BOOK REVIEW TINNITUS: CIBA FOUNDATION SYMPOSIUM 85, ed. David Evered and Geralyn Lawrenson. London: Pitman, 1981. Reviewed by Trudy Drucker Ten years ago, when the American Tinnitus Association was the fragment of an idea in the minds of Charles Unice and Jack Vernon, it was hard to find articles about tinnitus and hard to find physicians who knew much or seemed to care much. Patients were either misdiagnosed and subjected to much iatrogenic misery, or they were sent away with a breezy conclusion that the ear noise was a hopeless and trivial condition that one could easily learn to live with. With such dramatic, life-breaking problems as cancer, heart disease, and mental illness to occupy the attention of the medical establishment and the public, who wanted to bother with "Just a little noise"? Fortunately a handful of skilled audiological scientists, Vernon notably among them, was indeed very willing to bother. Publication of two books on tinnitus (the other is Proceedings of the First International Tinnitus Seminar from London) in a sense celebrates the progress of a decade that brought into existence dozens of tinnitus clinics, many fine articles in the medical and the lay press, and a means of treatment (masking) that really helps about two of every three patients who try it. More important even than all this is the fact that seven million (at least) American victims of tinnitus are now much more likely to be taken seriously and managed rationally. Research always precedes treatment, and in Tinnitus many important research-related problems are carefully examined. What is tinnitus and who gets it? Douek sums up the various methods of classifying tinnitus, concluding, as do his colleagues, that no satisfactory system exists now. Too many unknown physical and psychological variables cloud diagnoses. A group of scientists at the Institute of Hearing Research in England is conducting an epidemiological study that might confirm significant correlations between, for example, tinnitus and noise or tinnitus and age . According to Graham, children with hearing loss exhibit a considerable incidence of tinnitus. Oddly, most children report their tinnitus as intermittent whereas most adults report it as constant. Hazell used electric audiometry, among other modalities, to develop a very sophisticated protocol for measuring tinnitus (including, of course, pitch and loudness) and it remains to be seen if these precise results will be significant clinically. continued on page 2 $ We Need Your Money I!! The American Tinnitus Association is entirely supported by private donations. He cannot afford to send you a separate billing, nor do we think you would want us to spend your money that way, so please consider this your reminder that a contribution is in order. ATA does not have federal, state or local government support. He are not part of a University or any other group. We provide information, education, referral and research services for over 40,000 people. We cannot do this job without your support. We are proud to stand on our record of the last ten years and will continue to do all in our power to promote research for a cure for this distressing afflict ion. Please allow us to continue our work. This means that all of us must contribute. ~ THANK YOU. Tinnitus continued Investigation of acoustic and auditory phenomena has been greatly stimulated recently by development of extremely complex instrumentation. Kemp studied minute spontaneous mechanical vibrations within the cochlea as a possible source of tinnitus, and he was able to associate these events with a few eases of mild pure-tone tinnitus. Possibly this mechanical factor is present also in some of the more severe cases. According to Wilsoo and Sutton, types of acoustic emission can be picked up externally and the properties of these cochlear-echo phenomena are clues to the mechanism of cochlear tinnitus, the commonest type and the type most easily identified and masked. Berlin and Shearer studied electrophysiologic simulation with the expectation, not realized, that specific reproducible brains tem phenomena could be identified. Experiments in animals dosed with ototoxic levels of noise or salicylates suggest, according to Evans, Wilson, and Borerwe, that overactivity rather than depression of cochlear nerve fibers might be the underlying pathology of some types of tinnitus. A general discussion of factors that predispose to tinnitus or exacerbate it summarizes a good deal of well-known (but not always well-disseminated) information. For example, it was distressing to find in one signed article a recommendation that antidepressants be used in place of tranquilizers, and then to find in another signed article some clear evidence that many antidepressants will in fact worsen the primary complaint. Certainly it is time for some of this knowledge to filter down to patients. During the early years of my tinnitus, I consulted four Board-certified otologists, not one of whoa thought to caution me about loud noise or excessive aspirin consumption. Current knowledge about the commonest external causes of tinnitus, ototoxic drugs and noise (each has been shown to potentiate the other), is summarized by Brown and colleagues. Persons with a pre-existing cochlear defect are most clearly at