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

I am generally sceptical towards steroid injections as a simple lumbar puncture resulted in huge inflammatory reaction in my spine, however I am considering orals. But I think that even if I opted for a injection I would not be able to find a qualified doctor to administer it in my country.

 

Intratympanic injection = injection via the eardrum; this has nothing to do with a lumbar puncture. Lumbar puncture cannot be compared with anything else, and anyone getting a lumbar puncture would experience some kind of symptoms post intervention.

 

I know but it just seems like they are using steroids for everything and anything with quite aggressive treatments. I would not be surprised if there is some kind of steroid injection for lung cancer.

 

Steroids seem to be a miracle drug that treat a wide range of ailments but they are definitely not without risk. I honestly can't believe how often they are given out in the USA. In fact, prednisone is listed on the ATA pamphlet as both a treatment and potential cause of tinnitus.

I don't mean to say don't try the drug... definitely do if your doctor will think it can help your tinnitus. But do be aware of the side effects and if you have concerns speak with whomever is giving you the treatment.

My personal experience with corticosteroid is rather mixed. I've had numerous Kenalog injections for a skin condition, eczema, that flares up. This is a brand name corticosteroid and is one of the more common given out. I've also tried oral prednisone in the past for the same reason but I refuse to use it as when I tried it 5 years ago I had a huge spike for a month. Now, it could be that it was from something else and not the drug but I really didn't want to risk it. I never had issues with intramuscular injections until the last one...

3 hours after the doctor gave it to me my tinnitus started screaming and my anxiety levels went through the roof. Mood swings, unbearable stress, couldn't eat or sleep... nobody ever told me about this and yet a cursory Google search revealed this as a common reaction. I guess you can have new side effects to a drug at any time. Who knows if it was the induced anxiety that ramped up my tinnitus or any damage to my ear or body that the steroids did... it doesn't matter

It took about 2 weeks for my symptoms to calm down and my ear to reduce but it started up again a month later. I don't know if this new loudness has to do with my body being out of whack from the shot or from other drugs I was on. But, I know that the steroid injection definitely messed me up.

Again, I don't mean to say don't do this. In fact, I think you probably should if you fall in the category of people that will benefit from it but please please please look at the side effects first!

 

I have tried 5mg daily of dexamethasone and it decreased my tinnitus by 50-70% with almost no spikes at all. I am discontinuing it due to sideefects like joint pain and constant sweating which are becoming more crippling than tinnitus.

 

@Hengist how long did u use the dexamethasone for?
If it lowers your tinnitus, maybe a lower dose would have less side effects?

 

I started taking it a month after the onset and first took 2mg daily increasing to 5mg in next 3 days, after 3 days I noticed that my tinnitus is extremely stable and quiet, on the level that I can basically not hear it unless there is really nothing going on. After 2 days I notice that I wake up sweaty and that my skin is like 3 times more oily, I would also start sweating for no reason at all, even in relatively cold rooms doing nothing. After 3 days I noticed that my shoulders would snap and pop after almost every move, than my spine felt pain each time I would try to go to sleep, than I wake up one day and stand and my ankles hurt on every step, than I figure that dexamethasone is causing joint pain and I decide to taper down. Immediately I dropped the dose to 0.5mg (10% of that effective dose) and now, after 3 days tinnitus is crazy again with super-spikes and waking me up after 3 hours of sleep. The good thing is that there was no withdrawal symptoms like loss of appetite and stomach pain. With discontinuing that dose of dexamethasone also joint pain is slowly going away.

 

At least I had 3 days of semi-normal living.

 

@Hengist It's good that you tapered down. Those 3 days must have felt good.
I wonder if you overdid it a bit (dosage-wise) for those 3 days going from 2mg to 5mg.
Dexamethasone is a very potent corticosteroid, maybe you should try a lower dose for a longer period of time, your system might adapt better to the drug.
Also, as you might know, corticosteroids are anxiety's best friend. I would be rather skeptical about using such potent doses, especially before bedtime (I'd try taking my dose in the morning after a good breakfast and maybe after an early lunch). Just a thought...

