March 2001 Volume 26, Number 1

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Education -Advocacy - Research - Support
In This Issue:
Medicines to Treat the Inner Ear
Hearing Aids and Tinnitus
Cochlear Implants
Research Update - 'Ibward the Cure
Is Exercise Dangerous to Your Health?
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Tinnitus T o d ~ y
Editorial ond Advertising offices: Americon Tinnitus Association, P.O. Box 5, Porrlond, OR 97207 503248-9985, 800634-8978 linnitus@oto.org, www.oto.org
E:s:ecutivc Director: Cheryl McGi nnis, M.B.A.
Editor: Barbara Thbachnick Sanders
Tinmtus 1bday is published quarterly in March,
June, September, and December. It is mailed tO
American Tinnitus Association donors and a
selected list of tinnitus patients and profession-
als who treat tinnitus. Circulation is rotated to
80,000 annually.
American Tinnitus Association is a non-profit
human health and welfare agency under
26 USC 501 (c)(3)
o 2001 American Tinnims 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 writ-
ten pem1ission of the Publisher. ISSN: 0897-
6368 (print), ISSN 1530-6569 (online)
Board of Directors
Stephen M. Nagler, M.D., Atlanta, GA,
Chairman
Dhyan Cassie, M.A., CCC-A, Medford, NJ
James 0. Chmnis, Jr., Ph. D., Warrenton, VA
Gary P. Jacobson, Ph.D., Detroit, Ml
Sidney Kleinman, J.D., Chicago, IL
Paul Meade, 1lgard, OR
Kathy Peck, San Francisco, CA
Dan Purjes, New York, NY
Susan Seidel, M.A., CCC-A, Sunset Beach, NC
Tim Sotos, Lenexa, KS
Richard S. 1)rler, Ph.D., Iowa City, l A
Jack A. Vernon, Ph. D., Portland, OR
Honorary Directors
The Honorable Mark 0. Hatfield,
u.s. Senate, Retired
Tony Randall, New York, NY
William Shatner, Los Angeles, CA
Scientific Aclvisors
RichardS. 1)rler, Ph. D., Iowa City, lA,
Chairman
Ronald G Amedee, M.D., New Orleans, LA
Robert E. Bnumnett, Ph.D., Lilliwaup, WA
Jack D Clemis, M.D., Chicago, IL
Robert A. Dobie, M.D., Bethesda, MD
John R. Emmett, M.D., Memphis, TN
Barbara Goldstein, Ph.D., New York, NY
John W. House, M.D., Los Angeles, CA
Gary P. Jacobson, Ph.D., Detroit, Ml
Pawel J. Jastreboff, Ph. D., Atlanta, GA
William H. Marrin, Ph.D., Portland, OR
Douglas E. Mattox, M.D., Atlanta, GA
Mary B. Meikle, Ph.D., Portland, OR
Stephen M. Nagler, M.D., Atlanta, GA
J. Gail Neely, M.D., St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
Richard J . Salvi, Ph.D., Buffalo, NY
Alexander J . Schleuning, Tl, M.D., Portland, OR
Michael D. Seidman, M.D.,
West Bloomfield, Ml
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Robert Sweetow, Ph.D., San Francisco, CA
Cover: 1b You, acrylic on linen
and wood, 11'/, x ll 'h", 1994,
by Ellen George. Represented in
Houston by joan Wich & Co. Gallery,
713-227-2480. For information about
other works, contact the gallery or
Ms. George at P.O. Box 2871,
Vancouver. WA 98668.
The Journal of the American Tinnitus Association
Volume 26 Number 1, March 2001
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
6 Drug Studies Related to TimUtus
by James Kaltenbach, Ph.D.
7 Jts Not About the Implant
by Sidney C. Kleinman, J.D.
10 A Night to Remember
by Jessica Allen
11 Is Exercise Dangerous to Your Health?
by Rachel Wray
14 Hearing Aids and Tinnitus
by Robert Sweetow, Ph.D.
16 Medicines to Treat the Inner Ear
by Michael D. Seidman, M.D.
18 Research Update - 'Ibward the Cure
by Pat Daggett
20 ATNs Self-Help Groups
23 Back Issu es of Tinnitus 'Ibday
Regular Features
4 From the Executive Director
4 From the Editor
Go Home and Learn to Live with It
by Barbara Tabachnick Sanders
5 Letters to the Editor
21 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Special Donors and Tributes
The Publisher reserves the right to reject or edit any manuscript received for publication
and to reject any advertising deemed unsuitable for Tinnitus 7bday. Acceptance of
advertising by Tinnitus 7bday does not constitute endorsement of the advertiser, its
products or services, nor does Tinnitus 7bday make any claims or guarantees as to the
accuracy or validity of the advertiser's offer. The opinions expressed by contributors to
Tinnitw; 1bday are not necessarily t hose of the Publisher, editors, staff, or advertisers.
@ Printed on recycled paper
American Tinnitus Association Tinnicus 7bday/March 2001 3
FROM THE EXECUTIVE DIRECTOR
by Cheryl McGinnis, M.B.A.
ATA began the year with strong
media attention. Over 250 news-
papers featuring Dr. Paul
Donahue's health column
carried a question and answer
about pulsatile tinnitus.
Thousands of readers responded
to the article by contacting the
ATA. In turn, we replied with
information about tinnitus, the
ATA's services, and ways for each caller to become
involved to silence tinnitus.
In February, CBS-affiliate television stations in the
Midwest aired tinnitus public service announcements
highlighting the ATA. Dr. Jonathan Si1ver, host of Tb
Live Longer and to Live Stronger, interviewed Dr. Jack
Vernon and me for two 30-minute segments. His radio
and TV programs and newspaper column are distrib-
uted throughout the country.
This issue of Tinnitus Today marks a momentous
effort to reach ear, nose and throat physicians (ENTh)
across the country. Each ENT will receive a compli-
From the E ditor
mentary copy of Tinnitus Tbday to read and to share
with patients. Our goal is to reach out to physicians
who treat people with tinnitus, raise their awareness
about tinnitus treatments, and promote the ATA as a
resource for them.
Healthcare professionals are ordering extra copies
of the "Hearing Conservation Tips" that we mailed in
December. ATA members received this fact sheet along
with earplugs to Celebrate Hearing (reprinted on page
9). Thank you for your generous donations to our
Celebrate Hearing campaign.
The ATA Web site (www.ata.org) has a new look.
All of the popular features remain, and many have
been expanded. This month, we are unveiling a
"Members Only" section. Each member was sent a
membership card with an individual member number
to gain access to this section. Visit this site today!
See ATA Members Only on page 19.
What can you do? Continue your support.
Encourage others to join the ATA. Share ATh informa-
tional brochures with your physicians, media, and
libraries. In these ways, you will help raise awareness
and public support for tinnitus.
Thank you. 8
Go Home and Learn to Live with It
by Barbara Tabachnick Sanders,
ATA Director of Education
Damaging, infuriating words.
I tremble at using them. Tinnitus
patients do more than tremble
when they hear their doctors say
those words. They get depressed
and anxious. Often their tinnitus
gets worse. Sometimes a lot worse.
This very issue of Tinnitus Tbday that you hold in
your hands is also in the hands of your ENT thanks to
joint sponsorship with Petroff Audio Technologies.
So, while we have the opportunity - and with your
indulgence - we'd like to say a few words to your
doctor.
Dear Doctor,
Thank you for reading this. That act alone sets you
apart from many other physicians. You clearly want to
learn more about tinnitus for the sake of your patients,
and we commend you. Your schedule is full so we'll
get right to the point.
We have a message to deliver to you. It is from
thousands of tinnitus patients (they call themselves
"sufferers," and they should know), and it screams at
4 Tinnitus 7bday/March 2001 American Tinnitus Association
them as loud as their tinnitus: "Do Nar t ell me to
go home and learn to live with it ."
When people with tinnitus ask for help, please tell
them about coping strategies like biofeedback, foods
like those with caffeine that can aggravate the condi-
tion, drugs like Xanax or herbs like Ginkgo biloba that
have helped the condition. Thll them about cognitive
therapy, tinnitus retraining therapy, and masking that
help many people with tinnitus live better lives.
Give tbem our free patient brochure, our toll-free
number, and our Web site address. ATA has materials
that are tailor-made for patients: videos, books,
articles, support group and provider network lists,
and the quarterly journal Tinnitus Tbday. We can help
your patients learn about their condition - the caus-
es, the treatments, and the ongoing research in search
of a cure.
Tell them, "Tb live with it, go home and learn."
It's a far, far better thing to say.
The American Tinnitus Association
Join the American Tinnitus Association
and receive a full year of Tinnitus Today.
Call 800-634-8978 or
visit www.ata.org for details.
Letters to the Editor
From time to time, we include letters from our mem-
bus about their experiences with Nnon-traditionaln
treatments. We do so in the hope that the informa-
tion offered might be helpful. Please read these
anecdotal reports carefully, consult with your physi-
cian or medical advisor, and decide for yourself if a
given treatment might be right for you. As always,
the opinions expressed are strictly those of the letter
writers and do not reflect an opinion or endorsement
by ATA.
I
must comment on the article written by Terri
Nagler, R.N. ("Tinnitus Spouse Survival,"
December 2000 Tinnitus 7bday). I have tried
explaining my tinnitus to people for the past
14 months, but they just don't seem to under-
stand it. I think they view it as a "mild ringing
in the ear." I've tried explaining to them what a
profound impact it has had on my life, but they
just don't seem to get it. After reading Mrs.
Nagler's column, I photocopied it and mailed it
to my friends and family. I highlighted:
+ "Tinnitus is invisible, no cast, no cough ...
This left my husband with the added burden
of continually explaining his head noise .. . and
justifying his misery."
+ "lt won't kill you, but at times you just might
want to kill yourself."
+ "It's easy to become blase about their suffer-
ing when they look so normal.. .. "
I now carry copies of the column in my hand-
bag. When people forget my problem because it
is invisible to them, and question my attention
span, I have it ready for them to re-read. The
author, who does not have tinnitus, wrote a
truly outstanding description of tinnitus and its
physical and emotional effects. Thank you,
Nurse Nagler.
Jo Saponare, Audubon, NJ
'
read with great interest Terri Nagler's insight-
ful article entitled "Tinnitus Spouse Survival"
that appeared in the December 2000 issue of
Tinnitus 7bday. I found her description of a hus-
band so distraught and stricken that he was all
but totally incapacitated to be not only viscerally
upsetting, but very difficult to believe. I found
the description difficult to believe - but it should
be believed, for I am that husband. And I want
each and every reader of this journal - tinnitus
patient, tinnitus spouse, friend of the tinnitus
community - to realize that not only is there
legitimate hope for a cure in the future, but there
are legitimate paths to relief today while waiting
for that cure of tomorrow. We need to discover
which path is best suited to each of our needs.
So - with spouse, with friend, or even alone -
start walking and do not stop until you find your
way. Oh yes, please continue to generously sup-
port the American Tinnitus Association during
your travels.
Stephen M. Nagler, M.D., FAGS, Chairman,
Board of Directors, American Tinnitus
Association
'
have noticed that more stores are playing
music and making announcements at extreme-
ly loud levels. A while ago, my husband and I
went to a restaurant at an off-hour so it would be
quieter. The volume of the music being played,
however, was going to prevent us from eating
there. So we asked the hostess if it could be
turned down so we could stay. She said yes and
that she appreciated us asking because, frankly,
(continued on page 9)
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American Tinnitus Association Tinnitus Thday/March 2001 5
DRUG STUDIES
RELATED TO TINNITUS
by James Kaltenbach, Ph.D.,
Wayne State University, Dept. of
Otolaryngology.
[Dr. 1 ames Kaltenbach is a
researcher working to identify
neural and chemical compo-
J1ents of tinnitus. This infor-
mation is needed to pave the
way toward future develop-
ment of tinnitus drug therapies. Dr. Kaltenbach dis-
cusses the progress that he and his tinnitus research
team are making.)
