tinnitus today june 1996 vol 21, no 2

7/30/2019 Tinnitus Today June 1996 Vol 21, No 2

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June 1996 Vo lume 21, Number 2Tinnitus TodayT H E JOURNAL O F T H E AMERICAN T INN IT U S ASSO CIAT ION

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

Since 1971Research- Referrals- Resources

In This Issue:ATA's 1996 Patient SurveyWilliam Shatner Testifiesfor Tinnitus ResearchTinnitus and Hyperacusis:A "Multi-Therapies"TreatmentCapitalizing on CelebritiesWe Need Each Other


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Tinnitus T o d ~ y and advertising offices:

Tinnitus Association,Box 5 Portland, OR 97207Director&' Editor:E. Reich, Ph.D.Editor:a Thbachnick

Drucker, Ph.D.ATA-AD, P.O. Box 5,, 800/634-8978

Thday is published quarterly inSeptember an d December. l t isto members of American Tinnitus

and a selected list of tinnitus sufand professionals who rreat tinnitus.is rotated to 75,000 annually.

e Publisher reserves the right to reject orany manuscript received for publicationto reject an y advertising deemed unsuitTinnitus Thday. Acceptance of adver

by Tinnirus 1bday does not constituteof the advertiser, its productsservices, nor does Tinnitus Thday makeclaims or guarantees as to the accuracyvalidity of the advertiser's offer. Th e opinby contributors to Ttnmtusare not necessarily those of the

or advertisers.Tinnitus Association is a nonhuman health and welfare agency26 USC 501 (c)(3)

by American TinnitusNo part of this publication mayreproduced, stored in a retrieval system,transmitted in any form, or by any means,the prior written permission of theISSN: 0897-6368tific Advisory Committee

Orleans, LAE. Brummett, Ph.D., Portland, ORD. Clemis, M.D., Chicago, ILA .Dobie, M.D., San Antonio, TX

R. Emmett, M.D., Memphis, TNB. Foster, M.D., San Diego, CA

Ph .D., New York, NYL. Goode, M.D., Stanford, CAW. House, M.D., Los Angeles, CAM. Johnson, Ph.D., Portland, ORlphia, PAw. Miller, M.D., Cincinnati, OHGail Neely, M.D., St. Louis, MONorthern, Ph.D., Denver, COE. Sandlin, Ph.D., San Diego, CAr J. Schleuning, IT, MD,

Portland, ORShulman, M.D., Brooklyn, NYSmith, M.D., San Jose, CA

Board0. HatfieldRandall, New York, NY

CounselC. BreithauptJones & GreyPortland, ORof DirectorsGrossberg, Chicago, IL

F. S. Hopmeier, St. Louis, MO0. Morton, Portland, OR, Chmn.I. Osherow, St. Louis, MOE. Reich, Ph.D., Portland, OR

The Journal of the American Tinnitus AssociationVolume 21 Number 21 June 1996Tinnitus, ringing in the ears or head noises, is experienced by as manyas 50 million Americans. Medical help is often sought by those whohave it in a severe, stressful, or life-disrupting form.Contents4 From the Editor

by Gloria E. Reich, Ph.D.5 ATA Regional Meeting: Maryland8 NIDCD to Fund T innitus Research9 William Shatner Thstifi.es for Tinnitus Research

by Glo ria E. Reich, Ph.D.10 ATA's Tinnitus Support Network10 Media Noise

by Barbara Th.bachnick11 My Pets, the Spider and the Cricket

by Leon Morgenstern, M.D.14 The Road from Marathon

by Barbara Th.bachnickI 5 Tinnitus and Hyperacusis: A "Multiple-Therapies" ' freatmentby Kenneth Greenspan, M.D.

16 Capitalizing on Celebritiesby Corky Stewart

18 Book Reviewby Barbara Th.bachnick

18 Glossary of Hearing- and Non-Hearing-Related Thrmsby Bena Shuster

21 Public and Professional Awareness22 Bibliography Update23 We Need Each Other

by Michael CohenRegular Features6 Letters to the Editor20 Questions & Answers25 'fributes, Sponsors, Special Donors, Professional AssociatesCover: 'Succulent Sunburst (oil on canvas) by Dorothy Churchill-Johnson.Inquiries to the Indigo Gallery Fine Art & Jewelry, 311 Avenue B, Suite B,Lake Oswego, OR 97034, (503) 636-3454.


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From the Editorby Gloria E. Reich, Ph.D.Hope is the hidden ingredientin research, and here is a measure of hope that should brighten your day.The following is from Dr. PawelJastreboff whose recentresearch work has been supported by ATA. "I am happy toinform you that it seems we dohave in hand an animal model of tinnitus resulting from exposure to sound! The paradigmallows for evaluating the extent of sound-induced

tinnitus in individual rats while i t is insensitiveto the hearing loss per se (conductive hearingloss did not induce behavioral manifestation oftinnitus, and even in animals with soundinduced cochlear injury there was only a mildcorrelation of hearing loss and tinnitus.) Thisfeature of the model is of particular importance,since it is very easy when working on hearingloss-related tinnitus to get results reflecting nonspecific effects which have no direct connectionwith tinnitus. We can measure the extent of tinnitus and hearing loss independently and therefore correlate physiological measurements, suchas metabolic activity, single unit spontaneousactivity, etc. with both the extent oftinnitus andthe extent of hearing loss. We can then determine what features of our physiological mea-surements are really related to tinnitus.""I See What You Say ..."As a hearingimpaired person who reliesheavily on speechreading, I found the "I SeeWhat You Say" tape enjoyable and engaging. (Seeadvertisement in this issue.) I learned some newtricks for recognizing speech sounds on the faceand found Ms. Kleeman's use of descriptiveterms for individual speech sounds such as"pinchers," "lip-biters," ' ~ l o w i n g , " and "teethy"both innovative and easy to remember. I wouldrecommend this tape to people who are selfmotivated and will take the time to use it andlearn from it. The advantages of this self-helpmethod is that you can choose your own time topractice, and you don't risk being in aspeechreading class where you are either the

4 Tinnitus Thday/ June 1996

worst or the best learner. The disadvantage ithat you don't have an opportunity to compayour progress with others. At the very least, tests are good for a few laughs as you compawhat you thought you heard with the actual If your family is willing to watch the tape wiyou, they will learn a great deal about the prlems of listening when the listener's listeninequipment isn't working well. They'll also lethat sometimes giving you a "topic" clue canhelp keep you abreast of a conversation withdisrupting the situation by calling attention tyour difficulty. For example, on the tape thera section called "Tiivia" where you are givenone word cue for each sentence presented. Wjust that one word, it's a cinch to speechreadsentence. Without the cue, it's very difficult. have a friend who hears better now with acochlear implant, but before that she used tonal her husband by making a "T" with her fingers to indicate that he was supposed to cluein on the topic of conversation. The methodworked well for her but I've yet to train my hband to give one word answers to anything!"I'm easily satisfied with thevery best."Quite a few issues ago I told you about mdelight at being able to wear "in the canal" heing aids. After 20 years of the big, behind theaids, it almost seemed as though I had normahearing. Mind you, this is an overstatement bit expresses some of my joy. I was even ablepay less attention to my tinnitus. But, alas, awearing the new aids for more than a year Ibegan to experience what I thought was an agic reaction in my ears. They would itch, burand run, and nothing Iwould do - short ofnot wearing theaids - seemed tohelp. Finally theproblembecame soacute that myear canalsswelled and I


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Letters to the EditorProm time to time, we include letters from ourmembers about their experiences with "non-traditional treatments. We do so in the hope that theinformation offered will help others. Please readthese anecdotal reports carefully, consult with yourphysician or medical advisor, and decide for yourself if a given treatment is right for you. As always,the opinions expressed are strictly those of the letterwriters and do not reflect an opinion or endorsement by ATA.

I m writing to thank you for all the supportand information that you have provided formy patients. As an audiologist, I routinelyrefer patients who have tinnitus to your organization. These people tell me that they havebeen extremely pleased with the ATA, especiallythose who have telephone or computer consultations with Dr. Vernon. I display your magazinein the waiting room of our outpatient audiologyunit and patients enjoy reading it. Thank youagain for all your help.Lisa B. Kaye, M.C.S.D. I CCC-A, Director ofOutpatient Audiology, Framingham, MA

Fr the past year I have been suffering

from tinnitus which came on graduaUybut intensified to such an extent that it

interfered with my sleep and dominated mywaking existence. My daughter, who is aresearch biologist, got on her computer andaccessed a report on an experimental study thatemployed ginkgo. I immediately began to usethis substance which I obtained through a mailorder drug firm from which I buy my vitamins.The label simply says "Ginkgo Biloba extract,250 mg."Before the bottle of 100 table ts were consumed I saw definite improvement. The intensity of the signal diminished as well as its lengthof duration. Moreover it became very uneven,hesitating. I t still came on when I did anythingrequiring any intense effort. Gradually itbecame less obvious to me and eventuallyalmost disappeared. Right now it is like quietbuzz from a distance and has ceased to be adominant problem. Once in a while it comes onwhen I awake, but stops completely as I startmy day. I take one tablet every day. At the star tI was taking two but cut back.

