.

,
September 1996 Volume 21) Npmber 3
Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To carry on and support research and educ
1
ational activities relating to the treatment of
tinnitus and other defects or diseases of the ear."
In This Issue:
What You Should Know About
Ototoxic Medications
New ATA-Funded Research
Silent Dental Work - At Last!
Rising Above the Cacophony
Since 1971
Research - Referrals-Resources
Sounds Of Silence
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Tinnitus T o d ~ y
Editorial and advertising offices:
American Tinnitus Association,
P.O. Box 5 Portland, OR 97207
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Editorial Advisor: 'Trudy Drucker, Ph.D.
Advertising sales: ATA-AD, P.O. Box 5,
Portland, OR 97207, 800/634-8978
Tinnitus 7bday is published quarterly in
March, June, September and December. It is
mailed to members of American Tinnitus
Association and a selected list of tinnitus suf-
ferers and professionals who treat tinnitus.
Circulation is rotated to 75,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit-
able for Tinnitus Today. Acceptance of adver-
tising by TinnihtS 7i>day does not constitute
endorsement of the advertiser, its products
or services. nor does Tinnitus TOday make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The
opinions expressed by contributors to
Tinnittt.$ 7bday are not necessarily those of
the Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-
profit human health and welfare agency
under 26 USC 501 (c)(3)
Copyright 1996 by American Tinnitus
Association. No pan of this publication may
be reproduced, stored in <l retrieva I system,
or transmitted in any form. or by any means.
without the prior written permission of the
Publisher. ISSN: 0897-6368
Scientifi c Advisory Committee
Ronald G. Amedee, M.D .. New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clemis, M.D., Chicago, IL
Robert A. Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster, M.D., La Jolla, CA
Barbara Goldstein, Ph.D., New York, NY
Richard L. Goode, M.D., Stanford. CA
John W. House, M.D., Los Angeles, CA
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia, PA
Gale W. Miller, M.D .. Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Jerry Northern, Ph.D .• Denver, CO
Robert E. Sandlin, Ph.D., El Cajon, CA
Alexander J. Schleuning, II, MD,
Portland, OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith. M.D., San Jose, CA
Honorary Directors
Senator Mark 0 . Hatfield
Tony Randall, New York, NY
William Shatner, Los Angeles, CA
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey
Portland, OR
Board of Directors
Edmund Grossberg, Northbrook, IL
W. F. S. Hopmeier, St. Louis, MO
Paul Meade, Tigard, OR
Philip 0. Morton, Portland, OR, Chmn.
Aaron l. Osherow, Clayton, MO
Gloria E. Reich, Ph.D., Portland, OR
The Journal of the American Tinnitus Association
Volume 21 Number 3
1
September 1996
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.
Contents
5 New ATA-Funded Research
8 ATA's New Brochure
9 What You Should Know About Ototoxic Medications
by Stephen Epstein, M.D.
10 Research Subjects Sought
11 1996 PDR Guide to Drug Interactions
13 Book Review
by Trudy Drucker, Ph. D.
14 Kindness Begets Kindness- ATA's Self-Help Network
by Barbara Tabachnick
16 ATA Research Report - An Interview with
James A. Kaltenbach, Ph.D.
by Barbara Tabachnick
1 7 Highlights From Illinois - ATA's First Regional Meeting
18 Silent Dental Work - At Last!
by Barbara Thbachnick
19 ATA's New Support Contacts
22 Profile: New Board Member Paul Meade
22 College Park, Maryland Regional Meeting
Registration Form
23 Rising Above the Cacophony
by Mary Holmes Dague
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
6 Letters to the Editor
20 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Tributes, Sponsors, Special Donors, Professional Associates
Cover: ·vn·ed Flowers• (oil) by Sandro Negri; Mantua, ltaly. Inquiries to the Indigo Gallery
Fine Art & j ewelry, 311 Avenue B, Suite B, Lake Oswego, OR 97034, (503) 636-3454.
From the Editor
by Gloria E. Reich, Ph.D.,
Executive Director
"We'll talk about that" ... and talk
they did, for two and a half
days. Pawel Jastreboff, Ph.D.,
Susan Gold, M.A., and William
Gray, M.D. hosted a training
workshop for twenty hearing
health professionals from the
U.S., Canada, and Germany
who absorbed, listened, and learned how tinni-
tus retraining therapy (TRT), also called auditory
habituation or habituation-based treatment, can
help people ·with tinnitus and hyperacusis. The
treatment is designed to induce and facilitate the
habituation of tinnitus perception, resulting in a
decreased awareness of tinnitus.
TRT is not a "quick-fix," nor is it a cure, but
if a person is willing to follow the protocol and
be patient about results, it can be very benefi-
cial. The theory is quite simple and uses the
naturally occurring mechanisms of the auditory
system to reduce the annoyance and perception
of tinnitus.
Almost everyone attending the course spoke
of how they had espoused components of the
treatment but had not put it all together in the
way the group in Maryland was demonstrating.
We talked about hearing aids, maskers, drugs,
biofeedback, counseling, relaxation therapy. All
of these can be helpful as stand-alone treatment,
(1. to r.) William C. Gray, M.D. , Susan Gold, M.A., CCC SPIA,
and Pawel Jastreboff. Ph.D. - faculty for workshop.
4 Tinnitus Today/September 1996
but the revelation was in understanding how
instrumentation plus counseling can achieve
much more dramatic results.
Here's what happens. There are three deter-
mining factors for selecting a treatment protocol:
If hyperacusis or sound-sensitivity is present
If the patient considers his or her hearing
loss significant enough to create a communi-
cation problem
Ifbeing in loud noise impacts hearing, tinni-
tus, or hyperacusis for more than just a few
hours
Based on these factors, five categories of
treatments are employed for patients at the
Maryland Tinnitus and Hyperacusis Center.
Some attendees were concerned that these five
categories might not be sufficient to describe the
patient population seen in their own practices.
Protocols may involve the use of noise gener-
ators, hearing-aids, both, or neither, and always
involve directive counseling to help the patient
neutralize any negative associations they might
have formed about their tinnitus. The patient's
sound environment is enriched through the
wearing of noise generators or with other tech-
niques if necessary. After a period of time the
auditory system begins to ignore the sounds of
both the noise generator and the tinnitus. Yes, it
sounds simple, and in theory it is, but as with all
treatments, not everyone is a candidate. If you
and your health professional believe this is the
correct approach for your tinnitus, then be pre-
pared to fully comply with the protocol for up to
two years before achieving habituation. rt is rea-
sonable to expect some change in the first few
months of treatment but the habituation process
takes time. (Remember, if you're Uke most of us,
your tinnitus has been training the system to
notice it for some time
now. Learning not to
notice it won' t hap-
pen overnight.)
A number of the
clinicians who attend-
ed this training are
already seeing tinni-
tus patients and will be
New ATA-Funded Research
POSITRON EMISSION
TOMOGRAPHY
STUDY OF TINNITUS
AND ITS RELATION-
SHIP TO AUDITORY
PLASTICITY. Principal
Investigators: Alan
Lockwood, M.D. and
Richard Salvi, Ph.D.,
State University of
Richard Salvi, Ph.D. New York at Buffalo
Amount of Award: $46,145
Purpose: Th investigate the neural basis of
subjective tinnitus by measuring changes in
cerebral blood flow in the cerebral cortex using
positron emission tomography (PET).
Dr. Salvi writes: Tinnitus symptoms are cur-
rently assessed through patients' self reports,
questionnaires, and pitch and loudness match-
ing techniques. However, these techniques do
not provide any information about the neural
mechanisms that are responsible for subjective
tinnitus. To overcome this problem, we will use
a powerful, new brain imaging technique,
positron emission tomography (PET) to measure
the regional blood flow in the cerebral cortex of
patients with unilateral tinnitus. On the basis of
our preliminary data, we hypothesize that the
phantom tinnitus sensation will be associated
with a high level ofblood flow in the auditory
cortex. Thus, PET imaging may provide an
objective method for assessing tinnitus and aid
in identifying the region of the brain that is
From the Editor (continued)
identified on our referral list as soon as they
inform us that they are ready to receive new
referrals for TRT
Dr. Jastreboffhas indicated that there will be
more of these workshops in the future. If you
are a professional treating tinnitus patients, I
urge you to avail yourself of this information.
