Steroids: Prednisone / Dexamethasone / Others (Oral and Intratympanic Injections)

[tweak]

Hi all,
Just wondering has anyone ever got this treatment or know anything about it? Apparently it has to be done in first 3 months to be effective. The ENT never mentioned anything about this as a treatment and I'm 6 weeks with tinnitus symptoms. Any info about this much appreciated.
Thanks

 

[Markku]

I know that many ENTs prescribe i.e. prednisone right after the onset of tinnitus.

I don't know if that's because corticosteroids are often the first line treatment after sudden sensorineural hearing loss (which is oftentimes accompanied by tinnitus)

http://www.ncbi.nlm.nih.gov/pubmed/20735183
http://www.ncbi.nlm.nih.gov/pubmed/11318462


Where did you find the 3 month window though? Based on my quick Google search the corticosteroid treatment should be started within 24-48 hours of onset, and the sooner, the better and more likely helpful it is.

Also the success rate of this treatment for noise-induced tinnitus doesn't seem to be that good.

The injections are rarer though, usually they give you oral stuff. I couldn't find any studies comparing intratympanic and oral administration of corticosteroids for the treatment of (noise-induced) tinnitus.

One study (re: Meniere's and oral prednisone, though): http://www.ncbi.nlm.nih.gov/pubmed/16151353
"Prednisone-treated patients manifested a significant reduction in tinnitus"

 

[tweak]

I got this information in an email response to email I sent to a clinic in Freiberg, Germany ("ENTs use corticosteroid treatment disregarding the origin of hearing loss and/or tinnitus during the first three months. But I believe that the success rate decreases with the time."). This doctor suggested this can be done in first three months and if this is not effective then they administer HBO. Of course they charge and arm and leg for this service so it might be wise to exercise caution. I was at my GP within 2 days of onset so I could have had this but she never suggested it. Prescribed SERC instead which did nothing. So going by the studies above it seems this treatment seems more effective if its Menieres disease related tinnitus?

 

[Markku]

So going by the studies above it seems this treatment seems more effective if its Menieres disease related tinnitus?

I came to that conclusion, yes. Also if the tinnitus was due to sudden sensorineural hearing loss, the corticosteroid treatment's prognosis looks better.

Oh and yes, Serc! Goes by the brand name Betaserc in Finland. That's the thing GPs prescribe here to new tinnitus patients too! Even if one doesn't have Meniere's disease...

Serc improving tinnitus doesn't have much of a track record though, does it? I haven't heard anyone's getting better...

I browsed through a few studies just now...

Well...

http://www.ncbi.nlm.nih.gov/pubmed/16848175
RESULTS:
Completion of treatment, tinnitus loudness matching assessment showed that the efficacy of the Betahistine mesilate group was better then the control group. The efficacy of treatment was respectively 65.5% by per protocol (PP) and 63.3% by intend to treat (ITT) in the Betahistine mesilate group and 39.3% by PP and 36.7% by ITT in the control group. The difference of tinnitus loudness improvement rate between the experimental group and control group was statistically significant. But the subjective tinnitus improvement rate showed no difference between two groups. There were not serious side effects in the two groups.

CONCLUSIONS:
Betahistine mesilate can be a choice for tinnitus treatment clinically. Further studies of larger series and placebo-controlled trial are needed.


Betahistine seems like a suitable drug to treat tinnitus patients with vestibular problems:
http://www.ncbi.nlm.nih.gov/pubmed/21860977
RESULTS:
Clinical improvement was observed in 80/262 (30. 5%) of patients treated with betahistine and 43/252 (17. 1%) of control patients. Betahistine significantly (p<0. 0001) improved tinnitus in treated individuals.

CONCLUSIONS:
The daily dosage of 48 mg of betahistine during 120 consecutive days is useful to reduce or eliminate tinnitus in patients with vestibular disorders.


