Curing Tinnitus ...

[Dr. Nagler]

Dr Nagler, I recently heard a radio interview with a neurologist or surgeon who is conducting treatment of stroke victims with something I think (I was driving at the time) was called deep brain-cell stimulation, where a micro probe was inserted into the brain. This probe ...

The results of deep brain stimulation for tinnitus have been mixed. A good bit of the work was done by the OHSU group in Portland, Oregon. In a series of seven patients who were receiving deep brain stimulation for movement disorders (e.g., severe Parkinson's disease) and who also had tinnitus, three reported some degree of reduced tinnitus loudness when the deep brain stimulation unit was turned on. I know of nobody studying deep brain stimulation for tinnitus in the absence of an already established clear indication for the procedure.

Stephen Nagler

 

[Valentin]

@MattK, I do not see tinnitus as a brain malfunction. I said that my position would be unpopular here, but it is what it is.

Most importantly, and please keep this in mind. What I happen to think about tinnitus has absolutely no bearing whatsoever on if or when it will ever be cured.

And for what it's worth, I hold @jchinnis in very high regard. I have known him personally for some 18 years now and absolutely love his posts in this thread.

Stephen Nagler

tinnitus does originate either in the cochlea or in the brain but in all cases the clinical studies show hyperactive neurons.

if you had limbs moving by "themselves" or flashes of light when you closed your eyes, this would more than certainly be classified as brain malfunction.

our brains did adapt very poorly to the loss of input, i recently visited a french customer, the guy is in his 80's no hair loss, but heavy hearing loss.

he can't even hear his cellphone ringing, but he's in a peacefull silence, his brain did adapt normally to the loss of input from his cochlea.

 

[Dr. Nagler]

if you had limbs moving by "themselves" or flashes of light when you closed your eyes, this would more than certainly be classified as brain malfunction.

We all see flashes of lights and various designs upon closing our eyes tightly if we wait long enough. That is the cortical representation of normal brain function in the absence of external visual stimulation. It's a good analogy for tinnitus in terms of what happens in the auditory system with hair cell damage. The limbs moving by themselves example may indeed represent abnormal brain function, but the analogy has nothing to do with tinnitus.

Stephen Nagler

 

[MattK]

We all see flashes of lights and various designs upon closing our eyes tightly if we wait long enough. That is the cortical representation of normal brain function in the absence of external visual stimulation. It's a good analogy for tinnitus in terms of what happens in the auditory system with hair cell damage. The limbs moving by themselves example may indeed represent abnormal brain function, but the analogy has nothing to do with tinnitus.

Dr Nagler, I'm not a medical expert by any stretch of the imagination. But what I do know is that one moment I was normal and the next moment I have ringing in my ears. There has to be something wrong. Even if you could make the argument that I used to have tinnitus, but it wasn't noticeable, then that would still indicate that something was wrong, because at one moment it was silent enough for me to never even know I had it for the past 30 years, to now it's so loud that I have no choice but to know I have it. Perhaps I missed your reason for it, but is there a reason you're not willing to think of it as a brain malfunction? Is it because you don't think the brain is involved?

 

[Dr. Nagler]

@MattK, I definitely think the brain is involved. I just don't see it is a malfunction.

Stephen Nagler

 

[Valentin]

@MattK, I definitely think the brain is involved. I just don't see it is a malfunction.

Stephen Nagler

like a while ago you didn"t recognize the problem regarding tinnitus volume, but you'll come to recognize this malfunction sooner or later ;-)

 

[Dr. Nagler]

like a while ago you didn"t recognize the problem regarding tinnitus volume, but you'll come to recognize this malfunction sooner or later ;-)

One can always learn, @Valentin. One can always learn.

But here's the thing. What I happen to think about it really doesn't matter.

What matters is the suffering. I have tinnitus, but I no longer suffer. Now that may be a subject worthy of discussion. And it has nothing to do with brain malfunctioning.

Stephen Nagler

 

[MattK]

What matters is the suffering. I have tinnitus, but I no longer suffer. Now that may be a subject worthy of discussion. And it has nothing to do with brain malfunctioning.

It is a worthy topic of discussion, because really, coping is the only thing we can actually do about tinnitus. And coping does involve time, but not only time. No therapist tells his patient who may be grieving for some reason, "Oh you'll get over it naturally in 5 months". That'd be ridiculous. There are obvious coping mechanisms that can be utilized for tinnitus suffers to help them get through the "time" it takes for their suffering to end.

