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

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.

 

Hi ajc,

Do you mean it's a low dose and the effect would not be noticeable for the acoustic trauma or for posing a risk to contracting a COVID-19 infection?

I don't normally do it... but I have done it before and have never really noticed. My high frequency tinnitus is deafening since October, I can not hear myself talk clearly. That's why I did it... to see if I can hear something different (aside from the loud high frequency tinnitus).

I'm just wondering if that faint sound can get worse... or if it will be more noticeable once this 4 month long spike subsides...

 

I can't speak to the COVID-19 risk. I meant 20 mg of Prednisone is so little that it probably wouldn't do much for an acoustic trauma. Conversely you probably wouldn't get much side effects either from a short 5-day course. Why would you start it tomorrow though if you are concerned? Wouldn't starting today be better? The window of opportunity is very short for Prednisone. Sooner it is started, better.

I wish I was clairvoyant! One thing's for sure, tinnitus can always get worse, sometimes without reason!

 

Because it is currently early evening here and the pharmacist said to not take Prednisone after 12pm as it intereferes with sleep.

I don't know what to do...

 

It sounds like the start of dysacusis and what I have, made worse by steroids. It's a crappy situation, if you're still getting worse tell the ENT and they might do intratympanic steroids.

If you do steroids, wean very, very slowly off them.

Try lowering salt (1.5 g spread over the day) and see what happens as well for a few days.

 

Hi Matchbox,

Thank you for your reply! I am under such a massive amount of stress lately.

I wonder if it even makes sense to take Prednisone. It is hard for me to tell if I have had an acoustic trauma or not, since my tinnitus is loud and seems to go from bad to worse the last few weeks.

But I assume that it is probably perception. Correct me if I am wrong but for tinnitus to get worse from acoustic trauma there should have been some sort of acute hearing loss related to it? I went to the ENT 4 hours after the “trauma” and my eardrums were fine and my audiogram normal and identical to a previous audiogram 2 months prior.

If I understand this correctly, Prednisone will have very little impact? Doesn’t the ear heal by itself if it's not a major trauma?

Thanks for the salt advice. I will try it. I just want to stop focusing on it so much...

Thank you.

 

I started taking the Prednisone. I have been having this spike since mid October 2020... I need to somehow break the cycle... I feel like with every doctor visit it gets worse... COVID-19 sure is not helping... this is really triggering all my anxieties and former OCD. I am now in my 30s... I haven't felt like this (bad, mentally) since my early 20s.

I want to avoid antidepressants at all cost... they ruined my life 10 years ago.

Does Prednisone (20mg/day) for 5 days significantly lower immunity? In light of COVID-19...

 

TAPER off the last few days stupidly slowly to avoid new tinnitus sounds.

If you are stressed out, you are kind of making it worse with Prednisone, but it could also be keeping inflammation at bay.

Keep eating carbs, I think anything with maltose (don't quote, figure it out) goes past the blood brain barrier readily.

With that in mind I'd start taking L-Carnitine too, it'll help the neurons burn Ketone bodies and will be an antioxidant.

I say that because neurons under stress (literally exposed to cortisol/Prednisolone) tend to start dying if it lasts too long, but from what I've read that occurs really ONLY if they run out of energy. So keep them fed.

Unless you go deaf, don't do another course after this, whatever you're left with, in my opinion.

 

Hi,

I have been on Prednisone for 4 days so far and I decided that I want to stop taking it now. Although I was only supposed to take one extra pill tomorrow, enough is enough... it made me even more agitated and anxious. According to the pharmacist I can just stop, since it's only been 4 days and “only 20 mg”. I was tempted to take 10 mg tomorrow but I can also not doubt everything and everyone. Better to just stop. While I can.

I mean I did have an audiogram 3-4 hours after the sound exposure and the result was within the hearing range, although slightly less “perfect” than before.

I'm just going crazy with this increased tinnitus since October and pulsatile tinnitus in my left ear. Any head movement changes the sound, bending over etc...

You guys think it's ok to stop the Prednisone now? I really don't want to take any more (I was supposed to take 5 days, I took 4 days, no taper).

Thanks!

 

I think not tapering after effectively slamming your receptors is foolhardy. The most I'd do is 50% reductions. If you don't notice new sounds doing that... well that's the point. Yes it's a modest dose but your pharmacist is not a doctor nor an endocrinologist. They have a degree in pharmacy which doesn't cover as much Biochem as you think.

 

I dropped a glass jar by mistake last night and the impact was LOUD.

I thought I'd be fine, but I've developed a very minimal low tone along with my already existing high pitch tone...

Should I try to have Prednisone prescribed to me? Or should I wait it out and hope this new tone fades soon?

 

Hi @Matchbox,

Thanks for the advice. My doctor also said I could stop it! The doctor prescribed 20 mg for 5 days, then said to stop.

I took a hearing test after my noise exposure, approximately 4 hours after. If I understood correctly, it cannot get worse in the next weeks/months (due to this exposure). I don't feel any withdrawal symptoms (yet).