 

I remember when I took cosrticosteroids for the first time.. I had like a day and a half T free.. I was 50% better mood and everything that day, just after I notices that it was quiet Took them few times after it but never really had it so quiet in my head from corticosteroids as that time

 

Hi, I have Tinnitus since 2005 in one ear. The other ear is perfect in hearing. Over the years I got used to it and it hasn't been a problem. It was mild and audible in quiet places. In public places, I could hear it if I concentrated on it. But last week, all of a sudden it increased. There were no warning signals. Also, I noticed considerable change in terms of hearing loss. So I did what most of us would do in such a scenario, visit an ENT specialist (Otolaryngologist). He made me go through an audiometry test and revealed significant hearing loss. He also gave me a tympanic steroid injection. Its been almost 3 days since I got the injection. After the injection, my Tinnitus has severely increased. Its like a rock show in my ear now. Still, my other ear is unaffected. I also feel a little sensitive in the affected ear post injection. My doctor told me that post injection my tinnitus would increase for a couple of days and subside post that. But its been almost 3 days and my Tinnitus hasn't subsided. Its too loud and I can hear it everywhere. Even in noisy surroundings, the voulme of my Tinnitus masks the external sounds. Can anybody who's had this injection shed some light on this? is the increase in my tinnitus because of the injection? Will it subside in a few days or has the injection permanently messed up with my tinnitus? Also, will this affect my other ear somewhere down the line?

PS: Over the years my tinnitus has had a clear relationship with cough and cold. It increases when I have cough and cold also causes reduced hearing in the affected ear. When the cough and cold subsides, my tinnitus reduces and my hearing is improved. Basically, cough days are bad for tinnitus. But once, cough is gone, both tinnitus and hearing improve.

 

Thanks Markku.

I am trying to staying strong. Just that it's too loud and annoying. It was bearable at the lesser volume. But now it's just unbearable. And i feel a little pain in the ear because of the volume. That maybe the temporary after effect of the injection and I am sincerely hoping that it is.

 

Hello all,

I've got a pretty recent case of T and have been reading up on here. Some people say taking Prednison in the early stages can help so I went to a GP asking for a prescription. She said my ears looked a 'little swollen' (probably from the acoustic damage - the usual too loud music thing many of us hear made the mistake with) and gave me some.

Problem is, I got a pack with 50 tablets, but the doc said take 5 one day, 4 the next, then 3, then 2, then 1, then 0. But that would only use 15 of the tablets. Should I take all of them??

If anyone here has experience with Prednisone love to hear from you. I am only on day 2 of this, today my T is softer than yesterday.

Wishing a quiet or at least peaceful day/night to you all.

 

Hello all,
I would like to ask you: do you think it's a good idea to try corticosteroids 2 months after tinnitus onset (acoustic shock)? I am a highly anxious person and I see there are bad psychologic (and other) side effects of these. After all I've read, I don't find any hint that corticosteroids could help after two months (I've tried everything else, even HBO). Tinnitus is ruining my life and I am afraid that corticosteroids could have permanent side effects that would destroy what's left of me. Do you think I am right to not take them, or should I take the risk? Thank you.

 

Barrowww and anyone else interested: I'm taking steroid orally one month in. I feel like it has made the T quieter for me, but this effect maybe disappear as soon as I stop taking the drug. I'm not experiencing any side effects from 60mg for about a week. Oh, aside from a huge amount of energy and a pretty major anxiety spike (I take valium at night to calm down). In some ways being on the steroids actually feels like being on several strong coffees.

No idea if it will help or not but I think if there is something one can do it is worth trying because what we all seem to find here is that if T comes it generally stays if we do nothing

 

Taken from http://www.racgp.org.au/afp/2013/september/sudden-onset-hearing-loss/


The mainstay of treatment is early initiation of oral steroids (prednisolone at a dose of 1 mg/kg/day to a maximum of 60 mg/day) unless contraindicated. The use of steroids should be tailored to the individual patient, and any comorbidities or risk factors taken into account and discussed with the patient. Even in diabetic patients, the individual risk-benefit analysis usually favours steroid use, with appropriate monitoring and management of diabetes.

