DECEMBER 1989 VOLUME 14, NUMBER 4

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To carry on and support research and educational activities relating
to the treatment of tinnitus and other detects or diseases of the ear."
WHEN THE PATIENT COMPLAINS
OF NOISES IN THE EAR
ALLERGY POTENTIAL TEST
LEITERS FROM READERS
INTERNATIONAL REPORTS
NEWS AND MEETINGS UPDATES
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Starkey products, including
tinnitus maskers, are available
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Editorial and advertising offices:
American Tinnitus Association
P.O. Box 5
Portland, OR 97207
(503) 248-9985
Executive Director & Editor:
Gloria E. Reich, Ph.D.
National Chairman:
Robert M. Johnson, Ph.D.
Editorial Advisor:
Trudy Drucker, Ph.D.
Production & mailing:
Direct Mail Services, Portland,
OR 97266
Advertising sales: ATA-AD
P. 0. Box 5, Portland, OR
97207 (800-634-8978)
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Association is a non-profit
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Copyright 1989 by American
Tinnitus Association. No
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TINNITUS
TODAY
The Journal of the December 1989
Volume 14 Number 4 American Tinnitus Association
CONTENTS
4
8
8
9
10
11
12
17
TINNITUS: WHEN THE PATIENT COMPLAINS OF NOISES
IN THE EAR, by Ronald J. Goodey, Otolaryngologist, Green
Lane Hospital, Auckland, New Zealand
ALLERGY POTENTIAL TEST by Soraya Hoover, M.D. A
self-test for deciding whether you have allergies.
LETTERS FROM READERS: FILING CLAIMS WITH THE
VETERANS ADMINISTRATION
INTERNATIONAL REPORTS by Abe Shulman, M.D.
FLORIDA MEETING; FOX APPOINTMENT
ATA ADVISORY BOARD MEETS; POEM
BRITISH TINNITUS MEETING; ATA SEMINARS INFO
REGISTRATION FORM; WASHINGTON, DC TINNITUS
CONFERENCE, JUNE 1990
16 Professional Associates
16 Sponsors
16 Tributes
19 Membership Information
Cover Illustration: ''Ramona," 1988, by Portland artist Mary
Josephson, shows a young woman in a red dress reaching
upward to pick an avocado. Josephson says she is fascinated
by ears and features them in many of her paintings.
Inquiries about Josephson's work may be directed to the
Quartersaw Gallery, 528 N.W. 12th Ave., Portland, OR 97209
3
TINNITUS: WHEN THE PATIENT
COMPLAINS OF EAR NOISES
By Ronald J. Goodey BMed Sc., MB Ch 8, FRACS,
Otolaryngologist
Sensation of noise in the ears or head is
usually the result of stimulation from an external
sound source. However, it can be a sound
generated within the body by structures close to
the auditory system, usually vascular or myoclonic.
When the sensation of sound is not brought about
by such simultaneously applied mechano-acoustic
or electrical signals it meets the current strict
definition of tinnitus. (Ed. note: At the 1981 Ciba
symposium the following definition was adopted. 'Tinnitus
is defined as the sensation of sound not brought about by
simultaneously applied mechano-acoustic or electrical
signals.") It is very tempting to diagnose the
patient's complaint as tinnitus without first
considering noises generated by para-auditory
structures or even an external sound source. I
have had one patient referred as having tinnitus
who had a spider living within a cocoon adjacent
to the eardrum!
NOISES GENERATED BY PARA-AUDITORY
STRUCTURES
The body is continually producing many
noises which are not usually audible. However,
such sounds may increase in intensity until they
can be heard, e.-g. a vascular bruit or venous hum
may increase with physical activity or posture.
Sounds may become audible because of conductive
hearing loss which reduces the masking effect of
environmental sound. However, the onset of an
audible sound may be the first symptom of
disease.
VASCULAR BRUITS AND GLOMUS
TUMOURS
A patient will commonly hear and complain
of a vascular bruit. The sound keeps time with
their pulse, varying with heart rate and is usually
louder when they lie flat. A carotid bruit will
4
often be audible to the examiner. However,
branches of the external carotid may at other times
be the source of bruit. If they can be identified
and compression gives relief there is sometimes a
case for ligation. With other patients similar
sound is not audible to the examiner but may well
be relieved by gentle traction on the neck
suggesting it is arising in the vertebral system.
Such vascular bruits must be distinguished
from the glomus tumour(chemodectoma) arising
either in the middle ear (glomus tympanicum) or
close to the jugular bulb (glomus jugularae).
Frequently a tumour can be seen through the
otoscope as an inferior pulsating bluish red flush.
An impedance tympanogram may also confirm
pulsation. Further investigations may include a
jugular venogram, arteriogram, and/or CT scan.
Early recognition of glomus tumours is important
because they are almost always benign and when
small, removal is relatively straightforward.
However, if overlooked they become very large
and vascular, and involve nerves and vessels,
especially of the infratemporal region.
Arteriovenous malformations share many of
the features of glomus tumours. They may be
spontaneous or follow injury, and are usually
detected by the same investigations and require
surgical treatment.
VENOUS HUMS
Venous hums are quite common in children
and young people. They are also found in
conditions of increased cardiac output such as
thyrotoxicosis, anaemia and pregnancy. A venous
hum can usually be controlled by quite gentle
pressure on the neck and will fluctuate with neck
turning. Sometimes an arteriogram is necessary to
distinguish these from vascular bruits. Rarely,
venous ligation may be required.
MYOCLONUS
Fasciculation of the tensor and levator
palatae, the tensor tympany or the superior
constrictor produces rapid clicking sounds which
are heard by the patient and quite often by the
examiner. Rapid movement of the soft palate may
be visible or detected on an impedance
tympanogram. Myoclonus usually occurs in short
bursts, may be associated with temporomandibular
joint problems, or with other neurological
problems.
Bouts of myoclonus can often be stopped
by opening the mouth, touching the palate or
drinking cold water. If severe, the bouts may need
to be controlled with oral anticonvulsants. Rarely
division of tensor tympani tendon or dislocation of
the tensor palatae tendon may be needed.
TRUE TINNITUS
Here the sensation of sound does not
correlate with any simultaneously applied signals
either from within or without the body. Usually,
but not always, the tinnitus is associated with
some sensory neural hearing loss. While tinnitus
may be intermittent or fluctuate, the sound, when
present, tends to be continuous compared with the
pulsating or clicking sounds generated by para-
auditory structures. In general, low tone hearing
loss is accompanied by low tone tinnitus likened
to the roaring of the sea or a generator or
transformer. High toned hearing loss tends to be
accompanied by high frequency tinnitus which may
be likened to pure tones, bells or a band of high
frequency sound similar to cicadas or crickets.
