DECEMBER 1992 VOLUME 17, NUMBER 4

Tinnitus Today THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION

"To carry on and support research and educational activities relating to the treatment of tinnitus and other defects or diseases of the ear."

1£o[iday (jreetings

IN THIS ISSUE: Tinnitus of TMJ Origin

Are You a Fear Junkie?

Tales of Tinnitus & Recovery - #2

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Tinnitus Today Editorial and advenising oflices: American Tinnitus Association. P.O. Box 5 Port­land. OR 97207 Executive Director & Editor: Gloria E. Reich, Ph.D. Editorial Advisor: Trudy Drucker, Ph.D. Advertising sales: AT A-AD, P. 0. Box 5, Port­land, OR 972r.J7 (800-634-8978) Tinnillls Today is published quarterly in March, June, September and December. lt is mailed to members of American Tinnitus Associat.ion and a selected list of tinnitus sufferers and professionals who treat tinnitus. Circulation is rotated to 200.000 annually. The Publisher reserves the right to reject or edit any manuscript received for publication and tore­ject any advertising deemed unsuitable for Tinni­IIIS Today. Acceptance of advertising by Tinniws Today does not constitute endorsement of the ad­vertiser. its products or services, nor does Tinnitus Today make any claims or guarantees as to the ac­curacy or validity of the advertiser's offer. The opinions expressed by contributors to Tinnitus To­day are not necessarily those of the Publisher, edi­tors, staff. or advertisers. American Tinnitus Association is a non-profit hwnan health and wel­fare agency under 26 USC 501 (c)(3) Copyright 1992 by American Tinnitus Associa­tion. No part of this publication may be repro­doced, stored in a retrieval system, or transmitted in any form, or by any means, without the prior written permission of the Publisher. lSSN: 0897-6368

Scientific Advisory Board Ronald G. Amedee. MD, New Orleans. LA Robert E. Brwnmen. PhD, Portland, OR Jack D. Ciemis. MD, Chicago, £L John R. Emmett, MD, Memphis, TN Barbara Goldstein, Ph.D., New York, NY Richard L. Goode. MD. Stanford, CA Chris B. Foster. MD, San Diego. CA John W. House, MD. Los Angeles, CA W. F. S. Hopmeier. St. Louis. MO Robert M. Johnson. PhD, Portland, OR Gale W. Miller, MD. Cincinnati. OH J. Gail Neely, MD, St. Loui>, MO Jcny Northern, PhD, Denver, CO Robert E. Sandlin, PhD, San Diego, CA Abraham Shulman, MD, Brooklyn, NY Mansfield Smith, MD. San Jose, CA Harold G. Tabb, MD, New Orleans. LA Alfred Weiss, MD, Boston, MA Honorary Board Senaror Mark 0 . Hatfield Mr. Tony Randall Board of Dir ectors Edmund Grossberg, Chicago, IL Dan Robert Hocks. Portland. OR Robert M. Johnson. PhD, Portland, OR Philip 0 . Morton, Portland, OR Aaron I. Oshcrow, St. Louis. MO Gk>ria E. Reich, PhD. Portland. OR Thomas Wissbawn, CPA, Portland, OR

The Journal of the American Tinnitus Association

Volume 17 Number 4 December 1992

Tinnitus, ringing in the ears or head noises, is experienced by as many as 50 million Americans. Medical help is often sought by those who have it in a severe, stressful , or life disrupting form.

Contents

4

11

12

13

16

17

Tinnitus of TMJ Origin: A Preliminary Report by Douglas H. Morgan

Are You a Fear Junkie? I Was. by Syd Hunt

Mission 2000 ATA's Long Range Plan

Self Help: News from the Groups by Laurie Bauer Rosborough

Tales of Tinnitus and Recovery by Elliot Wineburg, M.D.

Meetings Update by Patricia Daggett & Gloria Reich

Regular Features

7 10 18 19

Questions & Answers Media Watch: Tinnitus in the News Tributes, Sponsor Members, Professional Associates Books Available, Donation Form

Cover photo: Mt . Hood ( 11,235 ft .), Oregon's tallest peak, reflects into Lost Lake in the Mt. Hood National Forest. Photo by Larry Geddis, Gresham, Oregon Cartoons: Thank you, ATA members: P.J I, AI Testa; P .JJ &14, Beuy Mathis; P.17, Ernie Olson .

Tinnitus of TMJ Origin: A Preliminary Report

by Douglas H. Morgan, D.D.S., La Crescenta, California What follows is an abbreviated version of the report pub­lished in "The Journal of Craniomandibular Practice", Apri/1992. The complete report is available from Dr. Mor­gan or through the ATA Bibliography service. The research was supported by a grant.from the American Tinnitus Asso­ciation.

History A syndrome in which ear and sinus symptoms

were related to disturbed function of the temporo­mandibular joint (TMJ) was first described by Cos­ten in 1936. That same year, Goodfriend also wrote concerning ear symptoms related to dental factors. In 1969, Bernstein et al. wrote ofTMJ dysfunction masquerading as Ear Nose & Throat (ENT) dis­ease; and in 1971, Morgan wrote of results of joint surgery correcting pain, dysfunction, tinnitus, and vertigo. More recently, in 1984, House etal. related the results of TMJ surgery over a 14 year period. In this study there was an elimination or improve­ment in over 80% of the pain symptoms. In the symptoms other than pain, including tinnitus, there was an elimination or improvement of the tinnitus in 39%.

These cases involved individuals who had osteoarthritis of the TMJ that did not respond to non-surgical treatment. Their chief symptoms were pain and dysfunction. However, a significant percentage also had tinnitus, vertigo, subjective hearing loss, nausea, and other otologic symptoms. One patient had no pain and/or dysfunction, only severe vertigo and moderate tinnitus. X -rays and a clinical examination revealed he had severe osteoarthritis in the right TMJ.

It was explained to him that surgery was usually accomplished for pain and/or dysfunction. He had been to a center specializing in problems of the ear, but no otologic basis for his Meniere's­lik:e symptoms could be found. He agreed to TMJ surgery on an experimental basis. After surgery the vertigo was eliminated and the tinnitus loudness was reduced. Although an individual might have ear symptoms related primarily to a TMJ disorder, this area is not usually considered or examined unless there are apparent TMJ symptoms.

