so the premise of your question really makes no sense in real life.

..............

when you started TRT how long did it take before your life changed for the better?

The results vary along with the pattern of recovery/habituation. Some people notice significant improvement as early as three months. Some improve very gradually over time. For me, there was no improvement for about a year ... but then things took off like a rocket, and within three or four more weeks I was fine. I still had loud screaming tinnitus, of course, but I was fine.

..................

thank you for your time!!

You are welcome.

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
Gilly6864

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 #3 
Thank you for your responses! So the big question is when you have severe intrusive tinnitus the key is to train the mind to overcome the automatic emotional response that the noise triggers? What gets me is that noise techniques have been used to torture individuals where they were driven to insanity. However, someone with intrusive T can live a happy life through the right techniques! At first glance it seems almost impossible but your a true living example! Thank you!
Dr. Nagler

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 #4 
Quote:
Originally Posted by Gilly
Thank you for your responses!

You are welcome.

Quote:
So the big question is when you have severe intrusive tinnitus the key is to train the mind to overcome the automatic emotional response that the noise triggers?

No. The key is to retrain the brain to overcome the autonomic protective response that the noise triggers.

Quote:
What gets me is that noise techniques have been used to torture individuals where they were driven to insanity.

Noise techniques can help or noise techniques can torture. Just like fire can be used for warmth or fire can be used to burn down a house. What is surprising about that?

Quote:
However, someone with intrusive T can live a happy life through the right techniques!

The way I see it, through using the right strategies intrusive tinnitus becomes less and less intrusive, thereby allowing one to live a happy life.

Quote:
At first glance it seems almost impossible but your a true living example!

Me and thousands of others like me who sought out a knowledgeable and experienced TRT clinician and did what that TRT clinician said to do. Unfortunately there are a number of TRT clinicians who are not particularly knowledgeable and experienced - so some due diligence is involved in finding somebody who is - but why folks who are truly suffering sit around month after month posting on repositories of ignorance like Tinnitus Talk instead of doing what I myself did when I was in their shoes totally confounds me.

Quote:
Thank you!

Glad to help.

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi
Gilly6864

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 #5 
Thanks for the responses DR!!  just curious:  what prevents TRT from being close to 100% effective? Is it because not every trt clinician is dong it the right way or is it the individual?  In your practice what would be the percentage of people that have habituated and return to normal life?  This seems like the best option when it comes to T; habituating to the noise! thank you!
Dr. Nagler

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 #6 
Quote:
Originally Posted by Gilly
Thanks for the responses DR!!

You are welcome.

Quote:
just curious:  what prevents TRT from being close to 100% effective? Is it because not every trt clinician is dong it the right way or is it the individual?

In order to answer that question, I would need to know what exactly you mean by "effective."

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi
Gilly6864

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 #7 
Hello dr nagler! By effective I was looking at it in terms of people living happy normal lives without using sleep aids and or medication. Not being bothered by the noise. Hope this answers the question!
Dr. Nagler

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 #8 
Quote:
Hello dr nagler! By effective I was looking at it in terms of people living happy normal lives without using sleep aids and or medication. Not being bothered by the noise. Hope this answers the question!

Yes, Gilly, you have answered my question. But your answer to my question in many ways points to how difficult it is for me to answer yours; indeed, how difficult it is for anybody to measure efficacy of treatment protocols such as TRT that do not purport to cure tinnitus but rather that seek to mitigate tinnitus-related distress. For instance, you are attempting to define TRT efficacy in terms of people living happy normal lives after TRT, but what about those who did not live particularly happy normal lives before tinnitus? Do we just throw them out of the equation? And the idea of "not being bothered by the noise" is difficult as well. Do you mean never ever being distracted, even for a moment? I ask because a diamond cutter or neurosurgeon who is rarely but unpredictably distracted by his or her tinnitus after TRT would likely have to change careers whereas an interior designer or chemical engineer 
who is rarely but unpredictably distracted by his or her tinnitus after TRT would consider himself or herself all-but-cured. Or how about the person who is largely bedridden due to his tinnitus-related distress prior to TRT and now after TRT is bothered to some degree or other perhaps 5% of the time? That person would not meet your "not being bothered" standard - but he or she would be totally thrilled.

So let me answer this way ...

TRT is highly clinician-dependent, and if after TRT an individual is not pleased with his or her outcome, then in my opinion it is likely the fault of the clinician. And when it is not the fault of the clinician, I think it grossly unfair to lay the blame at the feet of the patient. Sometimes in spite of a patient's being fully cooperative and in spite of his or her clinician's being knowledgeable, experienced, and totally committed, things simply do not work out.

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi
Gilly6864

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 #9 
Thanks dr nagler! That wasn't a very clear question by me. I was thinking if you overcame intrusive tinnitus after being bed ridden with the complications of T and now your living a very productive and happy life I figured trt would be highly successful with many T suffers. Any noise can distract even a non T person so I understand that logic. It just seems that people are just getting by w T and not willing to take the leap into Trt therapy. I guess if I had intrusive T like yours TRT would be the first option. I was just curious on why trt wouldn't work with others and whether it worked a second or third time around. Thanks for your time and I apologize for the confusion.
Dr. Nagler

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 #10 
Quote:
Thanks dr nagler! That wasn't a very clear question by me. I was thinking if you overcame intrusive tinnitus after being bed ridden with the complications of T and now your living a very productive and happy life I figured trt would be highly successful with many T suffers.

I did indeed, but I had an extremely knowledgeable and experienced TRT clinician. I am very comfortable in stating that it is highly unlikely that I would have experienced the same incredibly gratifying result in the hands of the vast majority of individuals who call themselves TRT clinicians today. As I took pains to point out in my article Tinnitus Retraining Therapy - there is no standardization or credentialing in TRT. And as I see it, that is a huge problem.

Quote:
Any noise can distract even a non T person so I understand that logic.

Right, but a "non T person" can avoid distraction if he or she chooses to do so.

Quote:
It just seems that people are just getting by w T and not willing to take the leap into Trt therapy.

Considering the lack of credentialing/standardization in TRT and adding in all the inaccurate bull spit you read about TRT on various sites, can you really blame them for feeling that way?

Quote:
I guess if I had intrusive T like yours TRT would be the first option.

TRT done right would be the first option. In my opinion anyway.

Quote:
I was just curious on why trt wouldn't work with others and whether it worked a second or third time around. Thanks for your time and I apologize for the confusion.

Not a problem. I hope my responses did not serve merely to compound that confusion!

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.