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

[cyberspace]

Was anyone else's anxiety and mental state completely through the roof whilst tapering off Prednisone?

How fast did you taper?

 

[Hardwell]

How fast did you taper?

So I went 60 mg, 60 mg, 50 mg, 50 mg, 40 mg, 40 mg, 30 mg, 30 mg and am now starting 20 mg, 20 mg, 10 mg, 10 mg.

 

[yeezysqueezy]

Was anyone else's anxiety and mental state completely through the roof whilst tapering off Prednisone?

Yeah, this is always terrible for me with Prednisone. And I get insomnia like nobody's business.

 

[Nick47]

I'm just wondering how you guys find doctors to do intratympanic Dexamethasone injections with no hearing loss on the audiogram? Did you guys have to fake the audiogram or are there otologists willing to do certain treatments regardless of audiogram results?

I asked about this. There is no good evidence for steroids after onset of tinnitus without hearing loss. There is evidence steroids may help with sudden hearing loss from an infection etc.

No, you never fake a medical diagnostic test; that is out of order!

 

[Hardwell]

Yeah, this is always terrible for me with Prednisone. And I get insomnia like nobody's business.

It's an absolute killer.

 

[dealwithshit]

Sorry, I forgot to update. My tinnitus got worse when I tapered off the steroids but overall the tinnitus is still better than before the steroids. I don't know though if that was just natural healing or not.

 

[cyberspace]

I'm tapering off of the Prednisone and my tinnitus is worsening. Getting a new Morse code tone in my right ear. I used to only have tinnitus in my left ear. Help.

Prednisone made me much worse. Be careful of this med. I listened to all the panicked advice here about needing Prednisone asap after onset and went for it when I probably didn't need it.

 

[Adamsk117]

I'm not sure that Prednisone even helped my tinnitus, but what I do know is it massively heightened my anxiety and gave me chronic insomnia which I've only just got over. It also gave me muscle and bone weakness which again I am just recovering from. It's not a drug to trifle with, that's for sure.

My tinnitus has improved quite a bit since onset (January), although I had a setback today. What is working for me is honestly not letting it get in the way of stuff and causing me anxiety. Easier said than done, of course.

My biggest issue is not the tinnitus anymore, but the feeling of fullness, stuffed sinuses, jaw tension and my masseter muscles all clumped up. Absolutely horrid.

 

[jimvee]

I'm almost two months in and seriously considering intratympanic steroid injections. I have been looking for and contacting hospitals/ENTs in the Netherlands (where I'm from), Belgium, Germany and the UK. So far not much luck with either willingness or waiting times. Does anyone have good suggestions for places/doctors in Western Europe that I could have success with?

 

[andwaai99]

Hi everyone,

I've had tinnitus (sudden onset, high-pitched ringing felt 'inside' head) for 2.5 years. In the last year I habituated and it no longers cause me the psychological hell it once did.

Yesterday I was walking and a motorbike drove past and backfired from exhaust at 1 meter distance (can't make this sh** up, I know...)

Since then, my left ear (closest to bike) and surrounding jaw area feels 'full'. My hearing is mildly affected and feels stronger on the right. Tinnitus hasn't really changed.

As it didn't improve after waking up today, I saw an ENT who examined my ears (all normal) and prescribed 16 mg daily tapering down in 8 mg daily of Methylprednisolone (2 days 16 mg, 3 days 8 mg).

I voiced concerns based on comments I saw regarding it making tinnitus louder/worse/change, but they didn't seem convinced and stated it is used as a tinnitus treatment (which I have also seen people have positive results with).

I then did an audiometry test which showed apparently normal results, similar across both ears (slightly worse on left) - the ENT then said based on this I could monitor how it was and decide if to take the meds, but that I must do it within the initial 72 hours window.

As my hearing loss doesn't seem to be severe, I'm wondering whether this feeling of fullness and the hearing imbalance will go away on its own? Or if I should take this relatively low dose Methylprednisolone course for 5 days?

Also, since the examination, I've had an itch in my ear (particularly when swallowing) - not sure if this is sign of infection or irritation.

I don't want to take this decision lightly as I know it's a serious medication and am very worried about the side effects people have mentioned (although there's a mix of positive/negative) - but I feel constrained by this countdown of the post-trauma window.

