Tinnitus Today June 1998 Vol 23, No 2

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June 1998 Volume 23, Number 2Tinnitus TodayTHE JOURNAL O F THE AMERI CAN TINN ITUS ASSOCIATION

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

Education -Advocacy - Research - Support

T i ~ ~ i f t J S iS a ~ y i ~ 3 . l ! i S S i ~ or roari113 SOOII


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Tinnitus T o d ~ y Editorial and Advertising offices:American Tinnitus Association,P.O. Box 5 Por dand, OR 97207, 503/ 248-9985,800/ 634-8978, http: / /www.ata.orgExecutive Director & Editor:Gloria g, Reich, Ph.D.Associate Editor: Batbara 'ThbachnickTlmlln(S Thday is published quarterly inMarch, June, September, and December. It ismailed to American Tinnitus Associationdonors and a seleeted list of tinnitus sufferers and professionals who treat tinnitus.Circulation is rotated to 80,000 annually.The Publisher reserves the right to reject oredit any manuscript received for publicationand to reject any advertising deemed unsuitable for Tmnuus 'Tbday. Acceptance of advertising by Tlmttrus Thday does not constituteendorsement of the advertiser, its productsor services, nor does Tinnitus 1bday makeany claims or guarantees as to the accuracyor validity of the advertiser's offer. The opinions expressed by contributors to Tinnitus1bday are not necessarily those of thePublisher, editors, staff, or advertisers.American Tinnitus Association is a non-profit human health and welfare agency tmder26 USC 501 (c)(3)Copyright 1998 by American TinnitusAssociation. No part of this publication maybe reproduced, stored in a retrieval system,or transmitted in any form, or by any means,without the prior written permission of thePublisher. TSSN: 08976368Executive DirectorGloria E. Reich, Ph.D., Portland, ORBoard of DirectorsJames 0 . Chinn s , Jr., Ph.D., Manassas, VAEdmund Grossberg, Northbrook, ILw. F. S. Hopmeier, St. Louis, MOSidney Kleinman, Chicago, ILPaul Meade, Tigard, ORPhilip 0. Morton, Portland, OR, Chmn.Stephen Nagler, M.D ., P.A.C.S., Atlanta, GADan Purjes, New York , NYAaron I. Osherow. Clayton, MOJack. A. Vernon, Ph.D., Portland, ORMegan Vidis. Chicago, fLHonorary DirectorsThe Honorable Mark 0. HatfieldTony Randall, New York, NYWilliam Shatner, Los Angeles, CAScientificAdv isory CommitteeRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland, ORJack D. Clemis, M.D., Chicago, TLRobertA. Dobie, M.D. , San Antonio, TX,John R. Emmett, M.D., Memphis, TNChris 8. Foster, M.D., La Jolla. CABarbara Goldstein, Ph.D. , New York, NYJohn WHouse, M.D., Los Angeles, CAGary P. Jacobson, Ph.D., Detroit, MIPawel J. Jastreboff, Ph.D. , Baltimore, MDRobert M. Johnson, Ph.D., Portland, ORWilliam H. Martin, Ph.D., Philadelphia, PAGale w. Miller, M.D., Cincinnati, OHJ. Gail Neely, M.D., St. Louis, MORobert E. Sandlin, Ph.D., El Cajon, CAAlexander J. Schlcuning, II, M.D.,Portland, ORAbraham Shulman, M.D., Brooklyn, NYMansfield Smith, M.D. , San Jose, C1\Robert Sweetow, Ph.D. , San Francisco, CALegalCounselHenry C. BreithauptStoel Rives Boley Jones & Grey,

Portland, OR

The Journal of the American TinnitusAssociationVolume 23Number 2, June 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 Contents5 ATA's New Board Member8 Hidden Treasures

by William H. Martin, Ph.D., Robert L. Folmer; Ph.D, and Baker Yang-bing Shi, M.D., Ph.D.10 Announcements11 Poster Perfect

by Barbara Tabachnick12 Air Bags - Why This Issue Hasn't Gone Away

by Barbara Tabachnick13 Noise Cancellation Devices Given a Thst Drive

by Cliff Collins14 Dear Abby, Dear Abby

by Kathryn Armstrong15 Tinnitus 'Ireatments for Veterans

by Harvey B. Abrams, Ph.D.18 Book Reviewby Barbara Thbachnick

20 Tinnitus Patient Rights & Responsibilitiesby Sidney C. Kleinman

21 www.ata.orgby Barbara Thbachnick

24 Tinnitus and Our Emotionsby Lois N. Cohen, CSW, ACSW, BCD

Regular Features4 From th e Editorby Gloria E. Reich, Ph.D.6 Letters to the Editor22 Questions an d Answers

by Jack A. Vernon, Ph.D.25 Special Donors and 'IributesCover: ATA's new elementary school hearing conservation poster. Artist: Thko FujisaJ...i,Brooklyn, New York


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FROM THE EDITORby Gloria E. Reich, Ph.D.,Executive DirectorAre we meeting the goals? Inour mission statement (onthe front cover) we talk aboutbenefitting present and futuregenerations. We try to helpyou get good care by keepingyou informed about currenttinnitus research and treatments. Our school programspeaks to the upcoming generation by educatingthem to respect their ears and protect themfrom loud noise. You can help us by letting us

k n ? ~ what you want to read about. If you haveopm10ns to express, write a Letter to the Editoror S'_lbmit an article. We 're always open to suggestwns and hope to make our publication oneyou'll look forward to receiving. Several yearsago, we set some goals for Tinnitus Tbday. I'msharing those with you here. Do you think we'remeeting them? If not, how can we improve? Promote the science of tinnitus and the betterment of public health Publish original, important, well-documentedarticles Enable readers to remain informed ~ 1 e v a t e quality of care and research by anmformed readership Foster debate Forecast trends and issues

ATA's "Young Researcher Award" was notgiven this year because unfortunately no oneapplied for it. This is a newannual cash award for the besttinnitus presentation at theannual meeting of theAssociation for Research in" Otolaryngology (ARO). We'rehoping that we'll get lots ofrequests for next year's award.

I t will be announced to all AROmembers through the Internet.If you are a new, youngresearcher in the field of tinnitusand have a presentation for nextFebruary's research meeting, le tus know and we will send youmore information about criteria forthe award.

4 Tinni tus 'TOday /June 1998

. Pat Daggett and I have been busy representmg .ATA at various professional meetings thisspnng. In February, accompanied by board meber Dan Purjes, I testified before the U.S. HousAppropriations Subcommittee in support of thebudget for the National Institute for Deafnessand other Communication Disorders (NIDCD)and tinnitus research. I attended the Associatiofor Research in Otolaryngology annual wintermeeting where our advisory committee also meWhile there I had the pleasure of speaking toThm D'Aiuto's Thmpa group at their regularFebruary meeting. Pat and Walt Daggett attendethe Thi-State Hearing Society's annual meetingThcoma, Washington. In March I presented apaper about ATA at the Prosper Meniere's Socieannual meeting in Colorado, conducted a classfor social workers titled "A tinnitus care giver'schecklist," and exhibited ATA's publications at tNational Council on Aging in Washington. Whilin Washington my husband and I had a pleasandinner with tinnitus supporters Shirley and MoRosenhaft, and a fine morning meeting withOregon's Senator Ron Wyden who is known forhis interest in health issues and issues affectingolder Americans.. April brought two more big meetings. I carned.the ATA banner at the American AcademyAudiOlogy, helped by Bob Sandlin Gail Brenner

Malvina Levy, and Dhyan Cassie. 'our material~ a s so popular that halfway through the conventiOn we had to take names and addresses to mamaterials to because we had completely run ouof handouts. At the same time Pat and WaltDaggett were distributing thousands of informative brochures to doGtors attending the annualmeeting of the American College of PhysiciansSan Diego. ATA donor Brian Woolsey showed upto help at the booth. In May I attended the tinntus meeting at the NIDCD. ATA has a presence dozens of additional meetings through information tables that are staffed by our network of vounteers. If you think you might enjoy theexperience ofbeing the "tinnitus expert" andhanding out our material to health fair attendeewe'd love you to help us. Please call Pat (exten-sion 12) and she'll tell you how you can help.Here's an issue that I'm sure has plaguedmany of you: automated answering on telephones. You know, where the voice says "to dothis, press 1; to do that, press 2." I know that I'vwasted hours listening to those machines over


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and over trying to make out the words. SelfHelp for Hard of Hearing Persons (SHHH) hasrecommended a universal "out" - dialing "0" totalk to a person. That certainly would be useful!Others have made more recommendations suchas having an alternate message that is read slower. If this issue is one you care about, you canbe heard by writing to Ms. Meryl S. !cove,Director, Disabilities Issues Thsk Force, 2033 MStreet NW, Washington, D.C. 20554. And not toofar off the subject, let me take this opportunityto apologize for our own automated voice messaging system. When ATA receives a deluge ofcalls (such as the more than 40,000 calls we'velogged since "Dear Abby" ran a letter about ATAin February), we simply can't answer them personally. We've tried to make the system as userfriendly as possible and hope you understand.

Finally, those of you who have occasion totalk to me on the phone might have noticed thatI ask you to repeat yourself less frequently thanin the past. The reason is a wonderful new ALD(assistive listening device) called a Hearset. Thisdevice looks like a telephone operator's headsetand connects to my office telephone. The interesting part is tha t the headset is really an amplifier which brings in the speaker's voice loud andclear. Best of all there is a switch that allows theheadset to act as a hearing aid with volume control for sounds in the room. (My regular hearingaid takes a rest while I'm using the Hearset.)The down side is that I'm tethered to the phonewhile wearing it and have a range of movementof only about 10 feet. Small price to pay forbeing able to communicate, I say. So, if you'relike me and have poor hearing but need to usethe phone at work, ask your hearing specialist tolook into the Hearset. It's made by StarkeyLaboratories of Eden Prairie, Minnesota.A special welcome to all the new readers of

Tinnitus Tbday. Most of you came to us becauseof "Dear Abby." There's an article about thatevent further along in this issue. We hope youlike what you see and will take an active part inATA's work. The part of ATA that might be closest to you is one of our support groups. Youreceived some information about tinnitus selfhelp in your Welcome Packet. There are literallyhundreds of ways you can become involvedwith ATA. Just le t us know that you can helpand we'll help you find your special niche.

