June 1998 Volume 23, Number 2

Tinnitus Today
THE JOURNAL OF THE AMERI CAN TINNITUS ASSOCIATION
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Education -Advocacy - Research - Support
iS or roari113 SOOII<f fllaf your ears ttJake
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American Tinnitus Association ((a> J
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In This Issue:
Tinnitus Treatments
for Veterans
Tinnitus and our
Emotions
Air Bags - Why This
Issue Hasn't Gone
Away
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Tinnitus T o d ~ y
Editorial and Advertising offices:
American Tinnitus Association,
P.O. Box 5 Pordand, OR 97207, 503/ 248-9985,
800/ 634-8978, http://www.ata.org
Executive Director & Editor:
Gloria g, Reich, Ph. D.
Associate Editor: Batbara 'Thbachnick
Tlmlln(S Thday is published quarterly in
March, June, September, and December. It is
mailed to American Tinnitus Association
donors and a seleeted list of tinnitus suffer-
ers and professionals who treat tinnitus.
Circulation is rotated to 80,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit-
able for Tmnuus 'Tbday. Acceptance of adver-
tising by Tlmttrus Thday does not constitute
endorsement of the advertiser, its products
or services, nor does Tinnitus 1bday make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin
ions expressed by contributors to Tinnitus
1bday are not necessarily those of the
Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-prof-
it human health and welfare agency tmder
26 USC 501 ( c)(3)
Copyright 1998 by American Tinnitus
Association. No part of this publication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any means,
without the prior written permission of the
Publisher. TSSN: 08976368
Executive Director
Gloria E. Reich, Ph.D., Portland, OR
Board of Directors
James 0 . Chinn is, Jr., Ph.D., Manassas, VA
Edmund Grossberg, Northbrook, IL
w. F. S. Hopmeier, St. Louis, MO
Sidney Kleinman, Chicago, IL
Paul Meade, Tigard, OR
Philip 0. Morton, Portland, OR, Chmn.
Stephen Nagler, M.D., P.A.C.S., Atlanta, GA
Dan Purjes, New York, NY
Aaron I. Osherow. Clayton, MO
Jack. A. Vernon, Ph.D., Portland, OR
Megan Vidis. Chicago, fL
Honorary Directors
The Honorable Mark 0. Hatfield
Tony Randall, New York, NY
William Shatner, Los Angeles, CA
Scientific Advisor y Committee
Ronald G. Amedee, M.D., New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clemis, M.D., Chicago, TL
Robert A. Dobie, M.D. , San Antonio, TX
,John R. Emmett, M.D., Memphis, TN
Chris 8. Foster, M.D., La Jolla. CA
Barbara Goldstein, Ph.D. , New York, NY
John W, House, M.D., Los Angeles, CA
Gary P. Jacobson, Ph.D., Detroit, MI
Pawel J. Jastreboff, Ph.D. , Baltimore, MD
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia, PA
Gale w. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Robert E. Sandlin, Ph.D., El Cajon, CA
Alexander J. Schlcuning, II, M.D.,
Portland, OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith, M.D. , San Jose, C1\
Robert Sweetow, Ph.D. , San Francisco, CA
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey,
Portland, OR
The Journal of the American Tinnitus Association
Volume 23 Number 2, June 1998
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
5 ATA's New Board Member
8 Hidden Treasures
by William H. Martin, Ph.D., Robert L. Folmer; Ph.D, and Baker Yang-
bing Shi, M.D., Ph.D.
10 Announcements
11 Poster Perfect
by Barbara Tabachnick
12 Air Bags- Why This Issue Hasn't Gone Away
by Barbara Tabachnick
13 Noise Cancellation Devices Given a Thst Drive
by Cliff Collins
14 Dear Abby, Dear Abby
by Kathryn Armstrong
15 Tinnitus 'Ireatments for Veterans
by Harvey B. Abrams, Ph.D.
18 Book Review
by Barbara Thbachnick
20 Tinnitus Patient Rights & Responsibilities
by Sidney C. Kleinman
21 www.ata.org
by Barbara Thbachnick
24 Tinnitus and Our Emotions
by Lois N. Cohen, CSW, ACSW, BCD
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
6 Letters to the Editor
22 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Special Donors and 'Iributes
Cover: ATA's new elementary school hearing conservation poster. Artist: Thko FujisaJ...i,
Brooklyn, New York
FROM THE EDITOR
by Gloria E. Reich, Ph.D.,
Executive Director
Are we meeting the goals? In
our mission statement (on
the front cover) we talk about
benefitting present and future
generations. We try to help
you get good care by keeping
you informed about current
tinnitus research and treat-
ments. Our school program
speaks to the upcoming generation by educating
them to respect their ears and protect them
from loud noise. You can help us by letting us
what you want to read about. If you have
opm10ns to express, write a Letter to the Editor
or S'_lbmit an article. We're always open to sug-
gestwns and hope to make our publication one
you'll look forward to receiving. Several years
ago, we set some goals for Tinnitus Tbday. I'm
sharing those with you here. Do you think we're
meeting them? If not, how can we improve?
Promote the science of tinnitus and the bet-
terment of public health
Publish original, important, well-documented
articles
Enable readers to remain informed
quality of care and research by an
mformed readership
Foster debate
Forecast trends and issues
ATA's "Young Researcher Award" was not
given this year because unfortunately no one
applied for it. This is a new
annual cash award for the best
tinnitus presentation at the
annual meeting of the
Association for Research in
" Otolaryngology (ARO). We're
hoping that we'll get lots of
requests for next year's award.
It will be announced to all ARO
members through the Internet.
If you are a new, young
researcher in the field of tinnitus
and have a presentation for next
February's research meeting, let
us know and we will send you
more information about criteria for
the award.
4 Tinni tus 'TOday/ June 1998
. Pat Daggett and I have been busy represent-
mg.ATA at various professional meetings this
spnng. In February, accompanied by board mem-
ber Dan Purjes, I testified before the U.S. House
Appropriations Subcommittee in support of the
budget for the National Institute for Deafness
and other Communication Disorders (NIDCD)
and tinnitus research. I attended the Association
for Research in Otolaryngology annual winter
meeting where our advisory committee also met.
While there I had the pleasure of speaking to
Thm D'Aiuto's Thmpa group at their regular
February meeting. Pat and Walt Daggett attended
the Thi-State Hearing Society's annual meeting in
Thcoma, Washington. In March I presented a
paper about ATA at the Prosper Meniere's Society
annual meeting in Colorado, conducted a class
for social workers titled "A tinnitus care giver's
checklist," and exhibited ATA's publications at the
National Council on Aging in Washington. While
in Washington my husband and I had a pleasant
dinner with tinnitus supporters Shirley and Mort
Rosenhaft, and a fine morning meeting with
Oregon's Senator Ron Wyden who is known for
his interest in health issues and issues affecting
older Americans.
. April brought two more big meetings. I car-
ned.the ATA banner at the American Academy of
AudiOlogy, helped by Bob Sandlin Gail Brenner
Malvina Levy, and Dhyan Cassie. 'our material'
so popular that halfway through the conven-
tiOn we had to take names and addresses to mail
materials to because we had completely run out
of handouts. At the same time Pat and Walt
Daggett were distributing thousands of informa-
tive brochures to doGtors attending the annual
meeting of the American College of Physicians in
San Diego. ATA donor Brian Woolsey showed up
to help at the booth. In May I attended the tinni-
tus meeting at the NIDCD. ATA has a presence at
dozens of additional meetings through informa-
tion tables that are staffed by our network of vol-
unteers. If you think you might enjoy the
experience ofbeing the "tinnitus expert" and
handing out our material to health fair attendees
we'd love you to help us. Please call Pat (exten- '
sion 12) and she'll tell you how you can help.
Here's an issue that I'm sure has plagued
many of you: automated answering on tele-
phones. You know, where the voice says "to do
this, press 1; to do that, press 2." I know that I've
wasted hours listening to those machines over
and over trying to make out the words. Sel f
Help for Hard of Hearing Persons (SHHH) has
recommended a universal "out" - dialing "0" to
talk to a person. That certainly would be useful!
Others have made more recommendations such
as having an alternate message that is read slow-
er. If this issue is one you care about, you can
be heard by writing to Ms. Meryl S. !cove,
Director, Disabilities Issues Thsk Force, 2033 M
Street NW, Washington, D.C. 20554. And not too
far off the subject, let me take this opportunity
to apologize for our own automated voice mes-
saging system. When ATA receives a deluge of
calls (such as the more than 40,000 calls we've
logged since "Dear Abby" ran a letter about ATA
in February), we simply can't answer them per-
sonally. We've tried to make the system as user
friendly as possible and hope you understand.
Finally, those of you who have occasion to
talk to me on the phone might have noticed that
I ask you to repeat yourself less frequently than
in the past. The reason is a wonderful new ALD
(assistive listening device) called a Hearset. This
device looks like a telephone operator's headset
and connects to my office telephone. The inter-
esting part is that the headset is really an ampli-
fier which brings in the speaker's voice loud and
clear. Best of all there is a switch that allows the
headset to act as a hearing aid with volume con-
trol for sounds in the room. (My regular hearing
aid takes a rest while I'm using the Hearset.)
The down side is that I'm tethered to the phone
while wearing it and have a range of movement
of only about 10 feet. Small price to pay for
being able to communicate, I say. So, if you're
like me and have poor hearing but need to use
the phone at work, ask your hearing specialist to
look into the Hearset. It's made by Starkey
Laboratories of Eden Prairie, Minnesota.
A special welcome to all the new readers of
Tinnitus Tbday. Most of you came to us because
of "Dear Abby." There's an article about that
event further along in this issue. We hope you
like what you see and will take an active part in
ATA's work. The part of ATA that might be clos-
est to you is one of our support groups. You
received some information about tinnitus self-
help in your Welcome Packet. There are literally
hundreds of ways you can become involved
with ATA. Just let us know that you can help
and we'll help you find your special niche.
We will be funding more research in the
near future, and will report about it to you in
upcoming issues. If you'd like to read more
about tinnitus, there are some highly recom-
mended books and back issues of Tinnitus Tbday
available. Look for them on the order form
inside this magazine.
Again, WELCOME! IBI
ATXsNew
Board Member
James 0 . Chinnis, Jr. , Ph.D.
Jim writes: "I have been
luckier than some in that
my tinnitus - as disrup-
tive to my life as it was
when it began out of the
blue in 1990 - was also
'interesting' to me. I had
studied neuropsychology and perception
in graduate school and I began to learn
all I could about this strange affliction.
Some good has come from this experience
in that I have met a lot of great people along
the way.
I am most anxious to serve ATA in ways
where my education, talents, and unconditional
commitment to the mission of this organization
can be put to best use."
Jim is President of Decision Science
Associates, Inc. He received his doctorate in
psychology at the University of Michigan and a
B.S. in physics from MIT. 19
Tinnitus 1bday/June 1998 5
Letters to the Editor
From time to time, we include letters
from our members about their experi-
ences with ((non-traditional" treatments.
We do so in the hope that the informa-
tion offered might be helpful. Please read
these anecdotal reports carefully, consult
with your physician or medical advisor,
and decide for yourself if a given treat-
m.ent 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.
T
hrough our little support group, we are help-
ing each other in beautiful ways, and we're
coping much better. We now meet four times
a year (once a month proved to be too much),
and are learning to go on with our lives in spite
of our noisy companion. ATA membership and
the magazine are so helpful! Thanks.
Myrna Calkins, 1409 Girard Blvd. SE,
Albuquerque, NM 87106, 505/ 268-8754
I
have enjoyed Tinnitus Today and found it
useful all the many years I have been an ATA
member. I must say that for my needs and
interest, Vol 23, Number 1, (March 1998) is the
very best issue of all. The highlight of that issue
was the article "TRT and the Neurophysiological
Model of Tinnitus" by Dr. Stephen Nagler.
