Major Aggravation of Tinnitus: Prednisolone — Yes or No? Ototoxic or Not?

[Bill_]

As I mentioned in another thread I have a major aggravation of my tinnitus from some stupid ENT who did some LOUD test on my ear.

Went to see another ENT (at the hospital ER) today and he prescribed me prednisolone (oral, 10 days, starting with 100 mg for 3 days).

The leaflet doesn't say anything about possible ototoxicity or tinnitus as a side effect, but I have read on this forum that some people had their tinnitus actually aggravated by prednisolone. Actually you won't find any mentions of prednisolone causing tinnitus in any German publications, only in a few English ones, albeit not a lot...

I took a 4 day-scheme of prednisone in August which I ended without tapering off which caused a spike in my tinnitus (I think that went away eventually).

But I'm kind of afraid of prednisolone now...

What should I do?

 

[glynis]

100mg is a massive dose of steroid so I would not recommend it.

love glynis

 

[Bill_]

I know the international standard would be 60mg but here in germany they even give 250mg IV for 3 days as a guideline treatment, so 100mg isn't that much in comparison.
I'm just kinda worried because of the possible side effects such as even further aggravation of T (although it's a 0.08% chance according to https://www.ehealthme.com/ds/prednisolone/tinnitus/) and the higher likelyhood of infections, especially ear infections. Also i have read quite a few studies that claimed that steroid intake shows no significant difference to placebo...yet it's prescribed all the time....

 

[Red]

It can be ototoxic, yes. But I've never heard of anyone getting a permanent spike from it, just temporary ones.

 

[Bill Bauer]

@Bill_

As for Prednisone, your guess is as good as our guess. There is a chance that it will help, and there is a chance that you will experience one of its side effects (e.g., bone loss leading to dental problems). Nobody really knows the probabilities (of it helping and of it causing problems) involved. You have to choose one of those options (basically at random) and then try to not second guess your decision.

 

[Arseny]

100mg is a massive dose of steroid so I would not recommend it.

love glynis

100 mg is not a high dose, I've used it numerous times for allergies before.
30 mg or 60 mg after acoustic trauma or sudden hearing loss is not enough.

And yes standard treatment protocol in acute cases is starting at 250 mg Prednisolone or 40 mg Dexamethasone.

@Bill_ Should decide for himself, but if he indeed has a major increase in tinnitus at least 90-100 mg seems to be an adequate dose.

You should find a HBOT clinic too.

 

[Bill_]

@Bill_

Well that sums up pretty well where I am at. On the pro side is: it might help my T. But the con side is: might worsen T (unlikely), May promote infections (This is my biggest concern- ear infection being of particular concern), may cause anxiety (which I am struggling with anyways)...

All of this wouldn't matter of course if there was at least some evidence of Prednisolone really helping T but it i actually can't find any study that states more than "it might help but we don't know"....

 

[Bill_]

100 mg is not a high dose, I've used it numerous times for allergies before.
30 mg or 60 mg after acoustic trauma or sudden hearing loss is not enough.

And yes standard treatment protocol in acute cases is starting at 250 mg Prednisolone or 40 mg Dexamethasone.

@Bill_ Should decide for himself, but if he indeed has a major increase in tinnitus at least 90-100 mg seems to be an adequate dose.

You should find a HBOT clinic too.

There's an HBOT clinic some 150km away. Will call them tomorrow. Not sure though if I will do it - very few anecdotes of it being actually helpful

 

[Arseny]

Well that sums up pretty well where I am at. On the pro side is: it might help my T. But the con side is: might worsen T (unlikely), May promote infections (This is my biggest concern- ear infection being of particular concern), may cause anxiety (which I am struggling with anyways)...

All of this wouldn't matter of course if there was at least some evidence of Prednisolone really helping T but it i actually can't find any study that states more than "it might help but we don't know"....

Don't worry about anxiety, just call someone over to monitor you. I have panic attacks and tremor from Prednisolone. It's fine, don't stress about it. It's only scary for first 30 minutes.

You are unlikely to get any infection if you don't expose yourself to dangerous environments. Especially if your steroid course is under 5 days. Just wear a surgical mask for the next two weeks when going out and use earmuffs instead of earplugs.

Steroids have a long proven history of treating acute hearing loss. In these cases tinnitus usually goes away when hearing is restored.

 

[Arseny]

There's an HBOT clinic some 150km away. Will call them tomorrow. Not sure though if I will do it - very few anecdotes of it being actually helpful

It helped me even after 6 weeks after onset and 4 weeks after noise exposure (brain MRI with earplugs and earmuffs 15 minutes under 99 db).

If you read HBOT thread I remember one guy did sessions within a week after onset and it his noise induced tinnitus went away completely.

 

[Bill_]

Don't worry about anxiety, just call someone over to monitor you. I have panic attacks and tremor from Prednisolone. It's fine, don't stress about it. It's only scary for first 30 minutes.

