Tinnitus Today December 1998 Vol 23, No 4

7/23/2019 Tinnitus Today December 1998 Vol 23, No 4

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December 1998 Volume 23, Number 4

Tinnitus TodayTHE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION"To promote relief, prevention, an d the eventual cure of tinnitus forthe benefit of present and future generations"

Since 1971Education - Advocacy -Research - Support


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Tinnitus T o d ~ y Editorialand Adverising offices: AmericanTinnitus Association, P.O. Box 5, Porrtand, OR 97207 503/248-9985, 800/[email protected], htp:/ www.oto.orgExecutive Director& Editor:Gloria E. Reich, Ph.D.Associate Editor: Barbara ThbachnickTinmtus 7bday is published quarterly inMarch, June, September, and December. It ismailed to American Tinnitus Associat iondonors and a selected list of tinnitus sufferers and p r o f e s i o n a b who trea t tinn itus.Circulation is rotated to 80,000 annually.Th e Publisher reserves the righ t to reject oredit any manuscript received for publicationand to reject any advertising deemed unsu itable for Ti1mitus 7bday. Acceptance of adve rtising by T!nmtus 7bda.y does no t constituteendorsement of the advertiser. its productsor services, nor does T!nmlus 7bday makeany claims or guarantees as to the accuracyor validity of the advertiser 's offer. Th e opinions expressed by r.ontributors to T!nnrtusToday are not necessarily those of thePublisher, editors, staff, or advertisers.American Tinnitus Association is a nonprofit human health and welfare agencyunder 26 USC SOl (c)(3).Copyrigh t I 998 by American T innitusASsociat ion. No pan of th is publ ication maybe reproduced, stored in a retrieval system,or transmitted in any form, or by any means,without the prior ,,,riuen permission of thePublisher. ISSN: 0897-6368Executive DirectorGloria E. Reich. Ph.D . Portland, ORBoard of DirectorsJames 0. Chinn is, Jr., Ph .D., Manassas, VAW. F. S. Hopmeier, St. Louis, MOGary P. Jacobson, Ph.D., Detroit , MlSidney Kleinman, Chicago, ILPaul Meade, T igard, OR, Chmn.Philip 0. Monon, Portland, ORStephen Nagler, M.D., F.A.C.S., At lanta, GADan Purjes, New York, NYAaron I. Osherow, Clayton, MOSusan Seidel, M.A . CCC-A, Towson, MDJack. A. Vernon, Ph.D ., Portland, O RMegan Vidis, Chicago, ILHonorary DirectorsThe Honorable Mark 0. Hatfield, U.S.

Senate, Ret iredTony ~ n d a l New York, NYWilliam Sbamer, Los Angeles, CAScientific Advisory CommitteeRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland, ORJack D. Clemis, M. D., Ch icago, JLRobert A. Dobie, M.D., San Amonio, T XJohn R. Emmett, M.D., Memphis, TNChris B. Foster, M.D., La Jolla, CABarbara Goldste in, Ph.D., New York, NYJohn w. House. M.D., Los Angeles, CAGary P. Jacobson, Ph.D., Detroit, M lPawcl J. Jastreboff, Ph.D., Baltimore, MDRobert M. Johnson, Ph.D ., Portland, OR

The Journal of the American Tinnitus AssociationVolume 23 Number 4, December 1998Tinnitus, 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.Table of Contents7 Announcements8 Managing Meniere's Disease

by Barbara Tabachnick11 Book Review: Meniere's Disease - What You Need to Know

by Barbara Thbachnick13 Where Does Tinnitus Come From?by Aage R. Mller; Ph.D.

17 Ginkgo Biloba: A Word of Hope and a Word of Cautionby Stephen Nagler; M.D. , FA .C.S.

18 Caring fo r Yourself Despite Tinnitusby Reverend Radha

19 A Long-Thrm Look at Ginkgoby Susan Seidel, M.A ., CCC-A21 Support Giving and Getting: In Our Own Time21 Nordstrom/ATA Partnership Puts Tinnitus Book in

Medical Librariesby Cora Lee (Corky) Stewart

Regular Features4 From the Editor

by Gloria E. Reich, Ph.D.5 Letters to the Editor23 Questions and Answers

by Jack A. Vernon, PhD.25 Special Donors and 'fributesCover: 'Love Button ' (watercolor an d pencil on paper) by Gail Wells-Hess, [email protected] 800/ 776-4245. Represented by Chroma Gallery, Fair Oaks, California and the Seattle Ar t


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FROM THE EDITORby Goria E. Reich, Ph.D.,Executive DirectorAnother year has passed andwe at ATA wish you the bestofholidays an d a happy andhealthy 1999. Every day ourmail brings us news of discoveries that give us hope forbetter treatments and evenpossible solutions to hearingand tinnitus problems. Evena few years ago who would have dreamed thata fully implantable hearing aid would be understudy? Could we have imagined that geneticresearch would find ways to address the problems of familial deafness? Would we havebelieved that scientists could "see" tinnitus inthe brain? Stay tuned everyone, because the newmillennium is going to bring big surprises andhopefully solutions to problems such as thosewe face with diminished hearing systems. ATA isproud to have sponsored some of these seminalstudies and we'll be keeping you posted on thelatest happen ings.

We hope you've noticed Tinnitus Tbday's newlook. Our graphic design consultant, Gail WellsHess of Portland, has introduced several changesdesigned to make the magazine more readableand interesting. You'll also note that several newadvertisements have appeared . These are consistent with our policy to offer our readers as manysensible choices as we can find of items thatmight possibly help them battle tinnitus.

We and you both know that ATA cannot offeryou a cure for your tinnitus. We'd like, however,to help you make good decisions about yourcare. What do you want to know? We'll gladlyresearch an d write about topics that you'd like tosee covered in Tinnitus Tbday. Let us know bywriting to us, either by fax or e-mail, or snailmail if that's your only choice. I'm1.... I going to give you something to" start with by listing topics

llr below. These are some of the~ = - - #' topics that were requested to

International Tinnitus Seminar which will takeplace in Cambridge from the 5th to the 9th ofSeptember, 1999. Come yourselves or suggestthat your doctor or hearing professional attend.Look for an announcement of this meeting inthis issue.Possible topics for discussion about tinnitus: Psychological impacts of severe an d

persistent tinnitus Development of new equipment toobjectively test tinnitus Electronic contTol of tinnitus Outcome measures for various tinnitustreatments, including masking, retrainingtherapy, drugs, non-traditional methods, etc. Audiological examinations for tinnitus Providing information about tinnitus: whatdo people really want to know, and does it

bring relief? Potential causes of tinnitus Tinnitus in children, elderly Management strategies by country:USA, Germany, France, U.K., Scandinavia,

Japan, etc.These are just a few ideas for you to startwith. I'm sure they will suggest more questionsthat you would like to have answered. Directspecific questions to the "Question and Answer"column written by Dr. Jack Vernon. Your experi

ences with he lpful treatments can be used inthe "Letters to the Editor" column. And yourideas abou t more general topics will beresearched for longer articles. Thank you forhelping us by making these suggestions.As we approach the new year and the end ofthis century it is important to look beyond ourpersonal desires for a tinnitus cure. We mustlook for better treatments for those who have

tinnitus now and prevent people who don't haveit from get ting it. The cure might come later,


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Letters to the EditorFrom time to time, we include lettersfrom our members about theirexperiences with "non-traditional"treatments. We do so in the hope thatthe information offered might be helpful.Please read these anecdotal reportscarefully, consult with your physicianor medical advisor; and decide foryourself if a given treatment might beright for you. As always, the opinionsexpressed are strictly those of the letterwriters and do not reflect an opinion orendorsement by ATA.In August of 1995, my right ear began to "ping"very loudly over the top of my existing tinnitus which I had in both ears. In as little as twodays, the incessant pinging broke down my resistance and frayed my nerves. As the days woreon, sustaining my sanity became very difficult.The pinging noise invaded every corner of mylife, interrupted every thought. This pulsatilepinging noise was truly more bothersome tome than my existing tinnitus which I had beenliving with since 1988.

My subconscious couldn't quite ignore therandom, pulsatile sounds as I'd learned to dowith my tinnitus. My doctor couldn't find a connection between the pinging and a biologicalfunction such as pulse or breathing, and I beganto despair that this new noise would be a lifelong companion.

I ruled out medications such as Xanax,Pamelor, and Elavi1 as the cause because l'd beenexperimenting with them for years for my "regular tinnitus" before the pinging began. The medications took the edge off of my tinnitus but theyalso made me drowsy. I started to drink severalcups of coffee daily to counter the drowsyingeffect of the medication. Simultaneously, I was

that could be responsible for my pinging noises.Cold turkey, I stopped all caffeinated coffee andsalt. I couldn't maintain a coherent state ofmind on medication without coffee, so I stoppedthe medication too. It was only a matter of daysbefore the pinging stopped and I found relief.

Since my discovery three years ago, I havenot taken any medications and I only drinkone half-cup of caffeinated coffee a day. I havetinnitus in both ears, but over the years we havebecome compatible. If my resolve cracks and Itest myself on an extra cup or I get careless andover-salt my foods, the pinging returns. I t seemsall too simple but the fact remains: my pulsatiletinnitus was caused by too much caffeinatedcoffee and too much salt.

