Dr. Nagler has said he can hear his tinnitus in niagara falls on the maid of the mist boat.
That is correct. The almost deafening roaring sound of Niagara Falls does not mask my tinnitus. I can hear my tinnitus readily and clearly while in the Maid of the Mist boat at the foot of the falls.
But please understand, what I am describing is a real life uncontrolled reflection of maskability, not a formal measure of loudness taken under controlled conditions in an audiology booth. There are a number of qualities besides loudness that go into whether or not any given sound will mask one's tinnitus. In my own case, I have yet to find any external sound that can mask my tinnitus - including the very loud broadband roar of Niagara Falls.
Dr. Nagler has also said his tinnitus is 11 dB SL
I was specifically asked what the dB level of my tinnitus was on a tinnitus loudness match (done under controlled circumstances in an audiology booth), and I responded 91dB. In other words, when the audiologist introduces 85dB of sound into the audiology booth at the frequency (pitch) of my tinnitus in pulsed fashion (so I can differentiate it from my tinnitus) I tell her that my tinnitus is louder than that. Same for 86dB, 87dB, etc., all the way up to 91dB. When the sound reaches 91dB, I tell her that it matches my tinnitus exactly. But as it happens I have an 80dB threshold of hearing at the frequency of my tinnitus, which means I do not hear the first 80dB of sound introduced at that frequency. So it takes 11dB of sound above my threshold of hearing at that frequency to match my tinnitus. The unit used in such a measure is "dB SL." So my tinnitus matches at 91 dB and at 11 dB SL. It is interesting to note that in a study of 1630 individuals with tinnitus severe enough to lead them to seek evaluation and treatment at at university tinnitus clinic, less than 10% had a loudness match in excess of 11dB SL.
All that said, the tinnitus loudness match (whether in dB or in dB SL) means almost nothing in terms of actual clinical practice. Let me explain. The only loudness that matters clinically in tinnitus is how loud your tinnitus sounds
to you. That loudness is a function of the strength of the tinnitus signal itself (from wherever within your auditory system it originates) and however your brain processes that signal as it goes through various pathways within your brain on its way to your auditory cortex, the part of your brain where you "hear" sound (i.e., where sound is consciously perceived). The parameter that represents how loud your tinnitus sounds to you is your tinnitus loudness rating, which is generally given on a 1 to 10 scale. And since nobody can hear your tinnitus but you, the only person who can assign a numerical value to your tinnitus loudness rating is you. For some people their tinnitus loudness rating might vary from day to day (or even hour to hour!) For some it remains remarkably constant. And my tinnitus loudness rating has remained roughly between 9 and 10 over the past 20 years.
As I see it, the tinnitus loudness match (in dB or in dB SL) has only two purposes clinically. One is so that a tinnitus sufferer can actually "see" his or her tinnitus on an audiogram chart, which can help in better understanding is otherwise completely amorphous enemy. And the second is in documenting the actually existence of tinnitus for medical-legal purposes, since a malingerer who is "faking" tinnitus in an effort to unjustifiably establish damages cannot replicate a tinnitus pitch and loudness match when the study is performed on three consecutive occasions spaced by twenty minutes. But other than that, there is no clinical role at all for the loudness match. Specifically, it has absolutely no therapeutic or prognostic implications. It may, however, have research implications as a parameter to look at in terms of testing the efficacy of various agents in blinded controlled studies.
how is it possible he can hear a mild 11 dB SL tinnitus on maid of the mist?
I hope I have been able to adequately address that very good question in my response thus far.
is loudness imagination? what makes loudness loud?
There is nothing whatsoever imaginary about tinnitus, tinnitus pitch, or tinnitus loudness. Regarding what makes tinnitus loudness loud, that is a function of the strength of the tinnitus signal itself and how your brain processes that signal prior to its being "heard" in your auditory cortex.
stephen nagler
Member
Member
