Dr. Charlie — ENT Specialist With Tinnitus

[Dr. Charlie]

Hello to each of you. I am a retired ENT physician and surgeon who also suffered from tinnitus for years. My tinnitus began in 1997, before I retired from my practice. Later on, I also developed hyperacusis. Whenever I focus on it, I still hear the noise of tinnitus, but I no longer suffer from it. My hyperacusis remains problematic, but I have learned how to deal with noisy situations to avoid most of the pain.

I am available to share what I have learned during my own ordeal. There is a very close association between 1) fear/anxiety and 2) suffering from the noise of tinnitus and/or hyperacusis.

The human brain and autonomic nervous system go on high alert when a serious threat is recognized or suspected. This is the "fight or flight response." When your body is in this state of hyper-arousal, it becomes impossible for your brain to ignore the threat. Your brain typically considers the noise of tinnitus a threat, especially when the tinnitus first presents itself, or when the volume increases for whatever reason. "OMG, what is this noise?" "Am I going deaf?" "Do I have a brain tumor?" Sadly, many audiologists and/or physicians are not familiar with the causes of tinnitus, and are of little help to you. Some may prescribe useless or even dangerous tranquilizers, etc in an effort to help you find relief. (Certain tranquilizers may occasionally help a suffering patient through a difficult time, so they are not always bad - just overused, in my opinion. Use with caution, and only when closely monitored by your physician.)

Once you learn how to eliminate the fear associated with your tinnitus, your brain will automatically begin to ignore the noise. One or two very reliable methods exist to accomplish this end.

I look forward to sharing the methods I have found effective for my personal suffering, and for many of my clients over a period of more than 10 years.

No matter how severe your noise, you can be helped. Feel free to reach out to me. Within the guidelines set forth in this forum, I will answer whatever I can - at no cost - to help you relieve your personal suffering.

Dr Charlie
Charles Smithdeal MD, FACS (ret)

 

[Markku]

Hi, @Dr. Charlie!

You are the first ENT to join our forum. An exciting milestone, for sure.

I hope you will be available for questions from our members when it comes to your specialty. You have so many years of experience under your belt!



Here's for better days,
Markku

 

[Karen]

@Markku,

Could Dr. Charlie be added to "Doctors' Corner"?

 

[RaZaH]

Great to have you here , welcome.
I have read about this fear/anxiety aspect but cannot relate to it personally , I have never feared any aspects of T.
Thinking I had a brain tumour or something like that never even occurred to me.
I don't even mind the tone itself that much , it's the "electric current" running through my head that gets to me , quite a physical sensation and super annoying.

 

[Dr. Charlie]

If you find the "electric current" annoying, this is a form of fear. All negative emotions - anxiety, fear, frustration, anger, sadness, guilt, etc - represent a fear within your subconscious mind and autonomic nervous system.

 

[Dr. Charlie]

Yes, Markku, I intend to make myself available to answer as many questions as possible. I am quite impressed with your group and their eagerness to help each other. I have devoted my life to helping others.

 

[RaZaH]

Well, I mean its physically annoying , like having a splinter . I guess you can be positive about a splinter in your toe but that does not negate the annoyance. Having said that I kind of get it , I can apply this to my tone but not the physical sensation of my head bursting open.

 

[SoulStation]

This is fantastic. Thank you so much for giving your time @Dr. Charlie . It is also so encouraging to have another person who has triumphed over T here amongst a crowd of suffers.

For me and many other musicians on this board I think the sound isn't as hard as the disrailment of our passion and livelihood as a result of fear of increasing, annoyance of and distraction of the sound of tinnitus and feeling of hyperacusis.
I feel as though my life is empty and I am starting from scratch again with a limited amount of stuff I can do in life because of this aliment.
Have you worked with any professional musicians with intrusive tinnitus?

 

[Dr. Charlie]

RaZaH, yes you can apply the fear removal method to the sensation of your head bursting open. BTW, have you had studies such as MRI or CT scans to rule out other pathology?

SoulStation, yes I have worked with musicians, professional and amateur. Does being around the loud sounds of a band or orchestra exaggerate your tinnitus or hyperacusis?

 

[SoulStation]

RaZaH, yes you can apply the fear removal method to the sensation of your head bursting open. BTW, have you had studies such as MRI or CT scans to rule out other pathology?