Jeffrey B. Bell, 220 Old Tippecanoe Dr.,Springfield, IL 62707, 217/787-4507

R:ecent news media announcements havegiven the impression that the Aurex-3 systemprovides "tinnitus cancellation" technologythat can cancel, or nullify, tinnitus sounds. Asan audio and acoustics engineer, I would like toexplain why tinnitus cancellation is, in my opinion and in the opinion of other experts in thefield, not possible.The concept of tinnitus cancellation (sometimes referred to as "phase cancellation") isbased on the seemingly simple principle ofapplying a sound wave or vibration that is"equal-and-opposite" to the tinnitus sound,thereby canceling it out. While this process isfeasible when the sound to be canceled exists asan external sound, it is unfortunately not applic

able to tinnitus for many fundamental reasons.Principal among these reasons is the fact thatthere is no actual"sound" present in the ea r thatcorresponds to the perceived tinnitus. In otherwords, tinnitus involves the perception of sound,not the presence of sound. Any attempt to sonically cancel that which does not exist onlyresults in th e introduction of extraneous soundin the tinnitus frequency region. When extraneous sound is applied, a totally unrelated processcalled "masking" can occur to some extent,


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Letters to the Editor (continued)An analogy to tinnitus cancellation could be

illustrated by imagining an intoxicated personasking his friend to stop, or cancel, the movements of the room that he perceives in his mindto be spinning. The room is not actually movi.ng,so room movement cancellation is no t neces-sary, le t alone possible.I t is my u nderstanding that absolutely notinnitus treatment device is FDA-approved to

claim or infer tinnitus cancellation as a basis ofoperation. Anyone wishing to contact the FDAEnforcement Division regarding this mattermay do so at (phone) 301 / 594-4613 or(fax) 301/594-4683.Mike Petroff, PetroffAudio Technologies

It is our pleasure to donate the results of myworker's compensation claim for the use ofyour organization to further the cause ofresearch into this terrible condition.In 1993, as my junior high students werepreparing to leave their field day activities togo home on the last day of school, a studentprankster grabbed a large freon-powered boathorn, sneaked up behind me, held the horn tomy right ear, and discharged the can. The damage this event caused cannot be easily described.There was a resultant loss of consciousness, tem-porary blindness, speech and motor dysfunction,distorted vision, and a screaming noise in myhead that would no t go away.

The hospital emergency room staff reallycould not understand the problems and eventually discharged me when I could walk. The restof the story is chapter and verse of most of thoseI've read about in your publication. In additionto the skewed double vision, I suffered fromsevere debilitating tinnitus and hyperacusis withall of their side effects. The attempts at therapywere unsuccessful. Ultimately, I had to leave myteaching profession which I had so dearly lovedfor almost 30 years.

Finding your organization and its resourceswas the life preserver I needed to survive the fol

Finally, in early 1998, a friend referred meto a product called "Magna Bloc TM" - MagneticFlux Generator" (www.magnabloc.com) produced through Dr. Robert Holcomb in Nashville,TN (615/ 321-2251). After attaching these magnets just behind and below the ears at night, Ifound an immediate (within 30 minutes) changein my condition. After wearing the magnetsinfrequently over the past several months, I'vebegun to regain my life. I can actually toleratemultiple conversations near me; I can go intorestaurants again; I can concentrate on things;I can tolerate sounds again that would havecaused intense pain earlier. And most of all Ibegan to sleep again, now several hours at atime. Although the tinnitus is extant, it is finallyhabituated .

I hope that someday, somehow, health careprofessionals can be made aware of the mentalanguish and suffering they sometimes add to analready insufferable condition. With the help ofyour organization I remain eternally optimistic.E. Wayne South, PO Box. 91, 105 Hissim Rd.,Hope, NJ 07844

Iuffered with tinnitus for about 20 years

although there were times when I was so busythat the noise was no t noticeable. But when Ithought about it , the noise was there! In mycase, I hear whistling sound at 6000 Hz.

About a year ago, I started taking Ginkgobiloba (40 mg per day containing 24% ginkgoflavonoid glycosides). Since then the noise hassubsided dramatically and there are days whenthe noise disappears entirely.

Thomas W Donaldson, Claremont, CA

Mndful that people choose stapedectomiesfor several reasons, I've pu t together achecklist based on my personal and successful stapedectomy experience and extensiveinvestigation into the topic.

Stapedectomies ARE for correcting otosclerosis which is causing a conductive hearing loss.The hearing test results are obvious and your


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ANNOUNCEMENTS6th In ternational Tinnitus Seminar -Cambridge , EnglandSeptember S-9, 1999Hosted by the British Society ofAudiology

The 6th International TinnitusSeminar will be held on thegrounds of the historic andbeautiful Selwyn College atCambridge University, withfull conference facilities and alarge modern 500-seat lecture.._____ _, theater adjacent to the college.

We believe this is the perfect venue for thisimportant scientific meeting. Accommodationswill be provided for 300 in the college itself.Nearby hotel accommodations are also available.

Plenary session topics: Mechanism andModels of Tinnitus, Medical and SurgicalTreatments, Tinnitus Retraining Therapy, Roleof Psychologist, New Advances in Research, andMethods of Tinnitus Detection.For registration information, contact:Mrs. Jackie Reid32 Devonshire PlaceLondon WlN lPEUnited Kingdom44 + (0) 171486 4233FAX 171 486 2218E-Mail: j [email protected] site: www.tinnitus.org

Letters to the Editor (continued)of several of my Internet pals. In fact, some people who did no t have tinnitus before their operations have it now. There is no logic to it.

Find a doctor who performs severalstapedectomies in a year. An average of about35 to 40 a year would be my minimum. It'll give

The 19th European Instructional Course on"Tinnitus and ItsManagement"Sunday Aprilll - Thursday AprillS, 1999Nottingham, United Kingdom

The 19th annual course addresses thecauses, scientific background, investigation, andmanagement of tinnitus. It will consist of lectures, videos, practical demonstrations, andworkshop sessions. The course is suitable forotologists, audiological physicians, scientists,technicians, and hearing therapists who areinvolved in, or are developing, clinical orresearch work on tinnitus.Venue

The course is held on the campus of theUniversity of Nottingham. Accommodation andmeals are provided. The campus is within easyaccess of Nottingham city center.Faculty

The course organizers are Jonathan Hazelland Ross Coles. The faculty comprises AdrianDavis, David Baguley, Jean Baskil1, Terry Buffin,Lucy Handscomb, Laurence McKenna,Catherene McKinney, and Jacqueline Sheldrake.Enrollment

The course fee is 660 (residential), 580(non-residential). Both fees include comprehensive notes, lunches, dinners; the residentialoption also includes bed and breakfast. Earlyapplication is advised. There is an upper limitof 80 delegates. The closing date for receipt ofapplications is February 26 , 1999, by which dateall fees must be paid. Scholarships (coveringcourse fee and accommodation, no t travel) willbe awarded. Details will be supplied uponrequest.Registration details can be obtained from:Julie Whittington, Conference NottinghamRegent HouseClinton AvenueNottingham NG5 lAZUnited Kingdom


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Managing Meniere's Diseaseby Barbara Tabachnick,Client Services ManagerImagine that you are taking apeaceful walk, engaged inconversation. Five minuteslater, you are bent over, retching, spinning with uncontrolled dizziness, sick. Youhear roaring noises in yourhead and notice that yourhearing is muffled. This out-of-the-blue "attack"lasts two hours then slowly subsides. You areweak and unsteady for several days after. Andfor every day thereafter, you wonder whathappened, fearful that it might happen again.

For people with Meniere's, it will happenagain.Unrelenting vertigo, roaring tilmitus, hearing loss, and a sensation of fullness or pressurein the ears are agonizing symptoms each untothemselves. When they occur simultaneously,they characterize Meniere's disease, named forFrench otologist Prosper Meniere. In 1861,Meniere first identified the condition and notedit correctly as a dysfunction in the inner ear.

CausesThe cause of Meniere's disease is notknown. The physical manifestation of it, however, is well-known - a swelling of the inner earlabyrinths, the organs that house the balancemechanisms. This swelling, referred to asendolymphatic hydrops, results from an overproduction or an inadequate reabsorption of the

natural fluids (endolymph) in the labyrinths.The triggers for the swelling are still a mystery.Some causes being considered: autoimmunedysfunction, viral infection, hormonal influences, dietary deficiencies, and allergies. Called"a disease of exclusion," Meniere's is the conclusive diagnosis only when other causes - such asinner ea r infection, acoustic neuroma, a leak ofperilymph fluid (perilymphatic fistula), andeven syphilis - have been ruled out. When the

The Progression of Meniere)sOther than that the typical Meniere's patientis 30-50 years old when the disease first appears,Meniere's has its own timetable. In its earlystages (which can span a year or more), thesymptoms come and go unpredictably. Theepisodes (with dizziness, nausea, one-sided tinnitus, etc.) can last from 10 minutes to all day,with residual unsteadiness lasting days longer.

Symptoms generally disappear between attacksalthough in rare cases, the dizziness is constant.The intervals between attacks can be months orsometimes years.

