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

Yes, unfortunately it's all in German.
It recommends that dose based on 'practical experience' - the European guideline actually rates this guideline as very unreliable.
Should have listened.
Gonna get a blood work now to check if everything is back to normal, still feeling hot flashes from time to time.

 

Damn. 250 mg is simply an insane dosage of prednisone. I have an autoimmune disease, and we're only talking like 40 mg with 80 mg being the max, granted for much more than 3 days. Even 40 mg gave me a boatload of side effects like anxiety, mood swings, high blood pressure, etc.

I am fully confident that I would go days without sleeping and have a panic attack on 250 mg.

 

I really feel you if you have to take this drug regularly. Stay strong!

Roughly one week after taking the dose, I'm sort of back to normal. My muscles/joints are still affected and I lost 5 kg, but it's slowly fading. The panic pulses are less frequent, and I don't spiral out of control anymore.

Now I'm actually glad that tinnitus is the only health issue I have. Damn, I'm one of those emotionally inept guys who didn't even cry when their father died, but that drug made me cry like a fucking baby.

 

No one has an in-between opinion of Prednisone (certainly no one who popped 250 mg!). It is either the single most critical drug in existence to help you or it just causes side-effects and gives you misery. I appear to need the drug, but I hate it. I hate being on it and I hate the withdrawal/rebound flare up from coming down from it.

 

60 mg of prednisone is quite a high dose... 250 mg sounds like crazy to me...

 

Would there be harm to say a monthly intratympanic injection of Prednisone if oral Prednisone significantly cuts down on tinnitus? I assume the eardrum would heal just fine, but would the cochlea suffer from repeated exposure to a steroid?

 

There is always a risk but Meniere's patients sometimes have them done monthly. Otonomy's extended release Dexamethasone would cut that down to every 3 months (and it looks to be released next year).

 

Thanks for pointing that out!

 

Aren't there joint issues associated with long-term Prednisone use? But I'm sure the instant relief is well worth it for you.

 

But what joints would it be touching if it goes directly into my ear? I imagine the joint issues are more of a thing with oral systemic Prednisone.

 

No placebo group, no evolved hearing test (only PTA). Duration of tinnitus: 1 month at least.

Comparative Efficacy of intra-tympanic methylprednisolone injections in different concentrations on subjective cochlear tinnitus

Introduction: Subjective tinnitus is an awareness of a phantom sound which is audible solely to the individual. Intra-tympanic steroid injections especially dexamethasone 8mg/ml have been used with variable success in relieving it; however this desired concentration is unavailable in India. The aim of this study was to assess the comparative efficacy of intra-tympanic methylprednisolone injections in different concentrations in subjective cochlear tinnitus.

Materials and Methods: Ninety patients with complaint of abnormal ringing in uni/bilateral ear, with/without hearing loss were enrolled from our outpatient set-up. After written informed consent, the participants received a tinnitus loudness and frequency matching test. They were randomly assigned into three different subgroups (each with 30 patients) by a single-blind method.0.5ml of 40mg/ml concentration methylprednisolone solution was injected intratympanically in study set one (Group A), 125mg/ml in second set (Group B) and 250mg/ml in the third set (Group C). The groups were compared in terms of subjective tinnitus intensity and loudness matching after the intervention.

Results: On subjective analysis of tinnitus intensity 1 patient of Group A and 2 each of groups B and C demonstrated improvement. On loudness matching test for tinnitus, no patient in Group A was cured, though 3 each in groups B and C were cured.

Conclusions: In the present study, no significant change was observed in the three treatment groups in subjective analysis of tinnitus intensity based on questionnaire. Similarly a non-significant response was obtained in loudness matching test for tinnitus. The intra-tympanic methylprednisolone injection gave suboptimal and inconsistent results at varying concentrations. Further prospective studies to evaluate the effect of intratympanic methylprednisolone on tinnitus are warranted in carefully selected group of patients.

 

Intratympanic steroids versus oral steroids in idiopathic sudden sensorineural hearing loss, hospital-based study

Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as a hearing loss of 30 dB or more, affecting at least 3 consecutive frequencies, occurring within 3 days without any identifiable cause. To find the effectiveness of intratympanic steroid injection (ITS) for hearing recovery and comparing the results with oral steroids therapy.

