Tinnitus Today March 1999 Vol 24, No 1

7/23/2019 Tinnitus Today March 1999 Vol 24, No 1

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March 1999 Volume 24, Number 1

Tinnitus TodayT HE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION

"To promote relief, prevention, and th e eventual cure of tinnitus for

the benefit of present and future generations"

Since 1971

Education - Advocacy - Research - Support

In This Issue:Tinnitus 'Thrge ted

Therapy

Tinnitusin

Co llegeAcoust ical Effects of

Air Bag Deployment

Internet Links toTinnitus

ATA Researchers toStudy Drug Effects

A Salute to Bravery



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Tinnitus T o d ~ y Editorial ond Advertiing offices: AmericanTnnitusAssociatio n, P.O. Bx 5, Portland, OR97207 • 503/248·9985, 800/634·8978 • [email protected], hHp:jWIWI.otoog

Executive Direcror&' Editor:Gloria E. Reich, Ph.D.

Associate Editor: Barbara Thbachnick

Tinnitus Today is published quarterly in

March, June, September, and December. It ismailed to American Tinnitus Associationdonors and a selected 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 Tinruws Tbday. Acceptance of advertising by Tinnitus Thday does not constitute

endorsement of the advertiser, its productsor services, nor does Tinnitus Tbday makeany claims or guarantees as to the accuracyor validity of the advertiser's offer. Th e

opinions expressed by contributOrs toTi1mitus 1bday are not necessarily those ofthe Publisher, editors, staff, or advertisers.American Tinnitus Association is a non

profit human health and welfare agencyunder 26 USC 501 (c (3).

Copyright 1999 by American Tinnitus

Association. No part of this publication may

be reproduced, stored in a retrieval system,or transmitted in any form, or by any means,withOltt the prior written permission of thePublisher. ISSN: 0897-6368

Executive DirectorGloria E. Reich, Ph.D., Portland, OR

Board of DirectorsJames 0. Chinnis, Jr., Ph.D., Manassos, VA

Claude H. Grizzard, Sr., Atlanta, GAw. F. S. Hopmeier, St. Louis, MOGary P Jacobson, Ph.D., Detroit, MlSidney Kleinman, Chicago, ILPaul Meade, Tigard. OR, Chmn.Philip 0. Morton, Portland, ORStephen Nagler, M.D., F.A.C.S., Atlanta, GADan Purjes, New York, NY

Aaron l. Osherow, Clayton, MOSusan Seidel, M.A., CCC-A, Towson, MDTim Sotos, Lenexa, KSJack A. Vernon, Ph.D., Portland, OR

Megan Vidis, Chicago, IL

Honorary DirectorsThe Honorable Mark 0. Hatfield,U.S. Senate, Retired

Thny Randall, New York, NY

William Shamer. Los Angeles, CA

Scientific AdvisorsRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland, OR

Jack D. Clemis, M.D., Chicago, ILRobert A. Dobie, M.D . San Antonio, TXJohn R. Emmett, M.D., Memphis, TNChris B. Foster, M.D., La Jolla, CABarbara Goldstein, Ph.D., N ew York, NY

John w. House, M.D., Los Angeles, CAGary P. Jacobson, Ph.D., Detroit, MIPawel J. Jastreboff, Ph.D., Atlanta, GAWilliam H. Martin, Ph.D., Portland, OR

Calc w. Miller, M.D., Cincinnati, OH

J. Gail Neely, M.D., St. Louis, MORobert E. Sandlin, Ph.D., El Cajon, CA

The Journal of the American Tinnitus Association

Volume 24 Number 11March 1999

Tinnitus, ringing in the ears or head noises, is experienced by as many as50 million Americans. Medical help is often sought by those who have it in

a severe, stressful, or life-disrupting form.

Table of Contents

7 New ATA Board Members

8 Tinnitus Thrgeted Therapy : A Medical/ Audiological Approach

by Barbara Goldstein, Ph.D., and Abraham Shulman, M.D.

12 Mile After Mile

by Barbara Thbachnick13 Announcements

14 A Salute to Braver y

by Mary Meikle, Ph .D.

15 ATA Researchers to Study Drug Effects

17 Acoustical Effects of Air Bag Deployment

by James 0. Chinnis, Jr. , Ph.D.

19 Federal Funds Available for Al temative Tinnitus Researchby Barbara Thbachnick

20 Tinnitus in College - A Comparison of the Incidence

of Tinnitus in College Music Majors and Non -music Majors

by Mark Zeigler, Ph.D.

22 Intemet Links to Tinnitus

by Barbara Thbachnick

Regular Features4 From the Editor

by Gloria E. Reich, Ph.D.

6 Le tters to the Editor

23 Questions and Answers

by j ack A. Vernon, Ph.D.

25 Special Donors and 'fributes

Cover: 'Cottage Interior• (acrylic on canvas, 36'x36") by Barbara Markle, 1083 Norway Dr.,

Columbus, Ohio 43221, 614/451-4441. Ms. Markle is an artist andATA member:



FROM THE EDITOR

byGloria E.

Reich, Ph.D.,Executive Director

The most exciting event

related to tinnitus for the year

1999 is the Sixth InternationalTinnitus Seminar, a quadrennial meeting of tinnitusresearchers, which will takeplace in Cambridge, England

from September 5th through9th. This meeting, like the

five that preceded it, will draw the best tinnituspresentations worldwide and will give both

researchers and laymen the opportunity toques-

tion one another and share the latest theories and

discoveries. If you'd like to attend this meeting,please see the announcement on the back coverof this issue. There will also be a meeting of the

International Tinnitus Support Association onSeptember 5th, in Cambridge just preceding theSixth International Tinnitus Seminar.

On the home front, ATA is busily planning

programs for next year. (Our fiscal year starts on

July 1st.) The Strategic Plan, which was adoptedand implemented in 1997, outlines programs relating to Education, Advocacy, Research and Support(EARS). While most programs are ongoing, the

plan calls for certain additions in fiscal year ending June 2000. Audiologists, hearing instrument

specialists, neurologists, and psychologists aretargeted for professional outreach this year.Healthcare curriculum programs are to be expanded , especially in terms of prevention. Partnershipswith other health care organizations and withcorporations vvill be pursued. Research fundingwill be increased, self-help leadership training will

commence, and the ATA board vvill continue toexpand its membership.

ATA has been overwhelmed with requests forresearch grants in the last several months and

many of the projects look very promising. A fewyears ago we received a large bequest that made itpossible for us to fund more than our usual num-

ber of grants. We'd like to be able to fund worthystudies at a greater rate but our resources, princi

pa11y from that one bequest, have been depletedconsiderably and we are now dependent on the

restricted research donations you make. These canbe in the form ofbequests, stock transfers, tributedonations commemorat ing special events, or sim

are some of the research topics that we've recently

been asked to support:• Cochlear pharmacology of lidocaine and

ZD7288• Determination of normative data for loudness

discomfort levels (LDLs) for the tinnitus andhyperacusic patient

• Effectiveness of tinnitus retraining therapy• Gene discovery in tinnitus• Involvement of the non-primary auditory

nervous system in severe tinnitus and apossibility to develop a diagnostic method

• Mechanisms of hyperexcitability in the inferiorcolliculus: GABA and protein kinase Cs

• New in vitro system to study the effects of

tinnitus-inducing and tinnitus treatment drugs• Tinnitus amelioration using 100% digital

completely-in-canal hearing instruments

• Use of functional MRI to localize brain activity

related to tinnitus• Use of auditory reorganization to minimize

tinnitus perception• Spontaneous activity in cat auditory cortex after

acute and early-age induced pure tone trauma:are mechanisms for transient and long-standingtinnitus different?

• The role of the t rigeminal ganglion and cochlearnucleus in the modulation of tinnitus

The amount of research donations we receivewill determine the extent to which we can fundthese projects.

Other research about the auditory system willbenefit the tinnitus sufferer, too, although not asdirectly as the kinds of projects listed above. Weread about new discoveries almost every day on

the Internet. In January, a sampling of this information revealed that:

1) tissue graft surgery might help the hearingimpaired by aiding in the regeneration of damagedauditory pathways - from the journal

NeuroReport; http :/ www.foxnews.com/ js

Gloria Reich,

Ph .D., and Bob

Johnson, Ph.D.



FROM THE EDITOR {continued)

2) hearing might be restored after noise exposure

through the application of antioxidants; similartechniques might also benefit some Meniere'ssufferers - from the New York Times,http:/ search.nytimes.com/search/ daily/bin/

fastweb?getdoc + site+ site + 20623 + 2 +wAAA +cochlea

3) certain proteins, Del ta and Notch, are instrumental in arranging the pattern ofhair cells inexperimental animals. "These findings will aid in

bringing scientists closer to the day when they willbe able to restore hair cells in the human ear," saysDr. Edwin Rubel at the University of Washington-

in Nov. Science Magazine, www.sciencemag.org

4) a breakthrough in genetic research that may ultimately benefit public health by identifying mutations that are affiliated with specific disease -from Wired magazine, http://www.wired.com

5) cochlear implants have resurfaced with newtechnology designed to improve the function ofolder implants. Some of the ones from the 1970'shave deteriorated in performance over the years.Dr. Michael Dorman at Arizona State University

works with old cochlear implants updating them

with new processors. He can be contacted [email protected]

These and other scientists will be quick toremind us that jumping from here to a promisingcure for tinnitus is like jumping over the GrandCanyon without a means of transportation or abridge. Tinnitus research is the bridge, from theringing we hear to the silence that one day will be

ours.

A last and sad note: ATA lost a champion thisyear. Bob Johnson, who died in January, was afriend to all who suffered with tinnitus. Almost20 years ago, colleagues dubbed his successes incaring for tinnitus patients as "the Johnson effect."Those of us who knew Bob always got the fulleffect - 100% of his effort whether as friend, colleague, or patient. His wish to perpetuate care and

research for tinnitus patients will thankfully liveon. You may join us in honoring Bob Johnsonthrough remembrances for treatment and researchas described in the centerfold insert of this issue. ml

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Letters to the Editor

From time to time, we include letters from our

members about their experiences with •non-traditional"

treatments. We do so in the hope that the information

offered might be helpful. Please read these anecdotal

reports carefully, consult with your physician or

medical advisor, and decide for yourself i fa given

treatment might be right for you. As always, the

opinions expressed are strictly those of the letter

writers and do not reflect an opinion or endorsement

byATA.

Ater years of trying everyth ing from acupuncture

to Xanax, I read about a medical doctor in Israelwho successfully treats noise-induced tinnitus.Particularly convincing was an article in "TheJerusalem Post" which stated: "In a study of 200soldiers, [Zacharya Shemesh, M.D.] and colleaguesin the Israel Defense Forces found a no table

improvement in the quality oflife of tinnituspatients. They reported an overall success rate of

90% -higher than anywhere else in the worldand many patients said the noise had completelydisappeared ... " I contacted an Israeli patient of Dr.Shemesh's. A fellow teacher, she swore that Dr.Shemesh had made he r life worth living again. Thisencouragement led me to Israel to seek his help.When I anived, I received a comprehensive med

ical evaluation,which included

protracted,empa

thetic, one-on-one consultations (in English) and

body chemistry tests. On the basis of the results,Dr. Shemesh and I built an individualized treatment program for me - a program which I am

pleased to report has brought my tinnitus under

control.

Should readers wish to know more about Dr.Shemesh's program for foreign visitors (conducted

by him at Hadassah Medical Center Jerusalemand recently approved by Blue Cro;s/Blue i ~ l d , and others), they can contact him directly.phone: 011-972-2-677-6078,e-mail: [email protected], or web site:www.hadassah.org.il/ hmo/tinnitus/tinnitus.htm

I now reside in Israel an d look forward to hearinvfrom you. Shalom! o

Mike Cohen, e-mail: [email protected], phone:

011-972-9-955-6606, 52 Yehoshua Ben Nun St.,Herzliya Pituach, 46763, ISRAEL

I ave had tinnitus for almost three years. I t started when I had a tooth extracted and at the same

my great surprise, the scopolamine patch stopped

the tinnitus when I wore it behind my left ea r

(which has the tinnitus). I wear the patch for threedays, take it off, then wait three days before applying another one. When I don't wear the patch, the

tinnitus resumes. Within two hours of applying the

patch, the tinnitus disappears. I hope this can helpothers - if only temporarily. This patch has givenme tremendous relief.

