Suggestions Chapter 8: Treatments

Suggestions for Chapter 8: Treatments

Put all of your suggestions, comments and ideas in here and we'll update the guide as we go.

The guide can be found here Tinnitus Help: The Guide

The content that goes in the guide will be for everyone. Please consider that this is for people from many different cultures and belief systems - don't be offended if there are certain things that don't make it in

 

I did CBT and an anxiety workshop. They helped but also finding out that tinnitus was not a dreaded disease also helped. Mostly, it was time and positive thinking and actions. CBT and the reduction in anxiety helped tremendously with these...not to mention the great support I got here.

 

DISCLAIMER: I'm not a doctor. These are mostly personal experiences.

Having been a lab rat for various drugs for some time (as many others in this forum) I think I have a slight insight on drug-based treatments. I won't mention experimental stuff, since there is no way of obtaining them.
I'll try to order the drug treatments by success rate, based on the knowledge I have accumulated over the past 2 years.

- Lidocaine: Seems to have a consistent effect on many tinnitus type subgroups, by temporarily eliminating t or reducing it by a great deal. This only refers to intravenous or intramuscular delivery or the drug, not the patches available OTC. It seems quite effective but the delivery method makes it not particularly viable for frequent use.
- Benzodiazepines: A very large percentage of tinnitus patients have reported that a even small amount of drugs such as xanax, ativan, rivotril etc have a severe impact on the loudness of their tinnitus. I believe that tinnitus reduction is possible on all tinnitus patients, provided a large enough dose is provided. Benzodiazepines can help, but they are addictive and potentially harmful medications, if taken for long periods. VERY personal opinion: if you can get your hands on Bromazepam, use that. It is better tolerated and very effective. It has the best properties of all benzodiazepines (does not mean it is safe though).
- Corticosteroids: Tinnitus that can be attributed to inflammation, allergies, ETD, auto-immune problems can be severely reduced by corticosteroids (drugs like Prednisolone, Dexamethasone, Betamethasone). Again, the effect is temporary and corticosteroids may be harmful if taken for a long time since they mess up the body's natural production of important hormones.
- Calcium channel blockers: Drugs like Pregabalin and Gabapentin have shown some effect on reducing tinnitus and its annoyance. Probably the only type of drugs, which have been properly tested for tinnitus on large scale studies with lots of participants over long periods of time. They are (relatively) safe to take. Small doses (like 300-600mg gabapentin or 25-50mg Pregabalin) won't do much. Effects will be observed when one starts hitting dosages over 1200mg / 100mg (these are personal observations, consult your doctor on how to use these drugs as they have to be properly tapered).
- Potassium channel modulators: Retigabine and Flupirine are two drugs that have some effect on a novel target for tinnitus treatment (potassium channels). The first is an anti-epileptic, the second is an analgesic. I have experienced complete silence with retigabine, almost complete silence with flupirtine. Some more anecdotal reports can be found on the provided link. The effect of both drugs is temporary, dose related and prone to severe side effects. Some of those side effects can be permanent and dangerous (kidney damage, eye issues, skin discoloration and more). Use at your own risk, be responsible and know that these drugs may have a large impact on your future health.
- Cinnarizine: It's a safe drug, widely available and you have nothing to lose by using it. 150mg per day on divided dosages may do something for your tinnitus. There are reports of it reducing tinnitus, mostly anecdotal though.
- Ginko biloba: Just kidding (on a more serious note, gb may have some efficacy DEPENDING on how pure the products is... there is a lot of gb on the market and 99.999% of it is useless synthetic crap. So unless you can find the purest extract, you might as well don't bother.)
- Betaserc: It might work for some, using huge doses (like 150-200mg per day), especially if your tinnitus is menieres related or originates in the labyrinth. Betaserc is basically a vasolidator, therefore it may cause a big headache in large doses. Not really recommended but it can't hurt to try as it a relatively safe drug (I would call it a supplement actually). Has not worked for me even at those large doses but you never know.
- TRT: Really kidding this time.

 

I forgot to mention a couple of very important drugs.

Tegretol: If you look at some studies, there is no evidence that carbamazepine (tegretol) if effective against tinnitus. However, it is almost certain that it has some effect when it comes to a specific tinnitus type (the Morse code/typewriter type). This type usually suggests a vascular problem near the auditory nerve but this is another issue altogether. Probably the biggest tinnitus expert in Europe (Dirk De Ridder) always suggests this drug for the typewriter tinnitus type. Be very careful though. Carbamazepine has serious side effects and is easily one of the most dangerous anti-epileptics out there. It can reduce white cell blood count, cause behavioral changes and other nasty stuff.
Furosemide: This is a diuretic which has also been found to reduce pressure in the head (some people's t can be attributed to increased head pressure). Furosemide (Lasix) can be very beneficial in these cases. Unfortunately, it has been mentioned many times that furosemide can be ototoxic as well. So there you go.