One of the best methods I have learned for myself was to give up looking for a cure or give up thinking that a doctor can help. Not that I have no confidence in an eventual cure or that a doctor might be able to give me more insight. But by accepting that I may have this for life, I have no longer put all my "eggs into one basket" so to speak. That way if I get news from a doctor that he can't help, then I'm not going to be devastated like I was when this all started.

Another thing that I have found is keeping a journal of how I feel throughout the day. When I read back, I'm sometimes able to find some really negative thoughts I have that can affect my mood.

And physically, I have cleaned up my diet. When I feel better physically, I feel better emotionally. And, by being physically more healthy, it does let me have some level of confidence that there is a chance that it could help my tinnitus... certainly couldn't hurt it.

 

[Dr. Nagler]

It is a worthy topic of discussion, because really, coping is the only thing we can actually do about tinnitus.

The topic indeed may be worthy of discussion, @MattK, but I respectfully disagree with your opinion that coping is the only thing we can actually do about tinnitus.

Right now you are likely wearing a pair of pants. I would suggest that you are not coping with your pants. You are not dealing with your pants. And you are most certainly not wondering whether tomorrow will be a good pants day or a bad pants day. You are just wearing your pants, right?

Well, the reason you don't need to cope with your pants is because you have habituated that stimulus - the feel of your pants on your legs.

And as hard as it may be to believe, you can do the same with your tinnitus.

So when you say that coping is the only thing we can actually do about tinnitus, in my opinion that's not quite right. Coping is but one of the things we can do about tinnitus. We can habituate it; then there is no need to cope.

Stephen Nagler

 

[MattK]

The topic indeed may be worthy of discussion, @MattK, but I respectfully disagree with your opinion that coping is the only thing we can actually do about tinnitus.

Right now you are likely wearing a pair of pants. I would suggest that you are not coping with your pants. You are not dealing with your pants. And you are most certainly not wondering whether tomorrow will be a good pants day or a bad pants day. You are just wearing your pants, right?

Well, the reason you don't need to cope with your pants is because you have habituated that stimulus - the feel of your pants on your legs.

And as hard as it may be to believe, you can do the same with your tinnitus.

So when you say that coping is the only thing we can actually do about tinnitus, in my opinion that's not quite right. Coping is but one of the things we can do about tinnitus. We can habituate it; then there is no need to cope.

Stephen Nagler

Ok fair enough, but would you agree that to get to a point where we are fully habituated, that we need to first learn how to cope? Otherwise, if the tinnitus is bothering someone to the point of driving them towards thinking of options like suicide, how do they get through the time it takes to habituate? It seems like we first need to learn how to stand before we can walk. And first we need to learn to walk, before we can run. To me, anyway, it seems like we need to learn how to cope before we can habituate.

Now, I realize that I haven't been at this as long as you have, but that seems to make sense in my mind.

Btw, I liked your pants analogy. I feel like I have gotten to a point where my tinnitus doesn't really bother me like it used to, but I definitely still know its there. It would be awesome if I could get to a point where I just don't respond to it in any way at all, like I don't with my pants.

 

[Dr. Nagler]

Ok fair enough, but would you agree that to get to a point where we are fully habituated, that we need to first learn how to cope?

No, @MattK. I understand where you are coming from, but I would not agree.

I don't know about you and your tinnitus, but there is no way in the world I could have ever coped with my tinnitus. For me that would have been a losing strategy from Day One.

And by the way, nobody is ever fully habituated.

Stephen Nagler

 

[dan]

I don`t believe in God at all......., but I still go to church every Sunday - just in case

 

[Beth]

One can always learn, @Valentin. One can always learn.

But here's the thing. What I happen to think about it really doesn't matter.

What matters is the suffering. I have tinnitus, but I no longer suffer. Now that may be a subject worthy of discussion. And it has nothing to do with brain malfunctioning.

Stephen Nagler

Dr Nagler, Was there any one specific thing that really helped you on the road to habituation; Was it that you fully understood what was happening or was it changing the way you thought about the noise, or neither of the above? I know it's never a linear process in habituating the noise but I can have a few days when I'm more or less unconcerned about it then I go back into being afraid of it again and I don't feel that there's a change in my thought process but I guess there must be. Thoughts = emotional response?

 

[Beth]

No, @MattK. I understand where you are coming from, but I would not agree.

I don't know about you and your tinnitus, but there is no way in the world I could have ever coped with my tinnitus. For me that would have been a losing strategy from Day One.