John D. Perkins, 7667 N. Wickham Rd., #508,

Melbourne, FL 32940, 4071242-6599,KS4SO@webtv. ne t

I 'm no t afraid to dry my hair anymore! In the

past, the noise of my blow dryer exacerbated thenoise of my tinnitus. Th counter it, I used to wearearmuffs (under my chin) as well as earplugs. Notonly was I extremely uncomfortable wearingthese, but the noise of the dryer still got through.Then in a catalogue, I read about the WhisperQuiet #2 Hair Dryer distributed throughBrookstone (model #224113, $40 plus $5.95 shipping, 800/846-3000). I bought it and at last I candry my hair without plugs or muffs or loud hair

dryer noise. Happy hair drying!

Alice J. Mandel, Philadelphia, PA

Ieveloped pulsatile tinnitus several months ago,

to th e extent that I scoured my house for the culprit machinery that was pounding away! The condition persisted - loudly. I then read the letter tothe editor in the September 1998 Tinnitus Today ,which related the use of St. John's Wort by a sufferer of pulsatile tinnitus, and began taking St.John's Wort, one 300 mg. capsule, four times daily.After a month, the pounding subsided to barelyaudible. I've continued taking the product daily,with no recurrence of the hard pounding. An occasional soft pulsation does occur - bu t rarely. Myusual high-pitched whistle has not changed, but

the relief has been remarkable for the pulsations.

John E. Hart1ein, 12224 Ash St.,

Shawnee Mission, KS 66209

T

wo years ago, I began to have an incrediblyloud and frightening ringing in my head. After

visiting three otolaryngologists over six months, Ifelt I was alone. But I would not accept that I had

to "go home and learn to live with it." I intended togain some control over this constant ringing that

was causing me to lose sleep and have debilitating



letters to the Editor (continued)

no t do anything to eliminate the ringing, I had to

do something for the anxiety. I tried taking Xanax

but it made me very tired.I finally visited a naturopathic doctor who gave

me a dose of "aconite.'' I quickly stopped having

my debilitating anxiety attacks which allowed me

to be less aware of the ringing, and has enabled me

to enjoy life again . I was uneducated about homeopathies, but have changed my approach to health

issues as a result of my incredible success with th e

aconite.

Laura R. Enright, 150 FW Hartford Dr. ,Portsm outh, NH 03801 , 603/ 427-1431

Jack Vernon wrote to Stephen Martinez, M.D.,Director of the National Highway Thaffic SafetyAdministration, regarding air bags and auditory

damage. Dr. Vernon asked that we share his letter

with Tinnitus Today readers.

Dar Dr. Martinez:I have four patients each of whom have pro

found hearing loss and severe untreatable tinnitus

due to exposure to air bag explosions. In each case,the precipitating accident was a very simple fend

er bender. Life an d limb were not at risk for thesepeople but they will pay wHh a seriously reduced

quality of life for the rest of their lives because of

an overly cautious safety regulation.

I would like to propose to you that ai r bags

should be on an operator-controlled switch. Whenin local traffic where very minor accidents are the

primary hazard, the switch could be turned off.And then when in highway or freeway drivingwhere more serious accidents are possible, the

switch could be turned on as a preparatory measure. I seriously feel we should have th e option of

activating or not activating our air bags which present sur.h a serious r isk to hearing. At the sound

level at which th e air bags are exploded, ea r and

hearing damage is almost guaranteed .

Respectfully submitted, Jack Vemon, Ph.D.

Professor ofOtolaryngology (Emeritus)

New ATA Board Meinbers

Timothy S Sotos, lenexa, KSA'D\. gratefully welcomes Tim

Sotos to th e Board of Directors,again. Tim joined ATA's Boardof Directors once before - in

March 1994. But in 1996, afamily emergency interrupted

his term . Now, three years later,

with the emergency resolved,Tim decided to return to his work as an ATA board

member. He told us why:

"The combination of my being ready an d theprogress made by the board in my absence has

brought me back. I liked what I was reading and

what I was hearing about ATA's growth. I was

encouraged by Jack Vernon's fund raising efforts,and by his being on the board. I was encouraged

by Sid Kleinman's report about ATA's financialdirection. I was encouraged by Phil Morton'sinvolvement as a liaison with other hearing associations. The board has also grown to include Dr.

Nagler, Dr. Chinnis, and researcher Dr. Jacobson,

Caude H. Grizzard , Sr., Atlanta, GAATA board member AaronOsherow knew of a ClaudeGrizzard through professional circles. (Both are in the "direct mail"business.) But when a ClaudeGrizzard made a substantial

donation to ATA an d his name

appeared on the Champions ofSilence tribute list in Tinnitus 7bday, Osherowsaw it an d decided to contact him to see if the twoGrizzards were one and the same. They were.

We asked Claude about his reason for joining

ATA's Board of Directors. He says: "Basically, Iwant to be helpful. Aaron [Osherow) thought Icould bring my professional background to ATA.

And if that can play a part in increasing ATA's

membership, then that's what I want to do. I alsowant ATA members to feel that this organization isbeing ru n as best as it can be. And I'm not speaking of myself. I'm speaking of the others on the

board and the scientific advisory committee who



Tinnitus Targeted Therapy:by Barbara Goldstein, Ph.D., and Abraham Shulman, M.D.

The symptom of tinnitus is considered firstand foremost to be a medical/audiological problem

involving the cochleovestibular (hearing and balance) system in the peripheral and/or central

nervous system. ("Peripheral" refers to the ear;"central" refers to the brain.) Conditions such as

cardiovascular disease, hypertension, high cholesterol, thyroid disease, and diabetes can cause

tinnitus. Therefore, prior to any treatment of

tinnitus, we recommend a complete medical aswell as audiologic work-up to establish an accuratetinnitus diagnosis. We believe that successfultinnitus treatment is based on the accuracy of

the tinnitus diagnosis.

Realities 1999Both the professional and the patient must face

some realities about tinnitus in 1999.

1. There is no cure for tinnitus at this time.2. There are different types and subtypes of tinnitus. Further, it is necessary to differentiate between

patients with severe disabling tinnitus and the general tinnitus population. Severe disabling tinnitus

causes a serious interference in activities of dailyliving - e.g. sleep, work, and social skills.

3. There is no general agreement about a definitionof tinnitus, a classification system of tinnitus, or

mechanisms of tinnitus production.

4. There is no one treatment appropria te for alltinnitus patients.

5. There are many options for the relief/controland treatment of tinnitus.

6. Instrumentation offers significant tinnitus

control to th e tinnitus patient.

Since not all tinnitus is the same, not alltinnitus patients need the same medical/audio ogicwork-up. However, most patients with the primary

complaint of tinnitus want to know the following:What do I have? Is this a life-threatening condition?Do I have a brain tumor? Does this mean I am

going deaf, or losing my mind? Will it get worse?What caused it? What can I do to get rid of it?

Protocols of Diagnosis and Treatment

At our clinic, the patient with tinnitus Nor ofthe severe disabling type can expect to receive:

l. Neurotologic examination (of the ears, nose,throat, and cranial nerves) to exclude major

diseases of the head and neck (e.g., acoustic

2. Hearing screening test.

3. Tinnitus questionnaire to identify tinnitus by itscharacteristics: location, intensity, etc.

4. For asymmetric (one-sided) sensorineural hearing loss: a magnetic resonance imaging (MRI)test of the internal auditory canals to identify the

presence or absence of an acoustic tumor.

5. Follow-up office visits for treatment.

We believe that successful tinnitus

treatment is based on the accuracy of he

tinnitus diagnosis.

We strongly believe that individuals WITHsevere disabling tinnitus, who have seen severalhealth care providers and are still suffering requirea comprehensive evaluation. In our practice, weperform the Medical Audiologic Tinnitus PatientProtocol (MATPP).(I) This is a team approach thatattempts to identify the medical significance of thesymptom of tinnitus, the clinical type(s) of tinnitus,and the identification and treatment of factors

known to influence tinnitus. In this manner thephysician and the audiologist establish a basis fortinnitus control. The MATPP includes:

1. A neurotologic history (a review of th e patient'scomplaints of hearing loss, tinnitus, vertigo, and/or

ear blockage which might reflect a disorder of the

central nervous system).

2. Hearing screening test.

3. Consultation with the patient and physical examination of the head, neck, and cranial nerves.

4. Individualized tests to measure the sensitivity of

the nerve of the ear for hearing and balance.

5. A live trial of instrumentation - to give the

patient the acoustic experience of masking,habituation, and/or amplification.

6.Evaluation to identify the parameters oftinnitus.

7. Questionnaires - including a tinnitus question

naire, a stress test, a depression scale, and thetinnitus handicap inventory.

Our patients are also given an explanation and

understanding of their tinnitus, plus counselingabout avoidance of loud noise exposure and the use



Medical/Audiological ApproachTESTS

Patients who have been to other doctors frequently ask, "Why do I need another hearing test?I had all of these tests last year. I'm here for my

tinnitus, no t my hearing. And why do I need balance tests? I only have occasional unsteadiness

when I get up too fast, bu t it doesn 't bother me."

Tinnitus is closely associated with the hearing

and balance system. And because the nerve of the

ear has two parts - one for hearing and one for

balance -both parts of the system need to beevaluated.

Many patients with severe disabling tinnitus

are anxious and fearful that testing will increasetheir tinnitus. This is always a possibilHy! Patientsmust decide if they are willing to take the chance,no m atter how small. This has been an infrequent

occurrence in our practice. Generally if tinnitus

increases in intensity, it will return to its usual

level. However, no one can guarantee it.

The following is an explanation of the specific tests we

perfonn for cases of severe disabling tinnitus.

Audiologic Evaluation1. Site-of-lesion testing. This is a series of hearing

tests that attempt to establish the location of the

tinnitus. Tests consist of pure tone audiometry,speech audiometry (including speech recognitionthreshold), tone decay testing, and short increment

sensitivity index.

Central auditory speech testing is no t routinely

performed. It is performed, however, for individuals who complain of hearing difficulty because of

their tinnitus but whose hearing tests and AuditoryBrainstem Response Thsting are satisfactory, and

for individuals whose site-of-lesion test results do

no t explain their complaint of difficulty in hearingor understanding.C2l

2. Impedance audiometry. This battery of testsconsist of tympanometry, acoustic reflexes, reflexdecay, and the Metz test for detecting lesions

in the inner ear. These tests help establish the

presence or absence of hearing loss, the type and

degree of hearing loss, and the presence or absence

of recruitment (a sensitivity to sound). They also

help the audiologist evaluate the functional condition of the patient's middle ear, eardrum, and

Eustachian tube. For the patient complaining of ea r

blockage, these tests can determine if the source of

the blockage is the middle or inner ear.

patient. Establishing the tinnitus paran:teters . quality, location, duration, frequency, m t e ~ S l t _ Y , maskability, and rebound (an increase in tmmtus

intensity following sound presentation) - alsoenables us to monitor any changes that result fromtreatment. The tinnitus evaluation includes: pitchmatching, loudness matching, and the measurement of residual inhibition (temporary, post-masking tinnitus suppression), the Feldmann MaskingCurves (Minimal Masking Levels), and loudness

discomfort levels.

After the results are analyzed, an individualizedtrial of live instrumentation is offered. We hope

that individuals who experience residual inhibitionwhen they're tested will have the same experiencefollowing the use of instrumentation for masking.If rebound occurs, the otologist attempts to medically control the condition. From masking c u : ~ e testing we can determine if maskability is pos1tweor negative and which ea r (or ears) should be fitted

with devices. (J) Loudness discomfort levels areestablished for each ear individually at frequenciesfrom 250-8000Hz to assess the presence or absence

of hyperacusis and other sound sensitivities.<> Th e

outcome of these tests also influences the ch01ce of

instrumentation.

