Anxious and Alarmed

Hi there,

I thought I would introduce myself and ask for some advice and thoughts. Like many tinnitus sufferers, I've had intermittent (usually brief - not lasting more than a few seconds or minutes) tinnitus throughout much of my life, but it has never been an issue and ordinarily passes right away. However, during the past couple of days, it started in both ears (at a constant whistling level of 6 out of 10) and hasn't stopped since. So, my neurotic side has taught me to try and figure out as much as I can about what is going on.

Some background: I'm a 35 year old male living and working in the Northeastern United States. While I don't really consider myself subjected to audio trauma, I do wear earbuds every day during my commute on the subway and listen to videos at a moderately-high volume (for iPhones, anyways) for about 1-2 hours a day. However, most recently, I started experiencing some G.I. issues which were keeping me up at night, and three weeks ago, I was prescribed Ativan (Lorazepam) to take at night to help me sleep, while doctors try to figure out a longer course of treatment to treat and cure the epigastric distress I am feeling. I only take 1 mg a night, and have only done so for the past three weeks.

And so, I have become quite anxious as my tinnitus has started in full, and have several questions:

1. Could the Ativan/Lorazepam have caused this sudden onset of T?
   
   
2. My epigastric distress has a number of circulatory symptoms, including coldness on various parts of my body at various times. Is it possible that I am suffering from a circulatory issue that might be causing my T?
   
   
3. I've been reading a lot that trying to take positive and proactive steps at the earliest onset of tinnitus may often be critical. What should I be doing? Should I be exercising, drinking fluids, seeking specialized medical attention?
   
   
4. I just learned today that my paternal grandfather used to suffer from intermittent tinnitus that would last for days before resolving entirely. How likely is it that my tinnitus might have been inherited, and is there anything I can do to manage it?

I will be having an MRI of my brain conducted to rule out any obvious neurological causes in my case. However, I'm becoming alarmed as my normal G.I. symptoms (mostly abdominal discomfort and pounding when I lay down) have now been joined by this tinnitus.

I know it's very early for me - just a couple of days - when compared with the months and years that many of you have been suffering, but obviously, I am quite anxious about all of this, and my immediate inclination is to try and suspend taking Ativan and any other drugs that might peripherally be related to this sudden onset. But I could really use your thoughts and perspectives.

If you were me, what would you do?

Thanks.

 

Ativan is very unlikely the cause. You should chill with it and only use it when you need. It's not a long term med IMO. You're obviously from NYC and you need to wear ear plugs on the subway and when around noisy streets. Start to take some magnesium citrate, Nac, vitamins E a and c ... Also try to take melatonin at night to help with sleep. Exercise is good too.

 

Also ditch the ear buds ...if you're gonna listen make sure you have maximum isolation in your ear phones

 

Thanks, @SoulStation - I appreciate your thoughts and guidance.

I woke up in the middle of the night last night and was tinnitus free in my left ear (but still had tinnitus in my right ear), but by morning when I awoke a few hours later, the T had returned to both ears. Is that sort of intermittent, middle-of-the-night switching something that others have experienced? Could this be a sign that this might be sleep-deprivation caused? Sorry that I'm asking so many questions, but this constant T is a very new phenomenon for me.

I have my MRI this Saturday, so hopefully, will get some more answers before deciding to follow up with Neurology and an ENT.

 

If your T were from immediate audio trauma, then I think a lot of us would have more "do it now" suggestions for you, but since it just came out of the blue, I think SoulStation had good suggestions for you.

Rule out anything obvious, get lots of sleep and take care of your body. Not panicking is extremely important, that just teaches your brain to focus on the sound as a threat. Don't panic about not panicking though. Worrying wont do any permanent damage, but if the tinnitus persists, it will prolong the amount of time it takes for your brain to let the sound slip into the background.

If you think it's circulatory, you could try Ginko Biloba, acupuncture etc. There are lots of threads on the board. I'm in NYC, too. If you need some Dr. recommendations feel free to PM me. I am not a doctor at all, but I imagine working on your gastro issues couldn't hurt the chances of your T becoming calmer or going way. Our gut affects so much of our health, as I'm sure you know : ) I think meds for sleep are a great solution in the short term, but there are lots of ways to become calm that don't need to involve drugs. I've taken sleep aids when I needed them too, so I'm not writing them off. But the work that goes into getting there naturally pays off in the long run, I believe.