risk. The fact that aany tinnitus-causing drugs show convulsant activity at high dosage reinforces a current hypothesis that tinnitus might be a form of sensory epilepsy. The pharmacology of managing tinnitus bas always been, and continues to be, a thorny problem. Lidocaine, which can briefly suppress tinnitus, can worsen the condition if given in high doses. As one approaches the portions of this book that deal with treatments, the ground becomes even shakier. Evidently anything will work for somebody but nothing will work for everybody-- not medicines, not surgery, not psychology, not even masking. Everyone longs for a drug that will suppress tinnitus, but, as Goodey points out, it is infinitely easier to find medicines, roods, and drinks that are much more likely to trigger the condition. But there is some hope for an anti-tinnitus drug. Lidocaine and its oral analogue, tocainide, have produced interesting results and are now being extensively investigated as a possible suppressive. Other anticonvulsants such as Dilantin sometimes bring relief. Combined use of masking and an anti-tinnitus drug is a promising approach. Surgery specifically for tinnitus usually involved cutting the eighth nerve, and, as J. House and Brackmann note, the results have not justified this drastic procedure. Other operations on the ear occasionally have as a pleasant side effect the partial (very rarely total) relief of tinnitus. If the tinnitus has been caused by a tumor, relief might be anticipated from removal of the neuroma. The cochlear implant developed for profoundly deaf people has relieved tinnitus in a few. Aran and Cazals, also working chiefly with profoundly deaf patients, tried positive-current eleotric stimulation. Sometimes the 2 tinnitus is temporarily relieved but it will return when the stimulus is withdrawn. Many victims of severe tinnitus spend years on the shuttle bus between otologist and psychiatrist, usually coming out the same doors they walked in. Articles about the psychology of tinnitus patients are not greeted enthusiastically by people who are unconvinced that their problem lies anywhere but in their ears. Some patients, however, do benefit froa psychological techniques, and P. House reports some success with biofeedback and other aind-altering relaxation techniques. No doubt this approach bas its place. However, writing about the personalities of tinnitus patients, she groups Aljpersons with serious to debilitating tinnitus into three categories of psychological malfunction. These conclusions should be tested among a much larger series double-blinded with an unaffected sample. Suffering is not of itself an emotional illness. At present the most effective and least invasive means of managing tinnitus is with a masking device. Trying to cover an unpleasant internal sound with a pleasant external one has always been done by tinnitus patients. The technique was formalized, investigated, and i n s ~ t e d by Vernon, Meikle, and their colleagues at the Kresge Hearing Research Laboratory; it was a giant step. With a success rate of 60 to 80 percent, the authors can reasonably claim that most failures probably occur because of inability to match the tinnitus with the proper inhibiting sound. This book concludes much as it began, with a review of some intriguing unanswered questions arising from current experience: Does tinnitus originate centrally or peripherally? Why does masking often induce residual inhibition? The reader is presented finally with a teasing medico-legal question: Are some cases or tinnitus so unequivocally related to noise exposure that the condition is compensable? Physicians and audiologists evidently want to stay clear of courtrooms, and for the sake of completeness an attorney might have been invited to make a brief presentation. Tinnitus is a published symposiu (London, 13-15 January 1981) and one of its attractive and useful features is the lively casual discussion by all participants that followed each formal presentation. One senses in these interchanges a healthy candor, a willingness to admit mistakes and acknowledge limitations, and a productive free play of first-rate scientific intelligence. The editors deserve much credit for doing an immensely difficult job, transforming the random conversation, probably taped, into tight coherent mini-texts for the publication. References follow each presentation and usually each discussion. Collected, checked, and with repetitions eliminated, the references could form the best currently available tinnitus bibliography. The author index, subject index, glossary, and appendices seea carefully prepared. Its highly technical language and its price ($35.00) will put Tinnitus beyond the interest and reacb of most patients, but no otologist or audiologist will want to be without it. Otber health-care professionals with an interest in tinnitus, such as nurses and hearing-aid dispensers, might well find it useful and of course the book belongs in every medical library. It is a fine piece of work, broadly and fairly presenting the state-of-the-art of tinnitus research and treataent. One's best wish for it is that in another decade it will be of historical interest only, having been made obsolete by discovery of some universally effective and safe way of treating a terrible