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“An End-of-Summer Ode to My A/C Unit,” by a Pulsatile Tinnitus Sufferer

Dear, dear friend:

Summer is almost over.
Long days get shorter, 

cool breezes revisit,
dry air replaces the soupy muck until 

next spring.

Soon, I'll be turning you off, dear A/C

unit by my bed.

Oh, that day I dread. 

No more cold white noise
to drown out my whoosh 

at night.

Another whooshing summer. Gone.
You know it and you show it:
you're getting old (so am I, but I digress).

Sure, you're loud and you rumble
like a freight train.
Unique! Antique!
Your model generation has long been out of stock,
but your loyalty endures.

The young, brand new, sleek and quiet versions of you
wait
on store shelves. On sale.

Tempted? Me?
Never!
How could I say farewell to my loud whooshsaver,
forever?
You rid the air of humidity, hot air and... 

my whoosh!!

No sound machine rivals you,
my dear A/C!

Soon, I'll be longing for nights of air-conditioned
delight, with your

LOUD 

whooshing 

hum
that masks my own,

to help me sleep.



So, as whooshers in the southern hemisphere
dust theirs off with delight,
I say: So long.
'Til next year, dear A/C.
You deserve a break.
And chances are I'll need you
before next summer rolls in.
Maybe even on a snowy evening, 

for a restful sleep, 

just like
old times.



Whoosh. Whoosh.


-WhooshEr

Fri, September 3, 2010 | link          Comments

Poll Results: Have You Been Told to "Live With" Pulsatile Tinnitus?

Yes         83.3%

No           13.9%

Other        2.8%

Total Votes: 36

Thanks for voting!  Please vote in the latest Whooshers.com on the right side of this page, and don't forget to check results from previous polls on the Poll Results page.  

Wed, August 25, 2010 | link          Comments

Patient-Doctor Relations & The Pulsatile Tinnitus Patient

Unless you’re incredibly lucky, you’ve had a malady or two before the pulsatile tinnitus began.  And you’ve been to doctors’ offices before.  By the time I started seeing doctors regarding the whooshing heartbeat sound, I'd already learned the drill:

(This example is based on my experience in the United States.  Obviously, depending on where you live, this may vary.)

Call doctor’s office (with a referral?), make an appointment after being on hold for a while because of stressed office staff, wait for the day of said appointment (often days or weeks), make a mental list of symptoms and anticipate other questions that the doctor may ask (dig up necessary medical history files, if necessary), [night before appointment:] make sure the alarm is on, [morning of appointment:] wake up (with hope that I’ll wake up tomorrow with more answers than today), check the address (again) to make sure I’m going to the right office, inhale, exhale, get in my shoes, take the bus/train/car and make my way to the doctor’s office, with or without iPod or white noise earbud, depending on how loud the whoosh seems.

WHEW! That's a lot, but such is life.  If you're a pulsatile tinnitus patient, you may also have increased anxiety to deal with, in addition to the "normal" preparation for a doctor's appointment.  I mean let’s face it: if you have strep throat or a broken leg or another easy-to-diagnose issue, you can be fairly certain that you’ll leave with a prescription or a cast.  However, if you’re a pulsatile tinnitus patient, and you’ve surveyed what other pulsatile tinnitus patients have said on this site and many others, you already know that it’s not uncommon to leave the doctor’s office with no more answers than when you arrived.

A general experience at a doctor’s office might go something like this:

Check in, fill out a stack of forms, WAIT (even if we were early for our appointment), get called to the examination room, get asked boiler plate questions by the nurse, WAIT for the doctor, say hello to doctor who enters the room [determine first impression –Did the doctor smile at me? Shake my hand?], answer doctor's questions and hope that s/he has some helpful advice, be directed by doctor back to the front desk, pay insurance co-pay.  Leave.

If you’re a whoosher, at some point in the experience described above you’re also likely to:

1) be compartmentalized in a box (for example, we pulsatile tinnitus sufferers are often mistakenly boxed in with regular tinnitus sufferers) and told to “live with it,” OR 2) asked to have a diagnostic test or two, OR 3) you may be referred to another doctor.

My personal layperson view is that choices 2 or 3 should be the most common, but I don’t think this happens in reality.  Plus, each of us is different. 