 

I have a treatment that works for me. Reducing the tinnitus a great deal! I have no long dissertation, but try it , has no real side effects. Cymbalta 30mg once day use for about a month then move up over time to 60mg. get this from your doctor. Also 3 times a day NAC-NA-Cetyl 600 mg each dose this is a supplement, which you can buy online.
And then something everyone has heard of Lipoflavnoid one dose 3 times a day over time down to once a day.
This combination has work, again for me , with no side effects over a long period of time, and that is a big key.

 

Most if not every doctor will tell you that there is no cure for tinnitus. And most doctors will tell you that nobody knows how tinnitus comes to be. There are no cures for tinnitus yet. But several pharmaceutical companies and the community of patients are working on finding one. Most important is the understanding of what tinnitus is and what changes you need to make to your life to treat the condition.

1 - Acute relief.
Before anything else anyone that has just been introduced to tinnitus will want to have immediate relief. This can be achieved by masking the tinnitus with external sounds that confuse the nervous system. An excellent method to both diagnose your tinnitus frequency and to find short term relief is the website http://generalfuzz.net/acrn/
Once you have identified your frequency set the acoustic neuromodulator to play ACRN, and using the volume slider on the website set the volume to such that you can barely hear it. This way you can suppress your tinnitus and still go about your business.

2 - Acoustic regulation.
From birth we've been given a set amount of neural fibers and inner ear hair cells. If you have tinnitus you can no longer afford any damage. Daily life has changed quite a bit since the stone age, and we are now submitted to sound levels many thousands of times greater than we are rated for.
As soon as is convenient it is wise to get either custom made, or to buy yourself, some discrete earplugs that do not distort the outside world but simply lowers the volume. This will help protect you from harmful noise such as is present in all our cities.

 

Treatment and modalities.... Would be great if this area could give percent of success for each modality...some kind of very general picture statistically behind each one. Perhaps from the surveys you did. As well as from 4-8 other sources, so people can see what is least to most effective in general/loosely.

Would it be possible to have a place for actual names of top practitioners that are known to work with tinnitus patients behind each modality? That could make the guide too big... Maybe that's a separate project? Because you can suggest modalities, but then....where do I go for this? There's many more hours of reading and searching. I found a doctor in MI that does ear laser for tinnitus as well as acupuncture for tinnitus. A google search, pure luck, 3 hours from my home. I was going to try her and see how good she is first...then put her out there. She said there are 10 like her in the States... I plan to get all their names. Traveling to Dr. Wilden is not feasible for most people. She said Canada has more options since its approved by health insurance there.

 

Notch therapy: daily listening to sounds with a band of frequencies matching your tinnitus frequency removed.

Neuromonics or Tomatis therapy: daily listening to sounds with a band of frequencies matching your tinnitus frequency increased in volume and all others attenuated.

These seem to be opposite approaches. When should you use one over the other? What's the efficacy of each?

 

I have tried a lot of stuff. Have not gone the medication route and that would be a last resort. What I did find was helpful is getting aids that amplify the sounds in the frequency of my tinnitus. That is a slight moving target but it stays in a fairly narrow band. This, of course, does not eliminate the tinnitus but it makes it much more bearable. It still wakes me up early most mornings but it makes my days much better and has the plus that I am not straining at some words as much. My hearing loss is in the moderate range and only the lowest tones are in the very bottom of the normal range. If you don't have hearing loss with the tinnitus not sure if this will be effective.

For me, pills and potions had no effect. Notch therapy didn't change much. Been in two studies of noise therapies (they don't really explain what they are doing in the study) and neither one had any effect. I stopped grasping at straws and now I just follow along with the research to see if something comes up.

 

Doesn't Cymbalta have some side effects for you? That one is similar to a SSRI. I'm trying Lyrica with some OTC supplements. I had 1 great day but is difficult to duplicate. I have some Cymbalta too but am reluctant to "eat it" @Sam U, regardless thanks for your advice and I hope it continues to work for you. I may try that combo.

 

Where or who do you go to find those ear plugs? What are they called?

Scott Haas said, What I did find was helpful is getting aids that amplify the sounds in the frequency of my tinnitus.

Same questions for you! I should be seeing my doctor soon. Finally.... Been two years chasing my "affordable" insurance. Now I will have a new doctor. I really loved my old doctor... But I can't have her now. I have a soapbox, but I'm not stepping up on it...

 

I have tried tdcs at Brain in Antwerp in 2013. www.brai2n.com No real result but they have improved therapy now. They found proof for their theory so they expect to have better treatment in the near future. Also tried meds like alprozolam. That calms me down and has some effect on tinnitus. Be aware of all these internet scams. there is no cure yet, but research is now quite close to a solution. Maybe in four or five years it will be curable. TRT seems only therapy for people who are really scared by t. It does not cure but helps to understand.