One main objective of our work is to search
for drugs that will reduce or eliminate the pathol-
ogy underlying tinnitus. Our experiments suggest
that tinnitus results from an abnormally high
leve1 of spontaneous activity, or hyperactivity, in
the auditory system. One of our recent research
projects, which was supported by the Pfizer
Pharmaceutical Corporation, is showing that this
hyperactivity is reversible by applying certain
chemical compounds directly onto the brainstem
surface. We hope to determine if these drug
effects are also seen when the same compounds
are infused directly into the bloodstream. This is
necessary because drugs must be able to cross
the blood brain barrier if they are to affect brain
function in humans.
We continue to believe that the best game
plan for achieving effective treatment for tinnitus
is to understand the mechanisms underlying its
generation. Support from the NIDCD (National
Institutes for Deafness and other Communication
Disorders) has enabled us to move forward with
studies of tinnitus generating mechanisms. One
of the results of this work, which has us excited,
is our discovery that increases in hyperactivity in
the auditory brainstem can also be induced by
cisplatin, an anti-cancer drug that causes damage
to outer hair cells and can also cause tinnitus.
Our results now suggest that the hyperactivity is
related to the loss of outer hair cells caused by
cisplatin. This suggests that damage to or loss of
outer hair cells may be a critical factor underly-
ing the induction of tinnitus.
6 Tinnitus 'Zbday/ March 2001 American Tinnitus Association
We have also completed experiments testing
whether the hyperactivity induced in the
cochlear nucleus by intense sound exposure
originates in the brain or in the ear. The results
of these experiments show that the hyperactivity
in the cochlear nucleus persisted even after the
cochlea had been destroyed. This strengthens the
case that noise-induced tinnitus is a central
(brain) disorder, although clearly one that is trig-
gered by some effect of intense sound on the
inner ear. We are also examining these questions:
Does noise cause tinnitus because it mimics the
outer hair cell damage effect of cisplatin? Or does
cisplatin cause other changes in the auditory
pathway that cause tinnitus?
This is a very exciting time for our laboratory
and for people interested in tinnitus. We are gain-
ing new momentum every day. Each experiment
yields results that bring us a step closer to under-
standing the neural basis of tinnitus. In the best
of scenarios, we may also identify one or more
drug candidates within the next few years that
would qualify as worthy of clinical trials. B
Advemsemenc
TINNITUS RESEARCH
Volunteers Sought for
Drug Study
Participation requires
12 visits to San Diego over
a 20 week period.
Contact :
University of California,
San Diego
Depts. of Otolaryngology and
Psychiatry
Thornton Hospital &
Perlman Clinic
(858) 657-8596
It's Not About The Implant
by Sidney C. Kleinman, J.D.
I have been living with hear-
ing loss and tinnitus for a
long time. In December
1967, I became profoundly
deaf in my right ear in half
an hour. This sudden and
inexplicable deafness was
accompanied by roaring
tinnitus and a Meniere's overlay of dizziness.
Within two months, my hearing deteriorated even
further to where I could not hear sounds at 125
decibels, although I could feel them. I dealt with
the loss and the resulting tinnitus through disci-
pline, believing that every day is a gift, shortening
my "emotional focus" to 20 minutes at a time,
and, notwithstanding that my
tinnitus was ever-present, understanding that no
one lives life without a challenge and that I was
much better off than most.
Over time, the hearing levels in my "good" left
ear deteriorated and constant tinnitus developed
due, in part, to my having worked in an automo-
bile factory while I was in co11ege, as well as to a
probable genetic weakness.
Then 18 months ago, things changed rapidly
again. I lost an additional 25 decibels of hearing
acuity in my left ear so that I first hear sounds at
60 decibels. Furthermore, I began experiencing
what I call a "synapse delay" - I heard spoken
words but it took me 15 to 60 seconds to process
and understand the meaning of those words.
As the level of hearing in my left ear further
deteriorated and my tinnitus increased, it was
necessary for me to substantially increase the
volume my hearing aid. Of course, this
increased the level of non-informing sounds, like
restaurant noise. And I continually purchased
more powerful digital hearing aids to help me
deal with my hearing loss and tinnitus. As I strug-
gled to hear and understand speech, and then
appropriately communicate and respond, I had to
further shorten my emotional focus to 5 minutes
or so in order to cope. The emotional energy
required to cope was enormous.
In March 2000, I was diagnosed with lymph-
atic hydrops in my left ear. A diuretic, a salt-free
diet, and a regime of steroids were ineffective in
treating it. The prognosis for the hearing in my
left ear was guarded.
After thinking about the status of my hearing,
it became clear to me that any auditory clues I
could receive from the right side would enhance
my communication and comprehension skills
enormously. With the incredible advancements
in cochlear implant technology and speech
recoanition computer teclmology, I believed that
I had an opportunity to enhance my abilities to
comprehend sound.
I then began a quest to find a competent and
caring medical team who would help me a
way to achieve better auditory comprehensiOn.
I found such a team at the Henry Ford Hospital
in Detroit, Michigan: Gary P. Jacobson, Ph.D.,
(audiologist and Director of Audiology), Michael
D. Seidman, M.D., (ENT surgeon), and Ginette
Ruckel, Au.D., (audiologist and very patient tester
and programmer).
After many tests and much effort on the part
of the team, the surgery took place. My right ear
was "implanted" on September 21, 2000, with a
Cochlear Nucleus 24 implant device. The
surgery itself could not have gone better. The
healing process from the surgery was swift and
uneventful. Necessarily, the surgery rendered
the implanted ear incapable of any hearing on its
own. Notwithstanding the success of the surgery,
no one could or can predict how any implant will
actually work. Through this entire process, I felt
that I was embarking on a great adventure, and
that no matter the result, it would be positive and
beneficial.
The implant process involved threading a
wire with a 24-electrode array through the core
of the cochlea (in the inner ear) to provide direct
stimulation to the auditory nerve. The electrode
array was then connected to a coil and magnet
which were implanted under the skin behind the
ear. An external speech processor and micro-
phone are held to the internal magnet by an
outside magnet.
After the surgical site healed, my audiologist
activated and programmed the speech processor
then tested the implant on October 30, 2000.
From the very first sound -and without the use
of my hearing aid in my good ear - I
ous speech on the right side for the first t1me m
33 years.
(continued)
American Tinnitus Association Tinnitus 'Thday! March 2001 7
It's Not About
The ltnplant (continued)
The speech that I hear through the implant is
electronic and different than the sounds that one
hears through the mechanism of normal hearing,
but it is clearly speech and wonderfully so. For
reasons no one can explain, I have had little trou-
ble integrating the different types of sound from
the implant and my hearing aid. In fact, the inte-
gration has apparently eliminated my "synapse
delays.'' Within a week of the activation, I went to
the opera where my musical experience was
much richer and fuller.
Because of the incredible acuity of the speech
processor, I'm hearing new sounds that J had
never heard before, such as the click of a com-
puter mouse. My comprehension skills in group
settings, noisy restaurants, and on airplanes have
improved immeasurably. (I can even understand
the dialogue of in-flight films.) However, I have
found one side-effect from the implant, one that
I had not considered before the surgery: When
my implant is activated, I have no tinnitus on the
right side.
For me it's not about the implant, the hearing
loss, or the tinnitus. It's about aggressively and
realistically doing what I can to improve my
situation. Life is not fair. It just is what it is. No
one asks for or wants tinnitus, hearing loss, or
any other medical problem. But once I have a
problem, I deal with it and work at it with com-
petent professionals as best J can.
The wonders of sound and comprehension
were worth the risk and effort. 'ftuly the gift of
each day is even greater than before as I eagerly
enjoy and experience each new sound of my
life. a
Sidney Kleinman is an attorney in Chicago, Illinois,
and a member of ATA's Board of Directors.
8 Tinnitus Thday/ March 2001 American Tinnitus Association
The Cochlear Imj
Gineffe Ruckel, Au. D., CCC-A audiologist, Henry Ford
Hospital, Detroit, Ml
"Hearing-impaired people need to know that
cochlear implants are really a last resort for
restoring hearing. We need to make sure that a
cochlear implant (Cl) candidate can no longer
derive benefit from hearing aids. The kind of
sound that people hear with these two devices is
quite different. A hearing aid is basically an
amplification system consisting of a microphone,
an amplifier, and a receiver, much like our nor-
mal hearing system. On the other hand, a
cochlear implant electrically stimulates the hear-
ing nerve and so it produces an electronic sound.
If possible, we always want to attempt to success-
fully fit the patient with hearing aids first since
hearing aids mimic our natural hearing system
much better then cochlear implants do.
"To qualifY for a CI, patients need to meet the
individual criteria set by the implant manufactur-
ers (which is the same criteria as the FDA's) and
the medical facility where the implantation will
occur. (Three companies make cochlear implants:
Cochlear Corporation, Clarion, and MED-EL.].
Currently the FDA has only approved monaural
(or one) implantation per patient. When a patient
is implanted, he or she loses an usable hearing in
that ear because the electrode array upon inser-
tion destroys all hair cells in the cochlea. By only
implanting one ear, the patient can still wear a
hearing aid in the other ear if needed. At Henry
Ford, implant candidates must be cleared audio-
logically and medically. They must also have a
psychological evaluation and a CT scan of the
head.
"Most patients need at least six months to
learn how to get useful information from an
implant. It's like learning to hear all over again.
So most people can't do what Sid did, that is,
wear a hearing aid in one ear and a cochlear
implant in the other and experience speech and
sound recognition right from the start. Sid is out
of the ordinary. But his success is very real."
Michael Seidman, M.D., FACS, surgeon, Henry Ford Health
System, W Bloomfield, Ml
"The cochlear implant is a wonderful piece
of technology that results in varying degrees of
success. Although the surgery is an integral part
of the process, in my mind it is far from the most
important aspect. The fundamental challenge
really belongs to the person getting the CI, and it
lant Team
is through that person's motivation and determi-
nation (with the help of someone like Dr. Ruckel)
that a great outcome is possible.
"The CI is not for everyone with a profound
hearing loss. And there are known risks which I
tell to all my patients. The risks include: bleeding
( < 1% ), infection (1-3% ), extrusion of the implant
with the need to remove the implant ( < 1% ),
change or loss of sense oftaste (1-30% ), dizzi-
ness, numbness near the surgical site on the
scalp and ear (which seems to resolve in days to
months), and worsening of tinnitus ( < 2%).
"On a personal note, I feel blessed to be able
to help people like Mr. Kleinman realize their full
potential. It adds real meaning to my life."
Gary P. Jacobson, Ph.D., Audiologist Henry Ford Hospital,
Detroit Ml
"There are reports in the scientific hterature
describing tinnitus suppression for patients with
severe to profound hearing losses who received
cochlear implants. For Sid, I was hoping that, in
addition to the hearing benefit, he would receive
relief from his tinnitus as a secondary benefit. By
his report, he has received this benefit. I do not
suggest that cochlear implants be used as a treat-
ment for tinnitus. However, for patients who are
cochlear implant candidates and for whom tinni-
tus reduces quality of life, the cochlear implant
may provide an effective secondary benefit."
~ -.. - --...,;;;;:_;- ------: :ff : ~ . - .. - - - - . .- .-
Hearing Conservation Tips
The delightful and informative
"Sounds You Live By" decibel
chart with hearing conservation
tips is now available for sale.
Member price: 100 for $10;
non-member price: 100 for $15.
Note: These are sold only in
increments of 100. Please add
in shipping and handling
charges. (See the S&H chart
on the last page of this issue.)
To order, contact ATA at
800-634-8978 or
tinnitus@ata.com.
Letters to the Editor
(continued from page 5)
she had a headache from listening to it at that
volume all day. She said the corporate office told
them to keep the volume up thinking it would
increase business and make it seem more like a
"happenin'" place.
I think it's going to take all of us repeatedly
speaking up and writing to corporate headquar-
ters to ever make a dent in this notion that very
loud is better. We're not looking for silence. But
the world seems to be turning into a constant bar-
rage of loud, intrusive noise that lives rent-free in
our heads. So let's keep writing. "The pen is
mightier than the sword!" (although it would be
tempting to take a sword to certain offending
speaker wires).
