Dr. Nagler, 11 dB SL Tinnitus and Niagara Falls

As I see it, the only thing that matters is how loud your tinnitus sounds to you. And regardless of how many dB one's tinnitus loudness match might reflect, in the grand scheme of things that has relatively little to do with tinnitus severity.

You are certainly free to disagree. However as I see it, tinnitus severity is all about reaction. And the loudness match plays a but small role in that regard.

Let me ask you this. You have had tinnitus for some twenty years now, as I have. My tinnitus is incredibly loud, but I'm doing just fine these days. How are you doing?

 

I don't get this. Maybe I'm being thick, but if I understand the discussion so far, db SL is an attempt to measure how loud your tinnitus sounds to you. Therefore surely it does have relevance.

For example, in your bio you say "My tinnitus is as loud as ever - like a cross between a screaming teakettle and a roaring jet turbine." You compare your tinnitus to real, measurable sounds in the physical world. It is just natural or intuitive to attempt to quantify it in such a way. The db SL measurement simply provides a method and a scale with which to do this... and to do it a little more accurately and precisely.

Regarding rating, one person might have a different idea from another of what they are being asked to rate against when asked to give a tinnitus rating. One might rate against how bad it was when it first started, another against how bad they think it might get, another against the noise exposure that caused it, etc... It doesn't seem to provide anything meaningful to me. I say this because when I took part in the ANM neuromodulation trial I had to give this rating each visit and I was unsure what they wanted (guidance or clarification was resisted) and I consider the ratings I gave meaningless except as a way of assessing how my t might have fluctuated between visits... as well as how I was feeling about it on the day.

Also I would like to disagree that tinnitus severity is about reaction. Reaction severity is about reaction but surely tinnitus severity is about the dysfunctional activity of specific neurons. The severity of someone's arthritis, or psychosis, or bullet wound is not about their reaction either. Which is not to deny that their reaction is hugely important in how they cope, but I don't think it serves the interests of clarity to blur that distinction.

Finally, I would like to object to the way your assertion that you are doing fine with your tinnitus is used as a means to try to silence disagreement or win an argument. This strikes me as a manipulative tactic and not one that is conducive to either clarity or support. It seems to me to be a trick for putting somebody into a subordinate position. I am unable to see the way in which how you are doing with your tinnitus is relevant to what stelar said. That you are doing well with your tinnitus does not make you right in anything other than that you have a management strategy that works in your particular case.

 

@dboy u should consider medical school, we need more doctors with your kind of perspective- or at least a human rights advocate. Your post is so insightful and eloquent, it blew my mind. As I read your post it was as if I was looking at the open ocean as far as my eyes could see. I doubt there is any possible rebuttal to your statement, hence the silence. Bravo

 

Dan, that is the most generous thing anyone has said to me for quite a while. Thank you very much indeed.

 

I think this is a matter of whether we're talking about severity from the point of view of functional impairment, or some other metric. And, bullet wounds are a bit different, but there is mounting evidence that in the case of chronic pain conditions mental reaction has a measurable neurological impact on the propagation of the signal itself, because of how the brain plasticizes itself in response to stimuli (and the degree to which that's a feedback process which acts in concert with conscious thought).

Again, sticking with the chronic pain analogy, if two people have the same electrical activity in the same aberrant nerve, as measured by a conduction test and/or SPECT analysis of neurological activity, but person A says "my pain is the worst thing I can possibly imagine, and I am unable to work or leave my home" while person B says "my pain is uncomfortable but I am still fulfilled by life and able to work" -- would anyone seriously suggest that person B's pain is as severe as person A?

 

I agree with the objection to this sentiment, I don't see how it is helpful. Everyone is different. People are predisposed by genetics, upbringing and environment to tolerate noxious stimuli to different degrees. If you expose a group of 1000 people to the ld50 of some chemical, half of them will die, and half of them will not. Surely it's not the fault of the dead people that they couldn't tolerate that input?

