Dr. Charlie — ENT Specialist With Tinnitus

@Dr. Charlie
Just a couple of questions:
What do you think is most responsible for YOUR fade in t volume perception? i.e. How did YOU get to where you are today?
The earplugs you use - Are they custom made solid or musicians, or foam earplugs?
Thanks so much.

 

Its great to see an ENT here who has a clear understanding of how tinnitus works.
I would like to ask what you would recommend to change the way ENTs manage tinnitus?
How can we get them to stop saying there is nothing we can do about it and say what you have learnt from your experience here? I am a tinnitus therapist and psychotherapist based in London and am forever picking up the wreckage after negative messages around tinnitus. Thanks
Julian Cowan Hill

 

@J Cowan Hill
@Dr. Charlie
@Dr. Nagler
@Dr. Hubbard
@Dr. Gans

I would do any treatment that would help me get rid of this nightmare that I live - T noise with no sleep. I am sure that all on this forum will say the same. The only thing that looks like it may be working is the chemical Retigabine although there are eastern side effect free remedies (mixture of herbs) that seem to work too for some people as per their posts.
Some say use Xanax but we all know how dangerous and addictive Xanax is dont we?

How do we know which therapy to go for? None of them are free or even cheap. Julian Cowan Hill is the only one who has said that he can offer lower rates to those who are struggling financially.

Please I dont wish to offend anyone but:
Seems to me that you are all singing from the same hymn sheet........basically you all seem to say get rid of the anxiousness and fear and you manage to get your T to go into the background of your mind so that you are no longer aware of it - or in Julian's case he says the T goes completely....
Even in the curetinnitus.org that Julian used to be involved with but no longer is (although they are still using videos with Julian) it said the same thing....no fear, no panic, no adrenaline / cortisol = no T.....
Admittedly both Julian and to some extent Dr Charlie say that diet plays a part and Julian suggests hands on physical therapy (or martial arts) all come back to the one conclusion.......dont be stressed ie dont be unhappy....no adrenaline / cortisol means no T.

In other words we who have T are suffening one and all from overdrive stress....BUT most of us here would say that we were healthy happy and not using any meds or had any difficulty sleeping pre T (including myself) so were just run or the mill regualar Joe bloggs public person dealing with all the stresses of life. What is the difference between us and anyone else.......? I know of other people who are unable to deal with life and its problems whatsoever and pop pills like candy and who do not suffer T...and I know people who are very strong and capable who are suffering from T. None of it seems to make sense....


So I go back to whether it be TRT, EFT, ART or any other combination..it all seems to boil in the same cauldron....no stress, no anxiety, no problem with T

I wonder if it would be possible for the doctors to perhaps make a discussion new thread or discuss here on this, by debating with each other here, or just somehow interacting with each other on this thread or a new thread and show how their therapies differ significantly from each other. Maybe they may find that their therapies are all remarkably similar...I feel that if there was more conversation between the doctors and therapists, as Julian did here showing that ENT Dr Charlie's says get rid of the fear and you get rid of the T, may be more beneficial to the members of this forum. Then maybe we can make some decisions as to the therapy we try....
I appreciate that the doctors and therapists are making a living but surely for the sake of the support forum it should not be a case of competition between them but a case of inter cooperation.......such cooperation could only help us T sufferers.

In other words, my opinion is that all of them have the same therapy,,,,,calm down the patient, get him her to learn how to focus differently and control their fear reaction and the T wll be either controlled or unoticeable or cured....depending on the therapist as one says cured, one says unoticeable and or controlled...

By the way, all of the doctors and therapist say that getting lots of sleep is really important to reduce the T but none of them say how to get that sleep. I, for example, pre-T used to sleep like the proverbial baby. Now I am lucky if I get 4 hours a night. Now over the past 2 days it has gone down to 2 hours a night. I took half a sleeping pill this morning after 2 hours sleep and managed a further 2 hours sleep which is a far cry from the 7 hours promised by the GP who prescribed the pills.

(the latest comment I was told today here at home is: hurry up and get over this T thing... if we dont have help and cooperation from the experts on this forum then who can we turn tp?)