Henry Hirschberg, Warren, VT6 T innitus Thday /June 1996

I ave been fitted with inhibit_ors ( ~ a s k e r sfor six months and have noticed mcreasdiminishing of the sounds. The differencastonishing! The treatment is being given byPawel Jastreboff and his associates at theUniversity of Maryland.Charles chuck Atkinson, Millsboro, D

I ead with interest the short discussion ootosclerosis by Dr. Ian Storper in the morecent issue of Tinnitus Tbday. I found itbe a very nice overview of otosclerosis and tpotential treatments. I do however take excetion to one comment made by Dr. Storper.Under the treatment section Dr. Storper statthat "as a result of this procedure, there is nneed for hearing aids and the disease procesessentially removed from the inner ear." I fethat this comment is misleading. The stapedtomy operation only bypasses the otosclerosimprove hearing and conduct the sound presure waves to the inner ear. I t is still possibland often the case that the otosclerosis contues to progress into the cochlea. The stapedemy operation does not eradicate the otoscledisease process.

There has been a significant body of liteture published documenting the use of fluortherapy in otosclerosis. This therapy may arthe progression of the otosclerosis process anprevent cochlear otosclerosis and further sensorineural hearing loss. Thank you for theopportunity to present this point of view.

f. Thomas Roland Jr., M.D., New York,

I ried acupuncture for my tinnitus. The dtor was very competent both in Eastern Western medicine. He hooked the needlup to electrodes and zapped every nerve thacould possibly have any effect on the auditosystem. (It hurt!) I went for three treatmentsThe tinnitus remains the same.I continue taking Paxil and the sensationtinnitus is not as irritating - although the Pdoes not make it any better. Also, I wear themasker constantly. If I do not wear the maskam miserable. All and all the masker/ Paxil cbination helps me to cope and for that I amgrateful.Gladys Gottlieb, flion, NY


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Letters to the Editor (continued)l am a 34-year-old woman who, before May1995, had never heard of the term "tinnitus."I have suffered from chronic tonal tinnitussince that time. I had an MRI that ruled outacoustic neuroma or any other abnormal activity. I did not have a head trauma, nor had I beenexposed to extreme noise or ototoxic drugs. Iusing a masking machine at night tosleep, and by early July, I had resigned myself toaccept it as part of my life.

Then, on July 9th, I awoke with a horribleclicking sound in my ears. For months I wentfrom ear doctors to neurologists in search ofhelp. I was prescribed Thgretol"as a trial" butwithout much hope of help. Now at a dose of 400mg/ day, after four months of use, Tegretol helpsa great deal with the loudness and frequency ofthis rare type of objective ''muscle contractioninnitus." My particular type is called "palatalmyoclonus." I finally found a neurologist at

in La Jolla, CA and doctors at the HouseEar Clinic in L.A. who knew of this conditiond advised me to stay on the Thgretol at a

and helpful.In mid-November, I suddenly began experihorrific shock-like all-body myoclonus at

ight which was not only terrifying but allowed1-1.5 mg/bedtime. Over the past month, this

has greatly helped to quiet this multi-focalmyoclonus and allow me normal sleep patterns,though there is a bi t of sedation from the

presently feel I am back in life afterout of my former, very athletic, and creuctive life. I still have both types of

and the myoclonus I hope will just fadeone neurologist has suggested. I coninue to rely on the Thgretol and Klonopin, longalks, a positive attitude, laughter and getting

my artwork as best I can. I am baffledday how the brain, nervous system andcranial nerves could just "break down"

some aspects of mine have.Kim Frohsin, San Francisco, CA

! n avid woodworker who suffers frominnitus and hyperacusis, both of whichre greatly aggravated by noise exposure,ha d to seek out the best hearing protec

ion available to wear when operating power

tools, hammering, etc. The most effective muffstyle protection that I have found in severalyears of searching is the Peltor model HlOA.They have an exceptional noise reduction rating(NRR) of 29dB and are available through severalwoodworking supply catalogs. I obtained minefrom Trendlines (800/767-9999) for $19.95 plus$5.95 shipping, catalog number: PElO. Peltoroffers several other models with lower NRR ratings. I find their products to be very comfortableto wear.I often wear ear plugs in conjunction withmuffs or in situations where muffs are a bi t tooconspicuous. I highly recommend Max-1 foamearplugs by Howard Leight Industries. They areboth the most comfortable and the most effective that I have found, with a NRR of 33dB. Ipurchased them from McMaster-Carr Supply Co.(404/346-7000), at a cost of $30.20 plus $3.09shipping for a box of 200 pairs (the minimumorder), catalog number: 54725T32. This is thedeal of the century for hyperacusis sufferers.Richard R. Glisson, Bahama, NCI was injured by a NYC bus while I was ridingmy bicycle in 1991 and was hospitalizedfor three months. While in the hospital, Irealized that I had lost partial hearing in myright ear and had developed permanent ringingnoises. I became depressed and couldn'tconcentrate.Since recuperating, I have gone back to run-ning (I was a runner for 15 years before theaccident) which helps me to not think about tinnitus. Also listening to music CDs of rain, thun-der, and animal sounds through head phoneshelps out a lot. If it weren't for find-ing ou t about ATA I still wouldbe alone. By reading lettersfrom others I realize I'mnot alone.Barry Feder,Brooklyn, NY

Tinnitus Thday/ June 1996 7


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NIDCD To Fund Tinnitus ResearchThe National Institute on Deafness and

Other Communication Disorders (NIDCD)announced its invitation to researchers to specifically explore research addressing the "physiologic and molecular bases of tinnitus ." A total of$750,000 is being made available this year tosuccessful grant applicants.According to the NIDCD, "Tinnitus affects atleast 18.5 million people in the Unites States. Itusually results from a disease of the auditorysystem that also produces hearing impairment.Although the initial insult that produces tinnitusmay be known, there is little if any evidenceimplicating specific physiologic or molecularmechanisms in the pathogenic process.Recent advances in the physiology and molecular biology of the auditory system have provided insights into the function of the inner earand the auditory portion of the central nervoussystem.

Letters to the Editor (continued)

D ugs play a most vital part in the relieffrom tinnitus we hope to obtain. Mysource in the proper use of drugs tries tohelp me in this need. We all know that there isdanger in this area of treatment through thereactions drugs can cause.Two previous Letters to the Editor refer to theuse of drugs - one, Elavil; the other, Seldane -to help relieve tinnitus problems. My sourcewarns to NOT USE these drugs when otherdrugs will work without the dangers of sideeffects and reaction. Of course any question ofthis issue is to be thoroughly discussed withone's physician. I offer this only for the welfareof other tinnitus victims.Fred J. Jenkins, Pueblo West, CO

[Ed. Note: It is possible that other drugs were pre-scribed prior to the successes experienced withSeldane and Elavil. See Dr. Vernon's Q&A in thisissue for additional information on drug sideeffects.]


Progress in auditory system research hasadvanced this field to the point that concertedstudy of the problem of tinnitus is now possibAnticipated award date of this grant isDecember 1, 1996. By the time this issue ofTinnitus Tbday is printed, the grant applicatiodeadline will have passed. However,if you would still like informa-tion, please contact Kenneth A.Gruber, Ph.D., Division ofHuman Communication,NIDCD, 6120 Executive Blvd.,#400C - MSC-7180, Bethesda, MD,20892, Telephone: (301)402-3458,FAX: (301 )402-6251, e-mail:[email protected]

MEMOFrom: Phil Morton,

Chairman of the BoardTh: All ATA MembersTb those of you who donated to myresearch appeal in the last issue, thankyou very much.As I mentioned in my letter, the only realhope of finding relief and an eventualcure for tinnitus is through research. Iam determined to raise the funds necessary to push for ongoing, in-depthresearch.If you intend to donate, but haven't yet,this is a gentle reminder. We need yourhelp to reach our goal. Why not sendyour check today while you're thinkingabout it? Be sure to note on it "PhilMorton Research Appeal." Thanks!