Tinnitus will often increase with tiredness,
stress or stimulants such as caffeine or quinine.
Anything that makes hearing temporarily worse
tends to make the tinnitus temporarily worse.
For most people, tinnitus is less audible in
the presence of environmental sound (masking).
Carefully selected generated sounds may produce
much more effective masking. After a masking
sound is discontinued there may be a delay before
tinnitus recurs (residual inhibition). Residual
inhibition may be only partial or absent Masking
may not occur in some people and in others, any
5
noise makes their tinnitus worse.
For some patients, especially those with
cochlear deafness, intravenous lignocaine can
produce dramatic relief from tinnitus. However in
other patients lignocaine makes their tinnitus vastly
worse while in still others it has no effect at all.
Oral anticonvulsant drugs tend to have similar
effects to lignocaine but much less marked.
Various diets, vitamins, mineral
supplements, exercise, relaxation therapy and
biofeedback have all been helpful in relieving
tinnitus for some patients.
WHAT CAUSES TINNITUS?
Clearly tinnitus responds in such different
ways in different patients that there can not be a
single mechanism. According to Melding and
colleagues, the dramatic relief with lignocaine in
some patients with cochlear deafness suggests that
lack of peripheral stimulation may allow
hyperactivity higher in the auditory pathways.
However, recent experiments reported by
Wasterstrom suggest that most of the effect of
lignocaine is within the cochlea, so any such
hyperactivity must occur peripherally and hence
differ from central pain states which previously
were thought to be analogous. This may explain
the poorer correlation between response to oral
anticonvulsants and response to lignocaine of
tinnitus compared with central pain states.
Whatever the level, if the response to lignocaine is
taken as evidence of hyperactivity, the fact that it
makes some people worse suggests that, in them,
the tinnitus is associated with hypoactivity.
Tinnitus may occur in the absence of any
hearing loss. There may, of course, be
abnormalities not shown on conventional testing.
However, many of these patients have associated
abnormalities of the temporo-mandibular joint or
neck suggesting that these closely allied pathways
may influence the auditory cortex and cause
tinnitus.
Altered auditory
input
FIG. 1. The tinnitus model.
Non-auditory
input
When we synthesise sounds similar in
quality and loudness to tinnitus we find large
discrepancies. In some patients the tinnitus which
they regard as loud and intolerable is found to be
only 1 or 2 decibels above threshold. For other
patients, in whom tinnitus is tolerable, the
synthesiser may demonstrate a sound well above
threshold. Clearly there is not only a sensation of
sound but an affective reaction to it which
determines whether the tinnitus is friend or foe,
whether it dominates life or whether a patient
would almost feel lonely without it.
As a basis for management I suggest a
simple tinnitus model (fig.l). Even in complete
silence the auditory cortex receives a pattern of
messages from the auditory pathways. With
disease or damage anywhere in the pathways there
is an increase or decrease in this pattern and the
alteration would be perceived as tinnitus.
Similarly, input from the adjacent non-auditory
pathways (particularly those related to balance)
would be detected by the auditory cortex as sound.
Superimposed on this is the affective reaction
which differs not only from patient to patient, but
in one patient from time to time. Many patients
with long standing hearing loss become aware of
tinnitus which correlates closely with that hearing
loss. However, they may only become aware of
the tinnitus after a period of great stress or
depression, such as after a bereavement.
REASSURANCE WITHOUT EXPLANATION
AND UNDERSTANDING IS SELDOM
SUFFICIENT, NO MATTER HOW
PRESTIGIOUS THE CLINICIAN
6
MANAGEMENT OPTIONS IN TINNITUS
TABLE I.
Disease processes (reversed or halted)
Drugs, infection, metabolic disorder, deafness,
neck or jaw problems
Aggravating factors (minimised)
Stress, caffeine, quinine
Residual deafness (compensated)
Residual tinnitus (suppressed)
Masking, anticonvulsants, iontophoresis,
electrical stimulation
Mfective reaction (modified)
Antidepressants, tranquillisers,
biofeedback, holistic approach
Sup port groups
Disease processes May Be Reversed or
Halted: Precipitating drugs such as aspirin,
indomethacin, quinine, doxycycline, salbutamol
may need to be withdrawn. Hypotensive agents,
antidepressants and anticonvulsants, all of which
reduce tinnitus in some people, may be aggravating
or causing it in others, and their withdrawal may
result in improvement. A voidance of coffee, tea,
'cola,' red wine, spirits, cheese, chocolate,
'Marmite,' foods prepared with MSG, and many
other foods or drinks will, in the occasional
patient, result in relief from tinnitus.
Control of infection, especially tooth
abscesses and tonsil disease, is sometimes followed
by inexplicable relief from tinnitus. Correction of
metabolic disorders especially of the thyroid and of
glucose metabolism may also be followed by
improvement in tinnitus.
Correction of deafness, by treatment of
otitis media, insertion of a grommet, stapedectomy,
myringoplasty or simply temporary closure of a
perforation with a paper patch may all be followed
by relief from tinnitus. Even control of otitis
externa or removal of wax may give relief.
Control of neck problems by better posture or
trials of a soft collar may also relieve tinnitus.
A voidance of jaw clenching or tooth
grinding, correction of a bite or use of a bite plate
may be accompanied by relief from tinnitus.
Otosclerosis may be controlled with a 3-month
course of sodium fluoride 40mg daily (usually
together with Vitamin D and calcium). If the
otosclerosis is stabilised, tinnitus is often reduced.
Meniere's disease and any accompanying
tinnitus may respond to diet, salt restriction and
drugs such as betahistine, oxpentifylline and urea
solution. Treatment of depression is often
accompanied by relief from tinnitus.
Aggravating Factors Minimised:
Underlying tinnitus, usually related to sensory
neural hearing loss, will nearly always be
aggravated by stress and by excesses of caffeine.
Controlling these may keep the tinnitus at a
tolerable level.
Residual Deafness Compensated: If we
cannot correct the hearing loss, at least we may be
able to compensate for it with carefully selected
hearing aids. With modern computer technology,
our ability to exactly match the hearing aid to the
hearing loss is greatly improved. The closer the
match, the better the chance that while the hearing
aid is being worn, the tinnitus will be less or even
absent.
Residual Tinnitus Suppressed: Masking: A
hearing aid may relieve tinnitus by using
environmental sound for its masking effect.
However, a masking device which looks like a
hearing aid but is a sound generator is more
appropriate if there is no significant hearing loss,
and may be more effective in the presence of
hearing loss if used in combination with an aid.