SoulStation, yes I have worked with musicians, professional and amateur. Does being around the loud sounds of a band or orchestra exaggerate your tinnitus or hyperacusis?

@Dr. Charlie ---First, thank you for your reply...
Yes I find myself hearing "beeps" with certain sounds (e.g the pluck of a guitar string) as my Tinnitus "reacts" to the sounds. I just two months ago resigned from my position in a very profitable club/wedding band and gave up playing with electric bands. I had the custom fit musicians plugs and the strongest attenuation and did adamant research using two professional Db readers and found that because the band I was playing with was doing sets of music with no breaks in between songs that could last between 90-120 mins at a mean DbA level of 105 db (that was on a good night). I felt like even with protection my T would still be irritated at the end of the night and I looked in to in ear monitors and spoke with many audiologists who told me that if you T gets irritated you're not getting enough isolation. The reason I didn't get in ear monitors is because of the potential for competing with sound with the rest of the band from monitor wedge speakers... Anyway I'm rambling...
I try to avoid all loud sounds now.
What was your treatment protocol with the pro musicians you work with ? Were they tinnitus sufferers? I'm assuming it involved a CAE and possibly an OAE? I haven't had an OAE but my CAE in june that showed very good /non damaged-hearing still . Do you think I should have an OAE?

 

[DutchGuy]

I think frequent use of headphones while making music,
metal detecting and playing games on my pc gave me T and H.
Wrong syringing of my left ear was the last push over the edge.

H. became much worse 1 week after I tapered from ativan (lorazepam),
which I took to handle the T. stress. Started using the benzo right after T. hit me.
So I think ativan may have surpessed H. in the beginning.
Coincidence? I just don't know.

H. doesn't give me that much pain, it just scares me alot.
Outside traffic, metal sounds,cutlery on dishes,
slamming doors, voices, birds (I hate crows now), everything is amplifying.

May I ask, how do you coop with H. Dr.?

 

[DutchGuy]

I think otoxic medicine and noise induced injury are one of the main reasons that can cause T and H.

 

[Dr. Charlie]

SS, I cannot advise you about what tests to have. Your own ENT Dr must decide this, based on a complete examination. Certainly, enrich your home environment with soft, pleasant sounds 24/7. Protect your hearing against loud noises. Allow your cochlea and hair cells to recover as much as they can. I advised my clients/patients to then reintroduce sound gradually and see how this was tolerated. Follow your local ENT Docs advice.

DG, I use musician's earplugs when in any situation where I might be exposed to uncomfortable sounds. I insert them partway into my ear canals, so I can hear normally. Should a noisy truck or bus approach, for example, I push the earplugs in more deeply until the noise subsides. Same with someone speaking loudly, airplane flying over, etc. I control the amount of sound that I allow to enter my ear canals. Do NOT wear earplugs all the time. Your hearing system becomes more sensitive when deprived of normal sounds. Keep some pleasant sounds around you at all times, such as music, trickling water from a waterfall, etc. This includes when you sleep at night.

 

[SoulStation]

@Dr. Charlie -My ENT told me to keep on performing with protection but things still got worse.
I appreciate your response very much.

Just one more question -is there any way of explaining the way the reactive element of T (for example the sound of someone talking loud) causing me to hear my tinnitus tone every few words?
Hope you are well and thank you again.

 

[Amelia]

Welcome @Dr. Charlie - as a long time member of tinnitus talk, I'm so excited to have you with us and am keen to read about your experiences

Your quote about anxiety struck me:

There is a very close association between 1) fear/anxiety and 2) suffering from the noise of tinnitus and/or hyperacusis.

I've recently been told the exact same thing by a neurologist I saw for an issue unrelated to tinnitus. It's made me more interested in working on my stress and anxiety levels and focusing less on habituation. It's only taken me a year to realise that for me, if I reduce my anxiety it will lead to habituation, rather than expecting habituation to reduce my anxiety.

Looking forward to seeing you around the boards!

 

[derpytia]

Welcome Dr. Charlie,
I look forward to reading your posts and advice on this forum!

 

[slipware]

Thank you for joining us. Personally, I have screaming reactive tinnitus 95% of the time! luckily I can sleep through it! and of course, because it's reactive I don't have white or any other colour noise to help.