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William Shatner Testifies for Tinnitus Researchby Gloria E. Reich, Ph.D.

If you want a work well done,select a busy man:

the other kind has no time.ATA honorary board member William

Shatner took time from his busy schedule tomeet me in Washington, D.C. on March 5, 1996to testify before the House AppropriationsSubcommittee in support of the 1997 budgetfor the National Institute on Deafness andOther Communication Disorders. By coming for-ward, Shatner gives hope to all of us with thiscondition.

Gloria Reich and William Shatner are smiling because theubcommittee was responsive to their testimony in support of

I am asking, in fact, begging you to respond positively to thisto fund tinnitus research.

Representative Bonilla from Texas chairedthe meeting until Chairman Porter from Illinoisarrived. Shortly after Porter's arrival we werecalled to speak. Bill Shatner told the committeehow he had been exposed to a routine explosion30 years ago on the set of "Star 'frek" and hashad tinnitus ever since. He asked the legislatorsto make research monies available that can puta stop to the pain and suffering of tinnitus. Thecommittee members appeared to be moved byShatner's testimony and asked him many ques-tions about how he got it, how it felt to have it,and what he wanted them to do about it.Testimony has also been submitted to the SenateCommittee on Appropriations.

'llTA has been able to fund some research but, as Gloriaoutlined, it takes the sort ofbudget you are considering to reallymake a difference.

'Tb find the magic bullet we all hope for, we need moreresearch. Tinnitus Thday/ June 1996 9


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ATA's Tinnitus Support NetworkA Grateful Welcome to our NewSelf-Help Volunteers!New Support Group Leaders:Ralph Gentry135 Edgewater Dr. , Anderson, SC 29624(864) 224-8578Mort Gulden5179G Europa Dr., Boynton Beach, FL 33437(407) 369-0831Thomas D'Aiuto7205 Kingsbury Cir., Thmpa, FL 33610(813) 628-6168New Telephone/Letter contacts:Harry Hochman3 Railroad Ave., Califon, NJ 07830(908) 832-7641Christina Hewitt27 'Ifail Edge Circle, Powell, OH 43065(614) 885-4140Jeff Bassett419 Colorado Ave., Findlay, OH 45849(419) 425-2243

Media Noiseby Barbara Th.bachnick, Client Services ManagerNintendo's Play It Loud" Campaign -Still Too Loud

In response to last year's public protestagainst Nintendo's "Play I t Loud" advertisingcampaign, the company pulled the offendingslogan from its ads. I t was a triumph for hearingconservation in this country, or so it wasthought. Disappointingly the slogan resurfacedas part of Nintendo's ad campaign early thisyear. According to Beth Llewelyn, Nintendo'sPublic Relations Manager, the original ad thatcontained the "Play I t Loud" slogan ha d just runits course last year coincidental to the concertedoutcry against it.

Per Ms. Llewelyn, Nintendo has no imme-diate plans to withdraw the "Play I t Loud" tag10 Tinnitus 1bday/ June 1996

Jeffrey Selles1605 Norse Pkwy., Stoughton, WI 53589-1193(608) 873-8825

Tinnitus and Meniere'sPen Pal Support NetworkThe national and international Tinnitus aMeniere's Pen Pal Support Network has more th300 members. Each participant receives a me

ber directory listing names, addresses, phonenumbers, lifestyle information (occupation, psonal interests, etc.) and tinnitus particulars(onset, type, treatments/drugs tried). If you ainterested in joining the Pen Pal Network, cotact Lorraine Cherkas, PO Box 47172, St.Petersburg, FL 33743-7172. The cost is $5 in tU.S.; $10 outside of the U.S. To keep the direcry up-to-date, Lorraine asks all members topromptly notifY her of address changes. Hermail address: http:/ home .aol/com/lenni05.Ifyou are considering becomingpart ofourTinnitus SelfHelp Network, either as a groupleader or a telephone and/or letter contact, pleawrite for our SelfHelp Packet of nformation.

line from their ads. "We never meant for kidscrank up their TV's," she said, "just to live lifethe fullest." Their studies show that kids undstand Nintendo's intent. When Llewelyn wasasked if she understood the potential dangersexcessive noise exposure on ears, she had nocomment.Sony Takes the High RoadThe Sony Walkman model# WM -FX405 fetures an "Automatic Volume Limiter System"has two maximum sound output settings - 8and 95dB. (The user can override these settinThe instruction packet contains the followingwarning: "Hearing experts advise against conous, loud and extended play. Ifyou experiencringing in your ears, reduce volume or disconue use." In bold letters, Sony asserts, "Thrn itdown! We want you listening for a lifetime."


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My Pets, the Spider and the Cricketby Leon Morgenstern, M.D., Los Angeles, CA

In his decliningyears, bemoaning hisphysical deterioration,Michelangelo wrote apoem that included thelines, " A spider's web ishidden in one ear, andin the other, a cricketsings throughout thenight."

In this affliction, hewas not alone. In oneestimate, 40 millionAmericans are afflictedwith this auditory phenomenon of tinnitus,with a substantial proportion of them suffering serious disability.Beethoven also experienced a constant buzz in his ears, heraldingthe onset of his progressive deafness. Hedecried the inability of all the physicians he'dvisited to relieve him of his symptoms, andaccused them of making him worse.

Tinnitus is a word derived from the Latin"tinnere," meaning "to ring." The term "ringing"is not adequate to describe the variegated formsof this phenomenon. It may be a whistle a hiss Ia roar, a hum, a buzz, a chirp - or a thousandother sounds that intrude where they do notnaturally belong.I date the onset of my tinnitus to periods ofintense stress occurring almost ten years ago.Mercifully, at that time, the tinnitus was transitory. It was only about a year ago that I began toexperience a continuous, high-pitched ringing inone ear, resembling a flat note on the E string ofa violin.

The constancy of the tinnitus preoccupiedme. As a physician trained to attempt a differential diagnosis of all disorders, I naturally put theworst causes highest on the list. I postulated atumor of the cerebellopontile angle, an acousticneuroma, a serious metabolic disorder, cere

or a dozen other worrisome diagnoses.

The first physician I visited did a superficialear examination, removed some impacted cerumen, ordered audiometric tests, and ended upreassuring me that my ongoing tinnitus wasnothing to worry about. I had been hoping thatperhaps the cause might be impacted cerumen,but this was not the cause. The audiometrictests showed mild depression of acuity in thehigh-frequency range. To my dismay, the tinnitu s continued unabated, reassurance notwithstanding.As the tinnitus continued, I noted some lessened acuity in my hearing. I began to lean forward to catch some phrases uttered in a casualconversational tone. In noise-filled rooms'whether restaurants, meeting rooms, or hall-ways, the ambient noise made it difficult to discern words I should have been able to hearwithout difficulty. In the evenings I had to turnup the volume on the television or miss half thedialogue.

So there I was, along with Michelangelo,having a spider's web in one ear and a cricketsinging, not only all night but all day in theother.Inexplicably, there were some days when Tfelt that the problem had suddenly disappeared,so hardly noticeable was the adventitious soundin either ear. On other days, i t was a highpitched alarm whistle that made hearing underany circumstance more difficult. I tried to correlate this variation in the intensity of the tinnituswith every available circumstance and situationall to no avail.

1 finally came to explain it as a general phenomenon that I called the "periodicity of wellbeing." Some days thewhole body machinery

seems out of kilter -the head, the limbs, thegu t - and all other components of the human

machine feel unoiled andsomewhat awry, not with

any specific disorder, but justa general deviation from the norm of "feelingwell." I t is on these days that the cricket singsthe loudest and the spider's web is the thickest.I t is also on these days that the joints ache a lit-

Tinnitus Thday/June 1996 11


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My Pets, the Spider ... (continued)tle more, fatigue occurs earlier, and energy levelis at its nadir.