If anyone has a similar experience, I would love to hear about it!

Also on a side note, I've seen Magnesium recommended - I found a 365 mg sachet at a local pharmacy. Is this worth taking?

Thanks in advance!

 

[ajc]

As it didn't improve after waking up today, I saw an ENT who examined my ears (all normal) and prescribed 16 mg daily tapering down in 8 mg daily of Methylprednisolone (2 days 16 mg, 3 days 8 mg).

That dosage is extremely low, it won't do anything positive for your condition. If you take it, it should be a much higher dose.

 

[andwaai99]

That dosage is extremely low, it won't do anything positive for your condition. If you take it, it should be a much higher dose.

Okay I see - what sort of dosages would be more effective?

And would Methylprednisolone have a positive effect on this fullness I feel across my left side? As I can only seem to find information on its use for more severe hearing loss or for tinnitus itself.

As my audiometry test didn't show significant hearing loss and my tinnitus is unchanged, I'm not sure what to do.

 

[Jupiterman]

From what I've read; the longer people have had tinnitus for, and I'm meaning years, the less likely steroids will have a positive effect, even if a fresh noise exposure.

Steroids tend to work better if you are a newbie with a 'first' injury but even at that the evidence is weak. It may just be that your ears/brain managed to heal/adjust on their own as it's a 'new' injury.

Look, if steroids really worked as well as we all hoped they did, then would there be 37 pages of discussion about it?

I think there is a reason why many hospitals and doctors are unwilling to issue them as a treatment for tinnitus. That's why dosages vary so much from doctor to doctor. No one knows the correct dosage because there isn't one; sadly it's all guesswork and opinion.

I've read too many cases of people's tinnitus worsening from taking steroids and not enough benefitting for my liking.

 

[kingsfan]

Okay I see - what sort of dosages would be more effective?

(Source)

 

[ZFire]

The most common scenario: No positive or negative effect to tinnitus.

The worst case scenario: Tinnitus worsens, distortions and other ear issues may emerge,

The 'best' case scenario: Temporary tinnitus relief until tapering begins where then, the tinnitus reverts back to its initial pre-steroid state.

The idea that steroids are like this miracle cure for tinnitus spikes or tinnitus in general, swooping in to save the day, needs a reality check. Some folks are ready to gobble down these pills as if they're the cure for every low/moderate/high-decibel encounter. Playing with fire.

Take steroids if you notice any abrupt sudden hearing loss. That's its only purpose in relation to ears. End of discussion.

 

[andwaai99]

The most common scenario: No positive or negative effect to tinnitus.

The worst case scenario: Tinnitus worsens, distortions and other ear issues may emerge,

The 'best' case scenario: Temporary tinnitus relief until tapering begins where then, the tinnitus reverts back to its initial pre-steroid state.

The idea that steroids are like this miracle cure for tinnitus spikes or tinnitus in general, swooping in to save the day, needs a reality check. Some folks are ready to gobble down these pills as if they're the cure for every low/moderate/high-decibel encounter. Playing with fire.

Take steroids if you notice any abrupt sudden hearing loss. That's its only purpose in relation to ears. End of discussion.

Yeah I opted not to take it in the end, as my tinnitus didn't change & audiogram didn't show hearing loss.

My main question is if people have experienced positive effects for the full/blocked/dampened feeling that developed after the bike backfired.

I can't seem to find much information on this - has anyone experienced a similar feeling? And did it subside over time? And did you take any medication for it?

It's been 5 days for me and still no change - my audiometry was normal but my tympanogram was abnormal for the left ear. I'm hoping to see an ENT about this, but not sure how the acoustic trauma could cause this and if it's temporary.

Any advice/opinions are appreciated.

 

[ZFire]

Yeah I opted not to take it in the end, as my tinnitus didn't change & audiogram didn't show hearing loss.

My main question is if people have experienced positive effects for the full/blocked/dampened feeling that developed after the bike backfired.

I can't seem to find much information on this - has anyone experienced a similar feeling? And did it subside over time? And did you take any medication for it?

It's been 5 days for me and still no change - my audiometry was normal but my tympanogram was abnormal for the left ear. I'm hoping to see an ENT about this, but not sure how the acoustic trauma could cause this and if it's temporary.

