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

[kmohoruk]

It should be okay, but please be careful about getting into a cycle of dosing prednisone after every noise exposure, I know myself and many others became trapped in this cycle.

Thank you very much for your thoughtful concern @Liam_Cairns , I greatly appreciate it! I only plan on using prednisone for more serious acoustic exposures. If anything, taking a high dose of prednisone freaks me out a lot - so I GREATLY appreciate everyone's help with trying to figure out a good dose without causing any more issues.

In this case, the boat horn last week was probably my most serious acoustic exposure since the original onset of my increased T. One where it left me with a longer term spike (they usually settle after a day or two for me).

I have also had some issues sleeping (about 4 hours a night) the last couple of weeks (even before the acoustic shock of the boat horn last week), so hopefully with some rest, sleep, and prednisone - my spike starts to come back down.

 

[derpytia]

Should I take prednisone?

I was leaving work tonight and someone pulled out a shopping cart near me and it made a loud clanking noise (it's got metal parts) in my left ear. Only lasted for less than a second but I'm not sure how loud it was in decibels.

I came home and plugged my ears to listen. No new sounds but I can quite tell if my high pitched "eee" is more pronounced or if it's just a spike from the anxiety that almost overwhelmed me and made me almost panic. That ear has definitely been louder one days I don't get enough sleep. But I seriously cannot tell if I should take one of the prednisone pills I have on hand just in case. I only have a 24 hour window to make this decision. It happened at 8:00 pm this evening and it is now 10:58 pm while I'm making this post.

(Bill Bauer, I respectfully request you do not interact with this thread, thank you!)

 

[derpytia]

lol frig it. I took one 5 mg pill just in case. I'll go to bed tonight and see what tomorrow brings.

 

[annV]

lol frig it. I took one 5 mg pill just in case. I'll go to bed tonight and see what tomorrow brings.

Did it help? How are you now after waking up?

 

[derpytia]

Did it help? How are you now after waking up?

Well I don't know if it was the prednisone that helped or sleep. Woke up to my normal severe tinnitus. So that's good at least.

 

[Arseny]

Hello everyone,

I will be very honest with you that I couldn't make myself to read though every comment in this thread, because I freak out the moment I see that someone got bad side effects. It scares me the most.

I would like ask anybody that got similar treatment to tell me if their dosages were similar to mine.

After the spike on November 2 I've got a single 90 mg Prednisone injection that gave me very bad panic attacks and I think spiked the noise even more, but in the following days the noise has definitely gone down and my right ear has improved. The improvement in my right ear is undeniable.

A week later doctor decided to put me on Dexamethasone with
4 mg - skip a day - 8 mg - skip a day - 8 mg - skip a day - 8 mg - skip a day - 8 mg - skip a day - 4 mg.
6 injections in total.
Previously she prescribed 90 mg of Prednisone everyday for 5 days, but since I've got sever panic attacks from it I had to stop.
She said that 4 mg of Dexamethasone is equal to 30 mg of Prendisone. So right now I'm supposedly getting the equivalent of 60 mg of Prendnisone every other day.

I'm not sure that my dosage is adequate since I've read a couple of studies and they administered the steroids every day without skipping anything and in one study I found that they gave 40 mg of Dexamethasone for 3 days and then 10 mg for 3 days.

Please if you have been getting similar treatment or have knowledge in this topic I would ask you to evaluate my dosage and injection regimen. It seems to me that I should be getting everyday injections with a higher dosage although I'm not sure. I really don't want to discover later that my doctor has under dosed me in fears of side effects. I'm not experiencing any side effects on Dexamethasone and I'm ready to increase the dosage if necessary. I can also switch back to Prendnisone since my nervous system has somewhat stabilized.

