Oral Gabapentin and Intradermal Injection of Lidocaine: A Role for the Treatment of Tinnitus?

[AnnaW]

Oral gabapentin and intradermal injection of lidocaine: is there any role in the treatment of moderate/severe tinnitus?

 

[1000]

Anyone trying this?

 

[Nick47]

I have to say, what happened to this? Highly significant improvements.

in patients treated with oral gabapentin (Group I), oral gabapentin and intradermal injection of lidocaine (Group II), and placebo (Group III) Significant differences in THI scores from the 8th day of therapy to the 22nd (p < 0.0001) and from the 22nd day to the 36th (p = 0.0002 and p = 0.0004, respectively) were found in Group I and Group II. In Group II, another relevant decrease of THI scores from the 36th day of therapy to 3 months from the end of treatment (p = 0.0004) was found. A significant difference in THI scores between Group I and Group II was found after 8 days of treatment (p = 0.05) with a more relevant decrease registered in Group II; significant differences were also found in THI scores between Group I and Group III after 8 days of treatment (p = 0.01), with a more relevant decrease registered in Group III; significant differences in THI scores between Group II and Group III were found after 36 days of treatment (p = 0.009), 3 and 6 months after the end of therapy (p = 0.005 and p = 0.007, respectively), with a more relevant decrease registered in Group II. In conclusion, the use of gabapentin associated to lidocaine seems to be superior to placebo and gabapentin in relieving tinnitus.

 

[Forever hopeful]

I thought Gabapentin listed tinnitus as a side effect. I think it is rare though but a risk nonetheless. But like all meds, it is individual.

 

[Nick47]

I thought Gabapentin listed tinnitus as a side effect. I think it is rare though but a risk nonetheless. But like all meds, it is individual.

This thread is about a combination of Gabapentin and Lidocaine.

 

[Joeseph Stope]

The old question: acute (early onset ) -- or chronic tinnitus?

 

[Nick47]

The old question: acute (early onset ) -- or chronic tinnitus?

I can't access the full paper.

 

[annV]

I can't access the full paper.

Here it is.

 

[ErikaS]

I can't access the full paper.

I know that clinic down in Tennessee still apparently does the intratympanic Lidocaine shots. I'm just so surprised this method has not taken off more when there's studies as old or older than this and Mass Eye and Ear are doing one right now with intravenous Lidocaine and using MRI to see changes in the brain. Intratympanic Dexamethasone shots are given for obvious reasons when needed, I wonder why such a halt with Lidocaine when ENTs have nothing else for us?

 

[Nick47]

Here it is.

Thanks @annV.

• Moderate sized group.
• Double blind and randomised.
• @Joeseph Stope, all patients at least 6 months (chronic), up to 4 years.
• All patients moderate-severe.
• Gabapentin effective.
• Intradermal lidocaine + Gabapentin very effective.
• Highly significant results.
• Effects still present 6 months AFTER treatment finished.

I know that clinic down in Tennessee still apparently does the intratympanic Lidocaine shots. I'm just so surprised this method has not taken off more when there's studies as old or older than this and Mass Eye and Ear are doing one right now with intravenous Lidocaine and using MRI to see changes in the brain. Intratympanic Dexamethasone shots are given for obvious reasons when needed, I wonder why such a halt with Lidocaine when ENTs have nothing else for us?

The study did not use intratympanic injections, although results using this method have high response rates (81-86%) in trials. Side effects such as vomiting and vertigo are common temporary effects. It's a good option for severe patients.

I'm not sure why it's not offered. It's really the question I'm asking regarding the study.

The study mentioned used intradermal Licodaine injections in the auditory canal at 4 points + Gabapentin.

 

[Joeseph Stope]

Thanks @annV.

• Moderate sized group.
• Double blind and randomised.
• @Joeseph Stope, all patients at least 6 months (chronic), up to 4 years.
• All patients moderate-severe.
• Gabapentin effective.
• Intradermal lidocaine + Gabapentin very effective.
• Highly significant results.
• Effects still present 6 months AFTER treatment finished.