Out of pure personal interest, does anybody else have aural fullness, strange facial sensation and balance issues? My T was caused by a brainstem vascular event, so it's pure damage by blood supply loss.

 

[Marlene]

Slip ware ,I have this balance Swaying / Rocking ,ears always full up ,like I could be deaf ,I always hear my postman ,door some distance from my kitchen when he drops in the post ,even on my highest T day .The only time my balance is okay is when driving ,don't notice it ,my husband says cause I'm concentrating ,I truly don't understand any of it ,don't think any of us with this add on condition to T does .Hope Dr Charlie can help us with that ,and how it does increase our anxiety levels coping with this going on as well ,as you can't get away from that when your dealing with that every day ,and in turn it automatically draws you to the T ,it's a vicious circle .
Looking forward to the postings by the Dr .Best wishes to all on TT this Sunday .Hope next week will be kinder to all.especially to those who have to work and cope at same time .

 

[amandine]

@Dr. Charlie,

I understand that you actively endorse the use of ART (Anxiety Relief Techniques) as opposed to TRT (Tinnitus Retraining Therapy) which you say that, although it works in the majority of cases, simply takes an unacceptably long time and is terribly expensive. ART you say is as effective as TRT but works in a much shorter time frame which you say can be in a matter of hours or weeks as opposed to the 12 to 18 months associated with TRT.
To me as a layman, they seem to be similar if not the same therapies. Please could you explain on this forum what are the differences and when you decided to go away from the accepted norm of TRT into ART.
Many thanks with a big hi and welcome to this forum.

By the way, as your wife is also very involved in this field, I wonder if we can encourage and ask her if she would like to come and join us too on TT forum. It would be great to have her expertise as well and from a female perspective on things.

 

[AnnaW]

Dr Charlie,
Thank you for being an ENT and joining the forum. I have had Meniere's since age 17. It begin with Tinnitus and took my hearing away in the left ear within 3 yrs. I have suffered horrid vertigo and drop attacks. Last yr it went bilateral - the tinnitus that is. It is really something else. Despite being totally deaf and having T on the left side, it never really bothered me. But this bilateral T of all sorts of noises and tones. It is like a form of torture. I have thought about suicide nightly since it went bilateral.
Anyway, my question to you is please could you give me your thoughts on Stem Cell therapies or autophagy (where own blood is centrifuged then put back into body)?
I wonder about if say I embarked on one of these therapies, would the whole hydrops journey just begin again on a fresh ear becuase genetically I am programmed to have hydrops?
Also, what do you think about the theory that meniere's is immune related and is a dysfunction of the MALT (mucosa-associated lymphoid tissue). There is an australian named Stephen Spring who has a theory but unfortunately he has patented it and charges $5500 for the knowledge. Sounds like snake oil I know. But people with menieres, like me, are very very desperate.
Thanks in advance. Sorry if I'm posting in the wrong place. I'm havng an awful day. I'm dizzy, I'm nauseated, and I can't hear anyting over the Tinnitus. All I want to do is be a mum to my little girl. I want my life back.

 

[Dr. Charlie]

First, let me thank each of you who have posted comments or questions to this thread. In response:

SW , BL, and M: Have you ever been told that you may be suffering from endolymphatic hydrops (EH)? Some MDs now feel that this condition may be related to a sensitivity to foods, especially grains, & primarily wheat. Total elimination of wheat products from one's diet for a minimum of 6 to 8 weeks is required to obtain relief. this does not mean reducing the amount of wheat. Total abstinence. Read labels of packaged foods. Eliminate beer or any beverage derived from malt, etc. Other foods may also be responsible for increasing symptoms. Keep a food diary for a few months to see if there is any recurring pattern of food intake with subsequent symptoms. If you discover a particular food that's ingested prior to a worsening of your symptoms, try totally eliminating that food for 6 to 8 weeks. I have no experience with Stem Cell therapy or autophagy. Personally, I would not opt for either. I do believe that many cases of EH are immune related, but am not familiar with MALT. I would be highly suspect of anyone who patents knowledge and then charges $5500 for it. Do you know if this therapy has been reviewed in any scientific journals? (Not always the best indicator, but it's a start.)

