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Bart

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 #1 
Hello Doctor Nagler ,

My urologist prescribed me Cialis 20 mg because I suffer from prostate problems, (getting older) , I just took half and now my tinnitus has increased in intensity, the urologist and the apothecary where I got the drug told me that this drug is not known to cause ringing or problems with the ear, however in the leaflet and fro: info on the internet I read that this is one of the most common and major side-effects of ED drugs , this is confuisng and I am worried that my increased ringing is permanent ? 

What is your toughts on this matter, did you have patients or did you hear from people who developed or worsened there tinnitus with this drug ?

Thanks,
Bart M.
Dr. Nagler

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 #2 
Hi Bart -

Your question might seem straightforward, but actually it's a bit complex.

(1) How long after you took the Cialis pill was it before your tinnitus increased in intensity?

(2) Has your tinnitus ever increased in intensity before?

(3) Why did you take half a pill instead of a whole pill?

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
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No bird ever soared in a calm. Adversity is what lifts us.
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Bart

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 #3 
It seemed to increase 30 minutes after I took half a pill, roughly 10 mg
Dr. Nagler

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 #4 
I'm not sure what you mean by "seemed" to increase. Was it a marked unmistakable increase or more of a subtle increase? Also, did you notice any sudden hearing loss in one or both ears accompanying the increase in tinnitus?

[I have to run off and will check the board later for your responses to the above questions. In the meantime, if you did experience a sudden hearing loss (quite rare), contact an ENT immediately.]

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Bart

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 #5 
To answer the other questions :

2 : Yes it did increase and spike before (I have ringing in my ears for 6 years)

3: I only took half a pill as the urologist advised it to find the correct dose , I could start with 10 mg (recommended dose), but if that was insufficient I could take 20 mg 


Yes, the change in intesity  subtle but an unmistakable increase at the same time, my 'normal' tinnitus is maskable by the TV and other things but now I clearly hear tghe buzzing above everything else, I did not notice any noticable sudden hearing loss however.

Thanks for the replies doctor .
Dr. Nagler

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 #6 
So first of all, I really don't think you have anything to worry about. In fact, I honestly believe it much more likely that what you are experiencing is coincidence rather than some sort of a pharmacological effect of the drug. The thing is ... there is no way to know for sure. In my opinion it is highly unlikely that you have suffered some sort of damage to your auditory system. In fact, I suspect that by now your tinnitus may be settling back down regardless of whether it is coincidence or pharmacological effect (unless you purposely focus on it, of course!)

I'd be interested in knowing where on the Internet you read that tinnitus "is one of the most common and major side-effects of ED drugs" - because it's simply not true. 

Hope this helps.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Bart

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 #7 
Thanks for the replies Doctor Nagler,it is much appreciated.

It did not settle back down completely yet but it is reassuring to read that it most likely will .

Is it possible that the spike is psyhological in nature as I was worried what the drug would do for my tinnitus before I even took it ?

I think I read that tinnitus is a common side effect on some tinnitus forum from people who experienced similar things , it also is listed as a side-effect in the leaflet but I understand that tinnitus is listed as a side-effect in the leaflet of almost every drug.

Thanks again,
Bart
Dr. Nagler

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 #8 
Yes, it is quite possible that the concern you had prior to taking the Cialis about the possible effect of the drug on your tinnitus was the actual culprit rather than any pharmacological effect of the drug itself. No way to know for sure, of course, but if I were a gambling man, that is absolutely where I'd put my money - especially because, contrary to what you read, tinnitus is not one of the most common and major side-effects of ED drugs. So you take a drug while under the (false) impression that tinnitus is one of its most common and major side-effects, and it becomes a self-fulfilling prophecy. That would be my guess. [I did not raise this possibility in my initial response, preferring to call it coincidence, because I did not wish to introduce psychology into the mix unless you yourself brought it up.]

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Bart

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 #9 
Thanks dear Doctor Nagler,


For what it's worth , after a good nights sleep the spike seems to have settled down for the most part , so either it was a side effect of the drug or it was indeed psychological , in any case it seems to be temporary, thankfully , I tought I would post this update in case anyone is reading this thread.

The only thing that worries me is that I am suppose to take this drug on a regular basis , maybe I could try and lower the dose even more, do you think it is reasonably safe to continue this drug after my mind made the link , falsely or not , with increased ringing ? 


I would ask my urologist but he does not know anything about tinnitus and simply would say to continue the drug . So here I am asking the expert in the field of ringing 

Dr. Nagler

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 #10 
Quote:
The only thing that worries me is that I am suppose to take this drug on a regular basis , maybe I could try and lower the dose even more, do you think it is reasonably safe to continue this drug after my mind made the link , falsely or not , with increased ringing ?

Safe in what way? Not exactly sure what you mean. Sorry.

Stephen M. Nagler, M.D. 