Habituating a signal to make it a part of the sub-
conscious mind to the extent it does not become
a conscious problem is the very thing I have
been doing on my own for years.
My tinnitus, which I've had for many years
in both ears, was caused by screaming airplanes
in the military. I have the good fortune of an
education in many fields, including a B.S. in psy-
chology and an M.S. in counseling, so I had
some of my own tools to work with. I just decid-
ed I was alive, things could be worse, and I put
the noise out of my mind. Yes, at times it comes
to my attention. I miss hearing some of my
birds, etc., but I do not let it concern me. Like
6 Tinnitus 'Ibday I June 1998
the pair of pants Dr. Nagler describes in his arti-
cle, 1 knew the tinnitus was there but I didn't
worry about it.
I appreciate all the good work you are doing.
Lee 0. Cunningham, 29787 Dogwood Rd.,
Council Bluffs, IA 51503, 712/ 487-3834
I
n the March 1998 Tinnitus Today, Walter
Wernick wrote a brief letter concerning
ginkgo biloba. 1b ensure quality, we recom-
mend that people use only a standardized
extract of ginkgo biloba with 24% gingkoflavon-
glycocides and 6% terpene lactones. Nutritional
supplement companies should also be willing
and able to send a certificate of assay to prove
the quality and content of their products to
anyone who asks.
We concur with Susan Seidel and her
Baltimore tinnitus self-help group - the stan-
dard dosage for ginkgo biloba is 120 mg. daily.
Richard Carson, ProHealth, Inc.,
Santa Barbara, CA, 805/564-3064
I
had my first attack of tinnitus in 1995
following lengthy dental work. After three
months, the symptoms passed. My most
recent onset of debilitating tinnitus came with a
severe TMJ (temporomandibular jaw joint)
attack last summer. My ear doctor and my ortho-
pedic doctor (I have a degenerating disk in my
neck) recommended that I see a TMJ specialist.
Because of my tinnitus I had become
extremely depressed, frustrated, and withdrawn.
I could not participate in any social activities
and alienated myself from everyone. I even con-
templated suicide.
I searched the Internet for information on
tinnitus and found the address and telephone
number of the ATA. I called at once and became
a member. After I received my first issue of
Tinnitus 'Ibday, I immediately sent away for
Dr. Thddey's book (TMJ: The Self-Help Book) and
a back issue of the September 1994 Tinnitus
'Ibday that featured articles on TMJ. I could not
believe it! Dr. Thddey described every symptom
and understood the pain and difficulty I experi-
enced: dizziness, sensitivity to sound, sore
throats, ear pain, jaw pain, neck pain, head-
aches, and of course, the dreaded tinnitus.
After months of TMJ therapy and physical
therapy for my neck, my tinnitus and other
symptoms have been drastically reduced. I'll
need to wear a plastic splint in my mouth for
the rest of my life but it's a small price to pay.
I have tinnitus flair ups from time to time but
nothing like it was in the beginning.
I now await every issue of Tinnitus Tbday. It
reinforces that I am not alone, and that there
are others like me in this world. Thank you,
ATA and Dr. Thddey, for saving my life.
Shelly Oliva, 189-11 45 Rd., Flushing, NY
11358, 718/ 539-1718
I
would like to share some positive experi-
ences that I have had with my tinnitus. I
purchased a Norelco "Natural Sounds" Sound
Selector ST200 (for $34.95). It generates a vari-
ety of tones including sounds of rain, outdoors,
heartbeat, brook (my favorite) and the ocean. It
can operate from a wan plug or with AA batter-
ies. It has a 60-minute timer and a volume con-
trol. I set the sound level just below the point
where the brook sound and the sound of my tin-
nitus start to mix. This gives my mind a sound
to focus on other than my tinnitus when I am
trying to sleep. It has been very helpful, and
does not annoy my wife who is a light sleeper.
Also, I did a bit more reading on St. John's
Wort and found that it is helpful for sleeping
problems as well as for mild depression. So I
purchased it and have been taking one 300 mil-
ligram tablet once a day for several months. (I
know that if a person is taking other medica-
tions, a doctor should be consulted first.) I can-
not tell you how much better I have been
sleeping, using the combination of the sound
machine and the St. John's Wort. My wife noted
that I have not slept this well since the tinnitus
started. Thanks again for everything you do.
fohn f. Nichols, 10450 E. Desert Cove Ave.,
Scottsdale, AZ 85259, 602/860-5758
[Editors Note: John Nichols' moving letter about
his tinnitus experience and the ATA was the one
featured in Dear Abby's February 5, 1998 column.
fohn is the support group leader for the Phoenix
Tinnitus Support Group.]
I
joined ATA in 1994 to help my son. He had
suddenly lost enough hearing to render him
a candidate for a cochlear implant at the age
of 21. The doctors - an otolaryngologist and his
personal physician - who had treated him for
his accompanying tinnitus told him "nothing
can be done; learn to live with it." Had I not
been educated by the Alexander Graham Bell
Association for the Deaf, I would not have
known how to locate an educational support
network such as ATA to help us. My son has
chosen to not discuss his tinnitus. So I pass
along Tinnitus Tbday to him and allow him to
decide how he wishes to become involved or
use the information.
In my experience, doctors do not appreciate
patients informing them on subjects about
which they are not knowledgeable. Perhaps that
knowledge is seen as a threat. I am grateful to
have had the opportunity to provide your
"Tinnit us Treatments - What's New, What
Works" brochures to the appropriate health
professionals in our community. Thank you for
the phenomenal information I receive from
Tinnitus Tbday.
Sharon Lloyd, Burlington, Onta1io, Canada
I
would like to share my own treatment for
tinnitus having suffered with the malady
since 1984. I spent a lot of time in the
library with books on traditional medicine, alter-
native medicine, herbology. You name it, I've
tried it or read about it. Finally I started a seri-
ous regime of homeopathy centering on afflic-
tions of the ears, sinuses, and allergies; a strong
regime of vitamins (A, B-complex, C, D, natural
vitamin E) and trace minerals; and massage. In
January 1997, I opted to try acupuncture too.
After four acupuncture treatments I noticed less
ringing in my ears. TWo weeks after the fourth
treatment, I was aware of no ringing, buzzing, or
roaring. I had one little episode sbc weeks later
but it subsided and I have been noise-free since.
I don't recommend this course of treatment for
others, since no two people are alike and I've
fashioned it so closely to my own personal
needs. However, I wanted to share this with ATA
and others like myself who might feel that tinni-
tus can never end.
Sally Chapman, PO. Box 9322, Newport Beach,
CA 92660, AUGUSTSAL@aol. com
Tinnitus 'Ibday/ June 1998 7
Hidden Treasures
by William Hal Martin, Ph.D., Robert L. Folmer;
Ph.D., and Baker Yang-bing Shi, M.D., Ph.D.,
Oregon Hearing Research Center & Tinnitus Clinic,
Oregon Health Sciences University, Portland,
Oregon
It is amazing that something as widely expe-
rienced as tinnitus can remain so poorly under-
stood. Tinnitus has innumerable causes,
manifestations, and effects on its sufferers.
Unfortunately, there are few if any cures avail-
able. There have been exciting developments in
tinnitus rehabilitation (care and management of
the t innitus sufferer), but our understanding of
what causes this often distressing phenomenon
grows slowly.
The following three summaries of recent
research provide us 1<\Tith individual pieces of the
very complex tinnitus puzzle. They are presen-
tations of the results of one or more related
studies that show how we can manipulate tinni-
tus (make it louder or softer) and how tinnitus
seems to affect brain function. Each vignette
includes a brief description of the experiment
that was performed, the results, and what those
results suggest to us about tinnitus. We can call
them hidden treasures because they surely con-
tain valuable information that will, in time, illu-
minate our understanding and direct our
progress in studying tinnitus.
Shocking news!
Can tinnitus be affected by stimulating other
sensory systems? As a matter of fact, yes. In one
study, 26 tinnitus sufferers each received a
series of1ow-1evel electrical shocks to the medi-
an nerve in their wrists.
1
This nerve typically
carries information to the brain about the loca-
tion of the hand and fingers in space. The stim-
uli were presented at rates from 1-10 times per
second. The subjects were seated in an acousti-
cally treated sound booth and instructed to first
listen carefully to the loudness of their tinnitus.
They were then stimulated for 10-15 seconds.
Following stimulation, they were asked to report
changes in either the quality or intensity of
their tinnitus. It is important to note that all of
the subjects had equivalent hearing losses.
Most ofthe subjects (16) did not notice any
change in their tinnitus, but the others did. Four
subjects said that the wrist stimulation increased
the loudness of their tinnitus. Six of the subjects
8 Tinnitus 'Tbday/June 1998
reported a distinct decrease in the loudness of
their tinnitus when the arm on the same side as
their tinnitus ear was stimulated. One of the six
who reported a decrease in tinnitus in a deaf ear
had had previous surgical removal of an acoustic
neuroma (a benign tumor on the hearing nerve).
Three of the other patients who reported a tinni-
tus decrease also reported distinct changes in
the character of their tinnitus.
A group of normal hearing, non-tinnitus
patients were also tested to see if median nerve
stimulation changed their auditory perception.
Primarily they noticed that the wrist stimulation
increased the perceived loudness of a presented
sound.
This tells us that, in some cases, we can reach
tinnitus without going through the ear. It shows
that our hearing pathways are connected to
other nerve pathways and that they interact. It
also shows that our brains might process tinnitus
and normal sound in different ways.
In one ear and out the other.
The cochlea - the organ of hearing - is not
just a passive listemng device. It not only
receives sound, but it has its own built-in ampli-
fier to enable us to hear and understand a
tremendous range of sound intensities. The
evidences of this amplification process come in
the form of otoacoustic emissions (OAE). They
are sounds which can be recorded from the ear
canal that are produced by vibrations within
normal functioning cochleas. They occur in
response to a stimulus sound or tone and appear
almost like echos, coming back from the depths
of the ear. They are clearly not tinnitus. When a
person has damaged cochleas, the OAEs are
often diminished or absent in the frequency
range of the damage.
Another interesting thing about the auditory
system is that the brain not only receives signals
from the ears, it also sends nerve impulses back
to the ears. The ascending signals carry pitch,
loudness, and timing information that the brain
interprets as meaningful sounds (e.g. words,
music, doorbell). The descending signals serve
to help the cochlea be very selective in the infor-
mation that it transmits back up to the brain.
Studies
2

3

4
have evaluated this feedback loop
in subjects with tinnitus. The subjects had white
noise presented in one ear while clicks or tones
were used to evoke otoacoustic emissions from
the opposite ear. (This is evidence that the brain
controls the activity of the left ear because of
activity entering the right ear!) Subjects with
tinnitus did not have normal contralateral
(opposite ear) suppression of their OAEs. In
fact, some tinnitus subjects actually had higher
amplitude OAEs when sounds were presented to
the opposite ear than did non-tinnitus patients.
This tells us that, in many cases, people who
suffer from tinnitus might have a problem
somewhere in this ear-brain-ear feedback loop.
It could be that the cochlea receiving the contin-
uous noise signal is not communicating that
signal to the brain properly. It could be that the
brain itself is not processing the incoming sig-
nals and sending control signals to the opposite
ear properly. Or it could be that the OAE ear
(on the tinnitus side) isn't functioning properly.
Regardless, this is a clue that something at a
very low level in the hearing pathway isn't
working properly and needs to be studied.
Let's be objective about this.
One problem that we who study tinnitus
have is that we are dependent upon you, the tin-
nitus patient, for precise information about your
tinnitus. If we want to try a treatment and verify
that it works, we have to ask you to measure
your tinnitus before and after the treatment.
