Tinnitus Today September 1997 Vol 22, No 3

September 1997 Volume 22, Number 3
Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Research- Referrals- Resources
In This Issue:
Tinnitus and
Homeopathy
Back to School -
Children and Tinnitus
Fad Diets, Quick Fixes,
and Tinnitus
New PET Research
Sounds Of Silence
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- - -
Tinnitus
Editorial and Advertising offices: American
Tinnitus Association, P.O. Box 5. Portland,
OR 97207, 503/ 248-9985, 800/ 634-8978,
hupJ I w1"w.telepon.com/ NilW
Execuuve Director & Editor
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Ton111rus 7bday is published quarterly in
March, June. September, and December: It is
mailed to members of the American Tinnitus
and a selected list ot tinnitus sur.
fcrcn> and professionals who treat tinnitus.
Cnwlation is rotated to 75,000 annually.
The Publisher reserves the right to or
edit any manuscript received for publication
,111d to reject any advert1s1ng deemed unsuit
for nnmtus 7bday. Accept.mcc of adver
tt<ing by Tmnuu.s 7bday does not constitute
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or nor does Tlnntt!AS 7bday make
any cla1ms or guarantees to the accuracy
or validity of the advertiser's offer. The
opinions expressed by contributors to
Tmmrus 7bday are not necessarily those of
the Publisher, editors, staff, or advertisers
American Tinnitus Associauon is a non
profit human health and welfJre agency
under 26 USC 501 (c)(3)
Copynght 1997 by American Tinnitus
A<'<Ociation. No pan of th1s publication may
be reproduced, stOred in a retrie1al system,
or transmmed in anv form, or bv anv means.
wnhout the prior w;itten permission of the
Pubhsher ISSN: 08976368
Scientific Advisory Committee
Ronald G. Amedee, M.D., New Orleans. LA
Robert E. Brummett. Ph.D., Portland, OR
Jack D. Clemis. M.D. , Ch1r.ago, IL
Roben A Dobie, M D .. San Antonio. TX
John R. Emmett, M. D . Memphis. T;>;
Chris B. roster, M.D., La Jolla. CA
Barbara Goldstein, Ph.D .. New York. NY
John w. House, M.D., Los Angeles, CA
Gary Jacobson, Ph.D., Detroit, Ml
P<1wcl J. Jastrcboff, Ph.D., Baltimore. MD
Robert M Johnson, Ph.D .. Portland, OR
William H. Martin, Ph.D .. Philadelphia, PA
Galr. w Miller, M.D .. Cinc.innari, OH
J. Gail :-:eely. M.D .. St. Louis, MO
Roben E.. Sandlin. Ph D., E.l Cajon, CA
Alexander J. Schleuning. II. D.,
Portland, OR
Abraham Shulman, MD. , Brooklyn, NY
MJnsfield Smith. M.D., San Jose, CA
Robert Swcetow, Ph.D., San Francisco, CA
Honoruy Directors
The Honorable Mark 0. Hatfield
1bny Randall. New York :"'Y
Willi.lm Shamer. Los Angeles. C1\
Counsel
Henry C Breithaupt
Stot'l Rives Boley Jones & Grey
Portland, OR
Board of Directors
Edmund Grossberg. Northbrook, IL
W r S. Hopmeier, St Louis. MO
Sidney Kleinman. Chicago IL
Paul :>1eJde, Tigard. OR
Philip 0 Monon. Portland, OR, Chmn.
Stephen :'\agler, M.D., Atlanta, CA
A<tron I. Osherow, Clayton, MO
Gloria E. Reich, Ph.D., Portland, OR
Jack. A. Vernon, Ph.D., Portland. OR
Megan Vidis. Chicago. JL
The Journal of the American Tinnitus Association
Volume 22 Number 3, September 1997
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.
Table of Contents
7 Fad Diets, Quick Fixes, and Tinnitus
by Robert Sweetow, Ph.D.
8 Books at a Glance
by Barbara Thbachnick
9 New PET Research Study of Auditory System
10 Tinnitus and Homeopathy- My View
by Stephen M. Nagler, M.D.
12 Back to School
by Barbara Thbachnick
14 New ATA Support Network Volunteers
15 ATA's New Board Members
16 Announcements
1 7 Back Issues of Tinnitus 11:Jday
18 ATA's Passport to Progress
by Cora Lee (Corky) Stewart
23 Tinnitus Transformation - from Sufferer to Survivor
by Thomas]. D'Aiuto
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
5 Letters to the Editor
20 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Special Donors and Tributes
Cover: The Ladies Wall' hy Arletha Ryan. Inquiries to the Indigo Gallery Pine Art &
jewelry, 311 Avenue B., Suite B, Lake Oswego, OR 97034, 503/636-3454
From the Editor
by Gloria Reich, Ph.D.,
Executive Director
Summer is winding down,
we're fresh and rested from
vacations, and our children are
back in school. September is a
month of endings and begin-
nings for many of us.
Autumn is also the time
of year when professional
medical societies reconvene. For ATA, that
means meetings, meetings, and more meetings.
We attend these meetings to provide informa-
tion about tinnitus research and treatment to
the professionals whom you consult. We encour-
age the various societies to provide continuing
education about tinnitus to their members, and
most of them do. Sometimes we have the oppor-
tunity to participate in that education directly,
but usually someone well-known in the society's
particular discipline is asked to present a course
or a workshop. It is reasonable for you to ask
your doctor, audiologist, or hearing aid dis-
penser if they have participated in continuing
education for tinnitus at their annual meetings
or at other times. If they have, they are probably
aware of the latest effective treatments for, and
theories about, tinnitus.
Our thanks to everyone who wrote their
legislators asking for federally-supported tinni-
tus research. Many of you sent me copies of
your wonderful letters. They will help. We
must continue to work together to make our
law-makers aware of the problem of tinnitus.
Please continue talking to them, writing to
them, and letting them know that we expect
them to be our advocates for federal support of
tinnitus research. While you're at it, it would
help to put pressure on them to force insurance
companies and HMOs to recognize tinnitus as a
4 Tinnitus 'Ibday/ September 1997
condition that must be treated, and properly
reimbursed. Believe me, it's on our agenda too!
Some changes in leadership and news of
other organizations of interest to the tinnitus
community have been reported to us. The new
President of Deafness Research is Warren Y.
Adkins, Jr., M.D.; the new president of the
American Academy of Audiology is Sharon
Fujikawa, Ph.D.; new members to the AAA
board of directors are David Fabry, Michael
Marion, and Yvonne Sininger. We are told that
Dr. James Snow, Director of the National
Institute on Deafness and Other Communication
Disorders, will retire in September. A search
committee is looking for his replacement and
perhaps will have decided on his successor by
the time you read this. In the meantime the
I
Acting Director-Designate is James F. Battey,
M.D., Ph.D. A search committee is also in the
process of finding a new head for the Tinnitus
Clinic at the Oregon Health Sciences University.
Bob Johnson, who is still seeing patients one
day a week, will help the new person get settled
in the job before really retiring as he said he
would nearly a year ago. This month will mark
the third of the workshops given at the
University of Maryland to train professionals to
use Tinnitus Retraining Therapy. Several of the
tinnitus clinics and centers around the country
have incorporated this method into their menu
of treatments for tinnitus. You can identify these
clinics by checking a current ATA referral list for
your area. (If the copy you received with your
membership is outdated, write to us for a new
one.) A new tinnitus center is opening this
month in Atlanta, Georgia under the leadership
of Dr. Stephen Nagler, who has tinnitus himself,
and is also a new ATA board member. (Seep. 15)
As many of you know, ATA has been
involved for over a year in a strategic planning
process. Some ofyou participated in focusses-
sions relating to that plan and others have writ-
ten and called us with helpful suggestions. The
plan is now being implemented, and you'll read
about it in Corky Stewart's article in this issue.
The ATA board of directors has grown to ten
members but needs to add five more dedicated
and energetic souls in order to provide ATA with
the best governance possible. If you would like
Letters to the Editor
From time to time, we include letters from our
members about their experiences with "non-
traditional treatments. We do so in the hope that
the information offered might be helpful. Please
read these anecdotal reports carefully, consult with
your physician or medical advisor, and decide for
yourself if a given treatment might be right for you.
As always, the opinions expressed are strictly those
of the letter writers and do not reflect an opinion or
endorsement by ATA.
A
a thirty-year tinnitus sufferer, I appreci-
ted Barbara Thbachnick's article on
earing protection aboard airplanes
(June 1997 Tinnitus Tbday). Since I am a profes-
sor, I need to fly frequently to attend academic
conferences and always dread it for fear that
the noise might worsen my already bad ringing.
For years I have used foam earplugs of the type
she recommends. These help some, but they fail
to cut out the loud low drone of the engines.
However, there is a solution: noise cancellation
headphones. I have tried several brands and find
that, although all work well, the "Noise-Buster
Extremes" work best and are fairly cheap. They
From the Editor (continued)
to serve on a board committee -a starting point
for potential directors - please let us know. I'm
not going to enumerate all the jobs here; just be
assured that if you're willing, we have a job for
you! For those of you who have previously
responded to a similar request, we haven't
forgotten you. It has taken all this time to get
organized because we couldn't abandon our
regular duties while the planning was going on.
The regional meetings program that was so
successfully begun last year has been put on
hold for 12 months while we address resource
and membership development. That doesn't
mean you won't see us though. We've let the
support group leaders know our travel schedules
and whenever possible we'll be glad to come and
meet with the groups, answer your questions,
and listen to your ideas. Perhaps some of you
have been waiting for a fortuitous moment to get
can be purchased from Heartland America
for $69. (800-229-2901 ). Believe me, once you
try them, you'll never fly (or drive) without
them again!
Dr. William Fu.sfield, Pittsburgh, PA
[Editor's Note: According to a United Airlines
spokesperson, major U.S. airlines require passen-
gers to turn off all electronic devices during takeoff
and landing, regardless of a device's electrical out-
put. Noise Cancelation Technologies (NCT), manu-
facturer of Noise-Buster Extremes, claims that this
device should not interfere with critical airplane
controls. However, they cannot state it unequivocal-
ly. NCT concedes that it might be hard to convince
flight attendants to allow you to wear any electrical
device during takeoff and landing.]
A!
chnique for abating the annoyance of
mnitus, which I have had for most of
y life (I am 67 now) was taught to me
about 20 years ago during a human potential
seminar I attended. The technique was sup-
posed to temporarily sharpen hearing, but I
found it helpful for my tinnitus. Here it is: The
lower part of the palms of each hand are placed
a group started. Well, don't wait any longer. Fall
is a great time to get people together, and it's
always helpful to talk informally to others who
have tinnitus to share coping tips and experi-
ences. I guarantee you'll derive a great deal of
satisfaction and perhaps even therapeutic bene-
fit from being a part of our support network.
The bottom line is that we must work
together to conquer tinnitus. It is becoming
easier as more people learn about tinnitus. You
and we have to talk about tinnitus to anyone
who will listen. Ask people you know to support
ATA with their donations, and to become
involved by participating in support groups and
other volunteer activities. The more of us there
are, the lighter our individual load. We need
you. We appreciate you. Thank you for being
part of the tinnitus team.
Tinnitus Today/ September 1997 5
Letters to the Editor (continued)
over both ears in such a way that virtually no
noise can get through. Fingers are pointing to
the back. The index finger is then used to
thump on the bone at the base of the skull. It
will sound like a not-unpleasant pounding on a
wall. I thump with the finger from each hand
simultaneously about 50 times.
Even if the tinnitus sound doesn't diminish,
there is a considerable immediate sense of relief
that lasts for awhile. The technique doesn't
work as well for me as it did 20 years ago, but
there were many occasions when I thought this
was one of the more valuable coping things I
have learned.
Otherwise, losing some of my hearing and
the tinnitus have not prevented me from enjoy-
ing an active, productive life about which I feel
most grateful.
Murray Cohen, Delphos, OH
I
got a good laugh from
letter in the March 1997 1ssue of Tinmtus
Tbday. I'm too old to take up the bag pipes,
but he's right - it's a great "masker."
