Ultrasound-Guided Stellate Ganglion Block for the Treatment of Tinnitus

[Nick47]

Conclusion:

Ultrasound-guided stellate ganglion block demonstrates superior efficacy in managing tinnitus compared to conventional drug therapy. This study underscores the potential of integrating advanced ultrasound technology into healthcare to optimize treatment outcomes for auditory disorders.

Ultrasound guided stellate ganglion block for the treatment of tinnitus - PubMed

BackgroundTinnitus, a common auditory disorder, significantly impacts patient quality of life and lacks universally effective treatments. The integration of advanced imaging technology like ultrasound in therapeutic interventions offers new possibilities in healthcare.ObjectiveThis study...

pubmed.ncbi.nlm.nih.gov

The effects are modest. It involved a moderately sized group. This is not the full paper, so it lacks detail.

 

[annV]

This is not the full paper, so it lacks detail.

More detail is here:

Sage Journals: Ultrasound-guided stellate ganglion block for the treatment of tinnitus

 

[Nick47]

More detail is here:

Thanks, @annV. Are you OK?

 

[withintention]

The results seem impressive to me.

• There were 80 participants, and 100% showed improvement. The results were statistically significant compared to the control group, which received a standard Lidocaine injection.
  
  
• The average THI score dropped from around 63 to about 38, which means a shift from Severe Disability to the borderline between Moderate and Mild Disability.
  
  
• The average SAS score went from roughly 56 to 39, moving from Mild Anxiety to the Normal range.

I would go in for a shot once a week for results like that, without hesitation.

 

[Nick47]

The results seem impressive to me.

• There were 80 participants, and 100% showed improvement. The results were statistically significant compared to the control group, which received a standard Lidocaine injection.
  
  
• The average THI score dropped from around 63 to about 38, which means a shift from Severe Disability to the borderline between Moderate and Mild Disability.
  
  
• The average SAS score went from roughly 56 to 39, moving from Mild Anxiety to the Normal range.

I would go in for a shot once a week for results like that, without hesitation.

@withintention, now that I can see the full paper, I agree.

 

[hey]

This looks great, but I have a few questions if anyone knows the answers.

My first question is: how is this different from the treatment that was offered in Korea, which some members here tried?

The article mentions that the group that didn't receive the treatment also improved by, I think, 75%. How do they explain that?

Does anyone know where someone can try this treatment if they wanted to?

 

[withintention]

The difference appears to be the use of ultrasound to better target the stellate ganglion. I am not sure what treatment was offered in Korea. Can you provide a link?

Looking back through the forums, it seems that the few people who have tried this may not have received the injection from someone using ultrasound for guidance. That is the key point of this study — to demonstrate the benefits of using ultrasound to guide the injection.

I asked my doctor, and they said that pain specialists and anesthesiologists can offer this treatment. I am going to find one in my area and give it a try. I will report back after I do.

 

[Jammer]

I asked my doctor, and they said that pain specialists and anesthesiologists can offer this treatment. I am going to find one in my area and give it a try. I will report back after I do.

A short follow-up period of six days after treatment may not be sufficient to properly assess the long-term efficacy of ultrasound-guided stellate ganglion block for tinnitus.

It may be challenging to find a doctor who is willing to give it a try. Keep us updated if you find a doctor, along with the cost of treatment, whether it was done on both sides, and any long-term benefits you experience.

 

[Isabella 123]

What is the stellate ganglion? What does it mean to block it, and what does blocking it do? Thank you for any information!

 

[Joeseph Stope]

Ultrasound guided stellate ganglion block for the treatment of tinnitus - PubMed

BackgroundTinnitus, a common auditory disorder, significantly impacts patient quality of life and lacks universally effective treatments. The integration of advanced imaging technology like ultrasound in therapeutic interventions offers new possibilities in healthcare.ObjectiveThis study...

pubmed.ncbi.nlm.nih.gov

The effects are modest. It involved a moderately sized group. This is not the full paper, so it lacks detail.

The authors, specifically the research team, appear to be from China, Korea, or similar regions. I remember considering a treatment called "Ganglion Block" in the early nineties, during the early onset of my condition. If I recall correctly, the pioneers of this treatment were Dutch doctors. However, I was advised that it was somewhat dangerous and required a high level of precision to access the correct area.

