Protocol for Tinnitus Spikes / Aggravation — What to Do? — Prednisone - Pentoxifylline - LLLT Laser

[Jan64]

Dear All,

Having tinnitus means having to cope with spikes, and avoiding that the spike gets permanent.

My protocol:

As soon as possible after onset, when you assess it is a spike (e.g. went to a restaurant, discotheque, fireworks, blast):

• Take 60 mg of Prednisolone / Methylprednisolone (time of day doesn't matter, it is hard to fall asleep, but worth it!)
  
• Take 400 mg of Pentoxifylline (Trental / Hexal), and later on in the day another 400 mg, for a total max of 1,200 mg.
  
• Treat both ears with Konftec ear laser, 45 minutes, infrared 650 nanometer.

A day after the onset of the spike:

• In the morning: Take 60 mg of Prednisolone.
  
• In the morning: 3 pills of Pentoxifylline (Trental / Hexal, total of 1,200 mg)
• In the morning & evening: Konftec ear laser, 45 minutes, infrared 650 nanometer.

Third day:

• In the morning: Take 60 mg of Prednisolone.
  
• In the morning: 3 pills of Pentoxifylline (Trental / Hexal, total of 1,200 mg)
• In the morning & evening: Konftec ear laser, 45 minutes, infrared 650 nanometer.

Fourth till seventh day:

• In the morning: Start tapering off from 60 mg of Prednisolone, by 10 mg of Prednisolone per day.
  
• In the morning: 3 pills of Pentoxifylline (Trental / Hexal, total of 1,200 mg)
• In the morning & evening: Konftec ear laser, 45 minutes, infrared 650 nanometer.

Eighth till fifteenth day:

• In the morning: Take 10 mg of Prednisolone per day.
  
• In the morning: 3 pills of Pentoxifylline (Trental / Hexal, total of 1,200 mg)
• In the morning & evening: Konftec ear laser, 45 minutes, infrared 650 nanometer.

It is best to have these meds in your possession...

What is your opinion, what more to add? Vitamins, Mg? NAC?

Thanks in advance!

Kind regards, Jan

 

[Digital Doc]

Think it is better to prevent the exposure in the first place.

That is a large dose of steroids, and be hesitant to take that after each spike.

Is there any evidence for that ear laser?

I just take my omega3 daily, 500 mg or so.

 

[Eric N]

How do you know this works? Seems pretty dangerous protocol assuming you can get your hands on those medications as well.

 

[linearb]

Huh, I just do absolutely nothing because it's way way easier than doing any of this stuff and I think Prednisone is an extremely dangerous drug which has basically no evidentiary basis for being useful in hearing issues aside from the one specific case of SSHL which is a different animal from a "tinnitus spike".

By my last count there are as many cases in the medical literature of routine steroid use causing psychotic episodes, as there are case examples where they appeared to be beneficial for hearing. And, that's case studies -- for RCTs it's even dodgier, and in the handful of studies where a dramatic effect was shown -- the steroids were administered trans-tympanically, within minutes to a few hours of a serious noise trauma.

Think it is better to prevent the exposure in the first place.

That is a large dose of steroids, and be hesitant to take that after each spike.

I'd be hesitant to take it ever, steroids are super bad for you and reliably cause insomnia and anxiety which is not helpful to a distraught tinnitus patient.

Is there any evidence for that ear laser?

No, all the LLLT stuff is smoke and mirrors, there's long threads about it here but the bottom line is that despite it being a very lucrative "procedure" for some alt-med people to offer, there's no good evidence it works. Also, you can build a machine using LEDs at home that will do exactly the same thing for about $200 and the cost of a few afternoons of learning how to wire COB LED gear together.

 

[Jan64]

Thank you for the your comments, remarks, and questions...

Think it is better to prevent the exposure in the first place.

Yes! That is always better, but sometimes your hearing is affected by a blast, fire works, a loud evening, too loud music at a discotheque. Or when you use ear protection that is too weak...

That is a large dose of steroids, and be hesitant to take that after each spike.

It is sure a large dose... you can only do this max. twice a year. The protocol is designed by my German ENT doctor.

Is there any evidence for that ear laser?

Evidence is weak. But I think it is a bit effective early after onset of aggravation... See another thread which I started...

I just take my omega3 daily, 500 mg or so.

I also use omega3 but not on a daily basis. Is the effectiveness proven? I am interested in scientific proof.

How do you know this works?

I used this protocol before... It is based on a protocol designed by an ENT doctor. But evidence remains weak.

Seems pretty dangerous protocol assuming you can get your hands on those medications as well.

