Lidocaine and Dexamethasone Perfusion

My comments on the perfusion treatment at Shea were not meant as an endorsement and I also said that there is No Cure for most people with tinnitus. I only related my experience....which was somewhat positive...but not a cure....my tinnitus "loudness" and/or perception of it was significantly reduced from this procedure. The procedure is done in many Countries as can be seen by Googling "lidocaine and Dexamethasone for tinnitus". With regard to my mentioning the insurance.....I made the insurance comments for the benefit of those reading my post that have insurance. In fact, my insurance paid 100% of the procedure cost. My $500 deductible was met and Shea is an in network provider for my insurance (BCBS). My original post was meant to describe the procedure from start to finish and all that is involved in the procedure. Again, for the benefit of readers of this forum.

And yes, almost all ENTs and "Tinnitus Experts" are in business to part tinnitus patients with their money. This is unfortunate, but very true. Even some of the "big names" associated with tinnitus organizations and clinics never cured a sole and built multi-million dollar incomes from their practices, clinics and books.

A typical tinnitus patient shows up at the GP and/or ENT and the doctor pulls out an otoscope and or a flashlight and looks in the ear canal. Why? There is nothing to see in the ear canal. Certainly nothing related to tinnitus. They look in your ear because it's a billable procedure. Tinnitus originates in the middle ear mechanism. In order to "see" in the middle ear a doctor must see past the tympanic membrane/ear drum. At Shea clinic they are not ENTs that pull out otoscopes and a flashlight. They use every audiological test there is with state of the art equipment and they "look" in your ear by performing a myringotomy (laser hole in the ear drum) and they put a camera in there and microscope catheter and light source!

They are one of the only clinics that makes an attempt to actually provide relief to patients with ear maladys. If you go to Shea with tinnitus, menaries, vertigo, hearing loss, etc you can expect a fairly comprehensive treatment course. If you don't want someone to do something other than looking in your ear with a flash light then going to Shea is probably not for you.

The Shea waiting room holds over 100 people. It's like 10 rows of 10 seats.....and there is not many empty seats

It is a fact that there is no cure in most cases of tinnitus. All current treatment modalities work to habituate the sufferer and do nothing for either the volume or severity of the tinnitus. The person with tinnitus just reaches a point of habituation, but the tinnitus remains. The perfusion treatment procedure is the ONLY procedure that actually can make some impact on a persons tinnitus. In cases where there is cochlear damage (90%+) the treatment can actually reach the damaged site and "in some cases" the response is positive. Conversely, some people get no benefit from the treatment. This does not mean the procedure is without merit.

Getting the compounds past the round window membrane is where the variability is. There is a company that is producing a pump that will apply the compounds to the round window with a slight pressure over a few hours and the entire chochlea can be filled. The current procedure relays upon gravity for the perfusate to get into the chochlea and this is not always consistent.

Any ultimate cure for tinnitus will involve some chemical compound and the cochlea. It will not be a magic cure or pill. It will be a compound that reaches the fiberous nerve ending (cilla) in the ear. And said compound will ablate or impact the abbherent signals being sent to the brain from the damaged nerve and cilia. So the basis of the Shea treatment is sound....but may not be a cure and/or effective for everyone.

 

I did locate the MD's name via the ATA chapter in Atlanta....Stephen Nagler, MD. We had opportunities to discuss Tinnitus via the SIG of that era. The horror tales that he told at the time of his Lidocaine treatment always stuck with me....a) a medical professional nearing the end of his rope, b) he bought into the plausibility of the procedure...and in his willingness to rid himself, made matters worse.

Stephens references his procedure somewhere below the middle of this webpage that describes his personal trials and tribulations.

http://www.atlantatinnitus.com/patient-perspective.php

I think Stephen has ended his surgical practice and has a site devoted to helping other Tinnitus sufferers. Conspicuous by it's absence are comments such as yours that asserts: "any ultimate cure for tinnitus will involve some chemical compound and the cochlea."

That would be your opinion based in nothing that I've found to date....including the ATA site search and my conclusion would be that you are selling something either purposefully or without considering other tinnitus sources that generate the aural sensation along the aural nerve...such as pressure sensations caused by tumors in the aural canal....which has little or nothing to do with the cilla beds and anesthetic saturation. I think I saw the oft used word "lesions" in one of your comments that I don't believe I've once seen in Tinnitus discussion over the years. Tumors, bent or broken cilla....yes; lesions in the aural path....I'm just not sure about.