Methods: This prospective study was done in the department of ENT, Govt medical college, Srinagar, over a period of two years. A total 60 patients of ISSHL was selected for the study. Through examination, otoscopy and pure tone audiometry (PTA) was done for all the cases before initiation of therapy. Thirty patients received and thirty patients received oral prednisolone for a protocol-based dose and duration. PTA was repeated every two weeks over duration of two months for documentation of improvement of hearing on pure tone four frequency averages.

Results: Chances of recovery were more with middle ear injection group in 18 patients (60%) in comparison to oral steroids in 14 patients (46.66%). Complete recovery was found in six cases (20%) in injection group and four cases (13.33%) in oral steroid group. The ITS group showed a better control of associated symptoms like dizziness, tinnitus and vertigo are controlled better with ITS (73.33%) than oral steroid group (56.66%). The ITS group showed faster recovery also with lower side effects.

Conclusion: Intratympanic dexamethasone injection is more effective in comparison to oral prednisolone for the management of ISSHL, however larger studies may be required.

 

Despite official treatment protocols, there are some doubts if steroids can actually help at all. Because nobody (due to ethical reasons) does the studies with control group (people with ISSHL who would not get any treatment). These doubts came from anecdotal evidences that similar percentage of patients who never looked for the treatment actually gets better on their own.

So it is possible that steroids don't do anything.

This statement can be supported by other facts: first, nobody has actually prove what actually happens during ISSHL and what is a reason behind (only several theories with no serious evidences), second - there is no actual explanations why the steroids possibly help for some people and does not help for other.

As ISSHL sufferer who dig into this for some time, unfortunately, I came to the conclusion that this is a mystery in today's medicine and the treatment protocol is created on the basis "we still should do something".

 

Predictive Factors for the Success of Intratympanic Dexamethasone Treatment of Acute Subjective Tinnitus

OBJECTIVES: The purpose of this study was to determine the factors predicting the success or failure of intratympanic dexamethasone (ITD) injection in the treatment of acute subjective tinnitus (AST).

MATERIALS and METHODS: We enrolled patients who were treated with ITD within 3 months of the onset of tinnitus, between 2013 and 2017. We compared the clinical characteristics and audiological data of the patients in the cured group (n=38, 45.6±13.3 years old) and the nonresponder group (n=40, 48.9±18.6 years old).

RESULTS: The cured group was predominantly female (p=0.002). The mean duration of tinnitus before ITD was shorter in the cured group than the nonresponder group (p=0.002). The pure-tone averages in both sides were lower in the cured group than in the nonresponder group (p=0.018). The time of tinnitus awareness was shorter in the cured group than in the nonresponder group (p=0.014). Multivariable analysis showed that the duration of tinnitus (odds ratio [OR]=1.045), a history of exposure to noise just before tinnitus development (OR=7.766), and distortion product otoacoustic emissions results (OR=4.580) predicted the outcome of ITD treatment in AST.

CONCLUSION: A short duration of tinnitus, no history of immediate noise exposure, and normal distortion product otoacoustic emissions could be favorable prognostic factors for AST treated with ITD injection.

 

I had an acoustic trauma within the last two weeks that recently caused my tinnitus to substantially increase. It went from moderate to severe.

Am I still in the acute stage to receive intratympanic steroid injections?

 

You can try it but it may not work. I had no idea when I had my trauma that steroids were even a treatment. I had never heard about it at all. The only thing mentioned online is sudden hearing loss but the information is vague too. There goes the medical community failing the public yet again. I wasn't even offered steroids until 20 days after the trauma even though I had seen doctors previously. It may work but don't count in it.

 

How do you know if you've had a threshold shift?

 

I had all those symptoms for 4 months after a spinal injection. It was horrible. It changed my life. I think it led to a chain of events that started tinnitus for me.

 

Steroids likely caused rebound inflammation and, ironically, initiated my autoimmune disorder to come back. I also got new low frequency drone sounds from withdrawing.

Given the above, if you REALLY want to try it, to limit systemic side effects, go for intratympanic injections.

Steroids are very insidious as they make it better first, then worse, just like benzos.

DO NOT take them unless you are DYING or DEAF.

 

Interesting article for those with ISSNHL, even if effect on tinnitus is not mentioned.