Contact the Tinnitus and Hyperacusis Center at
the University of Maryland, Baltimore. MSTF
Building, Room 434F, 10 S. Pine St., Baltimore,
MD 21201. Phone: (410) 706-4339. Patients wish-
involved in producing these abnormal and some-
times debilitating phantom sensations. (Dr. Salvi
is seeking subjects for this study. See "Research
Subjects Sought," p. 10)
TINNITUS
ASSOCIATED WITH
SOUND-INDUCED
HEARING LOSS, PART
II, MAPPING THE
MODIFICATIONS OF
THE METABOLIC
ACTIVITY RELATED
TO TINNITUS AND
HEARING LOSS.
Pawel J. Jastreboff, Ph.D. Principal Investigator:
Pawel J. Jastreboff, Ph.D., Sc.D., University of
Maryland at Baltimore
Amount of Award: $111,536
Dr. Jastreboff writes: Hearing loss-related tin-
nitus is the most frequent type observed in clini-
cal practice. Until now there was no animal
model for studying this type of tinnitus. Work
performed under the first part of this grant creat-
ed such a model, which furthermore provides
assurance that our results express tinnitus and
not reflect accompanying hearing loss. The
investigations of changes of metabolic activity
related to tinnitus will point out the centers in
the brain involved in processing the tinnitus sig-
nal, and will be of fundamental significance for
further works aimed at proposing mechanism-
based methods of tinnitus alleviation.
ing more information may attend one of ATA's
regional meetings where the procedures used
at the Maryland clinic as well as procedures
used elsewhere will be discussed. Our next
meeting will be in College Park, Maryland
this month (registration form on p. 22)
followed by one in California in the spring
of 1997. Watch for information about the
California meeting in the December issue of
Tinnitus Tbday.
Tinnitus 'Jbday/ September 1996 5
Letters to the Editor
From lime to lime, we include letters from our mem-
bers about their experiences with •non-traditional•
treatments. We do so in the hope that the informa-
tion offered might be helpful. Please read these anec-
dotal reports carefully, consult with your physician
or medical advisor, and decide for yourself if a given
treatment is 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.
I
am writing to tell you about my victory over
chronic tinnitus. About l
1
/ 2 years ago after
target shooting with a .22 revolver, I started
having mild dizziness and tinnitus in both ears.
After waiting about nine months for my tinnitus
and dizziness to go away, it became obvious that
it wasn't going to, without intervention.
1 consulted anENT specialist who, after
doing a few tests, told me that l would have to
live with the chronic tinnitus. He also told me
that I had a mild case of Meniere's disease and
to restrict my salt intake. 1 was determined to
find a more effective remedy. 1 consulted Dr.
Hansel De Bartolo, a nutritionally-oriented ENT
specialist in Sugar Grove, Illinois. Dr. De Bartolo
put me on 90 mg. of zinc picolinate daily. In
addition, he prescribed niacin, manganese, mag-
nesium, rutin, and iodine. The zinc was by far
the most important nutrient in my case and in
most other cases of tinnitus that are precipitated
by acoustical or physical trauma, according to
Dr. De Bartolo. Because there aren't any satisfac-
tory blood or hair tests that indicate the body's
zinc levels, 1 use the "Zinc Status Thst" (Ethical
Nutrients, 800/ 877-1704) which indicates when
my body stores of zinc are saturated. (Level 1 is
profound zinc deficiency; level 4 is the desirable
zinc level.) I was also restrained temporarily
from having foods and medications that are high
in salicylates (raisins, apricots, apples, tomatoes,
almonds, vinegar, soft drinks, beer, aspirin, all
artificially flavored foods, and others). I was told
to use protective ear plugs when exposed to loud
noises such as a power lawn mower or when
going to the movies. After nine months of treat-
ment, I am 75% better and I'm improving every
month. 1 still take zinc in fairly high doses.
I also found that grape seed extract was help-
ful in controlling my dizziness. A few of my
6 Tinnitus 'Thday/September 1996
patients with dizziness who tried 50 mg. a day of
grape seed extract found that it worked equally
well for them. (Ginkgo was ineffective in con-
trolling my tinnitus and temporarily made my
dizziness worse while I was taking it).
Dr. fohn L. Mohney, Physician and
Surgeon - Osteopathic, Houston, TX
I
was having quite a problem with tinnitus for
a while and not having medical insurance
(or money) I wasn't sure what I would do.
I learned that tinnitus had been associated with
B-6 deficiency, and I knew that I'd been showing
other deficiency signs of this vitamin. When I
experienced the tinnitus, I increased my con-
sumption of B-6 and the tinnitus went away.
After a time, the tinnitus stayed away.
If B-6 is taken for any period of time, equal
doses of B-1 and B-2 must be taken. Ideally, all
the B vitamins would be taken at once. Since
there seems to be many causes of tinnitus, this
probably won't work for everyone but I'm cer-
tain it could help some.
R. Hoefs, Los Gatos, CA
A
s a relatively new tinnitus sufferer uust
over one year of severe ear and head
noises) I found your publication to be the
greatest support! Until I received that first issue,
I felt so alone with this new affliction. I read that
magazine from cover to cover and found such
comfort from the articles and from letters from
other people who were sharing their experi-
ences.
I highlighted suggestions from that issue that
could possibly help me. Muscle relaxants, vita-
mins, minerals and herbs, earmuffs, maskers,
walkman usage, ideas for de-stressing were all
treatments to consider. I did buy earmuff style
sound protection, I started using a walkman
when in noisy outdoor environments, I tried to
decrease the stressful situations in my life. And I
visited my local health food store to inquire
about any suggestions to help tinnitus.
"Ginkgo!" responded the store owner. She
showed me publications about this extract from
ginkgo tree leaves, which stated that increasing
cerebral blood flow might decrease symptoms of
tinnitus. Reluctantly, 1 purchased a two-month
supply, with very little confidence that it would
help.
Letters to the Editor (continued)
About six weeks later, I was amazed to realize
that I hadn't heard any loud noises for two days.
Then four days, then a week. Now, it's been
seven weeks! I no longer have the loud, ringing,
banging head noises. You can imagine how won-
derful it is for me to know the silence we all
pray for. I sleep at night without the terrible
intrusions. I'm not totally without symptoms.
I still experience muffled noises at times, and I
know that some sounds that used to trigger loud
noises still trigger some noises for me. But
they're so much softer, no loud ringing at all, and
they only happen occasionally. I'm becoming a
believer! Perhaps others might find some relief
from this simple treatment.
Janet R. Lull, Los Altos Hills, CA
I
would like to add a helpful hint. When using
ear plugs to reduce noise, I find that when I
add a little hand lotion to my ear canal first
- applied with the tip of a finger - the ear
plugs slip in better and give a much tighter fit.
Bill Stanley, Bloomfield, NJ
ru
: The "Letters to the Editor" column in
he June issue of Tinnitus 'Ibday, Kim
roshan describes having palatal
myoclonus, a clicking of the palate due to mus-
cle spasm. This is a condition that responds
rapidly to electromyographic biofeedback. The
sensors are placed on the frontalis muscle and
the patient is instructed to learn relaxation of the
frontalis muscle which helps all muscles associ-
ated with the seventh nerve. In my practice, this
has been extremely rapid and effective. I would
recommend a trial of EMG biofeedback for this
condition.
Murray Grossan, M.D., Los Angeles, CA
I
developed tinnitus in March of 1995 after a
head injury complicated by a severe infec-
tion in my left ear. I also developed recruit-
ment and pulsating sounds with dizziness. All
sounds were magnified so greatly that I was
unable to be in public places, listen to music, or
watch TV I had the most difficult time trying to
sleep at night without taking sleeping pills.
After trying many different drugs including
Xanax and Klonopin without relief and finding
nothing medically wrong I was referred to a psy-
chiatrist, Dr. Thnnenbaum, in Fremont. I was
then put on an anti-depressant drug called
Anafranil, 75 mg. before bedtime.