We will be funding more research in thenear future, and will report about it to you inupcoming issues. If you'd like to read moreabout tinnitus, there are some highly recommended books and back issues of Tinnitus Tbdayavailable. Look for them on the order forminside this magazine.

Again, WELCOME! IBI

ATXsNewBoard MemberJames 0 . Chinnis, Jr. , Ph.D.

Jim writes: "I have beenluckier than some in thatmy tinnitus - as disrup-tive to my life as it waswhen it began out of theblue in 1990 - was also'interesting' to me. I had

studied neuropsychology and perceptionin graduate school and I began to learnall I could about this strange affliction.

Some good has come from this experiencein that I have met a lo t of great people alongthe way.I am most anxious to serve ATA in wayswhere my education, talents, and unconditionalcommitment to the mission of this organizationcan be put to best use."Jim is President of Decision ScienceAssociates, Inc. He received his doctorate inpsychology at the University of Michigan and aB.S. in physics from MIT. 19

Tinnitus 1bday/June 1998 5


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Letters to the EditorFrom 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 treatm.ent 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.Trough our little support group, we are helping each other in beautiful ways, and we'recoping much better. We now meet four timesa year (once a month proved to be too much),and are learning to go on with our lives in spiteof our noisy companion. ATA membership andthe magazine are so helpful! Thanks.

My rna Calkins, 1409 Girard Blvd. SE,A lbuquerque, NM 87106, 505/ 268-8754

I ave enjoyed Tinnitus Today and found ituseful all the many years I have been an ATAmember. I must say that for my needs andinterest, Vol 23, Number 1, (March 1998) is thevery best issue of all. The highlight of that issuewas the article "TRT and the NeurophysiologicalModel of Tinnitus" by Dr. Stephen Nagler.Habituating a signal to make it a part of the subconscious mind to the extent it does not becomea conscious problem is the very thing I havebeen doing on my own for years.My tinnitus, which I've had for many yearsin both ears, was caused by screaming airplanes

in the military. I have the good fortune of aneducation in many fields, including a B.S . in psychology and an M.S. in counseling, so I hadsome of my own tools to work with. I just decided I was alive, things could be worse, and I putthe noise out of my mind. Yes, at times it comesto my attention. I miss hearing some of mybirds, etc., but I do not let it concern me. Like

6 Tinnitus 'Ibday June 1998

the pair of pants Dr. Nagler describes in his article, 1knew the tinnitus was there but I didn'tworry about it.I appreciate all the good work you are doingLee 0. Cunningham, 29787 Dogwood Rd.,Council Bluffs, IA 51503, 712 / 487-3834In the March 1998 Tinnitus Today, WalterWernick wrote a brief letter concerningginkgo biloba. 1b ensure quality, we recommend that people use only a standardizedextract of ginkgo biloba with 24% gingkoflavonglycocides and 6% terpene lactones. Nutritionasupplement companies should also be willingand able to send a certificate of assay to provethe quality and content of their products toanyone who asks.We concur with Susan Seidel and herBaltimore tinnitus self-help group - the stan

dard dosage for ginkgo biloba is 120 mg. daily.Richard Carson, ProHealth, Inc.,Santa Barbara, CA, 805/564-3064

I ad my first attack of tinnitus in 1995following lengthy dental work. After threemonths, the symptoms passed. My mostrecent onset of debilitating tinnitus came with asevere TMJ (temporomandibular jaw joint)attack last summer. My ear doctor and my orthopedic doctor (I have a degenerating disk in myneck) recommended that I see a TMJ specialist

Because of my tinnitus I had becomeextremely depressed, frustrated, and withdrawnI could not participate in any social activitiesand alienated myself from everyone. I even contemplated suicide.I searched the Internet for information ontinnitus and found the address and telephonenumber of the ATA. I called at once and becamea member. After I received my first issue ofTinnitus 'Ibday, I immediately sent away forDr. Thddey's book (TMJ: The Self-Help Book) anda back issue of the September 1994 Tinnitus'Ibday that featured articles on TMJ. I could no tbelieve it! Dr. Thddey described every symptomand understood the pain and difficulty I experi

enced: dizziness, sensitivity to sound, sorethroats, ear pain, jaw pain, neck pain, headaches, and of course, the dreaded tinnitus.After months of TMJ therapy and physical

therapy for my neck, my tinnitus and othersymptoms have been drastically reduced. I'll


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need to wear a plastic splint in my mouth forthe rest of my life but it's a small price to pay.I have tinnitus flair ups from time to time butnothing like it was in the beginning.I now await every issue of Tinnitus Tbday. Itreinforces that I am not alone, and that thereare others like me in this world. Thank you,ATA and Dr. Thddey, for saving my life.Shelly Oliva, 189-11 45 Rd., Flushing, NY11358, 718 / 539-1718I would like to share some positive experiences that I have had with my tinnitu s. Ipurchased a Norelco "Natural Sounds" SoundSelector ST200 (for $34.95). I t generates a variety of tones including sounds of rain, outdoors,heartbeat, brook (my favorite) and the ocean. I tcan operate from a wan plug or with AA batteries. It has a 60-minute timer and a volume control. I set the sound level just below the pointwhere the brook sound and the sound of my tinnitus start to mix. This gives my mind a soundto focus on other than my tinnitus when I amtrying to sleep. I t has been very helpful, anddoes not annoy my wife who is a light sleeper.Also, I did a bi t more reading on St. John'sWort and found that it is helpful for sleepingproblems as well as for mild depression. So Ipurchased i t and have been taking one 300 milligram tablet once a day for several months. (Iknow that if a person is taking other medications, a doctor should be consulted first.) I cannot tell you how much better I have beensleeping, using the combination of the soundmachine and the St. John's Wort. My wife notedthat I have not slept this well since the tinnitusstarted. Thanks again for everything you do.fohn f. Nichols, 10450 E. Desert Cove Ave.,Scottsdale, AZ 85259, 602/860-5758

[Editors Note: John Nichols' moving letter abouthis tinnitus experience and the ATA was the onefeatured in Dear Abby's February 5, 1998 column.fohn is the support group leader for the PhoenixTinnitus Support Group.]I oined ATA in 1994 to help my son. He hadsuddenly lost enough hearing to render hima candidate for a cochlear implant at the ageof 21. The doctors - an otolaryngologist and hispersonal physician - who had treated him forhis accompanying tinnitus told him "nothingcan be done; learn to live with it ." Had I notbeen educated by the Alexander Graham Bell

Association for the Deaf, I would not haveknown how to locate an educational supportnetwork such as ATA to help us . My son haschosen to not discuss his tinnitus. So I passalong Tinnitus Tbday to him and allow him todecide how he wishes to become involved oruse the information.

In my experience, doctors do not appreciatepatients informing them on subjects aboutwhich they are no t knowledgeable. Perhaps thatknowledge is seen as a threat. I am grateful tohave had the opportunity to provide your"Tinnitus Treatments - What's New, WhatWorks" b rochures to the appropriate healthprofessionals in our community. Thank you forthe phenomenal information I receive fromTinnitus Tbday.Sharon Lloyd, Burlington, Onta1io, CanadaI would like to share my own treatment fortinnitus having suffered with the maladysince 1984. I spent a lot of time in thelibrary with books on traditional medicine, alternative medicine, herbology. You name it, I'vetried it or read about it. Finally I started a serious regime of homeopathy centering on afflictions of the ears, sinuses, and allergies; a strongregime of vitamins (A, B-complex, C, D, naturalvitamin E) and trace minerals; and massage. In

January 1997, I opted to try acupuncture too.After four acupuncture treatments I noticed lessringing in my ears. TWo weeks after the fourthtreatment, I was aware of no ringing, buzzing, orroaring. I had one little episode sbc weeks laterbut it subsided and I have been noise-free since.I don't recommend this course of treatment forothers, since no two people are alike and I'vefashioned it so closely to my own personalneeds. However, I wanted to share this with ATAand others like myself who might feel that tinnitus can never end.Sally Chapman, PO. Box 9322, Newport Beach,CA 92660, AUGUSTSAL@aol. com

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Hidden Treasuresby William Hal Martin, Ph.D., Robert L. Folmer;Ph.D., and Baker Yang-bing Shi, M.D., Ph.D.,Oregon Hearing Research Center & Tinnitus Clinic,Oregon Health Sciences University, Portland,Oregon

I t is amazing that something as widely experienced as tinnitus can remain so poorly understood. Tinnitus has innumerable causes,manifestations, and effects on it s sufferers.Unfortunately, there are few if any cures available. There have been exciting developments intinnitus rehabilitation (care and management ofthe t innitus sufferer), but our understanding ofwhat causes this often distressing phenomenongrows slowly.

The following three summaries of recentresearch provide us 1


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controls the activity of the left ear because ofactivity entering the right ear!) Subjects withtinnitus did no t have normal contralateral(opposite ear) suppression of their OAEs. Infact, some tinnitus subjects actually had higheramplitude OAEs when sounds were presented tothe opposite ear than did non-tinnitus patients.

This tells us that, in many cases, people whosuffer from tinnitus might have a problemsomewhere in this ear-brain-ear feedback loop.I t could be that the cochlea receiving the continuous noise signal is not communicating thatsignal to the brain properly. I t could be that thebrain itself is not processing the incoming signals and sending control signals to the oppositeear properly. Or it could be that the OAE ear(on the tinnitus side) isn't functioning properly.Regardless, this is a clue tha t something at avery low level in the hearing pathway isn'tworking properly and needs to be studied.Let's be objective about this.

