To Take or Not to Take — Is That the Question (Sorry Hamlet)?

[Dr. Ancill]

As a doctor who has tinnitus and treats patients with tinnitus, I posted this as a reply to an ongoing thread which had several T patients blaming doctors for their tinnitus:

"Clearly, some people don't want to give up what they strongly believe but let's look at the logical conclusion of their position: If all these drugs are ototoxic and tinnitus can occur with both short-term or long-term use, doctors should stop prescribing all these drugs - now what? I would like to hear what is the alternative to antibiotics, antidepressants, cardiac and blood pressure medications. anticonvulsants, anti-cancer drugs, etc.........

Doctors don't go and kidnap people and force them to take medications. People come to see doctors because they are in distress or discomfort and want treatment. We do the best we can given the knowledge we have. Benefit has always got to be weighed against side-effects. I always discuss potential risks with my patients but who really knows how to evaluate a 1.2% or 0.4% or 4% risk of any given side-effect?

I have significant bilateral tinnitus and have to take a medication for a medical disorder and this medication has a 2% chance of causing/worsening tinnitus (according to the FDA). Not taking this medication could lead to my sudden demise....what should I do?"

So, let's have at it !!

 

[Natalie Roberts]

As a doctor who has tinnitus and treats patients with tinnitus, I posted this as a reply to an ongoing thread which had several T patients blaming doctors for their tinnitus:



I have significant bilateral tinnitus and have to take a medication for a medical disorder and this medication has a 2% chance of causing/worsening tinnitus (according to the FDA). Not taking this medication could lead to my sudden demise....what should I do?"

So, let's have at it !!

If the benefits of the medication outrisk the small risk of T worsening and the medication was really necesarry I would probably take the medication of course. I am pregnant and due to deliver in January. Since being on this website, I've learned about ototoxitcy and it has caused me slight distress when I think about all the medications they can possibly use for birth. My obgyn does not have a lot of information about ototoxic drugs so she isn't much of a resource. I'm concerned about the possible need for antibiotics, pitocin (haven't found any links between pit and ototoxicity and I know pitocin will be used in my case for risk of bleeding) or after delivery pain medication (tylenol 3 with codeine). I know a lot of the antibiotics like penicilin can be ototoxic but is there a safer alternative so I am prepared should antibiotics be required?

 

[noisebox]

The issue is doctors don't even tell us a drug may be ototoxic. Before T and reading all I can, I learned that there was such a thing as ototoxic drugs. I am 53, no doc ever told me they existed. Knowing I have T I am still offered ototoxic drugs instead of a viable alternative.
If it's life or death, I guess no contest but some days I'm not even sure about that.
Doctors need to take the risks of T seriously, a life can be ruined by an inappropriate choice of antibiotic, the patient never having been given the choice.
I suffered a very severe reaction to very high dose vitamin D3, I was not even told any reactions were possible, let alone severe. And guess what one of them I got was severe worsening of T and severe H. Coincided with the first day of taking 40000iu.
Looks like I disagree with you again.

 

[wishingluck]

I do not blame doctors for tinnitus, Dr Ancill. But I know that there's a very few very good doctors, and out of the many I have seen for different problems in many years, I can remember only 1 or 2.

I always got the impression that most really could care less. They prescribe drugs too easily.

'Benefits have to be weighted up against side effects'

?

Are you kidding? The worst things that happened to my person before tinnitus was breaking all my front teeth in a fall, and tearing my meniscus/not being able to walk for 3 months and not knowing if I'd walk again.

In the first instance, I can't even remember the pain I felt, and all the teeth grew again anew after a few years.

In the second, I got a knee operation and the problem was fixed, I could walk again.

I can tell you this: I'd rather smash my teeth again and walk with a crutch for the rest of my life than preferring tinnitus to both of these.

Not trying to be unfriendly to you, and I am sorry to know you have tinnitus too. But the idea of permanent tinnitus as being labelled just a. ehm, 'side effect' is REALLY worrying.

My opinion is, most doctors don't know what the heck they are doing, and that of course includes the companies who market these pills, etc etc

I can tell you what would the chance of me without tinnitus, would be of taking an antibiotic that would cause tinnitus: zero, except if I knew I was going to die if I would not take it.

