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Brant

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 #1 

Hello Dr. Nagler.

 

First, I would like to say that I have great admiration for all that you've gone through and all you've done to help others. You are truly an inspiration for me, I really mean that.

 

Nearly a week before Christmas, I developed extremely intrusive tinnitus in my right ear. It was like a low hum in my ear, but was very loud, and launched me in to a week long panic. After five days, the loudness faded almost as quickly as it appeared, but left behind very quiet sounds that seem to be ever changing.

 

First it was a quiet ringing, then an even quieter ringing joined by an obnoxious but soft bassy hum, and then the ringing became nearly unnoticeable (I can only barely hear it if I plug my ears) but the bassy hum is now joined by a quiet, distant hiss, possibly in both ears. The bassy hum doesn't seem to be present at all if there is certain background noise. At this point, I almost wonder if these noises have always been with me, and that the trauma of the initial loud tinnitus has just made me hyper aware.

 

I've gone to the ENT, and learned that I have minor high frequency hearing loss. I'm currently on prescription flonase due to the possibility of it being a Eustachian tube issue. During my panic attack, I took a trip to the ER and had a CT scan, which also found nothing.

 

So, I think it's safe to say at this point that not only is my tinnitus not life threatening, it's also almost as minor a case of tinnitus as it can get, as far as volume goes. And yet the amount of anxiety it is causing me is hard to overstate. I am always trying to retreat from the sound with masking (usually with music and streams on twitch), but the fact that I know I will have to hear it again eventually is always hovering over my head.

 

I am always wondering, "What new sound will I hear? What if it gets loud again? What if my ears start ringing very loud, and just never stop?" Some nights are okay, some are very bad and the stress keeps me up. The only thing that makes me feel better about this is knowing how much worse off I could be - in tinnitus and everything else! And yet the former thought just ends up making me worry more, because I feel like I'm at a risk now of randomly developing extremely loud tinnitus. I don't how I would handle that.

 

I don't know what to do, Dr. Nagler. I've never felt this kind of anxiety before, it's debilitating. I don't know if it's healthy to be trying to mask these noises all the time, running away from something that might always be with me or get WORSE. I don't know if I should seek out CBT or TRT or just a therapist at all. I don't know if I'm overreacting or worrying about this too early. I don't know if I should be treating this as seriously as someone who is suffering from extremely intrusive tinnitus.

 

Is there any advice you could offer me here? I actually feel guilty for even asking, given how much worse I know things could be for me.

Dr. Nagler

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 #2 
Thank you for your very interesting and compelling post.

Yes, interesting and compelling.

Why? Because you have severe intrusive tinnitus. You just don't realize it because your severe intrusive tinnitus is not particularly loud. One commonly equates loudness with severity, but that is so incredibly wrong and counterproductive. No, the primary determinant of severity is reaction (i.e., the extent to which your tinnitus affects your life, regardless of how loud it might be), which makes your tinnitus quite severe indeed. Moreover, you have no conscious control over how you react to your tinnitus. You cannot make yourself not react to your tinnitus. As a matter of fact, trying not to react to your tinnitus is a prescription for failure right from the start. Go ahead, close your eyes and try not to think of a pink elephant. Doesn't work, does it?

So the best advice I can offer you is to acknowledge that your tinnitus is severe. Maybe that will take some off of the pressure to overcome it so quickly.

Next, I think you should work on identifying and eliminating your Barriers to Habituation. And perhaps take a look at my Letter to a Tinnitus Sufferer.

Hope this helps.

Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC

__________________

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
Brant

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 #3 

Hello, Dr Nagler. Thank you for your quick reply.

 

I suppose if I'm thinking of my condition as severe and intrusive, then I should seek out treatment as such. After thinking about it for a while with this in mind, I had three questions that I hope you don't mind answering.


1) If I decided to go the TRT route, do you have a specialist in my area who you'd personally recommend? I am in Virginia Beach, Virginia.

 

2) This is causing me such anxiety that I think I may speak to a family therapist. If they recommend anxiety medication to help me manage, would that interfere with CBT or TRT to any great degree?

 

3) I have downloaded Tinnitus: A Self-Management Guide for the Ringing in Your Ears by Jane Henry and Peter Wilson. Is this a good supplement to TRT, or are the strategies within it counter to those provided by TRT as you would recommend it?

 

Again, thank you for your time and all that you do.

