Christiaan
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Christiaan

Member, Male, from The Hague, the Netherlands

Some say you get mentally stronger after 'surviving' a severe disease. I have to be honest I'm still crippled by PTSD after all those years Apr 7, 2024

    1. Christiaan
      Christiaan
      Some say you get mentally stronger after 'surviving' a severe disease. I have to be honest I'm still crippled by PTSD after all those years
      1. BB23
        BB23
        All for nothing. You still die in the end.
        Apr 7, 2024
        Sansa likes this.
      2. Christiaan
        Christiaan
        @BB23 That's a strong statement, but I get it. I'm still happy to be alive though, especially for my family who shared my burden. The thing is that I've become hyper vigilant for loud sounds wherever I go, because I don't want it to become just as bad as a few years ago and let my family experience the whole thing all over again.
        Apr 7, 2024
        L along the way, BB23 and streifzug like this.
    2. Fields
      Fields
      As a fellow Dutchman, could I ask for your advice on something? There's a clinic in De Bilt that offers a Tinnitus treatment via pulsed radiofrequency of the auriculotemporal nerve. I've been considering whether to give this a shot, but I'd appreciate some feedback from a fellow TT member. Would you mind taking a look at the related research paper and share your thoughts?
      1. Christiaan likes this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        Good question: I think I was prescribed a dose of 30 IU x 2 daily.
        Mar 27, 2024
        Fields likes this.
      4. Fields
        Fields
        That's the one! Thanks for the additional information. Do you perhaps remember how long a prescription would last you at that dose?
        Mar 27, 2024
        Christiaan likes this.
      5. Christiaan
        Christiaan
        Another good question:) I'm not entirely sure, but I belief it was for 3 or 4 weeks (2 small bottles).
        Mar 27, 2024
        Fields likes this.
    3. Christiaan
      Christiaan
      Hmmm...ADHD meds may interfere with tinnitus, I think. I'm on Elvanse/Vyvanse for about a week, and my HF tinnitus sounds softer than usual
      1. cyberspace
        cyberspace
        One dose of dextroamphetamine gave me a terrible spike
        Jan 29, 2024
      2. Christiaan
        Christiaan
        Sorry to hear that. Have you tried it only for a short while? I had an issue with Concerta that it would make my T worse in the first few weeks (which was no longer the case after +/- a month).
        Jan 30, 2024
    4. DebInAustralia
      DebInAustralia
      How did dahlia extract help?
      1. lymebite likes this.
      2. Christiaan
        Christiaan
        Jan 25, 2024
      3. DebInAustralia
        DebInAustralia
        Thanks

        Did you try it for yourself?
        Jan 25, 2024
      4. Christiaan
        Christiaan
        No, not yet, but I will update you and others when I start with these supplements.
        Jan 26, 2024
        lymebite likes this.
    5. Fields
      Fields
      1. Christiaan and Note like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        Two other nice bonuses: my visual snow is way less on Dahlia4 and it feels like I have more mental energy. Don't know if this is temporary or permanent, but will try to keep updating you all every now and then.
        Mar 13, 2024
        Note and Fields like this.
      4. Fields
        Fields
        Great to hear it works for you! Unfortunately, for me, it doesn't seem to do anything 2 weeks in.
        Mar 13, 2024
      5. Christiaan
        Christiaan
        @Fields Darn, sorry that it didn't give you the much needed relief.
        Mar 15, 2024
    6. Christiaan
      Christiaan
      Is there someone who wants to go to the TU Delft symposium with me? It's on the 6th of February.
      1. gameover likes this.
    7. ErikaS
      ErikaS
      Any update on your end with MT and early access requesting ?
      1. SarahMLFlemmer likes this.
      2. View previous comments...
      3. ErikaS
        ErikaS
        My Neurologist and I have the request letter ready to go along with research articles and a few other things. I just gave MyTomorrows my Doctor's email to communicate yesterday, so the next step I guess is for MT to contact my doctor and go from there? They didn't really explain what will happen when they contact my Neurologist, but yes did everything on my end!
        Oct 19, 2023
      4. Christiaan
        Christiaan
        I'm also not sure about that communication part between a physician and MT for EA (forgot to ask them about it), but I can imagine that your guess is most likely the case here (to verify your doctor's willingness/consent to participate in this trajectory, inform him about regulatory and program requirements, etc.).
        Oct 22, 2023
      5. Christiaan
        Christiaan
        You did absolutely everything you could, now it's up to MT to give the extra nudge in making this happen. I sure hope that you'll get that much needed relief.
        Oct 22, 2023
    8. Christiaan
      Christiaan
      Has anyone tried yellow dahlia flower extract? It seems to eliminate hypothalamic inflammation in animal models. Perhaps useful for tinnitus
      1. lymebite, 4Grace and 4alien2 like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        @ErikaS Maybe this is also of interest to you?
        Oct 8, 2023
        4alien2 and SarahMLFlemmer like this.
      4. Christiaan
        Christiaan
        @Mo8409 & @SarahMLFlemmer