Pretty dangerous: yes using prednison has serious side effects. You have to weigh this against the possible advantages. How to get your hands on these meds: I get them subscribed by my GP, my Dutch and German ENT doctors...

Huh, I just do absolutely nothing because it's way way easier than doing any of this stuff

I agree!

I think Prednisone is an extremely dangerous drug

There are indeed serious side effects, but it is quite safe when you use temporary... Max twice a year...

y my last count there are as many cases in the medical literature of routine steroid use causing psychotic episodes,

I did not read this side effect in the leaflet...

I'd be hesitant to take it ever, steroids are super bad for you and reliably cause insomnia and anxiety which is not helpful to a distraught tinnitus patient.

Prednisone is not candy... but is can have beneficial effects...

No, all the LLLT stuff is smoke and mirrors, there's long threads about it here but the bottom line is that despite it being a very lucrative "procedure" for some alt-med people to offer, there's no good evidence it works. Also, you can build a machine using LEDs at home that will do exactly the same thing for about $200 and the cost of a few afternoons of learning how to wire COB LED gear together.

There is some weak evidence... See my other thread, I 'think' it can be beneficial in acute cases...

 

[linearb]

There are indeed serious side effects, but it is quite safe when you use temporary... Max twice a year...

https://www.uspharmacist.com/article/systemic-corticosteroidassociated-psychiatric-adverse-effects

Systemic corticosteroid use—such as treatment with prednisone, commonly used in respiratory disorders, rheumatoid arthritis, and other conditions common in older adults—has been associated with psychiatric adverse effects. Symptoms such as euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis—referred to as corticosteroid-induced psychosis—have been estimated to develop in 5% to 18% of patients treated with corticosteroids.1 The primary risk factor for the development of corticosteroid-induced psychosis is a high dose of corticosteroids, with risk increasing among patients taking 40 mg or more of prednisone or its equivalent daily; psychiatric adverse effects occur in 1.3% of cases when the dose is less than 40 mg daily and 18.4% of cases for doses of 80 mg daily

This specifically mentions sinus infections, so we're including short-term use here. 1.3% ain't nothing and 18.4% definitely ain't nothing.

I did not read this side effect in the leaflet...

Did you, er, read the leaflet?
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021959s004lbl.pdf

Behavioral and mood disturbances: May Include euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis. Existing conditions may be aggravated. (5.5)

There is some weak evidence... See my other thread, I 'think' it can be beneficial in acute cases...

I will agree that there is some weak evidence that steroids are useful in some cases, especially when administered transtympanically within minutes to hours of trauma. I would just add that there is overwhelming evidence that steroids can have significant adverse effects, and the most dramatic single case study I saw was a guy with no history of mental health issues who had a full-on psychotic break after receiving ER corticosteroids for a sinus infection, and ended up involuntarily committed to a mental ward for 2 months until his family's lawyers were able to convince the hospital that actually he wasn't insane at all.

 

[Jan64]

https://www.uspharmacist.com/article/systemic-corticosteroidassociated-psychiatric-adverse-effects

This research is about systemic treatment... not about a shock treatment which I suggest. When yoy take your prednisone in the morning the chance on insommia is much smaller....

and the most dramatic single case study I saw was a guy with no history of mental health issues who had a full-on psychotic break after receiving ER corticosteroids for a sinus infection, and ended up involuntarily committed to a mental ward for 2 months until his family's lawyers were able to convince the hospital that actually he wasn't insane at all.

This is a extreme incident... I do not know the background, but you have to be careful...

I will agree that there is some weak evidence that steroids are useful in some cases,

I would say only use prednisone when you are sure there is serious damage to your inner ear...

I would just add that there is overwhelming evidence that steroids can have significant adverse effects,

This is especially the case with systemic use... better not to mix up shock treatment and systematic use.

I put down the whole protocol, but just stop with treatment when your T went back to normal or you notice it doesn't work for you...

 

[MRItechssuck]

So I started 60mg prednisone about 3-4 days after my MRI. That was the fastest I could get a doc prescribe it. I've been taking niacin, magnesium NAC, B12, curcumin...

Anyway.

How long should I stay on the 60mg prednisone (200 lbs male).
My initial plan was 60mgx7, 50mg, 40mg, 30mg, 20mg, 10mg, 10mg, 10mg, 10mg

The prednisone doesn't seem to help but I'll try what I can without causing any more problems (hyperbaric oxygen therapy risks were no go for me). Now it is just a waiting/healing/habituation game... what else can I do?

Thoughts? Thanks.