Commercial Lidocaine Patch as a Treatment for Ear-ringing

[Nick47]

Can you give me a little more of the science around the conduction theory? Am I risking permanent hearing loss continuing?

It was something Professor Bance wrote in your notes.

So it took you two weeks to see any benefit.

I have trialed a patch for 16 hours to check for side effects—no soreness but a bit of IBS, which settled down.

 

[Cmspgran]

It was something Professor Bance wrote in your notes.

So it took you two weeks to see any benefit.

I have trialed a patch for 16 hours to check for side effects—no soreness but a bit of IBS, which settled down.

I remember him writing about ectatic conduction in relation to Carbamazepine, mentioning it as the best drug for that condition. I tried researching it further, but it quickly became too scientific for me to follow.

It's interesting that you had an IBS flare-up. I wonder if there's any connection between that and the recurring bouts of nausea I was experiencing, which have now stopped...

 

[Nick47]

I remember him writing about ectatic conduction in relation to Carbamazepine, mentioning it as the best drug for that condition. I tried researching it further, but it quickly became too scientific for me to follow.

It's interesting that you had an IBS flare-up. I wonder if there's any connection between that and the recurring bouts of nausea I was experiencing, which have now stopped...

I've had IBS before. You were right about needing the tape, too.

Some people regularly wear the Lidocaine patches for pain. Maybe go 16 hours on, 8 hours off.

After a couple of weeks, they were undoubtedly helping quite significantly, especially the reactive element.

I was wondering if a TCA (tricyclic antidepressant) would be beneficial for us? Have you made any progress on this from your end?

I recently went out for my 50th birthday, wearing earplugs, but now I'm experiencing increased tinnitus, sound reactivity, and sensitivity. My GP prescribed 60 mg of Prednisolone for 5 days.

 

[Cmspgran]

I've had IBS before. You were right about needing the tape, too.

Some people regularly wear the Lidocaine patches for pain. Maybe go 16 hours on, 8 hours off.

I was wondering if a TCA (tricyclic antidepressant) would be beneficial for us? Have you made any progress on this from your end?

I recently went out for my 50th birthday, wearing earplugs, but now I'm experiencing increased tinnitus, sound reactivity, and sensitivity. My GP prescribed 60 mg of Prednisolone for 5 days.

Hi @Nick47,

I gave up on it after the hearing drop incident, which is a shame because it was working. However, it also made me nauseous, which wasn't pleasant. How did you get on?

I'm sorry to hear about your birthday celebrations. Happy 50th, by the way, but I'm really sorry that this awful condition put a damper on things. The impact it can have is truly soul-destroying at times.

At the moment, I'm taking Clonazepam most days at varying doses, but never more than 0.75 mg a day. It's definitely lost its effectiveness, but I got tired of the up-and-down rollercoaster of taking it just a few days a week. I ran out of Gabapentin and am hesitant to go back to the GP, worried they might take me off the Clonazepam.

I had an appointment this week at the NHS hospital tinnitus clinic. Interestingly, they take a hybrid approach—part CBT, but also focusing on the theory of neural circuit dizziness, which I hadn't really heard of before. It's somewhat similar to the idea of migraines and hypersensitivity.

I can't say I gained much from the appointment, but it was nice to sit in front of someone compassionate for nearly 90 minutes. They clearly cared and agreed that I had every right to be angry at the same hospital that caused this. There's not much else to try at the moment, but I'm experimenting with as many antidepressants and anxiety-lowering strategies as possible.

The way I see it, we've just got to keep hanging in there for another five years—surely one of these treatments will be available by then.

 

[Nick47]

I had an appointment this week at the NHS hospital tinnitus clinic. Interestingly, they take a hybrid approach—part CBT, but also focusing on the theory of neural circuit dizziness, which I hadn't really heard of before. It's somewhat similar to the idea of migraines and hypersensitivity.

It's interesting that they are finally moving with the times. Which hospital?