        After some research, I've decided to order Dahlia4 from the supplier. It seems that the product does contain the 3 essential flavonoids (butein, isoliquiritigenin & sulfuretin, which seems to have a strong synergistic effect). It may take a week before I can finally test it.
        Oct 8, 2023
        4alien2 likes this.
      5. SarahMLFlemmer
        SarahMLFlemmer
        @Christiaan Nice find! I'm willing to try almost anything!
        Oct 8, 2023
        Christiaan and 4alien2 like this.
    9. BB23
      BB23
      Please ask MyTomorrows if it will be possible to get BHV-7000 for compassionate use outside of EU and USA. If it's not available, can a non US&EU citizen get it if they were to go to us&eu and go to a hospital and ask for compassionate use there.
      1. ErikaS, Christiaan and Utdmad89 like this.
      2. Christiaan
        Christiaan
        I will ask them about it, np @BB23
        Oct 3, 2023
        BB23 likes this.
      3. Christiaan
        Christiaan
        @BB23 I forwarded your question to a patient navigator of MT. This is their response:

        ''Regarding your 2nd enquiry, the approach would be similar to your request. We can support and help a physician with a patient navigate the process if the EAP is possible and available for that patient situation.''
        Oct 5, 2023
      4. Christiaan
        Christiaan
        ''It is a rather complex process that is dependent on various factors related to pathway availability, patient eligibility, location of patient, regulatory board authorizations, finance, etc.''
        Oct 5, 2023
    10. ErikaS
      ErikaS
      Looking forward to your appointment on Wednesday! Can't wait to hear the feedback :)
      1. View previous comments...
      2. Christiaan
        Christiaan
        Maybe you're right, though I personally will just go ahead with it. Who knows, maybe they'll finally notice that there's commercially a huge potential by also incorporating tinnitus as an indication.
        Oct 8, 2023
      3. ErikaS
        ErikaS
        @Christiaan so will you involve MT then in your process ?
        Oct 8, 2023
        Christiaan likes this.
      4. Christiaan
        Christiaan
        Yes, that's the plan
        Oct 8, 2023
    11. ErikaS
      ErikaS
      I’m starting to gather research PDF docs in a folder. Ones that show evidence of KV7.2.3 pathogenic plasticity that leads to induction of T, to ones that discuss KV7 modulators as potential breakthrough targets to mitigate T. One discussing how Retigabine reduced HL & T in animal model…
      1. View previous comments...
      2. ErikaS
        ErikaS
        Yes I would be so appreciative of anything you can share! You are meeting with them a week before I am so that could be very helpful, thank you. Crossing fingers for the both of us and anyone else trying to access this drug for our disability.
        Sep 26, 2023
        Christiaan and 4alien2 like this.
      3. Christiaan
        Christiaan
        @ErikaS He certainly holds ENTs higher in that regard than we do:)
        Sep 27, 2023
      4. Christiaan
        Christiaan
        Thanks! I'm also rooting for you and others in this endeavour. Let's hope that Biohaven will be the first company in many years to offer REAL help to us
        Sep 27, 2023
        ErikaS likes this.
    12. Christiaan
      Christiaan
      I have an appointment with MyTomorrows on 4/10 concerning compassionate use for BHV-7000. Are there any questions you'd like me to ask them?
      1. tpj, ErikaS, Guywithapug and 3 others like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        @ErikaS That's indeed a bit tricky, but I do know that they have specialists (from different scientific fields) on board who know how to use the compassionate use framework, that they know how to get in contact with companies (that's my experience at least) and that they have already proven to set up successful compassionate use projects for other ailments
        Sep 19, 2023
        SarahMLFlemmer and ErikaS like this.
      4. ErikaS
        ErikaS
        @Christiaan thank you for the info. May have to set up a call myself just to learn more.
        Sep 19, 2023
        Christiaan and SarahMLFlemmer like this.
      5. Christiaan
        Christiaan
        @ErikaS MyTomorrows services are free of charge, so you don't have to pay anything.