Then there are days when the head is clear,the limbs are supple, the joints are painless, andthere is no limit to what can be accomplished.On such days, both the hearing and the tinnitusseem better and hope springs anew that the disorder may have disappeared. This periodicityhas no rhythm or definable explanation.Like most physicians, Ideferred seeking furthermedical attention or advicefor my increasingly annoying affliction. I kept hopingagainst hope that it was selflimiting, that I would awaken one morning to find itgone. I also entertained thefeeble hope that it was alabyrinthitis or some otherbland inflammatory condition that would play itselfout, so I could once againenjoy the luxury of silence.

ly felt as if somebody had seized me by theshoulder and spun me around clockwise. Inutter amazement, I found myself on the grobewildered as to what might have happenehad no t felt faint. My pulse was slow and relar. There was full power in all extremities.major accompanying symptom as I sat on tground was apprehension. It was bu t a singepisode that passed quickly, but worrisome

enough to make me seemedical help again.The second physician, well-known otologist, litened carefully to my cplaints and ordered thebattery of tests usually to investigate my maladAlso ordered was a magresonance imaging (MRprocedure, a new experfor me. With most serioetiologic mechanisms rout, I was given the usureassurance, and resignmyself to living with asensation.Then, two occurrenceshelped catapult me againinto the office of the otolaryngologist. The first of

these was my attendance ata wedding, where the brassypost-ceremony festivities ofband and master of ceremonies blared forth inmegadecibels. The combination of the crowded hall, theaural offense of the band,and the incessant chatter ofthe master of ceremoniesset my ears ringing like a

"Then there are days when the head

I began to make observtions into what made thcondition better and whmade it worse. I t was mbetter temporarily if Ioccluded my ear canalsfingers or cotton, excludall external sounds. Atis clear, the limbs are supple, the times, it seemed to meit was made better if I wrest rather than engageactivity. And there wer

joints are painless, and there is nolimit to what can be a c c o m p l i s h e d ' ~

thousand church bells. Several times, the ringingbecame almost painful, causing me to leave theroom for some relief. For days thereafter, theintensity of the high-pitched sounds in both earscontinued, an unsolicited memento of the raucous wedding.

The second occurrence was a surprise, aphysical sensation that I had never before experienced. Several days after the wedding, on asunny morning while walking with my wife at aleisurely pace, I looked to one side and sudden-

12 Tinnitus 1bday/ June 1996

periods when it was befor no obvious reason. But more than anythelse, it was made better by diversion. If Ibecame occupied with some task or thoughclaimed my complete attention, I was oftenprised that I had not noticed the tinnitus atThis, then, became my most potent weaponagainst the unwanted sounds.

Many things made it worse. Loud noiseany kind inevitably caused a worsening thagered. At home, the tinnitus was worse in srooms than in others, having something to


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My Pets, the Spider . . . (continued)with the configuration of the room. The ringingwas also made worse if I spoke loudly at longintervals. I t was made worse when I was undulyfatigued, when I was under unusual physicalexertion, or when I became upset for any reason. I t seemed to me that there might be somerelation with heightened blood pressure,although I never took my blood pressure onthese occasions. At times it seemed to me that itwas worse on immediately rising in the morn-ing, diminishing as the day went on. At othertimes, the ringing grew worse as the day progressed. Those were my "bad ear" days.

As for the episode of vertigo, I had severalmore minor episodes, but these gradually diminished and eventually disappeared.I should consider myself fortunate, along

with millions of others who have this annoyingmalady, inasmuch as I have only the gardenvariety form of tinnitus. The diagnostic gardenis filled with a vast array of exotic disorders,such as neoplasms, aneurysms, unusual inflammations, malformations, and others. Some of thevarieties are pulsatile, others vibratory. When

Assistive Listening Devicefor Cellular Phones

Palmer Wireless, Inc. offers a free assistivelistening device called HATIS (Hearing AidTelephone Interconnect System) with purchaseof an OKl 1335 cellular phone. The HATIS is ahand-free system that plugs directly into theheadphone jack of the wireless phone, andworks directly with any hearing aid with a

The HATIS can be purchased separately andplugged into any cellular phone that has a2.5mm earphone jack. The cost of the devicealone: $96.85 including shipping. For moreinformation, contact Valerie Thompson c/oHATIS Device, Marketing Dept., Palmerireless Inc., 12800 University Dr. #500, Ft.Myers, FL 33907.

the etiologic agent is unequivocally discoverable, treatment is perhaps possible. For the vastmajority, of which I am one, the cause remainsan unfathomable mystery.

Few things in nature have an elemental purity, such as sunlight or newly fa11en snow.Among them is utter, undiluted, and unsulliedsilence. What provoked my feeling of panic ini-tially, when the ringing became constant, wasthat I should never again experience that exquisite luxury of the pure absence of sound.But as every physician knows, time healsmany ailments by its mere passage. Althoughthe ringing has not changed in character andthere is a gradual loss of auditory acuity, still,neither is life-threatening. Diversion hasremained the most reliable remedy. Anotherdelectable aid is music, which masks, dilutes,and sweetens the unwanted noise.

In short, I have made peace with those twocreatures, who at first I deemed implacable enemies. I have made the spider and the cricket mycompanions for life, my pets. After all, it is theonly way we can live together in peace.

WANTED!HEARING-AIDS AND/ORMASKERS IN ANY CONDITION

If you have ever wondered what to do withthose aids that are just sitting in the drawer,think no further. ATA will be happy to receivethem. Donations to ATA are tax deductible, andwe'll provide an acknowledgement. Simplypackage them up carefully (a small paddedmailing bag is fine) and send to:

ATA, PO Box 5, Portland, OR 97207.Ifyou are using UPS or another shipper; ship toour street address: 1618 SW 1st Ave., #417,

Portland, OR 97201.What happens to the aids that you tum in? Insome cases they can be repaired and given toneedy people or used in charitable missions tounderdeveloped countries. Even if they can't bereused as is, the parts are needed for repairingother aids. (And the plastic is recycled.) Your

IJ old aid could give someone the gift of hearing!



14/27

The Road from Marathonby Barbara Tabachnick,Client Services ManagerOn one side of my desk is astack of research papers thatexamine the problem of objectively verifying the presence oftinnitus. On the other side ofmy desk is a stack of lettersfrom people in every agegroup; from every economic,educational, and social strata; ofboth genders inequal number. In long hand and at great length,these troubled authors describe intimate andnear-identical experiences with tinnitus -though they've never met another soul who has

endured what they endure. I began to wonderif these letters would amount to evidence goodenough to satisfy the "verifiability nay-sayers," ifthese letters are in truth a gold mine unquarried.

1 think of the many ba1lot petitions I'vesigned over the years, the dedicated signaturecollectors who stood in front of supermarketsreasoning for my support, and the democracythat acknowledges petitions from its citizens.I've seen enough names collected to attractnotice, and often to effect change. The powerhas always been in the numbers.Whether an election day goes my way or not,I'm always pleased when I do something. A winat the polls feels a little empty when I'm not inpart responsible for it. And regrets are hard toswallow when an important measure goes dmi\TUin defeat and I failed to act.

So I began to dream: V'lhat if we could turnover tens of thousands of personal accounts oftinnitus experiences to the American MedicalAssociation, the National Institutes of Healththe U.S. House and Senate Appropriations c o ~ -mittees? What if these documents inspiredpowerful political and scientific heads to pushtinnitus research beyond its present limits? Whatif these accounts filled legal data banks, and provided Worker's Compensation committees, SocialSecmity review boards, and the Department ofVeteran's Affairs with indisputable proof at last?What if?

14 Tinnitus 1bday/ June 1996

The 1996 "Tinnitus Patient Survey," inclin this issue of Tinnitus Tbday, may be themeans to that end. Many of the same questfrom the 1992 survey (''How long have youaware of your tinnitus?" "What does your tintus usually sound like?") are included to allous to track long-term changes and patterns. to the survey is our request for your opinioregarding ATA's services, and your experienwith legal and insurance issues. Finally, weinclude a place for you to write a personalaccount of your life since tinnitus. Many pehours will be spent on the surveys - codifytallying, transcribing. We expect and encoura huge response.

Thke caution against the thought that a sgle letter or, for that matter, a single vote cano weight. lt is just not true. What is true isit takes some organizational effort to bring tvotes and the letters home. I've seen dropswater, powerless one by one, turn turbines just a little channeling.Many who suffer with tinnitus do so unweight of unnecessary isolation. The road yare on, you write, is like the unfathomably land lonely passage from Marathon to Athenone that more than two millennia ago suppa solitary messenger and a single message.But it is an easier and far more fruitfultrip if run together. Imagine us traveling down the same road in unisonbearing the very message of that 'ancient herald: Victory.Write your story.Send in yoursurvey.


