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chaLLas

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 #1 
Dear Dr. Nagler,

thank you very much for offering your advice in this forum.

I will keep my story as short as possible:

3 Month ago, I got tinnitus after a very loud concert. I had a noise trauma, but according to hearing tests (up to 8 khz) me hearing recovered by 80-90%. Yet I was left with a high pitch cricket sound centered in my head. At night, another sound would appear (a "classic" frequent midrange tinnitus sound). I noticed that in some environments (like a small toilet with a fan running), I heard new sounds or "missinterpreted" sounds from my ears. That faded away after a few weeks. Yet I had horrible distress during the first 2 months, all tinnitus related.

After these 2 months, I faced another difficulty in my life. I was about to lose my girlfriend which frightenend me a lot, because I was very down and could not have standed being left alone and having destroyed my relationsship by getting tinnitus. Self-reproaches are a big part of my distress. Yet that new scenario kind of like switched my brain from reacting to my tinnitus all day to being concerned of losing my girlfriend and then not being able to get on with life.

Within days (I do not know if the tinnitus just got quieter because I was still in the accute stage where it can "self-heal" or if it was really the mental change) I felt no more tinnitus distress at all and went "back to normal". I was still left with anxiety regarding my girlfriend, but tinnitus was not a matter anymore. I was so glad that I asked my girlfriend to marry me - and she said "yes". We were so happy as everything that has build up in this hard time had been released and we were finally ready to take our next steps.

What then follow was the biggest mistake of my life. Because I was back to normal and full of Joy, I felt like going to a Disco with my friends. Of course I brought my ear plugs, yet after all I have been through with tinnitus, I should have known better to not go ANYWHERE NEAR such a loud environment. Still, light-headedly, I went there, drank some alcohol, and we were dancing. The bass was very extreme, it was a small room, I did feel it in my whole body, but I did not percieve it as "over the top" loud, since I was waering my earplugs and therefore felt "safe". I was just in there for 15 Minutes, but that seemed to be enough. I went out and the ringing was back at where I was 3 months ago. Instantly, tinnitus distress kicked in the hardest. I did not feel any deafness like I did after the concerct, yet all other smyptoms kicked right in. I wanted to kill myself for being so stupid to do such a thing after all I have been through. This is what is still causing most of my distress until today.

2 days later after it did not get better, I went to an ENT. The hearing test did not show another noise trauma. Hearing was maybe lessened a little bit here and there, but they said that is withing the measuring tolerance. The ENT said I should not go with a treatment again (infusions etc.) since I reacted slightly allergic to them the last time. I decided to not just wait and do nothing and do some sessions of hyperbare oxygen therapy and eating some supplements to help the ear regenerate (if that did not even make things worse...). So 5 days after the party, the real problem appeared: I got a "reactive" tinnitus sound on my right ear. I can only hear it when it is relatively quiet. If it get's silent, it takes a few seconds and the sound kicks in. It is like my brain is already expecting it. When I hear a fan or white/pink noise or other natural sounds, it get's louder than usual and often creates new frequency tones. When I switch the tone (e. g. the pink noise) off, the reactive sound is also gone immediately and then it takes some minutes in silence until it comes back. The tinnitus sounds like the brain is receiveing distorted signals from the ear. (Maybe several hair cells are damaged or have died and the brain compensates? Or may it "just" be hyperacusis?). And btw: the high pitch cricked sound is, of course, also still there, but since the new "reactive" sound sensations irritate me so much, it is, at least at the moment, just in the background and a "side problem".

So far, my story "in short".... now my questions:

- I have had the "reactive tinnitus" for 2 weeks now. Do you recommend any medical treatment I could still try since it is still the "accute state"? It is driving me nuts, feeling helpless and not knowing what to do. I visited several ENT's and they all are just sending me home with "your hearing is fine, it will just take time"

- Is this kind of tinnitus common? I am not finding many reports of people with similar problems online

- Since this sensation is irritating me so much, I am asking myself if it is able to ever overcome this. With my other sound, that is there 24/7 and static in loudness and tone, I can imagine to be able to take it to the background. But if the sound is reactive and creates irritating sensations and you are constantly monitoring it ... waiting for it to kick in ... being distracted because it varies so much ... how to deal with that?