Measuring a sound is easy. A device can sense
vibrations passing through the air and give pre-
cise measures regarding the intensity and fre-
quency of the sound. But measuring sound that
only you hear is a tough challenge for us. It
would be extremely valuable to be able to mea-
sure your tinnitus by measuring some activity
within your ear or brain, and to do so in a way
that doesn't require your participation.
There are a group of studies that have
attempted to do just that using a technique
called spectral averaging.
5

6
Spectral averaging is
a way to look at patterns of nerve firing in the
brain. An electrode is placed on a nerve bundle
in the brain, and the spontaneous background
activity of the nerve is recorded on a graph.
There will always be some level of nerve activi-
ty in the brain, even when it is at rest. It might
change it's firing pattern, but it is always run-
ning, day and night. Hearing a sound will acti-
vate specific nerve pathways and change the
firing patterns. All of these changes can be
recorded electrically.
Studies were performed on 23 patients
undergoing various surgical procedures.
Eighteen of the patients had tinnitus either
before or after their surgeries. Five did not. As
part of each surgical procedure, a tiny electrode
was placed directly on the hearing nerve if it
was neurosurgery, or on the round window of
the cochlear during middle ear surgery. Spectral
averaging was performed and graphs were made
of the nerve activity. (This testing is standard
procedure during such surgeries to aid the surgi-
cal staff and the patient. We took additional
readings simultaneously to find these data.) The
findings: 13 ofthe 18 tinnitus subjects had a
large peak of nerve activity near 200 Hz.
Another one of the 18 had other unusual activi-
ty while four had normal activity levels. None of
the five non-tinnitus patients showed unusual
firing patterns. It is important to understand
that nerve activity at 200 Hz did not mean that
the patients all heard tinnitus at 200 Hz (a very
low frequency). It just indicated that the nerve
pathway carrying the sound information was
overly active at that frequency.
Was this an objective measure? Absolutely.
All of the patients were deep under anesthesia
during the testing. Was it tinnitus? That is a
tougher question. None of the non-tinnitus, con-
trol patients had the 200 Hz activity. Recordings
from other, non-auditory structures of the brain
did not show the activity. It looks like tinnitus.
It acts like tinnitus.
The problem is that we can't just open up
someone's ear or head every time that we want
to measure their ringing, hissing, or buzzing.
But it does show that it is possible to record
activity that is very likely related to tinnitus in
an objective way. This information might also
lead us to other discoveries about abnormal
nerve firing patterns related to tinnitus.
Closing thoughts.
Hidden treasures are not valuable just
because they are hidden. The fact that they are
hidden makes them challenging. In 1995, over
300 treasure seekers - scientists and clinjcians
- gathered together in Portland at the last
International Tinnitus Seminar. Each was there
to share a piece of the tinnitus puzzle that he or
she had painstakingly discovered. 'TWenty-four
years ago there were only two - Dr. Jack
Vernon and Dr. Jonathan Hazell. This dramatic
increase in interest and commitment is a sign
that soon the puzzle will begin to fit together.
The clumps and clusters of information will
begin to project to us larger images which will
make it even easier to fit individual pieces into
Tinnitus Thday/ June 1998 9
Hidden Treasures <continued)
the complete picture. Momentum is gaining and
new developments are occurring on a regular
basis. All of these signs should encourage tinni-
tus sufferers to have hope and to keep fighting.
The next treasure discovered might be the one
that helps them. Ill
1. M0ller, A.R., M0ller, M.B. Masashi, Y. Some forms of tinn itus
may involve the extralemniscal auditory pathway. Laryngoscope
102: 1165-1171, 1992.
2. Chery-Croze S., Collet, L., Morgon A. Medial olivo-cochJear sys-
tem and tinnitus. Acta: Otolaryngol (Stockh), 113: 285-290, 1993.
3. Chery-Groze, S., Tfuy, E., Morgon, A. Contralateral supression of
transiently evoked otoacoustic emissions and tinnitus. Br. J. Audiol.
28: 255-266, 1994.
ANNOUNCEMENTS
National Institute of Deafness and Other
Communication Disorders (NIDCD)
Appoints New Director
James F Battey, Jr., M.D., Ph.D.,
has been named as the new
Director of the NIDCD, one of
the National Institutes of Health.
The NIDCD recently funded the
$1.5 million tinnitus research
study at the University of
Buffalo. Dr. Battey was Acting-
Director of the NIDCD at the time of the award
to Drs. Lockwood and Salvi in Buffalo.
Battey states: "Human communication
research has at this moment more possibilities
for productive exploration than at any other
time in history. I am particularly heartened by
powerful information we have recently obtained
through functional neuroimaging about tinnitus
and by the heightened scientific interest that
this research is receiving. With improved meth-
ods for understanding and measuring tinnitus
will come intervention and therapy greatly
needed by millions of Americans with so many
different kinds of hearing loss."
10 Tinnitus 1bday/ June 1998
4. Attias, J ., Bresloff, 1. , Furman, v. The influence of the efferent
auditory system on otoacoustic emissions in noise induced tinni-
tus: clinical relevance. Acta Otolaryngol (Stockh) 116: 534-539, 1996.
5. Martin, W.H., Spectral analysis of brain activity in the study of
tinnitus. ln: J.A. Vernon and A.R. M01ler (Eds.) Mechanisms of
Tinnitus, Boston: Allyn & Bacon, pp. 163-180, 1994.
6. Martin, W.H., Schwegler, J.W. , Shi, Yong-bit'lg, Pratt, H., Adler, S.
Developing an objective measurement tool for evaluating tinnitus:
Spectral averaging. In: G. E. Reich and J.A. Vernon (Eds.),
Proceedings of the Fifth lnremational Tinnitus Seminar, Portland:
American Tinnitus Association, pp. 127-134, 1996.
Dr. Martin is Director of the Tinnitus Clinic and
Head of Audiology at the Oregon Hearing Research
Center at OHSU, and is on ATA's Scientific
Advisory Committee.
Tinnitus Researcher Receives Award
Jos J. Eggermont has recently been named
Campbell McLaurin Chair for Hearing
Deficiencies at the Faculty of Medicine,
University of Calgary, Calgary, Canada. This is
in recognition of his longstanding commitment
to combining basic research in hearing with
clinical applications. The substantial endow-
ment associated with the chair will be used to
promote a "bench-to-bedside" approach to the
study of hearing disorders. This will be done by
assembling a research group consisting of scien-
tists and clinicians with the aim to create new
or improved diagnostic tests and treatments.
Research into the changes in brain activity that
cause tinnitus will be one of the featured
research topics.
American Academy of Audiology (AAA) Finds
New Executive Director
The AAA recently announced
the appointment of Carol Fraser
Fisk as its new Executive
Director. Fisk, who has champi-
oned health care issues for the
aging for most of her career, is
excited about her new challenge
as champion of an organization
dedicated to providing quality hearing care to
the public. On the issue of tinnitus, she states,
"We encourage audiologists to recognize tinnitus
as a serious problem, to get and stay educated
about it, to keep it upmost in their minds."
Poster Perfect
by Barbara Thbachnick, Client Services Manager
I wanted an elementary
school tinnitus poster that
would get kids' attention. I
asked Brian Woolsey to help
and I got a lot more. Patiently
and creatively, Brian orches-
trated the poster project
through his San Diego adver-
tising firm. The result is our
newest and most delightful
teaching tool, one ironically
being sought by people of all ages. (See the cover
of this issue.)
After several phone conversations with me to
learn what I was after, Brian pushed and pulled
ideas around with art director Sue Miley. They
sketched, wrote, faxed, and phoned until the lay-
out and text hit the mark. Next, they shopped for
the artist. Thko Fujisaki's art work leaped out
from a creative directory, and so she was con-
tacted at her studio in New York. She immediate-
ly agreed to do the project.
It is hard to miss the talent this poster repre-
sents. It is also hard for us to contain our grati-
tude: all members of the creative team donated
their time and artistry to ATA for the project.
Now that the dust has settled, and the posters
are flying across the U.S., I've asked these gener-
ous artisans to tell us why they did it.
Brian Woolsey: "Why'd I do it? Because I have
tinnitus and because I like ATA. Because as a
parent, I see how much loud noise kids are
exposed to. If I had my way, no one would ever
again get tinnitus from noise exposure; everyone
would know to protect their hearing."
Sue Miley: "I did it because I want my kids
and other kids to be safe. (You know, when chil-
dren are young, they think they're indestruc-
tible.) And even though I don't have tinnitus, I
know Brian and how tinnitus has affected his
life. Knowing him has brought this to a personal
level. It's an important cause; I was very happy
to help."
Thko Fujisaki: "1 like doing work for causes
I believe in. And I have something I can give,
and so I give. When I found out what it was for,
I said yes."
This poster is now part of ATA's elementary
school Hearing Conservation and Tinnitus
Prevention program packet. If you would like to
learn how to present the 30-minute in-class pro-
gram (ideal grade levels: lst-3rd), write or call us
for details. We'll supply you with the full teach-
ing packet, video, script, ear diagram, and, of
course, the best tinnitus poster anywhere. D
Individual posters can be ordered. (See new
order form inside Tinnitus Thday.)
Brian Woolsey, Sue Miley, and
Thko Fujisaki teamed up to
create ATA's new poster [or the
grade school tinnih1s awareness
program. Woolsey, who has
tinmhls, also volunteered the
services o[h1.s San Diego,
California, advertising firm to
create three previous posters a'1d
an ad campaign on behalf of
ATA For advertish1g,
marketing, new media,
broadcast and pmmotional
materials, contact him at
Brian Woolsey Creative, 10772
Caminito Bravura, San Diego,
CA 92108, 619/563-5083.
AlA'S NEW PHONE VOICE
That crisp, resonant voice now greeting and
directing callers to ATA belongs to Russell Duke,
a long-time ATA member. Response to Duke's
voice has been extremely positive. Many ATA
callers have taken the time to compliment "the
voice." Several have inquired if it is that of actor
William Shatner who has been an important
spokesperson for ATA's work. They might be sur-
prised to learn about Duke's background. The
native Oregonian was a sometimes-actor in the
golden era of television in the early '60s. He
appeared on one of the most popular television
shows of the period, "My Three Sons."
Duke attributes his own tinnitus and resul-
tant hearing loss to serving with a U.S. Army
infantry division in Germany in the early 1960s.
He first made contact with ATA through Dr.
Robert Johnson, at OHSU, whose evaluation of
Duke's condition assisted him in getting a
Veterans Administration disability rating.
He has been a strong supporter of ATA since
that time. Duke said he was happy to volunteer
to do the "phone thing" for ATA, and was sur-
prised and flattered to have his voice mistaken
for William Shatner's. 9
Tinni tus Today/ June 1998 11
AIR BAGS WHY THIS ISSUE HASN'T GONE AWAY
by Barbara Thbachnick,
Client Services Manager
The air bag debates at the
National Highway 'll'affic
Safety Administration
(NHTSA) are over. The out-
come: NHTSA is granting
permission for on-off switch
installation to those who
properly fill out the request
forms. Since the ruling was announced, NHTSA
has received a steady 10,000 requests per month.
So why are some people still very concerned
about their air bags? Perhaps because at this
time the majority of on-off switch permission
slips are not being honored. There are
several reasons:
J The brand and model-specific on-off switches
do not yet exist for most vehicles - Fords
and Oldsmobiles being the exceptions.
2 Some car manufacturers, like Honda and
Thyota, have gone public with their decision
to not make the switches at all.
3 Many dealerships and mechanics are skittish
about installing the switches even with
NHTSA's sanction.
The NHTSA decision itself contains some
wrinkles. Per the ruling, neither tinnitus nor
hyperacusis was deemed a severe enough med-
ical condition to justify air bag disconnection.