Ear and Balance Function Tests1. Auditory Brainstem Response 'Jesting (ABR). The

ABR test records the brain's electrical firing capability in the central auditory system by measuring

its response to sound. This "evoked p o t e ~ t i a 1 " is.recorded (via an electrode on the scalp) Immediately after a brief click or tone is m ~ d ~ . I t .is t?e most

sensitive and objective test for d1stmgmshmgbetween a cochlear lesion and a retrocochlearlesion (one between the cochlea and the brain).<)

2. Otoacoustic Emissions (OAE's) Otoacoustic emis

sions are low-level sounds generated by the outerhair cells of the cochlea.C6) Th e test is a non-invasive objective method of evaluating c o c h l e a ~ ~ n d auditory pathway function. OAEs are a sens1t1veindicator of cochlear status, especially outer hair

cells which are sensitive indicators of change in thecochlea. For the tinnitus patient, this improved

accuracy of a cochlear diagnosis helps in the selection and monitoring of the therapy.

3. Ultra High Frequency Audiometry (HFA).HFA permits an evaluation of the total r e s p ~ n s e of

the auditory system from 1000-20,000Hz. I t ts used

to identify the tinnitus, establish octave confusions,and monitor hearing in patients undergoing exter



Tinnitus Targeted Therapy ,,.. ;... J

in tinnitus patients whose previously recordedhearing levels were "normal" when tested with

conventional audiometry F>

Vestibular and Balance TestsVertigo and/or balance complaints are not

infrequent in patients with tinnitus. When thechief complaint is tinnitus, our clinical experiencewith respect to vertigo indicates that a significantnumber of patients (± 20%) have an associatedcomplain t of imbalance. Also, approximately 60%

of tinnitus patients - with or without symptomsof vertigo - demonstrate a vestibular abnormalitywhen tested.

Secondary endolymphatic hydrops, of tenfound during vestibular testing, requires treatment

by an otologist. I t can adversely influence tinnitus,result in an increased loss of hearing, and causethe patient to be more sensitive to sound. The

identification and treatment of secondary

endolymphatic hydrops (a syndrome of delayedMeniere's-like attacks) positively influences tinnitus control in approximately 35% of ou r patients.In our experience, use of maskers, hearing aids,or other devices in the presence of this conditiontends to aggravate the tinnitus, cause rebound, and

reduce or negate the usefulness of the devices.(Patients often reject the instrumentation.)Treatment of the hydrops reduces recruitment and

increases the efficacy of instrumentation.C8>

l. Electronystagmography (ENG). ENG is a recordingof eyeball movement in response to a series of balance tests. The tests include tracking, optokinetics,the Hallpike maneuver, and positional testing witheyes opened and closed.

2. Computerized Rotary Chair and Pursuit 'ltacking'Jests. These are used to screen for vestibular

abnormalities by identifying peripheral and central vestibular function.

Additional ProceduresOther tests are advised on an individual basis

and can include laboratory tests (like blood work),x-rays, CAT scan and MRI of the brain and temporal bones, and Single Photon Emission Tomography (SPECT).<>SPECT scanning of the brain isa functional imaging technique which our center

introduced for the identification of abnormalitiesof regional blood flow in patients with severe and

disabling central tinnitus. SPECT has also shownus an area of hyperexcitability in the brain identical to that identified for epilepsy. This has a practi

has also provided objective support for the speculation that, for some, tinnitus is a sign of central ner

vous system disease with associated complaints ofanxiety, depression, and fear.

Management Plan - Tinnitus Targeted TherapyAfter completing the MATPP, our patients have

a follow-up visit with the nem·otologist and theaudiologist dming which an individualized plan of

treatment, or Tinnitus Thrgeted Therapy, is recommended. Current treatments include instrumenta

tion (amplification with hearing aids, habituationwith Tinnitus Retraining Therapy, electrical stimulation, and masking), surgery (e.g.,intratympanicdrug infusion), drug therapy, counseling, and cognitive therapy. Individualized patient plans usuallycombine medication and instrumentation. Duringfollow-up visits, patients and their significant otherscan ask questions about the test results and theplan of therapy.

InstrumentationIn our experience, the following medical

criteria usually suggests a patient's suitability forinstrumentation.

l. Absence of active ear disease (fluid in the ears,mastoiditis, etc.).

2. Satisfactory aeration of the middle ear (properfunctioning of the Eustacian tube).

3. Peripheral site oflesion.

4. Absence of, or control of, vestibular disorder.

5. Patient is emotional1y stable.f11>

When an identif ied medical condition is treated,the chance of success with instrumentation isimproved.

Medications

The introduction and application of newdrug therapies have increased the success of ourTinnitus Thrgeted Therapy since 1997. Thesemedications include calcium channel blockers,free radical scavengers, corticosteroids, glutamateantagonists, and anti-seizure drugs. Surgical insertion of a new microcatheter can deliver drugsthrough the eardrum to the round window of theinner ear. This procedure increases the possibility

of tinnitus relief for cochlear-type tinnitus.This audiologic/ medical approach lets us

individualize and target the therapy for tinnitus.Approximately 75-80% of our tinnitus patients(more than 5000 patients) have achieved some



Tinnitus Targeted Therapy ,,.. ;...d,Our goal and the goal of the Martha Entenmann

Tinnitus Research Center is to improve the accura

cy of tinnitus diagnosis and the modalities of tinnitus control therapy. We also support educationalprograms both for the professional and the patient.The ultimate goal of our center is to achieve a cure

for all clinical types of tinnitus. 9

BibliographyI. Shulman, A. , Medical audiological tinnitus patient protocol.Tinmtus-Diagnosis / 'Ireatment , pp. 319 -321, l 991.

2. Goldstein, B., and A. Shulman, Central auditory speech test findings in individuals with subjective idiopathic tinnitus, Proceedings of

the Pifth International Ti•mitus Seminar, eel. G. Reich and .1. Vernon,pp. 488-493.

3. Feldmann, H., Homolateral and contalateral masking of tinnitus,Br [ Laryngol Otol: Suppl 5:60-70, 1981.

4. Goldstein, B. , and A. Shulman, Tinnitus - Hyperacusis and theloudness discomfort test: A preliminary report, The International

Tinnitus Journal, vol. 2, no. 1, pp. 83-89, 1996.

5. Shulman, A. , and M. Seitz, Central tinnitus - Diagnosis an d treat

ment. Observations simultaneous binaural auditory brain responseswith monaural stimulation in the tinnitus patient,The LanJngoscope, Vol. XCI, No.l2, pp. 2025-2035, December, 1981.

6. Shulman, A., an d B. Goldstein, B. Bhatcl, Spontaneous evokedotoacoustic emissions and tinnitus - its conclation / uncorrelationwith specific clinical types of innitus, Proceedings of he Fourth

International Tinnitus Seminar, ed . J .M. Aran, et al., pp . 95-99, 1991.

7. Goldstein B., an d A. Shulman, Electrical high frequency audiometry - Preliminary medical audiologic experience, Audiology

26:321 -333, 1987.

8. Go ldstein B., an d A. Shu lman, Tinnilus masking- A longitudinal study - 1987-1994, Proceedings of the Fifth International Tinnitus

Seminar, cd. G. Reich and J. Vernon, pp. 315-321, 1995.

9. Shulman, A., an d B. Goldstein, A final common pathway fortinnih1s - Implications for treatment, The International Tin ~ t i t u s Journal, Vol2, No 2, pp. 132-142, 1996

10. Shulman A. , Neuroprotective Drug Therapy, The international

Tinnitus Journal, Vol. 3, No. 2, pp. 77-94, 1997

ll . Goldstein, B., and A. Shulman, Tinnitus masking: A 20-year

perspective, Presentation of 25th Meeting of the NES.12. Shulman, A., A final common pathway for t innitus- Th e

medial temporal lobe system, The International T i ~ t n i t u s Journal

Vol 1, No 2, 115-126, 1996.

Barbara Goldstein, Ph.D., is Research AssistantProfessor in the Department ofNeurosurgery;Abraham Shulman, M.D., FA.C.S., is ProfessorEmeritus ofClinical Otolaryngology and ResearchProfessor ofNeurosurgery. They are with the Martha

Entenmann Tinnitus Research Center, Health SciencesCenter at Brooklyn State University of New York, Box1239, 450 Clarkson Avenue, Brooklyn, New York11203. Both also serve as Scientific Advisors to ATA.

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Mile after Mile

by Barbara Tabachnick, Client Services Manager

Since 1976, Dr. Gloria Reich has traveled morethan one million miles around the world - thedistance to the moon and back - for ATA. Sheattended one professional meeting in that firstyear: the conference of the American Academyof Otolaryngology and Ophthalmology (AAOO),now the AAO. Her modest purpose was to let ENTdoctors know that ATA existed. The response toGloria's (and ATA's) presence at that prestigious

meeting was lukewarm. Undaunted, she wentagain the following year, and the year after that.And the year after that.

ATA's annual presence at AAO meetings is now

sought by the meeting organizers, and of considerable interest to the thousands of physicians whoattend it. At the 1998 AAO conference in SanAntonio, ATA's booth was swamped with visitorsfor four non-stop days. Dr. Reich, he r husband Thd,

ATA's Assistant Director Pat Daggett, and Dr. BillyMartin, Oregon Hearing Research Center's tinnitusclinic director, all helped staff the booth. SaysDaggett, "Every shred of material, every brochure,Tinnitus Tbday, everything that we brought with us

was taken by the people at the meeting. And they

told us how pleased they were we were there."

Pat Daggett began her traveling days for ATA

in 1988 when the number of national meetingsincreased and they began to overlap. "Originally,doctors were condescending because we didn'thave 'the answer: Now they use ATA as a way tohe lp their patients. I think th e field is attractingmore interest and higher quality researchersbecause we're not sitting in an ivory tower sendingout information. We're out there!" Since 1988, Pathas logged a quarter of a million miles herself on

behalf of ATA.

"It's all about connecting," says Gloria Reichwhen she reflects on her extensive travel for ATA.

"When we meet people, we establish relationships.Our traveling has strengthened the whole tinnitusnetwork." There seems to be something to it. Whatwas once an organization of 250 members is nowone of 20,000 members. And what was once brushed off as a something "all in one's head" is now

knownto be

a physical, psychologically intrusive,and neurologically based symptom.

Establishing a national mind-set about thecredibility of tinnitus is a huge task, one that istaking diligence and a persistent presence to makeso. With airplane tickets and ATA brochures in

hand, Gloria, Pat, their spouses, staff members,and volunteers continue the forward momentum

- one hopeful mile at a time - towards educating

doctors, influencing researchers, and bolsteringsupport for all who are affected by the calamity of

tinnitus. Ia

Visiting the Central Institute for the Deaf, St. Louis, MO -

Michele Hartlove,

Director; Better

Hearing Institute7bp row, I. tor: : Bi11 Clark; Mary Meikle, Ph.D.; Jack Vernon,

Ph.D.; Stephen Nagler; M.D.; Paul Meade; Aaron Osherow;

Sam Hopmeier; BC-HIS. Front row, l. to r.: Carol Jude, Support

Group Leader; Gary Jacobson, Ph.D.; Jim Chinnis, Ph.D.; PatDaggett; Susan Seidel, M.A., CCC-A; Gloria Reich, Ph.D.



