June 2001 Volume 26, Number 2

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To silence tinnitus through education, advocacy, research, and support."
Since 1971
Education - Advocacy - Research - Support
In This Issue:
Advances in Tinnitus Research
Coping with Tinnitus Stress
Customized Sound Therapy
Musical Tinnitus
Adwrtisemerrt
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Tinnitus Today
Editorial and Advertising offices: American Tinnitus Association, PO Box 5, Portland, OR 97207 5032489985, 8006348978 tinnitus@oto.org, www.oto.org
Executive Director: Cheryl McGinnis, M.B.A.
Editor: Barbara 'Dlbachnick Sanders
Tmnrtt<s 1bday is published quarterly in
March, June. September, and December. It is
mailed to American Tinnitus Association
donors and a selected list of tinnitus patients
and professionals who treat tinnitus.
Circulation is rotated to 80,000 annually.
American Tinnitus Association is a non-profit
human health and welfare agency under 26
usc 501 ( c)(3).
02001 American Tinnitus Association. No part
of this publication may be reproduced, stored
in a retrieval system, or transmitted in any
fom1, or by any means, without the prior
written permission of the Publisher. ISSN:
0897-6368 (print), ISSN: 1530-6569 (online)
Board of Directors
Stephen M. Nagler, M.D., Atlanta, GA,
Chairman
Dhyan Cassie, M.A., CCCA, Medford, NJ
James 0. Chinnis, Jr., Ph.D., Warrenton, VA
Claude H. Grizzard, Sr., Atlanta, GA
Gary P. Jacobson, Ph.D., Detroit, M1
Sidney Kleinman, J.D., Chicago, IL
Paul Meade, Tigard, OR
Kathy Peck, San Francisco, CA
Dan Purjes, New York, NY
Susan Seidel, M.A., CCC-A, Sunset Beach, NC
Tim Sotos. Lenexa, KS
RichardS. "IYier. Ph.D., Iowa City. lA
Jack A. Vernon, Ph.D., Portland, OR
Honorary Directors
The Honorable Mark 0. Hatfield. U.S. Senate,
Retired
"Ibny Randall, New York, NY
William Shamer, Los Angeles, CA
Scientific Advisors
RichardS. 'JYler, Ph.D., Iowa City, lA,
Chairman
Paul J. Abbas, Ph.D., Iowa City, lA
Anthony Cacace, Ph.D., Albany, NY
Robert A. Dobie, M.D., Bethesda, MD
Gary P. Jacobson, Ph.D., Detroit, Ml
Pawel Jastreboff, Ph.D., Atlanta, GA
James K. Kaltenbach, Ph.D., Detroit, Ml
Paul R. Kileny, Ph.D., Ann Arbor, Ml
Robert A. Levine, M.D., Brookline, MA
William H. Martin, Ph.D., Portland, OR
Douglas E. Mattox, M.D., Atlanta, GA
Mary B. Meikle, Ph.D. , Portland, OR
Stephen M. Nagler, M.D., FACS, Atlanta, GA
Craig W. Newman, Ph.D., Cleveland, OH
Gloria E. Reich, Ph.D., Portland, OR
Jay Rubinstein, Ph.D., Iowa City, lA
Roger A. Ruth, Ph.D., Charlottesville, VA
Richard J. Salvi, Ph.D., Buffalo, NY
Michael D. Seidman, M.D.,
West Bloomfield, MI
Robert W. Sweetow, Ph.D., San Francisco, CA
DonnaS. Wayner, Ph.D., Latham, NY
Cover: 'Poet's House in the Sun,
oil on masonite, u x 14",
by Gail Wells-Hess. Inquiries to
Gail Wells-Hess at 800-7764245 or
gail@WalkThisWorld. com
The Journal of the American Tinnitus Association
Volume 26 Number 2, June 2001
Tinnitus, ringing in the ears or head noises, is experienced by as many
as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Table of Contents
9 Tinnitus and a Bloody Cough
by Stephen M. Nagler, M.D., FAGS
10 ATA-Funded Research 'lbward the Cure
by Pat Daggett
12 Advances in Research - 2001 Meeting of the Association for
Research in Otolaryngology
by James 0. Chinnis, Jr., Ph.D.
14 Coping with Tinnitus Stress
16 Customized Sound Therapy
by Alexander Kadner, Ph.D.
17 Exposure to Air Bag Deployment
by Kathleen Yaremchuk, M.D.
18 Practical Help with Tinnitus
by Jo Hazelby
20 Jack A. Vemon- Winner of Oticon Award
21 Member Notes
by Jessica Allen
22 Seeking ATA Board Committee Members
22 New Self-Help Volunteers
Regular Features
4 From the Executive Director
5 From the Editor
Ringing, Hissing, Roaring, and, yes, Music
- The Sounds of Your Tinnitus
by Barbara Tabachnick Sanders
7 Letters to the Editor
23 Questions and Answers
by Jack A. Vemon, Ph.D.
26 Special Donors and 'fributes
The Publisher reserves the right to reject or edit any manuscript received for publication
and to reject any advertising deemed unsuitab1e for Tinnirus 'Thday. Acceptance of
advertising by Tinnitus '10day does not constitute endorsement of the advertiser, its
products or services, nor does Tinnitus 'Thday make any claims or guarantees as to the
accuracy or validity of the advertiser's offer. The opinions expressed by contributors to
Tinnitus Today are not necessarily those of the Publisher, editors, staff, or advertisers.
@ Primed on recycled paper
American Tinnitus Association Tinnitus Today/ June 2001 3
FROM THE EXECUTIVE DIRECTOR
by Cheryl McGinnis, M.B.A.
Spring is a time for
change. In Oregon, spring
typically follows a rainy, gray
winter. Thus, the emerald
green terrain brightened with
an array of spring color in
bloom affirms why we've
chosen to hve here. Some
of us thrive with the opportu-
nities that change presents, and some wait
anxiously for the unknowns.
In this season of change, ATA is thriving with
opportunities and changes: a move of the
national headquarters, a new Web site design
with a Members Only section, a new Mission
Statement, and a new three-year strategic plan.
ATA National Headquarters Office - ATA's new
office is 10 blocks north of our old space. You can
contact us in the same ways you always have.
Our mailing address
1
telephone, FAX,
e-mail, and Web address all remain the same:
PO Box 5
Portland, OR 97207
503-248-9985 and toll-free: 800-634-8978
FAX 503-248-0024
e-mail: tinnitus@ata.org
Web: www.ata.org
Only our physical address has changed:
65 SW Yamhill Street, Suite 200, Portland,
Oregon, 97204. The new office has more space,
efficiently arranged, at a more economical cost.
We'll welcome your visit whenever you may be
in the Portland area!
ATA Web site (www.ata.org)- If you have
browsed our Web site you have seen our new
look. The overall design of the ATA Web site was
reconstructed in December and a Members Only
section was added in March. Most importantly to
you, when visiting this site you can expect regu-
lar updates- at least monthly. The Members
Only section provides you with lists of Self-Help
Groups and telephone support network volun-
teers1 and a complete on-line version of Tinnitus
'Ibday. In addition, the Members Only section
includes updates on research investigations and
member benefits.
The public section continues to provide
tinnitus information and research results to all
visitors. Callers frequently exclaim the ATA Web
site was the first site found during their search
on tinnitus and helped them learn just what
they wanted.
4 Tinnitus 7bday/June 2001 American Tinnitu$ Association
ATA Mission Statement - 'Ib silence tinnitUs
through education, advocacy, research, and support.
The Board of Directors established this new word-
ing to emphasize our search to bring an end to
tinnitus and to assert ATA's program services that
are key to silencing the sounds of tinnitus. The
mission statement does not stand alone as words
with no action. ATA's Board of Directors with Staff
developed a three-year strategic plan assuring
progress towards our mission.
ATA Three-Year Strategic Plan - Our educa-
tional program will create a strong network of
current and future healthcare professionals com-
mitted to providing relief for tinnitus patients.
We will build on our current success of engaging
healthcare professionals as members and leaders
of the ATA; sending copies of Tinnitus Tbday to
otolaryngologists; and encouraging professional
societies to advance services for tinnitus patients.
Currently, an online journal for audiologists
(AudiologyOnline.com) has an article about
tinnitus and the ATA. AudiologyOnline has regular
tinnitus articles many of which are written by ATA
professional members. The American Academy of
Otolaryngology and the American Academy of
Audiology also publish information on tinnitus
and include information on their Web sites for
professionals.
These activities also relate to a second educa-
tional goal: to increase public awareness about
tinnitus. When syndicated health columnists write
about tinnitus, we hear from significant numbers
of people asking for information and support.
Our Web site includes updates on the most recent
tinnitus media placements along with video
samples of television and radio public service
announcements that are airing nationally. During
April, writers from Barron's and Woman's World
began investigating tinnitus for their upcoming
issues.
Advocacy activities will encourage strong
public policies related to tinnitus issues.
Specifically, we will advocate for additional
tinnitus research funding, monitor public policies
that will impact tinnitus research, prevention, and
patient relief. The National Institutes of Health
funds research and has been targeted to receive
significant increases in funding in the federal
budget proposal. We will follow all activities
related to tinnitus and emphasize grassroots
education to leverage our national activities with
local efforts.
Research goals are preeminently important:
to increase the quantity and quality of tinnitus
(continued)
Fr o m the E ditor
Ringing, Hissing, Roaring, and, yes, Music
The Sounds of Your Tinnitus
by Barbara Tabachnick Sanders,
Director of Education
We moved into a new office
space last week. And as moves
go, it went as expected: We
waded hip-deep in boxes for
a week, struggled without
computers for a day, and
ultimately got from there to
here. We had outgrown our previous location more
than a year ago, so the move was timely and
appreciated.
As we packed up the old office, staff members
took time to sift through two decades' worth of
saved papers, and decide what to keep and what to
let go of. While sifting, I came across a file labeled
"music." In it I found 46 letters written between
1981 and 1989 from people who described some
form of musical tinnitus - true internal sounds -
that they or their loved ones heard. Their widely
FROM THE EXECUTIVE DIRECTOR (continued}
research projects. Our mandate is to promote
incentives and opportunities that attract investi-
gators to tinnitus research - including drug and
medical device manufacturers to complete
research that will develop cures or palliative
treatments for tinnitus. Financially, our goal is to
commit $500,000 towards research projects for
each of the next three years. The ATA research
program was promoted before hundreds of
researchers at the Association for Research in
Oto1aryngology. We promote this program
whenever we discuss ATA's services with media,
potential sponsors, healthcare providers,
professional organizations, and scientists.
Providing support for people with tinnitus is
an overarching ATA program. Our goal for the
next three years is to connect tinnitus patients,
their families, and providers to beneficial
resources. Issues of concern to patients are
investigated and reported on our Web site and
within this journal. Also during the next three
years, you will see increased services through
our Self-Help group program, telephone support
network, and provider resource listing.
Thank you for your continued support of the
ATA. Together, we will silence tinnitus. II
varied experiences included: a brass band;
Christmas music; the same song over and over
again; a rhythmic musical beat; sometimes familiar
melodies, sometimes not; nursery rhymes; Brahms
lullabies; old songs, male voices; female voices;
orchestras; hymns day and night ("hymnitis" as the
writer called it); monotonous chords; repetitive
descending and ascending scales; TV theme songs;
a full repeat of a song that the person had just sung
or heard; organ music; operatic arias; songs chang-
ing like on a radio; high piccolo music, and, as
reported by the grandson of a Confederate soldier,
"'Yankee Doodle' - not one of my favorite tunes."
Some of the letter writers also offered the sus-
pected causes of their musical tinnitus: ear surgery,
chemotherapy, antidepressants, antibiotics, regular
tinnitus that evolved into musical tinnitus, the
onset of sudden hearing loss, and no known cause.
Surrounded by these letters, I began to wonder if
musical tinnitus is a more common - or perhaps
less uncommon - experience than statistics now
show.
