tinnitus today september 1999 vol 24, no 3

7/23/2019 Tinnitus Today September 1999 Vol 24, No 3

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September 1999 Volume 24, Number 3Tinnitus dayTHE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION

"To promote relief, prevention, and the eventual cure of tinnitus forthe benefit of present and future generations"Since 1971

Education -Advocacy- Research - Support

In This Issue:Changing of the GuardNew Tinnitus Research:TRT vs. Masking Study and

ATA's. Four New Research GrantsLetters Home


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Tinnitus T o d ~ y Ediorial and Advertising offices: American Tnnius Associoon, P.O. Box 5, Porriond, OR 97207 503/2489985, 800/6348978 tinnitus@atoorg, http:/ www.ota.orgEditorial an d Advertising offices: AmericanTinnitus Association , P.O. Box 5, Portland, OR97207, 503/2 48-9985, 800/ 634-8978,[email protected], http://www.ata .orgExecutive Director: Steve Laubacher, Ph.D.Edhor: Barbara Thbachnick SandersTinmtus Tbday is published quarterly in March,June, September an d December. It is mailedto American Tinnitus Association donors an da selected list of tinnitus sufferers an d professionals who treat tinnitus. Circulation isrotated to 80,000 annually.Th e Publisher reserves the right to reject oredit any manuscript received for publication

The Journal of the American Tinnitus AssociationVolume 24 Number 3, September 1999Tinnitus, ringing in the ears or head noises, is experienced by as manyas 50 million Americans. Medical help is often sought by those who haveit in a severe, stressful, or life-disrupting form.Table of Contents

and to reject any advertising deemed unsuit 9able for T i n n i n ~ Tbdoy. Acceptance of advertis- New Directors on Boarding by Tinntus Tbday does no t constituteendorsement of he advertiser, its products orservices, no r does Tinmtl


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FROM THE EXECUTIVE DIRECTORby Steve Laubacher, Ph.D.I feel honored to havebeen selected by theBoard of Directors of theAmerican TinnitusAssociation to serve asExecutive Director. GloriaReich, my predecessor, isto be commended for herefforts and contributions

that she made to build and develop the ATA intothe premier health association that is committedto assisting the estimated 50 million Americanswho have tinnitus. It will be my job to buildupon her success and to work with you and allof our constituents to take us to even greaterheights. Accordingly, I thought I would sharewith you a few of my plans that will, hopefully,enable all of us to share first in the creation of anew vision and then the development of stepsto achieve that vision.

Our first effort in this regard has been toreorganize staff operations to insure that we aredoing the best we can to accomplish what hasalready been assigned to us by th e Board ofDirectors. ATA staff met with the Board at theirJune meeting and proposed a new fiscal year2000 work plan and budget. This work plan contained a new organizational chart and dutiesthat are all designed to make us as efficient andeffective as possible. Of particular importance isour attempt to respond quickly to those whoneed our help with information that will be useful. We also want to continue to improve thevery popular and successful Tinnitus Today. Wewill be reviewing the types of research projectsthat, hopefully, will lead to better ways of dealing with tinnitus. Finally, there will be effortsmade to become more involved in advocacy,governmental affairs, and legislation to insurenot on ly that maximum research dollars areavailable, but to get us involved in public policyissues such as environmental noise - a knowncause of tinnitus.

4 Tinnitus 1bday/ September 1999 American Tinn itus Association

In addition to these questions we must alscast an eye to the future with additional efforpaid to strategic long-range planning. 1b thatend we hope to have a new planning processcompleted by the end of next spring. This planeeds to address important issues such asreviewing our mission and determining if themight be better ways to achieve our goals. Foexample, should we focus solely on tinnitus oshould we begin to address related problems?Should we have chapters, a national conferenand more publications? How active should webe in governmental affairs'? All of these questions must be answered in order for us to besure that we are making the kind of contributhat can prevent, reduce, and even eliminatetinnitus. In order to assist with this process, oBoard has committed itself to becoming evenmore involved with governance by authorizinmore committee meetings and by becominginvolved in long-range planning. We will keepyou informed of our progress through mailingand Tinnitus Today.

I would like to invite you to becomeinvolved by sharing your ideas with us. Youcould also volunteer to help us out on a BoarCommittee in the areas of fund raising, business, human resources, or program development. And you could help us locally with somof our related projects such as public forumspublic education. We are all very excited abouour future prospects. And we are confident thif we pool our collective talents, we will be abto offer more relief and even more hope to peple who suffer with tinnitus. GlDr. Laubacher received a Ph.D. in Public Policyfrom the University ofHouston in 1990, a Mastedegree in Public Administration from Harvard in1994, and a Masters degree in Sociology fromDuquesne University in 1973. For additional biographical information, see nchanging of the Guapage 5.


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From th e Ed i t o rChanging of the Guardby Barbara Tabachnick SandersIt rained every day for SteveLaubacher's first two weeks inPortland. Since that time, justa few months ago, Steve'sjokes about our beautiful(though rainy) Northwest cityhave been plentiful, spoken asa true out-of-towner will. Justas plentiful are his ideas toadvance the significant workof Gloria Reich and to propel ATA an d the interests of those with tinnitus into even greaternational visibility.

Steve's resumeis impressive. Hewas the ExecutiveDirector of theNational DyslexiaAssociation inMaryland, the SpinaBifida Association

Research and will be the liaison to our ScientificAdvisory Committee. Her goal is to help thecommittee establish clear and forward-thinkingresearch guidelines. Cathie Glennon is our newResource Development Director and gives ATAthe benefit of her many years of experience inthe field. Robin Jennings is now the ExecutiveAssistant because there isn't much she can't doto make ATA run smoothly. Debbie Nisely is ou rnew Business Manager who is moving our bookseffortlessly (so it seems) into the 21st century.Janice Tagliareni is our Development Assistant,Cathie's right-hand person and ultra-diligent staffmember. Dan May is ou r new Fulfillment andMailing Specialist

who handily directseverything thatcomes intoor goes out ofthese offices.Adam Kramer,

of America inWashington, D.C.,and local and statechapters of theAssociation forRetarded Citizens,and was a consultantfor a variety of othergroups. His broadexperience withthese health organizations gives us afresh and comprehensive view of the

A'D1's StaffL to R: Adam Kramer, Debbie Nisely, Cathie Glennon,Robin Jennings, Pat Daggett, Janice Thgliareni, Dan May,Barbara Thbachnick Sanders, Steve Laubacher

our ComputerConsultant, makescertain that our computers are Internetconnected, okay forY2K, and up andrunning 365 days ayear. In the nextyear, more staff willlikely be added tohelp us reach theheights that Steve isconfident we can.

Although GloriaReich has resignedher office as A T ~ s world of non-profits. As one could expect withany changing of the guard, we are pointed - andnow moving - in a new direction.

These are exciting times. I've assumed therole of editor of Tinnitus 7bday, as well as additional duties in managing our educational programs. (Some of you might have noticed that I'vealso assumed a new last name. Yes, I've recentlymarried!) Pat Daggett is th e new Director of

Executive Director, she has chosen to stay activein the organization. She is now a member of ATA'sScientific Advisory Committee and will continueto help ATA with special proj ects. Her 25 years ofdevotion and labors to an organization that grewunder her leadership - from a membership of250 to 20,000- are remembered by all of us withgratitude. e

American Tinnitus Association Tinnitus Thday/ September 1999 5


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Letters to the EditorProm time to time, we include lettersfrom our members about their experiences with ((non- traditional" treatments.We do so in the hope that the information offered might be helpful. Please readthese anecdotal reports carefully, consultwith your physician or medical advisor,and decide for yourself i f a given treatment might be right for you. As always,the opinions expressed are strictly thoseof the letter writers and do not reflect anopinion or endorsement by ATA.Oe morning in April 1998, I woke up withvery loud tinnitus in my lef t ea r. During thenext several months I saw four specialists. Isoon discovered that my tinnitus was significantlydiminished when I exercised vigorously or took avery hot bath, so I mentioned to the physiciansthat I thought the cause of my tinnitus was relatedto poor circulation. None of them pursued this lineof reasoning. The fifth otologist almost immediately suggested that my problem was likely related tocirculation and prescribed Trental (400 mg, threetimes per day) . In two weeks, my debilitating tinnitus was gone. The tinnitus did return brieflywhen I had an infected tooth on the left side ofmy mouth. As soon as the tooth was pulled, thetinnitus disappeared again .

Janice Holmberg, Oceanside, CA, 760/945-3214D. Emmett is to be thanked for his very clearand much needed article in the June 1999Tinnitus Tbday detailing the relatively newinner ear perfusion approaches to Meniere's disease. There has been at least one controlled study(Silverstein et al., 1998) of inner ear perfusion bydexamethasone. However, this found no beneficialeffect. Silverstein used only late-stage Meniere'spatients and treated them with intratympanic but6 Tinnitu$ 'Thday/ September 1999 American Tinnitus Association

not intravenous dexamethasone. Another retrospective study (Arriaga and Goldman, 1998)found less than striking effects on hearing witintratympanic administration alone.

