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DECEMBER 1993 VOLUME 18, 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 defects or diseases of the ear."
In this issue:
Ending the Silence: The Lowdown on Alternative Treatments
Ginkgo - Fact or Fiction?
AT A's Mission 2000 Research Plan
Road to Recovery
Regular Features
SPECIAL PILLOW CAN
RELIEVE EAR NOISES
AND AID SLEEP
Your sleeping habit may be robbing you of a
proper night's sleep. The Ear Relaxer can change your
life. Austin Skaggs, the inventor of the Ear Relaxer
Pillow, reports that it has helped him and many other
people who have tried it. It is comfortable for those who
wear their hearing aids or maskers to bed. Testimonials
are available on request from Mr. Skaggs.
To order, send$17.95 (postpaid) ,outside U.S. send
$20.95 (U.S. funds), for postage paid shipment
to:
EAR RElAXER
ro
VICIDR WV 25938
Replacement pillow slips are available
for $5.00
"COPING WITH TINNITUS"
e STRISS MANAGEMENT &. TREATMENT
e TINNITUS MANAGEMENT IS OFTEN
COMPLICATED BY ANXIETY AND STRISS
e NOW A UNIQUE CASSETIE PROGRAM IS
AVAILABLE DESIGNED TO PROVIDE DAILY
REINFORCEMENT AND SUPPORT FROM DIE
STRISS OF TINNITUS WITIIOUT COMPLEX
INSTRUMENTATION &. VALUABLE omcr TIME
The program consists of one cassette tape of Metronome
Conditioned Relaxation and two additional tapes of unique
masking sounds which have demonstrated substantial benefit
\ whenever the patient feels the
need of additional relief. These
9
9
5 recordings can be used to induce
$ 5 fll ""od'
1
"g sleeping or as a soothing back-
drop for activity and can be played
+'l on a portable cassette player.
All ORDERS MUST BE ACCOMPANIED
CENT
BY CHECK, VISA, MASTERCARD,
OR INSTITUTIONAL P.O.
6796 MARKET ST., UPPER DARBY, PA 19082
Phone (215) 352--0600
Ear
A dynamic 32-page national monthly newspaper for
hearing impaired people.
We support the American Tinnitus Association, too!
Mail your Community Ear annual subscription of $19.00
today, and we will donate $3.00 to ATA in your honor.
Please fill out this coupon and mail it to:
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TINNITUS BIBLIOGRAPHY
Supplement #6, listing articles
published since the Fall of 1992, will be
available after January 1, 1994.
WANTED HEARING
AIDS AND/OR
MASKERS IN ANY
CONDITION
Donate your old instruments
to AT A and receive a receipt for a
tax-deductible donation.
What happens to the aids you
tum in? Old aids can be recycled for
parts and plastic, and sometimes are
repairable and can be used in pro-
grams to help people in underdevel-
oped countries.
Your discarded aid could give
someone less fortunate the gift of
hearing. Please help in this meaningful way. Simply package
them (a small padded mailing bag is fine,) and send to:
ATA, PO Box 5, Portland, OR 97207-0005.
If you are using UPS or another alternate shipper - our
street address is 1618 SW First Avenue, #417,
Portland, OR 97201. PH: (503) 248-9985.
Tinnitus Today
Editorial and advertising offices:
American Tinnitus Association, P.O. Box 5 Port-
land, OR 97207
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Editorial Advisor:
Trudy Drucker. Ph.D.
Advertising sales: AT A-AD, P. 0. Box 5, Port-
land. OR 97207 (8()0.634-8978)
Tinnitus Today is published quanerly in March,
June, September and December. It is mailed to
members of American Tinnitus Association and a
selected list of tinnitus sufferers and professionals
who treat tinnitus. Circulation is rotated to 200,000
annually.
The Publisher reserves the right to reject or edit
any manuscript received for publication and tore-
ject any advertising deemed unsuitable for Tinnitus
Today. Acceptance of advertising by Tinnitus Tt>-
day does not constitute endorsement of the adver-
tiser, its products or services, nor does Tinnitus
Today make any claims or guarantees as to the ac-
curacy or validity of the advertiser's offer. The
opinions expressed by coorributors to Tinnitus To-
day are not necessarily those of the Publisher, edi-
tors, staff. or advertisers. American Tinnitus
Association is a non-profit human health and wel-
fare agency under 26 USC 501 CcX3)
Copyright 1993 by American Tinnitus Associa-
tion. No part of this publication may be repro-
duced, stored in a retrieval system, or transmined
in any form, or by any means, without the prior
wrillen permission of the Publisher.
lSSN: 0897-6368
Scientific Advisory Committee
Ronald G. Amedee, M.D .. New Orleans, LA
Robert B. Brummell, Ph.D .. Portland, OR
Jack D. Clemis, M.D., Chicago, lL
John R. Emmett, M.D .. Memphis, TN
Barbara Goldstein, Ph.D .. New York, NY
Richard L. Goode, M.D .. Stanford, CA
Chris B. Foster, M.D., San Diego, CA
John W. House, M.D . Los Angeles, CA
W. F. S. Hopmeier, St. Louis. MO
Robert M. Johnson, Ph.D., Portland, OR
Gale W. Miller, M.D .. Cincinnati, OH
J. Gail Neely, M.D .. St. Louis, MO
Jeny Northern, Ph.D., Denver, CO
Robert E. Sandlin, Ph.D., San Diego, CA
Abraham Sbulman, M.D., Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Harold G. Tabb, M.D., New Orleans, LA
Honorary Board
Senator Mark 0. Hatfield
Mr. Tony Randall
Board of Oireors
Edmund Grossberg. Chicago, lL
Dan Robert Hocks, Portland, OR
Robert M. Johnson. Ph.D .. Portland, OR
Philip 0. Morton, Portland, OR
Aaron I. Osherow, St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
Thomas Wissbaum, C.P.A., Portland, OR
The Journal of the American Tinnitus Association
Volume 18 Number 4 December 1993
Tinnitus, ringing in the ears or head noises, is experienced by as
many as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Contents
4
5
10
12
15
17
22
23
25
From the Editor
by Gloria Reich
Ending the Silence: The Lowdown on Alternative
Tinnitus Therapies
by Barbara Tabachnick & ATA staff
Ginkgo- Fact or Fiction?
by Susan Seidel, MA,CCC-A
Development Directions
by Brent Mower
Membership Survey
(envelope included for return)
AT A - Mission 2000 Research Plan
compiled by Brent Mower
Meetings Update
by Patricia Daggett
Tinnitus: Road to Recovery
by Stefan P. Kruszewski, M.D.
The Best Medicine
by Barbara Tabachnick
Regular Features
20
11
26
27
Questions & Answers
Media Watch: Tinnitus in the News
Tributes, Sponsor & Corporate Members, Professional
Associates, Special & Matching Gifts
Publications List, Donation Form
Cover photograph, "Ginkgo biloba" by David Morowitz, Photography, 106/rving
Street NW, Washington, DC 20010
From the Editor
by Gloria E. Reich, Ph.D.,
Executive Director, American
Tinnitus Association
BOARD ACTIVITY
AT A's scienti fie advisory
committee met in Minneapolis
during the annual American
Academy of Otolaryngology
convention. The
members were enthustastlc m
their support of AT A's "Mission
2000" and volunteered their help to read grant
proposals and papers submitted for the 1995 Vth
International Tinnitus Seminar.
Dr. Gail Neeley stressed the importance of
maintaining stringent requirements both for grant
proposals and for papers for the 1995 meeting.
Most of the members present agreed with that
viewpoint with a dissenting view in favor of more
lenient requirements for clinical studies proposed
by Dr. Abe Shulman. Their recommendations were
presented to the Executive Board at a regular meet-
ing in November.
THENIDCD
While in Minneapolis I also had the opportu-
nity to meet with Dr. Stephen Epstein who is the
present chairman of the advisory board to the
tional Institute on Deafness and Other Commum-
cation Disorders. Dr. Epstein expressed his
willingness to cooperate with ATA and explained
the position of the NIDCD regarding tinnitus re-
search. They, like we, have had difficulty finding
high quality projects to support. Dr. Epstein also
reminded me that all hearing research will ulti-
mately benefit tinnitus sufferers.
I spoke with NIDCD director, Dr. James
Snow, and he has agreed to write an article about
the NIDCD and tinnitus research for the next issue
of Tinnitus Today. Watch for it.
According to Dr. Ralph Naunton, who spoke
to attendees at AT A's recent research meeting in
Detroit, the chances of an individual project being
funded by NIDCD is only about 20%. There are far
more proposals received than there are funds to pay
for them.
4 Tinnitus Today/December 1993
It was evident to us from talking to these
NIDCD representatives that the smaller
ing made by AT A and other private m
the area of tinnitus and hearing research are cnttcal
to many scientists. The small "see?" can
provide initial needed to JUSttfy devel-
oping major research proJects.
PUBLIC AWARENESS
It is evident to me, from my telephone calls
and letters that AT A is on the brink of a major
breakthrough in public awareness. You may think
I'm on the wrong track here and that what we want
is a breakthrough in treatment. OK, I agree, but we
need both. We won't get the "cure" until we get
more people thinking and devising new solutions
to the old problems. AT A is working to make
tinnitus a "household word" (no matter how you
pronounce it!). You can help, too by the
word about tinnitus in your communtty. We have
camera-ready copy for public service ads for maga-
zines and newspapers, and we have audio tapes f?r
radio and video tapes for TV. We have speakers m
many parts of the country who can talk to your
or business about tinnitus. We can help you wtth
background information if you want to share your
experience with tinnitus on a local "talk show".
You '11 find that involvment in ATA will even help
you forget your own tinnitus. (It worked for me!)
BOOKS
"Missing Words: The Family Handbook on
Adult Hearing Loss" by Kathleen Thomsett and
Eve Nickerson, is a beautiful and poignant
written by this mother-daughter tean:. In 1t
speaks candidly of her struggle to
a rich, productive life while losmg her
Kay adds useful information about
with someone who can't hear, and of a multitude
of options for help that are available. I liked read-
ing this book and recommend it highly. The book
won't tell you much about tinnitus but it presents a
step-by-step strategy to help cope with hearing l?ss.
Eve is now retired from secondary school teachmg,
and Kay is a writer and editor in the Department of
Veteran's Affairs. Call 1-800-451-1073 to order
this book from Gallaudet University Press. $21.95.