4 Tinnitus Today I December 1992

In 1962, Pinto described a tiny ligament that seemed to connect the malleus, a bone in the mid­dle ear, to the capsule and disk of the TMJ. He noticed that when the ligament was moved, the chain of ossicles(the bones of the middle ear) and the tympanic membrane( the ear drum) also moved. This provided one possible explanation for the TMJ-ear connection. In 1986, Komori confirmed the presence of this ligament by his dissections. However, he was unable to show movement of the middle ear bones and tympanic membrane, possi­bly due to the condition and preparation of the specimens he used.

Similar relationships appear in articles by Ar­len in 1977 (the Otomandibular Syndrome); Frumker & Kyle, (tinnitus: a symptom of TMJ dysfunction), 1987; Morgan (TMJ, tinnitus and related symptoms), 1987; Williamson (inner rela­tionship of internal derangements of the TMJ and headaches, vertigo, and tinnitus), 1990; Ruben­stein (symptoms of crania-mandibular disorders in patients with tinnitus), 1990; Eckerdal (petrotym­panic fissure as the connecting link between the tympanic cavity and the TMJ),1991; and Ash and Pinto (relationship of the middle-ear and TMJ due to the sphenomandibular ligament or the disk­omalleolar ligament), 1991.

Materials and Methods A computerized mandibular scan and elec­

tromyographic studies were done on each subject,

TMJ, (Continued)

S(/,ematic· of thl' umporomamlibult~r JUIIII.

a ted with TMJ dysfunction is often reported. Ad­ditionally, specialized dental X-rays were taken of the areas where most TMJ related osteoarthritic damage occurs. Clinical examination involved a careful palpation (feeling with the hands) of the jaw, face, and neck muscles for "trigger points." Information from these areas was recorded as were joint sounds such as popping, clicking, snapping, or crepitus (the rattling sound of bones rubbing together). Lastly, the joint itself was palpated for soreness.

Results Table 3 shows the results of the various ex­

aminations. It is interesting to note only 4 of the subjects were women. It is often stated that TMJ is primarily a female disorder. Our experience has been that it affects men and women almost equally. Scan No.1 showed 14 of the 20 or 70% had abnor­mal opening and closing movements of the mandi­ble. Scan No.2, the velocity trace, demonstrated 70% of the subjects had abnormal velocity meas­urements on opening and/or closing.

Ninety-five percent of the subjects x-rayed had some indication of organic osseous (bone) changes in the joint. A diagnosis of internal de­rangement or disk disease was not attempted from these x-rays. However, if x-rays revealed a bone­on-bone contact in the joint with erosion of the temporal and mandibular components and distinct crepitus could be heard, it is not unreasonable to infer that the disk was compressed and perforated.

Muscle trigger points as defined by Travell and Simons were found in 75% of the individuals palpated.

Scans No.9 and No.lO, which related to elec­tromyographic studies of the right and left anterior temporalis and medial masseter muscles, indicated 75% had abnormal electromyographic scans be­fore the muscles were relaxed. Afterward, when the muscles were pulsed with a transcutaneous electrical nerve stimulation unit for 45 minutes, there was only a 25% hyperactivity of the same temporalis and masseter muscles.

Joint sounds that were clearly audible with a stethoscope in one or both joints were next noted. These sounds were described as popping, clicking, snapping, or crepitus. It was discovered that 20% of the subjects had some type of joint sound. Inter­estingly, only two individuals were aware of occa­sional joint sounds. The other two people were not conscious of these sounds until the examiner brought them to their attention. One person com­mented that he wished he had not been made aware of the sound because it now annoys him.

Tinnitus Today I December 1992 5

TMJ, (Continued)

The last examination involved palpating the TMJ. Seventy-five percent of the subjects had some soreness or pain upon palpation. Most of the group was surprised at how painful the joint was to this type of pressure. All of the group denied being aware of any joint pain until they were palpated in this area.

Discussion and Conclusion In 1962 Pinto first speculated that ear symp­

toms could relate to a TMJ abnormality when he showed that a heretofore unidentified ligament which tuns from the front of the malleus to the back of the TMJ causes the middle ear bones to move. In 1974, Watanabe and his colleagues associated tinnitus with hyper-contraction of the stapedial muscle. He demonstrated that severance of the stapedial tendon eliminated this particular tinnitus.

Embryologically, the first branchial arch or Meckel 's cartilage, gives rise to the structures of the TMJ and some of the structures of the middle ear. It is not yet known the exact mechanism by which a pathologic condition of the TMJ affects the middle and inner ear. However, this does occur.

This study presents, for the first time, an examination of 20 individuals whose primary symptom was tinnitus and who were examined for possible tern ooromandi bul ar cfj sorder connection.

These subjects were not known to have a disorder of the temporomandibular apparatus . They did not have pain and/or dysfunction. They were examined by ear specialists who could find no otologic basis for the tinnitus. Some were given medication, nia­cin, histan1ines, and cortisone. None of these medi­cations changed their symptoms.

In some cases, where a sensorineural hearing loss was detected by audiograms, a hearing aid was recommended. This did not help. In some, a mask­ing device was used, which also did not help. However, it must be stated that some individuals with tinnitus are helped by masking devices and/or hearing aids.

The tests perfmmed in this study confirmed 19 of the 20 subjects had one or more radi agraphic and/or dinical indications of organic diseases of the joints.

When an individual bas tinnitus and an otologic examination cannot discover any ear basis for this symptom, an examination of the temporo­mandibular apparatus should be performed.

The List of References is available in the unabridged version of this study. (Please send a self-addressed stamped envelope with your re­quest.)

Table 3 Results of All Tests Performed on 20 Patients with Tinnitus

Abnormal Abnormal scan No. I Abnormal Abnormal Muscle Scan No. 9 saginal and scan No. 2 •·ray finding trigger points and 10 Joint TMJ pain to

No. Age Sex frontal velocity osteoarthritis palpation electromyography sounds palpation

I. 65 M Yes Yes Yes Yes Yes-No No Yes 2. 69 M Yes Yes Yes No Yes-No No No 3. 59 M Yes Y~s Yes Yes Yes-No Yes Yes 4. 65 M Yes Yes Yes Yes Yes-No No Yes s. 38 M No No Yes No Yes-No No No 6. 74 F Yes Yes Yes Yes Yes-No No Yes 7. 29 M No Yes Yes Yes Yes-No No Yes 8 . 60 M Yes No Yes Yes No-No No Yes 9. 47 M NA NA Yes No Yes-No No No

10. 55 M Yes Yes Yes Yes Yes-No No Yes 11. 57 M Yes Yes Yes Yes Yes-No Yes Yes 12. 22 F No No No Yes No-No No Yes 13. 66 M Yes Yes Yes No No-No No No 14. 55 M Yes Yes Yes Yes Yes-No No Yes 15. 51 F No Yes Yes Yes No-No No Yes 16. 59 M Yes No Yes Yes Yes-No No Yes 17. 48 M No No Yes Yes No-Yes No Yes 18. 59 M Yes Yes Yes Yes Yes-No Yes Yes 19. 71 F Yes Yes Yes Yes Yes-No Yes Yes 20. 57 M Yes Yes Yes No Yes-No No No

6 Tinnirus Today I December 1992

Questions & Answers

by lack Vernon, Director, Oregon Hearing Research Center Some questions, due to limited column space and the length of the answer required, have been answered directly rather than through this column. If my answers have provoked unresolved questions, please feel free to submit those addi­tional questions. We have learned about tinnitus primarily from tinnitus patients. Thus, you may have experiences or comments that inspire questions appropriate for this col­umn. lf so, send them in.

