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September 1995 Volume 20, Number 3

Tinnitus Today
THE JOURNAL OF THE AMERI CAN 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:
The Seminar Remembered
Doctor to Doctor - A Medical
Evaluation of the Tinnitus Patient
Incidence and Awareness ofTinnitus
in University Students
The Ear Defenders at
Shawmont School
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- - - __
Tinnitus
Editorial and advertising offices: American
Tinnitus Association, P.O. Box 5 Portland,
OR97207
Executive Director & Editor:
Gloria . Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Editorial Advisor: Trudy Drucker, Ph.D.
Advertising sales: ATA-AD, Box 5,
Portland, OR 97207 (800-634-8978)
Tmnirus Thday is published quarterly in
March, June, September and December. It is
mailed to members of American Tinnitus
Association and a selected list of tinnitus suf-
ferers and professionals who treat tinnitus.
Circulation is rotated to 100,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsu it-
able for TinnitUS 7bday. ACceptance of adver-
tising by Tinnitus 1bday does not constitute
endorsement of the advertiser. its products
or services, nor does Tin nit us 1bday make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by contnllutors to Tinni.tus
Thday are not necessarily those of the
Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-prof-
it human health and welfare agency under
26 USC 501 (c)(3)
Copyright 1995 by American Tinnitus
Association. No part of this publication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any means,
without the prior written permission of the
Publisher. ISSN: 0897-6368
Scientific Advisory Committee
Ronald G. Amedee, M.D., New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clemis, M.D., Chicago, I L
Robert A. Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster. M.D., San Diego, CA
Barbara Goldstein, Ph.D., New York, NY
Richard L Goode, M.D., Stanford, CA
John w. House, M.D., Los Angeles, CA
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia, PA
Gale W. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Jerry Northern, Ph.D., Denver, CO
Robert E. Sandlin, Ph.D., San Diego, CA
Alexander J. Schleuning, Tl, MD,
Portland, OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Honorary Board
Senator Mark 0 . Hatfield
Mr. 'Thny Randall
Legal Counsel
Henry C. Breilhaupt
Stoel Rives Boley Jones & Grey,
Portland, OR
Board of Directors
Edmund Grossberg, Chicago, IL
Dan Robert Hocks, Portland, OR
W. F. S. Hopmeier, St. Louis, MO
Philip 0. Morton, Portland, OR, Chmn.
Aaron I. Osherow, St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
Timothy S. Sotos, Lenexa, KS
The Journal of the American Tinnitus Association
Volume 20 Number 3, September 1995
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 From the Editor
by Gloria E. Reich
8 Communication Awareness Day
9 A Commentary
by Robert E. Sandlin
10 Doctor to Doctor
by Michael D. Seidman
12 The Seminar Remembered
by Barbara 'JlJ.bachnick
16 The Ear Defenders at Shawmont School
by Barbara 'JlJ.bachnick
18 Incidence and Awareness of Tinnitus in University Students
by Arlene Jewell
22 Tips for Hearing Aid Care
by Betty Mathis and Gloria E. Reich
23 New Tinnitus Suppor t Network Volunteers
24 Accentuate the Positive
by Theris Aldrich
Regular Features
6 Letters to the Editor
20 Questions & Answers
25 'fributes, Sponsors, Special Donors, Professional Associates
On the cover.
(L toR) Dr. Ross Coles, Gloria Reich, Ph.D., and Jack Vernon, Ph.D. at the
Fifth International Tinnitus Seminar's gala banquet
Photo by Stan Sanders
Tinnitus Thday/September 1995 3
From the Editor
by Gloria E. Reich, Ph.D.,
Executive Director
It was a wonderful meeting!
We heard this comment over
and over from people who
attended the Fifth International
Tinnitus Seminar. The meeting
had something for just about
everyone.
Three-and-a-half days
were filled with scientific presentations by
researchers from 25 countries. No, the "cure" for
tinnitus wasn't announced, but I have the
feeling that the time is growing shorter until
that actually happens. Quite a few people have
called and asked, "What's new that came out of
the meeting?" We'll be giving you reports from
the meeting over the next several issues of
Tinnitus Tbday, but I'll give you my personal
highlights and leave you to read the proceedings
yourself when they are published.
Dr. James Snow, Director of the National
Institute on Deafness and Other Communicative
Disorders, summarized a tinnitus workshop held
at NIDCD this spring, and he invited researchers
to apply for tinnitus grants. Dr. Ross Coles talked
about the conduct of research and explained
that to really be ofbenefit, a treatment effect
must be long term, repeatable, and in the
patient's best interest. Sometimes even placebo
treatment can be helpful. The "new" informa-
tion from the epidemiology and demographics
section was Dr. Mary Meikle's announcement of
the availability on World Wide Web of the infor-
mation on more than 1600 patients represented
in the Tinnitus Data Registry. She can be con-
tacted for further instructions at her e-mail
address: meiklem@ohsu.edu.
The assessment section brought news of
specialized tests that help clinicians determine
the cause of a patient's tinnitus more precisely.
This, of course, enhances their ability to pre-
scribe an appropriate treatment. In the instru-
mentation section we heard of the long- term
efficacy of treatments such as hearing-aids and
masking. Several new approaches such as noise
generators for auditory habituation were dis-
cussed. The aetiology section brought forth
4 Tinnitus 'Ibday/ September 1995
theories about how tinnitus might be triggered
and how we must consider not only the auditory
neural transfer system but also the limbic or
emotional system when trying to mediate tinni-
tus. The TMJ section brought forth information
relating certain dental problems to tinnitus.
One question was laid to rest by Dr. Barbara
Rubenstein: There is no correlation between
tinnitus and amalgam fillings.
The section on objective measures for tinni-
tus discussed such complex issues as spectral
averaging, evoked potentials, the negative differ-
ence wave, and presence or absence of certain
chemical transmitters. Perhaps what can best be
said here is that these methods have shown
progress since the last seminar and are begin-
ning to show promise. The mechanisms section
I
too, was complicated, with discussions mainly
about brain mechanisms that might possibly
point to tinnitus. Again, it's a bit early to shout
"Eureka!"
In the drug section, both successes and fail-
ures of various drugs were discussed. A term for
drugs affecting tinnitus, used in the UK but
somewhat new to the US, is tinnitolytics. A new
section for this international seminar was about
legal and noise issues. Questions of severity,
prognosis, causality, and duration were dis-
cussed by experts with many years of experi-
ence. The largest section was devoted to clinical
issues and ranged from oxygen therapy to aller-
gies, from clinical tests to nuclear imaging,
objective tinnitus to metabolic markers and
I
some down- to- earth discussion about the reali-
ties of clinical practice.
The psychological rehabilitation section
reinforced the notion that tinnitus is as severe
as the person who has it thinks it is. If someone
who already has a personality disorder is afflict-
ed with tinnitus, the risk for depression is high.
Various therapies were discussed and positive
effects were reported for directive counseling,
stress reduction, and cognitive reasoning.
Another interesting new section addressed a
number of alternative therapies. It was pointed
out that ALL tinnitus treatments were at one
time considered "alternative." Again, the range
of discussion was wide -from acupuncture to
ginkgo therapy, nutrition, and physiotherapy.
From the Editor (continued)
The self-help workshop section brought an
influx of tinnitus support group leaders and
patients who joined the seminar participants to
hear presentations about group dynamics strate-
gies, patient reactions to group involvement, and
other issues affecting support groups.
At a small meeting of invited participants,
the subject of classifYing tinnitus was discussed.
Researchers and clinicians have used a myriad
of systems to classify their tinnitus subjects leav-
ing precise comparisons impossible. Tinnitus, as
we all know, takes many forms and arises from
many different causes. For example, if a group
of patients whose tinnitus is associated with
Meniere's is studied, can the results from that
study accurately predict how patients whose tin-
nitus is associated with noise exposure will react
if similarly studied? Dr. Nabih Ramadan, from
the Henry Ford Hospital in Detroit, Michigan,
explained how the international classification
system for headaches had evolved and how
some ofthe same procedures could be used to
devise a classification system for tinnitus. Gary
Jacobson was elected to serve as chairman of
the c1assification committee, which will meet
again during the Association for Research in
Otolaryngology (ARO) meeting in 1996.
The seminar closed with a public forum
moderated by co- chairman Jack Vernon.
Questions from the audience, still about 175
strong, were answered by Dr. Vernon and the
heads of the various sections from the seminar.
The seminar's extra-curricular evening
events allowed people to establish a camaraderie
that made the meeting even more enjoyable.
Most people attending were happy to be on a
first name basis as they rapidly moved from
being strangers to being colleagues and friends.
The afternoon and evening before the meet-
ing, people started appearing at the hotel, and
many pitched right in and helped us organize
both the poster and exhibit room and the regis-
tration area. That evening, we greeted all the
early comers at a reception on the top floor of
the Marriott where local volunteers had helped
by bringing all sorts of wonderful goodies to
supplement the liquid refreshments. Even more
food was provided by a generous gift from Frye
Electronics, and the ATA. The weather was
warm, Mt. Hood was beautifully covered with
snow, and in the lovely pink sunset light, a full
moon came up to complete the picture. Indeed,
it was an auspicious beginning to our meeting.