I was put on a 5-day course of oral steroids this morning—60 mg per day. I also applied a Lidocaine patch this evening. I have nine patches, so I can use them for a while. Today, I took 900 mg of Gabapentin and 400 mg of Magnesium glycinate. I've run out of ALA (Alpha-Lipoic Acid)—it's not cheap, but I've ordered more. It seems we often take a combined approach of things that are effective or possibly effective, even though it feels contradictory in our thinking.

The GP I saw this morning had good bedside manner and seemed somewhat open to what I was saying. He was, however, reluctant to prescribe Nortriptyline, even though I mentioned the migraine studies. Instead, he wanted to refer me to a tinnitus clinic. I said, "What tinnitus clinic? If they exist, it's just an audiologist with hearing aids, right?"

So, the patch is on! The plan is to wear it from 9 p.m. to 1 p.m., for 16 hours a day. Wearing it mainly at night reduces any discomfort. Since the patches are 4% Lidocaine, not 5% like in the study, 16 hours should be adequate. Lidocaine has a two-hour half-life, so a good amount will leave my system before applying the next patch.

Like you mentioned, if this works for me, what do we do next? How do we use it moving forward? When did you first feel it might be making a difference? There are a few others here who have found it effective.

Basically, Lidocaine's main mechanism is as a sodium channel blocker (SCB). That's why I suggested Nortriptyline, as it's also an SCB. Carbamazepine is structurally similar to Lidocaine and readily available. About two-thirds of people respond to Lidocaine, and of those, 50% respond to Carbamazepine.

Yes, five years sounds about right. It's been a long time after these last two years and seven months. There are a few people on Discord claiming good results with DIY auricle treatments.

This recent setback has lowered my expectations and thrown me back into panic mode.

1. First, finish these steroids.
2. Second, check my response to the lidocaine patches.
3. Third, speak to my GP about Dr. Djalilian's approach.

Does that sound reasonable?

 

[Cmspgran]

It's interesting that they are finally moving with the times. Which hospital?

I was put on a 5-day course of oral steroids this morning—60 mg per day. I also applied a Lidocaine patch this evening. I have nine patches, so I can use them for a while. Today, I took 900 mg of Gabapentin and 400 mg of Magnesium glycinate. I've run out of ALA (Alpha-Lipoic Acid)—it's not cheap, but I've ordered more. It seems we often take a combined approach of things that are effective or possibly effective, even though it feels contradictory in our thinking.

The GP I saw this morning had good bedside manner and seemed somewhat open to what I was saying. He was, however, reluctant to prescribe Nortriptyline, even though I mentioned the migraine studies. Instead, he wanted to refer me to a tinnitus clinic. I said, "What tinnitus clinic? If they exist, it's just an audiologist with hearing aids, right?"

So, the patch is on! The plan is to wear it from 9 p.m. to 1 p.m., for 16 hours a day. Wearing it mainly at night reduces any discomfort. Since the patches are 4% Lidocaine, not 5% like in the study, 16 hours should be adequate. Lidocaine has a two-hour half-life, so a good amount will leave my system before applying the next patch.

Like you mentioned, if this works for me, what do we do next? How do we use it moving forward? When did you first feel it might be making a difference? There are a few others here who have found it effective.

Basically, Lidocaine's main mechanism is as a sodium channel blocker (SCB). That's why I suggested Nortriptyline, as it's also an SCB. Carbamazepine is structurally similar to Lidocaine and readily available. About two-thirds of people respond to Lidocaine, and of those, 50% respond to Carbamazepine.

Yes, five years sounds about right. It's been a long time after these last two years and seven months. There are a few people on Discord claiming good results with DIY auricle treatments.

This recent setback has lowered my expectations and thrown me back into panic mode.

1. First, finish these steroids.
2. Second, check my response to the lidocaine patches.
3. Third, speak to my GP about Dr. Djalilian's approach.

Does that sound reasonable?

I completely understand that feeling of panic. For me, it's the helplessness that's the most frightening.

My hospital is in Merseyside, and I have a follow-up session next week. I'm just taking advantage of what's available while I can. Interestingly, when this whole nightmare started, I paid to see an ENT specialist privately. He prescribed two weeks of low-dose Amitriptyline, and I remember the letter stating it was "for the nerve element of tinnitus." I never took it because I was already on Clonazepam at the time, as my GP had agreed to a small trial of it.

