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Dr. Nagler

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David asked:

Dr. Nagler, I believe you once wrote that TRT did not do anything for you during the first year. Then after 14 months over a few weeks things started to improve rapidly. Can you explain a little more what happened? Did you go from being quite focused on the T and withe noise to just not being aware of it during a few week?

Is this normal to happened or is it more normal that improvement happening gradually over time?


TRT today is a bit different than it was twenty years ago when I went through it. While the length of treatment can still run as long as 16-18 months, patients today can experience noticeable improvement in as little as one month and statistically significant improvement in three months. I recently had a patient with severe intrusive tinnitus (catastrophic by THI criteria) who was completely finished in four months. That said, a fair approximation of overall average treatment time is still around 10-12 months.

The typical pattern for improvement is not like a straight line with positive slope over time. It is more like a sine wave with overall positive slope over time, where the good days gradually get better and better, and the bad days gradually get less and less bad.

For me back in 1994-5, there were no good days at all for around 14 months into TRT; they were all bad. Then, over a span of maybe a couple of weeks things just got great. It was a palpable quantum change. I had had my fourth directive counseling session (today it would be called "TRT counseling") about a week before I began noticing improvement. I suspect that played a role in it - sort of a "Eureka moment" - but I do not know.

You asked: "Did you go from being quite focused on the T and withe noise to just not being aware of it ..." In TRT you are never focused on the white noise except when you set your devices each morning. After that you quickly become largely unaware of the white noise for the remainder of the day because you habituate it. What happened to me at the 14 month point was that I just began not to care about my tinnitus. And that process sort of snowballed.

As they say, your mileage may vary.

Hope this helps.

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
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