A GROWING PROGRAM

Bob Johnson
Our travels around the country and Jack Vernon ' s
recent trip to Europe have pointed out an ever growing
interest in the area of tinnitus . Along with this
interest, has come the need for sever a 1 changes in
programming and for the design and development of
new equipment. f1any of these changes were fore-
seeable and have been sorely needed for the proper
treatment of tinnitus patients.
A recent change of primary concern to those inter-
ested in the tinnitus masking program regards the
procedure by which professionals are certified to
participate in the program. Previously, as many
of you the qualifying and educational program
had been conducted at the University of Oregon Health
Sciences Center. Over 500 physicians, audiologists
and hearing aid dispensers have attended these
training sessions and many have developed tinnitus
programs in their respective geographic locations.
because of the extensive of interest
a decision was recent ly made to develop tinnitus
workshops which will be conducted in several of the
larger cities throughout the United States .
The primary goal of these workshops is to provide
training for professionals interested in the evalu-
ation and management of the tinnitus patient . These
training sessions will be conducted on a monthly
basis and are scheduled to begin in January 1979.
The scbedule for 1979 is as follows :
January 18,19
February 8,9
flarch 3,10
April 19,20
folay 17,18
June 21,22
September 13,14
September 27,28
October 25,26
November 29,30
Portland, Oregon
llashington, D.C.
Vai l, Colorado
Boston, tlassachusetts
Chicago, Illinois
Philadelphia, Pennsylvania
Atlanta, Georgia
Diego, California
New York, New York
Da ll as, Texas
The workshop meets the criteria for 10 hours of
in Category II for the Physician 's Recog-
nition At<Jard of the American Medical Association.
Also approval has been given by the Hearing Instru-
ments Institute for credit to apply tot<Jard National
Hearing Aid Society recertification and Stqte Li-
censing Board requirements. Finally, all partici-
pants receive a certificate from the American
Tinnitus Association.
As indicated earlier, interest in the tinnitus pro-
gram also led to the development of several new
instruments for the use of evaluating and treati ng
tinnitus patients. The long awaited tinnitus syn-
thesizer is almost a rea l ity and two models should
be commercially available within the next couple of
months. These synthesizers will allow for definitive
measures of the patients' tinnitus and both units
will also provide a system that the clinician can
utilize to monitor high frequency thresholds of
Volume 4, No. 1 January, 1979
The American Tinnitus Association
E
patients treated with qtotoxic drugs. Additional
information regarding the synthesizers can be obtained
by contacting the American Tinnitus Association, P.O.
Box 5, Portland, Oregon 97207.
Even more exci ting than the development of the tinnitus
synthes i zer, i s the design of the new masking units
promise to enhance the effectiveness of the
masking program. Several limitations in the present
maskers have created problems which current technol ogy
promises to overcome. Already, commercially available
are high frequency maskers which have energy up through
17,000 Hz. These units have been experimentally a-
vailable for the past three months and have been used
successfully in the treatment of patients whose tin-
nitus i s above 8,000 Hz . Although the frequency res-
ponses of these instruments are not exactly repeatable
from unit to unit, t hose patients with high frequency
tinnitus have benefited signi ficant ly from the use of
them.
A resolution to an even more difficult problem may be
soon forthcoming. One of the most difficult situations
which cl ini cians encounter in masking tinnitus patients
i nvolves patients with high frequency sensorineural
hearing losses where the tinnitus is located in the
depressed area . In order to effectively mask these
patients, the clinician is forced to increase the in-
tensity of the noise sufficiently to overcome the
hearing loss. However, in so doi ng, the wide bands
of noise in the present maskers tend to i nvade the
areas where there i s no hearinn loss and cause the pa-
tient discomfort . (See Figure 1) As a consequence,
PRESENT MASKER OUTPUT CHARACTERISTICS
FREQUENCY, kHz
the patient is reluctant to substitute the external
signal of the masker for his own tinnitus. In order to
overcome thi s problem, maskers must be des i gned which
will produce narrow bands of noise which (See F1gure 2)
PROPOSED MASKER OUTPUT CHARACTERISTICS
I 2
FREQUENCY, kHr
will only a small area around the tinnitus
frequency. Such units would greatly decrease the
overall level of noise, but more importantly would
limit the noi'se to the depressed frequency region.
