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DrNagler
 #1 
Hi All -

I've decided to start a new thread called "Words of Wisdom."  The thread will be locked and pinned to the top of the board, and it will contain a series of individual posts that I think may be of particular value for any of a variety of reasons.  If you are aware of any posts that you feel should be considered for inclusion, please notify me by PM or by e-mail at smn@sptinnitus.com

Thanks -

stephen nagler
DrNagler
 #2 
From Rob in Denver -

I'd like to share some thoughts on "What tinnitus is not."  Science (except for a small minority of cases) does not yet know what causes tinnitus, so in that sense we don't yet know what tinnitus is.

However, we have plenty of information about what tinnitus isn't, and -- as a fellow tinnitus sufferer (although my "suffering" has gone down by orders of magnitude over the last few years) -- I'd like to note seven things that tinnitus is NOT, to wit:

1. Tinnitus is not -- in the overwhelming number of cases -- an indication of anything health threatening in any way, shape, or form.  In all likelihood it is caused by some very minor nerve damage together with a natural compensatory mechanism of the nervous system. (There are causes of tinnitus -- like acoustic neuromas -- that must be dealt with, but such are in the tiny minority.  However, they are one reason everyone who develops tinnitus should be checked out by an ENT or other medical ear specialist).

2. Tinnitus itself is not a direct cause of emotional distress, anxiety, or depression.  But the reaction to tinnitus can cause all of the above, in spades. That does not mean that there is something wrong with someone who has a negative emotional reaction to tinnitus.  There is nothing wrong with such people.  I was among them, as many of us are or have been.  But there is something wrong with not realizing this very important fact.  Wrong in the sense of "incorrect".  Tinnitus is not your problem.  Your reaction to it is. 

3. Tinnitus is not something that can shape your life in any way that can ruin it, degrade it, distort it, sabotage it.  Unless you let it.  You are in charge.

4. Tinnitus (the intrusive, continual kind) is not something that most people who do not have it can understand.  So it is usually a waste of time trying to explain it to them.  Not in all cases, it is true.  But even in those few cases where you can (or think you can) convey what having tinnitus is like, the results of your efforts are rarely helpful to either you or the other person (and I am not referring here to a clinician or therapist).

5. Tinnitus is not uncommon.  It is rampant.  There are hundreds and thousands -- nay, millions of us tinnitus cognescenti out there.  And yet the world still revolves around its axis, work gets done (by a lot of folks with tinnitus), laughter is heard, and happiness happens. It can happen to you.

6. Tinnitus is not an enemy.  It is neutral, without value (in every conceivable sense of the word).   It is just there.  Some neurons in your brain have decided to fire (or not fire) in such a way as to create the sense of a sound when there is no external cause.  There is no more malice behind it than there is behind a hangnail or a thunderstorm.  You have not been singled out for punishment or for anything else.

7. Tinnitus is not important.  Your reaction to it is.  In fact, your reaction to it is everything.  Now you can't will yourself not to have a negative reaction, but you can whittle down the negative response.  And when you do, and your nervous system classifies tinnitus as not important anymore, you will find that it will start to recede from your awareness.  The mechanism I just described is programmed into every human being.  So if you think you can't habituate (which is the name for this process), you are wrong.  And in this case it is wonderful to be wrong.  Take my word for it.

Rob in Denver
DrNagler
 #3 

From a friend of the community -

 

When folks argue that they are offended by the idea that it's one's reaction that is the source of the difficulty, rather than the thing itself (such as tinnitus or a death in the family), they are not understanding a very simple point.

 

To react with sadness, grief, anger and so forth in particular situations is perfectly appropriate.  What something like CBT tries to do, when it's done right, is to examine some of the thoughts going through one's mind to see if they are appropriate and realistic or not.  This is because CBT practitioners believe there is a connection between the thoughts we have and the emotions we feel as a result.  So, when a person reacts with sadness to the loss of a parent or incurable cancer, that is a completely human response and there would be no good reason to try to reconsider one's thinking.  The reason CBT is well-suited to tinnitus is that, while a measure of sadness, grief and anger are perfectly appropriate, and particularly so at first, many of the thoughts one tends to have with regard to tinnitus (e.g., my life is ruined, I will never be happy again, no one could habituate to tinnitus this loud, etc.) are not always accurate and realistic.  That's the crucial distinction between feeling terrible because one's parent has died and feeling terrible because of one's tinnitus.  And the CBT folks believe that to challenge one's thoughts on tinnitus and replace the unrealistic thinking with a more realistic and balanced view can help us with regard to how we react to tinnitus and how we feel.