Two nights later, 149 of us boarded a local tour
boat, "The Spirit of Portland," for a two-and-a-
half hour ride up and down the Willamette
River and for a feast of local salmon, roast beef,
and all the trimmings. On the last evening, we
assembled for a gala banquet where the keynote
address was given by Oregon's senior senator,
Mark 0. Hatfield. The senator, who wears hear-
ing aids himself, has been instrumental in pre-
serving federal research funding and in helping
to find support for the Oregon Hearing Research
Center.
The Hocks Award, an annual ATA memorial
research award honoring the memory of Robert
W Hocks, ATA's first national chairman, was
presented to Dr. Ross R. A. Coles, who was also
the seminar's guest of honor.
Most of the seminar's presenters have
turned in their manuscripts. When we have all
of them, we'll go to print with the "Proceedings of
the Fifth International Tinnitus
Seminar." We anticipate that
it will be available by
the end of the year.
Tinnitus Thday/ Septcmber 1995 5
Letters to the Editor
I
am still smiling about your "Letter to a
Friend" in the March 1995 issue of Tinnitus
Tbday. The most valuable support that those
of us who endure constant, abrasive head noises
can possibly have is the kind of information
reported in that issue. Practical knowledge is
gained from reports on drugs, and from letters,
book reviews, and relaxation therapies.
I have had left ear concentrated tinnitus for
seven years and slight hearing loss in both ears.
Having diligently tried almost every masking
device on the market, I have discovered that the
basic over-the-ear Starkey TMS works best for
me. Added amplification does not improve the
masking effect. Likewise, wearing maskers in
both ears does not improve the quality of mask-
ing. I wear a masker day and night.
Recently I have found that the antidepres-
sant Paxil works beautifully in keeping my spir-
its up. Although the tinnitus remains the same
as it ever was, I can manage to be happy any-
way. I am active in community affairs, maintain
a circle of friends, and am an elementary school
teacher. The children help to keep me going.
Thank you for your compassionate open let-
ter to me. Your friend,
Gladys Gottlieb, Upstate New York
A
bout four years ago, I started getting a
buzzing in my left ear. 'IWo years ago I
took a series of allergy tests, found that I
was allergic to many things, and started taking
allergy shots. But one day I realized that I no
longer had the "motorcycle" in my ear. What a
relie1 After two years of taking the shots, I am
still free of that noise in my ear.
I hope my experience with the allergy tests
and shots will clear up some of the mystery of
the noises in ears. P.S. My doctor just shakes his
head when I tell him about my experience.
Jean McGregor, Gresham, OR
A
s a sufferer of tinnitus for about 25 years
and one whose tinnitus has developed to
the severe stage, I have become very
aware of causes and methods of coping with tin-
nitus. One of my major concerns is that young
people don't seem to be interested in preserving
their hearing. During this past term at the
University of West Florida, I did a research pro-
ject on the incidence of tinnitus on a college
6 Tinnit us Toclay/ September 1995
campus (See "The Incidence and Awareness of
Tinnitus in University Students"), and was quite
disturbed that the students were so uninformed
about the harm that can be done by loud sound.
When I made a presentation (which included
playing a portion of the tinnitus tape) to my
graduate student classmates, a few cringed at
the piercing sound, but none gave any indica-
tion that they might change their behavior.
I sincerely hope that ATA is successful in
informing elementary school children about tin-
nitus. I feel that the only way we will be able to
prevent the avoidable cases of tinnitus is to
make noise reduction a way of life starting with
the very young.
Arlene Jewell, Pensacola FL
I
read with great interest the recent article
d e a l i n ~ w_ith electrical suppression of tinni-
tus (Tinmtus Tbday, June, 1995). I would like
to share with your readership our experiences
with tinnitus suppression in a patient popula-
tion implanted with the Nucleus multichannel
cochlear implant (Archives of Otolaryngology
Head and Neck Surgery, 1992:118:1291-1297).
Using a closed-ended quantifiable question-
naire, we investigated 33 post-lingually
deafened patients implanted at the University
of Michigan Medical Center in Ann Arbor
between 1986 and 1990. Eighty-five percent
of these patients presented with unilateral or
bilateral tinnitus preoperatively.
Overall, there was a statistically significant
reduction in tinnitus loudness and annoyance
following cochlear implantation. An interesting
finding was that those patients who experienced
the most post-implantation tinnitus reduction
presented with the highest preoperative tinnitus
loudness and annoyance estimates. Another
interesting finding in our study was that 42% of
the patients included in this study experienced
some degree of contralateral tinnitus suppres-
sion. Additionally, SO% of the patients experi-
enced residual inhibition lasting from 60
seconds to several hours after they turned off
their implants. These latter findings would tend
to support a central nervous system source of
the tinnitus as opposed to an exclusive inner ear
origin. This of course has important implica-
tions relative to treatment strategies of tinnitus.
Letters to the Editor (continued)
Overall, 74% of the patients studied consid-
ered their implant to be helpful in tinnitus
suppression, especially on the implanted side.
Paul R. Kileny Ph.D., Professor and
Director, Division of Audiology and
Electrophysiology, University of Michigan
Medical Center
A
bout six months ago, after reading about
ginkgo biloba for tinnitus, I started taking
40 mgs. three times a day. I no longer
gave it any thought until recently, when I real-
ized I wasn't hearing bells in the night! And then
along came your article re: ginkgo biloba.
I realize one isolated case does not present
scientific proof, but I do not know to what else
to attribute the lessening of noises in my ears.
I'm just very grateful to be back in the land of
the quiet.
Dolores Rogers, San Jose, CA
I
'd like to report that I've been taking ginkgo
in modest dosage (24%, 60-120 mg. per day)
for about six months. During this time, I've
enjoyed a substantial reduction in both intensity
and in throbbing, painful pulsating and hissing
noise. Mercifully, these problems have for the
most part been eliminated. Now I just have
ringing or high pitched noise. For the last few
weeks, I have reduced the dosage of ginkgo to
one tablet in the morning and the benefits have
not diminished.
Charles M. Gross, Derby Line, VT
I
was interested in Sharyn Friedman's account
in Tinnitus 'Ibday (March 1995) of her unfor-
tunate experience with acupuncture that
gave her tinnitus. I had reliable information on
authentic acupuncture clinics and went to one in
Springfield, MA a number of years ago. I was
told that acupuncture had not as yet proved
effective for tinnitus but that nevertheless it
might help. No needles were placed around my
ears. (Acupuncture points can be at some dis-
tance from the part of the body being treated.)
There was no massage. I felt comfortable with
the procedure and I trusted the well-trained
acupuncturist from Thiwan. My tinnitus
remained the same, but I did feel that my gener-
al health was improved. Some patients at the
clinic did find relief from arthritis and
intractable pain.
I cannot believe that Sharyn Friedman's
practitioner was a qualified acupuncturist in the
tradition of the Far East.
Elizabeth S. Helfman, Medford, NJ
B
arbara Thbachnick's excellent article "A
Chronicle of Electric Stimulation Therapy"
lists the various attempts and their authors
from 1 7 45 onwards. This list omits the excellent
book by H. Macnaughton Jones, M.D., titled
"Subjective Noises in the Head & Ears" published
in London in 1891. In this book, Jones gave care-
fully annotated examples of electrical stimula-
tion by DC current for patients with tinnitus. He
recorded a number of successes that were short
lived, and suggested that continued research
would produce useful results.
It is good to know that in Sweden and else-
where this research is continuing and that
Tinnitus 'Ibday will report further news of this
research as it comes along.
Jack Shapiro, London
I
read with a great deal of interest your recent
article "A Chronicle of Electrical Stimulation
Therapy" in the June issue of Tinnitus 'Ibday,
which my mother receives.
In 1951, my mother underwent an operation
on her left ear to remedy her deteriorating hear-
ing which resulted from otosclerosis. She lost the
hearing in that ear five years after the first
surgery, and had surgery on the right ear after
that. Since those surgeries, she has had mild
background "roaring" noise which she had
learned to live with. She woke up a year ago
with incredible roaring which apparently marked
the loss of hearing in the right ear. Since then,
she has been plagued with severe tinnitus mani-
fested by a constant noise which she describes as
a "man singing" the same song over and over,
and occasionally a very loud roaring.
Last fall, after nine months of total deafness,
she underwent cochlear implant surgery at the
Washington Hospital Center. She was implanted
with the Cochlear Nucleus 22 Channel implant.
For a few days after the surgery, she reported no
"singing" whatsoever, and fairly mild roaring.
However, as she began to heal, the "singing" and
roaring came back. Her hearing is extremely
good with the implant, but she occasionally com-
Tinnitus 'Ibday / September l 995 7
Letters to the Editor (cont;nued)
plains that the tinnitus noises are so loud that it
makes hearing difficult.
Brian N. Vinson, Arlington, VA
A
bout five years ago, I enrolled in a Jenny
Craig Weight Loss Program. Along with
their food program, they recommended
their "Intensive Replenishment and Stress
Formula" vitamin, now known as PRO TECT
Anti-Oxidant Formulation. I took only one a
day although the bottle said to take two a day.