        You can go to the bottom of the page (https://mytomorrows.com/en/patients) to answer some questions (quiz) before making an appointment or send a message
        Sep 20, 2023
    13. Christiaan
      Christiaan
      Went to a climate protest with my political organisation. There was also live music (punk bands). Wore my ear plugs. No spike so far
      1. 4Grace, cjbhab, jimvee and 2 others like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        @4Grace I said the same thing about 3 years ago, a lot has changed since then. Tinnitus is unpredictable, but can even lower in intensity & volume after many years
        Sep 14, 2023
        Utdmad89 and Strawberryblonde like this.
      4. 4Grace
        4Grace
        @Christiaan - first bit of hope I have had in a while. Thank you. Outside of the unfortunate noise exposures I had I was just thinking I did not have a chance since I am now on mirt. I see your on it too so maybe it can still get better even if on 15 mg mirt?
        Sep 15, 2023
        Christiaan, BrOKeN_1 and Utdmad89 like this.
      5. Christiaan
        Christiaan
        Yes, I take Mirtazapine; consume 7,5 mg almost every day for the last few years
        Sep 17, 2023
    14. Christiaan
      Christiaan
      Concerta update: upped my dose to 63 mg, now my tinnitus is pretty non-existent. 54 mg made it rage like hell. Trying to enjoy this moment
      1. tpj, kingsfan, Ondine and 1 other person like this.
      2. View previous comments...
      3. gameover
        gameover
        @Christiaan Tha drug is some scary s**t. How did you even get that prescribed? For another issue? Keep us posted.
        Sep 1, 2023
      4. Christiaan
        Christiaan
        @gameover For ADHD, as I have trouble focusing. Some get those scary side-effects like heart palpitations, headache, mood swings, high blood pressure, etc. I haven't experienced that so far, luckily enough.
        Sep 1, 2023
      5. Christiaan
        Christiaan
        @kingsfan One of the first things that comes to mind is that you have less inner chatter. You just have a more relaxed, restful + more alert mindset and that alone helps to do the things that we often postpone. It's not a magic pill though. Procrastination is still an issue, but less so than before.
        Sep 1, 2023
    15. Christiaan
      Christiaan
      Just absolutely grand. My tinnitus changed from a 3 to a 9 overnight and I can't sleep anymore. Concerta fucked me up. You just can't win
      1. gameover, 4Grace, tpj and 1 other person like this.
      2. Utdmad89
        Utdmad89
        I would stip taking the Concerta. And find other ways to deal with your ADHD.
        Aug 23, 2023
        Christiaan and gameover like this.
      3. kingsfan
        kingsfan
        taper down if you can, unless you are on the lowest dose you can possibly take. my experience has been tinnitus goes down some time after discontinuing, not with concerta but a bunch of different drugs.
        Aug 23, 2023
        Christiaan likes this.
      4. Christiaan
        Christiaan
        Thanks for your helpful insights @Utdmad89 & @kingsfan. I decided to taper down from 54 to 36 mg. Perhaps that will help to ease this burden. The tinnitus is still annoying, but less so than yesterday.
        Aug 23, 2023
    16. Christiaan
      Christiaan
      Interesting news about Belgian musician Bart Peeters: he got tinnitus in 1996 but it's now gone, only for it to be replaced by hyperacusis:/
      1. JPGL and jimvee like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        @SarahMLFlemmer Yeah, it is somewhat hopeful that tinnitus can just disappear after so many years, yet also terrifying that you could easily get dragged back to hell if you don't watch out with noise exposure
        Aug 16, 2023
        SarahMLFlemmer and jimvee like this.
      4. Juliane
        Juliane
        Say what?
        Aug 20, 2023
        Christiaan likes this.
      5. 4Grace
        4Grace
        I second that “say whaaaat?”
        Aug 28, 2023
        Christiaan likes this.
    17. Nick23
      Nick23
      Hey man how’s your tinnitus?
      1. View previous comments...
      2. Nick23
        Nick23
        It’s not bad. Maybe similar to yours. I read somewhere here you had some success with a certain protocol? I just have it in my left ear likely due to some hearing loss and some mild barro trauma from HBOT
        Aug 10, 2023
        Christiaan likes this.
      3. Christiaan
        Christiaan
        Yeah, I mentioned somewhere in the Lion's Mane thread that I've tried tons of things consistently for a long period in hopes of reducing my T (combination of supplements, microdosing psilocybin shrooms/truffels, exercise, diet, sound therapy). It could have played a part in reducing it from 10/10 to 3-5/10.
        Aug 11, 2023
        Nick23 likes this.
      4. Christiaan
        Christiaan
        Nice to hear that yours isn't bad. I see that you got your T quite recently. There's some chance that it could reduce in intensity by its own volition in the next few years, as it has happened to a lot of people on TT. The first few months are always rough, but you'll get there:)
        Aug 11, 2023
        Nick23 likes this.
    18. Christiaan
      Christiaan
      Oh boy, ever since I started on Concerta a few weeks ago, my mind is more focused on tinnitus. Do other ADHD folks also have this issue?
      1. View previous comments...
      2. Christiaan
        Christiaan
        @Strawberryblonde Wow, that is so recognisable. I think your description could tik a lot of boxes for ADHD. Do you also tend to zone out often during conversations or meetings? Lots of people with ADHD have that issue as well.

