Steroids: Prednisone / Dexamethasone / Others (Oral and Injections)

This is how I used prednisone

First off I got T and some hearing loss at a long shooting session with large bore rifles and machine guns - and that on top of decades of loud clubbing and military service

While it won't fix older wounds I use it to prevent getting it worse whenever I am subject to new exposure

First off I did stock up some predsinone at home because it's only effective in the first hours or maybe 1-2 day and it takes 12 hours to build up in blood then the serum half life is about 3-4 hours so it's completley eliminated after 24 h

I needed to be prepared - no time for running and asking for it at the last minute , usually week-ends when offices are closed etc

I can either order on the web or just visit an ENT and fake the audiogram by pushing late on the high frequencies then keep the pills in the fridge those have a few years before expiry

What I did last time is to take 60mg as soon as possible after the loud noise - engine backfire - then 60mg the next day before 9am then another 60mg before 9am the 3rd day. It's proven that higher dosages early on are going to be most effective that's why the best method is still a direct intra-thympanic injection if you have access to.

For a 3 days course only I did not taper down i just stopped cold turkey and felt a bit groggy and tired for half a day on the 4th day but that's just me other people may get other reactions.

Check with your doc first of course.

Dont use if you have diabetes or infections
Watch the diet as it will spike sugar levels

For me the only side effect is a noticeable difficulty to sleep well. Previously I was on two 15 days taper down courses as well. I had a doc prescribe it to me before so I felt confident self medicating on the 3rd time .

 

Hi,
I'm new to T due to acoustic trauma (dentist drill). Very loud 12khz in my head. Can't sleep nor concentrate.
I don't think I have hearing loss (not more than before.. it seems acceptable).

I have an ENT appt for next Tues, 4 April.

Please, Will you help me identify in this short time before my appt what potential drugs/steriods I should ask the ENT about that might be beneficial if taken now (at 3 weeks since trauma/2 weeks since T appeared)?

I fear I missed the window.

1. Here's what I read in this thread... anything else?
2. Also, I'm sensing injections are not worth the risk of hitting the ear drum? Is that correct?
3. Am I right in that it sounds like the best oral alternatives are:
   • Corticosteroids
   • Prednisolone or Prednisone

• Betahistine Mesilate https://www.ncbi.nlm.nih.gov/pubmed/16848175

• Betahistine https://www.ncbi.nlm.nih.gov/pubmed/21860977

• Intratympanic prednisolone https://www.ncbi.nlm.nih.gov/pubmed/20735183

• trimetazidine, prednisolone https://www.ncbi.nlm.nih.gov/pubmed/11318462

• corticosteroid

• intratympanic prednisolone vs. dexamethasone injection https://www.ncbi.nlm.nih.gov/pubmed/19160857

• dexamethasone (a corticosteroid)

• cortisone (Medrol) https://www.tinnitustalk.com/thread...ers-oral-and-injections.348/page-2#post-69512

 

@JimChicago he will probably give you prednisone as that is the most used steroid. Ask him about dosage and try to get a starting dose of at least 60mg. Hopefully it reduces the tinnitus for you!

 

@JimChicago also rectongize that even if the prednisone doesn't eliminate the tinnitus entirely you will get used to it over time. The reason you are having so much trouble is due to your brain interpreting the noise as a threat because it's new and unusual. But if you are able to not stress about the sound, and do your best not to focus on it this will help your brain get used to the sound and it will not be as noticeable to you. This is called habituation. I wish you well and try to stay calm. If it's causing you serious anxiety try to get a prescription for clonazepam

 

I've had T that was onset from ETD for almost a month and a half now. I've done my best to reduce loud noise exposure and protect my ears. Today at work someone let a relief valve of air off somewhere near me and it was a little loud.

The ringing seems louder. I had a mental breakdown when I got home, the worst I've ever had, and what I'm wondering is if it's just me stressing and noticing it more that's making it louder or it was that jackass with the air gun. I've heard that Prednisone if taken within a certain amount of time can help if it is acoustically related. Would this be worth going into an urgent care tomorrow morning?

My ears have been acting up all week and I have an ENT appointment on Friday since the spray isn't helping much.

Someone please help. This is like living in a bad dream.

 

@LukeT130 doubtful that an urgent care would prescribe you a steroid unless it was clear you needed it. I would try to get the ent appt moved closer and ask him about a steroid if I were you. Also try to get a prescription for an anti anxiety drug like clonazepam if you are having serious anxiety as it seems like you are. Ask a psychiatrist or your regular doctor if you can. Good luck

 

You have to use the nasal spray properly (have a look at the video I posted in my thread in success stories) Have patience, it takes a long time. Mine took nearly 6 months to resolve. I strongly believe that I had T because of ETD. I no longer have it. Loud noises wouldn't bother me at all. it actually helped me to die down the volume of my T. That is why I did not wear any protection for the whole period. Strange but true. I guess that is because my T was not sound induced.