Their medical expert did concede that the 160-
170dB explosive noise of a deploying air bag
could damage human hearing. Still, the on-off
switch is NHTSA's single offering to the majority
of people who feel that the risk of air bags out-
weighs their benefit. Also, new car shoppers
have to purchase air bag-equipped vehicles first,
request permission from NHTSA second (the
request form requires the vehicle identification
number of the car intended to receive the switch
or switches), and wait for NHTSA's approval
third.
1YPically, though, when there is a void,
something moves in to fill it. Three independent
companies have sprung up recently to fill in the
gaps left by NHTSA's less-than-comprehensive
rule. Airbag Service, Inc. is a group of nation-
wide franchises that specialize in installations,
repairs, and (when presented with authorization
from NHTSA) factory-made on-off switch installa-
tions. Airbag Options, Inc. is run differently.
12 Tinnitus 1bday/June 1998
These air bag specialists travel across the U.S. to
densely populated areas and directly to clients'
homes or offices to install Airbag Options' own
design of on-off switch, suitable for any vehicle.
NHTSA's permission is required for this service.
Airbag Systems, Inc. takes a third approach:
they produce do-it-yourself air bag disconnec-
tion kits for every vehicle make and model.
Permission from NHTSA is not required to
purchase these kits, but moderate mechanical
skill is required for the task.
Air bag statistics continue to be bandied
about: the number ofhves saved; the number
oflives lost. (Both numbers are growing.) The
statistics about injuries are less often discussed.
Robert Dobie, M.D., chairman of the American
Academy of Otolaryngology's "Medical Aspects
of Noise" subcommittee, became interested in
the relationship between auditory damage and
air bag deployment. His committee began a
study last year to examine it. The results of the
study, which is being conducted by Kathleen
Yaremchuk, M.D., will be presented at a session
during the Acoustical Society of America (ASA)'s
annual meeting in Norfolk, Virginia in October
1998. Elliott H. Berger, Senior Scientist, Auditory
Research, E-A-R Products, is chairman of the ses-
sion entitled ''Airbag Deployment and Auditory
Risk." Presenters include auditory researchers,
hyperacusis and tinnitus patient Janet Garman,
and representatives from General Motors and
NHTSA. The ASA will open this session to the
public. Says Berger, "I think it is clear that air
bags present a problem for noise-sensitive ears."
He hopes that NHTSA and the public will take
another look at this issue.
The switch is an answer, but an unsatisfacto-
ry answer, for those who object to (or cannot
afford) the additional $200-$500 to turn off the
devices. It is unsatisfactory to those who are
unable to do it for themselves and who cannot
find mechanical help. The good news: some
new air bags have been "depowered," although
the real world effect of depowering is not
known. (For example, noise reduction from
170dB to lSOdB is numerically significant but
would not be meaningful to the human ear.)
It is an ongoing hope that the public's
persistant call for choice, coupled with the
research community's vocal concern about air
bags, will steer auto makers towards develop-
ment of safety devices that really are safe for
everyone. a
Acoustical Society of
America
500 Sunnyside Blvd.
Woodbury, NY 11797
516/576-2360
http:! /asa.aip.org
Contact Elaine Moran for
conference information:
elaine@aip.org
Airbag Options, Inc.
P.O. Box 180294
Arlington, TX 76096
888/903-0004
Jay@airbag.net
www.airbag.net
'Iechni.cians travel to your city to
install switches or deactivate air
bags; requires permission from
NHTSA.
Airbag Service, Inc.
1045 12th Ave. NW #F2
Issaquah , WA 98027
425/391-9664
airbag2@aol.com
www.airbagservice.com/
Franchisees across the U.S. will
disconnect air bags/install
switches; requires permission from
NHTSA. (Note: Not all franchisees
are trained in this service.)
Airbag Systems, Inc.
6110 E. Mockingbird Ln.
#102-107
Dallas, TX 75214
800/205-0628 x106
Fax 214/265-1242
www.airbagsystems.com
Do-it-yourself air bag disconnec-
tion kits. Permission from NHTSA
not required; car owner assumes
liability.
National Highway Traffic
Safety Administration
(NHTSA)
400 7th St. S. W.
Washington, D.C. 20590-1000
800/ 424-9393
202/366-2106 fax
www.nhtsa.dot.gov/ airbags/
Airbag on-off switch permission
application and full text of
ruling are available on NHTSA's
website.
Noise Cancellation Devices
Given a Test Drive
by Cliff Collins, Aloha
1
OR
Earlier this year, several of
us in the Portland area who have
tinnitus and hyperacusis (super-
sensitivity to sound) learned of
the availability of the newest
noise-cancellation head-sets.
What interested us was that
these headsets were a combina-
tion of actual ear protection
devices - like regular passive
earmuffs - and the newest
noise-cancellation technology.
It sounded promising. (Earlier
models more resembled stereo
headsets in that, when turned
off, they offered little or no
protection on their own.)
Through the courtesy of the
ATA and two manufacturers,
Noise Cancellation Technologies
Inc.(NCT) and David Clark Co.
Inc., three of us were able to
borrow earmuff/headsets from
both companies for a
11
test drive."
One set was NCT's ProACTIVE
3000, designed for industrial
workers. The other was David
Clark's Model Hl0-13HX, made
for helicopter pilots.
Both muffs gave outstanding
noise cancellation protection
from low-frequency sounds,
such as the road noise that
comes up through the floor of a
car. Noise-cancellation technolo-
gy acts by generating a signal
that is identical to incoming
sound-pressure level, but exactly
reversed in phase. The result is
a cancellation of the noise
before it reaches the ear.
Unfortunately, this technolo-
gy is not yet able to cancel high-
frequency sounds, which tend to
give people with hyperacusis the
most trouble. Still, we found that
both muffs shut out low frequen-
cies (up to 500Hz) better than
any passive muffs we'd tried.
NCT's ProACTIVE muffwas
comfortable and has the advan-
tage of no external wires or
cords. The battery and all the
technology are built into the ear
cups. Also, it uses a rechargeable
nickel-cadmium battery (which is
good for 12 hours before needing
to be recharged). The drawbacks
are that it's heavy and bulky, so
the longer they are worn, the
heavier they feel. They can emit
a shriek from feedback when
they're being taken off or being
put on. This can be avoided by
turning the muffs on and off
while they are on the head. The
ProACTIVEs also emit a beeping
noise when the battery needs
recharging. The Clark model's
advantages: lighter weight and
smaller ear cup size, since and
external cord attaches to a bat-
tery pack that is worn on the
belt. The Clark muffs had no
feedback noise and flash a red
light (no beep) when the batter-
ies need replacing. One disadvan-
tage to both muffs, reminiscent
of previous noise-canceling head-
sets, is their lack of space for
larger ears.
Active noise cancellation
devices can give good low fre-
quency noise protection in work
environments, on aircraft, or
anywhere where those sounds
are present and bothersome.
Further development and refine-
ment of this technology - and
not just for the industrial market
- could give people with tinnitus
and hyperacusis greater freedom,
mobility and safety. Properly
marketed, it could be a winner. 1.1
Noise Cancellation 'Iechnologies
(800/278-3526), ProACTIVE 3000,
$289.
David Clark (508/756-6216),
E-mail: salesatdavidclark. com,
Model Hl0-13HX, $710.
Tinnitus lbday/ June 1998 13
Dear Abby,
Dear Abby,
my life is
a mess ...
by Kathryn Armstrong,
Resource Development Manager
You might not be familiar with John
Prine's ode to Dear Abby. But you're
probably familiar with the relief, antici-
pation - even excitement - experienced
by tinnitus sufferers and their families
when they first learn that their life with
tinnitus does not have to be a mess.
Remember when you first found out that
an organization exists dedicated to noth-
ing but tinnitus?
Now, imagine that you learned about that
organization at the same time 40,000 others
learned about it - and you all called at the
same time.
That was reality for ATA when Dear Abby
featured us in a February column. Over 40,000
people called or wrote in the following months
for information about our services and
resources. As a nonprofit organization with a
staff of eight and a handful of dedicated volun-
teers, we were thrilled - and overwhelmed -
by the response. If you tried to call the office
14 Tinnitus 'Ibday/ June 1998
during February and March and had trouble get-
ting through, it is because our phone system
became seriously bogged down by all the Dear
Abby callers. Thank you for your patience.
Dear Abby presented us with a unique
opportunity to offer assistance to many more of
the 50 million Americans who experience the
"head noise" or "ear ringing" that is tinnitus.
Everyone on the ATA staff pitched in to take
calls and messages in order to ensure that
callers received information as soon as possible.
We rallied so
strongly in
responding to the
inquires spurred
by Dear Abby
because we know
that tinnitus is a
very real malady
that can be dis-
tracting, painful,
and sometimes
disabling, yet
receives very
little public
attention and is
frequently mis-
understood. For
many of those
Dear Abby readers,
that column was
the first they
learned that there
is hope - hope
that their tinnitus
might be alleviat-
ed, hope in the
knowledge that
they are not
alone.
We look
forward to wel-
coming all those
Dear Abby
readers to ATA.
We sincerely
appreciate
everyone's
The Oregonian February 5, 1998
~ P .can help JJeople
'ft:CII With tinnitUs
support as we work to educate
even more individuals about tinnitus and
continue to fund research into further relief,
and a possible cure. B
Tinnitus Treatments for Veterans
by Harvey B. Abrams, Ph.D., Chief, Audiology
& Speech Pathology Service, VA Medical C e n t e 1 ~
PO. Box 5005, Bay Pines, Florida 33744
As an audiologist for the Department of
Veterans Affairs, I have responded to
many questions from veterans about
their tinnitus over the years. And I've
been happy to do so. Many ofus who
work for the VA are, ourselves, veterans,
and are particularly sensitive to tinni-
tus-related issues because it is such a
pervasive problem among our patients.
This article addresses some of those
questions from this unique group of men
and women.
How can veterans receive treatment for their
tinnitus at a VA hospital?
In order to be treated for any condition by
the VA, either the veteran has to be enrolled in
the VA Healthcare Program or the disorder Oike
tinnitus) has to have been "adjudicated" as a
service-connected condition. (That means that
after a veteran has claimed that his or her disor-
der resulted from military service, a medical
examination and a review of the veteran's ser-
vice records by a VA adjudicator have substanti-
ated the claim.)
How does a veteran enroll in the VA Healthcare
Program?
Often all that is required is the completion
of enrollment forms. This can be done at a near-
by VA facility or by requesting and returning the
forms by mail. The local telephone directory
lists the closest VA facility under "United States
Government." The facility will verify the veter-
an's service record, then notify him or her of
the initial appointment.
Some veterans who get tinnitus-related med-
ical and audiological services in some parts of
the country are then denied the same services
when they move to or visit another part of the
country. Why does this happen?
We appreciate how frustrating this is for
our patients! First of all, veterans are entitled
to health care at any of the llOO VA centers
throughout the country whether treat ment is
needed for specialized care unavailable at the
"home" facility or because of relocation or
travel. The reason for the lack of uniformity
was an unequal distribution of VA Healthcare
resources throughout the country. As veterans
moved from the northern urban centers to the
"sun belt" states, many of the hospitals in the
sun belt states had to limit services to veterans.
Other hospitals, primarily in the north, did not
have to impose these limitations. Recent federal
legislation designed to "move resources to where
the veterans are" combined with the enrollment
process should eliminate this problem.
What kind of examination is conducted for a
veteran who claims that his or her tinnitus is
service-related?
