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

Definitely try everything you can, that’s what I’m doing. ENTs tell me HF hearing loss caused but there is definitely some other issues with me besides that, especially in my left ear. I know it’s disgusting waking up to this crap every day.

 

My ENT has suggested steroid injections. I don’t know what to say to him.

 

Your onset is recent, you could try. When I was in the beginning I consulted three otologists, two advised against and one in favour. But in restrospective I should have tried. There are risks. You could also try oral steroids, less risks for balance and hearing but more risks for systemic effects, however the concentration in the inner ear with oral steroids would be weaker. I tried them in the beginning and they did nothing for me.

 

I'm trying everything I can, but I'm running out of options and the symptom has become debilitating. I am in a corner.

 

Thank you!

 

I see Eagles Syndrome can cause tinnitus and a lump in throat feeling which I have. I had seen it mentioned on Facebook TMJ. Maybe something to look into?

https://en.wikipedia.org/wiki/Eagle_syndrome

 

I'll look into it, but both my dentist and my tinnitus-specialized osteopath told me I have no TMJ issues. Also, I don't have nerve pain in tongue or jaw area. But I'll ask the doctor.

 

Hi,

I'm 30 and have been suffering with fairly significant tinnitus since acoustic trauma on June 26th. I've already had a strong 14 day course of prednisolone. I have been testing my hearing with an app regularly and my ear has recently recovered to within a normal range up to 8 kHz. The app results match closely with an earlier audiogram so seem accurate.

I'm wondering if I should try for intratympanic dexamethasone or prednisolone injections, and/or HBOT which is supposed to be good for acoustic trauma? I know these have risks and work better if done sooner, I'm not sure I am a suitable patient given my hearing is within a normal range up to 8 kHz?

I might be in the category where it's best to take no further action but don't want to regret not trying something in the early stages. Please can someone advise?

Many thanks.

 

Anyone?

 

Would also love to hear what people think. Still in the early stages myself.

 

I have a prednisone dose pack on hand.

If someone shot a gun off next to my ear and I could take it within 24 hours I definitely would, 48hours probably would, 96hrs maybe, not after that because of lack of any evidence of efficiency, vs the strong knowledge that taking a dose pack of prednisone causes severe insomnia and anxiety in me for 1-2 weeks which is not really something I want to deal with on top of an acoustic trauma and tinnitus increase, unless I could start it fast enough to maybe actually be useful. (Hence why I have a dose pack on hand, rather than relying on being able to get one if necessary).

The evidence that prednisone is useful in the case of acoustic trauma is sparse, with some studies showing a strong protective effect if the steroid is used transtympanically, immediately before or after the trauma. Evidence for efficiency of oral steroids is weaker and more focused on SSNHL than acoustic trauma, and I find basically zero evidence in the literature of any of these things being helpful once you're more than a few days past.

The idea with prednisone is that the body's own inflammatory response causes a worsening of damage to the auditory nerve, so whacking yourself with an immunosuppressant drug arrests that. However, this inflammatory process begins happening more or less immediately after an injury, and in the case of acoustic trauma seems to peak, maximally, within a few days.

Taking oral steroids within that window is dubious, there's not a ton of data to support it. Taking it outside that window is probably just reckless because there's basically no reason to think it's helpful, and may be harmful.

 

Just to mention that the first injection had no effect and the worsening trend continues, so we decided to suspend them. This seems to confirm that late intervention with steroid injections are dubious.

 

@linearb I'm glad you've taken the time to dive into some of the literature. I sometimes feel like we are all grasping for straws. As I've mentioned, my T is mild and I just want it to get worse - even though obviously I want to get rid of it, too.

In the Dutch T Facebook group is a guy who had 3 prednisolut shots within a few weeks and they did wonders for him, not removing but still greatly reducing his H and T.

As for the inflammatory stuff, I've started drinking golden milk, which is based on turmeric. No effect yet, but... it's been two days.

 

this is very interesting; do you know if these shots are delivered directly to the inner ear through the eardrum (vs injections of some other kind)?

If so, that's quite interesting. I know of two different studies, one each from the US and Israeli military, which showed that into-the-eardrum ("transtympanic") injections of prednisone helped with hearing loss, though only if they were administered within a couple days. None the less, there are two giant variables here:

* whether the steroids are injected directly into the inner ear, or taken through some other means
* whether the steroids are given before/immediately following the event, vs days or weeks later

I think that both of these things probably impact the way the effect works pretty dramatically. But, to ferret that out at all definitively, you'd need a series of experiments at different dose levels where the only variable was whether the steroid was transtympanic, oral, IV, etc.

I think this is super interesting, and I wish someone would spend the several million dollars it would take to do a bunch of animal studies to try to shine a light on this and then design better human protocols based off that. As is, it's a total crapshoot if you get steroids at all following an infection or trauma, and if you do there's a lack of consistency about exactly what you get, and a lack of an evidentiary basis for why you get that.

 

In the arm, 3 shots in 3 days.

 

If this really worked these forums wouldn't be full of people with hearing problems, as just injecting a corticoid is very easy, and can be done at any health clinic.

 

I don't think it works on all cases, or maybe most.

There's a sparse but growing cache of data exploring steroids for SSNHL and, less commonly, acoustic trauma.