Then back to the prednisolone, intratympanic:
http://www.ncbi.nlm.nih.gov/pubmed/19160857
RESULT:
All of the cases accepted the whole treatment and were followed up for half a year successfully. The effective rate of the prednisolone group, dexamethasone group and the carbamazepine group was 48.6%, 33.3%, 44.0%, respectively; the control rate half a year after the treatment was 45.7%, 27.8%, 36.0%, respectively. There was no statistically significant difference in the effective rate and control rate between intratympanic perfusion group and carbamazepine group. There is a statistically significant difference both in the effective rate and the control rate between the prednisolone group and the dexamethasone group. Prednisolone may be better than dexamethasone in intratympanic perfusion for subjective tinnitus.

CONCLUSION:
Intratympanic steroid injection has a positive effect on subjective tinnitus and may be considered to be an alternative treatment to subjective tinnitus.

 

[Markku]

By the way, HBO is another treatment that should be started as soon as possible after the onset of tinnitus, although you probably knew that?

Finland's HBO-treatment center suggest that it should be started within few weeks, but the sooner the patient goes in for the sessions, the better results can be expected.

It's a shame time has passed by in my case, but for new tinnitus cases this sort of information should be presented as per standard.

 

[sheila turner]

just happened 10 days ago are steroids helpful when it first starts.please give me your thoughts

 

[Mikejohn]

I went to my ENT about 14 days after the onset of sudden loss of hearing. ( I had Tinnitus since 2002) I was given steroid treatment for a week with full dose and weaned down for a week. It seemed to lessen the hissing of the Tinnitus but it didn't help me with regaining my hearing. My first ENT should have given me the steroids since I saw him within the 7 days of the onset as the window of better response is within 7 days. However, he led me to believe I had 30 days and when I went to see another doctor he admonished the first ENT. I went thru a CAT scan and ABR hearing test to determine what could have caused the loss in hearing. The specialists in NYC did another CAT scan with contrast and another audio test but the future seems grim as far as getting back my hearing. The tinnitus has returned with a vengeance and seems to be mostly in the bad ear. At times I don't hear the Tinnitus and now I know that the sounds are not coming from my ear but from my head. I am on coumadin therapy so I wasn't able to take the MRI test that is more definitive. I am a newbie and have not had time to read and maneuver thru the site. So beg forgiveness if I didn't go to "intro" first. It was suggested that I get a BICROS HEARING AID????? I had purchased Resound hearing aid several years ago to see if it would reduce my Tinnitus. Now I am in deep .....

Mikejohn

 

[Bells]

I posted the long version of my story in the Intro section, but I was wondering if anyone has been prescribed steroids for tinnitus? How long did you take them and were you told to taper off them?
I have been prescribed 60 mgs predisone for 10 days by an ENT and told not to taper. From my reading, this sounds like a high dose, and I'm not a very large person (not sure if that matters). They are making me feel a bit nuts but not to the point of an "emergency" I guess. As luck would have it, he's on vacation for a week. I suppose I could call around to see if I can get in to another doctor in the next few days, but just wondering if anyone else has had experience with these crazy pills.

 

[Luca]

I think it was a couple of days, maybe a week. Either way it is normal depending on the physician. Some docs will say the dosage is very high, and others say not high enough.

It is just something they give you in the acute stage.

 

[Bells]

Hm I might be more comfortable with a lower dose of these steroids due to side effects. But don't want to hinder the effectiveness if 60 mgs is the standard treatment and it has a chance of helping. I guess I'll see how the rest of the day goes.

 

[MikeA]

As I mentioned in my introduction, I'm 20+ with T. It's been mild to occasionally moderate all along. Habituated fairly well I guess. T has noticeably increased due to noise exposure 8 days ago. Could also be tiredness due to lack of sleep and anxiety I suppose. I understand a course of steroids may help some. Questions:

1) I live in the northeast US. Should I expect to be seen by an ENT this week?

2) Do practices which specialize in treating T consider this urgent? I see there are several within a 2 hour drive.

3) Any studies or data on effectiveness if prescribed within 2-3 weeks?

4) Other suggestions?

 

[MikeA]

Clearly these weren't the right questions to ask. LOL I have an appointment with my PCP tomorrow morning. Probably more anxious about what he or any ENT I see may say. Happy that the regularly schedule appointment with therapist is tomorrow evening

As for now and sleep.....I'm fairly optimistic if I can get over this "hump" all will be well. Was sleeping OK for much of the past year with nothing more than a single scotch on the rocks. Going to try melatonin, magnesium, white noise, added exercise, Camomile tea. The first three helping some now.