Any advice/opinions are appreciated.

I remember taking a tympanogram during my onset, the audiologist told me that I had negative ear pressure. I was prescribed Flonase (OTC). It did nothing to solve the pressure/fullness feeling at the time. The fullness and pressure went away overtime. It's mostly gone, but the fullness and blocked ear feeling can creep back up every now and then though.

This is all I can tell you.

 

[andwaai99]

I remember taking a tympanogram during my onset, the audiologist told me that I had negative ear pressure. I was prescribed Flonase (OTC). It did nothing to solve the pressure/fullness feeling at the time. The fullness and pressure went away overtime. It's mostly gone, but the fullness and blocked ear feeling can creep back up every now and then though.

This is all I can tell you.

Okay, thanks for the info!

Do you think your fullness was only due to the negative pressure? Or something else?

As my tympanogram showed abnormal results on the left, but I still don't understand if/how a noise could cause that - I also don't get any relief even when 'popping' my ear.

This makes me think it's more so due to the muscles or Tensor Tympani etc.

And how long did it take for it to improve for you? Was it gradual?

 

[ZFire]

Do you think your fullness was only due to the negative pressure? Or something else?

No, I also have Eustachian tube dysfunction and get flare ups from time to time. This usually leads to having a blocked ear (fullness), autophony, clicking sounds when swallowing, and pressure issues.

And how long did it take for it to improve for you? Was it gradual?

Improvements were non linear and it took about 6-8 months. I would have periods where the fullness and dampened hearing was nearly reduced, and then it came crawling back at full force for like the next 3-5 days. Overtime, I have experienced fullness less and less.

I think you'll get there too.

 

[andwaai99]

No, I also have Eustachian tube dysfunction and get flare ups from time to time. This usually leads to having a blocked ear (fullness), autophony, clicking sounds when swallowing, and pressure issues.

Improvements were non linear and it took about 6-8 months. I would have periods where the fullness and dampened hearing was nearly reduced, and then it came crawling back at full force for like the next 3-5 days. Overtime, I have experienced fullness less and less.

I think you'll get there too.

I have been experiencing some of these symptoms associated with Eustachian tube dysfunction such as pressure, clicking and weird sensation when swallowing - but only since the onset of the fullness following the acoustic trauma.

So I really don't understand if this is a major coincidence or if the loud sound somehow caused this damage/problem.

I've also noticed I get some very mild relief when pulling the top of my ear - have you also happened to experience this?

I'm glad to hear you saw improvements over time! Hoping I do too

 

[silenceismusic]

Hi all, I visited an ENT couple of days ago because of my increased tinnitus / new tinnitus in right ear. I've had mild tinnitus for years but it's been equal on both ears, and now there has been a new increased tinnitus in right ear that's been going on for two months or so. It will come and go in intensity. Some days I feel like it's healed and then it comes back the next day. My tinnitus used to be very stable.

I'm a musician and it is very likely this is related to noise exposure, even though I protect my ears. But before this developed there was an instance where my ears were not protected and it spiked my tinnitus a little bit. This new tinnitus in the right ear started to slowly develop in the coming weeks of that (new tone first appeared maybe 2 weeks after), so there was really not much change of hitting a 48 hour window for prednisone treatment because the noise exposure at the time didn't seem THAT bad...

Now I feel my right ear has lost some high frequency hearing, and the ENT booked me for a hearing test which is in 8 days (long time to wait if things are acute). My right ear has had a slight dip in the very highest range since forever, but I feel it has got a bit worse now. And even with the previous slight hearing loss my tinnitus was always bilateral, not just in the right ear.

I straight up asked the ENT about prescribing steroid treatment for me, and she refused. She said it's only prescribed if it's "bad enough" like a gunshot next to my ear or something. That didn't make sense to me.

Another thing to mention, I have had a sense of fullness / dullness / inflammation in the right inner ear which comes and goes every now and then and is almost always accompanied by increase in tinnitus. This is why I feel things might be still in acute phase and a steroid treatment might be helpful. Also the fact that my tinnitus goes up and down and hasn't yet settled. During these two months I've even had moments where my right ear loses hearing in a sudden "whoom" and tinnitus appears and then the hearing slowly restores. So things seem kinda unstable.