 

My ENT surgeon said, within 24-48 hours this treatment will be effective.

 

I've been taking the prednisone for 7 days and haven't seen improvement. In fact, I'm pretty certain the pitch and volume has increased. (This could be due to my being exposed to more loud sounds since the tinnitus onset.) I'm thinking maybe I should just get off of it.

Any thoughts or ideas are greatly appreciated

 

I was given a 7-day supply of prednisone at the emergency. This was about 10 days after my acoustic trauma. I didn't see any improvement. About 17 days after my acoustic trauma, when I finally got to see my ENT, he did NOT renew my prescription. Since the standard course of prednisone is 14 days, I really wish I were given a chance to finish my course of prednisone...

 

I hope these studies will help someone with recent onset (less than 2 weeks, see the first study below) of T. You could also show these studies to your doctor, in order to convince your doctor to try this treatment.

http://journals.lww.com/otology-neu...Prognostic_Factors_for_the_Outcomes_of.6.aspx
"Tinnitus was cured in 43 of 114 patients (37.7%) within 3 months. The mean tinnitus loudness score, the mean tinnitus awareness score, and the mean tinnitus handicap inventory score were significantly reduced at 3 months after ITD. Audiometric responses were detected in 12 of 43 patients (27.9%) who underwent follow-up audiograms. The cure rate was significantly greater in patients with symptoms lasting for 2 weeks or less than in patients with symptoms lasting for more than 1 month (64.7% vs. 15.7%; p < 0.05)."

http://ejo.eg.net/article.asp?issn=...31;issue=4;spage=224;epage=230;aulast=Weshahy
"IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic tinnitus. The tinnitus may not disappear, but will be alleviated, enabling the patient to cope more easily with the disease, and thus reducing their handicap."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5169077/
"Whereas in the acute stage it is recommended to initiate high-dose cortisone therapy (with moderate but however existing evidence) in analogy to the treatment of sudden hearing loss,"

Oh, how I despise my ENT... I visited him within days of the onset of my T, and evidently he knew nothing about the studies above...

 

I had the option to do IT steroids within the same week of my tinnitus onset, but because of scheduling conflicts and not knowing any better I decided to hold off on doing them. A few weeks later I was enrolled in the AM-101 trials so I could not do them. Even a year later I regret not trying it the day I was offered. It's a hit and miss, but still worth trying if done early.

 

Neither of those studies had a control group, so I don't understand how they show anything at all? That is, they took a bunch of people with tinnitus, injected them with IT steroids, and.... some of them got better and some of them didn't. At a glance, the percentage of people who improved looks pretty similar to a number of other studies about the number of people who improve from tinnitus onset with no intervention at all. Because of such confounding factors, drug trials which aren't placebo controlled and double-blind are pretty useless for anything aside from Phase I/II safety studies.

I have spent a fair amount of time looking into this, and I have not been able to find any studies which show a statistically relevant positive effect and are also:
* large sample size
* placebo controlled
* single or double blinded

Are you aware of any such studies? I'd love to be wrong about this, because steroids are relatively cheap and well understood -- but people have been stabbing at this for decades, and yet there's not a single study which meets those criteria...

edit: I think I may have seen one study from either the US or Israeli military which did meet these criteria, but the effect was pretty modest and the window for any effect at all was some short number of hours following gunshot noise trauma. That would still be pretty interesting if it's really true, but it hasn't been replicated anywhere that I'm aware of. The Israeli military has a similar and probably more compelling study about the effect of magnesium supplementation on noise trauma... but to get the positive effect, soldiers were taking the supplement prior to the noise trauma. That fits in pretty well with what we know about the role of NMDA in excitotoxicity, but the takeaway there is just "eat lots of green leafy vegetables" (high in mag) which is sort of basic life hacks 101.

 

I'd agree, if this was non invasive and completely benign, but it's not. I have read a good number of threads over the years from people who feel like they were substantially harmed by IT steroids. I can probably dig some of them up if anyone cares, though, anecdotal data is not great conversation fodder.

 

Good point...

 

Yeah :-/ The thing that really drives me nuts is I can't actually find a single study where they even attempted to look at this with placebo control. I know there are a number of places in the US (and maybe abroad) which offer this as treatment -- but no one's even tried to A/B test it? As these things go, this would be a relatively inexpensive study, just take the next 100 early-onset tinnitus cases that come through the door, offer them a chance to be in a trial, give half of them dexmethasone and the other half an inert injection, and then track outcomes.

