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Ringing in ears
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Ringing in ears

Hi all,
    is ringing in the ears a symptom of hep c?  My husband who was recentley dx has been complaining of this on and off lately.  
                                                                                     thanks, kat
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23 Comments Post a Comment
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179856_tn?1333550962
On treatment it's usually a sign of hemolytic anemia, which is common for heppers to get with all the ribavirin we take.
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717272_tn?1277594380
It's a common sign of hearing loss.  The brain is trying to make up for the sound that's no longer being received (and I thought brain was supposed to be the smart part of a human being).

Also a fairly common side effect of the drugs used for Hep C treatment.
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Avatar_f_tn
I have to say that I don't think tinnitus/ringing in the ears IS a fairly common side effect of Hep C treatment.  I know some people who have had that happen to them but they are very few.  I think the percentage of those who have permanent thyroid damage is in the 20 percentile thereabouts and tinnitus is far far less. I think overall it would be a very, very small percentage of people and would not qualify as fairly common.
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Avatar_m_tn
It's not common but it can be serious so see a doctor. There are articles suggesting an autoimmune component as well as other theories.
I have seen it mostly during treatment when many people believe an autoimmune disorder is induced or triggered by Peg Interferon.
I would see a specialist very soon whether or not he is treating and even sooner if he is treating. Generally, in that case, interferon is discontinued immediately and often any hearing loss and/or tinnitus resolves thereafter.
Mike.
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Avatar_f_tn
Thanks,
    I thought I read something on here about ringing in ears...but it may have been for people that were being treated.  He is not on treatment yet as they want to wait another 4 months to see if this is in the acute phase or if it is chronic.  kat
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179856_tn?1333550962
Why doesn't he get a biopsy to determine if he needs to treat or not? It would save the time of waiting and wondering and give you the answer you need anyway.  Acute is usually eaiser to cure I believe.....it has better odds, I think it's like over 80%.  But either way if he does have some degree of advanced liver damage (I didn't know I had the disease and was already stage 3 at diagnosis) you'll be a jump ahead?

Why would they think he was just infected? Is there a reason you would definitively think he was acute? Most of us were shocked to find out we had it but it was from along long ago and not everybody has an obvious reason (ivdu etc) that they know of that could have given it to them.
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Avatar_f_tn
I think they may be sending him for a biopsy...the doc mentioned 2 over tests that needed to be done..this was on a phone call to find out the resuslts of the genotype  which is 3a.  The reason they think it's a recent infection is because he was tested last year and he was negative.  He started feeling sick maybe during the summer...feeling tired...depressed severe joint aches and muscle pain.  When he first got the results that he was neg/pos for antibodies...the doc pulled his chart, but he tested him for the is it PCR RNA?  and his vl was 53,000.  (I thought that 53,000 didnt sound to bad....but I see I was wrong )
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87972_tn?1322664839
Hi Kat--

I doubt they will subject your husband to a biopsy if they feel he might have acute infection; if true, he would be expected to have very limited fibrosis.

Bill
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Avatar_f_tn
Hey Bill,
   do you have any idea what other 2 tests he would like to do?  I couldn't talk to him much on the phone since his office was busy the day we called for results. I know he is having an ultrasound.  They did the genotype...what else is there?  do you have any clue?  He has had alot of bloodwork done very recently between the rheumo doc..then the regular and GI doc who work in the same office.  Boy this is confusing!!  All I know is that they want to see him every month for 6 months.  When you first get the dx..you really don't know what to ask...you're clueless.
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87972_tn?1322664839
I’m actually a little surprised they ordered an ultrasound scan; they don’t even know if he’s chronically infected. My guess would be they’d order more blood tests; do you know if they’ve ordered things like iron studies, thyroid panel, comprehensive metabolic panel, serum glucose, things like that? My thinking is if they feel he’s in the acute phase, it would be hard to justify excessive medical resources or taking surgical risk if it might self-resolve.

Bill
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Avatar_f_tn
They definately want the ultrasound...I was there when he ordered it.  I just assumed the other may be a biopsy....(u know what they say when you assume)   lol  I can just here him now that they may want more blood ...haha  He thinks they are draining him already!  He already asked the doc why they couldn't use the blood they already took EEK!  (like they just save it somewhere)  The GI was the one who told us to wait for the 6 months to see if it was acute or chronic...and what he told us is that some people clear it themselves..15 to 20% in this time.  He could have it anytime since march 2008 since that was when the last blood test was performed.  Do some people feel sick when its in the acute phase?  If so...this could be another reason they think so....he was going to the doc so often since the summer...he could have had a room there.  He was never sick a day except for gallbladder surgery and rotor cuff.  I'm trying to read as much as I can but there are so many articles out there!
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Avatar_f_tn
From the article below, it would seem that waiting six months is overly long if his doc does indeed consider him to be acute.  When did the doctors first conclude he had Hep C?  He has a viral load so they must have done a PCR.  When did they do that?

http://www.hivandhepatitis.com/2009icr/easl/docs/050509_a.html


Acute hepatitis C virus (HCV) infection -- within the first 6 months -- is much easier to treat with interferon-based therapy than chronic infection, but the optimal time for starting therapy, length of treatment, and need for ribavirin are not clearly established.