Ending the Silence --
THE LOWDOWN ON ALTERNATIVE
TINNITUS THERAPIES
Compiled by Barbara Tabachnick
and the AT A staff
For 22 years, AT A has been a small but very
persistent fish in an immense ocean of non-profit
health agencies, all vying for the same philan-
thropic and governmental dollars. Through these
years, there has been an unwavering determination
on the part of ATA to maintain credibility with the
established medical community as a means of de-
veloping the kind of credentials that would attract
positive attention-- and J.Qls of it. It is a persistence
that has been rewarded with success. Our Scien-
tific Advisory Board grew to contain some of the
best tinnitus-related medical minds in this country.
Our Board of Directors and Honorary Directors,
including actor Tony Randall and U.S. Senator
Mark Hatfield, is a nationally respected collective.
We became a certified National Voluntary Health
Agency affiliate, and helped in the formation ofthe
NIDCD, one of the most esteemed hearing health
institutes in the country today.
With our credentials established and a con-
stituency numbering a quarter of a million, we
purposefully continued to side-step reporting about
many "experimental" tinnitus treatments that we'd
heard about, as much to sanction the code of re-
search ethics followed by the U.S. medical commu-
nity, as to avoid offering false hope and possibly
dangerous and misleading information to desperate
people. ATA is an ally to both the medical com-
munity and the tinnitus sufferer, yet we seem to be
uncomfortably caught in the middle and drawing
fire regardless of the side on which we stand. Our
past apprehensions and the current discord have
made us stop and take a closer look at how we serve
those we serve.
Physicians and other hearing health profes-
sionals in this country have looked to AT A not only
for support of their medical therapies but also to
"fill in the gaps" for their tinnitus patients when
they've been unable to provide any concrete solu-
tions for these patients. We cannot stress more
strongly the importance of consulting with a phy-
sician first and as soon as possible. Our Profes-
sional Referral Network is the backbone of our
patient services. But we see ourselves as a more
useful tool to the professional medical community
if we offer a greater breadth of options for tinnitus
sufferers.
As a tinnitus sufferer, your concern for your
own wellness is only matched by our determination
to support your search for answers. To that end,
this issue of Tinnitus Today contains a summary
of the most current tinnitus research information in
the U.S. today, a result of the Detroit research
meeting which was held on October 16, 1993. (See
Research Plan article, p.l7.) However, those with
tinnitus in this country want AT A to be the clear-
inghouse for all tinnitus research worldwide, and if
not the proponent of it, at least the reporter of it.
With some discretionary screening and without
endorsement, we have decided to report what we
know about non-traditional tinnitus treatments, with
the hope that these therapies -- even the non-scientifi-
cally proven ones --can help. We just advise you to
read carefully, consult your personal physician or
medical advisor, and decide for yourself.
Ginkgo
Much has been written and tried regarding
tinnitus and this ancient herb. Ginkgo is used to
increase blood flow and accelerate oxygen supply
to carry away toxins. The frustration for us has
been that to date most of the scientific work in this
field has been in non-English speaking countries.
Translations of these studies have been fraught
with syntactic errors making the data hard to un-
derstand. Added confusion has resulted from the
fact that different translations of the same docu-
ments contain some contradictory data The fol-
lowing is our best current interpretation of the
translated studies.
Ginkgo-Laser
The first study that we've found using this
herb is the "Selective Photo-Biochemotherapy in
the Combination of Laser and Ginkgo Flavenex-
tract with Dr. Witt's Methodology", a 1986 Ger-
man study by Dr. Uwe Witt. This was not a
double-blind study. Five hundred people -- of all
ages with varying tinnitus-onset dates -- partici-
pated. The therapy consisted of twelve 8-minute
Tinnitus Today/December 1993 5
their tinnitus, versus 16.7% cure with NCG and
15.2% cure with ARB. It was noted that patients
whose tinnitus duration was less than 30 days had
a much better prognosis, regardless of the severity
of the tinnitus.
(Ed. note: It must be remembered that many
experts do not consider tinnitus to be established as
permanent until it has been non-fluctuating for
about 2 years. In fact, tinnitus from sudden noise
exposure will sometimes disappear in 4 to 5
months. There will always be some people who
experience spontaneous remission of their tinnitus,
without any treatment, especially during these
early stages.)
In a separate study in 1986 through the same
hospital, 10 ENT's conducted a double blind/pla-
cebo study using EGB on 103 tinnitus patients over
a 13-month treatment period. We have only the
French version of this study with a short synopsis
in English. It concludes:
"The results were conclusive as regards the
effectiveness of Ginkgo biloba extract and made it
possible to determine the prognostic value of dif-
ferent parameters. Of special importance among
these parameters were site and periodicity of the
disease. However, the Ginkgo biloba extract treat-
ment improved the condition of all the tinnitus
patients, irrespective of the prognostic factor."
In response to many letters to the Royal Na-
tional Institute for the Deaf and the British Tinnitus
Association in November 1986, following reports
about the French study, an open trial (not double-
blind/placebo) on Ginkgo biloba was conducted in
England by Dr. Ross Coles. Twenty-three patients
took 3 40mg. tablets of EGB each day for 12 weeks.
Of the 21 who completed the study, two reported
that their tinnitus was "slightly less", two others
said theirs was "very slightly less", two reported a
"very slight worsening", and one reported their
tinnitus to be markedly worse. One patient had
improvement in all of his Meniere's symptoms,
including tinnitus. Regarding the disappointing re-
sults of this trial, Dr. Coles stated "if the beneficial
results of a particular treatment cannot be replicated
elsewhere in a seemingly typical sample of patients
having the disorder in question, then there must be
grave doubts as to the widespread usefulness of that
treatment for that condition."
Since 1991, Susan Seidel, MA/CCCA, has
been conducting an open Ginkgo biloba study with
members of her tinnitus self-help group. Six people
dropped out of the study early due to mild side
effects (two had stomach upset, four had a slight
worsening of their tinnitus), but the remaining 52
people report that for the past 2 1/2 years, they have
had positive results and they intend to continue
taking the herb. (See Ginkgo - Fact or Fiction?)
In response to his interest in the French ginkgo
studies, Pawell Jastreboff, Ph.D, of the University
of Maryland Tinnitus Center, is conducting the first
(that we know of) laboratory animal studies on
EGB.
Vitamin B-12
In 1991, five different research centers in Is-
rael conducted a study comparing the vitamin B-12
levels of 113 noise-exposed army personnel: 57
patients with chronic tinnitus and noise-induced
hearing loss (NIHL), 29 patients with NIHL only,
and 29 subjects with normal hearing. The noise
exposure for all of these subjects was essentially
the same.
The recorded data show that 47% of the pa-
tients with tinnitus and NIHL had a B-12 deficiency
(250 pg/ml) versus only 19% of the subjects with
normal hearing and no tinnitus who had a similar
deficiency.
The severity of tinnitus symptoms in patients
with and without B-12 deficiency varied accord-
ingly. There is a "tendency toward more severe
tinnitus complaints from patients with (vitamin
B-12) deficiency than from patients with normal
(B-12) levels." (Ed.note: Vitamin B-12 deficiency
can occur in people who eat no animal protein.)
As an adjunct to this study, 12 of these tinnitus
sufferers were given B-12 replacement therapy via
injection over a period of four months. There was
"mild subjective improvement" noted by these pa-
tients. The authors of the study commented that
these improvements might be explained by a pla-
cebo effect but that the "slight but significant im-
provement observed should be addressed."
Tinnitus Today/December 1993 7
their tinnitus, versus 16.7% cure with NCG and
15.2% cure with ARB. It was noted that patients
whose tinnitus duration was less than 30 days had
a much better prognosis, regardless of the severity
of the tinnitus.
(Ed. note: It must be remembered that many
experts do not consider tinnitus to be established as
pennanent until it has been non-fluctuating for
about 2 years. In fact, tinnitus from sudden noise
exposure will sometimes disappear in 4 to 5
months. There will always be some people who
experience spontaneous remission of their tinnitus,
without any treatment, especially during these
early stages.)
In a separate study in 1986 through the same
hospital, 10 ENT's conducted a double blind/pla-
cebo study using EGB on 103 tinnitus patients over
a 13-month treatment period. We have only the
French version of this study with a short synopsis
in English. It concludes:
"The results were conclusive as regards the
effectiveness of Ginkgo biloba extract and made it
possible to detennine the prognostic value of dif-
ferent parameters. Of special importance among
these parameters were site and periodicity of the
disease. However, the Ginkgo biloba extract treat-
ment improved the condition of all the tinnitus
patients, irrespective of the prognostic factor."
In response to many letters to the Royal Na-
tional Institute for the Deaf and the British Tinnitus
Association in November 1986, following reports
about the French study, an open trial (not double-
blind/placebo) on Ginkgo biloba was conducted in
England by Dr. Ross Coles. Twenty-three patients
took 3 40mg. tablets of EGB each day for 12 weeks.
Of the 21 who completed the study, two reported
that their tinnitus was "slightly less", two others
said theirs was "very slightly less", two reported a
"very slight worsening", and one reported their
tinnitus to be markedly worse. One patient had
improvement in all of his Meniere's symptoms,
including tinnitus. Regarding the disappointing re-
sults of this trial, Dr. Coles stated "if the beneficial
results of a particular treatment cannot be replicated
elsewhere in a seemingly typical sample of patients
having the disorder in question, then there must be
grave doubts as to the widespread usefulness of that
treatment for that condition."
Since 1991, Susan Seidel, MA/CCCA, has
been conducting an open Ginkgo biloba study with
members of her tinnitus self-help group. Six people
dropped out of the study early due to mild side
effects (two had stomach upset, four had a slight
worsening of their tinnitus), but the remaining 52
people report that for the past 2 1/2 years, they have
had positive results and they intend to continue
taking the herb. (See Ginkgo- Fact or Fiction?)
In response to his interest in the French ginkgo
studies, Pawell Jastreboff, Ph.D, of the University
of Maryland Tinnitus Center, is conducting the first
(that we know of) laboratory animal studies on
EGB.
Vitamin B-12
In 1991, five different research centers in Is-
rael conducted a study comparing the vitamin B-12
levels of 113 noise-exposed anny personnel: 57
patients with chronic tinnitus and noise-induced
hearing loss (NIHL), 29 patients with NIHL only,
and 29 subjects with nonnal hearing. The noise
exposure for all of these subjects was essentially
the same.
The recorded data show that 47% of the pa-
tients with tinnitus and NIHL had a B-12 deficiency
(250 pg/ml) versus only 19% of the subjects with
nonnal hearing and no tinnitus who had a similar
deficiency.
The severity of tinnitus symptoms in patients
with and without B-12 deficiency varied accord-
ingly. There is a "tendency toward more severe
tinnitus complaints from patients with (vitamin
B-12) deficiency than from patients with nonnal
(B-12) levels." (Ed. note: Vitamin B-12 deficiency
can occur in people who eat no animal protein.)