Marlea Rice Warren, St. Louis Park, MN
H
aving recently completed my experi-
mental tinnitus therapy, coordinated by
Drs. Kenneth Greenspan and Jack
Wazen of Columbia-Presbyterian Medical Center
in New York, my ability to tolerate my affliction
has improved greatly. Like most sufferers, my
visits to doctor after doctor proved an exercise in
futility. Their single answer of "you must learn
to live and cope" is easier said than done. Those
of us who are battling this malady can truly
understand this. The combination of cranial-
sacral therapy combined with drug therapy has
reduced my tinnitus and renewed my zest for
living. Greenspan's and Wazen's intuitiveness,
professionalism, and under-
standing of tinnitus should
be modeled by all others
in their field.
6 Tinnitus Thday/ September 1997
Jerry LaForgia,
Lynbrook, NY
E
leven years ago I was diagnosed with tin-
nitus (the intermittent, one-note whistle
variety). I was told there was no known
cure. 'IWo years later, while under chiropractic
care for a slightly herniated disk, I was advised
to take lOOmg. of manganese sulfate and 300mg.
of B-complex daily. This helped my back but
surprisingly cured my tinnitus completely with-
in a month. The tinnitus would return only if I
stopped taking the manganese. I gradually low-
ered the amount as the tinnitus episodes abated.
Thday, I have been tinnitus-free for nine
years and only rarely take manganese. This
"anecdotal cure" also worked for my husband's
tinnitus. Dr. Lendon Smith suggests, in his book
Feed Yourself Right (Dell Publishing Co., 1983),
that manganese "five to lOmg. a day for a month
or two" might help nervous tissue.
Barbara Carlson, Ottawa, Ontario, Canada.
T
hank you for your very well-written
article, "Air Bag Ruling? - Still Up in the
Air" in the June 1997 issue of Tinnitus
Tbday. I have written to NHTSA several times to
ask that our government require automobile
manufacturers to do the research and develop-
ment necessary for the production of an air bag
system that will not damage hearing. I am frus-
trated by the lack of attention this issue is get-
ting, and by the unresponsive replies I've gotten
- "stock" letters referring to the problem of air
bag trauma killing children and small adults.
Part of my frustration stems from the fact
that I am not anti-government, and I am not
anti-air bag. I simply feel that there must be
pressure from the citizenry to cause manufac-
turers to focus on the need for quieter, as well as
less violent, air bags. I would like to have air
bags in my car, but I want them to not injure
my hearing if they deploy, and not smash my
face in either.
I recently received. a letter from NHTSA
authorizing me to disconnect my air bag. This
did not help with my frustration level since I
never asked NHTSA for permission to do this.
(For one thing, my car does not have an air
bag.) I appreciate your continuing coverage of
the issue. Keep up the good work.
Joseph E. Wall, Raleigh, NC
Fad Diets, Quick Fixes, and Tinnitus
by Robert Sweetow, Ph.D.
There are two conditions affecting millions
of Americans that most of us will go to great
lengths to avoid. One, as all the readers of this
publication are aware, is tinnitus. The other is
obesity. Obesity and some of the medical prob-
lems that result from it (like hyperlipidemia)
have been associated with tinnitus. Thus, many
tinnitus patients have tried a variety of diets in
well-intentioned efforts to control their weight
and "get healthy." Recently, one of my tinnitus
patients, who has made a wonderful adaptation
to the symptom, phoned me in a minor panic
because his tinnitus had suddenly increased
"tenfold." One week later, the tinnitus returned
to its baseline. The apparent culprit was the diet
medication he started just before a trip overseas.
Once he stopped taking the pills, the tinnitus
decreased within three days. He asked me to
look into a possible relationship between the
diet and tinnitus.
Ironically, two days after I began my investi-
gation, this diet hit the front pages. My patient
was one of over 18 million people who have
taken the very popular Fen-Phen diet medica-
tions since 1990. On July 8th of this year, it was
announced that the FDA and doctors at the
Mayo Clinic found that the Fen-phen diet (which
stands for Fenfluramine and Phentermine - also
known as Fastin capsules and Adipex tablets)
might cause fatal pulmonary hypertension and
damaged heart valves in certain patients. These
findings are not being universally accepted,
as one doctor at UCLA has prescribed the diet
medications to over 1,000 patients with no com-
plications. However, the FDA has announced it
will be conducting further studies.
Getting back to tinnitus, I am uncertain why
the drug may have produced this salicylate-type
effect. Salicylates (like aspirin) can cause
extreme increases in tinnitus which will disap-
pear after the drug leaves the system. Perhaps a
similar effect was produced by this ampheta-
mine. Interestingly, the Physician's Desk
Reference, which lists tinnitus as a side effect of
hundreds of drugs, does not mention tinnitus as
a possible side effect from Fen-Phen (Fastin).
The point of all this is that tinnitus patients
should proceed with fad diets (and, for that mat-
ter, any unproven "cures" for tinnitus) with
extreme caution. There is no long-lasting, quick
weight loss scheme. If you lose weight fast, and
then return to your previous eating habits, the
pounds will inevitably return. Long-term exer-
cise and reduction in calorie intake is generally
essential. In other words, a behavioral and psy-
chological modification must be made. Tinnitus
"cures" will likely meet with similarly short-lived
fates unless you also alter previous behavioral
patterns, including exposure to noise, exposure
to silence (equally as aversive), and make a psy-
chological adjustment to your symptom, recog-
nizing that regardless of where the tinnitus
originates from, it is the brain that ultimately
perceives it. Thus, you and your health profes-
sional must work together toward developing a
strategy to alter your reaction to your tinnitus so
that you might facilitate eventual habituation.
AIRBAGS .. . Still Waiting
One year ago, the National Highway Traffic
Safety Administration (NHTSA) put forth a plan
to allow the deactivation of airbags for people
who request it for medical reasons. Strong
lobbying efforts by airbag and car manufactur-
ers, however, have stalled the decision.
Airbag deployments have caused the deaths
of 77 people - children, small females, and the
elderly - plus physical injuries and hearing
damage to an unknown number of people. (The
average noise output of a deploying airbag is 160
decibels at the explosion's center, 130 decibels at
adult head level.) NHTSA researchers continue
their work on lower-powered airbags, hoping to
create a safety device that itself inflicts no harm.
Rodney Slater, Secretary of the U.S. Dept. of
Thansportation, will be making the final ruling
on this matter soon. If there is still time, and
you wish to have a voice in the decision, contact
Secretary Slater at 400 Seventh St. SW,
Washington, D.C.2059, 202/366-4000 (voice)
or 202/366-7202 (fax).
Tinnitus 1bday/ September 1997 7
Books at a Glance
by Barbara Thbachnick, Client Services Manaver
b
Clinical Otology, by Gordon B. Hughes and
Myles L. Pensak, 1997.
Thieme Medical Publishers, Inc., The Maple
Press Distribution Center, I-83 Industrial Park
POB 15100, York, PA 17405. Hardbound
I
480 pages, $139.
This large, glossy, colorfully illustrated book
is a collection of material by clinicians for clini-
cians. Two chapters focus on tinnitus. The chap-
ter on non-pulsatile tinnitus by Richard H.
Nodar and Thny L. Sahey is a short primer on
case history-taking, evaluating tinnitus mecha-
I
msms of tinnitus, and consulting with patients.
The authors advise clinicians to approach tinni-
tus patients with compassion, to acknowledge
how distressing the condition can be, and if a
patient appears to be at "the very edge of con-
trol" to gently ask if he or she would like a refer-
ral for counseling. The authors admit that this
chapter only scratches the surface of a complex
and distressing auditory experience.
Aristides Sismanis delineates the multiple
causes of pulsatile tinnitus in a very technical
and thorough chapter replete with diagrams and
photographs. The various forms (vascular and
non-vascular; subjective and objective) of this
uncommon type of tinnitus are well-considered
explained. More than a dozen pathologies,
mcludmg benign intracranial hypertension
(BIH) and malformation of veins or arteries can
manifest in pulsatile tinnitus. The
and tests required to screen for these conditions
are listed.
Aphasia and Related Neurogenic Language
Disorders, 2nd edition, by Leonard LaPointe
I
POB 15100, York, PA 17405. Hardbound,
298 pages, $49.
Aphasia is a language disorder characterized
by halting speech. It's causes, treatments, and
psychol-social implications are intelligently dis-
cussed in individual chapters by separate
8 Tinnitus 1bday/ September 1997
authors. Tinnitus is not specifically mentioned,
?ut brain injury is. This type of injury
IS the leadmg cause of death and disability in
the United States for individuals age 40 and
younger. Head trauma has been cited as a com-
mon cause of tinnitus.
Hearing Loss, by Peter S. Roland, Bradley F
Marple, and William L. Meyerhoff, 1997.
POB 15100, York, PA 17405. Hardbound,
316 pages, $69.
This book gives strong focus to the ear's
physiology and what can go wrong with it.
Multiple contributors discuss disorders of the
outer ear, tympanic membrane, mastoid, middle
ear, and inner ear. Vestibular disorders and reha-
bilitation are also discussed at length. Tinnitus
is mentioned twice - one paragraph defining it
and its relationship with hearing loss, and
another explaining the benefits of hearing aids,
maskers, and tinnitus instruments (hearing aid
and masker in one unit). Audiologic tests, like
auditory brainstem response (ABR), electro-
cochleography (ECoG), and otoacoustic emis-
sions (OAEs) are clearly explained. This highly
technical book is intended for use by hearing
health professionals.
Vertigo, Nausea, Tinnitus and Hearing
Loss in Central and Peripheral Vestibular
Diseases: Proceedings of the 22nd annual meeting
of the International Neuro-otologic and
Equilibriometric Society
Hakone, Japan, April 6-9, 1995; Claus Frenz-
Claussen, Eiji Sakata, Akinori Itoh, editors; 1995.
Elsevier Science, P.O. Box 211, 1000 AE
Amsterdam, The Netherlands Hardbound I
401 pages, $206.25.
This book contains a fascinating collection
of inten1ational research papers relating to
vestibular disorders and their accompanying
symptoms. Included research covers the topics
of space sickness, risk factors for pilots during
flight, "Chernoble vertigo," results from different
cochlear implants, and Van Gogh's undiagnosed
Meniere's disease. Tinnitus figures in with many
New PET Research Study of
Auditory System
The University at Buffalo recently received a
$107,000 grant from the James H. Cummings
Foundation of Buffalo to fund a pioneering
research project that will look at how the brain
transforms the sounds we hear into information.
This three-year study will combine images of
brain activity using Positron Emission
Tomography (PET) scans with images of struc-
tures in the brain acquired through Magnetic
Resonance Imaging (MRI) to create a unique
image that links neural activities to specific
brain sites. Through the combined images,
researchers hope to gain new insights into how
sounds relayed by the auditory system are
understood.
Directed by Alan Lockwood, M.D., professor
of neurology, the multi-disciplinary project will
involve the departments of nuclear medicine,
neurology, communicative disorders and sci-
ences, linguistics, psychiatry and rehabilitation
medicine, and the Faculty of Social Sciences.
Also participating is the Department of Veterans
Affairs through the VA Western New York
Healthcare System.
"This award by the Cummings Foundation
will allow us to continue mapping the critical
pathways by which humans understand lan-
guage," said Lockwood. "By studying the links
Books at a Glance (continued)
of the studies but only as a symptom secondary
to vertigo. One such research study by B.
Fattori, etal ., conducted at the University of
Pisa, Italy, compared the effects of hyperbaric
oxygen (100% 0 2) treatment and alternobaric
oxygen (alternating Ozpressure) treatment on
vertigo, tinnitus, and hyperacusis symptoms in
Meniere's patients. A control group of patients
who were given medications (glycerol during an
attack, betahistine during remission) but not
oxygen therapy were also part of the study.
Almost all patients experienced a reduction in
between sound and the emotion centers in the
brain, we may also be able to better understand
hearing loss and disorders such as tinnitus or
'ringing' in the ears, which is associated with
adverse psychological symptoms such as depres-
sion, anxiety and insomnia." This study will
compare the auditory function of "normal hear-
ing" subjects with that of subjects affected by
various hearing disorders. Lockwood and
Richard Salvi, Ph.D. recently received an ATA
grant to study the neural basis of subjective tin-
nitus using Positron Emission Tomography.