I don't know anything about the Shea clinic or procedure...with the exception of your comments. Your authoritative candor of the procedure is a tacit approval that many first year or worn out Tinnitus sufferers are looking for out of desperation. However the caveats of "not for everyone" raises the same red flag that I saw when the $40,000 hyperbaric treatment was offered to me by a group of white coats for a multi-week protocol. I went to the military to ask the opinion of the hyperbaric and upper/lower atmospheres flight surgeon and diver support.

Hyperbaric treatment sounded plausible until talking with the experts with the credentials and thousands of hours of treating every pressure and impact (such as huge helicopter blades in idle on a solid surface with ground personnel running through the effect zone without hearing protection) related malady imaginable...inclusive of aural canal pressure on the nerve or ear drums that didn't survive equalization and the resultant hearing losses and immediate Tinnitus. They allowed that I should take that $40,000 and buy a house....it was their opinion it was yet another scam that looked like the real deal because of the availability of the chambers and a nice looking professional office in a medical district.

I was desperate and almost fell for it. However I still see hyperbaric treatments in discussion in these forums although deemed a waste of effort and personal cash....but there are those that bring up these white coats by name and location as a sales pitch to a large group of desperate Tinnitus sufferers that came to this forum for answers.

 

To be equitable.....here is the link to the Shea Clinic:
http://www.sheaclinic.com/

It is a one call/does all center that I have no doubt has a seating room capacity of 100. I have to point out that with the very minimal information that Shea relates on their site to services rendered for Tinnitus....much less the blog of current events, studies and break-through research or procedure....the tinnitus procedure dealing with lidocaine perfusion is perhaps a treatment on request rather than widely advertised with a long list of happy customers and back slapping laudings from the medical industry or fellow ENT & otologists.

I do find a positive report that was published in the ATA back in 2000 that with the phrase "remarkable success rate" but the glaring fact of life....the "remarkable success rate" of 14 years ago hasn't gone prime time to the medical field as the procedure of choice. I would suspect that this is most likely due to either poor results or temporary results....or worse case adverse results.

http://www.ata.org/sites/ata.org/fi...s/a_new_look_at_lidocaine_sanders_sept_00.pdf

I would have to point out that the author for this thread had the procedure less than a month ago (please correct me if I'm mistaken here) and the results are not 100% as of this stage of the procedure.


I probably would not have entered into this discussion with the exception that I recall the ordeal of Dr Nagler many years ago and the title of this thread caught my eye. I'm not a regular participant at Tinnitus Talk...I pop in and out due to my own experience as well as a number of years on Tinnitus forums when I was relatively new to the topic. I gave most of my focus to Support (as can be found in Tinnitus Talk support section) to help those newbies over the hump of the first year. I gave up my role some time ago as too many desperate people were too often hitting their own switch to end their suffering.

One calamitous period of suicides took place specifically due to the abyss that they fell into after hitting a peak of hope with Herbal treatments that "weren't regulated by the FDA or money grubbing ENTs"....they ALL were convinced that the Herbal cure of that time was being withheld by their Doctors. Once the Herbal cure was discussed enough times ("I think my T noise is going away!!" and "I woke up this morning with a different sound in my head!!") and finally tapered off with the negative threads ("nothing happened except I lost money" and "I had my stomach pumped last night because I kept taking more" .... a feeding frenzy based partly in hope and desperation) and finally those threads that none of my group wanted to read....the ones where they've given up.

And they did give up. And they did shoot, overdose and step in front of a bus....hundreds of times before I had to go away. In fact one of the other members of the staff for that forum took her own life as she felt somehow responsible which made up my mind to take a long break.

I do appreciate the candor and disclosure of the author's experience and semi-success...it's still early to tell. But the other side of the coin would be ALL of the information and lack of evidence of success that has to be the caveat here. I myself could not submit to a procedure that may provide me with a worse situation than the one that I've learned to accept with Tinnitus.

 

Update- my tinnitus has remained reduced by 50% or more since the procedure. In fact, it has become significantly less intrusive. I have been in contact with several of the other patients that were there during my treatment stay and they are doing well. One person with a significant balance issue and tinnitus said that he considers himself "cured". My plan is to go back for a second 3 day treatment protocol in 2 months.

I had my ear drum looked at today and it has healed.

