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

[Mark Foster]

Managed to get my first out of 3 injection today, it was just fine!
My tongue is a bit numb now, but I feel ok.
Unfortunately the ENT didn't want to do it in both ears, so I only did it on the ear that rings the most.

I'll keep you updated.

 

[Juan]

Managed to get my first out of 3 injection today, it was just fine!
My tongue is a bit numb now, but I feel ok.
Unfortunately the ENT didn't want to do it in both ears, so I only did it on the ear that rings the most.

I'll keep you updated.

Keep us updated! I have never had corticoids injected yet.

 

[Mark Foster]

Well as always, to me at least, it's extremely hard to tell if anything gave me an improvement or not, as so many things play a role in tinnitus. Unfortunately the 2nd injection was cancelled and I don't know if I'm going to go ahead with them, given the price and that I'm not really disturbed by my tinnitus anymore. But it does seem really quieter, at any time, so I hope the Oxygen Therapy and the Steroids helped, but it might just have been spontaneous recovery.

I suggest doing both as I spent a massive amount of time reading research, and they both seem to help, you don't want to take the risk of not doing them (if the onset is recent).

I have been lucky of course, but I'm starting to think the internet is a bit too negative about tinnitus, of course there are a lot of sufferers, but it seems like the majority recovers fairly well after a noise trauma? That's also what 2 ENTs told me, and I didn't believe them, given all the stuff I read here, but now I do.

 

[Juan]

so I hope the Oxygen Therapy and the Steroids helped, but it might just have been spontaneous recovery.

Is hyperbaric oxygen therapy loud? Someone told me it is loud inside the chamber, like 80 dbs...

 

[Juan]

I have been lucky of course, but I'm starting to think the internet is a bit too negative about tinnitus, of course there are a lot of sufferers, but it seems like the majority recovers fairly well after a noise trauma? That's also what 2 ENTs told me, and I didn't believe them, given all the stuff I read here, but now I do.

It's a bit like baseball. This is just strike one. Be careful with noise, believe me, I have been there. I didnt read so much as you at the onset, I think. After all, I have been suffering from hearing problems for such a long time, and had corticoids, etc but not the eardrum injections, or the oxygen chamber.

 

[Andy9214]

My ENT suggested a steroid shot in my ear to help with the fullness/ringing. I'm nervous about this because I don't want the needle going in my ear making things worse. Has anyone done this before? Good idea or bad idea?

Thanks for all the responses guys. So, my ENT suggested another series of prednisone over the shots which I really didn't want to do anyways.

I did go to a concert before I started to experience eat fullness, then about 3 weeks later went for a hearing test and that's when my right ear started ringing constantly.

The doctor believes that's it's not from the concert, but a possible auto immune hearing loss which I don't know that much about. I don't have any auto immune issues which made the doctor skeptical, but he was pretty sure it's due to a high frequency hearing loss I had Since I was a child. I'm 25 now.

I spoke to the doctor about going to baseball games, concert, bars etc and asked about how to protect my ears/what ear plugs would be good. I was shocked by his response, but he said not to wear any protection because I will deprive my ears from natural sounds that it has to adjust back to again. Apparently wearing ear plus can make the ringing worse. I'm really nervous about that because I don't want any loud sounds to make anything worse. Has anyone heard of not protecting your ears so they can adapt back to normal? I'm still going to wear ear plugs when I go out.

Can someone explain the HBO treatment also?

Thank you.

Now that you mentioned that I recently started aggressively losing weight and changing my diet. I'm down 30 pounds in the last two months. MAYBE it could be related to that/stress that I have.

 

[Frédéric]

Intratympanic dexamethasone as an adjuvant to oral imipramine hydrochloride (Tofranil, a TCA) 25 mg twice daily in management of idiopathic unilateral subjective tinnitus

 

[JimChicago]

.... I have been lucky of course, but I'm starting to think the internet is a bit too negative about tinnitus, of course there are a lot of sufferers, but it seems like the majority recovers fairly well after a noise trauma? That's also what 2 ENTs told me, and I didn't believe them, given all the stuff I read here, but now I do.

No. I disagree. The internet is NOT too negative about T. The majority of sufferers do NOT recover.

It is the rare exception that someone fully recovers from T.