- My distress levels are at maximum at this point. I am thinking of the tinnitus issue 24/7, am anxious, depressed, yet I am forcing myself to function because I have to save my job and me and my girlfriend are planning our wedding for next year. I am in the ultimate state of overwhelm. If I just had the info that I can focus on CBT or getting habituated instead of thinking about what medical treatment I might be missing in the accute state, that would already help ...


Sorry for the long post, but since the situation is a bit complicated I think I had to explain things a bit... if you need anything more of information, of course I will gladly provide it.

Thank you in adance for your time and I am looking forward to hearing your opinion.

Best regards,
Jan


Dr. Nagler

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 #2 
Hello Jan. Thank you for your inquiry.

While I give thought to the issues you raise, please clarify something for me.

According to your post, you had "a noise trauma" three months ago and subsequently underwent an audiogram (hearing test) that showed your hearing had recovered by 80-90%. Have you ever had an audiogram prior to that one, or was that your first audiogram?

Thank you.

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
chaLLas

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Posts: 2
 #3 
Dear Dr. Nagler,

tahnk you for your reply.

I have had two noise exposures, one was 3 month ago (concert, ~1,5 hrs) and the other one was 3 weeks ago (club, ~15 minutes).

An audiogram was made just one day before the first noise exposure (I hat an examination at my new employer). After the first noise exposure, a noise trauma has been diagnosed. According to later audiograms that have been made, my hearing mostly recovered, but the tinnitus stayed. Yet I habituated relatively quick, the volume stayed the same, but it did not trigger any negative emotions anymore.

Then, 3 weeks ago, I had another noise exposure and the tinnitus was brought back to my awareness. I panicked and got very anxious. I still have light fullness and pressure now and then, sometimes on the right ear, sometimes on the left, sometimes both. Also I feel like having a light Hyperacusis. I went to an ENT 2 days after the exposure, an audiogram was made which showed no big differences. Therefore, the ENT did not diagnose another noise trauma. I then started a week of HBO therapy, just to be sure. But a few days later, another sound appeared in my right ear. It was intermittent, like it only appears when I hear certain frequencies or when it is quiet around me. It sounds like crickets chirping into my right ear irregularly. If I listen to pink noise, I can trigger it. It makes it present and louder. If I pause the pink noise, it is gone for short, but then comes back. In the 3 weeks, I took Pentoxyfillin, Cortison Pills (40mg per day) and some supplements (Magnesium, Zink, Vitamin D3, Vitamin B12).

I am now at a point where I am asking myself if it is maybe all psychosomatic, because no noise trauma was detected and I am observing and analysing my hearing and the tinnitus all day. Or if any damage was done, how can I find out what it is and what can I still do to treat it. My ENT's are not very cooperative, I now visited a few. Yet, time is running and making appointments far in the future with any specialist is not constructive in the accute state I suppose ...

I hope this clears things up and does not bring in more confusion^^ maybe I can send you the audiograms in private if that helps and you want to see for youself?

Best regards,
Jan
Dr. Nagler

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 #4 
Thank you for answering my question about the audiograms, Jan. I asked just out of curiosity - because I do not know how anybody can determine an 80-90% hearing recovery from the effects of noise exposure if one does not know the degree to which that same noise exposure maximally affected your hearing in the first place. But this board is about tinnitus, not about hearing loss. And there are many people with normal audiograms who have severe tinnitus - just like there are many people with severe hearing loss who are unaware of any tinnitus at all!

So I am going to take your audiograms completely out of the equation when I try to respond as best I can to your questions about your tinnitus.