One problem that we who study tinnitushave is that we are dependent upon you, the tinnitus patient, for precise information about yourtinnitus. If we want to try a treatment and verifythat it works, we have to ask you to measureyour tinnitus before and after the treatment.Measuring a sound is easy. A device can sensevibrations passing through the air and give precise measures regarding the intensity and frequency of the sound. But measuring sound thatonly you hear is a tough challenge for us. I twould be extremely valuable to be able to measure your tinnitus by measuring some activitywithin your ear or brain, and to do so in a waythat doesn't require your participation.

There are a group of studies that haveattempted to do just that using a techniquecalled spectral averaging.56 Spectral averaging isa way to look at patterns of nerve firing in thebrain. An electrode is placed on a nerve bundlein the brain, and the spontaneous backgroundactivity of the nerve is recorded on a graph.There will always be some level of nerve activity in the brain, even when it is at rest. It mightchange it's firing pattern, but it is always running, day and night. Hearing a sound will activate specific nerve pathways and change thefiring patterns. All of these changes can berecorded electrically.

Studies were performed on 23 patientsundergoing various surgical procedures.Eighteen of the patients had tinnitus either

before or after their surgeries. Five did not. Aspart of each surgical procedure, a tiny electrodewas placed directly on the hearing nerve if itwas neurosurgery, or on the round window ofthe cochlear during middle ear surgery. Spectralaveraging was performed and graphs were madeof the nerve activity. (This testing is standardprocedure during such surgeries to aid the surgical staff and the patient. We took additionalreadings simultaneously to find these data.) Thefindings: 13 ofthe 18 tinnitus subjects had alarge peak of nerve activity near 200 Hz.Another one of the 18 had other unusual activity while four had normal activity levels. None ofthe five non-tinnitus patients showed unusualfiring patterns. I t is important to understandthat nerve activity at 200 Hz did no t mean thatthe patients all heard tinnitus at 200 Hz (a verylow frequency). I t just indicated that the nervepathway carrying the sound information wasoverly active at that frequency.

Was this an objective measure? Absolutely.All of the patients were deep under anesthesiaduring the testing. Was it tinnitus? That is atougher question. None of the non-tinnitus, control patients had the 200 Hz activity. Recordingsfrom other, non-auditory structures of the braindid not show the activity. I t looks like tinnitus .It acts like tinnitus.The problem is that we can't just open upsomeone's ear or head every time that we wantto measure their ringing, hissing, or buzzing.But it does show that it is possible to recordactivity that is very likely related to tinnitus inan objective way. This information might alsolead us to other discoveries about abnormalnerve firing patterns related to tinnitus.

Closing thoughts .Hidden treasures are not valuable justbecause they are hidden. The fact that they are

hidden makes them challenging. In 1995, over300 treasure seekers - scientists and clinjcians- gathered together in Portland at the lastInternational Tinnitus Seminar. Each was thereto share a piece of the tinnitus puzzle that he orshe had painstakingly discovered. 'TWenty-fouryears ago there were only two - Dr. JackVernon and Dr. Jonathan Hazell. This dramaticincrease in interest and commitment is a signthat soon the puzzle will begin to fit together.The clumps and clusters of information willbegin to project to us larger images which willmake it even easier to fit individual pieces into

Tinnitus Thday/ June 1998 9


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Hidden Treasures


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Poster Perfectby Barbara Thbachnick, Client Services Manager

I wanted an elementaryschool tinnitus poster thatwould get kids' attention. Iasked Brian Woolsey to helpand I got a lot more. Patientlyand creatively, Brian orchestrated the poster projectthrough his San Diego advertising firm. The result is ournewest and most delightfulteaching tool, one ironicallybeing sought by people of all ages. (See the coverof this issue.)

After several phone conversations with me tolearn what I was after, Brian pushed and pulledideas around with ar t director Sue Miley. Theysketched, wrote, faxed, and phoned until the layout and text hit the mark. Next, they shopped forthe artist. Thko Fujisaki's ar t work leaped outfrom a creative directory, and so she was contacted at her studio in New York. She immediate-ly agreed to do the project.I t is hard to miss the talent this poster represents. I t is also hard for us to contain our gratitude: all members of the creative team donatedtheir time and artistry to ATA for the project.

Now that the dust has settled, and the postersare flying across the U.S., I've asked these generous artisans to tell us why they did it.

Brian Woolsey: "Why'd I do it? Because I havetinnitus and because I like ATA. Because as aparent, I see how much loud noise kids areexposed to. If I had my way, no one would everagain get tinnitus from noise exposure; everyonewould know to protect their hearing."Sue Miley: "I did it because I want my kidsand other kids to be safe. (You know, when children are young, they think they're indestructible.) And even though I don't have tinnitus, I

know Brian and how tinnitus has affected hislife. Knowing him has brought this to a personallevel. It's an important cause; I was very happyto help."Thko Fujisaki: "1 like doing work for causesI believe in. And I have something I can give,and so I give. When I found out what it was for,I said yes ."This poster is now part of ATA's elementaryschool Hearing Conservation and TinnitusPrevention program packet. If you would like to

learn how to present the 30-minute in-class program (ideal grade levels: lst-3rd), write or call us

for details. We'll supply you with the full teaching packet, video, script, ear diagram, and, ofcourse, the best tinnitus poster anywhere. DIndividual posters can be ordered. (See neworder form inside Tinnitus Thday .)

Brian Woolsey, Sue Miley, andThko Fujisaki teamed up tocreate ATA's new poster [or thegrade school tinnih1s awarenessprogram. Woolsey, who hastinmhls, also volunteered theservices o[h1.s San Diego,California, advertising firm tocreate three previous posters a'1dan ad campaign on behalfofATA For advertish1g,marketing, new media,broadcast and pmmotionalmaterials, contact him atBrian Woolsey Creative, 10772Caminito Bravura, San Diego,CA 92108, 619/563-5083.

AlA'S NEW PHONE VOICEThat crisp, resonant voice now greeting anddirecting callers to ATA belongs to Russell Duke,a long-time ATA member. Response to Duke'svoice has been extremely positive. Many ATAcallers have taken the time to compliment "thevoice." Several have inquired if it is that of actorWilliam Shatner who has been an importantspokesperson for ATA's work. They might be surprised to learn about Duke's background. The

native Oregonian was a sometimes-actor in thegolden era of television in the early '60s. Heappeared on one of the most popular televisionshows of the period, "My Three Sons."Duke attributes his own tinnitus and resultant hearing loss to serving with a U.S. Armyinfantry division in Germany in the early 1960s.He first made contact with ATA through Dr.Robert Johnson, at OHSU, whose evaluation ofDuke's condition assisted him in getting aVeterans Administration disability rating.

He has been a strong supporter of ATA sincethat time. Duke said he was happy to volunteerto do the "phone thing" for ATA, and was surprised and flattered to have his voice mistakenfor William Shatner's. 9 Tinni tus Today/ June 1998 11


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AIR BAGS WHY THIS ISSUE HASN'T GONE AWAby Barbara Thbachnick,Client Services Manager

The ai r bag debates at theNational Highway 'll'afficSafety Administration(NHTSA) are over. The outcome: NHTSA is grantingpermission for on-off switchinstallation to those whoproperly fill out the requestforms. Since the ruling was announced, NHTSAhas received a steady 10,000 requests per month.

So why are some people still very concernedabout their air bags? Perhaps because at thistime the majority of on-off switch permissionslips are not being honored. There areseveral reasons:J The brand and model-specific on-off switchesdo not yet exist for most vehicles - Fordsand Oldsmobiles being the exceptions.2 Some car manufacturers, like Honda andThyota, have gone public with their decisionto not make the switches at al l.3 Many dealerships and mechanics are skittishabout installing the switches even withNHTSA's sanction.

The NHTSA decision itself contains somewrinkles. Per the ruling, neither tinnitus norhyperacusis was deemed a severe enough medical condition to justify air bag disconnection.Their medical expert did concede that the 160-170dB explosive noise of a deploying air bagcould damage human hearing. Still, the on-offswitch is NHTSA's single offering to the majorityof people who feel that the risk of air bags outweighs their benefit. Also, new car shoppershave to purchase air bag-equipped vehicles first,request permission from NHTSA second (therequest form requires the vehicle identificationnumber of the car intended to receive the switchor switches), and wait for NHTSA's approvalthird.

1YPically, though, when there is a void,something moves in to fill it. Three independentcompanies have sprung up recently to fill in thegaps left by NHTSA's less-than-comprehensiverule. Airbag Service, Inc. is a group of nationwide franchises that specialize in installations,repairs, and (when presented with authorizationfrom NHTSA) factory-made on-off switch installations. Airbag Options, Inc. is ru n differently.

12 Tinnitus 1bday/June 1998

These air bag specialists travel across the U.S.densely populated areas and directly to clientshomes or offices to install Airbag Options' owndesign of on-off switch, suitable for any vehiclNHTSA's permission is required for this servicAirbag Systems, Inc. takes a third approach:they produce do-it-yourself air bag disconnection kits for every vehicle make and model.Permission from NHTSA is not required topurchase these kits, but moderate mechanicalskill is required for the task.