Take care and welcome

 

Thanks, @awbw8! When you say "rule out anything obvious" -- what are the obvious things I should be ruling out? Does lack of sleep cause tinnitus episodes? I've been worried for sometime that I've been sleep deprived due to the gastro issues. If you were in my shoes, is there something that I should be doing right away to try and see if the tinnitus improves?

Thanks again for the warm welcome!

 

Kaelon,

For me, sleep makes a big difference. Deep sleep and waking time seems to impact volume and sometimes I will have a day without tinnitus, but its changing lately, ya never know with the brain. It will do that. Its your brain and lots of different chemicals and activity at work thats a big mystery so don't go nuts trying to chase down why. I did and its hard to know!

But sleep is very important. When I don't deep sleep well, its always hell.

Ativan/Lorazepam are not a good solution for using always, unless an emergency for anxiety. My 2 cents.

Your other symptoms sound like anxiety, but you must consult your docs for any other issues that need medical attention.

I went through a lot when my T kicked in real bad, but 7 months in I have gotten past a lot of issues with the help from friends, family and this forum. Some meds at the start but I am off anti-anxity meds now.
The depression…well thats another story...

And STOP high volume earbuds NOW. Get noise cancel buds from Bose, they are great for reducing ambient noise and keep the volume down. Also get ear plugs in case. Protect your hearing.
I am a musician and did my time with my ears and volume and now tinnitus.

Check in on any other meds you use called. Some can make it worse when used too much. Thats a complicated territory depending on you and your body and brain.

Eat healthy and exercise. Lose tension and anxiety (breathing deep exercises and talk therapy) as much as possible.

See your docs and try and keep calm. Tinnitus won't kill you. Its a journey that has many corners.

peace,
Larry

 

Hi @Kaelon, by "obvious" I meant more anything that your doctor is going to find (tumor, meniere's disease, loud noise exposure/hearing loss, fluid behind the ears or severe wax build-up) Keep in mind the first two are pretty rare.

I highly doubt a lack of sleep would be the cause of chronic tinnitus,but I'd agree that T is harder to deal with mentally when you're exhausted.

If your other medical issues are severe enough that you are losing a significant amount of sleep, I would definitely go talk to a specialist about ways to deal with that. Tinnitus is only a symptom, I'm not a doctor, but I have my share of health issues. Since you asked the "if I were you" question, this is what I would do, if I were you (with the experiences I've gained since first getting T):

1. Go to an ENT, make sure I don't have a tumor, wax build-up, bad hearing loss etc. - make sure anything a doctor can see as the cause, isn't the cause. Maybe ask about TMJ or spinal alignment issues (those might require a dentist or chiropractor etc.)
   
2. Find a great psychiatrist who is understanding and can help with anxiety and sleep meds if necessary. Also someone to talk to about this difficult time.
   
3. Talk to people with T who are doing well, that can include doctors with T, they exist and are great, who are doing well (psychologists etc.). Do not read every horror story on the internet. TT is a great place, but most other places on the internet are doom and gloom - filled to brimming with the minority of people not dealing well with T, or who are very new to T and panicking.
4. Find a caring, interested, dedicated specialist for your other medical issues. Your body is one big working piece. T is largely a mystery in most respects. Be your own medical advocate and find the professionals who can help you. Your gut houses a lot of your immune capacity and is pretty central to everything happening in your body. If you can make that better, it's going to make you feel better on every level. Even if it doesn't get ride of your T, it might quiet it a bit, or at least make it mentally easier to handle. If you don't know what caused your T, fixing everything you can in your power will either A. make your T better/less intrusive or B. give you the peace of knowing you did all you could.
5. Find ways to relax and do not panic. Whether you T goes away or not, you are going to be fine. Even if you can't believe that right now, know somewhere in the back of your mind that it is true. I would say almost all of us have been in your shoes and many of us are more or less fine, if not completely fine a year or so later.
   
6. Try things, but don't feel the need to do it all at once. Try yoga, acupuncture, ginko - whatever you find here that seems like it could be helpful. Do each for a little while, give it time to help or not help and then move on. Your T isn't from an obvious immediate injury, so you're not on a tight timeline to "find a cure now." From a physical standpoint - relief! At any rate, you'll feel you're doing all you can to help yourself, even if they don't work. You wont look back and think "if only I had tried x."