The manufacturers of tinnitus maskers have been
aware of this problem for some time and considerable
research has been directed towards solving the prob-
lem. A prototype instrument is presently available
which would satisfy this need and hopefully,
will be commercially available to the clinician in
the near future. However, with the availability of
narrow bands of noise, the onus will be on the
clinician to definitely and accurately determine
the pitch of the tinnitus. As Dr. Mitchell so
clearly demonstrated in the last ATA Newsletter,
those patients with high frequency hearing losses
have only a small region surrounding the tinnitus
frequency where the masking signal effectively masks
the tinnitus (See Figure 3).

... $k , ..
An examination of this figure reveals the difficulty
one could encounter in masking the tinnitus patient
if the pitch was incorrectly identified. In the
case of this patient, if this tinnitus had been
identified at 2,000 Hz instead of 6,000 Hz approxi-
mately 70 dB of additional energy would have been
needed to effectively mask her. Such a mistake
would almost, assuredly, result in the rejection of
the masker.
A final problem which, again, the manufacturers are
attempting to resolve relates to the output of the
maskers. Presently, the maskers deliver a signal
which ranges in intensity from approximately 40 dB
to 90 dB SPL. For those patients with normal or
near normal hearing the output of the masker with
the volume control in the "off" position provides
a signal (40 dB SPL) which is objectionable to the
patient. This problem can be partially controlled
through the use of sintered filters or lambs wool.
However, neither of these methods provide a satis-
factory means of controlling the output and manufac-
turers are attempting to design instruments with
increased attenuation.
The continuing problem of insufficient masking for
the patient with a severe hearing loss also remains.
Unless the clinician is successful in masking the
tinnitus from the contralateral side, relief for this
patient must be obtained through other means of treat-
ment. Fortunately, in addition to the masking pro-
gram, advancements in the treatment of tinnitus pa-
tients through the use of biofeedback and drug therapy
are continuing to be made. It is, indeed, rewarding
to see the increased interest which has developed
over the last few years with regard to the treatment
of tinnitus patients. However, the road to success
in this area is bumpy and we have a long way to
travel.
The above photo was taken at the Ameriaan Aaademy of
and meetings in October.
Dr>. Bob Johnson of the Tinnitus Clinic in Portland,
Oregon is locating the tinnitus of Mrs . EUner W.
Lorenz on an ATA synthesizer whiZe Mr. Robert Hocks,
National Chairman of the American Tinnitus Assoc.,
explains the masking program to her husband Dr. Lorenz.
The Lorenz residence is in Colton, California.
As in past years, many interested persons stopped to
chat and inquire about the Zatest dispersements of
information.
dues are due
Phe following message comes from Mrs. Gloria Reich,
Administrator with the American Tinnitus Association.
As we embark on the New Year 1979 we can reflect on
our many new friendships made this past year and
acknowledge your great support and interest in the
work that we all are sharing.
Our ATA Newsletter mailing list has increased a
hundredfold in the last three years to bring you the
news of tinnitus developments.
In 1979 we shall be endeavoring to train hearing pro-
fessionals from all over the country in the latest
techniques of tinnitus management. There are now
500 persons so trained and that number will double
this next year. Hhile these people will be able to
bring relief to a good number of tinnitus sufferers,
the big questions still remain unanswered - Hhat
causes tinnitus? ... Hhat cures tinnitus?
Our hope is to raise enough money beyond the expenses
of the ATA Newsletter, correspondence and workshops
to be able to contribute in a significant way to
research projects on tinnitus.
ATA's sole source is private contributions
such as yours and therefore we ask the continuation
of your financial support through your annual member-
ship. Additional gifts for a special occasion or in
memory of someone dear are a thoughtful way to honor
a friend and also to further a worthwhile cause. An
envelope is enclosed for your tax-deductible contri-
bution. 11ay we hear from you soon?
t1oving??
Please don't let us miss you, keep in touch.
Name:
New address:
Pf;e .ar>ticZe was written by a patient of the
at the University of Oregon Health
Cen::er. Drucker is a FeZZow of the
Amenaan Wnters
1
Association and holds a
Ph.D. in English. '
DRUGS THAT CAN CAUSE TINNITUS
Trudy Drucker
Introduction
In the course of seeking treatment for my ear disease
four otologists to whom I reported severe'
t1nn1tus and considerable pain . None volunteered the
information that aspirin would be an unwise choise
for my earaches, and I had consumed jarsful of the
stuff before learning of its common side effect. The
ATA Newsletter printed letters from patients who had
been given amitriptyline or imipramine for tinnitus-
induced depression and who found that the tinnitus
got worse after these drugs and the depression not
too surprisingly, did not get better. I began'a
drug-watch for tinnitus-inducing agents, and
th1s paper resulted from my research.
