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Gspana

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Posted  #1 
Dr. Nagler,


    I posted about 1 year ago regarding Ibuprofen use and a tinnitus spike.  Since then I have been doing well.  Your advice was spot on at that time.  Now I am in need of more counseling.  

   Stress/anxiety and poor quality sleep are all triggers for my tinnitus and often cause me to have a noticeable increased perception of my tinnitus.  Yesterday I was shopping for new home with my real estate agent when a house alarm activated.  When he first opened the door the alarm sounded.  I was outside so no big deal.  I waited outside and after about 5 minutes the alarm stopped.  I was skeptical that the alarm was truly deactivated.  I read the forums here often and I have been trying to follow your advice of living life and not letting the tinnitus dictate your life.  So I put foam earplugs in (I keep a pair in my car for unexpected situations) and entered the house.  I made it to the back of the house and then the alarm tripped again.  Probably a motion sensor.  I quickly made an exit from the home.  Maybe 10 seconds exposure.  Of course the alarm is loud and high frequency as expected.  It all happened so fast that I don't recall having any ear pain from the noise.  Typically an alarm such as a smoke detector or car alarm hurts when I hear them without ear protection.  So I took the plugs out when I got back to my car.  Then the mental games started.  Is my T spiking?  How does it sound?  Did it damage my hair cells?  Is this going to cause permanent damage?  How much noise was I exposed to?  How much protection did the plugs give me?  Why did I even go in the house if I though the alarm might trip?  I ended up being trapped in a negative thought cycle which caused a panic attack and then a poor nights sleep.  So as predicted my tinnitus is noticeably louder and more intrusive.  
   Just for some background, this happens every time I have a "noise event."  I had an MRI in December of my lumbar spine (used hearing protection) and later that day I started with the negative thought cycle.  I had a tinnitus spike which in retrospect was clearly an anxiety/stress spike, but at the time I thought the MRI damaged my hearing.  I almost posted on the forum here at that time, but I decided to wait it out.  2 weeks later I settled back down and had a good 5-6 week run up until yesterday.  I do have a psychologist that I see regularly.  I called her yesterday after the alarm event and she tried to calm me down.  We have been through so many of these spikes (car alarm, ambulances, smoke alarm, etc) that it's old hat for her.  Despite all that I just keep having these negative thoughts that this time I really damaged my cochlea.  I need some sage words/advice from you.

Thank you for all that you do,

Greg
Dr. Nagler

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Posted  #2 
Hello Greg -

It is very common to equate the loudness of one's tinnitus with the degree of auditory damage. In other words, if you get exposed to a loud noise that results in an increase in the volume of your tinnitus, somehow it means you have suffered irreversible auditory damage. I refer to this belief as “common,” but it is absolutely wrong. The degree of auditory damage and the loudness of tinnitus are unrelated. There are people with very loud tinnitus who have normal audiograms, and there are people with severe hearing impairment who have very soft tinnitus, and there are all sorts of combinations and permutations in between. You yourself have noted that anxiety and stress can cause a spike - but clearly anxiety and stress do not damage the cochlea. Same for fatigue, certain foods, etc. And the same holds true for noise exposure. Yes, noise exposure can cause auditory damage, and noise exposure can cause an increase in tinnitus loudness, but the increase in tinnitus loudness is in no way a reflection of the amount of auditory damage.

We know that the amount of auditory damage caused by a loud noise is related to the dB level of the noise at its source and the length of time one is exposed to that noise. It is also inversely proportional to the square of one's distance from the source. And obviously it is related to whether or not one is using ear protection at the time of the noise exposure.

Based on what you describe in your post and taking into account the factors listed in the above paragraph, there is absolutely no way in the world you could possibly have damaged your cochlea. 

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
Gspana

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Posted  #3 
Dr. Nagler

    Thank you for your advice.  I waited to reply so that I could provide an update.  Within 3-4 days of exposure to the alarm I was back to baseline.  The anxiety over the noise exposure was worse than the alarm itself.  Currently I'm on a corticosteroid dose pack for lumbar disc herniation and I think that has irritated my tinnitus.  As you have posted in the past, these are not ototoxic drugs and any increase in tinnitus is either not related to the medication or if it is drug induced will return to baseline once the drug is tapered off.  I have gotten to the point where I have stopped trying to figure my tinnitus out.  However, noise exposure and medications are two things that always make me concerned about ototoxicity/permanent hair cell damage.  Not sure if I will ever overcome that last hurdle.

Thanks,

Greg
Dr. Nagler

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Posted  #4 
Quote:
I have gotten to the point where I have stopped trying to figure my tinnitus out.

Excellent!

Quote:
However, noise exposure and medications are two things that always make me concerned about ototoxicity/permanent hair cell damage.

Noise exposure and medications should make you concerned about ototoxicity and permanent hair cell damage. Fortunately, though, we know how much noise it takes to cause permanent hair cell damage, and we know the Drugs To Avoid.

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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