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curiousjones

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 #1 
Dr. Nagler,

I thought that I was doing well with MBCT up until my most recent ramp up, but I was dealing with mildly intrusive tinnitus that was easier to tune out while out and about. The relative loudness (or lack thereof) made it a bit easier for me to manage when it popped up in quieter environments and I was able to get to a point after 2 months of it not bugging me so much.

Unfortunately, something happened again and it is much more omnipresent, and I'm starting to look at TRT as another strategy to pursue. The loudness of it now without sound devices around to contrast with is very distracting, and I'm not sure it's really feasible to walk around with earbuds or a bluetooth speaker for however long it takes me to adjust to this stronger intrusion.

In the past you wrote this regarding TRT success:

Quote:
...people whose tinnitus gets significantly worse upon relatively brief exposure to loud or moderately loud sound and for whom it does not settle back down within 24 hours tend to do worse. Both groups are still candidates, but success rates are not as high.


My tinnitus has gotten significantly worse in the last 3 months due to a few subsequent noise events. I wouldn't call them every day events, more like unfortunate extraordinary circumstances, as far as loud sounds I've overheard in my lifetime. Sometimes I feel a bit cursed that this has all happened during this period of time, but I wonder if I fall into this camp based on what has happened.

If I was undergoing TRT and an event like this happened again, does the patient just need to contact their TRT clinician and try to adjust the devices again to start the process over? 

I just remember you mentioning that it is like learning to ride a bike, so if one is persistent with the therapy after an increase, couldn't they just keep learning to re-ride as these bumps in the road come up? 

I wonder if the origin of the tinnitus, such as particular types of acoustic trauma, lowers ones threshold and they end up being much more sensitive to it worsening? I guess I don't understand how one could consider themselves as possible less likely successful candidates, unless the only way to find out is to undergo TRT and see.

Thank you very much for your time.







Dr. Nagler

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 #2 
Quote:
Originally Posted by CJ
Dr. Nagler,

I thought that I was doing well with MBCT up until my most recent ramp up, but I was dealing with mildly intrusive tinnitus that was easier to tune out while out and about. The relative loudness (or lack thereof) made it a bit easier for me to manage when it popped up in quieter environments and I was able to get to a point after 2 months of it not bugging me so much. 

Unfortunately, something happened again and it is much more omnipresent, and I'm starting to look at TRT as another strategy to pursue. The loudness of it now without sound devices around to contrast with is very distracting, and I'm not sure it's really feasible to walk around with earbuds or a bluetooth speaker for however long it takes me to adjust to this stronger intrusion.

In the past you wrote this regarding TRT success:

Quote:
...people whose tinnitus gets significantly worse upon relatively brief exposure to loud or moderately loud sound and for whom it does not settle back down within 24 hours tend to do worse. Both groups are still candidates, but success rates are not as high.

My tinnitus has gotten significantly worse in the last 3 months due to a few subsequent noise events. I wouldn't call them every day events, more like unfortunate extraordinary circumstances, as far as loud sounds I've overheard in my lifetime. Sometimes I feel a bit cursed that this has all happened during this period of time, but I wonder if I fall into this camp based on what has happened.

Hard to say without taking a thorough history. There are a number of factors involved. But even if you do "fall into this camp," it just means that the TRT success rate is not as high as might otherwise be expected. It does not by any means imply that you will not succeed. I guess I would add that you really do not want to be in the hands of a "novice" if your tinnitus is particularly sensitive to sound.

Quote:
If I was undergoing TRT and an event like this happened again, does the patient just need to contact their TRT clinician and try to adjust the devices again to start the process over?

It's not a question of starting the process over; it's a question of working closely with your TRT clinician to navigate the various hills and valleys that are invariably encountered in every case. Now that does not mean you have to travel to your TRT clinician's office (which would be a helluva thing for my own patients who live in Europe), but it does mean that you have to be in frequent contact with your clinician by phone or Skype when the need arises.


Quote:
I just remember you mentioning that it is like learning to ride a bike, so if one is persistent with the therapy after an increase, couldn't they just keep learning to re-ride as these bumps in the road come up?

Wrong context. The "re-learning to ride a bike" analogy comes in when you have finished TRT and a few years later for whatever reason your tinnitus rears its ugly head again, as can happen in maybe 5-10% of cases. Should that occur, TRT the second time around is a lot easier and tons quicker - like re-learning how to ride a bike.


Quote:
I wonder if the origin of the tinnitus, such as particular types of acoustic trauma, lowers ones threshold and they end up being much more sensitive to it worsening? I guess I don't understand how one could consider themselves as possible less likely successful candidates, unless the only way to find out is to undergo TRT and see.

The origin of tinnitus is totally irrelevant in terms of TRT success rates - because TRT facilitates the mitigation of one's reaction to his or her tinnitus. It really has very little to do with the tinnitus itself.

Quote:
Thank you very much for your time.

You are welcome. For more on TRT, CLICK HERE.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC

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