The study did not use intratympanic injections, although results using this method have high response rates (81-86%) in trials. Side effects such as vomiting and vertigo are common temporary effects. It's a good option for severe patients.

I'm not sure why it's not offered. It's really the question I'm asking regarding the study.

The study mentioned used intradermal Licodaine injections in the auditory canal at 4 points + Gabapentin.

I appreciate @annV for locating the paper and @Nick47 for unravelling the study to get the gist of it.

It would be irony itself if it turns out that we have been waiting all these years and like the grass, we were letting the therapy grow under our feet

 

[Nick47]

It would be irony itself if it turns out that we have been waiting all these years and like the grass, we were letting the therapy grow under our feet

There has to be something wrong with the study?

@InNeedOfHelp, what do you make of this now that you can see the full paper?

 

[Kleiner]

It would not be a surprise for me if a relatively effective path remained forgotten. I remember the total immobility of tinnitus sufferers during the Team Trobalt era.

Gabapentin and Lidocaine represent some interest.

But I don't really understand, it's an intradermal injection but in the external ear canal, at four different points (up, down, left and right)?

 

[Nick47]

But I don't really understand, it's an intradermal injection but in the external ear canal, at four different points (up, down, left and right)?

Sometimes I think we forget things. I dug this up and saw 1 comment. I read the abstract and thought there must be some bullshit in the detail. All subjects were chronic.

With regards to the injection, they have indeed targeted the outer ear. Obviously the Lidocaine must perfuse to the inner ear.

But what stood out more was the continual improvement well after the treatment had stopped. Lidocaine is known to have a temporary effect, with a very short half life.

I would love some expert opinion on this.

 

[DeanD]

Sometimes I think we forget things. I dug this up and saw 1 comment. I read the abstract and thought there must be some bullshit in the detail. All subjects were chronic.

With regards to the injection, they have indeed targeted the outer ear. Obviously the Lidocaine must perfuse to the inner ear.

But what stood out more was the continual improvement well after the treatment had stopped. Lidocaine is known to have a temporary effect, with a very short half life.

I would love some expert opinion on this.

This is the outcome of when multiple researchers carry out case studies in small unconnected burrows. Yes, we have PubMed etc, but there are no combined continued efforts or studies when things show the remotest of efficacy.

Is there anyone in the expert field that would have such knowledge of the combined effect, plus with a good understanding of tinnitus?

Dr. Dirk De Ridder springs to mind, simply as being someone who has a good understanding of tinnitus and the combined effect of medication (although I know he opts for different medication within his studies).

It seems almost careless such a study, done almost 10 years ago and showing at least some positive results, has had zero in the way of follow-up, or any that I can find using any type of search or AI tools.

 

[slc]

It is pretty impressive to see the improvement when measured 6 months following treatment.

ORAL GABAPENTIN (2700 MG DAILY) (GROUP I)

Before treatment

• 12 patients (50 %) suffered from severe tinnitus and 12 (50 %) from moderate tinnitus

6 months following treatment

• 6 patients (25 %) suffered from severe tinnitus, 6 (25 %) from moderate tinnitus, 9 (37.5 %) from mild tinnitus, and 3 (12.5 %) referred abolition of tinnitus

ORAL GABAPENTIN + INTRADERMAL INJECTION OF LIDOCAINE (GROUP II)

Before treatment

• 9 patients (37.5 %) suffered from severe tinnitus, and 15 patients (62.5 %) from moderate tinnitus

6 months following treatment

• 6 patients (25 %) suffered from severe tinnitus, 0 (0 %) from moderate tinnitus, 12 (50 %) from mild tinnitus, and 6 (25 %) referred abolition of tinnitus

I think I've transcribed this correctly. It's a bit late but I triple checked the research paper to make sure I correctly identified the groups.

 

[Nick47]

This is the outcome of when multiple researchers carry out case studies in small unconnected burrows. Yes, we have PubMed etc, but there are no combined continued efforts or studies when things show the remotest of efficacy.