Another thing to mention that these last two months or so I had worsened hyperacusis. I feel like it has now come down 80% but for a while it was quite bad.

I'm also taking bunch of supplements and vitamins for the last 4-5 weeks or so, including Ginkgo and NAC. Seems to have maybe helped a bit.

What I'm trying to figure out is if I should go to another doctor to demand steroid treatment, or if in my case it is indeed better to not go for that. I've read that in some rare cases Prednisone has made tinnitus worse, but in most cases it seems to have either temporary or even some kind of permanent positive effect? This has been going on for some time for me so there's that... But then again things still seem quite unstable and "acute" in a way. Would it be good idea to demand steroid treatment from a different doctor now?

 

[kingsfan]

Hi all, I visited an ENT couple of days ago because of my increased tinnitus / new tinnitus in right ear. I've had mild tinnitus for years but it's been equal on both ears, and now there has been a new increased tinnitus in right ear that's been going on for two months or so. It will come and go in intensity. Some days I feel like it's healed and then it comes back the next day. My tinnitus used to be very stable.

I'm a musician and it is very likely this is related to noise exposure, even though I protect my ears. But before this developed there was an instance where my ears were not protected and it spiked my tinnitus a little bit. This new tinnitus in the right ear started to slowly develop in the coming weeks of that (new tone first appeared maybe 2 weeks after), so there was really not much change of hitting a 48 hour window for prednisone treatment because the noise exposure at the time didn't seem THAT bad...

Now I feel my right ear has lost some high frequency hearing, and the ENT booked me for a hearing test which is in 8 days (long time to wait if things are acute). My right ear has had a slight dip in the very highest range since forever, but I feel it has got a bit worse now. And even with the previous slight hearing loss my tinnitus was always bilateral, not just in the right ear.

I straight up asked the ENT about prescribing steroid treatment for me, and she refused. She said it's only prescribed if it's "bad enough" like a gunshot next to my ear or something. That didn't make sense to me.

Another thing to mention, I have had a sense of fullness / dullness / inflammation in the right inner ear which comes and goes every now and then and is almost always accompanied by increase in tinnitus. This is why I feel things might be still in acute phase and a steroid treatment might be helpful. Also the fact that my tinnitus goes up and down and hasn't yet settled. During these two months I've even had moments where my right ear loses hearing in a sudden "whoom" and tinnitus appears and then the hearing slowly restores. So things seem kinda unstable.

Another thing to mention that these last two months or so I had worsened hyperacusis. I feel like it has now come down 80% but for a while it was quite bad.

I'm also taking bunch of supplements and vitamins for the last 4-5 weeks or so, including Ginkgo and NAC. Seems to have maybe helped a bit.

What I'm trying to figure out is if I should go to another doctor to demand steroid treatment, or if in my case it is indeed better to not go for that. I've read that in some rare cases Prednisone has made tinnitus worse, but in most cases it seems to have either temporary or even some kind of permanent positive effect? This has been going on for some time for me so there's that... But then again things still seem quite unstable and "acute" in a way. Would it be good idea to demand steroid treatment from a different doctor now?

I think once the tinnitus sets in, the Prednisone isn't going to help much. I've seen so many accounts of people whose SSHL improved with steroids, yet the tinnitus remained.

 

[jimvee]

This Friday I had my final 4 mg/1 ml Dexamethasone intratympanic injections. I started at two months in, and had oral Prednisolone 7 x 50 mg in the week of my onset without noticeable effect. I now had a total of 20 injections (10 x 2 ears) at daily intervals except for Saturdays and Sundays. So far it is hard to tell if there has been any definitive effect. Maybe there is a difference in the sounds themselves, but unfortunately it's hard to say as mine are complex. I have been fluctuating more intensely, with highs and lows that aren't much unlike those I've experienced before. Right now the tinnitus is at its highest, while a few days ago it was at its lowest. All in all still around my baseline. I will come back later with a further report. I know many studies have their 'after' measurement at a month after the final injections, some at three.

About the injections itself: the first time was horrible. Even applying the anesthesia hurt, and the injections themselves were close to hellish. Fortunately this was just the feeling of the actual injection, so it passed after a few seconds. The second time was already so much easier, as now the anesthesia was in for longer and I was warming up the vials for longer. It continued to get even easier each time. The injections themselves really weren't a big deal at all in the end. My eardrums had healed over the weekend.