According to a survey of 1,626 tinnitus patients
at the Oregon Hearing Research Center's Tinnitus
Clinic, ringing was the most common sound
(reported by almost 57% of patients), followed by
hissing, clear tone, high-tension wire, buzzing,
multiple tones, sizzling, transformer noise, crickets
or insects, whistle, hum, pulsating, ocean roar,
pounding, clicking, and - rarest of all - music,
reported by less than 1% of patients. The
Nottingham Tinnitus Clinic in England reports
a slightly higher number: 5% of their patients
have musical tinnitus. Many of these patients had
been musicians, singers, or music lovers.
Several of the musical tinnitus letter writers
said they had been hesitant to write to us because
they feared that we'd think they were crazy. Many
were more concerned about what others would
think. One woman wrote that her family has asked
her to not talk about it anymore. Because of the
understandable stigma associated with "hearing
things," it is likely that this unusual experience is
underreported.
Not to be overlooked, musical hallucination
is a documented though rare symptom of schizo-
phrenia, a psychiatric disorder. So, people who do
report musical tinnitus to their doctors are often
(continued)
American Tinnitus Association Tinnitus 7bday/ June 2001 5
The Sounds of Your Tinnitus (continued)
sent on for mental health evaluation. This might
explain why doctors at psychiatric and neurology
clinics have done most of the research on this
phenomenon. As it turns out, mentally healthy
people make up the bulk of subjects in the pub-
lished research papers on musical tinnitus. A few
other general observations emerge from these
studies: Musical tinnitus is usually experienced by
people with severe hearing loss, and predominantly
by elderly women.
So where does musical tinnitus come from? In
one study, researcher Tim Griffiths examined six
musical hallucination patients with PET (positron
emission tomography) scans to find out which part
of the brain had increased activity during the musi-
cal hallucination experience. Griffiths noted that
none of the patients had epilepsy or a mental disor-
der. In these subjects, the brain areas that process
sound patterns were activated during episodes of
musical tinnitus.
Scientists had hoped at one time to find a con-
nection between the sounds of tinnitus (buzzing,
roaring, etc.), the causes (over-exposure to noise,
drugs that damage hearing, etc.), and the physical
sites of origin (the inner ear, the brain, or some-
where in between). 'Ib date, they have not found a
consistent connection. Dr. James Kaltenbach's
experiments with animals have shown a connec-
tion between noise exposure and increased activity
in a specific structure - the dorsal cochlear
nucleus - in the auditory portion of the brainstem.
However, Drs. Alan Lockwood and Richard Salvi's
research with people who have gaze-evoked
tinnitus (tinnitus made louder or softer with eye
movement), has shown that the regions ofbrain
activity during tinnitus episodes varies from
person to person.
In the absenc:e of an absolute c:onnection,
researchers have been able to cross a few things
off their list. Specific causes of tinnitus
(excessive noise exposure, etc.) do not result
in specific sounds of tinnitus. That is,
noise-induced tinnitus can sound like ring-
ing, chirping, hissing, roaring, whistling,
music, or other sounds. Specific tinnitus
sounds are not associated with specific brain
regions of activity. That is, ringing is not
"here" in the brain, nor is roaring
"there.''
Other researchers have other ideas.
Drs. R.R. David and H.H. Fernandez
theorize that when the hearing ear sends
6 Tinnitus Thday/ June 2001 American Tinnitus Association
sound to the brain, it stops the emergence of
"memory traces" in the brain. But when hearing
fails, the brain is deprived of this sound input. The
researchers suggest that an interruption in sound
input triggers a "release" of previously recorded
perceptions, or musical hallucinations. Obviously,
other factors play a role since the number of
people who hear musical tinnitus is dramatically
small compared to the very large number of
people who have hearing loss. Dr. Salvi also sees
a connection between tinnitus and the sound-
deprived brain. He believes that when sound
cannot make its way to the brain because the
ear is deafened, some part or parts of the brain
become hyperactive in reaction to the absence of
sound. That hyperactivity could be the origin of
tinnitus - musical and otherwise.
On a practical note, musical tinnitus is often
relieved with hearing aids. In part, this might be
because the stress associated with the struggle
to hear can make tinnitus worse. Also, some
musical tinnitus patients have found relief with
low-frequency masking. (Low-frequency masking
sound can relieve low-frequency tinnitus when
the patient also has useable low-frequency
hearing.) Patient counseling is helpful and
sometimes sufficient treatment when patients are
reassured that the sounds they hear do not
represent a mental disorder.
Right now, research on musical tinnitus
consists mostly of individual case studies.
However, interest in the topic is picking up speed.
Psychiatric, audiologic, and neurologic researchers
have identified a common ground: the brain's
involvement in all forms of tinnitus perception.
And where only six research studies on musical
tinnitus were conducted before 1990, 60 studies
have been conducted since 1990. Perhaps not the
biggest crescendo, but it is an exciting start. B
References:
Berrios GE, Musical hallucinations: a statistical analysis of
46 cases, Psychopathology 1991; 24(6):356-60.
David RR, Fernandez HH, Quetiapine for hypnogogic musical
release hallucinations, J Geriatr Psychiatry Neural, 2000 Winter;
13(4):210-1.
Griffitl1s TD, Musical hallucinosis in acquired deafness.
Phenomenology and brain substrate, Brain, 2000 Oct;
123(10):2065-76.
Kaltenbach JA, Afman CE, Hyperactivity in the dorsal cochlear
nucleus after intense sound exposure and its resemblance to
tone-evoked activity: a physiological model for tinnitus. Hear
Res, 2000 Feb; 140(1-2):165-72.
Lockwood AH, Wack DS, Burkard RF, Goad ML, Reyes SA,
Arnold SA, Salvi RJ, The functional anatomy of gaze-evoked
tinnitus and sustained lateral gaze, Neurology, 2001 Feb
27;56( 4):472-80
Letters to the Editor
From time to time, we include letters from
our members about their experiences with
/(non-traditional" treatments. We do so in
the hope that the information offered might
be helpful. Please read these anecdotal
reports carefully, consult with your
physician or medical advisor, and decide
for yourself if a given treatment might be
right for you. As always, the opinions
expressed are strictly those of the letter
writers and do not reflect an opinion or
endorsement by ATA.
F
or 40 years, I'd been plagued with high-
frequency tinnitus in both ears, which began
after a severe throat and middle ear infec-
tion. As I've aged, my tinnitus has become
louder, and I've spent large sums of money seek-
ing relief. None of the sound devices, drugs, or
CDs that I tried helped to mitigate the tinnitus.
Three months ago, I visited an electronics
store while on vacation in Florida and happened
to listen to the "sound soother" option on a
Sharper Image CD/ radio (model# SI 686). The
soother selections included sounds of rain,
streams, surf, nighttime in the Everglades, and
rainforest. I was elated to find that the chorus of
insects in the rainforest masked my tinnitus. I
purchased the device and enjoy it regularly. But
it is only effective nearby because it only has two
small speakers.
I became intrigued about the species of
insect that produced the same frequency sound
as my tinnitus and contacted H&R Nature
Sound Recordings. I talked with biologist Wil
Hershberger, their sound engineer, who was
unaware that certain insect recordings could be
helpful to some people with tinnitus. He sent me
two CDs full of insect calls. And on one of them,
I found my speciesl Mr. Hershberger is making
me a CD with a continuous sound of the match-
ing species so I can play it on speakers through-
out my home. (He can be contacted at
tinnitusmasking@aol.com.) It is wonderful to
finally find relief. And as a wildlife biologist
myself, I was particularly satisfied to know that
the source is a natural sound.
Edgar P Bailey, Homer; Alaska,
fausbail@xyz. net
I
believe that I gave myself tinnitus by taking
the benzodiazepine, xanax, prescribed to me
for anxiety. I can hear your collective gasp as
you read this. I know. There is literature that
recommends Xanax for tinnitus relief. For me, it
wasn't so. I was quite upset to read in Tinnitus
Tbday that certain drugs, including xanax, are
being used for tinnitus treatments. My hope with
this letter is to make my fellow tinnitus sufferers
aware of drug side effects and to discourage the
use of medications for tinnitus. According to the
"Drugs with Side Effects" list from the 1995
Physicians Desk Reference, xanax causes tinnitus
at a high rate. I belong to an Intemet benzodi-
azepine support group (www.egroups.com/
group/ benzo) where a large majority of the 800
or so members have tinnitus. Often the tinnitus
goes away when they go off the drug that they're
taking. Some of the other benzodiazepines are:
Ativan, Valium, Restoril, and Klonopin. I don't
know about their percentages of inducing
tinnitus, but personally I wouldn't take a chance.
Lisa Freedman, rgds2brdwy@aol.com
Editor's Note: All medications - whether prescrip-
tion or over-the-counter - carry some risk. Patients
need to weigh the risks of known side effects agai nst
the expected gains before they make the decision to
take a drug for tinnitus or for any disorder.
In the case of Xanax, 6. 6% of consumers
reported tinnitus onset with the drug according to the
1999 PDR, (although the amount taken and the pace
at which patients went off the drug are not known)
Xanax has been discussed in Tinnitus Today and in
other publications as a tinnitus relief agent based on
patient reports and on a double-blind placebo con-
trolled study conducted in 1993 by Johnson et al.
This study showed that 76% of patients who took
1.5 mg of Xanax daily had a 40% or more measura-
ble reduction in their tinnitus volume.
Because of the seriousness of this letter's topic,
we invited comments from two members of our
Scientific Advisory Committee: Robert A. Dobie,
M.D., and Michael D. Seidman, M.D. , FAGS.
(continued)
American Tinnitus Association Tinnitus 'Tbday/June 2001 7
Letters to the Editor rcontinuedfrompagelJ
From Robert A. Dobie, M.D., Director,
Division of Extramural Research, National
Institutes of Health: Tinnitus is listed as a side
effect of many drugs. But in most cases, the drug has
not really been proven to cause tinnitus more often
than a placebo (sugar pilZ). Nevertheless, there is rea-
son for concern regarding benzodia.zepines (including
Xanax) and tinnitus. One study found that many
patients improved while taking these drugs, but their
tinnitus returned to its prior level or worse when
they stopped taking it. Another study found that
some patients developed tinnitus when they were
weaned off of long-term use of benzodiazepines.
There are no long-term studies, as far as I know, of
patients taking these drugs for tinnitus. So it's hard
to know if, in the long run, these drugs relieve tinni-
tus more often than placebos, or if some patients are
worse off than before.
From Michael D. Seidman, M.D., FACS, Dept.
of Otolaryngology / Medical Director, Tinnitus
Center, Henry Ford Health System: It is well
known that many medications can elicit tinnitus.
Obvious examples include aspirin, quinine, some
antibiotics, anti-anxiety drugs, and even drugs that
are used to treat tinnitus.
The notion of using a drug that might cause
tinnitus to treat tinnitus is actually known in the
clinical setting. The basis ofhomeopathy (a system
of medical practice that treats disease with minute
doses of a remedy) is that "like treats like. n For exam-
ple, one homeopathic treatment for tinnitus includes
very low doses of aspirin. Just about every known
side effect is listed in the Physicians Desk Reference
and other sources for drug information. Can Xanax
cause tinnitus? Yes. It is listed that way in the PDR.
And as physicians we must warn patients about all
potential side effects of prescribed drugs. But does
this mean that we should not use Xanax to treat
tinnitus? No. Elavil and Xanax have been used for
many years to treat patients with tinnitus. Xanax.
enjoys up to a 78% chance of alleviating (not curing)
tinnitus. In my clinical experience of treating
thousands of tinnitus patients, I have never seen a
patient whose tinnitus was caused by Xanax.
8 Tinnitus 'Ibday/June 2001 American Tinnitus Association
M
y tinnitus hit early in the morning after
celebrating my 40th birthday, although
I'm sure it had been coming on for years
as a result of my disc jockey days in the 1980s.
