Here Is How I Solved My Tinnitus — New Protocols and Supplements To Try

[Kaelon]

Thanks for the heads up on the antibiotics, @awbw8. However, I'm pretty convinced I'm going to need them -- or something similar -- to really knock out this infection.

Last night, I tried the Salt Water method again - #7 - but this time only got modest results. Still a definite improvement over the 8/10 nightmare that I had been experiencing a couple of days earlier. But my T in my affected ear is sitting at around 2/10 - 3/10, and doesn't seem to be moving much with just the saline solution through the neti pot. I took a Claritin and I definitely felt much better -- like it was much less noticeable.

My concern is that generally, ENT's (and doctors in general, really) cannot diagnose a middle or inner ear infection, unless if it's a middle ear infection that happens to cause borderline tissue inflammation near the outer ear's lining (like the eardrum). There are some tricks they can use to see the Eustachian Tube openings, but not much up inside the tubes themselves, and certainly not the inner ear without surgery. Considering it's been 7 weeks of madness, I'd really love to figure out a way to bring some silence - or some semblance of relaxation - in time for the Holidays next week.

I'll report back from my experience with the ENT. In the meantime, Advil + Claritin + Neti Pot seem to be helping me cope significantly.

 

[Kaelon]

Just thought I would give everyone an update on how this played out. The day after my repeated efforts to treat my T, I had a relapse - sound went back up to a 4/10 or 5/10 on the left side (generally unchanged on the right). It was pretty discouraging. I went to see my ENT that day over at Massachusetts Eye & Ear Infirmary, and he was adamant that there's no definitive way to diagnose Tinnitus or its origins and that, in my case, it appeared that it might be multifactorial -- that is to say, it could be a combination of issues like ETD, mild TMJ, hypoadrenia, and even a minor muscular-skeletal issue connected in some way to a neurovascular complication. The "perfect storm" to initiate an onset.

More infuriatingly, however, they were pretty adamant that unless if they see inflammation of the ears or swelling of the Eustachian tube openings through a simple nasal exam, they're not going to move forward with any ETD treatment. This includes refusal to prescribe antibiotics or corticosteroids, especially because in their view, "these may do more harm than good." (This is a point raised by @awbw8 earlier in this thread.)

They recommended TRT and even ACRN as the most reliable methods of dealing with Tinnitus, and that in time, it would simply "fade into the background" (habituation).

Needless to say that was pretty disappointing. So I went home, and did a double-treatment of the neti pot, back to back, and really concentrated on letting it pour over my ETD.

I woke up this morning and was largely cured, again. There's something to this method -- or an incredible coincidence -- that is helping reduce the volume of the T down to a negligible 1/10 or 2/10. I've been trying to isolate what other anti-inflammatory measures I might be taking that are helping, and they include:

• Neti Pot treatment, just before bed
• Claritin, daily.
• Vitamin B-12 supplement (500 mcg)
• Hydration
• At least 8 hours of sleep

I found that in the prior night when I had a relapse, I had omitted Vitamin B-12 and only had 6 hours of sleep. When I remedied both of those, I experienced a much better recovery the following morning.

Here's hoping this is a path towards improvement!

 

[marqualler]

Interesting! Are you still taking Ibuprofin?

 

[engineerLA]

Hi Folks - since several people have asked - yes my T is still completely gone. I do think the combination of the water method, and the supplements, with a Z pack (zithromax antibiotic), was what finally did it.

 

[Kaelon]

Just to follow up - I'm really glad that @engineerLA provided us with an update. His complete cure for Eustachian Tube Dysfunction / Otitis Media + Labyrinthitis are a beacon of hope for all of us who feel that we may have a similar pathology.

EngineerLA and I corresponded briefly over private conversations, and he convinced me to push forward with a regimen of antibiotics and steroids. I went to my GP today and she examined my ears to find a collection of fluid behind my left (worse) ear; she also found I had a low fever and confirmed the pain in my ears when pressing against the base underneath my ear lobe (near my tubes). She prescribed a 10-day regimen of Amoxicilin 500 mg x3 daily, and a 10-day regimen of Prednisone (50 mg daily, tapering down to 10 mg daily). If I notice any substantial improvement, this will effectively confirm inflammatory and infectious causes. If I don't notice any improvement, I will be able to move on.