}'anet Garman, Barrington Hills, IL
NJ
y tinnitus began in 1994 as a result of
exposure to allergens. Thsts were positive
for Meniere's syndrome (or endolymphatic
hydrops). The sound was so severe that it often
sent me to the emergency room to complain. Th
say that it was debilitating is an understatement.
I routinely took an antihistamine (because
I had allergies) which sometimes decreased the
severity of the noises and allowed me to func-
tion. However, after five years, the dosage that
I needed increased to a toxic level and I had to
stop taking it. Allergy shots did not help the
tinnitus, nor did diuretics or maskers. The
doctors assured me that there were no further
treatment options available.
I then consulted with an alternative medicine
doctor who prescribed vitamin therapy and
acupuncture. I began seeing the acupuncturist
in February 2000 who used 15 to 20 needles per
20-minute session to redirect my blocked "Chi"
(life energy) and access my allergy points. After
10 treatments, the acupuncturist was able to
reduce the intensity of the noises to 50% of what
it had been. Immediately following a treatment,
the tinnitus would disappear for hours and some-
times days, but it always returned - though not
as loud.
By avoiding allergens and having acupunc-
ture treatments, my tinnitus is now at a manage-
able, livable level and I am able again to function
in society.
Ronald Britt, diamondbackOl @earthlink. net
American Tinnitus Association Tinnitus 1bday! March 2001 9
A Night to Remember
by Jessica Allen, ATA Director of
Resource Development
Although the weather was
stormy, there were many smil-
ing faces in Portland, Oregon
on November 10, 2000. More
than 130 people traveling from
as far away as England gath-
ered to pay tribute to Dr. Gloria Reich for her
more than 20 years of service to the American
Tinnitus Association. Dr. Reich started her tenure
with the ATA in 1975 as a volunteer and became
our first Executive Director a few years later.
Member benefits that we share with you today,
such as tinnitus research funding, national self-
help and healthcare provider resources, and the
quarterly journal Tinnitus 7bday, are all due to the
efforts of Dr. Reich. So it was fitting that Gloria
was the honoree at ATA's first Founders' Gala.
As Dr. Reich looked over the crowd, she was
honored and touched to see such widespread sup-
port for the association. In addition to ATA Board,
staff, and volunteers, ATA members were present
from Arizona, Florida, Nevada, Thxas, California,
Oregon, Washington, and Louisiana.
Gala presenters with Guest of Honor: I. to r., Cheryl D.
McGinnis, Sidney C. Kleinman, Gloria E. Reich,
Jack A. Vemon, and Mary B. Meikle.
The $160,000 check to ATA in Gloria's honor. This check
1epresents donations by ATA's Board, staff, members, and
volunteers.
10 Tinnitus 7bdCiy1March 2001 Ame1ican Tinnitus Association
Gloria E. Reich, Ph.D., ATA's first Founders' honoree.
One of the evening's highlights was the pre-
sentation of a check to the American Tinnitus
Association in Dr. Reich's honor. The check, total-
ing $160,000, represented a combination of gifts
from the Board of Directors, members, friends,
and staff of ATA. We are deeply grateful to all
who gave to or attended the dinner not only
because it honored Dr. Reich, but also because it
paid tlibute to the strides the American Tinnitus
Association has made over the years.
As the music faded and the evening drew to a
close, all who attended felt a special unity and
sense of purpose. There was a bond that brought
these travelers to their destination, a cause that
they, too, were dedicating their efforts and in
some cases life's work to: Tinnitus, its prevention
and cure. B
We hope you plan on attending the
next Founders' Gala, November 10, 2001.
We will be honoring Dr. Jack Ven1on,
author, scientist, humanitarian, and
perhaps the greatest contributor to
tinnitus awareness and research to date.
For information on attending or
sponsoring the event call 800-634-8978
extension 218.
Is Exercise Dangerous to your Health?
by Rachel Wroy, ATA Director of
Advocacy and Support
Erlinda McGinty does not
have tinnitus.
In fact, she doesn't even
have hearing loss.
But she crusades on behalf
of those who have one or
both of these conditions-
and those who are susceptible to it-with a mis-
sionary's zeal. McGinty's cause: the ear-splitting
volumes of health club music.
. Every day, in institutions devoted to improv-
mg people's health and well-being, the music vol-
ume in group exercise classes, free weight fitness
areas, and even locker rooms regularly exceeds
recommended levels for noise exposure. The
irony of this does not escape McGinty. She
explains, "[Health clubs] are in the business of
promoting health, but hearing health is part of
fitness." She sighs, "Our ears are just as important
to our health as our deltoids."
McGinty took this belief to heart. And so tor a
while, she was content to march to her aerobics
classes am1ed with the usual workout accou-
trements-water bottle, fitness shoes-as well as
foam earplugs. But with the music still too loud
she bought a pair of occupational hearing
tors from a local hardware store. She also asked
her aerobics instructors to turn the music down
but more often than not, she got blank or frus- '
trated stares-even when she told the instructors
about the effects of noise-induced hearing loss
and tinnitus.
Calls to her local health commissioner
'
state Department of Public Health, and the U.S.
Department of Occupational Safety and Health
Administration (OSHA) yielded less than inspir-
ing results. Since McGinty was not an employee
of the club, OSHA regulations could not be
applied unless an instructor complained- and
none had.
Requests to the health club's management
were similarly discouraging. She was rebuffed
with explanations on how loud music correlates
with motivation in exercise classes. And the
owner went so far as to tell her that if they
turned the music down, members would quit.
Eventually, after she continued requesting that
the volume be turned down, the owner accused
her of harassing the staff and told her it might be
better if she left the club.
So she did.
Then she contacted her state Senator, Michael
Morrissey, who, intrigued by her arguments,
offered to sponsor a bill in the state legislature.
And so began McGinty's quest to introduce leais-
1ation into the state of Massachusetts that
regulate the volume of music in health clubs-
that is, that would turn health clubs into healthy
hearing clubs.
Science is certainly on McGinty's side. In
1999, Kathleen Yaremchuk, M.D., and Janet C.
Kaczor, M.D., published a study in ENT- Ear,
Nose<! Throat Journal. They researched 125 group
exerCise classes at five different health clubs and
found that in 79 percent of the classes, noise lev-
els ranged between 90 and 98 dB. Six classes had
noise levels above 100 dB, and six instructors-
not surprisingly-said that they experienced
tinnitus more than 50 percent of the time.
An earlier study, conducted by Raymond H.
Hull, Ph.D., found that at 90 health clubs, 80 per-
cent of the clubs featured music hitting peaks
of over 105 dB. Sixty percent of the clubs held
microphones used by the group
exerctse mstructors exceeded levels over 110 dB.
Additionally, four instructors in Hull's study
consistently held classes where the volume
exceeded 120 dB.
While OSHA recommends that eight hours
of occupational exposure per day is permissible
for 90 dB, the requirements do not address expo-
sure during a one-hour aerobics class or other
recreational activities. Compounding the issue,
for each 10 dB increase, the noise is ten times
the previous increment, and the recommended
length of exposure shrinks. For noise levels of
110 dB, people should be exposed for only a half
an hour. For 120 dB, people are at risk after less
than five minutes, which is a rather risky statistic
for an activity that's supposed to improve the
body.
Learning more about the dangers inherent in
loud noises contributed to McGinty's enthusiasm,
though at first, she wasn't sure if she was up to
the task of being a citizen activist. "I'm a very
busy she says now, "But 1 felt strongly
about this ISsue." Plus, she was determined to
turn her anger at the health club manager into
something more positive, something that could
potentially have a lasting effect on overall health.
(continued)
American Tinnitus Association TinmhtS 'TI:Iday/ March 2001 11
Is Exercise Dangerous to your Health? (continued)
McGinty relied on the expertise and experi-
ence of others when drafting the bill. The result
was a brief document focusing on disclosure and
prevention. In part, it states, "A health club shall
permanently and prominently post warning signs
about the danger of exposure to amplified sound.
Such signs shall state that consumers and employ-
ees endanger their hearing when exposed to
amplified sound exceeding 90 dB." The bill goes
on to require health clubs with sounds exceeding
that level to provide hearing protection devices or,
alternatively, to turn the music down-a require-
ment not so very different from OSHA's regula-
tion that a hearing conservation program must be
in place for employees exposed to sounds above
90 dB.
Before long, McGinty had support from the
League of the Hard of Hearing, the Massachusetts
Governor's Commission on Physical Fitness and
Sports, Self-Help for the Hard of Hearing, Hard of
Hearing Advocates, and the National Hearing
Conservation Association. She garnered publicity
in the Chicago TH.bune, Hearing Loss, the Boston
Globe, the Patriot Ledger, the New York Times, and
the New York Daily News.
The International Association of Fitness
Professionals -known as IDEA- also backed
McGinty's efforts. In 1997, the Association stated,
"Because hearing loss is a slow, cumulative
process, and usually doesn't hurt, group exercise
instructors need to be aware that the intensity of
their music and accompanying voice may be
putting them and their students at risk without
causing any apparent symptoms." Acknowledging
that loud music can be a motivator in many group
exercise classes, IDEA concluded that the possible
health risk is of far greater importance.
Senator Morrissey filed the bill in 1998, where
it was referred to the Commerce and Labor
Committee. On March 31, 1999, the Committee
held a hearing on it, and McGinty and audiologist
Pam Gordon provided testimony. Unfortunately,
the Committee relegated the bill to "study order,"
effectively stalling its progress for the rest of the
session. The Committee was also very candid
with McGinty, saying that it did not want to inter-
fere with business, and that it was difficult for
bills spearheaded by just one person-rather than
a local organization replete with lobbyists and
voting constituents-to fight the uphill battle.
12 Tinnitus Today/ March 2001 American Tinnitus Associarion
McGinty was ready to give up. But as the
deadline approached for filing bills for the 2001
session, Senator Morrissey encouraged her to
continue her efforts. She agreed. In December
2000, here-filed the bill. Again, it was referred to
the Commerce and Labor Committee, and anoth-
er hearing will be scheduled this spring. Sandy
Callahan, an aide to Senator Morrissey, is prag-
matic about the bill's future, "Even if it doesn't
get passed into law, it's helpful to have a public
forum, which educates the committee and edu-
cates the public." She allows, however, that
McGinty's bill is in some crowded company:
6,000 bills are introduced in the state of
Massachusetts each two-year session. Most
languish in committee.
McGinty is honest about her bill's slim
chances, but she embraces the accompanying
benefits of promoting the proposed legislation:
more exposure, more awareness, and more
enlightenment. "Consumers have the right to
know that when they go to classes, they could
damage their ears," she explains. McGinty's tire-
less efforts have no doubt contributed to a greater
awareness of hearing conservation and tinnitus
prevention in Massachusetts and beyond, illus-
trating the power of one person to reach and
educate a large audience. And as she prepares
for her next legislative hearing, she is excited
by the prospect of reaching out to still more
people. "Hearing loss is the silent enemy," she
says with conviction. She doesn't plan to be
silent about it. B
For more information, please contact Erlinda
McGinty at 617-472-7102.
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American Tinnitus Association Tinnitus 7bday! March 2001 13
Hearing Aids and Tinnitus
by Robert W. Sweetow, Ph.D.,
Director of Audiolog'ft University of
California, San Francisco
The value of hearing aids for
tinnitus patients has been
recognized for over fifty years.
The exact mechanism account-
ing for the beneficial effects of
amplification is uncertain but
is probably related to at least
four functions. One, it is likely that tinnitus is exacer-
bated by silence, perhaps because the brain turns up
its sensitivity to spontaneous electrical activity by
seeking out the neural stimulation it is being
deprived of due to the hearing loss. Amplification
with hearing aids increases neural activity and thus
may assist in "turning down" the brain's sensitivity
control. Two, it is possible that tinnitus is related to
a lack of neural inhibition. In other words, the brain
is capable of suppressing the perception of tinnitus.
But in an impaired auditory system, this inhibitory
ability is compromised. Perhaps the greater activity
created by amplification with hearing aids allows
the inhibitory function to correct itself somewhat.