        I tend to think that Concerta helps. Even though my tinnitus is now a bit louder, it certainly helps with focus and the ability to get the job done when I have a lot of work on my plate:)
        Aug 9, 2023
      3. dd314
        dd314
        Have you ever tried Guanfacine for the ADHD? Some people say it gives them tinnitus so I'm weary about starting it, but it's supposed to be great for ADHD
        Mar 8, 2024
        Christiaan likes this.
      4. Christiaan
        Christiaan
        No, I haven't. First Concerta, now Vyvanse/Elvanse. Both are stimulants. Guanfacine seems to have less side-effects, but it's a non-stimulant, and that is generally less effective for ADHD than aforementioned stimulants. FWIW, I don't have T spikes on Elvanse.
        Mar 12, 2024
    19. Christiaan
      Christiaan
      Interesting talk with someone the other day. Her tinnitus was gone after dexamethasone treatment. She did this after 1 year of living with T
      1. Strawberryblonde and Ngo13 like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        @4Grace Yes, she did tell me that she was quite elated when her tinnitus was gone after treatment. I hope we'll get there too, eventually
        Aug 9, 2023
        SarahMLFlemmer and 4Grace like this.
      4. SarahMLFlemmer
        SarahMLFlemmer
        Oct 3, 2023
        Christiaan likes this.
      5. Christiaan
        Christiaan
        Noise-induced hearing loss as a result of exposure to loud music during a concert
        Oct 3, 2023
    20. ErikaS
      ErikaS
      Hey @Christiaan , I reviewed your "healing protocol" and I am so happy that your research, hard work, and discipline paid off for you. I know you suffered from hyperacusis that has become mild. Was your tinnitus ever very sensitive to sound/reactive? If so, wondering if you are able to pinpoint certain supplements or diet that helped this.
      1. View previous comments...
      2. Christiaan
        Christiaan
        I do hope you will get relieve from your reactive tinnitus. I've read your story in the transcranial stimulation thread and it sounds like your doctor knows what he is doing. Just know that we're all rooting for you, Erika
        Jul 4, 2023
      3. Mo8409
        Mo8409
        @Christiaan How long did you have mild hyperacusis for? Was it anything you did special to help get rid of it?
        Aug 10, 2023
      4. Christiaan
        Christiaan
        About 2 years or so. I tried all kinds of things to reduce it plus tinnitus: sound therapy (notched therapy), diet (organic vegan food), meditation, exercise, specific supplements (e.g. magnesium l-threonate, algae oil, lions mane, etc.). That's about it, I guess:)
        Aug 10, 2023
        SarahMLFlemmer likes this.
    21. twa
      twa
      Hope you are well! I'm teaching and started writing my dissertation for my doctorate. Are you working at the railroad company?
      1. SarahMLFlemmer likes this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        I really like that you don't let tinnitus get in the way of your ambitions. I really do hope you succeed in writing your dissertation. Are you planning on teaching at university level in case you receive your PhD?
        Jul 2, 2023
        twa likes this.
      4. twa
        twa
        Hi Christiaan, thank you & good to hear from you! I hope you can continue with your studies and teach in the near future! I teach in a large college system, so I am very happy where I am. When I finish my doctorate it would be nice to write while continuing to teach.
        Jul 2, 2023
        Christiaan likes this.
      5. Christiaan
        Christiaan
        @twa Nice! Writing and teaching sounds like a great combination. I hope to read your work when you're finished with your dissertation. Please keep me informed:)
        Jul 4, 2023
        twa likes this.
    22. twa
      twa
      Hey @Christiaan so glad you are doing well. I haven't been on in a while. I have been teaching for a year and a half now at the college level. Hope you are teaching and continuing to do well!
      1. NYCGuy and Damocles like this.
      2. Christiaan
        Christiaan
        Thanks @twa I hope you still enjoy teaching.