and widespread affliction. Ms. Drucker is a patient of the Tinnitus Clinic of the Kresge Hearing Research Laboratory. She holds a Ph.D. in English and is a Fellow of the American Medical Writers Association. -- POINT OF VIEW MASKING FOR TINNITUS RELIEF BJ Jack 1. leroon, Pb.D., Protesaor in Otolaryngology, Oregon Bealtb Sciences UDiYeraity, Director, lresge BeariDg leaearcb Laboratory. Masking, in one of three different has been available for the relief of tinnitus for a score of years. Despite that fact however we constantly encounter gross misunderstanding about masking. Interestingly enough the misunderstanding comes from professionals and laymen alike. It is excusable that the layman should be confused and not understand but it is unforgivable that the professional can be a source of misinformation. Time and again tinnitus patients have indicat9d to us that one or more ENT physicians have told them that masking will not work for them. we ask the patient if masking was tried on them they always reply "no, he didn't try anything, be just said -tt would not work. n II It is true that masking is not appropriate or will not work for all patients but there is only way to find out whether it will or will not work in a given case and that is by actual trial of masking. I would consider it immoral if I denied a patient relief of their tinnitus because of my own ignorance or because of some preconceived prejudice that I held, If the professional is uninformed then the proper response is to admit tba t fact instead of prejudging. Arrogance of that sort is bard to understand and for masking it is essential that an actual trial be made and even then there is room for lots of errors. For example I remember one patient who came to our clinic after having been fitted (?) for a masker in another state. The patient was clearly in desperate straits and adamant in his claim that masking would not work for him because it had been tried and it had failed. As it turned out be had bilateral tinnitus but masking had only been placed in one ear, his better ear. When properly fitted with two maskers it was very easy to completely relieve his tinnitus. Another common error is that of neglecting the patients' hearing loss. When the tinnitus is located in a hearing region for which there is substantial bearing loss it is almost always the case that masking alone is not sufficient. In such cases a tinnitus instrument (the unit that combines the tinnitus masker and hearing aid into a single case but with independent volume controls) is required. In our tinnitus clinic we find that the tinnitus instrument is recommended 75% of the time to those for whom some of recommendation is made. We find several confusions among the professionals concerning tinnitus instruments (called "tinnitus aids" by some manufacturers). Because a hearing aid is included many professionals jump to the erroneous conclusion that it is the bearing aid alone that relieves the tinnitus. We have repeatedly encountered tinnitus patients with hearing who have been told that nothing can be done for their tinnitus since a hearing aid could not be Prescribed. Note that once again a decision has been made based on the clinician's knowledge (actually the lack of knowledge) and not on the empirical results of an actual testl It is essential that testing with actual units be conducted prior to making any recommendations. In the above case it would have been desirable to have tested the patient with a masker and then with a bearing aid (yes, even on normal hearing ears) to determine if either produced relief of the tinnitus In an area where we know so little it is absolutely essential to conduct trials with actual units. We try every conceivable arrangement and combination of units before admitting failure. 3 Sometimes I think our failures are due more to the lack of our own imagination than to the intractable nature of the tinnitus. Another confusion about tinnitus instruments which also involves the hearing loss of the patient is present when the hearing loss is severe. So severe that the speech discrimination results mitigate against the use of a hearing aid. Because of this, the clinician then concludes that the combination unit cannot be recommended forgetting that it is the tinnitus for which relief is sought. Once again a decision is rendered without the benefit of an actual test. I recall a patient with low frequency (low pitch) tinnitus for whom a hearing aid completely relieved her tinnitus despite the fact that it did not help her hearing one bit. There is one prevalant confusion about masking which appears in the mind of the patient and the professional alike. Moreover it is a very logical confusion. The patients say something like this: "I already have enough noise in my ears, I certainly don't want any more noise." (Note once again a decision is made in the absence of knowledge.) It is certainly the case that we do not know why masking works. But the unassailable fact remains that some 15,000 patients utilize maskers to relieve their tinnitus. Originally I had the mistaken notion that masking would reduce the tinnitus so that the patient would be listening to .tG low volume sounds rather than QW1 high volume sound. That would make sense--it would be better to listen to two low volume