Intratympanic High Dose Dexamethasone / Methylprednisolone

[Frédéric]

 

[JohnAdams]

According to the British Tinnitus Association, IT dexamethasone didn't show any benefit over placebo.

Oh look, here's that study the BTA quoted:

So they tested IT dexamethasone of people that were diagnosed with tinnitus between 2006 and 2007 and the study was conducted sometime not before 2009. So at a minimum, they had tinnitus for 2-3 years, well outside of the therapeutic window for steroid injections, which are clearly and early intervention, which the above study posted by @Frédéric shows, a study which had great results including a 20% complete recovery.

So there is a treatment that could have saved many of us from this chronic torture but it is not offered in most cases because it is not the standard of care, even though oral steroids are.

The British Tinnitus Association mentions this amazing therapy only one time on their website and completely downplays any efficacy of it whatsoever by referencing a study in which their patients were treated years outside of the therapeutic window. That's at best very incompetent and at the worst intentionally misleading. I invite @David to clarify their summary of this article to mention that the patients had chronic tinnitus for multiple years and also mention this above article stating that IT dexamethasone is in fact very effective as an early intervention.

 

[JohnAdams]

I have brought this to their attention on Twitter with a link to this thread.

Let's see if they will correct this. @David, the ball is in your court.

At the very least they should clarify that the study they referenced treated patients that were outside of the therapeutic window and balance their summary with the article that showed efficacy as an early intervention.

 

[Adaś]

I just want to mention that when I had my first T onset in 2013 I had few Dexamethasone (Dexaven) intravenous (not intratympanic) injections during a span of few months when I was desperately looking for cure and these injections were the only moment I was getting (almost instant) relief from T.

I tried to talk with many ENTs asking them to explain why the ringing in my ears goes away, but nobody wanted to discuss it with me. I think they simply had no idea how this works. They were just saying they I should not take steroids, to get the idea of using Dexaven out of my head, and that they are allowed to administer steroids only for short while.

All I can say Dexamethasone worked for me at that time at least it was causing relief. So it has some effect that should be understood and that can eventually help, and it should be not downplayed, even it it is not a direct cure.

Thinking loud. The both advantage and disadvantage of Dexamethasone is that it is so well know, cheap & accessible. Hence it would barely create great profits if it was effective.

 

[Renka]

I cured my T using intratympanic dex. But I must agree injections don't do shit. Research the anatomy first. There is only one place where a drug can penetrate the inner ear it is called round window membrane. What you want to do is apply dex to this membrane only, otherwise it is a waste. It can be done by inserting basically a tampon called microwick and applying dex through it. Easy! The last operation I did was a week ago to reduce a slight hiss in my left ear. Right ear went silent a while ago. It was a success. It was 2 years after onset of tinnitus, hence I think it is an urban legend that you have to do this in the first 24 hours.

 

[Adaś]

I cured my T using intratympanic dex. (...) It was a success. It was 2 years after onset of tinnitus, hence I think it is an urban legend that you have to do this in the first 24 hours.

It sounds really promising so it would be great if you can share the details. Is it some standard procedure practiced in some clinic?
Interesting coincidence - my friend today mentioned that dex was also helping him, apparently temporarily, but still I can see some pattern here.
Nevertheless it looks like your T was not acoustic trauma but ototoxic drug, right? Still like I said I believe my T is mostly acoustic trauma, and it was improving temporarily from dex. I think we all deserve some information why it works!

 

[Adaś]

I have brought this to their attention on Twitter with a link to this thread. (...)

John, I reached this tweet but your comment is gone, your account is gone too. What's going on?

 

[Christopher805]

I've had tinnitus and hyperacusis for 9 months after ingesting ototoxin. Are you saying I have a chance to get rid of ring with dexamethasone?