As an adjunct to this study, 12 of these tinnitus
sufferers were given B-12 replacement therapy via
injection over a period of four months. There was
"mild subjective improvement" noted by these pa-
tients. The authors of the study commented that
these improvements might be explained by a pla-
cebo effect but that the "slight but significant im-
provement observed should be addressed."
Tinnitus Today/December 1993 7
Ending the Silence-- (continued)
Acupuncture
Acupuncture therapy involves the subcutane-
ous insertion of very small needles at various points
throughout the body. Occasionally these needles
are heated or electrically stimulated while in the
skin. This Chinese treatment for healing dates back
more than 2000 years and has found recent popu-
larity worldwide.
Acupuncture, it has been suggested, stimu-
lates the production of "endogenous opiates" -the
body's own natural sedatives, such as endorphins.
Building on that theory and the theory that tinnitus
and pain share the same pathway to the brain,
acupuncture as a tinnitus treatment was studied in
England in 1981. In a double blind, cross-over,
placebo study by Marks, Onisiphoron, and
Trounce, 14 tinnitus patients were tested, all of
whom had constant tinnitus and had not responded
to any other form of tinnitus treatment. Five out of
the 14 noticed a "subjective improvement" after
two acupuncture treatments while none of the pla-
cebo patients reported any improvement. No nega-
tive side effects were noted.
In 1982, a follow-up trial in Denmark on 17
tinnitus patients followed a protocol very similar to
the Marks study but found no significant improve-
ment in either the placebo or acupuncture group.
Interestingly, after the study concluded, they found
that the study participants had "a drift to improve-
ment with time which was independent of treat-
ment."
An Australian study in 1983 followed 20 tin-
nitus patients through I 0 acupuncture treatments.
Three out of the 20 reported complete disappear-
ance of their tinnitus for more than 3 months. Three
others had transient relief (lasting up to 5 days).
The remaining 14 had no change in their tinnitus.
In 1989, a controlled placebo study was con-
ducted in Israel comparing the treatments of Cin-
narizine, biofeedback, and acupuncture on 30
patients with idiopathic tinnitus. Of the 10 patients
treated with Cinnarizine, only one had some im-
provement. Five out of the 10 who had biofeedback
sessions experienced improvement, and 3 out of the 10
who had acupuncture indicated some improvement.
8 Tinnitus Today/December 1993
The overall conclusion from these studies is
that acupuncture can produce some relief for some
tinnitus sufferers. The researchers themselves uni-
formly suggested that acupuncture is a reasonable
alternative to try when other therapies for tinnitus
have failed.
Ed. Note: At press time there is pending leg-
islation that would restrict or eliminate the sale of
most herbs and vitamin supplements in the U.S. as
of 1/1/94. The passage of an alternative bill, the
Dietary Supplement Health and Education Act of
1993, would replace this legislation and allow for
continued availability of herbs and vitamins, while
requiring the creation of an Office of Dietary Sup-
plements within the National Institute of Health to
research the benefits of supplements.
GINKGO-LASER THERAPY CONTACTS
l)Dr Uwe Witt
Muhienkamp 32
2000 Hamburg 60
GERMANY
(040) 271 32 05/08
Original Ginkgo-Laser Study Author
2)Dr Klaus Peter Meyer
Kurpark -Sanatorium
897 4 Oberstauffen/ Allgau
AM Kurpark 6-8
GERMANY
Used Dr Witt's Method:Claim success rate of40%
improved - 20% cured
3)Dr Renate Swoboda
Dr Albrecht Schott
Laser-Medizin-Technik, Fehr & Fisher
Morikeweg 8, Postfach 1244
6839 Oberhausen, Rheinhausen
GERMANY
Tried to duplicate Dr Witt's study without success
4)Hans Knorr, President
Deutsche Tinnitus-Liga
Erbschloerstrasse 22
D-42369 Wuppertal
GERMANY
Ph: 0202 24 65 20
Has interpreted 3 German Ginkgo-Laser studies
(conflicting results) and is sending surveys to 200
patients who had this treatment to get their stories.
(Speaks English)
5)Dr. M. Walger &
Professor von Wedel
The ENT University Clinic
Joseph-Stelzmann Str. 9
D-50931 Cologne
GERMANY cochlea.
Ph: 0221-478-4793
Conducted Ginkgo-laser study hut were not suc-
cessful in duplicating Witt's results. Measured
laser energy that reaches cochlea.
1) B. Meyer
Service d'ORL, Hopital Saint-Antoine
184, Faubourg St-Antoine
F75571 Paris Cedux 12
FRANCE
Conducted 2 studies in 1986, 1 with ginkgo and 2
other drugs, and 1 ginkgo double blind/ placebo.
Both equate ginkgo with successful tinnitus alle-
viation.
2)Dr. Ross Coles
MCR Institute of Hearing Research
University of Nottingham
University Park
Nottingham NG7 2RD
ENGLAND
Ph: 44-602-223431
FAX: 44-602-423710
Conducted open ginkgo study with 23 people in
1986. Not successful.
3) Susan Seidel MA/CCCA
Greater Baltimore Medical Center
Dept. of Otolaryngology
670 I N Charles St
Baltimore MD 2 I 204
Ph: 410/828-2142
Conducting on-going open ginkgo study since
1991. Six people dropped out early due to mild
side effects. Fifty-two remaining people are all
experiencing positive results.
4) Pawell Jastreboff PhD
University of MD Tinnitus Center
419 W Redwood St #360
Baltimore MD 21201
Ph: 410-328-6866
Has begun animal studies
on ginkgo.
Tinnitus Today/December 1993 9
Ginkgo- Fact or Fiction?
by Susan J. Seidel, M A., CCC/A, Greater Balti-
more Medical Center, Department of Otolaryn-
gology-Head & Neck Surgery, Division of
Audiology
The Baltimore Area Tinnitus Self-Help Group
would like to share its experiences with Ginkgo
biloba.
By now most readers have heard of Ginkgo
biloba extract (EGB). It contains purified stand-
ardized extracts from the Ginkgo biloba leaf. The
herbal extract from this leaf includes a group of
substances which nutritionally seem to contribute
to mental acuity by supporting brain function. We
use a phytosome form of Ginkgo biloba. The phy-
tosome process is said to insure the most nutritional
value from herbal extracts by intensifying the
power of standardized herbs by improving absorp-
tion, increasing biological activity and enhancing
delivery of the nutrients to the cell membranes. We
have a registered pharmacist /nutritionist in our
group who has researched this Ginkgo phytosome
for us and feels that it is superior in purity and
strength. It contains no sugar, salt, yeast, wheat,
com, dairy products, coloring, flavoring or preserv-
atives. Ginkgo phytosome is a complex of phos-
phatidy )choline and standardized extract of Ginkgo
biloba containing 24% ginkgoheterosides.
For those who cannot obtain this particular
ginkgo complex, we believe the most beneficial
product would be one which is allergen-free and
contains the least preservatives or binders.
EBG appears to improve circulation, metabo-
lism, blood viscosity and neurotransmission in the
aging. Improvements with EGB seem to come from
an increased cerebral blood flow and therefore
oxygen and glucose utilization. EGB also tends to
increase the rate at which information is transmit-
ted at the nerve cell level. There have been observ-
able improvements in mental performance,
muscular rehabilitation, early senility, macular de-
generation, sensorineural hearing loss, edema, and
of most importance to us- tinnitus and hyperacusis.
Our Baltimore Area Tinnitus Self-Help Group
has 52 members taking EGB with positive results
since March 1991. We began keeping our records
10 Tinnitus Today/December 1993
at that time but some had started taking their
Ginkgo before that. Except for a slight upset stom-
ach by two members when they first started taking
Ginkgo, the 52 of us have reported no other nega-
tive side effects during the past 2 Y2 years. (Four
members dropped out of the study in the early
weeks because they felt their tinnitus was slightly
worsened and didn't want to continue taking the
EGB.)
We have followed the suggested dose of 40
milligrams three times a day with food and have
found that it should be taken consistently for at least
twelve weeks to determine its effectiveness. It
seems the longer the Ginkgo treatment continues
the more obvious and lasting the results. At least
eight days seem necessary before the first effects
are manifested.
Of our 52 who continue to take Ginkgo, we
have rated our tinnitus on a scale of 1 to 10 with I 0
being the worst. We feel the tinnitus has decreased
by 1 to 4 points. No one's tinnitus has disappeared
but we feel any improvement is significant. Six
people who reported hyperacusis noted that it has
improved for them. Other positive improvements
include general feeling of well being, improved
energy, lower blood pressure, better appetite, and
better sleeping with less fatigue.
Is our tinnitus and hyperacusis improved be-
cause we feel better and are dealing more positively
with these symptoms? We only know that those of
us involved in this program plan to remain! We will
continue to take our daily Ginkgo phytosome and
continue to share our on-going progress.
References
1. Ginkgo biloba extract bibliography and abstracts. Murdock Pharmaceuticals (Na
tures Way Products) #1 0 Mountain Springs Pari<way, Springville, Utah 84663. J u ~ .
1990.
2. Ginkgo biloba extract in Perspective. ADIS Press Urrited. Aucldand 10, New
Zealand 1990.
3. Herbal Bio-Therapy. P. 0. Box 22310. Green Bay, WISCOOSin 54305.
4. Murray, Michael. "Ginkgo Biloba Review." PhytgpPharmajca Vol.3, No.6.
5. Kleinjnen and Knipsheild. "Ginkgo biloba." The Lance! Vol.340, Nov. 7, 1992,
p.1136-1139.
6. Schui1emaker, G.E., European Institute for Orthomolecular Sciences. Ortho sup-
plement, 1988.
Media Watch: Tinnitus in the News
by Cliff Collins, Oregon freelance writer. Please
send clips, noting source and date, to Media
Watch, PO Box 5, Portland, OR 97207.
One way to know what media are having the
greatest impact in reaching people about tinnitus is
to weigh the number of calls and letters the ATA
receives once a report runs. For example, when
Ann Landers, "Dear Abby", or the National En-
quirer mention tinnitus, response is sure to follow.
ButCNN?
Apparently the all-news cable network gets
watched by a broad spectrum of the public, for the
A TA sure heard about it when the network did a
story in July on tinnitus. Everyone in the country
who had tinnitus, it seemed, had caught the show
about tinnitus research at the University of Mary-
land, Baltimore.
The program focused on Dr. Pawel Jastreboff
and his colleagues' use of what they call "auditory
habituation," which attempts to make tinnitus "less
noticeable," according to literature provided by the
school's tinnitus center. Owing largely to the CNN
broadcast, the center now has a waiting list of about
three years. (Dr. Gloria Reich, AT A's director, visited
the center and wrote about it in the last issue.)