Given that thirty years have passed since then, I am confident that the precision aspect has likely improved significantly with modern imaging technology. The fact that researchers are still exploring this approach suggests it may be more than just a speculative idea.

 

[AverageJoe12]

What is the stellate ganglion? What does it mean to block it, and what does blocking it do? Thank you for any information!

Google is your best bet here. The search results are helpful:

A stellate ganglion block is a medical procedure where a local anesthetic is injected near the stellate ganglion, a cluster of nerves in the neck.

SGB is primarily used to treat:

• Chronic pain, particularly in the upper extremities, head, and face
• Complex regional pain syndrome (CRPS)
• Post-traumatic stress disorder (PTSD)
• Vasomotor symptoms, such as hot flashes

 

[withintention]

I am not entirely sure what it is or what it does, but the study linked above suggests what blocking it might do for tinnitus sufferers.

I received a referral from my doctor for the procedure, but I have not gone through with it yet. I am still not entirely sure I will, as there is a chance of complications from the procedure.

My doctor referred me to a specialist at a clinic that focuses on pain medicine and physical rehabilitation. If anyone else gets a referral and tries it before I do, please share your experience here.

 

[ErikaS]

I had been looking into this for its potential use in treating PTSD, as it may help reset the nervous system and break the constant fight or flight cycle. After reviewing this study, I feel even more encouraged to pursue it. I am currently in the process of finding well-reviewed practitioners in my area who offer this treatment. I will share updates as I move forward.

 

[Dizzyhead888]

Where can we get this treatment?

 

[ErikaS]

After some tedious searching and making phone calls, I found a local doctor who is a board-certified neurologist with fellowship training in pain medicine and neurophysiology. He has a special interest in neurological disorders such as migraine, trigeminal neuralgia, and cluster headaches. He opened his own pain management center this past October.

He performs many procedures for pain management, including various nerve blocks and Botox. I was initially looking for someone who could perform the stellate ganglion block, but after reading his background, I decided to share everything about my tinnitus condition and see what he thought. He was very kind, knowledgeable, and empathetic, and he seemed genuinely intrigued by my symptoms.

He believes that tinnitus is closely tied to migraine processes and explained how the ears can be affected by a continuous migraine loop. He understood that I do not suffer from head pain migraines but still felt the migraine pathway was worth exploring. His suggested approach was to "work our way up" through different treatments to see if any would bring relief. His recommendation was: start with a CGRP inhibitor migraine medication, then try an occipital nerve block, followed by a stellate ganglion block, and finally consider Botox.

He gave me samples of Ubrelvy, a CGRP inhibitor similar to Nurtec. My ENT had given me Nurtec samples a few months ago, which had no effect, but I agreed to try Ubrelvy just to say we had covered that step. He also made it clear that he would never recommend first-generation migraine medications like Topiramate for my case, as he strongly believes they would worsen tinnitus. I found that especially interesting in light of the NeuroMed treatment.

I am not experiencing any improvement with Ubrelvy, so I am scheduled to return on the 12th for the occipital nerve blocks. His words to me were, "I will work with you if you work with me." I am very grateful to have found him, and even more grateful that he genuinely cares and is trying to help, rather than simply prescribing an SSRI or downplaying my experience.

I will post an update in the appropriate place regarding the occipital nerve block procedure. If we move forward with the stellate ganglion block, I will be sure to provide an update here.

 

[SouthBound]

This looks great, but I have a few questions if anyone knows the answers.

My first question is: how is this different from the treatment that was offered in Korea, which some members here tried?

The article mentions that the group that didn't receive the treatment also improved by, I think, 75%. How do they explain that?

Does anyone know where someone can try this treatment if they wanted to?

They do not state in the abstract what was the standard for improvement. It may have been set pretty low if the placebo group had an 84% response rate. Typical placebo response rate in studies ranges from 40-55%, so this is high. All we can say is the magnitude of change from the procedure.

 

[SouthBound]

A short follow-up period of six days after treatment may not be sufficient to properly assess the long-term efficacy of ultrasound-guided stellate ganglion block for tinnitus.

It may be challenging to find a doctor who is willing to give it a try. Keep us updated if you find a doctor, along with the cost of treatment, whether it was done on both sides, and any long-term benefits you experience.