What ended happening to me was predicted by veterans with T on this board. That is after 2 years: 1) the mind learns to tune it out so it is not UNconsciously noticeable every awaken second of my life, AND 2) I learned to not have an emotional reaction to a 12khz and 4hz constant ringing in my ears.

But the T is still there as loud as ever... Especially when thinking (conscious) about it.

 

[GregCA]

No. I disagree. The internet is NOT too negative about T. The majority of sufferers do NOT recover.

That is incorrect. This impression is due to the sampling bias of the forum: https://www.tinnitustalk.com/threads/spontaneous-recovery-stats-many-recover-3-studies.21441/

 

[JimChicago]

That is incorrect. This impression is due to the sampling bias of the forum: https://www.tinnitustalk.com/threads/spontaneous-recovery-stats-many-recover-3-studies.21441/

Your disagreement with me is out-of-the-original-context.

Specifically your link refers to a clinical study of a particular treatment for a particular type of single/limited acoustical trauma whereas the original statements I disagreed with were "the internet is too negative about T" and "the majority recovers fairly well after a noise trauma."

I do agree that T induced by periodic and limited acoustical trauma is recoverable when T persists in time frames ranging from hours to days. But when T persists"weeks" uninterrupted, I maintain (and sufferers on this forum I believe will concur), the likelihood of recovery is unlikely.

Similarly in the 2.5 yrs that I've had chronic acoustical trauma-induced T, EVERY person I have met that has shared chronic acoustical trauma-induced T has also said they had not recovered. All these individuals I've met in-person have had T for 10-50 years.

I posit that the "likely/common/typical" scenario of unrecoverable acoustical trauma induced T goes something like this:
- It begins with acoustical trauma with no noticeable T.
- Then advances with subsequent acoustical trauma where T is noticed for minutes to hours afterwards.
- then advances further with subsequent acoustical trauma where T is noticed for hours to days afterwards.
- And then materializes in unrecoverable acoustical trauma-induced T once T surpasses a threshold of 3weeks - 2 months.

Naturally there will be outliers and T-drivers other than acoustical trauma, but my position relates to chronic (not acute) acoustical trauma induced T based on the feedback of T sufferers on this forum and those that I have met in person.

Let's not inadvertently and inappropriately get the hopes up of T-sufferers visiting TinnitusTalk.com for the first time.
If first time visitors were anything like me, they didn't discover TinnitusTalk.com until T persisted for a longer period of time.

Just my 2 cents.

 

[JimChicago]

Separately but related, one TT.com member a few years back wondered aloud if the reduced visitation of legacy TT.com forum members was an indication that T is fleeting or generally recoverable.

I would posit: No, That the reduced visitation of legacy TT.com forum members is generally due to one or more of:
- the brain's acclimation to T in ADLs
- the intellectual realization that one needs to adapt to this "new normal" (Afterall, "aging" is one long adaptation to a string of "new normals")
- the mastery of the emotional reaction to chronic T.

 

[Frédéric]

High Dose of Intratympanic Steroids for Sudden Sensorineural Hearing Loss Salvage.

Abstract
OBJECTIVE:
Intratympanic (IT) steroid administration for sudden sensorineural hearing loss is offered as salvage to patients who failed systemic steroid treatment. Our objective was to study the audiometric and clinical outcomes of patients given salvage therapy with high-dose IT steroids instilled via ventilation tube.

STUDY DESIGN:
Retrospective case review.

SETTING:
Academic secondary medical center.

PATIENTS:
One hundred three patients >18 years of age with sudden sensorineural hearing loss who failed systemic steroids and received IT treatment between 2010 and 2018.

INTERVENTION:
Following ventilation tube insertion, 1 ml of 10 mg/ml dexamethasone was instilled, twice daily, for 7 days.

OUTCOME MEASURES:
Hearing assessment immediately before and after treatment. Tinnitus and vertigo complaints and risk factors were also retrieved.