DrNagler
 #4 

Letter to a Tinnitus Sufferer

by Stephen M. Nagler, M.D., F.A.C.S.

 

Dear [fill in your name if you truly suffer from tinnitus],

 

I’m so glad I finally found a few moments to write to you personally.  I’ve been meaning to write for quite a while, and although I realize others might read this letter too, it’s really meant for you.  Only for you.

 

Approximately 20% of the population of the industrialized world has tinnitus, but most are not tinnitus sufferers like you.  Their ears ring, but it doesn’t seem to bother them much.  You, on the other hand, have intrusive tinnitus.  Not only do you have tinnitus, but your tinnitus has you!  Intrusive tinnitus has caused you to suffer.  A lot.  Sometimes you can barely get through the day, and you’d pay almost any price for some quiet.

 

Why am I writing to you?  It’s because I am one of the world’s authorities on tinnitus suffering.  But it’s not my medical degree that makes me an authority.  In fact, no amount of schooling or study can make a person an authority on tinnitus suffering.  What makes me an authority is first-hand experience.  I recall spending hour after hour, day after day, rolling in bed from side-to-side holding my ears in agony.  Tinnitus kept me out of work for over a year.  I was absolutely miserable.  Every day.  All day long.  Yes, it is my own suffering that makes me an authority – just like your suffering makes you an authority.  You are every bit as much of an authority on tinnitus suffering as I am.  And although your friends and loved ones try to understand, they don’t get it, do they?

 

So let’s talk a bit.  One authority to another.  I want you to know you can have tinnitus – loud screaming tinnitus – and not be a tinnitus sufferer.  I’m not saying that it’s easy.  It’s not, but it can be done.  Of course, what I want most for you is for your tinnitus to go away completely.  That might happen someday.  But until it does – if it does – wouldn’t it be wonderful if, over time, your “bad ear days” became “not-so-bad ear days?”  Or even “good ear days?”  Wouldn’t it be fantastic if you reached the point where you didn’t care about tinnitus one way or another?  That’s pretty much where I am now, even though my tinnitus hasn’t changed a bit!  It still sounds like a cross between an ear‑splitting teakettle and a roaring jet turbine.  Every single day.  All day long. 

 

What makes somebody who has tinnitus go to the doctor?  Obviously people with tinnitus go to a doctor because their ears are ringing, right?  Well it turns out that many people with tinnitus don’t consult a doctor.  What do the ones who do have in common?  They have ringing in the ears and it makes them feel bad!  If their tinnitus didn’t cause them distress, they wouldn’t see a doctor about it.  Unfortunately after running a few tests to rule out any significant underlying problems, more than likely the doctor will tell them that there’s nothing that can be done, and they’ll have to learn to live with it.  So they walk into the doctor’s office because their ears are ringing and it makes them feel bad, but when they leave, their ears are still ringing … and they feel even worse.  At least that’s what happened to me!

 

Why go to the doctor at all if you’re just going to feel worse when you leave?  Because in some cases there may be an underlying problem that requires attention – and besides, the doctor might find a hair or some wax lying up against your eardrum, remove it, and cure your tinnitus.  It happens!

 

Most of the time there won’t be a threatening underlying problem, but there won’t be a “quick fix” either.  So here’s what I’d like you to do.  When the doctor says, “You’ll have to learn to live with it,” I want you to see it not as a nail in your coffin of misery, but rather as, “Fortunately your tinnitus isn’t caused by something that is a threat to your life.”  Then I want you to go about finding which of the various effective approaches to achieving relief best fits your situation.