Prior to this, I was having a severe tinnitus prob-
lem as well as a throat clearing problem which
was also quite severe.
After taking the vitamins for awhile, I real-
ized that these two problems were gone, much
to my delight, and have not returned. However,
the last time I went in to replace my supply, I
found that they had changed the name, the
dosage, and the strength. The cost of the old
bottle was $12.50, and contained 60 capsules.
The new bottle holds 30 double strength cap-
sules and costs $12.50. I haven't run out yet of
the old vitamins, so I have no idea what the new
ones will do for me.
Lena Lusian, Rancho Palos Verdes, CA
T
he most recent issue of the ATA publica-
tion contained an ad for the book,
"Tinnitus - New Hope for a Cure." I sent
off for it and I've just finished reading it. It is
extremely interesting. I would recommend pro-
viding this item to competent researchers who
could respond to what the book is suggesting/
recommending. Just thought I'd let you know
what a marvelous help ATA is, and items such
as this book definitely offer "new hope for a
cure!"
Robert E. Yorke, yorker@deltanet.com
1 A T A NTED f Communication Awareness
.

__________ __
Hearzng Atds and/or Friends ofthe NIDCD is sponsoring the first
national Communications Awareness Day,
Maskers in Any Condition October 18, 1995 on Capitol Hill in Washington,
D.C. The NIDCD hopes to illustrate to members
If you have ever wondered what to do with
those aids that are just sitting in the drawer,
think no further. ATA will be happy to receive
them. Donations to ATA are tax deductible, and
we'll provide a receipt. Simply package them up
carefully (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 shipper, ship to
our street address: 1618 SW 1st Ave., Suite #417,
Portland, OR 97201.
What happens to the aids that you turn in?
In some cases they can be repaired and given to
needy people or used in charitable missions to
underdeveloped countries. Even if they can't be
re-used as is, the parts are needed for repairing
other aids. (And the plastic is recycled.) Your old
aid could give someone the gift of hearing!
8 Tinnitus Thday/ September 1995
of Congress (who have been invited to this
event) the critical importance of scientific
research to the quality of life for people with
communication disorders.
From 10:00 am to noon, the scheduled pro-
gram will begin with scientific exhibits about
interactive TTY, hearing aid developments,
regeneration of inner ear hair cells, cochlear
implants, the latest developments in tinnitus
treatments, and others. This exhibit event, in
the House Office Building, is free and open to
the public.
From noon to 2:30pm, a luncheon meeting
will be held in the Senate Office Building tenta-
tively featuring scientific presentations on
smell, taste, speech, hearing, and balance.
Tickets are required for this event.
For exact locations or further details,
please contact Stephen Epstein, M.D. at
301/949-3800.
A Commentary
by Robert E. Sandlin Ph.D.
Recently I had the pleasure of attending
the Fifth International Tinnitus Seminar in
Portland, Oregon. The hard work done by
Gloria Reich and Jack Vernon was evident.
Congratulations are in order, also, to their
respective staffs.
Although I have been a member of the
Scientific Advisory Board of the American
Tinnitus Association for a number of years
this was my first attendance at an international
meeting. As such, my comments about the
conduct of the meeting may not be a true repre-
sentation of the assessment or expectation of
other attendees.
Undoubtedly, the Herculean task of prepar-
ing for an international meeting dictated what
was to be presented and who was to be the pre-
senter. In my view, the meeting was divided,
unintentionally, into several camps, with each
camp hesitant to agree or interact with the
other. Some proposed the clinical utility of
masking devices adjusted to "cover" the ongoing
subjective tinnitus, providing relief or improving
coping skills. Opposed to this view was the
suggesting that habituation to the ongoing
tmmtus was best achieved not by covering the
tinnitus but by "mixing" the tinnitus with a
broad band masking device, encouraging the
habituation process over a 12- to 18-month
period. Still another camp fostered the notion
that TMJ problems can give rise to subjective
tinnitus. Then there was the alternative group
which defended the utility of acupuncture,
nutrition, chiropractic manipulation, low-power
laser and ginkgo extract therapy, and the use of
drugs to alleviate tinnitus. Psychological and
emotional needs of the tinnitus patient were
addressed.
There is nothing wrong with presenting a
host of concepts regarding tinnitus and its man-
agement. In my view, however, it was not evi-
dent that the speakers were interested in trying
to find some common denominator among the
several therapies. Even with the apparent accep-
tance of a multiplicity of clinical approaches, lit-
tle attention was given to a multi-causal
relationship. That is, there may be a number of
possible neural-generating sites requiring a
unique therapeutic approach, yet broad thera-
peutic remedies are applied regardless of the
etiology.
Even though each of the methods discussed
had some positive affect on tinnitus relative to
the patient's ability to cope with the disorder,
there did not appear to be any consensus on the
mechanisms involved. It was interesting to note
that in controlled studies, some placebo affect
was One wonders if part of the nega-
tive reactions associated with subjective tinnitus
could be alleviated simply by having the patient
feel as though something is being done. Perhaps,
it would be wise to investigate possible reasons
for reported improvement in the placebo group.
It was my observation, also, that a few per-
seemed to dominate the meeting,
e1ther by chairing several sections or participat-
ing in the discussion following the formal
papers. The drawback to such dominance is that
a biased view is presented relative to the pre-
sent state of tinnitus therapy and investigation.
There were two sections in particular,
Alternative Therapies and Self-Help Groups,
that deserved more attention than was evident.
Certainly, it is important in any international
meeting that existing therapeutic approaches be
challenged by alternative approaches. Likewise
I
1t 1s Important that the evidence supporting the
alternative therapies be challenged, but not the
concept of alternative therapy itself. Indeed, if
alternative approaches had been denied histori-
cally, therapies now considered mainstream
would not be viable approaches to tinnitus
management.
The International Tinnitus Seminar is of sig-
nificant value to those of us involved in patient
management. It is the single most important
meeting for the dissemination of knowledge
regarding the current status of tinnitus and its
treatment. If reorganization of the meeting
structure can improve the methods by which
information is given, then we all benefit.
Gloria Reich and Jack Vernon have been
and should continue to be, two very special '
movers relative to the generation of interest in
tinnitus on a national and worldwide basis.
The American Tinnitus Association and the
(continued on page 22)
Tinnitus 'Ibday/September 1995 9
DOCTOR TO DOCTOR
A Medical Evaluation of the Tinnitus Patient
by Michael D. Seidman M.D.,
Henry Ford Hospital, Detroit, MI
A physician can say nothing more discourag-
ing to a patient than "there is nothing you can
do about your tinnitus so you'll have to learn to
live with it." Statements such as this are inaccu-
rate, insensitive, uncompassionate, and promote
a feeling ofhelplessness and despair in the
patient. As health care professionals, we have
both moral and ethical obligations to provide
whatever help we can.
Tinnitus is classically described as either
objective or subjective. Objective tinnitus is
sound heard not only by the patient, but also by
an independent observer. Subjective tinnitus is
heard only by the patient. Of the two, subjective
tinnitus is far more common.
There are many medical conditions that can
cause ringing or sounds in the ears. These
include hypertension, arterial sclerosis,
aneurysms, vascular loops, multiple sclerosis,
palatal myoclonus, nutritional deficiencies,
temporal mandibular joint problems, migraine
disorders, seizure disorders, hyperthyroidism,
hyperlipidemia, anemia, Paget's disease, and
hypo pigmentation.
In order to comprehensively evaluate the
patient with tinnitus, it is imperative to have a
thorough general medical evaluation and history
taken by an internist or a family practitioner.
The primary care physician should pay particu-
lar attention to cardiovascular, pulmonary and
neurological systems. This includes listening to
the neck vessels for bruits (abnormal sounds)
that might suggest an abnormal or reduced vas-
cular flow as the cause of the ringing. Routine
blood sampling would be necessary to rule out
medical disorders such as anemia or low blood
counts. These disorders cause the heart to work
harder and create vascular turbulence that may
exacerbate or lead to tinnitus. Other tests may
be indicated to rule out thyroid disease, high
cholesterol and lipids, or diabetes.
The clinical course of the tinnitus is very
important. First, the physician must attempt to
learn what event or symptom was associated
with its onset:
+ Was it associated with an upper respiratory
tract infection or an infection elsewhere in
the body?
10 Tinnitus 1bday/September 1995
+ Is it possibly related to any type of medica-
tion that the patient is taking?
+ Has the patient ever been exposed to explo-
sions, gunfire, loud music, or chronic noise
from working in a factory, an airport, or in
the military?
It is also necessary to note associated symp-
toms, including headache, nausea, vomiting,
fullness in the ear, hearing fluctuation, or neuro-
logical symptoms including weakness, paresthe-
sia (numbness), confusion, or memory changes.
If the patient's or physician's concerns are
not answered in this preliminary examination, a
more extensive otolaryngologic evaluation is
warranted. Learning the characteristics and the
location of the tinnitus is important in the diag-
nosis, evaluation, and treatment of tinnitus.
Questions to ask the patient:
+ Is sound heard in one or both ears, or does it
appear to be coming from inside the head?
+ What does it sound like to you? (ringing,
hissing, etc.)
+ Is it pulsatile? High or low frequency?