Dr. Nagler

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 #4 

 

Quote:
Hello, Dr Nagler. Thank you for your quick reply.

You are welcome.

Quote:
I suppose if I'm thinking of my condition as severe and intrusive, then I should seek out treatment as such.

No, I think you ought to seek out information, not treatment. Perhaps start with Tinnitus 101.

Beyond that, I'm not sure I'd rush into anything. You have only had tinnitus for a few weeks. A bit of knowledge can often go a long way towards making a huge difference. Severe intrusive tinnitus can become just plain ol' run-of-the-mill tinnitus in relatively short order, especially this early on. So maybe draw up a list of questions to ask your ENT or somebody else in the field who might be well-informed. Hell, if nobody around can give you the advice you need, you can even scrape the bottom of the barrel and set up a Phone Consultation with me!

Quote:
After thinking about it for a while with this in mind, I had three questions that I hope you don't mind answering.

I don't mind at all. That's why I set up this board! :-)

Quote:
1) If I decided to go the TRT route, do you have a specialist in my area who you'd personally recommend? I am in Virginia Beach, Virginia.

If you decided to do TRT, the closest specialist to you that I would recommend is Dr. Gail Brenner in Philly. There may well be some fine TRT clinicians closer than that, but none I know well enough to recommend.

Quote:
2) This is causing me such anxiety that I think I may speak to a family therapist. If they recommend anxiety medication to help me manage, would that interfere with CBT or TRT to any great degree?

That's a controversial subject. Some say yes; some say no. I can tell you that when I myself did TRT, I was on enough medication to kill a small elephant. Couldn't have gotten through it without the drugs. And if it delayed my progress a bit, so be it it. 

Quote:
3) I have downloaded Tinnitus: A Self-Management Guide for the Ringing in Your Ears by Jane Henry and Peter Wilson. Is this a good supplement to TRT, or are the strategies within it counter to those provided by TRT as you would recommend it?

It's a book on self-guided CBT. I would not use it as a supplement for TRT because CBT is an active process ... while in TRT the less you do in that regard, the better off you are.

But honestly, in my humble opinion you appear to be getting way way ahead of yourself. Catch your breath. Read Tinnitus 101 and also perhaps take a look at my article on Barriers to Habituation. But other than that and possibly bringing your questions to your ENT or another knowledgeable source, are you familiar with the old saying, "Don't just stand there, DO SOMETHING?" Well, in the short run my suggestion to you would be, "Don't just do something, STAND THERE!" I suspect you’ll be just fine.

Hope this helps.

Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC


__________________

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
Brant

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 #5 

Thank you for the responses, Dr. Nagler.

 

I am the sort of person who scours the internet for information when I have an issue, which is exactly how I found you and your wonderful articles. Unfortunately, I also found some support boards that may have caused me some unrealistic worries that I'm not fully aware of right now. Regardless, I have definitely read all the articles you've linked, and they were a tremendous help. Without them I don't think I'd have had myself together enough to contact you at all.

 

I suppose I will try to wait then and see if I can adjust to this condition before taking a trip to Philly. I'm just having a really hard time even starting to get habituated because I feel like I'm always waiting for some new noise to intrude in my life. It's taken over my days. I have dropped all of my usual activities and am having difficulty picking them back up instead of just masking the noise all day.

 

Anyway, I won't contact you again unless I have another question my ENT can't answer. Thank you for your patience and time, Dr. Nagler.

Dr. Nagler

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 #6 
Brant, if you are really anxious about all this and it is eating at you (as it appears to be) ... then the anxiety can take on a life of its own! I have given all this some thought and have come up with a compromise of sorts. Why don't you call Dr. Brenner, explain your situation to her, and see what she suggests in terms of the best path for you. Perhaps consider it part of your information-gathering?

So tell Dr. Brenner I suggested you give her a call. She and I are not only colleagues; we are good friends. And I hold her in very high regard.

Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC

__________________

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
Brant

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Posts: 8
 #7 

Hello Dr. Nagler. I did what you suggested and called Dr. Brenner. Thank you very much for the recommendation, she was very friendly, helpful and knowledgeable and I think I have an improved idea now of how to move forward.

 

I had one more question for the time being, if you don't mind.