        I'm doing fine. I am actually working for a railroad company, for the simple reason that they offer a safe tinnitus and hyperacusis space. I'm still dealing with phonophobia and PTSD issues, but maybe in a year or so I'll give teaching another try:)
        Feb 3, 2023
        twa likes this.
    23. ErikaS
      ErikaS
      Hey @Christiaan just read some of your posts here. Saw you are having improvements, that is amazing! You mentioned doing notched sound therapy. How do you do this with more than 1 sound? I have about 3-4 sounds, and they themselves change frequency with reactiveness.
      1. Christiaan and NYCGuy like this.
      2. View previous comments...
      3. Christiaan
        Christiaan
        I have to add that people can still have dips at frequencies that are not specifically tested by audiologists/ENTs. They only test between 125-1500-7000-12.000 Hz., etc. They don't check between those specific frequencies (e.g. 375 or 6850 Hz.). This is called hidden hearing loss: https://www.healthyhearing.com/report/53066-Hidden-hearing-loss
        Feb 3, 2023
      4. ErikaS
        ErikaS
        @Christiaan thank you for the input! Unfortunately, my only consistent tone on frequency is my high electric hiss/whine tone. All the others jump around, there’s a definite pattern to the frequencies they jump to, like one pure tone in my L ear goes from 2200 to 2100 then 2700. So can’t really do this with that nonsense :(
        Feb 3, 2023
      5. Christiaan
        Christiaan
        Sorry to hear about that @ErikaS . Hopefully Shore's device will be released asap to help you with your dreadful tones.
        Feb 5, 2023
        ErikaS likes this.
    24. Christiaan
      Christiaan
      I can say with certainty that tinnitus can improve after two years. My T is low enough that I think about going back to teaching next year
      1. gameover, Eleanor89, ErikaS and 21 others like this.
      2. View previous comments...
      3. ZFire
        ZFire
        Makes sense. Your English is superb.
        May 20, 2022
        twa, Damocles and Christiaan like this.
      4. Christiaan
        Christiaan
        @aura I hope all is well. Anyway, you can find my new post on the pro-BDNF/NGF regime in the Lion's Mane Mushroom thread.
        May 20, 2022
        twa, ZFire and aura like this.
      5. Christiaan
        Christiaan
        @ZFire That's very nice of you to say. Thank you!
        May 20, 2022
        Damocles and ZFire like this.
    25. Christiaan
      Christiaan
      Who's going to the Eurovision Song Contest finals? I think Austria, Ukraine & Switzerland are a sure bet.
      1. Farida, Damocles, kuromi and 4 others like this.
      2. View previous comments...
      3. aura
        aura
        May 14, 2022
        Christiaan likes this.
      4. aura
      5. Christiaan
        Christiaan
        @aura The guy has such an impeccable voice. I can't help but think that if the situation in Ukraine was a bit different, England could have won the Eurovision song contest.
        May 16, 2022
        aura likes this.
    26. Aaron91
      Aaron91
      Christian, how are you doing man? I noticed you weren't active here for a while
      1. View previous comments...
      2. Christiaan
        Christiaan
        @Steph1710 wow, that's very kind of you to say. And I also like to say that I enjoy reading your posts as well. You're sort of a mental coach that people really need around here on TT:)
        May 8, 2022
      3. Christiaan
        Christiaan
        @Aaron91 Ey Aron, sorry to hear about your situation. It's tough, isn't it? Like you, I'm not out of the woods yet. Every day is a small step forward, and that's ok. Time really is a healer in that regard.
        May 8, 2022
      4. Christiaan
        Christiaan
        I'm sorry to hear about your hyperacusis. I hope you'll succeed in offing your H.