Since trying engineerLA's water method in the initial post, I have had good days and bad days. My really good days follow a rigorous attempt of the water method and gargling/yawning as the water passes over my Eustachian tubes, coupled with at least a full 8 hours of sleep, with the T down to 2/10 or possibly lower (including sensations of complete or near silence throughout the day). My bad days witness hyperacousis with volumes at the 6/10 level and usually correspond to a poor night's sleep and/or not really doing the water method effectively. I find that things that reduce my inflammation help: hot showers, drinking plenty of clear fluids, etc.

I have discontinued the ibuprofen regimen, and instead only take ibuprofen periodically for ear pain and/or headaches as they occur.

Here is hoping that the amoxicillin + prednisone yield results. I will report back!

 

[Kaelon]

Hi everyone - I thought I would report back as per above.

I'm on my third day of Amoxicillin and Prednisone, and I am pleased to report I am experiencing tremendous relief. I suspect the prednisone is largely to thank (especially since the dosage is front-loaded, and is tapering off over time); the congestion in my ears has lessened considerably, and the volume of my tinnitus is much reduced -- probably a 2/10 and sometimes a 1/10. This morning, I awoke initially to hear the Tinnitus louder, but when I yawned, I experienced a forceful "popping" of both of my ears -- something that had eluded me since the start of these episodes -- and the Tinnitus quieted down immediately. Again, this is more evidence in my view that @engineerLA was right all along, and the condition he and I both share is at least significantly driven by Eustachian Tube issues.

I've also noticed that in this process, my ears are hurting more, especially when I lay down at night. This possibly has to do with whatever fluid or congestion pooling and gathering down in my middle or inner ear (wherever the infection or inflammation is based).

I have another 7 days to go on this regimen, but I've already reported back to my GP who has indicated she is likely to want to extend the prednisone at least for a month.

I'm very hopeful and wishful that this is leading me towards a resolution of this condition that has plagued me for the past 9 weeks.

K.

 

[Jesse Pinkman]

Hi everyone - I thought I would report back as per above.

I'm on my third day of Amoxicillin and Prednisone, and I am pleased to report I am experiencing tremendous relief. I suspect the prednisone is largely to thank (especially since the dosage is front-loaded, and is tapering off over time); the congestion in my ears has lessened considerably, and the volume of my tinnitus is much reduced -- probably a 2/10 and sometimes a 1/10. This morning, I awoke initially to hear the Tinnitus louder, but when I yawned, I experienced a forceful "popping" of both of my ears -- something that had eluded me since the start of these episodes -- and the Tinnitus quieted down immediately. Again, this is more evidence in my view that @engineerLA was right all along, and the condition he and I both share is at least significantly driven by Eustachian Tube issues.

I've also noticed that in this process, my ears are hurting more, especially when I lay down at night. This possibly has to do with whatever fluid or congestion pooling and gathering down in my middle or inner ear (wherever the infection or inflammation is based).

I have another 7 days to go on this regimen, but I've already reported back to my GP who has indicated she is likely to want to extend the prednisone at least for a month.

I'm very hopeful and wishful that this is leading me towards a resolution of this condition that has plagued me for the past 9 weeks.

K.

That is great news Kaelon! What would you say your tinnitus was before this approach? (on a scale of 1 to 10)

 

[Kaelon]

Thanks! I was at 6/10 and 7/10 before the antibiotics + prednisone. When, a couple of weeks back when I first posted in this thread, I was driven to try @engineerLA's water method he describes in the first post of this thread, I was at 9/10 with extremely loud volumes combined with dizziness and general insanity. Being at 1/10 or 2/10 is a piece of cake, though obviously, I am hoping for a complete resolution -- even if I don't get it for some time, I can live with this level.

 

[marqualler]

@Kaelon Great to hear! I have really felt e-tube congestion so I am going to call my ENT tomorrow to see if I can get a prednisone prescription. With that popping, did you also feel like your hearing was less muffled?

 

[RaZaH]

@engineerLA , when I do the valsalva ,sometimes my more affected ear will just squeal , and I mean loud , other people can hear it . Would you think that this is indicitive of inflammation ?

 

[Max_fcktr]

@engineerLA , when I do the valsalva ,

stop doing it dude, valsalva is the way to hell

 

[RaZaH]

Why ? I think divers do that all the time ? Also , I dont do it all the time , it seems to take a week or so for my ear to need that squealing thing to take place to go back to "normal". Its strange , if I would do the valsalva right now it would not squeal , I can kind of feel when it will do that .