Q uestion: "What about the use of Ginkgo biloba for the relief of tinnitus." Mr. D. from Pennsylva­nia.

A nswer: This question has come up several times but allow me to repeat. Ginkgo biloba has not been tested in a controlled manner to determine whether or not it helps with tinnitus. Ginkgo, atone time or another, has been claimed to relieve many things; stroke, memory loss, vertigo, deafness, macular degeneration, impotence, etc. Dr. Ross Coles at Nottingham, England, conducted an open study of Ginkgo and found that 2 of 23 patients obtained slight relief and 2 got very slight relief. Dr. Coles concluded the results of the open study did not justify the time and effort necessary to conduct a properly controlled study. An open study means that both his patient and the experimenter knew that all patients received the drug under study. Ginkgo is not a prescription drug, and thus is easily available. Perhaps that is one of its attrac­tions. (ed.note: We continue to receive articles about Ginkgo. We try to contact the sources for the testimonials in these writings and will inform you when and if we receive compelling evidence of its effectiveness. In the meantime, the substance is said to have an ability to increase blood flow and to be relatively free of side effects.)

Mr. D. also indicated that he has been taking niacin for many years. I realize niacin has often been prescribed for tinnitus on the theory that, as a vasodilator, it would improve the blood supply to the ear. I have never seen a tinnitus patient who has been helped by niacin. But then, if they had been helped, they would not have sought my help. Would they? To recommend niacin is to suggest the tinnitus is actually located in the inner ear when, in fact, we do not yet have tests which can

determine the actual location of the problem gen­erating the tinnitus.

Q uestion: "Is there noise reduction research go­ing on in this country?" Mr. M. from Maryland.

A nswer: No, there is no research devoted to noise reduction beyond testing of ear-plugs and ear-protectors. There are some Federal guidelines about noise for industry but nothing about recrea­tional noise and nothing about ordinary everyday noise. Mr. M. goes on to say, "We talk about a war on drugs, a war on teen-age pregnancy, a war on AIDS, a war on cancer, etc., but how about a war on noise?" I agree completely! We need a war on noise! There is no health problem more prevent­able than the loss of hearing due to exposure to excessive noise.

WE NEED A WAR ON NOISE. Each of you could conduct a war on noise by working through the local public schools to teach the students about the effects of exces­sive noise.

Q uestion: "Are the inner ear hairs altered by the aging process the way the hair on our head is altered- turning gray, thinning, coming out etc.?" Mr. Me from New Jersey.

A nswer: This question was prompted by an ar­ticle about otoacoustic emissions in the Science section of the New York Times (June 9, 1992). The article states that otoacoustic emissions are due to movement of the hair cells in the inner ear.

The cilia on the cuticular plate of the hair cells in the inner ear are very different from external hair; they do not tum gray, etc. The aging process, in my opinion, is a very real phenomenon but it is not simply that the ear gets older- it is an accu­mulation of noise damage over time.

It should be clear that the otoacoustic emis­sions are not tinnitus. That possibility has been tested and found wanting. Those of us working in tinnitus had so hoped that otoacoustic emissions would tum out to be tinnitus so the identification

Tinnitus Today I December 1992 7

Questions & Answers

of tinnitus could be easily and reliably established. Unfortunately, it is not so.

Q uestion: "I invariably awaken with a racing pulse, shortness of breath, and loud pulsing tinni­tus. Can you explain this exacerbation of my tinni­tus, which seems to be caused by sleep?" Mrs. D from Ontario.

Answer: I wish I could. I am complete! y puzzled by the effect of sleep upon tinnitus, which occurs in a small select group of our patients. The fact that you awaken with a racing pulse and shortness of breath suggests that you should see your cardiolo­gist. You say you cannot exercise, and I think you should ask your cardiologist about that. We see many tinnitus patients who are exercising even though for some there is a temporary exacerbation of their tinnitus. It seems, Mrs. D. , that everything has its price.

Q uestion: "My tinnitus happened after awaken­ing from knee surgery. What is the relationship of that surgery to tinnitus?" Mrs. K from Wisconsin.

Answer: I think we may never know the real cause of your tinnitus, but we have heard other patients give a similar description as to the origin of their tinnitus. The main thing is that if the tinnitus is bothering you, we need to see if relief is possible. If, on the other hand, your tinnitus is more of a curiosity, then mark it up as an unusual occur­

rence and forget it. Someone told you your tinnitus was due to the stress of three knee sur­geries. It is almost cer­tainly true that tinnitus can be exacerbated by stress, but I do not think it can be produced by stress.

Q uestion: "Why do I get more relief from heating pads around my neck than I do from pills? Why does motion

8 Tinnitus Today /December 1992 disturb me more than

noise? And, why does Tylenol seem to make my tinnitus worse?" Mrs. K , no address.

A nswer: You did not indicate what pills you have tried, nevertheless, if the heating pad works, use it. It is unlikely that Tylenol has exacerbated your tinnitus. It is possible that if your hearing has declined, the tinnitus will appear louder. You men­tioned movement disturbs you. Does that mean that normal movement makes your tinnitus worse? Or does it mean movement creates unsteadiness or disequilibrium? Depending on the severity of the problem, I'd suggest seeing an otolaryngologist who specializes in balance problems.