Three, hearing aids amplify enough background
noise (wanted or otherwise) to partially "mask" the
tinnitus. Four, if hearing aids assist in reducing the
fatigue and stress that accompany having to strain to
hear, the ability to cope with tinnitus is improved.
Tinnitus patients have many models and
brands of hearing aids from which they can choose.
What hearing aids are most beneficial for them?
Unfortunately, the media, advertisers, manufactur-
ers, and even some audiologists have done a mar-
velous job, intended or accidental, of confusing the
public about available devices. So let's first discuss
the differences among hearing aids and then deter-
mine how they apply to tinnitus.
Conventional hearing aids can be defined as
analog instruments that amplify, fi lter, and limit the
maximum power of sound by manipulating these
parameters via switches or rotary controls on the
instrument. The efficiency of these devices is Hmit-
ed. Furthermore, with many of these devices, users
report that in order to hear soft sounds, they must
increase the volume of their hearing aids. While this
accomplishes the objective of hearing soft sounds, it
also produces the undesired effect of making loud
sounds uncomfortable. This occurs if the same
amount of amplification is produced by the hearing
aid, regardless of the intensity of the sound entering
it. This is referred to as linear technology. A better
way of controlling loudness, while still providing
14 Tinnitus 7bday! March 2001 American Tinnitus Association
sufficient amplification for soft sounds is with com-
pression hearing aids. Compression aids offer more
amplification for soft sounds than for louder
sounds. In other words, when the sound entering
(or in some cases, exiting) the hearing aid reaches a
certain level, amplification is reduced.
Digitally Programmable Hearing Aids
Digitally programmable hearing aids were intro-
duced in the 1980s. With these instruments, signals
remain processed by analog components, as is the
case with conventional amplification. This technolo-
gy is really a hybrid (a combination of analog and
digital) because a computer (digital technology) is
used to program the hearing aids. In addition to
enhanced precision and quality control over analog
devices, these hybrid hearing aids allow for an
increase in the flexibility of the aids, both for the
audiologist and the user.
The advantages of digitally programmable
instruments include:
+ Programmability and ease of adjustment:
If the listener's hearing or listening environ-
ment changes, these hearing aids can generally be
re-programmed by the audiologist to compensate
for their revised requirements.
+ Multiple programs
Some programmable hearing aids offer multiple
programs so that at the touch of a button on t h ~ .
hearing aids or a remote control, the charactenstics
can be instantaneously changed by the user to
(hopefully) allow for improved performance in a
particular acoustic environment. For example, one
program can be adjusted for listening in quiet,
another for listening in noise, and another for
listening to music.
+ Multiple-band compression
There are two basic rules that must be followed
if a hearing aid fitting is to be successful. One, soft
sounds must be made audible, and t i " ~ O , loud sounds
must not be uncomfortable. Compression is
designed to accomplish this effect. However, it
may fail to achieve this objective because many
compression instruments utilize single band
compression. In other words, when compression is
activated, amplification of all sounds (low, medium,
and high pitched) becomes reduced. This broad
reduction may not be good for two reasons. First,
hearing-impaired individuals tend to show greater
tolerance for sounds at certain frequencies (pitches)
than for others. Second, an invasive noise that may
be restricted to certain frequencies (Le., the low
frequencies) would produce a decrease in amplifica-
tion for all of the frequencies, thus making the
weaker high-frequency consonants in speech harder
to hear. It's generally better if the characteristics
programmed into the hearing aid differ for the
various frequencies. Through the use of mul tiple
bands (modern systems range from two to as many
as sixteen) a completely unique set of signal pro-
cessing instructions can be provided for different
frequencies. This not only helps to maintain com-
fort throughout the frequency range, but it also
ensures that reduction in amplification is limited to
those frequencies comprising the offending, loud
noises.
Digital Hearing Aids
Digital hearing aids were introduced in the mid-
1 990s. Digitization means that incoming analog sig-
nals received by the microphone are sent through a
pre-amplifier to an analog-to-digital converter where
the signals are converted to a series ofbinary digits.
These numbers are then manipulated by the digital
signal processor according to a set of instructions
(algorithms) that are either pre-set or programmed
by the audiologist. A new set ofbinary digits is
formed which is then reconverted from digital to
analog as it exits the loudspeaker in the hearing aid
and enters the ear canal.
In addition to all the features contained in
digitally programmable hearing aids, digital hearing
aids may have characteristics that cannot be
attained with any other hearing aid system. These
include:
+ Active Feedback Control
Digital processing improves the hearing aids'
ability to maximize amplification while minimizing
feedback (whistling sounds from the hearing aid).
+ Multiple Microphones
Hearing aids with multiple microphones can
amplify signals that originate in front of the listener
while partially suppressing amplification of sounds
that originate from the side and behind the wearer.
This technology can improve the listener's ability
to hear in the presence ofbackground noise.
Although the use of multiple microphones does not
technically require digital processing, flexibility and
directionality may be enhanced by digital control.
+ Noise Reduction Strategies
Digital noise reduction strategies can analyze
not only the intensity of the incoming sound but
also its timing pattern. In doing this, digital noise
reduction attempts to differentiate speech from
noise and then selectively reduce only those
components thought to be noise.
Are Digital Hearing Aids Superior?
Numerous studies have demonstrated that
patients show a subjective preference for high tech
(digital and programmable) hearing aids over con-
ventional instruments. However, there are little
data existing that demonstrate significant objective
improvements for digital hearing aids over conven-
tional and programmable devices with regard to
word recognition scores. But, in each of these
studies, subjects reported preferences for the
digital devices. It is possible that increased word
recognition scores constitute only a minor percent-
age of the total components that reflect satisfac-
tion from amplification. For example, in recent
studies, digital hearing aids are invariably judged
as providing a more comfortable sound than earli-
er instruments and that they provide greater
amplification for softer sounds.
Impact on Tinnitus
The criteria for selecting specific models and
features of hearing aids for tinnitus patients are
slightly different than for individuals with hearing
loss alone. The most important considerations for
tinnitus patients are:
+ Programmability, whether digital or analog,
is vital because of the capability of changing the
acoustics based on the preferences of the user.
+ Multi-band compression is important
because it increases amplification of soft sounds
(providing partial masking with environmental
sounds and increasing neural activity) while still
protecting sensitive ears from loud sounds.
+ Multiple programs allow for the user to
adjust the hearing aids so that they can select
different amplification for quiet (where they might
want greater amplification of soft environmental
noise) versus noisy environments (where they
might want to suppress annoying background
signals that interfere with communication).
+ While many people tend to opt for
perceived cosmetic advantages of very tiny
Completely-In-Canal (CIC) hearing aids, there is
much to be said for the advantages of using small
Behind-The-Ear (BTE) hearing aids that do not
occlude the ear canal and allow for certain natural
sound to pass though.
+ Binaural (two-eared) fittings are usually
appropriate (even if the tinnitus is perceived pre-
dominantly on one side) because it ensures neural
stimulation on both sides of the brain and increases
the chances for the effects described earlier.
Conclusions
Patients with tinnitus and any
degree of hearing loss may benefit
from amplification. The rationale for
selecting and programming amplifi-
cation devices for a person with tin-
nitus and hearing loss may differ
somewhat from those used for
patients with hearing loss only. For
patients, the most important consid-
erations are to establish a relation-
ship with an audiologist you trust,
remember that hearing aids are not a
cure, and realize that educational
and emotional counseling is always an
important component to tinnitus therapy. e
American Tinnitus Association Tinnitus 7bday/March 2001 15
MEDICINES TO TREAT THE
by Michael D. Seidman, M.D.,
FACS, Henry Ford Health System,
Dept. of Oto-HNS, Director-
Division of OtologicjNeurotologic
Surgery, 248-661-7211,
6777 W Maple Rd.,
W Bloomfield, M/48323
Dr. Seidman presented this
information at the 18th annual
meeting of the International
Tinnitus Fomm on September 23, 2000, chaired by
Abraham Shulman, M.D. , and Barbara Goldstein, Ph.D ..
This professional meeting focused on neuroprotective
therapy and dmg delivery to the inner ear.
It is well known that the inner ear is isolated -
physically, anatomically, and chemically - from
the rest of the body. Most likely this is a protective
mechanism designed to keep toxins out of the inner
ear. However, this isolation also reduces the otolary-
gologists' ability to treat inner ear disease. Since the
early 1950's, otolaryngologists have attempted to
treat ear disorders by using transtympanic (through
the eardrum) injected medicines. Unfortunately,
the hearing mechanism is at great risk from any
medicine delivered to the inner ear. Over the past
l 0 years, significant improvements have been devel-
oped that allow for a more controlled delivery of
medicines to the ear. This has reduced, but not
eliminated, the risk of permanent hearing loss from
drugs in the inner ear.
Medications that are delivered through the
bloodstream with the intention of treating otologic
problems typically have significant and sometimes
adverse effects on the rest of the body. For example,
diuretics are used as part of the management of
Meniere's disease to reduce the overall fluid volume
in the inner ear. However, the primary effect is a
reduction of fluid within the entire body, with a
very slight fluid reduction in the inner ear. One
side effect from some diuretics is the lowering of
potassium levels. Clearly, it would be better to avoid
the systemic side effect and have a diuretic that
worked only on the inner ear.
There are some medications which when given
systemically for problems unrelated to the ear, have
a pronounced effect on the inner ear. For example,
aspirin in high doses causes tinnitus. Certain
antibiotics. pass into the inner ear and may cause
permanent balance disturbances and partial or
severe sensorineural hearing loss. The systemic use
16 Tinnitus Thday!March 2001 American Tinnitus Association
of cisplatin for its anti-tumor activity can cause
significant hearing loss. However, if the ear is treat-
ed with a protective agent, hearing could be spared
without reducing or eliminating the anti-cancer
effects of the drug. (This is discussed later in the
article.)
There are many techniques and drugs currently
used to treat the inner ear. The three techniques
used most are:
+ Transtympanic injection using a syringe and
a small-gauge needle
+ Round window microcatheter - A small
catheter surgically implanted under the
eardrum to deliver medicine to a small
window to the inner ear
+ Silverstein Microwick" - A small tube with
a "wick" that is placed through the tube to
the round window allowing the patient to
self-medicate
The following is an overview of the more com-
monly used medications and novel compounds that
may have a role in treating inner ear disorders.
Antibiotics
For Meniere's patients, gentamicin (an aminogly-
coside antiobiotic) is directly applied to the inner
ear to partially destroy vestibular function and
relieve vertigo. The risk of hearing loss ranges from
1-80% but averages 30-40%. The new delivery
techniques appear to reduce this risk.
Corticosteroids
Corticosteroids are commonly used in the
management of several inner ear disorders, includ-
ing sudden sensorineural hearing loss, Meniere's
syndrome and disease, and autoimmune inner ear
disease. There is some scientific and anecdotal
evidence to support the use of steroids - directly
applied to the inner ear - for the management
of hearing loss, ear fullness, and in some cases
tinnitus.
Lidocaine and Steroids
Lidocaine is a commonly used anesthetic agent.
Dexamethasone is a well-known steroid molecule
with potent anti-inflammatory properties. In one
study, Meniere's patients were treated with a combi-
nation of lidocaine and dexamethasone by inner ear
perfusion. Eighty-three percent (83%) of these
patients experienced immediate relief from ear full-
ness and dizziness; 69% of patients had sustained
relief after one year. A recent study reported by
Shea and Ge indicated tl1at 70% of patients with
intractable tinnitus achieved relief from tinnitus
INNER EAR
within one month of treatment with lidocaine, dex-
amethasone, and hyaluron perfusion of the inner
ear plus intravenous lidocaine administration.
Tinnitus relief was achieved in 76.9% of patients
after three months, and 83.3% after one year. The
Shea study has come under scrutiny because the
patients also received counseling and one or more
antidepressants or anti-anxiety drugs which in and
of themselves may reduce tinnitus for some people.