 

What do I mean by an effective approach to achieving relief?  Well, if you’ll recall that there are a lot of people who have tinnitus that doesn’t make them feel bad (or else they’d have gone to the doctor), and if you’ll remember that the reason you went to the doctor is because your tinnitus makes you feel bad, then it seems to me that until science discovers a universal cure for tinnitus, it might be of considerable value to look at strategies for converting your tinnitus that makes you feel bad into tinnitus that doesn’t make you feel bad.

 

And that’s what the rest of this letter is all about – one effective approach to feeling better.  Will the strategy I am going to suggest make you feel 100% better by tomorrow?  Of course not.  But I strongly believe it will help you to gradually feel better over time – so that you will find yourself having fewer and fewer bad ear days and more and more not‑so‑bad ear days.  Yes, plenty of good ear days too.

 

Will this strategy interfere with any treatments you might now be undergoing?  No.  Does it involve diet or medication?  No.  Does it cost anything?  Yes.  It costs a little time – ten or fifteen minutes a day.  But in order for it to work, you must do it every day!  If you will accept as your goal the conversion of tinnitus that makes you feel bad into tinnitus that does not make you feel bad, if you will try not to view partial success as total failure, and if you will resist the urge to look for some sort of magic bullet overnight miracle, then I just might have something for you.

 

To begin with, I’d like to ask you to accept a concept that is completely valid, but that people who suffer from intrusive tinnitus often have a very hard time accepting:  The key to converting tinnitus that makes you feel bad into tinnitus that does not make you feel bad lies in learning and effectively applying the tools that significantly impact your reaction to your tinnitus.

 

Hard as it is to believe, many people with incredibly loud tinnitus are not at all distressed by it.  And some people with relatively soft tinnitus are completely overwhelmed.  The same is true for people whose tinnitus varies in pitch, timbre, the number of different tones, consistency, etc.  So if the same tinnitus sound is no big deal to one person, yet is overwhelming to another, the only possible factor at play is how each person reacts to his or her tinnitus.

 

It is extremely important to understand the fact that our reaction to tinnitus is a subconsciously‑mediated event.  We cannot simply “decide” to react differently to tinnitus.  Nor is the ability to impact our reaction to tinnitus a question of strength, character, or determination.  But that said, it is also important to realize that no matter how loud our tinnitus, whether it is constant or intermittent, whether it is high-pitched or low‑pitched, and whether it contains one sound or multiple sounds – if somehow we didn’t react to our tinnitus, we wouldn’t feel bad.  We couldn’t feel bad.  Why?  Because how we feel is a reaction.

 

Right now you’re probably thinking:  “Fine.  Even if I believed the key is in my reaction to my tinnitus (and I’m still not sure I buy it), what does that have to do with converting tinnitus that makes me feel bad into tinnitus that does not make me feel bad?”

 

The answer is that the primary determinant of how we feel is how we think.  The best illustration of this important principle can be found in a story that I first heard from Dr. Laurence McKenna, a brilliant and dedicated UK psychologist and cognitive behavioral therapist.

 

Fred gets into a subway train that is overflowing with passengers.  A man starts poking him in the back with an umbrella for no reason at all.  What happens?  Fred gets angry of course.  His pulse quickens, his blood pressure rises, and his face turns red.  But when he turns around to tell the man to stop poking him in the back, Fred sees that the man isn’t carrying an umbrella.  He’s carrying a gun.  What happens now?  Fred’s face turns pale, his palms grow moist, and his mouth becomes dry.  He reaches into his pocket to hand over his wallet, but when he turns around again, Fred discovers that the would-be robber isn’t carrying a gun after all.  In fact it’s a blind man with a cane who is struggling to find a safe location in the moving train.  The color returns to Fred’s face, his pulse slows, and his blood pressure normalizes … as he assists the man to a nearby seat.  So what has happened here?  Within two or three minutes, Fred has felt anger, then fear, and then compassion – along with the physical changes generated by these three powerful emotions – all because of his thoughts about a few pokes in his back.

 

As you can see from this story, how our passenger feels as a result of the poke in the back is greatly influenced by how he thinks about it.  “All well and good,” you are mumbling under your breath, “but intrusive tinnitus is no mere poke in the back.”  And you’re right.  That’s what makes this process challenging.  But the principle remains the same, and I would like to suggest how you can use it to your great advantage.