15/27

innitus and Hyperacusis:"Multiple-Therapies" TreatmentKenneth Greenspan, M.D.In 1973, I created The Center for Stress and

at the Columbiaian Medical Center in New York City.years, many stress-related disordersbeen treated there including tinnitus,

temporomandibular and cervicaldysfunction, migraine headaches anx- Iinsomnia, and depression. Over the pastyears, our treatments have expanded toan integration of supportive and cognive therapy, relaxation therapy, exercises, tapes,breathing, biofeedback, self-hypnosis,imagery, transcutaneous nerve stimula

and psychopharmacology.Most practitioners use only one or two of theten treatments with any given tinnitus

each of these treatments canthat none are as effecas when applied in an integrated approach.is because tinnitus has multiple physical

d psychological causes, and each is at leastsustained by distress. When the above

treatment approaches are utilized, in a manr and sequence that fits the specific physicald psychological needs of the individual, then

are positive and prolonged.By using this "multiple-therapies" approach,had exciting success with tinnitus and

Out of the five patientsare no longer aware of their tinni

and hyperacusis, and the other two have hadThese clinical benefits

treatment ended moreyear ago.Based on these results, Jack Wazen, M.D.,

of Otology and Neurotology atCenter in New

City, Maurice H. Miller, Ph.D.1, Professor ofand Speech Language Pathology atYork University, and I, have joined togethto develop a Tinnitus and Hyperacusisand Research Center. As the center'sDr. Wazen will be responsible for all inievaluations, and for the research control

of 35 patients.2 Dr. Miller is developingaudiological protocol, will test each patient

before and after treatment, and will participatein the evaluations. I will administer the treatments for the 35 clinical research patients, eachof whom will receive the "multiple therapy"approach for a total of 15 one-hour sessions afteran initial screening evaluation.

Our treatment protocol utilizes a model ofcoping and adaptation, based on studies done byCannon, in which he defined the fight-flightresponse.3 Much research has been done thatexamines various aspects of this fight or flightresponse and the heightened arousal of the muscular, sympathetic:, and central nervous system.Patients who suffer from tinnitus and hyperacusis usually exhibit these heightened motor, sympathetic, and central nervous system patterns.All of our techniques work by decreasing thelevel of stress and by giving the patient conscious control over this response.Biofeedback, foT example, decreases thesemaladaptive response patterns through the useof modern technology. The object is to give thepatient moment-to-moment information aboutspecific physiological and psychological processes. This gives the individual an element of control over their distress responses. When we addbreathing and cognitive conditioning techniquesthat reinforce healthier psycho-physiologicresponses, the patient becomes even morerelaxed and in control.

There is a fee for these services althoughmany insurance companies will cover all or partof the treatment. If you would like more information, or are interested in participating in thisstudy, please contact the office of KennethGreenspan, M.D. at the Center for Stress locat-ed at 348 E. 51st Street, New York, NY 10022,(212) 888-5140.l . Or. Miller is ~ ! s o Chief Audiological Consultant at New York CityDepartment of Health.2. There will be a research control status for 50% of patients accepted forthe protocol. These patients will initially (for the first nine months)receive only part of the treatment, followed by the full treat ment at the

end of the nine months.3. Cannon, W.B.: The ~ m e r g e n c y function of the adrenal medulla in painand the maJOr emot1ons. Am J Physiol 33:356, 1914



16/27

Capitalizing on Celebritiesby Corky Stewart, Special Projects Coordinator

He's a delightful person and talented actorbut does the fact that 'Tbny Randall has t i n n i ~ s make a difference to others wjth it? Yes it does.Maybe not directly (unless they're in the "misery loves company" crowd) but by talking abouthis own experience with tinnitus, Thny has donemuch to expand awareness and understandingof the problem.By the same token, when Barbra Streisandgave ATA $25,000 for tinnitus research, it didn'tmean that a cure would be instantly discovered.But it did call attention to the fact that researchinto the causes and treatment of tinnitus is necessary and a worthwhile investment.

An opinion, concern, or illness alwaysseems to have greater relevance for the generalpublic when expressed or experienced by acelebrity or "public" figure. That may no t seemfair, but neither is tinnitus. So what we intend todo is make the best ofboth of them - capitalizeon one to benefit the other.

That is why we were so excited whenWilliam Shatner joined ou r cast. An eloquentadvocate of tinnitus research, he never fails touse an opportunity to speak on our behalf, be itin connection with Star Trek, promoting his lates t book or a general public appearance. And itworks. Through personal letters, he has enticedseveral other celebrities to join ATA and toauthorize use of their names in our publicity.Some, like Steve Martin and Leonard Nimoy,have tinnitus; others, like Hugh O'Brian, don'thave it but joined anyway.

Further, on a recent Late Night with DavidLetterman Show, no t only did Shatner talk aboutATA, his own tinnitus, and how he had recentlytestified on the critical need for tinnitusresearch at federal budget hearings inWashington D.C., but he actually got Lettermanto discuss the sounds he (Letterman) hearsbecause of tinnitus.

16 Tinnitus Thday/June 1996

Needless to say, ATA received lots of calbecause of that show. For many people, it mhave been the celebrity that got their initialattention, but it was the discussion of tinnitthat helped put them in contact with ATA. Sknew what they had but didn't know whereget information, others thought they were ain hearing these strange sounds.We're about to release two new public sevice spots to TV stations nat ionwide (yes, atlong last!). One features Tony Randall and JStiller, the other is by William Shatner. We'rcertain that both will heighten public awareof tinnitus.But, ATA's success depends on our entircast of celebrities - and that includes you. Oyes, even if you don't currently appear on sor screen, you have your audience, your cirof influence. Chances are huge that you cominto daily contact with people who need toknow more about tinnitus and/ or would appciate being asked to help support such a wocause. Thlk about tinnitus and about .ATA. Hus provide information or support to patienand the professionals who treat them. Helpfund research. Help us ring down the curtaitinnitus.

Former First Lady ROSALYNN CARTERjoinedATA in 1and says 'I am pleased to be a member of the AmericanTinnitus Association and strongly support research andeducation programs about tinnitus. As a sufferer myself, that someday soon we'll be able to find a cure for this nagaffliction. (Photo by Rick Diamond)


17/27

Capitalizing on Celebrities (continued)

SONNY LANDRETH has been a SponsorMember since 1984 and proclaimed his supportof the work an d research efforts ofATA in theliner notes ofhis CD 'South ofl-10.' (Photo byDennis Keeley)

STEVE MARTIN knows there's nothing funnyabout tinnitus. He has become an ATAChampion ofSilence to prove it.

Also a Champion ofSilence, LEONARDNIMOY has heard ahigh thin whistle in hisleft ear since anexplosion on the Star1Yek set (which alsogave William Shatnerhis tinnitus).

TONY RANDALL madehis first public servicespots for ATA in 1985.Watch for his latest inwhich he and JERRYSTILLER take to theNew York streets to talkabout ti-nigh-tus (or is ittin-i-tus?).



18/27

Book Reviewby Barbara Tabachnick, Client Services Manager

Life After Deafness - A Resource Book forLate-Deafened Adults, by Berra Shuster, addressesthe practical and sometimes painful aspects oflifestyle adjustments necessary for newly deafened individuals. In a warm and experiencedvoice, the author discusses rehabilitation optionsand tips for successful social interaction, travel,driving, education, and job interviewing. Shusteralso discusses alternative methods of communication for th e technologically-shy (modems,computers), as well as sign language, relay services, speech reading, TTY, hearing ea r dogs,oraJ interpreters, closed captioning, and allmanner of assistive devices.

home). Despite its Canadian flavor, the book solid resource for anyone anywhere who hashearing.Th order, send $20 in U.S. or Canadian fun

plus shipping ($5 Canada, $6 US, $7 Internatito: The Canadian Hard of Hearing Association(CHHA), 2435 Ho1ly Lane, Suite #205, OttawaOntario, K1V 7P2, Canada. Voice: (613) 526-15or TTY: (613) 526-2692.

The book is packed with government andservice agency references for the hearingimpaired communities in Canada (the author's

When You Order Books from ATA .... .It's best if you can keep your membershipnumber handy when you call. (You'll find iton the label of this magazine.) This will helpspeed up the ordering process, take less timon the telephone, and save everyone moneyThank you!

Glossary ofHearing and Non-Hearing-Related Termsby Bena Shuster

(The following glossary was takenfrom Life After Deafness: A ResourceBook for Late-Deafened Adults an d isreprinted with permission from theauthor.)adventitiously deafpersons born with hearing whose senseof hearing has become non-functionalthrough illness or accidentAmerican Sign Language (ASL)in Canada and the United States, avisual-gestural language used as a pr imary means of communication by pe rsons who are deaf; the native languageof Deaf people an d Deaf cultureaudiograma graph showing the degree of loudnessat which a person responds to a soundat a given frequency; loudness is givenin decibels, and frequency is given inhertzaudiologista health care professional who measures hearing and assists individualswith hearing problems; requires atleast a master's degree in audiologyaudio-loop systema system that uses electromagneticwaves for transmission of sound inpublic areas such as theaters. The electrical output from an amplifier is fedeither into a wire loop surrounding theseating area, or into a small individualloop worn around the listener's neck.