The veteran undergoes a comprehensive
audiological "compensation and pension evalua-
tion" which includes pure tone and speech
threshold testing, speech recognition testing
at several presentation levels, and middle ear
testing. In addition, the examiner will ask the
veteran several questions relating to his or her
tinnitus such as the severity and when and how
the tinnitus was initially noticed. Some audiolo-
gists might perform pitch and loudness match-
ing tests during the "compensation and pension
examination," but the tests are not required nor
are the results considered for determination of
service-connection. Because tinnitus is a subjec-
tive complaint, it has been difficult to develop
standardized tests to measure the severity of
the complaint. We know, too, that while two
individuals might "match" their tinnitus to the
same pitch and loudness, they can dramatically
differ in their perception of the severity. The
important consideration in determining service-
connection is a documented "cause and effect,"
for example with a head injury, exposure to
incoming or outgoing artillery that caused
tinnitus at the t ime of the episode, or repeated
exposures to high levels of noise from aircraft,
tanks, or small arms fire which over time
resulted in tinnitus.
Tinnitus Thday/ June 1998 15
Tinnitus Treatinents for Veterans <continued)
What if the tinnitus was caused by weapons or
loud engine noise but was never documented in
the veteran's record?
Many veterans never complained about their
tinnitus while they were in the service nor did
they complain for many years following dis-
charge from the military. The longer the time
between separation from the military and the
claim for compensation, the more difficult it
will be for the veteran to be granted service-
connected status. That's why we urge newly
discharged service men and women to submit
a claim for compensation as soon as possible.
Also, a veteran did not have to be in combat
in order for the tinnitus to be considered a ser-
vice-connected condition. The tinnitus might
have been caused by exposure to noise during
training, or might have resulted from a head
injury sustained in a car accident while the ser-
vice member was on vacation. Any illness or
accident that occurs while the service member is
on an active duty status, excepting those caused
by the service member's own willful misconduct,
will be considered a service- related event.
Once the veteran is enrolled in the VA's
Healthcare Program or their tinnitus has been
adjudicated as a service-connected condition,
what kind of core can he or she expect to
receive of the VA facility?
There is a well-known expression throughout
the Department that "once you've seen one VA,
you've seen one VA." The audiology departments
differ throughout the system in terms of their
organization, staff size, clinical focus, equipment,
etc. A single consultant might staff the smallest
audiology facility, while the largest facility might
have specialized programs for cochlear implants,
aural rehabilitation, and tinnitus treatment. The
best way to find out what type of tinnitus treat-
ment is available at a VA hospital or outpatient
clinic is to call their audiology department and
inquire directly.
What kind of tinnitus-related services does your
department provide?
The audiology department at Bay Pines is
one of the largest in the system, having provided
tinnitus treatment for almost 20 years. We refer
to our treatment approach as "progressive inter-
vention." We begin with counseling and progress,
if indicated, through hearing aids, biofeedback,
16 Tinnitus lbday/ June 1998
imagery, masking devices, medication, and
finally referral to a center of excellence such as
the University of Maryland's Tinnitus and
Hyperacusis Center. This progression is not
always a linear one; particular intervention
strategies might be skipped if necessary, and
several approaches might be implemented at the
same time.
What tinnitus treatment protocols ore used at
other VA hospitals?
In an unofficial poll of the audiology and
speech pathology departments throughout the
VA, I learned that some audiology departments
provide only counseling while others offer a
combination of approaches. Most clinics have
been successful in reducing and in some cases
eliminating their patients' tinnitus with hearing
aid use. (VA patients have a very high incidence
of hearing loss that coexists with tinnitus. This
might differ from the general population.)
Many of our patients with tinnitus com-
plaints are concerned that the tinnitus is a
symptom of a serious illness. The counseling
often takes the form of reassuring our patients
that they do not have a serious condition, which
is often enough to reduce the anxiety associated
with their tinnitus. Counseling also educates the
patient as to the causes of tinnitus and ways to
prevent an aggravation of symptoms. The hear-
ing aids help tinnitus patients in two ways. First,
hearing aids amplify environmental sounds that
can effectively mask the internal tinnitus.
Secondly, hearing aids themselves have an audi-
ble internal noise, which can effectively mask
some tinnitus. At bedtime, when the hearing
aids are out, many patients find tinnitus relief
from listening to "white noise" from a bedside
masker, a fan, or a radio set between FM
stations. The audiology program at the VA in
Portland, Oregon has had considerable success
with wearable tinnitus maskers as part of a com-
prehensive tinnitus management program and
fits more maskers than any other VA program in
the system.
Are veterans entitled to tinnitus-relieving
devices, like bedside maskers?
If the veteran i.s entitled to treatment for a
particular disorder, he or she is entitled to med-
ication or devices which have been shown to be
safe and effective for the treatment of that disor-
der. For tinnitus, this includes wearable tinnitus
maskers, hearing aids, and bedside maskers.
Do many of the VA programs have success with
biofeedback and relaxation training?
Several of the VA audiologists who respond-
ed to my inquiry either perform relaxation
training in the audiology clinic or refer tinnitus
patients to the behavioral sciences department
for the training. One of the advantages of
providing services in a medical center is the
availability of many specialties in a single
location that can provide expert treatment to
the veteran. One of the patient populations that
we have found to be most challenging and
rewarding is the group of veterans suffering
from post-traumatic stress disorder. Many of
these patients have a difficult time coping not
only with their tinnitus but with other life
"stressors'' too. We have found that the relax-
ation tools we provide to them, such as biofeed-
back and guided imagery, are not only effective
at reducing the secondary effects of tinnitus,
like sleeplessness, but are also useful in helping
them cope with their reaction to all stress.
Is Tinnitus Retraining Therapy (TRT) offered
through the VA?
No one in my poll has indicated that he or
she received TRT training, although some of the
elements of the program are being used on a
limited basis. If TRT proves to be an effective
treatment choice for tinnitus relief, I'm certain
we'll see many of our VA audiologists actively
pursuing training in the technique.
What do you foresee as the future direction of
VA audiology in the treatment of tinnitus for
veterans?
I have been privileged to be part of such a
remarkable group of professionals. We
encounter tinnitus every day in our clinical
practice. By and large, our clinicians have been
successful in providing effective tinnitus treat-
ment for our patients. In terms of the future, we
will continue to read, study, train, and imple-
ment new techniques and methods that have
been shown to be effective. There will never be
a "VA way" of treating tinnitus because different
methods appear to work for different individu-
als. There will, however, always be a "VA way"
of treating our patients - with professionalism,
respect, dignity, and compassion. B
Tinnitus
Prevention
Information Hits
High School Text
Books
by Barbara Th.bachnick, Client Services Manager
I
t isn't fancy and it isn't much but it's there!
A paragraph about tinnitus and hearing
conservation is now standard text in
Glencoe/ McGraw-Hill Publishing Company's
1999 high school health text book, Glencoe
Health (6th revision). And ATA board Chairman
Phil Morton gets the credit. He has pursued
school book publishers and educational organi-
zations for years in hopes that they would
include such information. Phil has said, "If (the
text book publishers) would only print the word
'tinnitus' I would be happy!" (yVe got 100 addi-
tional words. Phil is very happy.) The predomi-
nant message in the text is that overexposure to
loud noise is a far-too-common cause of tinnitus,
and that you can do something (like wear
earplugs) to avoid it.
Negotiations with middle school and elemen-
tary school text book publishers are in the early
stages but seem just as hopeful. The Glencoe/
McGraw-Hill high school text books
will be distributed nationally
this September. a
Tinnitus TOday/ June 1998 17
BOOK REVIEW
Richard Carmen, MA, CCC-A,
ed., Hearing Loss & Hearing
Aids - A Bridge to Healing.
Sedona, AZ: Auricle Ink
Publishers, 1998, reviewed by
Barbara Thbachnick
When audiologist and
author Richard Carmen was
a university professor, he
asked a class of his gradu-
ate students to wear
earplugs for one full day
and to keep a diary of their
feelings throughout the day. Their responses
were uniform and their emotions ran deep after
the experience: they felt incompetent, isolated,
unnerved, depressed, disoriented, and exhaust-
ed. "Hearing is an essential human sense," writes
Carmen in his opening chapter, The Emotions of
Losing Hearing. "It's absence would be greatly
missed by anyone." This sensitive approach to
the struggles faced by hard-of-hearing people is
evident on every page of Hearing Loss & Hearing
Aids - A Bridge to Healing. The book, edited and
compiled by Carmen, is a treasure chest for
hearing aid users and their families - filled with
resource lists, a photo guide of assistive listening
devices, the questions hearing-impaired people
ask, and, most importantly, the answers.
Richard 1)r1er, Ph.D., discusses the frustration
and understandable stress experienced by tinni-
tus patients who also do not hear well. 1)rler and
others in this book explain the part that tinnitus
plays in the lives of hearing-impaired people,
and the realistic effect that improved hearing
through hearing aid use has on the lives of tinni-
tus patients. In his chapter, Ways to Improve
Listening and Hearing, Mark Ross, Ph.D., states
that first of all, the principle to keep in mind
when adjusting to hearing aids is: "Don't get dis-
couraged. And that's second and third of all too!"
Kathleen Campbell's Prevention of Hearing Loss
chapter contains an eye-opening list of sub-
stances - from over-the-counter drugs to envi-
ronmental toxins - known to damage hearing.
"The saddest thing a hard-of-hearing person
can do is nothing," writes Paula Bonillas in her
chapter on assistive listening devices. Blinking
telephones, vibrating alarm clocks, personal lis-
tening equipment, closed-captioned decoders,
and other devices have been adapted and created
to help hard-of-hearing people stay in the hear-
ing world.
Carmen and his writers keep it simple and
explain as they go, so that the reader gains a sub-
stantial and satisfying handhold on how and why
and for whom hearing aids work. They examine
the emotional difficulties (anger, frustration,
denial) faced by all people with hearing loss, and
the practical care of hearing aids - standard to
programmable, behind-the-ear to completely-in-
the-canal.
Hearing Loss & Hearing Aids- A Bridge to
Healing earns big marks for its thoroughness,
humor, and clarity. We've looked for years for a
resource like this to add to our list of informa-
tional materials. When we found it, we added it
instantly. A very likeable book.
Do enjoy it! B
Re-Release of a Classic Text
Abraham Shulman, M.D., ed. Tinnitus:
Diagnosis/Treatment. San Diego, CA: Singular
Publication Group, Inc., 1997. 592 pages. $85
"The clear aim of this book is to investigate
various avenues of diagnosis that in time will be
sufficiently reliable to provide a rational basis of
treatment," wrote Trudy Drucker in her review
of this book in the March 1991 Tinnitus Tbday.
The book's prestigious array of authors explain
tinnitus from their varied perspectives of otol-
ogy, audiology, neurology, neuroscience, and
18 Tinnitus Thday/ June 1998
neuropsychology. Shulman was ahead of his
time: the book includes his uncannily correct
prediction and focus on the brain's involvement
in tinnitus perception. Although some of the
material is suitable for patients, it is primarily a
medical resource - and a fine one - for stu-
dents and professionals in the field. Available in
paperback from Singular Publishing Group, Inc.,
401 West "A" St., Suite #325, San Diego, CA
92101-7904, 619/238-6777, 800/521-8545
e-mail: singpub@mail.cerfnet.com
website: www.singpub.com a
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l
am writing you to voice my unrestrained enthusiasm for
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- Dr Steven M. Rouse (ENT)
I
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(despite the use of a 'sound soother' from the Sharper Image),
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this progression I have consulted among the. best doctors in the
field. With failed treatments ranging from ginkgo biloba to hav-
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up empty with respect to tinnitus. My initial reaction once I
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I can vividly remember having to turn the CD player on and off
again several times to make sure I still had tinnitus! With the
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- Paul Pedrazzi
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Web site: www. tinnitushelp.com
Tinnitus1bday/June1998 19
TINNITUS PATIENT RIGHTS & RESPONSIBILITIES
by Sidney C. Kleinman
It began as a typical gray December
morning day of practicing law in
Chicago. Then, as I left the office of one
of my clients, I was suddenly unable to
hear anything in my right ear; my head
was roaring, and I was feeling some-
what dizzy - a feeling that became pro-
gressively worse as the day wore on.