Comparison among Three Different Steroid Therapies for Idiopathic Sudden Sensorineural Hearing Loss

Background and Objectives
The optimal dose or type of systemic steroid for treating idiopathic sudden sensorineural hearing loss (ISSNHL) is unclear. Herein, we compare the efficacy of three steroid treatment protocols.

Subjects and Method
We reviewed the medical records of 140 adult ISSNHL patients from a tertiary medical center. The patients were divided into three groups based on their treatment regimen: Group 1 received intravenous 10 mg/day dexamethasone combined with intratympanic (IT) steroid injection, followed by prednisolone for 5 days after discharge; Group 2 received 10 mg/day dexamethasone for 5 days, followed by 5 mg/day for 5 days over a 10-day hospitalization period; and Group 3 received 10 mg/day dexamethasone combined with IT steroid injection during a 5-day hospital stay, followed by 5 mg/day dexamethasone for 5 days after discharge. The hearing thresholds were measured using an automatic audiometer at 0.5, 1, 2, 3, 4, and 8 kHz. Hearing recovery on Day 90 was categorized according to Siegel’s criteria.

Results
Univariate and multivariate analyses showed that patients in Group 3 had the lowest hearing thresholds, and the best results for speech reception threshold and speech discrimination scores. The impact of favorable thresholds in Group 3 was better among patients with a baseline average hearing threshold of ＜70 dB. Complete recovery was more likely in Group 3 than in the other groups, based on the odds ratios.

Conclusion
Administration of dexamethasone-based systemic steroid combined with IT steroid injection and a relatively long hospitalization period produced the most favorable result.

 

Evaluation and comparison of the efficacy of long-acting betamethasone and dexamethasone as injections in the treatment of idiopathic sudden hearing loss

Introduction & objective
The aim of the present study was to determine the efficacy of long-acting betamethasone, and its comparison with Dexamethasone as an intratympanic injection in the treatment of Sudden Sensorineural Hearing Loss (SSNHL).

Materials and methods
Thirty-one patients who do not respond to systemic steroids and poor prognosis patients were enrolled in this study. The patients divided randomly into two groups: 1- Dexamethasone and 2- Long acting betamethasone. Dexamethasone (0.4 ml/mg) or long-acting betamethasone (0.1 ml/mg) was slowly injected (0.4 to 0.6 cc) into the superior-anterior area of the tympanic membrane as 6 injections twice a week for a total of 3 weeks. Right after the treatment and one, two and six months after completion of treatment, an audiometry was performed and compared with the pre-injection values.

Results
Speech Reception Threshold (SRT) showed improvements in both groups immediately after treatment and in the follow-up period, compared to baseline. Speech Discrimination Score (SDS) also improved in both groups directly after treatment and at one-month follow-up. The hearing improvement in the Dexamethasone group was clinically better than in the Beta group, but due to the non-parametric data, it was not possible to analyze the hearing improvement process in the variable group.

Conclusion
According to the results obtained in this study, intratympanic corticosteroid injection in the treatment of patients with SSNHL has positive and promising results on improving hearing level.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0196070921000569

 

I need some help.

I took one dose of Prednisone because the night before I felt I had muffled hearing in my right ear followed by a new low tinnitus tone.

My normal everyday tinnitus has now spiked and it's still spiked after 2 days.

I only took one 50mg Prednisone dose and I did not take any more after that. Am I supposed to taper one 50mg Prednisone dose? I guess it must have spiked my cortisol? Will my tinnitus go back to normal?

 

If your hearing felt muffled you probably did the right thing.

It's likely temporary, you should taper always and pretty damn slow imo... however it's rolling the dice regardless and if you missed two days it'd do more harm than good to add more Prednisone unless you get muffled hearing again.

I got a low tone too which almost made me reach for it.

Give it a couple of weeks. Do a hearing test to confirm things are fine. If you see a drop of more than 15 dB, get worried.

 

I only took one 50mg Prednisone tablet and I didn't taper that. My tinnitus is still worse now. It's been 7 days. I used to have hissing days, now it's all loud ringing

Why did Prednisone make my tinnitus worse? Is it because of cortisol?

My tinnitus started when I drank caffeine (I was under benzo withdrawal at that time). I'm taking NAC now. I don't know if it will help. I can deal with my severe hissing tinnitus but this is not bearable

 

Hello all,

Just wanted to tell you about my experience with Prednisone and Dexamethasone.