I expect that this post is probably as clear as mud but if anyone understands what I am trying to get at, please do help me out here......

 

@amandine, we all understand your frustration and your pain; indeed, that's why we're here! But with all due respect, you are making a lot of statements and assumptions in your above post that are simply inaccurate. I am not going to list them one-by-one, but I have a suggestion for you. In the last line of your post you write: "Please do help me out here." My suggestion is that you help yourself out here by doing your own due diligence. Individually contact the clinicians with whom you wish to speak (there are many excellent ones in addition to the five who post here), explain your particular situation, and see what each might have to offer you. Most every tinnitus clinician in the world has contact information on his or her website, but please do not expect anybody to "duke it out" on an Internet message board.

Thank you for your kind understanding.

Dr. Stephen Nagler

 

Dr. Charlie, or any doctor here, I would like to ask you some questions about my tinnitus and hyperacusis if you dont mind.
It came out of the blue a month ago;the only thing I noticed before was that I felt more congested than usual (I'm allergic),and that I was in an anxious mood for many causes.
My tinnitus is bilateral and sometimes in the head,like a tv static,usually worse in the left.
It changes constantly when I move my head, breathe deep, wake up/lay down,etc. Sometimes its very low/high in one ear, sometimes in the other...
Everytime I swallow I notice a click in my ears. When I yawn or blow my nose the T worsens.
My ENT told me it was probably eustachian tubes inflamation, but she wasnt sure.She told me to take Deflazacort 30mg for a week, and then Avamys,which is the only thing Im taking right now.Nothing has changed, in fact I have developed hyperacusis a week ago.
When I plug my ears I can feel something vibrating very hard,like an engine.It doesnt relate to the heartbeat.
Right now,Im taking Alprazolam 0,50mg every night in order to sleep,and I feel like the noise is slightly lower and I feel less dizzyness.
Sometimes when Im in bed I feel a pain in my head,not always in the same place;it lasts like 2 seconds,and it feels like a coagule or something.Also sometimes I see flashes of light or blackness with my eyes closed,it also lasts a second.
What do you think is the cause of my T and H?
I couldn't take an MRI or scan because the sound its too high for my hyperacusis.Thank you.
(sorry for my english)

 

@billie48 Billie, I certainly respect Dr Hubbard's success story, as I do anyone who has found a solution that works to relieve their suffering from the noise of tinnitus.
Re the following statement, however, allow me to share my own personal experience over a period of many years:

Having learned to apply various methods of energy psychology - particularly EFT - my experience is that it does not require much time before the brain can remain calm. This can occur within minutes of correct application of the technique. I have witnessed many, many situations where the fear response was removed within a few minutes to an hour or so. These fear responses include outright fear, panic attacks, anxiety, frustration, anger, sadness, guilt, shame, and remorse. The method helps remove any fear response from the associated noise. The only real courage required is to try something that you may not fully understand at first.


Bless you,

Dr Charlie

 

I wish I had a satisfactory answer to this question. I always recommend that anyone suffering from this affliction first consult an ENT specialist. A thorough professional evaluation is important to rule out causes that can and should be corrected, such as acoustic neuromas, TMD, otosclerosis, or even simple things such as wax in the ear canal. Unfortunately, when the final diagnosis includes something for which there is no ready solution, then ENT doctors - surgically oriented by training - consider that there is nothing they can do for the patient. I disagree, but also understand how this comes about. ENT doctors are not trained mental health professionals.

Thank God other healthcare professionals such as you are stepping up to the plate to fill this void.

One additional issue is that for anyone to conduct and report on large scale studies (including double blinded ones, where possible) - many years, thousands of patients, and a great deal of money are required. Major pharmaceutical companies can afford to fund such studies - often conducted by full-time paid researchers and/or residents in training at major universities. The average clinician or healthcare practitioner cannot. The result is that peer-reviewed studies of any new therapeutic or self-help approach are pretty much out of the question for the average practitioner. And pharmaceutical companies are not interested in funding any studies that are not drug-related.