Unlike other imaging technologies, PET
scans produce images of the body's functions
rather than its structure. Magnetic Resonance
Imaging provides a detailed three-dimensional
image of anatomical structures.
Using newly installed MRI equipment and
powerful computers in the VA Medical Center,
the researchers will combine the MRI and PET
images to map the functions observed in the
PET scans onto precise locations in the body
indicated by the MRI images. Part of the funds
provided by the Cummings Foundation grant
will be used to upgrade the computer equip-
ment and software to include this sophisticated
image-fusion capability.
excellent resource nevertheless.
Tinnitus Thday/ Se ptember 1997 9
Tinnitus and Homeopathy
My View
by Stephen M. Nagler; M.D., FA.C.S.
The question regarding the appropriateness
of homeopathic approaches to tinnitus manage-
ment frequently arises. I thought I might try to
shed some practical light on it from a Western
medicine perspective.
First of all, it is important not to confuse
homeopathic medicine with holistic medicine -
an easy mistake to make because the words start
and end with the same phonetic sounds.
Holistic medicine is based upon the theory that
an organism is not merely equal to the sum of
its parts, but must be perceived or studied as a
whole. This particular philosophy has a lot of
appeal to me for many reasons, not the least of
which is demonstrated by the general observa-
tion (and my professional experience) that if a
patient has a good relationship with his/her sur-
geon and has a good self-concept, that patient
tends to recover more quickly from a given
operation than one who does not.
Homeopathy is something entirely different.
It is based upon the "law" of similia (likes are
cured by likes). In practical application by
homeopaths, the law of similia states that a sub-
stance which can cause certain symptoms in
healthy individuals may be effective (in very
dilute quantities) in treating illnesses that have
symptoms similar to those produced by the
undiluted substance. One might think that this
approach is like that of conventional allergists
l 0 Tinnitus 'Jbday/ September 1997
who use "extracts" to build up resistance to,
for instance, various pollens. There are two
differences:
1. The pollens from which the extracts are made
elicit no symptoms in healthy individuals -
only in individuals with allergies to the pollens
in the first place.
2. The dilutions used by homeopaths are purer
than distilled water. Distilled water theoretically
has less than 1 part in 10
9
in impurities- or one
part per billion. Homeopaths frequently use
dilutions as pure as 1 part in 10
100
- or one part
per billion billion billion billion billion billion
billion billion billion billion. That dilution math-
ematically has been judged roughly analogous to
placing a crushed grain of rice in a pool of pure
water the radius of which is the distance from
the sun to Pluto - then drinking a glass of the
solution to get the effect of the rice. (With this
in mind, whether or not homeopathic remedies
help you, it seems highly unlikely that they can
hurt you.)
The problems that many of us who practice
more traditional Western medicine have with
homeopathy are as follows:
1. The theory - likes are cured by likes - just
does not make a lot of sense on its own merit. It
is true, however, that many effective treatments
in Western medicine don't make much initial
sense either - for instance, giving a mold
(penicillin) to someone with an infection.
2. There is unequivocally no "science" behind
homeopathy. Th my knowledge, no studies
demonstrating the efficacy of homeopathic
preparations in large enough numbers to make
the results statistically relevant have ever been
published in a "peer-reviewed" journal, even
knowing that publication of data thus obtained
would serve to simultaneously quiet the detrac-
tors of homeopathy once and for all AND would
serve as a tremendous contribution towards alle-
viating the traumatic effects of tinnitus and
other afflictions for everyone concerned.
Tinnitus and Homeopathy (continued)
Since I question the basis of the theory and
since simple double-blind experiments have not
been done to any statistical satisfaction, I find it
difficult to recommend homeopathy as a treat-
ment for tinnitus. Still, some tinnitus sufferers
report that homeopathy occasionally seems to
help them. This observation is termed "anecdo-
tal evidence" - a phrase that unfortunately car-
ries a lighthearted connotation. But there is
nothing remotely lighthearted about a treatment
that might in certain circumstances be benefi-
cial in alleviating the discomfort oftinnitus. In
my experience: No tinnitus sufferer who found
even a small amount of relief ever cared one iota
whether or not the treatment which resulted in that
relief was based on "science. n (Nagler's Law.)
So, how does a reasonable person reconcile
the above apparently conflicting positions - no
scientific basis or solid evidence vs. anecdotal
reports of successful treatment? And what posi-
tion should a responsible health care profession-
al take when faced with this question?
Doctors who state that they depend strictly
on the results of double-blind randomized
prospective studies when they make recommen-
dations to patients are either naive or forgetful.
Most of us have tricks that "seem to work well
in our hands" or remedies handed down (like
chicken soup) that are apparently effective even
though never tested scientifically. I am remind-
ed of a young physician who would not adminis-
ter a particular laxative to a patient absolutely
miserable vr>th constipation because he "hadn't
seen the conclusive data" - a double-blind ran-
domized prospective study indicating that this
widely used, effective preparation really works
to statistical satisfaction!
Why might homeopathy work in some
instances? If we accept - for a moment - the
premise that the medicaments in and of them-
selves do not hold the key, then something else
must be going on here. (It is my opinion that if
the medicaments did indeed work on their own,
then this issue would have been settled in favor
of homeopathy a long time ago.) Homeopaths
typically spend a considerable amount of time
with their patients - analyzing the history,
describing the treatment in depth, following the
treatment along, modifying the treatment as
indicated, and in general developing a meaning-
ful relationship with the afflicted. This sounds
like what M.D!s used to do years ago before
some began to sacrifice time at the "bedside" for
quantity of patients treated. Whether this grad-
ual change in posture in modern American
medicine is a result of the onslaught of managed
care, or economic reality, or advancing science,
or just plain greed (I suspect a combination of
each), many of our patients have ultimately had
to pay the price. To the homeopath's credit, no
significant compromise has been made with
respect to the time spent with each patient.
Herein might lie the answer to the homeopath's
occasional anecdotal success.
The philosophy of homeopathy cannot readi-
ly be measured by traditional double-blind ran-
domized prospective methodology, which may
in part explain the reluctance of the homeopath-
ic community to subject their treatment proto-
cols to this type of rigorous testing. It does not,
however, explain the reluctance of the homeo-
pathic community to report even retrospectively
specific success rates backed by good data.
If a tinnitus patient told me that he had
experienced success with homeopathy for
another ailment and wanted to include a home-
opathic approach in his tinnitus management, I
would be remiss if I did not encourage him to
attempt some of the more "scientifically based"
approaches available. However, r would be
equally remiss if I tried to discourage him from
seeking care from someone in whose hands he
had experienced even anecdotal success in treat-
ment of a previous malady - especially where a
multifaceted condition like tinnitus is con-
cerned. I might offer to contact the homeopath
to see if together we could design a treatment
plan for this particular patient that could prove
more beneficial than would be the case if the
patient saw us independently - a truly holistic
approach!
Given that I have a biased education and
come from a biased medical community, I hope
this information - provided in as unbiased a
manner as possible - is helpful.
Back to School
by Barbara Tabachnick, Client Services Manager
I walk into the second grade classroom laden
with a large and mysterious cardboard box.
Despite their curiosity, the seated children there
ask no questions and I give no clues. I put the
box down, take out a video and put it in the
VCR. I do not press the "play" button just yet.
With the teacher's permission, I erase some
space on the blackboard then wait to be intro-
duced. "I have an important question for you,"
I begin. "How many of you have ears?"
I can tell by the giggles and the 25 hands
that shoot up in the air that this is not going
to be a tough crowd. I continue, "Oh good. I
came to the
right room. I
have another
question: How
many ofyou
like your ears?"
All hands shoot
up again. I
smile and take
a long, hard
look at the
young faces - and at the trust written all over
them. These eight-year-olds are ready to learn
what I'm about to teach them:
1) how the ear works
2) how loud noise causes damage to the ear
3) the three things they can do to avoid loud
noise (turn it down, move away from the noise
source, and use ear protectors)
4) how to wear and care for earplugs
5) the definition of t innitus
(I write the word tinnitus on the blackboard in
the beginning of the presentation and say "I
want you to see this word because I never want
you to hear it.")
6) that loud noise is the most common and most
avoidable cause of tinnitus
I'm always surprised, though, to learn what
they teach me. Some children have hearing loss
and wear hearing aids. Some children have
grandparents who, they tell me, should wear
12 Tinnitus 'TOday/ September 1997
hearing aids but won't. And some children have
tinnitus - intermittent, pulsatile, and some-
times constant to the point that they cannot
sleep at night. Alarmingly, their parents don't
always know. Also alarming is the data I unwit-
tingly gather: an average of two children per
classroom confide in me that they have tinnitus.
Children With Tinnitus
The actual number of children with tinnitus
is not known, and for a number of very good
reasons: Children have a difficult time convinc-
ing adults of their condition. Children are often
afraid to tell adults that they hear noises.
Children who are born with tinnitus have no
frame of reference and do not know that it is
unusual. When children are given hearing tests,
they typically give positive answers to please
the testers. (This makes it hard for testers to
identify what children really hear.) Children also
likely under-report the condHion because their
busy and distracted lifestyles help them get past
the problems associated with tinnitus.
Dr. Richard Nodar conducted a study in
1972 to approximate the prevalence of tinnitus
---------- in children.
Ofthe 2000
"normal hear-
~ ing" children
~ examined, 15%
reported tinni-
tus. In his 1984
follow-up study of 56 children with impaired
hearing, 55% reported tinnitus. Other studies
show similar ratios.
Children who have tinnitus have it intermit-
tently in far greater numbers than those who
have it constantly - the opposite of our adult
population. John M. Graham of the Royal Ear
Hospital in London has extensively studied tin-
nitus in children. He notes that if the electrical
potential that the brain perceives as tinnitus has
been present since birth, a person might never
notice it as sound. He cited the report of a child
born with objective tinnitus - intermittent in
one ear and constant in the other. The child was
not aware of the constant tone (which was the
louder of the two) - only the intermittent tone.
Back to School <continued)
In another study, Graham found that only two
out of 78 hearing-impaired school-age children
with tinnitus reported their tinnitus to be con-
stant. "This suggests," he writes, "that where the
a ~ electrical
'-' ' activity asso-
ciated with
tinnitus has
been present
since birth, it
generally
needs to be
intermittent
to be per-
ceived."
Researchers speculate that children's intermit-
tent tinnitus might become constant when they
reach adulthood.
When it comes to avoiding environmental
noise, like the kind in school gyms or movie
theaters, children have relatively little power -
and they know it. I encourage them to exercise
that power anyway, however slight it might be.
"Ask for your world to be quieter. Ask for the
noise to be turned down. Grown-ups are out
there asking too," I assure them. "We can't
change everything, but we can change some
things."
Excessive noise exposure has other troubling
outcomes for children. In a soon-to-be-published
study in the journal Environment and Behavior,
researchers Evans and Maxwell measured read-
ing levels of children in two different New York
City elementary schools: one in the flight path of
a major airport, the other not. All children had
good hearing, spoke English as a first language,
and had equal family incomes. But the "flight
path children" showed significant deficits in
their reading comprehension- even when they
were tested in quiet settings.
For over a year, our team of four (Susan
Greist, Linda Press, and Rhonda Dojan from the
Oregon Hearing Research Center, and me) has
taken the Hearing Conservation and Tinnitus
Prevention show on the road locally, polishing
and modifying as we go. The program takes 25
minutes to present - long enough to get the
message across and short enough to get it across
before we lose our audience's attention. We ask
questions, draw on the board, watch a video, do
an earplug demonstration, play a game. Every
week from September through June, we present
the program to a different school. And by
request, we send Hearing Conservation kits to
volunteers across the U.S.
Teaching is a slow process. It is also won-
drously rewarding. Thousands of children are
now putting earplugs in their ears properly (or
close to it) who had not done so before. Children
tell us that now they understand why their ears
ring after they go to basketball games. One
seven-year-old who complained about his broth-
er's loud stereo before the presentation said to
me excitedly afterwards, "I know what I'll do. 1'11
tell him to TURN IT DOWN! But I'll have to
shout it, 'cause if I don't, he won't hear me."