Despite these negative results, it may wellthat effective Meniere 's and tinnitus treatmentapproaches v.rill come from this general approaWe look forward to a better determination of wmight make the approach effective.

Jim Chinnis, Warrenton, VA,jchinnis@alum. mit. edu

At.er a recent hand fracture, my doctor prescribed 'JYlox for the pain. Though it takeup to 45 minutes to start working, it workwonders on the pain - AND my tinnitus. Withevery dose (two capsules every 4-6 hours), I'veexperienced complete relief from the ringing.After an unfortunate requirement for 'JYloxyesterday, I promised myself I'd le t someoneknow today.

Bob Marquis, Hampton, 333 Harris Ave.,Hampton, VA 23665, 7571766-0549(Editor's Note: 'I]jlox is a prescription drug made of oxycodone and acetaminophen. As a narcotic, carries a warning that it can be habit-forming.)

Te I n ~ e r n e t p r o v i d ~ ~ us with absolutely miboggling opportumt1es - from ordering floers to trading stock options. We have accesto more information than we probably know wto do with . I admit that I am like millions of peple who can't wait to log onto the Internet. Buknow that it's important to not get too caught in the excitement and become confused or, mopointedly, misinformed.Many individuals with tinnitus venture dothe "information superhighway" because theirhealthcare providers offer them no viable solu

tions. Yet it is nearly impossible for us to get aaccurate diagnosis and treatment recommendation from someone over the Internet - healthcare professional or not - who doesn't know u

'TWo things must be considered when wecollect information on the Internet: everyone hequal access and everyone has an opinion. TheInternet is a great source of unregulatedand unmonitored material - some good, somebad. I feel we should all be cautious of opinion


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Letters to the Editor (continued)expressed so freely on the Internet. Free yet pooradvice cannot only be misleading, it can trulywound.

Norma Rivera Mraz, M.A., CCC-A, AssociateDirector, Southeastern Comprehensive TinnitusClinic, 980 Johnson Ferry Rd. NE, #760,Atlanta, Georgia 30342, 404/531-3979,www. tinn.com

NJ y tinnitus had progressed to the pointwhere my quality of life was beingaffected. I had difficulty understandingconversation and I became irritable. The additional energy used to function with the burden ofthis irritant sometimes left me willing to foregoactivities that I might otherwise have undertaken.A coworker, new to the Internet, showed mea printout of typical on-line "rumor-mail" thatassociated the use of the artificial sweetener"aspartame" with numerous ailments includingtinnitus. I almost discounted it, but my problemwas such a nuisance and the cost of testing thiswas low (simply switching from my exclusive useof diet drinks to no n-diet drinks and from artificial sweeteners to sugar) that I tried it. Do youknow that within two days my tinnitus problemreduced to perhaps 15% ofwhat it had been? I thas now been two months since I excluded artificial sweeteners from my diet and the amount of

improvement has been stable. I rarely thinkabout my tinnitus anymore. I encourage yourorganization to suggest this to those who cansafely remove artificial sweeteners from theirdiets. The improvement could be remarkable.Jim French, College Park, MD, [email protected]

In Ed Edward's letter to the editor in the June1999 issue of Tinni tus Thday, he testified abouthis remarkable results with a 600 mg dailydose of magnesium. Because of that, I purchasedand started taking magnesium and enjoyed identical results. In fact for the first week, the tinnituswas almost completely gone. Now, two monthslater, the tinnitus has gradually returned, butonly to about half of what it was. I'm stillamazed, and surprised that this has not beenknown before.

Roy C. Koeppe, PO. Box 43, Ro1fe, Iowa, 50581,712/848-3253

I n 1985, after the death of my father, I developed tinnitus in both ears. Like innumerabletinnitus sufferers, I found I couldn't sleep andhad difficulty concentrating. I consulted an ear,nose, and throat specialist who found no physicalcause for the tinnitus. I researched possible causes and tried several different approaches in anattempt to reduce the t inni tus - cut ting out caffeine and alcohol, reducing salt intake - all tono avail. I learned about the .ATA and startedreceiving Tinnitus Thday, which is a tremendoussource of information. There was an article in theDecember 1998 issue on the use of Ginkgo bilobato treat tinnitus. I decided to try ginkgo andbegan taking 40 mg per day. After two-and-a-halfmonths, I experienced almost complete relieffrom the tinnitus. There were a few days whenit recurred, but those were days of high stress.I hope you can pass this on to others who mightbe considering ginkgo. I only wish I had tried itsooner.

Donald Scoville, 1708 Culpepper Ct.,Severn, MD 21144Editor's Note: Many people have reported a reductionin their tinnitus as a result of taking daily doses ofginkgo, and with no adverse side effects. Ginkgo biloba is widely used in Europe to increase blood circulation, to improve memory, and for tinnitus relief It issuggested, however, that ginkgo not be taken alongwith blood-thinning medications, and that patientshave a simple 1Jleeding timep test performed prior totaking ginkgo to be sure they will not be overly sensitive to ginkgo's blood thinning properties.

American Tinn jtus Association Tinnitus 70day/ September 1999 7


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NEW DIRECTORSON BOARDThe American Tinnitus Associationwelcomes three new members to itsBoard of Directors: John Nichols, ofScottsdale, Arizona; Kathy Peck, of SanFrancisco, California; and JoelAlexander; ofPark Ridge, New Jersey.

John Nichols is an attorneyas well as the facilitator ofthe Phoenix Tinnitus SupportGroup, the third longest-running ATA tinnitus supportgroup in the U.S. His background in non-profit advocacy as well as his personalexperience with tinnitus ledhim to join ATA's Board of

John Nichols Directors. "I have tinnitus,"says Nichols, "and I under-stand the debilitating effect of it. I'm passionatelydedicated to helping others overcome the limitations of tinnitus and to live successful, productivelives. I also understand how Congress works, andwhy it listens to politically powerful organizations like AARP. It's because that organization hasmillions of members which means millions ofvoters. ATA also has to grow to have millions ofmembers to become politically effective. Whenwe do, legislators will have to listen to us becausewe'll be affecting their political futures!"Kathy Peck is the ExecutiveDirector and Co-Founder ofH.E.A.R., (Hearing Educationand Awareness for Rockers).The goal of her organizationis to teach teens and youngadults that overexposure toloud noise an d music cancause permanent hearingloss and tinnitus. Kathy's

Kathy Peck own hearing loss and tinni-tus followed immediatelyafter her performance in a rock band.Peck says, "The tinnitus problem with musicians is a BIG problem. Working with ATA can

only help me do a better job and bring the message to the people in the music industry." As forATA, Kathy's feelings run strong: "ATA is such agood organization, so people-oriented, sort of'advocacy by nature.' I t knows the people that it'sserving. If you go to ATA, you know you're goingto be helped."Joel Alexander is a CPA,and was Jacom ComputerServices' chief financial officer for many years. AfterAlexander's ai r bag-inducedtinnitus began two years ago,he decided to devote his timeto ATA and to the search fora solution for others whostruggle with tinnitus. Says

Joel Alexander Alexander, "Over the lasttwo years, I consulted withnumerous doctors, audiologists, and hearing professionals who assured me that I would get usedto hearing these sounds. But I did not get used toit. My motto has always been: 'God helps thosewho help themselves.' Therefore I intend to helpothers an d myselfby getting actively involvedin ATA. My fervent dream is to help the distinguished members of ATA's Board of Directorsachieve the ultimate goal of helping the millionsof Americans who are afflicted with tinnitus."

Phil Morton of Portland, Oregon, formerChairman of the Board, and Aaron Osherow ofSt. Louis, Missouri, have retired from the Boardof Directors after many years of service to 1\TA. 1B1Next Issue: Interviews with ou r new ScientificAdvisory Committee members: Douglas E. Mattox, M.D.,Mary B. Meikle, PJ1.D., Gloria E. Reich, Ph.D.,Michael D. Seidman, M.D., and Richard S. 7JJler, Ph.D.

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SwanSongby Robert Sandlin, Ph.D.

Swan song n: the last work, act, achievement of aperson (The Random House Dictionary)

At seventy-three years of age it seems wise, ifnot imperative, to entertain thoughts of undertaking challenges completely unrelated to the clinicalmanagement of the tinnitus patient. Such thingsas enrolling in a magic class for the sole purposeof entertaining my grandchildren. Th play theelectronic organ with more than just the righthand. 1b finish three novels which have beenstarted but now gather dust on my bookshelf.Th ge t up early in the morning just for the solepurpose of watching the sunrise.

In essence, this brief article represents reflections over the last two decades or so about tinnitus, those who suffer from it, an d those who offersome form of therapeutic intervention for it. Ththat extent, then, this is my swan song.I have experienced the joys an d frustrationsof treating individuals with unrelenting, subjective tinnitus. Joys are best defined as the professional and personal satisfaction of contributingto an individual's quality of life by eliminatingor reducing the negative emotional andbehavior changes often accompanying tinnitus.Frustrations are best defined as not knowing whatto do when what you have done results in minimal improvement - or no improvement at all -in the person's ability to cope more effectively

with the ongoing tinnitus.Equally as high on the listof frustrations is the naggingreality of not knowing whatyou did that resulted in animprovement of patientcoping strategies.