Because this idea has been around for a while, it seems unlikely to me that no one has ever tried to do this -- but if they did, and they didn't publish results, then it sounds like it didn't work very well?

I have seen sporadic anecdotal reports from people who think it did help -- in some cases, even after long periods of time -- but there are also horror stories out there. And, anecdotes are even worse than studies without controls.

I think this is exactly how the AUT0063 studies were done, so at least that's basically rigorous science, but it sounds like the results haven't been great. I'd also like to see some studies on trying to use IV ketamine for chronic tinnitus; if it truly has something in common with CRPS, and CRPS responds to ketamine, then it doesn't seem impossible that it might help some subset of the tinnitus population.

It's maddening, if the ATA would just bankroll a few studies on the obvious things that people always hear about and want to try, at least we could get some actual data about whether or not they work and what the risks are. Urgh. All these drugs are old and cheap, and there's not much money in them unless you can come up with some proprietary formulation (which was what AUT0063 was, basically -- a slightly tweaked ketamine molecule in some magic gel that dissolves slowly)

 

Ridiculous! Especially if it is the case that this treatment is actually effective.

Well, what can one expect, if they haven't even studied what fraction recover spontaneously? All they would have to do there, would be to contact 300 patients say a year after they visit their ENT complaining of T, and ask them whether they still have T, and if they do whether they had noticed any improvement and the month the improvement had taken place.

 

I think there are some decent studies on that, I can look and see what I've got in my stash of papers when I'm back from travel this week.

My own interests have more been in understanding the neurological correlates of tinnitus intensity and distress, though I will admit that I got to a point where I decided on a strategy for myself and sort of stopped looking. But, I think the short version is that most people show some improvement in the weeks following onset, and some people recover entirely (but may still be more predisposed to tinnitus in the future, especially if there's additional noise exposure). As for correlates, people with loud or distressing tinnitus seem to show reliable brain changes (and loudness and distress, though related, actually seem to arise from different brain regions -- which makes a degree of sense, given that some people are suicidal over relatively quiet tinnitus, and others describe very loud tinnitus as merely an annoyance). The question is the degree to which those changes can be reversed without actually fixing the hearing loss -- I think there's reason to believe that distress is easier to interact with consciously than actual volume, though the latter may also be possible, at least for some people.

 

Was that from the steroids or the procedure? I had 18 total injections with the AM-101 trials and suffered no ill effects.

Well that isn't entirely true, I had suctioning done one time in one ear and that gave me a new tone that was loud for about an hour then went into the background then faded away completely after a couple of weeks. I feel that IT injections are relatively safe when done by a competent doctor if they just use a dab of phenol and don't suction.

I do agree that there is shaky evidence that they help, but in my opinion it's worth a shot if you have a severe acoustic trauma. My new ENT told me he could do them and offered to, I told him if I have sudden hearing loss or another acoustic trauma like the first I'd take him up on that offer.

 

Please do.

All I could find were the studies I listed in
https://www.tinnitustalk.com/threads/spontaneous-recovery-stats-over-70-recover-3-studies.21441/

 

I see what you did there...

 

I have had tinnitus 3 times in my life all due to acoustic trauma.
1st time was in high school , where i got really bad ringing for a week after clubbing
2nd time was before 9 months where i visited a concert without proper hearing protection and the ringing lasted for over a month BUT I was in a great mood at that time , and paid nearly no attention.
3d time was before 2 weeks..

I went to a club again (no protection) , and the morning after the ringing hadn't gone away. I gave it another day to go away , it didn't. This time my tinnitus was about 6/10 . Acting quickly as I had educated myself in the past about tinnitus , I got on prednisolone. Day one on prednisolone no difference , I took 25mg a day.

Two days later tinnitus lowers to a 3/10 (manageable). I continue taking prednisolone in a lower dose , until day number 7 , tinnitus has come down to a 1/10. Since then 7 days have passed , and I've only taken a 5mg dose the second day. My tinnitus now is i'd say 0.5/10 I can't hear it when I'm outside , or inside talking to someone. I can only hear it at night and it doesn't bother me a lot.

Now I've been 5 days without medication and my T ranges from 0.3-1/10. I only got one spike for about an hour or so. I believe this was not a placebo effect , due to the fact that I am way to anxious to have faith in anything. My T was in around 800-1200Hz in pinch.