RESULTS:
Tinnitus had improved in 53 (52%) patients, vertigo in 4 (4%), and aural fullness sensation in 56 (55%) (p < 0.001, p = 0.344, p < 0.001, respectively). The mean pure-tone threshold difference across frequencies following treatment was between 0 and 6 dB. A significant improvement was observed at 250, 500, 1000 Hz (p < 0.001 in all), and at 2000 Hz (p = 0.035). No significant difference was found at 4000 and 8000 Hz (p = 0.055, p = 0.983 respectively). Mean pure-tone average improvement of 4.5 dB was detected in 61 (59%) patients (p = 0.001). The mean speech discrimination score improved by 7% (p = 0.001). Four (22%) diabetic and nine (20%) hypertensive patients had pure-tone average ≥10 dB improvement (p = 0.759, p = 0.852 respectively).

CONCLUSION:
Although more than half of the patients improved clinically, the significance of the slight audiometric improvement should be weighed against the treatment protocol's complications.

https://journals.lww.com/otology-ne...e_of_Intratympanic_Steroids_for_Sudden.7.aspx

 

[GregCA]

High Dose of Intratympanic Steroids for Sudden Sensorineural Hearing Loss Salvage.

Abstract
OBJECTIVE:
Intratympanic (IT) steroid administration for sudden sensorineural hearing loss is offered as salvage to patients who failed systemic steroid treatment. Our objective was to study the audiometric and clinical outcomes of patients given salvage therapy with high-dose IT steroids instilled via ventilation tube.

STUDY DESIGN:
Retrospective case review.

SETTING:
Academic secondary medical center.

PATIENTS:
One hundred three patients >18 years of age with sudden sensorineural hearing loss who failed systemic steroids and received IT treatment between 2010 and 2018.

INTERVENTION:
Following ventilation tube insertion, 1 ml of 10 mg/ml dexamethasone was instilled, twice daily, for 7 days.

OUTCOME MEASURES:
Hearing assessment immediately before and after treatment. Tinnitus and vertigo complaints and risk factors were also retrieved.

RESULTS:
Tinnitus had improved in 53 (52%) patients, vertigo in 4 (4%), and aural fullness sensation in 56 (55%) (p < 0.001, p = 0.344, p < 0.001, respectively). The mean pure-tone threshold difference across frequencies following treatment was between 0 and 6 dB. A significant improvement was observed at 250, 500, 1000 Hz (p < 0.001 in all), and at 2000 Hz (p = 0.035). No significant difference was found at 4000 and 8000 Hz (p = 0.055, p = 0.983 respectively). Mean pure-tone average improvement of 4.5 dB was detected in 61 (59%) patients (p = 0.001). The mean speech discrimination score improved by 7% (p = 0.001). Four (22%) diabetic and nine (20%) hypertensive patients had pure-tone average ≥10 dB improvement (p = 0.759, p = 0.852 respectively).

CONCLUSION:
Although more than half of the patients improved clinically, the significance of the slight audiometric improvement should be weighed against the treatment protocol's complications.

https://journals.lww.com/otology-ne...e_of_Intratympanic_Steroids_for_Sudden.7.aspx

No control? No placebo?
???

 

[iAzra]

I have a box of pills, prednisone, expired 06/19 which I haven't used. Now I am thinking about taking it for my acoustic trauma. Is it okay still or should I go ask for a new box?

 

[ChrisBoyMonkey]

I have a box of pills, prednisone, expired 06/19 which I haven't used. Now I am thinking about taking it for my acoustic trauma. Is it okay still or should I go ask for a new box?

I think that question would best be answered by a doctor, preferably an ENT, than anyone on here.

 

[unknownpleasures]

Hi All.

I need some reassurance about prednisolone if possible as I have got myself in a bit of a state.

I have had tinnitus for about three months now and wondering if I have had a spike happen caused by Prednisolone. I have taken this med due to having a gout attack that put me in bed for three days. The pain and inflammation were so bad that I was given Prednisolone 40mg for six days, not only did this help the gout my ears seemed a lot better (Went from high static to a low hiss) and this coincided with two weeks off work which was much needed due to stress at home and work.

After 4 days off the course with no taper as a low dose and a short course the gout started creeping back slowly. To nip it in the butt I was given another six-day course of Prednisolone but the higher static tones seem to be coming back to haunt me. I am really panicking. I have also been suffering with lack of sleep and have been back to work so maybe this is not helping but need some reassurance as I'm very scared right now.