 

[Rog]

@RaZaH How's your t now after trying RTG?
Thank you

Rog

 

[Max_fcktr]

Why ? I think divers do that all the time ? Also , I dont do it all the time , it seems to take a week or so for my ear to need that squealing thing to take place to go back to "normal". Its strange , if I would do the valsalva right now it would not squeal , I can kind of feel when it will do that .

thats right! and you can read about thousands of divers who have hearing loss and tinnitus

it is professional disease

 

[Kaelon]

@Kaelon Great to hear! I have really felt e-tube congestion so I am going to call my ENT tomorrow to see if I can get a prednisone prescription. With that popping, did you also feel like your hearing was less muffled?

Hi @marqualler -

Yes, with the popping on yesterday morning, I definitely felt a significant "de-muffling" when I yawned. The congestion returned soon thereafter, but the ringing was much improved. I continue to feel pretty congested in my lower ears (presumably, my lower middle ears, near my Eustachian tubes, or my inner ears, even), but it is by and large improved.

For everyone --

On day 4 right now of prednisone + amoxicillin, I continue to notice more subtle improvements to my ringing. Volume is now steadily at a 1/10, with periodic surges to 2/10. I can definitely notice it in a quiet room, but if there's much ambient sound at all, it is almost not noticeable. Tremendous relief from the 6/10 or 7/10's I was getting before. Also, no more dizziness or nausea the way I was getting before in those extremes. This leads me to speculate that the inflammatory and/or infectious condition that has been causing my tinnitus also is generally vestibular in origin because of its neurological side-effects. My doctor issued me another week of prednisone, so that will leave me on a 3 week prednisone regimen after all is said and done, starting at 50 mg daily and tapering to 10 mg, with an additional week at 20 mg daily.

 

[VaR]

Good for you @Kaelon. Hope you get better soon. I too will ask my doctor if I can take prednisone and see if there is some relief.

 

[Kaelon]

Good for you @Kaelon. Hope you get better soon. I too will ask my doctor if I can take prednisone and see if there is some relief.

Thanks, @VaR! I'm not sure if it's really the prednisone or the amoxicillin that is doing most of the work in my case right now (though @engineerLA recommended at least the amoxicillin, I have read that it takes at least ~4-7 days before antibiotics start delivering significant enough impact to combat infection), but the fact that I've had such a swift response in just a few days leads me to believe that my Eustachian issues are largely being caused by inflammation and the prednisone, as a powerful anti-inflammatory steroid, is most responsible for this.

 

[marqualler]

@Kaelon Congrats! That sounds like you are feeling a lot better right now.

One clarifying question--when you say you felt "congestion" come back, did that include the "muffled" sounds again? Or do you mean general congestion in your sinuses?

Just got back from the Tinnitus & Hyperacusis Clinic in Edina, MN and learned a lot. I will pose my learnings & questions to Dr. Nagler on his forum soon.

 

[Kaelon]

@Kaelon Congrats! That sounds like you are feeling a lot better right now.

One clarifying question--when you say you felt "congestion" come back, did that include the "muffled" sounds again? Or do you mean general congestion in your sinuses?

Just got back from the Tinnitus & Hyperacusis Clinic in Edina, MN and learned a lot. I will pose my learnings & questions to Dr. Nagler on his forum soon.

Thanks, @marqualler! I am definitely feeling a lot better -- the volume is much reduced, and while it hasn't been totally eliminated (and I still have momentary spikes up to 2/10, and some residual hyperacusis from "sharp" sounds), this is something I can deal with. I'm hoping this ultimately resolves entirely, but given how stubborn these Eustachian inflammatory/infectious things can be, I understand it may be several weeks/months before I reach a much better place. In the meantime, I am trying to take much better care of myself.

Re: your question - the congestion feeling I had was in the morning waking up on Sunday. I felt like my ears were both very clogged, and the ringing was extremely loud - like a 6/10. But when I yawned to force-pop them -- and in the past 9 weeks, yawning/force-popping created a cracking sound, not the actual popping relief that I'm used to getting -- this time, I had tremendous relief and the volume went down considerably. The congestion (feeling of fullness) returned a few hours later, but the ringing remained at a lower volume. So, there's something happening -- possibly positional, given that it happens overnight - with the fluid in my left ear, especially, that my GP was able to see upon inspection, that is aggravating this condition. But at least now, with the anti-inflammatory properties of prednisone or perhaps the anti-bacterial fighting power of the amoxicillin, I was able to get some relief by yawning/popping.