Consequently, we cannot be certain which of the
interventions led to the improvement. Additional
study of lidocaine and the combination of lidocaine
and dexamethasone seems warranted.
Neuroprotection - Glutamate and
Calpain antagonism
Decreased blood supply causes significant stress
to the nerve tissue by causing the production of free
radicals, which are
molecules made in our
own bodies. They are
extremely damaging
and known to be
responsible for more
than 100 human disor-
ders. The accumulation
of free radicals severely
damages the inner ear
and other tissues.
Through a complex
chain of events, this
damage can then cause
a release and accumu-
lation of glutamate and
calpains. These chemi-
cals in high concentra-
tion are extremely
destructive to the body.
tine, in treating inner ear disorders and recommend-
ed that they be delivered locally to the cochlea in
order to both maintain an effective therapeutic drug
level and avoid systemic side effects. The safety and
tolerability of memantine has been clearly demon-
strated throughout its use in Germany.
Caroverine has been shown to depress the activity
of glutamate receptors and protect the hearing of
guinea pigs. Also, its safety and tolerability have been
clearly demonstrated in clinical studies. In a single-
blind, placebo-controlled clinical study, 63% of
patients treated with intravenous caroverine reported
a significant improvement immediately after intra-
venous infusion. Over 48% of patients remained
stable after one week. Although no severe adverse
effects were identified for the majority of patients, a
few patients experienced mild transient side effects,
including a bad taste in the mouth, vertigo, headache,
'0 0'
. +

\ 0 0 /
_ _../ '
a "hot head" sensation,
and additional noise.
Conflicting data, how-
ever, suggest that
caroverine may not
have a therapeutic effect
on tinnitus beyond
placebo. More clinical
studies need to be con-
ducted to resolve the
controversy.
Since magnesium in
inner ear fluid decreases
significantly after
intense noise exposure,
the protective effect
of magnesium in pre-
venting noise-induced
hearing loss has been
studied. The results of
Studies have shown
that excessive gluta-
mate may play a role
in the production of
Round window microcatheter in the ear: Printed with pem1ission of
DURECT Corp. C2000
a placebo-controlled
double-blind study
showed that subjects
tinnitus. Studies also show that glutamate antago-
nists can have a protective effect on the inner ear
and possibly be a treatment for peripheral tinnitus,
a perception of tinnitus generated by the inner ear.
Three such drugs are currently under investigation
at the Henry Ford Health System for tinnitus:
memantine, caroverine, and magnesium.
Memantine has been used in Europe for more
than 10 years as a treatment for Parkinson's disease
and dementia. Oestreicher et al. (1999) proposed
the use of glutamate antagonists, such as meman-
who took oral magne-
sium supplements displayed a significantly lower
incidence of noise-induced hearing loss compared to
the control group. In 1998, a highly motivated patient
elected to undergo a catheter-delivered infusion of
magnesium sulfate to the round window. Within 60
seconds of the infusion, she experienced complete
resolution of her tinnitus. This effect lasted until the
flow of medicine was discontinued 48 hours later.
(continued on page 19)
American Tinnitus Association Tinnitus 'Thday!March 2001 17
Research Update - Toward the Cure
by Pat Daggett,
ATA Director of Research
We received four new
research proposals in
December and forwarded
them to ATA's Scientific
Advisory Committee (SAC)
for review. The SAC evaluat-
ed these grant proposals dur-
ing its February meeting and
will make funding or approval recommendations
to the ATA Board in March.
The following are two updates of ATA-funded
research projects - one still in progress and one
now completed.
Are mechanisms for transient and long-
standing tinnitus different?
Principle Investigator: Jos 1 Eggermont, Ph.D.,
University of Calgary
(This progress report is tentative as we are
about halfway through the planned experiments.)
Ttansient and long-standing tinnitus are likely
different, if only in that transient tinnitus disap-
pears after a while. I experienced this myself
about 25 years ago when I was
at a conference in Paris. We
were taken to a show and had
front row seats. However, the
big band style music was so
loud that after we left (we
stayed for three hours) I had
high-pitched tinnitus until
noon the next day. I had an
Jos J. Eggermont, audiogram at that time but it
Ph.D. showed no hearing loss.
What changes occun-ed in my
auditory system during those 12 to 15 hours?
This is one of the questions that we hope to
answer with this research project. Our initial
results show that there are changes in the audito-
ry cortex a few minutes to two days after noise-
induced hearing loss, including threshold shifts
for the high frequencies.
However, after waiting for at least two
months after a noise trauma was induced,
we found quite different results. Restricted per-
manent high-frequency cochlear damage, as
assessed by ABR, resulted in a profound reorgani-
zation of the primary auditory cortex. We found
18 Tinnitus 'Ibclay/ March 2001 American Tinnitus Association
an increase in spontaneous activity in the reorga-
nized part of the cortex, but no signs of loss of
inhibition. It will be most interesting to observe
what changes take place in the cortex between
two days and two months after the trauma. These
experiments are in progress.
'Itansient tinnitus is likely initiated by a dis-
continuity in the activity pattern in the auditory
nerve, caused by temporary functional loss of
outer hair cells. This causes a temporary hearing
loss and results in a reduction of inhibition at
more central levels that induces hyperactivity
along the auditory pathway and as we observed
also in auditory cortex. This hyperactivity may
slowly result in changes in the strength of synap-
tic connections and in a slow reorganization of
the auditory cortex. This causes vast numbers of
neurons to become tuned to a limited range of
frequencies. These neurons in the cortex are, by
their sheer number, enhancing the sensitivity to
very small activity changes in the inner ear and
so may have increased spontaneous activity
without demonstrating any remnants of reduced
inhibition. Thus, long-standing tinnitus resulting
from noise trauma may be the result of central
nervous system plasticity gone wrong. The chal-
lenge v.rill be to find ways to reverse this plastic
action in a non-invasive manner. B
Mechanisms of Hyperexcitability in the
Interior Colliculus
Principle Investigator: Richard E. Harlan, Ph.D.,
Thlane University
Loud sounds can induce damage to the hear-
ing system and can lead to tinnitus, either within
the ear or in the brain. Sound initiates activity in
Richard E.
Harlan, Ph.D.
specific neurons in the brain,
which process the information
and allow us to recognize and
interpret sounds. As individual
neurons are activated, they
send messages to surrounding
neurons to decrease their activ-
ity. As an analogy, imagine you
are in a crowded room where
everyone is trying to get the
attention of the same person.
You could get that person to
hear you if you could get all the other people to
be quiet. In the same way, neurons try to quiet
down other neurons so that they can be "heard."
Neurons quiet down surrounding neurons by
releasing a molecule called GABA. It is possible
that in tinnitus, the ability of neurons to quiet
down surrounding neurons is decreased. It is as if
an the people are talking at once, and you can't
hear the person you want to hear.
We reasoned that we might be able to
decrease the response to loud sounds by increas-
ing the amount of GABA in the brain. Prior to
exposing rats to a loud sound, we administered
vigabatrin, a drug that is used in the treatment
of epilepsy, and which increases the amount of
GABA in the brain. We found that administration
of vigabatrin decreased the response to sound.
Although these results need to be confirmed and
expanded, they suggest the possibi1ity that anti-
epileptic drugs may be beneficial in some forms
of tinnitus. U
It's Here!
ATA Members Only
. .. the Members Only section of the
American Tinnitus Association Web site. In
this new section, you can read Tinnitus Tbday
online, send a letter to the Editor, and search
for Support contacts near you. Please visit
www.ata.org. Click on the Members Only
button on the left-hand side of the screen.
Enter your ATA Member ID number, found
on your new membership card or on the label
of this magazine. You're in! lf you have any
problems accessing the site, please call
800-634-8978 or 503-248-9985, ext. 221. D
MEDICINES TO TREAT THE INNER EAR (continued from page 17)
Calpain inhibitors may protect the inner ear
from injuries that can lead to noise-induced hearing
loss and some forms of tinnitus. Chinchillas exposed
to noise had significantly reduced hearing loss when
leupeptin, a calpain inhibitor, was continuously
delivered directly to the inner ear. Because its long-
term safety has not been adequately assessed,
leupeptin has not yet been attempted in humans
to treat noise-induced hearing loss and tinnitus.
Antioxidants
Antioxidants are a class of medications whose
primary action is to scavenge free radicals. Schacht
and colleagues demonstrated the possible relation-
ship of dietary factors and ototoxicity. Specifically,
a free radical scavenger (glutathione) was shown
to reduce Gentamicin-induced hearing loss in guinea
pigs. Methionine, an essential amino acid is a
powerful antioxidant that provides protection against
the ototoxic effects of the cancer drug cisplatin.
In one study, both d-methionine and the naturally-
occurring I-methionine, completely blocked the
ototoxic effects of cisplatin for seven days.
Grape seed extract and pine bark extract are
excellent antioxidants. Currently, preliminary
studies in our lab are in progress to understand the
effects of grape seed extract on noise-induced and
age-related hearing loss.
Neurotrophic Factors
Neurotrophic factor (compounds that support
nerve health) including specific growth factors
(chemicals found in the body that support cell
growth) have been shown to aid the regeneration
and repair of hair cells in the mammalian inner ear.
These compounds may provide therapeutic options
for hearing loss and tinnitus.
In one study, NeuroTrophin-3 and another
neurotropic factor provided significant protection
from noise trauma when infused into the inner ear
in the guinea pig. In another study, a gene for
BDNF [brain-detived neurotropic factor] was intro-
duced into the cochlear-damaged inner ears of
mice. This BDNF gene therapy resulted in the
prevention of cochlear nerve degeneration.
Once an obvious mechanism for tinnitus can be
identified, new compounds or currently existing
medications may play a pivotal role in its manage-
ment. It must be remembered that the perfusion
form of treatment presumes a dysfunction of the
ear itself. It is entirely possible that many forms
of tinnitus are brain-related (central tinnitus) and
would not respond to treatment aimed directly at
the ear. It is also possible that through brain imag-
ing techniques like SPECT and PET, we may one
day be able to precisely determine the tinnitus site
of origin in the brain, then inhibit that precise area
in the brain and alleviate tinnitus. B
Contact Dr. Seidman for detailed references on
this article.
American Tinnitus Association Tinnih1s Thday! March 2001 19
ATA Salutes Its Self-Help Group Facilitators
The American Tinnitus Association is honored to
have the following volunteers facilitating tinnitus self-
help groups across the country. Some of our facilitators
are health professionals who share their expertise; oth-
ers are tinnitus patients who offer empathy, personal
experience, and gathered knowledge. All, however, are
to be lauded for giving information, resources, and hope
to their communities - as well as a positive, supportive
forum for tinnitus patients. Call today for more informa-
tion on a self-help group near you. If there is no group
in your area, ATA's Help Network consists of compas-
sionate volunteers who provide coping strategies, treat-
ment experiences, and other meaningful support via the
telephone, e-mail, and mail. For more information,
contact the ATA at 800-634-8978 or 503-248-9985,
extension 211.
Alabama
Loretta L. Sweers
Michigan
Linda Beach Sharon T. Hepfner,
Robin E. Auerbach
184 Ponderosa Cir.
Jack Berman
1307 White Horse Rd. M.A. , FAAA
510 S. 3rd St.
Parachute, CO 81635
19625 Greenwald Dr.
Voorhees. NJ 08043 222 Piedmont Ave. 115200
Gadsden, Al.. 35901
970-285-6582
Southfield, Ml 48075
856-3460200 Cincinnati, OH 45219
256-543-3221
sweers@mail2.gj.net
248-352-1646
Mary-Ann Halladay
513-475-8443
Jackie W. Bishop
Florida
Frank Agosta
5781 Rogers Ave.
sthepfner@aol.com
220 Presley Ave. Dja ne L. Bootz 15830 Fort St.
Pennsauken, NJ 08109 Lee R. Gulley
Gadsden, AL 35901 2734 Thnya 'lim. Southgate, Ml 48195
609-662-6527 Miami Valley Tinnitus
256-549-0181 Jacksonville, FL 32223 810-979-4370
Lynn Wolf
Group
904-308-5465
3435 Pennsylvania Ave.
43181011 Gate Ln.
Arizona Minnesota
Pennsauken, NJ 08109
Bellbrook, OH 45305
John J. Nichols
Betty D. Fisher
Michael M. Paparella, 609-665-5165
937-848-7079
l 0450 E. Desert Cove
644 Woodridge Dr
M.D.