Unfortunately the range of maskers is limited and
it is not always possible to achieve with a device
the same relief that can be achieved in the
laboratory.
Anticonvulsants: Response to intravenous
lignocaine can be dramatic but is almost always
7
brief and repeated intravenous injection is not a
useful strategy. However, if the response has been
very dramatic, tocainide (1 OOmg at night,
increasing slowly to 600mg 4 to 5 times daily),
and oral anticonvulsants such as carbamazepine
(lOOmg at night, increasing slowly to 200mg tid,
and to a maximum of 400mg tid if necessary to
achieve a therapeutic serum level), and sodium
valporate (200mg tid and 400mg at night,
increasing to a maximum of 400mg qid) may
produce some useful suppression. The tinnitus
must be sufficiently intolerable to justify the side
effects involved. An alternative is iontophoresis.
In this, lignocaine is placed in the ear canal and a
low DC current encourages its absorption through
the skin of the ear drum and possibly into the
inner ear. Its usefulness has yet to be established.
Electrical: Electrical stimulation applied
directly to the inner ear through a cochlea implant
or to the promontory through the drum, can
produce useful suppression of tinnitus in some
patients. Stimulation within the ear canal or to the
pinna is being investigated and produces brief and
partial relief in some.
Affective Reaction Modified:
Antidepressants and tranquillisers in appropriately
selected patients can have a marked effect on how
tolerable the tinnitus is.
Biofeedback (usually to achieve relaxation
of the frontalis muscle) helps some patients and
has gained considerable popularity in the USA.
Programmes of relaxation therapy seemed to
produce more consistent help for more patients.
For many patients attention to general
lifestyle, diet, sleep, exercise and
relationships can make all the difference to
whether tinnitus dominates their life or settles to a
tolerable level.
Support Groups: The aim of management
is for the tinnitus to cease to be an important
factor in a patient's life.
(continued on page 13)
ALLERGY POTENTIAL TEST
1. Do you snore when sleeping with your
ear to the side?
2. Do you feel dizzy or light-headed or feel
the floor is uneven and may dip down
under your feet?
3. Do you often have post nasal drip and
wake up with a lot of mucous in the back
of your throat?
4. Do you have a dry, hacking cough?
5. Do you breathe through your mouth
while you are sitting or resting?
6. Do you breathe through your mouth
while you are active?
7. Do your ears, nose, throat, or any part of
your body itch?
8. Do you get colds year-round and more
often than other people?
9. Are you bothered by frequent eye
irritation (itching, burning, or tearing)
without knowing why?
10. Do you experience frequent, unexplained
headaches?
If you answer "yes" to any of these you
may have allergies and will benefit from a full
work-up for pollen, molds, house dust mites, and
foods you eat frequently. Additional tests may be
indicated if your home or work has carpets or if
you live in a mobile home. Also, tell your doctor
whether natural gas, cigarette smoke, perfume, or
other smells bother you.
This information was provided by Dr.
Soraya Hoover who specializes in Ear-Nose-Throat
and Allergy in Houston, Texas. Her article about
tinnitus and allergy appeared two years ago in the
ATA Newsletter. Many patients do not realize
that allergies can make tinnitus seem worse. The
test above can help you decide whether to seek
help from an allergy specialist in your area.
8
LETTERS FROM READERS
REGARDING VA CLAIMS
"Many good citizens suffered hearing loss
in the military. In the past, little or no protection
was offered when they were near large-bore
military weapons. Later these men developed
tinnitus. Most did not know the two were
connected. Many have hidden their tinnitus for
years because they thought they were going nuts.
They had no idea what was wrong.
My question is this: Have any of your
readers filed claims with the Veterans
Administration? And have their claims been
honored?" (from W.M. in North Carolina)
Attention: Veterans with Service-connected
tinnitus and/or hearing loss.
If you have not already filed for VA
Disability Compensation, you should consider
getting help with your claim by contacting a State
Division of Veterans' Mfairs Counselor, or a
Service Representative from one of the veterans'
organizations.
Legislation in 1976 allows a 10% award,
currently $73.00 per month, for 'Tinnitus:
persistent as a symptom of head injury, concussion
or acoustic trauma.'
Other legislation in 1987 established a new
hearing-loss rating criteria, which may allow an
increased benefit, particularly for cases of profound
deafness. Since there are pitfalls with any claim,
you should get professional help, as mentioned
above. (This information from CS in New York)
Reference: VA Regulations-Title 38 Code of
Federal Regulations. Part 4 SCHEDULE FOR
RATING DISABILITIES - Trans. Sheet 23,
October 22, 1987, and Trans. Sheet 24, December
15, 1988. [Section 6260, Tinnitus; Section 8046
Cerebral arteriosclerosis; and Section 9305, Multi-
infarct dementia with cerebral arteriosclerosis.]

XIV INTERNATIONAL WORLD
CONGRESS OTOLARYNGOLOGY
MADRID, SPAIN
The XIV World Congress of
Otorhinolaryngology Head & Neck Surgery was
held in September 1989. Its success was
significant for patients with tinnitus.
Nineteen papers about tinnitus were
presented reflecting increased interest and efforts in
Europe, Japan, Russia, England, and the United
States.
Investigative studies for diagnosis were
highlighted by reports of a method which may
provide a means to measure objectively the stress
factor accompanying tinnitus; the use of the
auditory brainstem response for establishing an
electrophysiologic correlate of tinnitus; the use of
hearing and balance testing as a means of
establishing the degree of central nervous system
involvement. For treatment methods, review
articles and presentations included: the use of
lidocaine both as a test and a treatment;
biofeedback and tinnitus; masking and tinnitus
control; acupuncture and its effect on tinnitus; use
of a hepatogenic scale to measure tinnitus
intensity; the use of zinc; the association of
sensori-neural hearing loss and tinnitus.
Of interest for treatment were discussions
relating to drugs affecting the inner ear.
The Tinnitus Panel at this meeting was
organized by Dr. Abraham Shulman of the HSCB-
SUNY and included Dr. Harald Feldmann of the
University of Muenster, Dr. Jack Vernon of the
University of Oregon Health Sciences Center, Dr.
Jean Marie Aran of the National Research
Laboratory of Audiology of France, Dr. F. P.
Olivares from Caracas, Venezuela, Dr. Kitijima of
Shiga University, Japan, and Dr. Jonathan Hazell
of University College, London, England.
More than 200 people attended the panel
which was considered to have been a great
success. The next such meeting will be held in
Istanbul, Turkey.