 

My own experience: Low-Level-Laser-Therapy works.
But it is not easy to find the right parameters and especially for the personal conditions. So are very different studies and personal experiences about that. I give in short the explanation of the difficulties:

What is Low-Level-Laser therapy (LLLT)?
Laser light in the correct quality causes an increased energy supply to the cells. This allows the cells perform strengthened its internal cell-biological processes. One of these processes is the cell repair, an attempt is made by themselves in all body cells. Of course, it is a difference between to reach a skin surface or if the inner ear is to be the target. The aim of radiation is a sufficient amount to bring photons with certain characteristics in the cochlea (cochlea with equilibrium organ). Only this right quality can be described as Low-Level-Laser therapy. This results in that not every laser for any purpose is a low level laser therapy. The effect of Low-Level-Laser-Light to the cellular power plants (mitochondria) and cellular energy is as sure as sunlight causes certain pigment changes in the skin.

The right quality of the laser radiation.
There are several parameters of the quality determination. Wavelengths around 650 nm (visible red light) and 780 nm to 930nm (invisible near infrared) have yet to have the best effect. Longer waves penetrate deeper into the tissue as this shorter. In the tissue, the propagation of the laser light no longer passes linearly, but according to complicated rules. Home Laser are possible to buy with an output from 5mW, this is the 10,000th part of a 50-watt light source. From own experiences and div. Postings we keep at least 30 mw power than necessary. Laser can also be output as a continuous pulsed beam but. Higher power - up to 500 MW - are issued consistently pulsed, there are different pulsings possible. The distance from the laser source, the accuracy, the spread of the laser beam and the radiation reduction through the tissue between them determine the actual light energy to the cochlea. The effect of LLLT on the inner ear cells is such that too little just does nothing and too much an inhibiting effect on the regeneration. In between is an optimal dose. Not every laser treatment can ensure that. Not every home or practice laser achieved due to its construction, the inner ear sufficiently.

Application of LLLT: Proper laser quality and dosage times and breaks are critical to the success of LLLT.
The laser therapy is for the patient generally not as a linear reduction in complaints. Depending on which cell structures just regenerate, results in the kind and appreciable changes. A tinnitus at the beginning of treatment may change to restless, it's a sign of the effectiveness of LLLT, so positive. The hearing sensitivity increases. The prevention of noise pollution for the ear is important to also stress should be avoided. Furthermore, sufficient breaks the laser application are very important. The regeneration takes time, which can not be replaced by LaserPower you. This is especially true for home laser, since so alone determines the patient duration and frequency. A successful LLLT after having a useful regeneration time gives a better biological state of the cochlea and so reduce the discomfort.

Realistic expectations of LLLT in chronic inner ear disorders.
Each tinnitus or Ménière's disease is an individual situation, and if there will come an improvement, is not certain predictable. If one noticed no changes within 6 months after the number of treatments (depends on the base condition) carried out, so this therapy should be considered as unsuccessful. Due to the complex structure of the nerve cells in the inner ear, the repair takes time, because the regeneration takes place in small steps. Quote of an experienced patient:"I think it is important that people know that it can take quite a long time until someone achieves a good improvement. Too many end their therapy, if it does not go to them quite well within 2 to 3 months."
Anyone who tries this regenerative medicine, should be willing to endure it up to the best possible result.

The laser treatment can be used effectively over a long period and still leads even after many years to further improvements.

 

First suggestion: On each and every treatment, place a disclaimer: "Consult a Doctor before trying anything"
Second suggestion: Place some information from the survey that was done in this board. Something like: "This is what our members tried, this is their success rate"
third suggestion: On miracle cures and charlatans, I really like this Ted talk, it could be added as a resource:

 

I talked to Dr. Abraham Shulman a few years ago by phone. He said I didn't need to see him in New York and instead he talked to my Dr.'s at the time (3 of them). Due to his age he doesn't take new patients. I don't know what he currently recommends for tinnitus either.

Links to Dr. Shulman:
http://www.tinnituscenter.com/
http://www.tinnitusjournal.com/detalhe_artigo.asp?id=49


I think I started on 300mg Gabapentin + .5mg Clonazepam and titrated up to 900mg Gabapentin + .5mg Clonazepam. Both at 3 x/day. Worked very good for some time until your brain grows resistant or tolerant to it. It is worth trying, but will make you quite tired when you start, at least it did for me. I was still getting awakening hissing though after a quiet day.

Recently I've been having Eustachian Tube dysfunction in my left ear possibly causing the loud noise?? I have some TMJ disorder on left side too so confusing?? I may try a tube in left ear only instead of using EarPopper and Flonase.