Where We've Been - Fall 1998Sept. 10-12, In ternational Hearing Society, Nashville, TN

Sept. 12-16, American Academy of Otolaryngology,San Antonio, TX

Sept. 14, ATA's Scientific Adv isory Committee meetingand Public Foru m, San An tonio, TX

Sept. 17, American Academy of Family Physicians,San Francisco, CA

Sept. 17-19, Management of the Tinnitus Pa tient,Iowa City, IA

Sept. 12, 1st Community Conference on Balance &

Hearing, Austin, TXSept. 24. National Hearing Conservation Association.Seattle, WA

Oct. 8-10, Academy of Dispensing Au diologists,Monterey, CA

Nov. 13, Ce ntral lnstitute for the Deaf, St. Louis, MONov 13-14, ATA Board of Directors meeting, St. Lo uis, MO

Where We're Going - 1999Feb . 6, Univ. of Miami Medical School. Public meeting

and research seminar, Ft. Lauderdale, FLFeb . 13-17, Association of Research in Otolaryngology,St. Petersburg, FL

Feb. 25-27, National Hearing Conservation Association,Atlanta, GA

March 4-6, National Health Council & American AuditorySociety, Phoenix, AZ

March 17-18, Meniere's Society, Aspen, COApril 17, Sounding Off on Tinnitus, Los Angeles, CAApril 17-21, National Counci1 on Aging, San Diego, CA

Ap ril 20-24, Community Health Charities, Clearwater, FLApril 22-25, American College of Physicians,

New Orleans, LAApril 25-26, Combined Otolaryngological Spring Meeting,

Palm Desert, CAApril 29-May 2, American Academy of Aud iology,

Miami Beach, FLJune 1-3, American Aca demy of Physicians Assistan ts,

Atlanta, GASept. 5, In ternational Tinnitus Support Associa tion,

Cambridge, EnglandSept. 5-9, Sixth International Tinnitus Seminar,

Cambridge, EnglandSept. 16-19, American Academy of Family Physicians,

Orlando, FLSept. 26-29, American Academy of Otolaryngology,

New Orleans, LASept. 30-0ct.2, Tinnitus Patient Management,

Iowa City, TAOct. 13-17, International Hearing Society,Philadelphia, PAOct. 27-31, Association of Dispensing Au diologists,

BermudaNov. 17-21, American Speech Hearing Language

ANNOUNCEMENTS

Sounding Off on TinnitusDate: April17, 1999, 8:15a.m.- 12:30 p.m.

Location: UCLA, NPI Auditorium, 720 WestwoodBlvd., Los Angeles, CA

The Los Angeles Tinnitus Group is sponsoring ahalf-day seminar to celebrate 15 years of support andeducation for individuals with tinnitus . Designed forpatients, family m embers, and healthcare providers,the program features informative lectures and interactive discussions.Guest Speakers: Stephen Nagler, M.D., F.A.C.S.,Gloria Reich, Ph.D., Akira Ishiyama, M.D., and

Ma rcia Harris, family therapist.

Registration: $10 fee before April 9, 1999Pre-register: Send your name, address, phone

number, and check (no cash please) payable toth e L.A. Tinnitus Group, UCLA Rehabilitation Ctr.,Rm .15-54, 1000 Veteran Ave., Los Angeles, CA90095-1651.Contact Organizers: Nelly Nigro 310/474-9689,

Marjorie Harris 310/825-4101 for more information.

International Hearing Aid Conference V:

''Beyond Traditional Amplification"Date: June 4-6, 1999Location: The University of Iowa, Iowa City, IAGuest ofHonor: Mead Killion, Ph.D.

Speakers: Harry Levitt, Ph .D.; Victor Bray, Ph.D.;Larry Humes, Ph.D.; Pamela Souza, Ph.D.; Marshall

Chasin, M.Sc.; Steve Armstrong, M.Sc.; Jerry Yanz,Ph.D.; Do n Schum, Ph.D.; Rich 'JYler, Ph.D.; Ruth

Bentler, Ph.D.; an d Chris Thrner, Ph.D.

Contact: Rich 'JYler at 319/356-2471,fax: 319/ 353-6739, [email protected],

http:/ www.medicine.uiowa.edu / otolaryngology

news/ news.html.

Attendees are encouraged to submit presentations.

6th International Tinnitus Seminar Cambridge, UK

Date: September 5-9,1999 (See back cover of this

issue for details)

Seventh Annual Conference on the Managementof the Tinnitus PatientDate: September 30-0ctober 1, 1999Location: The University of Iowa, Iowa City, IA

For professionals and tinnitus patients.Guest ofHonor: Jack Vernon, Ph .D .

Speakers: Michael Block, Ph.D.; Gloria Reich, Ph.D.;Meredith Eldridge, M.A.; Soly Erlandsson, psy chiatrist; Anne M e t t e - M o h 1 ~ psychologist; Paul Abbas,Ph.D.; Bruce Gantz, M.D.; Brian McCabe, M.D.;Rich 'JYler, Ph.D.; David Young, M.A.; and Richard



A SALUTE TO

BRAVERYby Mary Meikle, Ph.D.

AU of us are taught at an early age that courageis a virtue and that we should try to act

bravely if the need arises. Few of us, though,

are ever severely tested. For the most part, lifepresents us with brief episodes that may requiresome moderate degree of courage, episodes that

are soon over and that do not leave us with any

lasting hardship.

This story is about someone who was forced todeal with the need for great courage and bravery,every day of his life for many years. Life dealt him

a terrible challenge, one that most people would

have found overwhelming. He met this challengehead-on, every day, without giving in. He did socheerfully, with grace, with energy, with optimism, with never-failing good humor. He was atrue hero, and his name was Robert Johnson.

Bob Johnson was my close friend and colleague at the Oregon Health Sciences Universityfor nearly 20 years. Our offices were side-by-side.And so I saw him in his day-to-day combat with

severe, intractable pain caused by degenerativedisk disease, one of the most severe and cripplingdisorders that can affect the spine, and with the

constantly worsening effects of that disorder.

It was an intense struggle between what

seemed like two opposing teams. There was the"Bob" team - Bob himself the captain aided by his

wife and family; his doctors with their surgicalteams; and the pharmaceutical companies who

kept bringing in new medications hoping to findone that would subdue the pain. And then there

was the "Pain" team - the spinal damage that

started the pain; the nerves that got damaged by

the deteriorating spinal disks, making his leg and

foot numb; the muscle atrophy in his leg that

forced him to limp no matter how hard he triednot to; the burning pain in his leg and foot that

made him unable to sit or stand or even lie down

for any length of time.No matter how hard the Bob team rallied itself

and fought back, the Pain team was always ahead.No one could outwit the Pain team or force it intosubmission. And the Pain team was insidious.

After each new back surgery, it would seem for awhile as though the Pain team was defeated onlyto have it come charging back after a brief pause,stronger and more vicious than ever. No amount

of reinforcement by the medical members of Bob'steam, no new medication or surgical procedure,

could ever keep the Pain team at bay.This grueling battle went on before our eyes,

every day for the last twenty years. We learnedfrom Bob's family that i t also went on at night,because the Pain team never slept and never permitted relaxation.

One might think that Bob, as the captain of ateam that kept on losing year after year, besiegedby setbacks and losses at every turn, might give up

trying. Faced with such a long and unequal struggle, one might expect Bob's team to become angryand embittered, or that Bob might now and thencomplain, raise his voice, or feel unjustly treated.But that never happened. Instead, the captain kept

rallying his troops. He kept charging back onto thefield, calling a new play. He kept trying not tolimp despite the ungovernable pain. And he wouldagain and again summon forth his key maneuver,

the one that always helped him to counter the setbacks and defeats. His key stratagem was called"helping others."

The more the pain pushed its heavy-handedadvantage, the more Bob fought back with diversionary tactics. He knew that he could forget thepain for brief intervals i f his atten tion was divertedto providing help for someone else's troubles. As aclinician, he was a superb listener, someone who

always put his patient's needs before his own.When people needed his help for their hearing

problems and their tinnitus, Bob was there forthem. He gave them his complete and undividedeffort. He became the captain of their team. He

tried to fashion a winning strategy for them, tobolster morale, and rally their families and theirsupport teams to help them. In this way, he tookit upon himself to be as victorious as possible in

defeating problems of hearing and tinnitus.Many, many people who came as patientsto the Tinnitus Clinic in Oregon willremember Bob Johnson as someone who

was totally devoted to their needs. He was devotedin a way that few clinicians ever achieve, sensinga great deal about each patient without having tobe told; offering advice in the gentlest, most sensible ways; and throughout all, maintaining an

unfailing and genuine good humor, delight in

interacting with people, and a true and informedconcern for their well being. He was practical,experienced, and always constructive. He was



ATA Researchers to Study Drug Effects

Kejian Chen, Ph.D., and Donald

Godfrey, Ph.D., at the MedicalCollege of Ohio in Toledo, recently

received a $33,000 grant from ATA to study

the effects of drugs on nerve cells of the

auditory system in laboratory animals that

have been exposed to loud sounds. Drs.

Chen and Godfrey shared their thoughtson this new research with us:

"One idea of how central tinnitus occurs isthat some nerve cells of the auditory system haveincreased activity. This increased background, or

'spontaneous,' activity might be interpreted by

higher brain centers as the occurrence of tones,because auditory nerve cells normally respond to

tones by increasing their activity. When rats areexposed to very loud tones - tones which wouldlikely produce tinni tus in people, the result isincreased spontaneous activity in nerve cellsof their dorsal cochlear nuclei. The mechanismof this increase in spontaneous activity remainsto be discovered.

"We have been studying the spontaneousactivity of dorsal cochlear nucleus nerve cells in

rats exposed to loud tones (125-130 decibels). We

will be applying drugs that affect the communication between nerve cells by neurotransmitters,

including the amino acids glutamate, glycine, andgamma-aminobutyrate or GABA, as well as acetylcholine. Drugs we will be testing include kynurenicacid, NMDA, and AMPA, which affect glutamatetransmission; strychnine, which affects glycinetransmission; muscimol, bicuculline, baclofen, and

saclofen, which affect GABA transmission; and

carbachol and scopolamine, which affect acetylcholine transmission.

"We are first looking for differences in the spontaneous activity of nerve cells in loud-tone-exposedrats as compared to normal rats. Then we will lookfor differences in the drug effects between exposedand normal rats. We hope to identify changes inneurotransmitter receptor properties that may be

related to the development of tinnitus. If we can

identify specific receptor types that are involved,then drugs affecting those receptors could be tried

for relief of central tinnitus. If a specific drug looksuseful in this animalstudy, it wouldprogress to a clinicalstudy. If that trialshows positive results,the drug could be

approved for use. That

process could likely takeabout two years."

a

A SALUTE TO BRAVERY (continued)

Among those who read this story, there will be

some who have to deal with lingering and difficult problems, perhaps even with problems

that trouble them severely every day. Such readersmay be able to learn an important thing fromBob's story: he showed that giving ofhimselfwas

the best and surest way to step away from his own

troubles and difficulties, to put them behind himno matter how bad they grew.

I t was a true act of courage that may be very

hard at first to do. But like all things in life itgrows easier with practice. And there is a substantial reward for such acts ofbravery. The reward isthat the enemy - the other "team" - your prob

I t is hard to be courageous like Bob, to act

bravely even when it hurts. Bob's gift to all of uswas to show that helping others is a way to helpyourself. If you can follow Bob is lead, if you can

try as he did to act bravely in the face of overwhelming difficulty, you too may receive theblessed respite that you seek. 19

Dr. Meikle is Professor ofOtolaryngology at OregonHealth Sciences University, Portland, Oregon.

CorrectionThe address for Phoenix Promotional

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Acoustical Effects of Air Bag Deployment

by James 0. Chinnis, Jr., Ph.D.The

air bag debate continues. The AcousticalSociety of America, at its annual meeting in

Norfolk, VA, devoted an October 13th sessionexclusively to ai r bag noise. Elliott H. Berger,Senior Scientist, Auditory Research, E-A-RProducts, chaired the session.

Richard L. McKinley. M.S., (AFRL / HESN at

Wright-Patterson Air Force Base in Ohio) reportedon a study performed over 30 years ago that used

prototype air bags and 91 military volunteers.The average peak noise level of the ai r bags was168 dB, now judged to be a low estimate by at least

several dB due to microphone limitations. A small,closed, and partially sealed car was used to maximize the air bag pressure effect.

