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Hello @Former newyorker. Sorry to hear of your tinnitus difficulties, compounded by the Covid-19 challenges we all face these days. You asked: As I understand it from your post, you last took Effexor back in July. While Effexor can (rarely) aggravate tinnitus, the drug does not cause auditory...

Hello @Roger79 - Thank you for your question. There are around a gazillion drugs that have been reported to potentially temporarily aggravate tinnitus. The precise mechanisms are for the most part not completely understood, and it is virtually impossible to avoid all of them without...

Before going further, I just want to be clear that ideally you want your tinnitus to be eliminated or at least significantly mitigated. So I believe that 100% of tinnitus research funds should be devoted to curing tinnitus rather than to habituation and the like. All I am talking about above is...

Hello @Aaaron8 - Thank you for your question. There are innumerable things that can cause tinnitus. The reason most folks try to figure out what has caused theirs is in the hopes that once it is identified, the cause can be fixed, thereby eliminating the tinnitus or at least significantly...

Hello Jacqueline - Thank you for your interesting question. I am sorry that it has taken me so long to get around to responding. I have been (and still am) attending to some important family matters. I hope over the next weeks to very slowly catch up with the backlog of questions and will start...

Hello @jb998 - Thank you for your question. With your history of boxing the first thing that comes to mind would be a structural problem - like possibly ossicular disruption or something along those lines. I would definitely see a neurotologist before considering some form of atypical...

Hello @lleyah - Perhaps I am missing something, but I do not see any clear connection between your four-year history of pulsatile tinnitus that does not bother you at all and your six-month history of dizziness and headaches. I assume you have been thoroughly evaluated by a neurologist, who may...

Hello @Wheella - Thank you for your interesting question. I apologize for taking so long to respond. There are three issues to be addressed: (1) How bothersome is the tinnitus? You say that it is causing you tremendous distress, but knowing that the cause does not represent a threat to your...

Hello @AfroSnowman. Having tinnitus (regardless of cause) does not make you more susceptible to noise-induced auditory damage than anybody else. So if you wish to go hunting with proper ear protection, you should be fine in that regard. The question of whether or not hunting with proper ear...

Hello @Watasha - It's really a personal decision ... If I were infected with coronavirus, and my doctor prescribed hydroxychloroquine/azithromycin based upon solid FDA guidelines (i.e., not based upon "very early anecdotal stories"), I would take it without hesitation. I am over 70, and to me...

Hello @monkey124 - I can well-understand your concern. As I see it, tinnitus loudness as one perceives it is a multifactorial phenomenon (see, for instance, the attachment below) - so I tend not to use it as some sort of predictor of the future but rather as a statement about the present. And...

Hello @Missmia87 - Diphenhydramine can cause tinnitus, but the incidence is *very rare*. In fact, diphenhydramine is one of the most frequently prescribed antihistamines for people who have tinnitus and need a decongestant. In any event, diphenhydramine does not cause auditory damage, which...

I am well indeed, @kitanakahn. Thanks for your good wishes! Excellent question. So here are my thoughts. The usual dose of aspirin for a headache is two 325 mg pills, to be repeated if necessary every 4-6 hours to a maximum of 12 pills in 24 hours. Here in the US it would be highly unusual to...

Hello @Air23 - With regard to relapse it helps to keep in mind that habituation is a process rather than a state - and that rather than being a straight line with positive slope, progress in habituation tends to be more like a sine wave with overall positive slope (i.e., there are natural hills...

Glad to help. Anxiety has been described as a side effect of either drug, but it is rare in my experience. More likely than not there are other anxiety-inducing factors at work, especially at the relatively low doses you describe. Best to discuss with your prescribing physician. Neither drug...

Glad to be back. It required a good bit of faith, a good bit of flexibility, and a good bit of determination - on the part of a number of people. But after some 115 questions asked and answered over the four months since my return, I hope that I have been able to once again start making some...

Hello again @Lilah - Your questions are excellent. Unfortunately the answers are a bit complicated because it all depends on exactly what you are trying to accomplish with the devices and on exactly how you are trying to accomplish it. In the most general terms it might help to keep in mind...

Hello again @Roger79 - Mirtazapine is an antidepressant. It is not ototoxic in the sense that it does not cause auditory damage. Like around a gazillion other drugs, mirtazapine can very rarely exacerbate tinnitus, but the effect is temporary - so in the unlikely event that your tinnitus gets...