Hethod
Carefully prepared and indexed abstracts of medical
literature were available for 13 years, 1964 through
1976, and these were scanned for reports of tinnitus
presumably induced by drugs . (t4r. Paul de Haen of
New York kindly gave me access to his files.)
The search_y1elded 108 relevant articles, grouped
and summar1zed below.
otherwise noted, dosages of the cited drugs
were the normal therapeutic ranges and usually
durat1on of treatment was not considered (or re-
ported) as a significant determinant . Tinnitus as
a side of drug therapy often was accompanied
ev1dence of ototoxicity (frequentl y but not
1nvar1ably reversible with discontinuance). Of
course, in many cases the tinnitus was the least
common or least troublesome of many and various side
reactions to the drugs.
Results
As expected, was cited most frequently, with
17 reports. G1ven usually for arthritis, aspirin
tinnitus_in two of 22 patients (l),in al l
pat1ents (2),1n a single patients with l upus (3),
three of ten patients (4),and in a single patient
w1th headache(5). Salicylic acid used as an oint-
ment in dermatology was by tinnitus in all
three patients(6). Ten investigative teams compared
aspirin with other drugs, usually for arthritic
in cross-over and double-blind experiments.
T1nn1tus occurred in 14 of 69 patients i n a cross-
over study with benorylate(7), and in one of 33
also crossed with benorylate(8). Two
stud1es comparing aspirin with indomethacin revealed
tinnitus in seven of 20 patients(9) and in two of
13 patients during aspirin administration (10).
Comparative administration of aspirin and naproxin
produced tinni tus in 12 of G3 patients on aspirin
and in of this group on naproxin(ll); tinnitus
1n one of patients in a similar study(l2)
ten of 42 during the aspiri n phase(13).
T1nn1tus occurred 1n 15 of 79 patients crossed with
and voltaren(l4), in six of 44 patients
crossed with aspirin and ibuprofen(l5), and in three
of 52 patients during the aspirin phase of an as-
pirin-alclofenac cross-over(l6) . One investi-
gative team attempted to correlate the serum level
of salicylate and the occurrence of tinnitus in 67
patients with arthritis and in seven healthy volun-
teers(l7) . Tinnitus was induced in 52 of these 74
subjects at salicylate levels ranging between 19.6
and 45.8 mg/100 ml; however, the serum level did not
correlate directly with the number of asoirin tablets
given daily. '
Indomethacin and naproxen are also implicated in
tinnitus, according to eight and five reports re-
spectively. Tinnitus was noted in five of 100
patients(l8), i n of 56 patients who were also
salicylates (19), in five of 24 patients(20),
of 228 patients(2l), in one of 27 patients(22),
1n of 45 patients(23), in one of 49 patients (24),
and ln. four (three of whom also took aspirin) of
20 pat1ents(25), had received indomethacin for
Tinnitus was reported by five of 83 patients
naproxen; later this group was crossed
vnth asp1r1n and 12 patients reported tinnitus(26).
Also with naproxen, tinnitus occurred in 56 of 64
in one of 49 patients(28), and in 12 of
42 pat1ents(29). One study of naproxen and a placebo
reveal ed a 7% incidence of tinnitus with the active
drug--and a 9% incidence with the placebo(30).
Quinine continues to be a reliable cause of tinnitus
eight reports during 13 years. Used '
aga1nst malar1a, the drug produced tinnitus in one of
some extent in all 24 patients(32),
1n one pat1ent(33), 1n one accidentally overdosed
patient(34), in 30 of 52 patients(35), and in 40 of
207 patients(36). Self-administered in extremely high
for aborti on or suicide, quinine caused tinnitus
1n the one(37) and two(38) patients reported for se-
vere quinine toxicity.
Ironically, people who become anxious or depressed
because of tinnitus might be given psycholeptic
that w1ll the ear disease. The major tran-
qu1l l zer haloper1dol caused tinnitus in one of 70
and ear noise developed in an unspeci-
of 45 patients given haloperidol and
a study(40). pro-
voked t1nn1tus 1n one of 32 patients(41) and in one
of 40 patients(42) who received this tranquilizer.