We have a phrase in medicine "nothing ruins good results like long-term follow-up", so I agree about the 6 days. Most used of stellate ganglion block are not approved by insurance companies, so the biggest challenge is finding someone with the skill set, more than a willingness to try it Just my opinion, but I am an insider (pain specialist who does the procedure).

 

[SouthBound]

The authors, specifically the research team, appear to be from China, Korea, or similar regions. I remember considering a treatment called "Ganglion Block" in the early nineties, during the early onset of my condition. If I recall correctly, the pioneers of this treatment were Dutch doctors. However, I was advised that it was somewhat dangerous and required a high level of precision to access the correct area.

Given that thirty years have passed since then, I am confident that the precision aspect has likely improved significantly with modern imaging technology. The fact that researchers are still exploring this approach suggests it may be more than just a speculative idea.

In the early 90's stellate ganglion blocks were only done under X-ray (fluoroscopy), which were less accurate and less safe. While some docs still use X-ray guidance, most have moved to the superior guidance of ultrasound. There is still risk, but it is much, much less.

 

[SouthBound]

I had been looking into this for its potential use in treating PTSD, as it may help reset the nervous system and break the constant fight or flight cycle. After reviewing this study, I feel even more encouraged to pursue it. I am currently in the process of finding well-reviewed practitioners in my area who offer this treatment. I will share updates as I move forward.

@ErikaS, the studies on treating PTSD are stronger than for any other condition. I have used this treatment with patients who have PTSD for the past 12 years. It does not work for everyone, but the results are usually remarkable.

After some tedious searching and making phone calls, I found a local doctor who is a board-certified neurologist with fellowship training in pain medicine and neurophysiology. He has a special interest in neurological disorders such as migraine, trigeminal neuralgia, and cluster headaches. He opened his own pain management center this past October.

He performs many procedures for pain management, including various nerve blocks and Botox. I was initially looking for someone who could perform the stellate ganglion block, but after reading his background, I decided to share everything about my tinnitus condition and see what he thought. He was very kind, knowledgeable, and empathetic, and he seemed genuinely intrigued by my symptoms.

He believes that tinnitus is closely tied to migraine processes and explained how the ears can be affected by a continuous migraine loop. He understood that I do not suffer from head pain migraines but still felt the migraine pathway was worth exploring. His suggested approach was to "work our way up" through different treatments to see if any would bring relief. His recommendation was: start with a CGRP inhibitor migraine medication, then try an occipital nerve block, followed by a stellate ganglion block, and finally consider Botox.

He gave me samples of Ubrelvy, a CGRP inhibitor similar to Nurtec. My ENT had given me Nurtec samples a few months ago, which had no effect, but I agreed to try Ubrelvy just to say we had covered that step. He also made it clear that he would never recommend first-generation migraine medications like Topiramate for my case, as he strongly believes they would worsen tinnitus. I found that especially interesting in light of the NeuroMed treatment.

I am not experiencing any improvement with Ubrelvy, so I am scheduled to return on the 12th for the occipital nerve blocks. His words to me were, "I will work with you if you work with me." I am very grateful to have found him, and even more grateful that he genuinely cares and is trying to help, rather than simply prescribing an SSRI or downplaying my experience.

I will post an update in the appropriate place regarding the occipital nerve block procedure. If we move forward with the stellate ganglion block, I will be sure to provide an update here.

From my perspective as a pain specialist who is also certified in interventional headache treatment, your doctor's approach is sound.

I am not entirely sure what it is or what it does, but the study linked above suggests what blocking it might do for tinnitus sufferers.

I received a referral from my doctor for the procedure, but I have not gone through with it yet. I am still not entirely sure I will, as there is a chance of complications from the procedure.

My doctor referred me to a specialist at a clinic that focuses on pain medicine and physical rehabilitation. If anyone else gets a referral and tries it before I do, please share your experience here.

In my opinion, the possibility of complications is not a valid reason to proceed. The risk is quite low, and I have never seen it occur in my practice.

What is the stellate ganglion? What does it mean to block it, and what does blocking it do? Thank you for any information!

The stellate (or "star-shaped") ganglion is a bundle of sympathetic nerves—part of the fight or flight system—located on each side of the lower front part of your neck, just above the collarbone. This nerve bundle connects to the arms and head.

The idea behind blocking these nerves is based on the theory that excessive sympathetic nervous system activity may play a role in tinnitus or increased sound sensitivity. Temporarily turning off these nerves by blocking them for 4 to 5 hours may allow for a "reset," which can provide lasting relief.