 

[MikeA]

Just wanted to add to my recent post.

I was seen yesterday by an otolaryngologist with experience in diagnosis and treatment of hearing loss and tinnitus. His opinion was that given that I was using hearing protection and that my hearing test was not outside normal range up to 8 kHz (about 15 dB at 3 kHz), that the risk/benefit of steroids in my case was high on the risk side. Suggest that those are bad, bad drugs that can cause psychosis (his word).

Before hearing test he pulled out two wads of cerumen from each ear and said that the recent reduction in ambient sound may be playing into the increase in T as of late. Didn't think recent noise exposure is responsible for exacerbating T level given that I was using hearing protection. Actually thought the wads of wax likely attenuated an additional several dB during the event. Not surprising he pointed to quality of sleep, stress (both of which not ideal at this time), and the importance of tuning out the noise.

 

[locoyeti]

Hi All,

First time post, but long time lurker. I have been deeply impressed by this forum and the wonderful community. I am currently pondering my next move and was wondering if I could get some input from you fine folks.

I am in my 7th week since onset of T (presenting mostly in the left ear). I have seen two ENTs about 3 times each and had two audiology exams. The first one (1 week from onset) showed mild hearing loss at 4k (40db) in left ear and 6k (40db) in right ear. I got another audiology exam a week later and it showed no hearing loss. Given that my T tone is not high, I don't suspect that I have much acoustic trauma, though I could be wrong. The main culprit seems to be a viral flu I had 3 weeks prior, but TMJD may have played a role as well.

The first 3 weeks were pretty scary, it would wax and wane, and I would rate the frequency at around 1400Hz. At 3.5 weeks, I went on a 14 day 60mg prednisone course with 5 day taper, and this seemed to help with the loudness as well as the frequency, which seemed to drop to 1000Hz or so. Since I have been off the prednisone for a week, I have not felt any rebound to how it was in the first 3 weeks, and I have days where the T is very light.

I was all set and ready to join the AM-101 trial, but I have been reading a lot of the literature on intra-tympanic dexamethasone injections and some of it seems promising. If I take the IT dexamethasone shot, it will disqualify me from the AM-101 trial (no way to hide the hole in my eardrum). Given that my T is mostly mild, I am wondering if 100% of dexamethasone at 2 months from onset will give my T one swift kick in the pants, in this acute stage. The alternative is 60% chance of the AM-101 drug (vs 40% placebo, through the trial) with a guarantee of the drug at 6 months, 9 months, and 12 months from onset (should I choose to participate in the AMPACT follow up).

My dilemma boils down to the efficacy of intra-tympanic glucosteroids vs the efficacy of intra-tympanic NMDA antagonists in the treatment of acute/sub-acute tinnitus. I have to decide in a few days so any feedback would be welcome.

 

[just1morething]

I would think the AM-101 would be the wise choice, but you may get a placebo. I don't think the intra-tympanic dexamethasone has panned out too well. They use that for SHL. I had the dexamethasone injections twice, but can't say they helped, but they were done way past your early onset timeframe. There was a lot more R&D put in the AM-101 injections, so probably a bigger swift kick in the pants if you get the real deal. Shea Clinic may say otherwise.

 

[Kimbo Slice]

One member on this forum is apparently getting the shot from a private doctor who specializes in intratympanic injections. I personally am sick of sitting around and waiting for Auris Medical to help me, as they are unreliable and have excluded Canada from the trials until next month plus, as said above by "just1morething," theirs the chance of receiving placebo, so I think I might try to find someone out here. I know it's technically illegal, so I'm going to say this probably isn't a good idea, but for your information I'm sure if others can find these people around you can as well, and might be more worth your time.

 

[mick]

My dilemma boils down to the efficacy of intra-tympanic glucosteroids vs the efficacy of intra-tympanic NMDA antagonists in the treatment of acute/sub-acute tinnitus. I have to decide in a few days so any feedback would be welcome.