How critical is it that we disseminate this
information? Completely. Children and their
parents, grandparents, and teachers are still in
the dark about the unforgiving consequences of
excessive noise: permanent hearing damage,
tinnitus, learning disabilities, other health ills,
and the concomitant damage to the emotional
well-being of everyone concerned.
We live in a world that has so much to learn.
Tinnitus Jbday/Septemher J 997 13
Back to School (continued)
Resources
Boodman, Sandra G., Researchers say airplane noise curbs
reading skill, The Washington Post.
Gabriels, Pam, Children with tinrtitus, Proceedings
of the Fifth International Tinnitus Seminar, editors,
Gloria Reich and Jack Vernon, 1995.
Graham, J.M., Tinnitus in hearing-impaired children,
Tinnitus, 1987; 131-143.
Graham, John, Paediatric Tinnitus, Journal of Laryngology
and Otology, Supplement 4, 1981; 117-120.
Graham, John, and Jane Butler, Tinnitus in children,
Joumal of Laryngology and Otology, Supplement 9, 1984;
236-241.
Mills, R.P., and D.M. Albert, C.E. Drain, Tinnitus in child-
hood, Clinical Otolaryngology, 1986, ll; 431-434.
Nodar, Richard H., Tinnitus aurium in school age children:
a survey, Journal of Auditory Research, 1972; 12, 133-135.
Nodar, Richard H., and Mary H. W. LeZak, Pediatric titmitus
(a thesis revisited), Journal of Laryngology and Otology,
Supplement 9, 1984; 234-235.
Stouffer, J.L., and R.S. 1Jier, J.C. Booth, B. Buckrell,
Tinnitus in normal-hearing and hearing-impaired children,
Proceedings of the Fourth International Tinnitus Seminar, edi-
tors, Jean-Marie Aran and Rene Dauman, 1991.
How can you get the free
Elementary School
Hearing Conservation
and Tinnitus Prevention
program materials?
Ask us for them. Most of the materials
- like the video - are reproducible. Script,
coloring worksheets, a letter to the parents,
an ear diagram, a poster (not reproducible),
and sample earplugs are in the packet.
Earplugs are available at local safety supply
stores in bulk. Teachers usually get their
schools or PTAs to chip in the few
dollars per class for them. ATA's Hearing
Conservation and Tinnitus Prevention
Program materials are designed for 1st-4th
grade levels.
Many ATA volunteers are out in the
field with this successful program. Please
let us know if you would like to get
involved too.
14 Tinnitus Today/September 1997
New ATA Support
Network Volunteers
Support groups commonly reassemble in the
fall after their summer hiatus. This fall, several
new groups are beginning too. Welcome back,
and welcome all!
The Tinnitus Support Network is designed
to offer one-on-one contact between those
who have found treatments and coping ski11s
that work and those who are still looking for
answers. Thousands of people use this resource
every year.
Are you ready to help others? Please let
us know. We will gladly send you a packet of
materials to help you become a telephone
contact or support group leader.
New Support Group Leaders
Sharon Weinhaus
425 E. 58th St. #40B
New York, NY 10022
212/758-0791
Larry Maurer
9680 Glenstone Dr.
Kirtland, OH 44094
216/256-8023
Edna Young
1808-C N.W O'Brien Rd.
Lee's Summit,
MO 64081
816/246-4644
(near Kansas City)
Mitzi Cahn
1439 Bonita Ave.
Berkeley, CA 94709
510/527-9075
New Telephone/Letter Contacts
Shirley Baldasaro
20 Palmer St.
Claremont, NH 037 43
603/542-4889
Ann 'lbcado
110 'Itavelers Lane
Beckley, WV 25801
304/252-1647
(8:30-10:30 p.m.)
Ed Jennings
2104 Lodestar Dr.
Raleigh, NC 27615
919/846-7168
Dolly Blair
27856 Inkster Rd.
Southfield
1
MI 48034
810/354-3384
Dale Mobley
3805 Hollis
Fort Worth, Texas 76111
817/831-6146
ATA's New Board Members
Stephen Nagler, M.D.,
F.A.C.S.
Dr. Nagler writes:
"After my graduation in
1975 from Northwestern
University Medical School,
I completed an internship
and residency in General
Surgery and surgical subspe-
cialties. I am a Diplomate of
Stephen M. Nagler, M.D. the American Board of
Surgery and a Fellow of the American College of
Surgeons. As a surgeon, I am intimately familiar
with the physical impact of disease as well as its
emotional consequences upon patients and their
loved ones.
"Prior to becoming Director of the new
Southeastern Comprehensive Tinnitus clinic, I
spent two years studying the anatomy, physiolo-
gy, and pathology of the auditory system as they
relate to the etiology of tinnitus and the efficacy
of various treatment modalities. I have lectured
on numerous tinnitus-related topics - including
the multi-modality approach to tinnitus patient
management, the role of pharmacologic agents
in tinnitus therapy, and the place of hypnosis in
tinnitus treatment.
"I do not believe that the ATA can be all
things to all people; however, I would like to
see our organization be more things to more
people.''
Dr. Nagler has tinnitus. He lives in Atlanta,
Georgia with his wife, Thrri, and their two chil-
dren, Bess and Matthew.
Sidney Kleinman
Sid writes:
"I believe that each day is a
'gift,' sometimes wonderful
and marvelous, and some-
times not so great. But it is
a gift to be enjoyed and
experienced. Furthermore,
one cannot just take from
the World and Life in a
Sidney Kleinman
narcissistic manner. One
must give back and try to assist others.
"As a result, throughout my professional
career, I have always made a commitment to
others as - among other roles - a volunteer
working with emotionally disturbed teenagers; a
volunteer attorney representing rent strike build-
ings in Chicago's inner city; a co-founder of a
chamber symphony; an active member of the
Advisory Board of the DePaul University School
of Music; and now as a member of the Board of
the American Tinnitus Association.
"It is my hope that I will be able to assist ATA
in its role as the advocate for the silent tinnitus
sufferers of this country - in advancing contin-
ued research to find the mechanisms of tinnitus
and the means to ameliorate its symptoms -
and, in a preventative manner, alerting the gen-
eral public, manufacturers, and governments as
to the dangers of our very noisy world."
Sid Kleinman has tinnitus and is a lawyer in
Chicago, Illinois.
The Combined Federal Campaign
We want to be
certain that the 796
ATA members who
contribute through
the CFC (and any
future CFC contrib-
utors too) receive
all of the benefits of
membership in our
Association, including our quarterly journal,
Tinnitus Tbday. Please check the box on your
pledge card that tells the CFC to notify us of
your contribution, and send a copy of the pledge
card to us. Remember - our national designa-
tion number is 0514. We'll put your gifts to work
on educational programs, services, and research
that will benefit all who have tinnitus. We appre-
ciate your help!
Tinnitus Thday/ September 1997 15
Announcements
ATA To Receive $5000 From
Barry Manilow
As the result of a court settlement, Barry
Manilow - the man who "writes the songs" -
has also written a check to ATA. Philip Espinosa,
an Arizona Court of Appeals judge and ATA
member, brought suit against the famous per-
former after a 1993 concert left him with severe
tinnitus. "I expected soft amplified music,"
Espinosa stated, but the music was too loud and
he now has a constant "screeching" in his ears.
While neither Manilow nor his production
company admits any fault, Espinosa believes the
suit will be helpful in raising consciousness
about the serious problem of high volume levels
at entertainment events. "Unfortunately in our
society, large industries like the music business
do not listen to you unless you file a lawsuit,"
he said. "It (the money) is not a large amount
in terms of a permanent injury, but it's a very
significant amount for the American Tinnitus
Association."
MedWatch
The U.S. Food and Drug Administration
(FDA) has a way for the public to confidentially
report problems with any medication (prescrip-
tion or over-the-counter), dietary supplement, or
medical device. The FDA's MedWatch Program
encourages the reporting of serious "adverse
events" that result from the use of medications
or medical devices. By FDA definition, an event
is "adverse" if it results in death, a life-threaten-
ing reaction, hospitalization, disability ( signifi-
cant, persistent, or permanent), or if it requires
intervention to prevent permanent impairment.
The FDA's MedWatch fact sheet lists the ototoxic
reaction to a drug as an example of an adverse
event. MedWatch can be reached by phone
(800/FDA-1088), fax (800/FDA-1078), or modem
(800/FDA-7737).
Jack Vernods Lecture on Video Tape-
Available Now
In January, 1997, Oregon Health Sciences
University's (OHSU) Marquam Hill Lecture
Series featured a lecture on tinnitus by Jack A.
Vernon, Ph.D. Dr. Vernon is the former Director
of OHSU's Oregon Hearing Research Center and
a recognized pioneer in tinnitus research. In this
video of that lecture, Dr. Vernon discusses the
origins of tinnitus treatment and the contempo-
rary applications of masking, hearing aid use,
and other treatments for tinnitus remediation.
His formidable knowledge, practical experience,
and gracious manner highlight the hour.
Cost. $20 (shipping included), Running time: 59
minutes, 20 seconds
Send check to: OHSU, Office of Community
Relations, Attn: Thrry Erb, 3181 Sam Jackson
Park Rd., L101, Portland, OR 97201-3098
The Third Course on Tinnitus
Retraining Therapy for Management of
Tinnitus & Hyperacusis
September 28-30 1997
Organizers: Pawel J. Jastreboff, Ph.D., Sc.D., and
Margaret M. Jastreboff, Ph.D.
Tinnitus & Hyperacusis Center, University of
Maryland, Baltimore, MD 21201 USA
This course will cover the following topics:
+ An outline of common methods for treating
tinnitus and hyperacusis
+ Theory and clinical implications of our
approach
+ Implementing the approach: (Audiological
and medical evaluation; basis for diagnosis;
variants and stages of treatment)
+ Evaluating the treatment outcome
+ Case presentations
+ Administrative and billing issues
COURSE FACULTY:
Mrs. Randa S. Blackwell
Susan L. Gold, M.A., CCC SPI A
William C. Gray, M.D.
Karen W. Humayun, M.A.
Margaret M. Jastreboff, Ph.D.
Pawel J. Jastreboff, Ph.D., Sc.D.
Douglas E. Mattox, M.D.
The course will have a limited number of
participants. If you are interested in attending
and would like more information, please contact
either Dr. Pawel J. Jastreboff or Donna Earling
at 410/706-4339 (phone), 410/706-4004 (fax), or
through e-mail:
pjastreboff@surgery2.ab.umd.edu
dearling@surgery2.ab.umd.edu
www. tinnitus-pjj. com
Back Issues of Tinnitus Today
Your interest in Tinnitus Tbday back issues
has been tremendous. Thank you!
The following is a list of the featured topics
in each issue. Almost every issue contains
Dr. Jack Vernon's Q & A column, information
about self-helping, research updates, and (from
September 1994 to the present) Letters to the
Editor.
The cost per issue:
$2.50 (member price); $5.00 (non-member price)
See the table below for shipping cost.
For orders outside the U.S., please add $5
to the total shipping cost.
Supplies are still ample for most issues
listed. A few, however, are available only as
photocopies. Every effort will be made to send
the originals.
J une 1997 Barometric Changes and the Ear;
Elderly People and Tinnitus; Air Bag update
March 1997 NIDCD-funded Tinnitus Research,
Treatments for Subjective Tinnitus; Similarities
between Tinnitus and Chronic Pain; Air Bag
update
Dec. 1996 Air Bag Safety- Air Bag Risk;
Interview with researcher Jos Eggermont, Ph.D.
Sept. 1996 Ototoxic medications; Silent Dental
work; Interview with researcher James A.
Kaltenbach, Ph.D.
J une 1996 Multi-Therapies Treatment;
Celebrities with Tinnitus
March 1996 Tinnitus and the Law; Otosclerosis;
Interview with researcher Pawel J. Jastreboff,
Ph.D.