In this context, "blocking" means injecting a local anesthetic next to the nerve bundle.

 

[Jammer]

@SouthBound, what are the side effects of these injections?

 

[SouthBound]

@SouthBound, what are the side effects of these injections?

This is the handout I give patients:

Within minutes after the procedure, an individual should begin to display and experience side effects from blockade of the sympathetic nerves on the side of the procedure. While these side effects may be unpleasant, they demonstrate the medication was successfully placed next to the target nerves. All side effects listed below typically last 4-5 hours, occasionally lasting through the end of the day. Your activity after the procedure is only limited by how you feel. You can take any of your usual medications after the procedure.

• Eye: Droopy eye lid (in some cases the eye cannot be opened at all), bloodshot eye, narrowed pupil diameter.
• Nasal congestion.
• Face: increased warmth, tingling, numbness.
• Throat: a feeling of fullness or sense something is stuck in the throat.

Other nerves in the area may also be exposed to local anesthetic and cause additional symptoms

• Hoarseness.
• Difficulty swallowing. This may be mild, interfering with eating solid food, or may be more severe impairing ability to swallow saliva. Do not try to overcome "power through" swallowing difficulties, doing so can cause choking. Dry mouth can be soothed by small sips of water or ice cubes, then spitting.
• The nerve that controls the diaphragm can be affected resulting in temporary paralysis of the diaphragm on that side. This is usually not noticeable unless someone exerts themselves (running, hiking, climbing stairs) which would cause them to feel short of breath. We recommend people rest for the remainder of the day.

Other miscellaneous side effects

• Most individuals feel tired ("washed out") after the procedure and they frequently want to nap, which is fine.
• Headache. If headache occurs, it is fine to take ibuprofen (Motrin), acetaminophen (Tylenol) or other medications you use for headache.
• Nausea (rare).
• Weakness/numbness in the arm (rare).

 

[Jammer]

@SouthBound, thanks for your response. Have you worked with patients who have tinnitus?

 

[SouthBound]

@SouthBound, thanks for your response. Have you worked with patients who have tinnitus?

@Jammer, I have performed a lot of stellate ganglion blocks for other reasons, but I do not have any experience treating tinnitus specifically. I have to rely on the published studies.

 

[Jammer]

@SouthBound, do you have tinnitus or did you accidentally run across our happy little forum?

 

[ECP]

According to Google, only around 80 percent of people have a stellate ganglion. That's because the definition of a stellate ganglion involves the fusion of two (or sometimes more) ganglia. The other 20 percent of people have the same ganglia, just without the fusion.

I wonder whether this is simply a trivial anatomical variation with no impact on a person's predisposition to various physical and psychological disorders, or if the presence or absence of fusion plays some role in our health that scientists have not yet fully understood.

On a related note, is the procedure still called a stellate ganglion block if it's performed on a patient who technically doesn't have a stellate ganglion?

 

[SouthBound]

@SouthBound, thanks for your response. Have you worked with patients who have tinnitus?

No.

@SouthBound, do you have tinnitus or did you accidentally run across our happy little forum?

I don't have tinnitus. My wife developed hyperacusis a couple of weeks ago, and so far, all findings have been negative. I started looking for information on whether a stellate ganglion block (SGB) might be helpful for her, since I perform them frequently, and in the process, I came across your thoughtful forum. I figured I would chime in.

According to Google, only around 80 percent of people have a stellate ganglion. That's because the definition of a stellate ganglion involves the fusion of two (or sometimes more) ganglia. The other 20 percent of people have the same ganglia, just without the fusion.

I wonder whether this is simply a trivial anatomical variation with no impact on a person's predisposition to various physical and psychological disorders, or if the presence or absence of fusion plays some role in our health that scientists have not yet fully understood.

On a related note, is the procedure still called a stellate ganglion block if it's performed on a patient who technically doesn't have a stellate ganglion?

You are correct. Whether there is a fusion or not does not matter—you still have the same nerves either way, just organized differently. Yes, we use "stellate block" as shorthand. To determine whether a fusion is present, one would need a cervical MRI or a surgical dissection. However, the procedure would be performed the same way regardless.

 

[ECP]

Thank you @SouthBound for your comments. I hope your wife feels better soon. We appreciate you taking the time to share your knowledge with us.