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JFT

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 #1 
Dr. Nagler,

First off, I am two months into TRT.  I email my audiologist with questions all the time but, sometimes for the information to really take root with me I like to have another source. I'm very happy with the level of care I am getting but, let's just say I'm looking for a second opinion.

A little about me: I live so close to you but so far since the I-85 debacle. Coming from Coweta there is no way I'm willingly driving through Atlanta right now. I think tinnitus is preferable! I am forty-one and a pilot for the big local airline. I've been around loud airplanes since high school and I am a musician that has played in loud bar bands for years and years. Needless to say I have abused my ears for decades.

I first heard of tinnitus not long ago. During July 4th weekend of 2015 my dad mentioned that he had had it for forty years and described it to me. When he told me I said, "Oh yeah, I have that!" I never knew there was a name for it. It was just the sounds in my head and they literally never bothered me. I couldn't remember a time when I didn't have them. If I wanted to hear it then I did and if I didn't want to then I didn't. Simple as that.

Over the next year and a half whenever I heard the sounds I could put a name to it and I started hearing the term tinnitus mentioned more and more. On January 6th I was on a trip and had an early morning pickup at the hotel in San Jose. During the van ride to the airport I joked to the other pilot that these early wake ups cause my tinnitus to act up (I think i've said this before but can't really remember) as it was slightly buzzing or squeaking.

But, as usual, I put it out of my head and forgot about it until Jan 14th while I was watching the Patriots playoff game. I was laying on the couch when I noticed that my tinnitus sounded louder than usual. This was the first time I ever googled it. But, I went to bed and forgot about it.

Sometime the following week (probably the 18th or 19th) I woke up at night and heard that my tinnitus seemed louder again. It sounded just like when I sometimes have too much to drink. I quickly fell back asleep and forgot about it again.

On Friday the 20th we went up to Atlanta for my daughters cheer competition at the World Congress Center. We got a hotel room so we wouldn't have to drive up so early from Newnan and I remember thinking to myself that I hoped that my tinnitus doesn't wake me up. Fortunately, it didn't and we went to the competition on Saturday which was very loud. I only stayed in there for my girl's routine.

Sunday Jan 22nd morning I was sitting in the kitchen with my wife drinking coffee when I realized that my tinnitus seemed louder than usual. I mentioned it to my wife and started reading as much as I could. The sounds were still no different that what I'd ever heard, just louder or more noticeable. I must have forgotten about it because, later that night was the Falcons game where they stomped Green Bay. I remember that game vividly but, I do not remember noticing any tinnitus. 

Tuesday the 24th I was driving up to the airport for a pilot meeting at about 9:30am. Shortly after getting on the interstate which is ten minutes from my house I heard the ringing again. I though to myself that I'd never heard it in the car before although now I'm unsure about that. On the way back home that afternoon after just passing I-285 I wondered if I could still hear it in the car so, I looked for it, immediately found it, and couldn't get rid off it. I don't remember the rest of the day.

The next couple of days I heard it off and on. Sometimes when going to bed I heard it so, I had started using a white noise machine. Still though, I didn't think anything was really unusual and it was probably only louder because of a sinus infection that I had earlier in the month.

On Friday the 27th I started a five day trip. I got into Ft. Walton rather late and went to bed soon after getting to my room. At 2:30am I woke up with my ears screaming! I now realize that this was probably because the a/c in the room was very loud. Anyway, panic was now starting to set in. I slept better the next few nights of the trip but, the anxiety was really starting to take hold. so, on the way home from the airport I went to see my AME. He told me that yep, you've got tinnitus, its from hearing loss but, just in case here is some amoxyl and take Claritin. 

On Feb 2nd I was sitting short call reserve at my house. That was the first day I just spent all day listening to my tinnitus. It seemed to get louder and louder until I was in full blown panic mode. I called in sick and stayed out from work for the next three weeks. I lost fifteen pounds and very low blood pressure.

I saw a few more doctors such as an ENT, spinal surgeon, and my regular doc. The replies were all pretty much the same thing.  You have tinnitus so, you just have to learn to live with it.

Just by happenstance, my stepmom mentioned that she had heard of an audiologist in Fayetteville that helped an acquaintance with tinnitus. So, I made an appointment with Dr. Tim Winstead at the Hearing Doctors of Georgia on the 15th. I went into that office with my wife totally emotionally drained. But, then I met Dr. Winstead. He was the first doc that wanted to hear my full story and was truly interested in it. I could instantly tell that he really cared.

First off was a hearing test. So, I went in to the booth fully expecting to find that I had severe hearing loss. But, when the doc opened the door after the test he had a big smile on his face and said, "This is very encouraging". I about collapsed. We went in to his office and he gave me some various options but said that I was a good candidate for TRT but, it was very expensive. So, we could do watchful waiting and try some other things if I'd prefer. I threw my wallet on the table and told to shut up and take my money!

I'm two months into TRT right now listening to Zen-A. Generally speaking I am leaps and bounds better than before. I still sometimes get a little anxiety but, I find what helps that more than anything is remembering the events of January. And, this is where you come in. In theory, When I first heard it loud on the 14th (it had been exactly one month since my last band practice which had been rather loud) the volume of my tinnitus did not change. However, I was already habituated to it but, over the next two weeks I was slowly loosing that ability to block it for some reason. Those reasons could be stress, ear infection, assigning negative emotion to the sounds which I had never done before.

Does this sound plausible to you? If my tinnitus went up in volume, which I'm still not convinced it did, did I just loose the ability to habituate or block it out?

Thanks so much for your time,
Joel


Dr. Nagler

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 #2 
Hello Jeff ... and welcome.

You are putting me in a bit of an awkward position here. My own audiologist is in that practice (in the Stockbridge office), and I really do not wish to second-guess Dr. Winstead regarding your TRT.

That said, I am sure that Dr. Winstead told you that habituation is not like a straight line with positive slope. Rather it is more like a sine wave wherein the overall slope is positive, but where there are definitely hills and valleys. Sounds to me like you might be in one of those valleys. Perhaps instead of e-mailing Dr. Winstead with questions, it might be time to actually schedule a formal follow-up TRT counseling session with him to iron out these issues and review the Neurophysiological Model in detail.

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

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