+ Is it continuous or intermittent?
+ Are you still able to go to work or is the
tinnitus causing too much stress?
+ Are you having difficulty with job perfor-
mance?
+ Are you under a great deal of "non-tinnitus''
stress?
+ Are there sleep disturbances? (difficulty
falling or staying asleep at night)
+ Do you find yourself becoming socially
reclusive because of the severity of the
ringing?
+ On a scale of 1 to 10, how would you rate
the severity of the tinnitus?
From the interview, the physician needs to
note if there is any suicidal ideation. These
questions can help the physician understand the
degree to which the tinnitus patient's lifestyle is
affected. Bear in mind that tinnitus does not
affect all patients the same way.
It is important to determine if the patient is
taking any ototoxic medications. The Physician's
Desk Reference lists over 70 drugs, including
aspirin, that can cause or exacerbate tinnitus.
(Tinnitus caused by high doses of aspirin is
often reversed when the drug is stopped.)
DOCTOR TO DOCTOR
A Medical Evaluation of the Tinnitus Patient (continued)
Quinine, diuretics, and aminoglycoside antibi-
otics such as gentamicin are other commonly
used drugs that can cause tinnitus. 'Ibbacco, caf-
feine, birth control pills, monosodium gluta-
mate, coloring agents, and marijuana may all
contribute to an increase in the tinnitus intensi-
ty and severity.
It is also helpful to learn if the tinnitus
patient has a family history of hearing loss,
premature graying, vestibular disturbances, or
heterochromic iris (different colored eyes) that
suggests Waardenburg syndrome.
Once the past medical history has been eval-
uated, the patient should have a complete head
and neck examination beginning with an exami-
nation of the external ear. (Tinnitus can be
caused by abnorrnalitjes anywhere from the
outer ear to the brain.) Auricular malformations,
external canal defects, or changes within the
tympanic membranes are important to note. By
placing a Toynbee stethoscope in the patient's
ear, the physician may be able hear the rare
form of tinnitus that can be heard by others.
In the middle ear, the otolaryngologist will
look for ossicular abnormalities, middle ear
tumors, loss ofbone between the middle ear
and the carotid and jugular vessels, and evi-
dence of previous or current chronic suppura-
tive otitis media (inflammation of the middle
ear). In evaluating the inner ear, one needs to
examine for evidence of hair cell damage, sen-
sorineural hearing loss, endolymphatic hydrops
(Meniere's disease), labyrinthitis, or otosclerosis.
Most of this information is determined from
audiologic and balance testing. It is also very
important to examine the retrocochlear areas
(beyond the inner ear) to rule out growths or
tumors of the cerebellopontine angle, the most
common being the vestibular schwannoma
(acoustic neuroma). One can also examine for
other abnormalities such as vascular loops,
meningiomas, or epidermoid tumors.
A complete evaluation of the mouth and
nasopharyngeal regions is imperative. The tem-
poral mandibular joints should be assessed for
any clicking, popping, or pain upon pressure to
the region. It is also important to look for any
abnormal contractions of the palate that may
suggest palatal myoclonus. (Note that when the
patient's mouth opens, these contractions will
often cease.) Look for evidence of patulous
eustachian tube syndrome (patients will hear
themselves especially loud when they speak), a
full or a blocked feeling in the ear, or the sensa-
tion of an in-and-out movement in the eardrum
when one breathes. The thyroid must be exam-
ined to be sure it is not palpable (perceptible by
touch). Cervical spinal abnormalities have occa-
sionally been associated with tinnitus.
Audiologic testing is mandatory to test pure
tone thresholds, speech reception thresholds,
and word recognition. Some physicians recom-
mend electrocochleography to assess for electri-
cal changes that may reflect an increase in
endolymph, a fluid found in the inner ear. Brain
stem auditory evoked response testing may also
be recommended, particularly if there is ringing
in only one ear or in one ear more than the
other. Otoacoustic emission testing is done to
measure and record the sounds generated by
hair cells in the cochlea.
Testing for zinc or other vitamin deficien-
cies, and random blood sugar tests may be con-
ducted. Radiologic screening may be necessary
to rule out the possibility of a growth or vascular
abnormalities. The computerized tomographic
scan (CAT scan) can give accurate pictures of
the brain and structures of the inner ear using
x-rays. Magnetic resonance imaging (MRI) pro-
duces impressive pictures of the soft tissues, and
can be extended to create pictures of the vessels
using magnetic resonance angiography (MRA).
A patient with pulsatile tinnitus or who is sus-
pected of having a glomus tumor may need to
have an angiogram. Additional neurological tests
using electroencephalography (EEG) may also
be warranted to rule out seizure abnormalities
or migraine equivalents that could have tinnitus
as a symptom.
A wide range of treatments for tinnitus
exist even when no pathology has been identi-
fied. Turning on FM radio static to mask the
tinnitus sound, hearing aids, biofeedback, coun-
seling, electrical suppression, drug therapies,
B- vitamins, acupuncture and more can be sug-
gested for use. As physicians, we must present
all therapeutic options - from approved proto-
cols to anecdotal remedies - to help make the
tinnitus more manageable.
Tinnitus 'Ibday/ September 1995 11
The Seminar Remembered
by Barbara Th:bachnick,
Client Services Manager
The following pictorial cap-
tures small slices of a remark-
able meeting - a meeting of
the world's great and caring
minds in the field of tinnitus.
The Fifth International
Tinnitus Seminar brought the
vast diversity of treatments
and views inescapably into
the open. From time to time,
audiologists nodded agreement
with the dentists, and ENT's
conceded the merits of patient-
to-patient support. Researchers
also considered the findings of
other researchers, although
often with difficulty and not
necessarily to the point of
agreement. Their hesitancy
was not unexpected.
Historically, when an idea
moved into the public arena, it
was usually because one person
had been its champion. Readily
seen today, certain researchers
are associated with certain
treatments: Jack Vernon with
masking and Xanax; Pawel
Jastreboff with auditory habitu-
ation; Doug Morgan with TMJ.
It is not surprising that their
conversations, their writings,
their views, and their presenta-
tions reflect a personal passion.
It is in all likelihood a phenom-
enon necessary to the process.
The movement of informa-
tion at the seminar was not
confined to the session room
alone. Lunches, chance meet-
ings in the hallway, and other
social occasions offered up pre-
cious opportunities for the
exchange of ideas. We ate, we
walked, and always we talked
tinnitus.
12 Tinnitus Thday/ September 1995
Dr. Ross Coles, Guest oj"Honor Senator Mark 0. Hatfield, keynote
speaker at Gala
Jack Vernon, Ph.D. Dr: Jonathan Hazell James Snow, M.D.
Aram Glorig, M.D. Alexander Schleuning, M.D. Abe Shulman, M.D.
Gloria Reich, Ph. D., and Joan Saunders Jack Vernon, Ph. D. and Rene Dauman
Barbara Rubenstein, D.D S. and Douglas
Morgan, D.D.S.
Craig Newman, Ph.D., Gary Jacobson,
Ph.D. , and Jim Henry, Ph.D.
Paul Guth, Ph.D. Dr. Adrian Davis Mary Meikle, Ph. D.
Bob Sandlin, Ph. D. Alf Axelsson, M.D. John House, M.D.
(L to R) 7Yudy Drucker, Ph.D., Barbara Thbachnick, Peter Saunders, Elizabeth Eayrs,
Jo Hazelby, Rudolf Dees, and Joan Saunders.
PawelJastreboff, Ph.D. and
Rich 7y/er, Ph.D.
Dr. Alastair Mackendrick, Gloria Reich,
Ph.D. and Pam Gabriels on the
Willamette River Cruise.
Billy Martin, Ph.D. and Jos Eggermont
Tinnitus 1bday/ September 1995 13
Pawel Jastreboff, Ph.D., and Margaret
Jastrebo!J, Ph.D.
Gloria Reich, Ph.D., Pam Gabriels, and
Billy Martin, Ph.D.
Dr. Ewart Davies and Pat Daggett
Phil Morton and Pat Daggett
14 Tinnitus Thday/September 1995
Gerhard Goebel, M.D. and
Gloria Reich, Ph. D.
Jennifer Derebery, M.D.
Karen Berliner, Ph.D.
Rich Nodar, Ph.D. and
Gail Brenner, MA CCC-A
Joseph Kraft, M.D.
Donna Wayner, P11.D.
Robe1-t Sweetow, Ph.D.
Paul Windle-Thy lor
Dr. Rich Barrett
Susan Gold, MA CCC
SPIA
Anne Young, from ATA, at the
registration des/.:.
Dr Neta Kolasa, former ATA support
group leader; and lwsband }ohr1
Jack Vernon, PhD Jacqueline Sheldrake Jolm Emmett, M D
Gallard Goebel, M.D. Peter Dyer and Marjorie Hooper; BTt\
Saturday Night Gala at the Montgomery Park Atrium
Glona Reich, Ph.D and Bob Brummett,
Ph.D
Aage Moller; Ph.D
Jml Kaltenbach, Ph.D. and Michael
Seldmcm, M.D.
A nne Young and Daue Tllmsen 111 front of
Marpac Exhibit.