Links to ETD:
https://www.tinnitustalk.com/threads/the-earpopper-machine.1061/#post-36217
https://www.tinnitustalk.com/threads/here-is-how-i-solved-my-tinnitus-—-new-protocols-and-supplements-to-try.6514/

 

I have also marked:
cyclobenzaprine
lamotrigine

With some positive users report.

It's all!

 

This is my list after four months of research around pubmed, forums and web.

Drugs:
Neuromodulators:
Rivotril, Clonazepam (can give significant results).
Flexiban, cyclobenzaprine (can give significant results).
Neurontin, gabapentin (can give significant results in a small number of cases).
Trobalt, retigabine (can give significant results in a number of cases; dangerous; it is not prescribed for tinnitus but only in cases of drug resistant epilepsy).
Tolep, oxcarbazepine (In association with Lyrica and Triptizol seems to have given positive results. There are not significant results in solitary assumption).
Cynazin, cinnarizzina (can give significant results).
Keppra, levetiracetam (can give significant results especially for hyperacusis).
Lyrica, pregabalin (can give significant results in a small number of cases).

Others:
Lamictal, lamotrigine (solo or in combination with Parmadolin, tranylcypromine, seems to have given significant results in some cases).
Triptizol, amitriptyline (tricyclic antidepressant. In association with Lyrica and
Tolep seems to have given positive results. There are not significant results in solitary assumption).
Lasix, Furosemide (I's have some significant results but not enough to justify its use for tinnitus; could give Tinnitus or worsening).
Prednisone (used primarily in acute phase, some users on the network show a decline in chronic tinnitus as a result of the assumption).
Betahistine (used mainly for dizziness, has yielded some positive effect on tinnitus even in the absence of vertiginous crisis in a small number of cases).
Campral, acamprosate (used to combat alcoholism addiction. It has yielded significant results in two controlled studies and strong doubts in a latest study controlled, can give significant results in a small number of cases? We don't know).
Memantine (can give significant results in a little % of people).
Nootropil, Piracetam + Pentosifillina, Trental (can give significant results in a little % of people).


RTMS. 50% success rate
hyperbaric chamber. For acute phase or barotrauma
Acupuncture. No studies but some success reports
Neurofeedback. No studies but some success reports
Vagus nerve stimulation with Serenity System. 50% success rate
TrT (sound teraphy). 50% success rate

 

For anyone that is interested, I mentioned 'head pressure' as a tinnitus cause in a previous post, with furosemide as a possible cure-treatment:
Here is a very lengthy explanation of the whole situation, quite a read actually.

And a very explanatory article about the sum of current t treatment, or would-be treatments.
I have another .pdf somewhere, which is more specific about medications, I'll try to find it and post.

Cheers

 

When I have had a hard time getting to sleep phenergan (promethazine) has always helped. The following day the sounds are much reduced. I sometimes even have silence. The effect lasts up to 12 hours before the racket begins again.

I forgot to add this silencing effect does not seem to happen with other drugs I 've taken to sleep eg mirtazipine.

 

After sleep, the most helpful thing you can do is to train your brain away from t.
When we first get t, we are in a state of shock/fight or flight, change, constantly researching and monitoring t. T is shown not only as present in the auditory track, but also other areas of the brain that can magnify the sound. Parts of the brain that are also responsible for emotion, perception etc.
Once we train our brain away from t, we can often find the volume decreases, and we spend most of the time not noticing or hearing it at all. It is effectively not there anymore.
One way to achieve this is to monitor our reactions only. Not monitor or describe the sound (Back to Silence thread).
Another way is to fake it til we make it. If we hear t, start by saying out loud "I don't care about this" (even if we do), "I am far too busy", "I am so over this and have other things I would rather be doing". If we start thinking we are going to monitor the sound, go for a walk, put on some music, phone a friend etc. Distract. The brain will soon train itself away from the sound.
In conjunction with training our brain away, we must relax our central nervous system, which connects at various points to the auditory track. This can be achieved by listening to relaxing music, going for walks, having bubble baths, yoga, breathing exercises, meditation, singing, art, and anything that can nurture and calm our systems.

 

Another treatment:
BARBITURATES. Except for causing Judy Garland's, Merilyn Monroe's and Jimmy Hendrix's death, barbiturates can actually act as a calming agent for the naughty tinnitus brain.
They pretty much act like benzodiazepines, increasing the availability of GABA (the chemical that keeps your brain calm and sleepy) for an undetermined amount of time, depending on the potency of the illegal dope you manage to buy from a former Soviet state or Mexico.
Please read my extremely interesting thread on the things here. I fed them to my cat, a T sufferer. Next for her, I plan to freeze her brain and reset it trying to remove the tinnitus, substituting the sound of it with "Scheiße" by Lady Gaga.