The tinnitus has now subsided enough for
me to completely forget about it during the day.
I sleep very well at night without sleeping pills
and only notice the tinnitus when I am sitting
and relaxing in the evening. The recruitment is
gone along with the pulsating and dizziness.
Anafranil has very little side effects and has
brought me back to my old self. I do believe it
saved my life!
Sally Darmitzel, Fremont, CA
W
hen I first wrote to you in September
1995, I thought tinnitus would be rela-
tively easy to cure if one "doctor-
shopped," used common sense with respect to
lifestyle, diet, etc. 1 was wrong. It has been a
very complicated journey, full of anguish and
suicidal ideation more than once. But I see the
light at the end of the tunnel, and would like to
share what I have learned.
My condition - intermittent, atypical tinni-
tus - manifests with buzzing sounds most
mornings when I wake up. It is also there in the
night if I should wake up, but not there when I
go to sleep. Sometimes the buzzing will start in
my left ear and, as the day progresses, create a
band of sound across my brain that moves into
the right ear. By bedtime, it is extremely loud,
and the roof of my mouth and my lower brain
vibrate. Once this starts, it usually lasts 48 hours
then abruptly stops on the third day. On other
days, the buzzing fades shortly after awakening.
I've learned to discern which way the day will
go by the quality of the morning sounds.
I have been able to diminish the number of
days per month where the buzzing increases by
doggedly sticking with regular
acupuncture/M.D. appointments despite
numerous times thinking it wasn't
really helping and by following the 1
advice to slow down, decrease stress, fj
increase sleep (10 mg. of Elavil in the
evening helps), practice meditation
daily, pray, and seriously rethink
priorities. In the year of doing this,
I have diminished the days of my
48-hour episodes from 11 days in
one month to four days this past
Tinnitus Today/ September 1996 7
Letters to the Editor (continued)
month. It took me almost a year and a half of
regular acupuncture treatments before I went
into partial remission.
I have also taken the alternative route of
Tibetan herbs, vitamins, and skeletal manipula-
tions with an excellent chiropractor. (I know
that putting oneself in the bands of non-medical
persons is not for everyone.)
On my first appointment with the acupunc-
turist I learned that my kidney "chi" was out of
balance. At that time l thought the connection
to my kidneys and ears might be esoteric but
have since been told by an audiologist that kid-
neys and ears are closely connected during the
embryonic stage. I've learned to drink much
more water and to stay away from anything cold
such as ice water and ice cream. I have even
learned to like drinking hot water!
Daphne S. Crocker-White, Ph.D.,
Hillsborough, CA
M
y congratulations on your recent issue
(June 1996) which is a candidate for
"classic" back issue. From the poetic
prose of Leon Morgenstern to Michael Cohen's
plea ("We Need Each Other"), it made such won-
derful reading for this sufferer of that mysteri-
ous condition we call tinnitus. Indeed, I was so
moved as to wonder whether we as human
ATXs NEW BROCHURE
"If You Have Tinnitus -
The First Steps To Take"
ATA's newest brochure is now available and
included on our Information You Can Order form
in the center of this issue. The brochure offers
new tinnitus patients a step-by-step approach to
managing the onset of tinnitus; defines the
scope of services offered by ENT's, audiologists,
and hearing aid specialists; includes a list of
23 crucial questions to ask one's health care
provider; and suggests practical self-help mea-
sures to take.
You will receive a free copy of this brochure
when you renew your membership during the
next year.
8 Tinnitus 1bday/ September 1996
beings need some sort of pain to have a mean-
ingful dialogue of any sort.
Ruknet Cezzar, Ph.D., Hampton, VA
T
hank you Dr. Morgenstern for your "My
Pets, the Spider and the Cricket." Th me
this was medical and psychological poet-
ry. I want you to know that I have walked, and
continue to walk, your road.
You mention several times something that I
call the "etiology agony." I suspect that for peo-
ple like us, whose vocational art involves diag-
nosing, not knowing what caused the tinnitus
has got to be agonizing and you write about this.
In my case, I suffered a concussion when I was
thrown through the windshield of my automo-
bile years ago, and I feel certain that that's the
episode that gave rise to the tinnitus.
But other than satisfying the appetite of my
intellect "to know," our experience is the same.
One treatment I have found that helps is
yoga, and especially the asana (posture) called
the Headstand. This, with diaphragmatic breath-
ing concurrent, appears to quiet the whistling.
Perhaps it is a result of the power of meditation
and the rich delivery of oxygenated blood to the
brain. Again thanks for the beautifully crafted
"slice of your life."
Arnold Thaw, Ph.D., Phoenix, AZ
Tinnitus and Hyperacusis: A
"Multi-Therapies" Treatment
Kenneth Greenspan, M.D., of the Center
for Stress and Pain Related Disorders and the
Columbia Presbyterian Medica] Center, is still
seeking patients for a study using a multi-
therapy approach to treating tinnitus and hyper-
acusis. (See the June 1996 Tinnitus Tbday for
details.)
Due to an extended interruption in phone
service, Dr. Greenspan expects that many peo-
ple tried to reach the Center but couldn't. He
invites them to call again.
Center for Stress and Pain Related Disorders,
348 E. 51st St., New York, NY 10022,
(212) 888-5140, (212) 888-5162
What You Should Know
About Ototoxic Medications
by Stephen Epstein, M.D.
Ototoxic medications are those drugs that
have the potential to cause damage to the inner
ear structures which may result in temporary or
permanent loss of hearing or an aggravation of
an existing sensorineural hearing loss.
If you have an existing sensorineural hear-
ing loss, regardless of the cause, when using oto-
toxic medications, you are more vulnerable to
aggravation of that hearing loss.
As a result of using ototoxic medications, the
degree of hearing loss that occurs and the
amount of recovery that follows depends upon
the amount and duration of the use of that par-
ticular medication. If you are consuming more
than one ototoxic medication, you are even
more vulnerable to developing a sensorineural
hearing loss or aggravation of your existing sen-
sorineural hearing loss.
Some ototoxic medications such as aspirin
and aspirin-containing drugs - regardless of the
amount and duration of usage - when discon-
tinued, result in complete recovery of hearing
and cessation of associated symptoms such as
tinnitus. (Ed. note: A few patients have reported
to us that their tinnitus continued after aspirin
use was stopped.)
Guidelines to Follow
In regard to the use of ototoxic medications,
whether they are over-the-counter or prescrip-
tion, there are several important facts you
should know and several important rules you
should follow:
+ Always inform your doctor that you have a
sensorineural hearing loss or nerve-type
hearing loss.
+ Always ask your doctor, when he or she is
prescribing new medications for you, to
inform you of any potential side effects,
especially if the medication is ototoxic.
+ Always read the labels or ask your pharma-
cist about the potential ototoxic effects of
over-the-counter medications.
+ Always be aware of the early warning signs
of ototoxicity.
Signs of Ototoxicity, Listed in Order of
Frequency
1. The development of tinnitus (noises in the
ears) in one or both ears.
2. The intensification of existing t innitus or the
appearance of another sound that didn't
exist before.
3. Fullness or pressure in your ears - other
than being secondary to an upper respirato-
ry infection.
4. The awareness of a hearing loss in an unaf-
fected ear or the progression or fluctuation
of an existing loss.
5. The development of vertigo or spinning sen-
sation usually aggravated by motion which
may or may not be accompanied by nausea.
Should any of these symptoms develop
while taking any medication, stop the medica-
tion immediately and call your doctor.
Ototoxic Medications
Finally, you should be aware of the common
ototoxic medications, how they are prescribed,
and for what conditions they are given.
The following is a simplified list of ototoxic
medications and represents the most common
drugs. (There are many other medications that
have been listed as potentially ototoxic; howev-
er, the incidence is insignificant. Consult your
physician to be sure.) Keep this list for ready
reference.
1. SALICYLATES -Aspirin and aspirin-contain-
ing products
+ 'Ibxic effects usually appear after consum-
ing an average of 6-8 pills per day.