18 Tinnitus Today/ June 1996

The signal from the loop ca n be pickedup by the telecoil in many hearingaids. (Hearing aids without a T-switchcan use a special induction receiver topick up the sound.) Also known asinduction loop system.auditory nervethe cranial nerve that carries information from the inner ea r to the brainaural rehabilitationeducation or therapeutic procedures toimprove the effectiveness of the communication ability of the hearingimpaired personsbarotraumarapid or forced air pressure changes during diving or aircraft descentclosed captionstext display of spoken dialogue andsounds included in some television signals and videos. Closed captions are visible on the screen only when processedthrough a caption decoder. (Most newertelevisions have a built-in decoder chip)cochleathe hearing part of the inner ear; resembles a snail in shapecochlear implanta device which directly stimulates theauditory fibers of the inner ear, allowingdeaf or deafened individuals to receivesome auditory information. The internalpart, surgically implanted in thecochlea, is connected to a tiny micro-phone and transmitter (hooked over theear) connected by wires to a speechprocessor (worn like a body hearing aid)

conductive hearing lossa deficit in hearing caused by an abnmality in the outer or middle earcongenitally deafpersons who are born deafDeaf (with a capital D)refers to individuals who are deaf (ohard of hearing) who identify with aparticipate in the language, society aculture of Deaf people, based on signlanguagedeaf (with a lowercase d)an audiological term used to describeindividuals who have no useful residhearing and who generally use sign lguage as their primary mode of comnication. They may also usespeechreacling, hearing aids, and othassistive technology to aid in commucation. See also congenitally deaf,adventitiously deaf.deafened adultspersons who grew up hearing or hardhearing and then experienced a grador sudden profound loss of hearing.They cannot understand speech withvisual clues such as speechreading, slanguage, or reading text (such as reatime captioning or note taking)decibel (dB)a logarithmic measure of the intensitor loudness of sound. The decibel reaing of a sound increases lOdB for eveten-fold increase in loudness. For exaple, a 30dB sound is 100 times louderthan a lOdB sound. This non-linear scorresponds roughly to the way humperceive sound.


19/27

Glossary of Hearing and Non-Hearing-Related Terms (continued)degrees of hearing loss ( in decibels)The faintest sounds a person with normal hearing can detect are at levels of 0to 20dB. With hearing loss, the thresholdat which sound can be detected becomehigher: mild: 26-40dB moderate: 41-SSdB moderately severe: 56-70dB severe: 71-90dB profound or deafness: over 90dBfinge r spellingA form of communication in whichthere is a separate hand shape for eachletter of the alphabet. Words are spelledout letter by letterfluxcoila small device, installed in the receiverof a telephone, which creates an electromagnetic signal compatible with the Tswitch on a hearing aidFM systema group listening system in which a lowpower transmitter broadcasts a signalvia frequency modulated (FM) radiowaves from the sound source to areceiver worn by the listener. FM systems have good sound quality, and theyare useful in large public areas becausethe signals can have a range of over 100meters and pass through physicalobstructionsfrequencythe number of complete cycles a soundsignal makes in one second; the higherthe frequency, the higher the pitch ofthe soundhair cellsthe sensory receptors in the inner earthat translate sound vibrations into messages that go to the brainhard of hearinga term used to describe persons withmild to moderate hearing Joss. Personswho are hard of hearing can understandsome speech sounds with or without ahearing aid. Most people who are hardof hearing are oralists, although a smallnumber learn sign language. Generally,these individuals are committed to participating in society by supplementingtheir residual bearing with hearing aids,speechreading, and assistive technologyto aid communication. Some la te-deafened adults prefer to describe themselves as hard of hearing.hearing ai dan amplification device to assist personswith hearing loss. Hearing aids can beworn in the ear, behind the ear, or onthe body. A hearing aid dispenser is anindividual who sells, fits, and adjustshearing aids and instructs the consumerin their use and care.hearing impaireda generic term formerly used todescribe all persons with a hearing loss,regardless of the degree of loss; nowused only as a description of a medicalcondition

Hertz (Hz)the scientific unit for measuring the frequency of waves or vibrations; equal toone cycle per secondinduction loop systemsee audio-loop systeminfrared sys te ma group listening system, frequentlyused in theaters, in which a transmitterbroadcasts a signal via invisible infraredlight waves. Users require specialreceiversLangue des signes quebecois (LSQ)the French-Canadian sign language, isbased on ASLlipreadingthe skill of understanding spoken language by observing the movement patterns of a speaker's lips. Seespeechreadingmanual deafpersons who are deaf whose preferredmode of communication is sign language; also known as signing deafManually Coded En glish (MCE)a visual representation of Englishdesigned to improve academic achievement. There are three systems of MCE:Signing Exact English, Signed English,and Seeing Essential English. MCE systems are used in educational settingswith childrenMeniere's diseasean over accumulation of fluid in theinner ear causing a fluctuating hearingloss, a roaring sound in the ear, dizziness, and a feeling of fullness in thehead and earsmeningitisa disease of the membranes of the brainor the spinal chord. Sometimes meningitis causes hearing lossneurofibromatosis (NF)a genetic neurological disorder that cancause the formation of tumors on thenerves. Some forms of this progressivedisorder can cause deafness. 'TWo distinct forms of neurofibromatosis havebeen identified: NF-1 (formerly calledReckinghausen's disease), and NF-2(also known as bilateral acoustic neuroma). In NF-2, the development oftumors in the cranial nerve complexaffects the auditory nerves, resulting indeafness and balance problems.otitis m edi ainflammation of the middle ear, usuallycaused by infectionotologythe study of the anatomy and diseasesof the earotorhinolaryngologythe surgical specialty concerned withdiseases of the ear, nose, and throat.Also known as otolaryngologyototoxicpoisonous to the ear; usually refers todrugs such as antibiotics

oral deafpersons who are deaf whose preferredmode of communication is speech andspeechreading; also known as oralistpre-lingual deaf (o r hard of hearing)an individual whose hear ing lossoccurred before normal language skillswere well established (usually before theage of four)post-lingual deaf (o r hard of hearing)an individual whose hearing lossoccurred after normal language patternshad been establishedpresbycus isa sensorineural hearing loss that occurswith ageresidual hearingthe amount of hearing available to ahearing-impaired person in the speechsound frequencies; charted on an audiogram by an audiologistsensorineural hearing lossloss of hearing sensitivity produced bydamage or alteration of the sensorymechanism of the cochlea or the neuralstructures that li e beyondsign languagea formal system of hand configurationsand movements that constitutes thebasis for communication. See AmericanSign Language, Langue des signesquebecois, Manually Coded Englishspeechreadinga skill used by a person with hearingloss to understand speech by observinga speaker's lip, tongue and jaw movements; formerly known as lipreading.The term speechreading is now preferred, since it includes facial expressions, gestures, and body language.TDDsee TTYtinnitusa ringing, roaring, buzzing, or othernoise in the head or ears caused bydamage to the auditory systemT-switcha setting on a hearing aid. Many hearingaids contain an induction telecoil whichis activated by moving a switch on thehearing aid to its "T" setting. The tetecoil can pick up the magnetic field generated by hearing-aid compatibletelephones, assistive listening devices oraudio loop systems.TTYan electronic device with a keyboardand a small screen which enables persons who are deaf, deafened, or hard ofhearing to communicate over the telephone lines; formerly called TDD(telecommunication device for thedeaf); also known as TT (text telephone)in the United States

Tinnitus 1bday June 1996 19


20/27

Questions and Answersby Jack A. Vernon, Ph.D., Oregon HearingResearch Center

[QJMr. S. in Alabama writes to say, "I don'tunderstand side effects. It seems thatalmost every drug has tinnitus listed asa side effect. Is this true? Are the number ofside effects additive? That is, if one is taking twodrugs at the same time will you get all of theside effects listed for both drugs?"First of all, please know that the listingof side effects does not mean that theywill happen to everyone who takes thedrug. Indeed, most of the side effects listed in

the Physician's Desk Reference (PDR) are thoseobserved in only 2% or 3% of the people testedwith the drug in question. For example, in thePDR under Lidocaine the following adversereactions are listed: "Central Nervous System:CNS manifestations are excitatory and/ordepressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus,blurred or double vision, vomiting, sensations ofheat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest." The listing goes on to includeother side effects under Systemic, Allergic andCardiovascular System.Thke a moment and carefully read this listing of side effects. Note that many of them needlittle more than the mere mention to create theeffect listed. Such things as nervousness, apprehension, confusion, respiratory suppression arevery prone to suggestion. Most of all, notice thattinnitus is included as a side effect even thoughit is well established that an IV injection of lidocaine eliminates tinnitus for half an hour or soin 88% of tinnitus patients.Mr. S., side effects do not happen to everyone taking drugs but they do happen to a smallpercentage of patients. Moreover, when sideeffects do occur they tend to habituate and disappear in time. Side effects also tend to be temporary so that if they do appear, cessation of thedrug will usually eliminate them. I think thebest approach to drugs is to discuss them andtheir potential side effects with either your primary physician or your prescribing physician.20 Tinnitus Thday/ June 1996

[QJ Mr. S. In Georgia writes that his tinniis altered by sleep conditions.Apparently when he goes to sleep wilow level of tinnitus it starts to increase in loness which he can stop if he wakes himself uMr. S. asks if there is some chemical in the bthat controls this function.