Hmmm... : Another news story that has re-
ceived wide attention is the phenomenon known as
"the Hum," or "the Sound." At first it was thought
that the sound many people were hearing in Taos,
New Mexico, was isolated to that town. Then as
word spread, residents of at least 26 states also
reported hearing a continuous low-frequency hum-
ming sound that was loud enough to be bother-
some. This story has appeared in numerous media,
including the "Today" show, Harpers, Newsweek,
The Cleveland Plain Dealer, and others (with a
piece on the Hum in England in Tinnitus Today's
September issue).
Scientists don't know what is causing the
sound, or even if the Hum in Taos is the same as
the ones heard elsewhere. Speculation of possible
sources ranges from sound waves caused by radio,
microwaves and cellular phones; to U.S. defense
operations; to the earth's tectonic plates slipping;
to otoacoustic emissions emanating from the ears
of the people who hear it. And a host of other
theories.
The Cleveland Plain Dealer (Associated
Press, Aug.25) story said research now is concen-
trating on the individuals who hear the sound.
Probably at least some of these have tinnitus with
low-frequency noises predominant. Scientists said.
some people may be unusually sensitive to the
growing volume of electromagnetic sounds that
surround us all.
End-of-the-year wrap-up: The Los Angeles
(Aug. 22) documented the explosion in ur-
ban noise, with the unsettling thesis that as noise
has soared, official interest -- and funding for pre-
vention and enforcement-- have plunged. That's
not just discouraging, it's irresponsible ... Longtime
A TA volunteer Betty Mathis -- and her longtime
case of tinnitus -- were written up in Senior Edition,
a tabloid distributed nationally by many hospitals
... Syndicated columnists Dr. Allan H.
and Dr. Paul Donohue each wrote on tmmtus.
Bruckheim noted that he himself suffers from the
condition, shared some coping strategies (staying
occupied, playing background music, etc.), and
concluded, "If research provides a better answer to
our problem, you can bet it will appear in this
column as soon as I find out about it." ... News
photos taken at air shows, multigun salute cerem?-
nies and similar loud events frequently show chtl-
dren plugging their ears, while the adults
there "all ears." Are children's ears more sensttJve
to noise, or do adults just become so used to
bombarded with noise that they learn to ignore tt,
even at dangerous levels? Scientists tell us that our
hearing range at birth usually is far broader and
keener than even a few short years later, thanks to
environmental noise exposure.
A Noel note: This marks the three-year anni-
versary of "Media Watch: Tinnitus in the News."
Many thanks to you readers who share with others
by sending in news reports. Every item the AT A
receives is read by several people and kept on file,
and each is considered for mention here, although
all cannot be included. And, whatever your circum-
stances, may the warmth of this special season
envelop you with renewal and hope.
Tinnitus Today/December 1993 11
Development Directions
by Brent Richard Mower
Development Director
Out of simple ideas often come
grand solutions. Jill McCormack, an
ATA member from Michigan, wrote to
me in August with the idea, "We need
big money for research .... If there are
30 million people with tinnitus - ask
everyone to donate one dollar, that
would give us 30 million dollars!!"
My first thought was, if it were only that easy.
But I've mulled it over many times over the past
months and received a considerable amount of sage
wisdom in my discussions with experts in other
non-profit organizations, as well as foundation and
business leaders. It boils down to identifying your
primary audience and serving it well.
A TA has just that opportunity. Jill is right on
target. We know there are millions of Americans
with tinnitus. That is well documented. Some peo-
ple are affected to a substantial degree. Others are
able to ignore it. But all are affected. So are their
friends and family, employers, health care provid-
ers, and everyone else who plays a significant role
in their lives.
We can be an organization of millions, not
thousands. Imagine the clout we would have in
science, in medicine, in government. Imagine the
millions of dollars we could raise and use for
tinnitus research. Dollars ultimately leading to
eliminating whatever tinnitus is to everyone - be it
a debilitating, life-altering condition or a simple
annoyance.
Public awareness of tinnitus, what it is and
what it does, and public awareness of ATA and its
services will lead us to that point. There are two
equal components to increasing that public aware-
ness. First is through promotion including media
coverage, advertising and events. In the very near
future, I'll be presenting an overall plan to AT A's
management and board outlining how best to ac-
complish that. Hand in hand with that plan is the
need for your help in reaching out to your local
media with your stories.
12 Tinnitus Today/December 1993
Your own stories. That is the second com-
ponent of increasing public awareness. Putting a
human face on tinnitus makes it real for others.
Only you can do that. I'm not suggesting that you
dedicate your waking hours to complaining
about this horrible condition you have to live
with, but simply begin to let others know you
have tinnitus and what impact it has on your life.
In your own words. You'll be an incredible
source of education and the best publicity money
could never buy.
Our voice needs to be strong, but not com-
plaining. Loud, but not obnoxious. Simply tell your
story. Encourage others to tell theirs. We will reach
millions.
WORKPLACE GIVING CAN SUPPORT ATA
Many of you already contribute to ATA
through the Combined Federal (Employees) Cam-
paign or through the National Voluntary Health
Agencies campaigns. That support is significant to
AT A and helps fund many of our programs and
services. It is a simple way to budget your personal
giving and helps support agencies and organiza-
tions you care about.
A number of employers now allow their em-
ployees to designate organizations in workplace
giving campaigns that employees specifically want
their contributions to fund. Please check with your
employer to see if that option exists for you. If you
have the flexibility to specify that your contribu-
tions go to AT A, please seriously consider that
option. You'll be helping us reach the goal of
eliminating tinnitus as a health problem by increas-
ing the financial abilities of ATA to fund promising
research and education.
If your employer does not give you the flexi-
bility to name organizations such as ATA in your
workplace giving campaigns, start your own cam-
paign to encourage them to give you that flexibility.
You should have the right to make your own
choices in giving. Many major companies, such as
Wells Fargo Bank, Levi Strauss & Company, Ap-
ple Computers, just to name a few, give their em-
ployees a wide range of options for giving. Yours
should too.
Some companies only participate in the
United Way campaign. That does not preclude you
from designating AT A as the beneficiary of your
workplace giving. All United Way campaigns have
a specific designation option available to you. You
can designate ATA by requesting the designation
form from your employer and listing AT A as re-
cipient for all or part of your donation. If you have
difficulty doing that, please give me a call. I'll be
glad to help. You 'II be helping ATA make faster
and greater strides in the fight against tinnitus.
NONPROFIT SECTOR ACCOUNTABILITY
There is increasing media and legislative at-
tention to highly questionable behavior of some non-
profit organizations and about the need for all
nonprofits to provide more information to the public
about finances, governance and accomplishments.
At ATA, we look upon scrutiny as positive. It
gives us the opportunity to demonstrate that our
cause and activities deserve contributed time and
money with public confidence. We welcome your
questions and your suggestions. AT A is your or-
ganization.
1994 RESEARCH CAMPAIGN
KICKOFF SOON
Please read carefully the overview of AT A's
research mission and plans included in this issue.
We believe it holds promise for significant ad-
vances in the treatment of tinnitus. You '11 soon be
receiving information about our 1993 fundraising
goals specifically targeted for research. Our goals
are aggressive, but with your help we will reach
them. Please seriously consider our requests for
funds and don't hesitate to contact us with your
ideas or to explore our plans in greater detail. You
do and will make the difference in beating tinnitus.
News stories and congres- ..-------------...
sional hearings expose fundraising WITH THANKS ...
scams that raise money for nonex- Many thanks to Ron Spag-
istent research; reveal ridiculous PLEASE COMPLETE AND nardi, Editor/Publisher of Mod-
claims of saving lives or souls and RETURN OUR ME,Ml3ER em Drummer Magazine for his
report secret compensation ar- SATISFACTION SURVEY full page ATA advertisement
rangements that are charitable INCLUDED IN THIS ISSUE. which reached over 100,000
only to the recipients. Hustlers and YOUR OPINIONS COUNT. people in October and to David
charlatans exist in every part of Kirkwood and Shirley Byles,
society but when they operate in respective Editors of The Hear-
the name of charity it is particu- ..... ____________ _. ing Journal and The Commu-
larly disheartening. Even though nity Ear for donating
such groups represent a tiny fraction of all volun- advertising space to ATA in recent issues. Their
tary organizations, their awfulness undermines generosity means growth for ATA and is very
public confidence in the groups that perform hon- appreciated.
estly and valuably Finally, thanks to each of you for your supper-
Please be assured that ATA will strongly en- tive phone calls and letters. You have made me feel
courage aggressive prosecution of fraudulent activ- very welcome as part of the ATA family during the
ity, support regular and fuller reporting to the past six months. Our mission will not be easy, but
public of all basic information about our institu- as a team we will accomplish great things. Of that
tions, help each of you become better judges about I am convinced.
the worthiness of AT A activities, and set a very Best wishes for a very happy holiday season
high standard of trusteeship and stewardship and a healthy, prosperous new year.
among our staff and board.
PLEASE GIVE GENEROUSLY TO ATA.
Tinnitus Today/December 1993 13
SCIENTIFIC ADVISORY BOARD
Ronald G. Amedee, M. D.
New Orleans, Louisiana
Robert E. Brummett, Ph.D.
Portland, Oregon
Jack D. Clemls, M.D.
Chicago, Illinois
John R. Emmett, M.D.
Memphis, Tennessee
Chris B. Foster, M.D.
San Diego, california
Barbara Goldstein, Ph.D ..
New York, New York
Richard L. Goode, M.D.
Stanford, california
W. F. S. Hopmeier
St. Louis, Missouri
John W. House, M.D.
Los Angeles, california
Robert Johnson, Ph.D.
Portland, Oregon
Gale W. Miller, M.D.
Cincinnati, Ohio
J. Gall Neely, M.D.
St. louis, Missouri
Jerry L. Northern, Ph.D.
Denver, Colorado
Robert E. Sandlin, Ph.D.
El CBjon, california
Abraham Shulman, M.D.
Brooklyn, New York
Mansfield Smith, M.D.
San Jose, california
Harold G. Tabb, M.D.
New Orleans, Louisiana
HONORARY DIRECTORS
The Honorable Mark o. Hatfield
United Ststes Senate
Mr. Tony Randall
New York, New York
LEGAL COUNSEL
Henry C. Breithaupt
Dear Friend,
AMERICAN
TINNITUS
ASSOCIATION
P. 0 . BOX 5, PORTLAND, OR 97207-0005
As the year ends, most of us reflect on past accomplishments and make plans for future
ones. At ATA, we're pleased with the efforts and successes of 1993 which we were able to
achieve because of your support. We hope you're pleased as well. But we'll not rest on our
laurels, for much remains to be done.
