How Important Is Early, Fast Treatment?

Discussion in 'Support' started by SecretDoubleCat, Mar 16, 2019.

    1. Aaron123

      Aaron123 Member

      Tinnitus Since:
      00/0000
      Cause of Tinnitus:
      Irrelevant
      No, in fact I said
      and
      In the present context, the point was that I think there are good reasons that this is not evidence that IGF-1 is "very effective" for SSHL. As the authors themselves say: "Present results suggest the possibility that IGF-1 is superior to intratympanic Dex therapy, but the current study design failed to confirm this possibility. The positive effect of topical
      IGF-1 application on hearing levels and its favorable safety profile suggest utility for topical IGF-1 therapy as a salvage treatment for SSHL." At a minimum it seems like it would be a useful tool if steroids aren't effective except of course that they are testing a proprietary formulation....
       
    2. Aaron123

      Aaron123 Member

      Tinnitus Since:
      00/0000
      Cause of Tinnitus:
      Irrelevant
      Not sure how to quote a quote so this will have to do.
      Even if it is MEEI, there is no link to the study. (I'm guessing it is https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/608834 which is widely cited.)

      It's weird if this is settled, that it's still an area of significant study. There are indeed studies that show there is an effect (including apparently from 1980), and there are other studies that show there isn't. See here: https://www.dizziness-and-balance.com/disorders/hearing/shl.htm for much more information and an extensive bibliography.

      Their bottom line conclusions seem right to me: (direct quotes of 4 paragraphs from above link)

      Bottom line: At this writing (2017) almost everything looks either ineffective or slightly effective. Because hearing tends to recover spontaneously at such a high rate, treatment is not always felt necessary, especially when impairment is minor. There is also an substantial possibility of bias, as it is difficult to "control" procedures that involve injections through the ear drum.
      ...
      When a treatment of SHL is used, it often consists of burst of steroids such as prednisone. There is an immense variability in otology/neurotology practice in regards to use of management and steroids for SHL (Coelho et al, 2011). 26% preferred oral steroids alone and 22% a combination of oral and intratympanic steroids. Some also used intravenous steroids.
      ...
      Our impression from the literature is that systemic (i.e. oral or IV) as well as intratympanic steroids have a small positive effect on SHL. As of 2017, the best approach for hearing appears to be more steroids - -both systemic and intratympanic. Our guess is that larger and more direct doses of steroids (i.e. intravenous or high-dose prednisone) are slightly better than safer and lower doses of steroids (i.e. medrol dose pack). Lets be clear however -- these are not big effects, and one should be careful to judge whether the risk of steroids is warranted by the small effect. For example, one would generally not want to use high dose systemic steroids in a diabetic, as the risk from steroid effects on diabetes might easily outweigh the small average effect on hearing. This involves an apples/oranges comparison however. The equation might be different in a professional musician with diabetes.
      ...
      Bottom line: We recommend IT steroids in persons who cannot or prefer not to be given oral steroids, and in whom the time frame is short (i.e. 4 days from onset), and in whom the hearing loss is very significant. We do not recommend IT steroids otherwise -- for example, in persons with minor hearing loss. We are not sure ourselves whether oral or IT steroids are superior in terms of hearing results to doing nothing, but we are certain that large amounts of oral steroids can cause significant side effects. Concerning intravenous steroids, they are likely superior to oral steroids, but they are far more difficult to administer. Again, their use would seem most reasonable in persons with very severe hearing loss.
       
      • Informative Informative x 1
    3. Aaron123

      Aaron123 Member

      Tinnitus Since:
      00/0000
      Cause of Tinnitus:
      Irrelevant
      @SecretDoubleCat

      My apologizes for all of the off-topic posts. I feel like I owe you a direct response. I went back and read your original post on the site. It sounds like you have different things going on - noise history, THC oil, the dremel, TMJ. Not sure that I understand the advice not to take muscle relaxants. Flexeril is a good thing sometimes though mine is for my back....

      Given the mixed history, it is unlikely that you would be a good candidate for steroids whether you went today or in two weeks. As discussed above, the evidence for using steroids for SSHL is mixed. If you had listened to a metal band in a concrete building standing by the speaker for 2 hours and couldn't hear or if you had a gun go off by your ear, I would say go immediately to get steroids (even though those aren't SSHL either). But that's not your situation.