I'd put my money on AM-101. My reasoning is simply that the dexamethasone & lidocaine treatment that Shea does has been around for a long time yet I hear few endorsements of it from doctors or otherwise. That doesn't mean that AM-101 is a slam dunk, but I believe its the odd-on fav when compared to the Shea treatment.

 

[locoyeti]

@just1morething how far from onset was your dexa shots? I have heard that within 4-5 months it can still be effective at eradicating tinnitus.

I am unsure as to whether my T is cochlear in origin, and it seems AM-101 is most effective for acoustic trauma / otitis media. my T is idiopathic, but i think if it fell into any bucket it would be mild issnhl, which makes me think IT dexa might work. i'm so torn though, because am-101 seems to be the best current treatment and i don't want to miss this boat.

 

[JohnG]

@just1morething how far from onset was your dexa shots? I have heard that within 4-5 months it can still be effective at eradicating tinnitus.

I am unsure as to whether my T is cochlear in origin, and it seems AM-101 is most effective for acoustic trauma / otitis media. my T is idiopathic, but i think if it fell into any bucket it would be mild issnhl, which makes me think IT dexa might work. i'm so torn though, because am-101 seems to be the best current treatment and i don't want to miss this boat.

AM-101 is not a current treatment. It is in clinical trials and if you are lucky to get into the trials, you have a 50% chance of just getting a saline solution injected into your middle ear. I'm still waiting to see if I can get in but have not heard back from the company. Even if I get in, I have a 50% chance of getting absolutely nothing. So to say AM-101 is ready to go...nope....it won't be for years until it rolls out to the masses and by then...it will be too late!

 

[locoyeti]

well, if AM-101 works in the sub-acute phase (3-12 months), then the ability to join the AMPACT follow up is what is really the golden ticket here. you get 3 extra treatments of the real drug, and i believe the first treatment (each treatment is 3 injections each) is 3 months after your first injection, and then 3 months after that, and then 3 months after that. i believe that is a good option to have, especially given that this drug won't make it to market for at least a few years.

 

[JohnG]

I'm right on the 3 month threshold and the clowns still have not got anyone here in Canada to to the trials. So it looks like IF I get in, I will be sub acute anyway. I was also considering the Shea clinic. If these bozos keep jacking me around, I'll be on the first plane to Memphis. Enough is Enough!

 

[Kimbo Slice]

well, if AM-101 works in the sub-acute phase (3-12 months), then the ability to join the AMPACT follow up is what is really the golden ticket here. you get 3 extra treatments of the real drug, and i believe the first treatment (each treatment is 3 injections each) is 3 months after your first injection, and then 3 months after that, and then 3 months after that. i believe that is a good option to have, especially given that this drug won't make it to market for at least a few years.

The problem with that is, if it truly only helps people within the 3 month window, and you get the placebo, you might be out of luck. I'm not sure how long they give you the extra 3 treatments after the first, but I think it's something like 3 months between each injection like you said. On the other hand, they also stated that there's no reason it shouldn't work for people with Chronic Tinnitus, so who really knows.

 

[RoyZ]

Hi All,

First time post, but long time lurker. I have been deeply impressed by this forum and the wonderful community. I am currently pondering my next move and was wondering if I could get some input from you fine folks.

I am in my 7th week since onset of T (presenting mostly in the left ear). I have seen two ENTs about 3 times each and had two audiology exams. The first one (1 week from onset) showed mild hearing loss at 4k (40db) in left ear and 6k (40db) in right ear. I got another audiology exam a week later and it showed no hearing loss. Given that my T tone is not high, I don't suspect that I have much acoustic trauma, though I could be wrong. The main culprit seems to be a viral flu I had 3 weeks prior, but TMJD may have played a role as well.

The first 3 weeks were pretty scary, it would wax and wane, and I would rate the frequency at around 1400Hz. At 3.5 weeks, I went on a 14 day 60mg prednisone course with 5 day taper, and this seemed to help with the loudness as well as the frequency, which seemed to drop to 1000Hz or so. Since I have been off the prednisone for a week, I have not felt any rebound to how it was in the first 3 weeks, and I have days where the T is very light.