 

[ZFire]

I've also noticed I get some very mild relief when pulling the top of my ear - have you also happened to experience this?

No.

 

[Nick47]

Treatment of Tinnitus with Intratympanic Injection of Dexamethasone Versus Oral Drugs

The improvement of the symptoms is significantly related with the duration of the symptoms in our study. Patients presenting with severe SNHL was the commonest presentation but had the least improvement (29.6%). Patients presenting within one year of occurrence of the symptoms had maximum improvement. Intratympanic dexamethasone can be considered as a good alternative for improvement of symptoms of tinnitus.

 

[elino]

Treatment of Tinnitus with Intratympanic Injection of Dexamethasone Versus Oral Drugs

The improvement of the symptoms is significantly related with the duration of the symptoms in our study. Patients presenting with severe SNHL was the commonest presentation but had the least improvement (29.6%). Patients presenting within one year of occurrence of the symptoms had maximum improvement. Intratympanic dexamethasone can be considered as a good alternative for improvement of symptoms of tinnitus.

@Nick47, do you maybe have access to the full study? It's the first time I'm seeing that intratympanic Dexamethasone can have an effect up to one year and it would be great knowing more about the patient sample.

I got rejected for these injections when my tinnitus was at 5 months because the ENT deemed it as too late.

 

[Nick47]

@Nick47, do you maybe have access to the full study? It's the first time I'm seeing that intratympanic Dexamethasone can have an effect up to one year and it would be great knowing more about the patient sample.

I got rejected for these injections when my tinnitus was at 5 months because the ENT deemed it as too late.

@elino, I don't have access to the full study. Personally I don't think it's worth it, and I'm suspicious of these studies. Unless you have low frequency hearing loss and Meniere's disease.

 

[annV]

@Nick47, do you maybe have access to the full study? It's the first time I'm seeing that intratympanic Dexamethasone can have an effect up to one year and it would be great knowing more about the patient sample.

I got rejected for these injections when my tinnitus was at 5 months because the ENT deemed it as too late.

@elino, I don't have access to the full study. Personally I don't think it's worth it, and I'm suspicious of these studies. Unless you have low frequency hearing loss and Meniere's disease.

I have attached the full article.

 

[elino]

I have attached the full article.

Thank you @annV.

The results are out of the ordinary compared to other studies I've seen regarding intratympanic Dexamethasone injections; they even show a 35% improvement for subjects that already have had tinnitus for 1-2 years and 22% for more than 2 years. However, they do not specify whether subjects with longer-lasting tinnitus received the treatment after experiencing additional worsening.

But in general, it does seem to me that these injections are the best first line of defense when getting tinnitus or experiencing an additional worsening. From what I can gather from comments, they also appear to be a safer option than Prednisone. Although I wish I had been offered either one (instead of nothing) when my tinnitus started.

 

[mrpetrov]

Hi all.

Following a (cursed) 110 dB concert on 17 October (this month), I've had chirping tinnitus, only in my right ear. First night was extreme Morse code, which went the next day and became arrhythmic chirping. No prior history of tinnitus. It's having a huge mental toll on me, very limited sleep, if any, since then. White noise or not, I'm not sleeping.

Today (exactly two weeks after event) I got a single Dexamethasone injection in my right ear only. My ENT was very reluctant, as the US standard is only to inject following hearing loss, which I had no evidence of. That said, I showed him the three recent non-US studies all showing statistically significant benefits for tinnitus even without hearing loss, which he acknowledged, but without accepting their testing or conclusions, of course. We discussed the risks and I accepted the risks - so he agreed to a single injection.

Given the studies' subjects had had between three and six injections over the course of a few weeks, I don't expect a single injection will be a miracle - but at least it was a start. I have not yet tried to request further injections, but I expect I will request at least another two. We shall see.

I shall keep you posted. Here are links to the three studies (one of which is just above obviously).

• The Efficacy of Intratympanic Steroid Injection in Tinnitus Cases Unresponsive to Medical Treatment
  
  
• Treatment of Tinnitus with Intratympanic Injection of Dexamethasone versus Oral Drugs
  
  
• Efficacy of Intratympanic Dexamethasone Injection in Subjective Idiopathic Tinnitus