Speaking for myself, going to the doctor (for just about any reason) feels a bit like going through airport security.  Even when I do everything I'm supposed to do -- get there early, remove my shoes and all metal items and change from my pockets, reveal my identification AND my boarding pass, etc. -- it often still feels like it’s ME against THEM, even though we’re all on the same side.  It feels robotic.  At the airport, we know the people behind the scanners and guard rails are there to help us, but it’s impossible not to sometimes wonder if one requirement of the job is forgetting everything you were ever taught about common decency.  I know I’m not the only one who has asked myself, is that person human? 

Don’t get me wrong, I’m not talking about discipline… I think it’s very important for airport screeners and doctors and every professional to remember what they’re trained to do.  But we’re all human.  And when pulsatile tinnitus patients look for medical attention, we’re even more vulnerable to the psychological impact of our symptoms.  

The New York Times recently published an article titled, “Not on the Doctor’s Checklist, but Touch Matters,” by Danielle Ofri, M.D.  Dr. Ofri suggests that a physical examination, where the doctor actually touches you, can be a crucial aspect of the patient-doctor relationship, even if it doesn’t directly aid in the diagnosis of the physical problem.  She writes generally, not about pulsatile tinnitus patients, but I think it’s an important point. 

I’m not a doctor, but I do feel qualified to suggest that the human interaction aspect of a doctor’s visit may very well have an impact on how the visit ends, e.g. the diagnosis and general feelings of and trust for the doctor.

The old saying, “Sticks and stones may break my bones but words can never hurt me,” is not entirely true, as far as I’m concerned.  Hearing my first doctor say, “Live with it!” before he did a single test to determine the cause of my pulsatile tinnitus, hurt a LOT.  Especially since, in my case, he was wrong. 

When you’re in a doctor’s office with pulsatile tinnitus, words matter a lot.  So does eye contact.  When you’re suffering from pulsatile tinnitus, asking for a little compassion and out-of-the box thinking is not asking too much.

There are all sorts of reasons why people go to the doctor, and there’s probably a standard checklist that doctors learn in medical school for each possible condition.  In some situations, a lot of doctors ask questions and never physically examine their patients.  The decision whether to physically examine a patient may be part of a “standard” learned in medical school.

Dr. Ofri concedes that there may not be any scientific evidence that a physical examination provides any quantifiable benefit.  Does that matter?  As she says, “touch is inherently humanizing,” and “[a] physical exam is likely to produce a bond, if not a diagnosis.”

When the person walks into the examination room with a white coat, the patient understands that the doctor has studied hard for many years and paid a lot of money to become an expert.  But sometimes that’s not enough.  Dr. Ofri’s premise is that if a doctor doesn’t address some other needs of the patient, it can be damaging to the doctor-patient relationship and maybe even to a proper diagnosis. 

She says:

“I cringe whenever our hospital administration refers to the doctors and nurses as “health care providers.” That term always makes me feel like a soft drink dispenser at Burger King.  I’m not a “provider”; I’m a person, a doctor.  And my patient is not a “customer” or “client."  We are not transacting business.”

Also, while I agree with Dr. Ofri that the personal touch adds an important humanizing layer to doctor/patient relations, so does interpersonal communication like eye contact and compassion.  So does an acknowledgement that you may not be the best doctor to treat a pulsatile tinnitus patient, instead of immediately throwing in the towel and saying, “live with it.”  Hey, none of us is perfect. 

I would go even further… when a patient visits a doctor, it’s an opportunity for interaction from which both sides can gain something: I can get answers to my pulsatile tinnitus, and the doctor can get experience seeing a rare set of symptoms that only 3% of tinnitus sufferers experience.  I’m a mystery… who doesn’t like a challenge like that?!  Aren’t lawyers challenged by a once-in-a-lifetime case?  Aren’t actors challenged by a rare opportunity to play a unique role in film or television?  Aren’t you gratified at work when your boss approaches you with a challenge instead of the run-of-mill duties (well, okay, I guess it depends how much you like your job. Hmmm)? 

Dr. Ofri’s article touched a chord with me and I think it will for you, too.  It was a long time before I found a doctor who simply looked up from the clipboard to me in the eye, spent more than five minutes with me in the room, and put his or her hand on my shoulder to tell me something comforting. 

Despite all my rants on this site, I really am not a very needy person, and I certainly don’t need or want anyone to hold my hand like my mother did when I was three years old or lie to me just to tell me what I want to hear.  But a smile once in a while, a hand on the shoulder, a nod of understanding, or an ear of appreciation -- beyond the allotted, standard five minutes -- for the anxiety I’m living with, would be nice. 