For example, TRT was developed by Dr Jastreboff in the 1980s when he was associated with the University of Maryland. He has since moved to Emory University in Atlanta, GA. Even presented by a well respected researcher with the backing of a major University, TRT was not readily accepted by many. It required many years and many presentations. Some 3o years later, TRT is finally accepted as a reliable method to help sufferers habituate their noise.

I would love to see demonstrations of EFT or ART provided at national or International meetings of ENT specialists. My guess is that only a handful might attend the session, because they have no frame of reference to understand how and why it is so effective. As I did when I first watched a presentation of this new and strange (to me) method, most would scoff at the concept and dismiss it with no further consideration. To educate ENT doctors about such a remarkably effective method will require many, many years. I hope you read my earlier post in this thread about Dr Semmelweiss.

I fully understand the skepticism of many of my colleagues. Medical professionals cannot immediately "jump onto" and start recommending every new treatment that comes along. As drug companies have demonstrated, many new treatments prove to be ineffective. Some turn out to be harmful. The result is that we are by nature quite conservative, and cautious in our acceptance of new ideas. We do this to protect our patients.

My guess is that such methods as EFT and ART will be accepted by mainstream physicians in another 20 or 25 years. Even then, I don't expect ENT surgeons to apply them. The time required for each patient will make this impractical in a busy practice. Some ENT surgeons may employ trained technicians in their offices or will refer their patients to outside practitioners. Some psychologists have already incorporated these methods into their own practices. Right now, ENT surgeons - and their patients who are suffering - need people like you. And me, and Dr Nagler, and Dr Hubbard. In time, the others will learn from our experiences.

Hope this sheds some light on what I believe to be the current situation.

 

Lisa, EFT is what primarily worked for me. I also used a bit of self-hypnosis early on, especially to sleep at night. I no longer require self hypnosis.

For most situations, I use High-Fidelity or HD Safety earplugs from Etymotic Research: http://www.etymotic.com/consumer/hearing-protection.html

The ones with clear stems are less obvious to others.

Bless you,

Dr Charlie

 

Thanks so much, Dr. Charlie. Just a follow up question - where did you find self hypnosis to sleep? I am a year from onset, cutting from a benzo, and having the worst time sleeping, which is causing worse t. Thanks, and sorry for yet another question.

 

I created my own stress relief CD and listened to it at night. To follow the guidelines of the forum, I cannot recommend or provide a link to it. There must be many available online from different sources.

 

This is very interesting. As far as I'm aware, the RVPFC acts as a sort of mediator of the threat response from the amygdala once it has reached the Dorsal Anterior Cingulate Cortex (the DACC informs the conscious mind how much to be concerned about something).

The exact mechanism is unknown but I suspect it's a way of prioritising threats so that immediate dangers are dealt with first and trivialities are put on the backburner for a later date.

After my recent health scare (which sent my T through the roof) My T disappeared completely when I received my all clear. It must have been there but I didn't consciously realise that. (Ironically it returned when I saw my bookmark for Tinnitustalk on my browser )

I'm at odds to why labeling emotions connected to T could attenuate it though. Perhaps if the RVPFC could be manually programmed by the conscious brain to downgrade T's importance, then making the emotions less abstract gives the conscious mind a better "grip" on them.

It's definitely the element of not caring which makes T manageable though. Like I said in a previous post: I lived by the sea for years next to a shingle beach and the noise from the waves didn't bother me in the slightest. It was just "noise". There was no emotional salience to it.

 

@Silvine

I agree. You clearly have an exceptional understanding of the situation.

This mechanism is one of the reasons that EFT and ART are so effective for relieving the suffering from the noise of tinnitus or hyperacusis. One rates the intensity of the fear (or associated anxiety, frustration, anger, etc) from 0 to 10. This is called the SUDS level (Subjective Units of Distress.) Once rated, the setup statements and tapping technique diminish this intensity until it goes completely away - i.e. at a SUDS level of 0. When at "0" no more fear remains about that particular trigger. This often occurs within minutes of applying the technique.

