Dr. Nagler's Tinnitus Corner
Latest Topics
 
 
 


Reply
  Author   Comment  
Michael2133

Member
Registered:
Posts: 14
 #1 
Dr Nagler - It appears I may need to get a filling. I understand that you do not wear earplugs at the dentist but have recommended to people if they are concerned to wear plugs and provide some to their dentist (as well as the 5 seconds on, 10 seconds off method from Dr. Vernon). Is the occlusion effect something to be concerned about when wearing plugs? Would over the ear protection be more effective and reduce the occlusion effect? Is there any evidence that dental drills conduction causes auditory damage at the exposure consistent with a filling?

As an aside, I've read recently that your patients tinnitus matching decibel level was typically in the upper teens and maybe maxed out around 20 db. I was wondering if you have had yours measured and would mind sharing? 

I had mentioned previously that my tinnitus had improved a great deal and then worsened (I won't speculate the cause here). In your experience, have you seen fluctuations like this, can a case have gotten louder and then held steady or can I expect further worsening (or even improvements). 

I've come a long way since the onset in March 2018 and recently started cbt to hopefully address some of these concerns to reach a point where it wouldn't matter either way. 

Lastly, my ENT did not recommend that I get an MRI after discussing with a neuro-otologist (spelling?) on site. He said that he had not seen an acoustic neuroma in someone with unilateral tinnitus with no other symptoms. Does this make sense to you or would you recommend a second opinion? Truthfully, I feel like I have it in both ears now anyways. 

Thank you and happy new year.
Dr. Nagler

Owner
Registered:
Posts: 1,759
 #2 
Quote:
Originally Posted by Michael2133
Dr Nagler - It appears I may need to get a filling. I understand that you do not wear earplugs at the dentist but have recommended to people if they are concerned to wear plugs and provide some to their dentist (as well as the 5 seconds on, 10 seconds off method from Dr. Vernon). Is the occlusion effect something to be concerned about when wearing plugs? Would over the ear protection be more effective and reduce the occlusion effect? Is there any evidence that dental drills conduction causes auditory damage at the exposure consistent with a filling?

It is fairly well-established that the "occlusion effect" is real, but I seriously doubt that it has any clinical significance in the setting you describe. Noise-induced auditory damage is related to the intensity of the noise as well as the length of time exposed to it. With or without earplugs you should be just fine having a cavity filled, especially if you use Dr. Vernon's approach. And in the unlikely event that you notice an increase in tinnitus loudness after visiting the dentist, it should settle down in short order. In fact, chances are it would be more related to your anxiety about noise exposure than to the noise exposure itself.

Quote:
As an aside, I've read recently that your patients tinnitus matching decibel level was typically in the upper teens and maybe maxed out around 20 db.

Actually more than half of individuals with severe intrusive tinnitus match at 6dB SL or less. I do not ever recall seeing anybody with a loudness match of greater than 20dB SL. But please note two things. First, we are talking about dB SL and not db. dB SL is the number of dB over the threshold of hearing at the frequency being tested. And second, many audiologists do not know how to do proper tinnitus pitch and loudness matching. So all bets are off if the audiologist doing the testing is not both knowledgeable and experienced in that regard.

Quote:
I was wondering if you have had yours measured and would mind sharing?

Mine was measured back in 1995 by Dr. Jastreboff's audiologist, Susan Gold, in Baltimore before I started TRT. That was more than 20 years ago, and I do not recall what it was.


Quote:
I had mentioned previously that my tinnitus had improved a great deal and then worsened (I won't speculate the cause here). In your experience, have you seen fluctuations like this, can a case have gotten louder and then held steady or can I expect further worsening (or even improvements).

Setting aside the fact that tinnitus loudness and tinnitus severity are two entirely different things, they can both fluctuate over time. But that said, there are some longitudinal data in a large clinic population that strongly suggest that things tend to improve with passing years. As to what any given individual can expect, there is simply no way to tell.  


Quote:
I've come a long way since the onset in March 2018 and recently started cbt to hopefully address some of these concerns to reach a point where it wouldn't matter either way.

Excellent. I wish you well with it. 


Quote:
Lastly, my ENT did not recommend that I get an MRI after discussing with a neuro-otologist (spelling?) on site. He said that he had not seen an acoustic neuroma in someone with unilateral tinnitus with no other symptoms. Does this make sense to you or would you recommend a second opinion? Truthfully, I feel like I have it in both ears now anyways.

I generally recommend an MRI of the brain and IACs with and without contrast for patients with unexplained unilateral tinnitus even in the absence of other symptoms. My thinking is that if a patient with unexplained unilateral tinnitus is found to have an acoustic neuroma before it causes any other symptoms, then likely it will be quite small and more readily treatable. Please do understand, though, that these lesions are very rare to begin with, and the overwhelming majority of MRIs done for unilateral tinnitus are normal.


Quote:
Thank you and happy new year.

Happy New Year to you as well.

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
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.



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.