I read a post above that someone had this procedure done at Paparella. At the Paparella clinic they had used a protocol where a needle just fills in the inner ear cavity and hope for the best.

To do this correctly, the perfusate must be placed on the round window membrane. So first, a hole in the ear drum must be made for viewing. Then the RWM must be verified to be unobstructed. This is important and essential. This procedure can not be done with a needle puncturing the ear drum.

My only regret is not having done this sooner.

 

That's great MEW, wish your T getting even better soon!
The Japanese doctors used needle for this treatment too and had pretty good results.
http://www.tinnitusjournal.com/detalhe_artigo.asp?id=322

Though, i would think that more modern procedure like Shea's would be even better.
Those with balance issues probably had meniere's or autoimmune problem and this treatment seems to be highly effective for them!

 

So great to hear that the good result maintains, I also did it here in China after reading this. But I have no improvement after 3 days' treatment, the doctor use a needle, I think he doesn't verifie the RWM to be unobstructed, maybe I should ask him about this next Monday, thanks a lot and good luck!

 

Lido/Dex treatment: Critical to the success of the perfusion procedure is visualization of the round window niche and removal of any tissue that may be blocking the niche, which would pre- vent medication from coming into direct contact with the round window membrane. (An outer layer of tissue covers the niche in approximately one-fourth of individuals.) This can be achieved by a standard middle ear exploration done through the ear canal whereby the middle ear can be inspected after folding back the eardrum. If the round window niche is blocked, the tissue is removed exposing the round window membrane, and the eardrum returned to its normal anatomical position. A small incision is made through the eardrum, and the middle ear space is filled with medication. An alternate method, which can be done under a topical anesthetic while the patient is awake, is done by making an incision through the eardrum directly over the round window thereby allowing visualization of the round window niche and membrane. Once it is established that the round window niche is not blocked, the medication is injected into the middle ear space through the incision in the eardrum. The incision in the eardrum typically heals in five to seven days. Most medicines are suspended in another solution, such as Hyaluron, which results in a viscous, or syrup-like, liquid that is introduced into the middle ear space. This helps maintain the medication in the middle ear space, adjacent to the round window membrane. If the medication was not suspended in such a material, it could drain down the eustachian tube and into the back of the throat. The patient is then instructed to lie down with the operated ear up for three hours. Depending upon the medication used and the ear disease being treated, the perfusion is usually done on a daily basis for several days. A gel pad may also be placed on the RWM that is soaked in Lido / Dex.

The main failure modality of this procedure is the inability for the perfusate to enter the RWM because of various types of potential obstructions. Just injecting the medication combo into the ear with a needle will have a high failure rate....as high as 90%. Most ENTs are not experienced enough or do not have the equipment to properly do this procedure. If the ENT does not have a laser and an otoscoptic camera they are not qualified. Two laser holes need to be made in the tympanic membrane. One for the camera and the other for instruments and tube used to fill the inner ear cavity with the medicine combination.

If your ENT is not doing it this way the chances of failure are quite high.

 

I am considering doing another round of lido/Dex treatments in an effort to gain an additional lessening of my tinnitus. In Israel it is common for soldiers to have this treatment twice a day for a month. And effectiveness is quite high.

One note: If Lidocaine in the inner ear stops the ringing this is a definitive diagnosis that ones tinnitus is originating in the cochlea. And not , TMJ or a pinched nerve or some other causation. This is important to know. Why? Because if it is certain that the tinnitus is originating from cochlear damage then a certain solution could be elected. If a person so chooses they can have a procedure where a chemical perfusion is done on the ear whereas the perfusate destroys are cilia and the hearing nerve (the hearing and vestibular action is lost). You will be forever deaf in that ear. This option is only realistic if a person has good hearing in the other ear. If a person has ringing in only one ear and testing reveals the other ear is not damaged (hearing well above 8000hz) then chemical destruction of the inner ear in the effected ear is an option.

 

But I feel dizzy for about 5 hours after the injection, the ENT said, if the medicine hasn't entered the inner ear, it cannot be explained that I experienced the dizzy so long, because it must be the lidocaine to influence the vestibule that I could got so long dizzy, how about that, do you have any idea? thanks a lot

 

I don't think using a needle will have such high failure rate. AM-101 is being administered through a needle.