I still have a lot of popping and cracking in my ears, when I move my jaw and try to yawn, for example, that doesn't do anything other than create sound and the most minute instance of relief. However, again, if I move my lower jaw, I am able to dramatically silence the T (down to a 1/10 or even a 0/10) -- again showing me that this inflammatory issue is what is really causing the Tinnitus to begin with. I'm sitting at around a 2/10 right now, and either I'm habituating quickly, or it's totally manageable.

I'd be very interested in hearing more about what you learned at the Tinnitus & Hyperacusis clinic. I'm wondering if there are any treatments or practices that might prove useful. It sounds like you and I have a lot of the similar sinus aggravating conditions that are exacerbating our Tinnitus. One possibility I've read about is that you and I may have had a very low, nearly undetectable, level of Tinnitus for many years now (possibly connected to aging-related or other-related hearing loss), but this inflammation has caused a sudden and unexpected surge. Hopefully, these are all manageable or resolvable conditions.

Thanks again!

 

[marqualler]

Just an update here--I talked with my ENT who believes my "muffling" sound has more to do with the scab around the spot where my eardrum is supposed to move more freely and not in this case e-tube issues. I am scheduled to see him again in early February but may see him a little earlier to see if he can help things along any further. For what it's worth, this phenomenon is somewhat validated by a couple of spots where there is an air-bone gap on my audiogram that I took today. The good news is that it is something that should go back to normal on its own. The bad news is that it probably won't affect my tinnitus too much. But I am definitely interested in the connection between inflammation and tinnitus--seems like it is a common denominator amongst many of us! @attheedgeofscience also mentioned his autoimmune eye condition that was cleared up by stem cell therapy--I also have had a lifelong autoimmune eye condition.

 

[attheedgeofscience]

@attheedgeofscience also mentioned his autoimmune eye condition that was cleared up by stem cell therapy--I also have had a lifelong autoimmune eye condition.

https://www.tinnitustalk.com/threads/tinnitus-in-one-ear.6688/#post-73778

 

[marqualler]

https://www.tinnitustalk.com/threads/tinnitus-in-one-ear.6688/#post-73778

Wow, that is startling. I had the very same symptoms (red eyes, inflamed, no real explainable reason other than "inflammation") for years from about age 10 to 5 or 6 years ago when my opthamologist prescribed Restasis for me. Prior to that it was treatments of steroid drops (sound familiar?) to control them when it happened. Amazing what could happen if stem cell treatment funding was not held up by certain factions of political belief...but that's a soapbox for a different forum.

 

[lyndy]

I don't know if I have a Eustachian tube problem or not. I believe I do since my ears are always full and my Eustachian tubes seem to be in the open position all the time. I have real bad allergies and get vertigo a lot. my allergist tried me on Dymista and it just makes me have more episodes of vertigo which I try to avoid like the plague. Does this work with pulsitile tinnitus as well?

 

[Kaelon]

I don't know if I have a Eustachian tube problem or not. I believe I do since my ears are always full and my Eustachian tubes seem to be in the open position all the time. I have real bad allergies and get vertigo a lot. my allergist tried me on Dymista and it just makes me have more episodes of vertigo which I try to avoid like the plague. Does this work with pulsitile tinnitus as well?

Hi @lyndy -

The term "pulsatile tinnitus" is sometimes misused. In the classic sense, pulsatile tinnitus has neurovascular conflicting symptoms -- a whooshing, clicking, or thumping sound that reflects your heartbeat. Separately, there are another "oscillating" rhythms that are common in inflammation - like a growing loudness of high-pitched tinnitus with moments of quiet in between each heartbeat - that do not necessarily indicate a neurovascular conflict, but instead speak to a muscular or inflammatory issue. The protocol that engineerLA and I have tried out really only applies to inflammation and infection; it doesn't help with people who have underlying neurovascular, neurological, or cardiovascular problems that are causing their tinnitus, I'm afraid.

I hope this helps!

 

[lyndy]

Hi Kaelon,
I don't think there is a sound I HAVEN'T experienced. I know I have air borne allergies, but so does a lot of people and they don't have pt with it. I think its a kink in a blood vessel in my head and am hoping to go see Dr. Eisenman in Baltimore. He has cured people with pt and actually knows how to read the slightest problems on MRIs. My main symptom is pounding in my head, whooshing, thumping with my heart beat. Really loud and is louder when I stand or bend over. I also know I have inflammation from allergies so it can be the symptoms you are describing happen when I am having allergies. I not only think I have some kind of kink in a blood vessel, I believe my Eustation tube is also involved. I sure would like to hear from people that stated out with fullness first or have fullness on a regular basis.
Thank you so much for taking the time to send this.