And, as I have repeatedly stated, when the associated fear response is removed, the brain will automatically habituate the noise of tinnitus. Thus, we no longer hear the noise unless we focus upon it. With hyperacusis, when the associated fear is removed, it becomes much easier to re-introduce and tolerate normal sounds without fear. In turn, this diminishes the hypexcitability of the Tensor Tympani muscle in the middle ear. The combination of this hyperxcitability and associated fear create a vicious circle that makes hyperacusis so miserable.

Bless you,

Dr Charlie

 

Dr Charlie.

Do you think that the habituation of tinnitus works on a similar mechanism to the therapeutic method of desensitisation used in the treatment of phobias?

The reason I'm asking is because; whilst desensitisation works from a slow but gentle fear mediation perspective it also involves a reward aspect where the patient is "socially" rewarded by the therapist but also their spouse or family/friends for overcoming the fear.

The Dorsal Anterior Cingulate Cortex is also involved with the perception of "social pain" (shame, ostracism etc) via a specific opioid reward circuit, so perhaps a reward of any kind linked to frequencies either side of a tinnitus notch [pure tones in nature are very rare so adjacent tones would involve a high level of synaptic connectivity] would heighten the amygdala threshold over what's a threat and what isn't? Each SUR ( Subjective Unit of Reward) would remove an SUD?

If we are really lucky; adjacent areas of the auditory cortex would plasticise into the redundant tinnitus neuron areas to increase receptivity to reward tones and eventually take over their remit.

It's conjecture on my part but leveraging a SUD level down even further via using a reward mechanism and taking tinnitus neurons off the grid so to speak would attack the problem from all sides.

 

Your idea makes good sense, Silvine. I can't speak to the usual therapeutic methods for phobia removal. Energy psychology methods such as EFT are so effective for phobia removal (often within minutes) that I have had no reason to investigate other methods.

Dr C

 

Dr. Charlie, I have had an anxiety/panic disorder with depression since I was 6 years old...I am now 45. I have had t for a year and a half. I have noticed recently that after a massage of the neck and head/face my t has faded/disappeared for up to 24 hours. I have been told that medical massage/trigger point massage releases negative energy....would this make sense as to why my T subsided for 24 hours? Would this tie into your EFT and Anxiety Therapy training that worked for yourself?

Is there a list or a way to find someone/provider who does the EFT/ART techniques in each state?

 

@Dr. Charlie
Hi Dr. Charlie,
I read your thread and is very interesting. I introduce myself ... my name is Marco, I'm 28 years old and I have a 7 month tinnitus by acoustic trauma after a rock concert, but in theory without any ENT ever found traces of hearing damage. I copy the part of my post hoping in your soon and kind answer. (P.S = Sorry for my bad english)

"I have a bilateral tinnitus since May 2014, after a rock concert. Initially my tinnitus was very loud, but over time has decreased, until recently has returned to the original levels. I was visited by several ENT specialists, but no one has ever found traces of hearing damage. My tinnitus is a constant electric buzz in the head, recently became unmasked by ambient sounds. I have several friends with tinnitus, is unfortunately all have deteriorated over time. I'm terrified of doing the same end and do not know what to do to avoid it. I ask those who have tinnitus by acoustic trauma for many years ... how has your tinnitus? And 'unchanged or increased volume?"

"Explain better my case, in search of answers and predictions of what awaits me in the future.
After the concert, seven months ago, I had very loud tinnitus and hyperacusis (disappeared almost immediately).
I had passed well four months ago the fear of tinnitus, which had declined considerably.
So much so that, stupidly, after months of imprisonment in my house, I decided to go to a club, whereas I have friends DJs and musicians with tinnitus for years that has not increased in volume (but many who unfortunately has increased as I wrote first).
Unfortunately it was not so 'for me.
Currently tinnitus is constant even back in the day and did not seem to lower volume (one month has passed since my stupid idea). What I do not understand, is why the ENT specialists have never found hearing loss or other problems to my ears. (I also tested the high frequencies, even after local).
My fear is that it is neurological damage, but even here the MRI with contrast method did not find anything.
Yet tinnitus increases and beginning to doubt that the cause is acoustic trauma.
For my ENT is a psychological maintenance, but now I was quiet for my tinnitus during these months and above any psychiatric drug (rivotril and Xanax) helped me.