I was terrified with this new high-pitched sound
in my ears. I had never heard of tirmitus until
my ENT specialist diagnosed me with it and
much to my shock told me I had to "learn to live
with it." I had never in my life had anything that
couldn't be fixed or healed, so this news was
extremely frustrating and depressing. I was
bound and determined to find an answer, a cure,
something.
I looked on the Internet, in books, and tried
herbal remedies, but nothing worked. When I
finally ran out of ideas and prayers, I decided to
change my focus - from tinnitus to life. (I call it
my "Life In, Tinnitus Out" refocus program.) I
realized that I had been using tinnitus to escape
from my other problems. So I turned my atten-
tion to those problems and got engrossed in life.
It worked. After two years, I can honestly say
that tinnitus is now a non-issue. When my
tinnitus is troubling me, it's an indicator that
something else is going on in my life that I'm
not dealing with. Once I figure out what that
something else is and deal with it, miraculously
the tinnitus is again a non-issue. I've noticed that
when I am tired, or after I use alcohol or caffeine
or eat salty foods, the tinnitus is worse, but I
accept that. Initially, tinnitus was a very scary
ordeal. Now it is only as big a deal as I allow it
to be.
This experience has made me ultra
concerned about protecting my hearing, so I
wear custom-fitted earplugs at concerts or any-
where that's too noisy. In the meantime, I make
my monthly tinnitus research donation and hold
out hope for a real treatment or a cure. Either
way, I know I'll be fine. I won!
Lance Kroetz, Los Angeles, CA
Tinnitus and a Bloody Cough
by Stephen M. Nogle" M.D., FACS
Go to a doctor complaining
of a persistent bloody cough,
and he or she will spring into
action. The doctor will take an
extensive history and follow
with a physical examination,
paying particular attention to
percussion (tapping with the finger) and ausculta-
tion (listening with a stethoscope) of the chest.
Next will likely come a chest x-ray, a sputum
analysis, and possibly some blood tests as the
doctor tries to determine the cause of the bloody
cough - is it pneumonia, bronchitis, lung cancer,
tuberculosis, etc? Once the doctor makes a diag-
nosis (i.e., once the cause of the bloody cough
is identified), treatment is directed at the
cause ... and the cough gets better. If the diagnosis
is pneumococccal pneumonia, antibiotics are
given; for bronchitis, some bronchodilators and an
expectorant; for lung cancer, possibly an operation
is in order to remove the diseased segment or
lobe. The pattern is the same - the classic
Western medical model - evaluate the symptom,
make an accurate diagnosis, treat the underlying
cause, and the symptom resolves. One problem:
It does not work in tinnitus!
Tinnitus is a symptom, not a diagnosis. But in
40% of tinnitus cases, a precipitating event cannot
be identified.' In the vast majority of the other
60%, even if the underlying cause can be identi-
fied and if a diagnosis can be made, effective
therapy addressing that diagnosis - and, in so
doing, cure the tinnitus - does not exist within
the constraints of current medical knowledge
and technology. Now certainly if one reports to
a doctor with a complaint of ringing in the ear,
and upon examination the doctor finds an ear
infection, and an antibiotic is prescribed to treat
the infection, and the infection resolves, and upon
resolution of the infection the tinnitus resolves as
well - that is a cure. In addition to the simplistic
case of the ear infection, there are other more
medically sophisticated examples of true cures for
tinnitus resulting from treatment directed at an
established diagnosis. But, sadly, those cases are
few and far between. We simply do not currently
1 Oregon Tinmtus Data Archive- Internet Reference
www.ohsu.edu/ oh rc-otda/95-01/ data/ OS.html
2 The exception is tinnitus associate with sudden hearing loss. In
such cases, patients should seek an immediate evaluation, as rapid
medical intervention can sometimes result in preservation of
hearing and resolution of tinnitus.
have the technology, for instance, to repair
damaged hair cells from noise or drug ototoxicity.
Once the correctable underlying cause or causes
have been ruled out, the nervous and unsuspect-
ing patient with tinnitus is all-too-often told by
the well-intentioned doctor, "You have tinnitus.
There's nothing that can be done for you. You'll
just have to learn to live with it." Those words -
words that can hammer the first nail in the coffin
of fear, frustration, and despair - are simply
untrue.
Allow me to offer a different perspective on
the evaluation and treatment of patients with
tinnitus. If a person has tinnitus for more than
four weeks without signs of spontaneous
resolution, a visit to the doctor is indicated.
2
The evaluation at that time should include at a
minimum a detailed head and neck examination
and a thorough audiological assessment. During
the evaluation, which may in some cases require
two or three visits, three main areas should be
considered:
+ Is the tinnitus caused by something that is
a threat to health or life? Such cases are
extraordinarily rare, but should be ruled out.
And, very importantly, when they indeed
have been ruled out, the patient should be so
informed in a clear, direct, and unequivocal
manner.
+ Is the tinnitus caused by an underlying
problem that can be effectively addressed
with current technology and in so doing
effectively resolve the tinnitus? If this is the
case, the patient should be so informed in a
clear, direct, and unequivocal manner, and
treatment directed at the underlying problem
should be considered. If such is not the case
or if treatment of the underlying problem
poses unacceptable risk, the patient should
be so informed in a clear, direct, and
unequivocal manner, and attention should
then be turned to the elements in the third
bullet. It is, in my opinion, unacceptable to
stop at this point.
(continued on page 11)
American Tinnitus Association Tinnitus 'Ibday/June 2001 9
ATA-Funded research
Toward the Cure
by Pat Daggett, Director of Research
ATA's Scientific Advisory
Committee and Board of
Directors are pleased to
announce approval of funding
for the following three research
grants:
1. Principle Investigator: Susan Shore, Ph.D.
The University of Michigan
Grant Award: $64,846
Generation & Modulation of Tinnitus:
The Role of the Trigeminal Ganglion-
Cochlear Nucleus Connection
This grant continues Dr.
Shore's study from a previous
ATA-funded project. The results
of the first study support the
hypothesis that the trigeminal
ganglion-cochlear nucleus path-
way (the pathway from the
Susan Shore, Ph.D. facial nerve to the brain) may
play a role in generating and/ or
modulating "somatic tinnitus" - the kind of
tinnitus that can be changed by manipulating
the head or neck. Two-thirds of tinnitus patients
are able to modulate, or change, their tinnitus
by clenching the jaw or touching the skin on
the face.
It has been demonstrated that the trigeminal
ganglion, a nerve cluster on the facial nerve that
sends signals to the skin and musculature of the
head, also sends a signal to the ventral cochlear
nucleus (VCN), a structure along the auditory
pathway from the ear to the brain. Increased
excitation of VCN nerve cells has been associated
with tinnitus. The studies proposed here will
explore the action of this pathway on nerve cells
in the dorsal cochlear nucleus (DCN) and its role
in tinnitus. Identification of the neurotransmit-
ter(s), or brain chemicals, involved will set the
stage for drug treatments to alleviate tinnitus.
10 Tinnitus 7bday/ June 2001 American Tinnitus Association
2. Principle Investigators: Robert Folmer, Ph. D.,
and William H. Martin, Ph.D.
Oregon Health Sciences University
Grant Award: $25,000
Functional Magnetic Resonance Imaging
of Brain Activity Associated with Tinnitus
Severity and Residual Inhibition
William H Martin, Ph.D. (left)
and Robert Folmer, Ph.D.
Brain-imaging
techniques such as
fMRI will help iden-
tify specific brain
structures and path-
ways related to
problematic tirmitus.
Once those struc-
t ures are identified,
the information wil1
increase our understanding of why tinnitus
becomes problematic. It could also lead to the
development of site- and mechanism-specific
treatments (such as medications, electrical stimu-
lation, or ablation) to provide relief and possibly
a cure. These techniques may also help us to
determine the basis for problematic tinnitus
across different patient populations.
3. Principle Investigators: Catherine Stevens, Ph.D.,
and Gary Walker, Ph.D.
University of Western Sydney
Grant Award: $26,702
Tinnitus and it s Effect on Attention
and Memory
Catherine Stevens, Ph.D. (left)
and Gary Walker, Ph.D.
Three experi-
ments will measure
the degree to which
attention and mem-
ory processes are
impeded by tinnitus.
Recent psychological
studies of tinnitus
have identified a
tendency toward
self-attention that may reduce the attentional
resources available. If it is the case that controlled
but not automatic processes are disrupted in
tinnitus, then management strategies will be
proposed that a) maximize automaticity; b) train
individuals to focus on component features of a
(continued)
Tinnitus and a Bloody Cough (continuedfrornpage9)
+ If the tinnitus is not caused by something that
is a threat to health or life, and if the tinnitus
is not caused by something that can be safely
and effectively addressed and in-so-doing
resolve the tinnitus, then a treatment program
should be outlined to effect relief to the
patient's satisfaction in the absence of a
true cure. At the same time it is extremely
important to offer legitimate reassurance that
research - research in the hopes of finding a
universal cure for tinnitus - is active and
ongoing. Again, the patient should be so
informed in a clear and unequivocal manner.
Now the type of treatment program (masking,
pharmacological approaches, Tinnitus Retraining
Therapy, cognitive behavioral therapy, etc.)
addressed in the third bullet above will vary
from patient to patient depending upon a host of
factors that are beyond the scope of this article.
Once it is established that the tinnitus is not a
threat to health or life and at the same time
cannot be effectively treated by treating the
cause, then the tinnitus is - for lack of a better
term- a "nuisance." What is or is not done to
effect relief depends on just how much of a
Toward the Cure (continued)
cognitive task; and c) structure the environment
to maximize the task's perfonnance. The imple-
mentation and evaluation of such strategies will
form the basis of a future application to ATA.
ATA-funded research projects
currently in progress:
+ "Imaging Human Tinnitus"-
Jennifer Melcher, Ph.D.
+ "Outcome of Cognitive Behavior Therapy
for Tinnitus"- John McQuaid, Ph.D., and
Shannon Robinson, M.D.
+ "Are Mechanisms for Transient and
Long-standing Tinnitus Different?" -
Jos J. Eggermont, Ph.D.
+ "Mapping Metabolic Brain Activity of
Tinnitus"- Pawel Jastreboff, Ph.D.
+ "The Role of Female Sex Steroids in
Tinnitus" - Aage Moller, Ph.D.
nuisance it is. Mild, non-intrusive tinnitus that is
not annoying requires no treatment whatsoever.
Loud annoying tinnitus that impacts daily
function and joie de vivre should certainly be
addressed. In approximately 25% of cases,
tinnitus resolves on its own in the first year -
regardless of what is or is not done to treat it.
Many authorities feel that the chances of
spontaneous resolution fall off markedly after
two years. At the same time, it is also felt by
many that regardless of what treatment protocol
is undertaken, the results of treatment are more
gratifying the earlier that treatment is initiated,
even taking spontaneous resolution into account.
Ifyour tinnitus is intrusive (i.e., if not only do
you have tinnitus, but tinnitus also has you), it
makes most sense that there is no real reason
to grit your teeth and suffer until one or two
years have passed! There is no reason that just
because you have tinnitus, you must suffer from
tinnitus. B
Dr. Nagler is the Director of the Alliance Tinnitus
and Hearing Center in Atlanta, Georgia
(www.tinn.com), and is Chairman of ATA's Board
of Directors.
It's easy to join ATA
Membership is $25 per year and
includes 4 issues of Tinnitus Tbday.
Please call 800-634-8978 ext. 219, or sign up
on our Web site - www.ata.org.
You may also mail us a check made out
to "ATA Membership."
Ametican Tinnitus Association
PO. Box 5
Portland, OR 97207-0005
American Tinnitus Association Tinnitus 7bday/ June 2001 11
Advances in Research - 2001 Meeting of the
by James 0. Chinnis, Jr., Ph.D.
Each year the Association
for Research in Otolaryngology
(ARO) hosts a meeting for the
discussion of ongoing research.
