Preventing Tinnitus from Becoming Worse

[Jaka]

Dear Dr. Nagler,

First of all let me say that I can't thank you enough for helping tinnitus sufferers all over the world with your advice and for your "tinnitus 101" set of documents.

To some extent I have acknowledge that "my horse has left the barn" (while still hoping that he may one day go back).
But my biggest concern is that seeing the horse roaming free, more tinnitus farm animals might want to follow the horse's example.

Joke aside, there are numerous horror stories on Tinnitus Talk where people exposed themselves to noise and their tinnitus grew worse even despite wearing ear protection.

While I fully appreciate their word of caution, the engineer in me refuses to blindly accept this as scientific evidence that the "damaging threshold" for tinnitus sufferers is definitively lower than of "tinnitus free" individuals.

It is a fact that our hearing only deteriorates as we age. You wrote that there are all possible combinations ranging from total deafness with no tinnitus to normal hearing with severe tinnitus.

Even if you are saying that one's tinnitus will do whatever it likes and most probably have its own course in any event, I would like to know if there is any medical evidence that dangerous dBSPL levels are lower for people with tinnitus. And that further deterioration of hearing apparatus of someone with tinnitus leads to increased tinnitus.

While I would like to prevent my tinnitus from worsening, I do not want to be over cautious.

Thanks again and Best Regards,
Jaka

 

[Dr. Nagler]

Hello @Jaka -

Thank you for your very interesting question. It would take a book chapter to do it justice - but I'll give it a shot in just a post or two.

First of all, it is important to draw a distinction between loud tinnitus and severe tinnitus. You ask your question in terms of what can make tinnitus worse (i.e., more severe), but I believe you mean what will make it louder. Of course most everybody who has tinnitus would prefer it to be less loud - but that said, there are people with very loud tinnitus who are hardly bothered by it at all (i.e., it is not severe), and there are people with relatively soft tinnitus who are largely incapacitated by it (i.e., it is very severe). I will add one more thing: There are people with very loud tinnitus who are largely incapacitated by it but who over time get to where they are hardly bothered by it at all, even though their tinnitus itself has not changed and remains very loud. So severity and loudness are indeed two different elements.

Tomorrow or the day after, whenever I have the chance, I will answer your question. I will do so in terms of loudness even though you asked it in terms of severity - because I think you really meant loudness when you said severity. If I am wrong about that, please let me know.

Stephen M. Nagler, M.D.

 

[Dr. Nagler]

Continuing ...

Joke aside, there are numerous horror stories on Tinnitus Talk where people exposed themselves to noise and their tinnitus grew worse even despite wearing ear protection. While I fully appreciate their word of caution, the engineer in me refuses to blindly accept this as scientific evidence that the "damaging threshold" for tinnitus sufferers is definitively lower than of "tinnitus free" individuals.

I am glad that you hesitate "to blindly accept this as scientific evidence" since it isn't scientific evidence at all. It is anecdotal evidence from a non-randomized population. Moreover, the fact that somebody's tinnitus has gotten louder does not necessarily mean that his or her auditory system has incurred any damage. And auditory damage does not necessarily aggravate tinnitus. That's one of the reasons I am fond of pointing out that the first step to overcoming your tinnitus is when you have finally figured out that you can't figure it out at all! [In my opinion, anyway.]

It is a fact that our hearing only deteriorates as we age.

That's right. We lose 0,5% of our hair cells for every year of our adult lives by natural attenuation. The medical term is presbycusis.

You wrote that there are all possible combinations ranging from total deafness with no tinnitus to normal hearing with severe tinnitus.

Yes, that's right too.

Even if you are saying that one's tinnitus will do whatever it likes and most probably have its own course in any event, I would like to know if there is any medical evidence that dangerous dBSPL levels are lower for people with tinnitus.

I am unaware of any studies that suggest that people with tinnitus are any more susceptible to noise-induced auditory damage than the general population.

And that further deterioration of hearing apparatus of someone with tinnitus leads to increased tinnitus.

To the best of my knowledge there is no correlation between the degree of hearing loss (presbycusis or otherwise) and tinnitus loudness.

Hope this helps.

Stephen M. Nagler, M.D.