sounds rather than one high volume sound. But, unfortunately masking does not work that way. The intensity of the tinnitus does not decrease as the masking intensity increases; instead the tinnitus remains stable until the masking sound has risen above it and masked it. As I said, we do not know bow masking works but here are some comments about masking which are relevant. In the first place, the masking sound is an external sound. In our everyday existence we consistently ignore many external sounds providing they are continuous, monotonous, not interesting and not too loud. We consistently ignore ventilator sounds, beating noises, traffic din, office clatter and the like. Internal sounds such as tinnitus are not nearly as easily ignored. Masking then, when it is successful, is an external sound which is easily ignored and since it covers up the tinnitus when it is ignored the tinnitus is automatically ignored. It seems to me that masking is a way of helping the patient to live with their tinnitus. Another comment on masking made by many patients is this: "My tinnitus means there ia something wrong with my auditory system, sound is a man-made sound and thus is more acceptable." To a person when they make such a comment as this they all say, masking sound. Another very frequent comment is something like this: "Before masking my tinnitus controlled me, but now I can control it. I can decide when I will and will not hear my tinnitus." Such an element of control is of psychological value to the patient. "The masking noise is not unpleasant like my tinnitus." This kind of comment is almost universal and it is easily understandable. A shrill high pitched tone, which most patients with severe tinnitus have, is a very unpleasant sound whereas a high pitched band of noise is esthetically much more acceptable. In part then, masking is trading an unpleasant sound for a pleasant one and that makes sense. What does not make sense is the case where the tinnitus is not a tone but a high pitched band of noise usually described as a "hissing". Even in such cases, where the tinnitus and the masking are nearly identical sounds, the patient often finds the masking sound more desirable and is thus able to obtain relief from their tinnitus. continued Masking continued Residual inhibition is another area of gross confusion. Some patients think that the purpose of masking is to produce residual inhibition. Residual inhibition, you will recall, is the temporary reduction or cessation of tinnitus after a period of appropriate masking. I recall one lady who repeatedly insisted that masking was not working for her because her residual inhibition was cons is tent.ly brief. It was not possible to convince her that the masking was effective and that residual inhibition, when it occurs, is only a bonus. There are some few professionals who have also misunderstood residual inhibition. In one case no recommendations for maskers were made unless the patient displayed residual inhibition during the clinical testing. It is true that people who display residual inhibition usually do well with masking but by no means is this an iron-clad rule. We have even seen some patients who initially displayed no residual inhibition but began to do so after several months of using the masker. Many patients, perhaps most, understand that the purpose of masking is not to produce residual inhibition. Nevertheless, these folks cannot but hope that residual inhibition will accumulate over time as masking is continued. And indeed this does seem to happen to some patients. On the other hand, there are some patients who find no accumulation or extension of residual inhibition regardless of the duration of masking. The idea of expanded residual inhibition is an extremely interesting one and for the reason that it addresses the problem of a cure for tinnitus. That is, of course, what most patients urgently wish for. There are several interesting comments about residual inhibition which have not been taken into account in current masking programs. One comment is the fact that residual inhibition rarely occurs when hearing aids alone are utilized to mask tinnitus. Let me explain: In a small number of cases (about 1 O%) the tinnitus is sufficiently low pitched as to respond to the use of a hearing aid. This is probably a matter of elevating the volume of ambient environmental noise in the region of the tinnitus frequency so as to produce masking. The interesting fact for the problem of residual inhibition is that such masking by a bearing aid while completely covering the tinnitus nevertheless does not produce residual inhibition. Why is this? Is it that the hearing aid produces too widespread effect extending too far into the lower frequencies? Does that mean that a masking sound precisely located at and only at the tinnitus frequency will produce maximum residual inhibition? There was one attempt a few decades ago to "burn out" tinnitus by overstimulation at the tinnitus frequency. It not only did not work but exacerbated the tinnitus tor most oases. But then they may have used the wrong frequency of stimulation since they did not check for "octave confusion". Unless specifically and correctly checked, about 7 out of 11 patients will misidentify the pitch of their tinnitus by one octave. When