Intratympanic Injection of Steroid for Treatment of Tinnitus

[ajc]

https://www.ncbi.nlm.nih.gov/pubmed/31750136

Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure.

In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients.

Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65 years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry.

Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval.

After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.

@mrbrightside614

 

[mrbrightside614]

https://www.ncbi.nlm.nih.gov/pubmed/31750136

Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure.

In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients.

Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65 years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry.

Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval.

After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.

@mrbrightside614

This is an extremely clear cut one, nice! I'm going to use this thread as a pool for various steroid treatments and write up a summary for each. Then we can sift through everything and set up a general format by which we can insert different therapies under different headings.

Gotta lift though and get that BDNF up first boys!

 

[JohnAdams]

Maddening that this was not offered to hardly any of us while we were in the acute stage. Simply maddening.

The most effective therapy for acute noise damage, with plenty of science to back it up, not offered. That's 100% bullshit.

 

[all to gain]

That sounds very promising. How many injections did each participant get in total? And for how long did the tinnitus remain 'gone'?

I wonder how severe the participants' tinnitus was. I don't like, "It has a moderately negative impact on patient's quality of life." May be for some, but as we know this is not true for all.

Dexamethasone seems to have quite a lot of side effects though (from a quick Google search).

See it was an Indian study.

Maddening that this was not offered to hardly any of us while we were in the acute stage. Simply maddening.

The most effective therapy for acute noise damage, with plenty of science to back it up, not offered. That's 100% bullshit.

Does it only work in the acute stage? It's not mentioned going by the link. And did the participants all have tinnitus from noise damage? I hope it does something for tinnitus caused by ototoxic reactions as well.

 

[Rafaa]

Only thing is how can I get an ENT to inject me with it? I have inflammation in the eustachian tube closer to the middle ear so nasal sprays won't get in there. An injection would.

 

[JohnAdams]

Does it only work in the acute stage?

Yes.

 

[ajc]

Here is the FULL ARTICLE of the study I linked to in my original post.

Recent onset tinnitus cases got maximum benefit.

@mrbrightside614 @JohnAdams

 

[JohnAdams]

I can't even think about this. This should be the absolute first thing any doctor or ENT offers a patient with a recent acoustic trauma and tinnitus, but it isn't. Very few things actually make me mad and this is one of them.

 

[mrbrightside614]

That sounds very promising. How many injections did each participant get in total? And for how long did the tinnitus remain 'gone'?

I wonder how severe the participants' tinnitus was. I don't like, "It has a moderately negative impact on patient's quality of life." May be for some, but as we know this is not true for all.

Dexamethasone seems to have quite a lot of side effects though (from a quick Google search).

See it was an Indian study.

Does it only work in the acute stage? It's not mentioned going by the link. And did the participants all have tinnitus from noise damage? I hope it does something for tinnitus caused by ototoxic reactions as well.

Keep in mind this is just one research study. Others have shown a not-so-clear correlation with complete tinnitus remission, while others use oral steroids in conjunction. The overarching theme that is emerging seems to overall be "steroids = good". I've not found one that specifically compares IT Dex vs. oral steroid, let alone one with a control group added. This makes it hard to evaluate and a proper review will rely on a lot of cross-referencing.

 

[JohnAdams]

Keep in mind this is just one research study. Others have shown a not-so-clear correlation with complete tinnitus remission, while others use oral steroids in conjunction.

What study?

 

[mrbrightside614]

What study?

The OP from @ajc.

I'll start logging my search queries and scholarly sites used so they can be referenced if we decide to write the review.

 

[just1morething]

https://www.ncbi.nlm.nih.gov/pubmed/31750136

Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure.

In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients.

Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65 years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry.

Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval.

After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.

@mrbrightside614

I had IT injections of dexamethasone years ago. I don't think they do them much anymore. I could check with Shea and see what they offer now. I was there in 2011. I was to Paparella in 2010 and had 3 dexamethasone injections spaced about a week apart in my left ear only.