Air bag statistics continue to be bandiedabout: the number ofhves saved; the numberoflives lost. (Both numbers are growing.) Thestatistics about injuries are less often discussedRobert Dobie, M.D., chairman of the AmericanAcademy of Otolaryngology's "Medical Aspectsof Noise" subcommittee, became interested inthe relationship between auditory damage andair bag deployment. His committee began astudy last year to examine it. The results of thstudy, which is being conducted by KathleenYaremchuk, M.D., will be presented at a sessioduring the Acoustical Society of America (ASAannual meeting in Norfolk, Virginia in Octobe1998. Elliott H . Berger, Senior Scientist, AuditoResearch, E-A-R Products, is chairman o f the ssion entitled ''Airbag Deployment and AuditoryRisk." Presenters include auditory researchers,hyperacusis and tinnitus patient Janet Garmanand representatives from General Motors andNHTSA. The ASA will open this session to thepublic. Says Berger, "I think it is clear that airbags present a problem for noise-sensitive earsHe hopes that NHTSA and the public will takeanother look at this issue.

The switch is an answer, but an unsatisfactry answer, for those who object to (or cannotafford) the additional $200-$500 to turn off thedevices. It is unsatisfactory to those who areunable to do it for themselves and who cannotfind mechanical help. The good news: somenew air bags have been "depowered," althoughthe real world effect of depowering is notknown. (For example, noise reduction from170dB to lSOdB is numerically significant butwould not be meaningful to the human ear.)

I t is an ongoing hope that the public'spersistant call for choice, coupled with theresearch community's vocal concern about airbags, will steer auto makers towards development of safety devices that really are safe foreveryone. a


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Acoustical Society ofAmerica500 Sunnyside Blvd.Woodbury, NY 11797516/576-2360http:! /asa.aip.orgContact Elaine Moran forconference information:[email protected] Options, Inc.P.O. Box 180294Arlington, TX 76096888/[email protected]'Iechni.cians travel to your city toinstall switches or deactivate airbags; requires permission fromNHTSA.Airbag Service, Inc.1045 12th Ave. NW #F2Issaquah , WA 98027425/[email protected] rvice.com/Franchisees across the U.S. willdisconnect air bags/installswitches; requires permission fromNHTSA. (Note: Not all franchiseesare trained in this service.)Airbag Systems, Inc.6110 E. Mockingbird Ln.#102-107Dallas, TX 75214800/205-0628 x106Fax 214/265-1242www.airbagsystems.comDo-it-yoursel fair bag disconnection kits. Permission from NHTSAnot required; car owner assumesliability.National Highway TrafficSafety Administration(NHTSA)400 7th St. S.W.Washington, D.C. 20590-1000800/ 424-9393202/366-2106 faxwww.nhtsa.dot.gov/ airbags/Airbag on-off switch permissionapplication and full text ofruling are available on NHTSA'swebsite.

Noise Cancellation DevicesGiven aTest Driveby Cli ff Collins, Aloha1 OR

Earlier this year, several ofus in the Portland area who havetinnitus and hyperacusis (supersensitivity to sound) learned ofthe availability of the newestnoise-cancellation head-sets.What interested us was thatthese headsets were a combination of actual ea r protectiondevices - like regular passiveearmuffs - an d the newestnoise-cancellation technology.I t sounded promising. (Earliermodels more resembled stereoheadsets in that, when turnedoff, they offered little or noprotection on their own.)

Through the courtesy of theATA and two manufacturers,Noise Cancellation TechnologiesInc.(NCT) an d David Clark Co.Inc., three of us were able toborrow earmuff/headsets fromboth companies for a 11test drive."One set was NCT's ProACTIVE3000, designed for industrialworkers. The other was DavidClark's Model Hl0-13HX, madefor helicopter pilots.

Both muffs gave outstandingnoise cancellation protectionfrom low-frequency sounds,such as the road noise thatcomes up through the floor of acar. Noise-cancellation technology acts by generating a signalthat is identical to incomingsound-pressure level, bu t exactlyreversed in phase. The result isa cancellation of the noisebefore it reaches the ear.

Unfortunately, this technology is not yet able to cancel highfrequency sounds, which tend togive people with hyperacusis themost trouble. Still, we found thatboth muffs shut out low frequencies (up to 500Hz) better thanan y passive muffs we'd tried.

NCT's ProACTIVE muffwascomfortable and has the advantage of no external wires orcords. The battery an d all th etechnology are built into the earcups. Also, it uses a rechargeablenickel-cadmium battery (which isgood for 12 hours before needingto be recharged). The drawbacksare that it's heavy and bulky, sothe longer they are worn, theheavier they feel. They can emita shriek from feedback whenthey're being taken off or beingput on. This can be avoided byturning the muffs on and offwhile they are on the head. TheProACTIVEs also emit a beepingnoise when the battery needsrecharging. The Clark model'sadvantages: lighter weight andsmaller ear cup size, since andexternal cord attaches to a battery pack that is worn on thebelt. The Clark muffs had nofeedback noise and flash a redlight (no beep) when the batteries need replacing. One disadvantage to both muffs, reminiscentof previous noise-canceling headsets, is their lack of space forlarger ears.

Active noise cancellationdevices can give good low frequency noise protection in workenvironments, on aircraft, oranywhere where those soundsare present and bothersome.Further development and refinement of this technology - andnot just for the industrial market- could give people with tinnitusan d hyperacusis greater freedom,mobility and safety. Properlymarketed, it could be a winner. 1.1Noise Cancellation 'Iechnologies(800/278-3526), ProACTIVE 3000,$289.David Clark (508/756-6216),E-mail: salesatdavidclark. com,Model Hl0-13HX, $710.

Tinnitus lbday/ June 1998 13


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Dear Abby,Dear Abby,my life isa mess ...by Kathryn Armstrong,Resource Development Manager

You might not be familiar with JohnPrine's ode to Dear Abby. But you'reprobably familiar with the relief, antici-pation - even excitement - experiencedby tinnitus sufferers and their familieswhen they first learn that their life withtinnitus does not have to be a mess.Remember when you first found out thatan organization exists dedicated to noth-ing but tinnitus?

Now, imagine that you learned about thatorganization at the same time 40,000 otherslearned about it - an d you al l called at thesame time.

That was reality for ATA when Dear Abbyfeatured us in a February column. Over 40,000people called or wrote in the following monthsfor information about our services andresources. As a nonprofit organization with astaff of eight and a handful of dedicated volunteers, we were thrilled - and overwhelmed -by the response. If you tried to call the office

14 Tinnitus 'Ibday/ June 1998

during February and March and had trouble geting through, it is because our phone systembecame seriously bogged down by all the DearAbby callers. Thank you for your patience.Dear Abby presented us with a uniqueopportunity to offer assistance to many more othe 50 million Americans who experience the"head noise" or "ear ringing" that is tinnitus.Everyone on the ATA staff pitched in to takecalls and messages in order to ensure thatcallers received information as soon as possibleWe rallied sostrongly inresponding to theinquires spurredby Dear Abbybecause we knowthat tinnitus is avery real malady

that can be distracting, painful,and sometimesdisabling, ye treceives verylittle publicattention and isfrequently misunderstood. Formany of thoseDear Abby readers,that column wasthe first theylearned that thereis hope - hopethat their tinnitusmight be alleviated, hope in theknowledge thatthey are no talone.

We lookforward to welcoming all thoseDear Abbyreaders to ATA.We sincerelyappreciateeveryone's

The Oregonian February 5, 1998.can help JJeople

'ft:CII With tinnitUs

support as we work to educateeven more individuals about tinnitus andcontinue to fund research into further relief,and a possible cure. B


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Tinnitus Treatments for Veteransby Harvey B. Abrams, Ph.D., Chief, Audiology& Speech Pathology Service, VA Medical C e n t e 1 ~ PO. Box 5005, Bay Pines, Florida 33744As an audiologist for the Department ofVeterans Affairs, I have responded tomany questions from veterans abouttheir tinnitus over the years. And I'vebeen happy to do so. Many ofus whowork for the VA are, ourselves, veterans,and are particularly sensitive to tinnitus-related issues because it is such apervasive problem among our patients.This article addresses some of thosequestions from this unique group ofmenand women.How can veterans receive treatment for theirtinnitus at a VA hospital?

In order to be treated for any condition bythe VA, either the veteran has to be enrolled inthe VA Healthcare Program or the disorder Oiketinnitus) has to have been "adjudicated" as aservice-connected condition. (That means thatafter a veteran has claimed that his or her disorder resulted from military service, a medicalexamination and a review of the veteran's service records by a VA adjudicator have substantiated the claim.)How does a veteran enroll in the VA HealthcareProgram?

Often all that is required is the completionof enrollment forms. This can be done at a nearby VA facility or by requesting and returning theforms by mail. The local telephone directorylists the closest VA facility under "United StatesGovernment." The facility will verify the veteran's service record, then notify him or her ofthe initial appointment.

Some veterans who ge t tinnitus-related medical and audiological services in some parts ofthe country are then denied the same serviceswhen they move to or visit another part of thecountry. Why does this happen?

We appreciate how frustrating this is forour patients! First of all, veterans are entitledto health care at any of the llOO VA centersthroughout the country whether treatment isneeded for specialized care unavailable at the"home" facility or because of relocation ortravel. The reason for the lack of uniformitywas an unequal distribution of VA Healthcareresources throughout the country. As veteransmoved from the northern urban centers to the"sun belt" states, many of the hospitals in thesun belt states had to limit services to veterans.Other hospitals, primarily in the north, did nothave to impose these limitations. Recent federallegislation designed to "move resources to wherethe veterans are" combined with the enrollmentprocess should eliminate this problem.What kind of examination is conducted for aveteran who claims that his or her tinnitus isservice-related?