You '11 be hearing from ATA more frequently about our increased focus on research.
We truly believe expanded research activities hold the key to improvements in tinnitus
treatment, leading ultimately to the elimination of tinnitus as a health problem. At the same
time, it's critical for us to expand our information and support services while medicine and
science continue their research. Providing information and support has been the cornerstone
of AT A's mission and will continue to receive substantial attention and effort.
But we can't do it without you. Your support, both fmancially and in time, enables ATA
to broaden and improve its services and activities with the goal of better serving you and
your needs. We want your input about which of our activities are important to you and how
we're doing in delivering them. Please take the time to complete and return our survey. It
will be of great assistance to us as we continue to refme, expand and improve our activities
and services. Remember, ATA is your organization.
As you consider giving in the spirit of the season, please remember AT A. Your
contributions to AT A mean additional research projects can be funded, new treatments can
be tested, and more information can be developed to help you, your family and friends, and
the medical community treating people with tinnitus. Our work is important.
Stoel, Rives, Boley, Jones & Grey, Please give generously. Your support will make a difference in the fight against tinnitus.
Best wishes from all of us at AT A for a joyous holiday season and a happy new year.
Robert Johnson, Ph.D. Sincerely,
Chairman, Portland, Or.
Edmund J. Grossberg
q foria 1. !Rs-icli
Portland, Oregon
Philip 0. Morton
Portland, Oregon
Aaron I. Osherow
Clayton, Missouri
Tom Wlasbaum, C.P.A.
Portland, Oregon
Gloria E. Reich, Ph.D.
Director, Portland, Oregon
Gloria E. Reich, Ph.D.
Executive Director
AMERICAN TINNITUS ASSOCIATION
MEMBERSHIP SURVEY
YOUR OPINIONS AND IDEAS ARE IMPORTANT TO US AND WILL
ASSIST US IN PLANNING OUR ACTIVITIES AND DIRECTING OUR
RESOURCES TO MOST APPROPRIATELY MEET YOUR NEEDS AND DESIRES. PLEASE
TAKE A MOMENT TO COMPLETE THIS SURVEY.
1. PLEASE RANK THE FOLLOWING ATA SERVICES AND ACTIVITIES IN THE ORDER OF IMPOR-
TANCE YOU FEEL IS MOST APPROPRIATE (1 BEING MOST IMPORTANT, 11 BEING LEAST IM-
PORTANT)
__ Financial support for tinnitus research
__ .Publication of Tinnitus Today
__ .Publication of tinnitus information brochures
__ .Sale of tinnitus information books
__ Professional clinician referral network
__ Establishment and support of local self-help groups
__ .Public awareness/education and prevention programs
__ Bibliography service
__ Workshops and seminars for physicians and medical providers
__ Seminars I forums for people with tinnitus
__ Lobbying and advocacy for tinnitus with Federal Government
2. HOW WELL INFORMED DO YOU BELIEVE YOU ARE ON HOW YOUR ATA CONTRIBUTIONS
ARE ALLOCATED?
__ Very well informed ___ Satisfied __ Need additional information
3. HOW WOULD YOU RATE THE QUALITY OF Tinnitus Today IN MEETING YOUR INFORMA-
TIONAL NEEDS ABOUT TINNITUS AND THE ACTIVITIES OF ATA?
____ Excellent ___ Good ___ Fair ___ Poor
4. PLEASE LIST TWO AREAS OF Tinnitus Today YOU LIKE BEST (I.e. Questions & Answers, Me-
dia Watch, Regular Columns, etc.)
5. PLEASE LIST TWO AREAS OF Tinnitus Today YOU LIKE LEAST OR BELIEVE NEED IM-
PROVEMENT (ALSO INCLUDE SUGGESTIONS FOR ADDITIONAL ARTICLES OR INFORMATION
YOU WOULD LIKE TO SEE IN Tinnitus Today.
6. PLEASE RATE THE QUALITY OF ANY BROCHURES OR BOOKS YOU HAVE PURCHASED
FROM ATA IN TERMS OF MEETING YOUR NEEDS IN PROVIDING HELP OR INFORMATION.
____ .Excellent ____ Good ___ Fair ___ Poor ___ Have not purchased
7. DID YOU SEE A PHYSICIAN OR HEALTH CARE PROVIDER LISTED IN ATA'S PROFESSIONAL
NETWORK DIRECTORY SENT TO YOU?
_ _ __ Yes ________ No
IF YES, HOW WOULD YOU RATE THE QUALITY OF CARE AND ATTENTION YOU RECEIVED
FROM THAT INDIVIDUAL OR CLINIC?
____ Excellent _ ___ Good ___ Fair _ __ .Poor
9. HAVE YOU PARTICIPATED IN AN ATA SPONSORED SELF-HELP GROUP IN YOUR AREA?
____ Yes
_____ .No ____ There are no active self-help groups in my area
10. IF YES, HOW WOULD YOU RATE THE QUALITY OF SUPPORT AND INFORMATION YOU RE
CEIVED FROM THAT SELF-HELP GROUP?
____ Excellent ____ Good - - ~ F a i r _ _ _ .Poor
11. IF ATA WERE TO ORGANIZE AN ANNUAL MEETING OR CONFERENCE WITH SPEAKERS,
SEMINARS AND WORKSHOPS FOR PEOPLE WITH TINNITUS, WOULD YOU CONSIDER AT
TENDING?
____ Yes ____ No
12. IF YES, HOW FAA WOULD YOU CONSIDER TRAVELING AND UP TO WHAT AMOUNT
WOULD YOU CONSIDER A REASONABLE CONFERENCE FEE? (Travel and lodging expenses
not included)
__ Maximum miles to conference
__ Distance would not be a consideration
$ Maximum reasonable conference fee
ENCLOSED IS MY CONTRIBUTION OF$ AS A SPECIAL GIFT TO EXPAND THE AE
SEARCH SUPPORT AND SERVICES OF THE AMERICAN TINNITUS ASSOCIATION.
PLEASE RETURN YOUR COMPLETED SURVEY IN THE ENVELOPE PROVIDED EVEN IF YOU
ARE UNABLE TO MAKE A CONTRIBUTION AT THIS TIME. WHILE WE WOULD APPRECIATE
KNOWING WHO YOU ARE, YOU NEED NOT COMPLETE YOUR NAME AND ADDRESS IF YOU
WOULD LIKE TO REMAIN ANONYMOUS, BUT PLEASE INCLUDE YOUR ZIP CODE FOR STATIS
TICAL PURPOSES.
NAME ____________________________________________ _
ADDRESS ______________________________________________ _
CITY & STATE---------------------------------------- ---
ZIP
THANK YOU FOR YOUR TIME AND GENEROSITY
AT A Mission 2000 - Research Plan
Compiled by Brent Mower
The past decade brought significant advances
in the study and treatment of tinnitus, both through
research projects specifically designed to study the
condition, as well as through anecdotal patient
observations and information gleaned from other
auditory or nervous system research. Lacking from
the process of the study of the condition, however,
has been an overall research plan or template to
guide and prioritize research activities and to en-
sure coordination among researchers. Further,
sparse communication among researchers and oc-
casional ego or "turf' wars have created fragmen-
tation of the research community involved in the
study of tinnitus.
In an effort to facilitate greater communica-
tion among researchers and develop a plan for
future tinnitus research activities and projects that
is well coordinated, prioritized and thorough, the
American Tinnitus Association held its first re-
search brainstorming session in Dearborn, Michi-
gan on October 16, 1993. Participants in the
meeting were invited by ATA based upon their past
involvement in tinnitus research. Participants in the
meeting included:
Ronald Amedee, M.D. Tulane University School of Medicine
Barbara Goldstein, Ph.D. State University of New Yol1<
Paul Guth, Ph.D. Tulane University Medical Center
Maureen Hannley, Ph.D. American Academy of Otolaryngology
Cynthia Ikner, D.O. West Virginia School of Osteopathic Medicine
Gary P. Jacobson, Ph.D. Henry Ford Hospital
Pawel J. Jastrebotf, Ph.D. University of Maryland School of Medicine
Robert M. Johnson, Ph.D. Oregon HeaHh Sciences University
Paul R. Kileny, Ph.D. University of Michigan School of Medicine
William Martin, Ph.D. Temple University School of Medicine
Mary Meikle, Ph.D. Oregon Health Sciences University
Edwin Monsen. M.D. Henry Ford Hospital
Douglas H. Morgan, D.D.S., The TMJ Foundation
Ralph Naunton, M.D., National Institute on Deafness & Comm.Disorders
CraigW. Newman, Ph.D. Henry Ford Hospital
Gloria E. Reich, Ph.D. American Tinnitus Association
Abraham Shulman, M.D. State University of New Yol1<
Robert Sweetow, Ph.D. University of California
Richard Tyler, Ph.D. University of Iowa School of Medicine
Jack Vernon, Ph.D. Oregon Health Sciences University
Donna Wayner, Ph.D. Albany Medical Center
AREAS OF TINNITUS RESEARCH
Tinnitus cannot, and should not, be consid-
ered as a single, homogenous entity. Analogously,
that would be like conducting a study on headaches
in an attempt to treat or cure them in one manner.
The study of tinnitus must be multi-disciplinary
and interactive. Consideration should be given to
identification and categorization of types of tinni-
tus rather than examining tinnitus as a generic
entity. To do so will help focus research and treat-
ment activities in a much more effective manner.
While not mutually exclusive, there are four
general areas of tinnitus research: Investigation of
the Mechanisms of Tinnitus; Diagnosis and As-
sessment of the Tinnitus Symptom; Treatment of
the Tinnitus Symptom and; Prevention of Tinnitus.
Although each area of research has its own unique
characteristics and problems, it cannot be stressed
enough that research in any of these fields must be
interactive with research in others. Outcomes must
be shared and greater coordination among research
professionals must be achieved.
In addition to these four general areas of re-
search, three more which impact tinnitus research
must be considered and furthered in order to
achieve gains in the overal I tinnitus research arena.
First, a critical need for standardization in measure-
ment and reporting exists. Second, further
epidemiological studies and organization are nec-
essary to gather important information about peo-
ple with tinnitus and their experience with the
symptom. Finally, establishment of guidelines or
standards for the level of quality of research must
be established.
MECHANISMS UNDERLYING TINNITUS
Historically, little of the research conducted
has focused on the mechanisms underlying tinni-
tus. A better understanding of both the biochemis-
try and electrophysiology of the central nervous
system will enhance some understanding and
should be encouraged and supported. However,
while studies of the basic auditory system and of
the neurological systems hold promise for better
understanding of the mechanisms of tinnitus, few
are specifically examining the symptom of tinnitus.