9
INTERNATIONAL TINNITUS STUDY
GROUP - NEW ORLEANS, LA,
SEPTEMBER 24, 1989
The ITSG has just entered it's second
decade of existence. Present chairman is A.
Shulman, M.D. and Vice-Chairman is John W.
House, M.D. The group meets yearly at the
American Academy of Otolaryngology's annual
convention.
Topic for discussion this year was
'Strategies for Tinnitus Control.' Speakers were:
Jack Vernon, Ph.D., Director of the Oregon
Hearing Research Center, who presented an update
on tinnitus masking as well as the areas that are
commonly encountered in the selection of tinnitus
masking and the fitting of patients with tinnitus
maskers; John W. House, M. D., of the Los
Angeles Otologic Medical Group, who described a
medical approach which attempts to establish an
accurate diagnosis; John Emmett, M. D. of the
Shea Clinic in Memphis, described a diagnostic
approach and a method for treatment using the
drug Lidocaine and its analog Tocainide; Abe
Shulman, M.D. of the HSCB-SUNY, described his
experience using a medical, audiologic tinnitus
patient protocol designed to identify and
differentiate between clinical types of tinnitus;
Claus Claussen, M.D. of West Germany presented
various strategies of tinnitus control based upon
speculations of anatomic pathways within the
central nervous system and the neurotransmitters
involved in their function.

American Tinnitus Association
is a participant in the
Combined Federal Campaign
#0514 in the CFC Brochure
Thank You For Helping
To Fight Tinnitus
CEDARS MEDICAL CENTER
TINNITUS CONFERENCE
J.FREEMAN HEARING & SPEECH CENTER
February 2, 1990
The public is invited to attend a tinnitus
forum at 4 p.m., Friday February 2, 1990. The
forum is free and provides an excellent opportunity
to ask questions of a panel of experts. The panel
will include Dr. John House, President of the
House Institute, Los Angeles, California; Dr.
Gloria Reich, Executive Director of the American
Tinnitus Association; Dr. Donald Smith, specialist
in TMJ, Coral Gables, Florida; Dr. Jack Vernon,
Director of the Oregon Hearing Research Center,
Portland, Oregon; and Lynda Wheeler, OTR,
Occupational therapist, Miami, Florida.
Attendance is by pre-arrangement only
because of limited space. Call for reservations and
information (305) 325-4773 Contact: Oscar
Armero, MS,CCCA. Professionals wishing to
attend the entire conference may obtain information
from the contact listed above.
GERALDINE DIETZ FOX
FIRST CHAIRPERSON FOR THE NA T/ONAL
DEAFNESS AND OTHER COMMUNICATION
DISORDERS ADVISORY BOARD
Mrs. Fox's interest in deafness began 32
years ago when she contracted mumps as a teacher
in a nursery school and became deafened in one
ear. She has been working since 1986 to promote
the creation of the new institute winning support
of the late congressman Claude Pepper, Senator
Tom Harkin, and maPy other members of congress.
The new institute will focus on hearing
research and research in related program areas.
"COPING WITH TINNITUS"'
e STRESS MANAGEMENT & TREATMENT
e TINNITUS MANAGEMENT IS OFTEN
COMPLICATED BY ANXIETY AND STRESS
e NOW A UNIQUE CASSETTE PROGRAM IS
AVAILABLE DESIGNED TO PROVIDE DAILY
REINFORCEMENT AND SUPPORT FROM THE
STRESS OF TINNITUS WITHOUT COMPLEX
INSTRUMENTATION & VALUABLE OFFICE TIME
There is a growing i nterest in psychological methods of tinnitus
control such as systematic relaxation procedures which help the
patient cope with the tension of tinni tus.
Subj ects with tinni tus are being taught ways to relax as part of a
total tinnitus program which may include hearing aids, tinnitus
maskers and progressive muscle relaxation based on principles of
conditioning. Relaxation procedures are usually easily mastered and can be performed daily in the
patient's home environment. It has been demonstrated that the relaxation response can release muscle
tension, l ower blood pressure and slow heart and breath rates.
A relaxation method has been developed entitled Metronome Conditioned Relaxation (MCRI which
has successfully treated for many years chronic pain, tension headaches. insomnia and many other
conditions.
A
ASSOCIATED
HEARING
CENTERS
The program consists of one cassette tape of Metronome Conditioned Relaxation and two additional
tapes of unique masking sounds which have demonstrated substantial benefit 1vhenever the pali ent
feels the need of additional relief. These recordi ngs can be used to induce sleeping or as a soothing
backdrop for activity and can be played on a simple portable cassette player.
ALL ORDERS MUST 8E ACCOMPANIED 8Y
CHOCK. VISA. MASTERCARD, OR INSTin.rTIONAL P.O.
6796 ~ T ST., UPPER DARBY. PA 19082
Phone (215) 5285222
ATA ADVISORY BOARD ANNUAL
MEETING - NEW ORLEANS, LA,
SEPTEMBER 25, 1989
The following board members were present
for the annual meeting. Jack Clemis, M.D., John
Emmett, M.D., John House, M.D., Robert Johnson,
Ph.D., Gail Neely, MD., and Abraham Shulman,
M.D. Others attending this meeting were Robert
Brummett, Ph.D., Barbara Goldstein, Ph.D., Paul
Guth, Ph.D., Douglas Kees, Charles Norris, M.D.,
John Risey, M.S., Jack Vernon, Ph.D. and Gloria
Reich, Ph.D.
Dr. Reich presented the executive director's
report. AT A continues to grow and to provide
services to approximately 200 new people each
week. The national headquarters provides general
information for public and professionals, guidelines
and support for self-help groups, and produces
various publications including Tinnitus Today.
AT A represents tinnitus sufferers nationally
through its activities in organizations such as the
National Voluntary Health Agencies, Council of
Representatives, and the Council for Better Hearing
& Speech Month. Tinnitus information is provided
to other organizations, (e.g. American Academy of
Otolaryngology, American Speech Hearing
Association, National Hearing Aid Society,
American Academy of Audiology, The TMJ
Foundation) through representation at their national
meetings. Details of this report are included in the
AT A Annual Report which is available on request
from the national office.
Topics of discussion included the continuing
need for board members to encourage research
about tinnitus. Grants for tinnitus research studies
are available to qualified scientists. Application
guidelines may be obtained by writing to ATA -
Grants, PO Box 5, Portland, OR 97207.
The board was asked to submit their
nominations for the 1989 Hocks Award candidate.
11
A SOUND NOT MADE
The dis-ease is tinnitus.
(Doctors say I will not be driven mad.)
The cause cannot be identified.
I alone attract the lightning.
Pitch varies from its low roar of engines
to the oscillating scream of the world storm.