I see that report was from India. Maybe dexamethasone plus PRP would be better?

 

[JohnAdams]

Maybe dexamethasone plus PRP would be better?

I had that.

 

[mrbrightside614]

I had IT injections of dexamethasone years ago. I don't think they do them much anymore. I could check with Shea and see what they offer now. I was there in 2011. I was to Paparella in 2010 and had 3 dexamethasone injections spaced about a week apart in my left ear only.

I see that report was from India. Maybe dexamethasone plus PRP would be better?

Undoubtedly yes but the chances of IT PRP becoming common practice before specifically targeted therapies like FX-322 arrive in the marketplace are slim to none. That's why we're focusing on steroidal therapies for the treatment of acute tinnitus/acoustic trauma.

Despite the observation i made in the first statement maybe the availability of such a therapy would keep FX-322 pricepoints in check. This could be worth advocating for but would need considerable research worthy of an entirely different review subject altogether.

 

[just1morething]

 

[RishRamsey]

My ENT prescribed oral prednisone 36 hours after the onset of my tinnitus (acoustic trauma from loud club). I started taking it and took it for a 3-4 days. I think it helped in the beginning with the volume but I started losing sleep (now I think because of the anxiety and all the stuff I read on the internet). I again read of people not benefiting from it and some reports saying it caused them suicidal thoughts and lack of sleep which was happening to me as well (I now really believe it wasn't from the prednisone but the initial tinnitus trauma). As a result, I threw mine away and hence, here I am with blaring tinnitus.

Maybe it would have helped if I'd done a complete course of 2-3 weeks, maybe not, but I should have completed it. One of the things I really regret doing after I got tinnitus.

 

[just1morething]

I seem some better today exercising my neck over the side of my bed. I did take 2 GABA CALM also. I'm not holding my breath as this being a fix. I know I had poor posture though.

https://www.tinnitustalk.com/threads/how-do-you-fix-poor-posture.25783/#post-302811

https://www.tinnitustalk.com/threads/how-do-you-fix-poor-posture.25783/#post-302808

 

[JohnAdams]

My ENT prescribed oral prednisone 36 hours after the onset of my tinnitus (acoustic trauma from loud club). I started taking it and took it for a 3-4 days. I think it helped in the beginning with the volume but I started losing sleep (now I think because of the anxiety and all the stuff I read on the internet). I again read of people not benefiting from it and some reports saying it caused them suicidal thoughts and lack of sleep which was happening to me as well (I now really believe it wasn't from the prednisone but the initial tinnitus trauma). As a result, I threw mine away and hence, here I am with blaring tinnitus.

Maybe it would have helped if I'd done a complete course of 2-3 weeks, maybe not, but I should have completed it. One of the things I really regret doing after I got tinnitus.

Yes. That was potentially a mistake.

 

[Shaqz]

My tinnitus started on December 10th 2019. Am I still in the acute stage?

 

[Frédéric]

My tinnitus started on December 10th 2019. Am I still in the acute stage?

What did you do so far? Did you go to an hospital, a tinnitus clinic?

 

[Shaqz]

@Frédéric Yea and I have severe tinnitus as they explained to me at the clinic and put me on sound therapy and benzos... my tinnitus came from ototoxicity and I will do anything to fix it.

 

[Jack V]

Here is the FULL ARTICLE of the study I linked to in my original post.

Recent onset tinnitus cases got maximum benefit.

@mrbrightside614 @JohnAdams

Thanks for posting that.

The lack of specificity suggests the quality of the research is not top notch. For example, it states: "In 15% of cases no improvement in tinnitus was observed and most of these patients who received no benefit had experienced tinnitus for long duration." However, it doesn't define "long duration" (2 months? 10 years?), or anything about durations or severity for anyone. Of the 60% who recovered, for example, was their tinnitus recent and mild and might they have recovered anyway? That the study begins by declaring the impact of tinnitus on quality of life only "moderately negative" could suggest patients with only mild cases, or bias, but we don't really know.