Peter Saunders, Bob johnson, Ph.D
Tinnitus 1bday September 1995 15
The Ear Defenders at Shawmont School
by Barbara 'Iabachnick, Client Services Manager
They know that sound waves enter the ear
canal, vibrate the ear drum, travel through the
middle ear bones and into the cochlea. They
know that loud noises from leaf blowers, vacu-
um cleaners, and boom boxes can cause damage
to the hair cells in the cochlea from which hear-
in"' loss tinnitus and deafness can result. They
0 I I
know when and how to use ear plugs, and to say
"Please turn that down!" when a TV or stereo is
too loud. They are students at Philadelphia's
Shawmont School. They are seven years old.
Last year, when Alice Mandel wrote to us for
our Hearing
Conservation
and Tinnitus
Prevention
Program
materials for
her second
grade class, I
thought that
her students
were too
young to ben-
efit from the
information.
That thought
prevailed until
I received a
package from her class last month, filled with
thank you letters and drawings of ears, sound
waves, ear plugs, and themselves as "Ear
Defenders." T now know how capable second
graders are of taking an important message to
heart and making it their own.
We watched the tape 3 times because the
class wanted to see it over and over again.
It was a very educational movie for
children to see. I like doing the work paper.
- Chambraia
According to Ms. Mandel, her Ear Defenders
are retaining even the subtle messages in the
material - that loud noises can make them feel
upset, and that they can exert some control over
their own exposure to offending noise. "They
16 Tinnitus 'Tbday/ September 1995
come to school now aware of loud noises outside
of class. It's sinking in. I think they'll always
know it," said Mandel.
I like the ear plugs. They are neat.
-Michael
Michael Graff, Shawmont's pdncipal, encour-
aged Mandel's use of ATA's tinnitus prevention
material as an adjunct to her class' health lesson.
This program is an obvious departure from the
standard curriculum in the Philadelphia School
District, but is
likely to be
slated for the
coming year's
second grade
health curricu-
lum- at
Shawmont any-
way. Mandel is
interested in
advancing the
program's use
beyond the sec-
ond grade
level, beyond
Shawmont's
walls, and pos-
sibly beyond the bounds of the district itself.
The materials we send to elementary schools
include a "Play it Safe, Thrn it down, We want
you listening for a lifetime" poster donated by
the Electronic Industries Association, an imagi-
native work sheet packet about tinnitus and
noise with ATA's letter to parents, a teacher's
guide to classroom activi-
ties, and several
tinnitus/hearing/ noise
research articles. Included
with these articles is a
transcript of the 1991
hearing before the House
of Representatives'
Committee on Children,
Youth, and Families enti-
tled "Thrn it Down: Effects
of Noise on Hearing Loss in Children and
Youth." We also send ear plug samples and care
instructions, all of our brochures, and the 8.5
minute NIDCD musical video, "I Love What I
Hear" that illustrates the hearing loss and noise
connection. This video of children encouraging
other children to save their precious hearing by
becoming "Ear Defenders" is very popular.
Although it fails to mention the word tinnitus, it
gets other critical ideas across.
I like the papers a lot and
the film was good.
-Elizabeth
Our tinnitus prevention packet has been
used successfully in 3rd, 4th, and even in 5th
grades with only a few modifications. For the
older grades, sound wave experiments take the
place of coloring sheets. Our middle and high
school posters use excellent graphics to encour-
age teens to monitor their immersion into loud
music. Unfortunately, as children get older, they
are less likely to be influenced by parental- like
dictates, especially dictates that appear to come
between them and their music. That sad fact
does not, however, change our responsibility to
try to reach the few who might listen. Ironically,
older teens today are experiencing unprecedent-
ed hearing loss (and often accompanying tinni-
tus) due to cumulative and excessive exposure to
noise.
Thank you for sending the tape.
You are a valuable friend to me.
- Seveta
ATA's Mission 2000 is a plan of action that
was designed by our board of directors in 1994 to
move tinnitus into the open, advance its
research, identify its mechanism thereby paving
the way for a cure, and prevent it in the only
preventable way known - all by the year 2000.
Addressing the latter directive, we are working to
have the health curricula in all states for aU
grades amended to include discussion of causes,
treatments, and issues of tinnitus by 1997.
Bureaucratically, it's a slow process. This grass
roots program is what we do while the bigger
wheels slowly turn.
I loved the movie you made.
I also like the health papers you made.
-James
ATA's hearing conservation and tinnitus pre-
vention materials are sent to anyone who
expresses a desire to pass it along to a school or
teacher - educators, former educators, or fami-
ly members who want to take the materials to
the schools attended by their children or grand-
children. Some people become hearing conser-
vation and tinnitus prevention ambassadors
because of a personal need to do it. Others, like
Mandel, give their gifts because that is how they
want to help in their communities. "And here
I am with my tinnitus," says Mandel, "helping
in my way. We can function; we can find our
way." When it comes to ear defending, any moti-
vation or messenger is a good one. We applaud
them all.
We had a fun time.
Thank you very very ve1y much.
-Adam
Tinnitus 1bday/ September 1995 17
Incidence and Awareness of Tinnitus in
University Students
By Arlene M. Jewell
Webster defines tinnitus as "a sensation of
noise (as a ringing or roaring) that is caused by
a bodily condition (as wax in the ear or a perfo-
rated tympanic membrane) and can usua1ly be
heard only by the one affected." If placed in a
perfectly quiet room, approximately 95% of the
population would have some sort of auditory
perception, though most people are not aware of
slight tinnitus because it is masked by ambient
noise. With certain types of tinnitus, according
to Dr. Max Goldstein, ''the patient is literally
listening to old age sneaking up on him."
Tinnitus can result from many sources, such
as certain medications, illness, or blows to the
head. However, loud noise is the most prevalent
cause of tinnitus and one of the most pre-
ventable causes of hearing impairment.
According to the American Speech-Language-
Hearing Association (ASHA), an estimated 20
million Americans are regularly exposed to
noise at dangerous levels. The louder the noise
the shorter the time h takes to affect a person's'
hearing. An arcade full of video games, for
example, could cause damage in two hours. The
average rock concert or stereo headset set at full
blast (about 110 dB) could damage a person's
ears in half an hour. Many young people who
enjoy the feeling of sounds ricocheting around
inside their heads don't realize until too late
what damage can be done.
Although the average age oftinnitus sufferer
is 58.5 years, there are 1.3 million tinnitus suf-
ferers in this country who are 18 years old or
younger, according to a 1990 survey by the
National Center for Health Statistics.
In a survey among teenagers in Thrin, Italy,
26% of the 159 respondents indicated that they
had experienced a dulling of their hearing or
ringing in their ears from frequent usage of per-
sonal cassette players at fairly loud volumes.
This survey echoed the results of a similar sur-
vey done by Rice in England. According to the
FDA Consumer, a researcher tested the hearing
of incoming freshmen at the University of
Thnnessee in 1969 and found that 60% of the
students already had some hearing loss. (For
reasons that are unclear, there are considerable
18 Tinnitus Today/ September 1995
differences in susceptibility to noise damage
between individuals, between ears, and at
different times for the same individual.)
Many of the "normal" activities of university
students, such as spending time in situations
with loud sound, drinking alcoholic beveracres
0 I
or consuming caffeine or salicylates, are
activities that can contribute to damage in the
auditory system that causes tinnitus. The stress
experienced by many university students can
increase the loudness of existing tinnitus.
I conducted a survey at a medium-sized
"commuter" university in the southeastern part
of the United States. An attempt was made to
randomly select a variety of students in a wide
variety of subject areas. Of the 175 survey ques-
tionnaires distributed, 134 (77%) were complet-
ed. By age group, 88 (66%) of the respondents
were 14-24 years old; 27 (20%) were 25-34 years
old; 9 (12%) were 35-44 years old; and 7 (5%)
were 45 years old or older. The questionnaire
asked if students had ever heard of tinnitus, and
how much time they spent in loud sound situa-
tions. It also requested information pertaining to
attitudes and habits, such as the probability of
removing oneself from a loud noise situation
the amount of alcohol consumed, and
evaluation of the respondent's hearing ability.
From those who were already experiencing tin-
nitus or tinnitus symptoms, information was
gathered regarding frequency and length of time
the individual had experienced tinnitus.
The results: Of the 134 responders, only 54
( 42%) had ever heard of tinnitus, almost equally
divided between males and females. In this sam-
ple, 23 (18%) acknowledged consuming seven or
more drinks per week. Five of the 23 who con-
sumed seven or more drinks per week admitted
to having tinnitus or tinnitus symptoms.
Fifteen (11%) of the 134 spent 3-6 hours or
more each day in the presence of loud sound,
10 (7%) spent 1-3 hours per day, 22 (16%) were
in the presence of loud sound every 2-3 clays, 35
(26%) were in the presence ofloud sound once
a week, while 53 (39%) were in the presence of
loud sound "once or twice a month" or "rarely."
The sample also included 37 (29%) who clain1ed
that they seldom removed themselves from the
loud sound.
