Lidocaine and Dexamethasone Perfusion

I just had this procedure (lidocain and dexamethosone) at Shea clinic and will post how it works and what to expect shortly.

 

Pictures: Shea Clinic from Poplar Street, Dr Paul Shea, Dr John Emmett, recovery room, perfusion room, IV in place.

 

hi mewisemagic

can you tell us on what is this based?

can you give us more details,costs,duration,effects,etc...?

 

hi mewisemagic,

Thank you for informing us about the Dexmethasone and lidocaine.
Are you getting Lidocaine injected as well as the Dexmethasone?
We at Tinnitus Talk will appreciate the details.

I am getting injections of Dexmethasone into one of my ears; every few months. It may be helping.

 

It's funny that this thread was so recently created. I stumbled upon an old study the other day that described a similar solution that actually boasted an impressive improvement rate. Take a look at this. Especially the part about the Decadoron injections.

http://www.ncbi.nlm.nih.gov/pubmed/6732647

 

The procedure:

You go to Shea Clinic in Memphis and they will give you a very very comprehensive audiological examination (possibly the most comprehensive you have had) and your tinnitus will be diagnosed and you will be given a choice of treatment options.

Hearing/Masking:

They have an entire floor dedicated to hearing aids and masking devices and you can try various units and see the effect. For tinnitus they have several 2 channel models that amplify the high frequency hearing range only (90% of tinnitus patients have high freq hear loss) and they also generate a white or blue noise frequency matched to your tinnitus frequency that can be soothing. They program these units to your specific situation and sensorineural frequency loss. In most cases your tinnitus frequency is the roll off edge frequency of your high frequency loss.

Perfusion:

They will offer you the option of a Lidocaine/Dexamethasone IV and inner ear perfusion procedure. They do 20-30 of these per day and use CPT code 69801. Insurance covers this procedure and Shea Clinic is an in-network provider for BCBS and other inductance company's.

The procedure is a near painless procedure where they use a laser and cut a hole in your ear drum and insert a needle to inject a mixture of hyluran, dexamethosone and lidocaine into your inner ear onto the round window membrane. They start by applying a drop of phenol on your ear drum (stings) and Dr Shea or Dr Emmett then performs the laser perforation of the ear drum.....then they insert the needle and fill the inner ear with the gel like custom formula.

Upon injection the solution feels ice cold as it fills up the inner ear and temporary vertigo instantly occurs. This vertigo is caused by the caloric effect of the cold temperature of the solution being injected. The entire procedure take 3 minutes.

You are then wheeled into the recovery room where an IV drip of lidocaine and dexamethosone is started and continued for 2 hours. This inner ear perfusion and IV is repeated three days in a row.

In my next post I will describe the procedure in detail and it's effects on my tinnitus.....and the others I spoke with while at the clinic.

 

How long does the effect last?

 

Hello@MEWISEMAGIC - I had the perfusions done (left ear only) in July 2011 at Shea. I do wish you well, but personally I don't think they helped me. Using a laser to make the hole in the eardrum worked very well. They did make a hole in my right ear also to ventilate. Back then my right ear did not have ringing. I did not know about the floor with the hearing aids and maskers. Mine was covered by insurance also...so you don't have much to lose. I found their pamphlets a little/lot misleading though.

 

Thanks, Jake. But that is a pretty old study, 1984. If these injections are so successful, why aren't they being used more? My understanding is the problem is the results are short term. But I am glad MeWiseMagic posted and hope he'll keep us updated on the results. Maybe they are fine tuning the delivery system or drug mix.

And it's great that is covered by insurance. I have BCBS and it has covered nothing but my ENT visits and some basic audiology.

 

@LadyDi Yeah I wish that I could find a study that isn't close to 30 years old haha. I guess the good thing is that they are finding things that actually provide some results, even though they are short in duration/not fully understood.

