Top Treatments to Consider in the Early Days After Onset

What are the top time-sensitive treatments to consider for tinnitus?

When I first arrived here the information was hard to dig out. It requires looking through many, many threads, and evaluating each one. This took a lot of time, which slowed me down and made my treatment worse, since I needed to drive my doctors to treat me properly.

Let's make a list of the top things to consider, in order, so that newcomers have an easy checklist of things to start from.

NOTE: This list isn't stating what everyone needs to do. People should evaluate each treatment based on their own circumstances. But, it would be incredibly useful to have a decently-ordered list of things to at least consider.

NOTE: This list is also focused on time-sensitive treatments. Long-term treatments can be explored at further length elsewhere, but this is really more of a "things not to miss in your first X days" list.

My list of so far:

1. Oral steriods, predniosne or prednisolone. Essential first-line defense. Ideally take within 2 days of onset, possibly effective up to 30 days after onset. Dosage: 1mg/kg of bodyweight, up to 60mg/day for at least a week, tapering off. Dosage matters! Get a high dose. (my doc badly underdosed me)
2. Magnesium supplements. No real risk here and some serious scientific reasons to think it works.
3. Vitamin B12. No real risk here and some serious scientific reasons to think it works.
4. Vitamin D. No real risk here and some serious scientific reasons to think it works.
5. Steroid injections into the ear. Possibly effective up to 90 days after onset, but best before 30. Some sources say these are ineffective, some state they work.

What other time-sensitive treatments would be worth at least considering?

(I'm currently 35 days from onset.)

 

@Canadaman

We are still in the Stone Age of tinnitus treatments, and even for acute cases there is basically nothing. Some people will try HBOT (Hyperbaric Oxygen Therapy), but the evidence is inconclusive to say the least. Other people might try LLLT, but again no real evidence that it does anything.

The description of your case from your other posts sounds like mild tinnitus, and it might improve over time without doing anything particular (just avoid any further acoustic trauma/stress). It is also very possible that you will habituate easily.

 

Prednisone had remarkable effect for me even 60 days after onset.

 

Thanks for the info. How much did you take for how long? What's your body weight (just to compare dosage)?

I took 2 weeks of 60mg/day. I'm ~90kg. It didn't seem to do much for me.

 

I haven't been able to get ahold of a doctor who would let me take the full (I think 30 mg per day for two weeks, followed by a taper pack?) course. Instead I was only given a taper pack, twice. Both times when taking the starting dose (the highest one, typically 20+ mg) I noticed a remarkable effect. I would wake up and it would be very dormant. I'm currently taking both amitriptyline and Gabapentin and those have not helped.

 

Add stem cells and HBOT.

 

A number of people have reported success with CBD oil. There's a number of other supplements that I've read that helped: 1) Magnesium; 2) Zinc; 3) Vit. A; 4) CoQ10; 5) Apple Cider Vinegar (internally and as ear drops--diluted); 6) Gingko Biloba; 7) Garlic-Mullein ear drops; and a few others, including Traditional Chinese Medicine (TCM).

One therapy I'm considering, and wish I would have been more famililar with in the beginning (a year ago), is Low-Level-Laser-Therapy (LLLT). There's a fairly long thread on it here on the forum, and the major takeaways I took is that it is time sensitive (the sooner the better), and that professional sessions are far more effective than trying to find a home unit that might do the trick. Apparently, quite a few practitioners offer LLLT therapy these days. -- Good luck to all!

 

Just to add to the info here I was given prednisone about 2 months after onset (ENT refused this at first, granted it on a second request) and it spiked my tinnitus for a week. Before taking it I gathered accounts on Facebook groups and saw some people said their tinnitus improved when they took this early on, some who'd had tinnitus long term said the tinnitus reduced or went when on prednisone but came back when they stopped, and some found it increased their tinnitus, as I did.

However as in my case all the increases I saw reported were temporary.