There is a fairly large number ofpatients whose tinnitus will change inloudness according to the sleep condition. If their tinnitus is loud when they go tosleep, they may wake up with it reduced. Or,is soft and they go to sleep they may wake up

with it loud. The real problem is that the patof sleep does not a1ways reverse the conditiotheir tinnitus. I t only does it sometimes and one understands this problem. I have discussi t with people who investigate sleep, and theare as confused as I am. Your case is differenthat you are able to exercise some control ovthe level of your tinnitus, and the nature of tcontrol causes me to make a suggestion. If youse bedtime masking with a bedside unit, yomight find that the presence of masking hassame effect as awakening yourself. It is worttry. A good bedside masker is available fromMarpac. (See inside front cover of Tinnitus1bday.)

[QJ Mr. P. in California makes the followistatement: "Six weeks ago I came dowwith a sinus infection which is nowcleared up. During the sinus infection my eastarted ringing and they are still ringing. Somdays the ringing is very low - almost gone, asome days it is very obvious and loud. Do I hpermanent tinnitus and, if so, what can be doabout it?"

I would guess that the sinus infectionstarted your tinnitus and that it willgradually go away. For some reason I do not understand, things that cause tinnitucan occur very rapidly while systems that corect tinnitus are very slow. I view it as a posisign that your tinnitus fluctuates; I think thapart of the healing process so don't get discouaged if your tinnitus is mild and acceptable fperiod and then becomes louder. As I said, Ithink that is part of the healing system. We d


21/27

Questions and Answers (continued)no t judge tinnitus as being permanent until ithas remained unchanged for a period of twoyears.

[Q] Mr. T. in Connecticut asks the following:"I have tinnitus which I am able tocontrol fairly well but I do no t want it toget any louder. I have heard of people whosetinnitus was produced by the inflation of the ai rbag in their automobile. Should I disconnect theair bag in my car?"

Some German literature indicates thatthe explosion which inflates the ai r bagproduces a brief sound of 130dB at the

ear level of the passenger and l60dB at the cente r of the steering wheel where the ai r bag iscontained. Sounds of this magnitude are muchtoo loud for tinnitus patients. The fact that theai r bag noise is very brief helps. Keep in mindthat people vary enormously in their susceptibility to hearing damage produced by loud sounds.

Nevertheless, I always think that tinnituspatients are especially susceptible to tinnitusexacerbation from loud sounds, and thus theyshould avoid loud sounds as much as possible.I don't know th e law about air bags inConnecticut but in some states it is unlawful todisconnect air bags. Best to check the law inyour state before you act. If I had ai r bags in mytruck, I would disconnect them, depend uponthe seat belt with a shoulder harness, and try todrive more cautiously.[Q] Mr. B. in New York comments that hehas read several anecdotal reportsregarding patients whose use of cortisone for other reasons brought relief from theirtinnitus too. If any of you have had experienceswith cortisone and tinnitus, please write andshare them with us!

Send your questions to Dr. Vernon c lo ATA,Tinnitus Tbday!Q&A, PO Box 5, Portland, OR97207-0005.

Public & Professional AwarenessEfforts ContinueAcross the West

The unveiling of a new display for ATA,(designed to be easily transported and assembled by one person), occurred at the Th-StateHearing Convention held February 28-March 3in Portland, OR. This annual meeting attractshearing aid dealers from Washington, Oregonand Idaho.Pat and Walt Daggett represented ATA at theannual convention of the American Society onAging March 16-19, in Anaheim, CA. I t was surprising that ATA was the only hearing-relatedexhibitor there considering the prevalence ofhearing problems in the senior population.Salt Lake City, UT was the site of the annualconvention of the American Academy ofAudiology, held April 18-21. Gloria and Pat distributed ATA information to thousands of audiologists on hand. Four sessions about tinnituswere included in this year's program. (Gloriaspoke at two of them.) In the past, it would havebeen surprising to see even one such presentation. We are making progress!

Pat Daggett and ATA's new dif.play.



22/27

ATA Bibliography UpdateThe latest update of our bibliography is nowavailable. The newest list (Supplement #8)

includes 150 newly published article titles abouttinnitus, which can be added to your originaledition. Bibliography update cost: $10. The complete bibliography is available for $40 (members) or $75 (non-members).

The ATA bibliography is a list of approximately 3000 published articles about tinnitus,alphabetical by author, that includes the sourceof the articles and their length in pages. (I t doesnot include the actual articles.)

Th narrow the search for information, wecan compile SUBJECT SEARCH lis ts for you ontopics ofyour choice. (Again, these are lists ofarticle titles, not the articles themselves.) Thecost per subject search: $5 (members) or $10(non-members).You can obtain the actual articles on the subject search list at your library, oryou can order copies of them from us for 10 apage, plus postage and handling. Please call usfirst to confirm the exact amount of your order.Suggested Subject Search 'Ibpics:Acoustic Neuroma

AcupunctureAllergyAntidepressantsBilateral TinnitusBiofeedbackClinical MaskingCochlear ImplantCognitive TherapyDepressionDiet/NutritionDrugs Known to Cause TinnitusDrug TreatmentsEighth Nerve SectionElectrical StimulationGinkgo BilobaHearing AidsHyperacusisHypnosisLidocaineMagnetic Resonance Imaging (MRI)Meniere's Disease

22 Tinnitus 'Ibday/ June 1996

MyoclonusNoiseOtoacoustic EmissionsOtosclerosisPulsatile TinnitusRecruitmentSleepStress/AnxietySudden Hearing LossSurgical ManagementTMJVertigoWhite NoiseXanaxOthers topics ca n be requested. Thke ad

tage of this opportunity to educate yourselfabout individual aspects of tinnitus.

The Combined FederalCampaignSince this will be tonly issue of Tinni7bday to reach youbefore the kickoffthe National VolunHealth Agency'sCombined FederalCampaign for 1996want to remind all

you who are federal employees to send us acopy of your pledge card. We don't want youmiss any of our quarterly reports on the lattreatments and coping strategies for tinnitusATA's national designation number is 0514.Many thanks for your ongoing interest andsupport!


23/27

eNeed Each Other nlcomPosedunre-. adolescence, whe compelled toslnce my love" letters, 1 am this time forquited "puppy te another lettersit down and wn d than myself.someone in more neether dramatic life event,Tinnitus, 1 ~ ~ any o n us: we must care no t

mlSS10n UpOforce a but for oth- .-----I January 4, 1996to feel b e t ~ e ~ . e c a m e more Ms. wR e c e n t l ~ r th the }'{fA as a Finley, TN