Thank you

 

[Arseny]

Hello again,

After discussing the dosages with my doctor we decided to start doing injections everyday for at least 2-3 days more to see if there's any difference.
Right now I'm on 8 mg a day of Dexamethasone.
I've noticed that the volume in my left ear fluctuates by a lot.
After single Prednisolone injection a had a decrease in volume couple of days later. To the point that I needed to concentrate on the hiss when I was pouring the water from water dispenser. But for some reason it has gone up again and it fluctuates by 20-30%.
I'm not sure if Dexamethasone is doing anything significant. The only thing that I can notice is that low frequency sound with feelings of pressure on my ear drum are mostly gone. It was there yesterday, but right now it's completely gone and I can hear slight ringing (1-2/10) and very loud high frequency hissing noise in the left side of my head that feels like it's affecting other parts of my head. It has slight pulsations too. The volume is loud and I can hear it over my PC fan to the point I don't really hear the fan. I think it's about 60 db in comparison to other noises. I hope it gets better. I'm feeling very distressed right now.

If everyday administration of Dexamethasone doesn't yield any significant improvements I will try intratympanic injections or switch back to Prednisolone. I want to try everything before starting HBOT treatment in 8 days.

How much time do you think I should give steroids to work?
I've read through this thread and some people report immediate improvements while others suggest that steroids need time to work.

 

[Arseny]

I wanted to share an update regarding my Dexamethasone injections.

2 days after I finished the treatment I have my allergies flare up again and symptoms of pulsating pressure on my left eardrum have returned although they have been diminished by about 50%. The Morse code/ringing tinnitus in my left ear is a bit quieter too. Actually I think it's still improving a bit.
I don't think there have been any noticeable change in volume of the hissing noise.

I've been to numerous specialists at this point, every one of them thinks I have different diagnosis. Several of them suggested that I have ETD and, since during the steroid treatment feelings of fluttering/pressure/fullness went away, I might agree with them, but I think it's very mild.

At this point there's almost no doubt that my mild/moderate tinnitus has been severely aggravated by 15 minutes of noise exposure from MRI. I still can't accept the reality.

 

[Tim Lawlor]

One note of EXTREME caution. I was prescribed Prednisone by an ENT doctor for two weeks relatively early after the ringing started. The prednisone apparently compromises your immune system. At the end of two weeks, while beginning to taper, I got what I thought were withdrawal symptoms. They were not -- my compromised immune system allowed a virus to infiltrate my nervous system and I was hospitalized for two weeks with Aseptic meninges encephalitis. This was a very close call -- two weeks in the hospital, two more in a rehab inpatient hospital, and six weeks of out patient rehab. After that, my tinnitus is apparently a permanent fixture. It may be related to TMJ issues I'm also having, but haven't returned for medical attention again yet -- a near fatal infection was enough for me for a while.

 

[RichardGuy]

My doctor is recommending prednisone. I've read so many conflicting things about prednisone and tinnitus.

Can somebody help me out?

I strongly recommend prednisone to anyone who thinks they are good for it. I've tried pred packs and they generally aren't enough... then I went to an 8 day taper course starting at 40mg. So 40 mg per day for two days, then 30, then 20... etc.

I had one of the quietest weeks ever since I got tinnitus.. the ringing was so quiet I could even forget about it while trying to sleep. Still a 3/10 for annoyance, though far less than the usual 7.5/10.

Once I dropped down to 10mg though I went back to baseline. So clearly a strong dose (for your weight) is needed.

 

[Marko Nakovski]

Do steroids work for hyperacusis too?

 

[IvanRus]

Do you think a dose of prednisone 40 mg per day for three days is sufficient?

Is it dangerous to immediately cut off such a dose? Suddenly the cochlear inflammation will flare up with a new baseline after such a short course and a quick withdrawal?

What do you think? Need a longer course?

 

[Bart]

Do you think a dose of prednisone 40 mg per day for three days is sufficient?

Is it dangerous to immediately cut off such a dose? Suddenly the cochlear inflammation will flare up with a new baseline after such a short course and a quick withdrawal?

What do you think? Need a longer course?

According to my ENT and the doctors at the tinnitus clinic those short courses are useless, for it to work optimally with permanent results you need to take them for at least a week.

The standard dose prescribed to me goes as follows: 64 mg for 3 days - 32 for 3 days and 16 for 3 days.