You asked:

- I have had the "reactive tinnitus" for 2 weeks now. Do you recommend any medical treatment I could still try since it is still the "accute state"? It is driving me nuts, feeling helpless and not knowing what to do. I visited several ENT's and they all are just sending me home with "your hearing is fine, it will just take time"

The way I see it, "reactive tinnitus" is no different than any other tinnitus in terms of treatment strategies and in terms of prognosis. I put "reactive tinnitus" in quotes because everybody's tinnitus reacts to something. Yours apparently reacts to certain sounds. Mine reacts to certain foods. The question is not what one's tinnitus reacts to. Rather, the question is how and why your tinnitus affects you the way it does regardless of how loud it might be at any given point in time - and what you can do about it.

I do want to make one comment at this point. And I want you to hear it LOUD and CLEAR. You wrote in your original post that after your previous unpleasant experience with tinnitus, going to the disco was "the biggest mistake of [your] life." And I would argue that not going to the disco would have been a far greater mistake than going. You were there for what? 15 minutes. And you were wearing earplugs. So you took proper precautions, and even then you left when you felt uncomfortable. You did exactly the right thing. The wrong thing to do would have been to stay at home and allow your concerns and fears about tinnitus dictate more and more of your life. What other pleasures would you have avoided once you started down that slope? Fifteen minutes in a disco wearing earplugs is not enough noise exposure to cause any damage at all. So where did the tinnitus recurrence come from? No way of knowing for sure what factors were at play, but I can tell you this: Your continually reproaching yourself ("Self-reproaches are a big part of my distress") is not helping matters one bit. You wrote about being "stupid." Look, "stupid" is lying down across the railroad tracks as a freight train is approaching. It is not "stupid" to go to the disco with your friends, taking proper precautions. Incidentally, there happens to be a very sophisticated medical term for going to a disco with your friends. And that term is NORMAL. So if you want to reproach yourself for being normal, go right ahead. But please don't do it here.

..............

- Is this kind of tinnitus common? I am not finding many reports of people with similar problems online

Tinnitus in general is rather common. The "kind of tinnitus" is largely irrelevant - because almost all of the problems one has with one's tinnitus are due to how one reacts to the tinnitus, rather than to its existence. I know. You are thinking that if you didn't have tinnitus, you wouldn't have anything to react to. But in that regard the cat is pretty much out of the bag. Your tinnitus may well go away on its own, but there is nothing I know of that will hasten its departure. For more information in that regard, you might take a look at Tinnitus 101 for Newbies.

..............

- Since this sensation is irritating me so much, I am asking myself if it is able to ever overcome this. With my other sound, that is there 24/7 and static in loudness and tone, I can imagine to be able to take it to the background. But if the sound is reactive and creates irritating sensations and you are constantly monitoring it ... waiting for it to kick in ... being distracted because it varies so much ... how to deal with that?

As I have come to see it, the trick is not to "deal with that" at all. Rather the trick is not to care, which is basically what the process of habituation is all about.

...............

- My distress levels are at maximum at this point. I am thinking of the tinnitus issue 24/7, am anxious, depressed, yet I am forcing myself to function because I have to save my job and me and my girlfriend are planning our wedding for next year. I am in the ultimate state of overwhelm. If I just had the info that I can focus on CBT or getting habituated instead of thinking about what medical treatment I might be missing in the accute state, that would already help ...

Congratulations on your upcoming wedding. Very exciting! I am not sure what you are talking about when you refer to the information on CBT. There is loads of information out there. You might start with my Letter to a Tinnitus Sufferer.

Jan, I have tried to address your concerns above in a general sense within the limited constraints of this board. If you have specific issues requiring a more in-depth discussion, you might consider setting up a phone or Skype consultation. CLICK HERE for more information.

I sincerely hope this response has been helpful - or has at least given you something to think about.

All the best -

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
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