The coping strategies that have worked for me in my path through this condition, have so far kept me basically functional, and even happy and peaceful a lot of the time. I would never suggest that these techniques would necessarily work for anyone else, and I definitely wouldn't phrase it as "I meditate like all the time man and my life is great, how is your life?"

 

I agree that there is a strong argument that reaction (and overall stress levels) in the initial acute stages of tinnitus probably have an effect on the permanence and or eventual severity of it. But as we discussed (and I thought agreed) only this evening in your moving to the countryside thread, your reaction to an established chronic tinnitus is not likely to actually reduce that tinnitus:

Well, I was not specifically talking about pain, and the pain analogy has been discussed a lot, but I do see your point. I think you pose a question that is open to interpretation. But yes, I can imagine someone arguing that the pain was as severe in both cases and that the two people differed mainly in their ability to cope with it.

 

I'm open to the idea that certain kinds of cognitive activity might actually modulate audial cortex activity, but there's not much data to go on either way. However, tinnitus isn't just an audio problem; it starts in that part of the brain and then seems to snake through (broken) thalamus perceptual gates, through the insula, into the amygdala. There is a decent stack of data implying that the structure and function of the latter two structures is malleable and changes in detectable ways as a result of cognitive practices.

So, I guess I'm saying I'm agnostic as to whether or not such things can have any impact on the tinnitus percept in the audial cortex, but am moderately convinced that such things do have an impact on the tinnitus signal as viewed as a pathology of the entire brain. Likewise, long-term meditators are not shown to generate less pain as a result of a given stimulus as far as I know, but it has been shown that the downstream neurological impact of the pain stimulus is of shorter duration and intensity than it is in matched controls. Then, the question of "does cognition change tinnitus" depends on how you are defining "tinnitus" -- are you looking at hyperactivity in the audial cortex and saying "that right there is tinnitus", or are you looking at the complete feedback circuit in the brain, where audial hyperactivity activates a limbic response and is perceived consciously as negative input, and saying "that is tinnitus"?

That is, this is a semantic argument at this point Given two people who have the same sound in their head, one of whom is better wired for whatever reason to not react to it aversively, and then followed over a period of years or decades -- it seems very reasonable to suggest that the person who has the aversive reaction, is going to have more negative brain development over that period of time. And, for me, this is what the argument about "reaction" comes down to -- I am just not as optimistic as Dr. Nagler that these things are exactly under conscious control. But, I am sort of agnostic as to the whole idea of conscious control of anything; it may be that we actually live in an entirely deterministic universe... and that's certainly a bigger question than we're going to answer here today.

 

Sorry if I sound like I'm lecturing there, lol. I think about this stuff way too much. I am definitely not qualified to really have a medical opinion, but my life's work is understanding how complex systems interact, and I tend to look at everything through that lens. If only I could just rewrite the source code to my brain, I'd be all set....

 

I was just about to say... one of the few things I'm good at is admitting when I'm out off my depth. This is one of those times: I'm afraid I cannot comment intelligently on what you say.

The only defence I can come up with is to refer to the following thread:

https://www.tinnitustalk.com/thread...y-argument-with-neurobabble.9677/#post-115935

 

Well everyone IS different. But we all do have certain things in common. I am trying very hard to speak to what we have in common. Now many here will disagree with my position on this issue. Of course, in the main they are the ones who are stuck. It boggles my mind that those who are struggling the most tend to be the ones who hold the strongest belief that I am wrong here. Go figure.

I used to feel exactly as they do, those who are struggling and suffering. And I felt about it just as strongly as they feel about it. But at least I kept an open mind.

 

Eh? Nobody was arguing that doing TRT or any other aspect of your tinnitus management strategy is not working for you. Let's review... stelar said:

You disagreed, yet with an 11db SL tinnitus you go on to claim that

I do not see any evidence here that disputes the original point. If anything what you say supports it.