Q uestion: "My tinnitus seems to be on a seven day cycle. When I awaken on the seventh day to a hissing in the left ear, it continues for seven days after which there are seven days of quiet and then the cycle repeats itself. Why?" Mr. C. from Penn­sylvania

A nswer: I have heard of tinnitus being turned on and off by sleep but not in such a cyclic fashion. I am almost afraid to make a suggestion for fear I might cause you seven days of noise. But consider this. Something is ongoing during sleep that serves as a trigger or switch to change your tinnitus. Thus, could certain impositions during sleep influence the trigger? For example, while you are in an "ON" phase, could FM masking during sleep activate the "OFF" trigger? Readers, if we find a solution you shall hear about it.

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There Is a growing interest in psychological methods of tinnitus control such as systematic relaxation procedures which help the patient cope with the tension of tinnitus.

Subjects with tinnitus are being taught ways to relax as part of a total tinnitus program which may Include hearing aids, tinnitus maskers and progressive muscle relaxation based on prindples of

conditioning. Relaxation procedures are usually easily mastered and can be performed dally in the patient's home environment It has been demonstrated that the relaxation response can release muscle tension, lower blood pressure and slow heart and breath rates.

A relaxation method has been developed entitled Metronome COnditioned Relaxation (MCR) which has successfully treated for many years chronic pain, tension headaches, insomnia and many other conditions.

The program consists of one cassette tape of Metronome COnditioned Relaxation and two additional tapes of unique masking sounds which have demonstrated substantial benefit whenever the patient feels the need of additional relief. These recordings can be used to induce sleeping or as a soothing backdrop for activity and can be played on a simple portable cassette player.

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Is Tinnitus Fashionable? Of Course Not. Tinnitus T-Sbirts - Funky & Wearable Fund Raiser? We Hope So!

Your Response Needed- Let us hear from you!** Send us a note expressing your interest (post cards are easiest)

'POSTCARD" - SEND TO AT A, POB 5, PORTLAND, OR 97207

T-Shirt Your Name Your Address Your City, State, Zip **To those of you who already sent

post cards, we thank you and have not forgotten you. However, the more shirts we can order at once, the lower the cost per shirt. Therefore, due to the small number of requests ( 40), we have not ordered T -shirts (a few hundred was the goal). We're hoping for more interest so that we can place a realistic, cost-effective order!

Tinnirus Today I December 1992 9

Media Watch: Tinnitus in the News

by Cliff Collins, Oregon freelance writer. Please address clips, including source and date, to Media Watch, PO Box 5, Portland, OR 97207.

"You look perlectly all right. Doctors can't find anything wrong. People wonder what's the matter with you. They say it's all in your head. And they're right."

This neat summary of tinnitus comes from 81-year-old Eva Benson, a resident of Winfield, British Columbia. Benson acquired tinnitus 40 years ago after a bout of meningitis, according to an interview in The Calendar, a community news­paper.

Never heard of The Calendar? My column generally highlights media coverage of tinnitus that originated in major markets and nationally known publications. But each issue, a portion of the mail hails from the hinterlands.

That's good, because small-town newspa­pers, radio and television programs also are impor­tant means of reaching the people- those with tinnitus and related ear problems, and those who might benefit from hearing about these problems and how they may be prevented. If the word is making it into the backwoods and burgs-not just The New York Times- that's progress.

Benson herself said she was one of the 125,000 folks who learned of the ATA through Ann Landers' first column on tinnitus a few years back. She saw it in her hometown paper.

Survival of the fittest: Joseph J. Schall, writ­ing from Colchester, Vermont, responded to my request in previous columns for readers to tell us about historical figures who "experience the phan­tom sounds of tinnitus," as Schall puts it. He re­ports that the great 19th-century naturalist Charles Darwin, father of evolutionary theory, was a tinni­tus sufferer. Darwin joins such previously men­tioned notables as Beethoven, Luther, and van Gogh.

According to Schall, Darwin kept a careful record of the rise and fall of the noises in an attempt to discover what caused his "bad days." Schall adds that Darwin's scientific accomplishments included

10 Tinnitus Today I December 1992

important work in early childhood development as well as botany, geology and zoology.

"I think these examples show that anyone can have tinnitus and that it is possible to use one's strength of will and love of life to overcome the suffering and go on to a very productive life," writes Schall, who rightly figures that if these great men "could get up each day to produce such won­derful works," that should serve as inspiration for all "who have had the bad luck to be visited by these noises."

He also passes words that The New York Times Magazine recently ran a story on comedian Steve Martin, recounting that Martin got tinnitus filming the movie "Three Amigos." Martin "had to shoot over and over a segment in which a gun goes off close to his head, " says Schall. "He since has had rather severe tinnitus," yet has continued to work frequently in ftlms and television. Former actors Ronald Reagan and Hugh O'Brian paid for their cowboy roles with tinnitus and hearing loss; as I recall, Reagan says he got permanent tinnitus the same way Martin did, from a gun firing near his head. O'Brian has urged young people to pro­tect their hearing from loud noises. [ed.note. ATA has written to Martin's agent requesting his help in making people aware of tinnitus and the need to protect their hearing.]

End-of-the-year roundup: A tip ofthe T-cap to Ann Revere (Warsaw, Virginia) and Bill Haskin (Westland, Michigan) for sending in the bulk of the news clippings this time. The Saturday Evening Post ran a brief on tinnitus. Self magazine, the Richmond (VA) Times Dispatch, The Family Handyman, the Detroit Free Press and The Detroit News all carried stories on noise's dangers. And reports continue of young children and teens dam­aging their ears. "We teach our kids to keep their hands off hot stoves and to look both ways before crossing the street," says a musician quoted in one story. "Let 's do the same thing with their hearing."

Are You a Fear Junkie? I Was.

by Syd Hunt, Gwynedd, Pennsylvania. Mr. Hunt has been a member of AT A for many years. We always envied him when he lived in. the British Virgin Islands. How could it be possible to Live in such an idyllic place and suffer from tinnitus?

In my opinion, the British Tinnitus Associa­tion has long been convinced that anxiety is the only cause of tinnitus. Anxiety, however, disguises itself: fretting, hate, worry, dread, overconcern, disappointment, anger, hesitancy, hostility - each springing from basic fear. In 1990 I admitted to years of fear that seemed to generate little "tinni­tuses." Under these little short term noises I could still hear the unchanging long established rumble and roar.

All the fears I recognized seemed superficial. Still, it took lots of doing to rid even superficial fears: worry about the kids; resentment of certain people; disappointment in myself; anger over such trivia as delayed letters- all day long there was a parade of bellyachers. Once I stopped these anxi­eties the little daily " tins" also stopped. The rela­tionship seemed so clear it was actually exciting!