        I remember that you were quite active in the lion's mane/psilocybin threat. Are you still experimenting with smart drugs & psychedelics or have you moved on to something else?
        May 8, 2022
        JPGL likes this.
    27. Steph1710
      Steph1710
      I’ve missed you on here. <3
      1. Rockman, aura and Wrfortiscue like this.
      2. Christiaan
        Christiaan
        Hi Steph, thanks for your kind words. Very much appreciated. It's nice to see you too on TT.
        May 6, 2022
        JPGL, Steph1710 and Rockman like this.
    28. Christiaan
      Christiaan
      Animal shelters in Ukraine are taking a heavy toll by Putin's disgusting war. If you feel the need to chip in, support PETA with a donation
      1. JPGL, NYCGuy, Leila and 1 other person like this.
      2. View previous comments...
      3. Damocles
      4. Christiaan
        Christiaan
        @Steph1710 Yes, I've read that somewhere. And there are many other stories of people who were trying to bring food to animal shelters behind enemy lines but were killed by Russian soldiers. It's heartbreaking. It's hard to understand that people can be so cruel
        May 3, 2022
        Steph1710 likes this.
      5. Christiaan
        Christiaan
        @Damocles Damn, it's a bloody shame you can pull that card with your Prime Minister only once, since he's under scrutiny the last few weeks for some other naughty stuff (who else but BoJo):/
        May 3, 2022
        Damocles likes this.
    29. Christiaan
      Christiaan
      N'oubliez pas de voter pour Macron le 24 avril. Dites non à l'extrême droite de Marine Le Pen
      1. Tatsopa
        Tatsopa
        Et en bon français dans le texte, comme on dit ;)
        Ma voix n'ira ni à l'un ni à l'autre, par contre, si l'un d'eux veut bien prendre mon audition je serais plus que ravi de la lui donner.
        Apr 20, 2022
        CRGC likes this.
      2. Rockman
        Rockman
        Wish there was a translation button. Haha
        Apr 20, 2022
        Christiaan and Steph1710 like this.
      3. Christiaan
        Christiaan
        @Tatsopa Merci pour ces gentilles paroles;) C'est un point de vue intéressant. Si je peux me permettre, pourquoi tu ne voteras pas pour l'un des deux?
        Apr 21, 2022
    30. Ela Stefan
      Ela Stefan
      Hi, Christiaan! How was the appointment with Dr. De Ridder ? Did he give any useful insights?
      1. JPGL likes this.
      2. View previous comments...
      3. Damocles
        Damocles
        You've become like the ambassador for relations between De Ridder and tinnitus sufferers on TT, @Christiaan.

        We should make you the official correspondent!
        Apr 18, 2022
        JPGL likes this.
      4. Christiaan
        Christiaan
        @Damocles Good idea! I'm going to ask Dr. De Ridder if he's okay with that;)
        Apr 19, 2022
        JPGL and Damocles like this.
      5. Christiaan
        Christiaan
        @Ela Stefan If it is of any help, medical devices may receive an earlier approval in Europe vs. USA because of the European CE-mark regulations (could be given after 1st successful trial).
        Apr 19, 2022
        JPGL and Damocles like this.
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  • About

    Gender:
    Male
    Location:
    The Hague, the Netherlands
    Tinnitus Since:
    2016
    Cause of Tinnitus:
    2016: headphones, 2020: worsened thanks to Rammstein