At What Level of Loudness/Noise Exposure Would You Take Corticosteroids (Prednisone)?

Someone posted a question about how he was exposed to a loud sound and wondered if he should go get meds. I have wondered the same thing -- after exposure to fireworks, I asked my doctor and the answer was no.

Recently I had an exposure to a loud sound while doing the dishes (dropped a plate). I was so startled that I yelled. I felt my ears get full, which freaked me out. And I felt my anxiety go up.

Called a friend who came over and recreated what I had done (with ear protection of course), and we got readings from 100-107 dB, depending on the app (his Apple Watch on the lower end, my NIOSH app on the higher end -- although his Apple Watch had more accurate placement). At a brief exposure (1-2 seconds), this is still below the threshold where noise causes hearing damage.

So a 1-2 second exposure, likely around 103-105 dB -- that doesn't seem to warrant me racing out to the docor to ask for Prednisone. However, what was different about this experience was the full feeling in my ears. Even though it quickly subsided, I know that this is a symptom of acoustic trauma. I didn't notice a change in hearing afterward and my tinnitus didn't change. (Pain isn't a great indicator for me as far as potential hearing damage because of the hyperacusis...)

I'm about 2 days out from this happening, and I did think of calling my ENT on Monday morning and asking to go in / get a prescription -- but not sure if ear fullness necessarily means permanent damage may have been done. I even wonder if the full feeling may have been caused by being so startled and the panic that happened right after the noise, but I don't think so. This was LOUD, approx 2 ft from my head in a metal sink. I have never taken corticosteroids and frankly am a bit scared to take them because it suppressed the immune system (not desirable now with coronavirus).

What would you do? What is your noise exposure threshold for seeking medical attention?

 

Here's what my ENT PA (who I prefer to ask over the MD) messaged me:

"Acoustic Trauma is usually caused after 1/2 hour of exposure or loud exposions.You ear cuts out and ears feeling full because your own ear is physiologically trying to protect you from the noise. There is a certain criteria for giving steroids, I've had patients who were treated 1-3 days after loud concerts and explosions WITHOUT any recovery from steroids.

It seems like you are worried. You can call the nurse after 9am at XXX-XXXX for 1) hearing test and 2) follow up with me on the same day within 1 week."​

 

I keep a Prednisone dose pack on hand, but, the stuff I'd even think about using it for is:

* waking up with SSNHL (this is the only thing that has real good data for oral corticosteroids being useful)
* exposure to gunshot at 10' or less with no hearing protection
* exposure to airbag deployment with no hearing protection
* exposure to lightning at 25' or less with no hearing protection (the closest I've come in my life was about 150', and that was certainly loud, but mostly only terrifying because it travelled straight towards the house through the ground lines and fried our well)

Bottom line, routine noise exposure that makes my ears "cranky and more ringy" is very much something I try to avoid (I use double earpro for chainsaws/guns/motorcycles/mowers/etc), but it would take some kind of "drastic, clearly instantly damaging noise" to make me take prednisone because I know from experience that it's guaranteed to make me an anxious insomniac for a week, and so that would only be worth it in the case of some kind of gross damage.

Understanding the mechanisms that Prednisone is theorized to be protective by, should help people make informed decisions in this regard. Unless you're dealing with something so severe that it triggers a fairly massive inflammatory response, it's not going to be useful. Viruses are real, real good at doing that -- and so is noise, but only if it gets into fairly insane levels.

 

Thanks @linearb! Very helpful. I honestly don't think I need or will be prescribed prednisone — the ENT said it hasn't always been effective anyway (and like you mentioned, it's only reliably effective for SSNHL)... and my hearing seems fine.

I'm even thinking of cancelling my hearing test and appointment with her, but I would like to get some more info from her about what to do next time and also what is a normal reaction. For instance, two days later my pulsatile tinnitus came back! Coincidence? I know pulsatile tinnitus isn't noise induced, and for me it comes and goes (for months at a time), so I was just wondering about these things.

 

So I saw the ENT and had an audiogram. Hearing is excellent. I had a nice discussion with her.

In her experience, she advises against steroids for anything mild (as was my case, 1-2 seconds at 105 dB). She said she has given it to people who've gone to rock concerts, been around explosions, and their outcomes arent good. She said it WILL work for SSNHL, but she said even those folks generally only recover about 50% -- which is still good. But steroids are not the miracle cure.

For vitamins, she recommend Lipoflavonoid. I asked her about NAC, Magnesium. She had no opinion on them.

She also said the reason the ear feels full and hearing cuts out is the muscles protecting the ear. She said the ear drum kind of curves and deflects the sound back out, so the feeling of fullness in my ear after the loud sound is due to that.

She also said that because my hearing is so good, I'm more likely to be startled by things that aren't super loud. I asked her about if this is why I can hear the tinnitus in my head, that my internal receptors (or whatever) are turned way up, but she said most likely not -- otherwise tinnitus would affect a lot more people who have good hearing (mostly young people is my guess!). I am surprised my hearing is so good, as I did some pretty dumb things in my youth.