If your T were from an immediate noise trauma, then I'd say ask your doc about steroids etc., but you would know if this is what the T were from. In your case, I'd go for the above. Really focus on your other health issues, you never know what might make your T chill out a bit.

Get rest, relax as much as you can and take one day at a time

 

Hi K I've been dealing with T for close to 42 years. After you have all your test run and they don't find any thing wrong all you have to do is keep in mind that its annoying as heck but it wont kill you! Don't let the doctors get you on the pill program or you will have something that could do more harm than T. May the peace of the Lord be with you!

 

Hi Everyone,

I just thought that I'd update you all, especially since you've been so warm and welcoming and people like @engineerLA have hypothesized with me that this might be a Eustachian Tube issue for me. In my case, my ENT confirmed that TMJ is causing my Tinnitus and that it's likely a chronic condition that will wax-and-wane for the rest of my life. I'm currently exploring options, including meeting with a maxillofacial surgeon in a couple of days (it's now been ~6 weeks of nonstop T in both ears).

A few things I have noticed:

• Clenching my jaw, moving my jaw changes the volume of my T.
• The intensity of the T changes throughout the day.
• Some days are much better than others, almost to the point where I barely notice it. It returns a few days later.
• ENT indicated that my TMJ is caused by stress, grinding of my teeth, etc.

It's strange for me, because I'm also somewhat hyperaccoustic in my symptoms (i.e., snapping my fingers in my ears will cause an additional high-pitched T sound), but the theory that this is TMJ does seem to be playing out.

Does anyone else here have TMJ-caused Tinnitus?

 

I would be very cautious and get multiple opinions before having the surgery. The vast majority of TMJ issues - even severe ones - can be managed other ways (splints, nightguards, etc.). TMJ surgery does not help a lot of people and can make things worse in some cases.

I have suffered from Tinnitus for three weeks now and two TMJ doctors and an ENT Dr. said my TMJ issue might be the cause although they cannot guarantee it. I too can sense a change in my Tinnitus when I clench my teeth or eat something and bite hard. My TMj has been acting up the last couple of months too with jaw pain near ears, minor ear aches and minor headaches, jaw clicking...all classic TMJ signs. Ear ringing/Tinnitus is not that uncommon with TMJ they tell me anyway.

Every few days my Tinnitus drops by at least 80% and is barely noticeable, but then flares right up the next day. Goes from hissing to humming. However, I do have some hearing loss so perhaps that is the real cause or it could be a combination of I have very minor Tinnitus, but my TMJ makes it worse.

I clench my teeth while sleeping (having for years) and had been using a basic bruxism guard for top teeth which is thermo and has to get replaced every 1-2 years as it wears out, but decided to give the NTI nightguard a chance before going into a splint. A splint is far costlier for me and generally is supposed to be used 24/7 for at least the first 4 months.

 

@dh42 - Your symptoms, and the pathology, are identical to mine in every way. I know that misery loves company, but I have to say I am very encouraged by hearing your story and feeling that, at long last, I'm really not alone. I have also read that Tinnitus can be completely resolved over time with treatment of the underlying TMJ condition, and that while TMJ is likely to "wax and wane" over months and years, the Tinnitus beneath it can in fact be cured.

From my perspective, I've been told that I've ground my teeth when I sleep at night, and I often wake up with pain in my jaw joints and periodically mild ear aches or headaches. I always assumed, because there was no Tinnitus associated with them, that these were simple muscular pains that I could weather. I had no idea that these could eventually lead to Tinnitus, so I am coming to grips with what having TMJ really means.

More about my symptoms (I wonder if they are also identical to yours as well): Every few days, my symptoms subside and I almost feel like the Tinnitus is receding. In one of the two ears, it's almost non-existent, so I remain hopeful it is on the verge of resolving. But a few days later, it's back with a vengeance. I wonder if it's this sleeping at night that makes matters substantially worse and if the key to solving this is some sort of therapy that changes the positioning of my jaw at night. I also have a feeling of "fullness" in the affected ears -- my Tinnitus is in both ears, though it sometimes varies as to which of the two is more active at any given time.

I also have some hearing loss in both of my ears, though doctors really don't know why. My ENT suspects that because I'm young (I'm only 35), the Tinnitus itself is distorting my hearing and the TMJ aggravates both conditions.