Incidence and Awareness of Tinnitus in
University Students (continued)
Eight (6%) respondents had tinnitus "most
or all ofthe time" while an additional12 (9%)
answered "yes" to having tinnitus that lasted
"five minutes or more." An additional 46 said
they experienced tinnitus symptoms anywhere
from once a month to once a day. Within the
14-24 year old age group, 11 (14%) were already
experiencing symptoms of tinnitus, including
three who admitted to having tinnitus all or
most of the time.
Of the 20 from the original 134 who had
"tinnitus symptoms/tinnitus," 18 answered the
question about "present hearing ability."
Thirteen (72%) claimed "normal" or "above
normal" hearing, while five (28%) admitted to
having moderate to severe hearing loss. In the
total group of 134, 109 (81%) felt they had
normal or above normal hearing, and 25 (19%)
admitted to having mild to moderate hearing
loss.
When all of these results are extrapolated to
include the total student body, it is a probability
that 468 students out of the 3755 have tinnitus,
and an additional 702 are experiencing the
symptoms. This number of students with the
condition is significant. Although many of them
are not being disturbed by tinnitus a great deal
yet, the future may contain stress and frustra-
tion caused by a worsening of the condition.
Those currently experiencing it may be able to
keep it from worsening, but only if they are con-
vinced that the time to work towards that goal is
now. They must be willing to modify their
behavior and attitudes not after the fact, but
now. For those who do not have it, the time to
prevent it is now.
REFERENCES
American Tinnitus Association. (1994). Information about
Tinnitus. Portland, OR.
American Tinnitus Association. (1994). Noise: Its Effects on Hearing
and Tinnitus. Portland, OR.
American Tinnitus Association. (1992). Tinnitus Patient Survey.
Portland, OR.
Meyerhoff, W.L., (1986). Disorders of Hearing (pp. 78-87). Austin,
TX: PRO-ED.
Modeland, v. (1989). When the Bells are ringing (but there aren't
any bells). FDA Consumer, 23(3), 8-13.
Noise and Hearing Loss. (1991, July). The Lancet, 338(8758), 21-22.
Rice, C.G., Rossi, G., & Olina, M. (1987). Damage risk from
personal cassette players. British Journal of Audiology, 21, 279-288.
Ranis, M. (1984). Alcohol and dietary influences on tinnitus.
Proceedings, Second International Tinnitus Seminar. Edited by A.
Shulman & J. Ballantine. J. Laryngol., Otol. (Suppl] 9:242-246.
Ranis, M. & Wohl, D. (1991). Tinnitus & diet. Tinnitus:
Diagnosis & treatment. Lea & Febiger: Philadelphia.
Sheppard, L. & Hawkridge, A. (1987). Tinnitus: Learning to Live
with It. 1st ed. Ashgrove Press. Bath, England.
Stevens, S.D.G. (1987). Historical aspects of tinnitus. Tinnitus
edited by J.W.P. Hazell. Cburchill-Livingstone: New York.
Stouffer; J.L. & 'JYler, R.S. (1990). Characterization of tinnitus by
tinnitus patients. Journal of Speech & Hearing Disorders, 55(3),
439-453
Vernon, .J. (1995). Tinnitus: More than a "buzz word. Hearing
Health, 11(1), 38-41.
Wallin, N.L. (1986, April). The modern soundscape and noise
pollution. UNESCO Courier, 31-33.
Webster's Ninth New Collegiate Dictionary. (1991). Springfield, MA:
Merriam-Webster Inc.
Williams, R.D. (1992). Enjoy, protect the best ears of your life.
FDA Consumer, 26(4), 25-28.
Wilson, P.H., Henry, J., Bowen, M., Haralambous, G. (1991).
Tinnitus reaction questionnaire: psychometric properties of a
measure of distress associated with
tinnitus, Journal of Speech &
Hearing Research, 34, 197-201.
Tinnitus Thday/ September 1995 19
Questions & Answers
by Jack A. Vernon, Ph.D., Director, Oregon Hearing
Research Center, 3515 SW Veterans Hospital Rd.,
Portland, OR 97201
[Q]
Mr. B. In Thnnessee says "a hearing aid
dispenser told me he could relieve my
tinnitus with the new in-the-canal
hearing aid. Is he correct?"
As with most things concerning tinnitus,
there is only one way to find the answer
to that question: TRY AND SEE. Hearing
aid dispensers are required by federal law to
give you a 30-day money back guarantee, so
you have nothing to lose. As a general state-
ment, about 16% of those trying hearing aids
will find that they do give tinnitus relief, but
those data are all based on studies with more
conventional hearing aids and not the
in-the-canal (ITC) hearing aids. I have heard
one or two reports from patients fitted with ITC
aids who said that their tinnitus was relieved.
Have any ofyou readers experienced tinnitus
relief with in-the-canal hearing aids?
[Q]
Ms. K. from Nebraska asks, "My tinnitus
maskers work very well to relieve my
tinnitus, but with them in and working I
have trouble understanding those talking to me.
Can this situation be corrected?"
It is true that masking can sometimes
interfere with hearing, and it can do this
in two different ways. First of all, the
units are blocking the ear canal so that speech
signals would have a reduced opportunity to
reach the ear drum. Secondly, the masking
sound itself may be interfering with your ability
to attend to the speech sounds. However,
because speech sounds are primarily made up
of lower frequencies and are at the wrong
address to be interfered with by masking
sounds, which are at high frequencies (tinnitus
is usually a high pitched sound), the masking
sound itself should not cause a disruption of the
speech sounds.
I would guess that you not only have bilater-
al tinnitus but that you also have some hearing
loss. If that is the case, the answer to your prob-
lem is simple. Have the tinnitus maskers
20 Tinnitus 1bday/September l 995
replaced with tinnitus instruments which are
combination units containing a tinnitus masker
and a hearing aid.
Remember to always adjust the hearing aid
portion of the tinnitus instruments first, after
which you adjust the tinnitus masker. That way
you will have compensated for the heating loss,
making it possible to use lower levels of mask-
ing to effect tinnitus relief. And obviously, the
lower the loudness of the masking sound, the
less the opportunity for it to interfere with
things to which you wish to listen.
If you do not have any hearing loss, then it
may be possible to utilize an open mold configu-
ration with the tinnitus maskers you already
have, so as to not block the ear canal. Since you
have two maskers, does using only one masker
help with the hearing of speech as compared to
using two maskers?
[Q]
Mr. Q from Illinois asks, "In some of the
reading I have done, reference is made
to central and peripheral tinnitus. What
does that mean?"
Peripheral means the inner ear and
central means the brain. It is important
for you to realize that there are no tests
yet available which will designate peripheral
from central tinnitus. That classification system
is based more on guess work than on measur-
able facts. If one has suffered noise damage
which produced tinnitus, it seems reasonable to
assume that the locus of damage is the hair cells
in the inner ear. Thus, one might say that such
tinnitus is peripheral. But even in this clear cut
case, it is my guess that eventually we will find
that tinnitus resides primarily in the brain. As
the auditory nerve travels upward through the
various brain centers, there are four crossover
points that connect the ears to each other. It has
happened that tinnitus, which started out in one
ear only, eventually came to be heard in the
opposite ear as well even though nothing hap-
pened to that side to instigate tinnitus.
The location of the perception does not con-
stitute the differentiation. For example, tinnitus
perceived as being in the head does not mean a
central tinnitus. The in-the-head localization of
Questions & Answers (continued)
tinnitus is much more likely to be due to equal
neurological inputs from the two ears. It is possi-
ble to do that with external sounds. When two
equal, in-phase sounds are delivered to the ears
through ear phones, the perception of the
sounds is not in the ears but rather as a single
sound in the head.
It is not necessarily true either that tinnitus
resulting from head trauma is a case of central
tinnitus. Blows to the head can produce damage
at the inner ear as well as in the brain. In a simi-
lar manner, many assume a cervical connection
between a whiplash injury and resulting tinni-
tus. It seems much more likely to me that the
whiplash action produced brain injury by mov-
ing the brain about within the cranium.
[Q]
Mrs. T. from New Jersey asks, "I have
read or heard that a tiny microphone
inserted into the ear canal can detect the
tinnitus sounds we hear. Is that true?"
You have been reading about
"Otoacoustic Emissions." These were
discovered by Colin Kemp, an engineer
working in England. Otoacoustic emissions are
extremely low-level sounds that come in two
general forms. There is the transmitted emis-
sion, which results from stimulation of the ear
with sound. This emission is a kind of echo,
where the sound enters the ear canal, travels
through the inner ear, comes out of the inner
ear, and is reflected back through the ear drum
into the ear canal where it is detected by a
microphone used to record the otoacoustic
emission.
The other kind of otoacoustic emission is a
spontaneous emission, which is a sound coming
out of the ear in the absence of any sound being
put into the ear. As you can imagine, when the
spontaneous emission was first discovered,
everyone thought it might be tinnitus. And what
a wonderful thing that would have been, but
unfortunately it turned out that the spontaneous
emissions did not conespond to the tinnitus and
indeed they were present in some ears without
tinnitus. In rare cases, a person will have a num-
ber of different spontaneous emissions, most of
which will not be perceived, but one that will
conespond to his or her tinnitus.
[Q]
Mr. R. from Thxas asks, "What is
hyperacusis, and since I have tinnitus,
do I also have hyperacusis?"
