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markvonwes

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 #1 
Hi Dr Nagler

I'm based in London, although I have a great friend in Atlanta so maybe i'll kill 2 birds with one stone soon, and come and see you!

I developed tinnitus 2 years ago, bilateral, and during a slightly stressful period in my life, very high pitched and permanent. I saw a reputable Harley St ENT consultant in London, who, after numerous tests, MRI scans etc diagnosed the following
1. severe high frequency hearing loss, above about 6 khz
2. very high intracochlear pressures, 76% in the left ear and 98% in the right
3. marked signs of inner ear hydrops

He prescribed me serc betahistine, which I took for about 3 days but felt so sick I gave up. He also suggested he could insert grommets to release the pressure but it could cause discomfort and might not work

fast forward 2 years and I have been gradually habituating, to the extent that the tinnitus only really effects me at night, 1st thing in the morning (unbearable), and for some reason, mid to late afternoon, around 3-6pm-all other times it is there but I don't let it get to me. 

I am keen to persist with TRT and habituation, as from considerable internet research this is the best way forward,  but have this nagging  worry that there might be a cure for me, given my diagnosis, and I should perhaps take the Serc course properly, and/or the grommets, -the ENT was insistent I tried a very high dose of Serc for 2 weeks but i'm not convinced and not sure I can stomach the severe nausea i'm likely to have-

I would love to hear your thoughts on this and advice, given my diagnosis, on the best way forward-I feel if i'm 100% convinced TRT is the only way for me I will make real progress with it, but i keep thinking there maybe a cure

thanks in advance,
Mark
Dr. Nagler

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 #2 
Hi Mark -

I need to talk to a couple of my neurotology colleagues about your intracochlear pressures. Will do that this week.

What are your "marked signs" of inner ear hydrops (besides those intracochlear pressures)?

Also, if you don't mind e-mail a scanned copy of your audiogram to me at info@atlantatinnitus.com

The issues you raise are very important ones. I'll have a response after giving your post some thought and after I have the above information.

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.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
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David McCullough quoting Wilbur Wright
markvonwes

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 #3 
Hi Dr Nagler

I will need to review my reports which are at home, i'm actually on holiday this week away from London-

I will revert in due course, and provide a scanned copy of my audiogram

from memory the pressures were the main reason given for the 'marked signs' of hydrops, although I will need to confirm this

kindest regards
Mark
Dr. Nagler

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 #4 
Well strictly speaking, the pressures are a test result, which is different than a "marked sign."

Anyway, since I honestly do not know all that much about the reliability of intracochlear pressure measurements, I will run your case by my colleagues so that I can offer you a responsible response.

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
Dr. Nagler

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 #5 
Still waiting on your audiogram before addressing your post fully, Mark, but at least I have now had a chance to speak with a few of my colleagues about intracochlear pressure measurements. I can tell you that the reason I was a bit confused about your "very high intracochlear pressures" is that there really is no way to directly measure those pressures - and as best I can tell from my research, whatever indirect measures might be used in various clinics and labs are neither reliable nor verifiable. It may be that your Harley St ENT consultant has access to a testing methodology that might ultimately be proved to be reliable and verifiable, but I'm not sure at this point in time I would make a therapeutic decision based solely on those numbers.

Hope this helps more than frustrates

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.