I have the highest respect for sciences, researches, and medicine, but doctors are not high on my list. By that I do not mean that all doctors are bad, of course. Just that most of my experiences with them have been completely negative, and in most cases surreal. And I am not the only one.

Of course, I am speaking in general, and not just about doctors who prescribe drugs, although that too.

Bearing in mind, by 'doctor' I also include ENTs and 'psychologists'.

 

[Lisa88]

My t was triggered at an ENT office. A tympanometry was done which eliminated problems with the eustachian tube. Then a redundant further testing of the ET was done by applying endoscopic lidocaine and phenylephrine (adrenalin) solution followed by a probe.
I had a menstrual migraine at the time.
It was concluded that somehow the adrenalin solution reacted with the migraine to cause the brain chemistry change that resulted in t.
I would have appreciated the ENT doctor letting me know about the risk of t (however small), and checking off other risks such as the migraine.
Now, maybe as I was prone to t, it may have been triggered somehow down the line through anxiety build up etc.
But that's not the point. The doctor, especially an ENT doctor, needs to inform the patient of risks.

 

[wishingluck]

Lisa, I might be wrong, but I don't believe such a low frequency, such as 226 hz caused by timpanometry, can cause tinnitus, or it would be extremely difficult.

I have been told that tinnitus onset can also be a buildup of various damages that build up over time. In my case, I could well have had tinnitus starting 25 years ago, because I have always been stupid as I have often listened to music through earphones at very high volume.

I don't believe the 'anxiety buld up' theory either....as I wrote elsewhere, I never hear Holocaust survivors saying or writing 'I got tinnitus in concentration camps'.

I don't understand why doctors say this trash about 'anxiety build ups', I mean, what proof do they have?
In science, nothing is true until there's concrete evidence that it's true. So why do they say this nonsense? Maybe Dr. Ancill can provide an answer to that?

 

[dboy]

I have significant bilateral tinnitus and have to take a medication for a medical disorder and this medication has a 2% chance of causing/worsening tinnitus (according to the FDA). Not taking this medication could lead to my sudden demise....what should I do?"

I think this misses the point a little bit... you have the knowledge to make a reasonably informed choice. A lot of people here were advised or prescribed certain treatments without being also given the information to make an informed choice. Often for non life-threatening conditions. When I was prescribed Neomycin to go into my ear I directly asked my GP whether it might make my tinnitus worse and he told me it would not. But it did. If he had not given me a categorical denial then I would have done the research first and avoided the drug. Now I am older and wiser: I know not to trust what my doctor says and to do my own research.

If as a doctor you always discuss potential risks with your patients then that is greatly to your credit. People who are given enough information to make an informed choice (who are not misled about uncertainty that exists) should not have reason to complain. But my own impression is that in most cases doctors assume patients are incapable of making intelligent decisions about their own health (or the doctors just do not have the time/patience to enter into that dialogue).

It is a tough job, I would never deny that. And impossible to get right every time. I think there is a genuine reason, however, that this movie scene resonated so strongly in the public consciousness:

 

[Michael Leigh]

I have significant bilateral tinnitus and have to take a medication for a medical disorder and this medication has a 2% chance of causing/worsening tinnitus (according to the FDA). Not taking this medication could lead to my sudden demise....what should I do?"

I have severe bilateral tinnitus, that resulted in me being medically retired from my job many years ago.

There are some interesting points raised on this thread and I find myself agreeing with both points of view. Whether to take a certain medication even though it may or may not make tinnitus worse. Should a doctor advise their patient about any adverse affects a particular drug might have on their tinnitus?

In an ideal world probably yes but that may not always be possible as there are thousands of medicines out there. My blood pressure medicine is listed as can make tinnitus worse. I have been taking it for a long time and haven't noticed any adverse effects. Perhaps if I did then I would consult with my GP and hopefully there would be an alternative med that I could try.

Some people say Benzes make tinnitus worse and perhaps they do. I have habituated to my tinnitus but large fluctuations in its intensity remain. It ranges from: complete silence to mild, moderate, severe and extremely severe.