From the research I've done on the problem, it seems that tinnitus bilateral statistically increases for no apparent reason after a few years (10 -20 years) and frankly I could not stand it increased further. For this, I would like to know if anyone in this forum with tinnitus by acoustic trauma after so many years can confirm or not a deterioration (and if there is an improvement). The music was my life (I am a rock musician) and now live in fear for these loud sounds. "

Thx Dr Charlie for your patience and attention.
Greetings,
Marco.

 

@Mark Sympa ,

This is a recent blog post I wrote:

ACOUSTIC TRAUMA OR ACOUSTIC SHOCK?


Acoustic trauma and Acoustic Shock are separate and distinct conditions resulting from exposure to loud sounds.

Acoustic trauma (AT) is a physical injury to the hearing mechanism of the inner ear. AT results from exposure to sounds loud enough to cause physical damage to delicate structures within the cochlea. AT may follow a single exposure to an extremely high-volume loud, or repeated exposures to sounds of lesser volume, but still strong enough to inflict physical damage.

Acoustic Shock (AS) represents a group of very real physiologic symptoms resulting from a specific sound-exposure experience. AS typically occurs after exposure to a sudden and unexpected loud sound perceived as highly threatening (an acoustic incident.) AS becomes Acoustic Shock Disorder (ASD) if symptoms persist beyond a few hours to a few days.


Acoustic Shock Disorder (ASD)

The physical symptoms of ASD differ from those following a traditional noise injury (AT) and may include the following:

• a shock/trauma reaction. Severe ASD can lead to Post Traumatic Stress Disorder (PTSD)

• sensations of pain/blockage/pressure/tympanic fluttering in the ear

• subjective muffled or distorted hearing. ASD generally does not result in a hearing loss, although if present it tends not to follow the typical high frequency pattern of a noise induced hearing injury (AT) but affects low and mid frequency sensorineural hearing.

• other sensations including pain/burning/numbness around the ear/jaw/neck

• tinnitus, hyperacusis, and phonophobia (abnormal fear of sound)

• mild vertigo and nausea

• headache

Victims of AS often describe the initial sensation as like being stabbed or electrocuted in the ear. The initial response often includes a severe startle reaction with a head and neck jerk.

The dominant factors of an acoustic incident leading to ASD appear related to: 1) the sudden onset, 2) unexpectedness, and 3) impact quality of loudish sounds, 4) outside the person’s control, 5) heard near to the ear(s), rather than to high sound-volume levels alone.


Tonic Tensor Tympani Syndrome (TTTS)

The physiological symptoms of AS are considered to be a direct consequence of excessive, involuntary, middle-ear muscle contractions caused by a strong startle response to an acoustic incident. Middle ear muscle contractions, particularly of the tensor tympani muscle, have been demonstrated to occur as part of the startle reflex. Originally described by Dr. I. Klockhoff, this condition of abnormally increased muscle tone and contractions is termed Tonic Tensor Tympani Syndrome, or TTTS.

With TTTS, increased involuntary activity develops in the tensor tympani muscle as part of the startle and protective response to some sounds. This lowered reflex threshold for tensor tympani muscle contraction appears to be activated by the anticipation of sounds perceived as threatening, and the subconscious perception of these sounds as potentially damaging (i.e. a subconscious fear response.) TTTS activates a series of physiological reactions in and around the ear, which can include: alterations in tympanic membrane tension; an abnormal stimulation of the trigeminal nerve innervating the tensor tympani muscle; alterations in ventilation of the middle ear cavity; muscular tightness around the ear potentially extending to the cervical/shoulder girdle and upper limb muscles, muscular trigger points consistent with CNS pain pathway sensitization; and to a lesser extent abnormal stimulation of the nerves innervating the tympanic membrane and ossicular chain (tiny bones of hearing.)

The more extreme the resultant middle ear reflex contractions, the more severe the TTTS symptoms become, worsening the associated trauma reaction.