During the past twenty years,I have had the opportunity toexperiment with a numberof therapeutic approachesin the treatment of the tinnitus patient. Admittedly, I

have not investigated all conceivable treatmenmodalities. Th do so would have been a Hercutask that may have resulted in knowing only alittle bit about a lo t of things, but not enough tthoroughly understand the rationale of each. Ea cursory examination of the literature provideseemingly endless list of treatment modalities.Consider the following litany: masker therapy,tinnitus retraining therapy, selected use ofbendiazepines and tricyclic drugs, psychologicalintervention, psychiatric intervention, cognitivtherapy, TMJ modification, electrical stimulatibiofeedback, anticonvulsing drugs such as Tegand Misoline, surgical sectioning of the auditorbranch of the eighth nerve, microvascular surgselective use of diuretics, acupuncture, acupresure, vitamin therapy, hypnosis, an d homeopaintervention. Add to this the management ofhyperacusis, which often accompanies subjectitinnitus, and one begins to appreciate the magtude of the problem relating to selecting a therpeutic approach best suited to meet the patienneeds.

I t is difficult, i f not impossible, in my viewfor anyone to vigorously defend a single therapeutic approach as the only one to be used intreatment process. I say this because each of ththerapies listed has proven ofbenefit to some,but none has proven beneficial to all personshaving tinnitus. This is certainly not to indict amethod of treatment but rather to realize thatprimary, clinical responsibility is to the personsuffering from tinnitus. I t makes little differenwhat the method of intervention is, if the patiebenefits and is not negatively compromised.Patients seek help, not based on their understaing of the mechanisms of tinnitus, the rationala treatment method, or theoretical constructs osite of lesion, but rather on the degree of hurt.is not the tinnitus itself, but the patient's reactto it that generates the emotional unrest and ssequent negative behaviors. That is, patients aseeking relief from the incessant, acoustic-likesensations that are with them every hour of evday. They are not concerned about theories orscientific assumptions but whether or not a paular therapeutic approach offers demonstrable,ongoing beneficial results.E ach patient presents with a unique setof problems arising from tinnitus onset.Some of these problems are generated bfear of what the tinnitus portends. Patients draconclusions based on these fears, which dictatea variety ofbehaviors. Many such fears are notreality-based in terms of scientific knowledgeor objective evidence. However, this is of littleconsequence if the patient's negative behavioris perpetuated because of these fears. It is thes

10 Tinnitus 'lbclay/ September 1999 American Tinnitus Association


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maladaptive behaviors to which the clinicianmust give attention. I t is these behaviors whichneed to be modified in a more positive direction.

I have observed on a number of occasionsthat patients with similar histories related to theirtinnitus have almost diametrically opposed reactions to its presence. Some patients accept theirtinnitus as a consequence of that which caused it.Others experience marked changes in emotionalstability leading to overt behaviors that perpetuate the debilitating effects of their tinnitus.Regardless of the possible mechanisms involvedor the theoretical constructs of tinnitus origin,the patient's maladaptive behaviors are determined by emotional and psychological factorsunrelated to the neurological status. As such,the clinician's primary task is that of alteringattitudes and modifying behaviors through oneor more therapeutic approaches.

Further, I have observed that there is verylittle, i f any, predictable outcome in theseveral therapeutic approaches. This

means that one cannot predict with any degree ofcertainty what will happen over a given period oftime for a given patient as a result of therapeuticintervention. One can, however, predic t the probability of success by retrospective analysis. Byassessing the success rate of a given treatmentmodality for a number of patients, one can predict that a certain percentage will be successful.The trouble is that patients have little interest inprobability. They are more concerned with whatcan be done at the moment to reduce their anxiety and psychological and emotional distresses.I feel that patients must be managed in a mannerthat contributes not only to their understandingof the therapeutic process but the significant partthey play in achieving positive results. Effectivetreatment is not a one-way street. The patientmust play an active role in whatever treatmentplan is used.

The patient must be assured, or at least feel itto be true, that the clinician is interested in his orhe r well-being and is empathetic to his or herneeds. The patient needs to feel that the clinicianis not bound to a specific treatment modalitywhen it becomes evident that the therapeuticapproach is not working. The patient has theright to assume there will be changes in thetreatment modality of choice, if such changesare deemed appropriate and offer an increasedprobability of tinnitus relief. The caveat, ofcourse, is that a change in treatment must bebased on a defensible assessment that what iscurrently being used is not working. The decisionto alter the course of treatment should be basedon consensus between the clinician and thepatient. Th permit the patient to dictate when

change should occur is an abdication of clinicalresponsibility and not a true test of the treatmentplan. A change in the therapeutic approach doesnot imply, necessarily, that one discontinues agiven treatment plan, but rather that other treatment methods might be introduced to assesstheir value in providing tinnitus relief. I am convinced that more attention needs to be given toappropriate counseling and patient management,regardless of the therapy of choice.If there is a common need to be resolved forthe tinnitus patient it is the reinstatement ofquiet. Dr. Stephen Nagler first suggested this ideato me a number of months ago. In essence, thepurpose of any therapy is to eliminate or reducethe tinnitus loudness to a point that permits thepatient to lead a more normal and harmoniousexistence unfettered by the ever present, unre-lenting tinnitus.

None of us who has worked with tinnituspatients has all the answers to this perplexingproblem. Clinicians search for answers by evaluating the treatment modalities available. Theytake from them those features that seem toimprove the patients ability to obtain relief andto cope more effectively in daily life.

I think that some day we will find answerswhich have eluded us thus far. Perhaps the solution will come through greater awareness ofthose neurophysiologic mechanisms causing tinnitus. Perhaps the solution lies with the administration of specific drugs or surgical intervention.However, until such time these hopes anddreams become reality, clinicians must continueto assist the patient in dealing more effectivelywith his or her tinnitus so that an acceptablequality of life is maintained.

I would be remiss if I failed to mention thoseindividuals who have been so instrumentalin helping me understand the humandynamics of tinnitus. Dr. Jack Vernon has servedas my mentor for many years. The late RobertJohnson contributed so much to my understanding and treatment of tinnitus. Dr. Mary Meiklehas always been gracious in sharing with me thatvast amount of know edge she has regarding tinnitus. Dr. Gloria Reich is to be admired for heradministration and the positive, proactive direction taken by the American Tinnitus Association.Of course there are my tinnitus patients and others too numerous to mention in this brief article.Th all, my sincerest thanks. BDr. Sandlin is on ATA's Scientific AdvisoryCommittee and is the past Director of he CaliforniaTinnitus Assessment Center in San Diego,California.

America11 Tinnius Association Tinnitus 7bday/ September 1999 11


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TRT vs. Masking A Researby Jim Henry, Ph.D.The Veterans Affairs (VA) Medical Care system pro-vides health care for U.S. veterans and also fundsbasic and clinical medical research. One branch ofVA Research is Rehabilitation, Research, andDevelopment (RR&'D). The RR&'D service supportsmany research centers, one of which - the NationalCenter for Rehabilitative Auditory Research(NCRAR) - is in Portland, Oregon. The NCRAR isdirected by Stephen Fausti, Ph.D., and is a consor-tium of researchers, clinicians, and educators whospecialize in hearing disorders, including tinnitus.

Although there are manycauses for tinnitus, the mostcommon is noise-inducedhearing loss. Tinnitus isthus a common complaintamong veterans, of whon1over 115,000 reported service-connected tinnitus asof September 30, 1998.Tinnitus disability compen-sation for these individualsamounts to over $110 million per year. In spite of this major health prob

lem for veterans, it has not been feasible for theDepartment of Veterans Affairs (VA) medical system to establish a systematic protocol for tinnitusrehabilitation.

A proposal was recently approved by theVNs Rehabilitation, Research, and Developmentbranch to conduct a three-year study at thePortland VA Medical Center under the auspices ofthe NCRAR evaluating two different forms of tinnitus treatment: Masking Therapy and TinnitusRetraining Therapy. Mary Meikle, Ph.D., and Iare the principle investigators for this studywhich will begin October 1, 1999.

Despite many attempts to develop effectivetreatments for tinnitus, in general these are th eonly two that have achieved widespread use. Themethod of Tinnitus Masking employs wearableear-level devices tha t deliver selectable bands ofrelatively low-level noise to the ear in order tototally or partial1y obscure the tinnitus sound.Introduced in 1976, this method has been used inmany thousands of cases, with reported success

rates in the range 65-68%. Th e second method,Tinnitus Retraining Therapy, attempts to produ"habituation" of tinnitus through a specific protcol of education, directive counseling, and "southerapy" through the use of low-level broad-bannoise. Clinicians using this approach report success rates of 80-85% although published data arrelatively few.