Eventually, and with some difficulty, I was
able to schedule an emergency appointment for
that day with my then-physician (the chairman
of the ENT department at an excellent Chicago
medical school). The results of that very short
visit were neither enlightening nor helpful. He
stated that apparently I had suddenly lost most,
if not all, of my hearing in the right ear, that the
noise in my head had increased dramatically
(I'd had mild, unintrusive tinnitus for years),
and that he was unable to offer any explanation,
thoughts, or assistance to me in dealing with
those issues.
While the response by my physician was
"underwhelming," I realized that in the stress
and the trauma of the events of that day, I also
had failed to treat myself like a client. I did not
attempt to organize my thoughts or formulate
questions about what I was experiencing. Had I
done so, perhaps I could have elicited a more
positive response from my physician. The
"Tinnitus Patient Rights and Responsibilities" is
an outgrowth of that experience. Following this
advice enables me to understand and receive
better care for my tinnitus and hearing prob-
lems, and might be of assistance to you.
Tinnitus Patient Rights & Responsibilities
I suggest the following procedures to
enhance the likelihood of a positive and mean-
ingful response when selecting or dealing with a
tinnitus health care provider.
J Be your own "Medical Advocate for a
Loved One."
When loved ones are sick, we try to help
them receive the best and most appropriate
medical care available. By acting as a Medical
Advocate, we help them seek medical care
promptly, assist them in communicating the
20 Tinnitus Thday/ June 1998
nature of the problem to the appropriate med-
ical staff, and make certain that the medical
responses are appropriate. I suggest that you act
as your own Medical Advocate (where you are
the Loved One), even ifyou have someone else
helping you. It will help you receive better care
from tinnitus health providers, and assist you in
evaluating providers and treatments.
2 Look carefully at treatment claims.
The causes and symptoms of tinnitus are
complex and vary widely among individuals.
Any one treatment usually brings a variety of
results. To date, there is no one treatment (or
"magic potion") that works every time for every-
one. Broad generalizations such as "one program
and one device works for everyone" and claims
of extravagant success rates should be indicators
that a careful examination of such a program is
appropriate.
3 Keep a factual, written account of your
tinnitus symptoms.
In order to be able to evaluate if a tinnitus
health provider, product, service, or course of
action will be useful to you, first create a writ-
ten record of your tinnitus symptoms and the
facts surrounding its onset. Creating such an
account will have several positive results. Your
tinnitus will be more "concrete" than just a mad-
dening internal sound, or a series of symptoms
or pitches. (This might also help the tinnitus
become a little more manageable). Also, in
reconstructing the events surrounding the
beginning of your tinnitus, you might gain some
insight into how it occurred and be able to avoid
aggravating it further.
Most important of all, when you meet with a
tinnitus health provider, you will be able to
speak with confidence about your symptoms
and the events leading to their appearance. By
accepting the responsibility for giving good
information to the tinnitus health provider, you
have ''earned" the right to expect a good
response.
4 Study reliable tinnitus literature.
Tb the extent possible, seek out information
and literature - from ATA and other reliable
sources - that speak to your symptoms and
problems. Review and study the information as
best you can. Develop an informed background
in tinnitus, so that when you do speak with
tinnitus health providers, you will be better able
www.ata.org
by Barbara Tabachnick,
Client Services Manager
It's remarkable how often and
how easily we connect with each
other around the planet these
days. Thanks to computers,
modems, and a satellite or two,
we have the ability to nurture
friendships with people thousands
of miles and many countries
away - all in the wink of an eye.
A new form of global warming,
I think. Really quite amazing.
No less amazing is the
response we've seen to our new
Internet website, which is up and
running at last. From its first day
in the world's view, we've
received daily response to our
search for tinnitus support givers
- networkers interested in start-
ing local self-help groups or vol-
unteering as telephone contacts.
The response from on-line read-
ers who expressed interest in join-
ing our support network, at first
surprising, became completely
understandable when we stopped
to think about it. People who
enjoy using a network, like the
Internet, are the ones who
understand the value of it.
ATA's support network is a
little different from on-line chat
groups. It fills a different niche,
supporting instead the "low-tech"
communication techniques of
telephoning, writing (e-mailing
too), and assembling in a room
with others who have tinnitus.
We're happy to facilitate these
communication options. We
know that the touch of a human
voice or hand is therapeutic for
so many.
Our thanks goes out to all
who've given time to help others
feel better - regardless of the
approach, high-tech or low. And
should the time ever feel right
for you to help others with tinni-
tus, look on the web, look at your
schedules, look in your
hearts, and let us know. D
How to request a
Support Giver's Packet:
website: www.ata.org
e-mail: barbara@ata.org
write: ATA, P.O. Box 5,
Portland, OR 97207-0005
call: 800/634-8978 x16
fax: 503/248-0024
Welcome to ATN.s
Support Network
Self-Help Group Leader
Carrol Jude
1030 N. Market #204
Wichita, KS 67214-2936
316/264-8853
'Thl ephone and
Letter Contact
Georgiann Maloney
221 Oakridge Place
Decatur, IN 46733
219/728-9941
TINNITUS PATIENT RIGHTS & RESPONSIBILITIES (coNTINurn)
to understand and evaluate their qualifications
and proposed courses of treatment.
5 Ask questions.
You have the right to good and competent
care. With that right comes the responsibility for
analyzing the claims and approaches of any
health care provider or treatment. Stephen
Nagler, M.D., suggests that patients should seek
answers to the following questions from each
potential tinnitus health care provider:
a. What are your educational qualifications
and history of treating tinnitus patients?
b. Describe in detai1 the products and
procedures of the treatments you use.
c. What are the potential risks of the proposed
treatments and products?
d. How do you define success?
e. What are the success rates of the proposed
treatments?
6 Keep copies of all records related to your
tinnitus.
For your own files, obtain and maintain a
complete set of records with respect to your
tinnitus and its treatment. From time to time you
might need to see a new tinnitus health provider,
and having ready access to your records can save
a great deal of time - and possibly money.
The suggestions described above are all designed
to help you be better informed about your tinni-
tus - so you can make informed and rational
decisions about which providers, approaches,
and treatments are best suited to you. Once you
become your own "Medical Advocate for a Loved
One," you can exercise your right to receive the
best possible health care from your current and
future providers. IB
Sidney C. Kleinman is a practicing attorney in
Chicago, fllinois and a member of ATA's Board of
Directors.
Tinnitus Today/ June 1998 21
Questions and Answers
by Jack A. Vernon, Ph.D., Professor Emeritus,
Oregon Health Sciences University
Q
A number of you have asked questions
about the recent PET brain scan experi-
ments done in Buffalo, NY. Your que-
tions break into two general categories. One
question asks if the brain area identified is the
source or cause of tinnitus. The other question
asks if this work will lead to a cure for tinnitus.
A
The cause of the signal producing
tinnitus can be anywhere in the hearing
system but those signals have to be per-
ceived and interpreted. The work in Buffalo has
identified that portion of the brain in the audito-
ry cortex that is responsible for the interpreta-
tion or perception of tinnitus. This is very
important work and, yes, it might well lead to a
cure for some kinds of tinnitus although there is
a tremendous amount of work that must be
done first. I hope each of you takes pride in the
fact that the preliminary work for this study in
Buffalo was made possible by a research grant
from ATA. The outlook is promising and very
exciting.
Q
Mr. G. in California indicates that his
tinnitus of about 50 years has suddenly-
gotten much louder. He was prescribed
Cerumen ex to rid his ears of wax. His doctor's
directions: insert the drops for 20 minutes, place
the tip of the syringe bulb deep in the canal,
and vigorously flush the ear canal ten times
with warm water. The manufacturer's instruc-
tions stated to flush the ears gently but unfortu-
nately Mr. G did not see the manufacturer's
instruction until he had already flushed vigor-
ously. He asks if the vigorous flushing increased
the loudness of his tinnitus.
A
I have heard from a host of tinnitus
patients whose tinnitus was exacerbated
by such a flushing. In two patients where
an aspirator was used, tinnitus was produced,
not just exacerbated. Clearly ear wax needs to
be removed but I recommend that aspirator or
vigorous flushing not be used. The washing fluid
will run out of the ear when the ear is turned
downward and the tip of the ear is gently tugged
22 Tinnitus Thday/ June 1998
upward. Fluid can also be wicked out with small
cotton rolls. Mr. G., I expect that your increased
loudness is temporary and within a few weeks it
will return to its normal level. The recovery
process might involve some reversals so don't be
discouraged by periodic flare ups of the tinnitus.
It seems to be the natural course of recovery.
Q
Mr. K. from Arizona wants to know if
general anesthesia will protect his ears
while dental drilling is performed. He
also asks if earplugs will provide the needed
protection.
A
Unfortunately the answer to both of your
questions is in the negative. General
anesthesia will not protect your ears
although you will not be aware of the drilling
sounds. Also earplugs will not protect the ear
against dental drilling for the simple reason that
the drilling sounds are directly transmitted to the
inner ear through bone conduction which bypass
the outer and middle ear. I have suggested that
some protection is available if the dentist will
drill in short spurts: drill for five seconds and
stop for 10 seconds, drill for five seconds and
stop for ten seconds, and so on. The exacerbation
of tinnitus by sound is a time-intensity function
and by reducing the time of each drilling
episode, the degree to which this kind ofinsult
will influence the ears is also reduced.
Q
Mrs. C. in South Africa asks, "What is
severe hearing impairment and how
often does it occur? Is it the same as total
deafness? And what can be done about it?
A
One can have very severe hearing loss but
not be totally deaf. For example, someone
with a hearing impairment at the 70-80dB
level can still be helped with some form of hear-
ing prosthesis. One can never know if prosthetic
devices will help or not except by actual trial.
Remember that in the U.S., hearing aids are sold
with a 30-day money-back guarantee.
"How often does hearing impairment occur?"
I cannot answer for South Africa but I asked
Peter Steyger, Ph.D., professor at the Oregon
Hearing Research Center, the same question for
the U.S. His reply: For people less than 20 years
of age, one in 20 has a hearing impairment. For
people aged 20 to 40, one in 10 has a hearing
problem. And for people 65 or older, one in two
has a hearing impairment. I imagine we would
obtain similar figures for other industrialized
nations.
Dr. Steyger, who is severely hearing-impaired,
went on to make an interesting comment. He
said, "The biggest problem for hard-of-hearing
people is DENIAL, both by the patients and by
others. Once one gets past denial, the hard-of-
hearing person can do anything." I find that to
be extremely good advice.
Q
Mr. S. from MI indicates that his long-
time tinnitus did not bother him until
last January when he awakened with a
loud hissing sound in the right ear. He has now
seen five health care professionals, one of whom
said "learn to live with it." (When are they going
to learn not to say that?) Mr. S. wears a hearing
aid in his right ear, but when at home he wears
a masker in his right ear. Both devices give him
some relief. He takes Zoloft for depression and
Xanax plus some herbs at bed time to help with
sleeping. He asks:
1
On a scale of 0 to 10 how do most patients
rate the loudness of their tinnitus? Mine is
an 8.
2 Since wearing a hearing aid in my right ear,
I can now hear tinnitus in my left ear. Why
is that?
