Tinnitus Today March 2001 Vol 26, No 1

7/23/2019 Tinnitus Today March 2001 Vol 26, No 1

1/28

March 2001 Volume 26, Number 1Tinnitus TodayTHE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION

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

Education -Advocacy - Research - Support

In This Issue:Medicines to Treat the Inner EarHearing Aids and TinnitusCochlear ImplantsResearch Update - 'Ibward the CureIs Exercise Dangerous to Your Health?


2/28

Advertisement

Looking for a cost effectivetreatment that really works?Announcing the all-new Petroff Audio TechnologieDTM-6a home-use tinnitus mitigation system.

r PetroffAudioTecbies l

DTM-6aFDA,Peared

New advance in masking techno logy FDA-cleared & proven user success Endorsed by world 's foremost expert Selected for use in landmark VA stud Available from doctors or direct orde Affordable $139 system retail price

"I listened to all of the DTM audio COs andI can unequivocally state that you have created the besttinnitus masking sound with which I am experienced."

-Jack Vernon, Ph.D. (world 's leading expert on tinnitus masking)Following years of documented successand leading professional endorsements,Pe troff Audio Technologies introduces animproved version of its home-use tinnitusmitigation system, the DTM-6a. Uniquedynamically changing digital sound provideseffective temporary relief, even for severetinnitus sufferers. Temporary relief on anas-needed basis can offer a wide range ofmeaningful benefits, including a reduction instress and tinnitus interference with relaxationand falling asleep.

The DTM-6a is endorsed by experts includingthe world 's foremost authority on masking,Dr. Jack Vernon, and has been selected foruse in a landmark Veterans Administrationstudy. The DTM-6a includes six audio COsplus a Tin nitus Management Manual, andeffectively relieves tinnitus for most individualsat surprisingly low volume. The system maybe played on virtually any small CD playerwith speakers or headphones (not included) ,and is sold with an unconditional 30-daymoney back guarantee.

Order price: $139 + $6 S/H = $145 (CA Res. add $11.12 sales tax) .Available from ENT doctors or by direct order.We accept check or major credit card payment by mail, phone or on-line .Petroff Audio Technologies , 23507 Balmoral Lane, West Hills, CA 91307

Ph: 818-716-6166 Fax: 818-704-9976 E-mail: [email protected] Web Site: www.tinnitushelp .com


3/28

Tinnitus T o d ~ y Edi torial ond Advertising ofices:Americon Tin nitus Association, P.OBox 5, Porrlond, OR97207 503248-9985, 800634-8978 [email protected] rg ,www.oto.orgE:s:ecutivc Director: Cheryl McGinnis, M.B.A.Editor: Barbara Thbachnick SandersTinmtus 1bday is published quarterly in March,June, September, and December. It is mailed tOAmerican Tinni tus Association donors an d aselected list of tinnitus patients and professionals who treat tinn itus. Circulat ion is rotated to80,000 annually.American Tinnitus Association is a non-profithuman he alth and welfare agency under26 USC 501 (c)(3)o 2001 American Tinnims Association. No partof this publication may be reproduced, storedin a retrieval sys tem , or tra nsm itted in anyform, or by an y means, withou t the prior wri tten pe m1ission of the Publisher. ISSN: 0897-6368 (print), ISSN 1530-6569 (online)Board of DirectorsStephen M. Nagler, M.D., Atlanta, GA,ChairmanDhyan Cassie, M.A., CCC-A, Med fo rd, NJJames 0. Chmnis, Jr., Ph.D., Warrenton, VAGary P. Jacobson, Ph .D., Detroit, MlSidney Kleinman, J.D., Chicago, ILPaul Meade, 1lgard, ORKathy Peck, San Francisco, CADan Purjes, New York, NYSusan Seidel, M.A., CCC-A, Sunset Beach, NCT im Sotos, Lenexa, KSRichard S. 1)rler, Ph.D ., Iowa City, l AJac k A. Vernon, Ph.D. , Po rtland, ORHonorary DirectorsThe Honorable Mark 0. Hatfield,u.s. Senate, RetiredTony Randall, New York, NYWilliam Shatner, Los Angeles, CAScientific AclvisorsRichardS . 1)rler, Ph. D., Iowa City, lA,ChairmanRona ld G Amedee, M.D., New Or leans, LARobert E. Bnumnett, Ph.D., Lilliwaup, WAJack D Clemis, M.D., Chicago, ILRobert A. Dobie, M.D., Bethesda, MDJohn R. Emmett, M.D., Mem phis, TNBarbara Goldstein , Ph.D., New York, NYJohn WHouse, M.D., Los Angeles, CAGary P. Jacobson, Ph .D., Detroit, MlPawel J. Jastreboff, Ph. D., Atlanta, GAWilliam H. Marrin, Ph.D., Portland, ORDouglas E. Mattox, M.D., Atlanta, GAMary B. Me ikle, Ph.D ., Portland, ORStephe n M. Nagler, M.D., Atlanta, GAJ. Gail Neely, M.D., St. Louis, MOGlor ia E. Reich, Ph.D., Portland, ORRichard J . Salvi, Ph.D., Buffa lo, NYAlexander J . Schleuning, Tl, M.D., Portland, ORMichael D. Seidman, M.D.,West Bloom field, MlAbraham Shulman, M.D., Brooklyn, NYMansfield Smith, M.D., San Jose, CARobert Sweetow, Ph.D., San Francisco, CA

Cover: 1b You, acrylic on linenand wood, 11'/ , x ll 'h", 1994,by Ellen George. Represented inHouston by joan Wich & Co. Gallery,713-227-2480. Fo r information aboutother works, contact the gallery orMs. George at P.O. Box 2871,Vancouver. WA 98668.

The Journal of the American Tinnitus AssociationVolume 26Number 1,March 20 01Tinnitus, ringing in the ears or head no ises, is experienced by as manyas 50 million Americans. Medical he lp i s often sought by those whohave it in a severe, stressful, or life-disrupting form.Table of Contents6 Drug Studies Related to TimUtusby James Kaltenbach, Ph.D.7 Jts Not About the Implan t

by Sidney C. Kleinman, J.D.10 A Night to Rememberby Jessica Allen11 Is Exercise Dangerous to You r Health?

by Rachel Wray14 Hearing Aids and Tinnitus

by Robert Sweetow, Ph.D.16 Medicines to Treat the Inner Earby Michael D. Seidman, M.D.18 Research Update - 'Ibward the Cure

by Pat Daggett20 ATNs Self-Help Groups23 Back Is su es of Tinnitus 'IbdayRegular Features4 From the Executive Director4 From the EditorGo Hom e and Learn to Live with Itby Barbara Tabachnick Sanders5 Letters to the Editor21 Questions and Answers

by Jack A. Vernon, Ph.D.25 Special Donors and Tributes

The Publisher reserves the right to reject or edit any manuscript received for publicationand to reject any advertising deemed unsuitable for Tinnitus 7bday. Acceptance ofadvertising by Tinnitus 7bday does not constitute endorsement of the advertiser, itsproducts or services, nor does Tinnitus 7bday make any claims or guarantees as to theaccuracy or validity of the advertiser's offer. The opinions expressed by contributors toTinnitw; 1bday are not necessarily those of the Publisher, editors, sta ff, or advertisers.

@ Printed on recycled paperAmerican Tinnitus Association Tinnicus 7bday/March 2001 3


4/28

FROM THE EXECUTIVE DIRECTORby Cheryl McGinnis, MB.A.ATA began the year with strongmedia attention. Over 250 newspapers featuring Dr. PaulDonahue's health columncarried a question and answerabout pulsatile tinnitus.Thousands of readers respondedto the article by contacting theATA. In turn, we replied withinformation about tinnitus, theATA's services, and ways for each caller to becomeinvolved to silence tinnitus.

In February, CBS-affiliate television stations in theMidwest aired tinnitus public service announcementshighlighting the ATA. Dr. Jonathan Si1ver, host of TbLive Longer and to Live Stronger, interviewed Dr. JackVernon and me for two 30-minute segments. His radioand TV programs and newspaper column are distributed throughout the country.This issue of Tinnitus Today marks a momentouseffort to reach ear, nose and throat physicians (ENTh)across the country. Each ENT will receive a compli-

From th e E d i t o r

mentary copy of Tinnitus Tbday to read and to sharwith patients. Our goal is to reach out to physicianwho treat people with tinnitus, raise their awareneabout tinnitus treatments, and promote the ATA as resource for them.Healthcare professionals are ordering extra cop

of the "Hearing Conservation Tips" that we mailedDecember. ATA members received this fact sheet awith earplugs to Celebrate Hearing (reprinted on pag9). Thank you for your generous donations to ourCelebrate Hearing campaign.The ATA Web site (www.ata.org) has a new looAll of the popular features remain, and many havebeen expanded. This month, we are unveiling a"Members Only" section. Each member was sent amembership card with an individual member numto gain access to this section. Visit this site today !See ATA Members Only on page 19.What can you do? Continue your support.

Encourage others to join the ATA. Share ATh informtional brochures with your physicians, media, andlibraries. In these ways, you will help raise awarenand public support for tinnitus.Thank you. 8

Go Home and Learn to Live with Itby Ba rbara Tabachnick Sanders,AA Director ofEucationDamaging, infuriating words.I tremble at using them . Tinnituspatients do more than tremblewhen they hear their doctors saythose words. They get depressedand anxious. Often their tinnitusgets worse. Sometimes a lot worse.

This very issue of Tinnitus Tbday that you hold inyour hands is also in the hands of your ENT thanks tojoint sponsorship with Petroff Audio Technologies.So, while we have the opportunity - and with yourindulgence - we'd like to say a few words to yourdoctor.Dear Doctor,

Thank you for reading this. That act alone sets youapart from many other physicians. You clearly want tolearn more about tinnitus for the sake of your patients,and we commend you . Your schedule is full so we'llget right to the point.We have a message to deliver to you. It is fromthousands of tinnitus patients (they call themselves"sufferers," and they should know), and it screams at

4 Tinnitus 7bday/March 2001 American Tinnitus Association

them as loud as their tinnitus: "Do Na r t el l m e togo home and learn to live with it ."When people with tinnitus ask for help, please them about coping strategies like biofeedback, foodlike those with caffeine that can aggravate the condtion, drugs like Xanax or herbs like Ginkgo biloba thhave helped the condition. Thll them about cognitivtherapy, tinnitus retraining therapy, and masking thelp many people with tinnitus live better lives.Give tbem our free patient brochure, our toll-frnumber, and our Web site address. ATA has materiathat are tailor-made for patients: videos, books,articles, support group and provider network lists,and the quarterly journal Tinnitus Tbday. We can heyour patients learn about their condition - the caues, the treatments, and th e ongoing research in seaof a cure.Tell them, "Tb live with it, go home and learn."It's a far, far better thing to say.