How is AM-101 administered?
http://www.aurismedical.com/p/therapies/am_101.php

AM-101 is administered by intratympanic injection, a slightly invasive and safe procedure that has been known and practiced by ENT doctors for several decades. For the injection, the eardrum is first locally anaesthetized, then slightly perforated with a fine needle through which the drug is administered into the middle ear. During the procedure and for 30 minutes thereafter, patients are lying with their treated ear up. This shall allow for maximum contact of the drug product with the round window membrane - it is throgh this very small membrane that AM-101 then diffuses into the inner ear and reaches its target. After the resting period, patients get up and can go home.

 

I think no ENT could do that destroy for you except the ear with ringing is deaf or nearly deaf, actually, my situation is like you described. Perfect left ear with nothing wrong, and ringing in the right ear, with slight hearing loss about 10db in 4k and 5db in other frequencies, which means the right ear is also a "good" ear except the tinnitus. In this case, no ENT in the world could do that destroy procedure, since I considered that kind of extreme option long time ago, but nobody will do that for you. If this could be done, then everybody could do a cochlear implant to solve the T problem since so many reports of CI indicate that CI is quite a good way to cure or improve the situation of tinnitus. But why we can't take CI, because we are not deaf or nearly deaf in that ear.

After the lidocaine injection, my tinnitus changed for about 2 minutes, which means my T is originating in the cochlea, yes, I know that, because I got T by trauma, exactly at the cochlea. This is a good thing for me, at leat I confirmed that my T is in cochlear but not something wrong with my brain.

Anyway, good luck to your second treatment, keep us updated, thanks a lot.

 

I went to the Shea clinic about 4 years ago and blew several hundred dollars there..Desperate people do desperate things and I was one of them..It was one of the worse experiences I have ever had in the "medical" field including anything even not related to tinnitus.

If it looks like a duck, walks like a duck and QUACKS like a duck......well I guess its a damn duck.

 

You're damn right it is!

 

I am not a native speaker of English, but base on my poor English, I definitely understand this sentence and can't agree with it more. I really love this sentence, seems that we find another duck here in TT

 

Post script to my previous post. I have never mentioned the fact that I visited the Shea clinic before on this forum. It was not something that I would recommend as an effective treatment for tinnitus and in reality was an experience that I wanted to forget. However since the subject has come up I will elaborate on my experience.

I did my homework on the clinic and the procedure and convinced myself it was worth trying. Key word here is "convinced myself" as desperate people often do.

I drove about 500 miles and stayed in the nice motel which is I understand also owned by the same people who own the clinic. I didn't even have to get out in the snow since a enclosed walkway joins the clinic and hotel.

My appointment was for 8:30 am and I was early. The waiting room will hold about 100 plus people and has a huge TV screen to keep you occupied. I do not recall over a dozen or so people being there. Between 8 am and noon I was given a audiogram and that was that..Sometime about 1 pm I finally got to see a young doctor who appeared not old enough to be out of high school. In the 20 minutes or so I was allotted with him, he spent most of the time outside the office on his cellphone. He had a "don't give a damn" attitude and knew no more about tinnitus than the average ENT we all have seen.

We had a brief discussion and I mean brief about the lidocaine injection process. I had already done my homework and he added nothing to what I already knew. I of course had to sign the usual paperwork saying that I would not hold them liable for anything.

I was surprised to learn that my insurance would pay for most of the procedure but I would still have a upfront payment of about $800. This of course must be paid before anything could be done.

Some where about 2 or 3 pm I and a couple of other people where finally started on an IV solution of Lidocaine and whatever..Lidocaine is deadly in the wrong dosage but I do not recall either of the two nurses or whatever they were ever checking my vitals. After the IV drip had finished I was wheeled into the "operating" room where an injection was made into my inner ear. I remember a cold feeling and a slight taste in my mouth most likely from drainage. I had tinnitus only in one ear at that time so the procedure was limited to just that ear.

After a few minutes of lying down I was released to go back to my room and told to report back at the same time the next day to repeat the procedure. I felt a little light headed after the first procedure but I do not know if that was from the medication or just not having eaten all day. The IV needle was left in my arm.

2nd day same procedure except I did not have to wait all day..NO CHANGE in tinnitus. Just the usual assembly line treatment procedure.

