TRT

[Dubbyaman]

Dr. Nagler. When u say TRT brings 9s and 10s to 2s nd 3s, could you please elaborate on how this is so when the volume of the T remains the same?

 

[Dr. Nagler]

Dr. Nagler. When u say TRT brings 9s and 10s to 2s nd 3s, could you please elaborate on how this is so when the volume of the T remains the same?

Hi D'Man. Thanks for your excellent question.

Let's start by going over what makes a 2 a 2 and what makes a 9 a 9, OK? We are talking here about a scale that I came up with (truly not worth publishing!) that is a quickie estimate of the impact a person's tinnitus has upon his or life. And since that person is the only individual who hears his or her own tinnitus, the only thing that counts in terms of its impact is what that person says! So a 1 is "I have tinnitus, but I do not care one way or the other because my tinnitus does not bother me in the least," and 10 is "I have tinnitus, and my tinnitus has totally and irrevocably destroyed my life." Now everybody who has loud tinnitus would prefer it to be less loud. That is a given. But the fact of the matter is that there are some people with very loud tinnitus who consider themselves to be a 2. And there are some people with rather soft tinnitus that consider themselves to be a 9. And there are countless combinations an permutations in between. In other words there are factors other than loudness that play into how severely you are affected by your own tinnitus, factors that are largely beyond conscious control. Which means a 9 can become a 2 without any change in tinnitus loudness at all!

Now before I continue the above train of thought, let's look at the current state of tinnitus research. Almost all of the research that seems to excite the tinnitus community is directed at finding "the cure" or possibly better stated finding a way to either ablate the tinnitus signal entirely or predictably make that signal lastingly weaker (i.e., making one's tinnitus "less loud.") That's what folks wanted back in 1994 when I first developed tinnitus, and it's what folks still want today. Are we closer today than we were in 1994? We are without a doubt. But how much closer? Well, wanting something to be just around the corner is a whole lot different than something actually being just around the corner. I realize that retigabine and the potassium channel channel openers are all the rage these days. We even have a "Team Trobalt" right here on Tinnitus Talk! But every other promising silver bullet to date has ultimately fizzled out - so I certainly wouldn't put all my eggs in the potassium channel opener basket quite yet! I'd absolutely love it if the potassium channel openers turned out to finally be what we all have been waiting for. But I am not anything close to convinced that such will be the case. Let me quote a recent post of mine:

Back in the late 1990s the research community and the tinnitus sufferers of the day were just as excited about what they had going on at that time as the research community and the sufferers of today are about what we have going on with potassium channel openers and the like right now. Today in 2015 it is so very easy to say that tinnitus research was in its infancy back then, because it was! We have come so far. But I wonder what we will be thinking fifteen years from now in 2030 if there still is not a cure, which unfortunately is a real possibility. What we will be thinking in 2030 is that tinnitus research was still in its infancy back in 2015. We will be thinking in 2030 that we have come so far since all the excitement in 2015 about potassium channel openers. We will be thinking in 2030 about how naive we were back in 2015. We may still not have that cure in 2030, but we will be confident that we will have one within five years. Just like my dear friend Dr. Jack Vernon was confident we would have one within five years way back in the late 1990s.

Do I believe that as we speak today a cure is just around the corner? I certainly hope so, but honestly I have no idea - because like it or not, tinnitus research is still in its infancy.​

So while we are waiting around for that cure to finally happen, I personally like the idea of making 2s and 3s out of 9s and 10s. And since we do not have a way to lastingly decrease tinnitus loudness at this point in time, it seems to me quite reasonable to look at those factors other than loudness to which I referred in the opening paragraph of this response, factors like one's emotional response to one's tinnitus and one's autonomic ("fight-or-flight") response to one's tinnitus. The problem is that you cannot consciously mitigate your emotional and autonomic responses. If you could, we would not even be having this discussion! But you can most definitely indirectly mitigate your emotional and autonomic responses to tinnitus.

Which at the end of the day is what neuroplasticity and habituation are all about. Neuroplasticity and habituation are the phenomena that allow 9s and 10s to become 2s and 3s. And very fortunately those processes work independently of loudness - or else we'd all be in real trouble until that cure came along.

stephen nagler