That has worked well for me in the past, 64 mg is an extremely high dose though and will give some side effects, but overall not too bad. Those relative short doses of a week or 9 days are pretty safe.

They also mentioned that they have seen some good results up to 3 months (!) after onset from steroids, although the sooner the better still stands, after 1 month positive results dropped significantly to stop completely after the 3 month mark.

Typical side effects are insomnia , sweating and restlessness but stop after you finish the steroids , just take some sleeping aid the first days, especially with the 64 mg. It is a pretty heavy duty drug but it works.

 

[IvanRus]

According to my ENT and the doctors at the tinnitus clinic those short courses are useless, for it to work optimally with permanent results you need to take them for at least a week.

Does prednisolone really work for you?

Did you take it for tinnitus spikes?

What else do doctors prescribe in Belgium, except for prednisone in such cases?

 

[Bill_]

According to my ENT and the doctors at the tinnitus clinic those short courses are useless, for it to work optimally with permanent results you need to take them for at least a week.

The standard dose prescribed to me goes as follows: 64 mg for 3 days - 32 for 3 days and 16 for 3 days.

That has worked well for me in the past, 64 mg is an extremely high dose though and will give some side effects, but overall not too bad. Those relative short doses of a week or 9 days are pretty safe.

They also mentioned that they have seen some good results up to 3 months (!) after onset from steroids, although the sooner the better still stands, after 1 month positive results dropped significantly to stop completely after the 3 month mark.

Typical side effects are insomnia , sweating and restlessness but stop after you finish the steroids , just take some sleeping aid the first days, especially with the 64 mg. It is a pretty heavy duty drug but it works.

The problem with these oral regimen of steroids is that when compared to a control group they really do not make any statistically significant difference. There was a meta study in 2017 done by German health insurances in which they analyzed all available studies on oral steroids for SSNHL and the conclusion was that it really doesn't make a difference. Yet some doctors will tell you to take them immediately. Personally I do believe that the only effect it might have is due to placebo if your tinnitus is actually caused by an inflammation.

 

[Bart]

Does prednisolone really work for you?

Did you take it for tinnitus spikes?

What else do doctors prescribe in Belgium, except for prednisone in such cases?

It depends, when they suspect hearing loss in the acute stages they will prescribe steroids and HBOT, Rivotril (clonazepam) combined with Deanxit was prescribed to me as well when the steroids and HBOT failed initially.

 

[Bart]

The problem with these oral regimen of steroids is that when compared to a control group they really do not make any statistically significant difference. There was a meta study in 2017 done by German health insurances in which they analyzed all available studies on oral steroids for SSNHL and the conclusion was that it really doesn't make a difference. Yet some doctors will tell you to take them immediately. Personally I do believe that the only effect it might have is due to placebo if your tinnitus is actually caused by an inflammation.

I can only speak from my personal experience and when I take steroids it seems to calm down spikes every time, but indeed, how much of this can be attributed to the steroids or if it would have come down regardless is hard to say.

My ENT said they prescribe steroids just to be sure, sometimes there is inflammation or swelling that is hard to see, the exact mechanism on why or how it would work is unclear to me, but from my understanding when you suffer sudden hearing loss or damage to the auditory system the body responds with inflammatory responses that can make the damage permanent, not sure about this theory though ;-)

 

[IvanRus]

I can only speak from my personal experience and when I take steroids it seems to calm down spikes every time, but indeed, how much of this can be attributed to the steroids or if it would have come down regardless is hard to say.

And each time you use this "brutal" regimen - 65-65-65 mg and then with a decrease during the week? Or are there smaller and shorter regimens?

 

[Bart]

And each time you use this "brutal" regimen - 65-65-65 mg and then with a decrease during the week? Or are there smaller and shorter regimens?

Again it depends , sometimes I use 2-2-2 days , so 64-64-32-32-16-16 , or I switch it up , for example, 2 days at 64 , 4 days 32 and 2 or 3 days at 16 mg .

The 64 mg gives some side effects wich can be unpleasant , so I try to limit the days on those high doses . Be advised, the first day your tinnitus can spike dramatically from the steroids but it is temporary .