The veteran undergoes a comprehensiveaudiological "compensation and pension evaluation" which includes pure tone and speechthreshold testing, speech recognition tes tingat several presentation levels, and middle eartesting. In addition, the examiner will ask theveteran several questions relating to his or hertinnitus such as the severity and when and howthe tinnitu s was initially noticed. Some audiologists might perform pitch and loudness matching tests during the "compensation and pensionexamination," but the tests are no t required norare the results considered for determination ofservice-connection. Because tinnitus is a subjective complaint, it has been difficult to developstandardized tests to measure the severity ofthe complaint. We know, too, that while twoindividuals might "match" their tinnitus to thesame pitch and loudness, they can dramaticallydiffer in their perception of the severity. Theimportant consideration in determining serviceconnection is a documented "cause and effect,"for example with a head injury, exposure toincoming or outgoing artillery that causedtinnitus at the t ime of the episode, or repeatedexposures to h igh levels of noise from aircraft,tanks, or small arms fire which over timeresulted in tinnitus.

Tinnitu s Thday/ June 1998 15


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Tinnitus Treatinents for Veterans


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Do many of the VA programs have success withbiofeedback and relaxation training?Several of the VA audiologists who responded to my inquiry either perform relaxation

training in the audiology clinic or refer tinnituspatients to the behavioral sciences departmentfor the training. One of the advantages ofproviding services in a medical center is theavailability of many specialties in a singlelocation that can provide expert treatment tothe veteran. One of the patient populations thatwe have found to be most challenging andrewarding is the group of veterans sufferingfrom post-traumatic stress disorder. Many ofthese patients have a difficult time coping no tonly with their tinnitus but with other life"stressors'' too. We have found that the relaxation tools we provide to them, such as biofeedback and guided imagery, are not only effectiveat reducing the secondary effects of tinnitus,like sleeplessness, but are also useful in helpingthem cope with their reaction to all stress.Is Tinnitus Retraining Therapy (TRT) offeredthrough the VA?No one in my poll has indicated that he orshe received TRT training, although some of theelements of the program are being used on alimited basis. If TRT proves to be an effectivetreatment choice for tinnitus relief, I'm certainwe'll see many of our VA audiologists activelypursuing training in the technique.What do you foresee as the future direction ofVA audiology in the treatment of tinnitus forveterans?

I have been privileged to be part of such aremarkable group of professionals. Weencounter tinnitus every day in our clinicalpractice. By and large, our clinicians have beensuccessful in providing effective tinnitus treatment for our patients. In terms of the future, wewill continue to read, study, train, and implement new techniques and methods that havebeen shown to be effective. There will never bea "VA way" of treating tinnitus because differentmethods appear to work for different individuals. There will, however, always be a "VA way"of treating our patients - with professionalism,respect, dignity, and compassion. B

TinnitusPreventionInformation HitsHigh School TextBooksby Barbara Th.bachnick, Client Services Manager

It isn't fancy and it isn't much but it's there!A paragraph about tinnitus and hearingconservation is now standard text in

Glencoe/ McGraw-Hill Publishing Company's1999 high school health text book, GlencoeHealth (6th revision). And ATA board ChairmanPhil Morton gets the credit. He has pursuedschool book publishers and educational organizations for years in hopes that they wouldinclude such information. Phil has said, "If (thetext book publishers) would only print the word'tinnitus' I would be happy!" (yVe got 100 additional words. Phil is very happy.) The predominant message in the text is that overexposure toloud noise is a far-too-common cause of tinnitus,and that you can do something (like wearearplugs) to avoid it.

Negotiations with middle school and elementary school text book publishers are in the earlystages but seem just as hopeful. The Glencoe/McGraw-Hill high school text bookswill be distributed nationallythis September. a

Tinnitus TOday/ June 1998 17


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BOOK REVIEWRichard Carmen, MA, CCC-A,ed., Hearing Loss & HearingAids - A Bridge to Healing.Sedona, AZ: Auricle InkPublishers, 1998, reviewed byBarbara ThbachnickWhen audiologist andauthor Richard Carmen wasa university professor, heasked a class of his graduate students to wearearplugs for one full dayand to keep a diary of theirfeelings throughout the day. Their responseswere uniform and their emotions ran deep afterthe experience: they felt incompetent, isolated,unnerved, depressed, disoriented, and exhaust

ed. "Hearing is an essential human sense," writesCarmen in his opening chapter, The Emotions ofLosing Hearing. "It's absence would be greatlymissed by anyone." This sensitive approach tothe struggles faced by hard-of-hearing people isevident on every page of Hearing Loss & HearingAids - A Bridge to Healing. The book, edited andcompiled by Carmen, is a treasure chest forhearing aid users and their families - filled withresource lists, a photo guide of assistive listeningdevices, the questions hearing-impaired peopleask, and, most importantly, the answers.Richard 1)r1er, Ph.D., discusses the frustrationand understandable stress experienced by tinnitus patients who also do not hear well. 1)rler andothers in this book explain the part that tinnitusplays in the lives of hearing-impaired people,and the realistic effect that improved hearing

through hearing aid use has on the lives of tintus patients. In his chapter, Ways to ImproveListening and Hearing, Mark Ross, Ph .D., statthat first of all, the principle to keep in mindwhen adjusting to hearing aids is: "Don't get dcouraged. And that's second and third of all toKathleen Campbell's Prevention of Hearing Lochapter contains an eye-opening list of substances - from over-the-counter drugs to environmental toxins - known to damage hearing

"The saddest thing a hard-of-hearing persocan do is nothing," writes Paula Bonillas in hechapter on assistive listening devices. Blinkintelephones, vibrating alarm clocks, personal ltening equipment, closed-captioned decoders,and other devices have been adapted and creato help hard-of-hearing people stay in the heaing world.Carmen and his writers keep it simple andexplain as they go, so that the reader gains a sstantial and satisfying handhold on how and wand for whom hearing aids work. They examithe emotional difficulties (anger, frustration,denial) faced by all people with hearing loss,the practical care of hearing aids - standard tprogrammable, behind-the-ear to completely-ithe-canal.

Hearing Loss & Hearing Aids- A Bridge toHealing earns big marks for its thoroughness,humor, and clarity. We've looked for years forresource like this to add to our list of informational materials. When we found it, we addedinstantly. A very likeable book.Do enjoy it! B

Re -Release of a Classic TextAbraham Shulman, M.D., ed. Tinnitus:Diagnosis/Treatment. San Diego, CA: SingularPublication Group, Inc., 1997. 592 pages. $85"The clear aim of this book is to investigatevarious avenues of diagnosis that in time will besufficiently reliable to provide a rational basis oftreatment," wrote Trudy Drucker in her reviewof this book in the March 1991 Tinnitus Tbday.The book's prestigious array of authors explaintinnitus from their varied perspectives of otology, audiology, neurology, neuroscience, and

18 Tinnitus Thday/ June 1998

neuropsychology. Shulman was ahead of histime: the book includes his uncannily correctprediction and focus on the brain's involvemein tinnitus perception. Although some of thematerial is suitable for patients, it is primarilymedical resource - and a fine one - for students and professionals in the field. Availablepaperback from Singular Publishing Group, In401 West "A" St., Suite #325, San Diego, CA92101-7904, 619/238-6777, 800/521-8545e-mail: [email protected]: www.singpub.com a


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The Search is Over!Digital Tinnitus Mitigation

The FDA-approved DigitalTinnitus Mitigation DTM-4is the first multi-faceted costeffective tinnitus alleviationprogram ever developed.The DTM-4 system includestwo CDs with unique digitalsounds that gently distracthearing attention away fromtinnitus; one CD that providesproprietary auditory trainingsound patterns and verbalinstructions to train the userto focus on sounds other thanthe tinnitus; one CD that provides methods and techniquesrelating to stress-reduction,coping skills and other factorsessential to successful tinnitusalleviation; precision Sonyuear bud" headphones foroptional private listening;and a complete UserGuidebook. The PetroffAudio 'Technologies DTM-4system sells for $145 +$4 SIHwith a 30-day unconditionalmoney back guarantee.

TESTIMONIALS ON DTM EFFECTIVENESS

T 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)l 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 tried various devices in my practice. Personally, I suffer from tinnitus inboth 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 inboth ears. The condition reached a climax about six monthsago; at this time I could no longer achieve a good nights sleep(despite the use of a 'sound soother' from the Sharper Image),and would always awake feeling slightly nauseated and dizzywith the condition continuing throughout the day. Throughoutthis progression I have consulted among the.best doctors in thefield. With failed treatments ranging from ginkgo biloba to having tubes surgically implanted, these fine physicians have comeup empty with respect to tinnitus. My initial reaction once Iturned on the first CD was one of utter amazement; I simplycould not believe how low the volume level was while masking.I can vividly remember having to turn the CD player on and offagain several times to make sure I still had tinnitus! With theDTM process, I no longer hear the ringing (unless I concentrate). For the first time I have been able to get through a daywithout Advil and I have even been known to attend a fewmovies (with earplugs, of course). Thanks again."

- Paul PedrazziFor information or to order at $145+$4 S/ H (Calif. res. add 81/2%)with a 30-day unconditional money back guarantee, contactPetroff Audio Technologies, 6520 Platt Ave. #813, West Hills, CA 91307Ph: 818-883-1918 Fax: 818-704-9976 E-mail: [email protected] site: www.tinnitushelp.com

Tinnitus1bday/June1998 19


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TINNITUS PATIENT RIGHTS& ESPONSIBILITIESby Sidney C. KleinmanIt began as a typical gray Decembermorning day ofpracticing law inChicago. Then, as I left the office of oneofmy clients, I was suddenly unable tohear anything in my right ear; my headwas roaring, and I was feeling some-what dizzy - a feeling that became pro-gressively worse as the day wore on.