Once TTTS has become established, the range of sounds that elicit this involuntary response may increase to include everyday sounds, leading to the development and escalation of hyperacusis and phonophobia. A subsequent acoustic incident can lead to a highly enhanced startle response, so that repeated acoustic incidents can significantly enhance ASD vulnerability.


One recent study* reported that one or more symptoms consistent with TTTS were reported in 81.1% of patients with hyperacusis and in 40.6% of those with tinnitus only.

Symptoms consistent with TTTS are subjective and can cause high levels of anxiety. This can lead to tinnitus escalation, the development and escalation of hyperacusis, and limit the effectiveness of tinnitus or hyperacusis therapy.

There is strong evidence that middle ear muscle function is influenced by the serotoninergic system, consistent with a link between the emotional state and middle ear muscle contraction.

The central mediation of the reflex threshold for tensor tympani muscle activity is further supported in the cited study* by:

• The association demonstrated between hyperacusis and the high prevalence of symptoms consistent with TTTS

• The prevalence of symptom development/exacerbation following intolerable sound exposure, consistent with a stress/anxiety/threat response

Fear of the pain experience is one of the factors playing a significant role in explaining avoidance of sounds by people with hyperacusis. Hyperacusis clients often suffer tremendous fear of any situation where they risk sound‑induced pain.


The Promising Role of Energy Psychology

Several of my earlier posts have explained the process of habituation in relieving the suffering for victims of tinnitus or hyperacusis.

Habituation means that the brain develops a habit of automatically ignoring any stimulus it has determined to be non-threatening. This process is mediated through the fear center of our brains (limbic system.) Until fear is removed from the noise of tinnitus, habituation becomes impossible. Once habituation takes place, the brain automatically ignores the noise of tinnitus as though the noise no longer exists - unless the victim elects to focus upon it.

Experience over many thousands of applications has shown that Emotional Freedom Techniques (EFT™,) and Anxiety Relief Techniques® (ART) can quickly and permanently remove fears associated with A) the noise of tinnitus or B) hyperacusis.

It seems highly probable that by unhooking the fear response from TTTS, excessive, involuntary contractions gradually subside in the tensor tympani muscles of ASD victims. This can readily explain why these methods are so effective for those who suffer from this condition.

Suffering from the noise of tinnitus and/or the fear associated with hyperacusis are very real physical conditions. Clinical studies such as cited in this post have given us a much better understanding of the exact mechanisms for this suffering.

The link is much clearer now between A) the associated anxiety and fear responses of tinnitus or hyperacusis with B) hyper-contractility of the tensor tympani muscle in the middle ear.

My experience is that nothing has proven more effective than EFT and ART for removing fear responses from any source. TTTS and ASD should respond equally as well.


* Westcott M, Sanchez TG, Diges I, Saba C, Dineen R, McNeill C, et al. Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: A multi-clinic prevalence study. Noise Health 2013;15:117-28.

Hope this helps,

Bless you,

Dr Charlie
Charles Smithdeal MD, FACS

 

Heal me Dr. Doctor Charlie! Make me money Dr. Charlie!

 

I created an online Tinnitus Control course because very few EFT practitioners understand tinnitus or how to deal with it specifically. I am currently working on a training course for Tinnitus Control Guides to educate them about tinnitus. Meanwhile, you can learn EFT and apply it to your own fears and negative emotions. Visit http://Emofree.com for a free download of the technique.

Re trigger points and massage, I have no personal experience with this. My philosophy is, if it works for you, then go for it.

Bless you,

Dr Charlie
Charles Smithdeal MD, FACS

 

What an informative post Charlie! Thank you!

I think ASD is very real and that it should be shed some more light upon this condition and the mechanics behind it, and to me it seems like anxiety/fear has a great deal to do with it, as if the middle ear muscles are constantly being tensed up

Bless you

 

I wholeheartedly agree, Mr Cartman. It is my wish that you and other forum members will help spread the word about this connection. Thousands suffer daily as a result of not having reliable information.

Bless you,

Dr Charlie
Charles Smithdeal MD, FACS

 

I have a few questions for Dr Charles and Dr Nagler.