I think your approach sounds sensible, mate. I'd suggest a couple of things: switch your Lambert's ALA to an R-lipoic acid form. I know you'll say that's not what the study used, but there's plenty of evidence showing it's much more effective and crosses into the brain more easily.

Secondly, commit to an antidepressant protocol similar to what I'm trying. I know you're on Mirtazapine, but consider adding high-EPA fish oils, investing in a red light lamp, and practicing mindfulness every night. Part of this battle is keeping your head up.

I'm 100% with you on the pharmacological approach, but this is a war you'll be fighting for five years. You need to stay in the game, so throw everything in your favor. I get what you mean about the Lidocaine patches—not exactly easy to keep wearing.

I'm skeptical about some of these device reports, too, but I'm really hopeful for the Shore device, hopefully within a five-year timeframe.

 

[Nick47]

I get what you mean about the Lidocaine patches—not exactly easy to keep wearing.

Could you do two weeks on Lidocaine patches and Gabapentin, followed by a one-week break with Clonazepam and Gabapentin, then repeat the cycle?

Currently, I'm on 60 mg of Prednisolone and took 900 mg of Gabapentin last night, along with wearing a Lidocaine patch. I woke up with the lowest tinnitus and reactivity I've had in a long time. I'm wearing the patch for 16 hours on, followed by 8 hours off. It can't be the patch having an effect already, can it? I hope it's not mainly the steroids, as they're horrible and only a short-term solution.

If it's the Lidocaine and Gabapentin, that would be great!

 

[Cmspgran]

I'm not sure. If I could be assured that the temporary hearing drop was just related to channels and not causing permanent damage, I would have continued.

I'm in an awkward predicament now because I felt that Gabapentin helped me by complementing Clonazepam and improving my sleep. However, I know if I go back to the GP, he'll take me off Clonazepam.

 

[Nick47]

I'm not sure. If I could be assured that the temporary hearing drop was just related to channels and not causing permanent damage, I would have continued.

I'm in an awkward predicament now because I felt that Gabapentin helped me by complementing Clonazepam and improving my sleep. However, I know if I go back to the GP, he'll take me off Clonazepam.

Did you notice any benefits from the patches after just a few days, or did it happen suddenly during the second week?

 

[Cmspgran]

Did you notice any benefits from the patches after just a few days, or did it happen suddenly during the second week?

I can't remember the exact timeframe, but it was fairly soon—within about half a week. I was surprised myself, to be honest, as I hadn't expected anything from it.

 

[Nick47]

I wanted to share my experience after trialing Lidocaine patches for about a week, following the same protocol and using the same manufacturer as @Cmspgran. I can confirm that they work for me. I wore them for 15-16 hours a day, from 9 PM to about 1 PM, and started noticing effects within a few days. Both my reactivity and baseline have reduced, especially the reactivity. I also noticed a reduction in that tense feeling in the trigeminal and occipital nerves.

@ErikaS, you asked for an update, so here it is. Unfortunately, the effects start to wear off within a few hours in the afternoon since Lidocaine has a short half-life. I reapplied it, and the reactivity was less the next morning, though it did return later in the day. While some users wear them 24/7, I chose not to.

It would be interesting to have more people with "reactive tinnitus" try these so we can gather more data and reach a consensus—citizen science in action! This might be a better alternative than Trobalt, don't you think?

Lidocaine is a sodium channel blocker, similar to other, weaker sodium channel blockers like Nortriptyline, Topiramate, and Lamotrigine. Carbamazepine also belongs to this class but tends to cause more side effects. Oxcarbazepine is like Carbamazepine but with fewer side effects, though it seems less likely to reduce tinnitus based on what I've observed.

 

[Cmspgran]

I wanted to share my experience after trialing Lidocaine patches for about a week, following the same protocol and using the same manufacturer as @Cmspgran. I can confirm that they work for me. I wore them for 15-16 hours a day, from 9 PM to about 1 PM, and started noticing effects within a few days. Both my reactivity and baseline have reduced, especially the reactivity. I also noticed a reduction in that tense feeling in the trigeminal and occipital nerves.