That said, I'm for sure doing this.

Steroids seem to be one of the few things that are "tried and true" (I felt some immediate relief after starting oral prednisone), and directly flooding the affected area makes sense to me in order to squeeze out every drop of potential benefit. Or at least as I understand the risks, the potential rewards seem to outweigh them.

 

[Shaqz]

@Jack V how long have you had tinnitus?

 

[Jack V]

@Jack V how long have you had tinnitus?

A little over a month.

 

[Frédéric]

We don't know how the success rate was assessed. Tinnitus is mentioned but tinnitus reduction is not assessed.

The efficacy of intratympanic or combined steroids as the salvage treatment for moderate-to-severe to profound sudden sensorineural hearing loss

Objective:The objective is to investigate and compare the efficacy of intratympanic methylprednisolone or combination therapy as the salvage treatment for idiopathic sudden sensorineural hearing loss （ISSNHL）.

Method:Ninety patients with moderate-to-severe to profound SSNHL which were unresponsive to the conventional treatment were recruited. Among these 90 patients, 45 patients underwent intratympanic methylprednisolone therapy （IMT） alone and 45 patients underwent systemic dexamethasone+IMT（systemic steroids+IMT）. IMT was performed every other day, with a total of four times. The pure-tone audiogram （PTA） before and after IMT or systemic steroids+IMT was conducted. And for those with tinnitus or anxiety, tinnitus handicap inventory（THI）, visual analog scale （VAS） as well as Hamilton anxiety rating scale （HAMA） were performed before and after the treatment.

Result:The success rate was 31.1% with IMT and 51.1% with systemic steroids+IMT, and the difference was not significant between the two groups. The efficacy of patients with less than 30 days of onset was better than those with more than 30 days, and the difference was not significant, either. Both groups showed significant improvement in the scores of THI, VAS, and HAMA, but no significant difference was found between the two groups.

Conclusion:Intratympanic methylprednisolone is recommended as the salvage treatment for patients with moderate-to-severe to profound SSNHL which showed little efficacy after the conventional treatment. Prompt medication improves the therapeutic efficacy.

Source: https://pubmed.ncbi.nlm.nih.gov/32842187/

 

[Nick M]

In a selfish way I hope this isn't adopted because if it works, the headline will read "tinnitus has been cured" and we will be forgotten, research will dry up since there would no longer be incentive to develop a cure for a population of tinnitus sufferers that will eventually go down to near 0 in under 50 years.

 

[Jrblovsky]

Maddening that this was not offered to hardly any of us while we were in the acute stage. Simply maddening.

The most effective therapy for acute noise damage, with plenty of science to back it up, not offered. That's 100% bullshit.

Yep. I was not offered it until weeks later. I had no idea about steroids to begin with. Never thought I would ever be in a situation like this in my life. Truly a life ruining disorder.

 

[Jrblovsky]

In a selfish way I hope this isn't adopted because if it works, the headline will read "tinnitus has been cured" and we will be forgotten, research will dry up since there would no longer be incentive to develop a cure for a population of tinnitus sufferers that will eventually go down to near 0 in under 50 years.

If the drug cures hearing loss and tinnitus/hyperacusis, what more research would need to be done? That would eliminate the suffering and this forum would become defunct.

 

[Daniel Parker]

Hi I have recently got tinnitus a week ago. I woke from a bad nightmare with it really bad in my right ear. It's calmed down a bit but still there and worried it gets worse. I'm reading a lot about the steroid injections for tinnitus at early stages. I'm in Scotland and can't find anywhere that does them any help or advice on where I could get these ASAP? Thanks

 

[an1992]

@Daniel Parker talk to an ENT and see if there's hearing loss. You should not wait for it to calm down (that was my big mistake).