A sustained- release form of the antidepressant amitrip-
tyline_caused tinnitus in an unspecified percentage of
50 patlents(43). Three reports deal with imipramine
which was associ ated with the development of
in two of_53 patients(44), in an unstated percentage
of ?9 pat1ents(45), and in two of 72 patients(46).
Ipr1ndole caused tinnitus in one of 45 patients(47);
phenmetrazine administration was followed by tinnitus
of_60 patients(48); and protriptyline produced
t1n01tus 1n two of 157 patients(49). 14elitracen caused
tinnitus in "a few" of 29 patients(50) and in four of
72 patients(Sl).
The risk of tinnitus associated with antibiotics is
by many reports. Clindamycin (with
qu1n1ne) was followed by tinnitus in one of 26
patients(52); amikacin caused tinnitus in two of 35
patients(53); doxycycline was followed by tinnitus in
less than one percent of 215 patients(54); and procaine
penicillin produced "roaring in the head" in four
patients a few seconds after injection(55). Gentamicin
given orally or topically produced tinnitus in one of
127 patients with present or potential infection of the
ear, nose, or throat(56). A reversible and then repro-
duci bl e tinnitus occurred in one patient treated with
gentamicin(57) . Tinnitus was reported in an unstated
percentage of 244 patients given kanamycin(58), and
this antibiotic was by tinnitus in nine of
48 patients who had been treated for longer than four
weeks(59). 11inocycline produced tinnitus in two of
38 patients(60). Administration of streptomycin was
followed by tinnitus in one of 75 patients(61), in two
with other symptoms of ototoxicity(62), and in
two pat1ents who dropped out of a 131-patient study(63).
In the course of a 332-patient study of streptomycin
compared with ethambutol, one patient developed
tinnitus with the latter but not the formPr drug(64}
Ear noise has followed administration of several typns
of drugs as local and general anesthetics, and
as cardiac and central depressants. Benorylate ad-
ministration was followed by tinnitus in nine of 69
patients(65}, in four of 39 patients(66), and in an
unspecified percentage of 11 patients(67) . Seven of
531 patients(later 15 of 1208 patients) reported
tinnitus after obstetrical anesthesia with mepi-
vacaine(68,69); the final incidence in this large
series of patients was put at 0.1 % which increased
0. 4% when epinephrine was added to the regimen(70}.
Lidocaine was associated with tinnitus in an unspeci-
fied percentage of 66 patients(71) in two of 42
patients(72}, in 12 of 192 patients(73), in nine of
ten patients(74), and "very rarely" among a group of
149 patients(75) . One of 579 patients had tinnitus
after lidocaine anesthesia during delivery(76), and
in a larger collected series at the same hospital
tinnitus incidence with lidocaine was pl aced at
0.2%(77). Lidoflazine caused tinnitus in two of 40
patients(73), five of 20 patients(79), and one of
40 patients in a double-blind study with placebo(So;.
Some diuretic agents have been associated with tin-
nitus, but the incidence seems low. Furosemide
caused tinnitus in one patient(8l) and in another who
had received high doses(82). Clopamide and hydro-
chlorothiazide was followed by tinnitus in "a few"
of the 22 patients(83) . The combined use
of ethacrynic acid {for diures i s) and kanamycin pro-
duced profound ototoxicity incl uding severe tinnitus
in a pregnant woman, and the child was born appar-
ently without hearing(84).
Methotrexate, an antimetabolite, caused tinnitus in
one of 18 patients(BS). The antineoplastic drug
NSC 119875 produced tinnitus in about half of the
very few patients who had received it experimen-
tally(86) . Corticotropin apparently caused tinnitus
in one of 26 patients(37}; paramethasone had this
effect in a single reported patient(88); and pred-
nisolone caused "fullness in the ears" i n one of 78
patients{89). The only diagnostic agent reported
to cause tinnitus, in one of 136 patients, was
iothalamate meglumine(90).