Hello again @AlbertJ - What you describe might indeed be a variation of exploding head syndrome - but in your reading I am sure that you have come across the fact that other than being a distraction, exploding head syndrome is (like tinnitus) completely benign. In other words (again like...

Hello again @Shelbylynn - None of the vaccines available today can cause auditory damage. A few contain tiny amounts of an aminoglycoside antibiotic to maintain sterility, but not nearly enough of the drug to be a concern. In the highly unlikely event that you experience an increase in...

Hello again, @East - To answer your last question first, hyperacusis is a condition wherein sounds that are well-tolerated by others sound uncomfortably loud to those so affected. Your description of pain pattern does not fit with that description. If I were to hazard a guess without properly...

Hello again, @ANDREWCHARLES - It might help to view habituation as a process rather than as a state. And in that context, it would be more realistic to say that you had largely habituated rather than saying, "I finally habituated!!!!" Periods of tinnitus exacerbation (i.e., spikes) are not at...

Hello again @Indra - So that's quite a story you have there. I am sorry that you have had to deal with so many health challenges. Taking your questions in order ... I highly doubt that smart drugs and supplements affect neuroplasticity. I suspect that many will disagree with me in that regard...

Hello again, @Erin Jeanne - Thank you for your inquiry ... and for your patience while I was away. You asked: Most tinnitus resolves on its own. It may help to remember that the fine folks on this board are a self-selected group for whom unfortunately that was not the case. But for the...

Hello @Lilah - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @Roger79 - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @AlbertJ - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @Shelbylynn - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @East - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @ANDREWCHARLES - Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. I apologize for not being able to get to it sooner. Regards - Stephen M. Nagler, M.D.

Hello @Indra. Thank you for your inquiry. I am away taking care of a family matter and will be unable to respond by 3/3 (today) as requested. I should be back in Atlanta by next week and will respond then. Regards - Stephen M. Nagler, M.D.

Hello @Erin Jeanne. Thank you for your inquiry. I am away taking care of a family matter. I should be back in Atlanta by next week and will respond then. Regards - Stephen M. Nagler, M.D.

Hello @Beng50 - The half-life of escitalopram (Lexapro) is on the order of 30 hours. Most should be completely out of your system within a week of discontinuing the drug. In terms of tinnitus, I would give it longer - say two to three weeks. Escitalopram does not cause auditory damage, which...

Hello @Gerbit - Interesting question about yelling. I had to do a bit of research! So it turns out that the loudest yell ever measured was produced from the vocal cords of a Belfast grade school teacher, who yelled "Quiet" at an ear-splitting 121.7dB. She was quick to clarify that she never...

Hello @Shelbylynn - Thank you for your question. You may know this already, but in order for my response to make sense I want to review some basic anatomy. The ear is divided into three regions: outer, middle, and inner. The tympanic membrane (eardrum) separates the outer ear from the middle...

Hello @AshD - Nothing you have written above makes me think that you have put yourself in a situation that can cause auditory damage. Noise-induced auditory damage is a function of loudness and duration. The Occupational Safety and Health Administration has estimated that workers can be exposed...

Continuing ... I am glad that you hesitate "to blindly accept this as scientific evidence" since it isn't scientific evidence at all. It is anecdotal evidence from a non-randomized population. Moreover, the fact that somebody's tinnitus has gotten louder does not necessarily mean that his or...

Hello @Jaka - Thank you for your very interesting question. It would take a book chapter to do it justice - but I'll give it a shot in just a post or two. First of all, it is important to draw a distinction between loud tinnitus and severe tinnitus. You ask your question in terms of what can...

You are welcome. Glad to help. In terms of damaging your auditory system, you should be just fine shooting occasionally wearing high quality muffs and plugs. Is it possible that you can shoot with that sort of protection and still aggravate your tinnitus? Sure, I guess. I mean even worrying...

Glad to help. My apologies for not responding sooner. I've had some "stuff" going on, Goes with being into my 70s, I guess. My mother used to say that the only things in life that are certain are death and taxes. So with apologies to Mom, I am going to take the liberty of adding a third: The...

@Bartoli, some of the wording in my original response may have been unclear. I have cleaned it up a bit, and I hope it now makes more sense. Please take another look. All the best as you move forward - Stephen M. Nagler, M.D.