Within a month of the getting noise induced hearing loss and hence tinnitus, I went to my doctor and was given three shots of Dexamethasone in span of 2 weeks, at the same time I targeted the problem with oral Prednisone of 50 mg dosage. It reduced my tinnitus back then.
But now there is no difference.
I don’t know why.

Also, back then at the same time I used the Tinnitool laser therapy and that was also not beneficial.

All that being said, when I randomly take Prednisone of 50 mg, it somehow reduced my tinnitus from time to time, but of course it comes at the price of losing sleep and getting moody and pimples all over my face. I am now in the battle of taking/not taking Prednisone on my own... patiently waiting for FX322.

 

Intravenous or intratympanic?

 

Intratympanic.

 

Even more bad news for using steroids past the initial noise insult. Makes sense why you'd feel better temporarily and turn out worse.

Chronic steroid levels decrease inflammation but kills neurons in the hippocampus (which is involved in gating auditory signals, aka tinnitus).

Stress and Health: From Molecules to Societies

 

Hi everyone,

I unfortunately do not have enough time to get into the specifics, but I will add a post to the (Introduce Yourself) section shortly.

I have had tinnitus (both sides) since 2007, it started suddenly and my hearing tests have all been perfect ever since. It took me 2 years of daily hell and a few years more to accept my tinnitus and to live my life. I actually managed to live a tinnitus "carefree" life for the biggest part of the last 10 years, tinnitus seldomly crossed my mind and I never complained about it, googled anything, (it was liberating), up to a point where it did not affect my life anymore.

I had gone through some horrible, stressful periods in my life, none of these events caused a significant change in the long term (for my tinnitus).

Now... 2020.

Since October 2020, I have been dealing with a horrible spike (that never ends) and my tinnitus has become unbearable and I am trying my best not to fall deep into depression. It. is. hard.

I felt like I was set back 10 years (minus the ignorance I had about tinnitus back then), it just felt so much worse. None of my coping mechanisms, habituation methods seem to work. I wake up in the morning and it's just so loud , instantly... hearing is still "amazing" and all the tests came back inconclusive.

Now, my situation is hard enough as it is. Since October I have been paying EXTRA attention to protecting my ears (on top of the already existing precautions I have been taking for 10 years, you guys know what I mean).

Now I want to avoid any acoustic trauma at all cost, the prospect of my tinnitus getting worse or to have hearing loss on top of my existing non acoustic induced tinnitus is unthinkable.

So today, I FEEL like I experienced an acoustic trauma with the slamming of a steel door against a steel frame (it slipped out of my hands). It was quite loud and I immediately felt anxiety ridden... holding my ears closed to check if my tinnitus increased... well it's still loud, but when I press (and I mean really press) my finger on my right ear to keep it shut I hear a different tinnitus sound (usually HF). It sounds like when you circle a glass with a wet finger in the rhythm of a telegram... very faint, almost sounds exactly like the sounds they play in the beginning of a hearing test if that makes sense?

Now, I went to a locally available ENT (the kind that doesn't care) and got prescribed Prednisone (20 mg) for 5 days (starting tomorrow) after doing a hearing test (again... perfect).

I am asking myself: How likely is it that this "new" sound was already there but I didn't notice? How likely is it that a few days/weeks down the line I will have complications because of this event (without treatment)? Will this make my not noised induced tinnitus worse by adding a potentially noise induced component to it? Can the slamming of a steel door on a steel door frame cause that much damage?

More importantly, this stress I have been under since October and the many ENT visits, CT scans, tests and medical visits have really been triggering all my long forgotten anxiety and OCD...

Considering the current pandemic is it even safe to take Prednisone? Was I prescribed it just so I would "shut up"? Will taking the medicine just aggravate my anxiety and OCD and put me down a dark path of "seeking reassurance"... stressing me out much more in the long run?

Should I wait and see? I feel like I should but also like I would regret not acting quickly now if things get worse in the future...

Well... that's my current headspace... not good.

Happy for any advice.

Cheers,
A.

 

First things first: 20 mg is a very low dose of Prednisone and would not have any noticeable effect. I think the faint sound might have been there before but you only noticed now when shutting your ear with your finger. Why would you even do that? Do you normally plug your ear to test your tinnitus? Don't do that anymore. I would wait and see. I don't believe slamming a steel door can cause permanent damage.