Am: First, I love your Avatar - simply adorable! (Yes, I am a dog lover.) I fully appreciate your quandry. Many unscrupulous affiliate marketers and a few professional practitioners take advantage of people's suffering by offering phony "cures." This has been the case for years. Some of them honestly believe in what they are pushing - having seen one or two "miraculous" results that they mistakenly attribute to their recommended product or method. And then there are techniques that actually help some people and not others. For example, all tinnitus does not share a single cause - i.e., endolymphatic hydrops, Vs acoustic trauma, Vs head injury, Vs ototoxic medications, etc. Thus, a single "treatment" may help one person, and not another. I have great respect for Dr Pawel Jastreboff's work (He developed TRT in the 1980s while at the University of Maryland.) As you pointed out, I believe there is a faster and less expensive way today to accomplish the same end results for most sufferers. Are you familiar with Gary Craig's EFT (Emotional Freedom Techniques) or Dr Roger Callahan's TFT (Thought Field Therapy)? My own method of ART (Anxiety Relief Techniques) is an extension of their work. My specific application for tinnitus sufferers came about because of my training and interest in the auditory system (My ENT training and experience) plus my personal battle with tinnitus and hyperacusis. Treatments evolve just as technology evolves. I have always resisted the tendency to reject new ideas simply because they were unfamiliar to me at the time. I attempt to always keep at least one little corner of my mind open to new ideas. When I first saw EFT demonstrated, I thought it was ludicrous. And then I watched it relieve someone's fear (a phobia.) And I saw it work again, and again. After personally observing hundreds of successful applications, I became a believer. (This post is already too long, so I will wrap it up for now.) In short, I investigated the emerging field of "energy psychology" and applied my new-found knowledge to my own suffering from tinnitus and hyperacusis. I also applied it successfully for personal optical migraines. I gradually began sharing this with other sufferers. My personal experience today is that this is the most effective method I have ever witnessed to remove one's fear and anxiety from any cause, including that associated with tinnitus and hyperacusis. This fear includes frustration, anxiety, anger, sadness, guilt, shame - ALL negative emotions. Yes the technique is different. It is new. It represents a new paradigm in therapy. And, in my personal experience, it has been successful over and over and over. Removing one's fear is absolutely essential before habituation becomes possible. This is a foundational component of TRT. Anxiety Relief Techniques simply does this faster and more effectively, in my experience.

Re CST, I'm aware of a few tinnitus sufferers who's tinnitus was apparently caused by a problem in the atlanto-occipital area of the cervical spine. Have you ever had the experience of noticing a high-pitched ringing in one ear when falling asleep at night? I have. When this occurs, I find that if I vigorously rotate my head around several times on my neck, the noise quickly abates. I'm not sure why this occurs, but it is very real. I once thought it might be a pinched blood vessel (vertebral arteries -> basilar artery ->internal auditory arteries.) Today, I suspect it has to do with a vertebral alignment issue. I have referred many patients to Osteopathic or Chiropractic physicians for cervical vertebra evaluations. A few of them received relief. My personal preference is for the earlier manipulation techniques, rather than Cranio-Sacral Therapy. Having said this, I do not claim to be an expert on issues of the spine.

One last response: Why did I retire from my practice? I was exhausted. I received my MD degree at age 22, was double trained, with full residency trainings in both Otolaryngology and Plastic and Reconstructive Surgery, and enjoyed an extremely busy practice for 40 years. Today, at the tender age of 78, I continue to enjoy learning new ideas and concepts, and sharing this knowledge with those whom I believe can benefit from what I have learned.

I have several websites that contain articles (posts) dealing with tinnitus-related issues. I also have great respect for the founders and members of this forum. In time, and only with the approval of the administrators of this forum, I will share links to some of these sites and articles. I charge a nominal fee for an online course that teaches my method. Unless and until the forum administrators review and approve my course, I prefer not to promote my course here. I hope you understand. Meanwhile, I am delighted to answer any questions that you pose.

May God continue to bless each of us.

Dr Charlie
Charles Smithdeal MD, FACS (ret)

 

[BobDigi]

Yes, Markku, I intend to make myself available to answer as many questions as possible. I am quite impressed with your group and their eagerness to help each other. I have devoted my life to helping others.

Thanks for helping. I hope you stick around.