Dec. 1995 Masking; William Shatner and ATA;
De-stressing Techniques
Sept. 1995 Fifth International Tinnitus Seminar;
Doctor to Doctor - Tinnitus Patient Evaluation;
Elementary School Hearing Conservation
program
June 1995 Electrical Stimulation; Cochlear
Implants; Temporal Bone donations; Ginkgo bilo-
ba and animal research (PHOTOCOPIES ONLY)
March 1995 Drugs and Tinnitus Relief
December 1994 Alternative Therapies; Sleep
Management
September 1994 TMJ; Ototoxicity
June 1994 Hearing Protection Devices
March 1994 Auditory Habituation; Thies of
Tinnitus Recovery (PHOTOCOPIES ONLY)
December 1993 Alternative Treatments; Ginkgo;
Research Plan (PHOTOCOPIES ONLY)
September 1993 How Tinnitus is Generated;
Hypnosis
June 1993 1Jpes of Hearing Loss
March 1993 Anatomy of the Ear; Research
report (PHOTOCOPIES ONLY)
December 1992 TMJ
September 1992 Industrial Liability Case
June 1992 ATA history; Monitoring Your
Tinnitus
March 1992 Interaction of Earmold Acoustics,
Real Ear Resonances, and Tinnitus Masker
Responses
December 1991 Fourth International Tinnitus
Seminar; Personal Injury lawsuits
September 1991 Tinnitus in the Nursing
Home; Research report; Cochlear Implants
June 1991 VA Info; Hyperacusis; Research
highlights (PHOTOCOPIES ONLY)
March 1991 Noise and Tinnitus; There is Hope;
Tbny Randall
December 1990 Tinnitus Measurement; Drug
Therapies
September 1990 Older Americans and
Tinnitus; Research Report; ADA
June 1990 Cognitive Therapy; Amplification
Mar ch 1990 Noise-induced Hearing Loss in
Musicians; Vestibular Disorders; Tinnitus in the
14th Century
December 1989 Tinnitus Patient Management;
Allergy potential (ALL PREVIOUSLY MAILED
AND RETURNED COPIES)
The following issues are available as photocopies
only:
September 1989 Tinnitus Severity Scaling;
Consumer Tips; Tinnitus in the 16th Century
J une 1989 Tinnitus in Burnt-out Meneire's
March 1989 Combined 'freatment for
Intolerable Tinnitus; Care for Hearing Aids and
Maskers
December 1988 Hyperacusis; Pathophysiology
of Tinnitus; AI Unser and Jeff Float
(FIRST ISSUE AS Tinnitus Tbday)
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Tinnitus 'Ibday/ September 1997 17
ATXs Passport to Progress
by Cora Lee (Corky) Stewart,
Program Development Director
While it is often fun to impulsively take off
on a quick trip to an undetermined destination
a real journey requires careful planning. You
I
need to know where you are going, how you
will get there and, perhaps most importantly,
why you are going there. For the past year, the
ATA Board of Directors and staff members have
been planning what could be classified "a major
journey" for ATA. As such, it's bound to be the
trip of the century, so hop on board for ATA's
Big Adventure.
What I'm referring to is, of course, ATA's
Strategic Plan, which sounds like a rather boring
business document but is really an exciting
itinerary that defines ATA's direction, approach,
and focus for the next five years. On July 1 (the
start of this fiscal year), the Plan became our
road map.
This is not to imply that ATA has been drift-
ing aimlessly; far from it - as a non-profit
organization, it is in an enviable position. With
a diverse membership, it is financially stable,
recognized internationally as a credible source
for tinnitus information, and is the leading advo-
cate for tinnitus research. But we wanted to be
certain that the association is following the right
course, pursuing the proper objectives and using
the correct methods to achieve results that are
appropriate and in the best interest of members
the tinnitus community, and the general public.'
So we embarked on a year-long, mini-voyage to
evaluate every aspect of ATA for value and rela-
tive merit according to our mission
~ : ; ; ; ; ; ; p - and limited resources.
Hundreds of people helped
with the process, including ATA
members, advisors, community
and civic leaders, public and pri-
vate sector representatives, and
even a few people who had never
before heard of ATA. Utilizing
focus sessions, private interviews,
and lengthy retreats, they per-
18 Tinnitus Thclay/ September 1997
formed an incredibly intense inspection of
everything ATA has done and wants to do what
I
similar organizations are doing; and what needs
aren't being met in the tinnitus arena at large.
They agreed, disagreed, discussed, and even
cussed. But the result is a clearly defined Plan
for ATA, complete with measurable objectives,
workable projects, and reachable time lines.
The good news is that there was consensus
on the major points and considerable validation
of much of ATA's past activities. The bad news is
that we had to accept the fact that our resources
are limited and we can't continue to be all
things to all people. This clarity of focus is
reflected in the new ATA mission statement:
Th promote relief, prevention and the eventual
cure of tinnitus for the benefit of present and
future generations.
Naturally, finding a cure for tinnitus was
(and is) the number one priority for everyone,
so investing in- and advocating for- research
will continue to be the most important compo-
nent for ATA. And until the cure is found, there
is clearly a continuing need for an organization
that provides programs to help people avoid get-
ting tinnitus and that supports those who have
it. Thus we've ended up with the EARS Plan
(Education, Advocacy, Research and Support).
Considerable time was devoted to identifying
appropriate and desirable outcomes within each
of the program areas and then to developing
projects which would achieve those results (see
the accompanying box for specifics). This is
where the hard decisions came in (akin to pack-
ing our suitcases, some things have to be left
behind). In order to concentrate on the priority
projects, we'll not be able to do some of the
things we'd like to do. Additionally, it was made
clear that we must expand our resources.
Emphasis will be on adding to the membership.
So there you have the ATA itinerary for the
next three years. We'll give you ongoing reports
from our log as we validate our passport to
progress. It's an exciting adventure and we
certainly hope you'll continue to travel with
us. After all, whatever your involvement with
tinnitus might be, the whole journey is for you
and because of you.
AMERICAN TINNITUS ASSOCIATION
Strategic Plan- July 1997 through June 2000
Mission:
PROGRAMS:
7b promote relief, prevention, and the eventual cure of tinnitus for the benefit of
present and future generations
Education Goal: To further awareness and understanding of tinnitus through education
Thrgets: Hearing health professionals, primary care physicians, general public
'Ibols: Tinnitus Today and ATA brochures, professional workshops, workplace
and classroom seminars, exhibits at conventions, targeted mailings, media
placements
Measurements: Currently there are no statistics pertaining to actual
awareness of tinnitus, so the first step will be to conduct a survey to establish
benchmarks. (Education efforts work: In 1986, patients were told to "learn to
live with it" ahout 83% of the time. By 1996, the figure was down to 74%.
Similarly, in 1986 only 33.7% felt their physicians were helpful, but that
improved to 58.2% by 1996. In 1986, only 31% of the people surveyed had tried
any form of tinnitus treatment. By 1996 that number had jumped to 60%.)
Advocacy Goal: To advocate for tinnitus in the development and implementation of
public and private policies
'Ibols: Participation in federal meetings and policy making for the National
Institute on Deafness and other Communication Disorders (NIDCD) or similar
agencies; direct contact with health insurance providers and with manufacturers
of noisy products.
Measurements: While 83.7% of the respondents to ATA's 1986 survey received
partial or complete insurance coverage for their tinnitus treatments, claim
processing is often complicated and sometimes litigious. ATA will work to
establish a liaison/ advisory role with major insurers to improve this situation.
Many manufacturers of noisy products provide cautionary information, but few
specifY tinnitus. Efforts will be undertaken to add "tinnitus or ringing in the
ears" to such warning labels.
Research Goal: To stimulate tinnitus research
'Ibols: ATA seed grants, awards, and encouragement of other funders
Measurements: Since 1980, ATA has awarded over $900,000 for tinnitus
research projects. Most of these were small "seed" grants that led to sufficient
results to qualifY for greater funding (i.e. from NIDCD). ATA intends to give at
least $150,000 in such grants yearly. In 1997, after testimony by ATA Executive
Director Gloria Reich, Ph.D. and Honorary Director William Shatner, the NIDCD
gave $807,383 for tinnitus research projects. A special recognition award has
been established by ATA for the best paper or poster on tinnitus by a young
investigator.
Support Goal: To provide and facilitate support for people affected by tinnitus
Thrgets: Tinnitus patients, their families and friends, professionals, ATA
members
Measurements: While ATA does not provide or advocate a particular course of
treatment, the volume of daily inquiries justifies expansion of programs via
written materials, support groups, telecommunication, and the Internet.
Organization Goal: To develop the organizational capacity to effectively and efficiently
implement programs
'Ibols: Board expansion, increased membership, continued financial stability
Measurements: More voluntary committees will be activated, corporate
partnerships sought, and membership base doubled. Achievement of the EARS
Plan objectives and continued financial stability will indicate overall success.
Tinnitus Today / September 1997 19
Questions and Answers
by Jack A. Vernon, Ph.D.
[Q]
Mr. S. from Hawaii writes to report an
unusual aspect about his pulsatile
tinnitus. He indicates that his pulsatile
tinnitus can be 99% eliminated by extended
neck flexion, that is, placing the chin firmly on
the chest. What, he asks, is the possible mean-
ing of this effect?
It may mean that the pulsatile tinnitus
is coming from a partial occlusion in the
carotid artery and that the neck flexion
causes that blockage to be somehow relieved.
Mr. S., may I ask you if any physician has
listened to your neck region to see if he or she
can hear your pulsatile tinnitus? You describe it
as a high-pitched whine, thus the listener would
need to have good high frequency hearing in
order to detect your pulsatile tinnitus. If your
pulsatile tinnitus is an objective tinnitus
(detectable by others), then a surgical explo-
ration of the neck region using temporary liga-
tion (a tying-off) of the possibly offending artery
may lead to a cure for you. Note that this is a
major procedure! I do know of one case where a
surgeon did essentially that. With a stethoscope,
the surgeon explored the opened neck area and
discovered that the patient's pulsatile tinnitus
came from a "kink" in the carotid artery. The
surgeon completely sectioned the abnormal
artery (in this case possible to do because the
patient had dual carotids). This procedure com-
pletely removed the patient's pulsatile tinnitus.
Mr. S., you may have a form of tinnitus for
which a cure is now possible. I hope you will
keep us informed about your progress in
this matter. Have any others in our
readership with pulsatile tinnitus
made a similar observation?
[Q]
Ms. B. from
Canada asks:
"What is the
difference between white
noise and pink noise.
Should I listen to just one
kind of noise or are they
interchangeable?"
There is a significant difference between
pink noise and white noise. White noise
contains all frequencies from 20Hz
through 20,000Hz. Pink noise contains frequen-
cies from 200Hz through 6000Hz. The purpose
of the listening exercise is to establish normal
loudness tolerance for everyday ordinary
sounds. Remember hyperacusis is not the low-
ered threshold for sound detection but rather it
is a collapse of loudness tolerance. The usual
sounds to which we are exposed are composed
of frequencies from around 200Hz to around
4000Hz. Also recall that hyperacusis is inversely
related to the pitch of the sound: The higher the
pitch, the less the loudness tolerance. Some
time back, a patient in our hyperacusis treat-
ment program questioned our use of white
noise for desensitizing hyperacusis ears on the
grounds that the high frequency portion of the
white noise would delay the recovery process.
Instead the patient suggested that we use pink
noise which contains those frequencies found
in normal environmental sounds and does not
contain the high frequencies. Our patient's
reasoning seemed reasonable to us and we have
been using pink noise ever since. It is critically
important for hyperacusis patients to not over-
protect their ears so they can reestablish their
loudness tolerance.
[Q]
Ms. H. from Pennsylvania also writes
about hyperacusis. I've suggested to her
that she should listen_ to pink noise at
the maximum comfort level for two hours each
day. (The Moses/Lang pink noise CD is avail-
able from the Oregon Hearing Research Center,
503-494-8032.) Ms. H. asks if she should pur-
chase a stereo CD player or if a regular CD
player would suffice.