As the episodes continue, the patient's hearing usually worsens and the tinnitus that wasepisodic becomes permanent. Hearing loss oftenbegins in the lower frequencies but can spreadacross all frequencies as the disease advances.The tinnitus can progress similarly. Fortunately,the violent attacks of vertigo usually lessen thenstop in the later stages of the disease, often to bereplaced with a mild, constant state of disequilibrium. (However, not all cases of Meniere's stabilize.) Doctors refer to these permanent, leveledoff changes as Meniere's "burnout."TestsThe patient experiencing Meniere's-likesymptoms usuaUy faces a battery of tests to ruleout other disorders as the cause, and to "rule in"subtle symptoms that suggest Meniere's. A puretone audiogram is a standard first test. It willshow if the lower frequencies of hearing, typicalfor the early-stage Meniere' s patient, have beenaffected. Meniere's-related roaring tinnitus is inthe lower frequency ranges too.Balance tests (on computerized platforms, inrotating chairs) can determine i f he dizzinessexperienced by the patient is vestibular dizziness, the type associated with Meniere's. Eyemovement and head shaking tests are alsocommonly used for this purpose. Magneticresonance imaging (MRI), auditory brainstemresponse (ABR), and blood tests might beordered to look for other medical conditions


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Treatments"The best treatment is one that eliminatesthe cause of a problem." writes P. J. Haybach.But with Meniere's elusive origins, that is no tpossible. Attending to the symptoms, Haybachconcludes, is the patient's and doctor's logicalgoal for now.Drugs

Medications for Meniere's are aimed predominantly at arresting the dizziness and theaccompanying nausea and vomiting. Theyinclude diuretics, antiemetics, motion sicknessdrugs, anti-anxiety drugs, niacin, and steroids.Sere (betahistine hydrochloride) was onceavailable in the U.S. for relief of debilitatingMeniere's dizzy spells. I t is still available inCanada and Europe by prescription, and inMexico without prescription. Betahistine isavailable by prescription in the U.S. but canonly be obtained at a compounding pharmacy.(Histamine injections are an alternat ive to it.)None of these medications is intended to alleviate tinnitus or restore lost hearing. However,patients report that these symptoms are lesstroublesome than the vertigo, at least in theearly stages of the disease.Surgery

The number one goal of surgical management for Meniere's is also to control vertigo.One group of operations was designed to reducethe pressure in the endolymphatic sacs by theinsertion of shunts (a kind of tubing) or valves,or by decompressing the sac. For some patients,these surgeries offer long-term relief from vertigo. Many shunt patients, though, experience initial relief then a recurrence of the symptom, orno relief at all.Ototoxic drugs, like gentamicin, can bedelivered by injection through the eardrum todestroy inner ear vestibular hair cells and endthe vertigo. Miraculously, this procedure worksfor 65-95% of patients although it often needs to

be repeated for long-term help. A complicationfrom this procedure that is difficult to avoid:

Labyrinthectomy, a more dramatic surgery,is the complete excision of the balance organs inthe affected ear. The operation causes total hearing loss on the operated side and is wiselyreserved for patients with constant vertigo andtotal or near-total deafness on the affected side.

Vestibular nerve section - cutting the balance nerve - is a more invasive procedure thanlabyrinthectomy. This surgery necessitates goingbeyond the ear, in fact through the lining of thebrain, to reach the vestibula-cochlear nerve. Tenpercent of patients who undergo this procedurelose their hearing on the affected side. The rateof long-term success in controlling vertigo forboth labyrinthectomy and vestibular nerve section is high: 90%.

Radical removal or destruction of the balanceorgans leads to an end of the jarring attacks ofvertigo, but patients are left with a new andpermanent balance impediment with which tocontend. And if the Meniere's begins to affectthe other ear, as is sometimes the case, then thesymptoms would return. Over and above therisks associated with any surgery, complications(like worsened tinnitus and hearing loss, andfacial paralysis) are uncomfortably common.Surgery is an option, but usually the last optionto be considered.Allergy TreatmentsAllergies are suspected to contribute to theonset of Meniere's and are the subject of newresearch in this field. An allergic reaction -whether to foods eaten or particles inhaled - isa chemical reaction in the body that can lead to,among other things, the deposit of microscopicdebris in the endolymphatic sacs. And if the sacsbecome damaged, the mysterious chain ofevents that leads to Meniere's disease couldbegin. In 1997, one group of 113 Meniere'spatients, with a variety of allergies, underwentallergy desensitization and dietary treatments.Once treatments were completed, all of thepatients felt that their allergy and Meniere'ssymptoms had significantly improved.


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Managing Meniere's Disease continuedof a diuretic, successfully lessens vertigo for amajority of Meniere's patients. This regimen isaimed at dehydrating the inner ear which couldreduce the amount of endolymph and thereforethe dizziness. (It's been noted that once patientsadjust to a low-salt diet, they become moresensitive than before to salt excesses.)

Also, by eating several small meals throughou t the day, patients can help stabilize fluctuations of the endolymph levels. For some, thiswill reduce the frequency of Meniere's attacks.Improved blood flow to the ear can accomplishthe same thing. Patients are encouraged to eliminate use of nicotine, alcohol, anti-sleep medications, caffeine drinks, and chocolate - all ofwhich contain vein-constricting agents.Tinnitus and Meniere>s

Howard Gutnick, Ph.D., likens tinnitus to aforest fire. I t begins, he says, with a spark -excessive noise, physical trauma, hearing loss, orany disease that damages outer rather than innerhair cells. The tinnitus is then fueled by thebrain's failure to habituate it , and the flames arefanned by environmental assaults, like alcohol,caffeine, nicotine, and stress. Tinnitus associatedwith active Meniere's is different, Gutnick states,from other tinnitus in that i t has a continual newsource of sparks that feed the fire. "A person withactive Meniere's disease has an unstable innerear that is continually undergoing trauma due tohydrops," he says. As long as the disease processis untreated, he believes that any therapy for theaccompanying tinnitus will have little effect. "Assoon as the Meniere's disease comes under control," Is discussion groupSend e-mail to: [email protected] message: "subscribe menieres_talk"ReferencesEstrem, S.A., and W.E . Davis, Meniere's disease- recentadvances, Missowi Medicine, vol. 85, no. 3, p. 151-154, 1988Goldenberg, R.A., an d M. Justus, Endolymphatic mastoidshunt for Meniere's disease: do results change over time?,p. 141, La1yngoscope 100: Feb. 1990Gutnick, H., Internet posting, Sept. 5, 1997Haybach, P. J., Meniere's Disease, What You Need to Know,Vestibular Disorders Association, Underwood, J., (ed.), 1998Hughes, G.B., and Pensak, M. L., Clinical Otology,2nd edition, Thieme Medical Publishers, Inc., 1997Pappas, D.G., Is there a relationship between Meniere'sdisease and allergy or sinusitis, Steady, The Meniere'sNetwork, vol. 7 no. 4, 1995Severtson, M., Current research in Meniere's disease,Steady, Th e Meniere's Network, vol. 8, no. 3, Sept., 1998


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BOOK REVIEWby Barbara Tabachnick, Client Services Manager

Meniere's Disease - What You Need to Knowby P. J. Haybach, R.N., M.S., Vestibular DisordersAssociation, 1998. 336 pgs., soft-cover $24.95,hardbound $34.95When Meniere's Disease - What You Need toKnow arrived on my desk this summer, I picked

it up, read it, then immediately called JerryUnderwood, Ph.D., director of the VestibularDisorders Association (VEDA). I wanted tothank him, and to tell him that P. J. Haybach,as author, and he, as editor, have done us a hugefavor. They have produced a teaching tool for usand a reassuring guide for people who have orsuspect they have Meniere's. I wanted to tellhim that he hit the mark.

Haybach begins the book with a rather finelayman's lesson in ear anatomy, and auditoryand vestibular processes. She moves on todescribe Meniere's symptoms; the "attack" andits aftermath; the details of tests (hearing, movement, blood, and imaging) that might be orderedand the reasons for them. Haybach then coversthe treatments: dietary changes (the most common treatment in the U.S.); an array of diureticsand their differences; corticosteroid use; shuntand decompression surgeries; drugs (like niacinan d histamines) to block symptoms temporarily;and drugs (like transtympanic gentamicin injections, and streptomycin) for permanent symptom alleviation.

Haybach discusses the process of selectingqualified doctors and how to obtain health insurance coverage for this complex problem. Alsoincluded: first-person patient success stories,research studies related to and specific toMeniere's, a list of patient support organizationsworldwide, and questions to ask the doctor(once you've found one who is Meniere's-savvy).The author quiets the controversies - from thenumber of accent marks in the name to whetheror not Meniere's is accurately labeled a disease.Precise drawings, readable charts, references,and a glossary appear in the volume just when

I t occurred to me why this book wouldappeal to someone beleaguered by hearingcomplications, unsteadiness, and surpriseattacks of vertigo. Haybach' s writing style andthe material's presentation are clear, calming -and balanced.

Meniere's Disease- What You Need to Know isa saving grace for Meniere's patients and theirfamilies, and a satisfying addition to ourresource library. IBIThe book can be purchased directly fromVEDA, PO. Box 4467, Portland, OR 97208-4467.800/837-8428, (fax) 503/229-8064,www. vestibular.org.

Meniere's DiseaseWhat You Need to Knowby P. J. Haybach, R.N., M.S.This Importantnew book Includes:symptoms of Meniere's disease

testing-what to expect, what you will learntreatments w11at you can do tips on copinganatomy and physiology of the Inner ear

diet research a lternat ive treatmentsinsurance surgery drugsother resources- organizations, support groups'The authors have successfully accomplished the difficulttask of accurately and succinctly summarizing an Immenseamountof technical information fo r the nonscientistreader.'F. owen BlaCk, M.D., Director of NeurotologyResearch,HolladayPark Clinical Research and TechnologyCenter,Legacy Health System

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12/29

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WHERE DOESTINNITUSCOME FROM?by Aage R. Melle" Ph.D., University of Texas at Dallas,Callier Center for Communication Disorders,1966 Inwood Rd., Dallas, TX 75235Physicians often examine patients with tinnitus only to find that there is nothing wrongwith the patients' ears. This does not helpthe patients who might only get confused by theinformation and perhaps think that the tinnitusthey hear is not reaL

The ear tells the brain everything about thesounds we hear. But the brain makes it possibleto perceive sound, to hear thedifference between sounds,making it possible to understand speech, enjoy music,etc. Tinnitus could occur no tonly because of an alterationin how the ear works, butalso due to an alteration in

11 h how the brain works. I t isAage R. M0 er; P .D. necessary to know where tin-nitus is generated in order to find treatments forit and to find ways to prevent it.We know much about what parts of the brain

are involved in hearing normal sounds but theymight not be the same parts of the brain thatcause tinnitus.Which parts of the brain are involved in hearingand tinnitus?