Dhyan Cassie
leergulley@yahoo.com
Fern Park, FL 32730
Ave.
407-645-4024
701 25th Ave. S H200
College of NJ Oregon
Scottsdale, AZ 85259
Jerry Wilkinson
Minneapolis, MN 55454
2000 Pennington/
Marsha Johnson, M.S.,
480-860-5758 612-339-2120
Forcina Hall
JNichols18@j uno.com
38 E. Beach Rd.
CCC-A
'Tavernier, FL 33070
'Ii'eva Crane Ewing, NJ 08628
545 N.E. 47th, 11212
California
305-852-1620
701 25th Ave. South 609-771-2322
Portland, OR 97213
Nelly A. Nigro
Steve Ratner, BC-HIS
Minneapol is, MN 55454
New Mexico
503-309-4223
612-339-2120
Los Angeles Tinnitus
Tinnitus Group of Palm Myrna M. Calkins
oregon7@aol.com
Brad Kuhlman, Ph.D.
Group
Beach County
St. Cloud Hasp l NW -
1409 Girard S.E. Pennsylvania
10755 Holman Ave. 114
5797-B Brook Bound Ln. Albuquerque, NM 87106
Edward J. Cborle
Los Angeles, CA 90024
Pain Rehab
Boynton Beach, FL 33437
l406 6th Ave. North
505-268-8754
124 fifth St.
310-474-9689
561-495-2002 (day)
St. Cloud, MN 56303 New York
Aspinwall, PA 15215
nan igro@com puserve.
561-743-4853 (eve)
320-251 -2700
412-781-9102
com
800-732-9217 (in FL)
Lisa Kennedy
Mari Quigley sratner@yahoo.com Mississippi
808 Garden Dr.
Judith K. Brivchik
9565 Slater Ave. #21
Illinois
Karen N. Fowler, M.S.,
Franklin Square, NY
Tinnitus Support Group
Fountain Valley, CA
11010
of Lancaster County
Re ginald E. Thomas
CCC-A
516-486-67 46
75 Hershey Ave.
92708
892 E. Goodman Rd. 114
714-505-3466
1 467 E. 55th Pl.
Southaven, MS 38671
Elayne Myers
Lancaster, PA 1 7603
717-393-4279
Malvina C. Levy, M.A.
Chicago, IL 60637
662-349-7481
40 Pennyroyal Rd.
1234 Divisadero St.
773-761-6599
Mal ta, NY 12020
Gail B. Brenner, M.A.,
San Francisco, CA 94Jl 5 Indiana
Missouri
518-899-4885
CCC-A
415-921 -7658
Patty John
Marie Richter, M.S.,
layne552@cs.com
1015 Chestnut St., 11300
CCC-A
Harvey A. Pines, Ph.D.
Philadelphia, PA 19107
E. Larry Strom 6440 Lively Ln.
12352 Olive St. Blvd. 21 5-413-0800
In Balance Vestibular Evansvill e, IN 47720
St. Louis, MO 63141
2001 Main St.
heartec@aol.com
Wellness Support 812-4 24-4903
314-514-7800
Buffalo, NY 14208
www.taphelp.com
PO Box 1135
716-882-6194
Los Gatos, CA 95031
Kansas
hearamohue@iuno.com
Ohio
Texas
408-395-7334
Elmer P . Jennings
Edna K. Young
Deborah Saunders
Kansas Tinnitus
1710 NW Obrien Rd. 11102 Christina M. Hewitt
22610 Powell House Ln.
Colorado
Association
Lee's Summit, MO 64081 27 Thai! Edge Circle
Katy, TX 77449
Donna F. Brown 707 S. Lightner
8J 6-246-4644 Powell, OH 43065
281-347-7927
Broomfield, CO Wichita, KS 67218
New Jersey
61 4-885-4140
303-469-1683 31 6-682-6033
CHRISHEWITT@
Milagros E. Rios-
Richard L. Marr elmerjen@gte. net
Lainie Ganley
columbus.rr.com
Walker, M.A., CCC-A
PO Box 481624
North J ersey Tinnitus
Larry E. Maurer
4201 Bee Cave Rd.,
Maryland Support Group Ste. A-102
Denver, CO 80208
Clevela11d Tinnitus
Ann DePaolo
84 N. Prospect Ave.
Support Group
Austin, TX 78746
303-292-6408
Bergenfield, NJ 07621 512-327-3004
1109 Kathryn Rd.
9680 Glenstone Dr.
Luann F. Kirsch
Silver Spring, MD 20904
201-833-7177
Kirtland, OH 44094 West Virginia
3325 S. Kendall St.
301 -622-9672 Suzanne Hohorst Meth,
216-256-8023 Becky Blankenship, M.D.
Denver, CO 80227
303-936-6979
Stephanie Ross
M.A., CCC-A
Elliottmaurer@cs.com 1616 13th Ave. #100
kbob@aol .com
Greater Baltimore
St. Glares Hospital
Ruth G. Bradshaw Huntington, Y.tV 25701
Medical Genter
400 W. Blackwell St.
7195 South St., Route 123 304-522-8800
6701 N. Charles St.
Dover, NJ 07801
Blanchester, OH 45107
Thwson, MD 21204
973-989-3634
973-783-4 613
410-828-2142
20 Tinnitus "'bday! March 2001 American Tinnitus Association
QUESTIONS AND ANSWERS
Jack Vernon's Personal Responses to Questions from our Readers
by Jack A. Vernon, Ph.D., Professor Emeritus,
Oregon Health Sciences University
Q
Ms. C., an audiologist
in New Jersey, fitted
a tinnitus patient
with the best possible hear-
ing aids. And although the
hearing aids worked very
well for speech comprehen-
sion, they did not relieve the
patient's tinnitus. Ms. C.
asks, "Since the hearing loss
produced the tinnitus, why then did correction of
the hearing loss not relieve the tinnitus?"
A
Ms. C., tinnitus is not caused by hearing
loss. Tinnitus is a symptom of something
wrong somewhere that often- but not
always - is accompanied by hearing loss. But
yours is a common finding and the reason is this:
The pitch of tinnitus is usually somewhere
between 7000 Hz and 10,000 Hz. Properly fitted
hearing aids can do an excellent job of making
environmental sounds (in the 250-4000 Hz range)
available such as speech and music. But none of
these sounds is in the higher frequency region of
the tinnitus and are thus not sufficiently high
pitched to mask the usual form of tinnitus. Low-
pitched tinnitus in the presence of low-pitched
hearing loss is relieved by properly fitted hearing
aids. In the future, Ms. C., I recommend that you
not only measure the hearing loss but the pitch of
the tinnitus as well. We once studied 192 tinnitus
patients, all of whom had been informed that use
of hearing aids would relieve their tinnitus. As it
turned out, only about 10% of these patients had
their tinnitus relieved with hearing aids. In each
case of relieved tinnitus, the patient had low-
pitched tinnitus and low-frequency hearing loss.
Q
Mr. P. in California indicates that over a
year ago he had a heart attack shortly
after which his ears started ringing. A
hearing test revealed that he also had some high-
frequency hearing loss. Along with his letter he
included an On Health Web report about Dr. John
Shea's use of lidocaine for tinnitus. Mr. P. wants to
know what we know about lidocaine for tinnitus.
A
Some years ago, we delivered lidocaine
intravenously to 26 tinnitus patients. For
23 patients (or 88% ), the tinnitus disap-
peared and remained that way for about half an
hour after the IV drip was stopped. Two weeks
later we repeated the same experiment with the
same patients and found that almost none had
their tinnitus relieved at all. Dr. Shea's treatment
uses IV lidocaine plus lidocaine with other sub-
stances injected into the ear. Like many sec-
ondary reports, the On Health Web report failed
to indicate two very important aspects of Dr.
Shea's work. At the initial injection of lidocaine
into the ear, 90% of the patients experience a
severe vertiginous (dizziness) reaction. Each
patient is also taking Xanax or another drug
which could well be contributing to the tinnitus
relief. To evaluate any drug treatment for tinni-
tus, have the loudness of your tinnitus measured
before and after the treatment in order to quanti-
fy the actual amount of tinnitus relief. [See also
"Medicines to Treat the Inner Ear" by Michael
Seidman, M.D., page 16.)
Q
Dr. S. in Hawaii makes an interesting
observation that may be of value to
others. He had been taking Xanax for
several months to relieve his tinnitus when the
drug suddenly stopped working. In addition, it
started to give him a "weird" feeling in the head.
At that point, he switched to Klonopin and it
worked well. But after about 12 months, the
strange head feelings returned. When he discon-
tinued the Klonopin, he started to experience
moderately severe positional vertigo and sleep-
lessness. After being off the Klonopin for 10 to
14 days, he returned to it. But the strange head
feelings did not recur and the sleeplessness and
vertigo were relieved. He suggests that drug
"holidays" may be an effective way to restore
the effectiveness of a drug that has lost its
effectiveness.
A
Dr. S., what you have observed is the
rather common effect of tolerance build-
up. There are patients who can take Xanax
and other drugs for eight or nine years without
experiencing the tolerance build-up effect or
noticing that the drugs have lost their effective-
ness. We've found in a few cases the opposite of
(continued)
American Tinnitus Association Tinnitus 7bday/ March 2001 21
QUESTIONS AND ANSWERS (continued)
tolerance build-up, that is, patients can reduce
the amount of a drug they take once the tinnitus
has been initially relieved and still obtain the
same relief. The concept of a drug "holiday" is a
new one to me and certainly an interesting one.
Q
~ r . ~ - in New York vvrites that he has had
tmmtus for the past 20 years which he
was able to tolerate. But the tinnitus
became much louder this last year. He tried hear-
ing aids but they had no effect on the tinnitus.
He asks if there is anything he can do to relieve
the tinnitus.
A
Mr. E., it is possible that your tinnitus
got louder due to a drop in your hearing
ability. Or it may be that the tinnitus for
reasons unknown simply got louder of its own
accord. You indicate that the tinnitus is a hissing
sound and that means that most likely it is high
pitched. It is for this reason that the hearing aids
did not help the tinnitus. For more on this topic,
see the answer provided for Ms. C. on the previ-
ous page. What you really need are tinnitus
instruments, devices that are a combination of
high-frequency hearing aids and high-frequency
tinnitus maskers. One adjusts the hearing aid
portion first to get the high-frequency hearing to
the best level possible and then adds in the high-
frequency masking sound to relieve the tinnitus.
Any hearing aid dispenser or dispensing audiolo-
gist can obtain these units for you to try.
Q
Mr. S. in California writes, "Due to an
infection, I was given large doses of
antibiotics and Lasix. The result is that I
am now completely deaf in both ears and have
very severe tinnitus. T have tried everything from
acupuncture to Xanax to cranial massage but with
no effect. My ENT physician said that a cochlear
implant might restore hearing for the implanted
ear as well as eliminate tinnitus on that side.
I had the implant done, but unfortunately it
had no effect on the tinnitus. And the restoration
of hearing has been minimal at best. I am now
considering having the hearing nerves surgically
sectioned, so I'm writing to ask if you know of a
surgeon who you would recommend for this
procedure. I am willing to travel anywhere."
22 Tinnitus 7bday/ March 2001 American Tinnitus Association
A
A patient many years ago had his hearing
nerve sectioned (severed) in the tinnitus
ear. The result was that the tinnitus
increased fivefold after the operation. Don't have
the nerve severed. Any hearing that you can pre-
serve in any way will at least reduce the tinnitus.
Also, a cochlear implant needs a good, intact
hearing nerve to function. By keeping your hear-
ing nerve, you '11 be able to take advantage of
improvements in implant technology as they
occur. But I can suggest something to try.