Ms. H., it doesn't matter what kind of
CD player is used. I do recommend,
however, that one use ear phones with it
so that the loudness level established for each
listening period remains constant. If the pink
noise is delivered over speakers, the loudness
level may vary according to one's position
relative to the speakers.
Questions and Answers (continued)
[Q]
Ms. G. from Ohio writes that one health
care professional said she did not need
hearing aids, another said that she does,
and a third said that she needs both tinnitus
maskers and hearing aids. Naturally she is
confused.
Regarding hearing aids, the way to
determine whether or not you need
them is to try them. You can do this with
a 30-day money-back guarantee. In some cases,
a hearing aid is all that is necessary for relief
of tinnitus. Mostly it will depend upon the kind
of hearing loss you have and the pitch of your
tinnitus. If the tinnitus is low-pitched and if the
hearing loss extends into the low frequencies
then perhaps hearing aids are all you need.
If, on the other hand, you have a high-pitched
tinnitus and a high-pitched hearing loss then
the combination of hearing aids and tinnitus
maskers (called tinnitus instruments) are what
you should try. Many physicians believe that
the high frequency loss does not interfere with
normal hearing. And they are correct - so long
as the patient is in a quiet place and speaking
one-on-one. Unfortunately we are more com-
monly in the presence of background noise.
Under that condition, the ability to analyze
speech shifts upward into the high frequency
region of the ear. If those high frequencies
are impaired, then you will have difficulty
understanding speech in the presence ofback-
ground noise.
[Q]
Mr. T., a World War II veteran now
living in New Jersey, writes to ask if
vi.npocetine is as good for tinnitus as
suggested by a report circulated by Interlab, its
distributor. In that report, Interlab claims that
vinpocetine effectively improves memory loss,
treats stroke, relieves menopausal symptoms,
treats macular degeneration, improves hearing
loss, and relieves tinnitus. Mr. T. wants to know
how he can get vinpocetine and how much he
should take.
I get immediately suspicious when so
many different claims are made for a
single product. I have, however, been
impressed by the number oftinnitus patients -
all from Europe (Vinpocetine is not available in
the U.S.) -who claim to have gotten tinnitus
relief from the use of vinpocetine. Hopefully
someone here in the U.S. will conduct a pair of
studies of this drug. First, an open study should
be done where everyone gets the drug. If that
turns out to produce positive effects in high
enough numbers, then a double-blind placebo-
controlled study should be done. If you don't
want to wait for the results from such studies,
you can write to Interlab, BCM Box 5890,
London WCIN 3XX, England and request an
order form. Vinpocetine (or Cavinton) is an
over-the-counter drug in England and South
America but you still might need a physician's
prescription to order it. Vinpocetine sells for
$26 per 100. If you order and use vinpocetine
we will be most interested in your results.
[Q]
Mr. B. from California, who noticed
comments in Tinnitus 1bday suggesting
a relationship between pain and tinnitus,
offers direct evidence of such a relationship.
Mr. B is cursed with otalgia (ear pain) and tinni-
tus which started eight years ago. The cause of
his otalgia has not been discovered but the pain
can be relieved by narcotics. Severe chronic pain
has kept Mr. B. on Demerol which has been
effective not only for the pain but has also
reduced or eliminated his tinnitus.
Demerol is not a drug to be taken
lightly. According to the PDR, Demerol
can produce drug dependency of the
morphine type and has the potential ofbeing
abused. In addition, other adverse reactions
have been observed such as lightheadedness,
dizziness, sedation and nausea. Many of you are
aware that another pain medication, Lidocaine,
which is a topical anesthetic often used in dental
procedures, can relieve tinnitus. In a study of
26 tinnitus patients at Oregon Hearing Research
Center, 23 (88%) obtained complete relief of
their tinnitus with an i. v. injections of lidocaine.
Unfortunately the relief lasted only about
30 minutes indicating that lidocaine is not a
practical therapy for tinnitus. That experiment,
however does demonstrate that the chemistry
of pain relief substances can possibly have a
positive effect upon tinnitus. We have searched
for a pain medication in pill form that could
have the same effect as the injected lidocaine.
So far that search has been unsuccessful.
Questions and Answers (continued)
[Q]
Mr. B. from Michigan was told that his
hearing was so impaired that masking
would not help him. He further states
that even with hearing aids, he can hear people
speaking but cannot understand what they are
saying.
Regarding masking, never judge in
advance. Always conduct a trial. Most
likely the best chance for success for
you, Mr. B., is with tinnitus instruments. Ifyou
try the tinnitus instrument remember that it is
essential to adjust the hearing aid portion first.
Only after that do you add in the masking
sound.
Speech comprehension is a common complaint,
especially among elderly patients with hearing
losses. The act of understanding speech involves
not only hearing the speech sounds but also pro-
cessing those sounds in the brain. The process-
ing actually requires a certain amount of time to
achieve. Apparently as we age, that processing
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22 Tinnitus 1bday/ September 1997
of speech sounds (like many other things) sim-
ply slows down. And it doesn't have to slow
down much for speech to become an incompre-
hensible mess. Dr. David Lilly of OHSU conduct-
ed a study where the time interval between
utterances was increased by 250 milliseconds.
The delayed timing as compared to the normal
timing of speech improved speech comprehen-
sion significantly for the elderly hearing-
impaired. Unfortunately, as yet there is no
wearable electronic device available that can
effect the slower presentation. It will be helpful
to you, however, if you suggest that those speak-
ing to you do so not louder but more slowly.
Notice: Many of you have left messages requesting
that I phone you. I simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:30a.m.- noon and 1:30-4:30 p.m.
(503/494-2187). Please send your questions to:
Dr. Jack Vernon c/o ATA, Tinnitus 7bday
PO Box 5, Portland, OR 97207-0005.
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Tinnitus Transformation
from Sufferer to Survivor
by Thomas J. DA.iuto
I had never heard the word
tinnitus uttered until the
day of my injury. And after
15 years as a police officer, I
wish I could say I was
injured in some heroic way.
But my injury was the result
of a weight-lifting accident
in the police fitness room.
The medical diagnosis was
"perilymph fistula," but basically I pushed too
hard on the bench press and exploded my inner
ear. I clearly remember that other than the sen-
sation of a pop and a clogged feeling, the first
symptom was a ringing sound which I thought
was a phone in the gym!
When I got up from the weight bench, I was
nauseous and off-balance. I stumbled back to
my office to call my doctor but there was no dial
tone when I picked up the phone. Now sick and
mad that the phones were broken, I asked my
secretary to check her phone. It worked. As I
tried her phone I discovered that I was deaf in
my right ear.
After two unsuccessful operations to .try to
recover some hearing and balance, in despera-
tion I underwent a complete removal of my
inner ear along with the severing of the balance
and hearing nerves in hopes of silencing the
tinnitus. I never cared about recovering my
hearing or that I was no longer as agile as I used
to be. But I was willing to undertake any risk to
silence the roar from within. After a week in the
hospital and two days in ICU, both the tinnitus
and I survived the operation.
. I received my police disability pension, a
mce farewell party, and off I went into a private,
secluded exile. Because my tinnitus was irritated
from three main stimuli - stress noise and
oddly my own deep voice - to the p o i ~ t of
being unbearable, I secluded myself from these
tinnitus stimulants. In doing so, I also cut
myself off from the rest of the world. As cruel as
tinnitus can be, a fourth problem began that I
now know feeds directly from and supports the
tinnitus. It is depression.
Until my audiologist told me about the .ATA,
I had been on a two-year downward spiral, with
what appeared to be no help in sight. I can
clearly remember receiving my first issue of
Tinnitus Tbday and how I read it from cover to
cover as if it were food for a starving individual.
1 also can remember sitting there alone and cry-
ing, realizing that I was not crazy or unique in
my pain. Tinnitus Tbday has become my "life
preserver." And it seems to always be thrown
my way just when I most need it.
I began and continue to receive counseling
and drug treatment for depression. Stil1, when
the depression starts to clear and I feel active
and alive, the tinnitus reminds me that living in
this noisy, busy world extracts a hefty price. It is
a vicious circle in that when I do feel well and
in need of stimuli, it is the stimuli that will
drive me back to seclusion which starts the
cycle over. Although I know my major tinnitus
triggers, there is no way to eliminate them
entirely without eliminating my quality of life.
This is where tinnitus and depression appear to
be linked for me. I continue to seek a median
where the depression and tinnitus can co-exist
without either suffering a setback.
It is frustrating sometimes trying to get non-
sufferers to try to understand something that
only fellow tinnitus sufferers can truly know.
Even so, I get a tremendous emotional payback
from educating those around me - especially as
a tinnitus support group leader here in 'Thmpa.
It has helped me to not be
ashamed of a disease that cannot
be seen, felt, or measured
but is nonetheless
real and, for some,
debilitating. I never
ask for sympathy.
Instead, my
aim is to help
Tinnitus Thday/ September 1997 23
Tinnitus Transformation (continued)
bring tinnitus out of the closet and in turn and if
possible, help prevent someone else from suffer-
ing from this affliction, maybe even help find a
cure. Since tinnitus is not a fatal illness, it is
hard for many to take it seriously. I am con-
vinced that it's up to us - people with tinnitus
-to push for acceptance, understanding and,
ultimately treatment. This has been a huge fac-
tor in my transformation from tinnitus sufferer
to tinnitus survivor.
I am also blessed in having a wonderful and
understanding family- my wife, Lindy, and my
son, Tony - who perceive my discomfort level
when we're out socially and are completely sup-
portive if I need to leave when the noise
becomes unbearable. Both Lindy and Tony are
well-educated about tinnitus, and volunteer
their time and efforts at our monthly support
group meetings and by taking support phone
calls when I'm not able to. This is another major
positive factor in living with this disease.
Now with the help of excellent therapists
and rehabilitation counselors, I am back in
Guidelines for Writers
Tinnitus Thday, the Journal ofthe American
Tinnitus Association welcomes submission of
original articles about tinnitus and related sub-
jects. The articles should speak to an audience of
people with tinnitus, and to audiologists, otolaryn-
gologists, otologists, hearing aid specia1ists, and
other medical, legal, and governmental specia1ists
with an interest in tinnitus.
Manuscripts should be typewritten, double-
spaced, on plain paper and should include title;
author(s) name(s) and biographical information;
and, when appropriate, footnotes, references,
legends for tables, figures, and other illustrations
and photo captions. 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 3.5"
diskette in WordPerfect 5.1 or higher for-
mat (IBM compatible).
Please do not submit previously pub-
lished articles unless permission has been
school full-time (and pulling straight A's) work-
ing towards a paralegal degree. I know I cannot
work in a traditional work environment due to
the severity of my tinnitus but I can utilize new
computer technology to work from home. I've
learned through vocational counseling and mar-
ket surveys that there are many local employers
who will accommodate my needs. I look forward
to making the transition from a police criminal
investigator to a criminal and litigation
researcher. The tools will change - from hand-
cuffs and a gun to a computer mouse and the
Internet- but the skills remain the same.
So I try to enjoy the good days, and know
that even on the deepest, darkest days, just over
the next cresting wave is a lifeboat. Inside are
fellow survivors (not sufferers) smiling, as one
tosses the next copy of Tinnitus Tbday my way.
While I yearn for the day my "life preserver"
carries the headline TINNITUS CURED, the
warmth, compassion, and understanding of
these survivors rescue me and 1 know that
I am not alone.
obtained in writing frn their use in Tinnitus
Thday. (Please attach a copy of the written release
to the article submitted.)
All letters accompanying manuscripts submitted
for publication should contain the following lan-
guage: In consideration of Tinnitus Thday taking
action in reviewing and editing my (our) submis-
sion, the author(s) undersigned hereby transfer(s),
or otherwise convey(s) all copyright ownership to
Tinnitus 7bday in the event that such work is pub-
lished by Tinnitus 7bday.
Tinnitus Thday also welcomes news items of
interest to those with tinnitus and to tinnitus
SPECIAL DONORS and TRIBUTES
ATA's Champions of Silence are a remarkable
group of donors who have demonstrated their com-
mitment in the fight against tinnitus by making a
contribution or research donation of $500 or more.