The American Tinnitus AssociatiJoin the American Tinnitus Associationand receive a full year of Tinnitus Today

Call 800-634-8978 orvisit www.ata.org for details.


5/28

Letters to the EditorFrom time to time, we include letters from our membus about their experiences with Nnon-traditionalntreatments. We do so in the hope that the information offered might be helpful. Please read theseanecdotal reports carefully, consult with your physician or medical advisor, and decide for yourself i f agiven treatment might be right for you. As always,the opinions expressed are strictly those of the letterwriters and do not reflect an opinion or endorsementby ATA.

I us t comment on the article written by TerriNagler, R.N. ("Tinnitus Spouse Survival,"December 2000 Tinnitus 7bday). I have triedexplaining my tinnitus to people for the past14 months, bu t they just don't seem to understand it. I think they view it as a "mild ringingin the ear." I've tried explaining to them what aprofound impact it has ha d on my life, but theyjust don't seem to get it. After reading Mrs.Nagler's column, I photocopied it and mailed itto my friends and family. I highlighted:+ "Tinnitus is invisible, no cast, no cough ..This left my husband with the added burdenof continually explaining his head noise . . andjustifying his misery."+ "l t won't kill you, but at times you just mightwant to kill yourself."+ "It's easy to become blase about their suffer

ing when they look so normal.. ."I now carry copies of the column in my handbag. When people forget my problem because itis invisible to them, and question my attentionspan, I have it ready for them to re-read. Theauthor, who does not have tinnitus, wrote atruly outstanding description of tinnitus and itsphysical and emotional effects. Thank you,Nurse Nagler.Jo Saponare, Audubon, NJ

'

read with great interest Terri Nagler's insightful article entitled "Tinnitus Spouse Survival"that appeared in the December 2000 issue ofTinnitus 7bday. I found her description of a hus

band so distraught and stricken that he was allbut totally incapacitated to be not only viscerallyupsetting, but very difficult to believe. I foundthe description difficult to believe - but it shouldbe believed, for I am that husband. And I wanteach and every reader of this journal - tinnituspatient, tinnitus spouse, friend of the tinnituscommunity - to realize that not only is there

legitimate hope for a cure in the future, but thereare legitimate paths to relief today while waitingfor that cure of tomorrow. We need to discoverwhich path is best suited to each of our needs.So - with spouse, with friend, or even alone -start walking and do not stop until you find yourway. Oh yes, please continue to generously support th e American Tinnitus Association duringyour travels.

Stephen M. Nagler, M.D., FAGS, Chairman,Board of Directors, American TinnitusAssociation

'

have noticed that more stores are playingmusic and making announcements at extremely loud levels. A while ago, my husband and Iwent to a restaurant at an off-hour so it would be

quieter. The volume of the music being played,however, was going to prevent us from eatingthere. So we asked the hostess if it could beturned down so we could stay. She said yes andthat she appreciated us asking because, frankly,(continued on page 9)

Advertisement- - - - - - - - - - - - - - - - - - ~ Ninth Annual Conference on the

Management of the Tinnitus PatientFor professionals & tinnitus patientsThe University of Iowa

Department of Otolaryngology - Head and Neck SurgeryDepartment ofSpeech Pathology & Audiology

Guest Speakers include:Robert Levine, M.D., Mass Eye & Ear Inst.; Roger Ruth,Ph.D., U of Virginia; Michael Bloc k, Ph.D., StarkeyLaboratories; Cheryl McGinnis, M.B.A., American TinnitusAssociation; Meredith Eldridge, General HearingInstruments; Anne-Mette Mohr, PsychologislUniversity of Iowa Faculty: Paul Abbas, Ph.D., AuditoryPhysiologist; Jay Rubinstein, M.D., Neuro-otologist;Brian McCabe, M.D., Neuro-otologist; Richard 'JYler,Ph.D., Audiologist; David Young, M.A., BiofeedbackTherapist; Christy Novak, Ph.D., Clinical Psychologist;

Richard Smith, M.D., Pediatric Otolaryngologist;Catherine Woodman , M.D., PsychiatristEpidemiology, Physiology, Audiological Measurement,Psychology, Habitua tion Training, Cognitive BehaviorTherapy, Medical & Surgical Evaluation & Management,Hearing Aids & Maskers, Hyperacusis, Tinnitus in Children,Support Groups, Psychotherapy, Relaxation Therapy, PatientForum

October 4-6, 2001Iowa City, Iowa USAFor further information contact: Cheryl J, SchlotePhone: 319-384-9757 Fax: 31 9-353-6739Email: [email protected]

American Tinnitus Association Tinnitus Thday/March 2001 5


6/28

DRUG STUDIESRELATED TO TINNITUS

by James Kaltenbach, Ph.D.,Wayne State University, Dept.ofOtolaryngology.[Dr. 1 mes Kaltenbach is aresearcher working to identifyneural and chemical compo-J1ents of innitus. This infor-mation is needed to pave theway toward future develop-

ment of tinnitus drug therapies. Dr. Kaltenbach dis-cusses the progress that he and his tinnitus researchteam are making.)One main objective of our work is to searchfor drugs that will reduce or eliminate the pathology underlying tinnitus. Our experiments suggestthat tinnitus results from an abnormally highleve1 of spontaneous activity, or hyperactivity, inthe auditory system . One of our recent researchprojects, wh ich was supported by the PfizerPharmaceutical Corporation, is showing that thishyperact ivity is reversible by applying certainchemical compounds directly onto the brainstemsurface. We hope to determine if these drugeffects are also seen when the same compounds

are infused directly into the bloodstream. This isnecessary because drugs must be able to crossthe blood brain barrier i f hey are to affect brainfunction in humans.We continue to believe that the best game

plan for achieving effective treatment for tinnitusis to understand the mechanisms underlying itsgeneration. Support from the NIDCD (NationalInstitutes for Deafness and other CommunicationDisorders) has enabled us to move forward withstudies of tinnitus generating mechanisms. Oneof the results of this work, which has us excited,is our discovery that increases in hyperactivity inthe auditory brainstem can also be induced bycisplatin, an an ti-cancer drug that causes damageto outer hair cells and can also cause tinnitus.Our results now suggest that the hyperactivity isrelated to the loss of ou ter hair cells caused bycisplatin. This suggests that damage to or loss ofouter hair cells may be a critical factor underlying the induction of tinnitus.

6 Tinnitus 'Zbday/ March 2001 American Tinnitus Association

We have also completed experiments testinwhether the hyperactivity induced in thecochlear nucleus by intense sound exposureoriginates in the brain or in the ear. The resultof th ese experiments show that the hyperactiviin the cochlear nucleus persisted even after thecochlea had been destroyed. This strengthens tcase that noise-induced tinnitus is a central(brain) disorder, although clearly one that is trigered by some effect of intense sound on theinner ear. We are also examining these questioDoes noise cause tinnitus because it mimics thouter hair cell damage effect of cisplatin? Or dcisplatin cause other changes in the auditorypath way that cause tinnitus?

This is a very exciting time for our laboratoand for people interested in tinnitus. We are gaing new mom entum every day. Each experimeyields results that bring us a step closer to undstanding the neural basis of tinnitus. In the besof scenarios, we may also identify one or moredrug candidates within the next few years thatwould qualify as worthy of clinical trials. BAdvemsemenc

TINNITUS RESEARCHVo lunteers Sought forDrug StudyParticipation requires12 visits to San Diego overa 20 week period.

Contact:University of California,San DiegoDepts. of Otolaryngology andPsychiatryThornton Hospital &

Perlman Clinic(858) 657-8596


7/28

It's Not About The Implantby Sidney C. Kle inman, J.D.I have been living with hear-ing loss and tinnitus for along time. In December1967, I became profoundlydeaf in my right ear in halfan hour. This sudden andinexplicable deafness wasaccompanied by roaringtinnitus and a Meniere's overlay of dizziness.Within two months, my hearing deteriorated even

further to where I could not hear sounds at 125decibels, although I could feel them. I dealt withthe loss and the resulting tinnitus through discipline, believing that every day is a gift, shorteningmy "emotional focus" to 20 minutes at a time,and, notwithstanding that mytinnitus was ever-present, understanding that noone lives life without a challenge and that I wasmuch better off than most.

Over time, the hearing levels in my "good" leftear deteriorated and constant tinnitus developeddue, in part, to my having worked in an automobile factory while I was in co11ege, as well as to aprobable genetic weakness.Then 18 months ago, things changed rapidlyagain. I lost an additional 25 decibels of hearingacuity in my left ear so that I first hear sounds at

60 decibels. Furthermore, I began experiencingwhat I call a "synapse delay" - I heard spokenwords but it took me 15 to 60 seconds to processand understand the meaning of those words.As the level of hearing in my left ear furtherdeteriorated and my tinnitus increased, it was

necessary for me to substantially increase thevolume my hearing aid. Of course, thisincreased the level of non-informing sounds, likerestaurant noise. And I continually purchasedmore powerful digital hearing aids to help medeal with my hearing loss and tinnitus. As I struggled to hear and understand speech, and thenappropriately communicate and respond, I had tofurther shorten my emotional focus to 5 minutesor so in order to cope. The emotional energyrequired to cope was enormous.

In March 2000, I was diagnosed with lymph-atic hydrops in my left ear. A diuretic, a salt-freediet, and a regime of steroids were ineffective intreating it. The prognosis for th e hearing in myleft ear was guarded.

After thinking about the status of my hearing,it became clear to me that any auditory clues Icould receive from the right side would enhancemy communication and comprehension skillsenormously. With the incredible advancementsin cochlear implant technology and speechrecoanition computer teclmology, I believed thatI had an opportunity to enhance my abilities tocomprehend sound.