+ Toxic effects are always reversible once
medications are discontinued.
2. NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDS) - Advil, Aleve, Anaprox,
Clinoril, Feldene, Indocin, Lodine, Motrin,
Nalfon, Naprosyn, Nuprin, Poradol, Voltarin
+ Thxic effects usually appear after consum-
ing an average of 6-8 pills per day.
+ Toxic effects are usually reversible once
medications are discontinued.
3. ANTIBIOTICS- Aminoglycosides,
Erythromycin, Vancomycin
a. Aminoglycosides - Streptomycin, Kanamycin,
Neomycin, Gentamycin, Tobramysin, Amikacin,
Netilmicin. These medica-
tions are ototoxic when
used intravenously in seri-
ous life-threatening situa-
tions. The blood levels of
these medications are usu-
ally monitored to prevent
ototoxicity. ThpicaJ prepa-
Tinnitus Thday/ September 1996 9
What You Should Know
About Ototoxic Medications (continued)
rations and ear drops containing Neomycin and
Gentamycin have not been demonstrated to be
ototoxic in humans.
b. Erythromycin - EES, Eryc, E-mycin, Ilosone,
Pediazole, and new derivatives of Erythromycin
- Biaxin, Zithromax
Erythromycin is usually ototoxic when given
intravenously in dosages of 2-4 grams per 24
hours, especially if there is underlying kidney
insufficiency. The usual oral dosage of
Erythromycin averaging one gram per 24 hours
is not ototoxic. There are no significant reports
of ototoxicity with the new Erythromycin deriv-
atives since they are given orally and in lower
dosages.
c. Vancomycin - Vancocin
This antibiotic is used in a similar manner
as the aminoglycosides; when given intra-
venously in serious life-threatening infections, it
is potentially ototoxic. It is usually used in con-
junction with the aminoglycosides which
enhances the possibility of ototoxicity.
Research Subjects Sought
for Brain Imaging Study
of Tinnitus
Subjects are needed to participate in a
study whose purpose is to identify regions of
the brain that are activated or involved with
tinnitus. We are seeking individuals who can
alter the loudness (intensity) or pitch (fre-
quency) of their tinnitus by: (1) moving or
pressing on their jaw, tongue, teeth, face,
neck or head or (2) moving their eyes (gaze
evoked tinnitus) . Brain regions activated by
tinnitus will be identified by Positron
Emission Thmography (PET).
For details, contact: Richard Salvi, Ph.D.,
Hearing Research Lab, SUNY University of
Buffalo, Buffalo, NY 14214,
Ph: (716) 829-2001, FAX (716) 829-2980,
e-mail: Salvi@acsu.buffalo.edu
or: Alan Lockwood, M.D., PET Center, VA
Hospital, Buffalo, NY 14215,
Ph: (716) 862-3450; FAX (716) 862-3462,
e-mail: alan@promo.nucmed.buffalo.edu
10 Tinnitus Today/ September 1996
4. LOOP DIURETICS - Lasix, Edecrin, Bumex
These medications are usually ototoxic when
given intravenously for acute kidney failure or
acute hypertension. Rare cases of ototoxicity
have been reported when these medications
are taken orally in high doses in people with
chronic kidney disease.
5. CHEMOTHERAPEUTIC AGENTS -
Cisplatin, Nitrogen Mustard, Vincristine
These medications are ototoxic when given
for treatment of cancer. Their ototoxic effects
can be minimized by maintaining blood levels of
the medications and performing serial audio-
grams. The ototoxic effects of these medications
are enhanced in patients who are already taking
other ototoxic medications such as the amino-
glycoside antibiotics and the loop diuretics.
6. QUININE- Aralen, Atabrine (for treatment
ofmalaria), Legatrin, QVel Muscle Relaxant
(for treatment of night cramps)
The ototoxic effects of quinine are very simi-
lar to aspirin and the toxic effects are usually
reversible once medication is discontinued.
If you must take ototoxic medications, you
should have your hearing monitored with peri-
odic audiological evaluations.
Just as you are responsible for your overall
health, you can take responsibility for the
preservation of your hearing or your existing
hearing reserve. Being aware of ototoxic medica-
tions and their potential warnings is a good safe-
guard to protect your hearing - and a sound
investment!
Stephen Epstein, M.D, FA.C.S, is an otologist and a fellow of
tl1e American Academy of Otolaryngology- Head and Neck
Surgery, Inc., and the American College of Surgeons. He is the
director of The Ear Center in Wheaton, Maryland.
Reprinted with permission from the SHHH Journal.
Copyright 1996 Self Help for Hard of Hearing People, Inc.,
7910 Woodmont Ave, #1200, Bethesda, MD 20814
CORRECTION
from Tinnitus - In the Eyes of The Law, March
1996, Corrected spelling: Alan Spielman, Esq.
1996 PDR Guide to Drug Interactions, Side Effects,
and Indications: Tinnitus
The following is a list of prescription and
over-the-counter drugs that when tested pro-
duced tinnitus. These tests were either "con-
trolled" studies conducted by the manufacturer
before the drugs were released, or "post-market-
ing" studies conducted with a larger population
after the drugs were released. The incidence of
tinnitus as a side effect from these drugs varies
but is generally quite small. The percentages are
based on drug use at recommended dosages.
Accutane Capsules
(Less than I %) .... ..... 2076
Achromycin v Capsules ... ........ 1367
Actifed with Codeine Cough
Syrup ............... ....................... 1067
Adalat CC (Less than 1.0%) ........ 589
Children's Advil Suspension
(Less than 3%) .... ............ ....... 2692
Alka-Selrzer Effervescent
Antacid and Pain Reliever ..... e 70I
Alka-Seltzer Extra Strength
Effervescent Antacid
and Pain Reliever ................. . 703
Alka-Seltzer Lemon Lime
Effervescent Antacid
and Pain Reliever ....... ......... 703
Altace Capsules
(Less than 1%) ........ .. ......... .. .. 1 232
Ambien 'Pdblets ( Infrequent) .... 2416
Amicar Thblets, and Injection
(Occasional) ... .......... ........... ... 1267
A.Anafranil Capsules (4% to 6%)803
A.Anaprox/ Naprosyn
(3% to 9%) .............................. 2117
1\nsaid Thblets (1-3%) ............... 2579
Atalen Hydrochloride IJ1jection
(1 patiem) .................... ........... 2301
Aralen Phosphate Thblets
(1 patiem) ............................... 230l
Arthritis Foundation Safety Coated
Aspirin Thblets .......... ............ e 675
Asacol Delayed-Release Thblets 1979
Arthritis Pain Ascriptin ............. 631
Maximum Strength Ascriptin .. e 630
Regular Strength Ascriptin
'Pdblets ......................... ........ ... 629
Asendin Thblets (Less than I %) 1369
Atretol Thblets .................... ......... 573
Atrohist Plus Thblets .................. .454
for JJ1jection
(Less than 1 %) ................ ......... 734
Azo Gamanol Thblets ................ 2080
Azo Gantrisin Thblets ................ 2081
Azulfidine (Rare) ...................... . J949
Arthritis Strength BC Pow'der ... e 609
BC Powder ................................ e 609
Backache Caplets .. ............ ... ..... e 613
Bactrim DS Thblets .... ......... ....... 2084
Bactrim I.V: lnfusion ................. 2082
Bactrim ............................. ... ...... 2084
Bayer Children's Chewable
Aspirin ....................... ............. 711
Genuine Bayer Aspirin Thblets
& Caplets....... .. .. 713
Extra Strength Bayer Anhritis
Pain Regimen Fonnula .......... e m