Another cochlear implant patient has found great
tinnitus reliefby listening to masking sounds
through the cochlear implant. He uses a band of
white noise from the Moses/ Lang CD (available
from the Oregon Hearing Research Center,
503-494-8032), but other masking CDs and sound
sources can be used. Please do not give up hope,
Mr. S. There is much you have not yet tried. (See
"It's Not About the ImplantH on page 7.]
Q
Ms. F. in Florida writes to say that about a
year ago, anENT physician removed the
cerumen (wax) from her ears using water
under pressure. This produced tinnitus in both
ears that has persisted unchanged to this day.
She feels that her ears now need cleaning again
but wonders how she can have it done without
having it increase her tinnitus.
A
We always recommend that ear cleaning
be done manually and not with pressur-
ized water or a high pressure vacuum.
Starkey makes a "video otoscope" with a fiber
optic tip that allows EN'TS to view the ear canal
on a computer screen and see the operator's wax
removal manipulations in large and very clear
detail. We recommend that you call Starkey
(800-328-8602) and ask for the Star Service
department to find a physician in your area
who uses this device. I have seen this apparatus
in operation. It is by far the safest and most
thorough way to clean the ear canal .
Notice;: Many of you have left messages requesting
that I phone you. J simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:00a.m. -noon and 1:00 - 5:00p.m.
Pacific Time (503-494-2187) . Or mail your questions
to: Dr. Vernon cl o Tinnitus Today, American
Tinnitus Association, PO. Box 5, Portland, OR
97207-0005. Or send e-mail to: vemonj@ohsu.edu.
Back Issues of Tinnitus Today
The following is a list of the featured topics in each
issue ofTinnitus Today. Every issue also contains
research updates, Dr. Jack Vernon's Q&A column,
information about selfhelping, and (from September
1994 to the present) Letters to the Editor.
The cost per issue:
$2.50 (member price); $5.00 (non-member price)
To order back issues of Tinnitus Tbday:
Use the order form on the last page of this
journal or on ATA's Web site (www.ata.org). Write
in the date(s) of the issue(s) that you want. For
orders outside the U.S., p1ease can (800-634-8978
ext. 220) or e-mail (tinnitus@ata.org) for shipping
costs.
Supplies are still ample for most issues listed.
A few, however, are available only as photocopies.
Every effort will be made to send the originals
to you.
December 2000: Hair Cell Regeneration: Implications for
Tinnitus Relief, Health Insurance and Tinnitus, Medical
Intervention for Tinnitus, Tinnitus Spouse Survival, Tinnitus
Today Readership Survey Results
September 2000: Masking in the Millennium, A New Look
at Lidocaine, Acoustic Neuroma, Hypnosis: Often
Overlooked Therapy for Tinnitus, Filing a Successful VA
Claim, Curing Tinnitus with a New Pair of Genes
June 2000: Advances in Tinnitus Research; Hormones and
Tinnitus- an Informal Study Opportunity; Tinnitus
Treatment in Israel; Quiet Appliances
March 2000: Alternative Management of Tinnitus, Part n
- Herbal Remedies; Quinine and Its Effects on Outer Hair
Cells; Tinnitus Caused by Sudden Changes in Pressure
December 1999: Alternative Management ofTinnitus,
Part I - Vitamins and Minerals; Worldwide Look at
Tinnih1s; Progress through Research
September 1999: TRT vs. Masking Study; Letters Home
(Patient's Account of Tinnitus 'Iteatment)
June 1999: Gaze-evoked Tinnitus; Tinnitus and TMJ
Dysfunction; Perfusion of the Inner Ear via Round Window
Membrane; Tinnitus Research Consortium
March 1999: Tinnitus 'Thrgeted Therapy; Tinni tus in
College (Music and Non-music Majors); Acoustical Effects of
Air Bag Deployment
December 1998: Managing Meniere's Disease; Ginkgo
Biloba and Tinnitus; Where Does Tinnitus Come From?
Sep tember 1998: Sound Sensitivity- Hyperacusis and
Recruitment; Pulsatile Tinnitus; An Audiological
Perspective; ATA-funded Research; A Self-help Journey
J une 1998: Tinnitus Treatments for Veterans; Tinnitus and
Our Emotions; Air Bags - Why this Issue Hasn't Gone
Away
March 1998: $1.5 Million Awarded for Tinnitus Research;
Tinnitus Retraining Therapy; Cognitive-Behavioral Therapy
December 1997: Air Bags- One Year Later; Interview
with Researcher Alfred Nuttall, Ph.D.; Reducing Tinnitus -
Food for Thought
September 1997: New PET Research Study; Back to School
- Children and Tinnitus; Tinnitus and Homeopathy; 1996
Tinnitus Patient Survey Results; Tinnitus Transformation -
from Sufferer to Survivor (PHOTOCOPIES ONLY)
June 1997: Barometric Changes and the Ear; New Drug
Research; Elderly People and Tinnitus; Air Bag Ruling? -
Still Up in the Air; You Can Overcome Your Tinnitus
March 1997: New NIDCD-funded Tinnitus Research;
Treatments for Subjective Tinnit us; Similarities between
Tinnitus and Chronic Pain
December 1996: Air Bag Safety - Air Bag Risk; Interview
with Researcher Jos Eggem1ont, Ph.D.; Thles of Tinnitus
Recovery
September 1996: Ototoxic Medications; Silent Dental Work;
Interview with Researcher James A. Kaltenbach, Ph.D.;
Rising Above the Cacophony
June 1996: Tinnitus and Hyperacusis: Multi-Therapies
neatment; Celebrities with Tinnitus; Glossary of Hearing
Terms
March 1996: Tinnitus and the Law; Otosclerosis; Interview
with Researcher Pawel J. Jastreboff, Ph.D.; The Way of
Peace
December 1995: Miracle of Masking; William Shatner and
ATA; De-stressing Techniques
September 1995: Fifth International Tinnitus Seminar;
Doctor to Doctor - Tinnitus Patient Evaluation; Elementary
School Hearing Conservation Program
June 1995: Electrical Stimulation; Cochlear Implants;
Temporal Bone Donations; Ginkgo Biloba and Animal
Research (PHOTOCOPIES ONLY)
March 1995: Drugs and Tinnitus Relief; Bio-Ear update;
Letter to a Friend
December 1994: Alternative Therapies- Another Look;
Sleep Management
September 1994: TMJ - a Profile; Ototoxicity
June 1994: Hearing Protection Devices; A Message of
Hope
March 1994: Auditory Habituation; Thles of Tinnitus
Recovery (PHOTOCOPIES ONLY)
December 1993: Ending the Silence: The Lowdown on
Alternative Tinnitus Therapies; Ginkgo Biloba; Research
Plan (PHOTOCOPIES ONLY)
September 1993: Tinnitus: How is it Generated?; Hypnosis
June 1993: '!ypes of Hearing Loss
March 1993: Anatomy of the Ear; Research report
(PHOTOCOPIES ONLY)
December 1992: TMJ
September 1992: Industrial Liability Case
June 1992: ATA history; Monitoring Your Tinnitus
March 1992: Interaction of Earmold Acoustics, Real Ear
Resonances, and Tinnitus Masker Responses
December 1991: Fourth International Tinnitus Seminar;
Personal Injury lawsuits
September 1991: Tinnitus in the Nursing Home; Research
Report; Cochlear Implants
June 1991: VA Info; Hyperacusis; Research Highlights
(PHOTOCOPIES ONLY)
March 1991: Noise and Tinnitus; Thny Randall
December 1990: Tinnitus Measurement; Drug Therapies
September 1990: Older Americans and Tinnitus; Research
Report; ADA
June 1990: Cognitive Therapy; Amplification
March 1990: Noise-induced Hearing Loss in Musicians;
Vestibular Disorders; Tinnitus in the 14th Century
December 1989: Tinnitus Patient Management; Allergy
Potential
The following issues ore available as photocopies only:
September 1989: Tinnitus Severity Scaling; Consumer
Tips; Tinnitus in the 16th Century
June 1989: Tinnitus in Burnt-out Meniere's
March 1989: Combined 'Iteatment for Intolerable Tinnitus;
Care for Hearing Aids and Maskers
December 1988: Hyperacusis; Pathophysiology of
Tinnitus; Al Unser and Jeff Float (FIRST ISSUE as Tinnitus
Tbday)
American Tinnitus Association Tinnitus Thday/ March 2001 23
ATAPublic
Forum
San Diego
April 18, 2001
The American Tinnitus Association continues
its Public Forum Series with a special event in
San Diego, California, on Wednesday, April 18,
2001. This free, open-to-the-pub1k forum will fea-
ture notable tinnitus researchers and clinicians as
well as an informative question and answer ses-
sion. For more information, please contact the
ATA at 800-634-8978, extension 211. 9
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let two wafer-thin micro-stereo speakers nestled within a plush full-size
pillow ease your Tinnitus troubles today. With a speaker jack that fits most
radios, cd players, and televisions, the Sound Pillow delivers the soothing
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24 Tinnitus 7bday/ March 2001 American Tinnitus Association
$39.95
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$49. 95 regular price
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(877) TINNITUS
(846-6488}
SPECIAL DONORS AND TRIBUTES
ATA's Champion Members are a remarkable group
of donors who have demonstrated their commitment in
the fight against tinnitus by making a contribution or
research donation of $1000 or more. Sustaining
Members have given memberships or research donations
at the $500-$999 level. Contributing Members have
given memberships at the $250-499 level. Supporting
Members have given memberships at the $100-499 level.
Research Donors have made research-restricted contri-
butions in any amount from $100 to $499.
Contributions to ATA's 'fribute Fund will be used to
fund tinnitus research and other ATA programs. If you
would like this contribution restricted for research,
please indicate it with your donation. Tribute contribu-
tions are promptly acknowledged with an appropriate
card to the honoree or family of the honoree. The gift
amount is never disclosed.
Our beartfelt thanks to all of these special donors.
All contributions to the American Tinnitus Association
are tax-deductible.
Gifts from 10-2-00 to 1-01-0J
Champion Members
(Conrri5urions of $1000 and
abouo)
Joel Alexander
Julia R. Amaral
Greg Armstrong
Susan Bently
Stephen Chandler
Anthony G. A. Correa
William J ~ Curry
Laverle H. Gordon
Neil Hammond Gordon
Ronald K. Granger
Claude H. Grizzard, Sr.
Donald L. and Bluma
Hcm1an
Helen J. Hersrud
Jerry lnfeld
Khairy A. Kawi, Ph.D.
Cheryl D. McGinnis
John E. Meehan
Mary B. Meikle, Ph.D.
John L. Mercer
Stephen Moksnes
Aaron I. Osherow
Dan PUJjes
Robert Schiller
Rudi Schulte
Susan Seidel, M.A., CCCA
Wanda M. Shannon
Saul N. Silbert
Paula French Vanakkeren
Jack A. Vernon, Ph.D.
Laura Winston
Adelaide W. Zabriskie,
Ed.D., CFA
Sustaining Members
(Conrribunons of $500999)
Robert H. Boerner
J'eter 0 . Bonanno
George Crandall, Jr.
Rob M. Crichton
Michael D. Deakin, CPA
Joseph Decker
Katherine A. Elberfeld
James and Donna Fijolek
David H. Goodman
Josephine K. Gump
Christopher V. Houghton
John w House, M n
Stephen W. Lewis
Don Morse
John K. Orrell
Jerome Ott
Thny Randall
Jerome A. Rich
N. Schaefer
William Shatner
Paul Siskin
Barbara F' Sturtevant
William E. Thrley
Contributing Members
(Contnburio>lS of $250-499)
Jsabela Allen
Robert K. Ashworth
Randall C. and Elise
Ducote
David E. F1atow
Lynne A. Grader
Shirma M. Huizenga
Marsha Johnson, M.S.,
CCC-A
Grant Jones
Bernard Kaminsky
Sidney C. Kleinman
Charles Kostel
T.H. Lang
Emily Laurent
Ed Leigh McMillan, II
Paul J. Meade
Norma Mraz, M.A., C C - C ~ A
Elisabeth J. Nicholson
M. Frank Norman
John K. Orrell
Sheila A. and William F'.
