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MountainCreek

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 #1 
I had cholesteatoma in 1980 when I was 6 years old. The middle ear bones had to be removed. I think the surgeon cut small pieces of bone from my skull and replaced the middle ear bones with these pieces. I got very much reduced hearing on my right ear by this operation. Cholesteatoma returned in 1985 and 1990. After that I have just had regular check-ups once a year and there have been no more problems. I have now got tinnitus by being exposed to sounds like water flowing in a Korean mountain creek, by driving an old car and by listening to the car radio, and by being exposed to my child's screaming. I have had tinnitus three times since 2010. I have cured tinnitus twice by staying indoors in silence for about two weeks in a row. This time is the third time and I haven't yet completely cured it, but almost. The sound is that of a old-fashioned Korean motorbike idling somewhere far outside my apartment. This sound appears to come from the middle of my head and it is turned on only when I am going to fall asleep and is there just before I wake up in the morning. In the day it is gone. This is why I did not want to stay in silence at once during the day since I thought it was gone. But it returned each night, and it got worse and worse for several weeks of ignorance, until I took care of it by staying in silence throughout the days for a couple of weeks. Only after that, I have been able to reduce the intensitity so much that I can almost not hear it anymore as I wake up in the morning and before I go to sleep it was gone. Now if I would go out in the city noise again I am worried if this tinnitus will come back. I am also wondering if you can support my idea, which I has worked for me now three times, that isolating myself from the rest of the civilization and staying in complete silence for an extended period of time like a couple of weeks, can actually cure tinnitus? My problem here is to convince my boss that I am doing something that is necessary to cure my tinnitus, much the same way as it is necessary to keep the bandage around a broken leg until the leg has been healed before one starts walking on the leg. My philosophy is that tinnitus is much the same as a broken leg. The sound corresponds to the pain in the broken leg. Small sounds corresponds to small bendings of the broken leg, which will make the healing process take much longer. Only a loud sound can cause tinnitus, but once developed, my idea is that just very small sounds can be enough to maintain the tinnitus. To cure the tinnitus I therefore go to complete silence. Silence that is such that I for instance do not tolerate the noise from the laptop fan. I mostly sit and read and stay in silence all the time. And it works. For me. I just wonder if silence is the trick, or if I would have been cured anyway. But that does not seem to be the case, by my experiences that tinnitus level went up as long as I kept exposing myself to noise.
Dr. Nagler

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 #2 
Hi Mountain Creek ... and welcome.

Your post is very interesting to me. Basically it boils down to the following:

Quote:
I am also wondering if you can support my idea, which I has worked for me now three times, that isolating myself from the rest of the civilization and staying in complete silence for an extended period of time like a couple of weeks, can actually cure tinnitus?


I can only speak here in terms of the basic principles of auditory neurophysiology. And on a neurophysiological basis your observations make absolutely no sense to me. Indeed, silence is the enemy of tinnitus. Basically, the auditory system always does what it is designed to do - to hear - and if there are no externally-generated sounds for the auditory system to access (i.e., in complete silence), the auditory system will turn up the gain and thereby exacerbate tinnitus.

So that's one principle. But here's another: In tinnitus, perception is the only reality. And if you feel that you do better in complete silence, who am I to argue with you??!!

My concern over the long haul is that seeking silence can potentially lead to hyperacusis wherein sounds that are well-tolerated by others sound uncomfortably loud to you, which leads you to seek more silence. More than that, I can envision a situation where more and more you isolate yourself in attempts to cure your tinnitus. In your own words:

Quote:
To cure the tinnitus I therefore go to complete silence. Silence that is such that I for instance do not tolerate the noise from the laptop fan. I mostly sit and read and stay in silence all the time. And it works. For me.


It may work for your tinnitus (although I confess that I do not see how), but it does not sound like much of a strategy in terms of quality of life - especially if you have to resort to it more and more as time goes on. Come to think of it, there are reliable studies demonstrating that silence actually induces tinnitus. See, for instance, the Heller and Bergman study.

So where does that leave us? Well for sure I am not for one moment doubting what you experience. If silence helps your tinnitus, then silence helps your tinnitus. Period. What I am saying is that to the best of my knowledge your strategy has no neurophysiological basis, and moreover over time it might prove to be counterproductive.

I hope this response clarifies more than frustrates.

All the best -

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC


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The best way to find yourself is to lose yourself in the service of others.
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No bird ever soared in a calm. Adversity is what lifts us.
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MountainCreek

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 #3 
I agree that hearing gets more sensitive, or that the brain turns up all volumes to hear anything, in complete silence. This means it also turns up the volume of the tinnitus. 

But as my goal is to turn off tinnitus, I want to isolate it and then turn it off. Much like when you want to take away a tick from your skin, you may use a magnifying glass to see it better, and then carefully peel it off by detatching each leg of the tick from the skin, making sure there are no traces left in the skin. To be able to do this, one needs a good magnifying glass. When the tick is gone, zero remnant, no matter how sharp magnifying glass I use, I will see nothing. Zero times a million is still zero. 

If I can turn tinnitus to zero by silence, then no matter how much my brain turns up volumes of sounds, I will still hear zero. 