Hyperacusis is a lack of loudness
tolerance. Sounds that are perfectly
acceptable to others are uncomfortable
to hyperacusis patients. The fact is that hypera-
cusis patients are in extreme discomfort almost
all of the time. Things like refrigerator motors,
normal conversation, dish sounds, running
water, or automobile sounds are all uncomfort-
ably loud. Most hyperacusis patients complain
that their hearing sensitivity is excessive and
that they hear things others do not hear, but that
is not true. Some hyperacusis patients actually
do have hearing loss. Many tend to overprotect
their ears, with the result that they make their
hyperacusis worse. They need to protect their
ears from truly loud sounds, but they also need
to not overprotect them from ordinary sounds.
I recommend that all hyperacusis patients
join Dan Malcore's Hyperacusis Network (Dan
Malcore, 444 Edgewood Drive, Green Bay, WI
54302-4873, 414/ 468-4667).
Tinnitus Thday/ September I 995 21
Tips for Hearing Aid Care
by Betty Mathis and Gloria E. Reich, Ph.D.
These suggestions apply to all in-the-ear
and behind-the-ear (BTE) aids. Some of these
tips were learned the hard way.
1
Keep them dry. (Do not wear them in the
shower, even under a shower cap.)
2
Keep them clean. Wipe them at night with
alcohol, taking care not to get them too wet.
3
Don't take them off over a hard surface. You
might drop them and damage delicate parts.
(Repairs are not cheap.)
4
Always keep spare batteries with you in
your purse, pocket, or car.
5
Remove the aids and turn them off at night.
You can take the batteries out entirely.
6
Leave the aids in the same place every
night. (Otherwise you might go crazy trying
to find them in the morning!)
7
Remove them when you go to the hair-
dresser. Do not sit under the dryer while
wearing them.
8
Your aid may not work as well in a hot and
humid climate because moisture can get into
your ear and into your hearing aid. Solution: put
the aid in a jar with a little bag of silica crystals
22 Tinnitus 1bday/ September 1995
or gel, close it up and leave it in there over-
night. This will take the moisture out. You can
get the silica bags or jel in a shoe store, craft
store, or drug store. There is also a product
called "dry aid" just for this purpose.
9
Educate your family about your hearing
aids, especially if you have young children
or grandchildren.
10
Don't let the aids lie around where pets
can get ahold of them. (Dogs and cats
love the smell of ear wax and will chew and roll
on your aids. Pets are also bothered by the high-
pitched squeal of aids that haven't been turned
off completely.) Put aids inside containers that
pets can't open. A film can works well for small
hearing aids.
11
Get the tubing changed in your BTE aid
about every six months or when the tube
starts to get hard.
12
13
For all in-the- ear aids, make sure the
sound opening is clear of wax.
If you can afford it, keep a spare hearing
aid around. This is inexpensive insur-
ance ifyou have a moderate to severe hearing
loss.
A Commentary
(continued from page 9)
Oregon Hearing Research Center stand tall
among those institutions promoting tinnitus
therapy and research. Dr. Vernon retires this
year, yet that which he has contributed to our
understanding of the human dynamics of tinni-
tus will persist. My guess is, even in retirement,
his presence will be felt by us all.
Editors note:
The quantity and content of the papers submitted
dictated the number of papers selected for presenta-
tion at the Fifth International Tinnitus Seminar.
While a few scientists had much of their work fea-
tured, it was reflective of the volume and quality of
research they had conducted.
Welcome and Thanks to
Our New Tinnitus Support
Network Volunteers:
Support Group Coordinators
Deborah Saunders
22610 Powell House
Katy, TX 77449
713/347-7927
(Houston Area)
Megan Vidis
731 W. Briar Pl. #3 East
Chicago, IL 60657
312/477-1044
Telephone & Letter Contacts
Ellen Werblow
66-25 103rd St.
Forest Hills, NY 11375
(TTY) 718/459-7096
Robert Aurandt
2144 Sloan St.
Maplewood, MN 55117-2029
612/771- 9948
Telephone Contact
Mr. Jan L. Peterson
Appleton, W1
414/730-1193
Letter Contact
John B. Sampson
504 E. Th1egraph Rd. #51
Washington, UT 84780-1850
TINNITUS
NEW HOPE FOR A CURE
by Paul VanValkenburgh
AN ORIGINAL NEW BOOK
Explaining the mecharusms of tinnitus and
potential therapies, by an internationally known
research engineer/writer.
Introducing entirely new ideas on how tinnitus
works and how to stop it. Revolutionary theories
provide a unified explanation for each and all of the
peculiarities of tinnitus.
Written for both sufferers and professionals, with
extensive new biomedical research references for
neuroscientific support. Surprising revelations in:
+ spectrum edges + tonotopic maps
+ internal filtering + filter overload
+ auditory resonance + sensation adaptation
+ cochlear capillaries + normal reaction ringing
128 pages, paperback, $15.00 postpaid (in U.S.)
(FREE 2-page contents and synopsis. Just send a
SASE.)
TlNNITUS
Box 3611
Seal Beach, CA 907 40
If you are interested in
starting a support group, or
volunteering on the phone
or as a pen pal, please write
for our self-help packet of
information.
Tinnitus lbday/September 1995 23
Accentuate the Positive
by Theri.s Aldrich
Anxiety and fear swept over me for months
after suddenly being startled by incessant shril1
hissing in my ear. However, when I compare my
miserable quality of life a year ago to my cur-
rent activities and attitude, I realize that I have
been making a journey from despair to hope.
Eager to encourage others with whom I share
tinnitus, I offer some self-help ideas that made
a world of difference to me.
Begin with a thorough medical examination
to determine if your tinnitus has an identifiable
physical cause that may be remedied. In my
case, none could be found. At first, the report
disappointed me; I had hoped the problem was
something like curable impacted ear wax. Then
common sense took over. I thought of my
friend, a true heroine, who is courageously bat-
tling multiple medical problems in addition to
tinnitus. Sometimes one needs to turn outward
to be appreciative of what one doesn't have.
Learn as much as possible about tinnitus.
Whatever the tmth may be, it is more an advan-
tage to one's well-being than are imaginary
fears. Because there is more unknown than
known about tinnitus, well-documented litera-
ture on the subject is sparse on library and shop
shelves. When I found the American Tinnitus
Association, I became a member as soon as pos-
sible. I treasure their articles and recommended
literature. Equally valuable is the association's
fostering of self-help groups that help empha-
size our common human connection to one
another.
Keep to an optimistic expectation that tinni-
tus eventually will be understood. But in the
meantime, do not be apathetically resigned to a
miserable existence. Determine to be an "action
researcher" to improve your own life.
Consult an audiologist knowledgeable about
masking devices purposed to make tinnitus less
disturbing. These devices can possibly provide
short periods of time free of noise. An audiolo-
gist friend of mine suggested an individually
molded in-the-ear masker for me since I have
no appreciable hearing loss. The masker manu-
facturer offers a three-month free trial period
24 Tinnitus 'TOday/September 1995
after which the masker can be purchased or
returned. Do use the masker regularly for two
months before deciding; effectiveness varies
among individuals. Admittedly it serves me
better at times than at others, but I would not
choose to be without it. Before bed, I remove it
and use a walkman earphone radio which does
not disturb my husband's sleep and allows me a
restful night.
My supportive husband had a jack installed
in our TV. A portable speaker is wired to the
jack and set near me when I watch TV. When
the volume is at a certain level, it acts as a
masker and also allows us to enjoy TV programs
together.
Never over-indulge nor demand efforts
beyond your abilities. Who knows your abilities
and limits better than you? Much of accentuat-
ing the positive is self-discipline but not to a
degree that will allow social withdrawal or aban-
donment of mainstream living. Tinnitus can
make it so tempting to give up, to retreat.
Realize that being human includes accepting
temporary barriers.
Inventory your strengths and needs, then
use what you learn to move towards the positive
person you can become. I need to be physically
active and find that walking and breathing
deeply at the same time is invigorating and
stress reducing. Sometimes two or three short
walks are more beneficial than one long one. I
need to be socially involved, preferably with
individuals or small groups where chatting
doesn't escalate to clamor. I profit from mental
activity: reading, crosswords, playing cards, writ-
ing letters. I find relaxation in listening to
music, watching professional ice skating, driving
in areas of natural beauty.
In my 77 years, life has been full of blessings
- some as direct answers to prayers, others as
unexpected gifts. Whatever your faith or philoso-
phy, use it to enable you to know a better
ton1orrow.
Tributes, Sponsors, Special Donors,
Professional Associates
Champions of Silence are special donors who have demonstrated their commitment in the fight against tinni-
tus by making a contribution or research donation of $500 or more. Sponsors and Professional Associates con-
tribute at the $100-$499 level. ATA's tribute fund is designated 100% for research. We send our thanks to all of
those listed below for sharing memorable occasions in this hopeful way. Contributions are tax deductible and
are promptly acknowledged with an appropriate card. The gift amount is never disclosed. GIFTS FROM 4- 6- 95
to 7-15-95:
Champions of
Heba R. Harmon Arlene & Dennis Roth F.W. Mansfield Smith, M.D.
