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jazzguitarist

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 #1 

Hi Dr. Nagler,

I play jazz guitar semi-professionally.  Last September for a performance in an organ/guitar/drums trio, I hired a different drummer than I usually do, which turned out to be a mistake.  He was significantly louder and harder-hitting than my usual drummer, and I wasn’t wearing plugs, assuming the volume level would be the same as it usually is.  The next morning, I noticed diminished hearing and a sense of fullness in my right ear, the side where the drummer was.  Initially, I chalked it up to allergies, but after it didn’t go away, I saw an ENT.

He said that everything looked OK with my eardrums / Eustachian tubes / tympanogram and that I probably had an acoustic trauma and experienced some noise-induced hearing loss.  I now have a very mild noise notch in my right ear — 15 dB threshold as opposed to 5 dB threshold on my left.  (I had an audiogram a year or two before the event, and they used to be equal.) 

The problem is that six months after this event, I still feel fullness and tension in my right ear, and with it comes a perception of decreased loudness.  The feeling comes and goes — if I get a good night’s rest, I’ll often have good hearing in the morning, but by the end of the day, I’ll have tension in my right ear all the way down to my right shoulder.  Additionally, when I hear bright sounds or sibilance sounds that fall in the range that was damaged, it feels like my right ear will "seize up".  This is very frustrating to me, since I’ve always had a very fine-tuned sense of hearing, and I feel like I can’t trust my ears to locate sounds any more.  As a result, listening to music is often frustrating rather than pleasurable.

Does this sound like tonic tensor tympani syndrome?  If so, what’s the treatment?  If not, what else might it be?

Thanks!

Dr. Nagler

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 #2 
Hello jg -

I am sorry that you are having a difficult time of it, especially given the important role that music plays in your life.

As I read your post, it seems to me that TTTS may well represent an explanation for your symptoms, but to be very honest with you this sort of thing is really not in my wheelhouse. Let me look into it a bit so as not to lead you astray, and kindly check back in a few days when hopefully I'll have a bit more information for you.

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

No bird ever soared in a calm. Adversity is what lifts us.
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David McCullough quoting Wilbur Wright
Dr. Nagler

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 #3 
Still working on it, jg. Stay tuned.

If you don't mind, what is the nearest city to your home?

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
jazzguitarist

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 #4 
Hi Dr. Nagler,

Thanks so much for your response!

I live in Austin, TX.
Dr. Nagler

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 #5 
jg, I copied your inquiry to a couple of my colleagues whose opinions on TTTS I hold in particularly high regard. One of them is away for a few weeks; when I hear back from her, I will post her thoughts. I am posting the other's comments below (with his permission).

  • It doesn’t sound like tensor tympani syndrome to me.  He should have his loudness discomfort levels checked to see if his tolerance of sound is within normal range.  Perhaps his additional hearing loss has to do with a single exposure to loud drums or perhaps it is cumulative.  Since he has hearing loss, what does he mean when he says he often has good hearing after a good night’s sleep?  I’m not clear what he means by his ear seizing up, that he feels tension in his ear, or that he has a hard time locating sounds.  Is he saying he can’t hear sounds, he can’t tell what direction they are coming from, or something else?  What does the tension feel like?  Does it hurt?

You will see that your inquiry raises a number of additional points that should be considered. And obviously all of that should be done in conjunction with a proper examination. Fortunately there is a very knowledgeable neurotologist in Austin, Dr. Patrick Slater, who should be able to evaluate you, arrive at an accurate diagnosis, and outline your treatment options based upon that diagnosis. So I think that should be your next step.

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
Dr. Nagler

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 #6 
Hello jg -

I just now heard from Myriam Westcott, an Australian audiologist who is one of the world's leading authorities on TTTS. Myriam has been away from her clinic for the past six weeks, which accounts for her delay in responding to the inquiry. Here is what she writes:

The diminished hearing and the sense of fullness after exposure to the loud drumming is consistent with TTTS developing as an involuntary ‘threat’ response to that sound. I don’t consider a hearing threshold shift from 5dB to 15dB to constitute significant damage, and a 15 dB threshold is still within the normal range of hearing. The persistent symptom cluster of fluctuating fullness/tension in that ear, radiating to the arm, with decreased hearing, triggered by tiredness/stress and certain sounds are all consistent with TTTS. This indicates that exposure to those sounds, enhanced by tiredness, remains a continued threat to you as a musician.

In my experience, this reaction triggering these symptoms are common in musicians who are understandably anxious about the potential for damage to their hearing. My advice is to:

  • protect your hearing appropriately
  • be reassured that your persistent TTTS symptoms are not indicative of any ongoing damage to your ears/hearing
  • acknowledge/accept/understand your involuntary ‘threat’ response
  • try not to monitor the TTTS symptoms
  • work on stress management strategies
  • give it more time
  • and continue to enjoy playing and listening to music!

Hope this helps,

Kind regards,

Myriam Westcott
Audiologist, Director
dineen westcott moore
74 Mount Street, Heidelberg 3084
Tel: 03 9457 6588
Fax: 03 94576833
http://www.dineenwestcottmoore.com.au


__________________

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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