Question: Is meeting with a maxillofacial surgeon the right next step towards treating the underlying TMJ? My ENT over at Mass Eye & Ear Infirmary (supposedly one of the top in the country) suggested to me that while a dentist could help me, a maxillofacial surgeon who understands the temporomandibular joint from a musculoskeletal perspective would be more equipped to provide targeted treatment that will address the TMJ and not just the jawbone or the teeth.

Also, what about over-sensitive hearing? I found that when I started getting this constant T about 5 weeks ago, in whichever of the two ears is acting up most, snapping my fingers near my ear produced a second concurrent resonating T high-pitched sound. My T sounds like the 14khz high pitched sound of an old cathode-ray tube. Is this common for TMJ-induced T?

Thanks for your thoughts! I wonder if there's a group of TMJ Tinnitus sufferers here that discuss treatments and recovery, given that this is a sort of chronic condition with a pretty clear set of resolving approaches.

 

This is the reason:

Considering the (very) loud environment of a subway, you would really need to turn up the volume in order to hear anything with earbuds. With the two noise sources - earbuds and the subway - you are essentially subjecting yourself to noise levels of a concert (give or take). Every day.

Instead of wearing earbuds, you should wear earplugs while riding the subway. Of course we are not brought up with that mentality as public health officials are absent when the focus area turns to noise safety in public. With very real consequences for some of us.

I believe you are overthinking what the cause behind your tinnitus might be. You have most likely already found it.

 

Agreed , if you have hearing loss , that is very probably the cause.

 

If hearing loss is truly the cause, that would be very disturbing. My ENT thought TMJ was exclusively to blame (she was adamant and certain about this) because of the pulsatile nature of my Tinnitus, and the fact that I can control the volume by clenching my jaw (and even almost entirely silence it in one of the two ears if I move my jaw off-center). She could also feel the tense joint and muscle pressing against the side of my ear. I presume that both of these qualities -- jaw-driven amplification / silence, and pulsatile shifts -- are unique to either Eustachian Tube issues (which mine does not appear to be) or to TMJ.

That said, I did listen to my music and movies on the subway at a moderately loud volume for ~2 hours a day for 3 years. As soon as the T began in November, I ditched the earbuds and started wearing noise-canceling headphones at a much lower volume. However, if I understand all of you correctly, you're telling me I should basically ditch headphones altogether and start wearing earplugs. Is that right?

Aside from wearing earplugs, what else can I do to improve my T? If it's hearing loss induced, I understand that this may be something that I have to live with for the rest of my life, but I would love to improve my ability to manage it. Because, like @dh42, there are days when it's almost entirely silent in one of the two ears (and this changes from time to time), I suspect that this is the body's way of trying to heal. Is there anything else I can do? Should I ask for steroids or antibiotics, or are these basically reserved for serious acoustic trauma and not the sort of gradual earphone-induced T that I might have?

I'll continue down the TMJ path, for sure, but anything else I can do to improve is something I want to make sure I'm doing now, since I'm still in the first 3-month period when things can, theoretically, be done.

Thanks for your help!

 

hi kaelon,
I've had T since first of sept. 2014 so I know what your going through now.Right now if you have anxiety not sleeping ect. that is what you should be concerned with T is the issue but it will not harm you .I too have a touch of TMJ but hearing lose is the major cause in most cases.I went to the SHEA clinic in Memphis and after alot of hearing test I was told I had subjective T in my right ear.
MAsking is good,TRT but if you need meds then a phychiatrist would be the route to go .I am currently taking 1/2 to 1 mg klodipin and just started 100mg of fluvoxamine a day ,once the fluvox takes effect I will slowly wean off klodipin and mabe go a more natural method.FRom what I understand our brain learns to tune it out no matter what you do, untill then some methods speed up the process some slow it down my theory is to let my brain figure it out untill then I will do what I can to manage.IN time it will get better YOU ARE NOT ALONE we are all in this together.And there will be more people every day The medical world needs to do more as far as awareness of tinnitus as a major condition, but at least they are doing alot of research into T ,hopefuly someday a cure.
Take one day at a time
Easier said than done but try to go on with your life
stop worrying about it keep busy keep your mind off T

Michael

 