I made a lot of changes before this spike including cutting out a lot of the alcohol I drink, gave up the small amount of vaping I did and have been eating much better and taking supplements. I am just wanting to know if this could be permanent, returning to baseline or just a spike due to the Prednisolone. I know nobody can know for sure but when you are new to this any feedback helps.

Thanks and hope you are all well.

 

[Chriscom]

Hi All.

I need some reassurance about prednisolone if possible as I have got myself in a bit of a state....

As you said, there's no way to know for sure since tinnitus can be so random. But I was on three courses of oral prednisone earlier this year (in attempts to improve or salvage hearing loss) and I noticed no change in my own high-tone tinnitus. I think you're right that the more likely culprits are lack of sleep and work stress.

My main tinnitus issues are the high tone (constant) and the warble/buzz effect when exposed to speech, crowd noise, music, etc. But every once in awhile I'll get a new tone at a different frequency in addition to the usual one, and while those go away under a minute I always fear they'll stay. That happened this morning, in fact. FWIW I got very little sleep last night.

(Prednisone and prednisolone are "Both steroidal anti-inflammatory drugs belonging to the drug class "corticosteroids". " There are differences but that's what I know.)

 

[unknownpleasures]

As you said, there's no way to know for sure since tinnitus can be so random. But I was on three courses of oral prednisone earlier this year (in attempts to improve or salvage hearing loss) and I noticed no change in my own high-tone tinnitus. I think you're right that the more likely culprits are lack of sleep and work stress.

My main tinnitus issues are the high tone (constant) and the warble/buzz effect when exposed to speech, crowd noise, music, etc. But every once in awhile I'll get a new tone at a different frequency in addition to the usual one, and while those go away under a minute I always fear they'll stay. That happened this morning, in fact. FWIW I got very little sleep last night.

(Prednisone and prednisolone are "Both steroidal anti-inflammatory drugs belonging to the drug class "corticosteroids". " There are differences but that's what I know.)

Thank you for your response. I think you are right and it is not the Prednisolone. As you know with this condition you worry so much about every little change and like you even the slightest quick change sends me into worry.

I have had some improvement over what is just under three months since it started after ear irrigation. I think it needs more time and less worry but as usual I've got myself in a state thinking the Prednisolone and not something else has made it worse.

I hope you are feeling a bit better today and sleep better tonight.

 

[unknownpleasures]

After my last post I have spoken to my GP who has suggested a short taper to minimize any side effects coming off the Prednisolone. It was my second 5 day course after about a week and a half break after the first course, as my gout flared again.

Dose was 40 mg made up of eight 5 mg tabs. Starting today and tomorrow I take seven, then six for two days and so on until down to zero. Does this sound OK to you guys, I think as it's such a short course/lower dose it is not a long taper. The doc also said it should not affect my tinnitus really, as I told him I was worrying.

Any advice would be great as I am still worrying the Prednisolone may have caused a spike that will never go away or that maybe it is going back to baseline for a bit and I got used to not having it as loud as normal for a while.

 

[ajc]

Any advice would be great as I am still worrying the Prednisolone may have caused a spike that will never go away or that maybe it is going back to baseline for a bit and I got used to not having it as loud as normal for a while.

Advice with LOTS of prednisolone experience:

Your tinnitus WILL go back to baseline about 1-2 weeks after you are no longer taking prednisolone.

But I warn you now. If you keep analyzing your tinnitus and listening to it constantly ("is it better or worse now"), you are able to imprint the spike into your brain forever. So DO NOT listen to your tinnitus. Use masking.

 

[unknownpleasures]

Advice with LOTS of prednisolone experience:

Your tinnitus WILL go back to baseline about 1-2 weeks after you are no longer taking prednisolone.

But I warn you now. If you keep analyzing your tinnitus and listening to it constantly ("is it better or worse now"), you are able to imprint the spike into your brain forever. So DO NOT listen to your tinnitus. Use masking.

Thank you so much that makes perfect sense and I am going to try and get back to where I was a couple of weeks ago when it did improve a bit. The not focusing helped then and I need to do that again. That's great re the tinnitus returning to baseline and to be honest I think it is not far off just think where it went for a bit I got used to that. Thanks again so much.