I then began a quest to find a competent andcaring medical team who would help me f i ~ d away to achieve better auditory comprehensiOn.I found such a team at the Henry Ford Hospitalin Detroit, Michigan: Gary P. Jacobson, Ph.D.,(audiologist and Director of Audiology), MichaelD. Seidman, M.D., (ENT surgeon), and GinetteRuckel, Au.D., (audiologist and very patient testerand programmer).After many tests and much effort on the partof the team, the surgery took place. My right earwas "implanted" on September 21, 2000, with aCochlear Nucleus 24 implant device. Thesurgery itself could not have gone better. Thehealing process from the surgery was swift anduneventful. Necessarily, the surgery renderedthe implanted ear incapable of any hearing on itsown. Notwithstanding the success of the surgery,no one could or can predict how any implant willactually work. Through this entire process, I feltthat I was embarking on a great adventure, andthat no matter the result, it would be positive andbeneficial.

The implant process involved threading awire with a 24-electrode array through the coreof the cochlea (in the inner ear) to provide directstimulation to the auditory nerve. The electrodearray was then connected to a coil and magnetwhich were implanted under the skin behind theear. An external speech processor and microphone are held to the internal magnet by anoutside magnet.

After the surgical site healed, my audiologistactivated and programmed the speech processorthen tested the implant on October 30, 2000.From the very first sound - and without the useof my hearing aid in my good ear - I h e ~ r d g ~ o r i -ous speech on the right side for the first t1me m33 years.

(continued)

American Tinnitus Association Tinnitus 'Thday ! March 2001 7


8/28

It's Not AboutThe ltnplant (continued)

The speech that I hear through the implant iselectronic and different than the sounds that onehears through the mechanism of normal hearing,bu t it is clearly speech and wonderfully so. Forreasons no one can explain, I have had little trouble integrating the different types of sound fromthe implant and my hearing aid. In fact, the integration has apparently eliminated my "synapsedelays.'' Within a week of the activation, I went tothe opera where my musical experience wasmuch richer and fuller.

Because of the incredible acuity of th e speechprocessor, I'm hearing new sounds that J hadnever heard before, such as the click of a computer mouse. My comprehension skills in groupsettings, noisy restaurants, and on airplanes haveimproved immeasurably. (I can even understandthe dialogue of in-flight films.) However, I havefound one side-effect from the implant, one thatI had not considered before the surgery: Whenmy implant is activated, I have no tinnitus on theright side.For me it's no t about the implant, the hearingloss, or the tinnitus. It's about aggressively andrealistically doing what I can to improve mysituation. Life is not fair. I t just is what it is. Noone asks for or wants tinnitus, hearing loss, or

any other medical problem. But once I have aproblem, I deal with it and work at it with competent professionals as best J can.The wonders of sound and comprehensionwere worth the risk and effort. 'ftuly the gift ofeach day is even greater than before as I eagerlyenjoy and experience each new sound of mylife. a

Sidney Kleinman is an attorney in Chicago, Illinois,and a member ofATA's Board ofDirectors.

8 Tinnitus Thday/ March 2001 American Tinnitus Association

The Cochlear ImGineffe Ruckel, Au.D., CCC-A audiologist, Henry FordHospital, Detroit, Ml

"Hearing-impaired people need to know thacochlear implants are really a last resort forrestoring hearing. We need to make sure that acochlear implant (Cl) candidate can no longerderive benefit from hearing aids. The kind ofsound that people hear with these two devices iquite different. A hearing aid is basically anamplification system consisting of a microphonan amplifier, and a receiver, much like our normal hearing system. On the other hand, acochlear implant electrically stimulates the heaing nerve and so it produces an electronic sounIf possible, we always want to attempt to succefully fit the patient with hearing aids first sincehearing aids mimic our natural hearing systemmuch better then cochlear implants do.

"To qualifY for a CI, patients need to meet tindividual criteria se t by the implant manufactuers (which is the same criteria as the FDA's) anthe medical facility where the implantation wiloccur. (Three companies make cochlear implanCochlear Corporation, Clarion, and MED-EL.].Currently the FDA has only approved monaura(or one) implantation per patient. When a patieis implanted, he or she loses an usable hearingthat ear because the electrode array upon insertion destroys all hair cells in the cochlea. By onimplanting one ear, the patient can still wear ahearing aid in the other ear i f needed. At HenryFord, implant candidates must be cleared audiologically and medically. They must also have apsychological evaluation and a CT scan of thehead.

"Most patients need at least six months tolearn how to get useful information from animplant. It's like learning to hear all over againSo most people can't do what Sid did, that is,wear a hearing aid in one ear and a cochlearimplant in the other and experience speech andsound recognition right from the start. Sid is ouof the ordinary. But his success is very real."Michael Seidman, M.D., FACS, surgeon, Henry Ford HealSystem, WBloomfield, Ml

"The cochlear implant is a wonderful pieceof technology that results in varying degrees ofsuccess. Although the surgery is an integral parof the process, in my mind it is far from the moimportant aspect. The fundamental challengereally belongs to the person getting the CI, and


9/28

t Teamis through that person's motivation and determination (with th e help of someone like Dr. Ruckel)that a great outcome is possible.

"The CI is not for everyone with a profoundhearing loss. And there are known risks which Itell to all my patients. The risks include: bleeding( < 1% ), infection (1-3% ), ext rusion of the implantwith the need to remove the implant ( < 1% ),change or loss of sense oftaste (1-30% ), dizziness, numbness near the surgical site on thescalp and ear (which seems to resolve in days tomonths), and worsening of tinnitus ( < 2%)."On a personal note, I feel blessed to be ableto help people like Mr. Kleinman realize their fullpotential. I t adds real meaning to my life."

Gary P. Jacobson, Ph.D., Audiologist Henry Ford Hospital,Detroit Ml"There are reports in the scientific hteraturedescribing tinnitus suppression for patients withsevere to profound hearing losses who receivedcochlear implants. For Sid, I was hoping that, inaddition to the hearing benefit, he would receiverelief from his tinnitus as a secondary benefit. Byhis report, he has received this benefit. I do notsuggest that cochlear implants be used as a treat

ment for tinnitus. However, for patients who arecochlear implant candidates and for whom tinnitus reduces quality of life, the cochlear implantmay provide an effective secondary benefit."

-..- --...,;;;;:_;- ------: :ff : .- .. - - - - . .- .-

Hearing Conservation TipsThe delightful and informative"Sounds You Live By" decibelchart with hearing conservationtips is now available for sale.Member price: 100 for $10;non-member price: 100 for $15.Note: These are sold only inincrements of 100. Please addin shipping an d handlingcharges. (See the S&H charton the last page of this issue.)To order, contact ATA at800-634-8978 [email protected].

Letters to the Editor(continued from page 5)she had a headache from listening to it at thatvolume all day. She said the corporate office toldthem to keep the volume up thinking it wouldincrease business and make it seem more like a"happenin'" place.I think it's going to take all of us repeatedlyspeaking up and writing to corporate headquarters to ever make a dent in this notion that veryloud is better. We're not looking for silence. Butthe world seems to be turning into a constant barrage of loud, intrusive noise that lives rent-free inour heads. So let's keep writing. "The pen ismightier than the sword!" (although it would betempting to take a sword to certain offendingspeaker wires).

}'anet Garman, Barrington Hills, IL

NJ y tinnitus began in 1994 as a result ofexposure to allergens. Thsts were positivefor Meniere's syndrome (or endolymphatichydrops). The sound was so severe that it oftensent me to the emergency room to complain. Thsay that it was debilitating is an understatement.I routinely took an antihistamine (becauseI had allergies) which sometimes decreased theseverity of the noises and allowed me to function. However, after five years, the dosage thatI needed increased to a toxic level and I had to

stop taking it. Allergy shots did not help thetinnitus, nor did diuretics or maskers. Thedoctors assured me that there were no furthertreatment options available.I then consulted with an alternative medicinedoctor who prescribed vitamin therapy andacupuncture. I began seeing the acupuncturist

in February 2000 who used 15 to 20 needles per20-minute session to redirect my blocked "Chi"(life energy) and access my allergy points. After10 treatments, the acupuncturist was able toreduce the intensity of the noises to 50% of whatit had been. Immediately following a treatment,the tinnitus would disappear for hours and sometimes days, but it always returned - though notas loud.

By avoiding allergens and having acupuncture treatments, my tinnitus is now at a manageable, livable level and I am able again to functionin society.

Ronald Britt, diamondbackOl@earthlink. net

American Tinn itus Association Tinnitus 1bday ! Mar ch 2001 9


10/28

A Night to Rememberby Jessica Allen, ATA Director ofResource DevelopmentAlthough the weather wasstormy, there were many smiling faces in Portland, Oregonon November 10, 2000. Morethan 130 people traveling fromas far away as England gathered to pay tribute to Dr. Gloria Reich for hermore than 20 years of service to the American

Tinnitus Association. Dr. Reich started her tenurewith the ATA in 1975 as a volunteer and becameour first Executive Director a few years later.Member benefits that we share with you today,

such as tinnitus research funding, national selfhelp and healthcare provider resources, and thequarterly journal Tinnitus 7bday, are all due to theefforts of Dr. Reich. So it was fitting that Gloriawas the honoree at ATA's first Founders' Gala.

As Dr. Reich looked over the crowd, she washonored and touched to see such widespread support for the association. In addition to ATA Board,staff, and volunteers, ATA members were presentfrom Arizona, Florida, Nevada, Thxas, California,Oregon, Washington, and Louisiana.

Gala presenters with Guest ofHonor: I. to r., Cheryl D.McGinnis, Sidney C. Kleinman, Gloria E. Reich,Jack A. Vemon, andMary B. Meikle.

The $160,000 check to ATA in Gloria's honor. This check1epresents donations by ATA's Board, staff, members, andvolunteers.10 Tinnitus 7bdCiy1March 2001 Ame1ican Tinnitus Association

Gloria E. Reich, Ph.D., ATA's first Founders' honoree.One of the evening's highlights was the presentation of a check to the American TinnitusAssociation in Dr. Reich's honor. The check, tota

ing $160,000, represented a combination of giftsfrom the Board of Directors, members, friends,an d staff of ATA. We are deeply grateful to allwho gave to or attended the dinner not onlybecause it honored Dr. Reich, but also because ipaid tlibute to the strides the American TinnituAssociation has made over the years.

