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pt
 #1 
sp, this came up before and i am confused about it, so if you or someone else who knows could enlighten me, i would appreciate it.

i had asked about loudness matching. (this was on cazzie's "beautiful day" thread.) you said that a dozen years ago this was the measurement for you:

The pitch of my tinnitus was 8000Hz. My hearing threshold at 8K was 50 dB. My tinnitus loudness matched at 63 dB at 8K, making it 13 dbSL.


ok, so you subtract your hearing threshold to get your tinnitus at 13 dB.

here is what i don't understand. if the 63 dB measurement is objective, then why and how does hearing threshold figure in? because your hearing threshold, which includes some hearing loss, is something unique to you.

suppose your hearing threshold were 63 dB. does that mean you wouldn't perceive your tinnitus at all? somehow, i don't think that's how it works. or would your tinnitus, assume it doesn't change, always measure 13 dB above your hearing threshold?

if we can objectively measure an external sound of 63 dB, and your hearing loss is such that you hear it at 13 dB, that is understandable. but you are hearing an internal sound that nobody else can hear.

so does that mean you hear what a person with no hearing loss hears at 63 dB or at 13 dB?

putting it another way, i can understand tinnitus matching in volume when it comes to someone with no hearing loss. what they hear objectively at 63 dB, you hear in your head at 63 dB. but i can't understand it when someone has profound hearing loss. what a normal-hearing person hears objectively at 63 dB, the hearing-loss person wouldn't hear at all. except in their head. so how is that even measurable?

they say time is the fourth dimension. maybe loudness is the fifth. i like quantifying things, and this is bugging me because i can't figure it out.

stringplayer
 #2 
There are two ways to look at the loudness match, Peach. 

One is in dB, the number that shows up on the audiometer gauge in front of the audiologist at the moment that you, sitting inside the booth, indicate that the sound you are hearing through the headphones (working slowly up from 0 dB) is as loud as your tinnitus at the tinnitus frequency (pitch).  Lets say that Fred and Bill both have tinnitus that measures 43 dB using this method.

The second is in dB SL - dB sensory level. 

OK.  Fred has really good hearing at the tinnitus frequency, a threshold of 0 dB.  But Bill, on the other hand, has a 40 dB threshold of hearing at the tinnitus frequency.  That means that he does not hear he first 40 dB of sound introduced to the booth.  Fred goes first, and at 43 dB he indicates that the sound he hears through the headphones is as loud as his tinnitus.  Next comes Bill.  The audiologist starts increasing the volume of the sound being introduced to the booth.  10 dB.  20 dB.  30 dB.  What's Bill doing?  He's still waiting for the audiologist to start the test!  When the audiologist gets to 40 dB, Bill finally hears the faintest sound through the headphones.  (Remember, at 40 dB Fred was already hearing a very loud sound through his headphones, but it still wasn't loud enough to match his tinnitus!)  Back to Bill. At 43 dB (a mere 3 dB over his threshold of hearing) he indicates to the audiologist that the sound he is hearing though the headphones is as loud as his tinnitus.

So both Fred and Bill have a 43 dB tinnitus loudness match, right?  But clearly Fred's tinnitus is much much louder than Bill's.  And the only way we would know that from the loudness match would be by taking the threshold of hearing into account.  That's what dB SL does.  It subtracts the threshold of hearing from the loudness match in dB.  So Fred's tinnitus is 43 dB SL, while Bill's is 3 dB SL.

Please note that I chose these figures for illustrative purposes only - as a tinnitus loudness match of 43 dB SL is almost unheard of.  In fact in 70% of cases the loudness match is 6 dB SL or less.

Please also note that neither dB nor dB SL correlates well with how loud you judge your tinnitus to be on a 1 to 10 scale.  But that's another story.

Hope this helps more than confuses.

sp

pt
 #3 
Thank you, sp.

I see that the audiologists have already tackled the topic of loudness vs loudness sensory level.