 

[Chriscom]

Dose was 40 mg made up of eight 5 mg tabs. Starting today and tomorrow I take seven, then six for two days and so on until down to zero.

I am not a doctor etc. but this is a typical dose and similar to all three of the courses I was on.

 

[unknownpleasures]

I am not a doctor etc. but this is a typical dose and similar to all three of the courses I was on.

Thanks and how was you experience with the Prednisone?

 

[Chriscom]

Thanks and how was you experience with the Prednisone?

First of all, my body tolerated it well--I didn't have any side effects, although that's not guaranteed for everyone.

Secondly, I think I said above that it didn't affect my tinnitus but on reflection I can't be sure of that. Because in I think two out of three treatments, it actually declined slighted after starting on the drug. That could definitely be a placebo effect. Tinnitus later revived closer to its earlier levels (while I was still on prednisone, in at least one case). FWIW I've lately experienced medium-high to medium tinnitus, with occasional new sounds that have left, although a new sort of "shining" sound has become more evident in my left ear (the bad one), in addition to the pure tone. That new tone goes away most of the time when I hear noise or speech etc.

All of which is to say, in the final analysis I don't think it affected my tinnitus at all. But it also didn't hurt me.

I took prednisone the first time to see if it would help restore additional hearing loss I experienced after the first loss was measured by the audiologist (I sensed more loss). My hearing did improve back to the baseline level in that case. The second time was for the same reason, but not only did my hearing not return to the initial loss-baseline, it actually was worse! The third time was for a similar additional decline, and in that case my hearing returned more closely to the original loss baseline.

The upshot is, as my ENTs noted, there's really no way to know if prednisone helped any of the above. I later even got a steroid shot through my eardrum, another long shot (especially because of the time that passed) that didn't help. But others have had better results. When an old friend of mine suffered sudden hearing loss (as I did), she got the eardrum shot quickly, and had a complete recovery. With this stuff, you never know.

Edit: All of my doses were tapered, though one of them had slightly different doses. The second one was pretty dang strong, according to the highly experienced nurse practitioner who administered it.

 

[unknownpleasures]

First of all, my body tolerated it well--I didn't have any side effects, although that's not guaranteed for everyone.

Secondly, I think I said above that it didn't affect my tinnitus but on reflection I can't be sure of that. Because in I think two out of three treatments, it actually declined slighted after starting on the drug. That could definitely be a placebo effect. Tinnitus later revived closer to its earlier levels (while I was still on prednisone, in at least one case). FWIW I've lately experienced medium-high to medium tinnitus, with occasional new sounds that have left, although a new sort of "shining" sound has become more evident in my left ear (the bad one), in addition to the pure tone. That new tone goes away most of the time when I hear noise or speech etc.

All of which is to say, in the final analysis I don't think it affected my tinnitus at all. But it also didn't hurt me.

I took prednisone the first time to see if it would help restore additional hearing loss I experienced after the first loss was measured by the audiologist (I sensed more loss). My hearing did improve back to the baseline level in that case. The second time was for the same reason, but not only did my hearing not return to the initial loss-baseline, it actually was worse! The third time was for a similar additional decline, and in that case my hearing returned more closely to the original loss baseline.

The upshot is, as my ENTs noted, there's really no way to know if prednisone helped any of the above. I later even got a steroid shot through my eardrum, another long shot (especially because of the time that passed) that didn't help. But others have had better results. When an old friend of mine suffered sudden hearing loss (as I did), she got the eardrum shot quickly, and had a complete recovery. With this stuff, you never know.

Edit: All of my doses were tapered, though one of them had slightly different doses. The second one was pretty dang strong, according to the highly experienced nurse practitioner who administered it.

Thanks Chris. Really appreciate your detailed response.

It's so hard to know what is and what isn't working at any given time as some many factors play a part in tinnitus.

I think the Prednisolone is making me really depressed and I am having bad thoughts. I just don't feel myself at all at the moment. I have been told to taper down 5mg every two days after this 6 day course of 40 mgs. I really want to quit cold turkey as I am worried sick that the Prednisolone could be making my tinnitus worse or when rational this could be due to my anxiety. I was even thinking of doing a 10 mg reduction each day instead of 5 every two days as I want this out of my system but worried even that could make things worse. If anyone has any further advice that would be great as I am in a very dark place right now.