As the music faded an d the evening drew toclose, all who attended felt a special unity andsense of purpose. There was a bond that broughthese travelers to their destination, a cause thatthey, too, were dedicating their efforts and insome cases life's work to : Tinnitus, its preventioan d cure. B

We hope you plan on attending thenext Founders' Gala, November 10, 2001We will be honoring Dr. Jack Ven1on,author, scientist, humanitarian, andperhaps the greatest contributor totinnitus awareness and research to date.For information on attending orsponsoring the event call 800-634-8978extension 218.


11/28

Is Exercise Dangerous to your Health?by Rachel Wroy, ATA Director ofAdvocacy and SupportErlinda McGinty does nothave tinnitus.In fact, she doesn't evenhave hearing loss.But she crusades on behalfof those who have one orboth of these conditionsand those who ar e susceptible to it-with a missionary's zeal. McGinty's cause: the ear-splittingvolumes of health club music.

. Every day, in institutions devoted to improvmg people's health and well-being, the music volume in group exercise classes, free weight fitnessareas, and even locker rooms regularly exceedsrecommended levels for noise exposure. Theirony of this does not escape McGinty. Sheexplains, "[Health clubs] are in the business ofpromoting health, but hearing health is part offitness." She sighs, "Our ears are just as importantto our health as our deltoids."McGinty took this belief to heart. And so tor awhile, she was content to march to her aerobicsclasses am1ed with the usual workout accoutrements-water bottle, fitness shoes-as well asfoam earplugs. But with the music still too loudshe bought a pair of occupational hearing p r o t e ~tors from a local hardware store. She also asked

he r aerobics instructors to turn the music downbut more often than not, she got blank or frus- 'trated stares-even when she told the instructorsabout the effects of noise-induced hearing lossand tinnitus.Calls to her local health commissioner'state Department of Public Health, and the U.S.Department of Occupational Safety and HealthAdministration (OSHA) yielded less than inspiring results. Since McGinty was not an employeeof the club, OSHA regulations could not beapplied unless an instructor complained- andnone had.Requests to the health club's managementwere similarly discouraging. She was rebuffedwith explanations on how loud music correlateswith motivation in exercise classes. And theowner went so far as to tell her that if theyturned the music down, members would quit.Eventually, after she continued requesting thatthe volume be turned down, the owner accusedher of harassing the staff and told her it might bebetter if she left the club.So she did.

Then she contacted her state Senator, MichaelMorrissey, who, intrigued by her arguments,offered to sponsor a bill in the s tate legislature.And so began McGinty's quest to introduce leais-1ation into the state of Massachusetts that w o t ~ i d regulate the volume of music in health clubsthat is, that would turn health clubs into healthyhearing clubs.

Science is certainly on McGinty's side. In1999, Kathleen Yaremchuk, M.D., and Janet C.Kaczor, M.D., published a study in ENT - Ear,Nose

c l a s s ~ s ~ h e r e microphones used by the groupexerctse mstructors exceeded levels over 110 dB.Additionally, four instructors in Hull's studyconsistently held classes where the volum eexceeded 120 dB.While OSHA recommends that eight hoursof occupational exposure pe r day is permissiblefor 90 dB, the requirements do not address exposure during a one-hour aerobics class or otherrecreational activities. Compounding the issue,for each 10 dB increase, the noise is ten timesthe previous increment, and the recommendedlength of exposure shrinks. For noise levels of110 dB, people should be exposed for only a halfan hour. For 120 dB, people are at risk after lessthan five minutes, which is a rather risky statisticfor an activity that's supposed to improve thebody.Learning more about the dangers inherent inloud noises contributed to McGinty's enthusiasm,though at first, she wasn't sure if she was up tothe task of being a citizen activist. "I'm a verybusy p e ~ s o . n , " she says now, "But 1 felt stronglyabout this ISsue." Plus, she was determined toturn her anger at the health club manager intosomething more positive, something that couldpotentially have a lasting effect on overall health.

(continued)

American Tinnitus Association TinmhtS 'TI:Iday/ March 2001 11


12/28

Is Exercise Dangerous to your Health? (continuedMcGinty relied on the expertise and experience of others when drafting the bill. The resultwas a brief document focusing on disclosure andprevention. In part, it states, "A health club shallpermanently and prominently post warning signsabout the danger of exposure to amplified sound.Such signs shall state that consumers and employees endanger their hearing when exposed toamplified sound exceeding 90 dB." The bill goeson to require health clubs with sounds exceedingthat level to provide hearing protection devices or,alternatively, to turn the music down-a requirement no t so very different from OSHA's regulation that a hearing conservation program must bein place for employees exposed to sounds above90 dB.Before long, McGinty had support from theLeague of the Hard of Hearing, the MassachusettsGovernor's Commission on Physical Fitness andSports, Self-Help for the Hard of Hearing, Hard ofHearing Advocates, and the National HearingConservation Association. She garnered publicityin the Chicago TH.bune, Hearing Loss, the BostonGlobe, the Patriot Ledger, the New York Times, andthe New York Daily News.The International Association of FitnessProfessionals -known as IDEA- also backedMcGinty's efforts. In 1997, the Association stated,"Because hearing loss is a slow, cumulativeprocess, and usually doesn't hurt, group exercise

instructors need to be aware that the intensity oftheir music and accompanying voice may beputting them and their students at risk withoutcausing any apparent symptoms." Acknowledgingthat loud music can be a motivator in many groupexercise classes, IDEA concluded that the possiblehealth risk is of far greater importance.Senator Morrissey filed the bill in 1998, whereit was referred to the Commerce and LaborCommittee. On March 31, 1999, the Committeeheld a hearing on it, and McGinty and audiologistPam Gordon provided testimony. Unfortunately,

the Committee relegated the bill to "study order,"effectively stalling its progress for the rest of thesession. The Committee was also very candidwith McGinty, saying that it did no t want to interfere with business, and that it was difficult forbills spearheaded by just one person-rather thana local organization replete with lobbyists andvoting constituents-to fight the uphill battle.

12 Tinnitus Today/ March 2001 American Tinnitus Associarion

McGinty was ready to give up. But as thedeadline approached for filing bills for the 200session, Senator Morrissey encouraged her tocontinue her efforts. She agreed. In December2000, here-filed the bill. Again, it was referredthe Commerce and Labor Committee, and anoer hearing will be scheduled this spring. SandCallahan, an aide to Senator Morrissey, is pragmatic about the bill's future, "Even i f it doesn'ge t passed into law, it's helpful to have a publiforum, which educates the committee and educates the public." She allows, however, thatMcGinty's bill is in some crowded company:6,000 bills are introduced in the state ofMassachusetts each two-year session. Mostlanguish in committee.McGinty is honest about her bill's slimchances, bu t she embraces the accompanyingbenefits of promoting the proposed legislationmore exposure, more awareness, and moreenlightenment. "Consumers have the right toknow that when they go to classes, they coulddamage their ears," she explains. McGinty's tirless efforts have no doubt contr ibuted to a greawareness of hearing conservation and tinnituprevention in Massachusetts and beyond, illustrating the power of one person to reach andeducate a large audience. And as she preparesfor her next legislative hearing, she is excitedby the prospect of reaching out to still more

people. "Hearing loss is the silent enemy," shesays with conviction. She doesn't plan to besilent about it. BFor more information, please contact ErlindaMcGinty at 617-472-7102.

Advert1.sement

Hearing Loss?Learn Lip ReadingCompensate for noise, distortion & inniwith the I See What You Say program

Self-Help Video & Manua"Instruction andpractice are maginativeeasy to follow and enjoyable."JcumsJ56/fH8lp lorHafffofHNring Po


13/28

Advertisement

Allyn & Bacon Introduces Three Valuable Resourcesfor Patients and Healthcare Professionals!

Tinnitus: Questions and Answers Jack A. Vernon, Professor Emeritus, Oregon Health Sciences University Barbara Tabachnick Sanders, American Tinnitus Association ' , 2001 Paperback 266 pp. ISBN: 0-205-32685-4 Order# 2685L2 $25.99Finally, a handy resource for Patients and Healthcare Professionals!This book provides a comprehensive collection of the most frequently asked questions-organized by topic, currently available. Hundreds of actual patient questionsare answered clearly and accurately by two of the lead ing experts in the field. Coverage includes:drug treatment programs, alternative remedies, hearing loss, hyperacusis, Meniere's Disease, masking,Tinnitus Retraining Therapy-and much morelThe Psychological Management of Chronic Tinnitu-Jane L. Henry, Un iversity of New South Wales ,Peter H. Wilson, Southern Cross Un iversity 1 1 2001 Hardcover 272 pp. ISBN: 0-205-31365-5 Order# 1365L1 $39.00This book offers an extensive overview of Tinnitus, including its causes, hypothesizedmechanisms and conventiona l medical and audiological treatments. The Authors drawupon their years of clinical experience in dealing with associated problems includingthe management of depression , anxiety and sleep disorders to provide this comprehensive resource.

You'll receive step by step guidance from the initial interview, designing appropriate psychometricassessment, therapeutic decision making, as well as a variety treatment options and interventions.Tinnitus: Treatment and Relief Jack A. Vernon, Professor Emeritus, Oregon Health Sciences University .' ..1998 hardcover ISBN: 0-205-18269-0 Order# H82696 $30.00Bringing together leading researchers from around the world, Jack Vernon hasdesigned this book to help readers understand and evaluate the various treatmentoptions available. Experts in each area present specific treatment options, describingtheir success, failures and key issues to consider. You'll receive coverage of medicalaspects, drug therapy, electrical suppression, psychological controls, masking, and much more. Eachchapter contains a helpful list of most frequently asked questions, as well as possible responses.

View our complete product line at www.ablongman.com/professionalORDER TODAY!