A
Mr. S. , the average loudness rating of
patients attending the Tinnitus Clinic at
Oregon Health Sciences University is
slightly over 7, on a scale of 0 to 10. Your rating
of 8 is not unusual. I once measured the loud-
ness of a patient's tinnitus and found it to be
25dB. That was the loudest tinnitus I had ever
measured, and yet on the 0 to 10 loudness scale
he had rated it a 4. Imagine that! I asked him
how he was able to rate his tinnitus so low
despite it actually being so loud. He answered
that originally he would have rated his tinnitus
as a 20 on that 0 to 10 scale but that he started
helping other people and soon discovered there
were people less fortunate than he. (I think
when we help others we always help ourselves
too.) Your second question suggests that you had
tinnitus in both ears all along but that the right
ear tinnitus was dominant. When you got a
hearing aid for the right ear it produced enough
masking on that side to leave you only aware of
the left ear tinnitus. This sort of thing happens
with regularity. In quite a few cases we've put a
tinnitus masker on the ear that the patient per-
ceives as their tinnitus ear only to have the
patient say "you knocked the tinnitus over to
my other ear!" In your case, Mr. S., if there is a
hearing loss in the left ear a hearing aid should
be tried to see if it relieves the tinnitus. If the
hearing aid does not relieve the tinnitus then I
would recommend a trial with a "tinnitus instru-
ment" - a combination unit that includes both a
hearing aid and a masker.
Q
Dr. S. in Hawaii asks, "Since intravenous
xylocaine (lidocaine) abolishes tinnitus
for about 30 minutes, have other oral
antiarrthymic cardiac medications been tried for
tinnitus?"
A
Your question is a good one. If an oral
medication could be found which acted
as well as intravenous lidocaine, many
tinnitus patients could be helped. Some of these
antiarrthymic drugs - Thcainide, Mexiletine,
Procainamide, Disopyramide, Phenytoin,
Bretylium, Propranolol, Amiodarone, and
Verapamil/ Diltiazem - are in comon use. We
tested Thcainide some years ago and found its
side effects caused 40 of the 60 patients to with-
draw from the study. Of the remaining 20
patients, only one experienced tinnitus relief.
With these results we concluded that Tocainide
was not a recommended therapy for tinnitus.
I would like to ask our readership to report to
us any experience, relative to tinnitus, that you
have had with any of the above drugs.
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). Or mail your questions to:
Dr. Vernon
c/o Tinnitus Today
American Tinnitus Association
PO Box 5
Portland, OR 97207-0005.
Tinnitus 'lbday I June 1998 23
TINNITUS
AND OUR
EMOTIONS
by Lois N. Cohen, CSW, ACSW, BCD
A tinnitus sufferer raised the question,
"Is it alright to feel the way I feel?" It is
not only alright, but imperative for our
mental health! There are no right or
wrong feelings. All of our emotions are
real and valid.
Owning and being aware of our feelings
us to know ourselves - our struggles,
fears, JOYS, sorrows, our likes and dislikes, our
values and goals. Our emotions enrich our lives.
S
ometimes it is too painful to own all of our
especially the negative ones. At
these tlmes, we try to deny or stifle them
- and we do so at a price. For example, anger
turned inward can lead to depression. When we
suppress anger, frustration, resentment, hurt, or
disappointment, we can feel exhausted and
drained, and have little energy left for produc-
tive or enjoyable endeavors. Often our ability to
concentrate, learn, and work is impaired.
When we suffer from a distressing and
potentially debilitating disorder such as tinnitus
it is natural to experience a wide range of '
negative emotions and to ask, "Why me?"
Acknowledging and expressing these feelings
enables us to begin to move beyond the devas-
tating impact tinnitus initially has on our lives.
The noises can be torturous and interfere
with every aspect of our functioning - our
work, our leisure, our relationships, and our
sleep. How can we just take this in stride? It's
like being invaded by a noisy alien! Many
people feel that their lives have been turned
upside down, and to feel anything but fury
would be unbelievable. We need to
1
instead
1
allow ourselves the adjustment and mourning
that is part of our tinnitus experience. It is quite
24 Tinnitus Thday/June 1998
normal to question why it happened and feel
the injustice. This is especially understandable
when the tinnitus is accompanied by hearing
loss which makes one's coping task even more
difficult. Mourning the loss of the way we were
or the dream of what we thought life would be
will enable us to eventually embrace the present
and move forward.
When we give ourselves permission to
express anger about what happened to us, we
begin to accept the reality of our situations. We
can constructively express negative feelings in
words by using "I feel. .. " messages. Stating our
needs, like "I need to be seated at a quiet table
in a restaurant" or asking people to face us
when they talk, can help us socialize and follow
our interests. Expressing our needs can lead to
changes in our environments that can satisfY
those needs.
S
imilarly, when we accept our fears we can
begin to look at the thoughts upon which
they are based and decide if the thoughts
are valid or irrational. This is the cognitive ther-
apy component that helps us resolve the worries
and distress that make our noises louder. When
we come to terms with a new self-image that
accepts limitations and builds on strengths, we
build the foundation for functioning fully once
again.
In addition to tinnitus' potential to cause
anxiety and depression, life's pre-existing stres-
sors can exacerbate our tinnitus. Many tinnitus
patients with whom I work struggle with addi-
tional difficulties, including marital, family and
career problems, infertility, and losses. Although
it is tempting to blame our loud noises for all of
our suffering and pain, we also need to work on
resolving our other dilemmas. Otherwise, life's
unresolved crises will make the tinnitus worse
and the vicious cycle will continue.
O
ur feelings are a gift from our hearts.
They act as a barometer and compass to
help us know what we need to do for
ourselves. When we listen and understand our
emotions, we can deal more effectively with
them and take the necessary steps to improve
our lives. Although we might not be able to con-
trol the loudness of our noises, we can control
our reaction to them. When we learn to do this
we can function more fully in the present while
looking more optimistically to the future. m
Lois N. Cohen, CSW, ACSW, BCD, is a psychother-
apist in Northport, NY who has first-hand experi-
ence in learning to integrate tinnitus into her own
life. She can be contacted at 5161754-6249.
SPECIAL DONORS AND TRIBUTES
ATA's Champions of Silence are a remarkable
group of donors who have demonstrated their
commitment in the fight against tinnitus by
making a contribution or research donation of
$500 or more. Sponsors and Professional
Sponsors 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!
AU contributions to the American Tinnitus
Association are tax-deductible.
ATA's Tribute Fund is designated 100% for
research. Tribute contributions are promptly
GIFTS FROM 1-16-98 to 4-15-98.
~ ~
Champions of Silence
Robert H. Crittenden W. Gordon Martin Edward R. Weiss Joe Ritacco's father
(Conmbunons of $500
Howard F. Crumb Andy Matthiesen Delmer D. Weisz Claire a.nd Jacques Simon
and above)
Henry Cunningham, m Colin L. McMaster Barry Wheeler Mark Sands
Edgar P. Bailey
Pierre David Joan Michelland Robert M. Whittington Claire and Jacques Simon
Warren S. Bender
Donald W. L.lavts Alexander Miller Theodore M. Wight Maurine Walker Smith
Matthias B. .Bowman,
Walter Z. Davis Eugene A. Miller AI E. Witten Thelma P. Batchelder
Thomas w. Buchholtz, M.D.
Robert B. Dellbrugge Ray Mize, Jr. Adelaide w. zabriskie, William Thbe
James 0. Chinnis, Jr.
Joaquin Delpino Eugene A. Moody Ed.D., C.F.A. Sybil Barlilay
Rob M. Crichton
Jeffrey J. Derossette Douglas Moore Marilyn K. Zion Lou.js Urias
William B. Farinon
Lewis G. Desch Earl R. Moore
Professional Sponsors
David and Helen Myers
Helen Pappas,
Anita E. Dever Don Morse .Estella Weber
Schoenstadt Family
William Dorman Jeanne A. Moslencr
(Professional Gonm'butions
Robert E. Crawford
Foundation
John L. Dosen Cameron R. Murray
from $100-$499)
Priscilla G. Ryan
Martha M. Smith
Russell K. Duke Donald E. Nace
Coastal E.N.T. & Facial
Deborah W. Smyth
William E. Thrley
Ralph C. Dutchin Jim Ed Norman
Plastic Surgery
Deborah and Andre Weber
Paula French Vanakkeren,
Bernard Fishman Patrick A. O'Boyle
Eduardo Go, M.D., HJS
Irwin L. Wiechelman
French Family Foundation
Kathrvn E. Fitzsimmons Ruth E. Ochs
Randy Morgan
Jess A. Hoskinson
Margaret Fleming Jean Osborne
Donata Oertel, Ph.D.
Jack A. Vernon, Ph.D.
Sheldon Palgon, M.D. In Honor Of
Harold E. Wells
Janet Florentin William E. Paland
F: Helmut Weymar
Mary A. Floyd Gerald J . Palazzola
Robert B. Quattlebaum, Jr., Mr. Steve Coughlin
Delbert w. Yocam
Dolores Garcia Wilfred Palmer
M.D. (Happy Easter)
George N. Gaston R. J. Palombit
Paul A. Reder, M.D., PA Jean E. Pepper
Sponsors
Veva J. Gibbard Randy L. Parks
Dean Edward Schanen, Mark Graham
(lndiuidual Contributions
Theodore T. Gillam Thomas J. Patrician
M.D. (34th birthday of my
from $100-$499)
James S. Gold Ford G. Pearson
Abraham Shulman, M.D. son)
Joy Agass-Smith
Bob Goodman Ronny Peleman
Steven Stegman Donna Graham
Lloyd Amaral
John R. Hafer Richard E. Popovits, Jr.
Milly E. R. Walker, M.A. , Christopher V. Houghton
Gerald W. Ape\
Robert Hager Howard M. Potiker
CCC-A (Happy Birthday)
Edwin N. Barnes
William D. Hagerty Daniel Pritchett
Robert Winkelaar, M.A. J.T. Wilson
Janet E. Baumgartner
A. James Heins Margaret w. Ratchford
Corporations with
Gretchen Paige, M.S.,
Susan Bentley
Mark Herritz James M. Reel
CCC-A
Mark Berman
Paul G. Hill Bill Retherford
Matching Gifts Stephen P. Maxin
Judy C. Bezek
Dorothy R. and John Bernard Richards
Computer Associates Barbara 'Thbachnick
Mobil Foundation
Jack A. Vernon
Gordon J. Birgbauer, ,Jr.
Hiltner William P. Roberts
union Pacific Dr. Jack A. Vernon
R. John Bishopp
Frank Hutto Anna S. Roemer
Peter Bouvier
Joan Imber N. T. Rutledge
US West Betty Webber
Michael L. Bowen
Robert C. lncerti Edmund B. Ruttledge Bequests Research Donors
Robert J. Bradley
Philip H. Ingber Alan Sands Estate of Adam Dean Moser John J. Accordino
Dorothy M. Brahm
James Irving Marie Saxe Helen D. Adams
Jane E. Braucher
Elizabeth A. Tvankovic Bryan Schwab
TRIBUTES
Elenor Adams
James W. Brennan
Nils P. Jensen Irving H. Schwartz Betty Adams
Alan L. Brock
Michael E. Johnson Bruce A. Shachat In Memory Of Marian H. Agee
Jack E. Brown
Kenneth w. Jones Glenda Sheppard Margaret Acker Robert R. Alexander
Mr. Ralph C. Brown
John Kapteyn Jerry Smalley Adele Steiner Vera Alston
Roben L. Brown
John B. Kent Raymond M. Smith, Til Carmela Bellafiore Stephen M. Altus
Kristin J. Bruno
Donald King Robert Lee Smith Harry a11d Rose Vogelfanger Marjorie Geary Anderson
Alfeo Brusetti
Laura P. Kleppick Eugene J. Sobel Jack Bennett Betty J. Anderson
Richard A. Burns
Shirley E. Kodmur Lou Somers Sylvia Eisenberg Helen M. Anderson
James Bussey
Bertram Kostant Lewis E. Stengel, Jr. Leo Brenner Nicholas Andrews
Merle C. Chambers
Pete Kubena Howard C. Stidham Stephen M. Nagler, M.D., Henry N. Angulo
Kerry N. Chatham, D.V.M
Clide V. Sonny Landreth, lU Walter H. Swver F.A.C.S Vernon R. Appelt
Clary Childers
Eric C. Larson Robert J. Suchomski Mrs. Mamie Coles
Jeff Archambult
Ralph G. Ciaramel\o
Shirley C. Lavenberg Michael M. Sullivan Stephen M. Nagler, M.D.,
Richard Baier
Guy R. Clark
Barton Lavine Ruth M. Swan F.A.C.S Philip J. Bankard
Gardner C. Cole
Michael C. Lehner Daniel K. Thrkington Joan L. Hulett Edward A. Baroody
Robert L. Coley
Jean R. Ljungkull JeffreyS. 'Thshman Mr. and Mrs. John H. Irma A. Barrett
Diana C. Connolly
Van A. Luoma Donald V. Thompson Schleter Harry Bassford
Frank J. Cook, M.D.
