Intratympanic Steroid Injection Increasing Pulsatile Tinnitus

[Sat]

I had a tympanic steroid injection in my right ear (4 days ago) and since then my pulsatile tinnitus has increased tenfold ( i think it has amplified). I am not quite sure how this works, so I will ask you guys some questions I request you to help me understand things better:

1. What exactly does the steroid do once injected in the ear?
2. How long does its effect last?
3. Does the steroid amplify internal sounds (within or close to the ear).

My understanding so far is :

1. It stimulates the hair cells so that they work in overdrive. This may improve hearing which is why they inject it.

2. The quantity I received was 2/3/4 mg. I suppose that's a small dose and its effects shouldn't last long (maybe a few days).

3. In my case the PT has significantly amplified. Its unbearably loud. I clearly understand when my pulse fluctuates. The sound is loud enough to make me feel pain and fullness in the affected ear.

Also, of note, is that i can reduce the loudness of my PT by placing my finger on the base of the affected ear. By moving my finger in that base region (upwards, downwards, sidewards), I can reduce the volume of the PT.

Can anybody shed some light on this?

Thanks in advance!!

 

[Karen]

Hi, Sat,

I don't know much about steroid injections in the ear myself, but I did look up the following information about these injections. I don't know if you received your injection for hearing loss or Meniere's, but it's still interesting:
http://my.clevelandclinic.org/services/head-neck/diseases-conditions/hic-treating-menieres-syndrome

Since you just had the injection four days ago, it's possible that you are still experiencing symptoms (as noted in the article) from the injection. These symptoms may subside in time, and if they don't, it would be best to get back in touch with your doctor. It may have simply amplified whatever was going on with your ear, PT/wise, before the injection. Increased blood flow around the site could be responsible, or simply the increased stimulation of the hair cells in the ear.

I understand that if you are able to press on your neck and have your pulsatile tinnitus get quieter, it is venous in nature. Since you are able to press on the area around your ear and reduce the PT, it may have something to do with fluid or inflammation around the ear.

I'd be interested to hear how you are doing at 10 days after the injection. If there is still a problem, I'd go back to the doctor for guidance. I'm wondering how long it takes for the hole (perforation) from the injection to totally heal (?)

Best wishes,
Karen

 

[Sat]

Thank you Karen. Unfortunately its been 11 days and my tinnitus hasn't reduced. Its still the same loud pulsatile sound. It gets better a couple of days but then goes back to loud. The volume fluctuates quite a lot and when I get up in the morning I have no idea what kind of day it's gonna give me. I have lived with it for 10 years but the current volume level is unbearable. I am unable to concentrate on anything and I fear my boss who has been very patient and understanding so far, is gonna give up one me. I cannot work or lead a normal life at this volume level. I can certainly live with tinnitus and have lived with it for 10 years but at the current volume I just cannot. I am truly hoping that the volume subsides in time. But after a while, if it doesn't I guess I will have to bring this extremely wonderful life to a sad miserable end.

 

[Karen]

Hi, Sat,

I'm sorry to hear that it's still so loud, and it must be pretty unbearable right now. I know how the pulsating and ringing can be (mine isn't so good this evening, either), and to me, the pulsating is more bothersome than the ringing.

Have you been back to your doctor, or will you consider calling your doctor's office about the effects of the injection, and how long they are supposed to last? I know that a lot of things can stir up PT, and I can see how this could definitely do that. I'll bet your doctor never asked you about that, or considered that your PT might be exacerbated by the injection.

I hope you won't give up, and will give it some time to see if it finally settles back down to its baseline level.

How long have you had PT, and have you had any tests to try to determine a cause? It's a good idea to have a neurotologist or neurologist check you out, to be sure you don't have anything like a fistula or tumor.

Please come back here at any time to vent. I understand what you must be going through right now!!!

Hugs,
Karen

 

[Sat]

Hi Karen, Thanks for the kind words.

I don't know the source of my PT. It used to be very mild. Infact if I concentrated I could clearly hear my heart beat and feel the pulse in my ear physically (if I inserted my finger in the ear). Now the PT is more tone-sounding. Also, I don't know the when the PT started, but I noticed it about 6 months ago (I had conditioned myself to ignore tinnitus in general). As far as the possibility of tumor is concerned, I had an MRI scan done very recently and it came back normal. I still wonder what could be the source of my PT as I did not have it when I first noticed tinnitus (about 10 years ago when it was a clear frequency tone).