 

Maybe it would help to look at what makes intrusive tinnitus different from a poke in the back.  We recently discussed this question on the Tinnitus and Hyperacusis Community Board (http://www.sptinnitus.com).  The participants listed several explanations:

 

·        Fear of an unknown danger.  We notice tinnitus one day and figure it will soon be gone, but it isn’t.  Surely it will be gone by the following morning, but it's still there.  And the next.  And the morning after that.  So we begin to wonder if it will ever go away.  And if it doesn't, what will happen to us?  To our ability to concentrate?  To our joy of life?  To our hearing?  How will we function?  What is causing it?  Is it a tumor?  Will we die?

 

·        The prolonged continuous presence of a neutral stimulus.  Tinnitus – even relatively soft tinnitus – doesn’t go away.

 

·        “Negative counseling.”  Our ears are ringing.  It’s not getting any better.  We mention it to a friend.  And our well‑meaning, but short-sighted friend recalls, “I once heard about a guy who had it so bad that he …”

 

·        Tinnitus is amorphous, not directly measurable, silent to others, and invisible to all.

 

So there are indeed plenty of reasons for the differences between intrusive tinnitus and that poke in the back.  But in the final analysis they are both stimuli, and the primary determinant for how we feel as a result of experiencing a given stimulus is how we think about that stimulus, a process over which we have little direct conscious control.

 

Having laid some important groundwork, I would now like to tell you how you can begin to convert tinnitus that makes you feel bad into tinnitus that does not make you feel bad.  I ask only two things.  First, please invest the time – a few minutes each day – to doing exactly what I am going to suggest.  It might sound like “busy work,” but it’s not.  Give it a fair trial of at least three or four months.  Second, do not equate less than 100% success with failure.  Remember, the idea is to use this strategy to help you feel better gradually – so that you will have fewer and fewer bad ear days … and more and more not-so-bad ear days.

 

Invariably people who suffer from intrusive tinnitus develop thought patterns based more in emotion than in logic.  For example, I clearly remember a morning in 1994 when – literally tortured by my screaming ears – I told my wife that my tinnitus was so bad I couldn’t get out of bed.  “OK,” she said, as she sat down in a chair in our bedroom to read the newspaper.  Half-an-hour later, when I got up to go to the bathroom, she asked me if my tinnitus was better.  I told her it wasn’t any better at all – in fact, it was worse.  My wife then asked why I wasn’t still in bed.  And she had me!  Obviously my earlier statement that I couldn’t get out of bed because of my tinnitus came from a place of emotion – not a place of reality.  Such thoughts are called “cognitive distortions.”  And very understandably, the more stressed, distressed, or depressed we are due to our suffering from intrusive tinnitus, the more deeply ingrained are our cognitive distortions.  These cognitive distortions serve only to reinforce our negative feelings, thereby resulting in more cognitive distortions.  The result is a profoundly self‑defeating vicious circle.  To impact our reaction to tinnitus, first we must learn how to identify our cognitive distortions, and then we must learn how to challenge them.    

 

In their (now out-of-print) book Tinnitus: A Self-Management Guide for the Ringing in Your Ears authors Jane Henry and Peter Wilson gave examples of twelve cognitive distortions commonly experienced by people who truly suffer from severe intrusive tinnitus.  You might recognize some that apply in your own case.  (And I suspect that you can come up with plenty of your own.)  Here is the list that appears in the book, copied with Professor Wilson’s kind permission:

 

·        An example of overgeneralization:

Because of my tinnitus I was awake all night.  Every night will be the same.

 

·        An example of all-or-nothing thinking:

Before I had tinnitus my life was perfect.  Now my life is ruined.

 

·        An example of filtering:

My tinnitus is much worse after the party.  I enjoyed the company but my tinnitus spoiled everything.

 

·        An example of mind-reading or jumping to conclusions:

When I have to ask people to repeat things because I don't hear well, I know they think I'm an idiot.

 

·        An example of magnification or catastrophizing:

My tinnitus is louder – I know I'll become deaf.

 

·        An example of minimization:

So what if I managed my tinnitus today?  I know that is a fluke.