And by the way, nobody is ever fully habituated.

Stephen Nagler

Dr Nagler, If you're accepting your tinnitus does that not mean that in a way you're coping with it. If you still hear it but don't react then isn't that kind of coping? I'm not picking faults with what you say, just trying to understand what your relationship is to it now. I would feel worried if I got to the point where I couldn't hear it at all because I'd live in fear of it coming back so I hope to get to the point where I hear it but it doesn't bother me at all so most of the time I can tune it out. I'm not sure I could handle silence for fear of the return of T. May be a bit silly but that's how I feel. When you say nobody is ever fully habituated does that mean that nobody ever gets to the stage where they don't hear it any more? Beth.

 

[Martin69]

Good questions Beth. I thought the same.

And to Dr. Nagler I want to say, it is so much appreciated you listen and answer here. Thank you so much. If I would live in Atlanta, I would directly come to your clinic. But Germany is a little bit too far away.

 

[Beth]

Good questions Beth. I thought the same.

And to Dr. Nagler I want to say, it is so much appreciated you listen and answer here. Thank you so much. If I would live in Atlanta, I would directly come to your clinic. But Germany is a little bit too far away.

Same here Martin69, a bit too far for me to go but I certainly appreciate his wisdom.

 

[Lisa88]

As a musician, I have been in sound proof booths for lengthy times, or in very quiet environments, and never heard any tinnitus. I heard complete silence. In an experiment where one is to listen out for sound in such a structured way, I can imagine that it is in fact imagination that takes over. The mind is a powerful tool that way. I remember silence, and in my humble opinion do not think everyone has tinnitus. I do in fact agree with the theory that those with tinnitus have spontaneous overfiring of neurons from excitatory neurotransmitters where those without tinnitus do not. This overfiring theory is the one theory that seems consistent in the t research that I have read.

 

[Dr. Nagler]

Dr Nagler, Was there any one specific thing that really helped you on the road to habituation; Was it that you fully understood what was happening or was it changing the way you thought about the noise, or neither of the above?

Neither. It was TRT.

I was miserable. I had traveled down a number of roads only to find dead ends. What made the difference for me was TRT.

Stephen Nagler

 

[Dr. Nagler]

Dr Nagler, If you're accepting your tinnitus does that not mean that in a way you're coping with it. If you still hear it but don't react then isn't that kind of coping?

Not if you don't care, it isn't.

When you say nobody is ever fully habituated does that mean that nobody ever gets to the stage where they don't hear it any more?

What I mean is that even the wildest habituation successes happen to briefly become aware of their tinnitus every once in a while. It might be a couple of times a day, it might be a couple of times a week, it might be a couple of times a month. But I have never encountered anybody who truly had severe intrusive tinnitus and subsequently habituated who remained totally unaware of his or her tinnitus (unless purposely seeking it, of course).

Stephen Nagler

 

[Dr. Nagler]

As a musician, I have been in sound proof booths for lengthy times, or in very quiet environments, and never heard any tinnitus. I heard complete silence. In an experiment where one is to listen out for sound in such a structured way, I can imagine that it is in fact imagination that takes over ...

Right, but please recall in the Heller & Bergman experiment that when the participants were asked to describe the sounds they heard upon hard listening in the audiology booth, the sounds they described were exactly the same sounds that folks with severe intrusive tinnitus describe: buzz, hum, roar, ring, crickets, etc. So if you are going to ascribe the sounds heard by those in the experiment to the imagination, then I guess you'd have to ascribe the sounds that everybody on this board hears to the imagination as well. I certainly don't believe that to be the case. And I bet neither do you!

Stephen Nagler

 

[Mpt]

Dr Nagler,

When you do notice your sound... what do you do to get your mind back off of it?-- or does it drift off of the sound naturally for you at this point?

 

[Lisa88]

Respectfully, I don't think there are many different timbre of sounds left. Tinnitus seems to pretty much cover the gamut . I hold you and your research in the highest regard, so please know this is just my personal perspective as a musician and one who can remember a time of serene silence. With warm wishes, and thanks for all that you do for our community, Dr. Nagler.

 

[Beth]

Neither. It was TRT.

I was miserable. I had traveled down a number of roads only to find dead ends. What made the difference for me was TRT.