Studies of which parts of the brain generatetinnitus recently got national attention when itwas shown by Lockwood and co-investigators1that a certain part of the brain became active

brain is a sign that it is consuming more energy,that it has become more active. PET scans showa picture of the brain that is similar to the CTscan or MRI scans. In a PET scan, areas ofincreased blood flow light up , similar to thunderstorms on a weather map on television.PET scans show which parts of the brainbecome active when for instance a person hearsa tone or speech. Even i f sounds reach only oneear, i t will cause the auditory cortex to becomeactive on both sides of the brain. This "lights up"the PET scan on both sides of the brain.Lockwood, et al, found that only the auditorycortex on one side "lights up" on the PET scan

when patients with tinnitus experience anincrease in their tinnitus. Lockwood concludedthat the neural activity that caused tinnitus didno t come from the ear because that would havecaused the auditory cortex on both sides tobecome active. These investigators also foundother differences between the way tinnitusand ordinary sounds activate the brain in thepatients they studied. Regions of the brain normally involved in emotions and memory wereactive when people heard their tinnitus butthese portions of the brain did not becomeactive when sounds reached one ear.

'

hese studies can only be done in patientswho can change their tinnitus from loud tosoft voluntarily. Few people with tinnituscan do that. The PET studies therefore had to bedone in people who had a special kind of tinnitus that they could turn on and turn off whenthey wanted. The results of this study thereforemight not be valid for other kinds of tinnitus.

Other methods have been used to find outwhich parts of the brain cause tinnitus. Someyears ago, we found that tinnitus in somepatients seemed to come from parts of the brainthat are normally no t activated by sound.2 Theauditory nervous system is similar to an information highway that connects the ear with thepart of the brain that interprets sounds. On theway, the information is sorted with regard to itsfrequency (spectrum) and many other qualitiesof a sound. Sorting of information occurs inclusters of nerve cells called nuclei. This part ofthe brain is called the classical auditory pathwayand it is the information highway that normalsounds travel to reach the (primary) auditory


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WHERE DOES TINNITUS COME FROM? continued

Tis information highway in the brain

branches out to other systems, one of whichis called the adjunct auditory system. Thatroute does not lead to the primary auditorycortex but to other parts of the brain, some ofwhich are involved in emotions. That adjunctsystem not only receives its information fromthe ear but also from the skin, muscles andjoints (somatosensory system), and from theeyes. Little is known about the adjunct systemexcept for the fact that it does not seem to bemuch concerned about what kinds of soundsreach the ears.

We wondered if this adjunct system might beinvolved in tinnitus. Th study whether this is thecase, we made use of the fact that the adjunctsystem receives information from the nervesthat go to the skin all over the body (somatosensory system). Information from these nervescan either increase or decrease the neural activity of some nerve cells in that adjunct system. Ifthe adjunct system is involved in tinnitus, stimulation of such nerves would then act as a volume control that could either turn the volumeof the tinnitus up or down. Th test that, weplaced electrodes on the wrist and stimulated alarge nerve by weak electrical impulses to see ifwe could change people's tinnitus. Indeed suchstimulation changed the tinnitus in some of thepeople we studied. The electrical stimulationwas felt as a tingling. Six out of the 26 peoplewe studied felt that the tinnitus became weakerand less annoying during the electrical stimulation of their wrist. Four of our patients felt thatthe tinnitus worsened. These changes occurredonly while stimulating the nerve, and the tinnitus returned to its normal value a short timeafter the stimulation was stopped. We interpreted these findings to show that the adjunct system is involved in tinnitus in some people withtinnitus. This means that neural activity thatcaused tinnitus in these people must travel inroutes in the brain that are no t normally traveled by sound.

Th find out if the adjunct system is normallyinvolved in hearing sounds, we tested people

ed their median nerve electrically. The nontinnitus sufferers experienced no change or onlyvery small changes. This means that the adjunctauditory system is probably not involved in perception of ordinary sounds. In some tinnituspatients, parts of the brain thus seem to havemade new connections with parts that normallyare not connected.What can cause the connections in the brain tochange?When the information travels from the ear tothe auditory cortex, it passes several clusters ofnerve cells - nuclei - that function as switching stations where each nerve cell has manyconnections to other nerve cells, and that allowsnerve cells to communicate with each other.This communication between nerve cells makesit possible to analyze sounds and direct theinformation of different kinds through differentroutes on its way to more central parts of thebrain. We believe that there are also connectionsthat are normally closed. These closed connections - called dormant synapses - may open inunusual situations. When that occurs, information can travel through new routes and reachparts of the brain that sound normally does notreach. Such a change in the "wiring" of the brainmight cause tinnitus. And the unpleasant natureof tinnitus might occur because part s of thebrain that are usually not involved in hearingare active.How can the wiring of the brain change?

Many studies have shown that connectionsbetween nerve cells in the brain are not staticbut can change. That is called "neural plasticity."Earlier, neural plasticity was believed to existonly in young individuals, but more recently, ithas been found that even the adult nervous system can change. Neural plasticity is probably anormal phenomenon of the brain that gives i tresilience. However, it is becoming evident thatneural plasticity going wrong may be the causeof many different disorders. Changes in thefunction of the nervous system through neural


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What can cause changes in the brain?One of the most powerful means is lack ofstimulation such as may occur when the ear isinjured. Normally, sounds of different frequencies activate different regions of the auditorynervous system. In a person with hearing loss atcertain frequencies, the regions of the brain normally occupied by these once-perceived frequencies will be taken over by frequencies

where hearing is not reduced. This is accomplished by opening connections between nervecells that are normally closed. In this process,however, the parts involved may become moresensitive than normal.5 ch increased sensitivity might make nervecells become active without any soundreaching the ear thus creating the sensationof a sound, thus creating tinnitus. Gerken3 hasshown in animals that certain nerve cellsbecome more active i f he ear is damaged sothat it cannot send information to the brain.Jastreboff4 has proposed that lack of stimulationcan cause tinnitus and restoration of stimulation(low-level masking) may reduce tinnitus. Thishas proven an effective treatment for some tinnitus sufferers.

The nervous system normally works with abalance between inhibition (''brake") and excitation ("accelerator") and the over-sensitivity mayoccur because inhibition has not kept up withthe excitation in these areas that have beentaken over. I t is like driving an automobile byholding one foot on the brake and the other onthe gas pedal. If the brakes become weak andthe same pressure is placed on the gas pedal,the car will accelerate. With financial supportfrom the American Tinnitus Association, wehave shown in experiments that some nuc1ei inthe brain become more active than normal afterexposure to strong sounds5 and the function ofthese parts of the brain could be restored bymedication. 6 The medications we used in thisstudy were bac1ofen and others in the family ofbenzodiazepines. Clinical experience has shown

References1. Lockwood, A. H.; Salvi, R. J.; Coad, B. A.; Townsley,M. A.; Wack, D. S.; and Murphy, M. S. The FunctionalNeuroanatomy ofTinnitus. Neurology, 50: 114-120. 1998.2. M0ller, A. R.; M0ller, M. B.; Yokota, M. Some Forms of

Tinnitus May Involve the Extralemniscal AuditoryPathway. Laryngoscope, 102: 1165-1171. 1992b.3. Gerken, G. M.; Saunders, S. S.; Paul, R. E. Hypersensitivity to Electrical Stimulation of Auditory Nuclei Follows

Hearing Loss in Cats. Hear. Res. 13: 249-260. 1984.4. Jastreboff, P. J. Tinnitus as a Phantom Perception:Theories an d Clinical Imp1ications, Chapter 8. In:Vernon, J. A.; M0ller, A. R.; eds., Mechanisms ofTinnitus.Allyn & Bacon . Boston. pp. 73-93. 1995.5. Szczepaniak, W. S. and M01ler, A. R. Evidence ofNeuronal Plasticity Within the Infer ior CoUiculus AfterNoise Exposure: A Study of Evoked Potentials in the Rat.Electroenceph. Clin. Neurophysiol. 100: 158-164. 1996.6. Szczepaniak, W. S. and M0ller, A. R. Effects of (-)Baclofen, Clonazepam, and Diazepam on Tone Exposure

induced Hyperexcitability of the Inferior Colliculus inthe Rat: Possible Therapeutic Implications for Pharmacological Management of Tinnitus and Hyperacusis.Hear. Res. 97: 46-53. 1996.

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TESTIMONIALS ON DTM EFFECTIVENESST he DTM technology effectively eliminates unwanted soundsproduced below the tinnitus region, which to date has beenthe major fault with conventional masking technology.-Dr . Jack Vernon (one of the world's foremost experts on tinnitus)I am writing you to voice my unrestrained enthusiasm foryour DTM technology. I have to say I was completely overwhelmed by the sample you sent me. For years I have triedvarious devices in my practice. Personally, I suffer from tinnitusin both ears. Your system alerted me to the potential that existswith well-thought-out solutions to this perplexing problem.- Dr Steven M. Rouse (ENT)I have been a three-year sufferer of high-pitched tinnitus in bothears. The condition reached a climax about six months ago; atthis time I could no longer achieve a good night's sleep (despitethe use of a "sound soother" from the Sharper Image), and wouldalways awake feeling slightly nauseated and dizzy with the condition continuing throughout the day. Throughout this progression I have consulted among the best doctors in the field. Withfailed treatments ranging from ginkgo biloba to having tubes surgically implanted , these fine physicians have come up emptywith respect to tinnitus. My initial reaction once I turned on thefirst CD was one of utter amazement; I simply could no t believehow low the volume level was while masking. I can vividlyremember having to turn the CD player on and off agajn severaltimes to make sure I still had tinnitus! With the DTM process, Ino longer hear the ringing (unless I concentrate). For the firsttime I have been able to get through a day without Advil and Ihave even been known to attend a few movies (with earplugs, ofcourse). Thanks again.-Pau l Pedrazzi


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GINKGO 8/LOBA AWORDOFHOPEANDA WORDOFCAUTIONby Stephen Nagler, M.D., fA.C.S.