As I can
I listen
Like some diviner of cosmological weather.
Mostly
I seek a mask.
The world is such a place.
There is no silence for me anymore.
Let there at least be music
to rush like silence
framing the terrible intrusion.
It measures the black
myself
empty receptacle.
The horn's call is not limited to the end.
Too bad
the poet will bear not less than everything.
Music is percussion then.
Can you perceive the fluttering heart
beneath the disheveled wing?
I am the siren man.
My bomb goes off constantly.
Feet
move to snake rattles;
mysterious syllables fall
on implacable hungers
belly full.
by John Campion, Austin Texas
HANDS ACROSS THE WATERS
ATA AND BTA COOPERATE TO
ENCOURAGE INTERNATIONAL
TINNITUS EFFORTS
Gloria Reich, ATA Executive Director, and Bill
Anderson, BTA Chairman, meet at tinnitus
conference in London.
Members of the British Tinnitus Association
working party met with Dr. Reich at the Royal
National Institute for the Deaf in London, England,
on September 14, 1989 to discuss the future
direction of BT A and the possible formation of an
international tinnitus organization.
BTA has been active for about 10 years
and provides information and services to about
50,000 people in England. Tinnitus support
services are provided through the RNID in the
person of David Wiggins, Coordinator. These
services promote general public awareness about
tinnitus through training seminars, research, and
information dissemination. BT A consists primarily
of the self-help groups which maintain a role of
mutual support for the tinnitus sufferer. The groups
offer varying degrees of counseling, raise funds for
tinnitus research, cooperate with research programs,
have social activities, educate the public and
professionals as to their condition, and act as
informed consumers and feed back ideas on
services to policy makers and administrators.
12
PROFESSIONAL CONTINUING
EDUCATION 1990 TINNITUS
SEMINAR PROGRAMS
Requests are now being processed for pre-
registration material for the first 1990 seminar.
This meeting will be held in Northern California.
The date is tentatively set for March 1990.
If you have already contacted us about the
seminar you will be receiving a packet sometime
in January.
The object of the seminar is to provide
theoretical and practical information for physicians,
audiologists, hearing aid specialists, and counselors
of tinnitus patients about the current techniques for
evaluating and managing tinnitus.
Participants should have a basic knowledge of
the anatomy and physiology of the hearing
mechanism and should be familiar with the basic
techniques needed to assess human hearing.
The evaluation and management of tinnitus
patients will be discussed in detail. Information
will be shared regarding appropriate test
instruments, questionnaires, use of existing
technologies for the assessment of tinnitus, and
followup procedures.
Continuing education credits will be available.
Among those preparing material for the seminars
are Dr. Robert E. Sandlin, Dr. Jack A. Vernon, Dr.
Robert M. Johnson, W. F. S. Hopmeier, Dr.
Murray Grossan, Dr. Robert Sweetow, and Dr.
Gloria E. Reich.
COURSE ENROLLMENT IS LIMITED. SPACES
WILL BE RESERVED IN THE ORDER
REGISTRATIONS ARE RECEIVED.
Watch your mail for further details.
(Continued from page 7)
We do not always achieve this. For those patients
in whom tinnitus is a continuing annoyance there
is tremendous benefit to be gained from joining a
support group. In such groups the patient finds
other people with similar or even worse tinnitus.
Together they share advice on how to cope with it,
and keep abreast of the latest developments in its
management. If a patient cannot ignore it, then
they are better to be familiar with it. Such
support groups can be contacted through the
Australian Tinnitus Association or through the
Hearing Association of New Zealand. (ed. note
Self-help groups in the U. S. may be contacted
through the American Tinnitus Association)
CONSULTATION
History: Is the tinnitus unilateral or
bilateral? Did it slowly develop or have an abrupt
onset? Is it steady or fluctuating? Is there
associated hearing loss, and if so, is it
symmetrical? Is there vertigo or other associated
problems? What is the tinnitus like?
Examination: Examination of the ears, nose
and throat, neck and jaws is essential. Listen for
any bruits.
MANAGEMENT
1. Are there any identifiable causes to treat?
Are there drugs to withdraw, is there wax or
infection to deal with, did the onset correlate with
depression that should be treated and are there
metabolic problems?
2. Is the noise pulsatile without an audible
bruit and not relieved by gentle traction on the
neck? If so, it may need investigation to exclude
a glomus tumour or arteriovenous malformation.
3. Is the tinnitus unilateral and if so, is
there an asymmetrical hearing loss? Ageing
changes are symmetrical and a one-sided problem
implies disease such as acoustic neuroma,
otosclerosis or endolymphatic hydrops (Meniere's
disease). If the cause of the asymmetrical hearing
has not already been decided then audiometry and
13
specialist assessment is almost certainly necessary.
4. If the tinnitus has developed slowly, is
bilateral and well-tolerated, an audiogram alone
may suffice to detect any evidence of a noise-
induced hearing loss and to further decide whether
associated hearing loss requires management. In
this situation, the family doctor can explain to the
patient that the tinnitus is due to their hearing loss.
My own method is to say that too few messages
are passing through the ear to keep the hearing
nerve busy and that, especially in quiet conditions,
the electrically active nerve generates its own
messages which are heard as tinnitus. General
advice can include the use of environmental
sounds or recorded music for their masking effects,
discussion of the various aggravating factors and
trials without them, and the possibility that the
tinnitus may be a reason to resort to a hearing aid
earlier than would otherwise be the case.
Even if symmetrical, significant hearing loss
before the age of 60 years requires specialist
referral, in the hope that the condition can be
halted.
THE PROCEDURE ON FIRST REFERRAL TO A
SPECIALIST FOR TREATMENT OF TINNITUS
TABLE II.
History
Onset
Fluctuations
Associated problems
Examination
ENT
Neck and jaw
Auditory
? Crude test for residual inhibition
Treatment (of identifiable causes)
Environmental masking
Hearing aid
Discussion
Written report or pamphlet
SPECIALIST REFERRAL (Table II)
Like his general practitioner colleague, the
otolaryngologist will enquire about the character,
onset, fluctuations, and associated problems with
hearing and balance.
'--'"'-= --.=. ~ e n e r a l examination will include the ears,
nose, throat, neck and jaws and auscultation. A
full audiogram will be routine and may include a
brief test for residual inhibition.
