How Important Is Early, Fast Treatment?

[Aaron123]

So are you saying that we should ignore and not fund further research into IGF-1 for the treatment of HL?

No, in fact I said

IGF-1 looks like it may have some promise

and

It would be interesting to know if it is effective for some causes of SSHL.

In the present context, the point was that I think there are good reasons that this is not evidence that IGF-1 is "very effective" for SSHL. As the authors themselves say: "Present results suggest the possibility that IGF-1 is superior to intratympanic Dex therapy, but the current study design failed to confirm this possibility. The positive effect of topical
IGF-1 application on hearing levels and its favorable safety profile suggest utility for topical IGF-1 therapy as a salvage treatment for SSHL." At a minimum it seems like it would be a useful tool if steroids aren't effective except of course that they are testing a proprietary formulation....

 

[Aaron123]

Not sure how to quote a quote so this will have to do.

Standard treatment for SSNHL is a tapering course of oral corticosteroids (prednisone or methylprednisolone). Since research performed at the Massachusetts Eye and Ear Infirmary in 1980 for demonstrated the effectiveness of this treatment, it has been widely used.

Even if it is MEEI, there is no link to the study. (I'm guessing it is https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/608834 which is widely cited.)

It's weird if this is settled, that it's still an area of significant study. There are indeed studies that show there is an effect (including apparently from 1980), and there are other studies that show there isn't. See here: https://www.dizziness-and-balance.com/disorders/hearing/shl.htm for much more information and an extensive bibliography.

Their bottom line conclusions seem right to me: (direct quotes of 4 paragraphs from above link)

Bottom line: At this writing (2017) almost everything looks either ineffective or slightly effective. Because hearing tends to recover spontaneously at such a high rate, treatment is not always felt necessary, especially when impairment is minor. There is also an substantial possibility of bias, as it is difficult to "control" procedures that involve injections through the ear drum.
...
When a treatment of SHL is used, it often consists of burst of steroids such as prednisone. There is an immense variability in otology/neurotology practice in regards to use of management and steroids for SHL (Coelho et al, 2011). 26% preferred oral steroids alone and 22% a combination of oral and intratympanic steroids. Some also used intravenous steroids.
...
Our impression from the literature is that systemic (i.e. oral or IV) as well as intratympanic steroids have a small positive effect on SHL. As of 2017, the best approach for hearing appears to be more steroids - -both systemic and intratympanic. Our guess is that larger and more direct doses of steroids (i.e. intravenous or high-dose prednisone) are slightly better than safer and lower doses of steroids (i.e. medrol dose pack). Lets be clear however -- these are not big effects, and one should be careful to judge whether the risk of steroids is warranted by the small effect. For example, one would generally not want to use high dose systemic steroids in a diabetic, as the risk from steroid effects on diabetes might easily outweigh the small average effect on hearing. This involves an apples/oranges comparison however. The equation might be different in a professional musician with diabetes.
...
Bottom line: We recommend IT steroids in persons who cannot or prefer not to be given oral steroids, and in whom the time frame is short (i.e. 4 days from onset), and in whom the hearing loss is very significant. We do not recommend IT steroids otherwise -- for example, in persons with minor hearing loss. We are not sure ourselves whether oral or IT steroids are superior in terms of hearing results to doing nothing, but we are certain that large amounts of oral steroids can cause significant side effects. Concerning intravenous steroids, they are likely superior to oral steroids, but they are far more difficult to administer. Again, their use would seem most reasonable in persons with very severe hearing loss.

 

[Aaron123]

@SecretDoubleCat

My apologizes for all of the off-topic posts. I feel like I owe you a direct response. I went back and read your original post on the site. It sounds like you have different things going on - noise history, THC oil, the dremel, TMJ. Not sure that I understand the advice not to take muscle relaxants. Flexeril is a good thing sometimes though mine is for my back....

Given the mixed history, it is unlikely that you would be a good candidate for steroids whether you went today or in two weeks. As discussed above, the evidence for using steroids for SSHL is mixed. If you had listened to a metal band in a concrete building standing by the speaker for 2 hours and couldn't hear or if you had a gun go off by your ear, I would say go immediately to get steroids (even though those aren't SSHL either). But that's not your situation.

Given that, I would suggest you listen to what @Ed209 says. Take care of yourself. If you are worried, you could see about leaving a message at the new doctor and explaining what happened and what you read and seeing if he or she thinks you should come in sooner.

 

[JohnAdams]

I'm not sure why you are so defensive about this.

I'm not being defensive so much as I'm stating the fact that this statement:

Ito's group clearly wants to find something here.

is a totally baseless allegation.

You're going from a perception of inadequacies in the conclusions made in the paper to allegations of bias and a conflict of interest without any evidence whatsoever.

 

[JohnAdams]

@Aaron123

Here is another paper from different authors from a different journal.

"Among these factors, IGF-1 promotes proliferation and survival of otic progenitor cells, supports neurogenesis and facilitates late differentiation in species from fish to humans"

https://www.researchgate.net/public...n_the_Progression_of_Age-Related_Hearing_Loss

Igf-1 promotes proliferation of otic progenitor cells.

 

[Agrajag364]

I'm not sure why you are so defensive about this.