Many individuals who are significantlyaffected by tinnitus encounter the maidenhairtree along their inevitable odyssey in s e a r c ~ ofrelief from incessant ringing. Some walk quicklyby, some stop and ponder, and some remain t?partake of the fruits (actual ly extracts f r ? ~ dnedleaves) of this tree, which is the oldest hvmgspecies of tree on earth, having been presentsince the days of th e dinosaur. Ginkgo biloba,the maidenhair tree, was believed at one timeto have magical powers. Today ginkgo is felt bymany to have a legitimate medicinal role. Theextract can be taken in pill form, as a liquid, orintravenously, and is administered for manyreasons - among them, to improve cerebralinsufficiency by increasing blood flow to thebrain, improving neurotransmission, and actingas a free-radical scavenger. Symptoms of cerebral insufficiency can include difficulties of cognitive skills, decreased energy and physicalperformance, depression, anxiety, dizziness,headache, and ..tinnitus. 1

Some members of the tinnitus populationswear by Ginkgo biloba; others feel that it is ineffective for this condition. The question of thetrue value of this agent should be answered conclusively within the next year, however, whenthe results will be published of the first largescale double-blind randomized prospective study(1000 volunteers at Birmingham University inthe U.K.) on the efficacy of ginkgo in tinnitustreatment. Regardless of the outcome of thestudy, the many affected by tinnitus who believethat ginkgo has improved their symptomatologywill undoubtedly continue to use it. Indeed, ifthe study does clearly demonstrate efficacy, ~ i l -lions with tinnitus will use it on a regular bas1s.

As a tinnitus treatment, ginkgo has someappealing aspects: 1) it is r e l ~ t i v e l y inexpens.iv.e,and 2) its sWe effects are beheved to be neghgtble. The purpose of this article is to exploreone particular side effect of ginkgo, which hasrecently appeared in the medical literature,and which may be under-reported.

In terms of mechanism of action, the mostimportant components of Ginkgo biloba areflavenoids and terpenoids. Ginkgolide B, aterpenoid which is not known to exist in ~ n y .other living species, has been shown m mtro (mthe laboratory) to inhibit the action of PlateletActivating Factor (PAF).3 PAF is a crucial element in initiation of platelet aggregation, anearly essential step in the coagulation c a s ~ a d e , the blood dotting mechanism. The potentialexists, therefore, that in vivo (in real life) ginkgomight adversely affect blood clotting.

Herein lies a potential explanation for thefew anecdotal reports of nosebleeds amongindividuals taking ginkgo.A question then arises:if we assume that Ginkgobiloba does, indeed, causenosebleeds in some cases,then what might it bedoing inside the body?In the June 1996 issue ofthe journal Neurology, acase report appeared ofa woman in her thirties,who had been taking120 mg of Ginkgo biloba

Stephen Nagler, M.D., fA.C.S. daily for two years andwho presented with large bilateral s u b d u r ~ l hematomas - bleeding beneath the covenngof the brain, compressing the brain matteritself.4 There was no history of head trauma,and the patient's only other medications wereacetaminophen and a very brief trial of ergotamine/ caffeine tablets. The patient had not takenanticoagulants, aspirin, or non-steroid_al a ~ t i -inflammatory medications. Her bleedmg t1mewas prolonged, but returned to normal when i twas re-checked a month after cessation of theginkgo. (She underwent surgical evacuat ion ofthe subdural hematomas and made a completerecovery.) Nine months after this case was published, a case appeared in the literature .reporting spontaneous bleeding into the a n t e ~ 1 0 r chamber of the eye, a rare occurrence, m aman who was taking ginkgo.5


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Ginkgo Bi/oba AWord of Hope and a Word of Caution (continued)2. Most physicians tend not to explore a "current medication" list further to see if agents such

as ginkgo, not typically considered by Westerndoctors to be medications at all, migh t have beeninadvertently lef t off the list.3. Most physicians do no t appreciate ginkgo'santicoagulant properties.These three factors might potentially contribute to under-reporting of a problem of somesignificance.What, then, would be a prudent position totake if one were considering initiating a courseof ginkgo or if one were already taking thisextract? I t seems reasonable to assume thatregardless of its efficacy with respect to tinnitustreatment, Ginkgo biloba might in certain casespredispose one to bleeding, not necessarily limited to nosebleeds. Fortunately there is a simple

laboratory test (called the '1Jleeding time") whichis a fairly sensitive measure of platelet functionand which can pu t every patient's and physician's mind at ease.There is general agreement that if Ginkgobiloba has not been effective for tinnitus reliefwithin three months, it will not become effectivethereafter. Thus, it is best to discontinue ginkgo

if no improvement is noted by that point. I fpatients want to continue taking ginkgo forlonger than three months, their bleeding timeshould be monitored at six-month intervals. If thebleeding time is prolonged, patients should consult with their physicians about continuing theginkgo. Ifbleeding gums, nosebleeds, bru ising,etc. are noticed while taking ginkgo, patientsshould obtain a bleeding time and then decide

with their physicians whether or not to continuethe ginkgo. If any individual is already takinganti-coagulants (blood thinners) and consideringstarting ginkgo, the decision whether or not tostart the ginkgo should be made in consultationwith the physician. If an individual taking ginkgo is contemplating elective surgery, a bleedingt ime should be obtained, and a decision shouldbe made in consultation with the physician andthe surgeon about discontinuing the ginkgoprior to the surgery. In all cases, physiciansshould be informed that Ginkgo biloba can interfere with platelet aggregation.

Ginkgo biloba is a commonly used agentwhich may be helpful in tinnitus therapy. TheBirmingham study will hopefully shed light onits true efficacy, and the guidelines above willhopefully increase the margin of safety. B1. Kleijnen, J. and Knipschild, P.: Ginkgo biloba. The Lancet340: 1136-1139, 1992.2. Personal communications; non-published an ecdotalreports.3. Campbell, W. B. and Halushka, P. V.: Lipid-DerivedAutacoids. Goodman & Gilman's The PharmacologicalBasis ofTherapeutics, 9th ed., McGraw-Hill, New York,1996, pp.601-616.4. Rowin, J. and Lewis, S. L.: Spontaneous BilateralSubdural Hematomas Associated with Chronic Ginkgo

Biloba Ingestion. Neurology 46(6): 1775-1776, 1996.5. Rosenblatt, M. And Mindel, J.: Spontaneous HyphemaAssociated with Ingestion of Ginkgo Biloba Extract.The New England Journal ofMedicine 336(15): 1108 , 1997.Dr. Nagler is the Director of the SoutheasternComprehensive Tinnitus Clinic in Atlanta, Georgia,and a member ofATA's Board ofDirectors.

CARING FOR YOURSELF DESPITE TINNITUSby Reverend Rodho, reprinted and adapted with permissionfrom Tnnitus-Foum, the Deutschen TinnitusLiga e. .journal, August 1998

time, it is possible to avoidbeing disturbed or, worse,dominated by it .

You have almost cer


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ALONG-TERM LOOK AT GINKGOby Susan SeideL M.A. cec-A

Ginkgo biloba and what itis doing to the blood: It'san important topic but itisn't a new one. Since1965, ginkgo has beenwidely used in Franceand Germany to increaseblood circulation inpatients' limbs. Its addedbenefits have been tohelp improve memoryand concentration - andtinnitus.

Most of my Baltimore tinnitus self-helpgroup members, along with other volunteers, arepart of my Ginkgo biloba project. Many of the512 participants have been taking 120 mg. pe rday, three tablets of 40 mg in phytosome form,for seven years. (The phytosome is a bondingagent that allows the ginkgo to be absorbedmore slowly.) And during these years, I haveheard only one complaint about it - from aman who took ginkgo on an empty stomach andgot an upset stomach. People regularly report tome that they feel a sense of well-being, warmthin their hands and feet, and for some, a reduction in tinnitus that they attribute to the ginkgo.I have always advised my group members andmy audiology patients to have blood thinningtests done and to not take ginkgo with otherblood thinning drugs.

From my reading of the case study publishedin Neurology, the woman who'd had subdural

What has happened? The image of the keys fellon your retinas and signals were transmitted tothe brain, but you did not see them. Your minddid not "focus" on the keys.Most tinnitus sufferers have a habit of "zoom

hematomas had also taken excessive amounts ofacetaminophen along with the ginkgo. Manyprescription and over-the-counter remedies cancause bleeding time to lengthen. And i f any ofthese substances is taken with ginkgo (or withother medications) and bleeding does occur, thecause will no t be known. I t is very hard to drawconclusions from one case.

Ginkgo has been studied for more than adecade in Europe. In those studies, ginkgo wasfound to be effective as a free radical scavenger,effective for improvement in macular degeneration, and helpful with asthma and allergic reactions in addition to its use as a blood thinner.Ginkgo biloba will be a hot topic at the 6thInternational Tinnitus Seminar in England nextyear. In addition to a report about the 1000-tinnitus patient/ ginkgo study in Birmingham, I will

be making a full presentation about my 512long-term "ginkgo takers." Right now, though,I can say that they've been helped by it. And sohave I. IDSusan Seidel is an audiologist at the GreaterBaltimore Medical Center and a member ofATA'sBoard ofDirectors.EDITOR'S NOTE: The assumptions regardingginkgo presented in both Nagler's and Seidel'sarticles are based on anecdotal reports, not onclinical research. For additional informationabout ginkgo and tinnitus research, see JJEndingthe Silence - the Lowdown on AlternativeTreatments" and "Ginkgo - Fact or Fiction?" inTinnitus Thday, val. 18, no. 4, December 1993.