Extra Strength Bayer Aspirin
Caplets & Thblets ................ ..... 712
Extended-Release Bayer 8-Hour
Aspirin ...................................... 712
Extra Strength Bayer PM
Aspirin ...................................... 713
Aspirin Regimen Bayer Regular
Strength 325 mg Caplets ..... .. .. l709
Bayer Select Backache Pain
ReliefFormula ....... ........... ..... e 715
Bcnadryl Capsules .... ................. 1898
Benadryl Injection .... .. , ........ ... .. 1898
Biocadren Thblets
(Less than 1 %) ....................... 1614
Arthritis Strength Bufferin
Analgesic Caplets ...... ............ e 6J4
Buprenex Injectable
(Less than I%) ........ .. ............. 2006
BuSpar (f'requent) ............ ........... 737
Cama Arthritis Pain Reliever ... e 785
Capastat Sulfate Vials ............... 2868
Carbocaine Hydrochloride
Injection ................................. 2303
Cardene Capsules (Rare) ........... 2095
Cardene I. v. (Rare) .... ....... .. ....... 2709
Cardizem CD Capsules
(Less than 1 %) ...................... .1506
Cardizcm SR Capsules
(Less than 1%} ........................ 1510
Cardizem Injectable .................. 1508
Cardizem Thblets
(Less than 1%) ....................... 1512
Cardura Thblets (1 %) ................. 2186
Cartrol Thblets (Less common) ... 410
(1% to 3%) .... .......... ..... 816
Cipro l.V. (1% or less) ................. 595
Cipro I.V. Pharmacy Bulk Package
(Less than 1%) ......................... 597
Cipro 'Pdblets (Less than 1%) ...... 592
Claritin (2% or fewer patients) .2349
Claritin-D (Less frequem) ......... 2350
Clinoril Tablets
(Greater than I %) .................. 1618
Clomid .. ................ .... ................. 1514
Cognex Capsules (Infrequent) .. 1901
CozaarThblets (Less than 1%) .. 1628
Cuprimine Capsules
(Greater than 1 %) ........... ....... 1630
Cytotec (Infrequent) ................. 2424
Cytovene (1% or less) .. ............. 2103
Dalgan Injection
(Less than 1 %) ......................... 538
Dapsone Thblets USP ................ 1284
Daranidc Thblets ....... ......... ....... 1633
Daypro Caplets (Greater than 1%
but less than 3%) ................... 2426
Dcconamine ................ ....... ....... 1320
Demadcx Thblets and Injection .. 686
Depakote Thblers (Greater than 1%
but not more than 5%) .. ......... .415
Depen Tirratable Thblets .... ....... 2662
Desferal Vials ............................ .. 820
Desyt-el and Desyrel Dividose
( 1.4%) ........ " ......... """" ... ........ . 503
Diamox lmravenous ... .. ...... .. ..... 1372
Diamox Sequels
(Sustained Release) ............... 1373
Diamox Thblets.......... . ... 1372
Drugs that report an incidence of tinnitus at
3% or more are marked with a triangle.
Drugs that include no percentage of inci-
dence can be further investigated by contacting
the drug manufacturers or a pharmacist. More
information about all of these drugs can be
found in the 1996 Physicians Desk Reference
(PDR). The corresponding PDR page number
follows each drug name.
Always consult with your physician before
making any changes in medication.
Dilacor XR Extended-release
Capsules (1.0%) ................ .. .... 2018
Dipentum Capsules (Rare) ........ 1951
Diprivan Injection
(Less than 1 %) ....................... 2833
Doan's Extra-Strength
Analgesic ............................... e 633
Extra Strength Dean's P.M ...... .. e 633
Dean's Regular Strength
Analgesic ................... ............ e 634
Dolobid 'Pdblets
(Greater than I in 100) .......... 1654
Duranest Injections .......... .. ........ 542
Dyclone 0.5% and 1% Topical
Solutions, USP .. ...... .................. 544
Easprin .................. ........... .. ....... 1914
AEC-Naprosyn Delayed-Release
'Pdblets (3% to 9%) ......... .... .... . 2117
Ecotrin ............................ .... ....... 2455
Edccrin ....... .. ........ 1657
Effexor (2%) .............................. 2719
Elavil ........... ............. : ................ 2838
Eldepryl Tablets ........................ 2550
Emcyt Capsules ....... ......... ......... l953
Emla Cream ...... .. .................. .. .... 545
Empirin with Codeine Thblets .. 1093
Endep Thblets ............................ 2174
Engcrix-B Unit-Dose Vials .. ....... 2482
Esgic-plus 1'dblets (Infrequent) .1013
Eskalith ...................................... 2485
Ethmozine Thblets
(Less than 2%) ...... ..... .. ...... .. .. 2041
Etrafon ... ......... .................... ....... 2355
Fansidar Thblets .... ........ .... ........ . 2114
Feldene Capsules
(Greater than 1 %) .. .. ....... ....... 1965
Fioricet Thblets (Infrequent) ..... 2258
Fioricet with Codeine Capsules
(lnfrequem) ... ........... .............. 2260
Fiorinal with Codeine Capsules
(lnfrequem) ... .................... ..... 2262
Flexeril Thblets (Less than I %) .1661
Floxin I.V. (Less than 1%) ......... 1571
Floxin 'Tllblets (200 mg, 300 mg, 400
mg) (Less than l%) ............ .. .. 1567
Flumadine Thblets & Syrup
(0.3% to 1%) ........................... 1015
Foscavir I J1jection
(Less than 1%) ......................... 547
Fungizone Intravenous ...... ......... 506
Gantanol Thblets ....................... 211 9
Gamrisin ...... ..................... ........ 2120
Garamycin lnjectable ................ 2360
Glauclabs ... ............................... 0 208
Halcion Thblets (Rare) ............... 2611
Healthprin Aspirin ................... . 2455
Hivid 1ablets (Less than I% to
less than 3%) .................... .. .... 2121
Hyperstat I.V. lnjection ............. 2363
Hytrin Capsules (At least 1%) .... 430
Hyzaar Thblets ........................... 1677
IBU Thblets (Greater than l %) .. 1342
Tlosone (Isolated reports) ..... ... .... 911
lmdur (Less than or equal
to 5%) ..... ................................ 1323
lnclocin (Greater than J %) ........ 1680
lntron A (Less than 5%) ........... 2364
Kerlone Thblets ( Less than 2%) 2436
Lan1ictal Thblets (1.1 %) ............. 1112
A.Lariam Thblets (Among most
frequent) .............. .. ................. 2128
Lasix Injection, Oral Solution
and Thblcts ............................. 1240
Lincocin (Occasional) ............ ... 2617
Lioresal 'Tllblets ........................... 829
Lithium Carbonate Capsules
& Thblets ................................ 2230
Lithonate/ Lithotabs!Lithobid ... 2543
Lodine Capsules and Thblets (More
than I CJ6 but less than 3%) ..... 2743
Loprcssor Ampuls ....................... 830
Lopressor HCT Thb1ets
(1 in 100 patients) .................... 832
Lopressor Thblets .............. .......... 830
Lore leo Thblets .......................... 1517
Lotensin HCI' (0.3% to 1.0%) ..... 837
Lotrel Capsules (Infrequent) ...... 840
Ludiomil Tablets (Rare) .............. 843
Luvox Thblets ............................ 2544
A.MZM (Among reactions occurring
most oftcn) ............................... 267
Marcaine Hydrochloride with
Epinephrine 1:200,000 ........... 2316
Marcaine Hydrochloride
IJ1jection ....................... ......... 2316
Marcaine Spina1 .............. ........... 2319
Marino! (Dronabinol) Capsules
(Less than I%) ....................... 2231
Maxaquin Thblets
(Less than I%) ....................... 2440
Methergine (Rare) ..................... 2272
Methotrexate Sodium Thblets.