attempting to burn out tinnitus they may have used too great an intensity, that is to say, perhaps a less intense tone might have produced residual inhibition. In any event, we have not used pure tones at the frequency of the tinnitus in an attempt to produce extended residual inhibition and such an idea is worth trying. Another and related point which has not been taken into account involves the pitch of the external tone. If one wants to maximally overstimulate a specific frequency region of the ear one does not sitmulate with that specific frequency. Instead one utilizes a stimulus which is 1/2 an it. Maximal energy in a overstimulating stimulus shifts upward by about 1/2 an octave. Therefore if we were to attempt to use pure tones to extend residual 4 inhibition we should select as a stimulating tone one whose frequency is 1/2 an octave lower than the pitch of the tinnitus. But these are things for the future, let us return to items and confusions of the past and hopefully prevent them from becoming items of the future. The use of FM-masking has created lots of confusion and misuse . Some clinicians have so misunderstood that they have recommended the use of FH radio to mask tinnitus. To be sure a radio program of interest might provide some distraction from the tinnitus, and while that sort of distraction may be helpful in some cases, it is not what is meant by FM-masking. FM-masking means use of the static between FM stations as a masking sound. But it can only work when the hearing ability at the region of the tinnitus is the same as for the entire frequency spectrum. FH static contains all frequencies--it is white noise. Now, suppose one has a profound high frequency hearing loss plus high frequency tinnitus but also has normal low frequency hearing. In such cases when the radio volume is sufficient for the high frequency portion of the static to mask the tinnitus the low frequency portion of stxtic-will be excessively loud and thus totally unacceptable to the patient. Another common misunderstanding about masking put forth by some clinicians concerns speech discrimination. They tell patients, "You can wear a masker if you wish, but it will prevent you from hearing." Such a statement reflects a total misunderstanding as to the composition of the masking sound. If the masking sound were a white noise, that is including all frequencies, then their claim might have merit. For example try this simple test. Turn on the water faucet full force at the kitchen sink and stand near it. With the water running try to bear what someone is saying to you from another room. You will find that the sounds of the runn.ing water (white noise) interferes with the sound of speech. The speech frequencies are primarily from about 300 Hz to about 3000 Hz. The most prevelant forms of severe tinnitus pitched, well above 3000 Hz, in our patient population they are mostly from 4000 to 12000 Hz. The masking noise utilized in the tinnitus masker is also high pitched and primarily above the speech frequencies so that it does not have much of. an opportunity to interfere with the hearing of speech--the masking sound is misaligned with and placed above the speech frequencies. By the way, when you were standing near the kitchen sink with the water running, could you hear your tinnitus? Didn't think to notice? Go back and try it again. If the sound of running water covered up or masked your tinnitus there is a good chance that some form of tinnitus masking may be made to work for you. That's not a guarantee but nevertheless it is information worth attention. On the other hand, if the sound of running water did not mask your tinnitus, that does not necessarily preclude you from a masking program. If you have a high frequency hearing loss and high frequency tinnitus, the sound of running water may not mask your tinnitus whereas a tinnitus instrument (that combination of a hearing aid and a masker) might be able to produce the desired effect. An actual test is the only way to find out. That "faucet-test" is a simple way for you to gain some information about your tinnitus. Not infrequently patients will ask, "Does tinnitus mean I'm going deaf?" The answer is no for the vast majority of cases. Tinnitus does mean that something is wrong with the auditory system, not just the ear, though the fault can lie there t .oo, but the entire auditory system including the neural tracts extending into the brain. It is for this reason that all tinnitus patients should see anENT physician in order to determine if possible what is causing the tinnitus. And usually if a cause can be found, it can be corrected. continued Masking continued Often patients ask, "Will my tinnitus get worse?" The answer is Xes. if vou do not orotect those ears from loud soyndatl That is almost a guarantee--loud sounds make tinnitus worse. If loud sounds make tinnitus worse, will not masking ultimately make my tinnitus worse? No is the answer and for the reason that masking is not a loud sound, Tinnitus for the vast majority of patients is only 5 to 10 dB above their ability to hear and that is a low volume or low sensation level. Thus the intensity of sound required to mask the tinnitus is also low, if it were otherwise the patient would not accept it as a substitute for the tinnitus. On a closing