 

·        An example of personalization:

I was so annoyed by my tinnitus that I ruined the night for everyone.

 

·        An example of jumping to conclusions:

The tests say that my hearing is OK, but I know I'm going deaf.

 

·        An example of emotional reasoning:

My tinnitus makes me feel so hopeless.  I know there is no hope.

 

·        An example of "should" statements:

Having tinnitus should never upset me.

 

·        An example of labeling:

Having tinnitus and hearing loss means that I am totally disabled.

 

·        An example of blaming:

I wouldn't be so annoyed with my tinnitus if my family understood.

 

My suggestion to you, derived from the work of cognitive behavioral therapist Aaron T. Beck and modified from a strategy found in Henry and Wilson’s book, is designed to break the vicious circle that reinforces the negative emotions that make you feel bad regardless of the loudness, pitch, timbre, etc. of your tinnitus.  To this end, each time these (or similar) cognitive distortions cross your mind, I want you to stop what you are doing as soon as possible and write them down.  Then, below each cognitive distortion, list all of the reasons it represents illogical thinking.  The writing part is essential.  This is not merely a mental exercise.  You must write down your thoughts and review your notes from time to time.

 

For instance, if you find yourself thinking, “I am such a burden to my family,” write it down.  Then ask your spouse and children to take a few moments to recall all the things they have done during past week that have nothing to do with your tinnitus.  I mean everything – from working to school to athletics to music to art to video games to reading a good book to playing a round of golf.  Write each one down under “I’m such a burden to my family.”  Stare at it.  Prove to yourself – documented in writing – that while your family would dearly love for you to find some relief, they are still accomplishing quite a lot in their own lives.  Whatever burden there is … is largely in your mind.

 

If you will commit to doing this exercise religiously – to writing down your negative thoughts and challenging them with logical, reality‑based examples – you cannot help but begin to impact your subconsciously‑mediated reactions to tinnitus.  And slowly, over time, you will break that self-defeating vicious circle.  You will begin to realize that you are having fewer bad ear days and more not‑so‑bad ear days – because the tinnitus that has been making you feel bad is gradually becoming tinnitus that does not make you feel bad.      

 

From one authority to another, I sincerely wish you well.

 

Kind regards,

 

stephen nagler

DrNagler
 #5 
From CPW:

cherie posts: "Ok, So I know habituation takes time, but I just can"t accept this T, can't accept it might be permanent. I continue to beg and pray and cry for it to go away. I continue to hope it was caused by something fixable. I mean the whole thing on one hand makes sense: the fire alarm was the loudest noise I ever heard and I couldn't protect my ears."
 
Cherie, when I read your post tonight it hit me very hard.  It brought back memories of almost three years ago when I sat up at night after night crying, holding my ears, praying to God to take it away, how could I accept this as permanent and if it was how was I going to end it all.  You beg, you pray, you make deals with God and then you go spending money you don't have on "cures" that don't work.  For me it was, or I blamed in on facet joint injections without sedation.  Had to blame it on something.  It was my fault.  With my background I should have known better.  I know you won't believe it now but ... It is just a sound.  As I write this it is screaming but it is just a sound and more and more I don't notice it.  It's there but the busier I get doing the things I like and always did it seems to just start taking a back seat in my life.  You are surrounded on this board by people who truly are empathetic as we have all been where you are.  It does take time, it does take "doing" something and that differs for all of us  ...  It is a journey and one you will walk with us.  There will be ups and downs, good times and bad but there is success.  It's not easy but it does get easier.  Hang in there - it does get better!

CPW
DrNagler
 #6 
From Murasaki:

Laurence Mckenna (a Clinical Psychologist with over 20 years experience in dealing with the management of tinnitus) told me recently that there is no connection between one's perceived strength of character and one's ability to handle tinnitus. In other words, 'strong' people can struggle to habituate it while 'weak' people can often progress more quickly.

[smn:  Dr. Laurence McKenna is one of the most knowledgeable people in the world when it comes to tinnitus and tinnitus-related distress.  The passage above should serve as a reminder to one and all that the fact that Joe might truly suffer from the exact same tinnitus that Bill finds to be but a minor inconvenience does not in any way imply that there is some sort of weakness or character flaw on Joe's part.]


