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smapti

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Posted  #1 
Hello Dr. Nagler - This is my very first post.  I have done a lot of searching (particularly tinnitus talk, which you suggest against doing - although I typically only do this when I am experiencing a spike).

For 25 years my tinnitus had maintained a steady tone - though some days I would think about it more than other days, it was relatively easy to handle, as I could get used to the sound.

I actually learned to make my tinnitus a "part of me" - kind of like a "friend", as I sometimes used it as a mindfulness meditation tool when I was thinking too much about other things (situations from the past, etc.), or even as a relaxation tool when sleeping at night (I found the cricket sounds that developed over time to be relaxing, as I enjoy listening to crickets at night).    

BUT as of recently (I would say within the past several months), it seems that my tinnitus unfortunately has developed into more of a "bully" than a "friend".  I have developed an extra tone in my left ear over top of the crickets, which at first could be described as a faint "morse code" sound, but has recently developed into what I describe as "oscillating ringing".  It's more of a steady tone than the morse code, but goes "in and out", almost like a sonar ping (but higher frequency).

To go even further, this does not maintain a steady tone 24/7, but changes to a really odd "hissing/sizzling" sound.  Sometimes the hissing can be faint (like now), and sometimes it can be loud.  But one thing is for sure:  it is not a stable sound, but is instead a choppy/intermittent sound.

I used to enjoy quiet spaces, and did very well with being in them.  I am an introverted, reflective person, and therefore value my quiet time very much (I hate noise).  Before it had been very easy for me to adjust, and had always enjoyed being in quiet .  But these days, unfortunately, the sizzling is quite bothersome to me, and is taking away something that I really valued in my life.

The worst part (I don't mean to sound pessimistic) is that it seems to be constantly changing (not maintaining a stable tone as before), and is therefore very hard to get used to. 

My questions:

(1)  I have been taking zoloft for almost 2 years (which I think has definitely been helping for anxiety - being afraid to be in quiet spaces, etc.)  Is there a chance that the Zoloft is causing this new tone and new hissing sound? If so, have you heard more positive outcomes from people who take Wellbutrin? 

(2)  I am now 41 years old.  I once heard William Shatner say that "it only gets worse with age".  Is it possible that my tinnitus has started to change after 25 years for no reason at all other than age? (after all, I protect my ears very well these days).

(3)  I'm wearing earplugs a lot lately as a result of noisy neighbors, airplane rides, etc. - as much as I LOVE them for turning down the volume when I need to, is it possible that wearing earplugs too tightly to eliminate noise is one of the culprits? 

(4)  According to other people you've spoken to in your sessions that have this same issue, what do you think might be the possible cause?

(5)  How can habituation / masking be possible if my tones are constantly changing?


Thanks for your advice!

 




Dr. Nagler

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Posted  #2 
Quote:
Originally Posted by smapti
Hello Dr. Nagler - This is my very first post.

Welcome to this site. I am sorry that you have need to find it, but I am glad it could be here for you.

Quote:
I have done a lot of searching (particularly tinnitus talk, which you suggest against doing - although I typically only do this when I am experiencing a spike).

Please allow me to emphasize just how strongly I feel about Tinnitus Talk. Elsewhere I have referred to it as a "repository of negativity, misinformation, pathology, and ignorance." And I go on to say, "I feel so strongly about this issue that if I were asked for the single best piece of advice I could offer any tinnitus sufferer in search of information and support, it would be to stay as far away as humanly possible from the Tinnitus Talk website." I am reminded of the story about the Ten Commandments, where God emphasizes that if they were merely suggestions, He would not have called them commandments. That is how serious I am about Tinnitus Talk. If I had the power to command tinnitus sufferers to avoid that site, I would do it! But suggest as I might, they are drawn to it like moths to a flame. 

Quote:
For 25 years my tinnitus had maintained a steady tone - though some days I would think about it more than other days, it was relatively easy to handle, as I could get used to the sound.

Interesting. I have had tinnitus for just as long as you, and I do not think I could ever get used to the sound. I have largely habituated it - but I am most certainly not used to it! One of the nice things about habituation is that when you have largely habituated your tinnitus, there is no need to get used to it or handle it - because you just don't care!

Quote:
I actually learned to make my tinnitus a "part of me" - kind of like a "friend", as I sometimes used it as a mindfulness meditation tool when I was thinking too much about other things (situations from the past, etc.), or even as a relaxation tool when sleeping at night (I found the cricket sounds that developed over time to be relaxing, as I enjoy listening to crickets at night).

Well, I applaud you there - and it certainly goes to show that there are many paths to relief. For me, the idea of making tinnitus my "friend" is utterly nauseating. Like with friends like that, who needs enemies??!! The best I can do is arrive at a place of ambivalence. But friendship? As I just said, I applaud you there!    

Quote:
BUT as of recently (I would say within the past several months), it seems that my tinnitus unfortunately has developed into more of a "bully" than a "friend".