note let me repeat that word AubAtitute. That is as good a definition of masking of tinnitus as I know. The masking sound is an acceptable substitution to the patient for their tinnitus. All of this makes it sound like I think masking is the only answer for tinnitus. I don t. I think ultimately we will find medications that help as well as other therapies. I know that biofeedback has helped some patients. It is very clear in my mind that to properly deal with tinnitus it will be necessary to have a variety of different relief or therapeutic procedures. After all, tinnitus is a symptom associated with a great variety of problems in the auditory system. No one single procedure could be expected to take care of all cases. It seems highly unlikely that I have answered all questions about masking that are in the m i ~ d s of all of you. Please feel free to contact me if you have QUestions and/or comments. The American Tinnitus Association St atement of Assets and Fund Balance October 31, 1981 Current Assets Cash in bank-Tribute Cash in bank FNB Marketable Securities (Merrill Lynch Ready Assets) ~ $751 .67 871.82 15,904.55 $ 17,528.04 Fixed Assets Equipment 39,739.00 (19,240.00) Accumulated Depreciation (Accelerated method) Fixed Assets, Net Total Asseh 20.499,00 $ 38,027.011 Liabilitiea aR4 Fund Balance Current Liabilities Total Current Liabilities Fund Balance $55,352.97 (17,325.93) $ .oo Fund Balance-beginning Fund Increase (Decrease) Total Fund Balance 38.027.0g Total Liabilities and Fund Balance $ 38,027.011 The above a1e numbers that !Jere e:r:tr:lcted from the audited year end statement of the American Tinnitus Assoaiation. 5 TRIBUTES Our thanks go to the f ollowing people who have contributed to the tribute fund f or tinnitus research. IN MEMORY OF Thelma Pugh Hr. Harry Haag Mr. Leo Barber George Valos My Parents Frank Spina James Harding Anthony Calderone Brother of Al Finklestein John (rawec Madeline Chicchi Joseph Impellizzeri Jennie Impellizzeri William Conklin, Sr. Mrs. H. Hegarty Hr. Lovic N. Thomas Mrs. Dell Thomas Robert Conner Victoria Kowaleski Edward Horney Mrs. Jean Winder Jones Frederick J . Binda Teresa Grotz Calvin Michael Etta Rayman Ann Weiser Victor F. Bolanda BIRTHDAY John G. Alam, Jr. Helen Beattie Thorp Nina Novich & Max Novich Jacqueline Doyle Charles Vogelfanger Eve Shaw Arlene Levy Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker Trudy Drucker J(atherine Sadock Carolyn Traver Arletta Dimberg Rick Tb011as IN HONOR OF Mr. & Mrs. Curtis Bowman E.B. Moss, new home without Rock Noise Promotion of Dean Lopez-Isa Phyllis Pugh Mr.& Mrs. Ken Ellerbrock Doris & Henry Adams Richard Adams Gertrude Hunrath Audrey Heillller Hal & Florence Linden Audrey & Frank Holbrook Florence Linden Mrs. Anna K. Szwec August L. Chicch1 S. F. Impellizzeri s. F. Iapellizzeri Mr. & Mrs. Hac Lamb Lawrence & Dorothy Maher Hs. Marie Thomas Ms. Marie Thomas Theodore J(ovaleski Theodore Kowaleski Shirlie Kesselm.an Harriet & John Waychua Eugenia H. Jacoby J(enneth Grotz Nancy E. Spagnoli Burton Zitkin Florence & Hal Linden Saverio F. Iapellizzeri J. Alam & T. Drucker J. Alam & T. Drucker J. Alam & T. Drucker J. Alaa & T. Drucker Harry Vogelfanger J. Alam & T. Drucker J. Alaa & T. Drucker Eve. D. Shaw Mary & Pat Tully Peg & Jia Doyle Jules H. Drucker Max Novich, M.D. Esau T. Joseph Arlene Levy & Sandy Caaael The Travers Joseph & Claire lauttman Adele B. Alam Joseph G. Alam J. Alam & T. Drucker J. Alaa & T. Drucker Daniel & Pamela Diaberg Paaela & Daniel Diaberg Donald H. Bowman J. Alam & T. Drucker Trudy Drucker Ears are our interest but sometimes we have to pay through the nose . If you don't notify us of your change of address the Postal Service r>eturns the Newsletter to us and charges us an additional 2 59. We have to pay and you don ' t get your Newsletter. Please, let us know bef ore you move. INSURANCE SURVEY While our primary interest is in finding a cure for tinnitus, as a national organization we sometimes are presented with opportunities that look interesting. We'd like to know if you'd be interested in a group Medicare Complement insur- ance plan. If enough eligible members say it's important to you to have this type of coverage the association can arrange for it. For less than $28 a month this type of insurance fills the spaces created by Medicare - with no lifetime maxi- mum on benefits you can receive. If you're 65 or older - and you're worried about the financial bite of hospital and doctor expenses not covered by Medicare - please drop us a line. But act today. If this is in fact a valuable membership benefit we want to know quickly. In order to tabu- late your responses in a timely way, we ask that you give us your opinion no later than April 30,1982 . If we expect our hearing problems to be solved 'We must help spread the word. Please do what you can in your community. For further info write to ATA or to the address on the picture. Charitable Gifts and Your IRA Did you know that you have the opportunity to name a charitable institution to receive part or all of the funds from your IRA if you die before your retirement payments start? Or, if your payments have commenced, you can name the institution to receive any payments you or your other beneficiaries don't receive prior to death. Other pension and profit-sharing plans have similar provisions. You can name ATA as a beneficiary of any of them. We'll be happy to supply additional information to anyone considering these options . 