DrNagler
 #7 
From Tpeace:

I went through a horrible time when my T first struck 8 months ago. Life was so miserable days after days. I was so anxious and depressed that pills were my best friends. I talked to others about my situations and none seemed to fully understand my problem. My wife was doing her best to be supportive, but she didn't understand the extent of my suffering. At one stage even hyperacusis appeared. It got worst to the point I could not go out to any social events, couldn't stand the noises of eating out in restaurants, or going to the malls. Somedays, I couldn't even stand the voice of my wife in the morning. I was staring into an abyss of living a withdrawn, lonely life while the T was screaming constantly at the highest of pitch, resembling scratching glass surface. At times, panic, anxiety and depression were so overwhelming that I sometimes went to sleep (with sleeping pills) not wishing to wake up to repeat the torture cycle again.

The turning point for me was visiting great tinnitus support forums like this great forum, as well as some others like the Success Story thread in another forum. People like DrNagler & Rob show me that there can be light at the end of the darkest tunnel. I put their advice to the practice, by just changing my attitude towards T, by living my life regardless of T, by daring my T without surrendering to its tyrany. I even started a thread called 'Daring my sound reactive T'.

Nowadays, I am at peace with my T and living my life as I enjoy it - fishing, gardening, playing my guitar, dancing with my wife, and of course working. My T is in the background. It still has its ups and downs but it has faded in significance. T is losing its power when you don't give it fire. I have ceased worrying about what T will do for this or that. If it spikes, I just treat it like I just got on a cross-continent train ride. It will come down. I also have not worn ear plugs for a few months whereas before I wore them often, even while driving. The hyperacusis just fades and gone for good.

In my 'Daring T' thread, I talked about one approach, which is trying to find out how other people have coped well or recovered from T. Perhaps some pointers there can help you. Here is an extract of part of the thread about how other people, including celebrities are living with their T. So keep up the hope. You will be well somedays like most of us. Below is the extract:

-------------------------------------------------------------------------
Another approach I took when newly hit with T and hurting quite badly was this - learn what others T people are doing with their lives. Are they all 'wasted' like me? Are their lives ruined totally by T?

Not Really! The T veterans on this board are living a produtive life despite their T.

Many people I have talked to, including my own dr. admitted that they had T too. Some had it years before, some still going, and yet they have recovered or just doing well living with their T. One thing stands out among them - they don't or have stopped treating T as a catastrophe in their lives. 

I have also researched and found out that many celebrities have T - Barbara Streisand, William Shatner (Star Trek), David Letterman (Late Night Show) and many famous celebrities in the music world, even legends like Beethovan etc. See this list: http://members.fortunecity.com/nrbq1/tinnitus.html

I watch this YouTube clip of Shatner and Letterman and just laughed my head off hearing Letterman say his two-tone high-pitched siren T is like testing the emergency broadcast system non-stop LOL (just his humorous self). See this link:


Shatner actually had tinnitus so bad (to him) that he was suicidal for a time. Now he is the spoke person for American Tennitus Association. Letterman is doing shows and still making people laugh night after night while his T is testing the emergency broadcast system. Just so funny.

I have also come across a young singer Melody Gardot. In her blog entries on Myspace, she described her challenges living with severe T and H. In fact she said she had to be on earplug all the time. She is also sensitive to bright light, so she has to wear dark sunglasses always. But worst to that, she was hit by a car while cycling and has to walk with a cane just to balance herself. Her conditions are worst than most people. She confesses that she is disable but that doesn't mean her life is disabled. She has gone on to a booming singing career (even singing with earplugs LOL) and seems to have a busy travel schedule doing shows all over the world. She is truly an inspiration. See this link: http://www.myspace.com/melody

These people all show one thing - carry on with life with a positive attitude regardless their T's and through them we know this is a reality and this message is what this board is all about.  

Tpeace
DrNagler
 #8 
In response to a question about the goal of habituation "in full," I posted:

Therefore the process that I have taken and continuing, should at some point lead to habituation in full.  Right?

...........

I think it is unlikely that the process you have taken and continue to take will at some point lead to habituation in full.