I feel like I'm jumping all over you here - but I really just want to make sure we're on the same page. I can see how a disease or a pain might have the power to bully you. But a sound? Moreover a sound that is not associated with a sound wave? Tinnitus is real, but since it is not associated with a sound wave (i.e., it has no physical properties), it has no power of its own. All of the power that your tinnitus has over you (its power to bully you, for instance) must by process of elimination come from you. There is simply nowhere else it can come from! So if your tinnitus is acting like a bully, perhaps you should start thinking about ways you can take the power back that you have unwittingly given away!

Quote:
I have developed an extra tone in my left ear over top of the crickets, which at first could be described as a faint "morse code" sound, but has recently developed into what I describe as "oscillating ringing".  It's more of a steady tone than the morse code, but goes "in and out", almost like a sonar ping (but higher frequency).

To go even further, this does not maintain a steady tone 24/7, but changes to a really odd "hissing/sizzling" sound.  Sometimes the hissing can be faint (like now), and sometimes it can be loud.  But one thing is for sure:  it is not a stable sound, but is instead a choppy/intermittent sound.

Got it.

Quote:
I used to enjoy quiet spaces, and did very well with being in them.

Here's an experiment. Go to one of the "quiet spaces" you used to enjoy, and take a decibel meter with you. (You can download a decibel meter app to your smartphone, if you like. No need to be ultra precise for this experiment.) Now if you check the dB level in your typical quiet space, I'm willing to bet that it reads in the neighborhood for 40dB or so. In other words, quiet isn't really quiet after all. What happens is that your brain codes all that noise in your quiet spaces as quiet. And guess what? Your brain has the power to code your tinnitus as quiet as well through a process known as neuroplasticity.

Quote:
I am an introverted, reflective person, and therefore value my quiet time very much (I hate noise).  Before it had been very easy for me to adjust, and had always enjoyed being in quiet .  But these days, unfortunately, the sizzling is quite bothersome to me, and is taking away something that I really valued in my life.

Yea, pretty much sounds like most of the tinnitus sufferers whom I used to see in my clinic before I retired. They think their particular situation is in some way unique and they really value their quiet time. I'm not yanking you around here - I used to feel that same way myself!

Quote:
The worst part (I don't mean to sound pessimistic) is that it seems to be constantly changing (not maintaining a stable tone as before), and is therefore very hard to get used to.

Well, if you wanted "easy," in tinnitus you have absolutely chosen the wrong condition! :-)  

Quote:
My questions:

(1)  I have been taking zoloft for almost 2 years (which I think has definitely been helping for anxiety - being afraid to be in quiet spaces, etc.)  Is there a chance that the Zoloft is causing this new tone and new hissing sound?

No, not if you've been on it for so long.

Quote:
If so, have you heard more positive outcomes from people who take Wellbutrin?

The key to a positive outcome lies within you, not in a medicine bottle.

Quote:
(2)  I am now 41 years old.  I once heard William Shatner say that "it only gets worse with age".

Any you believed him? Why? What makes Shatner an authority? Because he used to be the captain of a starship? :-)

Quote:
Is it possible that my tinnitus has started to change after 25 years for no reason at all other than age?

I do not know with 100% certainty what caused your tinnitus to change. I often say that the first step to overcoming your tinnitus is when you have finally figured out that you cannot figure it out at all. Seems to me that you are still in the trying to figure it out stage. And, by the way, longitudinal data collected from older patients who have tinnitus suggest that over time it gets better, not worse. So take that, Captain Kirk!

Quote:
(after all, I protect my ears very well these days).

Bad idea, in my opinion. Read on.

Quote:
(3)  I'm wearing earplugs a lot lately as a result of noisy neighbors, airplane rides, etc. - as much as I LOVE them for turning down the volume when I need to, is it possible that wearing earplugs too tightly to eliminate noise is one of the culprits?

I think that more likely than not, your earplugs are THE culprit. You are denying your auditory system the sounds it thirsts for. And the result is that your auditory system tries harder and harder to do what it was designed to do in the first place: to hear. So your brain "turns up the gain" in an attempt to access any sounds available to it, which serves only to magnify the sounds you create internally, your tinnitus. That is why, in my opinion, your tinnitus has become louder and has changed in character, timbre, pitch, pattern, etc. At least that's my best guess from afar. There are other possibilities - so you should certainly have a thorough ENT evaluation - but I'd put my money on overprotection.

Now you can't just stop wearing earplugs cold turkey, but I do think that a gradual purposeful approach is indicated with an eye towards eventually getting to the point where you only wear ear plugs when you are in environments such that you must raise your own voice in order to be heard by those around you (because environments that loud pose potential damage). I myself wear earplugs only at extremely loud sporting events and the occasional rock concert.

Quote:
(4)  According to other people you've spoken to in your sessions that have this same issue, what do you think might be the possible cause?

See above.

Quote:
(5)  How can habituation / masking be possible if my tones are constantly changing?

Habituation and masking are two different things. In terms of masking, you set the masker at whatever band and loudness will cover your tinnitus at the time you wish to mask it. Habituation, however, is all about reaction. The tinnitus sounds themselves are largely irrelevant.

Quote:
Thanks for your advice!

You are welcome.

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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