Therefore, considerably more research focused
on specific study of the mechanisms underlying
tinnitus is essential. Additionally, development
Tinnitus Today/December 1993 17
Research Plan (continued)
and refinement of an animal model for the study
of mechanisms, as well as treatments, is critical.
Twelve areas of study or categories were iden-
tified. To determine the etiologies of tinnitus, each
must be considered and fully examined. Each may
play a role individually or in combination with
other mechanisms or although not a mechanism,
each may be useful in the study of such. It may also
be appropriate to group these categories into
broader areas due to their interactive nature. Be-
cause it is most likely that multiple mechanisms
underly the various causes of tinnitus, methods of
differentiating these mechanisms must also be de-
termined.
TINNITUS DIAGNOSIS AND ASSESSMENT
As in studies of the mechanisms of tinnitus,
diagnosis and assessment of the condition have
been plagued by lack of standardized testing methods
and outcome measures. It is absolutely essential that
all diagnostic and assessment modalities utilize some
type of standardization. To achieve standardization, a
work group or task force will need to be established
for the purpose of development and adoption of test-
ing and measurement standards. Equally important
will be an effort to standardize all handicap or disabil-
ity scales or outcome measures in order to adequately
compare studies.
A myriad of patient evaluation methods exist
for assessment of tinnitus patients. They fall into
four basic categories: Physiologic, Psychologic,
Perceptive and Demographic. However, most are
currently used in a somewhat haphazard fashion,
especially by clinicians who do not regularly see or
treat tinnitus patients. Therefore, development of a
standardized testing battery which will provide
objective measurement and permit selection of ap-
propriate treatment modalities based upon a dis-
tinction of the underlying mechanism is of
paramount importance. Additionally, it is impor-
tant to develop a description of tinnitus charac-
teristics in patients with different etiologies to
further distinguish types of tinnitus and appropriate
treatment.
In conjunction with the development of stand-
ardized tests, it is also important to develop a flow
18 Tinnitus Today/December 1993
chart for testing based upon patient responses to
guide the testing protocol.
TREATMENT OF TINNITUS
As with tinnitus diagnoses and assessment, a
number of treatment modalities have been introduced
or tested, some with limited success, others with
minimal or no success. Most studies involved in the
treatment of tinnitus are based upon anecdotal patient
observations. While this type of treatment research is
important, there remains a critical need to tie the
study of treatment modalities to tinnitus mecha-
nisms research. Further, upon observation of a prom-
ising treatment modality, information about that
observation should be quickly shared in order that
additional observations may be gathered nationally
and internationally, and multi-site investigations into
the treatment can be undertaken. This will improve
not only the standard of such research, but will also
assist in expediting the dissemination of information
regarding study outcomes.
Treatment modalities fall into four basic cate-
gories: Physiological, Psychoacoustic, Psychosocial
and Physical. Additionally, many treatment plans in-
clude a combination of modalities from two or more
of the categories. Little research has been conducted
on the interaction of treatments or with the potential
of combinations and should be considered.
Because current specific treatment modalities
have been well reported, they will not be elaborated
upon in this plan. However, it is critical to empha-
size that a need exists for standardized outcome
measures to be developed and that certain re-
search standards must be developed and met in
the proposal of patient observation and clinical
trials in order to ensure that successful and
effective outcomes can be readily adopted by the
medical community without significant ques-
tion. This does not mean that casual observations
are not important. Rather, they should be reported,
studied epidemiologically and tested in a manner
acceptable to high standards of the medical and
scientific communities.
Finally, considerable research attention has
been given to physical and physiological treatment
modalities. In search of a "cure" or substantial
alleviation, that focus is paramount. However, ad-
ditional study into the psychosocial and cognitive
therapies available or proposed for development is
necessary to improve its use as an effective ad-
junct treatment modality pending the develop-
ment of better physical or physiological
treatments.
EPIDEMIOLOGIC RESEARCH
A significant amount of information regard-
ing the symptom of tinnitus can be developed by
additional epidemiologic studies into the charac-
teristics of the condition and histories and demo-
graphics of the tinnitus patient population. A
national database with shared information from as
extensive a population base as is possible should be
created and maintained.
The collection of this information will be ex-
tremely useful to researchers and clinicians alike in
their project and treatment efforts, as well as in
demonstration of the prevalence and significance
of the condition in other efforts to focus attention
and funding to tinnitus as a national health problem.
AT A'S ROLE IN TINNITUS RESEARCH
The number of researchers involved in the
research of tinnitus has been historically small for
many reasons. It remains an elusive and complex
condition which many scientists and clinicians do not
believe can be studied with hope of successful out-
comes. It is not a glamorous condition or a popular
cause. Funding for tinnitus research has been minimal
in comparison to its prevalence and significance in the
population. The level of research conducted has not
always met the high standards of the scientific and
medical communities. There also has been no central
"champion" or strong leader of the research efforts
undertaken to date. AT A can and should play a role in
improvement of each of those areas, by taking an active
role as leader and by facilitating greater communication
and cooperation in the medical and scientific research
communities.
ATA should continue to be a primary source
of "seed" money for preliminary research and
should encourage original ideas in tinnitus research
by careful consideration of projects in uncharted
waters. At the same time, A TA should encourage
research standards at a level that demands the re-
spect and attention of clinicians and scientists who
will utilize the results in productive ways.
ATA's role as an advocate for people with
tinnitus should include legislative and lobbying ef-
forts to focus the attention of Congress and appropri-
ate federal agencies on tinnitus as a significant
national health problem, and to ensure that tinnitus
research gets additional appropriate funding.
Support of more brainstorming and col labora-
tive meetings among tinnitus researchers on a regu-
lar basis should be a primary purpose of the
organization and work groups and task forces de-
veloping needed standardization should be organ-
ized and supported under the auspices of AT A. This
will facilitate a greater exchange of information in
both the research and clinical communities.
SUMMARY
Those involved in the study or support of
tinnitus should take a moment to bask in praise for
their dedication and perseverance in an unpopular
and frustrating field of study. The efforts of both
ATA and individual scientists and clinicians world-
wide have brought the tinnitus patient population
significant improvements in treatment and under-
standing of the condition.
It is now time to develop a national or interna-
tional strategy for dealing with the condition. An
organized, focused, high-quality research effort must
be undertaken to take advantage of the significant
strides being made in medical and scientific research
generally. The opportunity for remarkable advances
exists. A new generation of researchers should be
recruited and encouraged both by funding of activities
and upgrading the quality of research undertaken.
Most important, a community of researchers
must be created. Community in the sense of coopera-
tion, collaboration and communication. Anything less
than that is unacceptable. AT A must organize, lead
and facilitate that community. To do so will create a
solid foundation for solutions to this significant na-
tional health problem and will make heroes out of
those involved in the process.
To millions, it will mean tears of joy for
silence once a dream.
Tinnitus Today/December 1993 19
ditional study into the psychosocial and cognitive
therapies available or proposed for development is
necessary to improve its use as an effective ad-
junct treatment modality pending the develop-
ment of better physical or physiological
treatments.
EPIDEMIOLOGIC RESEARCH
A significant amount of information regard-
ing the symptom of tinnitus can be developed by
additional epidemiologic studies into the charac-
teristics of the condition and histories and demo-
graphics of the tinnitus patient population. A
national database with shared information from as
extensive a population base as is possible should be
created and maintained.
The collection of this information will be ex-
tremely useful to researchers and clinicians alike in
their project and treatment efforts, as well as in
demonstration of the prevalence and significance
of the condition in other efforts to focus attention
and funding to tinnitus as a national health problem.
AT A'S ROLE IN TINNITUS RESEARCH
The number of researchers involved in the
research of tinnitus has been historically small for
many reasons. It remains an elusive and complex
condition which many scientists and clinicians do not
believe can be studied with hope of successful out-
comes. It is not a glamorous condition or a popular
cause. Funding for tinnitus research has been minimal
in comparison to its prevalence and significance in the
population. The level of research conducted has not
always met the high standards of the scientific and
medical communities. There also has been no central
"champion" or strong leader of the research efforts
undertaken to date. AT A can and should play a role in
improvement of each of those areas, by taking an active
role as leader and by facilitating greater communication
and cooperation in the medical and scientific research
communities.
AT A should continue to be a primary source
of "seed" money for preliminary research and
should encourage original ideas in tinnitus research
by careful consideration of projects in uncharted
waters. At the same time, AT A should encourage
research standards at a level that demands the re-
spect and attention of clinicians and scientists who
will utilize the results in productive ways.
ATA's role as an advocate for people with
tinnitus should include legislative and lobbying ef-
forts to focus the attention of Congress and appropri-
ate federal agencies on tinnitus as a significant
national health problem, and to ensure that tinnitus
research gets additional appropriate funding.
Support of more brainstorming and collabora-
tive meetings among tinnitus researchers on a regu-
lar basis should be a primary purpose of the
organization and work groups and task forces de-
veloping needed standardization should be organ-
ized and supported under the auspices of AT A. This
will facilitate a greater exchange of information in
both the research and clinical communities.
SUMMARY
Those involved in the study or support of
tinnitus should take a moment to bask in praise for
their dedication and perseverance in an unpopular
and frustrating field of study. The efforts of both
AT A and individual scientists and clinicians world-
wide have brought the tinnitus patient population
significant improvements in treatment and under-
standing of the condition.
It is now time to develop a national or interna-
tional strategy for dealing with the condition. An
organized, focused, high-quality research effort must
be undertaken to take advantage of the significant
strides being made in medical and scientific research
generally. The opportunity for remarkable advances
exists. A new generation of researchers should be
recruited and encouraged both by funding of activities
and upgrading the quality of research undertaken.
Most important, a community of researchers
must be created. Community in the sense of coopera-
tion, collaboration and communication. Anything less
than that is unacceptable. AT A must organize, lead
and facilitate that community. To do so will create a
solid foundation for solutions to this significant na-
tional health problem and will make heroes out of
those involved in the process.
To millions, it will mean tears of joy for
silence once a dream.
Tinnitus Today/December 1993 19
greater the hyperacusis. For example one patient
we tested revealed a maximum tolerance of 15 dB
SL (sensation level) at 100Hz, 8 dB SLat 1000Hz
and 3 dB SL at 10,000 Hz.
The ear is equipped with a set of afferent
nerve fibers which take neurological signals from
the inner ear up to the brain. In addition there is a
set of efferent nerve fibers which traverse from the
brain downward to the inner ear. This efferent tract
is known as the olivocochlear bundle and it is
considered by most to be related to loudness control
of sound although there is a paucity of direct evi-
dence to support such a claim. It is very easy to
imagine the olivocochlear bundle as a feed-back
loop the purpose of which is to govern the input
system. And it is easy to imagine that something
has gone wrong with the olivocochlear bundle in
the hyperacusis patient.