 

[Renka]

Adas, you can find my detailed post somewhere on the forum. As you know nothing is practiced anywhere in any clinic whatsoever. The dark age in medicine we have regarding tinnitus is mind boggling. The only thing that saved me is capitalism. I hired a surgeon - a head of the largest otolaryngology dept in my country and said this is the operation I want you to do. He said ok it was never done before in my career therefore it looks interesting but I don't think it will work and I advise you not to do this, but since you are paying why not...

 

[Grand05]

Adas, you can find my detailed post somewhere on the forum. As you know nothing is practiced anywhere in any clinic whatsoever. The dark age in medicine we have regarding tinnitus is mind boggling. The only thing that saved me is capitalism. I hired a surgeon - a head of the largest otolaryngology dept in my country and said this is the operation I want you to do. He said ok it was never done before in my career therefore it looks interesting but I don't think it will work and I advise you not to do this, but since you are paying why not...

And how much did you pay him? Where do you live? I read your other post, Silverstein Microwick doesn't ship outside US, and it costs $100. How much did the operation cost?

 

[Renka]

No problem buying microwick. They charge you an arm and a leg for shipment though. The cost is like a regular tympanostomy procedure. There's a video on YouTube of the procedure. You have to search it by micowick not microwick.

 

[Grand05]

No problem buying microwick. They charge you an arm and a leg for shipment though. The cost is like a regular tympanostomy procedure. There's a video on YouTube of the procedure. You have to search it by micowick not microwick.

But the microwick thing is really a simple invention. It shouldn't fucking cost $100. Can't you buy a piece of cotton and get that kind of tube somewhere? Like really, its real price tag should be somewhere in the $10-$15 range, not fucking $100, that's ridiculous. I'm not gonna bother ordering it, rather trying to make one with a surgeon ourselves. I live in Europe, so i can't order it anyway.

 

[Adaś]

Adas, you can find my detailed post somewhere on the forum. As you know nothing is practiced anywhere in any clinic whatsoever. The dark age in medicine we have regarding tinnitus is mind boggling. The only thing that saved me is capitalism. I hired a surgeon - a head of the largest otolaryngology dept in my country and said this is the operation I want you to do. He said ok it was never done before in my career therefore it looks interesting but I don't think it will work and I advise you not to do this, but since you are paying why not...

I respect your determination and information you share here. Still I don't think that this is viable option for all of us. Not that topical Dex is not working, I tend to believe opposite. But that all the costs and the risk of possible mishandling the procedure is put on the paying patient. If something goes wrong clinic can always claim this is not a standard procedure hence not their fault.
I think the only sensible option is to have some determined clinician to start explaining why Dex can have ANY effect. Seriously, if corticosteroids stop inflammation and calm the immune system, then Tinnitus may be chronic inflammation of the inner ear, if the ringing stops, even temporarily, then how you explain that? Dex producing zombies out of dead IHCs, OHCs? Maybe they're just chronically inflamed and unable to work as expected, hence misfiring.
I wish someone can prove me wrong and finally explain Dex effect.
What can help is to follow on your case more thoroughly. Write some paper or article about it, shake this ossified sluggish and hermetic medicine world.

 

[Grand05]

Also, i want to know how many days and how much did you insert in your ear @Renka dexamethasone. Was it a month procedure in one ear and then another in the other ear? Please write as detailed as possible what should one do in order to reverse ototoxicity from meds with microwick intratympanic dexamethasone injections. Thanks in advance.

 

[Renka]

The procedure of inserting ventilation tubes is easy and is routinely done to children at least in Europe. The skill is to insert the wick precisely in the round membrane niche. Only highest grade specialists can do this. The inner ear is made of a very dense bone it is like a stone you cannot do any harm as far as I understand. The worst you can do is get otitis media afterwards. As to a theory my working assumption was that tinnitus occurs because something in the inner ear gets super exited or out of sync or loses electrons and sends incorrect data to the brain. Brain receives corrupted data and cannot decipher it. Somehow dexamethasone can calm something down in the inner ear. Now the kicker (most important) search this paper
Round Window Membrane Vibration May Increase the Effect of Intratympanic Dexamethasone Injection