Tinnitus is in some ways like pain. I t resultsfrom an injury or trauma to some part of thebrain or hearing apparatus. If we view the experience of tinnitus as being similar to that ofpain, then, when all medicine fails, there is


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CARING FOR YOURSELF DESPITE TINNITUS (continued)become angry, depressed, anxious, or physicallyand mentally tense. I t is this tension that causespain or tinnitus to be even worse.But we can take control of our lives, so thatour tinnitus (or pain) no longer dominates ourfeelings and emotions. We do this by trainingourselves systematically in "mindfulness." Putsimply, mindfulness is moment-to-momentawareness without reacting automatically towhat happens. It is cultivated by purposefullypaying attention to things to which we ordinarilynever give a moment's thought. Breathing is oneexample.

One way to think of mindfulness is thatit is a lens, focusing on things you are doing,thoughts you are at the moment thinking. Whathappens to the tinnitus? I t falls into the background. I t goes out of focus. I t loses its importance which allows us to get on with the businessof moment-to-moment living. In the course oftime the sounds pounding or whistling in ourheads become like the keys we could not find.

Training ourselves in mindfulness requiresa systematic approach to developing new kindsof control and wisdom in ou r lives. It requiresactive learning, in which we build on thestrengths we already have. In this learningprocess we can assume from the start that solong as we are breathing, there is more rightwith us than there is wrong, no matter how loudthe tinnitus or how hopeless we feel.

The problem of tinnitus does not submit tosimple-minded solutions or quick fixes. I t is anatural part of life (if not everybody's, then atleast yours and mine!). And so there is no moreescape from it than from the human conditionitself. The bottom line is that truly facing ourproblems is the only real way to get rid of them.Practicing mindfulness

If you were to look in on our tinnitus group,you would probably find us with our eyes closed,sitting quietly or lying motionless on the floor.This can go on for up to forty-five minutes at astretch. To the outside observer this might seemstrange. l t looks as though nothing is going on,

the coffee-break. They are not thinking abouttheir tinnitus and how bad it is. They are not trying to solve problems. They are practicing mindfulness - s topping all the "doing" in their livesand allowing body and mind to come to rest, nomatter how loud the tinnitus or how they feel.Seeing things as they are

When I first became a Buddhist monk, Iasked my teacher what was the most basic purpose of Buddhism. He told me that it was "to seethings exactly as they are," to see a noise in thehead, a pain, a feeling, or a thought just as it is,without immediately "doing" something about it,such as thinking, "I wish it would go away," or,"How terrible this is." These thoughts b1ing thetinnitus into the foreground and into focus,which is exactly where we don't want it. Themore you attach your thoughts to the tinnitusand the more importance you give it, thestronger it gets. But i f you can, so-to-speak"starve" it, it matters much less, and is no morea real disturbance than the police sirens youhear from the street. This process of letting tinnitus "lose weight" takes place through practicingmindfulness.Caring for yourself

You cannot, however, learn to do this overnight, nor in the few days spent in a seminar.You have to make a firm personal commitmentto spend some time each day practicing "justbeing." Then you will learn how to make timefor yourself, slow down, become calm, and howto observe what is going on in your mind.The more systematically and regularly you

practice, the more the power of mindfulness willgrow, and the more you will come to understandhow valuable it is. And no matter how muchyour doctor, relatives, or friends want to helpyou in your efforts to move towards greater lev-els of health and well-being, the basic effort stillhas to come from you. No one's care for youcould or should replace the care you can give toyourself. GReverend Radha (an Irishman!) has been living in


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SUPPORT GIVING &GETTING:In Our Own Time

The following names andnumbers belong to our newestsupport-giving volunteers.They join the many hundredsof others who've stepped forward over the years and said,"I want to help ."What do they do? Theyreceive calls from people troubled by their tinnitus. They

start and often lead local tinnitus self-help group meetingsfor patients and their families .They contact us for information and assistance wheneverthey need to.

What do they give) Theygive a few hours a month ormaybe a week to others withtinnitus who are out ofstrength or out of ideas.What do they get) They saythey get back two-fold, andsometimes ten-fold, in friendships, satisfaction, and purpose. (We say we could not dowithout them.)A list of current volunteersin your area was sent to youwhen you joined ATA. Pleaserefer to it if you need someonenearby with whom to talk.

Remember to call only duringreasonable day or eveninghours. Do you need anotherlist? Call or write to us for anew one. Are you interested inbeing a local support volunteer? Ask us for a SupportGiver's Packet. We'll send itright away.And if you are not ready

New Support GroupMark Gulliver, MSCNova Scotia Hearing & SpeechQE2 Health Services CenterDickson Bldg., 3rd floor5820 University Ave.Halifax, NS B3H 1V7CANADA902/473-4366New Telephone and E-mailContactsHerbert Hilton3000 Marcus Dr., #P-307Aventura, FL 33160305/ 792-0861Kathleen Krivak145 Burton Ave.Hasbrouck Heights, NJ 07604201 / 288-3038Dorothy Lewis360 Richboro Rd.Richboro, PA 18954-1710215 / 357-6047Paul MurphyP.O. Box 1184Sun City, AZ 85372602/ 972-5907John Reyes347 42nd St.Brooklyn, NY [email protected] Shippey204 Creamery Rd.TUnkhannock, PA 18657717 / 333-4945Richard C. Speedy765 N. 9th St.Harrisburg, OR 97446541/ 995-8608Robert Zeckleman

Nordstrom/ATAPartnershipPuts TinnitusBook inMedicalLibrariesbyCora Lee (Corky) Stewart,Program Development Manager

With the assistance of volunteers from Nordstrom, many ATAstaff members, and an unexpected bequest, ATA has been able todistribute complimentary copiesof the Proceedings of the FifthInternational Tinnitus Seminar toevery medical library in thena tion - all 2,911 of them.

During the Fifth InternationalTinnitus Seminar (co-sponsoredby ATA and the Oregon HearingResearch Center in 1995), nearly300 researchers, clinicians, andpatients from 25 countiiesexplored every aspect of tinnitus- from diagnosis to treatment,from personal concern toprofessional interaction. Thepapers from this quadrennialmeeting were published as theProceedings. (Individual copies

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Nordstrom/AlA Partnership continuedcheerfully provided the extrapeople-power necessary to package the two-pound books. Cost ofthe mailing, another obstacledelaying the long-planned project, was covered by receipt ofan unrestricted bequest from athoughtful , long-time ATA supporter, Frances T. Merz fromLees Summit, Missouri.

Completion of this projectaddressed several of ATA'sStrategic Plan goals includingprofessional outreach, medicalschool curriculum, corporate


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Questions and AnswersJock Vernon 's Personal Respon ses to Questions from Our Readersby Jack A. Vernon Ph.D., Professor Emeritus,Oregon Health Sciences University

I would like to reverse the order for our firstQ&A. I have asked the questions and he, thepatient, has provided the answers. Th e patientis Mr. D. who lives in Israel. He is a cochlearimplant patient to whom I sent a Moses/Langmasking sampler CD in order to determine ifplaying the masking tracks through his cochlearimplant could effect a masking of his tinnitus.Q When the Moses/ Lang CD is played throughyour cochlear implant, is the tinnitus stilldetected in the implanted ear?A No, the tinnitus in the implanted ear is completely masked.Q That is a surprising answer and an important one. When th e tinnitus in the implant-ed ear is completely masked, can you hear anytinnitus in the opposite and unimplanted ear?A Yes, the tinnitus in the unimplanted ea r isnot affected.Q Which track on the Moses/Lang CD is mosteffective in masking your tinnitus in theimplanted ear?A Track #S is best, although there is somemasking from several other tracks. ['Ifack #Sis a band of noise from 6000 Hz through 12 ,000Hz. Mr. D.'s tinnitus has not been measured butI would guess that it is high-pitched and somewhere in the 6k to 12k Hz range.]Q When the tinnitus in the implanted car ismasked does residual inhibition occur?A I am not sure. I need more time to experiment with it.Q When you played the Moses/Lang CD toyour implant what did you hear?A It's hard to describe but as best as I can do Iheard a sound, a noise, not necessarily apleasant sound but it's better than the tinnitus.

Q Are you sure that it is not that you arelearning more about how to respond to thecochlear implant? I'm told that often a greatdeal of training is necessary before one becomesreally proficient in using th e cochlear implant.A No, it is no t a matter of training. I have tested this effect many times by simply turningthe masking sound off and each time it is off,speech and music are not as clear as when it ison. I have repeated this test many times andalways with th e same effect.

In his last letter to me, Mr. D. indicated thatonce again he had taken up playing the violinand found that he could play Vivaldi rather wellwith the masking noise present. From this interchange I conclude that i t is possible to effecttinnitus masking and thus tinnitus reliefbyplaying masking sounds into the cochlearimplant for at least this one patient. Mr. D. hadfound that the action of his implant by itselfonly provided slight and partial masking whereas the masking noise afforded complete tinnitusrelief. His observation that the masking soundsmade speech and music clearer is a very surprising observation, one about which we needto learn more.Now, back to our regular Q&A ormat.Q According to Mr. P. in New Jersey, theInternet reveals that ADM Tronics offersa new device for the relief of tinnitus. Thedevice, which ha s FDA approval, is termed theAUREX-3. While no t specifically so stating, theAUREX-3 rather strongly implies that tinnituscontrol will be effected by "phase cancellation"much the same way that the ProActive 3000actively cancels incoming sounds. (See "NoiseCancellation Devices Given a 'Thst Drive" in theJune 1998 Tinnitus Tbday.) Mr. P. asks if I thinkphase cancellation of tinnitus is possible.