 

[Marlene]

Dr Charlie ,many thanks for answering ,this is the 2nd time this has been mentioned ,I will follow up on this ,I've had the basic allergy at local Hsp ,for allergy to rhinitis ,only 2 faintly raised from 10 markers ,no further test done,I also have eczema from childhood,but in past 9 yrs this has become a problem ,as the bacterial virus I had which set my T off to a different level ,the eczema changed more severe .
My dr at the time of the virus said my immune had been affected as I'd lost over 4 stone in weight in 4 months I had virus in system .i looked ill enough my family thought it was cancer .
I will certainly take up what you've said . Thank you again .

 

[Dr. Charlie]

Marlene, once again, my experience is that food sensitivities and/or allergies are more likely to be a causative factor in Endolymphatic Hydrops. Not inhalant allergies, which manifest as rhinitis, itching eyes, etc. However, anything that sets off the immune system in one area may spill over somewhat into another area. I would keep a very inclusive food diary for a few months - write down everything you ingest or inhale. Watch to see if a pattern emerges.

 

[Dr. Charlie]

I can't resist this one (no disrespect intended, I simply happen to really enjoy the following):

 

[amandine]

@Dr. Charlie,

Just wanted to say thank you so much for your posting. Very imformative. Yes it was a long post but one expects potentially a long posting if one is to impart important educated information. So please Dr Charlie, make your posts as long as you like as we all value your input. Most of us are able to concentrate long enough and, if not, then one can always read a paragraph, take in the information and then return to the posting paragraph by paragraph to slowly absorb the details and gems of wisdom.
Sometimes this is necessary anyway to ensure complete confidence that the info has been absorbed.
Love the joke above - made me laugh out loud so I thank you for bringing levity into it. Quite possibly a very good medicine, a good old belly laugh.
And also for showing us clearly that even with T one can live a long good and productive life well into older age. You are 78 years young and show no signs of slowing down! Fantastic! An ancient saying but : until 120!

By the way, may it be possible to ask your wife to sometimes post here as it would be great to also get a womans perspective especially as she is a trained professional like yourself with many years of experience behind her. If not then of course as she may be too busy. Just a hopeful thought.........
thank you again......

 

[Karen]

Welcome, @Dr. Charlie!

I'm so glad you've joined our forum, and are willing to share your knowledge and expertise with us.

I was wondering if you've ever treated patients who have both tinnitus and pulsatile tinnitus, and if pulsatile tinnitus always has a vascular cause.

Thanks for any information you can provide.

 

[Teri]

@Dr. Charlie,

I have been diagnosed with Endolymphatic Hydrops. I was tested for food allergies, but none showed up as being problematic. Is wheat something I should still avoid? I do have ragweed, mold, allergies and am taking shots.

Thanks

P.S. I am a dog lover as well. Our family rescued a little yorkie/poodle mix. Her name is Molly and she is delightful!

 

[Dr. Charlie]

@Am, K, and T:
Re EH and food testing, I have found testing unreliable for food sensitivities. Yes, I wold begin by totally eliminating wheat from my diet for 6 to 8 weeks. Also, keep a detailed food journal, and record your symptoms daily as well for later comparison with all foods ingested. If you become symptom free or greatly improved, you can add back the possible offending food as a test. It's possible to experience symptoms or physical issues such as EH without a true allergic reaction. This is why I often refer to substance sensitivity rather than allergy. They may overlap, but are not technically the same.

My personal experience has been that pulsatile tinnitus always had a vascular origin.

During a conference call with a good friend named "JJ," I mentioned that the day was my 78th birthday. JJ quickly replied, "Well congratulations, Doc, that's a good start." Gotta love him.

@Teri, my wife and I once had 9 dogs - all pound or found. We currently have two Yorkshire Terrorists - Austin Bailey and Bentley Rose. We love them dearly.

My wife works primarily with women who experience phobias, or anxiety, fear, or self-esteem issues from childhood abuse or abusive adult relationships. She leaves the tinnitus issues to me.

 

[Karen]

Thanks for your response regarding the pulsatile tinnitus, Dr. Charlie! I'm still trying to identify a cause for my PT, and have had a number of tests. I haven't given up hope yet, but it is difficult to find a doctor who understands what pulsatile tinnitus is, and is willing to work toward a solution. I appreciate your answer, and am so glad you've joined us on this forum.