Controlled studies have not been done tocompare the relative effectiveness ofthese twotreatments. Consequently, there is, as yet, noscientific basis for choosing between the two.Because of the prevailing need for tinnitustreatment efforts within the VA medical systemit is important to determine which of these twotechniques offers the better rehabilitationmethodology for U.S. veterans.

We will study 200 veterans with clinicallysignificant tinnitus (that is, tinnitus that hasadversely affected an individual's life to theextent that clinical treatment is sought). We wirecruit subjects from the patient populations ofthe Otolaryngology and Audiology clinics at thePortland VA Medical Center. Inclusion will bebased on a demonstrated need for tinnitus treament and the individual's willingness to complwith the requirements of the proposed study.After giving informed consent, subjects will berandomly assigned so as to obtain 100 subjectseach of two treatment groups (1) TinnitusMasking, and (2) Tinnitus Retraining Therapy.Baseline observations (including audiometric atinnitus test results) will be obtained, with theprincipal focus on measures of tinnitus severityTreatment will then begin.

The Tinnitus Masking program will beconducted by an experienced audiologist skillein the masking treatment method, who willapply standardized tinnitus masking techniqueaccording to published protocols. The TinnitusRetraining Therapy program will be conducteda different experienced audiologist skilled in thretraining treatment method, who will applystandardized tinnitus retraining techniquesaccording to published protocols. Throughoutthe study, expert consultation and advice willbe provided by the developers of the Maskingand the Tinnitus Retraining Therapy treatmentmetl1ods (Jack Vernon, Ph.D., Professor Emeritof Otolaryngology, Oregon Health SciencesUniversity; and Pawel Jastreboff, Ph.D., Sc.D.,

12 Tinnitus Thday/ September 1999 American Tinnims Association


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Professor of Otolaryngology, Emory UniversitySchool of Medicine, respectively) .All subjects will be assessed at 3, 6, 12, an d 18months by an evaluator who is unconnected with

the treatment program and who will be blind tothe treatment being administered. Two hundredsubjects will provide adequate statistical powerfor evaluating the significance of the results.Because of the well-controlled nature of thisstudy, and the careful attention to quantitativeoutcomes measures built into it, we anticipatethat this research will yield important information that will help guide th e VA medical systemto provide rehabilitation for veterans with tinnitus. Inevitably this research will be relevant tothe millions of tinnitus sufferers worldwide -veterans and non-veterans alike. Ia

Dr. Henry can be contacted at the VA MedicalCenter, 3710 SW US Veterans Hospital Rd., Portland,OR 97207, 503 / 220-8262 x.57466,henryj@ohsu. edu

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HELP FOR TINNITUS AND HYPERACUSISCAROL LEE BROOK suffered from a debilitating case of

both of these afflictions. She was hearing twelve differentsounds. Her own footsteps were unbearable o listen to, andtheshower sounded like Niagara Fal ls. She was unable oquiet the TINNITUS noises with outside sounds because ofpain from the HYPERACUSIS. Shewas unable o block outthe HYPERACUSIS with earplugs and muffs because thisintensified the TINNITUS.

Because Carol refused to accept her ENTs ' statements,"There is nothing you can do about it. You 'll just have to ge tused to it," she tried everything shecould think of to getrelief, but to no avail. She couldn't eat or sleep, and al lowedherself to be a guinea pig for anyone who offered a possiblecure. Just as she was about to give up, she heard about atreatment called TINNITUS RETRAINING THERAPY (TAl) thathad been developed by a neuroscientist, and out of desperation decided to try it.

As a form of her own therapy, Carol wrote abouther many experiences before and during her use of TRT.She ollowed her doctor's orders to the letter and theHYPERACUSIS gradually went away. She also found that the

longer she stayed on the program, the lower the volumeof her TINNITUSsounds appeared. Her doctor has helpedWlliam Shatner and many others, and is currentlyinstructing audiologists as to his TRT methods al overthe U.S. and in foreign countries.

Carol believes that she has achieved about 90%recovery to date,and shares with you her experiences andthe effects on her family and friends in her new book,TORTURED BY SOUND - BEYOND HUMAN ENDURANCE.She hopes it will both entertain and helpyou to overcomethe effects of these sometimes debi li tating afflictions.TO ORDER THE BOOK TORTURED BYSOUND- BEYOND HUMAN ENDURANCE,SEND $25.95 (CAN $38.00) PLUS $5 .95 S&H(CALIF. RESIDENTS PLEASE ADD $1.88 TAX)TO: ROARING PRODUCTIONS, INC -DEPT A, P.O . BOX 2500 ALAMEDA, CA 94501 .

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American Tinnius Association Tinnitus 7bday/ September 1999 13


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by Ray EnnisAfter suffering with tinnitus for nine years,seeing many different doctors, and trying their

drug therapies, cranial sacral work, hearingdevices, acupuncture, and massage, there was onething that stood out in my mind as much as theringing in my ears. I t was the words I'd heardfrom all of the doctors: IT'S NOT CURABLE.YOU'LL JUST HAVE TO LEARN TO LIVE WITH IT

My quality of life had deteriorated so muchthat I was depressed, anxious, closed down.I couldn't focus and was angry most of the time.I took sleeping pills and drank alcohol in order tosleep, and was ready to give up. I had even gottento the point where I didn't want to read Tinnitus7bday when it arrived because i t all seemed sohopeless. Fortunately, when the March 1999 issuearrived, I opened it and saw a small article writtenby Mike Cohen about a Dr. Zacharya Shemesh inIsrael who reports a 90% success rate for treatingtinnitus. I immediately contacted the HadassahHospital in Israel, spoke with Dr. Shemesh, andrealized there was hope for me.

When Tarrived in Israel and met Dr. Shemesh,I instantly knew that I had made the right decision to come this far for treatment. Dr. Shemeshhas devoted his life to working with tinnitus, andbelieves that in most cases tinnitus is a curabledisorder. God Bless Him!I began treatment andfelt inspired to send e-mail

home to my wife and family about my experiencesand feelings while beingtreated. Here are someexcerpts from myletters home.

14 TinnituS 'TOday/ September J999 American Tinnitus Association

May 1I arrived in Jerusalem last night around 8 pwhich is the start of Sabbath. A big mistake!Everything is closed and it is all so new to mI walked for hours and couldn't find a place Sabbath starts at sundown on Friday night agoes till sundown on Saturday and the wholshuts down. All the busses stop running andthe businesses are closed. I've never seen anthing like it.May 3Coming to Jerusalem was the right move foI've finally found a doctor who knows abouttus. It really takes a lot off my mind to knowdon't have to suffer with this "devil's symphfor the rest of my life. I finally understand t"whys" of some of my behavior patterns durthe last few years: I wasn't just crazy. Twas I found out that tinnitus is not simply a ringthe ears. It's a central nervous system ailmeMy depression and all the debilitating sympwere caused by the tinnitus. I t all makes so sense to me now.May 4I spent six hours with Dr. Shemesh today. Tso different from any experience I've ever hwith a doctor. His way of working is to find about you; he treats the whole person, not jsymptoms. Sensing his compassion and wisdheld back nothing.MaySToday I got back some of the blood test resuThis will help Dr. Shemesh know what typetreatment to start with. Other than a very hivitamin B-12 count, the tests show all my leare normal.May 10Today I received information on the medicaThe pharmacy at Hadassah hospital will prethe medication according to instructions froDr. Shemesh after he considers all the medicaspects of my condition, like my complaintsmedical history, imaging, audiometer readinblood test results, and his personal evaluatiomy particular health and living situation. Thessentially "conventional" treatment, but itreminds me of when I worked with the hompathic doctors back home. His approach is vthorough and individualized. Shemesh saysprogram is based on the same proven (but stcensored) protocol he uses in his long-standwork with Israeli Defense Forces tinnitus paI am impressed with this man's experience acontinue to build my trust in him. Dr. Shemsays he will continue to supervise my case othe next 12-18 months.