6 A PERSONAL EXPERIENCE time to time ATA publishes aaaounts of a patient ' s with tinnitus . This aaaoun t, of interest we believe, has been written by a man who is a praatiaing psychiatrist and whom tinnitus has been a aonsiderabZe "The following is a brief account of experience with tinnitus. It does not depict the severe and protracted stress that this affliction has caused me. It is very difficult to be open and truthful in an account such as this, but I can tell you that I have suffered a great deal and I am confident that without relief I could not have continued living. Prior to getting some relief, I had noticed that suicidal thoughts entered my mind more and more and also I developed stress related physical problems such as irritable bowel syndrome. Thank God much of that has changed since I got the masker about four months ago. I am a 49 year old physician specializing in adult and child psychiatry. I have high frequency tinnitus in both ears. The tinnitus in the left ear is about 53 decibels at approximately 8000 Hz units and the right ear is about 60 decibels and 8000 Hz units. This has been measured recently here in Topeka and I think it is fairly accurate. I have had tinnitus since I suffered trauma to my ears when I was 24 years old while in the United States Army while firing the H-1 rifle which bad a very high frequency ping to it. I think the reason my right ear is effected more than the left is because I fired mainly from the right side, but as good soldiers, we were taught to shoot from the left as well. I became aware of a low intensity, high frequency tinnitus and a slight hearing loss while in medical school after my serving in the army. I remember that I could not hear diastolic murmurs. While a student, I asked the professor of otolaryngology what could be done and he said that the only thing to try was vasodilators which I did and they did not help. This was the first of a series of quests for help from my otolaryngology colleagues which resulted in disappointment for me and the realization that they did not know much about it at that time. Host of them told me that nothing could be done and none of them told me how to prevent further deterioration. For example, I was not warned not to use alcohol, caffein, nicotine, marijuana, aspirin, trycyclic antidepressants, and above all to protect my ears from loud noises in an overkill fashion. Through the years the tinnitus increased in intensity perhaps as a result of not doing what I have recently learned to do to prevent further damage . After up to five or six consultations with otolaryngologists, I basically gave up expecting that anything could be done to help me, so I had to cope with it the best way I could. It was very difficult. Tinnitus is extremely distracting and preoccupying and when severe is so distressing that the sufferer does anything he can to rid himself of this affliction. I am certain there are a large number of suicides in this country and other countries because of this problem. In professional practice, I have had some patients with tinnitus tell me that they often felt like taking an ice pick and poking it in their ears just to stop the noises. It was in 1979, when I was about 46 years old that I happened to find the article in the Sunday paper, The Mysterious Ear Noises That Afflict Millions, by Lawrence Galton. The article featured the work of Dr. Jack Vernon at the University of Oregon Health Sciences Center. A tinnitus masker was noted in the article to be a definite help for tinnitus sufferers. At that time, I was unable to go to Oregon for various reasons but I remember experiencing a sense of gladness and thankfulness that 7 at least someone was doing something about the problem. I kept the article and I treasured it. My tinnitus continued and in July of 1981 I realized that I had to do something to get help or I could not continue to function at all and I was on the verge of disorganization. I called the American Tinnitus Association who encouraged me and referred me to Sharon Robinson who gave me further encouragement and she had me call Dr. Jack Vernon and Dr. Bob Johnson. All of the people at the American Tinnitus Association and at the University of Oregon Health Sciences Center have been wonderful and are knowledgeable people, who have consistently helped me by way of long distance phone calls. They gave me the name of a man, J. Hanford Barber, Ph.D., in Topeka who had some training at the University of Oregon. He admitted to me that I was his first tinnitus patient but together we got the tinnitus masker 3 and later the tinnitus masker 5 from Starkey Laboratories. These maskers have helped me a great deal, and even though they are not a cure for the problem, the masking noise and the problems in wearing the masker are much less a problem than the tinnitus itself. I have experienced some residual inhibition but not enough to get excited about. I expect to continue to consult by phone with Dr . Vernon and to modify the maskers to emphasize the high frequency noises. I continue to pray for further definition of the anatomical and physiological pathology of