This year again, over a thou-
sand studies were presented.
Most of these dealt with the
ear, or with central (brain) activity related to the
ear. Tinnitus-specific research was a small part of
all tllis activity, yet many of the research efforts
shed light on tinnitus. The paragraphs below are
intended to give a feel for the range of what tran-
spired at the meeting, but can only hint at the
nature of each study.
Chemistry
Much of the research focused on valious brain
chemicals or drugs found to have, or theorized to
have, an effect on tinnitus or hearing. An example
is work reported by Meredith Garcia, Ph.D., of
Thlane Medical School. Tinnitus and hyperacusis
may arise in some cases from "hyperexcitability"
of certain neurons, or nerve cells. Thls could
occur as the result of a loss of signals from
other brain regions that "quiet" those neurons.
Dr. Garcia's group-funded by the ATA-studied
the activity of GABA (gamma amino butyric acid),
a chemical that plays a role in the quieting
process. Dr. Garcia's results suggest that GABA
can reduce the central auditory response to sound
and may offer promise in reducing tinnitus.
James Kaltenbach, Ph.D., ofWayne State
University, used cisplatin-a drug known to cause
tinnitus-to explore the drug's effects and how
they may lead to tinnitus. It had been previously
shown that tinnitus may involve hyperactivity of
neurons in a region of the auditory brainstem
known as the dorsal cochlear nucleus (DCN) and
that cisplatin can cause such hyperactivity and
tinnitus. Dr. Kaltenbach examined the effect on
inner and outer hair cells in the inner ear, using
different dosages of cisplatin. He found that the
DCN hyperactivity (and tinnitus) was associated
with the loss of outer hair cells. In addition, dam-
age to inner hair cells that was caused by higher
dosages reduced the hyperactivity of the DCN. The
results suggest that tinnitus-as indicated by DCN
hyperactivity-may be caused by outer hair cell
damage, and that the effect may be offset or
reversed by inner hair cell damage.
Ablation
It has been known for some time that severing
the auditory nerve or destroying (ablating) the
12 Tinnitus 7bdayl June 2001 American Tinnitus Association
cochlea - the auditory part of the inner
ear - does not tend to relieve tinnitus. Quite a
few studies dealt with understanding the changes
that occur when these destructive procedures are
employed. Mark Zacharek, M.D., ofWayne State
University, desclibed one study that examined
the effect of cochlear destruction on spontaneous
activity in the dorsal cochlear nucleus (DCN)
when noise-induced tinnitus was present. The
researchers concluded that hyperactivity in the
DCN persists after removal of cochlear input.
Effects of muscle tension
Most of us know that sometimes jaw tension,
pressure against the head or neck, and the like
can change the loudness or character of tinnitus.
Last year, Robert Levine, M.D., of the
Massachusetts Eye and Ear Infirmary in Boston,
described his research on how body sensations
can influence tinnitus. This is technica11y
referred to as "somatic modulation oftinnitus."
Dr. Levine examined 70 consecutive tinnitus
clinic patients and found that 71% experienced a
resulting change in their tinnitus when they con-
tracted muscles in the head, neck, or extremities.
This year, Dr. Levine reported on the results
of a similar investigation performed on people
without tinnitus. He used a low-noise testing
room and found that most people developed
noticeable tinnitus in the quiet, and that their
tinnitus was modifiable by the same kinds of
muscle contractions as he identified before
in tinnitus patients. In addition, even among
the twenty people who developed no tinnitus
in the quiet room, eight developed loud, tempo-
rary tinnitus with at least one of the muscle
manipulations.
According to Dr. Levine, these results-which
must now be considered normal-can be under-
stood in terms of known interactions between
auditory and somatosensory systems within the
brain. In particular, Dr. Levine believes that the
principal interaction may occur within the dorsal
cochlear nucleus in the brainstem.
Electrical stimulation update
The brain and part of the inner ear operate
by means of electrochemical signals. While it is
possible to use sound to affect tinnitus, such as
with masking or habituation approaches, direct
electrical stimulation of neural structures is also
possible and can create effects that sound cannot.
Last year, several researchers reported their
attempts to reduce or silence tinnitus via electri-
cal stimulation. (See "Advances in Research -
A Report on the Association for Research in
Association for Research in Otolaryngology
Otolaryngology," June 2000 Tinnitus 7bday.)
Two of these had updates to report at this year's
meeting.
Jay Rubinstein, M.D., Ph.D., ofthe University
of Iowa Hospitals and Clinics, talked last year
about using electrical stimulation of the cochlea
to relieve tinnitus. Using a tiny electrode placed
through the eardrum near the round window of
the cochlea, a rapid stream of electrical pulses
was delivered. The rapid electrical pulse should,
in principle, restore the fiber firing patterns to a
more random, disorganized state, which could be
perceived as silence. In early testing, there was
evidence that some patients achieve a disappear-
ance of tinnitus during the stimulation, with the
stimulating pulse train itselfbeing heard or
"felt" by some but not by others. This year,
Dr. Rubinstein informally reported progress with
this testing and some tinnitus alleviation with
using cochlear implants to deliver the rapid
pulse train.
William Hal Martin, Ph.D., ofthe Oregon
Health Sciences University, talked last year about
preliminary work with electrical stimulation
aimed at the thalamus, a structure deep within
the brain. Deep brain stimulation has been tried
in the case of tremor and chronic pain, with
some success. Dr. Martin is exploring the idea
that stimulating parts of the thalamus with deep
brain implants (DBis) might disrupt abnormal
activity there and provide tinnitus relief. Early
tests continue to show that some patients experi-
ence quieter tinnitus when the stimulators are
turned on. Martin now reports that the lower
levels of electrical stimulation through the DBis
provide the most effective tinnitus relief,
although they do not know if the results apply
only to the group of patients studied so far. The
investigation continues.
All the rest
The meeting included 1,050 research papers.
Not all of the relevant studies can be described
here. Some that deserve at least mention
concerned the faint sound signal-known as
otoacoustic emissions-that are produced within
both normal and damaged inner ears. The under-
standing of these sounds produced within the ear
may lead to insights into inner ear function and
possible tinnitus treatments. An equally large
number of studies dealt with plasticity-the basic
ability of the brain to reorganize itself in complex
ways following, among other things, sensory
damage or long-term changes in stimulation.
Some researchers explored immune system
connections with Meniere's disease and other
inner ear disorders that include tinnitus as a
symptom. One study reported the first demon-
stration of fluid changes in the living inner ear
associated with endolymphatic hydrops (fluid
pressure within the inner ear that can cause
tinnitus, "fullness," impaired hearing, and balance
problems). Several research teams also reported
that bone-conducted ultrasound can activate the
auditory cortex in the brain via mechanisms that
bypass those of normal hearing. This lends
support to the efforts to develop both hearing
aids and tinnitus maskers based on ultrasound.
Momentum and promise
The problem of intrusive tinnitus is a com-
plex one still in need of answers. But individual
research projects like these help to illuminate the
whole puzzle. And there are-at last-promising
efforts underway. a
Chinnis is Vice-Chair of ATA's Board of Directors
and can be contacted at jchinnis@alum.mit.edu.
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American Tinnitus Association Tinnitus 7bday! June 2001 13
Coping with Tinnitus Stress
Stress is a natural response to many of life's
experiences, both positive and negative. Stress can
result from excitement before a big game or from
worry before a big test. A wedding, the first day
of a new job, and illness are all experiences that
stress us. In response to a stressful or threatening
situation, chemical changes occur in our bodies
that in turn cause physical changes in our bodies.
Blood vessels constrict in the skin, and heart rate,
breathing rate, and blood pressure increase. When
a stressful situation or threat is resolved, the body
returns to its normal levels of functioning.
Stress and Tinnitus
With tinnitus, the body often reacts as if it is
being threatened. When tinnitus is constant, the
stress-induced physical responses to the tinnitus
- such as agitation, depression, and insomnia -
can continue unresolved. It is very helpful for
tinnitus patients (and everyone else too) to learn
how to reduce the negative effects of stress.
A few stress-reducing therapies
that can help you cope -
Cognitive therapy
Cognitive therapy is a type of counseling that
is based on treating a patient's emotional reaction
to tinnitus rather than the tinnitus itself. To
accomplish this desired change in perception, a
counselor will help the patient identify negative
behaviors and thought patterns, then alter them.
Counseling programs are individually designed
for patients and are most effective when coupled
with other tinnitus treatments such as masking or
medication.
Biofeedback
Biofeedback is a relaxation technique that
teaches people to control certain autonomic (or
automatic) body functions, such as pulse and
brainwave activity. The goal ofbiofeedback is to
help people effectively cope vvith stressful situa-
tion - not by reducing the stress but by reducing
the body's physical reaction to it.
Biofeedback instruments have electrodes that
attach to the forehead and neck to measure skin
temperature, muscle contractions, and heart rate.
These measurements are electrically converted
into either blinking lights or audible beeps so
patients can "see" or "hear" their heart rate, tem-
perature, etc. Patients are taught to relax while
14 Tinnitus 7bdayl June 2001 American Tinnitus Association
they are connected to the biofeedback device.
When they are successful at relaxing, they will
hear slower beeps or see less frequent blinking
lights from the device. Eventually, patients learn
to control their physical tension without using
the device.
Hypnosis
Hypnosis is a procedure in which a hypnotist
suggests changes in thoughts, feelings, percep-
tions, or behavior to the person being hypnotized.
The goal is to create an external focus - such as
thinking about a relaxing scene - to redirect the
patient's attention away from the tinnitus. The
hypnotic state is not like being asleep. In fact,
brain waves are as active during the state of
hypnosis as they are during full wakefulness.
Tinnitus patients benefit greatly from the
deep relaxation afforded by one-on-one hypnosis
or self-hypnosis sessions. Patients can be easily
taught to do self-hypnosis.
Stress-Reduction Tips
The key to living with tinnitus is to remove it
from immediate attention. These stress control
suggestions and the following therapies have
helped tinnitus patients do just that.
1. Learn to relax.
Progressive Relaxation is one way to naturally
relax the body. By tensing and un-tensing
muscles throughout the body, you can induce a
pleasant state of head-to-toe relaxation. Will this
make tinnitus go away? No. But it can help you
feel calmer, more able to sleep, and better
equipped to manage other stresses in life that
can worsen tinnitus.
Here is one method of progressive relaxation:
+ Sit in a comfortable chair with eyes closed,
arms on the armrests, palms down.
+ Breathe deeply and slowly a few times.
+ Tighten each of the following muscles for
5 seconds, then release for 30 seconds.
+ Clench both fists, then release.
+ Press your back against the chair, then relax.
+ Tighten your abdomen, then relax.
+ Tighten your jaw, then relax.
Focus on other muscles one at a time, then
tighten and relax each one. Many books have
been written about relaxation. You Must Relax by
Edmund Jacobson and The Relaxation Response by
Herbert Benson are classics.
2. Breathe.
Deep, abdominal breathing is a natural relaxant.
To breathe abdominally, lead with your waist as
you breathe in. Breathe in through the nose to
the count of eight, slowly filling the diaphragm.
Hold for the count of four, then exhale slowly
through the mouth to the count of eight. Repeat
this cycle five times.
3. Exercise several times a week.
Thke a walk, swim, play tennis, golf. Do whatever
kind of exercise you enjoy. It will make you feel
stronger, and it is a great way to work off aggres-
sions and anxiety. If your exercise of choice
involves exposure to loud noise, like in an aero-
bics class, remember to protect your ears with
earplugs. (Some people have noticed that heavy
exertion makes their tinnitus louder, but only
temporarily.)
4. Play.
Many people are unaware of their tinnitus when
they get involved and engrossed in an enjoyable
activity: watching a movie, painting, sitting in a
hot tub, quilting, surfing the Internet, or stamp
collecting. Find a hobby that makes you happy.
