Major Relapse in Tinnitus Severity After Riding Motorcycle

[Rogi Cetpla]

Dear Nagler,

Allow me to introduce myself; I am a 52 year old male currently living in Switzerland suffering from acute atonal intrusive tinnitus.

In brief, I have had noise induced tinnitus for almost 10 years now… after years of excessive noise exposure (army, motorcycle riding and loud environment) my initial tinnitus was triggered in after going out in a night club.

Even though difficult to manage at the beginning I read up about the condition and worked on a personalised noise masking strategy (TRT influenced) and after time became accustomed to it. At the onset the noise level was only perceived indoors in quiet environment which made things acceptable and workable. Unfortunately my tinnitus level has increased three fold over the last decade, twice further to dentist visits (again managed, even though a very difficult initial phase as I was hearing it indoors and outdoors and difficult to mask). I nevertheless worked on myself using my initial strategy and, again after time, was able to get accustomed to it and managed my condition. Unfortunately the situation turned for the worse two months ago after a succession of motorcycle rides (I had not ridden for a decade but, ironically, had habituated so well that I felt confident enough to restart to ride with custom made earplugs) after which I had a major spike…which has not receded.

I have since consulted my local doctor who, after assessing me, prescribed various medication including Prednisolone 50mg (which I took for 5 days), Alprazolam 0.5mg and Zolpidem 10mg, Melatonin 2mg and Midazolam 7.5mg (which I have been taking every night for a month now). At this stage the noise level is still unbearable especially at night which is depriving me from any consistent sleep and making very difficult for me to function. I have not managed more than 2 to 4 hours in a row per night since the onset of this spike.

After 10 years of having this debilitating condition I consider(ed) myself experienced in tinnitus management and have never had to resort to medication or any sort of medical assistance. I have unfortunately now reached a level where I can no longer achieve this on my own and am nearing breaking point which is why I have now joined this forum and am reaching out to you.

I would greatly appreciate if you could offer me some advice/direction in order for me to find a way out.

Thank you in advance for your assistance,
Best regards.

 

[Dr. Nagler]

Dear Nagler,

Allow me to introduce myself; I am a 52 year old male currently living in Switzerland suffering from acute atonal intrusive tinnitus.

In brief, I have had noise induced tinnitus for almost 10 years now… after years of excessive noise exposure (army, motorcycle riding and loud environment) my initial tinnitus was triggered in after going out in a night club.

Even though difficult to manage at the beginning I read up about the condition and worked on a personalised noise masking strategy (TRT influenced) and after time became accustomed to it. At the onset the noise level was only perceived indoors in quiet environment which made things acceptable and workable. Unfortunately my tinnitus level has increased three fold over the last decade, twice further to dentist visits (again managed, even though a very difficult initial phase as I was hearing it indoors and outdoors and difficult to mask). I nevertheless worked on myself using my initial strategy and, again after time, was able to get accustomed to it and managed my condition. Unfortunately the situation turned for the worse two months ago after a succession of motorcycle rides (I had not ridden for a decade but, ironically, had habituated so well that I felt confident enough to restart to ride with custom made earplugs) after which I had a major spike…which has not receded.

I have since consulted my local doctor who, after assessing me, prescribed various medication including Prednisolone 50mg (which I took for 5 days), Alprazolam 0.5mg and Zolpidem 10mg, Melatonin 2mg and Midazolam 7.5mg (which I have been taking every night for a month now). At this stage the noise level is still unbearable especially at night which is depriving me from any consistent sleep and making very difficult for me to function. I have not managed more than 2 to 4 hours in a row per night since the onset of this spike.

After 10 years of having this debilitating condition I consider(ed) myself experienced in tinnitus management and have never had to resort to medication or any sort of medical assistance. I have unfortunately now reached a level where I can no longer achieve this on my own and am nearing breaking point which is why I have now joined this forum and am reaching out to you.

I would greatly appreciate if you could offer me some advice/direction in order for me to find a way out.

Thank you in advance for your assistance,

Best regards.

Hello @Rogi Cetpla –

I am sorry to hear of your struggles, but I am glad that you found your way to the Doctors' Corner. Thank you for your question.

Please understand that in trying to point you in a good direction, I am working from a distinct disadvantage because in the few short paragraphs above all I have is a brief glimpse of your history, and I have no idea what your audiogram, tinnitus pitch and loudness match. and other data look like. Indeed, the structure of this forum is not conducive to a back-and-forth dialog that might produce such information. And actually that's a good thing in a way – because it forces me to respond in generalities that could apply in a lot of cases.

So first of all, I bet you are beating yourself up for resuming motorcycle riding and "screwing up" your ears for good. And I'm not at all sure that's the case. I suspect that given the fact that you were wearing custom made earplugs, your motorcycle riding resulted in no appreciable auditory damage. Any number of things could have "kicked off" your tinnitus (including anxiety about the possibility of damage), which is to say that there is a good chance that things will settle back down to baseline in time. And even if they don't, there is a very good likelihood that you will accommodate to this new tinnitus as you have before. After all, you have a demonstrated track record of success in that regard!

In terms of your reference to "nearing breaking point," it seems to me that you are miserable, frightened, and frustrated (all justifiably so) – but I suspect that an experienced cognitive behavioral therapist would challenge the idea that you are nearing breaking point, if for no other reason than you have shown so much resilience in the past. The problem is that if you think of yourself as nearing breaking point, it just compounds your misery!

You mention that sleep is an issue for you, and I am uploading some "Hints for Sleep" that many have found to be helpful in the past.

I am also uploading some information on "What Makes a Sound Sound Loud" because studies have shown that a carefully performed tinnitus loudness match will reveal that for individuals with severe intrusive tinnitus whose tinnitus sounds extremely loud (like yours!), the loudness is typically no greater than 12dB over the threshold of hearing – hard to believe, but true. The problem is not the strength of the tinnitus signal, but rather the way your brain processes that signal. This phenomenon is more than a mere intellectual curiosity, because the way the brain processes the tinnitus signal can be modified over time.

I hope that this information will serve to at least get you started.

All the best with it.

Stephen M. Nagler, M.D.