Eventually, and with some difficulty, I wasable to schedule an emergency appointment forthat day with my then-physician (the chairmanof the ENT department at an excellent Chicagomedical school). The results of that very shortvisit were neither enlightening nor helpful. Hestated that apparently I had suddenly lost most,if no t all, of my hearing in the right ear, that thenoise in my head had increased dramatically(I'd had mild, unintrusive tinnitus for years),and that he was unable to offer any explanation,thoughts, or assistance to me in dealing withthose issues.While the response by my physician was"underwhelming," I realized that in the stressand the trauma of the events of that day, I also

had failed to treat myself like a client. I did no tattempt to organize my thoughts or formulatequestions about what I was experiencing. Had Idone so, perhaps I could have elicited a morepositive response from my physician. The"Tinnitus Patient Rights and Responsibilities" isan outgrowth of that experience. Following thisadvice enables me to understand and receivebetter care for my tinnitus and hearing problems, and might be of assistance to you.Tinnitus Patient Rights &Responsibilities

I suggest the following procedures toenhance the likelihood of a positive and mean-ingful response when selecting or dealing with atinnitus health care provider.JBe your own "Medical Advocate for aLoved One ."When loved ones are sick, we try to helpthem receive the best and most appropriatemedical care available. By acting as a MedicalAdvocate, we help them seek medical carepromptly, assist them in communicating the


na ture of the problem to the appropriate medical staff, and make certain that the medicalresponses are appropriate. I suggest that you aas your own Medical Advocate (where you arethe Loved One), even ifyou have someone elshelping you. I t will help you receive better carfrom tinnitus health providers, and assist youevaluating providers and treatments.2 Look carefully at treatment claims.

The causes and symptoms of tinnitus arecomplex and vary widely among individuals.Any one treatment usually brings a variety ofresults. To date, there is no one treatment (or"magic potion") that works every time for everone. Broad generalizations such as "one prograand one device works for everyone" and claimof extravagant success rates should be indicatothat a careful examination of such a program iappropriate.3 Keep a factual, written account of yourtinnitus symptoms.

In order to be able to evaluate if a tinnitushealth provider, product, service, or course ofaction will be useful to you, first create a written record of your tinnitus symptoms and thefacts surrounding its onset. Creating such anaccount will have several positive results. Youtinnitus will be more "concrete" than just a madening internal sound, or a series of symptomor pitches. (This might also help the tinnitusbecome a little more manageable). Also, inreconstructing the events surrounding thebeginning of your tinnitus, you might gain somins ight into how it occurred and be able to avoaggravating it further.

Most important of all, when you meet withtinnitus health provider, you will be able tospeak with confidence about your symptomsand the events leading to their appearance . Byaccepting the responsibility for giving goodinformation to the tinnitus health provider, yohave ''earned" the right to expect a goodresponse.4 Study reliable tinnitus literature.

Tb the extent possible, seek out informatioand literature - from ATA and other reliablesources - that speak to your symptoms andproblems. Review and study the information abest you can. Develop an informed backgrounin tinnitus, so that when you do speak withtinnitus health providers, you will be better ab


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www.ata.orgby Barbara Tabachnick,Client Services Manager

It's remarkable how often andhow easily we connect with eachother around the planet thesedays. Thanks to computers,modems, and a satellite or two,we have the ability to nurturefriendships with people thousandsof miles and many countriesaway - all in the wink of an eye.A new form of global warming,I think. Really quite amazing.No less amazing is theresponse we've seen to our newInternet website, which is up and

running at last. From its first dayin the world's view, we'vereceived daily response to oursearch for tinnitus support givers- networkers interested in starting local self-help groups or volunteering as telephone contacts.The response from on-line readers who expressed interest in joining our support network, at first

surprising, became completelyunderstandable when we stoppedto think about it. People whoenjoy using a network, like theInternet, are the ones whounderstand the value of it.ATA's support network is alittle different from on-line chatgroups. I t fills a different niche,supporting instead the "low-tech"communication techniques oftelephoning, writing (e-mailingtoo), and assembling in a roomwith others who have tinnitus.We're happy to facilitate thesecommunication options. Weknow that the touch of a humanvoice or hand is therapeutic forso many.

Our thanks goes out to allwho've given time to help othersfeel better - regardless of theapproach, high-tech or low. Andshould the time ever fee l rightfor you to help others with tinnitus, look on the web, look at your

schedules, look in yourhearts, and le t us know. DHow to request aSupport Giver's Packet: website: www.ata.org e-mail: [email protected] write: ATA, P.O. Box 5,Portland, OR 97207-0005 call: 800/634-8978 x16 fax: 503/248-0024Welcome to ATN.sSupport NetworkSelf-Help Group LeaderCarrol Jude1030 N. Market #204Wichita, KS 67214-2936316/264-8853'Thlephone andLetter ContactGeorgiann Maloney221 Oakridge PlaceDecatur, IN 46733219/728-9941

TINNITUS PATIENT RIGHTS &RESPONSIBILITIES (coNTINurn)to understand and evaluate their qualificationsand proposed courses of treatment.5 Ask questions .You have the right to good and competentcare. With that right comes the responsibi lity foranalyzing the claims and approaches of anyhealth care provider or treatment. StephenNagler, M.D., suggests that patients should seek

answers to the fo llowing questions from eachpotential tinnitus health care provider:a. What are your educational qualificationsand history of treating tinnitus patients?b. Describe in detai1 the products andprocedures of the treatments you use.c. What are the potential risks of the proposedtreatments and products?d. How do you define success?e. What are the success rates of the proposedtreatments?

6 Keep copies of all records related to yourtinnitus.For your own fi les, obtain and maintain acomplete se t of records with respect to yourtinnitus and its treatment. From time to time youmight need to see a new tinnitus health provider,and having ready access to your records can savea great deal of time - and possibly money.

The suggestions described above are all designedto help you be better informed about your tinnitu s - so you can make informed and rationaldecisions about which providers, approaches,and treatments are best suited to you. Once youbecome your own "Medical Advocate for a LovedOne," you can exercise your right to receive thebest possible health care from your current andfuture providers. IBSidney C. Kleinman is a practicing attorney inChicago, fllinois and a member ofATA's Board ofDirectors.

Tinnitus Today/ June 1998 21


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Questions and Answersby Jack A. Vernon, Ph.D., Professor Emeritus,Oregon Health Sciences University

Q A number of you have asked questionsabout the recent PET brain scan experiments done in Buffalo, NY. Your quetions break into two general categories. Onequestion asks if the brain area identified is thesource or cause of tinnitus. The other questionasks i f his work will lead to a cure for tinnitus.A he cause of the signal producingtinnitus can be anywhere in the hearingsystem but those signals have to be perceived and interpreted. The work in Buffalo hasidentified that portion of the brain in the auditory cortex that is responsible for the interpretation or perception of tinnitus. This is veryimportant work and, yes, it might well lead to acure for some kinds of tinnitus although there isa tremendous amount of work that must bedone first. I hope each of you takes pride in thefact that the preliminary work for this study inBuffalo was made possible by a research grantfrom ATA. The outlook is promising and veryexciting.

Q r. G. in California indicates that histinnitus of about 50 years has suddenlygotten much louder. He was prescribedCerumenex to rid his ears of wax. His doctor'sdirections: insert the drops for 20 minutes, placethe tip of the syringe bulb deep in the canal,and vigorously flush the ear canal ten timeswith warm water. The manufacturer's instructions stated to flush the ears gently but unfortunately Mr. G did not see the manufacturer'sinstruction until he had already flushed vigorously. He asks if the vigorous flushing increasedthe loudness of his tinnitus.A have heard from a host of tinnituspatients whose tinnitus was exacerbatedby such a flushing. In two patients wherean aspirator was used, tinnitus was produced,not just exacerbated. Clearly ear wax needs tobe removed but I recommend that aspirator orvigorous flushing not be used. The washing fluidwill run out of the ear when the ear is turneddownward and the tip of the ear is gently tugged


upward. Fluid can also be wicked out with smcotton rolls. Mr. G., I expect that your increasloudness is temporary and within a few weekwill return to its normal level. The recoveryprocess might involve some reversals so don'tdiscouraged by periodic flare ups of the tinnitI t seems to be the natural course of recovery.Q Mr. K. from Arizona wants to know ifgeneral anesthesia will protect his earwhile dental drilling is performed. Healso asks if earplugs will provide the neededprotection.A nfortunately the answer to both of yoquestions is in the negative. Generalanesthesia will no t protect your earsalthough you will not be aware of the drillingsounds. Also earplugs will not protect the earagainst dental drilling for the simple reason tthe drilling sounds are directly transmitted toinner ear through bone conduction which bypthe outer and middle ear. I have suggested thsome protection is available if the dentist willdrill in short spurts: drill for five seconds andstop for 10 seconds, drill for five seconds andstop for ten seconds, and so on. The exacerbaof tinnitus by sound is a time-intensity functiand by reducing the time of each drillingepisode, the degree to which this kind ofinsuwill influence the ears is also reduced.Q Mrs. C. in South Africa asks, "What issevere hearing impairment and howoften does it occur? Is it the same as tdeafness? And what can be done about it?A ne can have very severe hearing lossnot be totally deaf. For example, someowith a hearing impairment at the 70-80level can still be helped with some form of heing prosthesis. One can never know if prosthedevices will help or not except by actual trial.Remember that in the U.S., hearing aids are swith a 30-day money-back guarantee."How often does hearing impairment occur?"I cannot answer for South Africa but I askedPeter Steyger, Ph.D., professor at the OregonHearing Research Center, the same question fthe U.S. His reply: For people less than 20 yeaof age, one in 20 has a hearing impairment. F


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people aged 20 to 40, one in 10 has a hearingproblem. And for people 65 or older, one in twohas a hearing impairment. I imagine we wouldobtain similar figures for other industrializednations.Dr. Steyger, who is severely hearing-impaired,went on to make an interesting comment. Hesaid, "The biggest problem for hard-of-hearingpeople is DENIAL, both by the patients and byothers. Once one gets past denial, the hard-ofhearing person can do anything." I find that tobe extremely good advice.Q Mr. S. from MI indicates that his longtime tinnitus did not bother him until

last January when he awakened with aloud hissing sound in the right ear. He has nowfive health care professionals, one of whomwith it." (When are they going

to learn no t to say that?) Mr. S. wears a hearinghis right ear, but when at home he wears

in his right ear. Both devices give himrelief. He takes Zoloft for depression andanax plus some herbs at bed time to help withHe asks:1 On a scale of 0 to 10 how do most patientsrate the loudness of their tinnitus? Mine isan 8.2 Since wearing a hearing aid in my right ear,I can now hear tinnitus in my left ear. Whyis that?A r. S. , the average loudness rating ofpatients attending the Tinnitus Clinic atOregon Health Sciences University is