5. Talk.
Do not hold back from talking about tinnitus with
your friends and family members. Give them the
ATA brochure "Understanding Tinnitus - Advice
for Family and Friends" so they can appreciate
the scope of your problem. You might be sur-
prised by their consideration and support.
Also, talk with other people who have
tinnitus. ATA has support network lists for areas
throughout the U.S., Canada, and other countries.
These lists are yours for the asking.
6. Listen to soothing sound..<;.
Listening to soothing music or nature sounds on
CDs and tapes can promote a comfortable state
of relaxation. Other soothing sound suggestions:
aquarium, electric fan, a shower.
7. Move.
T'ai Chi and yoga are two body movement disci-
plines that require you to slowly move, breathe,
and stretch all at the same time. These gentle
activities can relax tight muscles and improve
circulation. Classes are available for people of a11
ages and physical limitations.
B. Sleep.
With or without tinnitus, we all need to get regu-
lar, restful sleep. Avoid caffeine close to bedtime
since it sbmulates the nervous system. Make
your place of sleep comfortable: Replace a sag-
ging mattress; keep the temperature between 60
and 65 F. Play quiet background sound from a
tabletop environmental sound machine, a radio,
or a specially designed pillow. Tinnitus can
sound even louder when you are in total silence.
9. Protect your ears.
Even a short exposure to very loud noise can
make the tinnitus worse (though usually tem-
porarily), which can ruin a perfectly good day.
Wear proper ear protection (earplugs, earmuffs,
or both if the environmental noise is extremely
loud) so you can enjoy your outing.
10. Learn.
The more you know about a problem, any prob-
lem, the more control you have over it. The
American Tinnitus Association (ATA) has educa-
tional brochures, videos, books, articles, and the
quarterly journal Tinnitus Today - all tailor-made
for the tinnitus patient. Ifyou have a specific
question about your tinnitus, you can write to
Dr. Jack Vernon c/o of ATA. Dr. Vernon writes
the Q& A column for Tinnitus Today and answers
every question personally. a
US BOOK!
Tinnitus: Questions and Answers
by Jack A. Vernon and
Barbara Thbachnick Sanders
- now available through .ATA
'Ibpics include drug treatments,
research, alternative remedies,
hearing loss, hyperacusis, Meniere's
disease, masking, and tinnitus
retraining therapy. Tinnitus: Questions and Answers
also contains a comprehensive glossary and index.
Th order, use the .ATA Products Catalogue order
form on the inside back cover of this issue or on
our Web site (www.ata.org).
ATA member price: $22.50
Non-member price: $26.00
American Tinnitus Association Tinnitus 7bday! June 2001 15
Customized Sound Therapy- Tinnitus Research at the
University of California San Diego
by Alexander Kadne" Ph.D.
Tinnitus - a persistent ringing in the ears
that affects as many as SO million people in the
United States alone - is commonly thought to
be incurable. In fact, most people who develop
tinnitus are told, simply, "Get used to it." The
trouble is that tinnitus can be anything from
mildly irritating to devastating, depriving suffer-
ers of peace, sleep. In the worst cases, it has even
contributed to suicides.
An interdisciplinary team of researchers -
Jaime A. Pineda, Ph.D.; Andrey Vankov, M.D.,
Ph.D.; Alexander Kadner, Ph.D.; John Hestenes,
Ph.D.; F. Richard Moore, Ph.D.; and Erik Viirre,
M.D., Ph.D. - working at the UCSD Cognitive
Neuroscience Laboratory, has developed a new
approach to tinnitus therapy that seems very
promising for alleviating the condition altogether
in some individuals. This approach combines
knowledge gained in medicine, neuroscience, and
musical sound synthesis. The starting point is the
observation that tinnitus seems to diminish or
vanish-at least temporarily-after Hstening to
sounds that match the tinnitus. The main
research question is whether this phenomenon
can be used as the basis for long-term and effec-
tive therapy. In order to demonstrate that such a
treatment is indeed effective, we must have an
objective measure of tinnitus as a diagnostic tool.
No such measure presently exists.
Tinnitus is currently diagnosed primarily
through hearing tests that show the hearing loss
and give an indication of the pitch and loudness
of the tinnitus. Questionnaires are also used to
obtain a description of what the tinnitus sounds
like and its impact on a patient's daily life.
Tinnitus is not caused by a real sound, but by
brain activity that is often associated with hear-
ing loss.
One major aim of our present research is to
observe tinnitus in brainwaves through electroen-
cephalogram (EEG) measurements. EEG reveals
activity in the brain when a person listens to real
sounds. The research idea is that because tinnitus
causes the perception of a sound, parts of the
brain involved in sound perception must be
permanently active when tinnitus is present.
When the corresponding real sound is presented
to tinnitus sufferers, the active brain centers are
suspected to contain both tinnitus-related activity
and activity caused by the real sound. One cur-
rent hypothesis suggests that tinnitus-related
activity interferes with the perception of real
16 Tinnitus 7bday/ June 2001 American Tinnitus Association
sounds, causing measurable changes in the EEG
of tinnitus sufferers as compared to the EEG of
individuals with normal hearing. Results to date
support this idea and indicate a measurable dif-
ference between tinnitus sufferers and normal
control subjects.
Another research aim is to develop an effec-
tive therapy for tinnitus sufferers based on expos-
ing tinnitus patients to sounds that mimic their
tinnitus. This work is a collaborative effort
involving our lab and Dr. Erik Viirre of the
Department of Surgery and Dr. Dick Moore-a
sound synthesis specialist in the UCSD Music
Department. The sound therapy is derived from a
learning-based form of tinnitus therapy: tinnitus
retraining therapy (TRT), introduced in the mid
1990s. TRT seeks to make tinnitus less annoying
by both counseling and exposing the patient to a
continuous, unchanging sound. Since this sound
does not convey useful information, after some
time habituation will occur: the sound is per-
ceived more weakly or not at all. While TRT
habituates patients to the presence of sound in
general, we have developed a Customized Sound
Therapy that utilizes each patient's unique
tinnitus sound as the habituation stimulus.
Through a sound synthesis procedure devel-
oped by Dr. Moore, patients listen to real sounds
that match their tinnitus perception. These
sounds are downloaded onto a small, portable
MP3 player. Patients listen to the sound for as
long as is comfortable every day. Over a short
period of time, patients habituate to the sound
of their MP3 players, and this habituation extends
to their tinnitus perception. Th date, we have 11
patients enrolled in the study at various stages of
treatment. A few patients, for example, have just
begun treatment, and one has had his progress
tracked for 10 months. All patients have reported
improvement, and some have reported temporar-
ily losing their tinnitus a1together. More specifi-
cally, the perceived loudness of the tinnitus
decreases by up to 30 dB within a few weeks of
starting the therapy. These results are very
encouraging to the researchers and, much more
importantly, to the patients.
Before Customized Sound Therapy can be
considered a tinnitus treatment, we have to
gather a larger sample of patients. It will still be
some time before we can prove its effectiveness,
but we are excited about it. B
Dr. Kadner can be contacted at akadner@ucsd. edu,
or 858-534-9754.
EXPOSURE TO AIR BAG DEPLOYMENT
by Kathleen Yoremchuk, M.D., Vice Choir, Dept. of
Otolaryngology /Head and Neck Surgery, Henry Ford
Hospital, Detroit Ml
It has been several years since the first report
of hearing loss or tinnitus from air bag deploy-
ment was published. Yet many emergency room
physicians, primary care physicians, and even
otolaryngologists are unaware that air bags have
the potential to cause otologic damage. Deploying
driver and passenger side air bags can produce
140-170 dB of impulse noise. Deploying side air
bags have been recorded at 185 dB.
We have collected close to 100 cases of
patients with aural complaints after air bag
deployment. We continue to solicit information
from patients and their physicians and audiolo-
gists to expand this study. There is a standard
form that can be obtained from my office by call-
ing 313-916-3282 to report patients with symp-
toms after air bag deployment. An audiogram
that was done before or after exposure to air bag
deployment is helpful for our data analysis and
should be included with the questionnaire.
Audiograms from before and after would be even
more helpful for us to see.
I have been contacted by several attorneys
who have wanted to review records of patients
whose tinnitus and hearing loss began after being
in motor vehicle accidents with air bag deploy-
ment. In looking through emergency room
records, it is clear that ringing in the ears and
decreased hearing are the most common post-
motor vehicle accident complaints from patients.
Routine Emergency Room procedure is to obtain
x-rays of the neck and skull. Yet audiograms are
not performed for months afterward. Usually, the
patient is seen by his or her primary care physi-
cian and then referred to an otolaryngologist who
may or may not obtain an audiogram at the first
visit. If you are in a car accident when an air bag
deploys, it is important to have an audiogram
performed as soon as possible afterwards to docu-
ment any damage that may have occurred.
The Society of Automotive Engineers (SAE)
Passive Restraint Task Force has decided to fund
a prospective study of otologic damage secondary
to air bag deployment. Unfortunately, due to a
change in staffing, nothing has happened for the
past year. A meeting is scheduled in the spring of
2001 to get the study back on track. Hopefully,
the public's perception that air bags are totally
harmless will be corrected. Hopefully, too, indus-
try will desist from its policy that more air bags
are only better, and acknowledge that more air
bags are also louder. B
You're Invited to Chat With Jack!
June 26, 2001 II www.ata.org
An exciting opportunity to chat with Jack Vernon in real-time
Join Jack A. Vernon, Ph.D., on Thesday, June 26, 2001, 3:30p.m. Pacific
time, for a LIVE Web chat at www.ata.org. This ATA Members Only chat will
follow the same question-and-answer format you've grown to love here in each issue
of Tinnitus 'Ibday. Ask Dr. Vernon about clinical treatments and research studies-
and about more in-depth topics like acoustic neuroma, hearing loss, masking,
medications for relief, alternative remedies, coping skills, and pulsatile tinnitus.
Instructions are on our Web site. Bring your questions or just log on and watch the
conversation! Ill
American Tinnitus Association Tinnitus 'Ibday/ June 2001 17
Practical Help with Tinnitus
by Jo Haze/by
We have access to masses
of information about tinnitus
these days, from national
tinnitus associations, profes-
sionals, the various Web sites.
Why, then, does tinnitus still
bother us? vVhat else do we
need to do? Exactly what are we trying to
achieve? Is it silence that we want? To me, being
profoundly deaf is silence and that is not what
1 want. All life consists of sound, so why are we
so distressed about the presence of tinnitus?
Personally, when I became severely depressed by
the constant sound, I wanted health and happi-
ness back in my life.
The Ottawa Charter for Health Promotion
gave a new definition of health: "To reach a state
of complete physical , mental, and social well-
being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs,
and to change or cope with the environment."
(Davey et al., 1995, p. 377.) We need to identify
our aims, look at our strengths that enable us to
achieve our aims, and decide how we wm know
that we have achieved our aims. Because day-to-
day progress can be so minute and unnoticeable,
how do the professionals measure their patients'
success? A common method of measurement is
the questionnaire that establishes how much
effect tinnitus currently has on our lives. And, in
six months' time, a comparison questionnaire can
show what progress we have made.
How do we achieve all these things without
expensive consultations? I would like to suggest
that, by working in a group, we can help our-
selves and others at the same time. It's true that
we each need to take responsibility for our own
condition and our own well being, and find our
own individual solutions. However, we do need
the understanding and support of others. Progress
can be slow, or at least seem slow, when we have
been listening to the sound of tinnitus for many
years. And setbacks will occur. But seeing and
hearing about other people's successes can make
such a difference! I run such a support group in
London. I recently asked members why they
come to the group. Many responded that they had
found the group so helpful that they wished to
pass on some of what they had learned to new-
comers. 'TWo people, however, were still as dis-
tressed as when they first came to the group. But
it became clear that other problems were at the
root of their distress. This could be why their
sound levels remained high.