 

40 MG of pred is amazing stuff; but the docs are not kidding around about the side effects.

Over the last year and a half (since Dec 17 really) I've been taking varying doses per my ability to "find" courses, taper packs, you name it. I've taken at least six full courses (2 x days of 40 mg, 2x days of 30, 2x days 20, etc) over 12 months and while I do get some serious relief it doesn't last very long and the downsides are obvious.

You're going to put on weight, start having panic attacks even if you've never had them in your life, start having vivid nightmares, be unable to sleep without an aid, there's a nasty after taste, and that's just the stuff that you can see. The stuff puts unbelievable stress on your adrenals and can compromise bone density with long term use. There are credible reports of long term users (as in people who did not stop using it and continued to take, say, 10 mg per day for three weeks straight) of actually developing tinnitus in those who didn't have it or worsened tinnitus in those who did.

This is an emergency drug. Period. It absolutely can help you at first onset and during a major spike (EG you can easily tell your tinnitus has gotten worse during a loud event) but it should NOT be used when you're feeling "bad" or when someone drove a lawnmower past you. This stuff will mess you up. I may be relatively lucky because I'm young, not taking other medicines and in decent shape, but I can't speak for everyone.

 

Hi all,

Several weeks ago I got tinnitus after exposure to loud music.

In looking around, I realize that many of the therapies I've read about talk about a window of opportunity - a window of time during which they may be somewhat effective, but lose efficacy with time.

Is there anything that the collective wisdom of Tinnitus Talk has come to understand is helpful, but must be done ASAP?

Many thanks.

 

For me, the first treatment is Prednisone (if tinnitus is noise-induced) AND benzodiazepines.

For me benzodiazepines is THE first treatment.
It responds to everything: stress, memory and focus.

It has been proven stress plays a role in tinnitus, as well as in memory. And benzodiazepines help both because they also have an anterograde amnesia effect.
And it's also proven that tinnitus is related to GABA.

So I am really confident benzodiazepines can actually prevent tinnitus from becoming chronic.

 

(By way of explanation, I started a new thread but it was moved here - wisely - to keep all the info in one place. However, my 1st post above may seem weird without that context).

So, to sum up so far:

These things seem to get mentioned multiple times:

1) Prednisone.
2) HBOT therapy.
3) Benzodiazepines.
4) Vitamin supplements (B, D, magnesium).

These things seem to get mentioned but less frequently:

- LLLT
- Other vitamin supplements
- Traditional Chinese Medicine

Any other thoughts about what to do in the precious early days?

Thanks,

Jack

 

Thanks for the response.

Can you give more info about benzodiazepines?

Did you have personal experience with them that was helpful?

My understanding was that they were just to deal with secondary stress, but you're saying they go beyond that.

 

If you can get your hands on a stronger NMDA receptor antagonist (e.g. memantine), I’d replace the magnesium with that.

 

I had a horrible mix of tinnitus, and the horrible sound was very high pitched, loud, electrical.
The benzo made it go from a horrible sound to a sshsshssh and then it disappeared. It came back two or three times but then completely disappeared.

I was also advised by a shrink to take benzodiazepines for any new tinnitus sounds because of the impact on stress and memory. And I have read a lot of articles on tinnitus and they all said the memory and emotion parts of the brain are involved and as I said, benzodiazepines work on both.

When you use benzodiazepines only temporarily, there shouldn't be adverse effects.

If I may say so, HBOT is useless if the tinnitus is not from a pressure problem.

Magnesium and vitamin B are really good picks. Even as long term treatment. With no side effects.

I also read a lot about Ginkgo Biloba. And science is backing it up. It can work in certain cases (inflammatory and blood flow).

 

How long was your treatment with prednisone? How many days?

If I understand correctly: after the treatment, things did not improve much?

I'm on day 2 of a high dose, with an expected time to be on prednisone for over a month and I am considering stopping right now, without tapering or anything... just 2 days. I haven't slept well in these 2 days and this is very rare for me, and I feel a bit nervous too, maybe anxious about this treatment.

 

Did you experience any side effects during those 2 weeks? Loss of sleep etc?

 

You should probably call your doctor ASAP and go over this with them.

If it's helpful, I was on prednisone for a week followed by a taper.