 

One of the noises that I've started to hear after this all started is a very low, quiet, bassy hum, that I swear I can 'feel' in my ear when I hear it. The catch is that I can only hear it in certain rooms, whether sound is in those rooms or not it seems. However, it can still be masked in those rooms, and when it is, it is totally unnoticeable.

 

I know I shouldn't be trying to 'figure out' my tinnitus. I guess for me it's more of a curiosity than anything, because for the time being, I feel like I can always escape this one sound. But is that something you've seen in your patients before? SHOULD I be concerned since it's so different from my other noises? Sorry if this seems like a frivolous question but it disturbs me whenever I have to hear it.

 

Thank you very much for your help, Dr. Nagler. I hope you have a great 2018!

Dr. Nagler

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 #8 
Quote:
I know I shouldn't be trying to 'figure out' my tinnitus.

Right. Trying to "figure out" your tinnitus serves only to stand in the way of habituation.

Quote:
I guess for me it's more of a curiosity than anything, because for the time being, I feel like I can always escape this one sound.

With all due respect, my friend, you are not describing a curiosity. No, from what I can gather from your postings you are describing an obsession. A curiosity is something you can fairly easily let go of when logic tells you it is not getting you anywhere.

Quote:
But is that something you've seen in your patients before?

Obsession? Yes, I have on occasion seen patients who are obsessed.

Quote:
SHOULD I be concerned since it's so different from my other noises?

No. But you might want to address why you can't seem to let this sort of thing go. I'm not talking about letting your tinnitus go; that can be a challenge. What I'm talking about is letting go of your obsessing about it.

Quote:
Sorry if this seems like a frivolous question but it disturbs me whenever I have to hear it.

It is not at all frivolous. But if you want to drive your own bus, you need to get into the drivers' seat and 
drive instead of continually wondering about it.

I truly mean no disrespect, Brant, and hope you will take no offense. But in the final analysis, the only power your tinnitus has over you is the power you yourself give it.

Best regards -

Stephen M. Nagler, M.D.
http://www.atlantatinnitus.com



__________________

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
Brant

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 #9 

Dr. Nagler, I appreciate your honesty with me. You're right, I have become obsessed. And I am hoping to address that obsession in upcoming appointments with my therapist and psychiatrist. In the meantime, I've tried to stop thinking about it so much, and surprisingly (to me) I feel I'm already having success at that. I managed to forget at times that the noise is there... only a few weeks ago I never would have believed such a thing possible. Especially since I've started to feel like my left ear has an extreme high pitched, almost inaudible ring causing me almost physical agitation. Even that has been put out of my mind occasionally.

 

I understand if I'm overstaying my welcome, but it's occurred to me that there was one other issue I didn't bring up. I would appreciate your input, if you don't mind.

 

I am a side sleeper, like most people. Ever since last week, when I put my head in my pillow, I start to hear a new sort of very loud ring. I noticed that this is the same sound I hear if I'm in a silent room for too long. It is as though I am hearing my own silence. It honestly frightens me, like if I listen to it for too long it'll never go away.

 

My question is, is this pillow ringing normal for people with tinnitus? Are my fears about this unfounded? If it is normal, do you recommend something to patients to deal with it, other than your sleep tips?

 

I'm doing my best to avoid support forums about this. Thank you for your continued patience, Dr. Nagler.

Dr. Nagler

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 #10 
Brant, environmental sounds serve as nature's tinnitus maskers. When you lie on your side with your head on a pillow, the environmental sounds in the room are blocked from entering your "down" ear, and therefore your tinnitus becomes more prominent. You might even start hearing tinnitus sounds you didn't even know were there! There is a very sophisticated medical term that is used to describe this particular phenomenon. And that very sophisticated medical term is ... NORMAL!

The best of all good things to you, my friend.

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
Brant

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Registered:
Posts: 8
 #11 

Hello Dr. Nagler. I'm wasn't sure if I should stay in this thread or start a new one at this point, but for sake of organization I will stay here.

 

Since I last posted, I saw a great deal of improvement. With the help of my doctor, I started obsessing less, and began to actually get used to what few sounds I heard. Originally, my doc wanted me on SSRIs, but I insisted on something else before I went that heavy on medication. I wanted to see if I could improve on my own, and I wasn't sure if SSRIs would inhibit my natural habituation. (Also, I should admit, I was worried about the SSRIs possibly making my tinnitus worse. My ENT said, with confidence, that they often do.) We settled on an antihistamine and a very low dose of benzo to used when the anxiety attacks were just too much to handle. It's been working well.