tinnitus and I am confident better treatment will natural'ly follow this. In the meantime, will all physicians who read this believe it and pass it on and let's hope we can get more and more tinnitus clinics around the country. Direct help is presently available by using tinnitus maskers for the many millions of people who have this malady. Thank you and I thank the American Tinnitus Association." Edward G. Mehrhof, M.D. Topeka State Hospital Topeka, Kansas Efficaciousness Clinic Do you treat tinnitus patients? Are you concerned with results? If you answered yes to the above questions you will want to come and hear presentations by those clinicians who are successfully treating tinnitus patients. Learn from them. Learn by doing. A tinnitus workshop for clinicians who are working with tinnitus patients and for those who are interested in getting started in this work. Working sessions will be held on July 16th and 17th. Fly in on the 15th and out on the 18th to take advantage of excursion fares. Tuition discount available for early registrants. Call or write before May 1st to take advantage of the saving. Space is limited -- call for information now. Gloria Reich, ATA, 503-248-9985, or Sam Hopmeier, Coordinator, 314-726-3344 If you wish to present a scientific paper at this meeting and have not yet been contacted; please call Sam Hopmeier. Travel and housing arrangements, pre and post meeting vacation in Oregon arrangements and general information about the extra-curricular recreational opportunities available may be obtained by calling Gloria Reich. SELF-HELP GROUP COORDINATORS Those people who are listed here have volunteered to start self-help groups in their areas. If you want to help or to join, please call them. If you want to be listed here, call or write ATA. Our next issue will have news of the groups. The first tinnitus self-help group met on March lOth in Bergen, NJ. Talking about it can help! We're anxious to see more of these groups formed where people can get together and share both their troubles and their solutions. Who knows? Maybe the answer for tinnitus problems will come from one of these meetings . Dr. William Crausman 100 Highland Avenue Providence, RI 02906 401-273-0333 Trudy Drucker 39 Holiday Court Rivervale, NJ 07675 201-664-7644 Michael Devlin 502 Pillow Ave Cheswick, PA 15024 Mrs. Charles R. Haaf 18 Rarris Lane Woodstown, NJ 08098 Marvin Weinberger 3118 Michael Drive Louisville, KY 40120 502-581-4200 Roy Schutte 616 Edna Ave Kirkwood, MO 63122 Sam Rappaport 9031 Pico Blvd. Los Angeles, CA 90035 Mike M. Mills 3600 Mystic Valley Pkwy Medford, MA 02155 Jules Gilbert 345 East 58th Street New York, NY 10022 Carmel Duval 8 Lloyd Avenue Malvern, PA 19355 Frank Scotchlass 5145 Hidden Branches Dr. Dunwoody, GA 30338 404-952-2414 Kathy roltner 1319 E. Michigan Ave. Lansing, MI 48912 517-372- 6725 Emma Matthews 1138-103 N.Foster Dr. Baton Rouge, LA 70806 504-924-3461 Betty Belke 4380 Caminito Pintoresco San Diego, CA 92108 JOIN THE FIGHT AGAINST TINNITUS! JOIN ATA NOW!!! Your donations are needed to continue ATA 's services such as the production of this Newsletter. Please help! I Published by the Margo Scott 37 Valley Rd Shelton, CT 06484 203-929-3609 Al Mandarino 157 Davis Ave Inwood, NY 11696 516-239-2087 Gustavo Joppert Av.L. Paula Machado 82t Rio de Janiero Brasil Dale Bonnycastle 2100 Marlowe Montreal, Quebec CANADA H4A3L6 Ruth Jones Aileen Burr 1608 Trailridge Rd. 816 Main St . Charlottesville,VA 22903 Lead, SD 57554 Mrs. Clyde Jones Dwight W. Black 900 Orange Ave. Winter Park, FL 305-647-6040 517 Margarette St. 32789 LakeHills, WI 53551 414-648-8157 Mrs. Richard Richter Thomas A. Butts 3567 N. Otter Creek 1730 Tiffany Ct . Monroe, MI 48161 Peoria, IL 61614 Robert E. Collawn 1578 Emerson Denver, CO 80218 303-399-9215 Mrs. Anna Green Rt1 Box 198 Dalhart, TX 79022 806-249- 2943 Al Berger 415-421-4874 (94105) 693 Mission St. #305, San Francisco, CA ANNUAL CONTRIBUTION AMERICAN TINNITUS ASSOCIATION Regular Member 15 or mor< 0 Sustaining Member $ 25 or more 0 Professional Member $100 or more 0 Benefactor $500 or more 0 YOUR GIFT IS TAX DEDUCTIBLE AMERICAN TINNITUS ASSOCIATION A private non-profit corporation under the laws of Oregon The American Tinnitus Association Post Office Box 5 Non-Profit Organ. U.S. Postage PAID Permit No. 1792 Portland, Oregon Medical Ad\tieory BoArd .Roger l!oles, H. D. Son Prancisoo, california Jack D. Clemis, H. D. Chicago, Illinois David D. DeWeese, M. D. 1\:>rt.J.ana,Oreqon Jom 1\, l?mnett, M. D. foleqbis, Tennessee Boward P, llOUse, M, D. LOs Angeles, california R<lbert M, Johnson, l'h.D. 1\:>rtland, Oreqon Merle Lawrence, l't!.D. linn Arbor, Michigan Jerry N)rtbern, l't!.D. Denver, Colorado Geot9fl P, lleed, M, D. Syracuse, New York R<lbert E. 5andlin, Ph.D. Son Dieqo, california Abraham ShulJMn, M, D. New York, New York Racold G. Tahb, M, D. New Orleans, LOOisiana Roard of pirectors R<lbert Hocks, Chairman oregon Gloria E. Reich, Exec.Dir. 1\:>tUand, Oregon 0\arles unice, M. D. [))..mey 1 california 'ih:lmas Wissbaum, C.P.A. Portland, Oreqon HonQrary Di res;tors Del Clawson, House of Rep.Ret. Downey, California Honorable Mark Hatfield Onited states Senate tcgal Cosmsel Henry c. Breithaupt Stoel,Rives,Boley,Fraser & WySe Portland, Oregon 97207 (503) 2489985 ADDRESS CORRECTION REQUESTED