I am battling a huge spike in my tinnitus since October and my tinnitus is somatic. I just got concerned by this noise exposure and I freaked out! I don't have muffled hearing. I just had a high sensitivity to sounds for 2 days that also seems to be better now. Tinnitus is still horrible but it was horrible before, hard to tell.

 

Hi @ronthejon,

I've dropped a few glasses over the years... It always spikes my tinnitus instantly, but has always eased over the coming week, returning to baseline. It's why I now use ear protectors to fill/empty the dishwasher.

That said... I have just today started taking Prednisolone, which I believe is a metabolite of Prednisone (or so my doctor says) so is basically the same thing. I'm 9 days in to the biggest spike I can recall having so likely too late to do much, but in this instance I didn't want to be looking back saying "I wish I'd tried...".

Perhaps get that prescription in so you have it if you need it, rather than the panic of trying to arrange in short order (as I did today) if your tinnitus is not subsiding in a day or so.

 

Hi!

My tinnitus just cropped up recently (3/8/2021), and made me anxious enough to see an ENT. I'm really suspecting jaw problems or stress, but after seeing me, the ENT came out of the blue to say I had sudden sensorineural hearing loss. This just really confused me, since he and the audiologist said I had perfectly good hearing just minutes ago. What's more, he prescribed me Prednisone, starting with 80mg tapered over 13 days. I'm extremely concerned, both because I'm afraid of such a high dosage and I've heard that Prednisone may make tinnitus worse. Should I follow his advice and take it, leave it, or try to go for a smaller dose in between (like 60-40mg)? If it helps, I'm in my 20s, and am about 120lbs.

Another concern - is this immediate? I heard that for people who really do have SSHL, a regimen of Prednisone as soon as possible helped some people eliminate their tinnitus. Would I be missing this "golden window" if I waited to get a second opinion? I'm mostly worried because my tinnitus is not that bad (a 3/10 at worst now, and only ever in quiet rooms), and seems to be improving (although that just may be me getting my anxiety in check). I just feel like I have a lot to lose, and very little to gain in this situation.

 

I would call them back and find out more information like specifically what led them to believe you had SSNHL.

 

That's a tough call. After my tinnitus started last Labor Day, I got to into my GP within a week of onset. He also called it SSNHL, even though I didn't notice any change in my hearing, and suspected a viral infection. He put me on 50mg Prednisone for only 5 days, and an anti-viral for 10 days. I am 195 pounds, so both the dosage and number of days of your prescribed treatment are much more aggressive than what my doctor prescribed. Neither the Prednisone nor the anti-viral did any good in my case. I was subsequently seen by an ENT and audiologist two weeks later who determined that I had age-related hearing loss. I still have my tinnitus, and it has gotten somewhat worse over the past 6 months.

Supposedly, the window for Prednisone treatment of SSNHL is about a week or two. That seems to the be standard of care if a doctor diagnoses SSNHL. I have not seen very many testimonials of people saying it helped them; but I have seen a fair number of testimonials of people saying they had bad side effects, or even worsening tinnitus, from Prednisone. But how does one ever know if it helped or not. My tinnitus and hearing loss may have been worse if I had not taken the Prednisone.

My advice would be to get a second opinion as quickly as possible.

 

Unless you notice you're deaf I wouldn't, or would stick to a very short course and taper no matter what the doctor says.

Considering you think stress brought it on, Prednisone is literally stress. It lowers inflammation, but if high stress created some kind of fluid imbalance (cortisol has mineral corticosteroid activity as does Prednisone, while Dexamethasone doesn't), you're just making it worse, hence the hedge your bets method.

 

Yep, it’s not an easy decision... it certainly wasn’t for me.

Tinnitus spikes run a natural course... they will either subside back to baseline, or they will take hold and become permanent. Any treatment we take for our spikes will sit alongside this, so when the treatment is finished, the spike may have naturally subsided, or it may have stuck. It’s easy to attribute both outcomes with the medication we took.

I know Prednisone has reduced the tinnitus for many folk on this forum for the duration they’ve taken it – 14 or so days (mine’s all over the place right now) but that doesn’t mean it makes a difference long term, good or bad. Many drugs temporarily increase tinnitus while taking them, some reduce it, but those effects are rarely permanent, and it seems very few drugs are genuinely ototoxic.

What tipped my decision was that my spike started increasing after a week, not subsiding. My doctor told me that Prednisone/Prednisolone is a recognised by NICE as a first line of defence for acoustic trauma and tinnitus onset, and it’s prescribed on the NHS here in the UK. So I took it. I just wish I’d taken it a week earlier when it was more likely to have had an impact on the damage causing inflammation.

Anyway... I’m now on my fourth day of taking Prednisolone and I’ve had zero side effects other than on the first day, which were pretty mild. I’m taking 30mg at breakfast, 30mg at lunchtime. Note I’m taking Prednisolone though, which is the active ingredient that the liver turns Prednisone into. I believe it’s a bit less harsh on the body because of that.