@ErikaS, you asked for an update, so here it is. Unfortunately, the effects start to wear off within a few hours in the afternoon since Lidocaine has a short half-life. I reapplied it, and the reactivity was less the next morning, though it did return later in the day. While some users wear them 24/7, I chose not to.

It would be interesting to have more people with "reactive tinnitus" try these so we can gather more data and reach a consensus—citizen science in action! This might be a better alternative than Trobalt, don't you think?

Lidocaine is a sodium channel blocker, similar to other, weaker sodium channel blockers like Nortriptyline, Topiramate, and Lamotrigine. Carbamazepine also belongs to this class but tends to cause more side effects. Oxcarbazepine is like Carbamazepine but with fewer side effects, though it seems less likely to reduce tinnitus based on what I've observed.

Glad to read this report! I told you it wasn't just a placebo effect. As for its practicalities and costs, that's another issue—it does have side effects, but that's a separate matter as well. Just try not to end up in A&E like I did, thinking you've got sudden sensorineural hearing loss after explaining what you've been doing. You can imagine the typical British response to that...

On a side note, I've tried Carbamazepine several times, and it either had no effect or worsened the condition for me; I didn't experience any positive effects at all.

 

[Nick47]

it does have side effects, but that's a separate matter as well. Just try not to end up in A&E

I have been wearing the patches for 15-16 hours instead of 24. The issue is back and blasting away today. I had a rough night of sleep, but I didn't experience any side effects.

 

[Nick47]

Hey @Cmspgran, how are you?

I'm still tinkering with the Lidocaine patches. They definitely help with the reactivity and baseline of my tinnitus. It's possible that after wearing them 24/7 for a few weeks, you built up low levels of the medication in your blood. I've been wearing them for about 16 hours a day for a week or so, then taking a break for a few days. The half-life of lidocaine is about 1.5 to 2 hours, so it's eliminated from the body in roughly half a day. I've been using a quarter of a patch because, as you mentioned, they're huge otherwise.

 

[Cmspgran]

I'm going through a rough patch at the moment, mate. Clonazepam has lost some of its effectiveness, and I'm hesitant to increase the dosage.

I have a question you might be able to help with. The original study mentioned that after a certain number of weeks, the TFI (Tinnitus Functional Index) scores and annoyance levels dropped significantly. Does this mean the effect was permanent? I'm trying to understand whether the prolonged use of six months eventually calms the neurons to a less erratic state, or if the idea was that people would need to keep wearing the devices continuously.

 

[HighleyTall]

I tried 5% Lidocaine ointment some time ago for about 10 days, but I didn't experience any improvement.

I'd like to try patches, but the only ones I can find online are these.

Each patch contains 25 mg of Lidocaine and 25 mg of Prilocaine, but they need to be removed after one hour.

Any thoughts?

P.S. I did find 5% 700 mg patches, but you need a prescription.

 

[AfroSnowman]

So, where are you applying these Lidocaine patches? Looking at the beginning of the thread, the study said back or torso.

 

[MaximBrutii]

I have a bunch of 5% Lidocaine patches that I don't really use. I'm just curious, @Nick47, where are you placing these patches on your body?

 

[Nick47]

So, where are you applying these Lidocaine patches? Looking at the beginning of the thread, the study said back or torso.

I have a bunch of 5% Lidocaine patches that I don't really use. I'm just curious, @Nick47, where are you placing these patches on your body?

I wore them on the back of my neck, just below the hairline. You'll need inexpensive surgical tape to keep them securely in place.

I'm going through a rough patch at the moment, mate. Clonazepam has lost some of its effectiveness, and I'm hesitant to increase the dosage.

I have a question you might be able to help with. The original study mentioned that after a certain number of weeks, the TFI (Tinnitus Functional Index) scores and annoyance levels dropped significantly. Does this mean the effect was permanent? I'm trying to understand whether the prolonged use of six months eventually calms the neurons to a less erratic state, or if the idea was that people would need to keep wearing the devices continuously.