The duration of the whole thing is 2 weeks. After two weeks the wick is extracted and the eardrum heals after 2,3 more weeks. Now the routine is this: 3 times per day I insert .2 or .4 ml with a help of a syringe into the ear (with no needle of course); lay for 20 minutes on a side; apply vibration to the skull with a help of my brown electric toothbrush for 4 minutes in a massage mode; lay for 20 minutes more; stay up and remove dex remaining in the ear. That's all. Of course Tinnitus will increase like hell therefore appraise progress in the morning after sleep. I cannot stress enough the vibration effect. That is the true holy grail. If you just lay and hope for the gravity to make dex work not much will happen. There is a reason why they call it a semi permeable membrane.

 

[Grand05]

The procedure of inserting ventilation tubes is easy and is routinely done to children at least in Europe. The skill is to insert the wick precisely in the round membrane niche. Only highest grade specialists can do this. The inner ear is made of a very dense bone it is like a stone you cannot do any harm as far as I understand. The worst you can do is get otitis media afterwards. As to a theory my working assumption was that tinnitus occurs because something in the inner ear gets super exited or out of sync or loses electrons and sends incorrect data to the brain. Brain receives corrupted data and cannot decipher it. Somehow dexamethasone can calm something down in the inner ear. Now the kicker (most important) search this paper
Round Window Membrane Vibration May Increase the Effect of Intratympanic Dexamethasone Injection

The duration of the whole thing is 2 weeks. After two weeks the wick is extracted and the eardrum heals after 2,3 more weeks. Now the routine is this: 3 times per day I insert .2 or .4 ml with a help of a syringe into the ear (with no needle of course); lay for 20 minutes on a side; apply vibration to the skull with a help of my brown electric toothbrush for 4 minutes in a massage mode; lay for 20 minutes more; stay up and remove dex remaining in the ear. That's all. Of course Tinnitus will increase like hell therefore appraise progress in the morning after sleep. I cannot stress enough the vibration effect. That is the true holy grail. If you just lay and hope for the gravity to make dex work not much will happen. There is a reason why they call it a semi permeable membrane.

Thank you a lot. But I feel like the manipulations with the toothbrush might dislocate the wick? Is the wick placed hard enough there to hold for 2 weeks?

 

[Frédéric]

The role of intratympanic dexamethasone in sudden sensorineural hearing loss

Background: Present study was conducted to assess the efficacy of intratympanic dexamethasone in patients with sudden sensorineural hearing loss and to determine factor affecting treatment outcome for sudden sensorineural hearing loss.

Methods: Prospective study was conducted on 24 patients of sudden sensorineural hearing loss between October 2019 to February 2020 in the department of ENT, OPD, SPMC, Bikaner. Group A were given oral steroids: prednisolone 1 mg/kg/day (maximal dose is 60 mg/day) full dose 14 days, then tapered over next 14 days. Group B were given intratympanic dexamethasone 4 mg/ml, 0.5 ml into middle ear space (into the posterior inferior quadrant) every 7 days for a total of 4 weeks. Audiogram was performed at end of every week for 4 weeks.

Results: Overall, 58% (n=14) patients showed improvement in pure-tone average. For ≤3 days of presentation; out of total 6 patients, 83.33% cases recovered. For 4 to 7 days of presentation; out of total 10 patients, 80% cases recovered. For 8 to 14 days presentation; out of total 8 patients 12.5% cases recovered (p=0.005).

Conclusions: We suggest the treatment approach in which interaural time difference is used adjuvantly with oral steroids.

Keywords: Intratympanic dexamethasone, Sudden sensorineural hearing loss, Audiogram

 

[TinniGone]

I had intratympanic Dexamethasone in late 2010 due to tinnitus from acoustic trauma.

Three injections in the ear over alternating days. It was followed by a treatment of small dosage Xanax over 6 months. My tinnitus improved significantly but I cannot know for sure if it was due to the Dexamethasone or the Xanax or simply time.

The injections must be performed within few weeks post the onset of tinnitus.