I was all set and ready to join the AM-101 trial, but I have been reading a lot of the literature on intra-tympanic dexamethasone injections and some of it seems promising. If I take the IT dexamethasone shot, it will disqualify me from the AM-101 trial (no way to hide the hole in my eardrum). Given that my T is mostly mild, I am wondering if 100% of dexamethasone at 2 months from onset will give my T one swift kick in the pants, in this acute stage. The alternative is 60% chance of the AM-101 drug (vs 40% placebo, through the trial) with a guarantee of the drug at 6 months, 9 months, and 12 months from onset (should I choose to participate in the AMPACT follow up).

My dilemma boils down to the efficacy of intra-tympanic glucosteroids vs the efficacy of intra-tympanic NMDA antagonists in the treatment of acute/sub-acute tinnitus. I have to decide in a few days so any feedback would be welcome.

about IT of steroids for T alone..
From what you are telling it seems you do have SHL.. I can tell you from my case of Sudden hearing loss that I've had 2 courses of steroids (by mouth) that before each course there was some loss in hearing and after a course there was an improvement, I was a month and a half away from onset after these 2 courses while clinically speaking at that point I had no hearing loss (at frequencies up to 8 KHz, above that the difference between my 2 ears was immense, about 40db difference in all freq's above 8KHz), but still had a "sick" ear and a wild T, so I wanted to get the IT Injections and did managed to convince one senior doctor to give it to me after he said it's not a recommended/possible treatment at that time since I had no hearing loss at up to 8KHz, so I went to the hospital and everything but then when they told me what the risks are I passed on it. didn't want to make more harm than good. there are 2 ways of doing this that I came to know of for treating SHL, there are IT perfusion and IT Injections and they are very different. where I went they only do perfusion, the success rate is higher but it involves more risks as they make a cut in the ear drum and perfuse the medicine twice a day for a week. (you need to be hospitalized) after a week there is a risk that the cut will not heal properly and there will be a need for a surgery to close it and many more risks. with the IT injections the success rate is lower and they only inject it to the ear drum once every period of time but I think less risky. (you don't need to be hospitalized). perfusion is the method that is recommended in the guidelines and that is probably based on the fact the success rate are higher.
then I was consulting with the professor who treats me who got back from overseas and I was asking about IT Injections of steroids he said that in my state of no hearing loss in the "clinic audiometric" range (up to 8KHz) any giving of steroids by mouth or by IT would be considered invasive treatment and is not something that is acceptable considering the guidelines and that it might cause more harm than good. the last option I had was HBOT which I am having, so just to mention, after the 10th session I had a major(!) improvement, now after the 16th session I see no further improvement but am trying till 20.

If you don't have hearing loss right now, I think that any steroids are not an option for you. and wouldn't see how a doctor will give you any. they are only to treat the hearing loss which you say you don't currently have. not T.

if you did have hearing loss, I wouldn't throw away proven treatments as steroids or HBOT on a trial of a drug which is:
1. not sure to work.
2. not sure that you'll get the drug and not the placebo.
3. still will have all the risks involving IT.
it's like a 50/50 chance on an unknown chance+risks. I would forget about it if I was you, you need to treat your SHL ASAP (don't lose a day) and not to experiment. I think your case is somewhat similar to mine and the best thing you can do now is HBOT which should/might help even if you got your hearing back but left with T (it doesn't interfere with IT treatments if you would've done them.) just my 2 cents.

Read me! SHL Guidelines.
some doctors opinions about the guidelines

 

[Asian]

I wasn't given anything useful from our so called ENTs in the first month since the onset. I visited a second ENT and he gave me deflazacort under the brand name cortimax which is an oral steroid. Didn't take it as my first ENT told me to take gingko and piracetam. I am in the 3rd month and don't know what to do. I haven't tried any potential treatments like hbo, steroids n all

 

[Freak12]

I have been taking Prednisolone for a week now. I just got back from seeing my ENT. He initually wouldn't prescribe me any more Prednisolone. He said if I didn't feel better in a week, it's probably useless for me. However, I insisted, because I wanted to take risk so he did.

I don't know if prednisolone is the cause, but my T seems to be more intense. A week ago my T sounded like a mosquito buzzing in my ears most of the time. Now it sounds like a police siren. It is almost unbearable. Could Prednisolone cause this? Should I stop taking it? Or is it just a side effect and will go eventually in the future? It seems to be giving me dizziness too.