Phone:Fax:E-mail:Mail:

800.278.3S2S781 .4SS. [email protected] for your FREE Audiology CatalogAllyn & Bacon , 160 Gould Street, Needham Heights, MA 02494

American Tinnitus Association Tinnitus 7bday! March 2001 13


14/28

Hearing Aids and Tinnitusby Robert W. Sweetow, Ph.D.,Director ofAudiolog'ft University ofCalifornia, San FranciscoThe value of hearing aids fortinnitus patients has beenrecognized for over fifty years.The exact mechanism accounting for the beneficial effects ofamplification is uncertain bu tis probably related to at leastfour functions. One, it is likely that tinnitus is exacer

bated by silence, perhaps because the brain turns upits sensitivity to spontaneous electrical activity byseeking out the neural stimulation it is beingdeprived of due to the hearing loss. Amplificationwith hearing aids increases neural activity and thusmay assist in "turning down" the brain's sensitivitycontrol. Two, it is possible that tinnitus is related toa lack of neural inhibition. In other words, the brainis capable of suppressing the perception of tinnitus.But in an impaired auditory system, this inhibitoryability is compromised. Perhaps the greater activitycreated by amplification with hearing aids allowsthe inhibitory function to correct itself somewhat.Three, hearing aids amplify enough backgroundnoise (wanted or otherwise) to partially "mask" thetinnitus. Four, i f hearing aids assist in reducing thefatigue and stress that accompany having to strain tohear, the ability to cope with tinnitus is improved.

Tinnitus patients have many models andbrands of hearing aids from which they can choose.What hearing aids are most beneficial for them?Unfortunately, the media, advertisers, manufacturers, and even some audiologists have done a mar-velous job, intended or accidental, of confusing thepublic about available devices. So let's first discussthe differences among hearing aids and then determine how they apply to tinnitus.

Conventional hearing aids can be defined asanalog instruments that amplify, fi lter, and limit themaximum power of sound by manipulating theseparameters via switch es or rotary controls on theinstrument. The efficiency of these devices is Hmited. Furthermore, with many of these devices, usersreport that in order to hear soft sounds, they mustincrease the volume of their hearing aids. While thisaccomplishes the objective ofhearing soft sounds, italso produces the undesired effect of making loudsounds uncomfortable. This occurs if the sameamount of amplification is produced by th e hearingaid, regardless of the intensity of the sound enteringit. This is referred to as linear technology. A betterway of controlling loudness, while still providing

14 Tinnitus 7bday! March 2001 American Tinnitus Association

sufficient amplification for soft sounds is with copression hearing aids. Compression aids offer moamplification for soft sounds than for loudersounds. In other words, when the sound entering(or in some cases, exiting) the hearing aid reachecertain level, amplification is reduced .Digitally Programmable Hearing AidsDigitally programmable hearing aids were intduced in the 1980s. With these instruments, signaremain processed by analog components, as is thcase with conventional amplification. This technogy is really a hybrid (a combination of analog anddigital) because a computer (digital technology) isused to program the hearing aids. In addition toenhanced precision and quality control over analdevices, these hybrid hearing aids allow for anincrease in the flexibility of the aids, both for theaudiologist and th e user.

The advantages of digitally programmableinstruments include:+ Programmability and ease ofadjustment:If the listener's hearing or listening environment changes, these hearing aids can generally b

re -programmed by the audiologist to compensatefor their revised requirements.+ Multiple programsSome programmable hearing aids offer multipprograms so that at the touch of a button on t h ~

hearing aids or a remote control, the charactenstican be instantaneously changed by the user to(hopefully) allow for improved performance in aparticular acoustic environment. For example, onprogram can be adjusted for listening in quiet,another for listening in noise, and another forlistening to music.

+ Multiple-band compressionThere are two basic rules that must be followif a hearing aid fitting is to be successful. One, so

sounds must be made audible, and t i " ~ O , loud sounmust no t be uncomfortable . Compression isdesigned to accomplish this effect. However, itmay fail to achieve this objective because manycompression instruments utilize single bandcompression. In other words, when compression activated, amplifica tion of all sounds (low, mediuand high pitched) becomes reduced. This broadreduction may not be good for two reasons. First,hearing-impaired individuals tend to show greatetolerance for sounds at certain frequencies (pitchethan for others. Second, an invasive noise that mabe restricted to certain frequencies (Le., the lowfrequencies) would produce a decrease in amplifition for all of the frequencies, thus making theweaker high-frequency consonants in speech hard


15/28

to hear. It's generally better i f the characteristicsprogrammed into the hearing aid differ for th evarious frequencies. Through th e use of mul tiplebands (modern systems range from two to as manyas sixteen) a completely unique se t of signal processing instructions can be provided for differentfrequencies. This not only helps to maintain comfort throughout the frequency range, but it alsoensures that reduction in amplification is limited tothose frequencies comprising the offending, loudnoises.Digital Hearing AidsDigital hearing aids were introduced in the mid-1990s. Digitization means that incoming analog signals received by the microphone are sent through apre-amplifier to an analog-to-digital converter wherethe signals are converted to a series ofbinary digits.These numbers are then manipulated by the digitalsignal processor according to a se t of instructions(algorithms) that are either pre-se t or programmedby the audiologist. A new se t ofbinary digits isformed which is then reconverted from digital toanalog as it exits the loudspeaker in the hearing aidand enters the ea r canal.

In addition to all the features contain ed indigitally programmable hearing aids, digital hearingaids may have characteristics that cannot beattained with any other hearing aid system. Theseinclude:+ Active Feedback ControlDigital processing improves the hearing aids'ability to maximize amplification while minimizingfeedback (whistling sounds from the hearing aid).+ Multiple MicrophonesHearing aids with multiple microphones canamplify signals that originate in front of the listenerwhile partially suppressing amplification of soundsthat originate from the side and behind the wearer.This technology can improve the listener's ability

to hear in the presence ofbackground noise.Although the use of multiple microphones does nottechnically require digital processing, flexibility anddirectionality may be enhanced by digital control.+ Noise Reduction StrategiesDigital noise reduction strategies can analyze

not only the intensity of the incoming sound butalso its timing pattern. In doing this, digital noisereduction attempts to differentiate speech fromnoise and then selectively reduce only thosecomponents thought to be noise.Are Digital Hearing Aids Superior?

Numerous studies have demonstrated thatpatients show a subjective preference for high tech(digital and programmable) hearing aids over co nventional instruments . However, there are littledata existing that demonstrate significant objectiveimprovements for digital hearing aids over conven-tional and programmable devices with regard toword recognition scores. But, in each of these

studies, subjects reported preferences for thedigital devices. I t is possible that increased wordrecognition scores constitute only a minor percent-age of the total components that reflect satisfaction from amplification. For example, in recentstudies, digital hearing aids are invariably judgedas providing a more comfortable sound than earlier instruments and that they provide greateramplification for softer sounds.Impact on TinnitusThe criteria for selecting specific models andfeatures of hearing aids for tinnitus patients areslightly different than for individuals with hearingloss alone. The most important considerations fortinnitus patients are:

+ Programmability, whether digital or analog,is vital because of the capability of changing theacoustics based on the preferences of the user.+ Multi-band compression is important

because it increases amplification of soft sounds(providing partial masking with environmentalsounds and increasing neural activity) while stillprotecting sensitive ears from loud sounds.

+ Multiple programs allow for the user toadjust the hearing aids so that they can selectdifferent amplification for quiet (where they mightwant greater amplification of soft environmentalnoise) versus noisy environments (where theymight want to suppress annoying backgroundsignals that interfere with communication).

+ While many people tend to opt forperceived cosmetic advantages of very tinyCompletely-In-Canal (CIC) hearing aids, there ismuch to be said for the advantages of using smallBehind-The-Ear (BTE) hearing aids that do no tocclude the ea r canal and allow for certain naturalsound to pass though.

+ Binaural (two-eared) fittings are usuallyappropriate (even if the tinnitus is perceived predominantly on one side) because it ensures neuralstimulation on both sides of the brain and increasesthe chances for the effects described earlier.ConclusionsPatients with tinnitus and anydegree of hearing loss may benefitfrom amplification. The rationale forselecting and programming amplification devices for a person with tinnitus and hearing loss may differsomewhat from those used forpatients with hearing loss only. Forpatients, the most important considerations are to establish a relationship with an audiologist you trust,remember that hearing aids are not acure, and realize that educationaland emotional counsel ing is always animportant component to tinnitus therapy. eAmerican Tinnitus Association Tinnitus 7bday/March 2001 15


16/28

MEDICINES TO TREAT THby Michael D. Seidman, M.D.,FACS, Henry Ford Health System,Dept. of Oto-HNS, Director-Division ofOtologicjNeurotologicSurgery, 248-661-7211,6777 WMaple Rd.,WBloomfield, M/48323Dr. Seidman presented thisinformation at the 18th annualmeeting of the InternationalTinnitus Fomm on September 23, 2000, chaired byAbraham Shulman, M.D. , and Barbara Goldstein, Ph.D .This professional meeting focused on neuroprotectivetherapy and dmg delivery to the inner ear.

I t is well known that the inner ear is isolated -physically, anatomical ly, and chemically - fromthe rest of the body. Most likely this is a protectivemechanism designed to keep toxins out of the innerear. However, this isolation also reduces the otolarygologists' ability to treat inner ea r disease. Since theearly 1950's, otolaryngologists have attempted totreat ear disorders by using transtympanic (throughthe eardrum) injected medicines. Unfortunately,the hearing mechanism is at great risk from anymedicine delivered to the inner ear. Over the pastl 0 years, significant improvements have been developed that allow for a more controlled delivery ofmedicines to the ear. This has reduced, bu t noteliminated, the risk of permanent hearing loss fromdrugs in the inner ear.

Medications that are delivered through thebloodstream with the intention of treating otologicproblems typically have significant and sometimesadverse effects on the rest of the body. For example,diuretics are used as part of the management ofMeniere's disease to reduce the overall fluid volumein the inner ear. However, the primary effect is areduction of fluid within the entire body, with avery slight fluid reduction in the inner ear. Oneside effect from some diuretics is the lowering ofpotassium levels. Clearly, it would be better to avoidthe systemic side effect and have a diuretic thatworked only on the inner ear.

There are some medications which when givensystemically for problems unrelated to the ear, havea pronounced effect on the inner ear. For example,aspirin in high doses causes tinnitus. Certainantibiotics.pass into the inner ear and may causepermanent balance disturbances and partial orsevere sensorineural hearing loss. The systemic use

16 Tinnitus Thday!March 2001 American Tinnitus Association

of cisplatin for its anti-tumor activity can causesignificant hearing loss. However, if the ear is treaed with a protective agent, hearing could be sparewithout reducing or eliminating the anti-cancereffects of the drug. (This is discussed later in thearticle.)