Then I discovered what seemed to be a deeper layer of fear going back a long time. I still had a tinnitus that went day after day varying unrelen­tlessly. This tinnitus seemed more habituated than from superficial anxieties.

Perhaps I had become a fear junkie. I made a drastic change in my life. (That's

how great the "tin" obsession was.) I sold every­thing I had in the Caribbean and moved back to the mainland. I dropped my occupation as a freelance travel writer. In this new setting I challenged each frustration. In less than a year I reduced the daily roaring tinnitus.

Then I developed nightmares. Every night. The strangest thing was that every dream had

the same theme ... unemployment. They went back to before I took early retirement: one time I was displaced by a young man. Once I was given a test which proved I could no longer do a simple task I used to perform regularly. Gradually the night­mares themselves became a disease with tinnitus all day and the terror of unemployment every night.

I howled my exasperation at my niece, a psy­chotherapist: "I have never been unemployed in my whole life. I have gone from one job to another, better. My father was often unemployed. He died a wreck. But not me! Never. Now I have ahead full of noises all day and a dread of unemployment all night. I have never been unemployed."

Quietly she replied, "But you ar·e now." This opened a possible insight into my tinni­

tus. All my early years I felt sorry for my father. I intended never to become an unemployed wreck. This fear· seemed much deeper than the spurts of fear that maybe I had lost the car-keys, or that someone had picked my pocket because, actually, I had left my wallet in yesterday's pants.

Now I had to admit a second level- habituated fear- deep down all my working life.

I cooked up a plan: anything I did which gave me a feeling of being in charge seemed to reduce the tinnitus. I got out all my financial papers and put them in order. (They were all reassuringly cozy.) I wrote a few small articles. Any direct action seemed to reduce the cracklings and crickets - in time, usually the next day.

A lifetime of gut worry is not easily erased.

"I'd rather hear my tinnitus than listen to you Gab, Gab, Gab all day long."

Tinnitus Today I December 1992 11

(Fear, Continued)

Here roughly is a formula; perhaps you would like to try and check it out with other "tin­heads."

List everything that annoys, disgusts, frus­trates you including - most definitely including -people. Decide which is the item or trait that bugs you most. Imagine the best that could be done to remove the irritation. Then list the first feasible action. If it is something such as "murder" substi­tute a less drastic first step such as "avoidance," which might be translated into a long trip, or a new job.

Write it out, even if you see no possible be­ginning. This will irnpa11 a feeling of reality. Savor the act awhile. This will give the thought a sense of possibility, positive thinking, success.

Now do something, even the slightest some­thing, toward the goal: telephone for information; clip a coupon; write a letter that suggests action. If mailing the letter seems too rash, stand it up where you can see your start.

For me, just taking action while thinking of the "tin" reduced the noise a little. When I followed up with recreation and exercise, I got some relief after about eight hours.

I don't expect sudden silence after twenty years of sputtering, cracking, whirling. So far, I have earned several three-week periods of silence. Not much for some people, but for me ....... Hallelujah'

Classified SPECIAL PILLOW CAN RELIEVE EAR

NOISES AND AID SLEEP Your sleeping habit may be robbing you of a proper

night's sleep. The Ear Relaxer can change your life. Austin Skaggs, the inventor of the Ear Relaxer Pillow, reports that it has helped him and many other people who have tried it. It is

comfortable for those who wear their hearing aids or maskers to bed. Testimonials are available on request from Mr. Skaggs. To order, send $17.95 (postpaid), outside U.S. send $20.95 (U.S. funds), for postage paid shipment to:

EAR RELAXER POBOX90 VICTOR WV 25938

Replacement pillow slips are available for $5.00 12 Tmrutus Today I December 1992

Mission 2000

The recently adopted "Mission 2000," a long range plan, calls for action by the American Tinni­tus Association in the following areas: Research, Education/Prevention, Support. The ultimate re­search goals are to identify the mechanism respon­sible for tinnitus, which will eventually lead to its cure; the education and prevention goals are to publicize the affliction and its cause so that it is as well known as cancer or AIDS; and the support goals call for having a full anay of support services in place such as self-help groups, referrals, activi­ties, literature and newsletters.

Within the next year the research plan invites the identification and contact of qualified medical institutions interested in tinnitus research and the release of funds for selected projects. In the field of education and prevention, a marketing plan is called for to produce public awareness materials and place them where they will reach the largest audience. Secondly, an attempt will be initiated to bring awareness of tinnitus and hearing conserva­tion into the school health curriculum.

The A TA staff has already accomplished some of the near term goals in the support area. These are to develop a brochure for tinnitus fami­lies (in publication), to update the tinnitus refenal list, and to recruit new volunteers and board mem­bers. Coming soon will be a revival of the self-help coordinators' newsletter, and additional support for promotiOnal events such as health fairs, senior centers 'activities, and conventions of other hearing related organizations.

If you would like to become involved in these or other ATA activities, or have additional sugges­tions, we would welcome hearing from you.

Tinnitus Bibliography Service The 1992 Update: Bibliography Supple­

ment Number 5, will be ready after January 1st. You may order this supplement to complete your present listings. Send $10.00 US funds only on US banks, or International Money Order, to BBL- ATA, PO Box 5, Portland, OR 97207-0005.

Self-Help: News from the Groups

by Laurie Bauer Rosborough. [Ed.note: Regular readers will notice the addition to Laurie's name. Laurie Bauer and Rob Rosbor­ough were married on September 5,1992. We wish them a long and happy life together.]

Report from a new self-help group: The "Tinn-Kan" Group by Elmer P. Jennings, group coordinator, Wichita, Kansas

The enthusiasm of the group and the fact that a scheduled two-hour meeting lasted two and one­half indicated that the first "Tinn-Kan Group" ses­sion was a great success. We met on Thursday, September 24 at 7 PM in Room 104 of Hubbard Hall on the Wichita State University campus. Our speaker, Dr. Mike Wynne, said he felt that he "hogged" the meeting, but the people wanted an­swers, and Mike has answers. This is the first tinnitus self-help group in Kansas in quite some time; I hope it is not the last. We decided to add a little humor to our group by creating a name for ourselves using "tinnitus" and "Kansas"; thus, the "Tinn-Kan" Group.

We are fortunate to have Dr. Wynne and his family as members of our busy city. Dr. Wynne, who moved to Wichita in 1989, holds a PhD in Speech and Hearing Sciences, an MA in Commu­nication Disorders & Sciences, and a BA in Psy­chology. Mike has had papers published in the Journal for Computer Users in Speech and Hearing and the Journal of the Acoustical Society of Amer­ica. He has presented anum ber of papers at various conventions and has a broad professional back­ground. Besides all that, he is a great guy with a lot of patience and understanding.