Stephen Nagler

Dr Nagler, thank you for you reply; what I was really asking was what part of TRT helped. Was it the one to one councelling that helped you to fear it less when you understood what was happening or was it the fact that you changed your reaction to it on a consistent basis because you no longer perceived it as a threat. Lots of people understand what is happening when T is present but still don't habituate. TRT seems to have a magic ingredient.

Hi all, I'm seeing my T therapist tomorrow so have a feeling I'll be 'banned' from being on the site but I will miss all the lovely, kind and helpful people here. My hope is to come back one day and post a success story and help other people. May speak soon, may not!! Thanks so much everyone. I'll report tomorrow but may be saying goodbye for a while after that.

 

[Dr. Nagler]

Dr Nagler, thank you for you reply; what I was really asking was what part of TRT helped. Was it the one to one councelling that helped you to fear it less when you understood what was happening or was it the fact that you changed your reaction to it on a consistent basis because you no longer perceived it as a threat. Lots of people understand what is happening when T is present but still don't habituate. TRT seems to have a magic ingredient.

@Beth, TRT has no "magic ingredient," and least none that I know of. TRT is a well-defined treatment protocol - a package, if you will - that induces and/or facilitates the habituation of tinnitus in a high percentage of individuals with intrusive tinnitus.

Stephen Nagler

 

[Dr. Nagler]

Dr Nagler,

When you do notice your sound... what do you do to get your mind back off of it?-- or does it drift off of the sound naturally for you at this point?

@Mpt, I do nothing to get my mind back off it. Since I do not care - or more properly stated, since my brain now classifies my tinnitus as a neutral stimulus - it drifts off naturally. Unless I check, of course.

Stephen Nagler

 

[Mpt]

I agree with you lisa... the whole line about silence not being "natural" strikes me as tinnitus-group apologetics--- our ancestors lived in caves... caves are some of the quietest places I have ever been... I'll tell you what's not normal-- tinnitus--- people have to tell themselves what they have to to make the best of a terrible situation

 

[DebS]

@Mpt, I do nothing to get my mind back off it. Since I do not care - or more properly stated, since my brain now classifies my tinnitus as a neutral stimulus - it drifts off naturally. Unless I check, of course.

Stephen Nagler

When you say it "drifts off naturally", do you mean you actually don't notice it? I have a few quiet days where I can pretty much ignore the sounds, but on loud intrusive days it permeates my entire brain (seems that way anyway) and I can't imagine ever being able to not react to it.

 

[Dr. Nagler]

I agree with you lisa... the whole line about silence not being "natural" strikes me as tinnitus-group apologetics--- our ancestors lived in caves... caves are some of the quietest places I have ever been ...

@Mpt, do you consider a pitch black room to be "natural?" I don't. In a pitch black room, your visual system turns the "gain" way up in an effort to see, and your pupils dilate widely to that end. To your brain, pitch black is hardly natural. In a pitch black room the visual system strains to do what it was meant to do - see! Well, silence is to the auditory system what a pitch black room is to the visual system. In the absence of readily accessible external sound your auditory will strain to do what it was meant to do - hear. Hear anything! And if the is no external sound for it to hear, it will turn up the gain and greatly magnify any internal sounds accessible to it. Like tinnitus.

Stephen Nagler

 

[cullenbohannon]

Thought I should chime in. I think I finally understand what you mean. I remember you saying that's there are two things you can do to make sure you always hear your t. Listen for it or actively try to ignore it. And I know what you mean by this as well now. I honestly didn't think I would get to the pointim at. So I think everyone else can get there as well.

@Mpt, I do nothing to get my mind back off it. Since I do not care - or more properly stated, since my brain now classifies my tinnitus as a neutral stimulus - it drifts off naturally. Unless I check, of course.

Stephen Nagler

 

[Dr. Nagler]

When you say it "drifts off naturally", do you mean you actually don't notice it? I have a few quiet days where I can pretty much ignore the sounds, but on loud intrusive days it permeates my entire brain (seems that way anyway) and I can't imagine ever being able to not react to it.

I do not ignore my tinnitus. To ignore something requires effort.

You don't ignore your pants, do you? You feel them when you put them on, and then the feeling just fades away on its own - unless you check.

Somebody here on this board came up with a much better analogy than that. Say you are driving along in your car, and it starts to rain. So you turn on your windshield wipers. And you notice them for just a minute, but then you don't "see" them any more. They are waving like mad in front of your face, screaming for attention - but you just don't see them. Interestingly, if you purposely try to ignore them, you will continue to see them.

Stephen Nagler