Then, just a few days ago, my tinnitus changed it up on me drastically. The very very quiet hiss I would barely notice before has become a quiet but very noticeable high pitched ring that I can only mask in the shower. It is my constant companion.

 

This has given me a pretty big emotional setback. I feel almost as though I am  back to square one when it comes to getting used to and eventually ceasing to react emotionally to these sounds. The result: I am considering starting the SSRIs in the next month or so here if I still can't stop reacting to this sound.

My question: In your experience, do SSRIs inhibit habituation in tinnitus sufferers to a significant degree? I may be wording that question poorly... so I would appreciate any general advice you feel is appropriate to offer when it comes to SSRIs and intrusive tinnitus.

 

Thank you so much for your time.

Dr. Nagler

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 #12 
Quote:
Originally Posted by Brant
My question: In your experience, do SSRIs inhibit habituation in tinnitus sufferers to a significant degree? I may be wording that question poorly... so I would appreciate any general advice you feel is appropriate to offer when it comes to SSRIs and intrusive tinnitus.

Brant, in my experience SSRIs do not inhibit habituation to a significant degree. If they inhibit it at all (which is doubtful in my opinion), the effect is minimal.

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
Brant

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Registered:
Posts: 8
 #13 

Hello, Dr. Nagler. I've been trying to avoid obsessing, and part of that is avoiding fielding more questions to you. On top of this, I feel that I may have already taken too much of your time. But recently my tinnitus has gone through a change that has me really distressed and has changed the severity of my situation for me. I am doing my best to avoid toxic support forums, and my resources for ENT appointments are depleted for the foreseeable future, as well...

Before, I had to really listen to hear my amorphous sounds, and found relief in rooms with noise. But it seems my tinnitus has chosen a pattern, and that pattern includes being unavoidable sometimes. I have several days of silence, and then several days of ringing that I can only drown out in a shower. When the ringing happens, it's so high pitched that I have the physical sensation of there being something in my right ear. My right ear feels 'tense' on this "bad ear days".

I feel that this sensation is what truly draws my attention to my ears and my ringing now. Is this normal from your experience, Dr Nagler? And assuming I see at least some success through TRT (which there is a very very real possibility of me pursuing now), is there any hope that this sensation will go away with habituation? Could it just be 'all in my head' so to speak?

Dr. Nagler

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 #14 

 

Quote:
Originally Posted by Brant
Hello, Dr. Nagler. I've been trying to avoid obsessing, and part of that is avoiding fielding more questions to you.

Brant, trying not to obsess is like trying not to think of a pink elephant. Go ahead. Try not to think about a pink elephant. Doesn't work, does it? Now try harder. That pink elephant in your mind's eye just got bigger, didn't it? Point is, I think that you might benefit from a different strategy.

Quote:
On top of this, I feel that I may have already taken too much of your time.

To be honest, it seems to me that it might be getting to the point where you should consider speaking with me (or somebody like me) on the phone about your particular concerns and underlying issues. All I can do on a site like this is paint in broad strokes and generalities.

Quote:
But recently my tinnitus has gone through a change that has me really distressed and has changed the severity of my situation for me. I am doing my best to avoid toxic support forums, and my resources for ENT appointments are depleted for the foreseeable future, as well...

Before, I had to really listen to hear my amorphous sounds, and found relief in rooms with noise. But it seems my tinnitus has chosen a pattern, and that pattern includes being unavoidable sometimes. I have several days of silence, and then several days of ringing that I can only drown out in a shower. When the ringing happens, it's so high pitched that I have the physical sensation of there being something in my right ear. My right ear feels 'tense' on this "bad ear days".

I feel that this sensation is what truly draws my attention to my ears and my ringing now. Is this normal from your experience, Dr Nagler?


Yes, it is not at all uncommon for a person with intrusive tinnitus to become aware of any number of head and neck sensations that were there all along below the radar but now became apparent because your autonomic nervous system is in "high alert mode," so to speak.

Quote:
And assuming I see at least some success through TRT (which there is a very very real possibility of me pursuing now), is there any hope that this sensation will go away with habituation? Could it just be 'all in my head' so to speak?

It is absolutely "all in your head." It is not in your imagination, though. It is quite real. But of course it's in your head. Where else would it be? :-)

All the best -

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.