I'm 57 years old african american.

Why is it that most of the time ( so far ) that when i fall asleep i wake up hearing no T.
Once i am awake i can hear it coming on within 10 minutes. I know maybe one day this will not be the case anything can change with T.

I been on xanax for over 7 years. I tried tapping my dose from .5 to .375 ( thats one .25 pill plus a 1/2 pill ).
Took me 4 weeks to get used to the lower dosage. Im not sure if this cause my T. I went back to my normal dosage and the T hasn't gone away. I take High blood pressure pills - Enalapril 10mg for 7 years.

My Cholesterol is 215 mg/dl (H), HDL is 36mg/dl (H), LDL is 156 mg/dl (H), Triglycerides is 206 mg/dl (H)
Glucose is 97 mg/dl

I also notice i get neck pain when i sleep - this started about 4-5 weeks ago about the same time the T started.

Being so many things happened - i dont know if it the Xanax or something wrong with my neck. I seen my ENT last week and forgot to mention the neck pain. I sleep with only one pillow now - used to be 2 and i would fold it to male it higher. Im seeing my ENT again on January 9th 2015.

I also have sinus issues ( Chronic Sinusitis ). Every morning for the last 3 year i have to cough up Phlegm to get it out of the back of my throat. Can build up of phlegm somehow get into the ear canals or something in there. I was given some nasal spray, can these nasal sprays damage the ears and cause T ? i stopped the spray.

MY ENT
I told him about the T and he did a hearing test and said i do have some hearing lose. then he wanted me to try Lipo-flavonoids ( Vitamins and herbs - really ? )

My Neurologist did a MRI, MRA of my head on aug 2014
For Unspecified Transient Cerebral Ischemia- the report is below. i also forgot to bring this report to my ENT. But i will Jan 9th 2015.


----------------- The MRI and MRA Report ------------------------------:

MR Angiogram of the corotid arteries
Technique: Neutral/sitting:129 thin slices axial images were obtained through the extracranial circulatiob utilizing 3D time-of-flight technique. 81thin slice axial images were obtained through the extracranial circulation utilizing 2D time-of-flight technique. 16 maximum intensity projection images were obtained from this data, which are presented in the sagittal plane for each technique.
History - Patient complains of headaches,dizziness and loss of hearing:
Impression: No evidence of Hemodynamically significant stenosis indentfied at either Carotid Bifurcation.
Vertebral arteries are patent Bilaterally.

MRI of the brain and IAC's without contrast
Technique: Neutral sitting: Axial T2, Axial FLAIR, Sagittal T1, Coronal T2, Axial T1 (IAC ), Coronal T1 ( IAC )
History: patient complained of dizzness
Interpretation: patient decline adminstration of gadolinium contrast

Several nonspecific bilateral faint punctate and patchy periventricular white matter signal hyperintensities are noted. Differential diagnosis would include mild changes related to microvascular disease or migraine headaches.
Alternate differential diagnostic etiologic possibilites to be considered in the approprate clinical setting would include mild changes related to lyme's disease, sarcoid, vasculitis disease. there is no evidence of midline shift.

There is no evidence of subdural,epidural or intracerebral hemorrhage. there is no evidence of hydrocephalus. There is no evidence of asymmetric atrophy. No mass lesions are identified. The pituitary gland, sella trucica and suprasellar cisten are normal with no evidence of mass or displacement of the pituitark stalk. Possibality of small intracanalicular acoustic nerve sheath tumor cannot be excluded without contrast administration.

Thin section high-resolution images through the posterior fossa including the auditory canals and cerebellopontine angle cisterns shows the nerves are symmetric. There is no evidence of CP mass. Possibility of small intercanalicular nerve sheath tumor cannot be excluded without contrast administration.

Moderate mucosal thickening is noted within the left maxillary, sphenoid and ethmoid sinuses. There is no evidence of additional paranasal sinus changes to indicate opacification or air fluid level. Otomastiod complexes are patent.Cavernous sinuses are symmetric. There is no evidence of retro-orbital mass lesion or ocular asymmetry. thereis no evidence of restricted diffusion. Susceptibility changes are noted within the maxilla compatibale with dental work.