Unless I missed it, nobody attempted to claim that addressing one's emotional reaction to tinnitus is not a good way to improve coping. Because this is not that discussion. Please excuse me being blunt: it seems arrogant to claim that anyone who disagrees with something you say is 'stuck'. And it also seems rather ironic when the evidence suggests that you are yourself replaying a previous discussion that has little relevance here.

Edit: And just for the record, although I am not the happiest bunny in the world, I do not think I am "struggling the most here". I also believe that some people here have considerably worse t than me (roughly 10db SL I believe).

 

You make a good point. I have no interest whatsoever in coping with my tinnitus. I have no need to cope with it. Perhaps that's where we differ. For those who are interested in coping and are coping well, that's their choice. I'm certainly not trying to rock that boat. But for those who are unable to cope or who are having difficulty coping, having a clear understanding about what makes loud tinnitus loud can, in my opinion, help. And for those who really want to get past their tinnitus so (like me) they have no need to cope, it can, in my opinion, help as well.

 

Yes, yesterday you wrote something that interested me:

If you could expand on that then I think it might develop the discussion in a really positive way.

 

Perhaps look at it this way ...

40dB is certainly louder than 19dB, yes? And if you measure the decibel level of whispering in a quiet library, your decibel meter will register around 40dB. So we are talking here about a tinnitus signal that is half as strong as a library whisper. What else besides what your brain does with that signal (i.e., central auditory processing) can possibly make 19dB of tinnitus sound so LOUD? The answer: Nothing. It has to be your brain.

I really have nothing more to contribute in that regard.

Best to all.

 

Answer: Central auditory processing!

I was not arguing with the veracity of your assertions there. Genuinely not out for a scrap. Interested, intrigued, hoping to learn more. Would you be able expand on your statements in a way that might, as you said, help? No problem if you want time to think that through - I need to sleep anyway now. But this is a chance for something of substance to come out of one of our petty skirmishes.

 

Why take a fellow member to task for the loudness of his tinnitus or the contents of his posts? I agree with @linearb and @LadyDi, it serves no productive purpose. Tinnitus loudness is subjective and different for all of us. This is a support forum and I couldn't have made it to where I am if I had been nitpicked to death on every post I made--it was the support, comfort and hope that I received here that helped me. The posters here, including @Dr. Nagler, gave me all that and more.

 

Oh OK, you edited your post while I was writing. Good night then.

 

OK, sleep interrupted by brief moment of clarity. The decibel meter will register around 40dB but nobody would hear that as 40dB unless they had perfect hearing across the range. Which most people - especially with 19dB SL tinnitus - do not have. If you have, say, 25dB hearing loss (a moderate amount) around the whisper frequencies then of course the 19dB will seem louder... because the whisper will only seem like 15dB... (yes???)

What was it that Dr. Nagler used to say about Dr. Wilden... oh yeah...

 

In the study cited earlier in this thread, a 19dB tinnitus loudness match means 19db SL. In other words 19dB over your threshold of hearing. In a person with a 25dM threshold, we are therefore talking about the equivalent of 44dB, which is about as quiet as that 40dB whisper in the library.

Nothing that I post on this board is "shadows and mirrors." NOTHING. How dare you!

I am so over this bullspit. Believe me or don't believe me. Maintain and open mind or don't. Understand a little elementary auditory neurophysiology or don't. Suffer a little less or don't. It's your tinnitus, not mine. And it's your suffering, not mine.

Shadows and mirrors my asp. What is this, some sort of game of "gotcha?" Sheesh.

 

To my rudimentary understanding, 44dB is louder than 40dB, so it seems you were therefore wrong when you said that...

However the hearing loss at the t frequency or frequencies may be different to the hearing loss at the range of frequencies involved in the whispering, so it is perhaps not so simple as this. But I think the idea is roughly right.

Now, does this perhaps start to answer the original post in this thread?