Results showed that many subjects experiencedvery substantial temporary threshold shifts: thesound level necessary for them to detect tones in

an audiology booth increased by as much as 60 dB.When retested at a later date, one subject showed apermanent hearing loss.

G. Richard Price, Ph.D., (U.S. Army ResearchLaboratory) reported on a general mathematicalmodel of auditory hazard. Model predictionsinclude that the greatest hazard is present when

the individual does not see the accident coming,is in a vehicle with windows open, is turned sothat an ear faces the ai r bag, and is naturally more

susceptible to damage. I t is thought that the pressure in a closed vehicle might protect hearing by

pressing the stapes inward against the restrainingpressure of a ligament thus reducing the sound

energy transmitted to the inner ear. (The modelfor this theory has been validated in animal testsonly.) Thsts have found that 1 - 2% of thoseexposed to test air bag deployments will experience permanent tinnitus or hearing loss.

Kathleen Yaremchuk, M.D. (Dept. of Otolaryngology, Head and Neck Surgery, Henry FordHospital, Detroit, MI), reported on the results of

two published requests for otolaryngologists toprovide information about pa tients who had been

exposed to air bag deployments and developedotologic symptoms. 'TWenty physicians replied with

reports of 29 patients who had beene v ~ u a t e d .

. .Tinnitus and hearing loss were present m a maJonty of the 29. There were two reports of eardrum

perforations and one report of a per ilymph fistula(an abnormal opening in the inner ear). 'IWo .

overcome the effect of the noise. And the additionof side air bags raises the ear-level noise inside a

car to 178 dB! Unbelievable."James E. Saunders, M.D., (University of

Oklahoma Health Science Center, Department ofOtorhinolaryngology, Oklahoma City), reported on

actual cases of air bag-induced otologic symptoms.He and his co-researchers report that they haveencountered six patients with ear-related symptoms related to air bag noise. Five patients have

documented hearing loss, one reported persistent

tinnitus, and two have significant dizziness.Following the technical papers, Janet C.

Garman described her life-altering experience of

tinnitus and hyperacusis following an air bagdeployment. She also cited a study recently presented at the American Academy of Otolaryngology's annual meeting. In the study, researcherMcFeely, et al., followed 20 patients whose otologicinjuries resul ted from air bag deployments.

Seventeen of the 20 patients reported tinnitus asthe most common complaint.

In discussions that followed the session, aquestion was raised: Would the risk of otologicdamage, including tinnitus, be higher in a car withdisconnected ai r bags due to the increased risk of

head injury? I t is generally agreed tha t ai r bagsimprove safety overall, as compared with seatbeltsalone. Seatbelts alone reduce fatalities by about45%. Adding air bags to seat belts reduces fatalitiesby an additional 9%. What is wrong is that air bagscan injure while performing their function. They

can injure even in minor accidents that pose nohazard. They can injure in rare cases when they

deploy accidentally.

The National Highway Traffic SafetyAdministration (NHTSA) did not send a repre

sentative to the session on ai r bags. Their web site(www.nhtsa.dot.gov/ airbags) includes an independent panel's statement that " .. the phenomenon

of hearing loss has not been noted to occur due toai r bags."*

Those of us with tinnitus, hearing loss, or

hyperacusis need to inform those who make therules and design the safety systems that these subjective complaints have been documented, are not

minor, and must not be ignored.•National Confe rence on Medical Indications for Air BagDisconnection conducted by The Ronald Reagan lnstiture of

Emergency Medicine Departmeni of E m e r g e ~ c y M e d i ~ i n e ~ n d theNational Crash Analysis Center George Washmgton Umvers1ty

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Federal Funds Available for

Alternative Tinnitus Research


The National Center for Complementary andAlternative Medicine (NCCAM) is the newest

research funding agency of the National Institutesof Health. In 1992, the NCCAM (then called, theOffice of Alternative Medicine) was given its firstbudget of $12 mil1ion to spend for alternative med

ical research. Today, its budget has expanded toSSO million.

What research have they funded so far? .A $1.9million clinical study on hypericum (St. John's

Wort) - Duke University. A $375,000 study on

acupuncture for dental pain - Univers ity ofMaryland. A $1 million study of alternative medicine for the elderly- Stanford University. Dozensof other esteemed research institutions received

funding for a wide assortment of therapies for anequally ·wide assortment of ailments. No, tinnitus

is not yet one of them.

I contacted the NCCAM to find out how tinnitus could be included in this new research arena.Mark Stern, of their office of communications,responded: "Encourage [tinnitus researchers] tosubmit proposals! Make sure they follow the grant

application process carefully. Not all of th e $50 mil

lion has been used. Tell them the money is outthere. There is an opportunity for this to happen."He wanted to be clear that the NCCAM cannot tellresearchers - or even suggest to them - which

diseases or disorders to study. Th e NCCAM cannotsolicit, for instance, a research proposal specificallyfor tinnitus.

The NCCAM research grant applicationis available on the Internet (http: / www.nih.gov/

grants/ funding/ funding.htm) and from the Centerfor Scientific Review (Grants Information Office,Center for Scientific Review, National Inst itutes ofHealth, 6701 Rockledge Ave., #3032, Bethesda, MD20892-7762).

Researchers are invited to look on NCCAM'sweb site for a very clear grant application preparation guide: http:/ www.altmed.od.nih.gov/nccam/ research/ preparation/ quick-guide.shtml

The site offers the following suggestions (andmore) to research applicants:

1) Be brief and concise. Use diagrams to help

explain complex models and ideas.

4) Clearly state how your work goes beyond

previous research.

5) Contact the NIH staff for guidance. They areexperienced with research proposals and are ready

to help.

Those interested in voicing opinions aboutalternative medical approaches for tinnitus relief

are invited to contact Geoffrey P. Cheung, Ph.D.,Deputy Director of the NIH National Center forComplementary and Alternative Medicine at31 Center Dr., Bldg. 31, Rm. 5B36, Bethesda, MD20892-2182.

A word to researchers: We urge you to tap

into the available pools of research money - the

NCCAM for alternative research, the NationalInstitute of Deafness and other Communication

Disorders for convent ional research, hospitals,universities, private foundations, and theAmerican Tinnitus Association - and studytinnitus. Millions of people are waiting andhoping that you do. B

Autographed Books Now AvailableTinnitus: What is That Noise in My Head

by Joan Saunders, 104 pages, softcover

$14.50 ATA members/$18 non-members

On a recent jaunt to the states from her home

in New Zealand, Joan Saunders (and husband

Peter) stopped in Portland for a quick visit and,

of course, to sign her books!Tinnitus: What is That Noise in My Head is

a heartening guide for the tinnitus patient fromthe tinnitus patient. Some of the topics covered:medical treatments; relaxation techniques;non-medical treatments with a notably cleardescription ofbiofeedback; and nutrition anddietary supplements (what to avoid and what toconsider).

Saunders has coped phenomenally well withsevere tinnitus for 40 years and with profoundlifelong deafness. In spite ofboth, she earned

her masters degree and worked to establish the



Tinnitus in College - A Comparison of

the Incidence of Tinnitus in College

Music Majors and Non-music Majorsby Mark C. Zeigler, Ph.D.

Millions of Americans suffer with tinnitus.Slightly more men than women have it and itsprevalence seems to increase with age, the average age being 59 years. However, tinnitus affectsall age groups. A survey conducted by the

National Center for Health Statistics reportedthat approximately 1.3 million people 18 years

old or younger have tinnitus . It's a worrisomeobservation that the incidence of tinnitus among

young adults appears to be on the rise.

Researcher J. M. Graham attributes the

increase in tinnitus cases among the youth in

America to excessive, loud recreational no iseexposure and, in particular, to music. Graham

writes, "This form of tinnitus [noise-induced tinnitus] is also increasingly reported by childrenwithout pre-existing hearing loss as the result of

'recreational noise' as the intensity of amplifiedmusic increases in discotheques and live performances and as the use of personal stereo headphones becomes more common." In a 1996survey of 479 tinnitus sufferers, Alf Axelsson

found that noise exposure was by far the mostcommon cause of tinnitus.

Recent research suggests that some musicians might be at risk for developing tinnitus .In 1995, Kathy Peck, co-founder and executive

6director of the Hearing Education·o and Awareness for Rockers(H.E.A.R.) organization, conducted

a survey of 400 San Francisco Bay

Area rock musicians. She questionedsubjects about their daily recreational

listening habits, number of

weekly performances, incidence of tinnitus and hearing

loss, and hearing conservationefforts. The results: nearly

SO% ofthose surveyed indicated the presence of tinnitus.

Since most forms of tinnitus are not curableand current treatments are often inadequate, it

would seem that the prevention of tinnitus is

critical. As a music student with tinnitus, Idecided to examine the potential link between

being a music major and the incidence of tinnitus. The data that follows became part of my

doctoral thesis on the subject.

The purpose of my study was to not onlyinvestigate the prevalence of tinnitus in collegemusic majors but to investigate the probableunderlying cause of the student's tinnitus. I alsowanted to learn if music majors are developingtinnitus from ensemble rehearsals or other related musical activities. Finally, the study sought

to determine if college music majors and nonmusic majors are practicing an y hearing conservation measures when they are around loudnon-music activities.

Data for this investigation was obtained viasurveys. 'IWo one-time-only questionnaires weredeveloped and distributed to first-year musicstudents and non-music students at selectedcolleges in Florida. Both surveys contained

several closed-ended (yes or no response)questions designed to glean information abouteach respondent's background in four areas:(a) demographics, (b) noise exposure history,(c) tinnitus history, and (d) bearing conservation history. A total of 498 surveys were completed and returned: 249 music major and 249

non-music major.

The results indicated that significantly moremusic majors than non-music majors (188 vs.

145) had some form of ear noise. The majorityof respondents with tinnitus in both groupsindicated experiencing only temporary tinnitus.However, 20 of the music majors as compared toonly six of the non-music majors reported theirtinnitus generally lasted three or more hours.And of six respondents indicating permanent

ear noise, all were music majors.The most common causes of tinnitus listed

by both groups were exposure to excessive noisefor an extended period of time, followed by

exposure to a brief intense sound, followed by



Tinnitus CollegeI l lear or sinus infection. When the two noiseinduced categories were combined, they

comprised nearly one half of the students'

responses.

Of the 198 music majors reporting tinnitus,about 20% (40) reported that they sometimes

experienced tinnitus immediately followingrehearsals or concerts. A small percentage, 4.5%,indicated that they regularly developed tinnitus

from musical activities.

Among other things, the students were asked

about their hearing conservation efforts - inparticular, their usage of hearing protection

(earplugs) when exposed to excessive noise.Both groups of students - non-music and musicmajors - reported nearly the same incidence of

earplug usage: in noisy environments, 2-5%wore earplugs regularly; 17-20% wore them

occasionally; and 75-80% never wore them at alL

l t was surprising to me to learn that threeout of four music majors surveyed had prior

experience with tinnitus. I t represents a realconcern for these young musicians, especiallyconsidering their age (average age of the music

majors was 21) and that, as musicians, they are

highly dependent upon their ears. While the vast

majority of students reported only temporary

tinnitus, many are experiencing the symptom so

often that they appear to be at risk for developing permanent tinnitus. TWenty percent of themusic majors and 14% of the non-music majorsreported regularly developing tinnitus once or

more per week.

Although we can speculate as to why music

majors appear to be developing tinnitus more

often than non-music majors, it is likely that the

cause is related to their musical activities. Nearlyone-fourth of the musicians surveyed reported

developing tinnitus from ensemble rehearsals.When asked how often they were around noisyenvironments that made normal conversationdifficult, 40% of the music students indicatedthat they were exposed to potentially hazardoussound levels daily as compared to only 11% of

the non-music majors. Yet, when it comes to stu

dents' recreational music listening habits (i.e.,stereo usage, attending rock concerts, etc.), the

two groups exhibited almost identical responses.I t appears that the combined exposure to exces

the ensemble

(continued)

The vast majority of students were not

aware that auditory stress is a potential problem

for college students. For example, 65% of themusic majors and 66% ofthe non-music majorshad not had an audiometric evaluation in the

last five years, and nearly half of the music

majors (49%) and two-thirds (70%) of the

non-music majors had never heard of tinnitusbefore completing this survey.