I surely have not habituated "in full," because that would mean I am never aware of my tinnitus unless I purposely listen for it and it never bothers me at all.

The fact is that I am largely unaware of my tinnitus, and it rarely bothers me to any appreciable degree.  I should add that there are some compromises I have made along the way to make things more manageable.  (I changed careers, for instance, so my hours would be more predictable, I could be assured of being able to rest when fatigued, I could avoid the extreme stress of all-night trauma surgery, etc.)

So, getting back to your question, I believe that at some point you may be able to achieve what I have described in the above paragraph.  In fact, you may already be there - or very close!   But I do not think it wise for anybody who has severe intrusive tinnitus to expect that at some point he or she will habituate "in full."  I'm not saying that it can't happen.  I'm only saying that it's not a very practical goal.

In my opinion.

smn

[smn:  Most of the "Words of Wisdom" on this board come from keyboards other than mine, but I thought that the distinction I have tried to make in this post was very important.]
DrNagler
 #9 
A post of mine included in this thread at Micky's request:

Habituation is a process.  In the TRT cosmos that process has two component processes, Hp (Habituation of Perception) and Hr (Habituation of Reaction).

If one were to achieve 100% Hp (i.e., never ever aware of tinnitus unless it is purposely sought), Hr would be an irrelevant factor - because if you never ever hear it, why even consider whether or not it would bother you if you did??!!

Well, I do not believe that 100% Hp is achievable by somebody who has at one time truly suffered from intrusive tinnitus.  Or if it is achievable, it is very rare.  I think that you can come close, but I don't think that 100% Hp (or even close to it) are realistic goals to set for yourself.  Rather, I think that a realistic goal would be to achieve meaningful relief to your great satisfaction.

So, if 100% Hp is not achieved, what about Hr?  Can we ever get to the point where when we are aware of our tinnitus, we are not in the least bothered by it.  And again I think that the 100% standard (or even close to it) might remotely be possible, but it does not represent a realistic goal.  The goal should be the achievement of meaningful relief to your great satisfaction.

The other side of the coin has to do with how to begin the process of Hp.  And Hp cannot begin without at least to some degree addressing the aversive response to tinnitus - in other words without at least starting on the road to Hr.  That in large part is what this board is about - because the more one understands about his or her tinnitus, the better equipped one is to travel along the Hr road.  Hp?  It pretty much follows along on its own, although it does help to avoid silence, at least at the beginning.

I do not for one moment believe that TRT is the only way to facilitate habituation, but I have taken the liberty of using TRT terminology in this thread because the Hr/Hp model seems to me to be a good way to break things down and make sense of it.

smn
DrNagler
 #10 
I'm not sure whether or not the following exchange truly falls under the category "Words of Wisdom," but I'm going to copy and paste a few posts nonetheless ...

***********

DrNagler

Your Host
Registered: 09/11/08
Posts: 197


Old post Today at 03:05 PM

Ana posted:

I have a feeling this is the start of a very interesting conversation.
 
...........
 
Interesting ... and hopefully over time very helpful to you.
 
.............

I know some people have to deal with t at about 60 dB. I can't even start to imagine how bad that feels.
 
.............
 
My tinnitus is over 60dB, Ana.  In fact, I can easily hear it while in the Maid of the Mist boat at the foot of Niagara Falls.


 
But most of the time I don't hear it unless I purposely listen for it.  So here again is an example of your drawing a conclusion based upon assumptions that might not have a logical basis in reality.  That's OK.  Almost everybody does it at first.  All we ask here is that you keep an open mind.
 
..............
 
As for myself, the sound was really, really low in the beginning.
 
.............
 