Management will include additional steps
such as the insertion of a grommet, closing of a
perforation with paper, exercises for the jaw or a
trial of a soft collar for the neck. However,
mostly the tinnitus will be found associated with
hearing loss, and management will centre on the
use of environmental sound for masking and on
whether or not to fit a hearing aid and/or masking
device. The most important component in the
consultation for the patient is a careful discussion
of the likely mechanisms of the tinnitus, with an
understanding of the factors that make it worse
and better and the reasons that the clinician is
confident that there is no sinister underlying
disease. Reassurance without explanation and
understanding is seldom sufficient, no matter how
prestigious the clinician. I think a personal written
report to the patient is the most effective way of
ensuring they are well informed and hence best
able to cope with their problem.
- REPEAT OR SECOND REFERRAL TO
SPECIALIST FOR TINNITUS TREAT:MENT
TABLE ill.
Reread previous report or pamphlet
History with questionnaire and extract data
Examination from worksheet and extract data
Audiology and residual inhibition test (white noise
for 60 seconds)
Special tests - food and/or drug withdrawals;
dental check for tooth abscesses; TMJ appliance
trial; patch and grommet tests; soft collar trial;
14
blood tests for thyroid hormones, GTT, Hb and
FT A; trial of sodium flouride; trial of antibiotics;
serum urea levels; diuretic, betahistine and
oxpentifylline trials; CT scan; Lignocaine test - if
lignocaine aggravates tinnitus reconsider drugs,
food, neural lesion.
For most patients thorough assessment,
explanation, understanding and a written report are
sufficient for them to cope with their problem.
For some however, the tinnitus remains intolerable
and reassessment essential.
1. Before attending again it is desirable for
the patient to reread their previous report or
pamphlet and arrive well-informed.
2. No factor in the history can now be
overlooked and a questionnaire is helpful to ensure
this.
3. Examination details are best entered in
a worksheet to ensure nothing is overlooked.
4. Audiology is repeated and additional
tests carried out, including detailed tests for
residual inhibition as a preliminary assessment of
whether or not masking devices would be helpful.
Using the history and examination, all
possible additional special tests are reconsidered.
If special tests are indicated and all results are to
hand, the lignocaine test should be carried out.
Lignocaine Test: With the patient lying
down, a maximum dosage of 2 mg/kg of 1%
lignocaine solution is drawn into a syringe. The
injection is then given intravenously and slowly
over several minutes, monitoring the patient's pulse
and talking to the patient. The patient is warned
they may feel some numbness around the mouth,
a fullness in the head and that their tinnitus may
become worse, improve, alter or be unchanged.
An attempt is made to express the relief as a
percentage - 100% is complete relief, 0 = no
change and worse is marked as such. The
response to lignocaine will help to determine
further management.
FURTHER MANAGEMENT OPTIONS FOR THE
PATIENT WITH TINNITUS
Explanation and Understanding: With the
additional information now obtained the
explanation is repeated and the patient's
understanding consolidated. Where before the
tinnitus was intolerable, the situation may now
change. The patient may be reassured to find that
the tinnitus can be relieved temporarily by residual
inhibition or by lignocaine. With this exciting
discovery, they may decide that they can cope with
their tinnitus without the help of a bulky masking
device or powerful drugs with associated side
effects.
Antidepressants and Stress Management:
The fitting of aids, maskers or use of
anticonvulsant drugs are all difficult if the patient
is depressed or under extreme stress. Relaxation
therapy or low dose antidepressants are often
desirable before proceeding further.
Aids, Maskers and Drugs: While the
techniques for fitting hearing aids have become
better and quicker, the selection and fitting of a
masking device is still time-consuming, but the
more time that is spent, the better the results.
Lack of such time limits the use of maskers.
If there is good residual inhibition, the
patient should be tried with an aid and/or masker.
If there is no residual inhibition, but
white noise is well-tolerated and lignocaine little
help, then again trial with an aid and/or masker.
If there is no residual inhibition but noise
is well-tolerated and the response to lignocaine
better than 80%, then the patient may be placed on
small doses of carbamazepine or sodium valproate
and subsequently aids and/or maskers tried.
If the masking noise is poorly tolerated
but response to lignocaine excellent, then the
patient should be put on carbamazepine, starting
with lOOmg daily and increasing each week until
200mg 3 times daily is reached. The effect may
be enhanced if a small dose of tricyclic is taken as
well. Tocainide is more likely to give relief with
15
fewer side effects but carries a greater risk of bone
marrow depression. If the response to lignocaine
was poor, then oral anticonvulsants or tocainide are
never justified.
If lignocaine is not effective and masking
poorly tolerated, the patient should be referred for
relaxation therapy. If there is associated bruxism
or other physiological signs of stress, then
biofeedback may be preferable.
If nothing helps then the diagnosis should
be reviewed, the patient encouraged to join a
support group and provided with an introduction to
further reading.
Destructive surgery is never indicated as
results are unpredictable. A third of patients may
be actually made worse and in the process lose
any hope of future treatment from newer
techniques such as electrical stimulation.

BIBLIOGRAPHY SERVICE
AT A's Tinnitus Bibliography service may be used in
two major ways: 1) Purchase of the complete bibliography
(a list of approximately 1800 writings relating to tinnitus,
including author, where published and date of publication) at
a price of $25 to ATA members, or $50 to non-members.-
2) Specific topic list. You may request a subject search list
(if you want only one or two specific topics) at a charge of
$5.00 per topic.
Hard copies of articles may be selected and ordered
from these lists. Our charge for copying the articles is $0.10
per page, plus postage and handling.

NOTICE NOTICE NOTICE
The American Tinnitus Association does not
endorse products. From time to time you may see
advertisements promising a relief or cure for
tinnitus. We suggest you contact your personal
physician who can help you decide whether or not
a product may be beneficial in your particular
case.
TRIBUTES
The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for sharing
memorable occasions in this helpful way. Contributions are tax deductible and are promptly acknowledged with
an appropriate card. The gift amount is never disclosed.
IN MEJIJRY OF
Erma Arivella
Dorthea Arnold
T. R. Bartell
Mother (Beauchamp)
M81Y Becker
Sister (Ber1<owitz)
Gibert A. Cassel
Mr & Mrs Stanley Czarnecki
Ethel Davis
Julius Dimont
Anne Coyne
Kenneth Eagle
Sister (Eggnatz)
Isadore Fernekees
Mayor Jack Hagen
Mrs Friedel Lentz
Mrs Friedel Lentz
Bob Jacobs
Leonora Malda!eiD
Cha!les R. McMaster
Mother & Brother (Moinester)
Ignatz Moscovitsh
Jane O'Garro
Lena (Oliver)
Meyer Ostrovsky
Marie Neer Pardon
Robert M. Ratner
RusseU Ross
Doris (Sachs)
Falher of Arlene Shulman
Alice Thompson's Gall Bladder
Jake & Celia Weinberger
Harvey Wilson Memorials
Delores Muntz
Donna Ewy
Ktnneth E. Wllson Memorials
Alta Turner
Don & Helen Horton
MIM Charles 0. carter, Jr.