There are two things I would like to reportas to the possibility of canceling tinnitus byphase manipulation. First of all, this was tried


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Questions and Answers (continued)average tinnitus pitch of the patients seen in theOregon Tinnitus Clinic is slightly over 7000 Hz.In my opinion, phase cancellation of tinnitus isnot possible for the simple reason that there isno physical sound present that is generating th etinnitus.QMrs. B. in Maine indicates that she is takingGinkgo biloba, 160 mg per day, and it hashelped her tinnitus. She asks how long she cancontinue taking ginkgo and are there any sideeffects from taking it.A Mrs. B., I hope yo u will continue to keep usapprised of your progress with ginkgo. 1bmy knowledge you can take it as long as youwish, but there is possibly one rare side effectwhich in certain cases ca n be serious. Ginkgomight alter bleeding time (see "Ginkgo Biloba -A Word of Hope and a Word of Caution" by Dr.Stephen Nagler, p. 17). Thus were you to requiresurgery or to receive an injury, special care maybe necessary.Q Mr. L. from Florida indicates that despite30 years as an engineer working withgas/ turbine engines, he has almost no hearingloss. That is due to the fact that he used bothearplugs and earmuffs to protect his ears. Thefaucet test works for him but his major problemis getting to and maintaining sleep. When he issuccessful in getting to sleep, his tinnitus willawaken him after an hour or so making it difficult to go back to sleep. Other than taking sleeping pills is there an answer to his problem?A Mr. L., I would like to suggest that we do asmall experiment with you. In as much asmasking seems to work for you, I would like torecommend that you try a "sound pillow."The pillow is available from R. Scott Armbusterof Phoenix Promotional Products, 2335Thousand Oaks, #6-269, San Antonio, TX 78247.You can play any kind of sound into th e pillow:music, masking noise, nature sounds, etc. Inyour case I would recommend that yo u playrain or water sounds into the pillow. This pillowis arranged so that when your head is lifted of f

QMr. R. from Florida reveals that he is 84years old living only on Social Security.His tinnitus seems to be getting worse by themonth. He asks if there is any hope for him.A The increase in the loudness of your tinnitu s may be due to a gradual decline in yourhearing ability. Ifyou are experiencing difficultyunderstanding th e speech of others, it is possiblethat a hearing aid would not only improve

your hearing ability but your tinnitus as well.Expense, of course, is the problem, but trycontacting a local Lion's Club through yourChamber of Commerce or library. Or call theLion's Club International (630/571-5466) andtell them of your financial situation and thatyou need a hearing aid. They are usually quitehappy to help.

Q Mr. F. in Oklahoma makes the followingstatement: The recent work in Buffalowhich identified the brain area responsible forthe perception of tinnitus is most interesting.Would it be helpful to study what goes on in thisperceptual area during residual inhibition?A Mr. F., you have asked one of those criticalquestions. Clearly i f we know what goes onduring residual inhibition (the temporary cessation of tinnitus produced after masking sound isturned off), we might then be able to increaseits magnitude as well as its duration. Let's makesome guesses. Suppose you find that the perceptual area in the brain is still active during complete residual inhibition. That would suggestthat some other, possibly lower, brain area isproducing the residual inhibition. On the otherhand if the perceptual area went silent duringcomplete residual inhibition, we then need tolearn what procedures or chemicals make thisarea go silent. All of these things are much easier said than done. Clearly much work is needed.Dr. Salvi, one of the Buffalo researchers on thisstudy, indicates that they hope to do this experiment. Can you help? Yes, indeed you can. Helpincrease the membership in ATA so that moresupport is available for this kind of research.


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SPECIAL DONORS AND TRIBUTESATA's Champions of Silence are a remarkable

group of donors who have demonstrated theircommitment in the fight against tinnitus bymaking a con tribution or research donation of$500 or more. Sponsors and Pro fessional Sponsorshave contributed at the $100-$499 level. ResearchDonors have made research-restricted contributions in any amo unt up to $499.

acknowledged with an appropriate card to thehonoree or family of the honoree . The giftamount is never disclosed.

Our h eartfelt thanks to all of these specialdonors!A ll contributions to the American TinnitusAssociation are tax-deductible.

ATA's Tribute Fund is designated 100% forresearch. Tribute contributions are prom ptlyGIFTS FROM 7-1 6-98 to 10-15-98.

~ ~ Champions ofSilence(Contributions oj'$500and above)Robert W. BoothJohn Buchman, M.D.Michael D. Deakin, CPACornelius R. DuffieJeanna L. FrenchSukey Garcert:iRoth Family FoundationKenneth M. JonesStephen R. KarpMarian B. LovellJohn E. MeehanPrances MerzJerry MonninDon MorseStephen M. Nagler, M.D.,F.A.C.S.Robert PenceHubert G. PhippsAnn L. PriceBrian RayerThrry N. ShermanE. Wavne SouthR i c h a ~ d K. StruckmeyerSponsors(Individual Contributwnsfrom $100$499)F. Edwin AdkinsBrian AlexanderArthur AltaracRonald G. Amedee, M.D.Duane A. BairdWilliam C. BeattyDavid D. BedworthMuriel BeeryIvan H. BehrmannMrs. fran BelkinM. Craig BellMrs. M. H. BergreenAllen R. BernsteinLarry BirenbaumAlain G. BoughtonGeorge S. BovitBenjamin Boykin, IIMalcom K BrachmanJohn F'. BrogowiczCharles BucknerA. Paul Camerino

Joe GalandoRichard J. GambateseCarol . Garris, CPAWilliam A. GerrellsHarriet L. GlazerI. Larry GoldmanAgnes GossC. Lee GoughJane GreenTh e Irvin Green FamilyFoundationNorman and GildaGreenbergJames an d Colleen HartelAvis S. HartleyDavid HayesGene HerritzManny HillmanRoger w. HollanderShirma M. HuizengaCharlotte M. JacobsonJean Pierre JaffeuxLarry C. James, Jr.L. Craig JohnstoneSam JordanJo Ann KarkennyVirginia KnightWilliam J. KnightPeter KobelanskyDennis S. KoharaJoseph KoppelmanDavid J. KovacicAl lan S. KushenElizabeth G. LampenJohn Lazopoulos, Sr.Dr. Herbert A. LevinKen D. LewisRomulus Z. LinneyMatt LowenAnthony R. MaganaAaron J. and Jean MartinTh e Jean and AaronMartin FundPittman T. MayseAnne Holmes McKayJack A. McKayEd Leigh McMillan, IIThomas F. McNultyPamela S. McNuttRobert J. McTigueBill McWilliams

Janis T. PedersenMary Ann PcrperDonald E. PullenDan PtujesRuth RasorNancy M. RosenJoann RosenbergBeverly and Mel RosenthalAndrew J . RosserErnest SaguesHuseyin SakaRandall J. SchoenbergRichard S. SchweikerEvelyn J. SchwertlEd Scott TI'easurerThelma M. SjostromJoel SmithSheila C. SmithRonald E. SnowHenry M. SottnekJoseph SoutoGuy SpillerWalter P. StrumskiPat ThuerJohn D. 'Tbrmed.isEli7..abeth VanPattenThomas K. WebbShirley L. WeddleFred and Sharon WeinhausPat WollowickDouglas WrightRober t B. Wrigh tLarry W. YorkMichael K. ZakoorPaul W. ZerbstProfessional Sponsors(Professional Contribullonsfrom $100-$499)Sidney N. Busis, M.D.Richard A. CholeProf. Giancarlo CianfroneF. Lawrence Clare, M.D.Kathlee11 Costa, M.A.,CCCAElaine DeSilva, Ph.D.Stephen Epstein, M.D .Born Eriksen, M.S.Elio J . Fornatto, M.D.Anne Curtis Gal loway, M.S.Michael Higgins

J . Thomas Roland, Jr., M.D.'Thnit Ganz Sanchez, M.D.Helena Solodar, M.S.Dr. Blair R. SwansonCorporations withMatching GiftsBank America FoundationChase ManhattanFoundationCPC International, Inc.Philip MorrisCompanies, Inc.BequestsEstate of Dorothy M. HornEstate of Frances T. MetzTRIBUTESIn Memory OfMr. and Mrs. JerryBlumberg's so nEdna Heller's motherSylvia EisenbergCur tis E. BowmanDonald M. Bowman'Ihtdy Drucker.Joseph G. AlamSandy DeluccaBenjamin BoykinNancy A. BrownDeutsch Bank SecuritiesAndrew and J ulie HascoeFoundationJames E. andSandra J. HealeyMichael Pigna telloSa lomon Smith BarneyRaymond G. SchuvilleThomas J. SklensJohn UtendahlArthur and Sandra WilliamsMike EnlmannRobert FitchArlo an d Phyllis NashPota LeventisMa rgaret Leven isGrace WishanClaire and Jacques SimonIn Honor OfJoseph Alam