 

[unknownpleasures]

I was rushed to the doctor's surgery today by a work colleague. My anxiety went through the roof, I had palpatations, felt generally unwell. The doc said to stop the Prednisolone with no taper as it's such a short course and not the highest dose. I've taken a couple of days off work to rest up and get this stuff off of my system over the weekend.

 

[Chriscom]

Thanks Chris. Really appreciate your detailed response.

It's so hard to know what is and what isn't working at any given time as some many factors play a part in tinnitus.

I think the Prednisolone is making me really depressed and I am having bad thoughts. I just don't feel myself at all at the moment. I have been told to taper down 5mg every two days after this 6 day course of 40 mgs. I really want to quit cold turkey as I am worried sick that the Prednisolone could be making my tinnitus worse or when rational this could be due to my anxiety. I was even thinking of doing a 10 mg reduction each day instead of 5 every two days as I want this out of my system but worried even that could make things worse. If anyone has any further advice that would be great as I am in a very dark place right now.

I'm very sorry to hear you're having a tough time. Speaking only as a fellow-patient, without talking to a doctor I strongly advise against suddenly stopping the prednisolone, which can lead to some serious side effects. At the same time, this drug can absolutely cause depression as well, so you're not imagining that (obviously, you're saying to yourself lol).

What you should do is contact the doctor or practice that prescribed the drug and let them know what's going on, and they certainly have had patients with this side effect and are your best source for working on how to handle it. I don't know if doing the 10mg reduction would be a better exit--but neither do you. Ask, do not self-prescribe, and I think you may find that even just talking about it will help.

Depression is nothing to be trifled with, so hang on through this temporary dark moment.

 

[unknownpleasures]

I'm very sorry to hear you're having a tough time. Speaking only as a fellow-patient, without talking to a doctor I strongly advise against suddenly stopping the prednisolone, which can lead to some serious side effects. At the same time, this drug can absolutely cause depression as well, so you're not imagining that (obviously, you're saying to yourself lol).

What you should do is contact the doctor or practice that prescribed the drug and let them know what's going on, and they certainly have had patients with this side effect and are your best source for working on how to handle it. I don't know if doing the 10mg reduction would be a better exit--but neither do you. Ask, do not self-prescribe, and I think you may find that even just talking about it will help.

Depression is nothing to be trifled with, so hang on through this temporary dark moment.

Thanks Chris. That's most helpful.

I was at the doc's today that prescribed as per my earlier post. As it has only been 6 or 7 days on a medium dose the doctor said no taper needed which I did before and was fine apart from some tiredness with.

I am currently more depressed than I have ever been due to thinking the tinnitus spike I have at the moment won't go now that I'm off the Prednisolone. I'm also panicking in case I do get bad withdrawals.

Sorry for being so honest above I just don't know what to do.

 

[Chriscom]

Thanks Chris. That's most helpful.

I was at the doc's today that prescribed as per my earlier post. As it has only been 6 or 7 days on a medium dose the doctor said no taper needed which I did before and was fine apart from some tiredness with.

I am currently more depressed than I have ever been due to thinking the tinnitus spike I have at the moment won't go now that I'm off the Prednisolone. I'm also panicking in case I do get bad withdrawals.

Sorry for being so honest above I just don't know what to do.

If you're under the care of a doctor--and it sure sounds you are--you should pay attention to whatever he or she says. Feeling concerned is normal, but if the doctor said no taper is needed, believe it. I know it's very easy for me to say, but try to take it one day at a time. If you--if anyone--contemplates every bad thing that can happen going forward, it gets overwhelming. Focus on the "now."

 

[unknownpleasures]

If you're under the care of a doctor--and it sure sounds you are--you should pay attention to whatever he or she says. Feeling concerned is normal, but if the doctor said no taper is needed, believe it. I know it's very easy for me to say, but try to take it one day at a time. If you--if anyone--contemplates every bad thing that can happen going forward, it gets overwhelming. Focus on the "now."

Thanks Chris. That's a massive help and very true.

I slept better last night after a tiny dose of lorazepam and already feel less anxious today. And as you say I have to take this each day and not worry about what might happen. Thanks again mate and hope you are well today.