Sponsor Members and Professional Associates
have contributed at the $100-$499 level. Research
Donors have made research-restricted contributions
in any amount up to $499.
acknowledged with an appropriate card to the
honoree or family of the honoree. The gift amount is
never disclosed.
Our heartfelt thanks to all of these special
donors!
All contributions to the American Tinnitus
Association are tax-deductible.
GIFTS FROM 4-16-97 to 7-15-97.
A T ~ s Tribute fund is designated 100% for
research. 'Ihbute contributions are promptly
Champions of
Silence
(Contributions of
$500 and above)
Julia R. Amaral
Allen R. Bernstein
Robert w. Booth
Richard Burnat
Rob M. Crichton
Glen R. Cuccinello
Cornelius R. Duffie
Josephine K. Gump
David W. Hopkins,
Fonnit Print
Management
W. F. Samuel
Hopmeier, BC-HIS
Harry G. and Marion
Keiper
John Malcolm
Bruce Martin
John E. Meehan
Ed Leigh McMillan, Il
Walter Mintz
Jerry Monnin
Stephen M. Nagler,
M.D. , F.A.C.S.
Kenneth A. Preston
Marion H. Schenk
William E. 'I\uley
Jack A. Vernon, Ph.D.
Sponsor Members
(Membership
Contributions
from $100-$499)
Joseph M. Baria
T. Larry Barnes
Ned K. Barthelmas
Judith E. Beaston
Deborah and Charles
Bern
Peter D. Bonanno
Alain G. Boughton
Ronald R. Bowden
Malcolm K. Brachman
Carol A. Brown
William A. Burgin
Raymond L. Buse, Jr.
Raymond L. Buse
Memorial
Foundation, Inc.
John F. Caddv
Barbara Young Camp
Stan Cole
Michael L. Connolly
Richard R. Cortright
Clifford S. Craig
George Crandall, Jr.
Carole Desnoes
Irene Duffield
A. T. Evans
Robert Fasic and Roy
Grieshaber
Bernard Fishman
David E. Flatow
Mary A. Floyd
Francine and Ray
Foster
Elliot S. Frankfort
Robin R. Fuller
E. Rebecca Gamble
Gerald Otis Gates
Dr. Arthur Gelb
Harriet .L Glazer
Mike Gleason
Robert E. Goodhart
Marlene Greenebaum
Seymour Greenstein
Elizabeth Grisbaum
J. Alton Hadley
William R. Hale, M.D.
Joseph G. Hampton
Lawrence E. Happ, Sr.
Charles B. Hauser
William F. Hendren
Elizabeth B. Hill
Patricia Hines
Lorraine Hizami
Ted Hofmeister
Roger W. Hollander
Robert B. Hom
Shirma M. Huizenga
William H. Hurt
H. June Ivins
Elmore Jenkins
Robert L. Jeske
Harold S. Karpe
Emma L. Kellaher
Marvin Kowit
E. Joseph Kubat
Allan S. Kushen
Henry G. Largey
Fred R. Lawson
Evelyn Schrader Lee
Ruth T. Lelsz
Gary W. Lightner
Gary L. Lombardi
Peter Manasse
Augusto Marciante
Ellen Anne Marks
Peter A. Marrinan
Andy Matthiesen
Mr. and Mrs. M.
Richard May
Gudrun Wallgren
Merrill
John M. Meyer
Alexander Miller
Judith Mmer
Matt Minninger
Philip 0. Morton
Edward J. Nierman
Patrick A. O'Boyle
Myles E. O'Reilly
Mark Owyang
Dr. Allan F. Pacela
Phil R. Pearcy
Stan Perimeter
Mary Ann Perper
Marceline Powell
Donald E. Pullen
Otis D. Rackley, Jr.,
D.D.S.
Gerald B. Renyer
Ludie G. Richard
Robert Gene Richter
Jeffrey A. Ristine
Lynn Rosemurgy
Nancy M. Rosen
Beth and Scott Ross
Alfred E. Ruppel
Jack Salerno
Patsy M. Samson
Anthony Scerbo
Wilham T
Schreitmueller
Richard S. Schweiker
Evelyn J . Schwertl
Peter Seifert
Forrest Shook
David J. Simm
Raymond C. Simon
Joel Smith
Connie Stanton
Richard H. Steckler
Veronica
Steffensmeier
Douglas H. Steves
William and Cora Lee
(Corky) Stewart
Elsebeth S. Stryker
Richard W. Sullivan
Antril C. Suydam
Robert L. Szabo
Fred D. Thompson
James C. Totten
Jack Wallner
David J . Walsh
J . Michael Wiggins
Mary B. Williamson
Shirley L. Wireman
Stephane W. Wratten
Carter Wurts
Larry W. York
Paul W. Zerbst
Professional
Associates
(Professional
Membership
Contributions
from $100-$499)
Advanced Hearing
Technologies, Inc.
Mel Abrams, M.D.,
P.A.
F. Javier Hernandez
Calvin, M.D.
Joel G. Cohen, M.D.
Lois N. Cohen, C.S.W.,
A.C.S.W., B.C.D.
Donald B. Douglas,
M.D.
Bjorn Eriksen, M.S.
Barbara A. Esses, M.D.
Carl Fonner
Anne C. Galloway,
M.S., CCC-A
Sharon T. Hepfner,
M.A., FAAA
Carlos Herraiz, M.D.
David T. Malicke, D.O.
Sol Marghzar. M.S.,
CCC-A
Ernest E. Mhoon, Jr.,
M.D.
Stephen E. Mock,
Ph.D.
Kenneth E. Mooney,
M.D.
Philip A. Rosenfeld,
M.D.
'Thnit Ganz Sanchez,
M.D.
Martin Smith
Dr. Blair R. Swanson
Corporations with
Matching Gifts
American Express
Chase Manhattan
CPC International
Hoechst Celanese
Johnson & Johnson
Shaklee
Bequests
From the Estate of
Anna Shennan
Tinnitus Tbday/September 1997 25
SPECIAL DONORS and TRIBUTES (continued )
TRIBUTES
In Memory Of
Florence Angello
Mary G. Kalil
Mrs. Louise Barrows
Mark Jurich
'frudy Drucker,
Ph.D.
Barbara M. Handy
Mary R. Kokes
Hazel V. Fingal
John H. And Faye L.
Schleter
Bernhard Garfinkle
Shirlie Kesselman
Lydia Konitzer
James Konitzer
Irene Lomax
Kolbrenner &
Alexander, L.L.C.
Jerry Prager
Sybil Barzilay
Ed Thnnien
Joella and Lester
Satterthwaite
Mary J. McGorray
'Thd Van Sl oote n
Arlo and Phyllis Nash
In Honor Of
Jack Harary
(for Father's Day)
Bob and Debbie
Harary and Family
RESEARCH
DONORS
(Research-restricted
donations up to $499.)
Kaye C. Anderson
Howard R Andrews
Henry Angulo
Alix Ankele
Calvin Artke
Dominic Avanzato
David S. Bailey
Charles L. Baker, Sr.
Bill Bannister
Florence M. Barham
Patricia A. Bartels
Theodore W. Bayler
Peter B. Baylinson
William T. Bell
Gladys S. Benbasat
Daniel L. Bergem
Elliott H. Berger
Robert 0 . Bergl und
Mary Lou Biddlestone
Duane L. Bierwirth
Hetty Bixby
David Black
Susie D. Blanton
Bruce T. Blythe
Ronald W. Bocksruker
Joyce C. Bodig
Darlene K. Bohinc
Mildred S. Bonwit
Richard C. Borella
Christina Bourdaa
Theodore T. Boutis
Bessie M. Bowens
Sr. Antoinette Boykin
Trene E. Brennan
Kathleen M. Brock
Elaine F. Brodey
Barbara F. Brown
Gay Browne
Harry A. Bruhn
J. Ben Buck
Paul Bunts
Michael W. Burnham
Abigail H. Burr
Daniel M. Cahill
Miriam W. Campbell
Michelle Canzio
Daniel J . Carlin
Joh n Carlo
Stuart A. Chalfant
Susan P. Chizeck
Lori mer T.
Christensen
Jean Cinader
C. Dennis Clardy
Thomas R. Coffey, II
Arthur P. Coletta, CVS-
Life
Arthur B. Collier
E. Landon Collins
Mary J. Collins
Eileen T. Corcoran
Bette B. Coulson
Josephine Crowley
Louis N. D'Ascoli
Anthony M.
Dalessandro
Fabio Romeiro
DeAlbuquerque
Joseph Decker
Johan E. Derijke
Katherine R.
DiFrancesca, Ph.D.
Robert J . DiGisi
Raymond J. Disher
Kathryn M Dobrinski
June S. Dubroff
Robert B. Dunn
Richard E. Dye
Miriam Eidlitz
Joseph P. Emidy
Nancy Essington
Ray E. Fankhauser
Julius D. Feigelson
Isabel Feld
Mary Toulouse Fett
Dennis R. Fields
Eunice Fitzell
Lovetta Wallis Fossett
James 0. Francis
Rhea Fried
Elaine Gannon
David J. Gaudieri
Mark S. Geller
Otto Genoni
Judith M. Gill
Erwi11 C. Gotsch
Peggy B. Gouldman
Seymour Greenstein
Norman Grolman
Jack A. Gubanc
John F. Hallgren
John R. Hammond
Laura E. Hardy
Charles T. Hawn
Mrs. F. W. Hees
Betty J . Reisch
Geraldine Herr
s. Dale Hess
E. Alan Hildstrom
Paul G. Hill
Cirel Hillman
Louise M. Hirasawa
Sara Jean Hoffmann
Loretta L. Hughes
Dorothy Ikemeyer
David P. Jankofsky
Barry V. Johnson
Howard W. Johnson
Christopher A. Kaelin
Rebecca B. Kaiserman
R. L. Keheley
Frank L. Kellogg, Jr.
Fred F. Kentop
Wayne M. Kern
Michael W. Kerschen
David Kiecker
John E. Kinney
A. J. Klekers
Doris L. Knecht
Elizabeth J. Koenig
Steve M. Konneman
Steven G. Korte
Henry T. Kostecki
M. Virginia Kreckman
Virginia C. Kuehner
Joseph A. Kuhn
Adelia M. Labudovich
Thomas B. Lake
John C. Larkin
Anna K. LaRocca
Richard LaRosa
Frances L. Lerch
Shirley Leviton
Maria Lifson
Manny Linares
Debbie Lindell
Marilyn Lindholm
Inna Lorents
Alice R. Lovvorn
Isabelle C. Ludlum
Arthur J. Lurie, M.D.
and Cary E. Lurie
Robert G. Lyon
Donald Mahler
Dan R. Malcore
Mary T. Malone
Byron R. Mann
Lillian P. Markowitz
John Mascia
Julianne Mattimore
Johnathon R.
McCartney
Marvin Mesker
Shirley A. Miller
Ward T. Milner
Gladys V. Moore
Walter N. Morgan
Franco Mormando
Harry H. Morritt
E. Susan Morton
David E. Mottern
Elayne Myers
Mae Nachman
lan L. Natkin
Vivian Newill
Jerome H. Newman
Regine R. Nexsen
Robert Nichols
Donald G. O'Brien, Sr.
William D. Odbert
Curtis S. Olson
Robert Orosz
Benjamin Ossman
Karl E. Owen
John Palazzo
Edward Palin
Janie L. Palmer
Carl J. Palucki
Thmmy Kells Parker
Kanti S. Patel
Sharon Payne
Robert Peccini
H. w. Pedersen
Juan D. Perez
Linda M. Peterson
Judith Piepsney
Mary Anne Pittmon
Elaine T. Platt
Bruce K. Powell
Sergio Quintanilla
Maj. Leonhard Raabe
Shirley Ravenshorst
Allen Raymon
Michael Reindl
David P. Rejmer
Maureen B. Rice
Sally Rice
Kydeen Riddle
Warren W. Roberts
Jose Negron Rodriguez
Mary E. Rosen
Nancy M. R.