 

As stated above, I had this procedure performed on one of my ears at Shea Clinic. The procedure itself is uneventful. After the drop of phenol on the ear drum you feel nothing. When the drop hits the ear drum it stings for 5-10 seconds or so and the Dr waits a few moments and then suctions off the excess phenol and wax/debris from on top of the ear drum. After about one minute the Dr takes a small instrument (laser) and makes a very small hole in the ear drum while watching on a large flat panel (30") display monitor that is being fed by a Leica stereo scope with video CCD attachment. The laser perforation of the tympanic membrane takes 1 second and then the nurse hands the Dr a 20 gage syringe with the mixture of dexamethosone and lidocaine. The Dr then tells you that a sensation of cold in the inner ear will happen upon injection of the mixture. As he begins the injection your vestibular system reacts to the cold temperature of the mixture and you get vertigo fairly quickly and it slowly subsides. The Dr asks if your ok....and if your hearing is ok. You are then taken to recovery and the dex/lido IV is started for 2 hours. As the IV is in place you feel a sensation of slight numbness throughout your body and the ringing in your ear diminishes measurably. This procedure is repeated (3) times over a 3 day period. On day 3 my tinnitus was almost 100% gone. I had go in the bathroom in complete silence to hear it. I stayed at the Residence Inn (owned by the Shea family trust) and each day I used the breezeway that connects to the clinic to make my trek to the 3rd floor out patient surgical center.

Does the procedure work? The answer is......"it depends". For me it turned my T into a shhhhhhhh sound from a EEEEEEEEE sound. And cut the volume in half. Since my insurance paid for the entire procedure 100% and I obtained a measure of improvement I am pleased and I would say it worked for me. It did NOT cure my T but it is the only procedure that has worked to reduce it at all and it easily cut the volume by 50%.

I have read comments on this site stating that if the Shea procedure was so great that many people would be getting the procedure.....well, after a visit to the Shea clinic it doesn't take long to see that the magnitude of the Shea operation is quite large in scale and many people (each day) have this procedure (perfusion). Some people have the procedure every 3-4 years and respond quite well to it.

During my 4 days at the Shea Clinic I had the occasion to speak with at least 10 separate perfusion patients during the free "social hour" at the Residence Inn dining room each evening where patients were comparing notes and talking about their ear problems. About half the people going through the perfusion treatment have tinnitus and balance issues (Menaries or hydrops).....and the others have just tinnitus. In each group there are positive and negative responders to the treatment protocol.

Perfusion effectiveness for tinnitus is probably a 50/50 situation for any given person. Tinnitus, while everyone wants to cloak it as some mysterious malady, is really quite simple to explain.....the hearing nerve becomes damaged (90%+ caused by aggregate exposure to to high sPL) and as the higher frequencies of the hearing range are lost tinnitus becomes noticeable as the range drops below 8000. To achieve deep silence in the auditory system the hearing nerve uses certain portions of the high frequency range to inhibit and maintain a "deep silence". Once this inhibitory function is lost tinnitus is perceived.

The perfusion process works by flooding the cochlea with a powerful corticosteroid through the round window membrane that (if it can reach the lesion) may be able to repair or lessen the damage. The lidocaine shuts down abbherent neuron function and allows for an opportunity to reset the auditory communication path ways should the dexamethosone have a positive effect on the targeted lesion.

In cases where dexamethosone reaches the lesion in the early stages of tinnitus it is very effective at ameliorating the malady. As time passes the lesion becomes more permanent and less receptive to repair/reversal.

There are also cases where the perfusate chemical concentration levels at the lesion site can be not be achieved for various reasons and mixed perfusion treatment results are achieved.

My particular perfusion treatment protocol reduced the volume of my tinnitus by an estimated 50% and changed the sound type to a more tolerated sound.

There is really no other known treatment protocol that offers any probable impact on tinnitus. None!

All other treatment modalities only play off an individuals ability to habituate to the tinnitus over time. Example; some people go out and get Soundcure or Neuromonics and report great results while others report it does nothing?

If a person perceives some relief while on sound therapy it is more probable that they reached some level of habituation during the sound therapy treatment than the sound therapy actually having an impact on the tinnitus.

The same for TRT and various drug protocols.

The perfusion treatment is not well aligned with a habituation curve in that it either works or does not and you have a direct correlation to its effectiveness, or lack thereof....very quickly.