Injection, for Injection andLPF
IJ1jection (Less common) ....... ! 275
Mexitil Capsules (1.9% to 2.4%) .678
Miacalcin Nasal Spray
(Less than 1%) .............. .. ...... 2275
Midamor Thblets
(Less than or equal to 1%) .... .1703
Minipress Capsules
(Less than 1%) ....................... 1937
Minizide Capsules (Rare) .......... l938
Mintezol ..................................... 1704
Mobigesic Thblers ........................ 602
Moduretic Thblets ........ .. ............ 1705
Mono-Gesic Thblets ..................... 792
Monopril 'Tablets (0.2% to 1.0%) 757
Children's Motrin Ibuprofen Oral
Suspension (Greater than 1%
but less than 3%) ................... 1546
Motrin Thblets (Less than 3%) .. 2625
Motrin Ibuprofen Suspension, Oral
Drops, Chewable Tablets, Caplets
(1% to less than 3%) .............. 1546
continued on page 12
Tinnitus Today/ September 1996 11
1996 PDR Guide to Drug Interactions, Side Effects,
and Indications: Tinnitus (continued)
Mustargen (lnfrequent) .... ...... ... 1709
Mykrox Thblets (Less than 2%) .. 993
&Nalfon 200 Pulvules & Nalfon
Thblets (4.5%) ..... . .. ........ 917
AAnaprox/Naprosyn
(3% to 9%) .............................. 2117
Nehcin Vials, Hyporets & ADD·
Vantage...... . .. ... 1464
Neoral (2% or less) .... ................ 2276
Neptazane Thblcts ..................... 1388
Nescaine/Nescaine MPF .. .. ........ . 554
Netromycin Injection
100 mg/mL.... ........ . .... 2373
Neurontin Capsules
(Infrequent)..... .. ..... . ... .l 922
Nicorette ..................... ............... 2458
Noroxin Thblets ............. ....... .. .... 1715
Noroxin Thblets ........... .............. 2048
Norpramin Thblets ................. ... 1526
Norvasc Thblets (More than 0.1%
to 1%) ........................ ............ 1940
Ornade Spansule Capsules ........ 2502
Onhoclone OKT3 Sterile
Sol uti on .................................. 1837
Orudis Capsules
(Greater than I%) ...... ............ 2766
Oruvail Capsules
(Greater than 1%) ....... .......... . 2766
PBZ Thblets ...... ............. ........ .. ..... 845
PBZ.SR Thblets ..... ...... .... ..... ....... . 844
Pamelor ........................... .......... 2280
Parnate Thblcrs ....... ......... ... ....... 2503
Paxil Thblets (Infrequent) ......... 2505
Penctrex Thblets
(Less than 1% but more than
or equal to 0.1%) ............ ..... ... 2031
Pepcid 11'\.iection (Infrequent) .. .1722
Pepcid (1nfrequent) .. .. ............... l720
Pepto-13ismol Original Liquid,
Original and Cherry Tablets and
Easy-To-Swallow Caplets ........ 1976
Pepto-13ismol Maximum Strength
Liquid ..................................... 1976
Periactin ....... ....................... ...... 1724
Pcnnax Thblets (lnfrequem) .... ... 575
Phenergan lrl,jection .................. 2773
Phenergan Thblets ............... ...... 2775
Phrenilin (Infrequent) ... .... ......... 785
Plaquenil Sulfate Thblets .... .... .. 2328
Platinol.. ................... ........... ...... 708
Platinol-AQlnjection ......... .......... 710
Pontocaine Hydrochloride for
Spinal Anesthesia... . ... . 2330
PREVACID Delayed-Release
Capsules (Less than I% ) .... .... 2562
Prilosec Delayed-Release Capsules
(Less than 1%) . . ... . .. ....... 529
Primaxin I.M ............. .. .............. 1727
Primaxin LV. (Less than 0.2%) .1729
Prinivil Thblets (0.3% to 1.0%) .1733
Prinzide Thblets (0.3 to 1%) .... .. 1737
Procardia XL Extended Release
'Thblets (1 % or less) .. .............. 1972
.APrograf (Greater than 3%) ..... 1042
ProSom Thblets (lnfrequent) ...... .449
Proven til (2%) .... ............ ........ .. . 2386
Prozac Pulvules & Liquid, Oral
Solution (2%) ..................... ...... 919
Questran Light ............................ 769
Qucstran Powder .. .... ...... .... ....... .. 770
Quinaglute Dura-Thbs Tablets ..... 649
Quinidex Extentabs ................... 2067
Rccombivax HB (Less than 1%)1744
.ARelafen Thblets (3% to 9%) .... 2510
Re Via Tablets (Less than 1%) .... . 940
Rifater .................... ............ ........ 1532
Risperdal (Rare)...... . ... ... 1301
Romazicon (Less than 1 %) ........ 2147
Rythmol T'.tblets · 150 mg,
225 mg, 300 mg (Less than 1%
to 1.9%) ....... .. ........ ......... ........ 1352
Salflex Tablets (Common) .......... 786
Sandimmune (2% or less) .. .... ... 2286
Sedapap Thblets 50 mg/ 650 mg
(Infrequem) ............................ l543
Sensorcaine .... .... ....................... .. 559
Septra ........ .... ...... . .. ........ .. 1174
Septra t.V. lnfusion .................... ll69
Septra t.V. Infusion ADD-Vantage
Vials ........ 1171
Septra .......... ......... ........... ......... .. 117 4
Serzone 'Thblets (Up to 3%) ......... 771
Sincquan (Occasional) .. ............ 2205
Soma Compound w/ CQdeine
Tablets .................................... 2676
Soma Compound Thblets .......... 2675
Tinnitus Poetry Book Planned
Daphne Crocker-White, Ph.D., clinical psy-
chologist, poet, and ATA member will edit and
publish a small book of tinnitus poetry. The
poems you have previously sent will be for-
warded to her for possible inclusion. We are
excited about this project and Daphne eagerly
awaits your poetry that describes your tinnitus
experiences.
12 Tinnitus 'Ibday/September 1996
Sporanox Capsules
(Less than 1 %) ....................... 1305
&Stadol (3% to 9%) .................... 775
Streptomycin Sulfate Tnjection2208
Surmontil Capsules.... . . .... 2811
Talacen (Rare) ........................... 2333
Thlwin 11'\.iection (Rare) ............. 2334
Talwin Compound ........ ... ........ .. 2335
Thlwin Injection ........................ 2334
Talwin Nx .................................. 2336
Tambocor Thblets
( 1% to less than 3%) .. .... ........ 1497
'Thvist Syrup .... ........ ......... .......... 2297
'Thvist Thblets ............................. 2298
Tegretol Chewable 'Uiblets .... .. .... 852
Thgretol Suspension .... ........... ..... 852
Thgretol Thblets .............. ....... ...... 852
Ternaril Thblets, Syrup and Spansule
E..xtended-Release Capsules .... .483
Tenex Thblets (3% or less) ........ 2074
Thera-Gesic ............................... 1781
Ticlid 'Thblets (0.5% to 1.0%) .... 2156
Timolide Thblets ........................ l748
Timoptic in Ocudose .. ............... l753
Timoptic Sterile Ophthalmic
Solution .................. .......... ...... 1751
Timoptio-XE .............................. 1755
1bbramycin Sulfate ll'\iection ... ... 968
Tofranil Am puis .. .. ................ .... 854
1bfranil Tablets ............................ 856
1bfrru1il-PM Capsules .................. 857
1blectin (200,400 and 600 mg)
(1 to 3%) .......... ....................... 1581
1bnocard Thblets (0.4 -1.5%) ....... 531
1bproi-XL 'Thblets .... ..... ... 565
1bradol (I% or less) .... ... ....... .... 2159
1brecau .... ............................. ..... 2245
Thiavil ... ..................... .... L 757
1riJisate (Less than 20% )2000
Thinalin Repetabs Tabletsl330
1bssend1783
Tympagesic Ear Drops2342
llltram Tablets (50 mg)
(Infrequent) ............................ 1585
Univasc Thblets (Less than 1 %) 2410
Ursinus lnlay-'Thbs ... .. ............... 794
Vancocin HCI, Oral Solution &
Pulvules (Rare) ... .................. .. l483
Vancocin HCI, Vials & ADD-Vantage
(Rare) ............... .... ................... 1481
Vannn for Oral Suspension and
Vantin Thblets
( Less than 1%) ....................... 2646
A Vascor (200, 300 and 400 mg)
Thblets (Up to 6.52%) ............. 1587
Vaseretic Thblets
(0.5% tO 2.0%) ........................ 1765
Vasotec LV ....... ......................... 1768
Vasotec Thblets (0.5% to 1.0%) .1771
Videx Thblets, Powder for Oral
Solution, & Pediatric Powder for
Oral Solution (Less than 1 %) ... 720
VivacrU Tablets .......................... 1774
Voltaren Thblets (I% to 3%) ........ 861
Wellbutrin 'Thblets ...... . ...... 1204
.AXanax Thblets (6.6%) ............ 2649
.AXylocaine Injections
(Among most common ............ 567
Zebeta Thblets ......... .. ........ .. ....... 1413
Zestoretic (0.3% to 1 %) ............. 2850
Zestril Thblets (0.3% to l.0%) ... 2854
Ziac......... . .. .. .. .... .... .. 1415
Zolofl Tablets (1.4%) .... .. .. .. ....... 2217
Zosyn (1.0% or less) .................. 1419
Zosyn Pharmacy Bulk Package
(1.0% or less)........ . .... 1422
Zyloprim Thblers
(Less than I%) ............ ........... 1226
• • Page numbers listed refer to the
1996 50th edition of the PDR.
e De.scribed in PDR For
Nonprescription Drugs
1 ncidence data in parentheses: A
3% or more
0 Described in PDR For
Ophthalmology
Copyright PDR* Guide to Dmg
Interactions, Side Effects, and
Indications"' keyed to PDR'* 50th
Edilion, published by Medical
Economics, Montvale, NJ 07645.