RULE NUMBER ONE FOR T : DON'T THINK ABOUT IT , GO OUTSIDE ENJOY LIFE , AND THINK THAT 99% OF T EITHER GOES AWAY OR YOU HABITUATE. WE HUMANS ARE MADE TO HABITUATE TO EVERYTHING.

And trust me , you haven't been to my position. I have both T and severe eye floaters , no job , and still studying. And I managed to get over a 6/10.


NOTE MY TINNITUS WAS CAUSED BY AN ACUTE ACOUSTIC TRAUMA , PREDNISOLONE IS NOT FOR EVERYONE.

 

I am glad you are feeling better.

It doesn't necessarily have to be a placebo effect; we have no way of knowing if your hearing would have recovered to the same extent or not without the steroids. This is why double-blinded controlled studies are the gold standard of evidence based medicine.

 

What is the window for this to help? I'm just wondering since none of the pro's even mentioned prednisolone. I'm 9 weeks on now and probably to late for this?

 

Some sources say it is the first 48 hours, some sources say 2 months, some sources say 3 months...

 

Bill, have you find any double-blinded medical studies or professional studies about prednisone use 2 to 3 months being useful beyond onset?

If one has an infection, Prednisone I guess could possibly help. With my first onset of tinnitus, it would help for a day or two after months, but then My T would go back to baseline. I would take a very small amount for 2 days or so. I think why it helped me, is because my ears have cell and nerve damage from noise being placed directing into my ears - syringing.

 

I found
http://www.tandfonline.com/doi/abs/10.1080/010503901300007461


Here is a good 2012 study
http://www.neurological.org.nz/sites/default/files/Current pharmacological, Langguth and Elgoyhen (2012).pdf

"Summarizing, there is consensus among clinicians that acute tinnitus, especially if it co-occurs with acute hearing loss, deserves specific attention and that there might be a short therapeutic window for specific pharmacological interventions. The most widely used treatment strategies are intratympanic or high-dose oral steroid administration. Apart from steroids, there are yet no treatments available which have shown repeated efficacy in controlled trials"

Actually, the paper above is very informative - it lists many studies of existing medications that seem to have demonstrated some success in treating T. Is there a way to make this study available to others on this site, who might not happen to read this thread? There needs to be a separate thread summarizing the successful studies listed in this paper.

Damn!!!!! Why am I only seeing the study below now (when I am 4 months in, and it is probably too late for me)?
https://www.researchgate.net/profil...e_Tinnitus/links/565d2d6508aefe619b2550d7.pdf
Objective:
To determine the prognostic factors for the outcomes of treating acute subjective tinnitus with intratympanic dexa-methasone (ITD) [Dexamethasone is a type of corticosteroid medication.]

"Results: Tinnitus was cured in 43 of 114 patients (37.7%) within 3 months. The mean tinnitus loudness score, the mean tinnitus awareness score, and the mean tinnitus handicap inventory score
were significantly reduced at 3 months after IT"

"The cure rate was significantly greater in patients with symptoms for 2 weeks or less than in patients with symptoms for more than 1 month (64.7% vs. 15.7%; p<0.05)"

Why hasn't my ENT suggested this treatment?!?!! I was at his office within a week of onset... This is a 2014 study...

On page 10 of
http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=569300b6-9b36-4352-84b6-ed16c2ca5823
"Treatment with oral steroids alone offers limited benefit; they are more beneficial if given within hours to days rather than weeks after the injury. ... Often, however, there is no appreciable improvement in symptoms such as fullness, tinnitus, or hyperacusis. These symptoms may decrease over time, but improvement typically occurs months to over a year."

 

I have tinnitus without an auto-immune disease, where if I did, very low doses of prednisone could be given. I always have a slight amount of fluid in my ears and ear aches. Just 1 mg or one-tenth of a 10gm tablet of prednisone daily over a period of several weeks helps. I've done this a couple of times, months and years after my first onset of T and it slightly lowered the T in my right ear where I have less of a hearing loss. It's doesn't permanently help, as my ears have weaken nerves from ear syringing. But it does help while I'm taking the very small amount of Prednisone. I think it helps me because of the weak nerves and fluid while I'm taking it.

Don't take prednisone on your own. Always consult a doctor before use. Although if I come across a loud noise trauma situation, I will grab my bottle of prednisone.

I wonder how Markku's T is doing, since his cause of tinnitus is listed as syringing. Although I attained more damage recently from a dental visit.

 

My ENT suggested only ginko biloba....I took it by myself

 

Check out
https://www.tinnitustalk.com/threads/my-tinnitus-is-completely-gone.16169/page-5#post-219222
If you live in North America, search for "ginkgold" on that page.