Tinnitus Grading...?

Hi.

I've had tinnitus now for 2 months and was wondering how does it get graded?

 

What do you mean by graded?

 

It doesn't. Nobody has been smart enough to figure out the only way to measure it is by comparing it to external sound measured in dB.

 

Does it not get graded due to the severity of the noise??

 

Well I suppose there are descriptors of mild/ moderate/ severe/catastrophic but these are subjective... How can you compare your noise to what some one else hears?

 

Well there's quite a few ways to "measure Tinnitus". See here.

 

Thanks for reply, the reason am asking is some mornings it seems to be louder than others... if graded I could confirm it against the run of my day to find out what makes it louder.. or does it just go up and down on its own??

 

It sounds like you want to do a volume match.
It is common for T to vary in volume/intrusiveness through the day. Mine generally gets worse as the day goes by, but some people start off waking up with bad T that gets better as the day goes by.

 

Yes a volume test would be a start,,,, how would I go about it ???

 

You can try to "do it yourself" or go to an audiologist to help you do it.

 

There is a grading system in trt. I think it goes from 0-4 where 4 is most severe. I was told I was a 4. The questions weren't on tinnitus level undead but on perceived impact on social functioning etc etc

 

I give my tinnitus an "F".

 

You had a volume test??

 

@Ron 007007, there's no accurate way to measure a subjective perception, but saying that, you can determine a sensory level in decibels. Firstly you need an audiogram to measure your hearing thresholds. Then you need to determine the frequency of your T by matching it to an external sound using a frequency generator.

Once you have determined this, you must try to match the loudness of the noise in your head (to the matched frequency) by slowly raising the decibel level until it closely matches your T. Finally, subtract your hearing threshold for that frequency from the result and you will have your sensory level result in decibels.

For example: you match your T frequency to 8khz. Your hearing threshold at 8khz is 15db, and your perceived loudness matches the outside signal at approximately 20db.

To get your sensory level we simply subtract 15db from 20db to give us 5db SL. This would be your approximate loudness match, but it's all based on a perception.

The other method is the famous tinnitus questionnaire which measures your reaction to tinnitus. This tries to find the amount of suffering the T is actually causing you.

Your perception of T can dramatically alter depending upon your mood. Depression and anxiety will ultimately make T more prominent. Sleep also seems to reset T for a lot of us.

 

Actually I did numerous ones with the AM101 trials. I was consistently around 30dbsl volume matching. They never did a volume masking test, but I'm sure it would be pretty high.

 

I'll just add to the above that loudness matching in general is a very poor predictor of how much a person will suffer. This is the reason why they made the THI questionnaire.

You can't just compare your tinnitus to external noises and say, "my T must be 90db because I can hear it over a loud bar", for example. It's far more complex than that. If you have a high pitched T then it's unlikely a common broadband sound will mask it. Your T will mix in in the same way a sound engineer would mix an album, so you can hear all the instruments and vocals clearly. Sometimes it only requires a small amplitude at a given frequency to mix in with much louder sounds at other frequencies.

 

You sure that's Db SL Alue? That's almost unheard of. Something like 70% of cases are 6db or less. Above 10db is considered extremely loud.

The numbers are subjective though based on our perception the day the test was performed. Our perception can change.

 

Yes it was dbsl, but it was not frequency matched. I did it 3 or 4 times over several months and it was always the same volume.

 

Oh ok, I get you. I've only ever done this using a 4khz reference signal and matching the volume to around 40db. But, this was using an iPhone without a soundproof booth.

I have no idea what my volume would be done professionally, frequency matched or otherwise.

 

To be honest, I think minimum masking level is probably a better indicator. The problem is the very high frequency tinnitus is harder to mask.

 

Good info ED209, Will make an appointment with the Doctor and see if i can get a referral to the ENT,,,,and i get your point as suffering can only be measured to each individual.
Dose T Peak at different times of the day?

 

I'd like to give mine an "FU".

I'm afraid I couldn't disagree more, Ed.

My (admittedly unscientific) source is this very forum, where threads pop up daily (hourly?) about people panicking because their T go louder, or because they are worried it will be louder after they do something (like take meds, go to a bar, drink alcohol, you name it). Just search the forum for "spike" and see for yourself how distressed people are wondering whether the increase in volume is permanent or not. They even forego medication (that they really need) in order to avoid the mere risk of an increase in volume.

Of course, my personal anecdotal evidence with just one data point also disagrees: the times I suffer most is when the T is the loudest, which is towards the end of the day for me.

You'll also find many posts where people state "if it was just half the volume I'd be so happy" or "I'd be able to function". Tons of reports about taking drugs that hopefully will lower the volume (even evil benzos): why would people be seeking a decrease in volume so bad?

I generally love to debunk "conventional wisdom" but the bulk of the evidence I find about this completely correlates volume and level of distress. I remember also reading it in a scientific study (which I can't find right now unfortunately - it wasn't the main topic of the study but it was a "side learning") and thinking "duh".

It's also completely logical from the physiological point of view: any stimulus associated with pain/suffering makes you suffer more when the intensity of the stimulus is increased. It's true of a needle poking you, of a headache, of stomach pain... I can't think of any example where this isn't true actually.

Granted, there is the occasional statement here and there that states volume doesn't matter, and it's usually by the people with the school of thought that "all you have to do is have no emotional reaction to it". When I hear that I want to tell them I'm going to stab their hand with a knife every 5 seconds and tell them to just not have any emotional reaction to it.

It seems like an innocuous statement, but I'm afraid it is perpetuated in clinical settings and through the medical profession, such that they feel there is no need to provide anything more than "psychological guidance" because, supposedly, your suffering (or not) is all under your control. So we end up getting from doctors what we're all too used to: "it'll get better with time, just don't think about it, put on a fan, get distracted, you're only suffering because you're reacting to it, many people live their lives full with it, you're magnifying its impact, it's really not such a big deal" etc.

And the thing is, they are not completely wrong in providing that advice: it suits the majority of sufferers because they have low volume T (as your own 70% statistic shows), not because volume/intrusiveness is irrelevant.

Yes, and I wouldn't expect those 70% to be on this forum (unless some other pre-existing condition predisposes them to suffer from a mild form of T). This forum is mostly crowded with people who are having trouble with their T, I'd almost say "by definition". I'm not surprised to find people with extreme cases here, as in "two or three sigmas out in terms of severity".

 

Greg, you're right that loudness absolutely matters. I know this first hand because when mine got louder it became incredibly hard to cope, and I struggled.

What I was referring to was tinnitus loudness matching. I used to read a lot of research after my T got worse. One thing that sticks out in my mind is that the Drs researching this stuff found no statistical predictor, correlating loudness from the Db SL test (frequency matched or otherwise), and how much a person was suffering. It was largely irrelevant which is why audiologists mainly prefer to use the THI questionnaire. How we perceive the loudness, and how it affects us emotionally, based on our limbic system's response, is very individual.

If, on a personal level our T gets louder then it will certainly distress us more (especially if the T was already a cause for concern). It's impossible to measure the subjective loudness/emotional response, at any fixed point, objectively.

 

If T can be seen on fMRI and MEG, can't it also be measured? Definitely it is the loudness of my T that influences my coping ability, not psych crap.

 

I disagree with subjective loudness. It should be objective ! Loudness

 

Good question, but I do not know if it can be measured by any scan.
For me too is the volume that is unbearable + this combined with multiple sounds + type of sounds