Reprinted with permission. All
rights reserved.
As far as seeing one's poems in print,
Daphne says, "Being published feels great - for
the first 30 minutes. In the end, it's the writing
of it that really counts." We believe that the
reading of it will also really count! The book is
scheduled to be available by early December. All
profits from the book will be donated to ATA.
Deadline for submission: October 15, 1996
All poems must be typed with name and
address clearly visible.
Maximum lines per poem: 25
Please submit to:
TINNITUS c/o
DSCW
1840 Brookvale Rd.
Hillsborough, CA 94010
Book Review
Bill Habets: The Tinnitus Handbook - A
Self-Help Guide. Encinitas, CA: United Research
Publishers, 1996., reviewed by TI'udy Drucker
The modest claims for this book for laymen
are fully justified. Although none of the infor-
mation is new, it's good to have a common-
sense, well-written, and intelligently organized
summary of most of what is generally known
about tinnitus. The Handbook will be especially
to ?aticnts who are just beginning to cope
w1th tmmtus, and wonder what might lie ahead.
The book begins with three comprehensive
accurate chapters on the anatomy and phys-
wlogy of hearing, on the nature of sound and its
effects, and on the various processes that might
produce tinnitus. A distinction is made between
people with "normal" tinnitus who are not both-
ered by it, and those who are more or less
severely troubled. Attempts to determine the
loudness or type of tinnitus do not correlate
with the degree of distress experienced by the
patients. Obviously, psychological factors are at
•vork. The chapter on psychological therapies
emphasizes the role of stress and the vicious cir-
cle of stress-induced-tinnitus and tinnitus-
induced-stress.
Habets is explicit about the role of noise in
causing or worsening tinnitus and hearing loss.
Various types of protection on the job and else-
where are described. Habets reminds everyone
that legal action can sometimes be taken by peo-
ple who are inadvertently subjected to other
people's recreational mega-decibels.
I especially liked a chapter about what the
patient can expect from examination and treat-
ment by a primary-care physician, a physician
specializing in diseases of the ear, and an audiol-
ogist. Habets urges all new patients to have a
thorough physical examination to rule out inter-
current disease, such as hypertension. The pos-
sibility that drugs can mitigate tinnitus
(tranquilizers, antidepressants) or worsen it
(aspirin, antibiotics) must be discussed with the
physician. Some patients find their tinnitus
improves if caffeine and/ or alcohol is eliminat-
ed or strictly limited. Smoking, even second-
hand smoke, is a known exacerbant. If the
tinnitus results from a food allergy, this must be
traced down. There isn't much evidence that
particular foods will be of benefit, although the
author's advice to follow a diet relatively low in
salt, sugar, and saturated fat is generally accept-
ed for most people.
The Handbook has a good index and a list of
organizations in America and England that can
provide additional information about many of
the topics discussed. The latter is rather heavily
weighted in favor of groups that advocate vari-
ous kinds of unconventional treatment. A few
well-known sources of excellent information
notably the Deafness Research Foundation
the Better Hearing Institute, were not included.
A bibliography for further reading and some
text-keyed references would have made a good
book better.
"Alternative" (complementary) therapy is the
current darling of many desperate people whose
suffering does not yield to the resources of
mainstream medicine. Habets presents us with a
veritable smorgasbord of options, ranging from
such accepted and possibly useful modalities as
hypnosis and biofeedback to the simply silly
such as "aroma therapy" and other types of "New
Age" gimmickry. To his credit, the author steers
clear of the exaggerated claims of too many
practitioners, claims that are not supported by
the well-designed and carefully controlled stud-
ies we have come to expect from good modern
medicine. It is not unusual that some people
wil1 feel better, or even get well, for no dis-
cernible physiological reason; the placebo effect
is us always. Anything will help somebody;
nothmg will help everybody.
Habets makes the important point that the
often heard claim, "well, it can't hurt" is not nec-
essarily true. No type of nonstandard treatment
will benefit the patient whose tinnitus is caused
by an acoustic-nerve tumor, and such "treat-
ment" is likely to keep him away from a real
cure. A recent front-page article in The New
York Times reported that, for
some instances of
m1sapphed chelation
therapy have resulted in
deaths. A fair-minded but
vigilant skepticism is a
powerful and vital weapon
in the war against tinnitus.
Tinnitus 1bday/ September 1996 13
Lester Lemke, Cape Coral, FL
Nelly Nigro, Los Angeles, CA
Dwne Bootz, Jacksonville, FL
Bob Lewicki, Las Vegas, NV
Arlene Jewell, Pensacola, FL
Ann Andruchiw, Parma, OH
14 Tinnitus Today/ September 1996
Malvina Levy,
San Francisco, CA
Cheryl Ann. Raisanen,
Woodridge, IL
Kindness Begets Kindness -
by Barbara Thbachnick, Client Services Manager
Oh, the comfort
The inexpressible comfort
Of feeling safe with a person
Having neither to weigh thoughts
Nor measure words
But pouring them
All right out, just as they are
Chaff and grain together,
Certain that a faithful hand will
Thke and sift them.
And with the breath of kindness
Blow the rest away
by Dinah Craik (Reprinted with permission from the Hyperacusis Network Newsletter. June 1996.)
When we give a pint of blood, a shoulder of solace, or a moment of
undivided attention, we are - as our species goes - really at our best.
It is a grand experience to extend handfuls of hope to people who on a
particular day are not able to do it for themselves.
We helper-types have all been on the receiving end of it too, which
is how we know that what we give can mean so much.
We asked our Tinnitus Support Network people to tell us just what
it is they get from giving their time and energy to others in this way.
They answered, "A chance to give back the precious help that was
given to me when I needed it most." "A place to go where people
understand my struggles." "Friendships I wouldn't part with." A kind-
ness, given in earnest, will always find its way back to the giver.
ATA's Self-Help Network changes weekly, shrinking with the natur-
al order of things and growing when people, who are helped by other
caring people, choose to be of service themselves. It's a random
growth. For example, some cities like Chicago have two active tinnitus
support groups with six additional telephone contacts. Other cities like
San Diego and entire states (see map) have no support contacts at all.
We're working to fill in these "support gaps." Do you live there? And
can you help?
Elaine Sauer; Saskatoon, SK,
Canada
Myrtha Castellvi,
Bolingbrook, IL
ATA's Self Help Network
If you are interested in joining ATA's network, write for our Self-
Help Packet. To assist you in getting a support group started, we'll
mail meeting announcements to 200-300 people with tinnitus in
your area, plus help you place press releases in your local papers to
announce the group. These efforts should help draw a good core of
people together. Or, if you prefer, we could list you as a telephone/
support person in our network - still a vital point of contact for
others with tinnitus. (There is no cost to you either way.)
Ours is an easily accessed network of telephone helpers and sup-
port groups. Current lists are sent to our members when they first
join ATA and then every year when they renew their memberships.
When you become part of our network, your name definitely gets
around!