I quite agree that most people with tinnitus won't benefit from steroid shots, especially after more than a couple days, so I don't encourage their use. However, there may well still be something useful there in some cases and I think it deserves more study since as you point out these drugs are cheap and available.

 

I know that Prednisone is often prescribed after acoustic trauma, but does anyone know of its effects on those mechanisms while on the drug? Does it make one's ears more sensitive/susceptible to damage? Or would it do the opposite and work the same way in subsequent damage after starting the course?

You can look at my other post for some context. Thanks in advance.

 

It's an anti-inflammatory. It helps with the inflammatory part of your injury. How big of a factor that is (inflammation) in each individual partly determines how useful steroids are.

At least in rats (and there is a doctor in Tacoma who strongly believes in people as well) also act on cochlear Na/K ATPase and this is somewhat protective during injuries and also helps with primary and secondary hydrops (can happen after acoustic trauma).

For the latter, aldosterone would do the same thing, if not better.

https://link.springer.com/article/10.1007/BF00186223

A low salt, high potassium diet will also elevate aldosterone to at least some degree. And, interestingly, this study shows a high potassium diet (be careful not to overdo this, too high potassium especially if your kidneys aren't perfect can cause heart problems, etc) may be protective:

https://www.nature.com/articles/s41598-019-45930-5

 

@Barrowww I know this is from years ago but how are you doing now? Did you ever do the steroids? How is your tinnitus? I am in the same situation.

 

@DingDong How are you feeling now? Did the withdrawal symptoms from the Prednisone improve?

I just took some Prednisone 5 weeks post Acoustic Trauma (I know, silly idea). But I was desperate since my tinnitus is so bad and the ENT said it may still help. I knew it wasn’t a good drug for me after the second day, so did my own quick taper. I took 20 mg, 17.5 mg, 7.5 mg, 2.5 mg. Such a small amount but I’m still feeling pretty crappy. :/

 

I took a prednisone pack after a root canal for pain and my tinnitus completely disappeared for 3 days but came back worse upon the taper.

I am 6 months in with tinnitus.

Can anyone explain why prednisone did this after 6 months?

If something as simple as prednisone can take the tinnitus away, are there NO other anti inflammatory meds that can do the same? How the hell does an anti inflammatory take away tinnitus 6 months after onset?

It is not like it repaired my dead cochlea hairs. What is the science behind this? I thought I was cured and then it all went back to hell.

 

You indicated that you have a blocked right sinus from your thread. Perhaps you also have some inflammation inside that you do not feel. If prednisone, an anti-inflammatory drug, reduces such swelling, it might relieve some nerves being pinched. Prednisone does not permanently reduce your swelling and so once it wears off, you're back to before. I would take this as a good sign that your tinnitus is completely gone with prednisone. Wait for what the ENT says and if you need the surgery to remove the blocked sinus.

FYI, long term use of prednisone is NOT good as it has some very serious side effects.

EDIT: So if your tinnitus is not caused by loud noise but by blocked sinuses + swelling, then that's treatable. And not all drugs work the same way or the same strength.

 

The blocked sinus is on the right and tinnitus on the left. Not sure it will help but I will discuss with the ENT.

 

@DingDong

Hi, are you feeling better now that it's been a while after the prednisone treatment?

 

I want to warn people who are thinking of trying intratympanic steroid injections. As I have mentioned in this thread a couple of years ago I did and it didn't cure my tinnitus (it is actually much worse now). The injections are totally useless IMHO and it can damage inner ear. Don't do it, don't ruin your inner ear...! You are warned!

Oral or infusion prednisone - same story, don't do it, it cures nothing except your money!

 

Curcumin and Omega 3 are the most powerful natural anti-inflammatories I can think of, though I imagine their efficacy is lower than a pharmaceutical.

 

Consider curcumin as an alternative.

 

Just wanted to add my few cents...

A few days ago I had a spike, a flare up in my tinnitus. This happens about maybe once or twice a year at this point. In an attempt to see what I could do I decided to take a small course of steroids, betamethasone to be correct, and I can honestly say that it reduced the intensity of the spike, as well as that "sore and tired ear" feeling.

I've had previous success with using some prednisone two years ago when I had a spike where I also noticed a reduction in my tinnitus.

It's morning now, and I'm getting ready for work. Last time I took betamethasone was two days ago, and it seems that my tinnitus is a bit louder now again, but manageable.

I'm still unsure to the exact cause of my tinnitus, and what the use of steroids and it lowering my tinnitus signifies, but it certainly could be that there are some inflammatory processes at work.

Perhaps one day I'll find an ENT here in Switzerland caring enough to be a good partner in figuring things out a bit better, even after all these years now.

 

Sitting outside last night (8 hours ago) with some friends at a bar and a dude drive by and said “you guys want to hear something loud?”

He revved his engine and it basically exploded. Very loud. I got my fingers in my ears right when it started but it was probably 30 feet away. I took 1200mg of NAC and 400mg of Magnesium right when I got home an hour later and am on NAD as well.

Funny enough tinnitus seems largely unchanged. BUT I’m obviously very worried about it. Should I seek prednisone this AM? Would you guys?

Is it possible to experience an acoustic trauma and not have an increase in tinnitus?