Dr. Nagler's Tinnitus Corner
Latest Topics
 
 
 


Reply
  Author   Comment  
numark

Member
Registered:
Posts: 8
 #1 
Dr. Nagler,

I have been using sound generators for 2 months and I am happy with my progress.

I really think my sound tolerance is increasing.

My generators were initially set at a maximum of 50db.

I have been hearing them at the maximum setting for almost all day and lately during the night too.

I take them out for some hours so that wax can come out as you advised me.

Initially I was using them for a few hours per day and not at all during the night. Also, I was not using the maximum setting.

Gradually I have been able to increase both the hours that I use it and the volume.

I guess that in itself is a sign of major improvement.

So is now the time to set the maximum at 60 db?

I have read that 10 db is about 100% increase in volume sensation (correct me if I am wrong).

So presumably once more, I will be using it at sub-maximal levels (perhaps starting from 50% of maximum) an gradually increase the volume up to maximum, as I build up tolerance.

Thank you very much for your time and advice!



Dr. Nagler

Owner
Registered:
Posts: 1,764
 #2 
Hi numark -

As I recall from your previous postings, you have both tinnitus and hyperacusis with hyperacusis being a far greater problem.

You have had an audiogram and LDLs performed, but we never talked about what those LDLs were. So in order to get a handle on what is going on here, it would really help if I knew what your original LDLs looked like and what a repeat set look like now.

I ask especially because if you are tolerating 50dB of broadband sound introduced through open molds (i.e., molds that do not block external sound), I would wonder whether you need any further treatment at all!

In terms of your dB question, an increase of 10dB roughly doubles perceived loudness of sound while an increase of 3dB doubles energy or intensity of sound.

Dr. Stephen Nagler
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
numark

Member
Registered:
Posts: 8
 #3 
Dr. Nagler,

I checked my LDL's. I did it in a foreign country so communication was difficult.

I thought I was instructed to press the button when the loudness was "unbearable", rather than "annoying" (experiencing discomfort). So I only pressed the button when the loudness was at 110db. It was "annoying" at a lower db level but I cannot remember exactly at what level.

In addition, I don't know how helpful is the LDL in my case as I can tolerate even loud sounds for few seconds, the problem arises when these last e.g. 10 min, 30min or 3 hours.

The doctor was also surprised by my results.

I have a probably unusual case of hyperacusis whereby I can "survive" in a relatively loud environment for a considerable time (e.g. cinema), yet the pain comes with a delay, sometimes after some hours and usually, the next morning. It is only in an extremely loud environment e.g. concert, club that I get pain much sooner and need to use ear protection. If the exposure is loud enough and for long enough, I get severe ear pain even after using ear protection.

Apart from this, when other aggravating factors are present (e.g. stress, use of certain medication e.g. benzodiazepines, antibiotics) my hyperacusis becomes much more intense to the point where the sound of the bus passing by or the washing machine becomes painful. So I have experienced the debilitating type of hyperacusis too, and very recently. Particularly irritating was the sound of my own voice which I need to use a lot while studying. It sounds extremely loud and creates pain in my ears. In addition, everything sounded much louder after I drank coffee, which i recently quit.

To make things more complicated, I get a considrable reduction in my hyperacusis when I use a low dose of a medication that blocks dopamine D2, serotonin 5-HT2, adrenergic a-1 and histamine receptors. I don't want at this point to name the medication but I think you get the idea. The effect of this medication is immediate (24-48 hours) and I have used it in the past with success, but i don't want to stay on it indefinitely because it has side-effects. Perhaps it reduces my stress level and reduces my hyperacusis in this way, but I am not certain if other mechanisms are at play. It is not therapeutic for hyperacusis because when you stop it, the sound sensitivity comes back to where it was. It works like a band aid, albeit an effective one.

Two months ago I made three simultaneous changes that have all contributed to a significant improvement: quitting coffee, starting this medication and starting TRT. I can now talk almost all day with much less ear pain than before. I cannot be certain what exactly has helped and to what degree, but I am definitely continuing TRT indefinitely (minimum 1-2 years). I actually very much enjoy the sound of pink noise, it is very calming and soothing and it helps with insomnia problems. I am sure it is increasing my sound tolerance.

Based on what I wrote in the last two emails and your patient experience, is it advisable to hear pink noise at a higher volume (60db max)?
Is it the purpose of treatment to later be able to tolerate 60db and even later, 70db?
Could this improve the therapeutic outcome compared to listening at maximum 50db?
Or do patients normally stay in the 0-50db range?
Is there any contraindication in hearing pink noise at a higher level ?