Our group was composed of both working and retired people, with a large portion of aircraft-re­lated employees (Boeing, Beech, Cessna, Learjet, and Piaggio make this Wichita's main business). Many fellow aircraft company employees have sustained hearing damage because we didn't know all that noise was hurting us. Machine noises so loud that we had to shout to be heard took a toll . Others in our group sustained head injuries or illness that left its mark. Some have Meniere's Syndrome, some have a hearing loss, some have

supersensitivity to sound (hyperacusis). Through the variety of individual circumstances, we haven't given up, and we look to each other, as caring people with a similar problem, for support.

In starting this self-help and support group, some unexpected seeds have been planted. Mike told me today that because of the interest generated by the group meeting, the Communications Disor­ders and Sciences department will offer a one­credit graduate course on tinnitus in the next summer session! I challenge others in my state to start a group- you never know what will tum up!

This meeting would not have been possible without the help of ATA and Mike Wynne. ATA told me how, encouraged me to do it, and provided copies of Tinnitus Today and other materials. Mike said "If you want to do it, I assure you that WSU will give you a place to meet and I will speak to the group." Thank you all.

.. l~

... _,l ' ·-

~.gf--1---,.- J ... . - _j

f ..... l --r

. ·- ! --'-~.,..........,-l_~T

Computer Support Network Update:

Tinnitus no longer an "Other" in Prodigy (R)

The September 1992 issue of Tinnitus Today announced a sort of "electronic tinnitus support group," using computers to bring people together. Since that time, 85 computer users have "logged on," sharing stories, information and suggestions, mainly through the Prodigy system. Due to the volume of use and efforts of two Prodigy users, the tinnitus bulletin board is now found by name under

Tinnitus Today I December 1992 13

Self-Help: News from the Groups

a "Hearing Disorders" sub-category, rather than "Support Groups - Other."

A variety of reasons:

Through the computer network, users share information on such things as their experiences with tinnitus, legal issues and disability claims, how medications affect their tinnitus, and their reasons for having tinnitus. Reported reasons for tinnitus are as varied as people are different, an observation noted by many self-help group coordi­nators. As an example, the Honolulu group re­cently reported tinnitus began for their group members in conjunction with these diverse events:

> after surgery and use of painkillers

> sitting in front of1V one night feeling stress

> pistol shooting practice plus a stressful period that led to heavy drinking

> aspirin use for arthritic condition

> a long aircraft flight after catching a cold

> sitting at home worrying about retirement

> accident on freeway resulting in whiplash

> stagefright before a speech

> during pregnancy

> accidental blow to head while doing yardwork

> listening to loud music at concerts

> watching the Lawrence Welk show.

We must all remember that each person's situation is different, each person's tinnitus is dif­ferent, and that we all search for the best way to help ourselves. Our job in helping one another requires that we offer infom1ation, support, en­couragement and acceptance.

Pen-Pal Network The Pen-Pal Network has a new address and

can now be reached by sending a Self-Addressed Stan1ped Envelope and $2 for printing costs to:

Lorraine Cran1er PO Box 47172 StPetersburg FL 33743-7172

14 Tinnitus Today I December 1992

To help in matching you with others, you are asked to include information on your affliction, age, and interests.

A note on Doctors: Every day, we hear reports of frustrating in­

teractions between a doctor and tinnitus patient. We are dispirited by this, right along with you! Through our professional referral network, we work to identify professionals who take an interest in tinnitus, who will answer questions and discuss options for relief. A variety of health care providers take part, including doctors, audiologists, hearing aid and masker dispensers, psychologists, psychia­trists, dentists, and biofeedback therapists. We continually revise and work to expand our network, and we need your input! How You Can Help:

Tell your health care providers about A TA: Explain that we have brochures they can or­

der, a tape with the "sounds of tinnitus," a tinnitus magazine, a bibliography of books and articles on tinnitus, support groups, and a referral network.

Tell US about THEM: Send us the names and addresses of any pro­

fessionals you recommend, with a short comment about WHY. If your doctor (or dentist, counselor, audiologist, etc) doesn't know about A TA or could use information about tinnitus, send the name and address, and we 'II introduce ourselves and our services!

Notices

New Tinnitus Brochure

"Tinnitus Family Information" is the latest in the series of brochures about tinnitus. This bro­chure is intended to help families and friends of tinnitus sufferers learn more about the problem so that they may be more supportive and under­standing of the person who has it.

Tinnitus Family Information is an eight-panel brochure. It is suitable for distribution to the gen­eral public. Topics included in the brochure are "Is Tinnitus a Common Problem?"; "How does a Per­son With Tinnitus Feel?"; "What Causes Tinni­tus?''; ''Can It be Treated?"; "Do Certain Things Make Tinnitus Worse?"; "How Can the Family Help?"; and "What is Being Done to Help Conquer Tinnitus?"

You'll find ordering information on the Pub­lications Page at the back of this magazine.

For your convenience, we '11 be enclosing a free copy of this new brochure with each donor acknowledgement for the next few months.

Hocks Award ATA is pleased to announce the winner of the

1992 Hocks Memorial Award for outstanding serv­ice to A TA and the field of tinnitus. This year's recipient is Robert M. Johnson, Ph.D.

Bob has been serving as chairman of the AT A Board of Directors since 1985. He has steadfastly refused to allow us to present him with this honor. This year, however, the board refused to let him refuse!

He joins previous winners: Jack Vernon, Ph.D., Jonathan Hazell, F.R.C.S. , John House, M.D., and Abraham Shulman, M.D.

Congratulations, Bob!

Bequests At this special time of year when gift giving

is uppermost in our minds, we'd like to remind you of ways you can help support the work of ATA that may not have occurred to you.

Gifts of Stock can be made to the organiza­tion. Sometimes a donor gives stock outright and sometimes only the capital gains are given. Your stock broker can advise you about the best method to give to ATA in this way.

Gifts of Real Estate; Often substantial gifts can be made during a person's lifetime which allow the person to retain use of the property while the charitable institution has ownership. This allows the giver to utilize a tax deduction now rather than waiting to transfer ownership after death.

Gifts of Life Insurance; As well as making the institution a beneficiary, a person may assign cash value as an immediate gift and annual policy divi­dends as continuing gifts. For the older person whose children are financially independent, this method of giving is often attractive.