In a late-breaker presentation at the 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009) last month in Copenhagen, K. Deterding and colleagues with the HEP-NET Acute HCV Study Group described findings from a randomized trial of early versus delayed treatment of acute hepatitis C.

ACUTE HEPATITIS C  


Early treatment of acute hepatitis C with interferon monotherapy is highly effective, producing sustained virological response (SVR) rates of 85% or higher, the investigators noted as background. An alternative strategy might be to delay treatment for 3 months, and only treat those patients who did not spontaneously clear the virus during that time.

The HEP-NET Acute HCV-III study was a prospective trial of patients with symptomatic or asymptomatic acute hepatitis C. Eligible individuals were either HCV antibody positive, had elevated ALT (> 10 x upper limit of normal), or were exposed to HCV within the past 4 months. None had hepatitis A, hepatitis B, or HIV coinfection.

A total of 108 participants at 72 centers in Germany enrolled between 2004 and 2008. A majority (60%) were men, the mean age was 40 years, about half had HCV genotype 1, and about 60% had jaundice (icterus). The present efficacy analysis included 89 patents; the other 19 dropped out for various reasons after randomization.

Participants were randomly assigned to receive either immediate treatment with pegylated interferon alfa-2b (PegIntron) monotherapy for 6 months (n = 52), or else delayed treatment with pegylated interferon alfa-2b plus ribavirin for 6 months starting 12 weeks after randomization in patients who remained HCV RNA positive (n = 20). All asymptomatic patients received early treatment with pegylated interferon monotherapy.


Results

In an intent-to-treat (ITT) analysis, the SVR rate was 78% for symptomatic patients in the immediate treatment arm, compared with 54% in the delayed treatment arm (P = 0.034).

Among symptomatic patients in the immediate treatment arm who achieved good adherence -- defined as taking 80% of prescribed therapy -- the SVR rate was 88%.

22% of symptomatic patients (8 of 37) randomized to the delayed treatment arm experienced spontaneous sustained HCV clearance.

The lower ITT SVR rate in the delayed treatment arm was mainly attributable to the high drop-out rate (16 of 37 patients) during the initial 12-week observation period prior to therapy.

When considering only adherent patients who remained in the study, delayed treatment with pegylated interferon plus ribavirin was comparably effective, with an SVR rate of 100% (12 of 12 patients).

Among the asymptomatic participants, the SVR rates were 69% in an ITT analysis and 88% among adherent patients.

Conclusion

"This so far largest prospective and the first randomized European trial on acute hepatitis C confirmed that early immediate treatment with [pegylated interferon alfa-2b] is highly effective in both symptomatic and asymptomatic patients," the investigators concluded.

"Delayed [pegylated interferon alfa-2b] plus ribavirin treatment resulted in lower overall response rates in this real-life treatment setting," they added, "however, if adherence can be assured this strategy seems to be of similar efficacy in symptomatic patients."


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Avatar_f_tn
Hi Trish,
They did the PCR test was done November 27th.  Thanks for all the information.  I think we should call the doc and make an appt and talk to him more and ask him about all of this.
                                                             Kat
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1117750_tn?1307390169
hang on ! acute infection with a VL of 53000, i dont think so ......must of had it at least 6 months
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Avatar_f_tn
What do you base that on?

This is an older publication but I would imagine still relevant with regard to virus production during an acute phase.

http://depts.washington.edu/hepstudy/hepC/clindx/acute/discussion.html

". Nevertheless, based on available data, investigators have described the viral dynamics of acute hepatitis as occurring in 3 phases: (1) pre-ramp up phase, also known as the eclipse phase (unknown duration), (2) ramp-up phase (lasting 8-10 days), and (3) plateau phase (lasting 45-68 days) (Figure 3) [5]. During the ramp-up phase, exponential growth of HCV occurs, with a doubling of viral load every 10.8 hours [5]. The ramp-up phase transitions to a plateau phase characterized by high-level hepatitis C viremia. Studies involving chimpanzees and humans have shown the plateau phase is typically reached within the first two weeks after inoculation of HCV via transfusion [7], but in some patients low-level viremia persists for up to 2 months before the virus even enters the ramp-up phase [5]. Serum HCV levels generally peak within 6 to 10 weeks of infection, regardless of eventual progression to chronic or resolved infection [8]. The HCV RNA levels can fluctuate widely in acute hepatitis C. Overall, approximately 70-80% of individuals infected with hepatitis C will progress to persistent infection and about 20-30% will spontaneously resolve the infection (Figure 4) [7]."
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997730_tn?1254281976
I've been experiencing the ringing in the ears, and my GI is certain that it is not caused by the HepC or the tx (I'm in my 19th week of tx, and I started getting the ringing in the ears at around week 14).