Here's another question about the sensory level. Suppose an objective ear with perfect hearing could crawl inside Fred and Bill's heads.

Would the objective ear "hear" Fred's tinnitus at 43 dB and Bill's at 3 dB? So that the ear would confirm that Fred has fairly loud tinnitus and Bill has fairly soft tinnitus? (Which I know has nothing to do with their own judgment or level of distress.)

Or is objective a meaningless concept in this regard?
pt
 #4 
And here is another question. Suppose someone has T from a drug reaction, someone else from noise trauma and someone else from a head injury.

Do you think they all have the same thing going on in their brain/nerve that causes their tinnitus, or do you think there are different things going on? In other words, are there different mechanisms for different causes?
CPW151
 #5 
SP, audiology is not my area of training.  Had some and should have paid more attention but this thread is educational and very interesting.  In my experience I had two db matches and I think they were both around 6 db above my hearing threshold.  However, both times were days when my tinnitus was just moderate, and a day when it was quite bearable, just a so-so day as I recall it.  On a day when my tinnitus was very loud and intrusive I was not able to get an appointment with the audiologist.  The last time they tried to do a db match my tinnitus was gone for the whole day - just not there even in a sound proof booth for 30 minutes.  The audiogram had not changed but they couldn't do a db match with nothing to match it to.  So the obvious question, does this indicate that the loudness of your measured tinnitus actually changes or is it just your perception of it?  Would it have been higher if I could have had it tested on a day that it was invasive and screaming.   On the last test day it wasn't there so could not be matched/measured.  My experience would lead me to believe the former is the case.

CPW
stringplayer
 #6 
CPW, the tinnitus loudness match tends to be remarkably constant.  In other words, if your tinnitus matches at 6 dB SL on a day when you judge your own tinnitus to be a "3" on a scale of 1 - 10, it will in most cases match at 6 dB SL on a day when you judge your own tinnitus to be a "9."

sp
pt
 #7 
CPW, I certainly understand what you're saying. It is easy to accept that tinnitus is in the brain and not the ear, just as hunger is in the brain and not the stomach.

But what's weird is that you can sometimes hear the loudness component changing.

Here are two examples. In my tinnitus ear, there are times when I can hear the tinnitus get louder. It is existing at its usual loudness, which is not very loud, and suddenly it just gets louder. I hear the change. I can pinpoint the moment of change. There it is. (It never happens, however, that I hear it get softer in an equivalent fashion. It is more that it dies down slowly.)

Similarly, my non-tinnitus ear is silent, but occasionally I have fleeting tinnitus, so suddenly a ringing will appear for maybe 10 seconds. Then it fades away. I definitely hear this.

This relates in part to my other question, about whether the mechanism of T is different depending on the cause. I wonder whether T caused by a drug reaction is consistent -- it seems that your T never varies, sp -- whereas T caused by noise is less consistent and more variable and sometimes even goes away spontaneously. I also wonder if there is a difference in having T alone and T along with H. Like maybe the mechanisms behind H exert some kind of influence on T. God only knows. I sure don't.
CPW151
 #8 
CPW, the tinnitus loudness match tends to be remarkably constant.  In other words, if your tinnitus matches at 6 dB SL on a day when you judge your own tinnitus to be a "3" on a scale of 1 - 10, it will in most cases match at 6 dB SL on a day when you judge your own tinnitus to be a "9."

sp

 
SP, this is what I've heard several times and honestly I find it hard to believe.  In no way am I questioning your answer but how then do you explain my last appointment with my audiologist, whom you know, when in a sound booth for 30 minutes, we could not do a match because my tinnitus was simply not there.  I have days, not many, when I just do not have tinnitus even if I try to listen for it and in a booth at that!  I clearly don't understand this and my audiologist friend that is nearby doesn't have the equipment to measure it.  Sorry to belabor the point and apparently I'm being rather dense.