Hello @Bartoli - Thank you for your interesting question. Let me first address the issues surrounding your 20dB SL tinnitus loudness match. You wrote, "Almost no one has more than 10dB SL loudness match," but that statement is inaccurate. In actuality more than 60% of the tinnitus population...

Hello @Susan C. Thank you for your interesting question. I can completely understand your frustration. You wrote: My question is if you have treated patients or know of research about developing tinnitus as a long term side effect of radiation therapy causing muscle atrophy in the neck and jaw...

Hello @Deniseh ... and thank you for your question. Cabin pressure and noise are two separate issues. And in each instance the rules for those with tinnitus are the same as those for who do not have tinnitus. First noise. Whether or not you are in a plane, if the noise in the environment is...

Well actually I started the Doctors' Corner with Markku's help way back in March 2014. I was away for a while but returned a few months ago. Good to be here. I just wish other doctors would be interested in participating. But it is what it is. You and me both! There's this thing called...

Addendum - Sorry, @analilia, I forgot to address your concern about pain in my initial response. In the absence of any ENT findings to account for the return of your ear pain, one possibility could be an increased sensitivity to all stimuli in and about your ears because of the heightened...

Hello @analilia. Very sorry to hear of your difficulties. I realize this information comes a bit too late for you - but for those who are considering dental procedures in the hopes that it will relieve their tinnitus, my suggestion is not to do it unless there is a reason other than tinnitus...

Glad to help. All the best with it. Stephen M. Nagler, M.D.

Hello @Eloy Resendez Jr. Goodness, with all those "-ologists," it's enough to make your head spin. So let me try to tease it out for you. You found an ENT (an otolaryngologist) who evaluated you and determined that you have AIED (Autoimmune Inner Ear Disease). Your Quantitative Rheumatoid...

Hello @Katy2707. Sorry to hear that you are having a difficult time of it. Thank you for your questions. I hope I can be of some help. The anxiety and panic you describe are not at all unusual at this stage. Much of it has to do with the type of "fight-or-flight" and emotional factors that I...

Hello @Harfang. I am sorry to hear that you are going through a rough patch with your tinnitus. First of all, regarding damage: There is absolutely no way that you could possibly have damaged either ear or any other part of your auditory system as the result of the telephone conversation you...

I feel the need to add an important clarification to my post above. I wrote [in part]: "So probably it is plain old ordinary tinnitus that happens to be low-pitched, which means it should be addressed (or not addressed if it is not bothersome!) like any other tinnitus." When I say that there...

Welcome, @Not Sure. Sorry you had need to find this place, but glad we could be here for you! Then I guess I will start by telling you the same thing I tell everybody. Reading is good. Too much reading is not so good. And just because something you read makes good sense, that does not...

So, @MusicTeacher Tom, to pick up where I left off yesterday ... The simplest guideline for when and when not to use ear protection would be the one devised by Dr. Jack Vernon (1922-2010). Dr. Vernon suggested that if you have to raise your own voice in order to be heard by a person standing...

OK @MusicTeacher Tom. I'm going to at least get started with my response and see how far I get. You wrote: So if you are normal, that means you are about to get overwhelmed, if you are not there already. You are wondering (1) how the hell did this happen to you? (2) will it ever go away? (3)...

Hello @MusicTeacher. Thank you for your question. I sense some urgency on your part, and I just wanted you to know that you haven't fallen off my radar. I am pretty well covered up today - but I will try to respond as soon as I am able. Please check back. Regards - Stephen M. Nagler, M.D.

I am. Thank you for asking. Well, everybody has hearing loss. Even people with normal audiograms have hearing loss. We lose 0.5% of our hair cells for every year of our adult lives through natural attrition (presbycusis). I am not saying that your hearing loss is the cause of your tinnitus...

@LanaK, I have had a chance to give your situation a bit more thought. I think it is important to have your Loudness Discomfort Levels (LDLs) checked by an experienced audiologist and have them re-checked every few months as you progress in your program. Most experienced audiologists do not...

Hello @LanaK. Thank you for your interesting question. It appears that with both tinnitus and hyperacusis, you are walking a tightrope. I would like to look into various options for a "Do It Yourself" approach towards a path to relief for you and will finish my response when I have a...

Glad to help any way I can. Not to change the subject, @Capstan, but if you have been reading through my prior posts, somewhere I suspect you encountered the following words: "The first step to overcoming you tinnitus is when you have finally figured out that you can't figure it out." Yet...