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y 11spent the 1ast three days with Dr. Shemeshfour, five, or six hours each day. Yesterday, Ithe first two medications and when I awoke

the ringing in my head had lowered 50 topercent. It's hard for me to gauge. Since I'ved tinnitus for so long, I'm not sure what is nor-can't tell you how happy I am without sonoise in my head! I can hardly believe it.to become too excited, but

13have had a slight relapse. I awoke this morningThe ringing has returned althoughe volume is lower than it was previously. Dr.says this is a good sign. It means my

the medication and this willhappen for a short time in the beginningf the treatment while everything is trying tounderstand this, it

still difficult to deal with my emotions whene ringing returns. Dr. Shemesh will be teachingtechniques to handle these times better.y 17I now seem to be going through major adjust-

have days when the tinnitus is mostlya background sound and the volume hasanywhere from 40 to 80 percent andtwo days later it's back. I notice that eachit comes back, it is a little different. Either

e volume is different or the pitch has changedwhole sound itself has changed from ring-g to buzzing to whistling. I also recall th e activi-of the previous day and can see factors that

have contributed to its return. Dr. Shemeshthe frequency of the recurrences will lessenI'm finally back home in my own environ-and settle into a somewhat stable routine

After a rendezvous with my wife who flewrom Hawaii to London to meet me for a veryI'm now back homen Hawaii. The tinnitus has decreased to a lightund noise, which I can manage with self-and the relaxation techniques I learnedrom Dr. Shemesh. I do have some "down days"ue to stress, but I'm learning to manage the

times better since I know it is a majoractor in aggravating tinnitus.I speak with Dr. Shemesh once a week, ormore often if something comes up. He is only a

phone call away if I need him. I feel like a wholeew person now, with a whole new life in frontfme. a

A (lo n g) Editor's Note:I called Dr. Shemesh in Israel to learn somespecifics about the treatment he offers, and to findout why the treatment protocol is, according to RayEnnis, 11Censored." Shemesh received my call warmlyand was frank about the limitations that have beenplaced upon him by the Israeli Army. (Many ofShemesh's patients are military personnel whosehearing was damaged by military noise exposure,like bomb and grenade blasts.) He is uneasy that hisclinical work might go unnoticed because of therestrictions. ':As you know, he said, "in the world ofscience, it is 'publish or perish.' I have not been ablepublish any papers about my work with tinnituspatients over the years. So recently we officiallyapplied to the Israeli Army for permission to publishthe details of these 19 years ofresearch. And wewere told 'officially' that we could not do it. Shemesh is optimistic that the hold wiU be liftedsoon. He explains: "We are a country that is used tosecrecy. And because of hat, I know that it is easierfor [the Israeli Army} to handle non-secret information than that which is secret. He believes that theIsraeli Army will, sooner than later, get weary of tshold on his work.From my conversation with Dr. Shemesh, I wasable to glean two clear things about his treatmentof tinnitus patients: He offers them an absoluteunderstanding of their condition, and a better investigation of their problem and overall health thanmost ofhis patients say they've had before. Shemeshadds, "Some physicians create crisis by saying to thepatient, 'You have to learn to live with it.' If someonecalls me, they don't have to come to Israel to feelbetter. Sometimes they feel better just knowing thatthere is help somewhere." He feels strongly that ATI'ltconveys the same important message to people withtinnitus. "You let people know that there is help fortheir condition. And by doing that, your organization is doing one of he most important jobs in thefield of tinnitus in the world."

Mr. Ennis can be contacted via e-mail at:[email protected]. netMike Cohen can be contacted via e-mail at:nu@netvision. net.ilDr. Shemesh can be contacted byMail: Hadassah Ein Kerem, Tinnitus Clinic,PO. Box 12000, Jerusalem 91120, Israele-mail: pr@hadassah. org. ilWeb site: www.hadassah.org.il/hmoltinn.html'Ielephone: on Sunday, Wednesday, and Friday,7-8 a.m. Israel time (7 hours later than Eastern time)011-972-9-899-7992, Fax: 011-972-2-677-6768

American Tinnius Association Tinnitus Thday/ Septembe r 1999 15


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$131,400 FORNEwATARESEARCH

The ATA Board of Directors recently approvedfunding for the following four tinnitus researchstudies. The grants total $131,400. The first threestudies are referred to as "basic" (in the lab,under the microscope) research. The last oneis a clinical study, one in which tinnitus patientsare evaluated.In their own words, the researchers explainthe goals of their work.

Title: Are mechanisms lor transient andlong-standing tinnitus different?Principal Investigator:Jos J. Eggermont, Ph.D.,University of CalgaryGrant Award: $35,000The mechanisms that underlaytransient and long-standing tinnitus may be different. Considerthe action of loud music provided by a rock group. This may induce in most listeners a temporary threshold shift accompaniedby transient tinnitus or, in more sensitive persons, a permanent high-frequency hearing lossand also permanent tinnitus. In the latter case, acomplete reorganization of the auditory cortexwill slowly occur so that the long-lasting tinnituseffects may be related to an over-representationof the audiometric edge-frequencies. In the caseof long-standing tinnitus, the reorganization of

the tonotopic map in the auditory cortex mayresult in increased synchronization of the spontaneous neural activity in that region. This has alsobeen proposed as a basis for tinnitus. The proposal will compare effects of transient and longstanding pure tone trauma, induced at an earlyage, on the spontaneous firing rate and synchrony in the damaged regions of three auditorycortical areas.

Title: Mechanisms ol hyperexcitability in theinferior co/lieu/usPrincipal Investigator:Richard E. Harlan, Ph.D.,Thlane University School ofMedicineGrant Award: $25,500We propose that tinnitus andhyperacusis may result fromhyperexcitability of certain nerons which relay auditory information in thebrain. Further, we propose that this hyperexcitability is due to a loss of inhibitory inputs othese neurons, leaving them with unopposed etatory input. The hyperexcitability results inexcess activation of relay neurons in response

normal sounds of low intensity (hyperacusis)in the absence of audible sound (tinnitus.) Thhyperexcitability of these neurons leads to expsion of a particular gene called c-Fos. We will the hypothesis that neurons expressing the c-Fgene in response to intense sound also contaiparticular receptors for excitatory and inhibitoneurotransmitters. We also propose that thehyperexcitability of these neurons could be coteracted by increasing the amount of the inhibry neurotransmitter gamma aminobutyric acid(GABA) . The ability of these drugs to decreaseexpression of the c-Fos gene in response to losounds would suggest that these drugs may beuseful in treating tinnitus and hyperacusis.Title: The role of the trigeminal ganglion andcochlear nucleus in the modulation of ~ ~ s o m a t itinnitus

Principal Investigator:Susan E. Shore, Ph.D.,Medical College of OhioGrant Award: $40,900Recently, pa tients have beendescribed who can modulatetheir tinnitus by clenching thjaw or touching the skin on tface. In addition, there are patients whose ons

of tinnitus can be attributed to some somatic(relating to, or affecting the body) insult in thhead and neck region, called "somatic tinnitusThese observations have led to the hypothesisthat somatosensory input to the cochlear nucl(CN) modulates the spontaneous rate of its ouneurons. Somatosensory input to the CN maytherefore play a role in the generation and molation of somatic tinnitus . We have recently dicovered a pathway from the trigeminal ganglioto neurons in the cochlear nucleus, which ma

16 Tinnitus 'Tbday! September 1999 American Tinnitus Association


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$131,400 FOR RESEARCH (continues)involved in the generation and/or modulation of"somatic tinnitus." This hypothesis will be testedby electrically stimulating the trigeminal gan-glion while recording spontaneous activity in theCN. If this pathway plays a role in somatic tinni-tus, changes in spontaneous activity shouldoccur.Title: Using auditory reorganization to minimizeperception and facilitate habituation of tinnitus

Principal Investigator:Robert W. Sweetow, Ph.D.,U. of California, San FranciscoGrant Award: $30,000Although tinnitus can resultfrom a wide range of disorders inthe ears, recent studies suggestthat it is the brain that is ulti-mately responsible for the problem. An abun-dance of research indicates that certainprocedures ca n be utilized to actually modify thefunction of portions of the brain used in hearing.

In this investigation, we will be testing the theorythat tinnitus can be eliminated or minimized byaltering the way sound is perceived (organized)in certain regions of the brain, specifically, theauditory cortex. We will be using computer-controlled auditory tasks that focus on temporal(tin1ing) and spectral (pitch and loudness) charac-teristics to direct the reorganization ofbrain func-tions. The tasks being used have been previouslytested and shown to produce these changes. Thespecific exercises will consist of reconstructionand recognition of specific sounds and soundsequences. BApplieation deadlines for ATA researchgrants: June 30 and December 31.'l b obtain an application, visit our Web site(WJvw.ata.org) or contact Pat Daggett atATA, P.O. Box 51 Portland OR 97207,e-mail: [email protected]

American Tinnius Association Tinnitus 7bday/September 1999 17


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HAPPY NEW YEARby Cathie Glennon, Director of Resource Development

Despite what the calendar says, I've alwaysthought of autumn as the beginning of the newy e a 1 ~ Instead of celebrating the transition bytossing confetti, sipping champagne, and listening to strains of Auld Lange Syne, I feel like I'membarking on a new year when I listen to theschool buses on th e streets and feel the coolerweather. This feeling returns right after LaborDay every year. Each year in the fall I regroupfor new challenges and in anticipation of something exciting in the future.

The anticipation of starting the new year isespecially strong here at the American TinnitusAssociation. The first of July was the beginningof our fiscal year and, as Barbara ThbachnickSanders mentions in her article, the year bringsstaff changes to ATA. Our Board of Directors haschanged as well . Several new members havejoined our dedicated and enthusiastic Board. Wehave the leadership, we have the vision, and wedefinitely have the enthusiasm to kick off thisyear. Just as importantly- maybe more importantly - we have thousands of supporters likeyou who will help to make ATA's future something to cheer about.

Since July 1st, we've been working out thedetails of our fund raising activities for the newyear and I'm very excited to tell you about them.+ We'll be staging an Annual Campaign this fall .