Because you, Dr Nagler, have a very large hearing loss (do I remember you saying somewhere around 90dB?) when you are in the 'Maid of the Mist' boat the waterfall does not seem anywhere near so loud to you as it does to a person with less of a hearing loss. Therefore the falls do not mask your tinnitus as much as they would somebody with less of a hearing loss. It makes sense to me, but maybe I am wrong. Are we getting somewhere? Anyone?

I do have an open mind, as a couple of my posts earlier tonight hopefully show - the ones where I asked you to expand on your statements in a way that might help people. I was expressing genuine curiosity, believe it or not. I have not, however, seen you yet say anything that I feel is relevant to my "suffering" - which I do not believe is particularly extreme, and which I do not believe fits neatly into your way of thinking about things. I am however open to ideas and assess what I read based on the merits I see in it.

If you do not want anyone to argue with things that you say then could I respectfully suggest that you tone down your own dogmatism and aggression, and that you be more open to the truths and the insights that other people express. It is this, as well as arrogant/manipulative tactics such as that objected to earlier by myself and linearb, that get people's backs up. To a great extent you reap what you sow. It is in your power to change this situation, since for all of our faults most of us here are good people.

 

In other words: "Thanks for taking the time to answer my question. It seems like the concept is a little more complex than I initially thought it was. I'm still somewhat confused about tinnitus loudness, but you have given me much to think about. I realize that you are a busy guy and hope you'll continue to be available from time to time to help guide us through muddy waters as we each try to find our own solution. I love your Strategy, Determination, Flexibility, Insight formula. Even though we may not agree on everything, we can all certainly agree on that!"

 

I'm sorry, but from everything I've seen so far you are guiding us into muddy waters. Forgive me, but I have seen no clarity from you at all in this thread. I have shown why I think what you said was incorrect. You have not so far shown any error in my reasoning. I fail to see what you are talking about.

I remain open to being corrected, but only by reason, not by bluster.

 

I didn't start the thread, my friend. You did.

Next time you want answers, I respectfully suggest that you ask somebody who will tell you exactly what you want to hear instead of somebody who is trying his very best to address a difficult subject and who apparently keeps coming up way short in your eyes.

Bottom line: In the final analysis all those loudness matching numbers are clinically irrelevant. They may have importance in research. It may be reassuring to see your tinnitus on a graph. But that's about it. Why? Because your tinnitus is exactly as loud as it sounds to you. Nothing else matters. Moreover, regardless of how loud it sounds to you, that has nothing to do with your ability to overcome it. I know that many here will disagree. That is to be understood - since those who have overcome their tinnitus have no reason to be here at all. Save, of course, for those of us who dare enter the lions' den to tell you that if we can do it, then you can do it do.

Either way, I wish you well with it.

 

Dr. Nagler, I didn't start the thread. I only entered the thread yesterday at the top of this second page (post #32). I wrote half of that post the day before, but at the time decided to just let it go without posting because I did not think that the thread was going to go anywhere interesting or useful. I completed post #32 and posted it on reading "My tinnitus is incredibly loud, but I'm doing just fine these days. How are you doing?" addressed to stelar. This is a tactic I've seen you use several times and which I object to for the reason I gave. I confess that seeing it made me feel some negative emotions from past discussions in which you have behaved with similarly manipulative tactics towards me and others. I did try to channel that, however, into clear thinking and intelligent debate (as best I could).

I think maybe we got somewhere. It wasn't where you wanted to go, and I get that the thread was hard on you. But you had and still have plenty of chance to explain and develop your point about central auditory processing. I would still be very interested to see you do so, since the assertion you made that...

... seems to hold out real promise, without delivering in and of itself.

So where I personally think we got to here is we got to a greater understanding of the question posed at the start of the thread by Stink. We have a clearer idea of at least one mechanism at work in the "Maid of the Mist" mystery - a mystery that I know has intrigued other members. This is that the degree of your hearing loss means that even objectively very loud sounds do not mask your tinnitus if your hearing aid is not in use. Please correct me if I am mistaken.