You are unlikely to get any infection if you don't expose yourself to dangerous environments. Especially if your steroid course is under 5 days. Just wear a surgical mask for the next two weeks when going out and use earmuffs instead of earplugs.

Steroids have a long proven history of treating acute hearing loss. In these cases tinnitus usually goes away when hearing is restored.

I have two kids who have runny noses all year long - is that what you would call a "dangerous environment" ?

 

[Arseny]

I have two kids who have runny noses all year long - is that what you would call a "dangerous environment" ?

If it's from allergies then no. But it's hard to track if it's from allergies or sickness during the winter.
I advise you to get out more. Cold air kills bacteria and in winter most people get sick, because they just sit at home and transfer viruses and bacteria to each other.
But I'll wear a surgical mask anyway if I were you. No point in risking it. Don't forget to swap it multiple times a day.

 

[Bill_]

If it's from allergies then no. But it's hard to track if it's from allergies or sickness during the winter.
I advise you to get out more. Cold air kills bacteria and in winter most people get sick, because they just sit at home and transfer viruses and bacteria to each other.
But I'll wear a surgical mask anyway if I were you. No point in risking it. Don't forget to swap it multiple times a day.

No it's most definitely not from allergies but from constant re-infection at the kindergarten I suppose...

 

[Arseny]

No it's most definitely not from allergies but from constant re-infection at the kindergarten I suppose...

Then use surgical mask at home. Avoid contact with their food plates and cups.

 

[Bill_]

I also have to mention that I have a mild cold and also some diarrhea - don't know if that's a problem too?

 

[Arseny]

I also have to mention that I have a mild cold and also some diarrhea - don't know if that's a problem too?

I can't say anything about your cold, you should talk to your doctor about that.
Regarding intestinal problems if you have history of bleeding or erosions or anything like that you should approach steroids with extreme caution.

 

[Bill_]

I can't say anything about your cold, you should talk to your doctor about that.
Regarding intestinal problems if you have history of bleeding or erosions or anything like that you should approach steroids with extreme caution.

Ok so i went to bed yesterday without taking the prednisolone because I couldn't make up my mind. Was able to fall asleep fairly easily but woke up just 5 hours later and could not really get back to sleep.
T seems to have dialed down VERY slightly but can't say for sure.
I'm still worried about infections while taking prednisolone because I had this diarrhea yesterday (although it seems to be gone now) and in general because i don't want to conceive something that might require to take antibiotics at some point

/edit i'm Still within the 48h windows - 44h now

 

[Gman]

For a very risky medication that's on the ototoxic list, it sure gets recommended a lot on this site.

I've read that melatonin is more effective.

Anyway, I hope your spike subsides soon. Sounds like a big dose. Would have thought tapering would be a must for that amount.

 

[Bill_]

For a very risky medication that's on the ototoxic list, it sure gets recommended a lot on this site.

I've read that melatonin is more effective.

Anyway, I hope your spike subsides soon. Sounds like a big dose. Would have thought tapering would be a must for that amount.

Yeah it's with a taper. It's something like 100-100-100-70-60-50-40-20-5-2.5

 

[Arseny]

For a very risky medication that's on the ototoxic list, it sure gets recommended a lot on this site.

I've read that melatonin is more effective.

Anyway, I hope your spike subsides soon. Sounds like a big dose. Would have thought tapering would be a must for that amount.

It gets recommended a lot because it's first in line treatment for acute hearing loss. It get prescribed by most ENTs in cases like this, because it has a proven track record of being effective in restoring hearing.
Melatonin is just a sleeping aid it has nothing to do with tinnutis. It doesn't reduce the inflammation in cochlea. It might be good in preventing hearing loss, but after damage is done it's not effective.

 

[Arseny]

Yeah it's with a taper. It's something like 100-100-100-70-60-50-40-20-5-2.5

The dosage seems to be pretty good. In some cases it might make sense to take higher dose for 5-7 days and then taper.

 

[Arseny]

Ok so i went to bed yesterday without taking the prednisolone because I couldn't make up my mind. Was able to fall asleep fairly easily but woke up just 5 hours later and could not really get back to sleep.
T seems to have dialed down VERY slightly but can't say for sure.
I'm still worried about infections while taking prednisolone because I had this diarrhea yesterday (although it seems to be gone now) and in general because i don't want to conceive something that might require to take antibiotics at some point

/edit i'm Still within the 48h windows - 44h now

If you decide to take them and feel that your cold or other symptoms increase you can just stop taking Prednisolone without taper if you took 1 or 2 100 mg doses.
I also recommend taking it in the morning and always at different time so your adrenal glands don't get used to steroids at the same time.

 

[Bill_]

The dosage seems to be pretty good. In some cases it might make sense to take higher dose for 5-7 days and then taper.