Mr. and Mrs. Ruben Drolc(50th WeddingAnniversary)Arlo and Phyllis NashJoe Lev(Happy 60th Birthday)Martin and Pat ButenskyGloria ReichStephen M. Nagler, M.D.,F.A.C.S.Dr. Jack A . VernonJohn R. UIJerichMatjorie YoungenJ. Richard Youngen, Jr.Research DonorsRod AbeleJohn J. AccordinoGeorge A. AndersonSally A. AndersonWilliam ApostolidesHarold Arlen, M.D .Mary AmheimRichard W BaizerJoshua S. BarclayF. Margaret BarnesRichard M. BennettJohn P BerganThrun BhatiaMary Lou BiddlestoneDiarmuid BoranRichard C. BorellaGarrison Bo ttsDennis D. BoyleAdelia BratsosCarol A. BrownNancy A. BrownSusan BrumfieldElizabeth C. BryanAnita C. BurdetteMichael W. BurnhamMarianne CarlsenAlyce J. CarlsonKate CarolanGladys Justin CarrMa rcia CarterDianne CaughellElizabeth CesarioCharlotte A. CochranJoseph R. Cohen,D.D.S., PC


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SPECIAL DONORS AND TRIBUTES (continued)Shirley DrabinskyHeyman C. DueckerMichael F. DuffieldGlen L. EdwardsRobert w. EichertJim W. EubanksThm E. FawcettMaurice A. FeldmanMaria F. FigueroaRonna Fisher, M.S.Harriet L. F'laccusFranklin L. FountaineDiane E. FreedmanJoana L. PrickIrving GamzaStephen P. GazzeraElaine M. GermontLeonard GreenHerbert GreenbergRichard C. GreeneBob HalpernRobert W. HamiltonFrances E. HammackShonie Hannah, M.A.Dr. Gorm P. HansenClayton R. HarrisDean HarrisSharon M. HartJames E. andSandra J. HealcF:W. Hees

Margaret P. HeppeSandra H. HernandezHumberto Hernandez,M.D.Michael HigginsE. Alan HildstromGeorge R. HoffmanLynda M. HoffmannDavid W. HollmeyerBetty D. HuebnerLinda A. HughesCyril D. JalonShirley J. KecklerR. L. KeheleyHeinz KleukerMary KlondaDoris L. KnechtCharles KneppMary R. KokesKit KolendaDavid J. KovacicMartin K.rasnitzSteve K.reizelThrn KuehleJudiS. LaneMary A. LeemanGail H. Leslie, M.S., CCC-ARomulus Z. LinneyMonique LiphamVirginia A. LobsingcrVirginia Longo

Alice E. MaisevRichard L. MarrRichard L. MartinSteve MartisA. Helen MauroMary J. McAlindonKathy L. McCainTommy D. McComasFrederick F. McGauleyFreddie J. McGowenGail M. MillerJohn Daniel MitchellCha rle s R. MoretzWayne A. MowryA. J. MurphyDonald E. NaceE. J. NaceEmil NatelliIra NewmanRegie R. NexsenCharles D. NicolausLouis M. NigroTerence E. NixonRoger A. OlayosShelley M. OlivaConvin R. OtteKarl E. OwenMarc J. PalumboRoxanne G. ParkerJackie PavichBrenda B. Person

Huben G. PhippsJudith PiepsneyRobert D. PowellMatthew PritchettMary T. PughMaj. Leonard RaabeKeiko M. RaoBarbara RavenGeorge A. RebhPatricia RenaudIrvin A. RenzJordi RibasMyron L. RothAndrew P. RowjohnWilliam L. RusselburgLynn RustebakkeJack SalernoManuel SanchezFrank A. ScafuriJames R. SchlauchD. Michael SchmitzRaphael F. Segura, .Jr.Richard SegusoMarlene K. ShawFrank ShekoskyRobert SilkLan-y SimmonsRoger J. Simpson, M.D.Elmer E. SmithLois I. SpaffordEugene Stengel

Dorothy T. StrainMireya SucreGeorge SutherlandRonald SwidlerD. Keith ThomasRobert N. TileyHelen Ti l ingerRichard W. VeeckJohn R. Veglia, Sr.Eleanor R. WagnerBarry WeeksDavid P. WeinerRuth F. WestGarv WhiteMartin G. WildMiriam H. WilsonEmil A. WolfJamee WolfPat WollowickRussell J. WolpertVirginia S. WoodMildred L. WoodhouseHenry H. YoungMichael K. ZakoorFrederick A. ZimmermanHarry Zimmerman, CCC-A

ATTENTION TINNITUS TODAY READERSResearchers at the University ofBuffalo are using a brain imagingtechnique called positron emissiontomography (PET) to study patientswho've developed an unusual form of"ringing or buzzing, " known as gaze-evoked tinnitus.

Patients with gaze-evoked tin ni tus cansignificantly alter the loudness or pitch of theirtinnitus by moving their eyes. The project isintended to determine the brain regions activat

understand how the brain functions after unilateral hearing loss. This research is supported bygrants from the National Institutes of Healthand is approved by the Institutional ReviewBoard at the University of Buffalo and the VAMedical Center. Patients participating in thestudy will have a comprehensive hearing testand PET scan. Persons interested in participating or learning more about this medicallyimportant research proj ect should contact:

Richard Salvi, Ph.D.Phone : (716) 829-2001Fax: (716) 829-2980E-mail: [email protected] Lockwood, M.D.Phone: (716) 862-3459


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BenefitATA and solve that search for a specialgift,or add to your own heirloom collection.

((Silent Night 1998"Only $54 plus shipping (includes attractive gift box and special card fromWilliam Shatner, ATA Honorary Director)

This is the first in a series of three, limited edition, European glass ornaments.All proceeds will benefit tinnitus education and research.'Ib order or to find a dealer near you:

Call toll free: 877-0RNAMENT (877-676-2636)Check the Internet: www.joyworldcollectibles.com

AMERICAN TINN ITUS ASSOCIATIO NP.O. Box 5, Por tland, OR 97207-0005Address Service Reques ted


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American Tinnitus AssociationWorking throughout the year to silence t innitus

1999January February March AprilS M T W T SSM TW T F SSM TW T F SSM TW T S12 123456 23456 2345

3 4 5 6 7 8 9 7 8 9 10 11 12 13 7 8 9 10 11 12 13 6 7 8 9 10 11 1210 11 12 13 14 15 16 14 15 16 17 18 20 19 14 15 16 17 18 20 19 13 14 15 16 17 18 2017 18 19 20 21 22 23 21 22 23 24 25 26 27 21 22 23 24 25 26 27 20 21 22 23 24 25 2624 25 26 27 28 29 30 2831

June

28 29 30 31 27 28 29 30

AugustS M MayT W T s S M TW T F SSM JulyT W FSSMTW TFS1 2 3 4 5

2 3 4 5 6 7 8 6 7 8 9 10 11 129 10 11 12 13 14 15 13 14 15 16 17 18 20

16 17 18 19 20 21 22 20 21 22 23 24 25 2623 24 25 26 27 28 29 27 28 29 3030 31

September October

123 2345674 5 6 7 8 9 10 8 9 10 11 12 13 14

11 12 13 14 15 16 17 15 16 17 18 20 19 2118 19 20 21 22 23 24 22 23 24 25 26 27 2825 26 27 28 29 30 31 29 30 31

November DecemberS M T W T S S M W T S S M T W T S S M T W T s

12345 2 2345 12346 7 8 9 10 11 12 3 4 5 6 7 8 9 6 7 8 9 10 11 12 5 6 7 8 9 10 1113 14 15 16 17 18 20 10 11 12 13 14 15 16 13 14 15 16 17 18 20 12 13 14 15 16 17 18

20 21 22 23 24 25 26 17 18 19 20 21 22 23 20 21 22 23 24 25 26 19 20 21 22 23 24 2527 28 29 30 24 25 26 27 28 29 30 27 28 29 30 26 27 28 29 30 31

31

AMERICAN

TINNITUSASSOCTATlON

Post Otfice Box 5, Portland, OR 97207-0005Tel. (503) 248-9985 (800) 634-8978Fax. (503) 248-0024e-mail: [email protected] www.ata.org

REMINDERS:e Make my annual contribution to

ATAon ________ ~ ~ - - - - - - - - - -e Watch for Tinnitus T6Qa.y in: March,

June, September(' Decembere O t h e r : - ~ - : - - - - - - - - - - - - - - - - - -


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.9Ls 1998 draws to a close and we look forward to a new year,the ATA Board of Directors, Scientific Advisory Committee,and Staff would all like to thank you for your valuable support and extend our warmest wishes to you for 1999.

Your support is what makes ATA's existence possible. With each renewal contribution, you help us further our goals of Education, Advocacy, Research, andSupport. But the need is great and to that end, we ask that you consider including a little extra for ATA in your holiday or year-end giving plans.Perhaps you could solve gift problems by making personal tribute donations (allThibute funds go entirely for research) or by giving ATA "membership" to others.Remember, ATA is a 501(c)(3) non-profit agency so your gifts are tax deductibleregardless of use. Please use the attached form to send your donation today.We hope you share our pride in ATA's accomplishments and the commitment tocontinue the effort until we silence tinnitus. In the meantime, with your help, wecan offer the following to make 1999 a more peaceful year for many of the50,000,000 Americans who experience the sounds of tinnitus:

Seed Grants for research of tinnitus causes, treatments, and potentialcures (over $1,085,500 have been given since 1980) Quarterly publication of Tinnitus TOday to provide current informationabout tinnitus treatments and research developments, explanations ofvarious aspects of tinnitus and related problems,and personal experiences Support provision through support groups, written materials,telephone contact, and the internet (ATA staff responded to at least101,541 first-time requests for information in 1998 alone) Hearing conservation and protection programs for classrooms andpresentations in the workplace

Advocacy and public awareness programs Professional support and development Public Forums

Thanks for making all this poss ible!

Tinnitus Today December 1998 Vol 23, No 4

Documents

Transcript of Tinnitus Today December 1998 Vol 23, No 4