3rd day sometime early in the morning and after no sleep and at which time my tinnitus seemed much worse due to the treatment or stress, I went crazy. I did not know why it was worse but it was and just perhaps it was because of the treatment. I woke my wife up and told her to pack. I wanted to be out of this place now. I stared to pull the IV needle out but decided if I did my insurance might not cover the 7 grand or so if I did..I managed to calm down and reported for my next appointment. I told them to remove the needle as I was refusing any further treatment. They did not want to remove it but it was either they do it or I would do it.

I was out of the Shea clinic and the Memphis city limits within 15 minutes. The only thing I got for the 7 grand or so my insurance paid was the "free" breakfast at the hotel. For 7 grand they ought to let you stay in the hotel for free but double dipping is fair game for desperate fools such as I.

Today my tinnitus is worse than it was then. Perhaps the treatment had nothing do with that but then again no one can say.

They even had the nerve to call and want me to come back..I told them to schedule me on the same day they started serving ice cream in Hell. I have never heard from them again.

 

You were dizzy after the injection because of the temperature difference between the lidocaine and the inner ear. The ear is sensitive and this caloric reaction is normal. The lidocaine also shuts down vestibular function and manifests itself with an off balance sensation. Both conditions will subside and are to be expected.

 

Neither Lidocaine nor Dexamethasone are substances that are known to increase tinnitus in a patient. It is more likely that your anxiety created the perception of some increase in your tinnitus. It is unfortunate that you did not finish the treatment. I'm not sure why you chose to discontinue in the middle of being treated. The objective is to saturate the cochlea and this can not be done in 1-2 sessions. It's like a sponge and takes some time to absorb the perfusate and raise the concentration levels to therapeutic levels.

 

Is your ENT doing only an injection of Lidocain? The lidocaine itself will not help. The lidocaine is used with dexamethosone and 3 days of IV treatment to raise the concentration levels in the blood stream. If it's just an injection of lidocaine it will do nothing.

 

High failure rates are to be expected with a puncture type single injection point. The RWM can be anatomically blocked with tissues, fats or other types of obstructions. If the ENT does not "look" in the ear at the RWM then it's just a chance that the procedure will have any effectiveness. The RWM MUST be verified clear (or made clear) prior to injection of anything. If the RWM is blocked or semi blocked then access to the inner ear is impossible.

 

Shea Clinic deffo has MEWISEMAGIC in their pocket ... they probably pay him??

who else would only write about this and know that much ?

LIKE THIS POST if ya think he is not what he seem !!

 

Yes, the temperature is an issue, but it cannot cause 5 hours dizzy. Because the temperature effect could only last for less than half an hour, my ENT mentioned that. I mean only when the medicine had entered the inner ear so that the dizzy could last so long. If the lidocaine hadn't entered the inner ear, then how could the vestibular function shut down? So the lido entered or hadn't entered?

 

If the tinnitus is caused by head injury, lidocaine will definitely increase the patient's tinnitus, this is a common sense among all the ENT in the world

 

I did the IV injection at the same time for 3 days. I did dexamethosone in 2012 when my T onset about 2 months, and that only increse my T level, so this time I just inject lidocaine and IV lidocaine as well. At least for me, nothing happened except temporary reaction. This method is very old and classical, I found some Japanese doctors did that in 80s, and my ENT also did it 90s, he said it works, about 30%, at least I am not the lucky one who got the fantastic effect as you, wish you be cured soon!

 

This is not a true statement. Tinnitus caused by a head injury will not increase with a perfusion of lidocaine. There is no physiological reason for this to occur.

 

Initial dizzyness upon injection of lido/Dex is temperature related and can last up to an hour or more. 5 hours of dizzyness indicates vestibular shut down from the medicine.

 

Ask your ENT if he has verified that the RWM is exposed prior the injection. If you don't see him using a video scope with a large flat panel display then he can not verify the RWM is clear. So it could be the reason you are a non responder is an incorrect method being used.

 

This treatment protocol was developed long before Shea/Ge started using it. It is proven to be THE ONLY medical "non scam" procedure that may work, when done correctly. The Japanese started using this procedure enmass with Sakata and Itoh performing well over 5 thousand of these procedures in aggregate between them.

Shea Clinic has performed over ten thousand of these procedures.

Just because it does not yield a 100% response rate does not indicate the procedure is not without merit.

 

My ENT told me that about half of his T patients had improvement after intratympanic dexamethasone injection.
I think this treatment is really worth a try, not necessary at Shea's.

 

I think this point is right

 

Yes, but IV lidocaine will increase the tinnitus caused by head injury, I don't mean the local perfusion