 

Did your prednisone course provide lasting results? I mean results that changed the situation of your tinnitus or hyperacusis for the better in a permanent way, or did it only provide temporary relief from symptoms?

My doctor is unavailable until Monday. I called the pharmacy and they said tapering is needed when the initial dose is high like mine, even if I started just 2 days ago (with 50 mg every day). I don't know what to do now...

 

At the very least, I wouldn't stop the prednisone cold turkey, but rather taper one less pill a day until you get to zero if you choose to stop.

Are you able to reach anyone else at your doctor's office today who might be able to help? A nurse or an assistant?

As for myself, I feel that I got some benefit from the prednisone. How much and whether it lasts, I'm not yet sure - this is all new to me.

 

I was able to reach someone, two people, at the pharmacy and also called on the emergency phone included on the information leaflet of prednisone. It is a phone to report intoxication by prednisone but I just called them to ask about stopping cold turkey or tapering. Both the pharmacy and the doctors on the phone recommended to stay on prednisone and taper.

They said my side effects (not able to sleep at all, slight anxiety, feeling really tired in general) are normal and will get better as I lower the dose. However, I am not seeing any benefit whatsoever from using prednisone. I would say my ears feel even more deafened. Tinnitus went up the first day and then went quiet. Understanding speech maybe got even worse when on prednisone. So basically I don't see the point of taking it and suffering the side effects without anything to gain from it, no improvement to my hearing condition.

I shouldn't have started taking this but anyway. I will talk to my ENT on Monday, see if I can taper faster instead of being a month on this.

 

Good luck with it - Monday will be here soon enough.

In the meantime, if it's any consolation, I've learned that prednisone seems to be one of the most common tools ENTs use in these circumstances, and that results might not always be immediate.

 

Just a small update. Sleeping was better yesterday. I now perceive sounds more dim, and tinnitus goes up and down, but generally better, I would say. Yesterday I had like a weird spasm on one side of my head, I don't know what that was, it wasn't exactly painful but like something big that moved or spasmed...

However I still think the prednisone is not worth it and the fact I hear dimmer is awful, because I have already some hearing loss and this is making my life more complicated.

Will try to talk to the doctor tomorrow.

 

The recommended course for a true acoustic trauma (gunfire etc) is two weeks- 60mg for 7 days followed by a taper beginning at 60.

Sleep can become an issue at first.... once your body gets used to it you'll be fine.

 

Thanks for your answer!

It seems sleeping is a bit better. I am not seeing any great results from the treatment but I think I will just trust the doctor, who has lots of experience, and keep going. If at the end I don't see any positive results, I will just forget about prednisone in the future.

 

According to my NYU ENT, tapers aren't needed for such a short course of steroids. He has me on a 7-day course of 60mg of Prednisone. Sleeping is hard but I have learned to take it early in the day and occasionally I use a sleeping aid (like Ambien).

I've gotten some other side effects, but I'm sure they are temporary and I think it's best to power through (even the toughest times) because this is the best chance for success and time is critical.

I'm also taking vitamins and I'm adding a few more to my list based on this thread. Thank you!

Best to everyone! I hope we see all able to find relief and improvement.

 

Maybe Lenire would be a good treatment if you use it early on. There are signs pointing towards that.

 

FWIW, I've always heard prednisone is tapered, even if the full dose is as short as one day, as is the case when using a standard pack (descending rows represent day 1, day 2, day 3, etc.)

 

I had a two week course of prednisone with no taper. Doctor said even two weeks is too short to bother tapering. I'm in the UK so don't know if it's different over here? Our packs look nothing like that.

 

I think there is a difference between prednisone and prednisolone. They are not exactly the same.

Also, my personal feeling about prednisone after many many years with hearing problems, and using both short and long courses of prednisone, is that each doctor has a different view on this drug, specially about tapering. I think tapering is not needed if you are on it for 7 days. For 15 days, there would be varied opinions. For more than 15 days you will have to taper for sure.

Actually, if you ask specifically about tapering and you refer to the information leaflet for prednisone, most people will just parrot what is on the leaflet, this is... that tapering is needed.