It may not just be nice; it may even play a significant part in my (our) diagnosis, treatment and (soon, I hope) recovery from the cause of pulsatile tinnitus symptoms.

I'd like to end by thanking all the doctors out there who ARE empathetic toward pulsatile tinnitus patients, like this one that I referred to recently.  They are out there, and they do not receive enough credit (or referrals!).  Paying attention to human needs is the crux of stories like these.  I hope other doctors and patients like you read them.  

Sources: 

"Not on the Doctor's Checklist, but Touch Matters," Danielle Ofri, M.D., The New York Times, August 3, 2010.

"Vital Signs: An Unwelcome Ringing," by Christopher Linstrom, M.D., Discover Magazine, April 2010. 

Sat, August 21, 2010 | link          Comments

Another Pulsatile Tinnitus Patient Cured. Another Possible Cause: Traumatic Carotid Cavernous Fistula

If the title of this article published recently in the medical journal, "Neurosurgery" by the Congress of Neurological Surgeons, is any indication,

"Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report"

is a topic and case report that should be reviewed with your doctor. 

While there is too much medical lingo here to interpret without a medical degree, what is clear from the abstract (aka, a summary of the article) is that this is yet another case of pulsatile tinnitus being diagnosed and cured.  Only the abstract is available for free; your doctor may be able to access the entire article for a fee. 

This particular patient is a 63-year-old woman who started experiencing right-sided pulsatile tinnitus after a bicycle accident.  A normal CT scan did not reveal the cause, but doctors used a "C-Arm Cone-Beam Computed Tomography," and were able to identify and fix the cause of the whooshing. 

The abstract even says, "[the] patient's symptoms resolved immediately after the procedure."

Another whoosher cured!  Anyone who tells you that there is no cure for pulsatile tinnitus is not paying attention to articles like these.  Some causes can be identified and cured. 

Meanwhile, I'll add this to our list of cured whooshers

There is hope!

Source: "Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report," Sato, Kenichi MD, PhD; Matsumoto, Yasushi MD; Kondo, Ryushi MD, PhD; Tominaga, Teiji MD, PhD, Neurosurgery: August 2010 - Volume 67 - Issue 2 - p 467–470.

Department of Neuroendovascular Therapy, Kohnan Hospital, and Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (Sato) Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan (Matsumoto) (Kondo) Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (Tominaga).

Sat, August 14, 2010 | link          Comments

A Whoosher Looks for Answers -- An Update on Blondie

People with pulsatile tinnitus search for answers.  We're like jitterbug investigators.  We have all sorts of diagnostic tests, sign myriads of medical forms, try to explain what a "whoosh" sounds like to someone who can't hear it (and may not even really care but has to ask) and, more often than not, go home with no more information than when we woke up that day.  Some doors close in our faces, others open slightly and then slam right back in our faces.  Sometimes the door slams in our faces and then the screen door slaps us on the way out.  It's enough to make anyone crazy!

But then, just when you lose all hope, sometimes you find a doctor and a medical team who understand pulsatile tinnitus and its long list of possible causes.  "Let's try this," they say.  Welcome words to someone who's heard "live with it," too many times! 

Many of you know our whoosher friend Blondie, at Tales From Clark Street.  Blondie has blogged about her experience with pulsatile tinnitus since it began over three years ago.  If you haven't already had the chance, take some time to read through her posts. 

In a couple weeks, Blondie is having a medical procedure to try to get to the bottom of her whooshing.  I wish her all the best, and I know all the whooshers out there do, too!! 

In the spirit of whoosher support, she's asked for some funny and supportive haiku she can take with her to the hospital.  Post your pulsatile tinnitus support haiku on Blondie's site or leave one here!

Dear Whoosher doctor:
We're rooting for you to find
Blondie's whoosh culprit!

To see previous Whooshers.com posts written by and about Blondie, do a search for "Blondie" in the search box at the top of this site or click here.  

Wed, August 11, 2010 | link          Comments

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A forum for people experiencing a constant and rhythmic whooshing, pulsing or otherwise heartbeat-like sound, often diagnosed as pulsatile tinnitus.