 

[lyndy]

P.S. What is your protocol and supplements you take and what are you experiencing and have you had it identified yet?

 

[lyndy]

Kaelon, I DID read further in your conversation and it sounds like you are taking Amoxacillan and Prednisone and are having success with it. When I tried Prednisone, it greatly increased my anxiety and panic attacks. It could be that the dosage was too high also. I did have days where my hearing was better. Dont know if it was the medication or just having good days. When I'm not having allergies and my ears are full, the pt is lower and vice versa. When I'm having allergies, they are both there. When I couldn't hear out of my left ear for 12 years, I took mass doses of antibiotic and when i was weening myself off of them I found out I have perfectly good hearing under the fullness and the pt. Also, if you happen to have enlarged adenoids, they can press on the Eustachian tube and cause the same symptoms we both are experienced
How long are you planning on staying on the medications?
I wish you continuous luck and please keep me informed of your progress. We sound as if we have a lot of the same issues.

 

[Kaelon]

Hi @lyndy -

Glad to hear that my experiences are helpful.

Re: "pulsatile" tinnitus, I ask the question because the term can mean a lot of different conditions. If you hear the clicking / thumping / whooshing sounds that others describe, it's typical of some sort of vascular problem (like a blocked artery or a narrow vein, or potentially even a blood vessel near the auditory nerve). If you hear something else, then it's possible that your issues may not be vascular, but inflammatory or muscular.

In my case, the prednisone is helping in part because I believe I'm dealing with significant inflammation and prednisone, as a powerful anti-inflammatory, is reducing that inflammation, which in turn, lowers the volume of my T. My Tinnitus is a high-pitched whistle in both ears. However, I find that if I am taking a lot of anti-inflammatory steps (neti pot, antibiotics, prednisone, hot showers, and 8 hours of sleep a night), the volume is much reduced and almost completely resolved. However, the relief usually only lasts a day or so. The inflammatory "pulse" that I experience is an oscillating sound - something that grows louder with each heartbeat, but softer in between each heartbeat. My research online tells me that this is not typically a vascular sign, but instead an inflammatory sign.

My antibiotics and prednisone regimen lasts for 15 days. I still have another week of this stuff to continue, though I've started to level off on the benefits at a 2/10 (down from 7/10, sometimes 8/10 spikes). I still have days that are "bad" (in that the ringing appears relentless), but I find that those days I haven't gotten enough sleep. So there's something deeply connected with sleep and inflammation that is driving the volume of the T at least in my case.

What sounds are you hearing? When you say you have pulsatile tinnitus, can you describe the "pulsing"?

Here's hoping you feel better soon!

 

[lyndy]

Hi Kaelon
I have had a whole range of sounds in the 15 years that I've had this. At first is was just a fullness. Then pounding like some teenager was driving by with his bass up too loud. A boom boom but not with my heart beat. Then the vertigo started. This was my left ear only. Then, as it started settling down into a pattern, its a boom, boom, boom with my heart beat. If my heart rate goes up, so does the boom boom in my ears. When my heart beat settles down sometimes so does the boom. My ears are worse in the Winter I think when the barometric pressure changes. It also gets worse if I don't eat often. All that is strange enough and should be enough for a diagnoses. Then 6 years after my left ear, my right ear started following the same path. They both pulsate to my heart beat but they are rarely doing the same thing at the same time. One may be fuller then the other, one may just be ringing while the other is pulsing with my heart beat but when I stand up, its a real loud boom boom boom for a few seconds in both ears.
When I swallow, or yawn, my hearing gets worse. When I swallow, the air seems to go right back up into my ears. I think my ears are in a constant state of being open. I need to plug my nose and pop my ears and it stays that way until I swallow and then it goes right back to worse hearing. OR if or when they do pop on their own, my hearing is worse until I plug my nose again and pop them, but its only temporary hearing. Its inflammation not fluid.
Also, when I put my left ear on my pillow, it does this suction cup thing to the pillow like a toilet plunger in a toilet.
Now that I have started getting allergic to this town, I'm dealing with what I had where I lived before. A constant mid range ring under the lower range boom, boom of my pt. I have also started having, again, the quiet roar that starts getting louder like you described as well as the hypercusis that will happen after the loud roar had settled down.
All this should be enough ( for a GOOD tinnitus dr, who knows what hes doing) to give a diagnosis. Forget ENTs, I am way past their knowledge. They want to deal with runny noses and sinusitis etc. I have seen 9 of them as well as many other different drs. It time to go to a knowledgeable pt dr and there aren't very many of them. I don't know if you have checked out the website Whooshers.com but the dr in Baltimore has cured a lot of people with pt.

