What Should I Do Next if Anything?

Discussion in 'Dr. Stephen Nagler (MD)' started by bwspot, Oct 5, 2014.

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    1. bwspot

      bwspot Member

      Tinnitus Since:
      First of all I would like to take this opportunity to thank you for all your support.
      Having somebody as knowledgeable as You are in the T matter is a blessing.

      It has been four moths since my T started. (july 13th)
      I went to see ENT two weeks after T happened and I had below tests done:

      Exam Of Nose And Sinuses
      An exam using a scope (endoscope) of the inside of the nose or sinuses.

      Series Of Hearing Tests
      A series of hearing tests that measures both speech and sound levels. The tests record the lowest level at which speech can be identified. They also record the quietest sound that can be heard (audiometry)

      Inner Ear Hearing Screening
      A screening test of the ability of the inner ear (cochlear) to pick up and measure sound.

      Eardrum Function Test
      Tympanometry is a hearing test that measures how well the eardrum moves in response to sound.

      I am 39.
      The ENT told me that I had slight hearing loss at 4Khz but said it was very minimal and normal for my age.
      I personally do not hear any differences in my hearing and I am proud to hear pretty good.
      My family always tells me that I am too sensitive to sounds and I just hear too much.
      Stuff like clocks or snoring people always annoyed me a lot.

      I am not sure why the T happened. It might be due to dental work, neck issues or just the sound exposure.
      (I did not attend any concert, just the regular listening to the music with 75-90db)
      My T started after I stopped listening to music for like 15min at low volume of 70-75db.
      I turned the music off, looked out the window and from silence it went to T mode.
      From the complete panic in the first two weeks I slowly accepted new reality.
      I keep digging and reading a lot trying to learn something new that would lead me to something revolutionary.
      I have seen many times that your best advice is to not worry and accept it.
      I did that almost 90% but there are things that bother my mind and I am not ready to drop out of my research yet. I just want to be sure I tried my best. Some days I sleep well some worse. It is harder to fall in sleep now, but I try. I noticed that use of any external sounds seem not to be working and I prefer silence together with the T. I just try to count numbers, imagine things until I forget about T and fall in sleep.
      In general I continue to work and do things I like, but when I wake up I always check if T is there hoping its gone. My reaction to T changed to better, but there is still stuff that circles my mind.

      I have few questions and sorry if too many:

      - Should I re-visit ENT? He told me to comeback and repeat the tests. (do I need different type of tests?)
      - Should I use any supplements? Is there anything that might help me in addition to healthy diet?
      - Should I investigate neck issue in more detail and rule out any effect of the neck stiffness on T?
      My T changes its volume when I move my head to left or right sideways or when I press on my forehead.
      - I purchased the ER20 plugs and I wear them when I am on train, in restaurants, or loud places.
      Should I continue to do so or am I overprotecting myself?
      - My T reacts to sounds like loud approaching train noise, squeezing a plastic bag, typing on the keyboard.
      What is that? Is this something that is a side effect of T? For me it sounds like broken speaker sound and its accompanied with increase of the T levels. Once external sounds decrease the weirdness goes away too.

      What are you thoughts?

      thank you
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      Hi @bwspot -

      Thanks for your great question. In fact, it's such an important question that I think I'm going to pin it to the top of my Doctors' Corner forum for a while!

      So basically, you've had tinnitus for four months and have undergone a thorough evaluation - and you want to know what steps you should take next.

      In terms of protecting your ears from auditory damage, you should take the same precautions that people who do not have tinnitus should take (but rarely do). By that I mean, if you find yourself in an environment such that you must raise your own voice to be heard by a person standing next to you, you should either leave or use ear protection.

      In terms of protecting yourself against things that might aggravate your tinnitus while not causing auditory damage, you can make yourself crazy trying to avoid anything and everything that might possibly aggravate your tinnitus, so I wouldn't bother with any of it. All that type of strategy accomplishes is put your tinnitus in the driver's seat - when your real goal is to kick it off your auditory bus entirely!

      Supplements and stuff like that? They are highly effective ... for stockholders in the companies that manufacture them, that is. But as far as tinnitus goes, keep your money.

      So ...

      It's been four months. What should you do?

      As I see it, what you should do depends on how your tinnitus affects your life. And except for the somewhat nebulous "My reaction to T changed to better," you really haven't been very specific in that regard.

      So let me try to help.