Its been 25 days now since I got the injection and the sound has just marginally decreased. Its still in the intolerable zone though. Masking doesn't work. Its the loudest thing I hear in a quiet room, on a busy road, in noisy restaurant, in a train station with all the trains passing by, in an airport lobby. Heck, I sat in a long distance flight and the sound of the aircraft was dwarfed by the sound of my tinnitus. I could hear my T clearly whereas the aircraft sound felt as though it was playing in the background. I don't know if an aircraft sound can't mask your T then what else could?

I do hear people talking in the affected ear but it sounds like murmur to me. Its actually that pub kinda thing. In a pub, the music is so loud that you can barely hear the other person speak. You have to speak very close to the ears in case you want the person to hear you. Its just that kind of thing with normal conversations for me. The normal voices get dwarfed by the tinnitus and are clear only when spoken close to my affected ear.
I am only managing to sleep for 3-4 hours. After that, the tinnitus sound awakens me much the same way an alarm clock awakens you.It's so loud that its absolutely impossible for me to mask it or ignore it.

I also have "normal" tinnitus which has increased in terms of tone as well as volume since the injection and is exactly the same level as the PT.

The doctor refused to agree that his injection could increase my tinnitus. He said he couldn't believe it. He even insinuated that I was lying with respect to my increase in tinnitus. Anyways, he washed his hands clean of me. He asked me to have an MRI scan which came back normal. So he wished me best of luck for my future and said there was no need of another follow up.

I am a 100% sure that these are the effects of the tymphanic steroid injections. What I do not know is if this increased tinnitus is temporary or permanent. Will it subside in some time or will I have it this way for the rest of my life. If it won't subside, then I will have no choice but to end this life.

 

[Karen]

Hi, @Sat,

I am very concerned about you, and really hope you'll give it a little time, to see if this is a temporary condition. In the meantime, what about getting a second opinion from another doctor? I don't know where you're located, but if your insurance will allow it, what about going to another type of doctor to see if they can look at you and give you some sort of prognosis. ENT's are not always very patient with those of us suffering with unusual conditions, and I am so sorry he brushed you off!!! How about a neurotologist or other type of specialist?

It sounds to me like the injection sent your PT into overdrive, and I know from my own experience with PT that a lot of things have made mine get worse -- but it then settled back down to baseline level.

Is there anyone else on this board who has knowledge of the effect of these steroid injections? I've had a lot of procedures (sometimes crazy ones) done to my ear in the hope of curing it, and most of the time, my pulsating got temporarily a lot worse. Even a hearing aid made my PT go through the roof for awhile!

Please let me know what you decide to do. Are you located in an area where you have access to other doctors or specialists?

 

[Karen]

Here's an article about these injections, and possible side effects/complications. It doesn't say anything about how it might affect pulsatile tinnitus, but I would imagine the injection of a steroid would increase blood flow to the area. For me, at least, any increase in blood flow to the ear makes my pulsatile tinnitus a whole lot worse. That's my personal observation, anyway.
http://cdn.intechopen.com/pdfs-wm/33876.pdf

Also, I wonder if (as article says) it could be affecting your mastoid area, and causing it to be irritated, which might affect your hearing (?).

 

[Sat]

Other ENTs? I think we all have a similar if not the same kind of experience with respect to ENTs. Infact, I think all ENTs are cut from the same cloth. The moment you mention your problem is Tinnitus, they mark you down on a "get rid of him/her ASAP" list. I did visit another ENT who told me the same nonsense I have heard from all ENT's - "Tinnitus is incurable. Just learn to live with it. Its not that big a deal." This ENT mentioned Tinnitus as though it was no big deal. Afterall, its just a harmless sound. Its just like a small bruise on your hand. I was pretty sure this fellow doesn't have T nor has any idea how it sounds or feels. In all probability, he thinks we tinnitus "sufferers" hear Mozart and Beethovan play Moonlight Sonata in our ears. He could potentially be jealous of our very own "personal radio station".

All these ENT's seem hell bent on diagnosing me with Meniere's. The weird thing is I had just one vertigo attack in 12+ years. My hearing does not fluctuate as it happens with Meniere's patients. My tinnitus was unchanged for 10 years despite any environmental changes, changes in eating patterns or quantity of food intake. I had no balance related or vertigo related problems in these years. Just had tinnitus. Despite all the symptoms which generally contradict Meniere's the doctors still tell me I have Meniere's. There are a couple of tests that help in identifying Meniere's to a reasonable certainty :Tymphanometry, ENG and ECOG. However, the doctors seem uninterested in me undergoing these tests.

I haven't lived very long so I am not someone who is very close to the end of the tunnel in terms of natural life and death. I am only 27 and have more than a decade before I hit my mid-life crisis, forget old-age. If I was 72 and had this level of tinnitus, I might have soldiered on knowing that my best days are behind me and suffering is part and parcel of old age. Also at that age, you know you don't have to suffer too long.