I just got up and noticed my nose being completely clogged which only adds to my fear of inducing infections of my respiratory/ auditory system by taking prednisolone.
This is so hard to decide

 

[Gman]

It gets recommended a lot because it's first in line treatment for acute hearing loss. It get prescribed by most ENTs in cases like this, because it has a proven track record of being effective in restoring hearing.
Melatonin is just a sleeping aid it has nothing to do with tinnutis. It doesn't reduce the inflammation in cochlea. It might be good in preventing hearing loss, but after damage is done it's not effective.

Please. I know pred is prescribed for hearing loss. It's apparently also a form of TT candy. Not saying @Bill_ shouldn't be taking it if it's really called for. It has proven to have a tonne of bad side effects too.

I also know what melatonin is typically used for, but I have read it was shown in at least one study to be more effective than pred for hearing loss. Just saying.

Karlidag T, Yalcin S, Ozturk A, et al. The role of free oxygen radicals in noise induced hearing loss: effects of melatonin and methylprednisolone. Auris Nasus Larynx. 2002 Apr;29(2):147-52.

Bas E, Martinez-Soriano F, Lainez JM, Marco J. An experimental comparative study of dexamethasone, melatonin and tacrolimus in noise-induced hearing loss. Acta Otolaryngol. 2009 Apr;129(4):385-9.

 

[Arseny]

I just got up and noticed my nose being completely clogged which only adds to my fear of inducing infections of my respiratory/ auditory system by taking prednisolone.
This is so hard to decide

I understand. Can you call a doctor to consult with him about your situation?
After my spike I had to stop steroids, because I got side effects and continued them couple of days later. I definitely regret this decision.

 

[Arseny]

Please. I know pred is prescribed for hearing loss. It's apparently also a form of TT candy. Not saying @Bill_ shouldn't be taking it if it's really called for. It has proven to have a tonne of bad side effects too.

I also know what melatonin is typically used for, but I have read it was shown in at least one study to be more effective than pred for hearing loss. Just saying.

Karlidag T, Yalcin S, Ozturk A, et al. The role of free oxygen radicals in noise induced hearing loss: effects of melatonin and methylprednisolone. Auris Nasus Larynx. 2002 Apr;29(2):147-52.

Bas E, Martinez-Soriano F, Lainez JM, Marco J. An experimental comparative study of dexamethasone, melatonin and tacrolimus in noise-induced hearing loss. Acta Otolaryngol. 2009 Apr;129(4):385-9.

Thanks man, I'll will read it today.
Tacrolimus? It's ototoxic. I had topical tacrolimus cream that I applied a couple of times to my ears. I always wonder if this was a culprit of my original tinnitus along with Cipro.

 

[Eric N]

I am not sure it would be a good idea to take prednisone unless you have a clinically significant hearing loss and even then it is not proven to work at all for this type of hearing loss, and if it does work it seems like the window of opportunely is only 1 hour and it wont actually make the tinnitus better even it helps hearing according to https://www.ncbi.nlm.nih.gov/pubmed/11318462

The degree of hearing improvement after medication did not seem to correlate with the relief of tinnitus.

 

[Bill_]

I understand. Can you call a doctor to consult with him about your situation?
After my spike I had to stop steroids, because I got side effects and continued them couple of days later. I definitely regret this decision.

I wrote a friend of mine who's ENT just a moment ago. He said the cold wouldn't be an issue and that I can take the prednisolone regardless.

What exactly do you regret? Stopping the steroids or taking them?

 

[glynis]

100 mg is not a high dose, I've used it numerous times for allergies before.
30 mg or 60 mg after acoustic trauma or sudden hearing loss is not enough.

And yes standard treatment protocol in acute cases is starting at 250 mg Prednisolone or 40 mg Dexamethasone.

@Bill_ Should decide for himself, but if he indeed has a major increase in tinnitus at least 90-100 mg seems to be an adequate dose.

You should find a HBOT clinic too.

It must be different in other countries as in the uk Prednisalone is only used for Allergies and breathing problems and not given out for tinnitus by doctors.
I have used Prednisalone many times for sever asthma.

love glynis

 

[Bill_]

I am not sure it would be a good idea to take prednisone unless you have a clinically significant hearing loss and even then it is not proven to work at all for this type of hearing loss, and if it does work it seems like the window of opportunely is only 1 hour and it wont actually make the tinnitus better even it helps hearing according to https://www.ncbi.nlm.nih.gov/pubmed/11318462

The degree of hearing improvement after medication did not seem to correlate with the relief of tinnitus.

That's my main concern! Although there's quite a few stories on this board on how people who took prednisone/prednisolone actually experienced an improvement for their T there's no hard evidence that this wouldn't have occurred also without steroids.

My main fear is that i'll contract some infection that might ultimately do more harm to my T - be it because it might be something ear-related it be it something that might require treatment with antibiotics

This sucks so bad