Q. Mr. J. from MN continues: "I don't under-
stand why you advocate desensitization for hyper-
acusis if the problem is one of collapsed tolerance
for loudness."
A. I suspect I have used an incorrect term to
describe the retraining I recommend to hyperacusis
patients. Unfortunately it is not the only time I have
suggested inappropriate terminology and probably
will not be the last time either. I should have called
it rehabilitation of the ear. As I see it the process I
called "desensitization" is a matter of retraining or
rehabilitating the ear to very gradually accept in-
creasing loudness of sound stimuli. The idea was
born out of the knowledge of what frequently hap-
pens to patients with otosclerosis who undergo a
successful operation (stapedectomy) to restore
their hearing. These patients have had subdued
due to hearing loss caused by
tmpatred function of the bones in the middle ear.
they are operated upon the hearing is essen-
bally restored. Very frequently their first words are
IT IS TOO LOUD!" For a long time prior to the
operation these patients have experienced only sub-
dued sounds and not loud sounds in the affected ear
but after the operation they gradually reestablish
nor:nal tolerance for loudness and hear normally.
I thmk we see much the same thing with the hyper-
acusis patient and in my opinion retraining of the
hyperacusis ear is the only way to treat hyperacusis.
(See the next question for a possible additional
treatment.) In addition to a desensitization exercise
I think it is critical that the hyperacusis patient not
overprotect their ears from normal every day
sounds for to do so will probably worsen the con-
dition. Most hyperacusis patients go about wearing
ear plugs all the time and I think that action will
make the ears even more intolerant of loudness.
Q. Mr. P. from WA states I have taken Ginkgo
biloba for tinnitus and lo and behold my hyper-
acusis improved! The tinnitus remained unchanged
but the hyperacusis got much better. Can you ex-
plain that effect?"
A. No, I cannot explain the effect you observed
but I do say if it works continue to use it. Many
would explain the result you got from Ginkgo
biloba as a coincidence but that is an easy way out.
If it happens that you go off Ginkgo and the hyper-
acusis returns to its usual level let us know the
effect of the second Ginkgo treatment.
MAY I ASK THE READERSHIP IF ANY OTHER
HYPERACUSIS PATIENTS HAVE OBTAINED RE-
LIEF FROM HYPERACUSIS BY TAKING
GINKGO?
Q. Mr. R. in NY says: "I am almost afraid to ask
my question, afraid you will think I' m round-the-
bend. Nevertheless here it is: When I have the flu
and run a fever my tinnitus completely disap-
pears! As the fever subsides and the flu goes away
my tinnitus returns. I have observed this same
effect a score of times over the years. It is very
predictable. Can you explain it?"
A. Mr. R., I cannot explain that most unusual
effect you describe. I assume that the tinnitus does
not disappear because you are distracted with your
flu symptoms. I assume it simply disappears. The
unusual part of your finding is that usually things
like colds and the flu cause hearing to decrease and
anything which causes hearing to decrease causes
tinnitus to appear to be louder. But you observe the
reverse. That is a real puzzle.
Tinnitus Today/December 1993 21
Questions & Answers (continued)
Mr. R. goes on to say that normally he does
not tolerate coffee at all well but during a cold or
flu attack he can drink coffee with impunity.
I
MAY I ASK THE READERSHIP IF ANY ONE HAS
OBSERVED THE EFFECT DESCRIBED BY MR. R.?
Q. Mr. C from PA describes an unusual cycle of
tinnitus: For the past two years I have awakened
every seven days to a high-pitched hissing in my
left ear. After seven days, the hissing stops and
silence returns for seven days. The trigger event is
always sleep. Recently an immunologist tried cor-
tisone injections which shortened the hissing cycles
to four days. Have you encountered any cases of
"CYCLICAL" tinnitus and can you offer any in-
sights into possible causes?"
A. What a fascinating story. I have not seen other
"cyclical" cases such as you describe, although we
have seen a small group of patients whose tinnitus
fluctuates and when it changes from either good to
bad or from bad to good it is always during sleep
and never when they are awake. When they are in
a good phase even a cat nap can reverse things. I've
discussed this matter with those who study sleep
and they fail to offer suggested explanations. The
fact that cortisone shortened your cycle to four days
suggests that the problem is not in some cyclic
activity of yours but rather something which could
be altered by cortisone. In as much as sleep appears
to be the trigger may I suggest that you use a
masking sound during sleep to see if that kind of
auditory stimulation will influence either the cyclic
nature of your tinnitus or its loudness. Also may I
ask if your tinnitus, when it is present, appears to
get louder when you plug your ear? (I seem to be
asking rather than answering questions.)
Meetings Update
by Patricia Daggett
The International Hearing Society held its
annual convention in San Diego this year, Septem-
ber 1-5. As many as 200 hearing professionals
attended from Japan, alone, with others coming
from as far away as Australia, Europe and Asia.
The final attendance count was a record 2,200!!
22 Tinnitus Today/December 1993
A seminar entitled "Management ot the Tm-
nitus Patient", given by one of ATA's advisory
board members, Robert Sandlin, was well attended.
Walt Daggett gave ATA executive assistant,
Pat Daggett, and development director, Brent
Mower, a hand representing the association. Infor-
mation and literature was disseminated to approxi-
mately 200 people who stopped by the ATA booth
next to the exhibit hall. Free ear plugs were avail-
able at the booth for the first time this year in an
effort to encourage hearing conservation.
~
:'l'l.nl!!lt..
Brent, Pat and Walt participated in an early
morning Fun Run/Walk, sponsored by The Better
Hearing Institute. Once again, there was the opportu-
nity to personally meet and talk with hearing profes-
sionals who treat tinnitus patients and share insights.
The Combined Federal Campaign got off to a
rousing start in September with individual state health
fairs across the U.S. Thanks to our many volunteers
who represented the AT A at these events, we have
reached many hundreds of people with information
about our association and its services.
American Tinnitus Association (#0514) is a partici-
pant in the Combined Federal Campaign. Thank you
for your annual CFC pledge to help fight Tinnitus.
Road To Recovery
by Stefan P. Kruszewski, M.D., Medical Director,
Psychiatry, Pottsville Hospital and Warne Clinic,
Pottsville, PA 17901
In the early afternoon of February 12, 1989
the ringing in my ears began. Though it persists, t h e ~
has been appreciable improvement from that day until
now. This account is intended as a positive message
for others who experience the same problem.
What affects or worsens my tinnitus may not
do so for you. The same is true of what makes mine
diminish. There are many likely causes. There may
be as many solutions. But just as the tinnitus stories
of individual people have helped me find answers,
I hope this additional self-report may help someone
who still looks for relief.
My tinnitus is a familial case. Unknown to me
when the ringing began, I subsequently learned it
also affects my two biological siblings and my
father. My 46 year old sister and I, age 42, hear a
relatively high frequency background noise which
v.aries in intensity. Mine is considerably more per-
ststent. My 48 year old brother hears musical melo-
dies (e.g. "Dixie" "Camptown Races") when he is
"congested." My father, a robust 80, episodically
hears bells, chimes and white background noise.
All of us have excellent hearing, unaided. Each of
us has been medically evaluated. Although our
separate stories differ, our collective frustration has
been considerable.
After my tinnitus began, I saw six Board
Certified Physicians (a Family Practitioner and five
Ear-Nose-Throat Specialists) in 1 8 months. They
ordered blood work including: CREAT, BUN,
SGOT, SGPT, LDH, alkaline phosphatase, acid
phosphatase, magnesium, T3, T4, TSH, uric acid,
HIV, Hepatitis Profile, IgE. All tests were normal
or negative. Other exams were done as well. The
results showed the following: Normal EKG. Unre-
n:tarkable urinalysis. Normal chest X-ray. Normal
smus films. Normal cerebral CT scan. Audiometry
showed minimal high frequency loss. Although
ENT exams varied (as described below), physical
exam was within normal limits. Neurological exam
and mental status were normal.
The physician responses to my tinnitus varied.
Despite being asymptomatic, my ENT examina-
tions were remarkably different. Chart 1 - will
succinctly present the specialists' comments and
findings. Where appropriate, my responses to their
suggestions are added.
Eighteen months of frustration! My tinnitus
was baseline awful. I began to look for my own
answers. I read multiple papers from the medical
literature. Much of the clinical work was discour-
aging. I did not want to experiment with lidocaine
or carbamazepine nor innovative and unproven
surgical techniques. I read the information mailed
to me from the American Tinnitus Association
(ATA). This was a turning point. There was relief
knowing that others faced the same problem -even
if the answers were elusive.
I returned to the ENT specialist who had been
especially empathetic. We began to work together.
With his help and the AT A literature, early inconsis-
tent improvements slowly gave way to significant
relief. Chart n -lists what has helped my tinnitus, what
has not, and what apparently makes it worse.
Four and one-half years later, I still have tin-
nitus. That is the bad News. The good news (if we
can proportion it) is that 15% of the time I have no
ringing in my ears, 80% of the time the ringing is
very tolerable and only the fraction oftime left over
is the ringing persistently troublesome. My hearing
is unchanged. However, as a side benefit, my physi-
cal, emotional and spiritual health have improved.
So, too, have my relationships with my family and
the care I can offer to my patients.
Epilogue
Were I a new tinnitus sufferer, I would diplo-
matically ask several questions before seeking help
from a physician. They are:
1. Does he/she have a special interest/knowl-
edge about tinnitus?
2. Is he/she or a staff member willing to work
with me on a solution?
3. Is he/she a member of the AT A?
If the answers are equivocal, unenthusiastic,
or negative, I would keep searching. I would spe-
cifically reference the ENT department of any local
Tinnitus Today/December 1993 23
Road to Recovery (continued)
medical school or the American Tinnitus Associa-
tion.
Chart I Physician Comments
1. FP-1: "I wish I could help. I guess you are
just going to have to make the best of it."
2. ENT -1 : "It's chronic allergies. Get this
quantitative IgE level, and then take these (antibi-
otics plus corticosteroid nasal spray)."
> Author's Note: This combination gave me diar-
rhea and made my nose bleed. It did not affect
my tinnitus whatsoever.
3. ENT-2: "Your problem is your tonsils. You
can't see it, but they are infected in the back. You
probably get chronic subclinical ear infections.
Let's take them out."
> Author's note: I have not had tonsillitis, nor an
ear or throat infection since my tinnitus began. I
declined the offer to have my tonsils removed.