Corporate Gifts; If you are a major stock­holder in your own corporation, you may be able to let the corporation do some of your giving. Your own lawyer can advise you about this kind of gift.

There are many ways to assist ATA andre­duce your taxable income. If you need more infor­mation, contact us . We'll try to help.

Tributes Any gift to ATA can be restricted solely to

research programs by specifying it as a tribute. Another benefit of this type of gift is the apprecia­tion of the honoree or his family who will receive an appropriate notice of your gift. (See page 18)

Tinnitus Today I December 1992 15

Tales of Tinnitus and Recovery - Number 2

by Elliot Wineburg, M.D., The Associated Biofeedback Medical Group, New York, NY

Ruggedly handsome, gray-haired, casually attired: tweed jacket and flannel slacks, all agreed with Lawrence's (not his real name) vocation -professor of philosophy at an Ivy League college. "I'm here because of the sound: an incessant high­pitched whistling- in my ear, in my head- wher­ever. It began two and a half years ago at a summer seminar I conducted. My family doctor reassured me everything was fine but last year it just esca­lated."

"Now I am about to get a bite plate from my dentist but I have no hope it will aid me. For the past half year I have been in a miserable state. And it's not just the ringing. There is something new -fear and panic. I have seen some of the foremost ear nose and throat specialists. They put me through a CAT scan, prescribed diuretics and anti­histamines, and even tried maskers, but nothing helped."

"One doctor prescribed Ativan, one of the tranquilizers. It holds back the panic a little bit. I seem to need two before dinnertime. Am I getting addicted?"

"There are some moments when I think I am coming apart. My head is going helter-skelter. It is very upsetting for my family. I even have thoughts of suicide now. I am sure I am depressed because of this constant noise in my head. Only in the shower do I feel fine."

Placing a two-way stethoscope in the patient's ears and in my own, I was able to reassure Lawrence that he heard a real sound. I could hear it, too. At least he felt he was not crazy.

Course of treatment began with reduction of muscle tension in and about the forehead and jaw areas. Lawrence was asked to insert the little finger in each ear and then move his jaw up and down. Feeling the action of that joint (temporomandibular joint) he understood that muscle contraction in tensing the jaw may have an effect on the hearing apparatus which anatomically is right next door.

16 Tinnitus Today I December 1992

After three sessions some improvement was noted but there was still far more to be done.

"I can't stay too long at parties or put up with the laughter of a crowd. The noise is intolerable." No doctor gives guarantees, but Lawrence's clear need to obtain rel ief spoke for a good prognosis.

Our patient was then begun on a series of stress-reduction biofeedback techniques. Known as temperature training, a very sensitive electronic thermometer was taped to a fingertip. A series of light bars showed differences of 1 one-hundredth of a degree in surface wrumth. By observing when the finger warmed or cooled, he was able to learn actually how to direct blood in the hands up into the fingers which is always accompanied by an overall feeling of anxiety reduction or relaxation.

Lawrence noted that slight improvement was not sufficient. His work with graduate students required lengthy sessions hearing them read their papers in class. The ongoing ringing seriously in­terfered with his earlier superb powers of concen­tration. He seriously considered giving up teaching, his life's work.

At this point an additional treatment was in­augurated. The presence of the sadness and the earlier suicidal thoughts did not go unnoticed. In addition, the panic reactions and the dependency on tranquilizers was a further consideration. After my detailed explanation Lawrence agreed to take slowly increasing levels of an antidepressant.

As will happen with some patients, initial medication proved ineffective but a second antide­pressant was substituted. Now the responses to both the biofeedback therapies and the medication were clearly noted in the marked reduction of tinnitus, a feeling of confidence, and a manage­ment of symptoms. Some ringing remained but it no longer was painfully intrusive. As therapy went on Lawrence found that his work was again pleas­urable and he was able to partake of social func­tions despite the high noise level.

Further stress reduction techniques and symp­tom relief were accomplished with hypnotic re­laxation exercises recorded on a tape so the patient could "take the doctor home wi tb him" and prac-

Tales, (Continued)

tice. A cooperative and energetic approach by Lawrence resulted in abandonment of the use of the potentially addictive tranquilizer. Work pro­ceeded at a splendid pace and in fact during the latter part of his therapy he completed a well-re­ceived book guaranteeing him fame if not fortune in the world of academia.

Depression was gone, functioning had re­turned and management of the tinnitus was easily exercised. Lawrence presented a difficult problem that was only clinically managed by a combination of appropriate therapies, namely antidepressant medication, stress reduction with biofeedback, and sel £-administered relaxation techniques. Work was required on the part of both patient and doctor.

The Lighter Side of Tinnitus by Ernie Olson, Ph.D.

But, Dr. Olson, that was the bell--not your tinnitus!

Meetings Update

International Hearing Society Pat Daggett reports that although attendance

was down from previous national hearing aid con­ventions, this year's event made it possible for her to meet or renew acquaintances with many of the hearing professionals who are part of our referral network. It was especially encouraging to speak with those who have taken the time to obtain positive results for their tinnitus patients. The meeting was held in Dallas, September 9-12, where attendees received a warm welcome from local residents and convention hotel staff. During this past year the association changed its name to the International Hearing Society and the meeting at­tracted many people from outside the US. The AT A was pleased to have the opportunity to make new contacts for helping those who are trying to cope with tinnitus in other countries.

ASHA Consumer Meeting The ATA was asked to participate in a con­

sumer dialogue, sponsored by the American Speech-Language Hearing Association (ASHA), on October 3. The purpose of this gathering was to inform national leaders of consumer groups with an interest in communication disabilities what ASHA is doing, to hear what unmet needs the consumer groups have and to develop specific work plans to meet these needs. Pat Daggett, who represented ATA at this meeting, relayed recom­mendations of interest to those with tinnitus. These included a request for specialized tinnitus training in the certification requirements for hearing profes­sionals and an increased professional awareness through tinnitus courses and seminars at state and national conventions. Annual ATA Advisory Board Meeting

Three new Advisory Board members were elected at the meeting held September 21 , 1992 in Washington, DC. They are Ronald Amedee, M.D. , RobertBrummett,Ph.D.,andBarbaraGoldstein,Ph.D.

Gloria Reich presented the Long Range Plan (Mission 2000), which was developed by the Ex­ecutive Board, and the advisors pledged their sup­port in helping to achieve the goals set out for the next decade.