The price of the procedure is $8400 for the three day protocol. If your insurance deductible is met the cost can be zero. Your insurance has no say if the procedure is covered or not. It's a standard CPT billing code of 69801 and simply means "delivery of medications and/or steroids to the inner ear". This CPT code does not require a pre authorization. Shea accepts the insurance pay rate for 69801 as payment in full.

Feel free to ask me any questions you wish regarding this procedure.

 

Thanks @MEWISEMAGIC for your very,very, detailed description of the procedure. I wasn't in the best state of mine when I had the procedure done at Shea. I previously had dexamethasone only injected with a syringe (painful) at Paparella on 3 consecutive days. On the third day the doctor missed the hole (ouch) and hit my eardrum membrane. They have since discontinued the steroid perfusions there for lack of evidence of improvement.

I also had balance issues after my perfusions at Paparella, so I was regretting having them done. They are definitely more refined at Shea, as I believe they pioneered the procedure. I do remember the "drunk like " state I was in after leaving the recovery room.

I am glad you had a improvement of your tinnitus, as this is the worst affliction I have ever experienced. I guess most of us here would probably say that. I hope you have a long lasting improvement in your tinnitus, as that would be one
obvious question, along with any possible risks involved. I cannot remember if I asked Dr. Paul Shea those questions.
I do have his report on file and may review it again. I believe he mentioned " or do nothing at all" twice on his report to me.

 

you met many people there. aneone cured?

 

I talked to some people there...some had balance problems or dizziness. I don't recall anyone saying they were cured, as most of them were there for the first time. I had bad ringing in my left ear, so wasn't in the best state of mind. I didn't know of all the specifics of the procedure, as I just wanted my ringing to go away.

 

Vkis....I spoke to numerous people at Shea and some were very happy with their results. I also am pleased with the results.

 

Hi, so I have T now for almost 4 months, what could this treatment do for me? Any risks involved that it gets worse? Please explain..

 

The sooner this treatment is applied the better. Within 90 days the cure rate is quite high. While the procedure sounds involved it takes all of 5 minutes to do the injection and is painless. At Shea they do 100s of these treatments and the complication rate is almost non-existent.

 

@MEWISEMAGIC is there any risk of making your tinnitus worse through this treatment? I just live up in St. Louis and a drive to Memphis isn't bad at all, especially for something like this. How far in advance do you have to schedule an appointment?

 

Dose it matter what type of T you got? Tonal? Bells ect.?

 

Mewisemagic, how many month after your T stated did you do the injection? Who recomended it to you?

Any other here that tried this in the past?

 

How the hell is there not more information about this? I would have definitely looked into this when my tinnitus got worse. I'm going on 10 months now... I suppose it would be too late for me to have such a procedure performed. I live up in Des Moines, Iowa... so I'm not too far away from Memphis either.

 

Strange that it isn’t more information about these injections out there. I mean if 20-30 persons a day are having the treatment.

Anyway, here is some general info. about it over the years. Written by Thomas Meyer (Auris medical)

http://www.noiseandhealth.org/artic...me=15;issue=63;spage=83;epage=90;aulast=Meyer

Here is also an old thread about Shea Clinics injection and what people think about it.

http://www.thegearpage.net/board/archive/index.php/t-673322.html

Please help me to dig up some more info. Is this worth trying?

 

I would go see them. My guess is yes. I would try it out.

 

Hello everyone, my T has reduced 80% and sometimes it went into 0.5/10 for weeks and i thought i was about to be cured and few days ago it suddenly bounced back to it's original level with no apparent reason
And that makes me come back to tinnitustalk... which now i suspect there are really many more T patient like me who has their T reduced or cured and never bother to participate in any T talk online anymore.

Back to this topic... i've done some research few months ago regarding intratympanic injection. Look at this,
http://www.tinnitusjournal.com/detalhe_artigo.asp?id=322

Notice that these doctors from Japan already treating T patients with lidocaine and dexamethasone since 80s and had pretty good results especially for those who's T is still early. IMO, if your T is of autoimmune/inflamation/unknown causes then you should try this. IV Lidocaine has a little risk though
http://www.biomedcentral.com/1471-2474/3/21

 

Update. Today I received an email from a person That I met at Shea Clinic that was having perfusion treatment for tinnitus. We had exchanged emails to stay in touch to see how effective the treatment was...over time. His ringing was reduced to almost zero and is now very faint. So while not cured he is thrilled with the results. He said it saved his life.