      If things are going in an overall positive direction for you, and you are satisfied with your progress, I'd do nothing save for making a conscious effort to spend less and less time on tinnitus boards. Why? Because as I see it you spend enough time necessarily attending to your tinnitus as is. Why spend even one minute unnecessarily attending to it? And if things are already going well for you, that's what the net result of being on tinnitus boards is doing: unnecessarily attending to your tinnitus.

      @bwspot, perhaps the above describes your situation precisely. I do hope so.

      But what if things are not progressing as you might wish? If that is the case, then after four months it makes no sense to me whatsoever to maintain the status quo. You already know the strategy that is resulting in your not progressing as you might wish. So if things are not progressing as you might wish, I'd adopt a new strategy.

      What strategy would I adopt? Hands down I'd do TRT. It's what I did myself in 1995. And it's what I'd recommend to anybody who is not progressing as he or she might wish in 2014.

      As I see it, TRT is the "gold standard" in habituation-based approaches to tinnitus, and until somebody comes up with a cure, habituation-based approaches are the very best things we have going for us. Am I biased? Yes, but only because I have looked at this problem every which way there is including inside out. And please let's not start with the "financial angle." I have none. (See: https://www.tinnitustalk.com/threads/tinnitus-retraining-therapy-trt-financial-disclosure.6281/)

      So let's look at the reasons why somebody who after four months is not progressing as he or she might wish would not start TRT.

      • The idea of habituation does not appeal to you. To that, I say Fine. TRT is a "Want To" and not a "Have To." If the idea of not caring one way or another about your tinnitus regardless of how loud it might be has no appeal, then TRT is definitely not for you! If the idea of being less and less aware of your tinnitus over time does not put a smile on your face, then again TRT is not for you.
      • You want to "Give it more time." Again, I say Fine. You're the one who's suffering. Far be it from me to tell you when it's time to take some positive steps towards changing that circumstance. Maybe "more time" is a solution for you. I do suggest, however, that you consider employing a strategy of one sort or another while you're giving it "more time" - because the only reason you are considering giving it "more time" in the first place is that with time alone you are not progressing as you might wish (as noted in the fifth paragraph above). My strong recommendation for that strategy would be TRT, but others see it differently.
      • You want to do TRT, but there is no knowledgeable and experienced TRT clinician in your city or even in your country. Then I suggest looking elsewhere. Most knowledgeable, experienced, and credible TRT clinicians will work with you via Skype for all follow-up after a single initial in-person evaluation/counseling session.
      • TRT has an 85% success rate, and with your luck you suspect you'll be in the 15% who do not succeed. Well, just about 100% of those who ultimately succeed in TRT figure that with their luck they'll be in the 15% who fail ... that is, until they start getting better! After all, you didn't get tinnitus by raping and pillaging. You got it because you had bad luck. Just like everybody else who succeeds.
      • You view TRT as sort of an "ace up your sleeve" - to use if all else fails. Me? I think it should be the very first card played!
      • TRT is expensive - especially if you have to travel for the first session. Well, here you have to consider the economic, social, and emotional cost of "Not TRT." Speaking only for myself, TRT was the second best investment of my entire life. (My wedding band was the best!) Moreover the cost of TRT was far less than the cost of all the stuff I tried before TRT that didn't have a chance of helping me, but that I blindly hoped would do just that. And, yes, I had to travel for TRT when I did it back in 1995 - a total of 4200 miles. (Back then in pre-Skype days you had to attend each session in person, and my TRT clinician was 700 miles away.) So for me, TRT was a considerable chunk of change indeed. I guess in the final analysis it all comes down to priorities.
      Yes, in the final analysis it does all come down to priorities. And yes, I am unapologetically biased in favor of TRT. But the question was what should you do next if you weren't progressing satisfactorily after four months. And what I would do under those circumstances is TRT. Indeed, the only reason to wait longer - in my mind - would be if you really needed to know that when you get better it was definitely due to TRT. Under such circumstances you might want to wait a year, two years, five years, ten years, whatever. For me, however, I didn't want to suffer even one more day than absolutely necessary. And precisely how I got better was nowhere near as important than that I got better. In fact, for that matter I believe that far too many tinnitus sufferers wait far too long!!! I wish I'd started TRT after a three or four weeks of suffering. But back then it was pretty-much in its infancy, and nobody knew much about it. I didn't even know it existed for six to eight months!

      Friends, I am opinionated and obviously quite passionate about this particular issue. I fully acknowledge that another person in the field might well respond differently than I. But the question was directed to me, and I answered frankly, honestly, and directly to the very best of my ability.

      Best to all -

      Dr. Stephen Nagler
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