 

[yonkapin]

What sort of doses have you been taking? Have you started to taper yet?

Typically oral steroids are prescribed for about a week, they start off with a high dose and then it's quickly tapered off and you're done. If you've already started to taper, then I would probably follow the original schedule you had planned with your doctor and discontinue using the drug.

The longer oral steroids are continued, the more likely you'll experience other, more serious side effects.

Don't stress too much about the increase in tinnitus, it could be any number of things but best thing is to relax and taper off the prednisolone properly.

 

[Ridimo]

hi all My tinnitus started on sunday and sort of just "levelled" out. its not getting louder or softer. my ENT today (4 days later) put me onto predisone. just like to know if anyone ever had results with such a delay from T starting to Treatment. Kinda feel a bit hopeless after reading the whole 48hr "deadline"

 

[yonkapin]

You can always give it a go, it is usually prescribed at the immediate onset of acoustic trauma, within 72 hours. However I remember reading one study where they mentioned that steroids were found to still be effective 3 to 4 weeks from onset, but as more time passes the less effective the solution becomes.

Since you don't know how your tinnitus occurred, it's a bit tricky. But if you're willing to try it, I would say go for it.

There are side effects to be wary of, but I've been on Prednisolone multiple times now and experience minimal side effects myself, the most notable are increases in energy and increased appetite, it's fun (for me) actually; my tinnitus also lowers in volume very significantly but this is a temporary effect in my case. Some people are more sensitive to it though and experience insomnia, anxiety, agitation, etc. Given that they are usually prescribed at high doses for a short period (eg. 7 day taper), the side effects experienced usually are very minimal. It's only with prolonged use that side effects become a bigger factor.

Best of luck!

 

[Hengist]

I am in acute phase of tinnitus and I am interested if steroids worked for anyone or if they know someone for whom they worked?

I think this is related to inflammation so steroids are logical choice, that is why I am considering them now.

 

[jazz]

I am in acute phase of tinnitus and I am interested if steroids worked for anyone or if they know someone for whom they worked?

I think this is related to inflammation so steroids are logical choice, that is why I am considering them now.

Go for it. You have about a 30% chance of a cure; but, even if not cured, you should be significantly lowered. And, after the steroids, you might consider hyperbaric oxygen.

Here's a journal article from September, 2013, describing injections for acute tinnitus:

The Prognostic Factors of Intratympanic Steroid Treatment for Acute Tinnitus
Hyun-Joon Shim, (presenter)
Yong-Hwi An
Hyun Woo Kang
Sang Won Yoon, MD

Abstract
Objectives: We report the better therapeutic efficacy of intratympanic dexamethasone injection (ITD) in patients with acute subjective tinnitus (AST) compared to alprazolam medication only. The present study aimed to determine the prognostic factors of ITD injection for AST.

Methods: A total of 139 subjects who underwent treatment of ITD injection for AST from 2009 to 2012 were enrolled. The relationships between treatment outcomes and various clinical features or audiometric findings were analyzed retrospectively. Three months post-treatment tinnitus questionnaires were completed in 90 patients. Audiologic response was defined as hearing threshold recovery greater than 15 dB in any frequency of the pure-tone audiogram.

Results: Tinnitus completely disappeared in 43 patients (cure rate = 30.9%). The mean duration of symptoms and initial tinnitus loudness score were significantly lower in the cure group than in other groups (P <.05). In the cure group, the number of patients with asymmetric hearing were larger than the number with symmetric hearing (P <.05).The mean improvement index of tinnitus was significantly higher in the unilateral tinnitus group than in the bilateral tinnitus group (P <.05). The audiologic response following ITD is more frequent in the patients with asymmetric hearing than in those with symmetric hearing (P <.05).

Conclusions: Duration of symptoms and initial tinnitus loudness score might affect the cure rate of AST by ITD injection. Audiometric asymmetry and unilaterality of tinnitus are preferable factors of ITD treatment for AST.

Reference:

http://oto.sagepub.com/content/149/2_suppl/P235.2.abstract​