Rotenberry
Benjamin Rothman
William A. Rowley
William H. Roy
Laura M. Russ
Charles J. Ryan
Frances Sacco
Ellen M. Scanlon
Mary R. Schaadt
James R. Schlauch
Richard S. Schonwald
William Schwartz
Arlan R. Schwoyer
Jim Shawn
Norma T. Sheld
Mark W. Sholofsky
Sylvia K. Shugrue
Katherine L. Simmons
Sherwood L. Simmons
Raymond C. Simon
Mark A. Sniegowski
Mildred F. Sohn
Jean Spence
Elizabeth H. Spencer
Maureen T. Sprohge
James J. Steponik
Douglas H. Steves
Jim Stokes
James E. Storer
Lyle E. Strahan
Steven Strong, M.D.
Elsebeth S. Stryker
Raymond L. Sullivan
Ronald Swid1er
Helen K. Thylor
Karen M. Thomson
Eugene F. TI:uax
Len Ufland
Wayne Vaughn
Maxine Vincent
Lee K. Vorisek
Michael Vucelich
Mildred WadJer
Mark K. Wallack, M.D.
Marc Weinstein
Richard L. Weis
Erik Wennermark
Mrs. H. A. Wheeler
Alan and Ruth
Whitman
lngrid M. Wiggins
Martin G. Wild
Janet R. Wilder
Judith A. Wildzumas
Frances E .Williams
Mildred B. Williams
Victoria P. Wilson
Wendi Wilson
Emil A. Wolf
Susan V. Zabinski
lise M. Zalaman
Margaret E. Zechman
Joann M. Zlatunich
Florence Zuchowski
Noise, either of short or long duration was
associated with the onset of tinnitus for 36.8% of
the respondents. Another 36% did not know where
their tinnitus came from. 12% reported it from ear
infections. Various other causes were reported in
small numbers.
Nearly 70% of people responding report
having a hearing loss. Strikingly 75% of these
people do not wear hearing aids. The majority
considers tinnitus a greater problem than hearing
loss.
Almost everyone, 97%, has health
insurance. Only 16% report no coverage for tinnitus,
83.7% received either partial or complete payment
Tinnitus has a significant effect on the lives
of those completing this survey. It interfered with
work for 56.8%, with social interaction for 69.3%,
and with general enjoyment of life for 85.7%.
Additionally, 70.8% of the respondents reported
being depressed. In spite of these numbers only
about 12% have had to quit work because of
tinnitus.
Ninety people reported their tinnitus led to
litigation, but most have taken no steps to achieve
a settlement. Ten have begun litigation. Twenty-six
reported receiving a favorable settlement and 33
reported receiving an unfavorable settlement.
It appears that some headway is being
made in educating both professionals and the
general public. Patients in 1986 were told to "learn
to live with it" about 83% of the time. That had
decreased to about 7 4% by 1996. Physicians will be
pleased to note that respondents now consider
them 58.2% helpful with tinnitus - a dramatic
increase from 33.7% ten years ago. However,
91.7% of the respondents did not think they had
been offered effective relief!
In 1986 only 31% of the people had tried
any form of tinnitus treatment, that number
increased a little in 1992, to 34%, but took a big
jump in 1996 to 60%. People also reported getting
relief from what they'd tried. Masking in its various
forms, including retraining therapy and bedside
masking accounted for most of the successes.
Drugs for tinnitus accounted for considerable relief,
but not as much as in 1992.
More than 10% of the respondents reported
attending ATA self-help group meetings with the
majority rating them good to excellent.
HOW CAN I FIND HELP FOR MY TINNITUS?
The American Tinnitus Association, a non-profit
organization, supported solely by private donations,
is dedicated to helping tinnitus patients and
supporting tinnitus research. Activities include the
production and distribution of public awareness
materials, educational programs for the professional
and lay communities, establishment and guidance
for self-help groups and their leaders, and the
promotion of community hearing protection
programs.
For further information and membership benefits:
AMERICAN TINNITUS ASSOCIATION
Post Office Box 5
Portland, OR 97207-0005
Tel: (503) 248-9985 Fax:(503) 248-0024
http://www.teleport.com/-ata
e-mail: tinnitus@ata.org
A non-profit voluntary human health and welfare agency under
26USC 501 (c)(3) @ATA 0997
RESULTS OF THE
1996 TINNITUS
PATIENT SURVEY
FROM THE
AMERICAN
TINNITUS
ASSOCIATION
I GENERAL INFORMATION
1. Age: Mean 59.76, Range 19-91
2. Sex: 62.3% male, 37.4% female
3. Marital Status:
Married
Not married
4. Ethnicity:
White
Non-white
5. Education level:
72.1%
27.9%
96.3%
3.7%
Grade school
High/vocnl school
1.0%
22.8%
6. Where residence located by geographic
census area:
Northeast
Midwest
South
West
27%
20%
25%
28%
7. Employment status:
Full time 36.9%
Part time 7.8%
Retired 42.8%
UnempiJDisabled 4.7%
Not empl.outside home 7.8%
Major Lifetime Occupation
8. Major occupation throughout life:
Sales/office
Teacher/student/creative
Homemaker/farmer
Ad min/manager
Scientist/medical
Mechanic/const.lfactory
Fire/Police/Military
9. Annual family income:
Under $25,000
$25,000 to $49,999
Over $50,000
10. General Health Level:
Excellent 34.6 %
Good 52.6%
Fair 11.0%
Poor 1.8% .
13.0%
33.8%
53.2%
23.8%
18.9%
15.6%
15.1%
14.9%
6.7%
4.9%
I TINNITUS DESCRIPTION
11. How long have you been aware of your
tinnitus?:
Up to 1 yr
1 up to 2 yr
up to 5 yr
5 up to 10 yr
10 up to 20 yr
20+ years
5.9%
8.7%
19.4%
22.7%
23.8%
19.4%
12. Did the tinnitus come on gradually or
suddenly?:
Gradually
Suddenly
Unsure
34.2%
51.0%
14.8%
13. Where does your tinnitus seem to be
located?:
Left ear 15.7%
Right ear 11.0%
Both ears 54.6%
In head 7.7%
In head & ears 10.0%
14.1s your tinnitus constant or intermittent?:
Hear it part time 16.6%
Constantly there 83.4%
15. What does your tinnitus usually sound
like?:
Ringing
Hissing
Transformer noise
Buzzing
Clear Tone
Sizzling
Pulsating
Whistle
High Tension
Ocean Roar
Hum
29.3%
22.2%
8.7%
5.3%
5.3%
4.1%
3.1%
3.1%
2.3%
2.3%
1.7%
16. Tinnitus loudness rating on a scale 1 to 10,
where 10 is the loudest.:
Mode 5; Mean 5.95; Median 4.92
17. Onset association:
Not known 36.0%
Noise exposure/long time 18.5%
Noise exposure/brief 18.3%
Ear Infection 12.0%
Drugs 5.6%
Illness 5.1%
Head Injury 3.1 o/o
Whiplash 1.4%
18. Do you also have a hearing loss?:
No 21.8%
Yes 69.9%
Unsure 9.7%
19. Do you currently wear a hearing-aid?:
No 74.9%
Left ear 8.1%
Right ear 6.3%
Both ears 10.7'1/o
20. Which is more of a problem?:
Tinnitus 59.4%
Hearing loss 14.6%
Equal bother 22.8%
Unsure 3.1%
TINNITUS AND HEALTH CARE
21. Do you have health insurance?:
No 2.9%
Yes 97.0%
22. Were the costs of your tinnitus visits
covered by insurance?:
No 16.0%
Partial 54.4%
Yes 29.3%
23. How many tinnitus visits to any health care
professionals have you made in the last 12
months?:
Mean 1.11
24. How many visits since tinnitus onset?:
Mean4.3
25. Were health care professionals helpful and
sympathetic?:
Agree
Disagree
58.2%
41.5%
26. The treatment offered reduced or
eliminated tinnitus:
Agree
Disagree
8.0%
91.7%
27. The treatment offered was ineffective:
Agree 58.5%
Disagree 41.0%
28. Only treatment offered was "Learn to Jive
with it":
Agree
Disagree
74.1%
25.3%
29. Have you tried any form of treatment for
your tinnitus?:
No 39.5%
Yes 60.0%
List any providing relief:
Bedside maskers
Auditory Habituation
Maskers
Drug Therapy
Hearing-aids
Biofeedback
Acupuncture
Other
65.0%
50.0%
47.3%
42.8%
37.4%
31.8%
19.1%
38.1%
30. Visited a health professional on ATA
referral list?:
No
Yes
81.5%
18.2%
31. Rate care received from that referral: (248
people reporting)
Excellent 29.4% Fair 17.6%
Good 37.3% Poor 12.9%
IV TINNTUS AND THE
QUAliTY OF UFE
32. How much effort to ignore tinnitus?:
Easily ignored 16.8%
Ignored with effort 41.5%
Considerable effort to ignore 26.9%
Can never ignore 14.9%
33. Feel irritable due to tinnitus?:
Never
Sometimes
Often
Always
16.5%
57.3%
21.4%
4.9%
34. Sleep problems due to tinnitus?:
Never
Sometimes
Often
Always
31.0%
48.4%
11.6%
9.0%
35. Ever feel depressed due to tinnitus?:
Never 28.24'/o
Sometimes 51.8%
Often 14.9%
Always 5.1%
36. How much does tinnitus interfere with
work?:
None
Slight amount
Moderate
Great
37. Ever quit work due to tinnitus?:
No
Yes Temporarily
Yes Permanently
43.1%
31.3%
16.7%
8.8%
88.0%
6.8%
5.3%
social activity?:
None
Slight amount
Moderate
Great
30.8%
30.24'/o
22.S0.4
16.6%
enjoyment of life?:
None
Slight amount
Moderate
Great
14.2%
42.5%
27.0%
16.2%
V RATING OF AT A'S SERVICES
40. Rank ATA services according to their
importance to you:
> Publication of "Tinnitus Today"
Very important 73.0%
Somewhat important 24.3%
Not at all important 2.0%
Financial support of tinnitus research
Publication of tinnitus brochures
Sale of books about tinnitus
Not at all important 21 .0%
Professional referral network
Establishment & support of local self-
help groups
Public awareness & prevention
programs
Bibliography service
Workshops/seminars for professionals
Very important 61 .3%
Forums/regional meetings for people
with tinnitus
Lobbying & advocacy about tinnitus
with Federal government
Very important
Somewhat important
Not at all important
68.2%
23.1%
8.1%
41. Rate quality of Tinnitus Today in meeting
informational needs about tinnitus and ATA
activities
Excellent
Good
Fair
Poor
50.1%
41.7%
8.0%
0.2%
42. Rate tinnitus books and brochures
purchased from ATA in terms of meeting your
needs
Excellent
Good
Fair
Poor
27.7%
54.4%
15.7%
1.1%
43. Have you participated in an ATA tinnitus
self-help group
No 72.0%
Yes 10.5%
None in my area 17.4%
44. Rate the self-help group you attended
Excellent 16.0%
Good 46.2%
Fair 26.1%
Poor 4.2%
VI TlNNmJS LEGAL ISSUES
45. Tinnitus caused by circumstance leading
to litigation?:
No
Yes
92.4%
7.6%
If yes, have you taken: (number of people who
checked this response)
No steps to settle 173
Plan to take steps 21
Have begun litigation 10
Reached favorable settle 26
Reached unfavorable settle 33
VI TlNNRUS SURVEYS:
Comparing 1986, 1992, and 1996:
ATA conducted a readership survey in 1986
and again in 1992 and 1996. The 1986 survey was
mailed to 130,000 names, 13,000 surveys were
completed and returned. Every 5th survey was
coded and a total of 2514 entered for statistical
analysis. In 1992, 39,000 were mailed and 7,500
returned. Again, every 5th survey, total 1429, was
coded for analysis. The 1996 survey was sent to
15,000 names, 3,736 were returned and every 3rd
one, a total of 1 ,232, was coded and analyzed.
Examination of the ATA database
corroborated our assumption that the surveys had
been completed by substantially different groups.
The demographic information provided in
each of the three surveys was strikingly similar.

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Tinnitus Today September 1997 Vol 22, No 3

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September 1997 Volume 22, Number 3

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