I went to my primary care doctor, and she said that Ibuprofen (which I was taking a lot of, for relief of tx side effects) can be a cause of it, as well as Wellbutrin (which I'm taking for emotional distress).  

My doctor said that I did have some low frequency hearing loss when she took a test.  

She advised that I stop taking the Ibuprofen, and after about a week, I noticed that the ringing is a lot less.  Unfortunately, I'm afraid to take too much Tylenol (hard on the liver), and Ibuprofen (hard on the kidneys) is out due to the ringing, so now I pretty much just suffer the headaches, body aches... because there is a chance that the tinnitus (ringing in the ears) could become permanent.  

That is all I know about it.  Good luck!
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Avatar_f_tn
Hi all,
     like I said....I know less then nothing about all this.  I am trying to read and ask as many questions as I can so I can learn what to do.  I don't know that it's still in the acute phase..i'm only going on what the doctor told me.  Like I said before..as of march 2008 the test was negative.  His liver enzymes were always fine as well as all of the other bloodwork.  He was always on the move from dawn to dusk..no fatigue no pain.  In August everything went haywire ...nobody could figure out what was going on with him...the weird symptoms..fatigue ..depression...then he found out it was hep c.  The test they ran for the vl was very detailed and everything was within range except his ALT was 42 and the particle part of the cholestrol was a bit high and one low....but he ate before the test...and the viral load of course was 53,000.  I don't know if this GI doctor is really on top of things or if I should try consulting someone else.  We live in NYC and we can see a specialist if need be..this doc is just very convienent.  Lately he is feeling alot better...he was treated for depression ..but he has complained of the ringing in the ears on and off which I thought was odd and he will have to ask doc about it.  He never took ibuprofen..but he was on vicodan for 2 small herniated discs last jan.  He hasn't taken them  for weeks since he;s feeling better.
Thank you all, for all your input.  I know i'm a bit of a pest with the questions but I learned the hard way that some doctors no more then others and its best to be prepared.
                                                                                 Kat
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87972_tn?1322664839
Oh my; you’re not being a pest at all. This is what this place is for; continue to ask and question. We all learn this way; it’s a win-win situation.

Let is know how things go—

Bill
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1117750_tn?1307390169
i base it on fact that the op had a test in november and was positive , meaning they have entered and by now left phase 2 , or otherwise they would have a much higher vl.
also the op said her husband subject was sick in the summer, and that the infection was possible anytime since march 08.
i base it on reading the info offered and by thinking as oppossed to listing reports pasted from the internet that i dont understand like you !
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Avatar_f_tn
Having a positive test in November doesn't mean that was when onset of acute Hepatitis occurred.  It could have started months or more before that based on the information offered.

I still don't see how anyone can predict what acute phase someone is in based on viral load alone and that's why I asked you the question - you seemed to have some kind of reasoning for it.  I don't think the question warranted your prickly response but whatever, I guess your comment on another thread of ".thats the beauty of an open forum there many views..but hopefully with one goal! " only applies when it's you who has the views.
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1117750_tn?1307390169
Having a positive test in November doesn't mean that was when onset of acute Hepatitis occurred.  It could have started months or more before that based on the information offered.

exactly hence another reason for not being an acute infection!!!!!
"keep digging"

your responce was prickly not mine, i innocently made a comment you then piped up asking me how thought that to be so! trying to make it look like i was wrong with your cut and pasted extract! as it happens looks like i was right after all!!!
why are you so argumentive i have been attacked by you before for no good reason why is that please?
re read you post and you will see how agressive it sounded , text has no tone !!!! you might want to add a few pleases and thank yous in your messages so that you sound less agressive!

".thats the beauty of an open forum there many views..but hopefully with one goal! " only applies when it's you who has the views.

you are transferring you own issues on to me here, you are the one who thinks they are right all the time, hence why you feel the need to cut and paste other peoples extracts on a subject you have limited knowledge of,!!!!!!!!!!!!!!!!!!!!!!,,,,,,hep c!

thank you for your comments though
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