Thank you, that is kind of you to say. I'm sticking to my own perception that my own tinnitus is not "incredibly" loud and that whatever problems I have around a lack of personal joie de vivre at this point in my life are complex and encompass many other factors alongside the influence of t (which I nevertheless do stubbornly insist on considering to be horrible and insidious). I wish you well with your own issues - whatever they are - since I suspect that none of us are completely free of problems.

 

My error. Sorry.

Yes, I understand that some object. The cold facts are sometimes hard to swallow. The reason I put it that way is to get people to think: "Why the hell is Nagler doing so well while I'm not. And what can I do to change that - because my current strategy hasn't gotten me very far."

You are mistaken. My moderate high frequency hearing loss is nothing compared to the dB level at the foot of Niagara Falls. That 90dB threshold you referred to earlier was at 12.5K, an ultra-high frequency that is way outside the range of the sounds encountered in everyday living! Putting it in more concrete terms, the frequency of the highest note on a piano is 4186 Hz. My 90dB threshold is at 12,500 Hz! And I always wear my hearing aids anyway. So if that's where you think you got, then you got nowhere.

If you really want to get somewhere in terms your understanding, then re-read what I posted earlier:

"In the final analysis all those loudness matching numbers are clinically irrelevant. They may have importance in research. It may be reassuring to see your tinnitus on a graph. But that's about it. Why? Because your tinnitus is exactly as loud as it sounds to you. Nothing else matters. Moreover, regardless of how loud it sounds to you, that has nothing to do with your ability to overcome it. I know that many here will disagree. That is to be understood - since those who have truly overcome their tinnitus have no reason to be here at all. Save, of course, for those of us who dare enter the lions' den to tell you that if we can do it, then you can do it do."​

 

Fair enough, thank you for correcting me on that point. It doesn't sound safe to me to wear hearing aids in the presence of such noise, but I guess you know what you are doing.

Thank you, yes, I've read a couple of versions of that. Maybe it is my fault, but I do not find that particularly enlightening. I mean no offence when I say that I personally think if you could congratulate yourself a little less, and listen a little more closely to what others say then you would give much better support to the folks who come here, and also be a more inspiring figure. I mean that as constructive criticism rather than an attack.

I'm sure your post will have been edited from the one I have replied to here. Nevertheless, I'm gonna back out now as I've got some stuff to do back in boring old reality. It's been a ride. Take care.

 

OK. Perhaps you might locate a doctor convenient to your location who knows this stuff well and can explain it to you on a one-to-one basis as it applies to your particular case. Message boards do not lend themselves well to that sort of thing.

Well, to be honest, I'm very proud of what I have accomplished. And if you were anywhere near as sick as I was, you would be too!

Listen closely? I do that in my clinic all the time. Here on this board all I want to do is give folks the tools to move ahead in their quest to overcome their tinnitus on their own. And if that doesn't get them anywhere, then they should get help - just like I did back in 1994.

Support "isn't my thang," as we say in the South. There's loads of support on this board. You don't need me for that.

Inspiration is in the eyes of the beholder, my friend. I was a hard-wired all-or-nothing black-and-white thinker who overcame his severe intrusive tinnitus using the formula Strategy, Determination, Flexibility, Insight. I basically revised my own hard-wiring. And if the fact that I can do it and that I care enough to come back to tell you that you can do it too isn't inspiring enough, then my being a kiss-ass softie isn't going to get you there either. I'll provide the facts and the formula ... and I'll let others supply the support and inspiration.

 

25 years of 'T' and three relapses I agree with Dr. Nagler. I'm still a productive person. I have good days and good years but I also have bad days and upon relapse(s) BAD year plus. The best way to describe it is perseverance. I will not give into my 'T'.

 

Well, this is the "support" subforum. If you have no interest in being supportive, and you don't need support yourself, why exactly are you here?

I personally have a dislike of most American made gasoline engine motorcycles, and as a result, you'd be hard pressed to find me on a Harley forum.

Tough love may have its place; being a sort of self-congratulatory smartmouth usually does not.