This is the one special time of the year whensupporters can step forward decisively andsupport the important ATA programs thatthey care about. Watch for details in yourmailbox and please give generously whenyou're asked.

+ We'll be contacting some of the hundreds ofthousands of people who over the years we'vehelped with tinnitus information and supportto invite them to become ATA donors.+ We'll be writing grants to private foundations,telling them about ou r good work, and gettingthem more closely involved in our work.+ We'll be participating in more national andlocal workplace giving campaigns. If you

donate at work through the CommunityHealth Charities or other workplace givingcampaigns, don't forget to check with yourcampaign chairperson to see how you canhave your donation benefit the AmericanTinnitus Association. ATA's national designation number is 0514.

18 Tinnitus Thday/ Septemb er 1999 American Tinnitus Association

+ We're hoping to make allies with serviceclubs, interest groups (the local tuba society- Portland's got one!), and professionalgroups that might have an interest in whatATA is doing. If you know of a group or aremember of a group that might have a speciaaffinity for tinnitus an d would like to havefun learning about ATA and raising money fus, please contact me at 800/ 634-8978 ext.l8We can follow up on your ideas.We'll be analyzing all elements of our fundraising to make sure it is effective an d efficientJust like you, we want to be sure that the largepossible percentage of the gift you give to ATAgoes directly to important programs and not tooverhead.I hope you are as excited about thi s new yeas I am. Being an ATA donor is something that

can give you a deep sense of pride. You can beproud, too, of ATA at this point of transition. Yocan be extremely proud of your past support fothe American Tinnitus Association, an d you cabe proud of the work that ATA has done withyour help. I t is only because of caring, generoupeople like you that we can hope to provide theextensive Education, Advocacy, Research, andSupport (E.A.R.S.) programs. This is somethingyou can really feel good about.

You might have noticed that a few of theleaves on the trees have a tinge of yellow, andthat school supplies are going on sale. Together,all of us - supporters, Board of Directors, andstaff - face the challenges of a new and excitinyear. e

WHERE THERE'S AWILL,THERE'S AWAY

Please consider including a bequest to theAmerican Tinnitus Association in your will.With a will, you can assure that the work thatis important to you, such as our efforts toeliminate tinnitus, will continue into thefuture. Your legacy can make a real difference

Please contact Cathie Glennon, Director ofResource Development, at (800) 634-8978ext.l8, for more information.


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COMMUNITYHEALTHCHARITIESCAMPAIGN

ANNOUNCEMENTSAmericanAcademy of Otolaryngology MeetingDate: September 26- 30, 1999, New Orleans, LA'Ibpics: Annual national meeting for ear, nose, andthroat physicians. This year, three courses aredevoted entirely to tinnitus.Tinnitus Speakers: Aristides Sismanis, M.D.;Gordon Hughes, M.D; Abraham Shulman, M.D.;Michael J. LaRouere, M.D.; John J. Zappia, M.D.Contact: AAO , One Prince St., Alexandria, VA22314-3357, 703 / 836-4444.Tinnitus Public ForumDate: September 27, 1999, 7-9 p.m.New Orleans Hilton Riverside, Oak Alley Room,Poydras at the Mississippi River, New Orleans, LA,504/ 556-3700 (call for directions)'Ibpics: There will be no charge for this open-tothe-public lecture and Question & Answer session.Meet ATA's Executive Director, ATA Board members, and members ofATA's Scientific AdvisoryCommittee. The Q & A session follows the panellecture. See back cover for more details.Seventh Annual Conference on the Managementof the Tinnitus PatientDate: September 30-0ctober 1, 1999Th e University of Iowa, Iowa City, Iowa'Ibpics: For professionals and tinnitus patients.Guest ofHonor: Jack Vernon, Ph.D.Speakers include: Michael Block, Ph.D.; GloriaReich, Ph.D.; Meredith Eldridge, M.A.; SolyErlandsson, Ph.D., psychiatrist; Anne Mette-Mohr,clinical psychologist; Paul Abbas, Ph.D.; BruceGantz, M.D.; Brian McCabe, M.D.; Rich 'JYler,Ph.D.; David Young, M.A.; and Richard Smith, M.D.Contact: Rich 'JYler 319/356-2471,fax: 319/ 353-6739, [email protected],http:! WV\rw.medicine. uiowa.edu/ otolaryngologynews/ news.html

ATA is a member of the Community HealthCharities (CHC). If yo u participate in a CHCworkplace giving campaign, you can designateyour gift to ATA using number 0514 on yourpledge card.

Ifyo u are involved in other workplace campaigns, check with your campaign chairpersonfor information on designating your gift to ATA.Last year, ATA raised over $80,000 for ourprograms through Community Health Charities

and other workplace giving. This is a significantpart of our budget.Thank you to those special donors! Your gift

means a lo t to us.

Mid-Atlantic Tinnitus ConferenceDate: April1, 2000, 9:30a.m.- 4 p.m.West Jersey Hospital, Voorhees, NJMeeting organizers: Dhyan Cassie, M.A. , CCC-A,Gail Brenner, M.A., CCC-A, and Linda BeachGuest Speakers (at press time): researcherRichard Salvi, Ph.D.; tinnitus clinic directorStephen Nagler, M.D.; and ATA's ExecutiveDirector; Steve Laubacher, Ph.D.Contact: Dhyan Cassie, 609/ 983-8981

ATXs Tinnitus Support Network-With a little help from your friendsOur support network of volunteers is thefoundation of hope for thousands of people with

tinnitus across the country. If you are interestedin giving telephone, e-mail, or in-person help toothers with tinnitus, please contact us. Or, forinformation about a support group or telephonecontact nearest you, call or write to us.(800/ 634-8978, ATA, P.O.Box 5, Portland, OR97207-0005)Welcome New Support Network Volunteers'Thlephone and Letter ContactBeryl Clark445 Seaside Ave., Box 164, Honolulu , HI 96815808/ 923-8716Thlep hone ContactSusan S. Partin336/835-3438

American Tinnius Association Tinnitus 7bday /September 1999 19


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TINNITUS: ABLESSING IN DISGUISE?by Richard A. Gordne" M.D.

My tinnitus began inNovember 1978 when I was47, and has remained with meever since. At that time, Ibecame aware of a hearingloss, which ultimately warranted my wearing hearingaids. I t is well known thatpresbyacusis (the hearing lossassociated with the agingprocess) predisposes individuals to tinnitus. This has been my situation. Mostoften my tinnitus is bilateral - in both ears -and consists of whistling and other high-pitchedsounds. Over the years I have learned that mytinnitus, for the most part, has a life of its own

and fluctuates for reasons that are entirelyunknown to me. There are two things, however,that will predictably intensify my tinnitus: loudnoise and certain medicines, e.g., aspirin andnonsteroidal ant i-inflammatory agents.We are living in a time when we are exposedto various kinds of acoustical trauma, and thisproblem is ever increasing. Probably the g r ~ a t e s t offenders are those who subject us to amplifiedmusic. Unfortunately, such amplification hasbecome so prevalent that it is difficult to avoid it .Rock concerts are well-known to be acoustically

traumatic. Theaters are also now amplifying theirmusic considerably. Nightclubs, cafes, and manyrestaurants are similarly exposing their patrons toacoustical trauma. Receptions at weddings andsimilar affairs typically expose guests to traumatic levels of music. Many subway lines in largecities expose riders to an acoustically traumaticenvironment.Exposure to loud noise will increase mytinnitus v.rith 100% predictability. In less than a

minute after such exposure, I suffer an instantaneous exacerbation of my tinnitus which canlast for minutes, hours, or days. Accordingly,I absolutely refuse to subject myself to suchtrauma. Much to the chagrin of some friendsand relatives, 1'11 attend the weddings an d BarMitzvahs but leave before the loud music starts.I've learned that those who Jove and care for meunderstand my reasons and are not offended.

Over the years I have given considerablethought to tinnitus and have evolved a theorythat makes sense to me. To understand my theo-

20 Tinnitus 'Zbday /September 1999 American Tinnitus Association

ry better one needs to give consideration to thw e l l k n o ~ body phenomenon of pain. Pain isnot a disease. Rather, i t is a symptom whichalerts the patient and the physician that something in the body is going wrong. It is a signalthat directs the patient's attention to the area.from which the pain emanates. For example, 1one inadvertently touches something extremehot, pain is felt instantaneously and the b o ~ y wreflexively jerk the hand away from the pamfustimulus in order to protect body tissues fromdamage. When the pain is the result of a n:edicondition, the proper medical and/ or s u r g ~ c a l treatment is likely to alleviate this symptom.

In the rare disease called FamilialDysautonomia (Riley-Day S y ~ d r o m e ) , a g e ~ e ~ idefect causes interference w1th the transm1ss1of pain stimuH from the skin to the central nervous system. Because of their insensitivitypain, children with this disease do not reflexivremove themselves from painful stimuli.Accordingly, they may not bring dangerous sittions to the attention of parents and other caretakers. Injur ies to the skin, eyes, tongue, andgums are common.

