Repeated Modified Nerve Blocks and Auditory and Non-Auditory Nerve Stimulation

Good luck my friend.

Thank you for your courage which in turn is giving us all hope.

Be strong. We are all behind you.

 

I'm posting this link here. Maybe someone can give insights! Is it similar or different with what they do in South Korea?

Effect of ultrasound-guided stellate ganglion block combined with acupuncture in the treatment of nervous tinnitus and earache: a case report

 

I was just confused because some places give SGB to C2, C3, C6 area... I have seen a chart on occipital nerves.

 

I was asking if anyone knows if these SGB blocks can help with subjective tinnitus or help reset the amygdala (fight or flight response)? The article itself says it can, and resetting the amygdala can help lower subjective tinnitus!

 

Just to say that I don't think this has much to do with the South Korean clinic treatment. Those are repeated treatments with small quantities of lidocaine, these are much more massive blocks that require imaging and can't be done without significant imaging equipment I would guess, but I haven't read the paper, I may be wrong.

 

Where was this done? China? Looks quite similar to this process.

@Chinmoku, they used 2% Lidocaine I believe.

 

Yes, it is China, looking at the article. I knew SGB can be used for pain, yet they say it helps with tinnitus as well and resets your amygdala.

 

Thanks, @Chinmoku, for all the help and detailed information. You’re giving everyone great insight into this treatment and its process. I saw imaging tests were brought up. Are they loud? Not MRI type stuff, I’m guessing.

 

2% indeed is more standard. The Seoul clinic uses 0.5%.

 

Yep, that's what I thought. I believe you stated that the lower dose removes any risk of ototoxicity. Do you know if there is any other reason for it? I am guessing you could always ask for a higher dose and see how they respond (if you have not asked about that already).

@ELA, SGBs are used to reduce signalling/kill off neuropathy - there are a couple of threads on here on SGBs and Lidocaine. I don't believe they always work and Lidocaine appears to generally provide temporary amelioration of tinnitus when it does. This technique combines nerve blocks around the ear and the effect of using needles to stimulate/reset the signal. I do not recall seeing anything about resetting the Amygdala, but wouldn't that be a joy!

Hope you are doing ok @Chinmoku.

 

I understand what you are saying, only the article I have posted above says otherwise! SGB and those acupuncture needles to reduce subjective tinnitus, plus resetting the amygdala. The procedure is made in China and seems similar with the South Korean one, but even they don't quite specify how exactly the acupuncture needles work, just the results. So I was left wondering. In the Western medicine it would be easy to work out the nerve block at least.

 

What do you mean? (I did not see any direct reference to the Amygdala in the article.)

 

I had a unilateral SGB done (on my worse side) on the basis of that paper from China, with 5 days of acupuncture after it. The SGB was ultrasound guided with a neck X-ray also taken prior to the procedure. Took ~10 minutes of them inserting a needle into my neck to find the right place. Felt very calm and relaxed for a good week after the SGB but had no real benefit to the tinnitus (aside from the mood/habituation benefit of being relaxed).

Couldn't do multiple SGBs unfortunately (too expensive in the US, plus doctor unwilling to do it repeatedly without more solid evidence) so I wasn't able to actually replicate the Chinese paper.

Who knows, maybe repeated blocks would've helped. But just one SGB is unlikely to do anything.

 

They are more prone to vary the volume than the concentration. They inject from 0.5 mg to 1 mg depending on the patient severity, but always at 0.5% concentration to avoid ototoxicity. I have seen volumes of 0.7 mg for example.

 

They seem to do some special acupuncture in these Asian countries. Was yours just normal acupuncture?

 

It was with a normal acupuncturist (American lady, trained in Chinese acupuncture) - but we did the exact same points around the ear in an attempt to replicate the Chinese case study.

 

The idea is primarily to improve if possible but also to provide the community with information. Unfortunately we are left with no choice but trying things across the world, given the glacial times of research in EU and US.

As for imaging, for Sirh clinic, they only X-ray you the first session. It's not loud.

 

Thank you @Chinmoku for your decision and bravery and paving the way for a possible tinnitus treatment.We know you are a trustworthy member of the forum. Your luck can be our luck. We all support you.

 

Last in the class again.

I'm still trying to get my brain around this latest treatment.

For yonks I more or less assumed that the tinnitus problem -- and its solution -- lay in the cochlea somewhere.

Then some people responded to sound and relaxation therapy -- but still had their tinnitus -- and from this I more or less accepted that the problem and the solution could be on the brain side of the cochlea somewhere.

But this one beats the band. If I have it right, it's treating the facial nerves with Lidocaine?

Well as you know, the proof of the pudding lies in the taste. If it works for a certain number of people, then fine, then it sure ain't placebo.

 

These particular nerve block procedures carry biological risks and tinnitus could also become much more severe.

 

Can this worsening be reversible?

I also found 2 articles posted by you about cervical nerve blocks. Can these carry the same risk of worsening?

Cervical Nerve Projections to the Auditory Pathway in Tinnitus

The eight cervical nerves and its role in Tinnitus

Can Deep Brain Surgery carry the same risk of worsening, for example? I'm very confused really, especially at the thought that a neurologist wouldn't know about it and be careful who and how to administer the surgery?!

 

SEOUL STIMULATION/NERVE BLOCKS TREATMENT – SECOND REPORT

Again, as a service to the community, I would like to give an update on the situation, as it has taken an unexpected and somehow unfortunate turn.

Let me preface this again by saying that everyone at the clinic is extremely kind and professional, patient, and they go well beyond what would be a normal clinic hospitality in helping patients.