Among drugs used to treat heart disease, practolol
caused in 15 of 27 patients(91) and it was
reported in another single patient{92). Quinidine
sulfate was associated with tinnitus in one of 13
patients(93) and in an unstated percentage of 200
patients{94) . Ear noise occurred in some of a group
of 43 patients treated with pentaorythrito1(95);
pronethalol produced tinnitus i n one patient{96),
and verapamil produced tinnitus in one of 71
patients{97). Administration of the hypotensive
drug pargyline was followed by tinnitus in two of
62 patients(98) and in one of 95 patients(99). Two
of 24 patients treated wi th the vasopressor metapro-
terenol developed tinnitus{ l OO).
The incidence of tinnitus apparently associated with
some oti1er drugs appears to be too low to be sig-
nificant, but probably there is no class of thera-
peutic agents incapable of producing ear noise in
some patients. Three antiparkinsonian drugs,
amantadine, hydroxytryptophan, and levodopa, pro-
duced tinnitus in two of 26 patients(lOl), one of
13 patients{102), and two of 50 patients{l03) re-
spectively. Nonhormonal antiarthritic agents are
also associated with tinnitus, according to four
reports. Ibuprofen treatment was followed by
tinnitus in 12 of 438 patients(l04); penicillamine
caused mild tinnitus in one of 30 patients(lOS);
caused tiunii.us ;,, one of 26
and was implicated in one of 229 pa-
tients{l07).
A comparison of dapsone and sulfadoxine in the treat-
ment of malaria indicated that tinnitus was more likely
to occur with the former drug(103). Metronidazole, an
antibacterial agent, caused slight tinnitus in an un -
stated percentage of 136 patients(109). Morphine was
reported to have caused tinnitus in two of than
a thousand patients given a single intramuscular dose{llO).
Other drugs for which only a single occurrence of tin-
nitus could be found during the search period are amino-
phylline( l ll), iron-dextran complex{112), folic acid(ll3),
methyl phenidate(l l 4), pentazocine(115), phenformin(116),
and vitamin A( 117).
Comment
Although no drug has yet been found to cure tinnitus,
it seems that quite a few drugs can cause it: numerous
medical articles cite ti nnitus as a side effect of
many drugs in current therapeutic use. Since some
patients and many physicians consider ear noises too
trivial to note , the reported incidence is probably
considerably lower than the actual incidence.
Drug- induced tinnitus, like many side effects of thera-
peutic agents, is evidently a highly idiosyncratic
phenomenon, and both i'eader and writer must beware of
hasty post hoc conclusions . The study of Lussier and
colleagues(30} during which the placebo induced a higher
incidence of tinnitus than did the active agent, is a
good example of the difficulties encountered in trying
to establish causality. However, a reasonable as-
sumption might be that patients who already have tir.nitus
would be especial ly susceptible to the possible ototo-
toxicity of a drug. With respect to certain drugs,
therefore, tinnitus patients might want to exercise
caution than would be warranted when there is no
pre-existing ear disease.
Su11111ary
Review of t he medical literature for 13 years, 1964
through 1976, uncovered 103 papers reporting tinnit.Js
as a side effect of many drugs in current medical u5e .
Aspirin and qui nine have the greatest likelihood of
causing tinnitus; antibiotics, antidepressants, lido-
caine, nonhormonal antiarthritic agents, and some drugs
used to treat heart disease can also provoke ear noises
in some patients .
References
Note: the full bibliographic citation and further in-
formation about any of the summarized articles can be
obtained by writing to Trudy Drucker at Bergen Communi-
ty Col lege , Paramus, New Jersey 07652.
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The artiaZe is tteprinted from the Hearsay,
May-June, l975, issue by permission of the editor
and Dr. David DeWeese.
A DIET FOR MENIERE'S DISEASE
David D. DeHeese, 1\.D. & Hilliam H. Saunders
The hearing loss associated with syndrome
{endolymphatic hydrops) is typically a sensorineural
loss of low tones. It is present in only one ear
in most instances. Rarely, there is bilateral endo-
lymphatic hydrops. The loss of hearing progresses
slowly, sometimes to severe cochlear damage. A sense
of fullness or pressure in the involved ear is a fre-
quent complaint when the hearing is down. Distor-
tion of certain words and diplacusis are common.
The tinnitus that accompanies this is typically a low
buzz, and it fluctuates. It is frequently louder
preceding or during the attack of vertiqo. Both
hearing loss and tinnitus remain between attacks of
vertigo.