I am in academia so I am well aware (painfully in fact) of peer review. My papers are subject to it, and I serve as a reviewer for other papers. It's this background and training that leads me to look at all of the details that may seem insignificant or nitpicky or whatever. I read *every* paper critically. The ones in the last few years on tinnitus drugs have been painful. Excruciating twisting and post hoc analysis to try to find an effect to justify another trial even if the evidence does not seem to be there.

Also, peer review is a great thing, but it doesn't in and of itself rule out "bias" or much of anything else. It's also not foolproof or there wouldn't be a need for retraction watch. (There are issues with peer review as well - is it really double-blind? etc etc) One thing very much in this paper's favor is the journal. Hearing Research is a serious journal. That's sometimes lost on here as people seem to think all journals are created equal.

I'm not sure why you think I am accusing anyone of impropriety. I would hope it is factually correct that they "clearly want to find something here". If they don't, they are wasting alot of time and energy. I believe they believe what they are doing. I believe they have accurately reported what they did. They accurately report they didn't find what they were looking for. I'm not suggesting they falsified data or anything else - it's important to understand, however, that if they had done so, peer review would not in general catch it.

Trust me, if you have worked for months - or years - on something and it didn't come out the way you wanted, you want to find a way to talk about it in the paper that highlights what "worked" and downplays a bit the parts that didn't. That's not impropriety. It's part of the academic world - an the world in general; human nature I guess regardless of context. In academia there also a publication bias against null results, and funders certainly like to see "positive" results. Both of these things are true even though null results contribute to knowledge by showing what didn't work. (And actually trials is may be a place where null results are valuable.)

So I am not accusing anyone of impropriety. I am suggesting that papers be read closely and critically, perhaps even skeptically.

Finally, I am not sure why large images were needed. They clutter up the thread and presumably increase hosting costs.

What field are you in Aaron? I used to work in academia. Witnessed an alarming amount of bullshit.

 

[Shaqz]

What's the latest I can get steroid injections?

My tinnitus onset was on December 10th 2019.

 

[Jack V]

What's the latest I can get steroid injections?

My tinnitus onset was on December 10th 2019.

Hi Shaqz. You and I have spoken before in the forum. We're both relatively new to tinnitus. Hope you're doing well.

Here's my take on this thread in general, and your question specifically.

Studies suggest that the earlier some treatments are given, the more effective they'll be.

Therefore go IMMEDIATELY, today, to your doctor, and discuss them.

Don't wait another day.

While cutoffs are frequently cited (XYZ is best within 2 days, or 1 month, or 6 weeks, or 2 months, or... etc etc), those are arbitrary dates your biology may or may not care about.

Be aggressive about seeing your doctor immediately -- urgently -- and exploring treatment.

Good luck!

 

[screechesilence]

Would steroid injections help someone with sensorineural hearing loss (not sudden! and not noise induced) 2 months from tinnitus onset? ENT never offered me any sound option.

 

[Kriszti]

Would steroid injections help someone with sensorineural hearing loss (not sudden! and not noise induced) 2 months from tinnitus onset? ENT never offered me any sound option.

I think chances are pretty low that it would help. Steroid should be used in the first 72 hours. Also, right now with COVID I would avoid steroid if it's not absolutely necessary.

 

[screechesilence]

But do steroids help all tinnitus sufferers despite the cause or just those with SSHL? In my case, I have sensorineural hearing loss in the high frequencies from birth, but only just started experiencing tinnitus.

 

[linearb]

some evidence that in the case of SSHL (not acoustic trauma) prednisone is useful if given within 2-48hrs of hearing loss

there is spottier evidence this is true for tinnitus; the best data is from a military study where prednisone was either given BEFORE the trauma or immediately after. also that study used transtympanic injected prednisone so it's a little hard to compare that to oral steroids

While cutoffs are frequently cited (XYZ is best within 2 days, or 1 month, or 6 weeks, or 2 months, or... etc etc), those are arbitrary dates your biology may or may not care about.

nah, these are numbers from substantial amounts of clinical work, and while there is some evidence of steroid efficiency, your window for it having any lasting effect is "a few minutes after the event" to "maybe a couple days after".

To see why this is, you need to understand what is at play here -- the idea is that in some viral infections and maybe in noise trauma, the body's immediate immune response is actually more damaging; over the 24-48hrs following the damage, having tons of inflammation can make the damage worse. So, you use steroids to kill your immune response; this does not repair in any way whatever damage happened, it just stops your body from further destroying itself.

So, your window is very short. By a week or two ex-post-facto, the damage is done and at that point it's down to how the brain reorganizes as a result.

Some subset of people with long term tinnitus notice temporary improvement from prednisone. In these cases, one might suspect that ongoing inflammation of some kind is making their noise "louder", but this isn't super useful because you can't just keep taking prednisone at immunosuppressive doses forever or real bad things happen.

But do steroids help all tinnitus sufferers despite the cause or just those with SSHL? In my case, I have sensorineural hearing loss in the high frequencies from birth, but only just started experiencing tinnitus.

If you go read every tinnitus/prednisone study in Pubmed I think you'll decide that the data is varied and in some cases conflicting, but that if there is a positive effect, your window for achieving it is very, very short.