Spiking Tinnitus with TRT Devices

Hello Dr Nagler,

I just had a question that I was hoping that you would be able to shed a little light on (I sent this same question to my audiologist, but she is out of town right now).

Currently I am working with my audiologist to deal with my H first, and my T second. So right now we are trying to push my sound tolerance by increasing the sound with my devices. Since I've started TRT, I have been noticing that after I take out my TRT white noise devices (Widex brand) at the end of the night, my T is A LOT louder, but then it usually settles down by morning after a good sleep. Is this experience common with people that have H, and more "reactive" T and are going through the TRT process?

I just popped on here quickly to follow up on something and I saw a recent answer that you gave to another question, and this little bit caught my eye (written below)

"He has severe intrusive "reactive" tinnitus and profound hyperacusis. External noise not only causes him incredible discomfort, it also ramps up his tinnitus to extremes."

So if your able to shed any sort of insight on the subject then that would be great. I imagine that the sound from TRT devices aren't even allowed to go to levels that could cause any permanent increases to your T anyways!

Positive Note:

I figure that I would just pass along this along as well while I'm here! I have been using my TRT devices for about 11 - 12 hours a day, and have mostly been keeping them on the default setting that my audiologist set up for me.

Since starting TRT, I have been to the dentist and had my first cavity taken care of (sadly I have one more that needs to be fixed haha drat!), been on the sky train (like a subway in the sky) a couple of times, and am back to riding the bus on a semi regular basis - after not riding one for about 4 months. I am trying to take it one step at a time, and not use hearing protection as much, but slowly I am seeing progress - even noticing that certain sounds that used to bother me before - don't seem as loud.

I have had some set backs along the way, such as being startled by certain high frequency noises and car horns - but I'm still sticking with the TRT plan that my audiologist set up for me.

I have also had moments where after going to bed I think to myself...

"Well while this T seems very loud right now, the white noise sound is actually louder then my T - and that didn't bother me...so why let this T bother me now" .......and then I just go to sleep haha.

So while I know that I have a long road ahead of me, I have been seeing small signs of hope that this is helping me. It also helps that both me and my audiologist have a good dialogue going, and she also pushes me (in a good way) to stick with the treatment and work with her. Next week I will be having my first TRT counceling session with Glynis!

Anyways, I'll stop the positive rambling haha. Who knows, if this continues going the way that it's going then you may have another TRT believer on your hands as well !

Cheers,

Kris

 

I do not know your TRT category, so I cannot comment on the protocol being used, but generally hyperacusis and tinnitus are addressed simultaneously in TRT - so the idea of continually pushing sound tolerance to treat hyperacusis first does not sound right to me. But maybe your audiologist has something else in mind here.

I guess you can use Widex devices for TRT, but the Zen fractal tones that come with the Widex devices are contraindicated in TRT. So if all you are using is the "white noise" memory, you are paying for technology (i.e., the fractal tones) that you do not need. Again, I'd need to know more about what your audiologist is trying to accomplish to comment further.

At around six weeks one-third of TRT patients notice an increase in tinnitus, but it has nothing to do with "reactive" tinnitus. Rather it is considered a good prognostic sign with the brain's beginning to process the tinnitus differently. Experienced TRT clinicians know to look out for it and know how to manage it. Since I do not know how far you are into the process, I do not know if this phenomenon applies to you.

Right. That describes a patient of mine prior to starting TRT. With properly adjusted TRT devices and counseling appropriate to his TRT category, he will not be experiencing what you are describing in your post (save for the six-week syndrome, if it applies).

In the balance of your post you indicate that overall things are going reasonably well with your treatment. Please do not interpret my responses above as being critical of what your audiologist is recommending and why. As I said a few times already, I do not have enough information to offer an opinion one way or the other in that regard.

I would like to make one comment about TRT and what some folks here call "reactive" tinnitus. The success rates for TRT are not affected by whether or not one's tinnitus is "reactive." Suggestions perpetuated on this board to the contrary are erroneous. The exception is those cases in which the tinnitus exacerbations after noise exposure typically last for more than 24 hours before settling back down. In those cases the TRT success rates are still good, but not as good as if the exacerbations typically last for less than 24 hours.

Hope this helps more than confuses.

Dr. Stephen Nagler