One successful method of managing continuing vertigo
of syndrome is still that of restricting
salt 1ntake. A neutral ash, salt-free diet, when
properly controlled, and ammonium chloride will give
relief of vertigo to more than 75% of patients. The
disappointment of some physicians with the results
of salt restriction and the use of ammonium chloride
is due, we believe, to the fact that they either have
been lax in controlling the diet or have not given
large enough doses of the ammonium chloride. To ob-
tain good results, salt must be completely elimi-
nated from the diet. This means preparation of food
without salt, the use of salt-free bread and butter,
and abstinence from foods high in sodium content.
In our experience, the following diet {The Furstenberg
diet) has been effective.
1. Fluids not restricted; however, excessive quan-
tities of water discouraged.
2. Proteins unrestricted or forced; calories permit-
ted as indicated; sodium allowance low.
3. All foods to be prepared and served without salt.
4. The foods to be eaten daily:
a. eggs, meat, fish, & fowl as desired
b. bread as desired
c. cereal, one of the following: farina, oatmeal,
rice, puffed rice, or puffed wheat
d. potato and at least one of the following:
macaroni, spaghetti, rice, corn, plums, prunes,
or cranberries.
e. any fruit and any vegetable not listed below.
f. milk as desired
g. butter, cream, honey, jellies, jam, sugar &
candy{except chocolate) as desired
5. These are to be avoided: salted meat & fish;
crackers, and butter prepared with salt; spinach;
end1ve; oysters; cheese; condensed milk; raisins; caviar.
6. The following foods may be taken no more than
twice weekly: Chard; kohlrabi; pumpkin; watercress
beets; cauliflower; turnips; rutabagas; radishes; '
celery; cantaloupe; strawberries; limes; peaches; figs;
dates; muskmelon; dried currants; dried coconut but-
termilk; peanuts; horseradish and mustard. '
r rr! nl& I& fiKc-JI,
TIICI'Ii 'S A !IOtE 1 ,J ;tAN I
III/I <tiJT<:I( ltiiT'TUS Jf '
SPEECH READING: The Subtle Art
Sylvia K. Tweedle, Ed.Assoc.
In response to the many requests of tinnitus sufferers
who display hearing impairments, Ms. 'rueedle from
the Portland Center for Hearing & Speech talks about
the importance of epeeahreading.
Lipreading, speechreading, the better term, is
something on the order of Gestalt psychology: the whole
is greater than the sum of its parts.
It is the art of understanding a speaker's thought by
watching t he movements of his mouth and facial expres-
sion. It is founded upon the principl e that the muscles
which produce sound move the vocal organs, and when such
movements are revealed upon the mouth, and their signi-
ficance understood, through "seeing" and "feeling" them,
we figuratively "hear" them. It is by no means a new
discovery.
In 1648 Dr. John Bulwer wrote of "that subtle Art
which may inable One with an Observant Eie to Hear
what any man Speaketh by the 1110vi ng of his Lips." In
this statement we have the whole idea behind speech-
reading: the speechreader must develop an observant eye.
The majority of sense i mpressions reach the brain
through the eye, so that as a means of making possi-
ble a knowledge of the worl d about us the eye
precedence in' importance over the other organs . The
infant in his crib follows movement with his eyes;
the mobi le dangling above him makes him coo and gur-
gle with appreciation. When he is a bit older, his
eyes follow the familiar figures about the
room, even to the point of turning his head, and
attempting to raise it. flost human activities , how-
ever, are performed in conjunction with other people,
and for this mutual relationship, communication is
dependent upon the ears . We cannot help but realize
that it is an "ear" world we live i n; appreciation
comes to us through sound.
life is interrelational to an almost incredible de-
gree. think of each individual as a unit, and
of society as a group of units, whi l e really each
person's activities and his life are so interwoven
with that of others that a detached, absolutely in-
troverted existence cannot be a normal l ife. The
agent most essential to a healthy and happy life,
to communication, is the instrument of language.
Through language we are connected both practical ly
and emotionally to that general life of which we
are, or should be, a part .
Speechreading is a skill that will not be mastered
by everyone. Some will become adept in a short
time; some do fairly well after much practice; some
will never be good at it, despite hours and even
years of instruction and practice. It, like every
art, depends upon motivation and skill: but most
of all I feel that it depends upon the development
of the synthetic mind--or the ability to quickly
put parts and elements into a of course,
the observant eye.