There are many techniques and drugs currentused to treat the inner ear. The three techniquesused most are:+ Transtympanic injection using a syringe aa small-gauge needle+ Round window microcatheter - A smallcatheter surgically implanted unde r theeardrum to deliver medicine to a smallwindow to the inner ear+ Silverstein Microwick" - A small tube wia "wick" that is placed through the tube tothe round window allowing the patient toself-medicate

The following is an overview of the more commonly used medications and novel compounds thmay have a role in treating inner ear disorders.AntibioticsFor Meniere's patients, gentamicin (an aminogcoside antiobiotic) is directly applied to the innerea r to partially destroy vestibular function andrelieve vertigo. The risk of hearing loss ranges fro1-80% but averages 30-40%. The new deliverytechniques appear to reduce this risk.CorticosteroidsCorticosteroids are commonly used in themanagement of several inner ear disorders, including sudden sensorineural hearing loss, Meniere'ssyndrome and disease, and autoimmune inner eadisease. There is some scientific and anecdotalevidence to support the use of steroids - directlyapplied to the inner ea r - for the managementof hearing loss, ear fullness, and in some casestinnitus.Lidocaine and SteroidsLidocaine is a commonly used anesthetic agenDexamethasone is a well-known steroid moleculewith potent anti-inflammatory properties. In onestudy, Meniere's patients were treated with a comnation of lidocaine and dexamethasone by inner eperfusion. Eighty-three percent (83%) of thesepatients experienced immediate relief from ear funess and dizziness; 69% of patients had sustainedrelief after one year. A recent study reported byShea and Ge indicated tl1at 70% of patients withintractable tinnitus achieved relief from tinnitus


17/28

EARwithin one month of treatment with lidocaine, dexamethasone, and hyaluron perfusion of the innerea r plus intravenous lidocaine administration.Tinnitus relief was achieved in 76.9% of patientsafter three months, and 83.3% after one year. TheShea study has come under scrutiny because thepatients also received counseling and one or moreantidepressants or anti-anxiety drugs which in andof themselves may reduce tinnitus for some people.Consequently, we cannot be certain which of theinterventions led to the improvement. Additionalstudy of lidocaine and the combination of lidocaineand dexamethasone seems warranted.Neuroprotection - Glutamate andCalpain antagonism

Decreased blood supply causes significant stressto the nerve tissue by causing the production of freeradicals, which aremolecules made in ourown bodies. They areextremely damagingand known to beresponsible for morethan 100 human disorders. The accumulationof free radicals severelydamages the inner earand other tissues.Through a complexchain of events, thisdamage can then causea release and accumulation of glutamate andcalpains. These chemicals in high concentration are extremelydestructive to the body.

tine, in treating inner ea r disorders and recommended that they be delivered locally to the cochlea inorder to both maintain an effective therapeutic druglevel and avoid systemic side effects. The safety andtolerability of memantine has been clearly demonstrated throughout its use in Germany.

Caroverine has been shown to depress the activityof glutamate receptors and protect the hearing ofguinea pigs. Also, its safety and tolerability have beenclearly demonstrated in clinical studies. In a singleblind, placebo-controlled clinical study, 63% ofpatients treated with intravenous caroverine reporteda significant improvement immediately after intravenous infusion. Over 48% of patients remainedstable after one week. Although no severe adverseeffects were identi fied for the majority of patients, afew patients experienced mild transient side effects,including a bad taste in the mouth, vertigo, headache,

'0 0 '. + ! t ~ / o , \

\ 0 0 /~ ~ ~ _.. '

a "hot head" sensation,and additional noise.Conflicting data, however, suggest thatcaroverine may nothave a therapeutic effecton tinnitus beyondplacebo. More clinicalstudies need to be conducted to resolve thecontroversy.

Since magnesium ininner ea r fluid decreasessignificantly afterintense noise exposure,the protective effectof magnesium in preventing noise-inducedhearing loss has beenstudied. The results of

Studies have shownthat excessive glutamate may play a rolein the production of

Round window microcatheter in the ear: Printed with pem1ission ofDURECT Corp. C2000

a placebo-controlleddouble-blind studyshowed that subjects

tinnitus. Studies also show that glutamate antagonists can have a protective effect on the inner ea rand possibly be a treatment for peripheral tinnitus,a perception of tinnitus generated by the inner ear.Three such drugs are currently under investigationat the Henry Ford Health System for tinnitus:memantine, caroverine, and magnesium.

Memantine has been used in Europe for morethan 10 years as a treatment for Parkinson's diseaseand dementia. Oestreicher et al. (1999) proposedthe use of glutamate antagonists, such as meman-

who took oral magnesium supplements displayed a significantly lowerincidence of noise-induced hearing loss compared tothe control group. In 1998, a highly motivated patientelected to undergo a catheter-delivered infusion ofmagnesium sulfate to the round window. Within 60seconds of the infusion, she experienced completeresolution of her tinnitus. This effect lasted until theflow of medicine was discontinued 48 hours later.

(continued on page 19)

American Tinnitus Association Tinnitus 'Thday!March 2001 17


18/28

Research Update - Toward the Cureby Pat Daggett,ATA Director of ResearchWe received four newresearch proposals inDecember and forwardedthem to ATA's ScientificAdvisory Committee (SAC)for review. The SAC evaluated these grant proposals during its February meeting andwill make funding or approval recommendationsto the ATA Board in March.

The following are two updates of ATA-fundedresearch projects - on e still in progress and onenow completed.Are mechanisms for transient and longstanding tinnitus different?Principle Investigator: Jos 1 Eggermont, Ph.D.,University ofCalgary

(This progress report is tentative as we areabout halfway through the planned experiments.)

Ttansient and long-standing tinnitus are likelydifferent, i f only in that transient tinnitus disappears after a while. I experienced this myselfabout 25 years ago when I wasat a conference in Paris. Wewere taken to a show and hadfront row seats. However, thebig band style music was soloud that after we left (westayed for three hours) I hadhigh-pitched tinnitus untilnoon the next day. I had an

Jos J. Eggermont, audiogram at that time but itPh.D. showed no hearing loss.What changes occun-ed in myauditory system during those 12 to 15 hours?This is one of the questions that we hope toanswer with this research project. Our initialresults show that there are changes in the auditory cortex a few minutes to two days after noiseinduced hearing loss, including threshold shiftsfor the high frequencies.

However, after waiting for at least twomonths after a noise trauma was induced,we found quite different results. Restricted permanent high-frequency cochlear damage, asassessed by ABR, resulted in a profound reorganization of the primary auditory cortex. We found

18 Tinnitus 'Ibclay/ March 2001 American Tinnitus Association

an increase in spontaneous activity in the reorgnized part of the cortex, but no signs of loss ofinhibition. I t will be most interesting to observewhat changes take place in the cortex betweentwo days and two months after the trauma. Theexperiments are in progress.

'Itansient tinnitus is likely initiated by a discontinuity in the activity pattern in the auditorynerve, caused by temporary functional loss ofouter hair cells. This causes a temporary hearinloss and results in a reduction of inhibition atmore central levels that induces hyperactivityalong the auditory pathway and as we observedalso in auditory cortex. This hyperactivity mayslowly result in changes in the strength of synaptic connections and in a slow reorganization ofthe auditory cortex. This causes vast numbers oneurons to become tuned to a limited range offrequencies. These neurons in the cortex are, bytheir sheer number, enhancing the sensitivity tovery small activity changes in the inner ear andso may have increased spontaneous activitywithout demonstrating any remnants of reduceinhibition. Thus, long-standing tinnitus resultinfrom noise trauma may be the result of centralnervous system plasticity gone wrong. The challenge v.rill be to find ways to reverse this plasticaction in a non-invasive manner. BMechanisms of Hyperexcitability in theInterior ColliculusPrinciple Investigator: Richard E. Harlan, Ph.D.,Thlane University

Loud sounds can induce damage to the hearing system and can lead to tinnitus, either withthe ear or in the brain. Sound initiates activity i

Richard E.Harlan, Ph.D.

specific neurons in the brain,which process the informatioand allow us to recognize andinterpret sounds. As individuaneurons are activated, theysend messages to surroundingneurons to decrease their actiity. As an analogy, imagine yoare in a crowded room whereeveryone is trying to get theattention of the same person.You could get that person tohear you if yo u could get all the other people tobe quiet. In the same way, neurons try to quiet

down other neurons so that they can be "heard."Neurons quiet down surrounding neurons byreleasing a molecule called GABA. It is possible


19/28

that in tinnitus, the ability of neurons to quietdown surrounding neurons is decreased. It is as ifan the people ar e talking at once, and you can'thear the person you want to hear.

We reasoned that we might be able todecrease the response to loud sounds by increasing the amount ofGABA in the brain. Prior toexposing rats to a loud sound, we administeredvigabatrin, a drug that is used in the treatmentof epilepsy, and which increases the amount ofGABA in the brain. We found that administrationof vigabatrin decreased the response to sound.Although these results need to be confirmed andexpanded, they suggest the possibi1ity that antiepileptic drugs may be beneficial in some formsof tinnitus.U

It's Here!ATA Members Only

. . the Members Only section of theAmerican Tinnitus Association Web site. Inthis new section, you can read Tinnitus Tbdayonline, send a letter to the Editor, and searchfor Support contacts near you. Please visitwww.ata.org. Click on the Members Onlybutton on the left-hand side of the screen.Enter your ATA Member ID number, foundon your new membership card or on the labelof this magazine. You're in! lf you have an yproblems accessing the site, please call800-634-8978 or 503-248-9985, ext. 221. D

MEDICINES TO TREAT THE INNER EAR (continued from page 17)Calpain inhibitors may protect the inner earfrom injuries that can lead to noise-induced hearingloss and some forms of tinnitus. Chinchillas exposed

to noise had significantly reduced hearing loss whenleupeptin, a calpain inhibitor, was continuouslydelivered directly to the inner ear. Because its longterm safety has no t been adequately assessed,leupeptin has not yet been attempted in humansto treat noise-induced hearing loss and tinnitus.Antioxidants

Antioxidants are a class of medications whoseprimary action is to scavenge free radicals. Schachtand colleagues demonstrated the possible relationship of dietary factors and ototoxicity. Specifically,a free radical scavenger (glutathione) was shownto reduce Gentamicin-induced hearing loss in guineapigs. Methionine, an essential amino acid is apowerful antioxidant that provides protection againstthe ototoxic effects of the cancer drug cisplatin.In one study, both d-methionine and the naturallyoccurring I-methionine, completely blocked theototoxic effects of cisplatin for seven days.