For the last three days it has gradually got worse and up to 6 hrs ago it was at a very severe level. So loud and intrusive it makes it difficult to cope. Although I didn't want to, I took 2x0.5mg of clonazapam and went to bed due to its sedative qualities. Fortunately, my tinnitus has now reduced to a very low level as I type. I try not to take this medication often because of it's addictive nature and the body will quickly habituate to it, and more of the drug needs to be taken to get the same relief.

As I said I agree with both points on this thread but find myself agreeing more with Dr. Ancill. I posted the article below on another thread some time ago but it was edited as it was written on another forum. I have submitted it again and this time unedited, as I believe it may give some pause for thought. I am aware some people will disagree with me but please understand, I'm not here to cause any unease, disquiet or to start a flame war. Therefore, I wont be answering any comments if I believe that anyone has this intention.

I would rather be happy than right.

Many years ago when I first got tinnitus, I was going through a difficult time like many newbies do. I read a newspaper article that helped to change my thinking and put me on the road to habituation. It mentioned 19 out of 20 medical conditions cannot be cured. At this moment, tinnitus is one of them.

Many people with intrusive tinnitus experience anxiety, depression and low moods. With time they often improve and some with the help of medications eventually habituate. Others may experience spikes in their tinnitus which can make them prone to mood swings. These people still manage to find a way through it with determination, character and inner strength.

There are others that will accept nothing less than a complete cure and therefore, never be able to habituate to tinnitus even if they had the best treatment in the world. My experience as a Tinnitus Support Contact, has involved talking to many people on the telephone, reading posts in forums and answering emails. The really sad part is, these people want to drag everyone else down with their pessimism.

Just as there are positive thinking people that are prepared to try and make a life with their tinnitus, negative ones prefer to sit on their backside and do nothing. Visiting every tinnitus forum moaning and groaning and feeling sorry for themselves because of their own weakness. They have no backbone and blame the world and every health professional and medical organisation for their misfortune in life and the sobering truth it's something that will be difficult to change.

There are those reading this post that will be infuriated by my comments and can't wait to jump on the keyboard to unleash their fury. Just before you do take time out and think. Ask yourself and be honest. What have you achieved with all your negative thinking and complaining? Absolutely nothing! Even if you are right you've got to have an unhappy life. Perhaps it's time to change your strategy and dare I say it to one of positivity.

Michael

 

[dboy]

I'm not looking for a flame war, and am quite happy to get no response, but for the record I am going to briefly restate my objection to divisive, unsupportive statements like this:

Visiting every tinnitus forum moaning and groaning and feeling sorry for themselves because of their own weakness. They have no backbone and blame the world and every health professional and medical organisation for their misfortune in life...

Getting intrusive tinnitus can be psychologically traumatic. If it is largely as a result of the actions of another person or of events beyond the sufferers control then it is highly possible that it will be accompanied by a sense of injustice, powerlessness or anger. This is not evidence of weakness so much as of human nature.

Psychological trauma and/or these sort of feelings do not in most cases go away over night. They take time to work through. Given the right conditions people can often process their feelings and become strong again. One thing that helps this along is having their feelings validated and accepted by those around them, even when those feelings might not be what those around them want to hear. People in distress are not always reasonable and not always focussed on putting others at ease. They often experience psychological pressures that are greater than the desire to be liked - or even respected - by those around them. This can lead them to seem obsessive or as though they do not want to move on. But although they may seem this way, and although you might feel irritated when listening to them, it does not mean that your perceptions are accurate or that their condition is their fault. This is especially relevant if they believe themselves to be in a context where the venting or exploration of feelings is allowed... where the factors that caused their distress are discussed... where support can reasonably be expected.

I'm not saying that everybody who has a whinge is justified, but I very much am saying that unless you are intimately familiar with the situation it is ungenerous, unsupportive and quite possibly wrong to assume otherwise.

So I do not see the point of generic statements about people having "no backbone." They encourage a lack of tolerance. It is OK to think it in private if you are so inclined, but for somebody to write it in public as though they are some kind of expert in other people's inadequacies strikes me personally as saying a great deal more about that person than about the people they are accusing.

Apologies for going off topic, but I do think this needed saying.