I Started on Prednisone 3 Days After Acoustic Shock — Advice on Duration + Taper?

Hello everyone,

About a week ago I sustained an acoustic shock from a faulty tone generator when I was building an amplifier, got spiked with approx 110 dB of 20 kHz noise for about a minute (I didn't hear it, but felt the pain). I have had hyperacusis and tinnitus since, improving initially quickly, but leveling off (80% after Prednisone, then about 10% per day since, sometimes no progress).

Luckily I work as a clinical researcher, and was able to get hold of some Prednisone + Gabapentin from the stores, completely illegal I know, but after a call to a few people I work with who are doctors they said it would be highly unlikely they would prescribe any steroid at A&E, and I would just be left on my own.

I'm currently on 100 mg of Prednisone per day, divided into two 50 mg doses, one in the morning and one in the evening.

Usual side effects but minor. Just before anyone jumps in and says "that's too high a dose!!"... It's not... Trust me. I've seen this used in cancer patients up to 1000 mg a day, not pretty but it's bearable and would stand a higher chance of protecting the hair cells from inflammation due to Reactive Oxygen Species (ROS) etc. The Gabapentin acts as a calcium channel blocker, as I've also read that during acoustic damage calcium will happily flood the hair cells and cause hair cell death.

So I could do with some advice! I've read a few papers on using Prednisone after gunshot exposure (the Korean military paper for one). They recommend about 14 days of Prednisone, then a taper over a week. I'm also thinking about switching to a physiologic dosage of hydrocortisone, say 20 mg, to reduce the shock on my adrenal system, as it's a lot kinder than Prednisone. Question is should I stay on the Prednisone longer? And has anyone else had experience of taking Prednisone this close to an acoustic trauma?

Thanks for reading and hope everyone is doing ok.

 

I'd just like to say I think it is really awful that you are in the position of having to buy Prednisone illegally from stores rather than being able to get a prescription for it from A&E, where you could get advice about correct dosage etc. Are you based in the UK?

The difficulty of obtaining Prednisone on prescription - a steroid which has been shown can help prevent acoustic shock damage becoming permanent - is one of the things which is most wrong about tinnitus treatment in the UK and one of the things that UK members of Tinnitus Talk need to try to change. Not that we'll get any help at all with that from the main UK tinnitus charities, whose corporate members are only to happy to see as many people as possible who suffer from acoustic shock go on to get permanent tinnitus (and become customers for their products).

 

Yes David. I'm in the UK with our wonderful 3rd world health system, just to clarify I didn't buy it from a store, I actually stole it from the university reagent stores where I work A bit naughty but my hearing is more important than my job.

As per the dosage, I'm a biologist and work as a clinical researcher, so I've got some experience with steroids and their dosages, but I'm not an expert for sure.

I would have liked to have got an intratympanic injection, but talking to colleagues I found out there's no way in hell the National Health Service would do that for an acoustic shock... despite the research.

Good news is I feel like I'm on the mend. Tinnitus is still high, I can hear it over noise of 50 dB,but the hyperacusis is much better. I really think I owe it to the steroids as well advice I found on the net and on Tinnitus Talk.

If I reach a plateau I might give a shot at LLLT, unlike what some say it is real and valuable science; you find the papers that decry it are really badly conducted tests (low treatment time especially), and I've managed to save my hair with it as well so I know personally that it can and does work.

As for advice from anyone, I'm all ears

Cheers.

 

Interesting to know. The fact that someone is driven to stealing Prednisone from their place of work to treat their acoustic shock because they know they won't be able to get it on prescription is truly an indictment of tinnitus treatment in the UK - and a contrast to many countries where it is possible to be prescribed this medication.

Once again it's worth emphasizing that this situation hasn't come about by accident. In any situation one of the first things to ask is "cui bono?" In this cast the groups who benefit from the inability to access prednisone (leading to a significant rise in long-term tinnitus patients) are the audiology companies, the mindfulness sellers, the CBT therapists and any group who sell services to long-term tinnitus sufferers. All of these groups have influential lobbyists on the boards of the main UK tinnitus charities.

 

I agree with you David. Lots of emphasis on CBT, mindfulness and other garbage (in my opinion). In the end it all boils down to "deal with it" along with the tunnel vision a lot of doctors have towards illness, and of course like you say money talks when it comes to influencing and researching treatments, it's the same all over the board believe it or not.

Now if I could get some more sleep without this screaming in my head, I think I'd do a lot better!

 

Sorry to hear about your situation, but would you mind if I asked for an update on how you're doing now if possible? It doesn't seem you're still active on the forum, but I was considering trying to get a prescription for the same drug to help my recent surge in noise-related tinnitus.

 

I took 120mg per day oral Prednisone for 4 days and then stopped cold turkey. If it's less than 1 week, you don't need to taper down.

• You want a high dosage ASAP to prevent swelling inside the ear, not to use for long time, injections are best.
• In Germany they prescribe 250mg a day oral Prednisone, from reading posts here
• Usual (but temporary) side effects: a bit of agitation, difficulties to sleep, high libido (time to meet the GF...!)
• It's very hard on the stomach lining, you really need to take a Proton Pump Inhibitor (PPI) pill at the same time. With a PPI, I felt no stomach issues.
• It only really works for the first 24 or 48 hours based on research, but always worth a try of course, starting even 2 weeks later but no later than that.
• Most of the scary stories online and "warnings" are for people using this for extended times, months etc... For ears/noise this won't be the same approach.

 

You can make your tinnitus worse using Prednisone. The Gabapentin probably was the best solution. I took Prednisone and was made much worse at much lower doses than this when stopping the drug by the following morning on rapid taper.

 

This is the truest thing I’ve read in a while.

The NHS would be wonderful if they ever bothered to keep up with the latest treatments - or perhaps even bother to see anyone in the first place! Imagine that!

On a side note, I always have a plentiful supply of prednisone for my lungs. So I’m okay on that front. And I never taper because the dose is too short each time.

 

@FFR any update?

 

I'm on Gabapentin. I started Gabapentin 4 days after I got tinnitus but compared to the first 4 days it's 60% less intensity. I've had tinnitus for 3 weeks now.

The problem is I think Gabapentin is causing my face to go slightly numb and more importantly giving me eye issues. I'm very very scared. I have an eye Dr appointment today. I hope it's nothing serious but now I'm extremely sensitive to light and I see white colors with a slight almost like film on them. No blurry vision but I can tell something is just off. I've been on Gabapentin for 3 weeks. 400 mg to help reduce anxiety which I've had for the past 20 years.

If they tell me to stop taking the Gabapentin, then I fear my anxiety and tinnitus will increase back to what it was the first 4 days which is unbearable. If I don't stop, I fear it will cause eye damage if it hasn't already.

I'm screwed.

 

Try tapering off for a few weeks then? You can get tinnitus from anything that screws with modulation really... so I mean Gabapentin could be making all this worse. Best to ask a neurologist as they'd know people who have been on it for life as to if this kind of thing happens.

 

Ok thank you. I will do that.

 

In Germany the standard for SSNHL and acute tinnitus is 3 days of 250 mg Prednisone per day.

No tapering necessary. Studies showed lower doses aren't effective, higher doses won't help more.

I've even got 5 days of 1000 mg Prednisone per day for inflammation, that's like standard for MS people, also no tapering.

GABA fucked up my tinnitus a lot along with other serious side effects, but that's different for every person.

 

I am curious what dose you were on and for how long that caused your worsened symptoms?

 

5 days of 60 mg Prednisone, cold turkey on day 6... That night was surreal with humming and both my ears were muffled by the morning.