In the last two months, I found myself actually wanting to increase the volume, it feels more pleasant and effective in this way.

Thank you very much for your reply and I apologise for how long my email was.
Dr. Nagler

Owner
Registered:
Posts: 1,764
 #4 
Well, here's a real problem - not only for you, but for me as well.

And the problem is that I'd really like to provide responsible and meaningful responses to your questions, but I cannot. You see, one of the limitations of this type of medium is that I am relying solely on the questioner's own history and assessment to formulate my responses, and based on what you are telling me I do not know what is wrong with you. Moreover, I do not know the validity of your LDLs, and I do not know much at all about the quality and reliability of the devices you are using to treat yourself. In other words, I am pretty much like a blind man here trying to suggest color schemes for your house.

I can say this. Whatever your diagnosis might be, it isn't hyperacusis. The loudness discomfort in hyperacusis is instantaneous - not delayed. More than that, the dB levels for your devices seem all wrong to me. None of the devices with which I am familiar require anywhere near the levels you describe to be effective.

So since I am at a complete loss with respect to telling what to do, let's try to go about this differently.

I am going to ask you a question - and since I do not know what your diagnosis is, for the purpose of the question I am going to refer to it as your "auditory condition."

Here's the question:

On a scale of 1 to 10 where 1 is "I would prefer not to have my auditory condition but in the grand scheme of things I really don't care much one way or the other because my auditory condition does not significantly affect my life," and 10 is "My auditory condition has totally, completely, permanently, and irrevocably destroyed my life," overall on average where would you place yourself on that huge continuum? Please try to respond with a single number. It would help if you did not try to explain the number or give any sort of commentary.

Dr. 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
numark

Member
Registered:
Posts: 8
 #5 
I am a 7 in the scale you proposed.

I would like to clarify that the discomfort comes instantly. Its the pain that usually comes a little bit later, unless its a very loud environment e.g.concert when it comes instantly.

My devices are from a reputable company and are set by the audiologist initially at a maximum of 50db. Presumably it has a 50db volume at the maximum user adjusted volume and 0db at the minimum. The user adjust volume ranges from a range of 1 to 4. So presumably they play at 25 db in the setting 2.5. I started at the setting 2.5 and gradually built up to the setting 4 (50db). My option now would be to have the audiologist change the maximum to 60 db.

I did some googling and i read that some clinicians use this approach, but its not widespread yet.

I dont know if i have hyperacusis or another condition but i do get significant pain from sounds and i often but not always avoid going out e.g to concert, bar, or club so as not to have pain in the next day.
Dr. Nagler

Owner
Registered:
Posts: 1,764
 #6 
Got it.

So to my eye, there are some crucial "presumablies" and "I don't knows" in your post. Moreover, you are working with an audiologist who is unfamiliar with your auditory condition to the extent that you are turning to the Internet for information so that you can tell your audiologist how to set your devices that "presumably" put out such and such a sound level at such and such an intensity.

Stepping back for just a minute, here is how I personally would look at it. You have a condition that you yourself rate as a 7 on a scale where 10 is "totally, completely, permanently, and irrevocably" destroys your life. In other words, you have a very very serious problem there. It is not life threatening, but it markedly affects your quality of life - and what good is a life without quality! Fortunately it is highly likely that your condition can be effectively addressed. You have turned to me for advice about how to do that, and under the circumstances the only responsible advice I can give you is to make addressing this problem your top priority. Which for me means actually seeing a clinician who is knowledgeable and experienced in the treatment of individuals with decreased sound tolerance, undergoing a proper evaluation, and following a treatment plan designed for you by that knowledgeable and experienced clinician, a treatment plan based on the results of your evaluation. Given your location, that project will involve some travel and some expense. You would only need to travel once since the follow-up could be done long distance - but the only responsible advice I can give you would be to make it happen. The closest individual to you whom I can personally vouch for under these circumstances would be Jacqui Sheldrake at the Tinnitus and Hyperacusis Centre on Devonshire Place in London, UK.

I am honored and flattered that you would seek my opinion, my friend, and there you have it.

All the best -

Dr. 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
numark

Member
Registered:
Posts: 8
 #7 
Thank you for your reply.
Dr. Nagler

Owner
Registered:
Posts: 1,764
 #8 
You are welcome, numark. I wish I could do better for you - but like I said, I'm blind here. And the last thing I want to do is point you in the wrong direction.

Kind regards -

Dr. 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
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.