Silence
James & Colleen Hartel Jack Salerno DonnaS. Wayner, Ph.D.
Charles B. Hauser Andre N. Schipper Robert J. Weiss, M.D.
Rob M. Crichton
Manny Hillman Richard S. Schweiker Howard D. Zipper, M.D.
Randall C. & Elise Ducote
Dorothy R. Hiltner Evelyn J. Schwertl
Sponsor Members
Lorraine Hizami Earl L. & Sybil P. Small In Memory Of
Robert B. Horn Robert A. Sperl
James Huiner
Angelo J. Ariani
Andrew Hrivnak Donald H. Steves
Arlo & Phyllis Nash
Claudia Bailey
Jack Huang Howard C. Stidham
Kathryn Knutson
John J. Banavige
William H. Hurt Ruth M. Swan
Joseph M. Baria
H. June Ivins James C. Totten
Arlo & Phyllis Nash
Ned K. BartheJmas
Barry V. Johnson Scott Thrner
Selma & Alan Rothenberg
Mrs. Fran Belkin
Ruth M. Johnston Arlene B. Vannorden
Susan R. Ericson
Thrrie Bergman
L. Craig Johnstone David Walsh
Grazia Volpe
Deborah & Charles Bern
Kenneth W. Jones Brenden D. Walz
Samaritan Hospital
R. John Bishop
Aravind Kancherla Michael Webber
Bldg. Services
Ira F. Breiter
Harold S. Karpe Rita Weisner
Mary E. Thomas
Charles T. Brown
Harry & Marion Keiper Charles E. White
William E. Brown, Jr.
Edward N. Kelly Kathleen M. Williams
In Honor Of
A. Paul Camerino
Robert A. Kirkman Derwin L. Williams
Birthday - John G. Alam
Lenore G. Chapman
Shirley E. Kodmur Shirley L. Wireman Joseph G A1am & 'Itudy
Donald J. Cook
David J. Kovacic Adelaide W. Zabriskie Drucker
Richard W. Cooper
Marvin Kowit
Birthday - Julie Alam
George Crandall Jr.
Robert M. Kyvik
Research Donors
Joseph G. Alam & 'Itudy
Gregory K. Crouch
Fred R. Lawson Joseph G. Alam
Drucker
Walter Z. Davis
Richard A. Layton Arnold Bellowe
Robert B. Dellbrugge
Bernard Lehrer
Eunice Fitzell
Birthday - Richard A.
Gardner
Edwin Devilbiss
Gary L. Lombardi Larry C. James, Jr.
Kit Dickerson
Vince Majerus Jerry Thompkins
Joseph G. Alam & 'Itudy
Drucker
Carolyn M. Domingus
A. F. Martin
Thya Dubonnet
Bruce Martin
Professional
Birthday - Kent E. Thylor
Irene Duffield
Andreas Mattheisen
Associates
Joseph G. Alam & 'Itudy
Eleanor G. Egli
Thomas F. McNulty
Drucker
James T Fehon
AJexander Miller
F. Owen Black, M.D.
Birthday - Mary 'fully
Ronald T. Ferguson
Mary T & James Moran
George T. Boris, M.D.
Joseph G. Alam & 1hldy
Richard J. Filanc
Glenn A Morton
Neil M. Daniels, Ph.D.
Drucker
Bernard Fishman
Mace Neufeld
Shahn A. Divorne
Community Service
David E. Flatow
Caroline S. Nunan
Bjorn Eriksen
Award - Trudy
Mary A. Floyd
Ruth E. Ochs
Jack R. Erwin, M.D.
Drucker
Janet G. Garman
David Oringdulph
Evelyn Gong, M.A.
Joseph G. Alam
Gerald Otis Gates
Benjamin Ossman
William C. Gray, M.D.
Father's Day - Jack
Perry Gault
.Randy L. Parks
W.F. Samuel Hopmeier,
Harary
Arthur Gelb
BC-HIS
Thomas J. Patrician
Bob & Debbie Harary
Ken P. Gelinas
Phil R. Pearcy
Valerie P. Kriney,
Danielle Gladding
MAl CCCA
Graduation -
Mary Ann Perper
Dr. Herbert A. Levin
Katelyne Lefevere
James S. Gold
Ruth M. Philpott
W. J. & Helen Gotschall
Tyrone E. Powell
Mark A. Lipton, M.D.
Joseph G. Alam & 'Itudy
Sol Marghzar, MS/ CCCA
Drucker
Charles Mark Grabinski
James K. Quire
William E. Gromen
Shirley A. Ramirez
Thrrence P. Murphy, M.D. Recovery-
Josephine K. Gump
Florence Reich
Harvey A Pines, Ph.D Lorraine Spivak
Lawrence E. Happ
Andrew J. Rosser
Dr. Otis D. Rackley, Jr. Joseph G. Alam
Tinnitus Thday/September 1995 25
1995 Available Now hardcover
ISBN: 0-205-14083- J
Order #H40835 $44.50
ANIMPORIANTBOOKIN
TH[ STUDY OF TINNITUS ...
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Mechanisms of Tinnitus
Jack A. Vernon a11d Aage R. Meller, editors
Distinguished contributors at the frontiers of tinnitus research thoroughly explore the
mechanisms and source of tinnitus in this important new book. Although tinnitus is a
serious problem for the miUions of people in the U.S. who are affected by it, lreatment
options are limited because its cause is not well understood. Jack Vernon and Aage
M0ller invited the leading researchers to share their evolving hypotheses and ideas-
the result is a stimulating view of tinnitus theory and research in progress. Chapter
authors discuss why adults usually experience tinnitus as constant while in children it is
almost always intermittent, how patients' belief that tinnitus is a serious health threat
may influence their level of tinnitus-related distress, and how initial medical counseling
may actually increase a patient's anxiety, resulting in more intense tinnitus perceptions.
Contents Psychophysiological Dimensions of Tinnitus, Raimuud Brix A Mechanism for Tinnitus?
Robert E. Bmmmett Classification of Causes. Med1anisms of Patient Disturbance. and Associated
Counseling_ Ross Coles Correlated Neural Activity and Tinnitus. Jos J. Bggermont and Yvonne Sininger
Mechanisms of Tinnitus, Harald Feldmatln Tinnitus in Children witll Hearing Loss, John M. Graham
Models of Tinnitus: Generation. Perception: Clinical Implications, Jonathan W. P. Hazell Tinnitus as a
Phantom Perception: Theories and Cl inical Implications. Pawel J. Jastreboff Tinnitus and Spontaneous
Activity in the Auditory System, Masaaki Kitahara, Hiroya Kitano, Mikio Suzuki, and Kazutomo Kitajima
Neural Medlanisms of Tinnitus with Special Relerence to the Pathological Ensemble Spontaneous Activity
of the Auditory System. Thomas Lenarz, Christoph Schreiner. Russell L. Snyder, and Arne Ernst A Model for
Cochlear Origin of Subjective Tinnitus: Excitatory Drift in Operating Point of Inner Hair Cells, Eric L. LePage
A Conversation About Tinnitus, Robert A. Levine a11d Nelson Y.S. Kiang Spectral Analysis of Brain Activity
in the Study o Tinnitus. William Hal Martin The Interaction of Central and Peripheral Mechanisms in
Tinnitus. Mary B. Meikle Pathophysiology of Tinnitus. Aage R. Meller Psychophysical Observations and the
Origin of Tinnitus. M.J. Penner and R.C. Bilger The Analogy Between Tinnitus and Pain: A Suggestion (or a
Physiological Basis of Chronic Tinnitus. Juergen Tomtdorf Codllear Motor Tinnitus, Transduction Tinnitus
and Signal Transfer Tinnitus- Three Models of Cochlear Tinrtitus, Hans Peter Zenner and Arne Ernst Index
Order Your Holiday Cards Now!
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Holiday Art Contest.
Set of 12 cards (4
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26 Tinnitus Thday/ September 1995
NATIONAL IDWNTARY
HFAL1H AGENCIES
The American Tinnitus
Association CFC#0514
The Combined Federal Campaign (CFC)]
under the auspices of the NVHA
1
will begin its annual
charitable giving drive in September.
For those of you who contribute to the ATA
in this way] please send us a copy of your pledge form.
(Notification of pledges to us is often delayed.)
If you are able to volunteer your time
as our representative at a CFC health fair in your area]
we
1
d be pleased to hear from you.
AMERICAN TINNITUS ASSOCIATION
P.O. Box 5, Portland, OR 97207-0005
Forward and Address Correction
Proceedings of the Fifth
International Tinnitus Seminar
Over 91 papers and 4 7 posters were
presented by 110 researchers, doctors, and
sufferers from 25 countries at the
Fifth International Tinnitus Seminar,
July 12 -15, 1995 in Portland, Oregon.
Every aspect of tinnitus was
explored- from diagnoses to treatments,
from personal concerns to professional
interaction, from fact to speculation.
This valuable information will soon be available
in a soft-bound publication. Containing the full
transcript of each paper and poster, this book will be
the most current and comprehensive source of
tinnitus information available anywhere.
At only $25, it also will be the most accessible.
Use the form below to order yours today.
(This book is currently in publication. Expect
delivery in 6-10 weeks.)
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