Grape seed extract and pine bark extract areexcellent antioxidants. Currently, preliminarystudies in our lab are in progress to understand theeffects of grape seed extract on noise-induced andage-related hearing loss.

Neurotrophic FactorsNeurotrophic factor (compounds that supportnerve health ) includ ing specific growth factors(chemicals found in the body that support cellgrowth) have been shown to aid the regenerationand repair of hair cells in the mammalian inner ear.These compounds may provide therapeutic optionsfor hearing loss and tinnitus.In one study, NeuroTrophin-3 and anotherneurotropic factor provided significant protectionfrom noise trauma when infused into the inner earin the guinea pig. In another study, a gene forBDNF [brain-detived neurotropic factor] was introduced into the cochlear-damaged inner ears ofmice. This BDNF gene therapy resulted in theprevention of cochlear nerve degeneration.

Once an obvious mechanism for tinnitus can beidentified, new compounds or currently existingmedications may play a pivotal role in its management. I t must be remembered that the perfusionform of treatment presumes a dysfunction of theea r itself. I t is entirely possible that many formsof tinnitus are brain-related (central tinnitus) andwould no t respond to treatment aimed directly atthe ear. I t is also possible that through brain imaging techniques like SPECT and PET, we may oneday be able to precisely determine the tinnitus siteof origin in the brain, then inhibit that precise areain the brain and alleviate tinnitus. BContact Dr. Seidman for detailed references onthis article.American Tinnitus Association Tinnih1s Thday! March 2001 19


20/28

ATA Salutes Its Self-Help Group FacilitatorsThe American Tinnitus Association is honored tohave the following volun teers facilitating tinnitus selfhelp groups across the country. Some of our facilitators

are health professionals who share their expertise; others are tinnitus patients who offer empathy, personalexperience, and gathered knowledge. All, however, areto be lauded for giving information, resources, and hopeto their communities - as well as a positive, supportive

forum for tinnitus patients. Call today for more informtion on a self-help group near you. If there is no grouin your area, ATA's Help Network consists of compassiona te volun teers who provide coping strategies, treament exper iences, and other meaningful support viatelephone, e-mail, and mail . Fo r mo re information,contact the ATA at 800-634-8978 or 503-248-9985,extension 211.Alabama Loretta L. Sweers Mchigan Linda Beach Sharon T. H epfner,Robin E. Auerbach 184 Ponderosa Cir. Jack Berman 1307 White Horse Rd. M.A., FAAA510 S. 3rd St. Parachute, CO 81635 19625 Greenwald Dr. Voorhees. NJ 08043 222 Pie dmont Ave. 115Gadsden, Al.. 35901 970-285-6582 Sou thfield, Ml 48075 856-3460200 Cincinnati, OH 45219256-543-3221 [email protected] t 248-352-1646 Ma ry -Ann Halladay 513-475-8443Jackie W. Bishop Florida Frank Agosta 5781 Rogers Ave. [email protected] Presley Ave. Dja ne L. Bootz 15830 Fort St. Pennsauken, NJ 08109 Lee R. GulleyGadsden, AL 35901 2734 Thnya ' l im. So uthgate, Ml 48195 609-662-6527 Miami Valley Tinnitus256-549-0181 Jacksonville, FL 32223 810-979-4370 Lynn Wolf Group904-308-5465 3435 Pennsylvania Ave. 43181011 Gate Ln.Arizona Mnnesota Pennsauken , NJ 08109 Bellbrook, OH 45305John J. Nicho ls Betty D. Fisher Michael M. Paparella, 609-665-5165 937-848-7079l 0450 E. Desert Cove 644 Woodridge Dr M.D. Dhyan Cass ie [email protected] Park, FL 32730Ave. 407-645-4024 701 25th Ave. S H200 College of NJ OregonScottsdale, AZ 85259 Jerry Wilkinson Minneapolis, MN 55454 2000 Pennington/ Marsha Johnson, M480-860-5758 612-339-2120 Forcina HallJNichols18@j uno.com 38 E. Beach Rd. CCC-A'Tavernier, FL 33070 'Ii'eva Crane Ewing, NJ 08628 545 N.E. 47th, 11212California 305-852-1620 701 25th Ave. South 609-771-2322 Portland, OR 97213Nel ly A. Nigro Steve Ratner, BC-HIS Minneapol is, MN 55454 New Mexico 503-309-4223612-339-2120Los Angeles Tinnitus Tinnitus Group of Palm Myrna M. Calkins [email protected] Kuhlman, Ph .D.Group Beach Co unty St. Cloud Hasp l NW - 1409 Girard S.E. Pennsylvania10755 Holma n Ave. 114 5797-B Brook Bou nd Ln. Albuquerque, NM 87106 Edward J. CborleLos Angeles, CA 90024 Pain RehabBoynton Beach, FL 33437 l406 6th Ave. North 505-268-8754 124 fifth St.310-474-9689 561-495-2002 (day) St. Cloud, MN 56303 New York Aspinwall, PA 15215nan igro@com puserve. 561-743-4853 (eve) 320-251 -2700 412-781 -9102com 800-732-9217 (in FL) Lisa KennedyMari Quigley [email protected] Mississippi 808 Garden Dr. Judith K. Brivchik9565 Slater Ave. #21 Illinois Karen N. Fowler, M.S., Franklin Square, NY Tinnitus Support GroFounta in Valley, CA 11010 of Lancaster CountyRe ginald E. Thomas CCC-A 516-486-6746 75 Hershey Ave.92708 892 E. Goodman Rd . 114714-505-3466 1467 E. 55th Pl. Southaven, MS 38671 Elayne Myers Lancaster, PA 17603717-393-4279Malvina C. Levy, M.A. Chicago, IL 60637 662-349-7481 40 Pennyroyal Rd .1234 Divisadero St. 773-761-6599 Mal ta, NY 12020 Gail B. Brenner, M.ASan Francisco, CA 94Jl 5 Ind iana Missouri 518-899-4885 CCC-A415-921 -7658 Patty John Marie Rich ter, M.S., [email protected] 1015 Chestnut St., 1130CCC-A Harvey A. Pines, Ph.D. Philadelph ia, PA 1910E. Larry Strom 6440 Lively Ln. 12352 Olive St. Blvd. 21 5-413 -0800In Balance Vestibular Evansv ille, IN 47720 St. Louis, MO 63141 2001 Main St. [email protected] Support 812-4 24-4903 314-514-7800 Buffalo, NY 14208 www.taphelp .comPO Box 1135 716 -882-6194Los Gatos, CA 95031 Kansas [email protected] Ohio Texas408-395-7334 Elm er P ennings Edna K. Young Deborah SaundersKansas Tinnitus 1710 NW Obrien Rd . 11102 Christina M. Hewitt 22610 Powell House LColorado Association Lee's Summi t, MO 64081 27 Thai! Edge Circle Katy, TX 77449Donna F. Brown 707 S. Lightner 8J6-246-4644 Powell, OH 43065 281-347-7927Broomfield, CO Wichita, KS 67218 New Jersey 61 4-885-4140303-469-1683 316-682-6033 CHRISHEWITT@ Milagros E. Rios-Richard L. Marr [email protected] Lainie Ganley co lumbus.rr.com Walker, M.A., CCC-PO Box 481624 North Jersey Tinni tus Larry E. Maurer 4201 Bee Cave Rd. ,Maryland Support Group Ste. A-102Denver, CO 80208 Clevela11d TinnitusAnn DePaolo 84 N. Prospe ct Ave. Support Group Austin, TX 78746303-292-6408 Bergenfield , NJ 07621 512-327-30041109 Kathryn Rd . 9680 Glenstone Dr.Luann F. Kirsch Silver Spring, MD 20904 201 -833-7177 Kirtland, OH 44094 West Virginia3325 S. Kendall St. 301 -622-9672 Suzanne Hohorst Meth, 216-256-8023 Becky Blankenship, MDenver, CO 80227303-936-6979 Stephanie Ross M.A., CCC-A [email protected] 1616 13th Ave. #100kbob@aol .com Greater Ba ltimore St. Glares Hospital Ruth G. Bradshaw Huntington, Y.tV 25701Medical Genter 400 W. Blackwell St. 7195 South St., Ro ute 123 304-522-88006701 N. Char les St. Dover, NJ 07801 Blanchester, OH 45107Thwson , MD 21204 973-989-3634 973-783-4613410-828-2142

20 Tinnitus "'bday! March 2001 American Tinnitus Association


21/28

QUESTIONS AND ANSWERSJack Vernon's Personal Responses to Questions from our Readersby Jack A. Vernon, Ph.D., Professor Emeritus,Oregon Health Sciences UniversityQMs. C., an audiologistin New Jersey, fitteda tinnitus patient

with the best possible hearing aids. And although thehearing aids worked verywell for speech comprehension, they did no t relieve thepatient's tinnitus. Ms. C.asks, "Since the hearing lossproduced the tinnitus, why then did correction ofthe hearing loss not relieve the tinnitus?"A s. C., tinnitus is no t caused by hearingloss. Tinnitus is a symptom of somethingwrong somewhere that often- bu t notalways - is accompanied by hearing loss. Butyours is a common finding and the reason is this:The pitch of tinnitus is usually somewherebetween 7000 Hz and 10,000 Hz. Properly fittedhearing aids can do an excellent job of makingenvironmental sounds (in the 250-4000 Hz range)available such as speech and music. But none ofthese sounds is in the higher frequency region ofthe tinnitus and are thus not sufficiently highpitched to mask the usual form of tinnitus. Lowpitched tinnitus in the presence of low-pitchedhearing loss is relieved by properly fitted hearingaids. In the future, Ms. C., I recommend that younot only measure the hearing loss bu t the pitch ofthe tinnitus as well. We once studied 192 tinnituspatients, all of whom had been informed that useof hearing aids would relieve their tinnitus. As itturned out, only about 10% of these patients hadtheir tinnitus relieved with hearing aids. In eachcase of relieved tinnitus, the patient had lowpitched tinnitus and low-frequency hearing loss.Q Mr. P. in California indicates that over ayear ago he had a heart attack shortlyafter which his ears started ringing. Ahearing test revealed that he also had some highfrequency hearing loss. Along with hi s letter heincluded an On Health Web report about Dr. JohnShea's use of lidocaine for tinnitus. Mr. P. wants toknow what we know about lidocaine for tinnitus.