Anyway, it was good to discuss with her. We discussed other ear things going on with me (fluttering, subwoofer like sounds when I go to sleep that apparently are not pulsatile tinnitus, but my muscle spasming), and I felt much better. Good to have an ENT who is very thorough and sympathetic!

 

"WITHOUT any recovery from steroids."

Does he mean the steroids didn't work for them?

 

* waking up with SSNHL (this is the only thing that has real good data for oral corticosteroids being useful)

Even in these cases it seems like trial and error, works for some for some not. That's what I gathered from some different SSNHL groups/boards.

I've had 3 times SSNHL and was always treated the same day, but it didn't work in all 3 cases. Yep, my hearing sucks.

For tinnitus alone it is basically nothing to expect from.

It's kinda weird that most people here on Tinnitus Talk claim not to have hearing loss (real one, not "hidden" one, not only 15 dB, or what people calling here high frequencies meaning 10 kHz, 12 kHz, 16 kHz... A range no ENT or audiologist cares for high frequency for them is anythings above 4 kHz), given that 2/3 of tinnitus patients have hearing loss or the statistics are lying

I'm overall -30 dB till 3.5 kHz then it goes down like hell. 40 dB around 4 kHz, 50 dB around 5 kHz, 70 dB around 6 kHz and up to 8 kHz it's dead ‍♂️

But guess what, it's still considered moderate hearing loss.

 

If I can't pronounce words and lysp or a shotgun boast.

 

I don’t mean to be a dick, but I wouldn’t take the advice about tinnitus from a PA. MDs barely have an understanding of tinnitus or noise induced damage, which means PAs have even less.

 

My wife and I have been through six cancers and I’ve been to some of the best institutions in this country. Mayo, Moffit, MSK, John Hopkins, MD Anderson, Michigan medicine, and of course a bunch of local practitioners. For very specialized things like delicate surgeries and so forth of course you want to be in direct contact with a qualified surgeon but for chronic health problems some of the best practitioners I have dealt with are PAs and AP RNs. For many years our PCP was a PA and our insurance allowed us to go anywhere. This of course is not true in all instances so you need to evaluate any practitioner to determine if that’s how you want to caring for you.

George

 

All I’m saying is that I would want someone who has more education and licenses to be my healthcare provider. Just like you want a lawyer and not a paralegal. I’m not bashing PAs or NPs, I just wouldn’t go to one for medical issues.

 

Nothing wrong with seeking those Credentials if that’s what’s important to you. The most talented medical professional I ever met was in APRN in the intensive care unit when my wife was sick with cancer and had multiple complicated problems. She did more to help her then virtually any medical professional we saw across that long list of high-quality institutions. I have no idea what her education level was or any of her specific credentials but she was super smart and very intuitive. During all those visits I met a lot of well educated doctors and I would never go back to see some of them again. Do whatever you’re comfortable with but my point is sometimes a top-notch PA or APRN is a better choice.

The full-blown medical oncologist at Mayo knew less about my wife’s ultra rare cancer and how to treat it then the APRN we met at Michigan medicine. We did meet the top medical oncologist at Michigan medicine who is a world level expert for this type of cancer but we never spoke with him again because everything was well handled by this very talented APRN.

This was not the case everywhere and medical doctors have of course performed all of our surgeries. In the case of my oncologist team for my prostate cancer, I prefer to see the doctor in that particular case although the APRN that he had for 30 years they recently retired was my first choice then.

George

 

I really wish I had read this post. I had noise trauma recently and developed tinnitus. I had multiple "normal" audiograms so was refused even oral steroid treatment. Wish I had taken matters into my own hand and get steroids right away.

Now it's too late (>1 month) and most ENTs I talked to said it's pointless to try steroids to salvage any kind "hidden" hearing loss or preventing tinnitus from getting worse.

I always knew something was really wrong with my ears after the noise exposure (various popping and pain and obviously non-stop tinnitus). But the doctors where I am (sigh...), I shouldn't have trusted them.

There is no harm in trying a very simple steroid for a week. It could have saved my life. Now my life is ruined and probably headed for a very painful end.

 

Just had this exact same thing happen. Glass bowl dropped in sink. But it wasn’t me who dropped it. It was my wife. It was LOUD. I was sitting at the table about 6-8 feet away. I took 1200 mg NAC immediately. Wondering if I should take Prednisone. I have a 5-day course of 60 mg on hand.

It doesn’t appear I have any muffled hearing or increased ringing. But obviously concerned that it could get worse later.

Anyone care to offer their thoughts?!

 

Nah I wouldn’t take Prednisone. In my opinion it shouldn’t be used all the time for any noise. People have gotten worse on it too...

NAC was the safe bet and maybe some Magnesium. Just try and relax some. Hopefully you don’t spike.

 

I agree. Some people seem to take it for the smallest of incidents... not good!

 

@Wrfortiscue, @2noist:

Thanks. I haven’t really seemed to spike yet but do feel like I have some pain. Going to go heavy on Magnesium/Melatonin/L-Theanine tonight. Probably eat an Ativan too. Cross your fingers I’m ok tomorrow.