Hi Kaelon,
I would meet with at least a couple of TMJ experts. There is a web site called "Health Grades" where patients have rated their doctors if you don't have a referral. The TMJ splint is considered the "Gold Standard" for managing TMJ. From what I have gathered in most cases, people are supposed to wear it 24/7 for the initial 1-6 months depending on the person then they just have to wear it at night. It does need modifications somewhat regularly. I am going to try the NTI nightguard first and see how it goes as it's a less costly option and should give me a 40% improvement within a couple of months. The Dr. told me if there is no improvement with the T during that time the it's probably not related to my TMJ.
My ears are sensitive to some sounds at times at moderate levels– and I have noticed this for some time well before the T started a few weeks ago.

We are fairly close in age too - I'm 42. I was surprised the hearing test showed that much of a loss with me as I have no problem hearing people can her things relatively faint (like raindrops outside). If someone is sort of whispering to me is where I might have an issue. However, I did listen to very loud music for a few years in my late teens. I also am into home theater and have had movies at volumes probably a bit too loud but it’s mostly peaks I have to watch (explosions, etc.).

It is true that most people who T have some hearing loss.

The theory is since there are damaged “hair” cells within the ear, the brain is no longer able to fully communicate, hence, ringing. As an analogy think of a radio and signal - imagine trying to dial in a radio station but it’s not completely clear as you hear static. That is kind of what is happening with the ears and brain with T. With that said, there are some people with very good hearing that still have it.
TMJ can also cause hearing loss. One TMJ Dr. told me the case of a younger patient who had significant hearing loss. He discovered her bite was off – once the bite was corrected, the hearing returned to normal levels.
It could also be a combination in both you and myself. Perhaps we’ve always had some very light T, but the TMJ issues have made it worse and now more noticeable.
Either way, don’t stress about it. Yes, it can be depressing at first, but will improve over time as your brain adapts, etc. And it very well may just come down on its own. It’s tough initially no doubt – but try to stay positive. Don't get me wrong, there are still some days where I am depressed andI know that is to be expected especially in the beginning.

Dave

 

Hi @Kaelon. If you can silence your T while moving your jaw, I have to imagine TMJ (or some other related thing) is the culprit.

That said, subways are loud, especially if you're listening to music. I regularly hear people's music coming from their own ear buds (and this is through my own earplugs.) People do not know how loudly they're playing their music in order to hear it over the train.

I would go for earplugs or noise isolating earbuds like the "Shure" brand. They are essentially earplugs with sound and can cut around 30db of outside noise so you don't have to listen to your music so loudly. That said, I rarely ever listen to music on my commute anymore and I don't miss it now. You get used to it : )

Other than that, I would try to work on anxiety if you feel you might have any. People who are bothered by T tend to have an issue with that (one that existed prior to t onset), and not only will that make T harder to get used to, but it can have you clenching your jaw unnaturally in your sleep, aggravating things like TMJ. When your body is on high alert, it's not working as best as it can to heal physically as well.

That's something I had to work on, so just a thought.

If you T wasn't from an obvious acoustic trauma, I do not think you need to worry too much about the "3 month window" for doing things to help it. Just generally take good care of yourself so that your body has every opportunity to heal.

 

You have nothing to lose by doing a full examination. So do it. But people who can modulate their tinnitus by clenching their jaw and/or pressing against the side of their jaw-bone is quite common. Regardless of the etiology.

You are probably best served by seeing a dentist. Jaw disorders do not specifically fall within the scope of an ENT. You can also see neuro-dental surgeon.

Right.

The inner ear is a delicate piece of biological machinery; stop treating your inner ear like a doormat (you will thank yourself for that one day).

Keep an eye out for upcoming clinical trials. As late as this week, I have shared no fewer than three pieces of information regarding clinical trials or product developments that have not been shared on the entire Internet before (not even shared by the pharmas themselves - just have a look at the AM-102 thread!).

Tense muscles in that area is more common than not. We use those muscles alot. Which creates trigger points. That said, your muscles may be more out of balance than the average person for whatever reason. Again, all that falls within the domain of a dentist...

Steroids are helpful in the very acute stage eg. 24/48 hours post onset - and in specific circumstances eg. acoustic trauma. If you have developed tinnitus due to long-term NIHL, then steriods will have no effect. In my non-medical opinion, at least...