Impression:
several faint nonspecific bilateral periventricular white matter signal hyperintensities compatible with mild changes related to microvascular disease or migraine headaches, with alternative differential disgnostic etiologic possibilities to be considered in the appropriate clinical setting, as discussed above.
No evidence of acoustic nerve sheath tumor or cerebellopontine angle mass.
Moderate Mucosal thickening within the paranasal sinuses.

MRA of the Brain
Technique: Neutral/sitting: 90 thin slice axial images were acquired through the circle of Willis and posterior fossa utilizing the 3D time-of-flight technique, 16 maximum intensity projection images were obtained from thisdata which presented in the axial and sagittal planes.
History: patient complained of dizzness, headaches and loss of hearing

Interpertation: There is no evidence of aneurysm of the anterior communicating artery, posterior communicating artery, ophthalmic arteries or middle cerebral arteries. there is no evidence of hemodynamically significant stenosis involving the major branch vessels of the anterior, middle and posterior cerebral arteries.

Cartotid siphon and basilar artery are patent. Both vertebral arteries are visualized. Mild asymmetric decreased signal intensity associated with the A1 segment of the right anterior cerebral arterty is suggestive of developmental hypoplasia.

Impression: No intercranial vascular abnormalities

------------------------ end of report -----------------------

Well that's all of it. Dr Charles and Dr Nagler can you give me some insight on what you think of my MRI/MRA report and my issues above so i can take your suggestions to my ENT on Jan 9th .

Thank you in advance. May you and your family have a good Holiday.
I'll try but it is hard for me now. Worried and scared and driving my wife to worry about me.

 

@Joseph Harney

Your case is interesting! I think you might need to alert the doctors so that your post will catch their attention.
Like this: @Dr. Charlie , @Dr. Nagler

 

thank you very much i sent it to Dr Charlie - i tried Dr Nagler but he some block on for now. it says ' You may not start a conversation with Dr. Nagler because of his or her privacy settings.'

I really need some feed back from them so i can talk to my ENT on Jan 9th 2014 and Neurologist ( i'm making an appointment with him soon )

 

Joseph, I don't see a clear pattern to suggest an explanation for your symptoms; however I find the above statement quite significant. May I suggest that you ask J Cowan Hill his opinion re a possible misalignment of your cervical vertebrae and your symptoms?

Also, are you aware that a high percentage of patients with tinnitus also have hyperinsulinemia? A diet low in carbohydrates (sugar etc) is important.

Bless you,

Dr Charlie
Charles Smithdeal MD, FACS

 

Prior studies.

http://www.tinnitusjournal.com/imagebank/pdf/v10n1a06.pdf

http://europepmc.org/abstract/MED/10753320

http://www.tinnitusjournal.com/detalhe_artigo.asp?id=458

 

Dr Charles

Thank for reviewing my MRI/MRA report. I just have a few more questions
Based on your interpretation what kind of doctor do i see for possible - Cervical vertebrae ? Yes i will seek out Dr HIll and get his assisment.

As for the hyperinsulinemia i'm guessing i have to cut out all sugar stuff Now. I was already told countless times to cut it out and lose the weight.

Strokes and Heart disease runs in my family history. I was thinking maybe this T could be a warning sign to me. I'm changing my diet and i hope it is Not too late.

oh, thank you for the links

Thank you again and i hope you and your family had a wonderful Holiday yesterday and many more to come. Of course this includes everyone here at Tinnitustalk.

Joseph Harney

 

You answered your own question.

Bless you, Joseph.

Dr Charlie
Charles Smithdeal MD FACS

 

Welcome and Thank You Dr. Charlie for being here to answer some questions we all have. I myself have had this terrible T for 3 months of hell, and keep learning and educating myself on ways to cope....it is a daily struggle filled with anxiety, stress, depression, lack of sleep, irritability, etc etc etc. Mine seems to get worse everyday as I find myself hiding from the outside world and creating my own inside world of noises I can handle..I am seeking therapy/counseling to cope daily,and stay strong