7, on a scale of 0 to 10. Your rating8 is not unusual. I once measured the loudness of a patient's tinnitus and found it to beThat was the loudest tinnitus I had evereasured, and yet on the 0 to 10 loudness scale

e had rated it a 4. Imagine that! I asked himw he was able to rate his tinnitus so lowit actually being so loud. He answeredoriginally he would have rated his tinnitus

20 on that 0 to 10 scale but that he startedother people and soon discovered there

less fortunate than he. (I thinkwe help others we always help ourselvesquestion suggests that you had

in both ears all along bu t that the right

ear tinnitus was dominant. When you got ahearing aid for the right ear it produced enoughmasking on that side to leave you only aware ofthe left ea r tinnitus. This sort of thing happenswith regularity. In quite a few cases we've pu t atinnitus masker on the ear that the patient perceives as their tinnitus ear only to have thepatient say "you knocked the tinnitus over tomy other ear!" In your case, Mr. S. , if there is ahearing loss in the left ear a hearing aid shouldbe tried to see if it relieves the tinnitus. I f thehearing aid does not relieve the tinnitus then Iwould recommend a trial with a "tinnitus instrument" - a combination unit that includes both ahearing aid and a masker.Q r. S. in Hawaii asks, "Since intravenousxylocaine (lidocaine) abolishes tinnitusfor about 30 minutes, have other oralantiarrthymic cardiac medications been tried fortinnitus?"A our question is a good one. If an oralmedication could be found which actedas well as intravenous lidocaine, manytinnitus patients could be helped. Some of theseantiarrthymic drugs - Thcainide, Mexiletine,Procainamide, Disopyramide, Phenytoin,Bretylium, Propranolol, Amiodarone, andVerapamil/ Diltiazem - are in comon use. Wetested Thcainide some years ago and found itsside effects caused 40 of the 60 patients to withdraw from the study. Of the remaining 20patients, only one experienced tinnitus relief.With these results we concluded that Tocainidewas not a recommended therapy for tinnitus.I would like to ask our readership to report tous any experience, relative to tinnitus, that youhave had with any of the above drugs.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.(503/494-2187). Or mail your questions to:Dr. Vernon

c/o Tinnitus TodayAmerican Tinnitus AssociationPO Box 5Portland, OR 97207-0005.

Tinnitus 'lbday June 1998 23


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TINNITUSAND OUR

EMOTIONSby Lois N. Cohen, CSW, ACSW, BCDA tinnitus sufferer raised the question,"Is it alright to feel the way I feel?" I t isnot only alright, but imperative for ourmental health! There are no right orwrong feelings. All of our emotions arereal and valid.

Owning and being aware of our feelingse n a b l ~ s us to know ourselves - our struggles,fears, JOYS, sorrows, our likes and dislikes, ourvalues and goals. Our emotions enrich our lives.S metimes it is too painful to own all of ourf e e l i n g ~ , especially the negative ones. Atthese tlmes, we try to deny or stifle them- and we do so at a price. For example, angerturned inward can lead to depression. When wesuppress anger, frustration, resentment, hurt, ordisappointment, we can feel exhausted anddrained, and have little energy left for productive or enjoyable endeavors. Often our ability toconcentrate, learn, and work is impaired.

When we suffer from a distressing andpotentially debilitating disorder such as tinnitusit is natural to experience a wide range of 'negative emotions and to ask, "Why me?"Acknowledging and expressing these feelingsenables us to begin to move beyond the devastating impact tinnitus initially has on our lives.

The noises can be torturous and interferewith every aspect of our functioning - ourwork, our leisure, our relationships, and oursleep. How can we just take this in stride? It'slike being invaded by a noisy alien! Manypeople feel that their lives have been turnedupside down, and to feel anything but furywould be unbelievable. We need to1 instead1allow ourselves the adjustment and mourningthat is part of our tinnitus experience . I t is quite

24 Tinnitus Thday /June 1998

normal to question why it happened and feelthe injustice. This is especially understandabwhen the tinnitus is accompanied by hearingloss which makes one's coping task even modifficult. Mourning the loss of the way we weor the dream of what we thought life would bwill enable us to eventually embrace the preand move forward.When we give ourselves permission to

express anger about what happened to us, webegin to accept the reality of our situations. Wcan construc tively express negative feelings iwords by using "I feel. .." messages. Stating ouneeds, like "I need to be seated at a quiet tabin a restaurant" or asking people to face uswhen they talk, can help us socialize and follour interests. Expressing our needs can lead changes in our environments that can satisfYthose needs.S milarly, when we accept our fears we cbegin to look at the thoughts upon whicthey are based and decide if the thoughare valid or irrational. This is the cognitive thapy component that helps us resolve the worand distress that make our noises louder. Whwe come to terms with a new self-image thataccepts limitations and builds on strengths, wbuild the foundation for functioning fully oncagain.

In addition to tinnitus' potential to causeanxiety and depression, life's pre-existing stresors can exacerbate our tinnitus. Many tinnitpatients with whom I work struggle with addtional difficulties, including marita l, family ancareer problems, infertility, and losses. Althoit is tempting to blame our loud noises for allour suffering and pain, we also need to workresolving our other dilemmas. Otherwise, lifeunresolved crises will make the tinnitus worsand the vicious cycle will continue.Our feelings are a gift from our hearts.They act as a barometer and compasshelp us know what we need to do forourselves. When we listen and understand ouemotions, we can deal more effectively withthem and take the necessary steps to improveour lives. Although we might not be able to ctrol the loudness of our noises, we can controour reaction to them. When we learn to do thwe can function more fully in the present whlooking more optimistically to the future.mLois N. Cohen, CSW, ACSW, BCD, is a psychothapist in Northport, NY who has first-hand experence in learning to integrate tinnitus into her owlife. She can be contacted at 5161754-6249.


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SPECIAL DONORS AND TRIBUTESATA's Champions of Silence are a remarkablegroup of donors who have demonstrated theircommitment in the fight against tinnitus bymaking a contribution or research donation of$500 or more. Sponsors and Professional

Sponsors have contributed at the $100-$499 level.Research Donors have made research-restrictedcontributions in any amount up to $499.

acknowledged with an appropriate card to thehonoree or family of the honoree. The giftamount is never disclosed.Our heartfelt thanks to all of these specialdonors!AU contributions to the American TinnitusAssociation are tax-deductible.

ATA's Tribute Fund is designated 100% forresearch. Tribute contributions are promptlyGIFTS FROM 1-16-98 to 4-15-98.~ ~