Source: Auris Medical Holding AG

 

I think your sensironeural hearing loss is causing your tinnitus. To date this hearing damage is not reviserable. For preventing a further increase in tinnitus protect your hearing in loud environmens.​

 

@attheedgeofscience

Is even moderate use of headphones detrimental to hearing? A couple of hours each day at low volumes.
Also, although I'm not sure of the accuracy of thee studies but as far as I am aware even excessive use of cellphones has been linked to Tinnitus.

 

Hi Everyone,

Thanks so much for your supportive and encouraging thoughts. I thought I would give everyone an update on my case, which unfortunately, continues to deteriorate. I'm currently ~6 weeks into dramatic onset on bilateral high-tonal pitched Tinnitus (with slightly more pronounced sounds on the left side).

My Tinnitus adventure continues to worsen; I've begun to notice a pulsatile quality, something that I spoke with @Karen about on this thread. Over the past few days, the pulsatile quality is getting more pronounced (the high-pitched whistle, in both ears, but more prominently on the left grows louder and softer with each heart beat), I've inherited some hyper-accoustic reaction to clapping and other jarring sounds (which exacerbates the tonal T even further), and the overall volume of my T skyrockets throughout the day.

I've made an interesting discovery, however -- early in the morning, when I am waking up, the T is almost entirely silent. It's only as I start waking up (and perhaps my blood pressure and heart rate start to increase?) that the pulsatile T becomes audible. This seems to have been made worse by going off of all my medications, which I did for ~5 days. I've resumed taking at least my blood pressure medication to see if this helps reduce the effect.

My questions continue to mount:

1. Is the fact that my T is somewhat rhythmic (in time with my heartbeat, exactly) mean that there's an underlying neuromuscular conflict, like all of the documentation states? Or is there another explanation for this type of T? It's just not whooshing, like appears to be most of the pulsatile T cases. It's tonal, but pulsatile -- like the 8060 hz you hear here, only with increasing and decreasing pitches/volumes with each heartbeat: http://generalfuzz.net/acrn/ Does anyone know what underlying causes might be contributing to this?
   
   
2. I've never had any imaging done of my neck or ears (though had extensive MRIs and MRAs of the brain and head, all of which came back perfectly normal). Should I be looking at having a CTA/V done? Or should I avoid radiation right now and try something like an MRA or MRI (both with and without contrast) to try and pinpoint a circulatory or neurovascular cause?
   
   
3. I am going to see my ENT again on Friday; really grateful she could squeeze me in the morning. The theory that this was TMJ seems to be less likely (per the maxillofacial surgeon who examined me and took X-rays). What sorts of tests, or information, should I bring to make sure my meeting with the ENT again is this time more successful in producing answers?
   
   
4. I found some momentary relief using ACRN as discussed on this thread, though because my Tinnitus has become more pulsatile, I am finding relief harder to come by and more elusive. I had discontinued most of my medications (I was taking Lisinopril for blood pressure, Omeprazole for acid reflux/gastric issues) to eliminate ototoxic concerns, but 5 days into this, my Tinnitus continued to worsen, so I went back on at least blood pressure meds. Does anyone have any other thoughts on what I should try to seek relief?

Because my T continues to progressive get worse -- becoming more pulsatile, louder, and hyper acoustic -- I'm becoming more determined to find a cause and, hopefully, correct it.

If anyone has any thoughts or guidance, I'd truly appreciate it! I just don't even know what I have.

 

Thanks so much, @Karen. Your kind words and generous thoughts are so encouraging in this turbulent time.

In my case, I've taken Lisinopril for years -- first with Hydrochlorothiazide, and then just on its own back in April since I had a low sodium count when some of my gastric issues started up (though well before gastritis kicked in back in October, and the Tinnitus started in November) -- so I would be quite stunned if it was Lisinopril that had caused my Tinnitus.

Is your Pulsatile Tinnitus tonal? Or do you hear the whooshing sounds? I'm really wondering if one has to hear whooshing, clicking, or some other biological sound for the tinnitus to actually be "pulsatile" (in the classic sense, that it is being caused by a neurovascular issue), or if the pulsatile nature of my entirely-tonal tinnitus is being caused by a benign case of inflammation or muscular tension in the neck and head. How have you managed your Tinnitus since your onset years ago? Have you habituated?

Thanks again.