MIM T. L. McCulley
MIM L E. McCulley
Mrs. W. R. McCulley
MIM Melvin L Hayes
MIM Richard B. Henry
Ken & Julie Hastings
MIM Nell Edds
CONTRIBUTOR
Rosem81)' Read
Angela F. DeiVillar
Don Bartell
C. Beauchamp
J. Alain & T. Drucker
Jean & Joe Woftson
J. Alain & T. Drucker
Mrs. Jane Czech
Pauline & Nathan Mar1<owiiZ
E & B Bonett
MIM Efrom Abramson
L G. Eagle
Jean & Joe Woftson
MIM Mile Kriger
Ms Ann Simone
Clifford & Margaret Hoffman
MIM Martin J. Unruh
J. Alain & T. Drucker
J. Maldarelli
MIM Sammy Hayward
Jean & Joe Woftson
Fred Fishbein
Edith George
Robert Oliver
Norman Brenschnelder
J. Alam & T. Drucker
MIM Sam Eisenberg
Mrs. Russell Ross
S. Kesselman
ATA staff
Jean & Joe WoHson
Ira Gleiberman
Univ.CO @ Boulder,Voi.Wr1<shp
Henry F. Scheig
G W & Lucy McDowell
MIM Jim McCoy
Hazel F. Johnson
Evelyn Boan
Charles & Phyllis Johnson
Duane & Joyce Johnson
Larry Johnson
Greg & Arlene Taylor
Oscar & Vera Swiler
MIM Clyde T unneU
Mabel Davidson
IN HONOR OF
MIM John Alarn Anniversary
Joseph Alarn 70th Birthday
Joseph Alam
Adele B. Alam birthday
Arlene & Sandy Levy-CasseU Anniv.
Nan-Sung Chu M.D.
James Edwa!d Snyder
Barry D. Ehrmann Good Luck
Jack Gilford 82nd Birthday
Jack R. H8!81)' Birthday
MIM Jack Har81)' Anniversary
Werner & Eleanor Harsch Anniversary
Alan Kanoff Promotion to NY Office
Joyce Koehler Birthday
George Marinelli Speedy Recovery
WOllam McCutchen Act of Bravery
Judy Moody Birthday
Claire Nutkis Speedy Recovery
Betty Portwood
Marcia V. Pruitt Birthday
Dr.& Mrs. Eugene Sayfie Kids to College
Sandy Schlater
Dorothy Siegel
Marlene Smith Recovery
Seymour Spector Birthday
MIM George WoHson 25th Anniversary
Samuel Woflson 75th Birthday
Chatie Wulliger Birthday
Jack Vernon Tinnitus SI4>POrt
SPONSOR MEMBERS July October 1989
M. Craig Bell
Robert H. Boerner
Cha!les T. Brown
L. D. Daugherty
Veva V. Gibbard
Emanuel Goldman
William & Isabel Hambright
Laurel Harvey
Harvey S. K8!P8
Eugene V. Klein
Robert M. Kyvil
Patrick S. Me Guinness
ATA PROFESSIONAL ASSOCIATES
COt-lTRIBUTOR
J. Alam &. T. Drucker
Jules H. Drucker
Trudy Drucker
J. Alam & T. Drucker
J. Alain & T. Drucker
Bergen Tinnhus Group
Verta M. Cowan
Mamacita & Gramps
Jean & Joe
Robert Har81)'
MIM Robert Harary
Charlie & Brenda Rush
Jean & Joe WoNson
J. Alam & T. Drucker
Bea & Joe Weintraub
Jean & Joe Woffson
Barry A. Curran
Jean & Joe
Robert E. Wilson
Beth West
Jean & Joe WoHson
Faye Schlater
Betty Friedman
Jean & Joe WoHson
Marie Spector
Jean & Joe
Jean & Joe WoKson
Richard C. Wulliger
Debbie Siciliano
Mary Meikle
Stuart M. Mitchell
T eleforo & Ramona Perez
Harry L Rickens
Wayne C. Sabean
Raymond & Sylvia Smith
Daniel J. Stange
Blanche Ware
Alt!rey D. Wentworth
Dr. Robert M. Woods
Professional Associates provide support to ATA at the sponsor level or above. The list below includes only those
people who have responded since the last issue to our recent request for referral update. Names of those
responding after November 1, 1989 will appear in the next issue.
Nancy J. Ahrens
George Atkins, DMD
Elias N. Costi8/l8S, DDS
Anne L Curtis, MS
D. Daspit, MD
M. Monica Dietsch
John R. Emmett, MD
Mel Grant, MA
Kenneth Greenspan, MD
Richard L Gresham, MCD
Paul W. Hartman, Ph.D.
Susan Healea, MA
Soroya Hoover, MD
John W. House, MD
Ron Hum
Eldon B. Huston
16
Yash Pal Kapur. MD
June F. Kennedy, Ph.D.
Barbara Kruger, Ph.D.
Robert D. McQuistan, MD
Mile Michel
Gale Miller, MD
William H. Moretz, Jr.,MD
Richard J. Osborn, MA
Robert H. Payne, MS
John Alsey, MCD
Dave Sisson
Donald G. Smith, DDS
Keith P. Smith, MD
WiUard C. Spiser
Judith Tampoll, MA
TINNITUS II EASTERN REGIONAL CONFERENCE
TINNITUS II EASTERN REGIONAL CONFERENCE, a one day seminar providing education and increased advocacy for people with ringing in the ears and head noises, is being spon-
sored by a consortium of self-help groups in the Eastern Seaboard states, affiliated with the American Tinnitus Association. The Fort Washington Tinnitus Group in Maryland serves as
host. The Conference will be held at the Quality Hotel Capitol Hill, 415 New Jersey Ave. NW, Washington, D.C. 20001 on june 9, 1990, 1-800.228-5151.
The Conference will generate community and public support while providing a forum for tinnitus sufferers, offering information on the latest development, advances and research in
this area, as well as suggested therapies for the alleviation of tinnitus.
Concurrently with morni ng and afternoon speakers will be Exhibits and Workshops. There will be a l uncheon with an address by a well known personality.
P i e ~ cui on dotted line
REGISTRATION FORM
(Complete a separate registration form for each attendee. If additional forms are required, photocopy.)
TINNITUS II EASTERN REGIONAL CONFERENCE
SATURDAY, JUNE 9, 1990
QUALITY HOTEL CAPITOL HILL
Washington, D.C. 20001
1-800.228-5151
Pre-registration Deadline:
March 31, 1990
S 15.00 per person now thru
March 31, 1990.