O"en
Thomas l'anno
William B. Salsgiver
Alan L. and Sandra Scharff
Timothy S. SolOS
Morton and Norma Steele
John R. and Deborah Lee
Steiner
Keith C. Winters
Steven Young
Supporting Members
(Conrribunons of $100.249)
Joseph C. Alam
Thm c. Aldrich
Barbara B. Allen
Lloyd T. Amaral
David R. Anderson
George A. Anderson
MichaelS. An.zia
Ralph w. Arend, Jr.
Marianne Ariyanto
Brewster L. Arms
Scott Badger
Edgar P. Bailey
Barbara Baker
Roy Barna
Robert C. Bashford
Thelma P. Batchelder
Dan Beach
Anson Hill Beard
Kaye E. Bechtold
Michael H. Beck
Jda J. Beebe
Alan D. Beggs
Ivan H. Behrmann
Robert L. and Joan M.
Benedetti
Philip Benedict
Martin Berenberg
Howard G . .Bernett
Sanford Blaser
Walter Blood
ruchJrd A. Bolt
Mario J. Bonello
Alain G. Boughton
Dennis Bradbury
Don Brice
Knox Brooks
Ralph C. Brown
Kristin J. Bruno, Ph.D.
Michael Burnham
Don Burns
Peter E. Campbell
Paul Carmichael
Santo Castillo
Don M. Chance
Charles J. Chiefie
F. Lawrence Clare, M.D.
Kenneth B. Cohen
Lois N. Cohen, CSW, ACSW
Gardner C. Cole
PhilipS. Collins
Chip Conlan
Michael L. Connolly
Anthony G.A. Correa
Lee M. Covitt
!Uchard D. Crafton
Don Crichton
Richard v. Cripe
Thd A. Curreri
Elizabeth J. Curtis
Joel C. Curtis
Le1.ris M. Cutter. Jr .. O.D.
Scott Dahlberg
Marco Dalla Ragione
Dennis M. Daly
Ali Danesh
Pierre David
Donald W. Davis
Mary Kay H. Davis
Linda Deane
D. M. Deardorff
Mary Ann Desutter
David Dewindt
Robert and .Jennifer Digisi
John Dimakopolous
H. Renwick Dunlap
Eric D. Eberhard
William R. English
Douglas C. Erikson
Thomas J. Fallon
Burdell S. Faust
Stephen and Gwen Fausti
Dwight W, Fawcett
Thm Fawcett
Nick Fender
!Uchard J. Filanc
Charles F'ischer
Bernard F' ishman
John J. F'lavio, Jr.
Julius F1ores, II
Mary A. F1oyd
Ron Fowler
Hugh fraser
AI Frei
Katherine L. French
Joana L. Frick
Larry F'ureigh
. Terry R Gaston
Veronica s. Gates
Perry Gault
Richard Gensler, D.D.S.
Beverly and ran Cetreu
Eric M. Gibber
Jeanette Gingold
John Jay Gimcr, Ill
Thomas Gleitsman
I. Larry Goldman
Andrew Good
Richard L. Goode, M.D.
J. Fred Gord11er
Christine Graf
Herbert Greenberg
Norman and Gilda
Greenberg
Seymour Greenstein
John P. Griesbach
John M. Grillos
Murray Crossan, M.l.).
Donald D. Guito
Abraham Habenstreit
Robert Hager
William J. Haskin
Sara Lee I latlcm
Thm Hattrup
Jean E. Havens
Ray Haydock, Jr.
Alrred E. Heller
Thomas Henkel
Rosemarie HerreraPena
I. Highstein, M.D.
Basil liodczak
'Thea D. Hodge
James R. Hoffman
Lynda M. Hoffmann
Paul S. Holbrook
Max Hom
Carolyn s. Horton
Scott Howlett
Shirma M. Huizenga
John C. Hunter
Joan Lmber
Jerry lnfeld
Gary P. Jacobson, Ph.D.
Lucille J. Jantz
Barbara H. Jenkins, M.S.,
CCC A
Nils P. Jensen
Robert L . Jeske
Bob Jones
Louis I. Jones
Cynthia C. Kahn
J im Kaloris
Greg Kaminski
!Uchard S. Kaufman, D.D.S.
Fawzi Kawasb
Mavis Kennedy
Myles Kessler, M.D. and
John Kveton, M.D.
Donald King
Horst Klein
Dennis s. Kohara
Robert Krotin
Barbara Krt1ger, Ph.D.
Eroa Ladage
Richard R. Landon
John M. Lappe
Eric C. Larson
Jennifer Fargo Lathrop
Donald w. Lemmons
Stanley D. Levin
Shirley Lewis
Richard E. Linde, M.D.
Romulus Z. Linney
William Lipira
Gary L. Lombardi
Palmer R. Long
Barry Lord
Sandy Lubin
John A. Lucian
Stan M. Lumsden
Jon H. lut-z
J . Patrick Lynch, M.D .
Thrrcncc Maclean
Vince Majerus
Barry Malkin
Carol and Al Marsella
Aaron J. and Jean Martin
William Hal Martin, Ph.D.
Norma M. Masella
Michael 'T. Matherly
John and Sandra Mathey
Douglas E. Mattox, M.D.
Richard E. McAdams
Michael L. McQuinn
David L. Mehlum, M.D.
Jennifer Melcher
Juerg Meng
F. N. Merralls
George A. Meyer
Mark Meza
Frank Milgrom
Anton P. Milo, M.D.
Roger M. Moak, Esq.
Miles Morgan
Don Morrow
Ruby S. Muniz
Nancy w. Munroe
Joel M. Mynders
Patricia A. Navarro
Glenna L. Neilsen
Lynn Nelsen
Brian R. Nelson
Donald P. Nies
Nelly A. Nigro
Laura Numeroff
Jerome A. Olson
Robert John Olsson, M.A.
PhyU is R. Ongert
Allan F. Pacela
Robert W. Palchanis
Ronald D. Parriott
John R. Patrick
John R. and Sara A.
Patterson
David D. Pearce
Phil R. Pearcy
Roger J . Peters
James B. Pittleman
Viktor Pokorny
Robert L. Pope
Margaret L. Possert
Howard M. Potiker
Ann L. Price
Dan Purjes
Alan C. Quirion
Shann Rand, M.A., CCCA.,
FAAA
Theo Regello
Florence S. Reich
Gloria E. Reich, Ph.D.
Gerald B. Renyer
Cornelia R.ich
Bernard Richards
Michael Riley, D.O.
Francis E. Robinson
Thomas J. Rodgers
Lynn Rosemurgy
Andrew J. Rosser
Howard Rothenstcin
Ira D. Rothfeld, M.D
Arnold Rowe
Jay T. Rubinstein, M.D.,
Ph. D.
frederick J. Ryan
F'ardin Saiidi
Jack Salerno
Robert. Sandlin, Ph.D.
Stewart Sandman
Berty Santangelo
Eugene Saporito
Jim L. Savage
Joseph J. Schall
Bruce A. Schommer
William T. Schreitmueller
Rudi Schulte
Ed Scott
Kathleen M. Seibel
Snsan Seidel, M.A., CCCA
Michael D. Seidman, M.D. ,
FACS
Hilmer H. Shackelford, Jr.
William Shatner
Alice L. Shields
Forrest Shook
1erry SJajr Sidwell
Richard Siletti
Raymond C. Simon
Gary Singer
Robert C. Sittig
Don L. Six, Sr.
David V. Skillman
Harlan w. Smith
Martin Smith
Patricia A. and Richard
Smith
Ronald E. Snow
Timothy S. Sotos
Manin Stanley
Leo Starkey
Natalie P. Stocking
Ed Street
Roger B. Sturgis
Robert J . Suchomski
Robert F. Sutherland
Loretta L. Sweers
Leon and Carol Thger
Gary Thmblin
Chuck Thai
Judith J. Tharrington
Alfred Thrco, Jr.
Ma1tuel Udko
Robert D. Utsey, Sr.
Monica Sue Vanbrussel
Brian Vanputten
Howard E. Voit
Albert E. Wareikis
Susan T. Wargo
Gerda Wassermann
David P. Weiner
Edward R. Weiss
John H. Werden
Bryan B. Williams
W. Williams
James B. Wilmot
Laura Winston
Keith c. Winters
Haymond Z. Wojtusiak
Pat Wollowick
Robert E. Wolons
Larry K. Wray
William F. Wray
Brax Wright
John W. Yottng, Jr.
.loan C. Zanfagna
Brad Zc:rman
Research Donors
(Comnburions of $100 to 499)
Gerald Aus
Adele Engel Behar
Beverly J. Digregorio
Mary M. Doyle
Frank L. Giancola
Richard P. Cross
E. Alan Hildstrom
Scott Howlett
fawzi Kawash
Ronald J. Kotnisk.i
John Malcolm
Philip 0 . Morton
Larry A. MoWTer
Michael F. Otero
Kathy Peck
Mary Ann Perper
Job n R. Priebe
Lynn Prior
James J . Steponik
Loretta L. Sweers
William R. Thwer , Jr.
Richard S. 1)11er , Ph.D.
Richard P. Woodbury
Marilyn C. Zekaria
TRlBUTES
In Honor Of
Nick Andrews
Paul S. Holbrook
Virginia Fitzgerald
PhQenix Tinnitus Support
GrOllp
.Dan a11d ed PUtjes
Paul Siskin
Gloria E. Reich, Ph.D.
Phoenix Tinnitus Support
Croup
L. Newton Thomas
David W. Skillman
Jack i\. Vernon, Ph.D.
Rich Alger
Dennis Daly
InMemoryOf
Ann Bro...n Gerber
Marcy F'eldman
Melani Cash
Anita N. Bauer
Dr. Trudy Drucker
Jim and Rosalie Traver
Morton Garelik
Marcy F'eldman
Earl and Lois Grt:enwood
Kaye E. Bechtold
AI Laurent
Emily Laurent
Eugene McFarland
Arlo and Phyllis Nash
Sally Michalski
Veronica S. Gates
Jack B. Nagler
Jerome Ott
Jack Reich
Florence S. Reich
Elaine Riggs
Peter J. McDonagh
Carmen Rivera
Debra Abel, M.A., CCC-A
Earle Van
Clint and Arvera Alleman
Ruth Wasserman
Marcy F'eldman
Corporations With
Matching Gifts
Chase Manhattan
F'oundation
Chicago Tribune
F'oundation
Kemper Insurance
Companies
Millipore Foundation
American Tinnitus Association Tinnitus Thday/March 2001 25
ATA Products Catalogue
ATA offers educational products for patients and
professionals. 1b purchase any ofthese products, call,
e-mail, visit ATA's Web site, or return this completed order
form by mail or fax. ATA members receive a discount on
all products. Thank you for your order'
FOR ORDERS IN THE U.S.
Mail: ATA. P.O. Box 5, Portland OR 97207-0005
Call: 800-634-8978
Fax: 503-248-0024
Web: www.ata.org
FOR ORDERS OUTSIDE U.S.
Call: 503-248-9985 or E.-mail: tinnitus@ata.org
for shipping cost
Prices effective January 2001 - subject to change
Please Allow 4-6 weeks delivery within the u.s.
Shipping & Handling in U.S.
If your subtotal is: Please add:
up to $6.00 S 1.00
6.01-24.99 4.00
25.00-49.99 6.00
50.00-74.99 8.00
75.00-99.99 10.00
100 00-149.99 15 00
Over 150.00 20.00
PLEASE PRINT - Complete information required. (Street address preferred.)
Name ATA ID # (if available)
Street Address City
Mailing Address City
Country Daytime telephone number (
Research Contribution
Grand Thtal (l'.S. doll ars)
(Prepayment required - Sorry, no
E-mail
State Zip/ Postal Code
State Zip/ Postal Code
Fax number (
0 Enclosed is my check payable to ATA
0 Bill my: Visa/ MasterCard Card Number Expiration Date: Signature
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chart
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ASSOCIATION
P. O . .Box 5
Portland, OR 97207-0005
Address Service Requested