But in my case, I am not there yet. There is no silver lining here. I might have to live with this volume for the rest of my life. That means maybe another 40 years (and I will still be 67 then...again not exactly the "very old" category). I will give it time, maybe a few months, maybe an year. But something's gotta give. I can't hope forever. At some stage, that hope transforms into hoping against hope.

Its one thing to live with this horrible condition. Its another to live knowing that your condition was ruthlessly and mercilessly aggravated by a doctor who doesn't even bother to help you recover/relieve the pain but seems more interested in defending his treatment to the point where he insinuates that the patient is blatantly lying or the trauma is just a figment of patient's imagination. Makes me wonder why they say US has the best health care facilities whereas the honest truth is some of our health care professionals seem more interested in avoiding a possible lawsuit rather than truly helping out a patient.

 

[Rube]

hi @Sat there are some promising treatments on the horizon. we're all going through a tough time with this and many of us have the same thoughts you are having. you are catastrophasizing (spelling?) but in all actuality your sound may reduce gradually and/or you will just not care and habituate. please check out some of the upcoming treatments such as Otonomy trial which is an intratympanic injection or Autifony phase 2 trials.....heck some of our friends here have found relief with Retigabine which is an off label medication which should be considered.

 

[Sat]

Hi @Rube I'm not sure catastrophasizing is a word or not but anyways I get your point.

Let me help you understand something. I am not new to tinnitus. I have suffered this for almost 10 years. Yes, 10 years. I know what it means to live with it. I know the kind of anxiety it creates. I know the mental trauma it causes. I know the "ignore it and you'll habituate" experience. I know the drill. Been there, done that.

I have lived a happy life despite Tinnitus. But now Sir, the volume is unbearably loud. Hence, my frustration.

I hope that the current wave of trials are bang on the target and we find our kryptonite: the cure to all kinds of tinnitus. But there's a difference between being optimistic and realistically optimistic. And to think that these will be able to heal or even treat all kinds of tinnitus is unrealistic. It might work for some people and not for some others. There will be a category of people who will have their condition worsened by these medications and treatment.

The point is that these pharmacuetical companies are more interested in finding a cure. But honestly, there is no one yet who can completely explain this phenomenon. There is no scientific journal which explains in detail how tinnitus occurs, what changes are brought on into the body just before the onset, what changes are brought on during the tinnitus, where exactly does this reside within the body, is there any way to measure it, is there any way to objectively compare the severity of two tinnitus patients. Without answering these questions you will never develop a complete understanding of the tinnitus problem. So how in the bloody hell do you find a solution when you don't even know what the scope of the problem is nor what your focus area should be. You see, the stumbling block is that there is no starting point nor any reference point.

While its good to see some development as far as solutions are concerned and these trials could potentially help us in understanding the T mechanism irrespective of whether they work or not, a complete solution is still some long way to go. I don't mean to subdue your optimism but having suffered this long enough, any "potential" solutions don't get my optimism in overdrive anymore.

Understand that these trials are more or less "trial and error" sessions. Undoubtedly, we'll learn from these but as far as we are concerned, mine and yours tinnitus isn't going anywhere anytime soon. Yes, reality bites..

 

[Alper]

Yesterday I have started the intratympanic injection to on my right ear. This morning second shot with metylprednison. After this weekend maybe third session and no positive changes so far or is it possible that its slowly working? First injection was strong pain but today the second one no pain (because doctor gave me extra lidocaine first with placing some tissue ). Dizziness; wow first time very strong 2-3 minutes and stopped now I have still a little bit dizziness. I didn't sleep long yesterday maybe thats also a playing factor. Still fullness feeling and also very remarkable hearingloss. You think this will recover over time? Doctor said it will.

 

[Alper]

Hey @Sat how are you now?
Is it back to normal again?


Me 1 week after the shots still loud and unbearable. Since the injections is T full force back to the start. I thought after the normal infusion (IV Steroids)I was feeling much better then before, but also decided to go for the intratympanic injection to eliminate T 100%. Sadly it made it worser. Hope it will go back to normal volume soon. I don't know for 100% if the injection are the cause of T is back to full force but likely there is a link.

The ENT keeps telling me such increases with the volume of T are happening right after the injections and it will pass away slowly.

Scared!!

 

[Blue_skyyy]

Hello.3 years ago I went to doctor and doctor injected dexamtehason in my left ear.my tinnitus worser than before injection.up to now my tinnitus continues.

 

[TOVEGA]

How is your T now? Is it still higher after the intratympanic injections? Or did your T come down again?