Clearly there is a need to inform collegestudents of the potential auditory hazards they

face daily and to educate them about hearingconservation techniques. Perhaps if incoming

freshmen completed a survey such as the one

used in this study, they could avoid years of

stress and fmstration due to noise-inducedauditory injury. Institutions of higher learning

could also encourage music students to takesteps to protect their ears when they are aroundexcessive noise outside of the rehearsal and

performance environment. As a musician withtinnitus, I might have followed and greatlybenefitted from such advice. B

References

American Tinnitus Association. Results of the 1992 tinnituspatient survey [Brochure ]. Portland, OR: Author, 1992.

American Tinnitus Association. tnformation about tinnitus[Brochure]. Portland, OR: Author, 1994.

Axelsson, A. Tinnitus epidemiology, G. E. Reich and J. A. Vernon(eds.), Proceedi11gs of he Fifth Jmemational Tinmtus Seminar,pp. 249-254, 1996.

Chasin, M., Musicians and the prevention of hearing loss, 1996.

Graham, J. M., Tinnitus in children V.' ith hearing loss, J. A. Vernonand A. R. M0ller (eds.), Mechanisms of tinnitus, pp. 51-56, 1995.

House, P. R. , Psychological issues of tinnitus, A. Shulman (eel.),

Tinnitus: Diagnosis/treatment, pp. 533-534, 1991.

Leske, M. C. , Prevalence estimates of communicative disorder in

the U.S.: Language, healing and vestibular disorders. AmericanSpeech and Hearing Association, 23 (3). 229-237, 1981.

Luxon, L. M • Tinnitus: lt s causes, diagnosis, and treatment,British Medical joumal, 306, 1490-1491, 1993.

Peck, K., and P. Ball, Musicians and music listeners hearing lossand tinnitus survey. Poster session at the Society for ScholarlyPublishing meeting, 'Thmpa, FL, 1995.

Shulman, A., Tinnitus: Diagnosis/treatment, 1991 .

Vernon, J .A., and A.R. M0ller, Mechanisms ofTinnihts, 1995.

Williams, R. D, Enjoy, protect the best ears of your life,•21

FDA Consumer. 26 (4), 25-28 , 1992.

Dr. Zeigler is Director ofChoral Activities at Nazareth

College ofRochester; 4245 East Ave., Rochester; NY



Internet Links to Tinnitus


If you go on the Internet and do a "net search"

for tinnitus, you will find over 8,000 tinnitusrelated web sites (including ours: www.ata.org).Clinics, universities, hearing health organizations,and private citizens have generated a huge body

of electronically published infom1ation about

tinnitus.

In addition to these sites, "newsgroups" an d

interactive real-time "chat rooms" have been

started and maintained by tinnitus patients to

streamline the exchange of ideas about tinnitus.Often th e groups are avenues to camaraderie.

For the most part, these assemblages of

tinnitus patients are unchaperoned - not overseen by a doctor, audiologist, or other health professional - so the information generated is oftenmore personal than professional. Occasionally,health professionals post their responses on these

sites. While it's important to sift through th e post

ings to sort out the "good'' from the "not so good"information, it's often hard to do. If you accessthese information sources, and have a question

about what you read, please ask us or a doctorfamiliar with the disorder for clarification.

Stephen Nagler, M.D., director of the

Southeastern Comprehensive Tinnitus Clinic in

Atlanta, is one of those professionals who fromtime to time visits th e cyber-support groups and

posts his comments. He's offered us the followinginstructions on How-To Access Internet Tinnitus

Groups:

1) alt.support.tinnitus is a UseNet newsgroup.The most efficient way to access it is with a newsreader such as Agent (by Forte). There is a freeversion of Agent readily available by dow nloadingfrom the Forte web site. Visit www.forteinc.com

and download "Free Agent." In Free Agent, subscribe to th e alt.support.tinnitus newsgroup. Youcan then refresh (update) the threads as desired.The new posts are very easy to identify and follow.If you do not wish to use a newsreader, visitwww.dejanews.com and do a search on

alt .support. innitus whenever you wish tocheck ou t th e newsgroup. Threads are a bi t

more difficult to follow in this manner.

2) Most Thursday and Friday nights at 9 p .m. ESTthere is an ongoing tinnitus chat group. You need

some form of interrelay chat to participate. Oneexcellent (free) program is miRC, which can be

readily downloaded. Do a search on miRC on

You will also need to assign yourself a nickname.The process is self-explanatory on miRC.

3) For a tinnitus chat group, visit:http: / /www.chat.yahoo.com

Then establish an "identity" or change your

''identity" if you choose. (Most people on chat

groups use nicknames rather than their realnames.) Then click "Start Chatting." Go to the

bottom of the page and click "Change Room,"then click "Health and Family," then click "UserRooms," then click "Tinnitus." The group is activeWednesday nights at 10 p.m. EST although peopleoccasionally show up to chat at other times.

4) The URL for the Tinnitus Message Board is:www.visi.com/ v weibergc/ tinnitus/ tinnitus.html

This useful site is in jeopardy due to lack of

fund ing.

5) Th e In ternet Ti nnitus Community has a nicesite of its own, maintained by Carol Brown. The

URL is www.eskimo.com / rv carol!T.html

6) There is a Tinnitus FAQ (frequently asked questions) site. It is nicely maintained by a lay personan d has medical disclaimers throughout. The URL

iS WWlV.CCCd.edu/faq/tinnitus.html r/J

Our one-on-one "people links" are still

th e lifelines to thousands. We gratefully wei-

- come our newest additions to the Tinnitus

Support Network. Please write or call us i fyou would like information about becoming atinnitus support giver too.

Telephone Contacts Support Group LeaderRichard D. Curtis Marsha Johnson,

251 Rainier Lane M.S., CCC-APort Ludlow, WA 98365 Oregon Tinnitus/3601437-9694 Hyperacusis Treatment

Linda M. Hastie24 Castleton St.Jamaica Plains,MA 02130617/ 524-2329

Helen J. Hersrud

1002 33rd St. S.

Spearfish , SD 57783605/ 644-0695

Shirma M. Huizenga9 Pear Tree LaneFranklin, MA 02038508/520-6641

Ceneer9272 S.W. BeavertonHillsdale Hwy.Beaverton, OR 97005503/296-7870



QUESTIONS AND ANSWERSJock Vernon's Personal Responses to Questions from our Readers

by Jack A. Vernon, Ph.D., Professor Emeritus,Oregon Health Sciences University

QMs. B. in Alabama reports that removal of atumor on her right eighth nenre has ren

dered her completely deaf in that ea r an d

that her tinnitus in that ear has gotten significantlylouder. She asks the following questions:

1) Is it common for tinnitus to become louder after

eighth nerve surgery? If one cannot hear in that

ear how then can one hear tinnitus in that ear?

2) I am now just beginning to hear some tinnitus in

the good ear. Is the system trying to balance itself?Should I be alarmed about this additional tinnitus?

3) I wear a CROS hearing aid. Could the

electronics or the battery or th e FM signal in

th e CROS aid cause the tinnitus in either orboth ears?

AMs. B., it was essential that your tumor be

removed. Although these tumors are always

benign and slow growing, they nevertheless

can cause death. One of my patients died as a consequence of a non-removed eighth nerve tumor.

It is very common for tinnitus to be louder

with removal of an 8th nerve tumor. Remember, ashearing ability decreases tinnitus increases. Alsoremember that although you perceive your tinnitus

in the left ear, it is actually being perceived in the

brain which in turn is referred to the ear. That you

are beginning to hear your tinnitus in the other ea r

is very common. As you trace the route of sound

from the ear up through th e brain, there are fourplaces where the hearing nerves of each ea r are

directly connected together. Thus it seems to methat it would be easy for th e tinnitus on one side tobe perceived on the other side. Because of this

interconnection, I wonder if masking in the good

ea r might reduce the tinnitus in the deaf ear.Would you try the faucet test on the good ear and

observe if there is any effect upon the tinnitus in

the other ear? Also, I am confident that the electronics of your CROS hearing aid had nothing to do

·with your tinnitus. Keep using that hearing aid. Intime you will even learn to localize sounds. Besideswith the CROS hearing aid, you no longer have toput people on your good side and you no longer

get surprised by sudden events on your bad side.

QMr. L. from New Jersey writes to say that

hyperacusis is becoming more and more

demanding in his life. He asks if there isany device that would protect him from loud and

sudden sounds.

A

Microtek Co. (3500 Holly Lane North, Suite

10, Plymouth, MN 55447, 800/745-4327)

makes a special hearing aid called the"Refuge Hyperacusis Hearing Aid." This unit wasdesigned by Dr. David Preves and is especially forhyperacusis patients. I t contains input compres

sion which can be adjusted to your specific loudness tolerance.

QMrs. R. in California indicates that she has

had no success with health care professionals. They've told her that nothing can be

done for her tinnitus. She also indicates that she's

called me on Wednesdays but could not get

through du e to a busy signaL

AMrs . R., we most ceTtainly want to be of help

to you and I hope you will continue to try tocall me. I t is not surprising that you got a

busy signal. Sometimes I get more than 30 callsin a given day. Let me infOTm you that there is

effective treatment for tinnitus regardless of what

some of the "professionals" tell you. Th e first thing

1 would suggest is for you to do the "faucet test."(Listen to running water to see i f t covers the

tinnitus sound.) Do that before you call me. It

would also help if I could know the results of your

most recent hearing test. I look forward to hearing

from you.

QMr. L. from Michigan indicates that he hasa masker which he has been using for three

months. He is trying to "adapt" to it but

with poor results. He asks if he should continue

trying for a longer period.

Af you are doing Tinnitus Retraining

Therapy (TRT), ask the clinician involvedwhat you should do. I've heard that some

patients need several months to adapt to th e TRTsound generators. If you are on a masking program, it might be that the masker is improperly

fitted . Also, ifyou have some hearing loss it is



Questions and Answers (continued)

likely that you should be using a tinnitus instrument (a combination of masker an d hearing aid)

rather than a simple masker. If you have no hearing loss but have bilateral tinnitus, it is likely that

you should have two maskers instead of one.Many hearing aid dispensers will fit a single hearing aid on a patient with dual hearing losses, and

that thinking often spills over to the fitting of tinnitus maskers. They incorrectly reason that adapting to only one unit is easier than adjusting to twounits. The fact is, in many cases, only by the use

of two maskers will patients experience the reliefthey seek.

QDr. 0. in Minnesota states that by using tl1e

Moses/Lang CD he can cover up his tinnitus completely with band #7 (8000-14,000

Hz) and receives some residual inhibition (temporary cessation of tinnitus after the masking sound

is removed) with that masking. He adds, however,that th e "pink noise" (200-6000Hz) on band #l is amuch more pleasant sound even though it doesn't

completely mask his tinnitus. Despite the production of only partial masking he prefers the pink

noise. I wonder how many other readers who havereceived the Moses/Lang CD find the same effect?

QMr. P. from Kentucky indicates that upon

ascent an d descent in airplanes he istemporarily deaf for a brief period. Would

continuing to fly cause permanent hearing loss?

AI assume that what you experience is afailure of the Eustachian tubes to functionproperly. And i f hat is so, then continued

flying will not produce any permanent hearing

loss. You can correct the problem of pressurechanges by wearing tightly fitted earplugs for both

takeoffs and landings. Foam plugs work just fine.

You can even insert the earplugs before boardingthe plane and remove them after you de-plane in

the terminal.

Q

Mr. N. in Arizona asks i f t is possible tohave health insurance companies pay for

tinnitus maskers.