RESOURCES

Find a Neurotologist: American Neurotological Society (ANS) Membership Roster 2010-2011, by state. (This PDF file will download when you click here)

Blog: Tales From Clark Street

Web Site: American Tinnitus Association

Web Site: British Tinnitus Association

Web Site: Tinnitus Association of Canada

Article: "Tinnitus," eMedicineHealth.com

Article: "How I Struggled with Tinnitus," The Story of Actor Graham Cole, Daily Mail Online.

Article: "Vital Signs: An Unwelcome Ringing," by Dr. Christopher Linstrom, Discover Magazine, April 2010. (About a cured pulsatile tinnitus patient!)

Article: "Technique Can Pinpoint Tinnitus," BBCNews.com, October 3, 2009

Article: "Tinnitus: The Noise That Annoys," The Independent, October 13, 2009

Article: "Neuroradiologic Assessment of Pulsatile Tinnitus," Department of Otolaryngology Head and Neck Surgery Loyola University Medical Center, Maywood, IL: Dr Kircher and Dr Leonetti; Department of Otolaryngology-Head and Neck Surgery Henry Ford Health System, Detroit, MI: Dr Standring; Presented at the Annual Meeting of the American Academy of Otolaryngology-Head Neck Surgery, Chicago, IL. Sept. 22-24, 2008. (CLICKING THIS LINK WILL DOWNLOAD THE PDF FILE)

Article: "Imaging of Tinnitus: A Review," Jane L. Weissman, MD and Barry E. Hirsch, MD, Radiology, August 2000.

Article: "Imaging in Pulsatile Tinnitus," G. Madania and S.E.J. Connor, Clinical Radiology, Volume 64, Issue 3, Pages 319-328 (March 2009).

Article: "Imaging of Pulsatile Tinnitus: A Review of 74 Patients," Guner Sonmez, C Cinar Basekim, Ersin Ozturk, Atilla Gungor, Esref Kizilkaya, Clinical Imaging, Volume 31, Issue 2, Pages 102-108 (March 2007). (This is an abstract/summary-you have to pay to see the article in its entirety)

Article: "Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report," Sato, Kenichi MD, PhD; Matsumoto, Yasushi MD; Kondo, Ryushi MD, PhD; Tominaga, Teiji MD, PhD, Neurosurgery: August 2010 - Volume 67 - Issue 2 - p 467470. (NEW!)

Article: "Brain AVM," (arteriovenous malformation), MayoClinic.com

Article: "Chiari Malformation," MayoClinic.com

Article: "Ménière's Disease," National Institute on Deafness and Other Communication Disorders (NIDCD)

Article: "TMJ Disorders," MayoClinic.com

Article: "Pseudotumor Cerebri," (also called Benign Intracranial Hypertension) MayoClinic.com

Article: "Pulse-Synchronous Tinnitus," The Intracranial Hypertension Research Foundation

Article: "Diagnosis and Cure of Venous Hum Tinnitus," Laryngoscope, Chandler JR, 93(7):892-5, July 1983.

Article: "Glomus Tympanicum," The New England Journal of Medicine, Volume 362:e66, Number 22, June 3, 2010.

Article: "Pulsatile Tinnitus Cured by Mastoidectomy," Duvillard C, Ballester M, Redon E, Romanet P., Department of Otolaryngology-Head and Neck Surgery, Hôpital Général, Dijon, France, Ann Otol Rhinol Laryngol, September 2004.

Article: "Pulsatile Tinnitus," Don McFerran FRCS Consultant Otolaryngologist Essex County Hospital, Colchester, British Tinnitus Association, October 2007.

Article: "Carotid Bruit: What is It?" By Jules Pop, Associated Content, December 18, 2007

Article: "That Noise Wasn't Just Tinnitus," By Sandra G. Boodman, Special to The Washington Post, July 7, 2009

Article: "The 'Rare' Disease That Isn't," By Thomas M. Burton, The Wall Street Journal, June 27, 2009

Video: "A Rare Disease That May Be Underdiagnosed," By Thomas M. Burton, June 26, 2009 (Hear an example of a whooshing sound in this short video)

Audio: Having trouble describing the sound you hear to others? Listen to this collection of sounds that whoosh and see if you can find a match to yours! Demonstrations: Heart Sounds & Murmurs, from the University of Washington Department of Medicine

Audio: Representation of Tinnitus Sounds (Contains some pulsatile tinnitus sounds), British Tinnitus Association

Audio: White Noise MP3s.com

Audio: SimplyNoise.com