Ana, it's really, really low now!  My goodness, you can't hear it over the very lowest setting in a TRT device, a device that is specifically designed to be able to be set softer than your tinntus
 
So I think that you might consider the fact that likely your tinnitus really isn't louder than when it first started - it only seems that way because you've been fighting this battle for three long years.  I really believe that you're going to do quite well, but maybe it might be worth a look at the strategies you've been using!
 
smn
 
Thatch

Registered: 10/21/08
Posts: 24

Old post Today at 03:38 PM

My tinnitus is over 60dB, Ana.  In fact, I can easily hear it while in the Maid of the Mist boat at the foot of Niagara Falls.
 
 
wow!, thats insane. And at that dB level you've habituated to it? how long has your t been at that level?
 
jerry

Registered: 03/24/08
Posts: 18

Old post Today at 04:30 PM

[response to an earlier unrelated question]
 
DrNagler

Your Host
Registered: 09/11/08
Posts: 197

Old post Today at 05:11 PM

Thatch posted [regarding my tinnitus that's louder than Niagara Falls]:

wow!, thats insane.
 
............
 
No, Thatch.  That is the reality.
 
................
 
And at that dB level you've habituated to it?
 
.................
 
Habituation is a process, not a state.  But I have largely habituated to it.  To have fully habituated, I'd NEVER hear it unless I purposely sought it.  And that is not the case.  But when I do hear it, while it can distract me, it rarely distresses me.  Early on the very same tinnitus pretty much put me in bed for a year.
 
.................
 
how long has your t been at that level?
 
................
 
Since 1994.
 
sp


 
winterbridge55

Registered: 05/27/08
Posts: 85

Old post Today at 05:53 PM

Dr. Nagler,

I never until this day heard you talk personally about your t. I find it superhuman that you have habituated to this level. I am just blown away by your Niagara Falls example. Can it be that there are people no matter what their chronic level of pain and distress will do better than others just because they are optimists?  I think the mind is a terrible master for some because it thinks automatically that everything is a disaster. Some of us can become a slave to our own minds which makes fighting chronic illnesses that much more difficult, like me. Thank you for sharing your tinnitus with us.  



__________________
Mark
 
DrNagler

Your Host
Registered: 09/11/08
Posts: 197

Unread post Today at 10:07 PM

Mark posted:

I never until this day heard you talk personally about your t.

...........

I don't talk about it much - because it's not particularly interesting to me.  I did write a piece about it that was published in the medical literature around five years ago:

Tinnitus - A Patient's Perspective

.............

I find it superhuman that you have habituated to this level.

............

I assure you - it is very human.

...............

I am just blown away by your Niagara Falls example.

...............

I can understand why you might feel that way.  Can you understand that a couple of years ago when I made that discovery while on vacation with my wife and kids, my reaction was one of mild amusement - nothing more than that!

.............

Can it be that there are people no matter what their chronic level of pain and distress will do better than others just because they are optimists?

..............

Possibly.  However, I can tell you that with my intrusuve tinnitus I sure wasn't any sort of optimist at all.  In fact I was just about the greatest whiner and woe-is-me-er on the planet.  But while I did not have anything approaching optimism, I did have four things that as I look back upon it were very helpful ... 

1)  A strategy for finding relief that made sense to me
2)  The determination to carry it through
3)  The unconditional love of my wife (who as part of that unconditional love placed limits on my whining and complaining)
4)  A psychiatrist who managed the antidepressants and benzodiazepines that helped me get through the day ... and who, when I said to him that I was afraid I might commit suicide, told me on no uncertain terms that there wasn't chance in the world that I'd commit suicide - because while I was absolutely miserable, I wasn't STUPID!

smn
 

DrNagler
 #11 
On tinnitus loudness matching:

There are two ways to look at the loudness match ...

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
DrNagler
 #12 
From Rob in Denver -

There is no evidence whatsoever that tinnitus is aggravated in any way by caffeine, or indeed by any food or drink.  None.  And [any] study's methodology would need to be very rigorous ... to prove otherwise.

Tinnitus does fluctuate, and no one knows why.  But I can tell you this.  If you monitor those fluctuations and try to correlate them with what you have eaten or drunk -- or for that matter, with any kind of experience -- the end result will be that you will focus on your tinnitus more, bringing it to center stage, and it will bother you more because you will be more aware of it.

In my opinion, eat and drink what you enjoy and don't give tinnitus the power to change that or anything else that is important to you.  Know that just getting on with your life and letting time pass is the key to improvement, as well as countering those negative and catastrophic thoughts that help the tinnitus dominate your attention and fuel its ability to bother and torment you. 

Rob in Denver
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