AMuch depends upon the kind of coverageyour health insurance company offers. Asa general rule, health insurance companies

do no t cover the cost of prosthetic devices. Thusit is very important that your insurance companyknow that tinnitus maskers are classified by theFDA as therapeutic devices, not as prosthetic

devices. You might also point out that ha d yougone to a psychiatri st for treatment of your

tinnitus, the cost would have been many timesthe cost of maskers. I'm told you should not acceptrejection by your company until after you haveapproached them at least three times.

QMr. L. in Minnesota comments that findingth e brain area responsible for generatingtinnitus is most interesting. He wonders

what problems or consequences might result fromdeadening this area.

AYou are correct that finding the brain arearesponsible for the perception (not the

generation) of tinnitus is important.Deadening or removal of this brain area might

mean the end of tinnitus. Or it might mean that

other brain cells will eventual ly take over this func

tion, since the brain is very "plastic" or adaptable.Or it might mean that the patient might lose theability to perceive certain sounds. Or it could meanthat the tinnitus would simply change the way it

sounds and be perceived elsewhere. Thking out thetinnitus brain perceptual area could mean many

things. Much work is needed before the proper

cure procedure can be determined.

Notice: Many ofyou have left messages requestingthat I phone you. I simply cannot afford to meetthose requests. Please feel free to call me on any

Wednesday, 9:30a.m. - noon and 1:30- 4:30p.m.PST (5031494-2187). Or mail your questions to:

Dr. Vernon c/o Tinnitus Thday, American TinnitusAssociation, PO Box 5, Portland, OR 97207-0005.



SPECIAL DONORS AND TRIBUTESATA's Champions ofSilence are a remarkable

group of donors who have demonstrated their

commitment in the figh t against tinnitus by

making a contribution or research donation of$500 or more. Sponsors and Professional Sponsorshave con tributed at the $100-$499 level. ResearchDonors have made research-restricted contributions in any amount up to $499.

ATA's Thbute Fund is designated 100% forresearch. Tribute contributions are promptlyacknowledged with an appropriate card to the

honoree or family of the honoree. The giftamount is never disclosed.

Our heartfelt thanks to all of these specialdonors!

GIFTS FROM 10-J 6-98 to 1-15-99.

All contributions to the American Tinni tus Association are tax-deductible.

Champions of Sponsors Donald W. Davis Lawrence E. Happ, Sr. Guy Madison Connie E. Reed

Silence (llldiuidual Li nda Deane Laura E. Hardy Vince Majerus Philip N. Rice(Contributions o[$50 0 Contributions from $100- Jeffrey J. Derossette Mary E. Harker John P. Malon e Jerome A. Rich

$499) Mary Ann Desutter Robert R. Harmon Vince A. Mangus Bernard Richardsand above)

Betty Adams A. J. Diani Charles B. Hauser Robert March Mary D. RobersonJulia R. AmaralSusan Bently Richard Allegretti Larry Dil'vlarzio Richard H. Haws Douglas Marshall Ph ilip L. Robinson

Betty J. Anderson John L. Dosen Ray Haydock, Jr. Richard L. Martin Linda Ron aldsonRobert B. Berry

David R. Anderson Mary M. Doyle David Hayes W. Gordon Martin Edward P. RosenbergWolf Creek CharitableFoundation Lauy P. Anduss Michael J. Doyle A. Ja mes Heins Joe Mastagn i, Sr. Andrew J. Rosser

Robert H. Boerner Alberta Mash Ran dall C. and Elise Alfred E. Heller Mr. and Mrs. John Howard Rothenstein

Stephen Chandler Stephen Axelrad Ducote Paul L. HeUman Mathey Richard E. Rush

Anthony G. A. Correa Joseph Axelrod Sherman E. Dugan Charles M. Helzberg Mary K. Matson Lowell Sachnoff

George Crandall, J r. Joseph F. Bader Thomas P. Dupree, Jr. DoroU1y R. and John Stuart I. Mayer William B. Salsgivet·

Rob M. CrichtonStanley Balick Ralph C. Dutchin Hiltner Kristin E. McAbier Eugene Saporito

Michael Field George D. Bane Gwen G. Eagle Howard Hirschy Carol P. McCurdy Joseph J . Schall

James and Donna Phyllis L Barry Susan H. Earl Jan C. Hoffmaster Edward F. McLaughlin Donna Scheckla

Fijolek Brian Bartsch Eric D. Eberhard Ray A. Hopp Ed Leigh McM illan, JJ AndreN. Schipper

Jean and Lou Fockele Th elma P. Batchelder Robert Eberle Kenneth A. Hovland Jo hn M. McNamara Craig w. Schnur

D. Jeanne Frantz David P. Becker Eleanor G. Egli Gaye V Hunt Dr. Duane D. Mead Stephen M. Schwarcz,

Ronald K. Granger Tina Bischoff RobertS. Epste in Timothy J. Jacoby Richard L. Meiss D.D.S.

Claude H. Gr izzard Sanford Blaser Douglas C. Erikson Frank H. Jellinek Richard Melms Robert F. Sears

Josephine K. Gump Richard A. Bolt Carl Esposito Roben L. Jeske F. N. Meualls Kathleen M. Seibe l

Donald L. Herman Charles D. Bowling Nancy Essington Michael E. Johnson George A. Meyer Hilmer H. Shackelford,

w. f. Samuel Hopmeier, Patricia A. Brands Burdell S. Faust John C. Johnston Carolyn B. Miller Jr.

BC-HIS 1 a F. Breiter 'Ibm E. Fawcett Ruth M. Jo hnston Robert L. Minelli Alice L. Shields

Christopher V. Glenn M. Brewer Ja mes T. Fehon Bob Jones Sarah P. Minges JosephS. Simone

Houghton Ruth H. BrisboisMarian F. Feldheim Ron Jorgensen David C. Mitchell Gary Singer

Jerry rnfeld Riccardo Z. Brognara Robert L. Feller Jan Jozefak Russell Moody, J r. Don L. Six, Sr.

Khairy A. Kawi, Ph.D. Mattie J. Brooks Richard J. Filanc Bernard Kaminsky Mr. and Mrs. Charles Georgia C. Smith

Sidney C. Kleinman Ralph C. Brown John W. Finger John Kapteyn Moon Marshall C. Smith

Jean R. Ljungkull Kristin J. Bruno, Ph.D. Will iam D. Finnell Lois s. Kee ney Mary T and James Patricia A. and Richard

Francis R. May Charles Buckner Helmut A. Fishcher K.D. Kennedy, Jr. Moran Smith

John L. Mercer Leffie Burton Robert S. Flaum John B Kent Albert Mostrangeli Raymond and Sylvia

Stephen Moksnes Michael L. Byers Margaret Fleming Wayne M. Kern Ralph Muniz Smith

Steven A. O'Brien William R. Cagney, Janet E. Florentin William C. Kim Ruby S. Muniz Martin V. Socha

Aaron T. Osherow Ph.D. Mary A. Floyd Donald King James C. Murphy Margaret C. Solomon

Sheila A. and William John N. Carlson Jean and Lou Fockelc Mary Lee Kirk Martine Naeve Richard V. Sowa

F. Owen Mary J. Cavins Curry Ford Rober t A. Kirk man Robert E. Nason Lar ry Spoden

Robert Pence Robert D. Chambers JackR. Fox Luann F. Kirsch Gail L. Neale Mrs. Theodore R.

Hubert G. Phipps Isabelle ChapmanElliot S. Frankfort

Laura P. Kleppick Glenna L. Neilsen StanleyBarbara A. Rickard, Gary M. Chase Isaac Frishma n Katherine C. Kli ne Phyllis G. Nexon Monon and Norma

Pres. & CEO Charles J. Chieffe Laura J. Fuller Rich Koch Elisabeth J . Nicholson Steele

Peacock foundation, Sam Churchman Jeremy T Garland Laura J. Ko linek M. Frank Norman David A. Stephens

Inc. Mary Coffey Perry Gault Larry Kopel Patrick A. O'Boyle Natalie P. Stocking

R. Peter Rutsch Nina A. Colbert Larry L. Gentry Ronald J. Korniski Jean Ann Olsen Andrew Stout

Marion H. Schenk Basil Cole Beverly and Ian Getrcu Stuart Krosser John K. Oscarson Glenn J. Straus

James L Schiller, CFP Robert w. Cole Harriet L. Glazer Robert Krotin Jerome O tt Orloff W. Styve

Wanda M. Shannon Robert E. Collawn F. K Gleason Pete Kubena William E. Paland Robert J. Suchomski

Saul N. Silbert Philip S. Collins Andrew Good Floyd E. and Karen Robert w. Palchanis Lo retta L. Sweet'S

Charitable Trust Michael L. Co nnolly David H. Goodman Kuehnis, Jr. James L. Paradise Richard F. Swenson

Martha M. Smith Ka thleen J . Converse Th e David H. Robert L. Kumler John D. Parsons Leon and Carol Thger

Timothy S. Sotos Donald J. Cook Goodman Foundation Robert S. Kurz John R. Pa trick Pat Thuer

Sheldon Stein Patrick M. Costigan Agnes Goss Robert M. Kyvik John R. and Sa1·a A. Judith J. TharringtonDonald V Thompson Rose Cottrell W. J. and Helen Clide V. Sonny Patterson Jerry R. Thompkins

Don Crichton Gotschall Landreth, Ill David D. Pearce J. E. TinneyWilliam E. 'TIHiey

Richard v. Cripe C. Rod Granberry, Jr. John M. Lappe Jean E. Pepper Will iam R Tower, Jr.Paula French

VanAkkeren Chris Cronberg Seymour Greenstein John C.Larkin Carolyn H. Peters Anthony Tropeano

French Family Mary F. Crosier Carolyn Grogan Eric C. Larson Harvey A. Pines, Ph.D. Manuel Udko

Henry Cunningham, Richard P. Gross Harris Laskey John C. Pogue Je rry Underwood



SPECIAL DONORS AND TRIBUTES (continue d)

Gary w. WeddelFred and Sharon

We inhausChristopher J. We iss

Robert J. Werner

Margaret A . WetterRobert M. 'v\lhittingtonRosalie Wicsentha lBryan B. WilliamsDerwin L. WilliamsJoseph H. Williams, Jr.Neil E. WilliamsAnn R. Will ner

Je rry L. Wilterding

Robert R. Windelspecht

John W. Young, J r.Adelaide w Zabriskie,

Ed D. , CFAPatricia A. ZappPaul W. ZerbstRobert K. ZoldRkhard A. Zubrycki

ProfessionaJSponsors(Pro[ess1011t1l

Contributions from $100-$499)John H. Abeles, M.D.Nancy J. Ahrens, BC -

HlSJuan J. Eermejo, Ph.D.Knox BrooksJack D. Clemis, M.D.Lawrence J. Danna,

M.D.Chris B. Foster, M.D.RobertA. Goldstein,

M.D.Dr. Elhanan Greenberg

Chris GustafsonTSeng Hung-Cheng,

M.D.

Barbara Je nkins, M.S.,CCC-A

Darrell A. l«lmmer, Jr.,M.D.

Richard S. Kaufman,D.D.S.

Leon W. Lipson, M.D.Alan H. Lockwood,

M.D.Frank H. Long, M.D.David L. Mehlum, M.D.Michael D. Mellow,

D.M.D.

Carl M. Nechtman ,M.D., PC

Barry S. Novek, BC-HISMeredith K. L. Pang,

M.D.Ruy Penha, M.D., Ph.D.Milagros E. Rios

Wal ker, M.A. , CCC-AJa y T. Rubinstein,

M.D., Ph.D.Arthur Rudd, D.D.S.Susan J. Seidel, M.A.,

CCC-ADonna S. Wa)rner,

Ph.D.Fred Zemke

Corporations with

Matching Gifts

Special FriendsFund In MemoryOf Dr. Robert M.

JohnsonMichael H. AyersRobert E. Brummett

Phyllis M. Harriman

Rober t and BarbaraHarriman

Ed and Mymie HeftyPat an d Sam Hopmeier

T.H. Lang/ JournalPublish ing Co.