A ome years ago, we delivered lidocaineintravenously to 26 tinni tus patients. For23 patients (or 88% ), the tinnitus disappeared and remained that way for about half anhour after the IV drip was stopped. Two weekslater we repeated the same experiment with thesame patients and found that almost none hadtheir tinnitus relieved at all. Dr. Shea's treatmentuses IV lidocaine plus lidocaine with other substances injected into the ear. Like many secondary reports, the On Health Web report failedto indicate two very important aspects of Dr.Shea's work. At the initial injection of lidocaineinto the ear, 90% of the patients experience asevere vertiginous (dizziness) reaction. Eachpatient is also taking Xanax or another drugwhich could well be contributing to the tinnitusrelief. To evaluate any drug treatment for tinnitus, have the loudness of your tinnitus measuredbefore and after the treatment in order to quantify the actual amount of tinnitus relief. [See also"Medicines to Treat the Inner Ear" by MichaelSeidman, M.D., page 16.)Q r. S. in Hawaii makes an interestingobservation that may be of value toothers. He had been taking Xanax forseveral months to relieve his tinnitus when thedrug suddenly stopped working. In addition, i tstarted to give him a "weird" feeling in the head.At that point, he switched to Klonopin and itworked well. But after about 12 months, thestrange head feelings returned. When he discontinued the Klonopin, he started to experiencemoderately severe positional vertigo and sleeplessness. After being off the Klonopin for 10 to14 days, he returned to it. But the strange headfeelings did no t recur and the sleeplessness andvertigo were relieved. He suggests that drug"holidays" may be an effective way to restorethe effectiveness of a drug that has lost itseffectiveness.A r. S., what you have observed is therather common effect of tolerance buildup. There are patients who can take Xanaxand other drugs for eight or nine years withoutexperiencing the tolerance build-up effect ornoticing that the drugs have lost their effectiveness. We've found in a few cases the opposite of

(continued)

American Tinnitus Association Tinnitus 7bday/ March 2001 21


22/28

QUESTIONS AND ANSWERS (continued)tolerance build-up, that is, patients can reducethe amount of a drug they take once the tinnitushas been initially relieved and still obtain thesame relief. The concept of a drug "holiday" is anew one to me an d certainly an interesting one.Q ~ r . ~ in New York vvrites that he has hadtmmtus for the past 20 years which hewas able to tolerate. But the tinnitusbecame much louder this last year. He tried hearing aids but they had no effect on the tinnitus.He asks if there is anything he can do to relievethe tinnitus.A r. E., it is possible that your tinnitusgot louder due to a drop in your hearingability. Or it may be that the tinnitus forreasons unknown simply got louder of its ownaccord. You indicate that the tinnitus is a hissingsound and that means that most likely it is highpitched. I t is for this reason that the hearing aidsdid not help the tinnitus. For more on this topic,see the answer provided for Ms. C. on the previous page. What you really need are tinnitusinstruments, devices that are a combination ofhigh-frequency hearing aids and high-frequencytinnitus maskers. One adjusts th e hearing aidportion first to ge t the high-frequency hearing tothe best level possible an d then adds in the highfrequency masking sound to relieve the tinnitus.Any hearing aid dispenser or dispensing audiologist can obtain these units for you to try.Q Mr. S. in California writes, "Due to aninfection, I was given large doses ofantibiotics and Lasix. The result is that Iam now completely deaf in both ears and havevery severe tinnitus. T have tried everything fromacupuncture to Xanax to cranial massage but withno effect. My ENT physician said that a cochlearimplant might restore hearing for th e implantedear as well as eliminate tinnitus on that side.I ha d the implant done, bu t unfortunately ithad no effect on the tinnitus. And the restorationof hearing has been minimal at best. I am nowconsidering having th e hearing nerves surgicallysectioned, so I'm writing to ask if you know of asurgeon who you would recommend for thisprocedure. I am willing to travel anywhere."

22 Tinnitus 7bday/ March 2001 American Tinnitus Association

A patient many years ago had his hearinnerve sectioned (severed) in the tinnitusear. The result was that the tinnitusincreased fivefold after the operation. Don't hathe nerve severed. Any hearing that you can prserve in an y way will at least reduce the tinnituAlso, a cochlear implant needs a good, intacthearing nerve to function. By keeping your heaing nerve, you 11 be able to take advantage ofimprovements in implant technology as theyoccur. But I can suggest something to try.Another cochlear implant patient has found gretinnitus reliefby listening to masking soundsthrough the cochlear implant. He uses a band owhite noise from the Moses/ Lang CD (availablfrom the Oregon Hearing Research Center,503-494-8032), but other masking CDs and sounsources can be used. Please do not give up hopMr. S. There is much you have not yet tried. (S"It's Not About the ImplantHon page 7.]Q Ms. F. in Florida writes to say that abouyear ago, anENT physician removed thcerumen (wax) from her ears using watunder pressure. This produced tinnitus in bothears that has persisted unchanged to this day.She feels that her ears now need cleaning againbut wonders how she can have it done withouthaving it increase her tinnitus.

AWe always recommend that ear cleaningbe done manually and not with pressurized water or a high pressure vacuum.Starkey makes a "video otoscope" with a fiberoptic tip that allows EN'TS to view the ear canaon a computer screen an d see the operator's waremoval manipulations in large and very cleardetail. We recommend that you call Starkey(800-328-8602) and ask for the Star Servicedepartment to find a physician in your areawho uses this device. I have seen this apparatuin operation. I t is by far the safest and mostthorough way to clean the ear canal .Notice;: Many ofyou have left messages requestingthat I phone you. J simply cannot afford to meetthose requests. Please feel free to call me on anyWednesday, 9:00a.m. -noon and 1:00 - 5:00p.m.Pacific Time (503-494-2187) . Or mail your questionto: Dr. Vernon clo Tinnitus Today, AmericanTinnitus Association, PO. Box 5, Portland, OR97207-0005. Or send e-mail to: [email protected].


23/28

Back Issues of Tinnitus TodayThe following is a list of the featured topics in eachissue ofTinnitus Today. Every issue also containsresearch updates, Dr. Jack Vernon's Q&A column,information about selfhelping, and (from September1994 to the present) Letters to the Editor.The cost per issue:$2.50 (member price); $5.00 (non-member price)To order back issues of Tinnitus Tbday:Use the order form on the last page of thisjournal or on ATA's Web site (www.ata.org). Writein the date(s) of the issue(s) that you want. Fororders outside the U.S., p1ease can (800-634-8978ext. 220) or e-mail ([email protected]) for shippingcosts.

Supplies are still ample for most issues listed.A few, however, are available only as photocopies.Every effort will be made to send the originalsto you.Dec ember 2000: Hair Cell Regeneration: Implications forTinnitus Relief, Health Insurance an d Tinnitus, MedicalIntervention for Tinnitus, Tinnitus Spouse Survival, TinnitusToday Readership Survey ResultsSeptember 2000: Masking in the Millennium, A New Lookat Lidocaine, Acoustic Neuroma, Hypnosis: OftenOverlooked Therapy for Tinnitus, Filing a Successful VAClaim, Curing Tinnitus with a New Pair of GenesJune 2000: Advances in Tinnitus Research; Hormones an dTinnitus- an Informal Study Opportunity; TinnitusTreatment in Israel; Quiet AppliancesMarch 2000: Alternative Management of Tinnitus, Part n- Herbal Remedies; Quinine an d Its Effects on Outer HairCells; Tinnitus Caused by Sudden Changes in PressureDec ember 1999: Alternative Management ofTinnitus,Part I - Vitamins an d Minerals; Worldwide Look atTinnih1s; Progress through ResearchSeptem ber 1999: TRT vs. Masking Study; Letters Home(Patient's Account ofTinnitus 'Iteatment)June 1999: Gaze-evoked Tinnitus; Tinnitus an d TMJDysfunction; Perfusion of the Inner Ear via Round WindowMembrane; Tinnitus Research ConsortiumMarch 1999: Tinnitus 'Thrgeted Therapy; Tinni tus inCollege (Music and Non-music Majors); Acoustical Effects ofAir Bag DeploymentDece mber 1998: Managing Meniere's Disease; GinkgoBiloba and Tinnitus; Where Does Tinnitus Come From?Sep tember 1998: Sound Sensitivity- Hyperacusis andRecruitment; Pulsatile Tinnitus; An AudiologicalPerspective; ATA-funded Research; A Self-help JourneyJ une 1998: Tinnitus Treatments for Veterans; Tinnitus andOur Emotions; Air Bags - Why this Issue Hasn't GoneAwayMar ch 1998 : $1.5 Million Awarded for Tinnitus Research;Tinnitus Retraining Therapy; Cognitive-Behavioral TherapyDecembe r 1997: Air Bags- One Year Later; Interviewwith Researcher Alfred Nuttall, Ph.D.; Reducing Tinnitus -Food for ThoughtSepte mber 199 7: New PET Research Study; Back to School- Children and Tinnitus; Tinnitus and Homeopathy; 1996Tinnitus Patient Survey Results; Tinnitus Transformation -from Sufferer to Survivor (PHOTOCOPIES ONLY)June 1997: Barometric Changes an d the Ear; New DrugResearch; Elderly People an d Tinnitus; Air Bag Ruling? -

Still Up in the Air; You Can Overcome Your TinnitusMarch 1997: New NIDCD-funded Tinnitus Research;Treatments for Subjective Tinnitus; Similarities betweenTinnitus and Chronic PainDecember 1996: Air Bag Safety - Air Bag Risk; Interviewwith Researcher Jos Eggem1ont, Ph.D.; Thles ofTinnitusRecoverySeptember 1996: Ototoxic Medications;

Tinnitus Today March 2001 Vol 26, No 1

Documents

Transcript of Tinnitus Today March 2001 Vol 26, No 1