18 Tinnitus 'Ibdayl June 2001 American Tinnitus Association
At group meetings, I use the expertise I gained
at the many psychology classes I attended from
1984 to 1990, when I could find little help or infor-
mation on tinnitus. I teach the skills we all need,
namely: relaxation techniques, self-hypnosis,
cognitive therapy related to tinnitus (which I
learned from Gloria Reich at a seminar in
Chicago), stress management, assertion training
which helps us state our needs without aggression
and make decisions without an excess of stress,
and healthy eating and living. Our group has
watched the video featuring Stephen Nagler (we
watched it in half-hour segments), and followed
each installment with discussion. We have com-
pleted a survey showing the wide variety of
sounds that we hear, what we have found helpful,
and what we have found that makes it worse. We
included our aims, our strengths, and how we will
know that we have reached those aims. If the aim
is for me to provide a cure for them, however, that
is unrealistic. If they hope that receiving informa-
tion will be sufficient, they might find that it's not
enough to effect a change. This more realistic aim
was put forward by one person: "A day where for
most of the time I am unaware of the sound."
As a support group facilitator, I do not profess to
provide a "cure." In fact, I do not actually DO any-
thing other than provide information. People come
to our support group to work on themselves.
I was told at a tinnitus retraining therapy
(TRT) training course that people have to change
their reaction to tinnitus before they can change
their perception of it. When I heard that, I recalled
my first reaction to tinnitus and my first thoughts:
"I cannot live with this noise. No one could." But it
wasn't true. I was living, but not enjoying it. Now
that I am unaware of the tinnitus most of the time,
my thoughts are, "Oh! I cannot be bothered to lis-
ten to that. There must be something more worth-
while to do or listen to." Those are the two
extremes of my reaction.
All of us who help others experience this com-
mon reward: We hear and see the difference we
have made in people's lives. The feedback that we
get makes it all worthwhile. We also learn from
people who attend our groups. One person in my
group said she felt that tinnitus was like having a
built-in barometer, with the tinnitus arriving to tell
her she needed to relax for a while, to worry less,
and to take better care of herself. Another person
related how irritated she was that her tinnitus
returned every day at 6 p.m. just as she was relax-
ing in front of the TV. On one occasion she said to
it, "You want me to listen to you, do you? I have
not heard you all day so I will. You have
15 minutes then I will be into my program."
In 15 minutes, it faded away again. She thought
making a friend of it was a good thing to do! I
hear success stories from all around the world,
not just within the U.K.
Years ago, when a consultant told me to go
away and lead a calm and happy life because
nothing could be done about the noise, I thought
bitterly that life is just not like that. So I studied
psychology, which taught me a lot about living,
about making choices, and about changing only
myself, not others. Now, I would not go back to
being the person I was prior to tinnitus, even if it
meant never hearing that sound again.
I have a lot to thank my ti.nnjtus for. It's
given me the chance to meet lots of interesting
people and create a wide circle of friends. It's
given me a worthwhile job to occupy me in
retirement and the motivation to continue learn-
ing. It brought me out for a visit to Portland,
Oregon, for the Fifth International Tinnitus
Seminar in 1995 and it's getting me ready for a
trip to Fremantle, Australia, for the next interna-
tional tinnitus seminar in March 2002. For me
there have been many rewards.
Not everyone needs to embark on the same
learning and training course as I did. The infor-
mation is at hand for anyone who looks for it.
But we do need to give and seek support. We do
need to be prepared to change aspects of our
lives that work against us. We do need to know
that it CAN be done. We just need to learn to live,
in order to live with tinnitus. Although it did take
a long time, my tinnitus went from the noise of
a jet engine on take off to a tinny sound that is
seldom heard. I am living proof that is possible.
If I can do it, anyone can. II
Reference:
Davey B., Gray A. and Seale C. (eds) (1995) Health and
Disease, Buckingham, Open University Press.
Ms. Hazelby is coordinator of the International
Tinnitus Support Association (ITSA) and a member
of the Council of Management of the British Tinnitus
Association.
Adverrisenumt
Now masking tinnitus won't
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Finally, here's the product that will help you both sleep - The Sound Pillow.
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American Tinnitus Association Tinnitus 7bday/ June 2001 19
Jack A. Vernon- Winner of the
2001 Oticon Focus on People Award
Jack A. Vernon, Ph.D., was the 1st place
practitioner-of-the-year winner of Oticon's 2001
Focus on People Award. The award ceremony was
.held on Aprill9, 2001 in San Diego, California.
When Jack stepped up to the podium to receive
his award, he began his acceptance speech in
typical Jack style. He shook his head he said,
"You've made a terrible mistake by giving me
this award. This really belongs to all people with
tinnitus. Everything I know about tinnitus I
learned from my patients."
With its annual award pro-
gram, Oticon, Inc. celebrates the
accomplishments of hearing-
impaired children, students,
adults, advocates, and profession-
als, and those who make outstand-
ing contributions to the lives of
people with hearing disorders.
Each winner receives $1,000 and
gets to designate an organization
as recipient of an additional
$1,000. Dr. Vernon chose the
American Tinnitus Association as
his $1 ,000 recipient.
So many people feel they
Dr. Vernon often says that his greatest
achievements were the result of his listening to
what patients told him. For example, while he
is known as the father of "masking," the first
useful and applied sound-emitting treatment for
tinnitus, he gives credit to Dr. Charles Unice for
the discovery. Unice exclaimed, while standing
near and listening to a fountain one day, that he
no longer noticed his tinnitus. Dr. Vernon pur-
sued Dr. Unice's eureka as a possibility for helping
others with tinnitus - and the
behind-the-ear "tinnitus masker"
was born. Likewise, a patient tied
a hearing aid and a masker
together and told Dr. Vernon that
it helped both his hearing loss
and his tinnitus. Dr. Vernon pur-
sued the idea with a hearing aid
company to produce a combina-
tion unit for the benefit of more
patients - and the
11
tinnitus
instrument" was born. Thday,
these devices are the backbone
of tinnitus therapy worldwide.
know Jack because they've read Jack A. Vernon, Ph.D., and
Dr. Vernon directly
influenced the start of many
hearing-related research projects
including: development of an
instrument to deliver painless
his "Questions and Answers" Oticon President Mikael Warning
column in Tinnitus 'Ibday or because they've
talked with him on the phone. If you are one of
those people, and you found him to be affable,
kind, generous, and dedicated, then you are right
- you do know Jack. But few people know the
magnitude of his involvement in the world of tin-
nitus. The following is a brief outline of the work
of a great man, and no doubt the reason for
Oticon's 1st place honor so appropriately
awarded.
Jack Vernon is a longtime champion of
tinnitus patients and an indisputable tinnitus
research pioneer. His own basic tinnitus research
began in 1968 and was followed by the founding
of the first tinnitus clinic in the U.S at the Oregon
Hearing Research Center, part of Oregon Health
Sciences University. Jack's passionate interest in
tinnitus prompted the founding of the American
Tinnitus Association in 1971, now a national
research-funding organization. His optimism for
the condition and his willingness to try out new
ideas pushed the mysterious disorder of tinnitus
into a national and NIH-funded spotlight.
20 Tinnitus 'Ibday!June 2001 American Tinnitus Association
anesthesia to the eardrum, development of a
masking device for the treatment of tinnitus,
development of a device to detect hearing loss in
the high frequencies, and development of an
implantable bone-conduction hearing aid to assist
individuals with certain kinds of hearing loss.
With international acclaim, Dr. Vernon con-
tinues to publish books on the topic of tinnitus
for patients and healthcare professionals, and
dedicates one working day each week to receive
patients' calls. And call they do, from all over the
world, for his help, compassion, wisdom, and
answers.
From his personal admonition to every
person to use hearing protection in noisy envi-
ronments without exception to his current,
persistent encouragement of pharmaceutical
companies to identify a drug for tinnitus, Jack
Vernon continues his advocacy for hearing health
and innovative research for the benefit of present
and future generations. B
Member Notes
by Jessica Allen, Director of Resource
Development
Thank you, members, for
your strong support. Our last
campaign raised over $55,000.
In addition, over 700 of our
lapsed members returned to
the ATA as renewed members.
We are very excited about this. The more voices
we have, the more we will be heard.
I hope you have been noticing the many arti-
cles being published on tinnitus and the ATA. On
March 26, 2001, USA Tbday ran an article on tin-
nitus in the living section. Several CBS television
affiliates ran tinnitus public service announce-
ments (PSAs) nationwide featuring Thny Randall
and Jerry Stiller. In addition, there was some
radio coverage as well featuring Thny Randall as
the tinnitus spokesperson. Preview the PSAs the
next time you access the ATA Web site
(www.ata.org).
If a tinnitus article runs in your area, please
let me know. You can reach me at 800-634-8978
ext. 218, or you can send a copy of the article to
my attention at the ATA office. Please look for
upcoming articles in Barron's and Woman's World.
Also keep an eye and an ear out for the radio and
television spots.
Don't Miss this Event!
Please plan on being in Portland, Oregon on
November 10, 2001, to help us honor a great
benefactor of the American Tinnitus Association
- Dr. Jack Vernon - at the second Founders'
Gala. Dr. Vernon has been treating tinnitus
patients and researching tinnitus treatments
since 1968. In fact, he is a founding father of
the ATA.
Most of you know him through his question
and answer column in Tinnitus Tbday. Some
might have experienced his warmth and compas-
sion personally when you contacted him to seek
help with your tinnitus. Dr. Vernon is truly an
outstanding hearing health care professional.
A full day of activities is planned. Saturday
morning begins with a free, public symposium
featuring national experts and highlighting the
latest in tinnitus research and treatments. The
Founders' Gala dinner will follow where Jack's
colleagues will do some serious and not-so-
serious reminiscing about his career. It will be an
opportunity to meet tinnitus researchers, health-
care providers, scientific advisors, the ATA Board
of Directors, fellow ATA members, and Dr. Jack
Vernon himself.
In honor of ATA guests, the Portland Hilton
Hotel extends a special nightly room rate of $119.
The Gala tickets are $150 each and include the
Saturday morning symposium, evening dinner
with wine, entertainment, many laughs, and a
few surprises. This is an event not to be missed!
Please call us at 800-634-8978 ext. 219 for
more information or if you did not receive your
special advance invitation in the mail.
Canine all ears for his master
Dennis Robertson of
Kamloops, British
Columbia, Canada, with
his hearing assist dog
Crackers
ATA member Dennis
Robertson, his wife Win,
and special hearing dog
Crackers visited the ATA
headquarters this April.
Dennis suffers from
tinnitus and severe high-
frequency hearing loss.
Crackers hears high-
pitched sounds for Dennis
like the telephone, door-
bell, or sirens and alerts
Dennis by barking or
touching him with his paw.
Having a dog
has also helped Dennis
cope with his tinnitus.
"Tiredness, depression,
loneliness, and lack of exercise all cause tinnitus
to become worse. Now what could be better to
overcome these problems than a dog, especially a
hearing dog? On down days, I just look at his big
brown eyes and think, 'How can I not take him
for a walk?' Activities with my dog keep me busy.
It's a lot better than if I sit around and 'listen!"
Guide animals, such as Crackers, are available
through Canine Companions for Independence
(800-572-2275 or www.caninecompanions.org).
Although the wait to get an alert dog can be a
year, in Dennis's case, it was worth it. B
American Tinnitus Association Tinnitus 7bday/ June 2001 21
SeekingATA
Board Committee
Members
The American Tinnitus Association (ATA)
Board of Directors is responsible for setting ATA
policy and determining the direction of the organi-
zation. The ATA Board Committees assist the
Board of Directors by recommending policies in
their specific areas of responsibility. Participation
on Board Committees offers an opportunity to
work with Board members to provide a needed
service to the ATA. These committees convene by
telephone monthly or bi-monthly (maximum of
nine times per year). Currently, the Board of
Directors is looking for volunteers who are willing
to commit to participating on an ATA Board
Committee for one year beginning August 1, 2001.