Barbara S. Lentz

John and Penny

Merkel

Stephen M. Nagler,M.D., F.A.C.S.

Einar M. NordahlWayne Olsen

Lynn K. PrattRobert v.WilcoxDr. and Mrs. David J.

Wrighl

TRIBUTES

In Memory OfKaren BagleyArlo and Phyll is Nash

Christopher BraatenArlo and Phyllis Nash

Jane Burkar dPauline GleasonChuck and Sara

Joh nsonBruno KisalaMark Shepardson

'li 'udy DruckerJim and Rosalie 'fraver

Rose Feu erbergKim RippetoeKay SaulsHugh Grogan

Carolyn GroganGeorge HendricksArlo and Phyllis NashJohn G. Jaser

Jasper J . JaserGeorge Jesfjeld

Arlo and Phyllis NashCh ar les Locking

William J. HaskinJack Reich

Th e Sherman

FamilyFlorence S. ReichNat RubinSylvia Eisenberg

J . Don al d Vaughn

Donald H. and Brenda

B. LathropPatricia L. McMahonRoger Paradis

In Honor OfNic k Andrews

Michael an d Susan

HolbrookPaul S. HolbrookRicltard R . Chu t ter

Cynthia C. l«lhn1\•r. an d Mr s. Fred

Cimbol

(Happy Chanukah)

John Flavio, Sr.Joh n J . Flavia, Jr.Jack H arary

(Happy Birthday)Michael and Cynthia

Harary

Bob Luthmann

Thny Tires SofoDr. H aitham Masri,

FAGSMrs. Preston L. Plews

Stephen M. Nagler,

M.D. , RA .C.S.Mrs. Ly la BerkoffJohn and Faye

Schleter

Sandra F. Schleter

J ac k A. Verno n,Ph.D.

Mrs. Ly la BerkoffBetty WebberA l l i ~ o n WeberCharles 0 . Bastien

Research DonorsJohn H. Abeles, M.D.John J. AccordinoEvelyn C. AdamsRichard L. Ah rens

Rich AlgerJames E. AllenBetty J. AndersonElizabeth T. AndersonPatty Andrews

Elizabeth A. t\rtandiNatalie AustSylvia AvilesWillia m C. Ba bcock

Ken Ballinger

Roy BarnaRudolph BeckAdele Engel Behar

Richard Behli ng

1-lowardG.

BernettJoseph BersonJack R. BertramGary A. Billey

Edward Bloom

David W. G. BondMario .r. BonelloRobert R. Borde nMarie V. Bore ll iniDouglas A. BosmaPhilip D .Bowman

Donald M. Bowman

Sharon E. Bowyer

E. Ayres BoydLillian BrabanderErtis J. Bradley

Raym ond J . BrejchaRonald C. Bricker

DavidS . BrombergConstance BrownDonna F. BrownDav id W. Bryan

Yvonne M. BryantRober t B. Budelm an, Jr.Gerald f. Bu rkeMichael W. Burnham

El izabeth L. Burn hamJames C. CachcrisT imothy P. CaireMyrla CaldwellLeo CaluoriPeggy B. Campbell

Dale R. Conan tFox ConnerRev. David A. CoolingMary A. CrouseGlen R. Cucc inelloShirley Cul lenMary Holme s DagueLillian Dangott, Ph.D.Kevin W. Davidson

Thelma L. DavisHelgi DavisJoel Defren

Chris A Degerness

Wilburn F. Delancey

Carroll Devine

Lynn Ditlove

Thelma D. Dry

Virginia M. DuBiancRon DumdeiMargaret A. Dunn

Gretchen Du rkin, M.D.James H. DyerMatjorie M. EllisAbraham i::lyLouis S. Emanue lRosie EsquiviasRobert R. FairburnThomas J. FallonHarold M. Familant,

Ph.D.

Mary Ann FantasiaE. Lillian Feldstein

William L. Ferra raBa •bara J. FogartyCaro lyn J. Fey-

Stromberg

Stephen C. FrainHugh Fraser

Joe FriedmanJim Ray Fugate

Pat GaribaldiJerry P. GastonStephen P. Gazzera

Michael GeisJohn GerardiFrank L. GiancolaMaurice J . GiffordHoward GinsbergL. Kirk GlennBen ny Goodman

Bob Goodma n

Lori GraceWilliam R. Green

Arlene H . Griest

John M. GrillesToni Hakim

Eugene Ha leJames D. Haney

Nancy A. Hartnet t

Paul W. Hastey

Jean E. Havens

Dr. Jess Hayden

Thomas L. Hemminger

E. Alan HildstromMargaret J. HoffmannAnneS. Holmes

HollandDorothy M. Ho m

JohnW.

House, M.D.Rober t K. HoyJack Huang

'Ibm lnderbitzenLes lsaacowitzLucille J . . antz

Pamela S. Johnson

Catherine A. KellitK. D. Kennedy, Jr.Emily S. Kerley

Ronald D. Kle inAn n Klimczak

Sandra KohlBarbara L. KohnRonald J . KorniskiSteve KrantPhyllis G. KreiderJim Laney

Margaret Larson-EverittMark us LarssonJoseph P. LeahySharon Ann Lemke

Paul LcnchukCatherine T. Leonar d

Mary Jane LillisRick Lindner

George LombardiKa ren K LovatoStan M. Lumsden

Ja mes E. Lyonsl{obert 1:: . LyonsKevin D. MackeyJack H. Mahan

Walter W. MalinowskiCarole A. MaloneyGurdev MangatEmanuel Maris

Nancy C. MartinIme lde MasiniMichael T MatherlyMary K. MatsonSteve MaxinJames R. MayBarbara B.

MazurkiewiczMichae l C. McCullough

Peter J. McDonaghWarren McKinz ieGordon T. McMurry,

M.D.

Charles L. McNultyMichael L. McQuinnRobert and Kathleen

MegginsonEvelyn A. Metzgar,

M.A., CCC-AChristophe r

Mon tgomery

Joseph MoraDonald D. MorrisonSamuel R. NewsomChris D. Niemeyer

Patrick O'Hara, .Jr.l«lren M. OliveriJerome Ott

Barbara Lee ParsonsJoseph PassalacquaFelicia A. PasseroRaymond F. Pauser

Donald E. Peters

David G. Peterson

Kurt T. Pfaff. M.A. ,CCC-A

Josephine PiccoliRaymond Plocharczyk

Mamie PoggioJohn PollockSuzanne Portner

Susan PostCynthia Postlewaitlvanell Pres ley

Elliott Press

Eleanor Regu laAaron B. RemleyGerald B. RenyerVenida f. ReynoldsRichard C. RiceSharon Richardson,

M.A., CCC-AGary Ric hes

Steven RobackVernon RobinsonWilliam G. RoeI. W. Rogers, Jr.Max RoseAmelia RugalaLaura M. Russt\1 rieda A. Russell,R.N.

Ruth 1-l. SantorePeter 0. SchultzSandra ScottRonald A. SeelyeRaphael F. Segura, Jr.Dick SeifertUlon a E. Senno

Arthur Serwer

Michael J. Ses trichAmy ShafferThe lma M. SjostromMary K. Smith

Regina P. Smilh

Richard F. SmithWilliam P. SmithSherwin Snyder

Sandra SolomonDarlene Somody

Larry Spoden

William W. StanfordFrank X. StaudingerJohn T. SteeleFrancis E. SteinSusan Ste inerman

Sedalise S. StouteDavid P. Sywak

Minnie ThrrillRichard G. TeutschGino TozziMarianaS. 1\1pperJa n J. VanarnamBaltfriet Verderber

Donna M. ViethMarcia E. VolkRobert H.

VollmerhausenDorothy M. WaddellLavetta Wallis FossenFrank E. Weaver

Rita We isnerEdward R. WeissRoger L. WentzGilbert R. Whitlock, Sr.Lawrence S. WickPhyllis Ann Wiley

Roland H. Wilkerson,Jr.

Theta WilkinsonJamee WolfRichard !'. WoodburyJoseph R. Wozniak

ShirleyA.

WrzesinskiJohn A. WunderlichWe mer E. ZarnikowP. Richard ZitelmanJrving M. Zorowitz



6th International

Tinnitus SeminarCambridge UK

September 5 - 9, 1999Hosted by th e British Society of Audiology

Plenary Sessions: Mechanism and Models

(tinnitus and hyperacusis); 'Iteatrnents: TRT;

Medical, Surgical; Role of the Psychologist;

New Advances in Research and Methodsof Detection.

Scientific Program: 'Ibnndorf Lecture, AwardLecture, Technical Exhibition, Free paper

sessions.

Social: Gala dinner in St. John's College with

choir, extensive "accompanying persons"

program. Combine with a holiday!

Deadlines: April lst submission of abstracts,

June 16th late registration.

Registration Fee:£350; College accommodation:

£33 per day (first cmne, first served) .Scholarships available.

AMERICAN TINNITUS ASSOCIATION

P.O. Box 5, Portland, OR 97207-0005

Address Service Requested

Further information and registration:

Website: www.tinnitus.orgAnn Allen, BSA secretary, 80 Brighton Rd. ,

Reading, Berks RG6 1PS, United KingdomTel: 44 + (0) 118 voice 9660622 fax [email protected]. uk

Chairman and academic program: Jonathan Hazell,

FRCS, 32 Devonshire Place, London

WlN lPE, UK, [email protected]

3rd International Tinnitus Support

Association Meeting

Cambridge, UK, September 5, 1999

For information, contact:

Gloria E. Reich, Ph.D., [email protected]

Non-Profit Org.

U.S. Postage

PAlD

American Tinn itus

Association



Robert M. (Bob) Johnson Ph.D.

May 1, 1932- January 10, 1999



A

TA and tinnitus patients the world over lost a dear friend when Bob

Johnson died of pneumonia in January. Bob served ATA in many

capacities. Appointed to the Scientific Advisory Committee in 1980,

he remained active even after his retirement from OHRC and he was Chairmanof the ATA Board of Directors from 1985 until 1994. He set the standard for

outstanding clinical work in research and teaching about tinnitus for which he

received ATN.s prestigious Hocks Memorial Research award in 1992.

But Bob's position with ATA was far more than an official one; he was an

integral part of the fight to silence tinnitus. Whether working with ATA todetermine a point of policy or personally piecing together an instrument for a

tinnitus sufferer, he was always available to help.

Bob's memory and inspiration will forever be a part of ATA and will be

especially commemorated through our SPECIAL FRIENDS FUND.

Contributions to the SPECIAL FRIENDS FUND in Bob's memory will help

maintain his primary concerns:

• assuring tinnitus treatment at Oregon Hearing Research

Center (OHRC) for those who cannot afford it and

• continuing the important clinical research to develop better

tinnitus treatments

Robert M. Johnson was born in Arnegard, North Dakota, served in the U.S. Air Force, and attended

North Dakota State University and Northwestern University from which he received his doctorate.

He was chiefof audiology and director of the audiology program at the University ofDenver prior to

coming to Oregon in 1978 as professor of otolaryngology at the Oregon Health Sciences University.

At that time he was appointed director of the Oregon Hearing Research Center's (OHRC) Tinnitus

Clinic, a post he held until his retirement in 1997. Bob and his family were active members of Our

Savior Lutheran Church in Lake Oswego, Oregon. He is survived by his wife Margaret, and children

David and Jeannie, grandchildren Kelli Ann and Elijah, and five brothers and sisters.

While initially established to benefit needy patients at the Oregon Hearing Research Center in Bob Johnson'shonor, the SPECIAL FRIENDS FUND welcomes donations honoring others as well. As funds become

available, ATA wiJI work to establish patient treatment assistance points nationwide.

Please note that the clinic or treatment center will determine patient need, not ATA.

Tinnitus Today March 1999 Vol 24, No 1

Documents

Transcript of Tinnitus Today March 1999 Vol 24, No 1