      Given that, I would suggest you listen to what @Ed209 says. Take care of yourself. If you are worried, you could see about leaving a message at the new doctor and explaining what happened and what you read and seeing if he or she thinks you should come in sooner.
       
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    4. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      I'm not being defensive so much as I'm stating the fact that this statement:
      is a totally baseless allegation.

      You're going from a perception of inadequacies in the conclusions made in the paper to allegations of bias and a conflict of interest without any evidence whatsoever.
       
    5. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
    6. Agrajag364

      Agrajag364 Member Benefactor

      Tinnitus Since:
      09/2017
      Cause of Tinnitus:
      Unknown
      What field are you in Aaron? I used to work in academia. Witnessed an alarming amount of bullshit.
       
    7. Shaqz

      Shaqz Member

      Tinnitus Since:
      12/10/19
      Cause of Tinnitus:
      Acoustic Trauma
      What’s the latest I can get steroid injections?

      My tinnitus onset was on December 10th 2019.
       
    8. Jack V

      Jack V Member Benefactor

      Tinnitus Since:
      1/2020
      Cause of Tinnitus:
      Something Wicked This Way Comes
      Hi Shaqz. You and I have spoken before in the forum. We're both relatively new to tinnitus. Hope you're doing well.

      Here's my take on this thread in general, and your question specifically.

      Studies suggest that the earlier some treatments are given, the more effective they'll be.

      Therefore go IMMEDIATELY, today, to your doctor, and discuss them.

      Don't wait another day.

      While cutoffs are frequently cited (XYZ is best within 2 days, or 1 month, or 6 weeks, or 2 months, or... etc etc), those are arbitrary dates your biology may or may not care about.

      Be aggressive about seeing your doctor immediately -- urgently -- and exploring treatment.

      Good luck!
       
    9. screechesilence
      Wishful

      screechesilence Member

      Location:
      U.K.
      Tinnitus Since:
      02/2020
      Cause of Tinnitus:
      STRESS, high frequency sensorineural loss (birth)
      Would steroid injections help someone with sensorineural hearing loss (not sudden! and not noise induced) 2 months from tinnitus onset? ENT never offered me any sound option.
       
    10. Kriszti

      Kriszti Member

      Tinnitus Since:
      2016/2017/2019
      Cause of Tinnitus:
      Unknown
      I think chances are pretty low that it would help. Steroid should be used in the first 72 hours. Also, right now with COVID I would avoid steroid if it's not absolutely necessary.
       
    11. screechesilence
      Wishful

      screechesilence Member

      Location:
      U.K.
      Tinnitus Since:
      02/2020
      Cause of Tinnitus:
      STRESS, high frequency sensorineural loss (birth)
      But do steroids help all tinnitus sufferers despite the cause or just those with SSHL? In my case, I have sensorineural hearing loss in the high frequencies from birth, but only just started experiencing tinnitus.
       
    12. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      temporarily banished from this plane of existence.
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      1999
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      karma
      some evidence that in the case of SSHL (not acoustic trauma) prednisone is useful if given within 2-48hrs of hearing loss

      there is spottier evidence this is true for tinnitus; the best data is from a military study where prednisone was either given BEFORE the trauma or immediately after. also that study used transtympanic injected prednisone so it's a little hard to compare that to oral steroids
      nah, these are numbers from substantial amounts of clinical work, and while there is some evidence of steroid efficiency, your window for it having any lasting effect is "a few minutes after the event" to "maybe a couple days after".

      To see why this is, you need to understand what is at play here -- the idea is that in some viral infections and maybe in noise trauma, the body's immediate immune response is actually more damaging; over the 24-48hrs following the damage, having tons of inflammation can make the damage worse. So, you use steroids to kill your immune response; this does not repair in any way whatever damage happened, it just stops your body from further destroying itself.

      So, your window is very short. By a week or two ex-post-facto, the damage is done and at that point it's down to how the brain reorganizes as a result.

      Some subset of people with long term tinnitus notice temporary improvement from prednisone. In these cases, one might suspect that ongoing inflammation of some kind is making their noise "louder", but this isn't super useful because you can't just keep taking prednisone at immunosuppressive doses forever or real bad things happen.

      If you go read every tinnitus/prednisone study in Pubmed I think you'll decide that the data is varied and in some cases conflicting, but that if there is a positive effect, your window for achieving it is very, very short.
       
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