I have done 6 sessions overall, so it would be normally early for an update, but as you read on you will understand why I am updating this now.

First, I have to say that my tinnitus has been elevated after every session, but differently from Bryson, for example, it hasn’t gone down the day after, it remained up. This is something typical of my tinnitus, it only goes up, no matter the reason. The clinic doctors have data showing cases of sustained elevation that however drops toward sessions 7-15, depending on the severity and other factors. According to their data, the sustained elevation comes down every single time given long enough and is never permanent. The paper mentions no permanent worsening either. However, by session 5 my tinnitus had become unbearable. I mean, when I arrived in Seoul I had very severe/borderline catastrophic tinnitus, inducing dark thoughts – let’s put it that way – often, but not all the time, there were still rare rays of hope, and I could still find rare moments of peace. After 5 sessions, this has become louder, more intrusive, dark thoughts 24/7, hell on Earth, I can’t think properly, can’t sleep or nap, except on benzos, I spend my days in misery, walking around blocks or hills to avoid going mad, but when at home I lay in bed shaking, can hardly eat, nausea etc. Now I could insist and keep going, waiting for a hump at treatments 7-15 to materialize, but this is simply too much, I can’t take any more worsening. With the clinic we tried alternative types of nerve blocks at session 6 that could bring the elevated tinnitus down, so as to open other options to continue treatment, and they are open to adapting their protocol to the patient evolution and quite professional about it. So far session 6 has not helped the tinnitus loudness or pitch. However, we have to recall that even in the paper, about 13% of people didn’t benefit from treatment. I could easily be in the 13%, as according to a quick tinnitus matching test, they noticed I am among the worst 3-5 patients they ever had. The problem is the worsening. I can’t handle it. Surviving this hump is beyond my forces, I already struggle to keep going as I am, and I am alone in a country where very few people speak English. Again, the clinic goes beyond their duties to help, for example they booked me an ENT who spoke English and checked my ears and cleaned them manually, and then proposed some medication, they helped with schedule changes, they even give you vitamins and food, they are very caring and polite, and when you ask questions, they can talk to you for 40 minutes easily without charging a cent. They even write to you by text if you have questions. Also, their dexterity with the needles is excellent, there are times I can’t even feel the needle insertion. But - and this is what I’m getting at - if you are already very severe, and can take little margins of punishment, be very careful. The paper claims that usually, by session 4, you get an idea of cases that will benefit and cases that won’t, but then in later interaction the clinic says that you may have to wait sessions 12 or 15 to see that, especially for chronic difficult cases. What I’m saying is that if someone is extremely severe, like me, they might not make it to session 12 or 15.

At the moment I’m in a kind of limbo, trying to decide what to do next, there are a few options but for all of them I need to gather the strength and resist this impossible torture to keep moving. It’s very hard.

I’m probably the worst patient they ever had in terms of impact, so I wouldn’t want to discourage people from trying this. The paper results are still astonishing, with 87% people improving with an average improvement of 7/10. Even accounting for some self-selection in the patients, given that this is a pain clinic and not an ENT clinic, it seems worth a shot. As I said, I’m uncertain about the next steps, but I may post a further update later.

Chinmoku out from Seoul.

--- END OF SECOND REPORT FROM SEOUL ---

 

Very interested in this, in the light of my second report above. When you feel like it, Greg, could you elaborate?

Also, do you think the worsening could be permanent? Lidocaine impact is temporary usually and they use very low concentration (0.5%) and dosage (I got 0.5-0.7mg). Is it the needles that could cause worsening? Would this be permanent? The doctors there have decades of experience with needles but we know tinnitus is a strange animal, defying all logic.

 

Oh no Chinmoku! I had so hoped you would benefit from this. My heart goes out to you!

Still thank you a lot for your detailed report. I sincerely believe that it will be of help to many tinnitus sufferers.

May you be well.

 

@Chinmoku - I am really sorry to read about this. What are you thinking about in terms of options?

I think the study had a doctor working out of a hospital there listed as a co-author. Might you ask if that person, or a neurologist/neurotologist could see you and run some tests?

What are you doing in terms of benzos? Same? Increasing a little for some relief?

Hang in there. I really hope it will pass.

 

At the moment I'm too ill to think clearly. I will wait a few days to see if this madness lets up a little, then I need to decide what to do.

I did see a neuro-otologist, but they don't know more about tinnitus than their colleagues in the UK etc. Same medications, same suggestions, same powerlessness.

Benzos I don't know but I feel I may have to increase. Unfortunately this never helps with the tinnitus, it might even make it worse, but it helps with sleep and being a little more calm.

Really bad luck all around.

 

You'll get there, man. And whatever you decide it'll be the right thing for you to do at this time.

 

Man, I'm sorry for this. All worsenings eventually settle and stabilize more, even though I understand this does not feel that way. I can imagine that this entire experience, including 12 hour flights, train/metro, to get to Seoul, walking around, eating, supermarket etc must have been extremely stressful and tinnitus elevating 100%, not only the nerve blocks. I'm confident you're peaking and it will settle. These nerve blocks do not cause hair cells to die, it does not cause hearing damage on previously weakened hair cells (makes no sense if it would), so hang in there.

 

It is, yes. Do what you feel you need to find some relief. It may be worth pushing through and trying a couple more treatments to see how you get on.

Try to rest a bit. We are with you. Hopefully it will pass.

 

David! I am so happy to read of your improvement. Mine has also improved in 2.5 months of using sound generators. I hardly protect in normal settings now. Let's keep up the good work!