Tinnitus Clinic Follow-Up Questions

[marqualler]

Hi Dr. Nagler,

First off, thanks again for your expertise on this board. Your analysis and expertise are invaluable for me and for others on the board.

Today I met with a Tinnitus clinician based in Edina, MN (the clinic where Dr. Paula Schwartz works) and learned quite a bit. I had an audiogram done that showed basically what I have already known--a notch of hearing loss to about the 25dB range in the 4hZ area, more pronounced in the left ear than the right. It also went above 8hZ and showed more a steep dropoff around 12hZ and basically cut off after 16hZ (the lowest point the equipment went to, and about 50dB loss there.) I also had a hyperacusis test that showed some sensitivity starting at 8hZ around 80dB and going above that a little above 8hZ. None of this was too surprising to me.

What was surprising was the test of my Tinnitus volume. It tested at a frequency of somewhere between 2hZ-4hZ and a volume of only 9dB! The frequency was not too surprising (mine fluctuates between a few different tones but is generally around that range) but was shocked at the volume. Here in my mind I assumed that the volume had to be around 50dB because I can sometimes hear it more than other times, but 9dB seems...somehow very insignificant.

My question is this: does this tinnitus "volume" sound about average to you? That lends a lot of credence to perception vs. reality for some sufferers. I'm lucky to not have profound hyperacusis to go along with my tinnitus but I am really floored at the actual "volume".

Finally, because a lot of the concepts are things you have preached here, I went in feeling more confirmed that I am doing the right thing--seeing a therapist for anxiety, stopping the limbic system from focusing on the sound as a fight-or-flight response, and using external noise as something to match, rather than fully masking.

Thanks for your expertise. Here's to hoping for more positive research in Tinnitus in 2015!

Mark

p.s. I heard you may be traveling to Minnesota in March? Would love to meet you in person!

 

[Dr. Nagler]

@marqualler posted:

First off, thanks again for your expertise on this board.

You are most welcome.

...........

Your analysis and expertise are invaluable for me and for others on the board.

Thank you for the kind works. I appreciate it.

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

What was surprising was the test of my Tinnitus volume. It tested at a frequency of somewhere between 2hZ-4hZ and a volume of only 9dB! The frequency was not too surprising (mine fluctuates between a few different tones but is generally around that range) but was shocked at the volume. Here in my mind I assumed that the volume had to be around 50dB because I can sometimes hear it more than other times, but 9dB seems...somehow very insignificant.

My question is this: does this tinnitus "volume" sound about average to you? That lends a lot of credence to perception vs. reality for some sufferers. I'm lucky to not have profound hyperacusis to go along with my tinnitus but I am really floored at the actual "volume".

The "9dB" figure means that you match your tinnitus loudness at 9dB over your threshold of hearing at that particular frequency. It is more properly referred to as 9dB SL. (Think about it for a minute. If your threshold of hearing were, say, 20 dB, you wouldn't hear a 9dB sound introduced to the audiology booth at all, right??!!)

In 85% of individuals whose tinnitus was severe enough to lead them to make appointments at a university tinnitus clinic, their loudness match was 9dB SL or less. So you are right in the ballpark with yours.

Dr. Stephen Nagler

 

[Dr. Nagler]

Just a quick follow-up to your post. When you say "85% of university patients with severe tinnitus...", does that about equate to the 16M who have severe enough tinnitus to bring it up to their doctor? Or is that in the range of the 2-3M who are sometimes quoted as the very severe tinnitus?

I do not know. It was a study of all patients who were seen at a university tinnitus clinic between 1981 and 1994.

The important thing in all of this is that you can have tinnitus that matches at 2dB SL that is debilitating ... and you can have tinnitus that matches at 16dB SL that is not debilitating at all. Not only that, you can have have tinnitus that matches at 16dB SL that is debilitating and that with treatment (CBT, TRT, whatever) becomes not debilitating at all in spite of the fact that the loudness match remains at 16dB SL.

Dr. Stephen Nagler