Treatment with oral steroids is usually between 7–14 days, and tapering is not required with shorter courses. Studies have not shown a conclusive benefit,2,12 however, oral steroids have been recommended in recent guidelines as the standard treatment for idiopathic SSNHL.11 The guidelines suggest the use of intratympanic steroid injections should this initial therapy fail, as it may offer some hope as a salvage treatment if the response to systemic steroids is poor.13 Patients who do not respond to oral steroids should be referred early for consideration of intratympanic steroids. There may be a role for hyperbaric oxygen therapy, but the clinical significance of this remains to be seen.14 There is no evidence for the use of other therapies, such as carbogen, vasodilators or thrombolytics.15,16

There may be concern about whether or not to treat SSNHL in the first instance, especially before PTA, as there is conflicting evidence in the literature as to whether or not treatment methods work. It is essential to empower the patient to make an informed choice and to provide reassurance.17

We propose a basic management strategy for use in primary care:

• Discuss the likely diagnosis of SSNHL and that the cause may not be found
• Explain that there is some evidence for the use of oral steroids, but their effectiveness is difficult to predict and hearing may return spontaneously. (The authors would, on balance, advocate the use of oral steroids)
• Discuss the risks and potential side effects of steroid use
• Help the patient to come to an informed choice.

Treatment with oral steroids can be commenced early if the clinical evaluation is convincing for SSNHL, with PTA and ENT review after this. We would always recommend discussion with the ENT specialist or department you are referring to, as there is a degree of variability within ENT specialists on how to treat idiopathic SSNHL.18 However, a United Kingdom survey study found that 98.5% of otolaryngologists would use steroids as part of their initial management.19 There is no data to support the routine use of antivirals.11

The importance of audiological rehabilitation, often with a multidisciplinary team, should not be underestimated in patients who suffer a non-reversible SSNHL.20

 

Thank you for your reply, 2131e. I hope the steroids help! Let us know if it works for you afterwards.

 

Anybody else with prednisone experience? Share your thoughts please.

 

I took prednisone and have just finished my course. It has not improved my tinnitus. I don't think it has made it worse. I think if you are ok with the side effect profile the risk is worth it as it might improve things. I am glad I took it because taking a proactive step in the acute stage felt better to me than taking no action (despite the lack of efficacy).

Independently, I felt *fantastic* on prednisone! I felt like I had the energy of 10 hyperactive 3 year olds. If it it was safe I'd take it forever. Good luck with your decision and with your T, Barrow.

 

Hi all,

I started prednisone about 2 weeks after onset from noise induced. The Dr gave me 30mg per day for a week. I am due back for a hearing test tomorrow. Since I started taking it, my T has gone down to a minor hiss which is tolerable. I am worried that after I'm off the medication, the T will come back as high pitch again. I really hope it doesn't come back. Anyone else took prednisone and experience improvement in T for long term? Need some encouragement...

 

@Thopeful prednisone lowered my T around 30% after the onset. More than a year after, it's still at the same level. Good luck!

 

I took cortisone (Medrol) in a tapering scheme 12 days after T onset.
3 days 64 mg, 3 days 32 mg and 3 days 16 mg.

It is not prescribed in the Netherlands, I got it from University Hospital of Antwerp.

It spiked my T after every evening intake. Noticable back in the head, just above the neck. Loud screaming sound.

It lowered my initial T by 25 to 30%. The following 30% decrease was with 5,5 months of TMJ treatment.

T is now 2/10 or 1/10 where it was 9/10.

Every ENT i spoke to doubts wheteher it has helped, but I still curse myself about taking it after 12 days. I got it after 3, but I did hydrocortisone first 10 days because my GP said so.

No hearing loss was measured (everywhere 0 db loss or -5db) but I think I could have done more when I started sooner.

And my current supply is almost empty, so I hope I won't get suddenly blasted or something.

I still doubt if I should have gone to Germany for the HAES infusions (pentoxifylline / cortisone and trental)

All in all: take it. I don't know what would have happened when I did not do it.

 

I've read 10 days after onset but am curious if it is worth trying past that?

Has anyone had luck using it longer than 10 days from onset?

 

Look at this thread:

https://www.tinnitustalk.com/thread...dexamethasone-others-oral-and-injections.348/

And other treatments, especially IT steroid injections, may help within three months. But you have to find an ENT to do this. Not an easy task.