According to Anne Bunger, one of the founders of the
Jena Method, there are three forms of language and
of thought: the auditory form; the visual form; and
the motor or "feeling" form. In Speechreading we
must depend on the visual and the motor forms. It
is necessary to know the feelings of the sound sen-
sations in order to recognize them in phrases and
sentences when they appear on the mouths and the
faces of the speaker, and the speechreader, in a
sense, "speaks with" the speaker subconsciously.
As stated before, the hearing handicapped are an
"eye" people; their eyes are a picture substitute
for their deaf ears. The eye, therefore, must be
trained to overcome as many of the difficulties in
speechreading as possible. The student should aim
first to see the movements as sentences, not singly .
(Hence, the Gestalt.) He should aim to see move-
ments as the words are pronounced quickly. It
would, of course, be easier to study them when
spoken slowly, but since the aim of speechreading
is to enable the student to read ordinary speech,
this procedure would defeat its own ends . And
finally, the aim should be to develop a nearly
infallible accuracy and quickness of perception of
the easi er movements leaving to the mi nd, in l arge
measure, the task of supplying the harder
The mind is much quicker than speech and thought
does not form every word. The power of association
is too strong to make this necessary. Although the
speaker says "Napoleon met defeat at the historic
battle of all the person to whom he i s
speaking needs to provoke a vivid image are two
words, Napoleon, and Waterl oo. This is the essence
of speechreading: the words in their context, or the
aforementioned power of association . Thus, f-Ir. Jones,
a brilliant attorney, and accustomed to weighing
every word methodically and judicial ly, may be a very
poor speechreader; Smith, nineteen, frivolous,
and whose conversation flits from subject to subject, may
be a very good one.
like everything one learns, speechreading is mind training,
as well as "eye" training , and this inevitably comes back
to motivation. The question one should ask oneself is
not, "how many 1 essons will it take?", but "how impor-
tant wil l this skill be in my working day, my social life,
my whole environment?" And, if one is honest, no matter
how long it takes, it wi l l be worth it.
Even in this enl ightened day- and-age the hearing impaired
try to conceal their problem. They insist on a hearing
aid that doesn't show for in the of their minds is
the thought that in admitting to a hearing loss, they are
admitting to imperf ecti on. Speechreading is a way of
hel ping one's self over this bar rier, for along with the
skill, comes the realization of the limitati ons the
hearing loss necessarily imposes upon one.
It is truly the subtl e art .
cAH"r cuft THM'
RfHGIND> 11\1
MZS. 1M' ff' Yol.t'RI
M'ISlCA&J:tf JNc:Lit.IID,
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IN 't'OUCH wt'PH It
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---------.-------------------------..---------------..---
MEDICAL ADVISORY BOARD
Bob R. Alford, M. D.
Houston, Texas
Roger Boles, M. D.
San Fr ancisco, Calif .
Howard P. House , M.D.
Angeles , Cal if.
Bob M. Johnson, Ph.D.
Por tl and, Oregon
Merle lawrence , Ph.D.
.Ann Arbor, Michigan
EXECUTIVE BOARD
HONORABLE DEL CLAWSON
Jerry l. Northern, Ph .D.
Denver, Colorado
Gunnar 0. Proud, M.D.
Kansas City, Kansas
George. F. Reed, M.D.
Syracuse, New York
Harold G. Tabb, M.D.
New Orleans, louisi ana
United States of Representatives
Washington, D.C.
DAVID D. DeWEESE, M.D.
Chainnan Dept. Otola.-yngology
of Oregon
Health Sciences Center
l!IE HONORABLE MARK 0. HATFIELD
United States Senate
Washington. D. C.
R08ERT W. HOCKS
National Chainnan ATA
Hocks Laboratories
Portland, Oregon
DAVID H. PLANT
2789 - 25th Street
San Francisco, CA 94110
CHARlES UN ICE, H. D.
10601 Horley Avenue
Downey, CA 90241
ATA Newsletter
Herlene Benson, Editor
35l5 S.W. Veterans Hospital Rd.