$25.00 per person after
March 31, 1990
I plan to attend the TINNITUS II conference and understand I must report to the registration desk upon arrival.
LUNCHEON:
Early Registrants:
After March 31:
$10.00
$15.00
DO NOT SEND CASH I SEND PAYMENT ALONG WITH COMPLETED REGISTRATION FORM TO: TINNITUS II EASTERN REGIONAL CONFERENCE, P.O. BOX 441228, FORT
WASHINGTON, MARYLAND 20744
NAME !PLEASE TYPE OR PRINT PLAINLY)
ADDRESS
NAME & LOCATION OF SUPPORT OR SELF HELP GROUP
(.,...)PLEASE CHECK APPROPRIATE BLOCKS
D ATA MEMBER
D I do not have Tinnitus but I
am a family member or friend.
D Other
I CITY
0 Tinnitus Sufferer
WORKSHOPS, SEMINARS & PANELS (Please indicate your preferences in numerical order).
1. COPING STRATEGIES:
D Mental Health Aspects of Tinnitus
D Exercise & Nutrition
D AlcohoVOrugs & Ti nnitus
11. REHA81LITATIVE PROCEDURES:
D Drug Therapy
D Cochlear Implants
0 Dental Treatments
111. 0 TINNITUS RESEARCH
IV. 0 MASKERS & HEARING AIDS
0 Support Facilities
0 Psycho-social Impact of Tinnitus
0 Noise & Its Consequences
D Electrical Stimulation
D Autosuggestion/biofeedback
V. O OTHER: _________________ _
I WOULD APPRECIATE YOU SENDING ME LITERATURE ON THE FOLLOWING:
D Local Transportation and Parking (local buses/transit line require exact change).
0 Travel Information.
NOTE: Hotel reservations must be made directly by calling the QUAliTY HOTEL CAPITOL HILL on: 1-800-228-5151.
DONATIONS
D I can not attend the conference, but I would be interested in having my name l isted in your program as a Donor.
ADVERTISING
I would be interested in advertising in your program
D Full Page (8x10) $100.00
D Half Page (8x5) $60.00
SPONSORSHIP
I STATE
D Tinnitus Service Provider
D Stress Management
0 Family Support Systems
D Medical Treatments
D Cognitive Therapy
D Business Card - $25.00
I ZIP CODE
We would appreciate sponsors for our conference luncheon, or our Friday night cocktail reception (6/8). For a $50.00 minimum you and your organization will be listed in our program
and publicly recogni zed at our luncheon.
TOTAL ENCLOSED:
Registration
Luncheon
Donation
Advertising
Sponsorship
@ $ ----per person ____ people
@ S per person people
($50.00 Minimum)
17
TOTAL
$ ______ _
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UIJ ..

What is tinnitus? It's a subjective
experience of hearing a sound, ring,
or a noise when no such external
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it head noises, ringing .. , or other
similarthings. TheOregonHealth
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reputation
Two names you know you can trust.
ACIIVAIR. 0 DURI'CR ..
AMERICAN TINNITUS ASSOCIATION
P.O. BOX 5, PORTLAND, OR 97207
ADDRESS CORRECTION REQUESTED
Sound Leadership 1M
NON-PROFIT ORG.
U.S. POSTAGE
PA l 0
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MEDtCAL ADVISORY BOAAD
Jacit 0. C19mis, M.D.
Chocaoo. lllon1$

Ponland, Oregon
John R. Emi!IMI. M.D.
Memphlo. 'leMessee
CMo Foster. M.D.
San o..go, Calllotrna
Rlcnard L Goode. M.D.
Caldornoa
W.F.S. Hcpmelor
S1 t..cxiiS. Mt$$0Un
JOlin W. H"""- M.D.
Los Angeles. C81<f<J<nia
Roboft M. Johneon. Ph.D.
Por11and. Oregon
Gale. W. Miller, M.D.
Cnc.nnatJ Dhro
J. Gail Neely. M.D.
Oldal>oma Ol<lahom8
Jerry L Northern, Ph. D.

Goo.ve F. Rood, M.D.
Syracv.aNeNYork
Robert E. Sandlln, Ph.D.
El ca,on, Calolornoa
Abraham Shulman, M.D.
New 'lbrk. New 'lbrl<
M&Miield Smilh, M.D.
San Jooa, CaloiOrnoa
Harold G. Tabb. M.D.
New Orleans. Loo1S18<1a
HONORARY DIRECTORS
Tho Honorable Del Clawson
US House o1 Rapresenlabves, Rei
The Honorable Marl< D. Hatfleld
Unrte<l States Sena:o
LEGAL COUNSEL
Henry C. B,.;lhaup4
Stool, RM!s, Bolay, Jones & Gray
Portland. Oregon
BOARD OF DIRECTORS
Dan Robert Hocks
Ponland. Oregon
Robert M. Johnson. Ph.D.
Cf\a1rman, pro tam
Ponland. Oregon
Phrllp 0. M0<10n
Por11and. Oregon
Gloria E R"'ch. Ph 0
E""""'""' O.recl<>r
Por11and, Oregon
Thomas S. Wlssbaum. C.P.A
Ponland, Oregon
American
Tinnitus
Association P.O. Box 5 Portland, Oregon 97207 (503) 248-9985
December 1989
Congratulations. Because of generous contributions from people like
you, we're able to send you this latest issue of Tinnitus Today.
When your life changed because of the distressing chronic condition
called tinnitus, everyone suffered. What's worse, no one can see your
problem.
We want you to know that no matter how much tinnitus troubles you,
we can help. American Tinnitus Association programs can assist you in
managing your tinnitus. If you are:
... seeking a place to find help, ATA can provide you with
referrals to professionals who know about tinnitus and are successfully
treating patients. They will get you started on the right track to tinnitus
control.
. .. looking for someone to talk to, ATA can give you the
names of the tinnitus self-help groups and support networks in your area.
Tinnitus patients can meet and share their experiences and coping
strategies with each other.
. . . searching for answers, A TA can help you find them.
Several times each year, ATA holds public forums throughout the country
where you may come and ask questions of a panel of tinnitus experts.
Information is also available through ATA publications.
... asking for a cure, there isn't one available ... yet! But,
your support of ATA helps to fund necessary research that will eventually
provide relief for all tinnitus sufferers.
Help us help you. Your generous contribution helps us fund all the
programs which are so desperately needed.
With gratitude,
?;,
Gloria E. Reich, Ph.D.
Executive Director
P. S. Please make a gift today, it really is needed.