 

[engineerLA]

Hi folks -- many months later, still my Tinnitus is totally resolved. My method works. It seems to resolve the following cluster of symptoms:

- Loud tinnitus in one ear, with no measurable hearing loss
- Ear fullness or sensation of negative pressure in the ear that doesn't resolve
- Sensation of hearing inside the ear more than usual (including pulsatile tinnitus)
- Difficulty clearing or popping the affected ear using the valsalva
- Eustachian tube dysfunction on the same side as the affected ear
- Slight pain or achiness in the affected ear canal

The solution is well covered in the thread above, but to reiterate:

I think if you are experiencing pain then you definitely have a lot of inflammation. You should be careful not to force the air into your ear if it hurts, you can accidentally pop your eardrum. Given the pain, you definitely need to do the anti-inflammatory regimen AND probably also you should try a 10 day course of zithromax at the same time to prevent further infection (get a prescription from your doctor - tell him/her that you think you have an ear infection or middle ear infection and it hurts and you want to see if a Z-pak will clear it up; they can't see a middle ear infection so they just have to believe you usually, which helps get this expedited; a 10 day course of zithromax is harmless and if you have a low-grade middle ear infection it could really help -- it's really one of the only ways to test if you have one since a low-grade middle ear infection can't be seen by your ENT from an external exam).

After 3 days of antibiotics, then you can start to try the water methods etc. You want to make sure you first have knocked out the infection before you start shooting water in there (shooting water into an infection could make it worse).

For the water methods, tilt your nose to the sink, spray the fluid in, close off the back of your throat/nose/tonsils to catch the liquid (do not swallow it!). When you feel the liquid squirt to the back of your nose and throat, turn your head so that the ear that has the problem is facing down towards the sink, and then do the valsalva once. You will hear a "squeak" sound if it works -- this is the sound of the water going into the eustachian tube. Then raise your head level and do the valsalva one or two more times. If desired, repeat the water method again once or twice, but don't do it more than 3 times a day at most. You may find that it hurts a little afterwards, but it should not hurt a LOT -- if it does hurt a LOT, stop and see your ENT. If you don't have pain, continue to do the normal valsalva without water hourly during the day.

If you also have pulsatile tinnitus along with a high frequency tinnitus and eustachian tube dysfunction, then this could very well be related to eustachian tube and middle ear inflammation and/or a low-grade middle ear infection. It's worth a test. Note that not all pulsatile T has this cause -- it could be caused by many other things. But you can at least rule out the inflammation/infection possibility with an antibiotic and anti-inflammatory protocols. I experienced it and it is now completely resolved thanks to the solution above.

The whole process of solving my T took me almost a year to figure out, with lots of experimentation and a lot of depression and frustration as well, but the final solution took only three weeks, once I figured out what worked!

Again, to reiterate:

1. Strong and consistent anti-inflammatory regimen for at least a month -- every day, many times a day. Use whatever works. See my suggested supplements above. Make sure to treat any allergies you may have as well.

2. You may also want to try the Agar 35 to relax and reduce stress-related and energy imbalance causes of T. This will definitely help you sleep and make you feel better, regardless, so it's not a bad thing to try anyway.

3. You MUST take Zithromax or equivalent antibiotic, at the same time as you do the anti-inflammatory regimen. A typical Z-pak is the way to go.

3. After a week or two of anti-inflammatory protocols, and after 3 days of Zithromax, then you can try the more advanced methods (water, norepinephrine, etc.), but be careful and never do anything that causes excessive pain.

4. If you are experiencing pain, first resolve that with steps 1 and 2, and you may also want to see an ENT to make sure you don't have a perforated eardrum or other physical problem causing pain. DO NOT DO THE VALSALVA IF IT HURTS A LOT WITHOUT SEEING YOUR ENT FIRST.

I am NOT a doctor. I'm an engineer. But my ENT agreed that my method works and is safe, if you follow my instructions. He also said there is a risk of causing an infection with the water method, or exacerbating one that might already be there -- that's why the antibiotics are a must. And he warned me that you should never pop the ear if it hurts a lot as that could be damaging.

These methods are "advanced" and your mileage may vary. Use at your own risk and coordinate with an ENT if you can. But I believe they are safe.