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Bart

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 #11 
Sorry for the lateness of my reply ,

I meant safe in regards for my tinnitus .

Unfortenatly a good 2 months later my ringing has not subsided, I even feel like it got worse over time , here are couple of things I did in the meantime :

- Had an audiogram with my audiologist : no changes or extra hearing loss compared to my previous test from 1 year ago 

- Contacted the pharmacy where I bought the Cialis and they told me that they never heard of another case where someone mentioned tinnitus as a side effect, let alone hearing loss, I was the first . My urologist and my GP told me the same thing ." It is not known to cause tinnitus or hearing loss but never say never off course " Maybe I am just unlucky and because I allready had tinnitus I am more susceptible to further damage from raised blood pressure or vascolidators , hurting the blood flow to the delicate ear  ? 

- My audiologist thinks that initially the drug might have caused a temporary spike, wich is not all that uncommon, but because my anxiety and panick over it causes it to remain in a heightened state so to speak, he thinks once I can get my anxiety in check the spike will go back down to baselevel as there is no sudden hearing loss .

I am worried though , even if it is just because of anxiety that I made the (temporary) increase chronic by freaking out over it ? Is that even possible ?

Your tought and opinion on this would be greatly appreciated.

Sorry for my late reply and the wall of text !
Dr. Nagler

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 #12 
Bart, tinnitus loudness is a multi-factorial phenomenon. If you are still struggling at this point, perhaps you should consider seeing a hearing healthcare professional with particular expertise in tinnitus and hyperacusis so that these issues can be properly teased out and addressed as they apply to your particular situation. Here I can only speak in generalities. Another option might be to set up a Telephone or Skype Consultation with me - but if you can actually see somebody for a proper evaluation, that would be preferable.

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Bart

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Posts: 19
 #13 
Hello Dr. Nagler ,


It has been several months now and my tinnitus had returned to it's base level eventually , with some fluctuations along the road ?

It improved so much in fact that after some talks with my therapist and urologist, they tought it was ok to start it up again , low single dose .

My therapist explained that it most likely was a conditioned automatic reflex that a temporary spike from medication can cause prolonged problems , we wxorked on that problem and after long talks I was confident that that was indeed the culprit , an irrational fear of certain medications .

My urologist, my GP and the pharmacist all seemed confident that the drug could cause temporary spike , any permanent damage is hughly unlikely and they where not at all convinced that that was the cause of my prolonged spike .

So against my better judgemt I started it up again last night, and initally things where fine, my tinnitus actually was gone for a couple of hours and me and my wife where very pleased .

However, after a couple of hours some nasty side effects set in, heavy sweating, restless feeling and yes , another dramatic increase in tinnitus volume, I barely slept at all despite taking a tranquilizer and it does not seem to have improved , now I understand that Cialis has a long half life and that it might take awhile before things settle back down again.

But after lookig though peoples experiences with this drug it seems that tinnitus is no all that uncommon , and that numbers of people suffer from permanent tinntus after taking just one pill .

I remember you saying that the current drugs for ED on the market or not in any way harmfull to the ear ? I seems that people who allready have tinnitus are more susceptible to this ?

I think this was yet another mistake that I made .

I could use some reassurance and an honest answer from a tinnitus proffesional as yourself .

My apologies if I bring it up again .

Thanks in advance ,
Bart
Bart

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 #14 
Here is an interesting but disconcerning article ...

[link deleted - smn]
Dr. Nagler

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 #15 
Quote:
I could use some reassurance and an honest answer from a tinnitus proffesional as yourself .

OK, Bart. Here's how I see it ...

Forget about Cialis and all the other PDE5 inhibitors. These drugs are simply not for you. Whether the issue is pharmacological or psychological is really irrelevant. You are never going to be 100% sure, and anything less than that will bug the spit out of you. It's just not worth the hassle. 

Talk to your urologist about alprostadil urethral suppositories or alprostadil injections. And screw the Cialis! :-)

Quote:
Here is an interesting but disconcerning article ...

I looked at the article and deleted the link from your post because the only thing about it that is interesting and disconcerting is that the general public is not always properly equipped to evaluate the medical literature. [I mean no offense; I doubt whether I would be properly equipped to evaluate an article in your line of work!] The first thing to look at when reading medical articles is whether or not they are published in one of the more highly-regarded journals. Usually if somebody is going to go through the time and effort of writing an article, he or she is going to try to get it accepted in the best journal that will accept it! In the case of the article in question, it appeared in a rather obscure journal, and one has to wonder why. Then you need to look at whether or not the data are reliable and independently verifiable. But the data in the article represent scattered anecdotes rather than properly controlled studies, which means they are neither reliable nor verifiable. And finally you look at the conclusion, which basically states that in order to justifiably draw any inferences whatsoever from the data, a proper reliable and independently verifiable study should be undertaken. Which is something anybody who has experience reading the literature knew before clicking on the link in the first place!

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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