According to my GP , the really bad long term adverse effects from this drug only happens when you are on it for months at a time, or even years , the short courses are pretty safe .

This is just my personal opinion and based on what my own ENT and GP are saying , every person is different though so always use it with caution and under supervision of a Healthcare proffesional .

 

[Trish S]

I have not had oral steroids, but have had 3 trans-tympanic injections of dexamethasone at intervals during last year: this was for Meniere's Disease. It has reduced the frequency, severity and duration of the dizzy turns - not quite abolished them, but they now only last for a few seconds or minutes and don't throw me off my feet any more! Unfortunately the injections haven't helped the tinnitus, and my hearing continues to deteriorate.

 

[Daniel Lion]

This condition is awful, as we all know.

Was riding my bike, a truck blasted me with a horn at point blank range. Absolutely crapped myself, went and bought steroids and self-medicated myself at 80mgs a day of prednisone.

You can by any drug here without a script, third world. Anyhow, prior to tinnitus and ear trauma, i would never pop pills, but things are different now. Didn't feel a damn thing, not unusual for me, and annoying base line pitch is still exactly the same. Glad i did it for the placebo effect and I think it is not possible to protect 24/7 in the city. Too many cars and industry. Just wanted to inform you all.

 

[Alue]

Hey I just thought I should share my experience with prednisone as a cautionary tale,

I took a course of prednisone for an acoustic trauma back in May and it left me crippled for a few months. It wasted all the muscle in my legs, I could barely walk without experiencing violent cramping and have only now just gotten back to being able to run after months of rehab.

While I truly believe this drug can help with some people's tinnitus, I think people need to be incredibly cautious about weighing up the risks, especially since this can cause vascular necrosis even after short-term treatment, which is truly awful.

Did your legs recover fully? Avascular necrosis is one of my biggest concerns with prednisone use. I thought it was most commonly seen in people that use it on a long term basis or frequent short term with high dosages, but maybe I'm mistaken. It's rare, but it's a horrible side effect.

I wonder if pentoxifylline or Vitamin E would help reduce the risk.

 

[Liam_Cairns]

Hey @Alue I did mainly recover in that I don't get any more pain, but my quads are still very weak and my left knee doesn't track properly so it constantly cracks, which is a sign that my quads still need strengthening. Additionally I took a single dose back in the start of this month when I freaked out about my tinnitus and it caused an insane amount of pain all thru my legs, so I immediately stopped.

Also I asked my Ent about that and he said statins could possibly help along with vitamin E as the mechanism of AVN is related to high cholesterol induced by the Prednisone. However statins can also be ototoxic so it's a bit of a shit show hahaha (classic tinnitus), transtympanic steroids can prevent AVN from occurring as well. I hope this was helpful.

 

[Alue]

Hey @Alue I did mainly recover in that I don't get any more pain, but my quads are still very weak and my left knee doesn't track properly so it constantly cracks, which is a sign that my quads still need strengthening. Additionally I took a single dose back in the start of this month when I freaked out about my tinnitus and it caused an insane amount of pain all thru my legs, so I immediately stopped.

Also I asked my Ent about that and he said statins could possibly help along with vitamin E as the mechanism of AVN is related to high cholesterol induced by the Prednisone. However statins can also be ototoxic so it's a bit of a shit show hahaha (classic tinnitus), transtympanic steroids can prevent AVN from occurring as well. I hope this was helpful.

Thanks. Do you think the pain was caused by avascular issues or something else? Did you talk with a doctor about it or get any scans done?
I've taken steroids a few times in the past, like you when freaking out about loud noise exposure (I have very reactive tinnitus and have developed new tones from additional noise exposure), but I'm starting to second guess the wisdom in doing this.

 

[Arseny]

@Alue @Liam_Cairns
I had lost a lot of muscle on dexamethasone.
I had 3 courses in 2 months.
I was going to the gym before that so the difference is quite noticeable. It was definitely induced by steroids since you can't lose that much muscle in less than 5 days even if you don't eat anything.

Doctors say that's normal and to be expected with steroids.