Oregon 9?20l


3? miHion tinnitus sufferers
"Wing l.ist of drugs (1l"4' j"rctrr Ns . t>rwikin ' s JJ"'ticl-B beg-:o:mting en Ptl9C 4. The
<Xm'f'ited by Dp. t . PharwKzcologittt at tM 1/rlivcrsity of Olocgon
i ences
DRUG
Amantadine
Ami nophy 111ne
Ala1trlptyllne
Asp! rln
Benorylate
Cllnda111)1cln
Clopamlde
Corticotropin
Dapsone
Doxycycllne
Ethacrynlc Acid
Folic Acid
Furosemide
Gentamicin
Haloperldo 1
Number of Nuni>er of Controlled
Patients Patients Experiments
Evaluated Tinnitus
26
35
50
22
6
1
10
1
69
33
20
13
33
79
44
74
69
39
11
26
2l
26
1
215
127
1
70
45
2
6
1
3
1
14
1
7
2
12
15
6
52
"few ..
<1%
no
no
no
no
no
no
no
no
no
yes
yes
yes
yes
yes
yes
yes
no
no
no
no
no
no
no
yes
no
no
no
no
no
no
no
no
yes
tlydroxytryptophan
lbuproben
13
438
no
12 no
Imipramine
Indomethacin
lotilalamate
lieglumine


29
72
100
56
24
228
27
45
49
20
136
45
5
31
5
1
1
1
1
4
Iron-dextran complex 1
KanaJ>1)'cln
Levodopa
lidocaine
244
48
50
66
42 2
192 12
10 9
149 "very rarely"'
579 1
? 0.2%
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
Lupus
Headache
Coornents
Compared with 8enorytate
Compared with Benorylate
Compared with Indomethacin
Compared with Indomethacin
Compared with Naproxln
Compared with Voltaren
Compared with Ibuprofen
Tinnitus occurred at serulll levels
ranging from 19.6 45.8 mg1
Patient also received quinine
Patients also received hydro
clorothiazlde
Compared with sulfadozlne
Patient also received kanamycin
Gave orally or topica ll y
wlth diazepam
PatIents at so received sallcylates
Three of the 4 with tlnnitis also
received aspirin
TreaU!d longer t han 4 weeks
Reference
101
53
111
43
1
2
3
4
5
7
8
9
10
11
14
15
17
67
66
67
52
83
87
108
54
84
113
81
82
56
57
39
40
102
104
44
45
46
14
19
20
21
22
23
24
25
90
47
112
58
59
103
71
72
73
74
75
76
77
DRUG
lldoflazlne
Melitracln

lle taprotereno 1
tlul'li>er of
Patients
Evaluated
40
20
40
29
72
1208
24
1-lethotrexate 18
Methyl phenl date
l*troni dazo le 136
Hlnocycllne 38
Hollndone 32
40
Mo11>hlne )1000
Naproxln 83
HSC 119875
Paramethasone
Pargyline
Penicillamine
Pentaerythrl to 1
Pentazocine
Phenformin
Phenmetrazine
Phenylbutazone
Practolol
Prednisolone
Procaine penicillin
Pronetha 1 o 1
Protrlptyline
Quinidine
Quinine
Strept0111)1cln
Sul f1npyrazone
Verapomll
VItamin A
64
49
42
62
91
30
43
60
26
27
1
78
157
13
200
3
24
1
1
52
207
1
2
75
2
131
332
229
71
Number of Controlled
Patients Experiments
Tinn1 tus
(few?)
4
15
5
56
1
12
7S
no
no
yes
no
no
no
no
no
no
no
no
no
no
no
yes
no
no
no
yes
50%(approx.) no
some(?)
15
.]
1
24
1
1
30
40
1
2
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
yes
no
no
no
CoAT!'Ients
Double-blind placebo control
Tinnitus aggravated by epinephrine
COffl!lared with aspirin
Placebo controls had a 91
incidence of tinnitus
Onset a few seconds after the
Injection of drug
Co.pared with ethal'li>utol
I

78
79
80
50
51
70
100
85
114
109
60
41
42
110
11
27
28
29
30
86
88
98
99
105
95
115
116
48
106
91
92
39
55
96
49
93
94
31
32
33
34
35
36
37
38
61
62
63
64
107
97
117
ANNUAL CONTRIBUTION AMERICAN TINNITUS ASSOCIATION
Regular Member S 10 or more 0
Sustaining Member $ 25 or more 0
Professio na I
$100 or more
0
Sustaining Member
Benefactor $500 or more 0
YOUR GIFT IS TAX DEDUCTIBLE
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Ndrne _____________________ _
Address---------------------
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The American Tinnitus Association
P. 0. Box 5
Portland, Oregon 97207
(503) 248 9985
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