Certain tissues do not have the capacity tofeel pain of the kind one experiences when a fger touches a hot plate. The retina of the eye ian example. Obviously, it can still be damagedFor example, if one were to try to look directlythe sun without protection, the human body wprovide automatic protection by reflexively cloing the eyelids and jerking the head away so. tthe light will not impinge directly on the retmaThe same principle holds with regard to thesense of smell. A noxious odor results in immeate attempts to withdraw and protect oneself.The sense of taste works in a similar manner.Something that is extremely bitter or distastefuis often reflexively spit out in order to protect body from the potential harm it might cause.

Although the external ea r can feel pain, thinternal ear (where the hearing organs are locaed) is not pain sensitive. However; like a l ~ othetissues in the body, the ear needs protectiOn frthat which will damage it: loud noise.

Now to my theory. Because tinnitus will usally increase if one subjects oneself to ongoingexposure to loud noises, and it will usuallyreduce when one removes oneself from the nosituation, my type of tinnitus (the kind a s s o ~ i av.rith presbyacusis) might simply be a body s1gthat says "get the hell out of there!"


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TINNITUS: ABLESSING IN DISGUISE? (CONTINUED)If this theory is correct, then the discovery ofa treatment that suppresses tinnitus might be amixed blessing. The same treatment that wouldalleviate the grief of the tinnitus sufferer mightalso deprive the individual of the mechanism thatalerts one to the danger of loud noises - andpossibly to the dangers of some disease process

that is cp.using the tinnitus.We who have tinnitus might never enjoy thepleasures of complete silence - walking through

quiet woods, silently enjoying a beautiful scene,or just sitting quietly and relaxing. It is a deprivation and a loss of a pleasure. But it is not a physical pain. For me, when I lead an active life,involve myself in those things that provide mewith interest and enjoyment, I am less likely tobe bothered by my tinnitus (or other irritants, forthat matter).

I t is my hope that my theory will prove useful for tinn itus sufferers by helping them take aslightly more positive attitude toward their tinnitus: to view it as a useful symptom (its grievousaspects notwithstanding) that helps them avoid

acoustical trauma and protects them from furtherhearing loss and further intensification of theirtinnitus.The Hippocratic dictum to doctors is: "Nullinocere" - Above all, do not harm. Doctors might

not be able to he lp most of the tinnitus patientswho come their way, but they can warn themabout the detrimental effects of noise trauma. Mytheory serves this principle, and is epitomized bya close friend's poignant warning: "If you don'tlisten to your body when it whispers, it wm startto scream., aRichard A. Gardner; M.D., is Clinical ProfessoY ofChild Psychiatry at Columbia University College ofPhysicians and Surgeons in New York City. He isalso in the private pmctice ofpsychiatry in Cresskill,New Jersey.

Ame1ican Tinnius Association Tinnitus Thday/September 1999 21


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Beethoven and Meby Julian Crandall HollickJulian Crandall Hollick is a well-known producer forNational Public Radio who sculpts with sound to produce highly complex and beautiful pieces. Currently,he is traveling abroad for a new series about Islam.In May of his year, he developed a middle ear infection that left him with tinnitus and quite literallyunable to hear.

For two weeks, Beethoven and I were membersof the same select society. I was brought up onBeethoven's music. I adore it. But I hated everyminute he and I belonged to the same selectgroup.The trouble started at the beginning of May.

I flew to Bangladesh - a long flight - and my earsdidn't immediately "pop" on landing. That wasunusual. I tried all the usual things - yawning,turning my head from side to side, blowing mynose. And after 24 hours my ears did clear, so allwas well.'TWo weeks later I flew to Boston and that'swhen the problem began. Normally my ears poponce I'm back inside the terminal. This time theydidn't.I waited. My son advised "candling" or burninga special tapered candle to suck up the offendingwax. This made sense. I'd last had my ears cleanedwhen I was six or seven. So maybe they were all

full of wax? I lay on my side with a candle burningaway a few inches above my ear. I t was ratherpleasant as 1 heard the wax being sucked up intothe candle.'1Full. Absolutely full! Look at the amount ofwax!" my wife triumphed. "I've never seen somuch wax. When did you last clean them?" Theonce-hollow candle was indeed full of wax. I twent on for three days like this. After each candling there seemed some improvement to mydiminished hearing and the slight buzz I heard.There would be a lessening of the buzz in one of

my ears when I tilted my head to one side. Buthope only lasted a few minutes as clouds movedback in.And then my hearing went. Thtally.One moment I was with my family. Th e nextI was isolated in a padded cell with a constantroaring sound inside my head. Anyone familiarwith recording would recognize it immediately as

22 Tinnitus ?belay/September 1999 American Tinnitus AssQciation

"white noise" - the sound a river or a waterfamakes, a sound indistinguishable from a raginwind. I t has no recognizable character. It is junoise. And this time it didn't le t up. I t didn't mte r if I tilted my head sideways or forward orupside down, or laid down on my side. 1t wasthere, ever-constant.

So I went to see an ear specialist. Apart frthe usual (telling me I was overweight), she pded and listened and then solemnly informedI had no movement in my middle ear, and thhad an infection. I t could have been brought by the flight, she said, and the candling couldhave aggravated things. But the fluid was nowstatic an d it had to be loosened. I t could onlycleared up by a hefty dose of penicillin and reclearing of the nasal passages, head swathed itowel over a basin ofboiling water, with plentVicks. I didn't dare seek another opinion andmaybe more bad news. But in the back of mymind, I wondered, "What would happen if it dclear up?"

Ten days came and went. I took the penicand steamed my head and nothing changed. Istarted wondering what Smetana, the 19th ceCzech composer who woke up one morning sdeaf, must have felt like. Did he feel suicidal?rage? Did he have any inkling beforehand?

Or what about Beethoven, who progressivlost his hearing and yet still"heard" his comptions, his music, within his head? Would I, coproduce radio programs in spite of, or perhapbecause I could no longer hear as others couldIf it were possible, what a challenge! I could iine strange wonderful new relationships betwsound and voice, both conceived as musical inments. But was it possible? Or was I imagininsuch potential creativity? I didn't want to pitymyself. I wanted to believe.

Ten years earlier, I had had a sudden andsimilar panic when I collapsed an d woke up ia hospital to discover I was a diabetic. For threweeks, I tried injecting myselfbut I was not vsuccessful. I went into a sweat just thinking ainjecting myself. My skin became leathery inanticipation. And how could I ever work abroin the deserts of Rajasthan or on a hike in theHimalayas and keep a cool supply of insulin?covered that NPRjournalist Scott Simon had ba diabetic since he had been sixteen, and somhow he managed to inject himself, even in foxholes during "Desert Storm." So it could be do


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QUESTIONS AND ANSWERSJack Vernon 'sPersonal Responses to Questions from our Readersby Jack A. Vernon, Ph.D., Professor Emeritus,Oregon Health Sciences UniversityQMs. B. in New York reports that she wasaware of a study of three tinnitus patientswho were treated with Prozac, all ofwhom had their tinnitus disappear. On the basisof this report, Ms. B. also started taking Prozac(10 mg a day) and on the fifth day her tinnituscompletely resolved. She has now been on Prozacfor nine days and her tinnitus has no t returned.She asks if others have taken Prozac and if sowith what result.AWe have had various reports from tinnitus patients who were prescribed Prozacand we conducted a rather informal openstudy of Prozac. Out of 25 patients, five receivedtinnitus relief, 13 reported no effect upon theirtinnitus, and seven said their tinnitus was tem-porarily worse. These results leave us not knowing exactly what to recommend regarding Prozacbut I think I would make th e following suggestion. 'lly Prozac if you wish and if there is exacerbation of your tinnitus immediately stoptaking it. May I ask of those who try Prozac toplease inform us of the results.