Tinnitus Today I December 1992 17

Tributes, Sponsors, Professional Associates The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for sharing memorable occasions in this helpful way. Contributions are tax deductible and are promptly ac­knowledged with an appropriate card. The gift amount is never disclosed. IN MEMORY OF Florence Accordino Richard & Hazel Blackwell Phyllis Trotta Robert P Ahrens Nancy J Ahrens Lillian Davis John & Faye Schlater Etalo DeiFiorentlno Leonard & Lucille Counihan Peter & Zelinda Ferrai Mr & Mrs H Sebree Vida J Kern Tom Fagerness Jerry Fagerness Mary Giovagnoli Bernard & Anne Silverman Dr Sewell Gordon Mr & Mrs Efrom Abramson Marilou Johnson's Mother John & Faye Schleter Seymour Mazer Sylvia & Sam Eisenberg Dr Proctor Richard L Ruggles MD Mrs Lena Roemer GAO's New York Regional Office Michael David Shapiro Anne Shapiro IN HONOR OF Nancy Ahrens & Cathi Berke Bergen Tinnitus Group Adele B Alam- Bithday Joseph Alam\Trudy Drucker Joseph G Alam- Birthday Trudy Drucker Jim & Rosalie Traver Mary & Patrick Tully John G Alam

Adele B Alam Jules H Drucker Mora C Emin Julie & John Alam -Anniversary Joseph Alam\Trudy Drucker Gil Berger's Mother-Speedy Recovery Len & Marisue Mayer Jules H Drucker- Birthday Joseph Alam\Trudy Drucker Dr Hugo Gregory Charles E Swain Jr PhD Robert Johnson PhD Bernice Dinner Joyce E Koehler Joseph Alam!Trudy Drucker Dr E R Libby Dr Irwin Rothman James & Janelle Mejia Alex & Linda Mejia William L Reeder - Birthday Ruth & Floyd Gathwright Amanda Slook - Birthday Dennis & Kimberly Slook Dr Bradley Thedinger W L Tigerman SPONSOR MEMBERS JULY TO OCTOBER 1992 Alan J Arnold MD M Craig Bell Thomas W Buchholtz MD Arthur Cellini Clayton School Employees Foundation Robert R Cooper MD Burdell S Faust Ronald T Ferguson Eldin L Fisher Bonnie Foster/ Westone Labs

Wanted! Hearing-Aids and/or Maskers in any condition

Hugh & Carolyn Grogan James C Hansberger Alfred E Heller Lorraine Hizami Robert H Lawrence Romulus Z Linney Frank Long MD William Don Lovell John M McNamara Aaron J Martin Barjona J Meek Phyllis E Meier Joyce Miller Earl R Moore Joy Narcusen Gerard P Niles Jeff L Norris Aaron Osherow Mary Ann Perper Nolan D Shipman MD Dennis & Kimberly Slook Raymond & Sylvia Smith Richard H Smith Helena Solodar Ronald Spagnardi Michael Steelman MD Douglas H Steves Francois Viallon Gentry Yeatman MD CORPORATE SPONSORS Cochlear Corporation PROFESSIONAL ASSOCIATES JULY TO OCTOBER 1992 Nancy J Ahrens, BC-HIS Harold Arlen, MD Natan Bauman, EdD. MSCCC-A Knox Brooks Sidney N Busis, MD R Melvin Butler, MD

Emmett E Campbell, MD Stanley J Cannon, MD George D Charles, DDS J Edward Dempsey, MD M Monica Dietsch Timothy L Drake, NBC-HIS Jack A Erwin, MD Roger Fagan, MSCCC-A Bruce A Feldman, MD Louis T Gnecco, MSEE Paula S Gnecco, MA Eric N Hagberg, PhD K D Haggerty Claude P Hobeika, MD Kenneth R Johnson, PhD Valerie P Kriney, MA/CCC-A Stefan P Kruszewski, MD Alan B Me Daniel, MD Gordon T MCMurry, MD Stephen Martinez, MA Patricia J Michaels Vicki Miller, MS/CCC-A Anton P Milo, MD John T Murray, MD Dorothy Muto-Coleman, MA Alan Nissen, MD Barry S Novek, BC-HIS Philip A Rosenfeld, MD Ira D Rothfeld, MD Irwin Rothman, MD Richard L Ruggles, MD Frank A Skinner, BC-HIS Robert W Sweetow, PhD Glenn Ellen Thomas Michael Tobin Hollis Underwood Frank J Weldele, PhD Richard J Wiet, MD Richard D Zujko, MD

If you have ever wondered what to do with those aids that are just sitting in the drawer, think no further. ATA will be happy to receive them and you will receive a receipt for tax purposes. Some of the aids can be refurbished and given to people who need them and are unable to afford them. Even if they cannot be re-used as is, the parts are needed for repairing other aids. Also, the plastic can be recycled. Your old aid could give someone the gift of hearing! Package the aids in a small box or padded mailing bag and send them to: Hearing Aid Recycle Program- ATA- PO Box 5- Portland, OR 97207-0005. If you are using UPS or another alternate shipper- our street address is 1618 SW First Avenue, Portland, OR 97201, telephone (503) 248-9985.

18 Tinnitus Today I December 1992

4. Describes Hyperacusls,

the problem of super-sensitive ears and how those who have it are affected. Urges protection from noise.

/Jrthi't Jttil! tlr 111f/ll'fNIII(/I 1111\'

Rlr"HARD HALLAM

LIVING WITH TINNITUS

1. Information is given in the form of questions and answers about tinnitus. Covers causes, treatments, and effects.

5. Supportive and useful information for families and friends of people who have tinnitus.

LEARNING TO UVE WITH IT LESLIE SHEPPARD

il1d AUDREY HAWKRIDGE

~

TINNITUS • LEARNING TO LIVE WITH IT

2. Presents coping tips for reducing stress. Lists ways for self­control of tinnitus, and how to seek help.

3. Describes how no ise can cause tinnitus and how to avoid it. Presents levels of permissible noise exposure.

ii~U TIIE SELF-HELP

PROGRAM

John 'Thddey, D.D.S. ...,c-·u.-~,......_.oa...

TMJ THE SELF-HELP PROGRAM

Dealing with the ringing How to recognize a TMJ in your ears through better Suggestions and advice problem, relieve pain and restore understanding and changing from authors who overcame health. When to seek profes-beliefs. much of their misery. sional help.

SEE INSIDE BACK COVER FOR FULL PUBLICATION LIST AND ORDERING INFORMATION.

AMERICAN TINNITUS ASSOCIATION P.O. BOX 5. PORTLAND. OR 97207

ADDRESS CORRECTION REQUESTED