Wl d letter contactlephone an e I Dear Ms. w.:rt"1-.e first respons 1 d fi d 1 d _, __1 u I am g a you oun my name as a te ephone an letter contact in Tinnitus TbwAy.from a woman Believe me, your letter of 12/28/95 was very touching.ho sounded What you have written about is pain - pain that is no t talked, empathized, kissedT e n n e s s ~ ~ ; ' wrote: "1 have an d loved, medicated, meditated, or even prayed away. It's a real you-know-what an d i tdoesn't stop.to n t h u m ~ ~ ~ ~ s o t h i n g they I know this because I have had constant tinnitus since this past summer, and evenert .....nltus. It has though r had a $10,000 operation to repair a tear in my cochlea, this did not help my tin-d abou t.u. nitus no r restore much hearing in my right ear. Fortunately. my left ea r is not affected.can life 1f there is Heartbroken after the failure of the operation, I went to a tinnitus "expert." This doctord e s t r o ~ e d ~ ~ c a n . te1l1ne was upbeat about his favorite histamine and allergy treatments. Unfortunately, hope for aa n y t h J horrid disease, I couple of months was alii got because neither treatment worked. The only thing that hasabout thlSld appreciate it." had any real palliative effec t is one .25 mg tablet of Xanax which 1 take every night aboutsure wou ly she an hour before bedtime. With the help of the pill an d a masking device called "Heart andV[hat to do? sure I Sound Soother and timer" se t at a low white noise level and placed next to my pillow, 1knows about the 1 s o t h u r ~ t ~ : usually get a fair night's sleep. And usually rcan get up for work without feeling too ener-h .KfA after a , vated: i.e. Tcan go through a busy day not overcome by self-pity.oft e d me V{hat So I survive. But I would be less than honest if I didn't tell you that there are timeshoW she ~ u ~ l a y ~ a n , when I feel like crying. And there are guilty moments when I wish J could change themore can fferer? 1 time last July when r blew my nose too hard an d screamed at the dog and then, withinoffer a fellow s ~ s i s t a n c e in one hour, felt dizzy, couldn't hear, and the hissing sound WHICH NEVER STOPS started.call directorby at there is no In your letter, you write, "If there is anything you can tell me about this horrid dis-Tennessee, u no ease, I sure would appreciate it .. I'm having a very hard time coping." I can tell you, Ms.

. . NoW 1 have W., that we are all having a hard time coping - whether it's William Shatner, a fellow suf-hstlfig. h first time ferer who is giving his name value to television spots and going to Washington, D.C., tochoice; fort e lobby for more research money, or Michael Cohen, a teacher bumped out of a full-timeposition and now trying to hold onto a substitute teaching job in a chaotic, gang-riddeninner city high school in Chicago while trying to find enough energy to single-parent a14-year-old son full-time.Ms. W., there is no simple response to you when you say, "It has destroyed my life.I've been to numerous doctors who say there's nothing they can do about it! How discouraging to hear this." I can only say that I believe there will be a cure some day , prayerfullyin our lifetime. But I don't believe that a cure is possible unless more of the estimated10 million tinnitus sufferers make some public noise instead of us t Jiving with it" inisolation.What I am trying to say is that each of us, to the best of our ability, has to make achoice. We must decide whether or not tinnitus education and research shou ld be sustained with as much intensity and consistently as the sound of tinnitus itself. 1 think theanswer should be "yes an d that in unity, our sufferings will have some meaning.Again, thanks for your letter, Ms. W., and for listening to my "tinnitus noise." I hopeyou will write back and perhaps give me a telephone number where you can be reached .

All of us - we need each other!Sincerely,Michael Cohen505 N. Lake Shore Dr. #5412Chicago, IL 606ll(312) 321-0783

. 1J day/ June 1996Ti:nrutus o

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Back By Popular Demand ..ATA's Holiday Cards

Guidelines for WritersTinnitus Thday, the Journal of the American

Tinnitus Association welcomes submission of originalarticles about tinnitus and related subjects. Th e articles should speak to an audience of people with tinnitus, and to audiologists, otolaryngologists, otologists,hearing aid specialists, and other medical, legal, andgovernmental specialists with an interest in tinnitus.

Manuscripts should be typewritten, doublespaced, on plain paper and should include title;author(s) name(s) and biographical information; and,when appropriate, footnotes, references, legends fortables, figures, and other illustrations and photo captions. Our readers like to "see" you. Please include areproducible photo. Generally, ar ticles should notexceed 1500 words and shorter articles are preferred.If possible, submit manuscripts on 3.5" diskette inWordPerfect 5.1 or higher format (IBM compatible) .Please do no t submit previously published articles unless permission has been obtained in writingfor their use in Tinnitus Thday. (Please attach a copyof the written release to the article submitted .)


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Tributes, Sponsors ... (continued)Sol CharenMichael S. CheckeAurelita ChervenRosanne ChilcoatLoretta C. ChoyJohn B. CliftonWillie L. CoberlyJames J. ContradaDonald J. CookJohn B. CorcoranWard S. CottrellHarold T. CrawfordPriscilla CrombieGlen R. Cuccine lloDennis M. DalyLori M. DelamarterRobert B. DellbruggeCarole DesnoesCarl D. DistefanoRosa and William DixonFrances Kaufman Dofl:Thelma D. DryJames T. DuckworthHoward 0. DuggerMr. and Mrs. Harold F. EalerMillicent B. EdgertonJames EisenbacherPaul EtxeberriMichael A. FerraroWilliam D. FinnellEunice FitzellMary A. FloydJuanita R. FochaLarry c . FochtMartin E. FosslerFranklin L. FountaineJames A. FoxxNorman FrankelLewis and June A. FreedmanHarlan R. FreySherry L. FreyJim Ray FugateVivian L. GallonGabriel B. GavinoFlorena GenzinkOlga GeoreffPam and Greg GibbsWilliam R. GillamMadge GlassSeymour Go ldbergHarriett S. GoldmanRonald K. GrangerCarl GranitzerMarjorie E. GremmelGerald GriepenstrohMr. and Mrs. August H.GrimaldiAllen GriswoldJohn F. HallgrenRichard E. HaneyWa lter W. HardcastleWalter C. HardebeckRita Harri sonJoseph and Janice HarveyMichael HaydenCharles R. HeidrickJames and Lois HeitzJulia Hicks

26 Tinnitus 'lbday/ J une 1996

E. Alan HildstromMargaret J. HoffmannAnne C. HollandArvid V. HoltFloyd K. HooperGulielma T. HooperBarbara HorowitzLucille J . JantzBarbara L. JensenGeorge C. JuilfsHenry C. KeeneR. L. KeheleyHarry G. and Marion KeiperJoan W. KellerTI:ish Lehr KeirnWayne M. KernDavid KieckerClifford H. KingsburyJoanne E. KinneyRichard KittellDaniel L. KnippleSteven G. KorteNorma KratzM. Virginia KreckmanStefan .P. Kruszewski, M.D.Joseph A. KuhnEm a LadageBlanche A. LagasseRose LanzaroneFlorence LeoneRobert L. LewisVil is I. LietuvietisDuane LogsdonBettY B. LotzMarian B. LovellIsabelle C. LudlumRichard C. LukeDelbert L. MabeChester J. MacksonDonald MahlerVince MajerusEleanor MamminoEmanuel MarisGeorge K. MarlangoutsosJohn W. MarsBruce MartinW. Gordon MartinBrenda J. McDanielMargaret E. McGroaryJanice A. McGuireJohn E. MeehanRichard L. MeissF. N. Men-allsMarvin MeskerMark MezaPatrick MichaelBu lut MihmandarliKarl W. MillerLawrence S. M illerJeff MorseLouis G. MoserStephanie MuenzbergFlorence C. Mu rphyArlo and Phyllis NashVilma NeillAlfred Q NervegnaLyle G. NewcombeEdward H. Newman

Jack M. O'LexeyPaul M. OlinskiJoseph OpitzWilliam L OverbeyElsie L. OwenKarl E. OwenJames L. Paradise- CleaningService Inc.Peter ParmagosCharles R. ParoubekThomas J. PatricianLawrence W. PeterkinJa n L. PetersonLinda M. PetersonHarold w. PiggottAnn S. PittengerAnna G. PlattRobert L. PopeLela M. PowellBa rbara PressDonald E. PullenThomas J. RabideauEldon RadtkeRose RainonaBarbara S. RaperRobert W Ravenscrofl:Allen RaymonHerman B. RaymondSunny RichJoy RiggsRaymond A. RitterJudy T. RobinsonSteven P. RoccoJames G. RuddVeronica C. RustFrederick J. RyanRebecca J. SammonsStewart SandmanHerman J. SchechterJennie M. SchimnoskiJohn H. and Faye Schlete rClaude H. SchmidtMartin F. SchmidtArlene SchrederGerald J . SchwartzGloria E. SennoNorma T. SheldClaire and Jacques SimonCarl ton B. SimonsLee L. SimsThelma M. SjostromJack N. SkiverSandy SlutskyIrene SmithMi ldred F. SohnDiane SolowjowSetty Jean SonnieLinda SteinbergEdward L. Stein manSusan K. StevensDo uglas H. StevesPhilip E. StrohmeierElsebeth S. StrykerDavid E. SullivanJack and Camille SwobodaFred J. ThupelKent J. ThompsonAlfred A. 'lbrre

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tinnitus today june 1996 vol 21, no 2

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