Treatment Decision — Wondering About Evidentiary Support

Discussion in 'Dr. Stephen Nagler (MD)' started by 21cbrain, May 8, 2015.

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    1. 21cbrain

      21cbrain Member

      New York City, NY
      Tinnitus Since:
      I am a 57 year old female having problems with wax in my ears for a couple of years, where my ear canal would stick shut and my hearing would muffle. Once or twice I had to irrigate my ear with hydrogen peroxide solution, and the issue resolved. I'm careful with my ears- no qtips, earbuds, rock concerts.

      I flew to Idaho from NY on April 7th. On Saturday, April 18th, I noticed this clogged feeling in my ears. I took a shower and let some warm water enter. Immediately my ears clogged up with pressure, and my hearing muffled. In subsequent hours, I could not clear my ears. Both of my ears developed tinnitus, with the ringing extremely loud in the right to the point where I could not concentrate or think. My hearing decreased 50%.

      Unfortunately, I am on Obamacare and it doesn't cover out of state. My insurer refused an ER visit. On Monday, I went to a clinic. They found both drums covered in wax and syringed it out. Immediately my left ear unclogged and its tinnitus stopped. My right ear unclogged but the tinnitus persisted, albeit at reduced volume. I could hear out of both ears.

      I asked the doctor if I could fly and whether I should urgently consult an ENT. She said to watch and wait. Unfortunately I was trapped in Idaho for another week due to a family member's health crisis. During this time a flu was going around the house and I had 3-4 days of sore throat for which I took Aleve 2 tabs q12h.

      I returned to NY and saw an ENT on Day 13. The audiogram revealed a mild hearing loss in the right ear- to 30-35 decibels between 2000-4000 khz, whereas the left ear was normal. My doctor prescribed Prednisone 60mg x 2 days, then 40mg x 2, then 20mg. Reviewing the literature seemed to indicate a common treatment for SHL is Prednisone 60mg for 10 days. I called my doctor and asked to stay on the Prednisone longer, and he agreed to continue at 40mg. He felt the hearing loss was probably caused by the virus, but I really believe that the pressure of the wax clogging was the cause.

      The tinnitus continues constantly but fluctuates. I hear high tones and then hisses, and it varies in loudness from able to be masked by environmental sounds (computer hum) to prevailing over sounds. It grates on my nerves. I don't notice the hearing loss as much. I'm really scared because both my father and aunt have had Meniere's and my aunt is totally deaf.

      Today (Day 20 since onset) and (Day #8 of Prednisone 60mg x 2, 40 mg x 6) I saw my doctor. An ABR was negative for acoustic neuroma. The audiogram showed no change. He proposed 3 possible plans of action: 1) Increase Prednisone 60mg and continue for another week. 2) Intra-tympanic steroid injections through the ear drum or 3) do nothing.

      So reviewing the literature: Cochrane says there is no real proof of oral steroid efficacy for SHL- studies insufficient. One study showed increased effectiveness with IT injection; others did not. Some insurance companies consider IT injections experimental; likely mine will agree. I'm also worried about risks to the injection. On the other hand, the oral steroids are making me feel pretty sick. I'm mainly interested in helping my tinnitus and I don't know of any proof steroids can help this. But perhaps reversing the hearing loss would help the tinnitus?

      It's all very confusing and very stressful and I feel the clock is ticking down in terms of what I can do and when. I feel time is of the essence and terribly regret the previous delay in getting help. I know I must make this decision on my own but I am wondering if your understanding of the research is congruent with mine.

      Another possibility would be enrolling in the AM101 trial, which is offered in my area. I don't know if my experience would count as acoustical trauma exactly; they are focused on noise.

      Any thoughts appreciated.
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      Hi 21c. That's quite a story you've got there. I read through it three times - and I still can't figure out which end is up. For instance, your doctor is proposing three possible plans 0f action, but for the life of me I can't figure out what exactly it is that he is treating and what exactly it is that he is seeking to accomplish with his treatment. Makes it tough for me to give you an opinion on this issue, an issue that is obviously of great importance to you.

      OK. Here are my thoughts. It may sound simplistic, but this is what I would do.

      Sit down with a pen and paper ... and after giving it due consideration, write down the three most important questions you would like your doctor to answer. Be specific. And keep it simple. The more complex and wordy the question, the less likely it is that you will get an answer that satisfies you.

      Then make an appointment for a follow-up visit with your doctor. Bring the paper with you into the examining room. And once you are there with him face to face, do not leave until your three straightforward questions are answered to your satisfaction.

      Hope this helps more than frustrates.

      stephen nagler

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