I can't really say if it was a coincidence or not, but with steroids and HBOT hyperacusis got much better (and then slowly faded away to zero until I got exposed to the noise again) and tinnitus got a bit quieter.
After a week of HBOT I noticed ~25% reduction, but later I got more noise exposure again.

 

[Liam_Cairns]

@Alue I got an MRI of my knees and hips (quiet MRI thank god) and it showed runners knee but no AVN thank god, apparently, MRI is like the only way to diagnose it in the early stages, which is important as the faster you can treat it the better. Yeah I am also starting to question the efficacy of steroids to be honest if you don't mind me asking Alue, what is your hearing like? Do you have any damage in normal or Ultra High frequencies?

 

[Liam_Cairns]

@Alue @Liam_Cairns
I had lost a lot of muscle on dexamethasone.
I had 3 courses in 2 months.
I was going to the gym before that so the difference is quite noticeable. It was definitely induced by steroids since you can't lose that much muscle in less than 5 days even if you don't eat anything.

Doctors say that's normal and to be expected with steroids.

I can't really say if it was a coincidence or not, but with steroids and HBOT hyperacusis got much better (and then slowly faded away to zero until I got exposed to the noise again) and tinnitus got a bit quieter.
After a week of HBOT I noticed ~25% reduction, but later I got more noise exposure again.

Yeah, muscle loss is common, especially with fluorinated steroids such as dexamethasone, did you get steroids for your hearing loss, or something unrelated? As I have never really heard of oral dexamethasone being used for tinnitus.

 

[Alue]

@Alue I got an MRI of my knees and hips (quiet MRI thank god) and it showed runners knee but no AVN thank god, apparently, MRI is like the only way to diagnose it in the early stages, which is important as the faster you can treat it the better. Yeah I am also starting to question the efficacy of steroids to be honest if you don't mind me asking Alue, what is your hearing like? Do you have any damage in normal or Ultra High frequencies?

I have damage in the ultra high frequencies, no detectable damage in normal frequencies.

Where did you find a quiet MRI? I'm afraid of ever doing one because of all the stories with people getting worse from them.

 

[Liam_Cairns]

I have damage in the ultra high frequencies, no detectable damage in normal frequencies.

Where did you find a quiet MRI? I'm afraid of ever doing one because of all the stories with people getting worse from them.

And I'm guessing your main tinnitus is in the UHF? Sorry for the random questions. Also, I found one at a hospital near me in Brisbane Australia, I used a Toshiba Vantage Titan 3T, the Toshiba ones are the only ones I would use if I was you as they have a vacuum chamber surrounding the magnet which significantly reduces noise produced. Look for machines with "pianissimo" technology. I will say tho, that the machine still produces a lot of bass as it scans, so it will still seem loud. They max out at 90 dba however I reckon the dbc figure would be much higher as it doesn't take into account the lower frequencies, but in saying that a normal MRI can go up to around 115 dba so it is far less loud. Apologies for the huge info dump, feel free to personal message me if you need any additional help finding an MRI just so it doesn't clog up the thread, I would be more than happy to help.

 

[Alue]

And I'm guessing your main tinnitus is in the UHF? Sorry for the random questions. Also, I found one at a hospital near me in Brisbane Australia, I used a Toshiba Vantage Titan 3T, the Toshiba ones are the only ones I would use if I was you as they have a vacuum chamber surrounding the magnet which significantly reduces noise produced. Look for machines with "pianissimo" technology. I will say tho, that the machine still produces a lot of bass as it scans, so it will still seem loud. They max out at 90 dba however I reckon the dbc figure would be much higher as it doesn't take into account the lower frequencies, but in saying that a normal MRI can go up to around 115 dba so it is far less loud. Apologies for the huge info dump, feel free to personal message me if you need any additional help finding an MRI just so it doesn't clog up the thread, I would be more than happy to help.

Yep. My main tone is ultra high frequency. I have a couple other tones that are also fairly high in frequency. What about you?

Thanks for the advice on MRIs. I'll keep that in mind if I ever need one.