I think that this turning up of volumes in complete silence is not a serious problem since it seems the brain very rapidly will adjust to noisy environment by turning down sound volumes again. In a matter of seconds up to a couple of minutes I think the brain can readjust to a new environment with new levels of sound? Am I completely wrong? I do have the concerns and worries about exactly the point you are rising. But the problem is that I clearly get a louder tinnitus each time I expose myself to sound by going out. This may be exactly the problem you mention, is this what you called hyperacusis? However, I do not feel pain or any discomfort when I expose myself to noise. It is a big relief to go out and not hear the tinnitus. The problem comes only when it gets silent and I want to sleep at night.
Dr. Nagler

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 #4 
Quote:
Originally Posted by MountainCreek
I agree that hearing gets more sensitive, or that the brain turns up all volumes to hear anything, in complete silence. This means it also turns up the volume of the tinnitus.

Right. That is basic auditory neurophysiology.

Quote:
But as my goal is to turn off tinnitus, I want to isolate it and then turn it off. Much like when you want to take away a tick from your skin, you may use a magnifying glass to see it better, and then carefully peel it off by detatching each leg of the tick from the skin, making sure there are no traces left in the skin. To be able to do this, one needs a good magnifying glass. When the tick is gone, zero remnant, no matter how sharp magnifying glass I use, I will see nothing. Zero times a million is still zero. 

If I can turn tinnitus to zero by silence, then no matter how much my brain turns up volumes of sounds, I will still hear zero.

Your approach makes no sense to me. I'm not saying that it does not work for you; apparently it does, which is fantastic. I'm only saying that it makes no sense to me.

Anyway, if you can find a way to lastingly, predictably, and universally turn tinnitus to zero - by silence or by any other method - then that is pretty much a guaranteed Nobel Prize. And whether or not it makes sense to me is irrelevant.

stephen nagler


__________________

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
MountainCreek

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 #5 
After two months I am now essentially tinnitus free. So I believe in silence as a valid method. But I really got scared after reading your reply, thinking I should really go out to a job meeting and not remain in silence all the time. But I now think I was lucky to cancel the job meeting. I wonder if silence has given anybody permanent tinnitus. What I can imagine is that silence can give temporary virtual tinnitus. I believe that kind of tinnitus is already present, and is heard and noticed by the person who stays in silence and goes away again after the person goes out from the silent chamber. Please correct me if I am wrong. I have not seen the reference you mention, on a person that got tinnitus from silence. 
MountainCreek

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 #6 
I read the paper from 1953. Clearly a more recent reference would be of more value! It did only confirm what I already knew very well. Everyone hears tinnitus sounds in silent chambers.

You say you do not see how low dB can affect tinnitus. This seems to be a common opinon of all doctors in this area. They seem to argue that since tinnitus can not be CAUSED BY low dB sounds, also low-dB sounds can not MAINTAIN tinnitus.

I would like to argue that this is not pure logic. The words, cause by and maintain are completely different category and have different meaning.

We can break a leg only by a tremendous force applied to the leg. But to maintain the broken leg broken, we don't need much force. Suppose we put the leg in a bandage and do not attach the bandage tightly enough. Then suppose a doctor enters our patient room every day to check how the leg is healing by making small bendings of the leg (to check whether it is rigid or not). Clearly this is not a good idea! 

I would like to argue that tinnitus works in parallel with this. Tinnitus can arise after a loud sound. To maintain it, only very low-dB sounds may be sufficient.

I would be very interested in performing a follow-up experiment of Heller-Bergman 1951 where I put volunteer tinnitus patients in a sound-isolated chamber for two weeks or more, and then find out how they perceive their tinnitus sounds after this. Finding volunteers may not be too difficult. Many people may find it difficult to habitualize and live in constant low-dB background noise, as doctors today suggest we should do. 
Dr. Nagler

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 #7 
Quote:
Originally Posted by MountainCreek
I read the paper from 1953. Clearly a more recent reference would be of more value! It did only confirm what I already knew very well. Everyone hears tinnitus sounds in silent chambers.

Yes, according to the study everybody hears tinnitus sounds in silent chambers. But that means that the presence of some degree of tinnitus in-and-of-itself is a normal physiological phenomenon ... and (as I have come to see it) for all practical purposes the problem therefore really lies in the extent to which one reacts to the tinnitus that he or she has. You may be an exception in that you have apparently figured out a way to temporarily cure your tinnitus. All you need to do is totally shut yourself off from society for weeks on end ... and everything will be just rosy! One wonders how often you will have to go through this exercise of yours and what kind of a life you will be facing - but after all it IS your life, so who am I to argue the point??!!

Now with all due respect, I am honestly not interested in pursuing this discussion further.

You say you have figured out a way to temporarily cure your tinnitus, and I am happy for you. I feel very strongly that in general it is unhealthy for tinnitus sufferers to seek total environmental silence, and I have explained why I feel that way in detail. You have taken another tack, and thus far it seems to have worked out to your satisfaction. I hope you do not wind up spending more and more weeks in total seclusion to achieve the same effect over time and that you do not need to do it more and more frequently over time - but that would be totally your call.

All the best -

stephen nagler

__________________

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.