 

I found this forum late. It’s now been 5 weeks since the onset of my tinnitus. I got tinnitus from having ear infection and using Neomycin ear drops.

Is 5 weeks too late for taking Prednisone? Will it help with my tinnitus and hyperacusis?

 

Prednisone is prescribed for use within 72 hours of acoustic trauma, or up to 4 weeks depending on what you read/who you believe, so 5 weeks seems like too long. But who knows.

I started taking Prednisolone 9 days after my recent spike and the taper will end in 4 days. No change in my tinnitus spike so far.

 

What acoustic traumas are you getting Prednisone (or Prednisolone) prescribed for?

I am wondering what qualifies as an acoustic trauma. Recently I was washing dishes and BANG dropped a dish. We repeated it (with ear protection) and it was ~105 dB. Short duration at least. But my ears felt very full, and I started to get panicked that I had caused damage. This was almost 2 days ago -- should I ask my ENT for steroids, if there is indeed a 72 hr window to start treatment?

Usually if a loud noise sets me off, I don't get the full ear feeling. But I felt it this time, which worried me.

 

@racedy, music played at too high a volume on one Sonos speaker. So annoyed with myself. I thought it was fine, but it clearly was not.

My regular GP didn't ask for many specifics... I just said my tinnitus had spiked due to music exposure, and I asked for a course of Prednisone. He looked it up and saw it was a NICE approved treatment, so I got the prescription.

I've dropped bazillions of plates over the years (I now wear earmuffs to load/empty the dishwasher) and it always freaks me out when it spikes my tinnitus, but after such an event it has always, always returned to baseline after 7-14 days. I suspect you will be fine and wouldn't worry too much, but I understand the dilemma with the short Prednisone window. Perhaps just get some and have it on standby?

For what it's worth, now I've had a course of Prednisolone and know what the side effects are like for me (mild), I'll 100% be taking it again should the need arise. Probably not for a plate smash though I think.

 

Thanks @Gav. I might call in just to get an audiogram done to see if hearing was affected, but after the plate smash my tinnitus did not spike, and my hearing seemed ok after the temporary ear fullness. I'm a little more sensitive around louder sounds, and my dog barking (which can get up to 95 decibels!) is a bit much for me again, but otherwise things seem ok.

Just hard to know because the effects of damage don't always appear immediately!

 

Here's what my ENT PA said in her message to me. While 1/2 hour is kind of arbitrary, the explanation for what happened to my ear was illuminating... previous I had just heard the tensor tympani muscle contracts to protect you. I'm not sure if this results in ear fullness or sound being cut out with this protective mechanism. I always thought not being able to hear (temporarily) = hearing damage.

"Acoustic Trauma is usually caused after 1/2 hour of exposure or loud exposions.You ear cuts out and ears feeling full because your own ear is physiologically trying to protect you from the noise. There is a certain criteria for giving steroids, I've had patients who were treated 1-3 days after loud concerts and explosions WITHOUT any recovery from steroids.

It seems like you are worried. You can call the nurse after 9am at XXX-XXXX for 1) hearing test and 2) follow up with me on the same day within 1 week."​

 

Hello all, I see ENT on Wednesday. When I spoke to him he said he thinks he would put me on steroid (likely Prednisolone) and antiviral. I believe my tinnitus is the result of post vaccine something or other. It's been a nightmare. Any reduction in hissing and crickets would be great. I haven't slept right in weeks.

Just wanted to get some of your input: I am praying on this. Is it worth taking those meds and risking a spike? If this sound gets louder I don't think I could handle it.

Thanks so much. I am so grateful for this forum. I am scared.

 

I am going to go back on Prednisone after a merciless spike, 60 mg for 4 days, 40 mg for 4 days, 20 mg 4 days, then 10 mg for 2 days.

Does anyone know if I can just take most of my dose during the day when I wake up or do I have to take it like twice at breakfast twice dinner and then twice before bedtime?

Asking because if I take at night I will have a lot of trouble sleeping.

Any advice is appreciated.

 

Oh great. I was just on steroids again for 9 days for asthma. Ringing has been bothering me again since.

 

@MaryA, "I haven't slept right in weeks." = how many weeks since your vaccination? Prednisone, if it does anything, should be taken as close to the acoustic trauma as possible. Within a few days is best, but some ENTs say you can take it within the first couple of weeks, even four weeks, to get some benefit.

I had little cricket sounds when my tinnitus first started... not nice, but they disappeared in time leaving just the continuous tones which I managed to habituate to. This may happen to you also.

 

@VeryUnfortunate, I took my Prednisolone taper (60 mg, 60 mg, 50 mg, 50 mg, 40 mg, 40 mg, 30 mg, 30 mg, 20 mg, 20 mg, 10 mg, 10 mg) by splitting each daily dose in half. I had half in the morning and half at 12 noon. I found this minimised the side effects and I slept just fine most days.