Champions of Silence Robert H. Crittenden W. Gordon Martin Edward R. Weiss Jo e Ritacco's father(Conmbunons of$500 Howard F. Crumb Andy Matthiesen Delmer D. Weisz Claire a.nd Jacques Simonand above) Henry Cunningham, m Colin L. McMaster Barry Wheeler Mark SandsEdgar P. Bailey Pierre David Joan Michelland Robert M. Whittington Claire and Jacques SimonWarren S. Bender Donald W. L.lavts Alexander Miller Theodore M. Wight Maurine Walker SmithMatthias B. .Bowman, Walter Z. Davis Eugene A. Miller AI E. Witten Th elma P. BatchelderThomas w. Buchholtz, M.D. Robert B. Dellbrugge Ray Mize, Jr. Adelaide w. zabriskie, William ThbeJames 0. Chinnis, Jr. Joaquin Delpino Eugene A. Moody Ed.D., C.F.A. Sybil BarlilayRob M. Crichton Jeffrey J. Derossette Douglas Moore Marilyn K. Zion Lou.js UriasWilliam B. Farinon Lewis G. Desch Earl R. Moore Professional Sponsors David and Helen MyersHe len Pappas, Anita E. Dever Don Morse .Estella WeberSchoenstadt Family William Dorman Jeanne A. Moslencr (Professional Gonm'butions Robert E. CrawfordFoundation John L. Dosen Cameron R. Murray from $100-$499) Priscilla G. RyanMartha M. Smith Russell K. Duke Donald E. Nace Coastal E.N.T. & Facial Deborah W. SmythWilliam E. Thrley Ralph C. Dutchin Jim Ed Norman Plastic Surgery Deborah and Andre WeberPaula French Vanakkeren, Bernard Fishman Patrick A. O'Boyle Eduardo Go, M.D., HJS Ir win L. WiechelmanFrench Family Foundation Kathrvn E. Fitzsimmons Ruth E. Ochs Randy Morgan Jess A. HoskinsonMargaret Fleming Jean Osborne Donata Oertel, Ph.D.Jack A. Vernon, Ph.D. Sheldon Palgon, M.D. In Honor OfHarold E. Wells Janet Florentin William E. PalandF: Helmut Weymar Mary A. Floyd Gerald J . Palazzola Robert B. Quattlebaum, Jr., Mr. Steve CoughlinDelbert w. Yocam Dolores Garcia Wilfred Palmer M.D. (Happy Easter)George N. Gaston R. J. Pa lombit Paul A. Reder, M.D., PA Jean E. PepperSponsors Veva J. Gibbard Randy L. Parks Dean Edward Schanen, Mark Graham(lndiuidual Contributions Theodore T. Gillam Thomas J. Patrician M.D. (34th birthday of myfrom $100-$499) James S. Gold Ford G. Pearson Abraham Shulman, M.D. son)Joy Agass-Smith Bob Goodman Ronny Pe leman Steven Stegman Donna GrahamLloyd Amaral John R. Hafer Richard E. Popovits, Jr. Milly E. R. Walker, M.A. , Christopher V. HoughtonGerald W. Ape\ Robert Hager Howard M. Potiker CCC-A (Happy Birthday)Edwin N. Barnes William D. Hagerty Daniel Pritchett Robert Winkelaar, M.A . J.T. WilsonJanet E. Baumgartner A. James Heins Margaret w. Ratchford Corporations with Gretchen Paige, M.S.,Susan Bentley Mark Herritz James M. Reel CCC-AMark Berman Paul G. Hill Bill Retherford Matching Gifts Stephen P. MaxinJudy C. Bezek Dorothy R. and John Bernard Richards Computer Associates Barbara 'ThbachnickMobil Foundation Jack A. Vernonordon J. Birgbauer, ,Jr. Hiltner William P. Roberts union Pacific Dr. Jack A. VernonR. John Bishopp Frank Hutto Anna S. RoemerPeter Bouvier Joan Imber N. T. Rutledge US West Betty WebberMichael L. Bowen Robert C. lncerti Edmund B. Ruttledge Bequests Research DonorsRobert J. Bradley Philip H. Ingber Alan Sands Estate of Adam Dean Moser John J. AccordinoDorothy M. Brahm James Irving Marie Saxe Helen D. AdamsJane E. Braucher Elizabeth A. Tvankovic Bryan Schwab TRIBUTES Elenor AdamsJames W. Brennan Nils P. Jensen Irving H. Schwartz Betty AdamsAlan L. Brock Michael E. Johnson Bruce A. Shachat In Memory Of Marian H. AgeeJack E. Brown Kenneth w. Jones Glenda Sheppard Margaret Acker Robert R. AlexanderMr. Ralph C. Brown John Kapteyn Jerry Smalley Adele Steiner Vera AlstonRoben L. Brown John B. Kent Raymond M. Smith, Ti l Carmela Bellafiore Stephen M. AltusKristin J. Bruno Donald King Robert Lee Smith Harry a11d Rose Vogelfanger Marjorie Ge ary AndersonAlfeo Brusetti Laura P. Kleppick Eugene J. Sobel Jack Bennett Betty J. AndersonRichard A. Burns Shirley E. Kodmur Lou Somers Sylvia Eisenberg He len M. AndersonJames Bussey Bertram Kostant Lewis E. Stengel, Jr. Leo Brenner Nicholas AndrewsMerle C. Chambers Pete Kubena Howard C. Stidham Stephen M. Nagler, M.D., Henry N. AnguloKerry N. Chatham, D.V.M Clide V. Sonny Landreth, lU Walter H. Swver F.A .C.S Vernon R. AppeltClary Childers Eric C. Larson Robert J. Suchomski Mrs. Mamie Coles Jeff ArchambultRalph G. Ciaramel\o Shirley C. Lavenberg Michael M. Sullivan Stephen M. Nagler, M.D., Richard BaierGuy R. Clark Barton Lavine Ruth M. Swan F.A.C.S Philip J. BankardGardner C. Cole Michael C. Lehner Daniel K. Thrkington Joan L. Hulett Edward A. BaroodyRobert L. Coley Jean R. Ljungkull JeffreyS. 'Thshman Mr. and Mrs. John H. Irma A. BarrettDiana C. Connolly Van A. Luoma Donald V. Thompson Schleter Harry BassfordFrank J. Cook, M.D. Annette D. Mallory Fred D. Thompson Merle Lien Sara Rouse BatchelorGeorge Cranda11. J t. Ruggero Mariani Scott Thrner Arlo and Phyllis Nash Connie J. BaxterBill Creeden Phil E. Marshall Arlene B. VanNorden Patricia Nash John J . .BeaumontRichard Martin Joseph A. Verdon Clint and Arvera Alleman Richard L. BehrRobert F. Weimer Arlo and Phyllis Nash Lucille Bender

Tinnitus 1bday/ June 1998 25


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SPECIAL DONORS AND TRIBUTES (continuedResearch Donors Johnston K. Fite Michael R. Jones Pau l M. Olinski Richard E Smith(continued) Glenn W. Flint Henry B. Keese Kuth and Stacy Olive r Patricia M. SmithMargrit Fontanilla R. L. Keheley Scott R. Olson Captola M. SmithCharlene Bennett Lovetta Wall is Fossett Harry G. and Marion Kristi A. Olson Randall S. SmithMitchell BensonMarsha and Morton Kim Frohsin Keipe r William S. Orcutt Richard C. SmithBerkowitz Cathy A. Frost Joseph J. Kelly Elmer D. Oswald J. Emory Smith, Jr.Robert T. Bialas Marilyn Garnick Guy Kerbstat James C. Owen Mark A. SniegowskiGary A. Billey Leroy E. Gaskin Wayne M. Kern Delores Pacifico Sheldon Soffer

George N. Gaston James and Lela Kester Bernice R. Pardue Mildred F. SohnMary Ann Blackburn Gabriel B. Gavino Charles L. Kidner Patricia Parker Larry SpodenMark A. Bleich Stephen P. Gazzera Louise M. King Marion K. Parker Gerald R. SprangleKim D. BlumeFrank Boland Rowland Gcngelbach John E. Kinney Wayne A. Parkola SFC (Ret) Larry A StafJohn A. Borries Carl 0. Gentry Gerald F. Kiplinger Charles R. Paroubek , Jr. Henry G. StanleyVernon C. Brangham Florena Genzink Angeline B. Kirk Vera J. Pech Lewis E. Stengel, Jr.Charles W. Gilbert Ira M. Klemons, D.D.S., Roi N. Peers Harry B. StephensDennis Braun Maria lnes Vilhena Girao Ph.D. Cornelia R. Pepoy Natalie P. StockingRalph C. Brown Paseo De La Habana Jane E. Kliefoth Angel Perez Ted StojekBarbara F. Brown Madge S. Glass Erna Kohane Ruth Preilfer Steven T. StonePatricia A. BrunkRuth Buchman Harriet L. Glazer Georgian Kolber Peter Phair Leilani L. StoodyLorraine E. BugaJski Benjamin S. Goldfarb Norma Kratz Patsy R. Phillips Thelma R StresakJames A. Gomes Marion A. Kreiter Catherine Pirritano Philip E. StrohmeierHelen S. Burkey Marta C. Gomez R. W. and Susan Krinks Judith Pisetzncr OrloffW. StyvcMichael W. Burnham Emma M. Gomez Walter A. Kunka Colleen C. Pitra Clemens E. SundstromJeffrey L. Burton Donna and Robert Graham Mildred A. Kunkel Mary Anne Pittmon John D. SuttonBettilee Byars Carl Granitzer Sarah E. Lamb Charlotte D. Ponder Charles M. SvajglMary Howard Cadwell David E. G r a t : ~ ; Will iam J . Landolt Richard E. Popovits, Jr. Leroy SweetMiriam w. Campbell

Edith M. Green Eileen E. Larkin Prescott T. Porter Diane SymeRalph Carmen Harold B. Greenberg Christina Laubscher Lela M. Powell Marjorie TerzianAlfredo Carvajal Seymour Greenblatt Jeannette Lawrence Caroline A. Prellwitz Frederick C. ThompsoMichael Celuch Richard and Ruth Greene Robert J. Lewicki Maj. Leonhard Raabe Wiillard C. ThornArlo ChanCarol Jean Chatterton Dick Greene Frank W. Little Eldon Radtke w. K. ThorntonEvelyn Childress Marjorie E. Grcmmcl Jean R. Ljungkull Rose M. Rainona Mary S. 'TracyJohn P. Griesbach Richard P. Loach Mary J. Raymond Anthony Trone, Jr.Virginia M. Clark Arlen e H. Griest Palmer R. Long John A. Reale Betty A. ThoyanekGuy R. Clark Dolorus Guffey Betty B. Lotz Bryce C. Redington Shirley li'ulsonElizabeth Clifford William Gulla Mr. and Mrs. Daniel E. James M. Reel Gera ldine VanBruggenMr. Stanton ColeBeverly J. Collins Frank Guzzi Ludwig Linda Reiman David W. VayoTheresa Concini Josephine C. Habighorst H. Edward Lyon Richard A. Reinhardt Margorie VincentJames J. Contrada Charles E. Haden Cecile MagalifT Karen Reissmann Maril yn S. VoorhiesAnna J. Conwell William D. Hagerty Beatrice Magee F. H. Richardson Dorothy R. WaisteDonald J. Cook Richard E. Haney Phyl lis L. Maihejean Marta Ridd Maebelle WakemanJohn B. Corcoran Jerry D. Harraman Jim Malise Donald J. Ritchie George T. WaldenJoseph A. Cordes Margaret A. Harrod Eleanor Mammino Ann Rizzetto Firth WaldonDoris E. Hart George D. Marcellos Peggy D. Robichaud Jack WallnerW, E. Couling

Richard H. Haws Ruggero Mariani Alden R. Rodgers Judith A. WallusGlen R. Cuccinello Marie L. Heffernan Ronald C. Mathis Thomas w. Rodman Roderick E. WalstonShirley Cullen Betty J. Heisch Janet M. Maynard Elsa P. Rodriguez Rolf Walter, PTSamuel F. Curcio Kristy Hennessee Ellen D. Mazza Doris J. Rohling Arleen WazlahowskyWilliam P. CurrvTimothy G. Cutry Mark Herritz Ann McAleer Craig Rostvedt Marvin WeinbergerSaul Hertzig James v. McCook Daniel Rothman Ronald S WeissDennis M. Daly Charles Hertzig Irene F. McL

Tinnitus Today June 1998 Vol 23, No 2

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Transcript of Tinnitus Today June 1998 Vol 23, No 2