I'm sorry to hear that. It says the Lidocaine is absorbed locally. The reason I wore them for 16 hours instead of 24 was to avoid the risk of systemic levels accumulating, especially if used over several weeks. I don't know if permanent effects are possible since that hasn't been studied. The study only showed a continued reduction in symptoms until the third month. In the studies, they used 5% Lidocaine patches.

If you decide to try them again, I suggest wearing them for 16 hours rather than 24. If they work, you can start tapering off Clonazepam once you feel the effects. After that, take a break from using them.

I'd like to try patches, but the only ones I can find online

I bought them on iHerb.

 

[ErikaS]

Incoming possible dumb question: If you cut the Lidocaine patch in half or even in quarters, does that lower the 4% dose, or not?

@Nick47, what brand are you using from iHerb?

 

[HighleyTall]

I just ordered 20 Lidocaine patches from iHerb. Delivery to Belgium will take about a week. I can't wait.

"Aspercreme, Pain Relief Patch with 4% Lidocaine, Max Strength, Fragrance-Free, 5 Patches"

 

[Nick47]

Incoming possible dumb question: If you cut the Lidocaine patch in half or even in quarters, does that lower the 4% dose, or not?

It's not a dumb question. The concentration will still be 4% in the area where you applied it. There may be less systemic absorption, although the authors mention that it's minimal regardless. I just wanted to be cautious. The brand I used is Aspercreme.

Some people experience itchy skin, but I didn't have any side effects at all.

 

[Ear Drummer]

I would really like to try this but I'm not ok with some of the ingredients in the Aspercreme brand:

https://www.ewg.org/cleaners/substances/11353-NONOXYNOL30/

Does anyone think another brand with apparently only 3 ingredients would be acceptable?

https://www.amazon.ca/Re-Lieved-Lidocaine-Maximum-Strength-Relief/dp/B08V563ZNQ/

 

[Fields]

Just read through the topic and recent posts. I don't have reactive tinnitus, but it might be worth a shot.

I'm seeing Dr. De Koning tomorrow for a third and final procedure. Maybe I'll discuss this with him and ask whether he's willing to prescribe the 5% patches for me.

 

[Ear Drummer]

I did read the topic, and while I'm concerned about my tinnitus possibly worsening, as others have experienced, I recently had a permanent spike that has been extremely stressful. I'm now looking for anything that might help. I have both somatic and reactive tinnitus, so I'm hoping this might offer some relief. I've also always had extremely tight neck and back muscles, so I'm hopeful these patches can help with both that and the tinnitus. Unfortunately, I feel like my tinnitus and hyperacusis are reaching an unbearable stage.

I hope your appointment goes well and that Dr. De Koning is open to prescribing it for you.

 

[Nick47]

I would really like to try this but I'm not ok with some of the ingredients in the Aspercreme brand:

@Ear Drummer, the amount is so small that it's insignificant. There are small amounts of Arsenic in Nutmeg. You get it...

 

[Fields]

So I got a prescription for the 5% version, but it's not covered by insurance. €50 for 10 patches.

The only version that's covered by insurance is a mixed 2.5% Lidocaine + 2.5% Prilocaine ointment that has to be combined with neutral patches (as in, they don't contain anything).

Perhaps it would be simpler to just order the Aspercreme ones.

 

[Nick47]

Perhaps it would be simpler to just order the Aspercreme ones.

@Fields, you could try the prescription ones first. Since they are large, I cut them in half. If they work for you, you could consider buying them online if it's cheaper.

 

[Fields]

@Fields, you could try the prescription ones first. Since they are large, I cut them in half. If they work for you, you could consider buying them online if it's cheaper.

I just noticed that the Aspercreme ones are around €15 per 3, so the difference in cost isn't as bad as I thought.

I'll have to check the size of the prescription ones, they didn't have them in stock at my local apothecary. How big are the Aspercremes?

 

[Nick47]

Sorry @ErikaS. I'm using Aspercreme, and its effects typically wear off about 12 to 24 hours after stopping.

The impact on reactivity becomes particularly noticeable after 3 to 5 days of use.