We will have limited openings on the following
committees:
Business Committee
The Business Committee seeks volunteers
who have financial experience, are willing to assist
in the oversight of ATA's financial and business
operations, as well as monitor ATA's investments
in accordance with ATA Investment Policies. This
committee plans to meet bi-monthly.
Human Resources Committee
The Human Resource Committee see1<s volun-
teers who are interested in recommending policy
in the area ofhuman resource needs, including
staff and volunteers. This committee plans to meet
bi-monthly.
Legal & Advocacy Committee
The Legal & Advocacy Committee seeks volun-
teers to provide leadership on legal and advocacy
issues related to ATA's mission, committees, board
and staff, and the overall organization. This com-
mittee plans to meet monthly.
Program Committee
The Program Committee seeks volunteers who
v.rill assist the ATA in brainstorming new program
ideas and evaluating existing programs in the
areas of education (patient and professional),
research, and support. This committee plans to
meet monthly.
If you are interested in participating as an
ATA Board Committee Member, feel free to obtain
an application from our Web site at www.ata.org or
contact Laura Grimes at 800-634-8978 ext. 223.
22 Tinnitus Thday/ June 2001 American Tinnitus Association
New Self-Help Volunteers
A warm welcome goes out to the American
Tinnitus Association's newest Help Network
volunteer and Self-Help Group leaders. Showing a
heartening commitment to tinnitus awareness
and support, these four people join the ATA net-
work oflaypeople and professionals who provide
tinnitus patients nationwide with support, infor-
mation, and resources.
If you're interested in becoming a Self-Help
Group leader or Help Network volunteer, please
call the ATA at 800-634-8978 or 503-248-9985,
ext. 211.
New Tinnitus Help Network Volunteer
Shelley Mae Oliva
189-11 45th Rd.
Flushing, NY 11358
bsbchik@dellepro.com
New Tinnitus Self-Help Groups
'Ibnya Bar low, M.S., CCC-A
406 Blankenbaker Pkwy., Suite A
Louisville, KY 40243
502-245-5101
bebalancedbytb@aol. com
Larry IJHeureax
6 Old Belgrade Ave.
Oakland, ME 04963-4601
207-465-4555
appraise@qsilver.net
Gordon Holloway
2230 N. Univ. Pkwy.- Cottontree Sq., Suite 9B
Provo, UT 84604
801-465-1956
utahtinnitus@sisna.com
Announcement
Ninth Annual Conference on the
Management of the Tinnitus Patient
October 4-6, 2001
For professionals and tinnitus patients.
The University of Iowa, Iowa City
Guest of Honor: Robert Levine, M.D.,
of the Harvard Medical School, Massachusetts
Eye & Ear Infirmary
Contact: Rich 1Jler, Ph.D., 319-356-2471,
rich-tyler@uiowa. edu
QUESTIONS AND ANSWERS
Jack Vernon's Personal Responses to Questions from our Readers
by Jock A. Vernon, Ph.D., Professor Emeritus,
Oregon Health Sciences University
Q
Mr.Z.from
Pennsylvania sent
us an advertisement
for Bio-Ear, and he asks if
he should continue using
it longer since initial use
has had no effect upon his
tinnitus.
A
I don't expect this
substance to have
any effect upon
your tinnitus no matter how long you use it.
While Bio-Ear claims "blissful tinnitus relief' in
its catalogue ads, the label on the bottle avoids
mentioning tinnitus, which is why the FDA has
no authority over it. Remember, this is a non-con-
trolled substance. Therefore it does not have to
be tested for either safety or effectiveness. To my
knowledge, Bio-Ear has not been properly tested
for tinnitus. We have heard from a few people
who've tried the product. Some have been mildly
helped; some had a worsening of their tinnitus.
Most, however, noticed no effect.
Bio-Ear contains: aloe in an alcohol base,
ginseng root, bitter orange, dandelion root,
myrrh, saffron, senna leaves, camphor, rhubarb
root, zedoary root, carline thistle root, and
angelica root. Although Bio-Ear's ingredients
seem innocuous, side effects are possible with
any drug or herb.
Q
Mrs. M. in Pennsylvania would like to
know why she hears music in one ear.
She says that she has not heard of any-
one having that kind of tinnitus.
A
This is a rare form of tinnitus although
I have seen two other patients whose
tinnitus took the form of music. One
heard a long list of hymns and the other heard
classical music. In neither case could they influ-
ence the actual music they heard. In Mrs. M:s
case, she hears a man's voice singing. I don't
know what causes this type of tinnitus but most
likely it involves some part of the memory sys-
tem in the brain. Note that in all these cases,
what they experience as tinnitus is what they had
actually heard at some point in their lives. They
were not creating new music. (See "The Sounds
of Your Tinnitus," p. 5)
Q
Mr. M. . in Utah has had tinnitus for about
two years, which in the beginning came
on at night but disappeared during the
day. Soon he noticed a drop in hearing and now
the tinnitus is present day and night. He is now
able to become somewhat unaware of his tinnitus
by saying to himself that his work is more impor-
tant than the distraction of his tinnitus. (That's a
pretty good adjustment, I'd say.) He had found
that the noise of the shower not only masked his
tinnitus but produced residual inhibition (a short-
term cessation of the tinnitus) as well. 1b this
end, he purchased a hearing aid, which helps the
tinnitus. "But," he asks, "why am I not getting
residual inhibition?"
A
Mr. M., residual inhibition is virtually
never achieved with the use of hearing
aids. But about 83% of patients studied at
the Oregon Hearing Research Center experienced
some form of temporary tinnitus cessation after a
masking sound was removed. It's good that you
are obtaining tinnitus relief with the hearing aid.
But I suggest that a tinnitus instrument - a com-
bination unit of hearing aid and masker - might
improve things. In the first place, you might find
that very little masking sound is needed to cover
your tinnitus. Secondly, you might experience
residual inhibHion when you turn the masker
portion off. Did your hearing test reveal a hear-
ing loss on one side only? If the loss is bilateral
you may find increased ease of communication
with two hearing devices, either hearing aids or
tinnitus instruments.
Q
Mr. D. in Israel asks if it is possible to
have two cochlear implants. His first
implant did not relieve his tinnitus. But
by introducing masking sounds through the
implant, he was able to control and relieve the
tinnitus in the implanted ear. He still has tinnitus
in the opposite ear and asks if it is possible to
also have a cochlear implant in that ear.
A
Currently, the U.S. Food and Drug
Administration only allows implantation
of one cochlear implant per person. This
has always been difficult for me to understand
(continued)
American Tinnitus Association Tinnitus 7bday! June 2001 23
QUESTIONS AND ANSWERS (continued)
since we were born with two ears for a reason.
Sound localization with one ear alone is almost
impossible, so events arising from the non-hear-
ing side tend to be alarming. Also, with only one
working ear, a person has to always place people
on the side of the good ear. I don't know the rul-
ing in Israel regarding bilateral cochlear implants,
but I do know that the possibility ofbilateral
implants is being investigated in the U.S.
Q
Mr. S. in Minnesota asks about the
difference between sound generators
and maskers.
A
The sound generator as used in tinnitus
retraining therapy (TRT) is operated at
an intensity level that allows the patient
to hear both the tinnitus and the noise from the
sound generator at the same time. The tinnitus
masker is operated at an intensity that either
covers up the tinnitus sound entirely or signifi-
cantly reduces its intensity. The TRT sound
generator is to be worn or used for the entire day
whereas the tinnitus masker is to be used on an
as-need basis. The therapies are different in that
patients wear maskers to obtain immediate relief,
and will need to wear them whenever tinnitus
relief is desired. In TRT, the devices are worn as
part of a long-term therapy, maybe lasting as
long as 24 months, with the intention that
patients will one day no longer need the devices.
Q
Mr. A. in Illinois asks how he can
get information about the tinnitus
instrument?
A
The tinnitus instrument is a special
device made for those who have not
only high-pitched tinnitus but also high-
frequency hearing losses. (This combination of
complaints is common.) The instrument is a
dual unit with a high-frequency-emphasis hearing
aid and a high-frequency tinnitus masker with
independent volume controls. These tinnitus
devices are made by Starkey, General Hearing
Instruments, and Seimens, and can be ordered
for you by any dispensing audiologist. To prop-
erly use the tinnitus instrument, adjust the hear-
ing aid portion first so that your high-frequency
hearing is at the best level possible. This way,
you can appreciate the high-frequency portion of
the masking sound when it is introduced next.
24 Tinnitus Thday/ June 2001 American Tinnitus Association
Q
Mr. C. in North Carolina indicates that
every time he cuts fiberboard on his
band saw his tinnitus disappears for sev-
eral hours and sometimes for as long as a full day
after. "How can this happen?" he asks. He notes
that the sound ofhis band saw and the sound of
his tinnitus are exactly the same.
A
The answer, I think, is simple. The sound
of the band saw in fiberboard is at the
exact pitch that masks your tinnitus,
which in tum induces residual inhibition. It is
my belief that one way to induce residual inhibi-
tion is to mask the tinnitus with an exact duplica-
tion of the tinnitus. And I believe, Mr. C., that is
what you have done. The interesting aspect of
this case is that your band saw noise has not
increased your tinnitus. When I use my band
saw, I have to wear earmuffs to prevent an exac-
erbation of my tinnitus. But then my band saw
noise does not match the pitch of my tinnitus.
Q
Mr. K from Illinois sent in a report about
the injection of lidocaine through the
eardrum into the middle ear space ask-
ing what I thought about this procedure.
A
Some time ago, we did a study wherein
26 tinnitus patients IV
of lidocaine. For 23 patients, the tmmtus
disappeared for about 30 minutes. One week
later, we repeated the procedure with the same
patients but were unable to get the same results.
From this we concluded that lidocaine is an inter-
esting drug to study but that it does not offer a
practical therapy for tinnitus. The current lido-
caine procedure needs to be studied in a double-
blind, placebo-controlled way and then repeated
at other centers with positive results. Those are
the correct steps to take to establish this proce-
dure. But neither step has been taken yet.
Q
Ms. J. from Washington states that
up until recently she has had only one
tinnitus sound, a high-frequency ringing.
But recently, another sound has been introduced
and it is a low-pitched humming, which is more
troubling. She asks what she can do to relieve her
condition.
A
You should be able to mask the humming
with a low-pitched masking sound.
Petroff Audio 'Technologies (818-716-6166)
manufactures CDs with a variety of masking
sounds and pitches, several of which would be
QUESTIONS AND ANSWERS (continued)
suitable for masking low-frequency tinnitus.
Because speech, music, and almost all of our
environmental sounds are also in the low-pitch
region (below 4000 Hz), the low-pitched masking
sound will most likely interfere with your ability
to hear speech, which means you might have to
remove the masking sound when you wish to
hear speech. Everything has its price.
Q
Mr. N. from Arizona asks, "What do you
know about Wobenzyme-N, and do you
know anyone who has taken it for
tinnitus? I saw it on the Internet."
A
The combination enzyme product called
Wobenzyme-N is of German origin. It is
being sold over the counter in the U.S.
as an anti-inflammatory medicine. As far as we
know - and we have been investigating this for
some time - there is no research that shows its
effectiveness for tinnitus. A German doctor wrote
to us a few years ago about his using Wobenzyme
for his own tinnitus as well as for his patients'
tinnitus, but he has not responded to any of our
letters ore-mails since that communication. It is
possible that this product could help tinnitus, but
without any scientific information, we are in the
dark. Be careful of what you read on the Internet!
Notice: Many of you have left messages requesting
that I phone you. I simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:00a.m. - noon and 1:00 - 5:00p.m.
Pacific Time (503-494-2187). Or mail your questions
to: Dr. Vernon clo Tinnitus Today, American
Tinnitus Association, P. 0. Box 5, Portland, OR
97207-0005. Or send e-mail to: vemonj@ohsu.edu.