The fact this shows sustained benefit after treatment is a big boon.

Is there anyone in the expert field that would have such knowledge of the combined effect, plus with a good understanding of tinnitus?

Dr. Dirk De Ridder springs to mind, simply as being someone who has a good understanding of tinnitus and the combined effect of medication (although I know he opts for different medication within his studies).

It seems almost careless such a study, done almost 10 years ago and showing at least some positive results, has had zero in the way of follow-up, or any that I can find using any type of search or AI tools.

Exactly my thoughts. We see these moderate sized groups studied with Cyclobenzaprine, Carbamazepine etc that show positive results, then no larger study as a follow-up.

Given the relatively non-invasive nature of this study, how hard would it be to do a larger trial?

I would like an opinion on this study from professionals. No comment from Tinnitus UK or the ATA either.

 

[Nick47]

Here is another example, although delivered transtympanically.

81% effective rate, nearly 300 participants:

Treatment of cochlear tinnitus with transtympanic infusion of 4% lidocaine into the tympanic cavity

 

[ErikaS]

Sometimes I think we forget things. I dug this up and saw 1 comment. I read the abstract and thought there must be some bullshit in the detail. All subjects were chronic.

With regards to the injection, they have indeed targeted the outer ear. Obviously the Lidocaine must perfuse to the inner ear.

But what stood out more was the continual improvement well after the treatment had stopped. Lidocaine is known to have a temporary effect, with a very short half life.

I would love some expert opinion on this.

Five or six months ago I was reading up on/learning about neural therapy. It is considered a very old alternative medicine modality since 1900s, but I cannot help but see a possible correlation to this. As provided on one of the sites I researched, they state:

Neural therapy is a healing method that consists of injecting a local anesthetic into certain areas of the body in low doses. The aim is to repair a damaged area/portion which is sending signals of pain to the autonomic nervous system (ANS). Neural therapy stimulates a lasting change to this nerve function and promotes healing of the ANS.

Another site provided places it can be injected to, including scars, trigger points, acupuncture points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, the epidural space, and other tissues to treat chronic pain and illness. What's curious is a repeated condition that is listed to be treated by this is trigeminal neuralgia.

I know it may not be the exact same, but I read enough about it and thought to myself "there has to be a way to apply this to tinnitus". Especially those of us who had direct damage to inner ear where scar tissue and nerve inflammation could be present.

 

[sergerold]

Exactly my thoughts. We see these moderate sized groups studied with Cyclobenzaprine, Carbamazepine etc that show positive results, then no larger study as a follow-up.

Unfortunately, I suspect that the reason for this is that there is little financial incentive in these types of treatment. Both Lidocaine and Gabapentin are fairly common drugs and so there is no new proprietary drug which can be sold. The result is that once academics have published this study, there is no commercial imperative to push it forward.

A slightly different study using Lidocaine is here.

 

[ErikaS]

I put a call into my ENT and when he calls me back I am going to present all of this to him and ask him what he would feel confident trying, if anything. I am going to mention how the Shea Clinic in Memphis, TN still does that 3 day intratympanic Dexamethasone + Lidocaine shot and see what he says. This is just not right how something like this could be part of clinical practice but it just isn't.

 

[Nick47]

I put a call into my ENT and when he calls me back I am going to present all of this to him and ask him what he would feel confident trying, if anything. I am going to mention how the Shea Clinic in Memphis, TN still does that 3 day intratympanic Dexamethasone + Lidocaine shot and see what he says. This is just not right how something like this could be part of clinical practice but it just isn't.

It's worth asking about other routes such as intradermal (4 points of external ear canal) and otic ganglion too.

I expect the intratympanic carries more side effects like vomiting and vertigo, looking at the studies so far.

So maybe start with intradermal + Gabapentin, followed by otic ganglion, as these seemed to be free of any significant side effects.

 

[chinup]

Isn't this similar to what was happening in Korea a couple years back, where we had members fly over there to try an injection-based treatment? I thought they were getting Lidocaine injected into nerves or something similar...