QMr. P. from Australia indicates that hehas had ear surgery whereby his earcanal was enlarged and grommets (or

tubes) were inserted through both eardrums. Asa result of the surgery, he now has severe tinnitus. 1b date he has found that bilateral hearingaids have been of no help with his tinnituswhich was measured to be 7330 Hz. He obtainssome relief from a Walkman and has been fitted with bilateral tinnitus instruments (unitsthat contain both hearing aids and tinnitusmaskers with independent volume controls).He asks why the hearing aids failed to providetinnitus relief. He also indicates that he experiences rather severe depression.A he fact that your tinnitus is at 7330 Hzplaces it well above any sounds that mosthearing aids would amplify. You needmasking sounds in the 7000 Hz region to effectmasking . The tinnitus instruments could provide th e relief you seek. In addition I would suggest bedside masking for sleeping, like a CDplayer with Petroff Audio 'Technology's CDs.Because of your depression, I would caution youagainst the use of tri-cyclic antidepressants(continued)

Beethoven and Me (continued)But losing hearing seemed a far darker situation. I started to retreat into a private world and aprivate language. I t was frustrating for others notto be able to talk with me. To be honest, I'm no t

sure I really missed them. Yes, I was in a cocoonand I couldn't get out. But if I wanted to be freeof unwanted conversations I had a perfect excuse.And then it happened. Something made mesneeze."I can hear! They're opening!" I screamed.Of course, I thought I was just talking at normalvolume. And nobody knew what I was talkingabout. They couldn't share in this wonderful joy.What was open? The Pub? The stores? What?And then, just as soon as they opened, a shaft ofsunlight streaming in, they closed again. I was

back in my ow n little world. In darkness. But theyhad opened!Two days later I sneezed again, and my earspopped opened for good.I have a lo t of sympathy now for deaf peopleand people with tinnitus. An awful lot. And Ithank God I can hear again and that the tinnitusis gone. I will never take hearing for granted.No doctor has advised me against flying again,perhaps because I haven't asked. Indeed, not fly-ing would make it rather difficult for me to work.Nevertheless, I wondered if J wasn't tempting Fatelast week when I flew again, this time to Pakistanand back.My ears never closed. B

American Tinnius Association Tinnitus Thday/ September 1999 23


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QUESTIONS AND ANSWERS (continued)because they can exacerbate tinnitus. I assumethat your depression will leave once your tinnitus is relieved. If not, you might want to tr y thedrug Wellbutrin or the herb St. John's Wort, bothof which are effective against depression and donot exacerbate tinnitus.QMs. S. from Pennsylvania has noticedthat he r tinnitus is worse after sleeping.She says that even a short nap in theafternoon can cause a significant increase inher tinnitus and she would like an explanation.A wish I could give a definitive answer.There is a group of tinnitus patients whofind that their tinnitus is greatly alteredby sleep. For these patients it can go either way.If they are having a good day and go to sleep, oreven take a nap, they awaken with increasedringing. Or if they are having a bad day and goto sleep, they awaken with a significant reduction in their tinnitus. The change always occursduring sleep. I have discussed this matter withsleep experts who throw their hands up and saythey have no idea why tinnitus should behavein this manner. Since we cannot explain thisphenomenon yet, let's see if we can change it.I would suggest that you sleep with a bedsidemasker as a possible way to break this unusualcycle.Q s. H. from Connecticut indicates thather tinnitus was exacerbated by dentalsurgery involving implants in both upperand lower gums. She describes the tinnitus as ahissing sound which covers the entire head plusa pulsatile tinnitus on the right side of the head.She has tried acupuncture, masking devices,hypnotherapy, and prayer and only the latterseems to help. She takes a variety of drugs:Darvocet, multi-vitamins, Nortriptyline,Lorazepam, Prozac, Premarin, and Provera.A ou are taking such a host of medicationsthat one wonders to what extent theircombination might be causing anincreased tinnitus. Perhaps you would be willingto discuss your drug regimen with your primaryphysician to see i f hey are all necessary. I alsowonder if you were properly fitted with themaskers you tried. It might also be reasonable totry CD masking sounds.

24 Tinmtus 'Jbday/September 1999 American Tinnitus Association

Q Mr. S. in Pennsylvania sent me aletter he had received about a "naturalformula" that had been discovered forthe relief of tinnitus. He asks: 11Do you haveany comments to make about this so-called'amazing' product?"A he letter Mr. S. received was also sento me and it makes tinnitus relief claimfor a product called "Tinnitabs." The sted effect of Tinnitabs is from the author's ownexperience (which means the results are notbased upon any properly conducted tests). Thproduct contains five natural homeopathicingredients that are said to trigger naturalhealing processes in the body. According to thletter, a bottle of 250 tablets costs $19.95 on amoney-back guarantee. Interestingly enough,Tinnitabs is not available in stores or healthproduct catalogues - jus t mail order from thecompany. Now, having said all that, it is myguess that Tinnitabs probably won't hurt youi f you want to try them although I doubt theclaims made for this product. If you or anyoneelse tries Tinnitabs, I would appreciate hearinabout the results.

Q r. K.in California says his tinnitus

sounds like 1,000 crickets. He has twohearing aids but only uses one from timto time. He adds that he sometime flies andwonders if he should use earplugs while flyingA n the face of bilateral hearing loss, itdoes very little good to use only one heing aid. I'd seriously recommend usingtwo hearing aids. That your tinnitus sounds likcrickets means that it has the pitch of about2000 Hz. I t is possible that hearing aids wouldrelieve tinnitus of that low a pitch. As for flyinI recommend the use of earplugs for takeoffsand landings and that you sit in an aisle seatas far forward on the plane as possible.(It's quietest there.)Notice: Many ofyou have left messages requestingthat I phone you. I simply cannot afford to meetthose requests. Please feel free to call me on anyWednesday, 9:30a.m.- noon and 1:30-4:30 p.m.Pacific Time at 503/494-2187. Or mail your questions to: Dr. Vernon c/o Tinnitus Today, AmericaTinnitus Association, PO. Box 5, Portland, OR97207-0005.


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SPECIAL DONORS AND TRIBUTESATA's Champions of Silence are a remarkablegroup of donors who have demonstrated their

commitment in the fight against tinnitus bymaking a contribution or research donationof $500 or more. Sponsors and ProfessionalSponsors have contributed at the $100-$499 levelResearch Donors have made research-restrictedcontributions in any amount up to $499.

Contributions to ATA's Tribute Fund will beused to fund tinnitus research and other ATA programs. If you would like your contribution restricted for research, please indicate it with your gift.1hbute contributions are promptly acknowledgedwith an appropriate card to the honoree or familyof the honoree. The gift amount is never disclosed.Our heartfelt thanks to all of these specialdonors.

A1l contributions to the American Tinnitus Association are tax-deductible.GIFTS FROM 4-16-99 to 7-15-99

Champions of Sol Charen Arthu r G. Kearney Bradley Ross Johnson & Johnson Max R o s e n ~ wSilence Ji m Chesnut Jack Kelly Barbara L. Sanders Pfizer Foundation Sylvia Eisenberg(Contributions of$500 Guy R. Clark Katherine C. Kline Bruce A. Schommer Readers Digest Selma an d AlanPhilip S. Collins Elliott Koidin Bryan Schwab Foundation Rothenbergand above) Craig Connelly Walter P. Kulpinski Palmer Sealy, Jr. US Borax, Inc. Susan R. EricsonJoel Alexander Capt. Thomas C. Henry G. Largey Rober t w. Selig Charles E. SikesJulia R. Amaral Crane, USN, Ret. Donald J. Larivee Marjorie Shaw-Kobe Special Friends Mrs. SikesAndrew Beaven Roy W. Cronacher, Jr. Michael C. Lehner John V. Shepherd, Sr. FundMatthias B. Bowman Elizabeth J. Curtis Charles B. Levitin Charles Siess In Honor OfThomas W. Buchholtz, Donald W. Davis Jeff rey Loder Hal Sitowiz I n Memory of Franl


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SPECIAL DONORS AND TRIBUTES (continuEddie BondMildred S. BonwitBruce BostonAlain G. BoughtonRita BourqueJoan L. BoyerStephen J. BoyleEugene Bradin, D.D.S.James W. BradyAdelia BratsosMerlin R. BretzmanLauran BromleyPastor John BroomallSarah BroshousDonna F. BrownKaren L. BurkeJudith E. CaldwellJohn J. CalliThrry R. CanterMildred E. CardDaniel CarrilloWilliam D. CasaleDoug CecilIsabelle ChapmanCarol Jean ChattertonMartha ChaykosldBruce H. ChilcoteCharlotte M.

Christensen-JohnsonF'lossie Anita Cla rkIris V. ClarkJohn P. Clark, Jr.Bruce D. ClowFrank S. CognatoJoan CohenRobert . CollawnMary J. CollinsMary L. CollinsJohn S. ConklinGail E. ConleyFoKConnerJames J . ComradaAnna J. ConwellDonald J. CookJohn H. CordonnierVivian CornwallElizabeth S. CostonWard S. Cottrel lCapt. Thomas C.Crane, U.S.N., Ret.Fred CucchiaraRaymond M. Dabler

r

Dennis M. DalyPierre DavidPhyllis M. DeatherageDana L. DegeestSandi L. DeloreyChandler S. DennisCarole DesnoesTimothy D. DobbinsPaul J. DorweilerNancy DoyleHoward 0. DuggerMary Ellen DurfeeSanford EbnerJoan EcholsJudith M. EdaWayne EdwardVivian EhrlichRobert w. EichertRobert ElassadDr. Robert EllingtonAbraham ElyRon and Joyce Evans'!yler D. EvansB. FarringtonJames T. FehonJudith FeldSylvia FeldmanSol FingarAugust E. FirgauRudy J. FleischackerVicki H. FlynnBernice FosterAntonio FraceMyer FrankEdward J . F'ranskowskiJoana L. FrickChuck FullerGeorge N. GastonDavid GenaMaj. Leo A. GendronJoseph GenoveseElaine M. GermontGerald GevertzBetty GibbsEd GiosciaGloria GiuntaBarry S. GoldbergEthel GordonVictoria GraorNorman and GildaGreenbergMarianne R. GuayBeth c. HaidtBetty C. Hall

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tinnitus today september 1999 vol 24, no 3

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