4. ENT-3: "You are probably going to slowly
lose your hearing. But, you don't need a hearing
aid yet. Why don't you come back and check with
us in six months to a year and we'll reevaluate your
hearing then?"
5. ENT-3 (Second Visit): "Same problem?
You know, people with tinnitus are my most diffi-
cult patients." After a brief evaluation, the physi-
cian said, " I think I know the problem. Your ear
canals are too small. Not enough air gets into your
middle ear. Why don't we try tubes?"
> Author' s note: The next week I had bilateral myrin-
gotomies. From these, I got my first ear infection
in IO years, the insurance company received a bill
for $1000.00 and my tinnitus was unchanged.
6. ENT A " I wish I could offer something that
would work. From my other patients who have
tinnitus, I understand how frustrating it can be. I am
sure you know to avoid aspirin, alcohol, stress, ... ?
Maybe we can work together on an answer?"
> Author's note: My ENT examination was now
normal. This was the physician to whom Ire-
turned.
24 Tinnitus Today/December 1993
7. ENT-5: "Tubes! What a waste. Who sug-
gested that? This is not my area of expertise, of
course. I can refer you to a neurosurgeon."
Chart II - Personal Causes & Solutions
A. WHAT MAKES MY TINNITUS WORSE?
I. Drugs used in therapy:
Caffeine
Buspirone
Beta-Blockers
Alcohol
2. Non-Drug Stimuli:
Prolonged loud noise
Time deadlines
Excessive stress
Intense emotions (anger, fear, anticipation)
Short naps
Ear Plugs
Unexpressed emotions
Concentrating on the noise itself
Excessive rest
B. OF NOV ALUE?
I. Myringotomies
2. Antibiotics
3. Ear Cleansing
C. WHAT MAKES IT BETTER
I. Drug Therapies:
Fluoxetine (20 mg. every two weeks.)
Niacin (100 mg. two times per day.)
Clonazepam (0.5 mg. every morning.)
2. Non - drug Therapies:
Brisk exercise
Taking a shower
Low level music
Prayer/Meditation
Progressive muscular relaxation
Empathetic listeners with same problem.
Knowledge that problem
won't worsen.
Knowing that hearing isn' t
worsening.
Strongly expressed emo-
tions (laughter, crying).
The Best Medicine
by Barbara Tabachnick, Client Services
Coordinator
The onset of tinnitus is often met with
panic followed by mad dashes to many doctors
for answers. The fact that the answers received
by new tinnitus sufferers are so often unsatis-
factory raises its own questions. Is it because
the tinnitus sufferer is anxious and worried and
not able to closely focus on the patient/doctor
dialogue? Is it because there are too many
health professionals who are still in the dark
about the treatments and causes of tinnitus? Or is it that
the right questions are not being asked?
Tinnitus sufferers really only have one question -
"How do I get rid of this noise in my head?" - a question
for which there could be hundreds of answers. But insisting
on extra conversation with your medical professional is
incredibly worthwhile, both in terms of clearly under-
standing the options and in getting the reassurance that is
vital. Regardless of the onset date of your tinnitus, if you
are still seeking medical answers, the following questions
for health care professionals might bring you the infor-
mation you really want.
What treatments are available?
What treatments have you used SU<:CeSSfully?
Are there patients in your practice who have tinnitus who have been helped ?
What is your treatment plan for my tinnitus.
Will you explain all of the risks/side effects of the treatments or drugs?
What are the exact instructions for tal<ing this medication? (Foods, drugs to avoid.)
What is the exact diagnosis? (Write it down.)
What expectations can I have for relief from the tinnitus or a return to normal hearing?
What can I do to prevent its exacerbation?
How can we decide what caused my tinnitus?
Could it be caused by a TMJ disorder? A drug I'm taking?
Can we rule out a tumor so I can stop worrying?
What tests do you require or suggest?
What will the test be like, and how much will it cost?
Will ~ be uncomfortable, and if so, for how long?
If I'Ve had a test elsewhere, do I need to repeat it?
How many v i ~ do you think I will need?
How much of this will be covered by my insurance?
Do you have patient information for me to read about tinnitus?
Will getting a hearing aid (or refitted for my hearing aid) affect my tinnitus?
What else can I do on my own to help? (Diet, exercise, environment.)
If I have to learn to tolerate this noise, HOW do I learn to tolerate this noise?
Can you refer me to a counselor?
If you can't help me, do you know someone who can?
Is there a tinnitus self-help group available in this city?
Are you a member of the American Tinnitus Association?
It is suggested that you bring the following with
you when you visit your doctor or hearing health
professional:
A complete, detailed written list of your symptoms.
- Copies of all of your previous test results and audiograms.
-A written Ust of ALL medications (OTC and prescription) you are currently taking
or have just recently taken.
(Be ready to get a second opinion if surgery is the first suggestion.)
It has long been observed that people who adjust
the best are the ones who do as much for themselves
as possible.
In a recent letter, one of our self-help coordinators
told us of her feelings about working with her group
and her involvement with AT A. "I feel good ... Not only
do I help myself, but I help others and it's so satisfying.
I feel like I'm my own best medicine." Our Self-Help
volunteers give time to their communities and help to
people who are in distress. They distribute our bro-
chures by the thousands, attend local health meetings
to discuss the prevalence of tinnitus and publicize the
services we offer. And they have let us know that ever
since they asked for information about being part of our
support network, their involvement with AT A has be-
come their therapy of choice. The appropriate health
care and the best medicines often appear, it seems, when
we ask the right questions -- of our doctors and our-
selves.
Our Support Network volunteers are the hands
and voices of ATA. We gratefully welcome six new
support group coordinators and three new tele-
phone contacts to our growing network.
Group Coordinators
Margaret Turner, W Palm Beach, FL 407/791-1246
Judy Brivchik, Lancaster PA, 717/393-4279
Joey Akins, Chattanooga TN/Chickamauga GA,
706/375-2272
Sandra Harper, Mesa AZ
Diane Shultz, Sun City AZ
Andrea Rosenthal, Phoenix AZ
(contact Virginia Fitzgerald, Phoenix AZ, 602/861-
3975 for new AZ group information)
Telephone Contacts
Dolores Cardinal, St. Paul MN, 612/222-7938
Rick Compton, Cincinnati OH, 513/761-8394
Bonnie Kucala, Maple Grove MN, 612/494-3554
Please write to me for our Self-Help Group
packet if you'd like to start a support group.
We are here and ready to help.
Tinnitus Today/December 1993 25
Tributes, Sponsors, Special Donors
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 ac-
knowledged with an appropriate card. The gift amount is never disclosed.
GAS FROM&-1-93-00to 10-31-93
IN MEMORY OF
Bernard Brown
Betty Abbott Brown
Molly Eder
Marsha & Morton Berkowitz
Arthur Hirshberg's Mother
Claire & Jacques Simon
Uncle Ted Jarvis
William J Haskin
Bella Kaytes
Paul Kaytes
Herman Loeb
Mr & Mrs John Meyer
Howard Oppenheim
Sam & Sylvia Eisenberg
Marilynn Smith's Mother
Constance E Farrell
Clara Stukey
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morel (See inside front cover for
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Guidelines for Writers
PROFESSIONAL ASSOCIATES
Ronald G Amedee MD
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MATCHING GIFTS
You might be able to double or
triple the size of your gift to the
American Tinnitus Association
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fits department or write to us
for more invormation.
Tinnitus Today, the Journal of the American Tinnitus Association welcomes submission of original articles about tinnitus and
related subjects. The articles should speak to an audience of people with tinnitus, audiologists, otolaryngologists, otologists,
hearing aid specialists, and other medical, legal, and governmental specialists with an interest in tinnitus.
Manuscripts should be typewritten, double-spaced, on plain paper and should include title; author(s) name(s) and biographi-
cal information; and when appropriate, footnotes, references, legends for tables, figures, and other illustrations and photo cap-
tions. Our readers like to "see" you. Please include a reproducible photo. Generally, articles should not exceed 1500 words
and shorter articles are preferred.If possible, submit manuscripts on diskette in WordPerfect format. Either 3.5" or 5.25" PC
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Please do not submit previously published articles unless permission has been obtained in writing (and attached to the article
submitted) for their use in Tinnitus Today.
All letters accompanying manuscripts submitted for publication should contain the following language:''In consideration of
Tinnitus Today taking action in reviewing and editing my (our) submission, the author(s) undersigned hereby transfer(s), or
otherwise convey(s) all copyright ownership to Tinnitus Today in the event that such work is published by Tinnitus Today."
Tinnitus Today also welcomes news items of interest to those with tinnitus and to tinnitus healthcare providers and informa-
tion or review copies of new publications in the field. All such items should contain the name and telephone number of the
sender or person to contact for further information.
Please address all submittals or inquiries to: Editor, Tinnitus Today, P. 0. Box 5, Portland, OR 97207-0005. Thank you for
your consideration.
26 Tinnitus Today/December 1993
TINNITUS
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Tinnitus - Learnint: to Live With It
Suggestions and advice from authors who
overcame much of thei r misery.
by Leslie Sheppard and Audrey Hawkridge
Tinnitus: When Silence is a
Stranger
Useful information about tinnitus causes,
related problems and treatment methods .
Includes discussion of alternative medi-
cine, maskers, and psychologically based
treatment techniques.
hy Leslie Sheppard
TM.I the Self-Help Program
How to recognize a TMJ problem, relieve
pain and restore health. When to seek pro-
fessional help.
by John Taddey
Tinnitus: What is that Noise in
My Head?
Clear information about causes and treat-
ments, both medical and non-medical. In-
cludes an affecting personal account by the
author, who has battled severe hearing loss
and tinnitus since childhood.
by Joan Saunders
Complete Bibliography; listing over 2,500
titles.
$75.00 non-members/$40.00 member
Specific Subject Search:
$10.00 non-memberl$5.00 member per &,
subject.
Information about Tinnitus
Provides factual answers to the most con
mon questions about tinnitus, includin
causes, treatments and effects.
Coping with the Stress
of Tinnitus
Includes coping tips for reducing stress,
list of tinnitus self-control techniques, an
information about how to seek help.
Noise: Its Effects on Hearing
and Tinnitus
Explains how noise can cause tinnitus an
how to avoid it. Defines permissible leve
of noise exposure.
Hyperacusis
Describes hyperacusis, the problem of st
per-sensitivity to sound, and explains ho
those who have it are affected. Urges pre
tection from noise.
Tinnitus Family Information
Provides supportive and useful inform:
tion for families and friends of people wt
have tinnitus.
SEE INSIDE BACK COVER FOR FULL PUBLICATION LIST AND ORDERING INFORMATION

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