 

are there any klinics perhabs in South germany that uses that stuf does anybody know.

 

Thanks for the update! Was this person also an early onset patient, as I think you are? I am entering my eighth month now and wonder if it would do me any good.

 

Just spoke with ENT in Frankfurt, they do this in Germany but have different techniques like no laser.
I will try now a medicament called NATIL or something and after 2 weeks consider Lidocaine treatment

 

I do not know the success of the Lidocaine & Dexamethasone perfusion.....or the lack of success thereof. There is a surgeon in Atlanta that underwent a Lidocaine style treatment when I first noticed my T and was searching for answers. He was a very good source of what not to do and his opinion of the treatment that he received was that the situation was compounded. He did leave his practice as his hand was no longer steady and after a few years, we've lost touch some 15 years ago.

This procedure may be the same one quoted as having been in the works for 30 years or more.

I would only urge caution to anyone that allows desperation or a last hope "let's give it a try" mindset to over-ride common sense. I have always found my ENT to be a real naysayer about anything....but, that's why I go to him. I have no doubt when the solution, technique, therapy, procedure or little red capsule comes along...he'll be the first to call me and write the prescription or directive. Most ENTs are cranky as hell about Tinnitus because...they're helpless to do anything.

I have found a lot of little guy and gals in white coats that are willing to risk it all....correction, willing to risk YOUR all. I've had hyperbaric scams and last ditch noise riddance by an aural nerve sever that I never got that desperate which is a good thing.....I would have wound up like some of his patients.....deaf and still with the dentist drill in my right ear.

Folks.....times are financially tough all over the place. Tinnitus sufferers are a target market....and I would suspect that Tinnitustalk.com has it's fair share of sharks that are offering up hope. I am NOT saying that the author for this thread is a shark...but I've learned in my 15 years of hitting dead ends....I do NOT want to see the sales pitch for a procedure that allows...."100% covered by your insurance with the proper coding" (subject to your deductible) as one of the keys for a procedure that is not yet universally accepted.

The insurance angle is a big thing...but being able to function after laser drilling a hole through the tympanic membrane and then inject medications that such as lidocaine that has Tinnitus listed as a side effect. Or....the instant vertigo that accompanies such a intrusion that hopefully will clear up....but according to the disabled surgeon in Atlanta...that was not the case for him.

Caution and suspect should be uppermost in everyone's mind. Again...we're a huge target market with a 1001 snake oil salesmen looking just for YOU. They'll use the same charm of an unscrupulous Funeral Home salesperson to take advantage of your emotions and then unload a $20,000 casket on you while you're at your weakest morale.

It's only business....a bad, irksome, heinously selfish business...but the natural supplements that don't fall under FDA rules are all over the place with Tinnitus cures since I first got into this big boat. I do not know of the first person that started a regimen of the natural supplements to be cured of their Tinnitus.

If you're not sure...ask your ENT or personal physician to research their sources for the rate of successful treatment of anything. They'll be the first to wish you well and away from Tinnitus...and if it cures you and gets you out of a problem, you'll be the first to get good news and recommendation.

 

I would agree with everything that @Dan Turner said, and said very, very well......"If it looks like a duck, walks like a duck, and quacks like a duck, it's probably a duck."

I think it would be WISE to check with the ATA on their opinion on the perfusions. I use to talk to a research person at the ATA every couple months or so, but he is not employed there anymore. I did ask him what his opinion was on the Shea perfusions and he said if they worked, they didn't last, so he was not a big fan of having them done. When I talked to the House Ear Clinic and the Silverstein Inst., neither one thought the perfusions was a good idea for tinnitus....Meniere's may be a different matter. Most people with tinnitus would spend $8000+ without thinking about insurance covering it, if the perfusions had a good track record of "curing" or lessening their head noise for a reasonably long duration of time.