That said, if you are interested for yourself, there's no evidence that oral or injected steroids will help after several months.

For another study on steroids for acute tinnitus, see this:

Laryngoscope. 2011 Dec;121(12):2619-25. doi: 10.1002/lary.22350.

Comparison of various treatment modalities for acute tinnitus.
Shim HJ1, Song SJ, Choi AY, Hyung Lee R, Yoon SW.
Author information
Abstract
OBJECTIVES/HYPOTHESIS:
Because in most cases the development of tinnitus is triggered by cochlear damage, there exists the opportunity to eliminate tinnitus while the cochlear lesion is still reversible. Therefore, we evaluated the therapeutic effects of various treatment modalities on acute subjective idiopathic tinnitus (SIT) and investigated prognostic factors affecting the treatment outcome.

STUDY DESIGN:
Prospective, controlled, double-blind trial.

METHODS:
A total 107 patients who underwent treatment for unilateral SIT that had developed within the previous 3 months completed the study. The patients were randomly assigned into three groups according to the treatment modality: group I (n = 32), alprazolam orally for 3 months; group II (n = 35), as for group I plus four intratympanic dexamethasone (ITD) injections; and group III (n = 40), as for group II plus four intravenous injections of lipo-prostaglandin E(1) .

RESULTS:
The improvement rate of group II (75.8%) was significantly higher than that of group I (40.3%; P < .05), and there was no significant difference in the improvement rate of group III (50.0%) compared with groups I and II (P > .05). The cure rates of group II (25.8%) and group III (20.0%) were significantly higher than that of group I (9.8%; P < .05). There was a significant correlation between the cure rate and duration of symptoms.

CONCLUSIONS:
The results of the present study indicate that ITD injection plus alprazolam medication is the best treatment choice for acute SIT within 3 months of development.

Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Reference:

http://www.ncbi.nlm.nih.gov/pubmed/22109762​

 

This was never ever presented as an option to me by my ENT. That borders on incompetence as far as I'm concerned.

Furthermore, if it wasn't for this forum, I would have never found out about AM-101...ENT basically told me.. Go home, it was get better.

 

Ditto

 

I don't believe there are any hard rules on when it is "too late" (it will be at the discretion of the doctor you see - and their on opinion can vary greatly on this specific topic). For what's worth - in my non-medical opinion - steriods are most effective during the very acute stage of tinnitus - specifically when the following three conditions are met:

1) hearing loss = threshold shift (on the audiogram)
2) cause = acoustic trauma
3) very recent onset (ie. 24/48 hours)

To understand why the timing element is important, it is necessary to look at what processes take place inside the ear when hearing loss occurs:

As a story from the real world of tinnitus - and I have "a few" to share - I did meet with an ENT surgeon who was also involved with the AM101 clinical trial here in Germany. He told me he had performed intra-tympanic steriod injections on a woman who was going to have chemotherapy. What he did, however, was to perform the intervention prior to the chemo-therapy sessions. It is impossible to do statistics on one individual alone, of course, but this particular woman did not end up developing hearing loss and/or tinnitus from the chemotherapy. Was it the intervention or was she just lucky? Well, it's hard to answer that, of course...

 

Has anyone had a look at this study?

Seems to me intratympanic injections might be something to try out. At least for some people.

http://www.tinnitusjournal.com/detalhe_artigo.asp?id=322

 

Hello all! I am new to this support forum. I have been bothered by tinnitus since June of 2013. Looking back at my ent records evidently I mentioned/was diagnosed with it as far back as Dec. of 2011 but it did not bother me until June of 2013. Suspecting I had Eustachian tube dysfunction as the cause of my T I went to a different my 3rd ent and she prescribed Flonase. During a allergy flare up in early September I went to my family doctor and told her that Flonase seems to help some with T so she said lets try a short course of low dose prednisone....two days after starting prednisone T almost completely went away...one day after finishing the rx for prednisone (which was a 10 day RX) the tinnitus came back. I have since gone to two different ent's and they say yeah inflammation from either my tmj or allergies could cause T so I ask ok then what to do about it...they say continue with Flonase and start allergy sublingual immunotherapy. My point in posting this is I had been bothered significantly by T for 15 months and prednisone made my T pretty much go away for as long as I was taking it.