Mvertisernent
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American Tinnitus Association Tinnitus Today/ June 2001 25
SPECIAL DONORS AND TRIBUTES
ATA"s Champion Members are a remarkable group
of donors who have demonstrated their commitment in
the fight against tinnitus by making a contribution or
research donation of $1000 or more. Sustaining
Members have given memberships or research donations
at the $500-$999 level. Contributing Members have
given memberships at the $250-499 level. Suppor ting
Members have given memberships at the $100-499 level.
Research Donors have made research-restricted contri-
butions in any amount from $100 to $499.
Contributions to ATA!s Tribute Fund will be used to
fund tinnitus research and other ATh programs. If you
would like this contribution restricted for research,
please indicate it with your donation. Thbute contribu-
tions are promptly acknowledged with an appropriate
card to the honoree or family of the honoree. The gift
amount is never disclosed.
Our heartfelt thanks to these special donors.
All contributions to the American Tinnitus
Association are tax-deductible.
GIFTS FROM 1-2-01 to 4-1-01
Champion Members Rae Arose Donna Graham
(Conniliutions of Duane A. Brurd Seymour Greenstein
$1000 and aboue) Jack Balos Donald F. Grundler
Greg Armstrong John J. Banavige Jane A. Grunewald
Robert W. Booth Carl Bannon Donald D. Guito
Matthias B. Bowman E. L. Barnes Philip J. Gutentag
John N. Carlson James R. Bamey Scott Gunman
Sidney C. I<Jeinman John Bartlett John R. Hafer
Mary B. Meikle, Ph.D. Sherwin A. Basil, M.A. William D. Hagerty
Don Morse M. Lloyd Baum Eugene Hale
Bert Pearl Peter B. Baylinson J ohn E. Hammill
Hubert G. Phipps Judith E. Beaston Robert R. Harmon
Robert E. Sandlin, Ph.D. Richard L. Behr John C. Harrington
Stephen M. Schwarcz, Philip Benedict Kent Harris
D.D.S. Dan G. Best James and Colleen
Gaynell Shady R. John Bishopp Hartel
Arthur C. Tauck Stewan Black Diana G. Haver
Jack A. Vernon, Ph.D. Sanford Blaser Richard H. Haws
Robert E. Bodoh A. James Heins
Sustaining Members Rod Bonser Mark Herritz
(Contributwns of Richard Bouthiette Paul G. Hill
SS00-999) Lois Bowman Dorothy R. and John
EliZabeth A. Artandi Robert J. Bradley Hiltner
Larry S. Brown Alan L. Brock Lorraine Hizami
Nina A. Colbert Sharon B. T. Buchan Thea D. Hodge
Rob M. Crichton Bryan Bunting Ted Hofmeister
Bill Lanehart William A Burgin Geo.rge Homa. Jr.
George A. Meyer Richard A Burns W.F.S. Hopmeier, BCHIS
Philip 0 . Morton Stephen c. Carlson V. Don Hopper
Jeffi'ey Nobel Mary J. Cavins Andrew Hrivnak, Ill
Ronald A. Seelye Merle C. Chambers Ted Hubbard
Martha M. Smith Linda Champlin Richard L. Huggins
Agnes Varis David M. Charles, M.D. Marti Huizenza
Dehner D. Weisz Davis Chauviere William H. Hurt
Raymond L. and Beverly Kenneth R. Cherry Steven M Huyck
J. Wells Clary Childers Robert C. Incert i
Delbert W. Yocam Gardner C. Cole James lrving
Arnold Zousmer Robert E. Collawn Earnest L. Jackson
Contributing Laura Collins Harry Jacobsen
Members James J. Corless Timothy J. Jacoby
Mary F. Crosier Wayne G. Jakobs
(Contributions of Russell A. Cunningham Eric Jensen
$250-499) Dennis M Daly Gary J. Jensen
David M. Alexander John G. o'avis Nils P. Jensen
Sam Berkman Walter Z. Davis, Jr. Frances M. Johnson
Dhyan Cassie, M.A., Ruth E. DeLynn Lyle Johnson
CCC-A Gilles C. Desbiens Scott Johnson
Gary M. Chase Lewis C. Desch L. Craig J ohnstone
John w. Finger James Dicicco Kenneth w. Jones
Bernard J. . Jack Dickens Louis I. Jones
Ntcholas T. G10rg1anm John L. Dosen Paul J. Jones, M.D.
James S. Gold Irene Duffield Thomas L. Jones
W. J: and Helen Gotschal1 Janet Eiseman Michael c. Jordan
Phihp H. Ingber Douglas E. Eller Daniel Kahn
Enc F. Janie Greg and Betty Evans David Kaplan
NJ.ls.P. Jensen. James D. Faville Michael Katsaros
Wilham J. Kfught Harold Feld Henry B. Keese
Jerry Lastehck Marcy Feldman Alexandra B. Keith
Mary K. Matson Jerry N. Fetter David C. Kelsall, M.D.
AndreN. Schipper Ronna Fishe M S Jim Kennedy
Richard W: Sullivan Bernard Fishman K.D. Kennedy, Jr.
Agn7s Vans Kathryn E. Fitzsimmons John B. Kent
Dame] H .. walker Margaret Fleming Donald King
R. W1.1\ner Paul M. Flowerman 0. Ray Kirkpatrick
Mtnam Wmner Mary A. Floyd Joan Kleinbard
Supporting Members D. Jearu1e Larry Kopel
(Contributions of Stephen Fre1feld, M.D. Egon Kot, BG-HIS, FNAO
$100-249) Katheri.ne L. French Martin Krasnitz
Vivian Urdaz Alvarez, L01s Fr1cke Ronald T.
M.D. Laura J. Fuller RobertS. Kupor
David R. Anderson Patricia Gans RobertS. Kurz
Joe H. Anderson, Jr,. Janet C. Garman Robert M. Kyvik
Gerald W. Apell Arthur Gelb Barbara K. Labelle
Frederick J. and Jane c. Robert W. George Victor Lasa
Artz Veva J. Gibbard Michael Leib
Robert K. Ashworth Deanna M. Glass mann Sharon Ann Lemke
Bryan Richard Aubie Bob Goodman .John P. Leopold
Gerald Aus Richard E. Goodman Donn L. Lithgow
Joseph Axelrod Stephen C. Goodrich Arthur Lo
26 Tinnitus 7bday/June 2001 American Tinnitus Association
John Lundsten
James E. Lyons
Joy S. Mankoff
Grace P. Maresca
Thomas E. Marler
John W. Mars
Richard L. Martin
Steve Martin
Stuart I. Mayer
Krisri11 E. McAbier
Molly McClellan
Eugene McFaddin
Guy E. McFarland, M.D.
Bryan McGurn
Colin L. McMaster
Richard L. Meiss
Marvin Mesker
Allan M. Metcalf
David S. Metlicka
Eugene A. Miller
David Mills
Robert L. Minelli
John Moore
Lori Morago
William H. Moretz, Jr.,
M.D.
Priscilla w. Morris
Ted Murray
Sally K. Neiderhiser
Samuel R. Newsom
William Barry Norman
Parrick A. O' Boyle
William F. O'Halloran
John J. O'Shaughnessy
Ruth E. Ochs
Robert C. Odie
Meredith K. L. Pang,
M.D.
Randy L. Parks
Felicia A. Passero
Thomas J . Patrician
Michael D. Patterson
.Adelio Percic
Colleen Whetstone
John F. Pfeiffer
Rita Hundt Pincsak
John C. Pogue
Margaret L. Possert
Howard M. Potiker
John Pow
Bruce K. Powell
Joy Powers
Leon D. Pryor
Kathleen Pueschel
Doug Pulling
Catherine S. Reitz
John B. Renfro
w. Roberts Richmond
Marnita M. Riddle
Antonio Rios
Rick Rizos
Barry J . Robbins, M.S.
Anna S. Roemer
Linda Ronaldson
Robert w. Roper
Bradley Ross
Benjamin Rothman
Arnold Rowe
Arthur Rudd, D.D.S.
R. Peter Rutsch
Russell A. Sabanek
Stewart Sandman
Marie Saxe
Jeffrey R. Schlesinger
Mark Sch,,ranz
EvelynJ. Schwenl
Don T. Seaquist
Robert F. Sears
DickSeifen
Robert w. Selig
Benson Selitsky, D.O.
Kenneth Shamordola
Gerald E. Shultz
Joseph G. Simmons
DameiSmith
Mark A. Smith
Robert Smith
Robert Lee Smith
David Sorg
Peter Sotory
James w. Soudriette
Richard J. Stapleton
Ronald L. Steenerson,
M.D
Louis C. Steffano
Howard C. Stidham
Walter H. Stover
Leonard Stowe
David Strom
Richard K. Struckmeyer
Michael M. Sullivan
Max and Jean
Thnnenbaum
Charles T ittle
'Ibm Thschi
Theo'Ibw
Scott Thrner
Clark W. Valentine
A.D. Van Meter, Jr.
Beryl J. Vannoy
Megan Vidis
Emil Vonkoehler
Erin Walborn
David L. Warters
JeffWeisend
Joyce Weiss
Margaret A. Wetter
Charles White
Fred H. Wilken
Neil E. Williams
Mark L. Winter, M.D.
AlE. Witten
Raymond Z. Wojrusiak
Bernard C. Wollmeringer
Robert E. Wolon5
James Wood
Brian and Karen Woolsey
Terry Younghanz
Barbara A. Younts
J. Richard Yourtee
Marilyn K. Zion
Research Donors
(Contnbutions of
$100 to 499)
Howard G. Bernett
Elizabeth Bishop
Davis Chauviere
Robert E. Collawn
Conley H. Heaberlin, Jr.
Bob Jones
Howard R. Katz
Harry G. and Marion
Keiper
Russell J. Kirschenbaum
Laura Numeroff
Felicia A. Passero
Thomas J. Patrician
Jeff Weisend
Shirley L. Wireman
Michael J . Zakoor
TRIBUTES
In Honor Of
Jessica Allen
Jack A. Vernon, Ph.D.
Nick Andrews
Patricia J. Sickel
Pat Daggett
William J Knight
'll::rri Nagler, R.N. and
Stephen M. Nagler,
M.D., FAGS
Suzanne Rundle
Steve Ratner
Mike Feld
Robert E. Sandlin,
Ph. D.
Jack A. Vernon, Ph.D.,
and Mary Meikle, Ph.D.
Barbara Tabachnick
Sanders
Jack A. Vernon, Ph.D.
Jack Vernon, Ph.D.
Bill Lanehart
Jack Vernon, Ph.D.,
and Mary Meikle,
Ph.D.
Robert E. Sandlin, Ph.D
InMemory Of
Norman Abelseth
Arlo and Phyllis Nash
Jackie Bishop
Robin L. Moyer
Stephen M Nagler; M.D. ,
fACS
Curtis E. Bowman
Donald M. Bo"man
Jeanne Cathcart
Leon S. and Dolores S.
Kimball
Josephine M. Elias
Eliz.abeth (Betty )
Richard M. Elias
Isabel Feld
Harold Feld
Clyde Leroy Haines
Virginia M. and Virginia
B. Bartz-Reinhart
Lorraine N. Haines
George Halverson
James C. La<v
Stephen Klein
Dorothy Klein
Charles LeBeaux
Marcy and Stuart
Feldman
Dorothy Nelson
Nancy Jean Salta
Be t ty L. Ott
Stephen M. Nagler, M.D.,
f'.ACS
Gladys Pogge
Opal Lanning
Martha A. Schector
Marcy Feldman
George Halverson
Earle Van
Arlo and Phyllis Nash
Matching Gifts
Advanced Micro Devices
Aetna Foundation, Inc.
American Express
Freddie Mac Foundation
Hoechst Celanese
Robert Wood Johnson
Foundation
Reader's Digest
Foundation
Safeco Insurance
Sara Lee Foundation
Smithi<Jine Beecham
Foundation
'li'ansamerica Foundation
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TINNITUS
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