 

[Nick47]

Isn't this similar to what was happening in Korea a couple years back, where we had members fly over there to try an injection-based treatment? I thought they were getting Lidocaine injected into nerves or something similar...

I'm not sure what that nonsense in Korea was about. A colourful chart of sorts, however I don't remember seeing a reputable publication.

 

[2noist]

I'm not sure what that nonsense in Korea was about. A colourful chart of sorts, however I don't remember seeing a reputable publication.

There was a reputable journal publication, peer reviewed by Will Sedley and Roland Schaette.

It was all a sham at the end...

 

[Nick47]

There was a reputable journal publication, peer reviewed by Will Sedley and Roland Schaette.

It was all a sham at the end...

@2noist, I stand corrected.

Although we know Lidocaine is very effective for tinnitus in about 2/3rds of patients.

 

[Joeseph Stope]

Isn't this similar to what was happening in Korea a couple years back, where we had members fly over there to try an injection-based treatment? I thought they were getting Lidocaine injected into nerves or something similar...

Yes, I can recall the story. I seem to think that it was acupuncture. The amazing thing about it is how the hype (or curiosity?) seemed to literally take off and one of our members took the chance, shelled out the money on the airline ticket and accommodation. Long story short, it was a big disappointment. He may have even got worse from the treatment. Maybe some other reader can recall the chap's name. A young American from one of the Western States if I recall correctly.

In my humble opinion, we all "let in a goal" on this one if I could wax poetic about the incident.

One of the prime functions of websites and organizations such as Tinnitus Talk is to prevent people running around like headless chickens pursuing rumours of a cure that harms both their auditory systems and their bank accounts. Hit by a double-whammy so-to-speak.

 

[StoneInFocus]

Yes, I can recall the story. I seem to think that it was acupuncture. The amazing thing about it is how the hype (or curiosity?) seemed to literally take off and one of our members took the chance, shelled out the money on the airline ticket and accommodation. Long story short, it was a big disappointment. He may have even got worse from the treatment. Maybe some other reader can recall the chap's name. A young American from one of the Western States if I recall correctly.

In my humble opinion, we all "let in a goal" on this one if I could wax poetic about the incident.

One of the prime functions of websites and organizations such as Tinnitus Talk is to prevent people running around like headless chickens pursuing rumours of a cure that harms both their auditory systems and their bank accounts. Hit by a double-whammy so-to-speak.

You read many of these horror stories on here from people permanently worsening from medication. I'm wondering to what extent co-supplementation with antioxidants like N-acetyl cysteine can protect against this drug-induced damage to the auditory system.

According to this study, "NAC reduces the risk of hearing loss after acoustic accidents in humans." NAC supplementation was also found to have a protective effect against drug-induced ototoxicity in uraemic patients with CAPD peritonitis.

Maybe taking NAC should be standard protocol when trying new drugs or treatments? What are some of the possible risks involved?

 

[Joeseph Stope]

You read many of these horror stories on here from people permanently worsening from medication. I'm wondering to what extent co-supplementation with antioxidants like N-acetyl cysteine can protect against this drug-induced damage to the auditory system.

According to this study, "NAC reduces the risk of hearing loss after acoustic accidents in humans." NAC supplementation was also found to have a protective effect against drug-induced ototoxicity in uraemic patients with CAPD peritonitis.

Maybe taking NAC should be standard protocol when trying new drugs or treatments? What are some of the possible risks involved?

Unfortunately, my medical background is pretty threadbare and your suggestion re NAC has my antenna raised to "what's that"?

On those horror stories... well, just take a look at things on the ground as they happen: some young person gets tinnitus, he learns that the longer it persists, the greater the danger that it will become chronic. Of course he gets into a panic and try literally anything to have it cured. If he doesn't respond to conventional medical therapy, well, it can be a dangerous world out there trying anything and everything.

 

[Pharz]

I have some Gabapentin lying around, shall I try them?