CPW
stringplayer
 #9 
CPW posted:

SP, this is what I've heard several times and honestly I find it hard to believe.

.........

You're supposed to find it hard to believe.  But it's true.

I've done it too many times on my own patients to doubt it.

There are, of course, rare exceptions.  And everybody with fluctuating tinnitus is absolutely convinced that he or she is one of those rare exceptions.  Until shown otherwise in the audiology booth, of course!

sp

[PS - You can't match tinnitus that isn't there, of course.  So do the match on a day that it is there!]

CPW151
 #10 
sp

[PS - You can't match tinnitus that isn't there, of course.  So do the match on a day that it is there!]

 
SP, I wish I had that option!  It was done on two rather soft days, none on a really loud day and the last when it wasn't there at all.  I live a long way from an audiologist who has the equipment to match and getting an appointment on the exact day it would be really loud, even if I could predict that, would be impossible.  Unless I went somewhere, stayed for a week or so and had an audiologist who would see me on any day that it was really loud.

CPW
stringplayer
 #11 
Then I guess you'll just have to take my word for it.  Or not. 

sp
CPW151
 #12 
Then I guess you'll just have to take my word for it.  Or not. 

sp


Then again I just might be one of those rare exceptions. Or not. 

CPW
stringplayer
 #13 
The bigger question, CPW, is what difference does it make either way?

sp
CPW151
 #14 
The bigger question, CPW, is what difference does it make either way?

sp


Not one iota of difference!  All it would satisfy is my curiosity.

CPW


frg
 #15 
In fact in 70% of cases the loudness match is 6 dB SL or less. (sp)
 
6 dB SL seems like nothing.  I breathe louder than that (I think).  Thanks, sp.  I find this information very encouraging, especially when I experience a spike or seem drawn to the T.  With this kind of information, I can tell myself that listening to tinnitus is a state of mind rather than an inevitable state.  God knows I need the power of positive thought. 

I took the advice of a fellow T & H poster and bought the book Mindful Way through Depression.  I'm finding the book very encouraging, and empowering.  Thanks.

frank
pt
 #16 
in a related vein: are there people here who have only tinnitus (or tinnitus plus hearing loss) -- NOT pain, pressure, aural fullness, weird sensations in the ear, no other ear symptoms whatsoever but ONLY tinnitus?
stringplayer
 #17 
Yes.

In fact most folks with tinnitus don't have those other symptoms - or if they do, the symptoms are transient.

sp

Rob_in_Denver
 #18 

Quote:
Originally Posted by pt
in a related vein: are there people here who have only tinnitus (or tinnitus plus hearing loss) -- NOT pain, pressure, aural fullness, weird sensations in the ear, no other ear symptoms whatsoever but ONLY tinnitus?

Yes.  There are hundreds of thousands (probably millions) of people who only have tinnitus (with or without hearing loss) and nothing else from your list.  I am one of them.

Rob in Denver
DrNagler
 #19 

Bbec, I'm sorry.  I don't understand your question.  Would you mind re-wording it?  Thanks.  smn

DrNagler
 #20 
Thanks for clarifying.

In tinnitus loudness matching, each ear is tested separately.  A loudness match of 13 dBSL indicates that in the particular ear tested the tinnitus matched at 13 dB louder than the threshold of hearing.  As best I can recall, one of my ears matched at 13 dBSL.  I presume my other ear matched at 13 dBSL as well, or I'd likely have remembered otherwise.

Bbec, my 13 dBSL tinnitus pretty much put me in bed for a year.  But 13 dB is much quieter than a whisper!  In fact, careful measurement has shown 13 dB to be equivalent to the "hum" of a regular (non-flourescent) light bulb.

How in the world could such a soft sound turn a person's life upside down (as it did mine)?  In other words, how could such a soft sound SOUND SO LOUD?  Because to me it was DEAFENING!!!

smn
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