Annette D. Mallory Fred D. Thompson Merle Lien Sara Rouse Batchelor
George Cranda 11. J t.
Ruggero Mariani Scott Thrner Arlo and Phyllis Nash Connie J. Baxter
Bill Creeden
Phil E. Marshall Arlene B. VanNorden Patricia Nash John J . .Beaumont
Richard Martin Joseph A. Verdon Clint and Arvera Alleman Richard L. Behr
Robert F. Weimer Arlo and Phyllis Nash
Lucille Bender
Tinnitus 1bday/ June 1998 25
SPECIAL DONORS AND TRIBUTES (continued)
Research Donors
Johnston K. Fite Michael R. Jones Paul M. Olinski Richard E Smith
(continued)
Glenn W. Flint Henry B. Keese Kuth and Stacy Oliver Patricia M. Smith
Margrit Fontanilla R. L. Keheley Scott R. Olson Captola M. Smith
Charlene Bennett
Lovetta Wall is Fossett Harry G. and Marion Kristi A. Olson Randall S. Smith
Mitchell Benson
Marsha and Morton
Kim Frohsin Keiper William S. Orcutt Richard C. Smith
Berkowitz
Cathy A. Frost Joseph J. Kelly Elmer D. Oswald J. Emory Smith, Jr.
Robert T. Bialas
Marilyn Garnick Guy Kerbstat James C. Owen Mark A. Sniegowski
Gary A. Billey
Leroy E. Gaskin Wayne M. Kern Delores Pacifico Sheldon Soffer
George N. Gaston James and Lela Kester Bernice R. Pardue Mildred F. Sohn
Mary Ann Blackburn
Gabriel B. Gavino Charles L. Kidner Patricia Parker Larry Spoden
Mark A. Bleich
Stephen P. Gazzera Louise M. King Marion K. Parker Gerald R. Sprangle
Kim D. Blume
Frank Boland
Rowland Gcngelbach John E. Kinney Wayne A. Parkola SFC (Ret) Larry A Stafford
John A. Borries
Carl 0. Gentry Gerald F. Kiplinger Charles R. Paroubek, Jr. Henry G. Stanley
Vernon C. Brangham
Florena Genzink Angeline B. Kirk Vera J. Pech Lewis E. Stengel, Jr.
Charles W. Gilbert Ira M. Klemons, D.D.S., Roi N. Peers Harry B. Stephens
Dennis Braun
Maria lnes Vilhena Girao Ph.D. Cornelia R. Pepoy Natalie P. Stocking
Ralph C. Brown
Paseo De La Habana Jane E. Kliefoth Angel Perez Ted Stojek
Barbara F. Brown
Madge S. Glass Erna Kohane Ruth Preilfer Steven T. Stone
Patricia A. Brunk
Ruth Buchman
Harriet L. Glazer Georgian Kolber Peter Phair Leilani L. Stoody
Lorraine E. BugaJski
Benjamin S. Goldfarb Norma Kratz Patsy R. Phillips Thelma R Stresak
James A. Gomes Marion A. Kreiter Catherine Pirritano Philip E. Strohmeier
Helen S. Burkey
Marta C. Gomez R. W. and Susan Krinks Judith Pisetzncr OrloffW. Styvc
Michael W. Burnham
Emma M. Gomez Walter A. Kunka Colleen C. Pitra Clemens E. Sundstrom
Jeffrey L. Burton
Donna and Robert Graham Mildred A. Kunkel Mary Anne Pittmon John D. Sutton
Bettilee Byars
Carl Granitzer Sarah E. Lamb Charlotte D. Ponder Charles M. Svajgl
Mary Howard Cadwell
David E. G r a t : ~ ; Will iam J . Landolt Richard E. Popovits, Jr. Leroy Sweet
Miriam w. Campbell
Edith M. Green Eileen E. Larkin Prescott T. Porter Diane Syme
Ralph Carmen
Harold B. Greenberg Christina Laubscher Lela M. Powell Marjorie Terzian
Alfredo Carvajal
Seymour Greenblatt Jeannette Lawrence Caroline A. Prellwitz Frederick C. Thompson
Michael Celuch
Richard and Ruth Greene Robert J. Lewicki Maj. Leonhard Raabe Wiillard C. Thorn
Arlo Chan
Carol Jean Chatterton
Dick Greene Frank W. Little Eldon Radtke w. K. Thornton
Evelyn Childress
Marjorie E. Grcmmcl Jean R. Ljungkull Rose M. Rainona Mary S. 'Tracy
John P. Griesbach Richard P. Loach Mary J. Raymond Anthony Trone, Jr.
Virginia M. Clark
Arlene H. Griest Palmer R. Long John A. Reale Betty A. Thoyanek
Guy R. Clark
Dolorus Guffey Betty B. Lotz Bryce C. Redington Shirley li'ulson
Elizabeth Clifford
William Gulla Mr. and Mrs. Daniel E. James M. Reel Geraldine VanBruggen
Mr. Stanton Cole
Beverly J. Collins
Frank Guzzi Ludwig Linda Reiman David W. Vayo
Theresa Concini
Josephine C. Habighorst H. Edward Lyon Richard A. Reinhardt Margorie Vincent
James J. Contrada
Charles E. Haden Cecile MagalifT Karen Reissmann Marilyn S. Voorhies
Anna J. Conwell
William D. Hagerty Beatrice Magee F. H. Richardson Dorothy R. Waiste
Donald J. Cook
Richard E. Haney Phyl lis L. Maihejean Marta Ridd Maebelle Wakeman
John B. Corcoran
Jerry D. Harraman Jim Malise Donald J. Ritchie George T. Walden
Joseph A. Cordes
Margaret A. Harrod Eleanor Mammino Ann Rizzetto Firth Waldon
Doris E. Hart George D. Marcellos Peggy D. Robichaud Jack Wallner
W, E. Couling
Richard H. Haws Ruggero Mariani Alden R. Rodgers Judith A. Wall us
Glen R. Cuccinello
Marie L. Heffernan Ronald C. Mathis Thomas w. Rodman Roderick E. Walston
Shirley Cullen
Betty J. Heisch Janet M. Maynard Elsa P. Rodriguez Rolf Walter, PT
Samuel F. Curcio
Kristy Hennessee Ellen D. Mazza Doris J. Rohling Arleen Wazlahowsky
William P. Currv
Timothy G. Cutry
Mark Herritz Ann McAleer Craig Rostvedt Marvin Weinberger
Saul Hertzig James v. McCook Daniel Rothman Ronald S Weiss
Dennis M. Daly
Charles Hertzig Irene F. McLaughlin Andrew Rowjohn Delmer D. Weisz
Scott Davis
Foundation Marie Meade William S. Royce Helen I. Wells
Marilyn C. Dee
Arlene Hertzog Edward J. Megerian Joann Asher Rubin Frank T. West, Jr.
Calvin D. Deeter
E. Alan Hildstrom Nick Mendoza N. T. Rutledge M. W. White
Joel Defren
Ricardo Delaespriella
John L. Hilgers Carolyn V. Merritt Peter L. Ruvolo James s. Whyte
Richard C. Hohnbaum, Jr. James Z. Metalios Frances Sacco Carol Williams
Greg Delespinesse
Philip D. Holland Patrick Michael, Jr. Arthur R Sansom Joseph H. Williams, Jr.
Joseph R. Demartino
Joseph E. Horak George G. Michael Elaine Schaller Louise H. Williams
Jennifer Dempsey
Alan A. Horak Cookie Miley Eileen Schuettinger Melissa Windham
Barbara S. Derick
Jeffrey ,J. Derossette
Daniel E. Horgan Steven Anthony Miller Palmer Sealy, Jr. Jerilyn Winters
Elizabeth Hornickel James A. Minor Gary Seelau Frank C. Wonderly, Jr.
George Dilgard
Ann M. Hotta Anthony T. Molisse Ronel J. Selbach Irene B. Wood
Ronald A. Dillow
Robert J. Donovan
David J. Hundt Joseph Mora Anna M. Sharkozy Phyllis R. Wood
Bruce A. Downs
Kenneth E. Hutchings Charlotte Morris Margaret B. Shattles Walter K. Wornick
Evelyn P. Drooks
Tim Hynes Rebecca MotTison Fr. Thomas F. Sheehan, Liv Grete Wright
Tom Tnderbitzen Jeff Morse OFM John A. Wunderlich
Virginia M. Dublanc
Laura Ingels Ann Moscola Jeanne Shelander Gladys C. Young
Abby S. Eason
John R. Intorcia Louis G. Moser Myrtle E. Shepard Thkouhi Zartarian
Sarah J. Ebert
Theodore M. Eck
James Irving Laurence Moynihan Glenda Sheppard Kenneth Zerda
Linda D. Elliott
Sam N. Isaac Peggy Munson William P. Sherman Milan M. Zilinek
Roberta H. Engstrom
Les Jsaacowitz Lyle G. Newcombe G. William Sholly Harry Louis Zimmermann
James A. Jackson James D. Newton Frederic Silberman James A. Zweifel
Robert J. Fend rich
Lucille E. Jacobsen Helen F. Niforos Angie Silva
Shirley Finfrock
Keith A. Jacobson Terry 0. Norris Robert C. Sittig
Joseph H. Fish
Lucille J. Jantz Thomas E. Nunnally Sharon J. Sjaastad
Dr. Sheila Fisher
Leonard N. Fisher
Kurt Jensen Peter E. Nye Thelma M. Sjostrom
Roberta Fisher
Nancy A. Johnson Sarnell Ogus Robert A. Smith
26 Tinnitus 'lbday/June 1998
Looking For Those Quiet Happy Days Again?
As a fellow Tinnitus sufferer, l was wid by a world renown medical center to
take Xanax and Pamelor, go home and learn to live with it. Well that did not
work for me and possibly some of you fee l the same way. So l decided to do
what L would do in my business if an obstacle of this magnitude arose- l did
research and became an autholity on the subjecL
I unco\'ered the following facts:
8 Tinnitus can be treated and it can go away
48 The mind grabs onto the sound and continues looking and listening for it
long after the cause has gone or healed
48 Research suggests that a portion of all tinnitus sufferers fall into this category
48 There are only a few proven methods to get your subconscious to change its
thought pattern
developed for my personal use. l have now decided r.o
offer it to other tinnims sufferers, and will also donate a poruon of those pro-
ceeds towards tinnitus research. The AW<Uf"' program has several
modules: a booklet with all my research; a subliminal tape developed for use
during the day while drivi ng, working or just relaxing; and a self-hypnosis,
two tape program that supplemems the subliminal tape.
For further informmion on write:
Robert Magedojj, President, POMgroup, Inc.
19714 8/ark Olive Lane, Boca Rawn, FL 33498
rmagedojjpo1ngroup.com
or alii tiS at 561.482.1393

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www.ata.org
AMERICAN TINNITUS ASSOCIATION
P.O. Box 5, Portland, OR 97207-0005
Forward and Address Correction
(at last)