If you see yourself in these words, do write to us and let us know
how you can help. If you are now or have ever been part of our net-
work, or if you see yourself in these pictures, we send you deepest
thanks from the bottom of our hearts.
Highlighted states are those without ATA support groups and/or telephone contacts.
Megan Vidis, Chicago, IL
Mike Cohen, Chicago, IL
Lillian Markowitz, Melrose, MA
:-;- ___ .... , ..:.
.• _ · · : ! f ~ ~ - - ~ - ~ ~
" .
' / .... ·.
- ,I
.•. ·· ·:
• I Oi
I ., i , ' '
Gail Brenner; M.A. C.C.C.A.,
Philadelphia, PA
Thomas D'Aiuto, Thmpa, FL
Tinnitus Today/September 1996 15
ATA Research Report-
An Interview with James A. Kaltenbach, Ph.D.
by Barbara Th.bachnick, Client Services Manager
James A. Kaltenbach, Ph.D., Associate Professor, Wayne State
University School of Medicine, discusses his recently-funded
ATA research project, ' Changes in Spontaneous Activity and
Neurochemistry of the Cochlear Nucleus Following Exposure to
High Intensity Sound'
B'n Dr. Kaltenbach, please explain the
theory behind your research project.
JK: When a normal-hearing person goes
from an environment of silence to one that is
filled with acoustic stimulation (or sound), the
electrical activity in the auditory system goes
from a low-level spontaneous (or
resting) activity to a higher level of
stimulus-driven activity. Since tin-
nitus is the sensation of sound in
the absence of acoustic stimulation,
we would expect that the auditory
structures of the brain of someone
with tinnitus might show an
increase in spontaneous activity
that resembles stimulus-driven
activity.
B'n How are you testing your
hypothesis?
JK: We have been studying the
B'n Why is the dorsal cochlear nucleus in
particular being studied?
JK: There are a couple of reasons. One is
that the dorsal cochlear nucleus receives input
directly from the auditory nerve, then processes
it, and passes its output to higher levels of the
auditory system. To understand what leads to
increases in spontaneous activity, we have to
study the dorsal cochlear nucleus where those
increases are likely to originate.
Also, in a recent study, tinnitus in some
patients was reduced or eliminated by electrical-
ly stimulating the surface of the
dorsal cochlear nucleus. (These
patients had had acoustic neuromas
removed and auditory brainstem
implants surgically implanted to
restore their hearing.) It appears
that the dorsal cochlear nucleus is
involved in both the production and
the suppression of tinnitus.
B'n What led you to study the
brain's involvement in tinnitus gen-
eration instead of studying the ear
structure itself?
spontaneous activity in the audita- fames A. Kaltenbach, Ph.D.
JK: It's true that central disor-
ders like tinnitus usually begin with
an injury to the ear. However, it's
known that more than half of tinnitus cases
ry systems of hamsters, specifically
in a structure in the auditory brainstem called
the "dorsal cochlear nucleus." The animals were
exposed to an intense tone for a period of four
hours, allowed to recover, and were then exam-
ined after one month. The spontaneous activity
in their dorsal cochlear nuclei was compared to
that in non-exposed animals.
B'n What did you find?
JK: We found that the animals exposed to
the intense tone one month earlier had abnor-
mally high levels of spontaneous activity.
Indeed, the increase was rather dramatic-
between five and 10 times higher than in nor-
mal-hearing animals.
There is another interesting aspect of this
finding that makes it very attractive as a model
of tinnitus. Specifically, one month after expo-
sure to an intense sound, the dorsal cochlear
nucleus behaved like a normal-hearing animal's
dorsal cochlear nucleus in the presence of a
high-pitch sound.
16 Tinnitus 1bday/ September 1996
appear to involve changes in the auditory por-
t ion of the brain. The notion is upheld by two
important findings. First, surgical removal of the
cochlea or severing of the auditory nerve does
not "cure" or relieve the symptoms of tinnitus.
Instead, following these surgeries, more than
half of such patients continue to have tinnitus,
and in many cases, the tinnitus is worsened.
Second, in patients with tinnitus on one side
(unilateral tinnitus), the tinnitus can be masked
by presenting a masking noise to the opposite
ear. This implies that the masking effect must
be mediated by structures between the ears-
in other words, by the brain itself.
Bn What do you expect to learn from this
research?
JK: We expect to learn precisely why
intense sound exposure leads to increases in
spontaneous activity and to tinnitus. Thanks to
ATA's support, we're beginning to obtain some
important clues.
An Interview with James A. Kaltenbach, Ph.D. (continued)
My collaborator, Dr. Donald Godfrey at the
Medical College of Ohio, found evidence of sig-
nificant chemical changes present in animals
with abnormal spontaneous activity levels one
month after they'd been exposed to sound. One
such chemical change was an increase in the
amount of glutamate, a neurotransmitter which
acts to increase the activity of many cells in the
auditory system.
BT: How will this information be translated
into treatments for tinnitus?
JK: Once the sites of the tinnitus generators
have been firmly established, and the mecha-
nisms that trigger them have been identified
chemically, we can use our animal model to
begin a search for drugs that will block increases
in spontaneous activity. The development of
effective drug therapies for people with tinnitus
depends ultimately on gaining an understanding
of the chemical pathways that underlie changes
in spontaneous activity.
Highlights from Illinois - ATA's First Regional Meeting
ATA's Regional Meeting in Arlington Heights,
IL this past May closely resembled a tinnitus
"town meeting" - an aU-day forum for a mixed
audience, balanced evenly between lay and pro-
fessional attendees. During the morning's open
session, patients and professionals alike heard
Dr. Reich present an overview of ATA's research
goals and mission, and Robert Sandlin, Ph.D.,
Director of the California Tinnitus Assessment
Center in San Diego, offer a thorough overview
ofknown tinnitus causes. James Kaltenbach,
Ph.D. explained his ATA-funded research project
(see "ATA Research Report- An Interview with
James A. Kaltenbach, Ph.D.", p. 16) in which
cochlear cell changes were examined before and
after exposure to high intensity noise. Sam
Hopmeier, BC-HIS, President of Hopmeier
Hearing Services and Dr. Sandlin together dis-
cussed the benefits of hearing aids, maskers, and
auditory habituation as relief-giving therapies for
tinnitus.
In the afternoon, two concurrent sessions
were offered: one for health professionals and
one focusing on self-help. For the professionals,
Drs. Sandlin, Kaltenbach, and Reich as well as
Sam Hopmeier elaborated on auditory habituator
and masker fittings plus the scope of tinnitus
research in the U.S. During the workshop-style
self-help session, Barbara Thbachnick demon-
strated listening and communication techniques
to help anyone become an able one-on-one sup-
port giver. She encouraged the attendees to tap
into their rich resources of support - family,
friends, and, of course, ATA. Jo Hazelby, a certi-
fied tinnitus counselor in the U.K. spoke of the
enormous benefits realized by tinnitus patients
Nancy Good and Reg Thomas
who receive focused counseling. (Jo also spoke
at the professional session to explain the link
between the medical and emotional needs of
tinnitus patients.) Dr. Reich explained the princi-
ples of cognitive therapy, a crucial self-help aid
that treats the patient's reaction to tinnitus
rather than the tinnitus itself. Nancy Good,
LCSW, discussed and demonstrated the princi-
ples ofbiofeedback as a stress reduction tool.
Good believes that the aim of stress manage-
ment is not to reduce the stress, but to change
the body's reaction to it. In her hands-on (and
"electrode-on") demonstration, Good's volunteer
was able to lower his heart rate by watching the
device to which he was attached, relaxing his
face, and adjusting his breathing. Both
Thbachnick and Good will reprise their presenta-
tions at the Maryland meeting in September.
Tinnitus 1bday/ September 1996 17
Silent Dental Work At Last!
by Barbara Tabachnick, Client Services Manager
Micro-air abrasion dentistry is exceptionally
quiet, so quiet in fact that one has to listen hard
to hear it at all. This new star of dental technolo-
gy was actually developed more than 40 years
ago at a time when its cost was 10 times greater
than that of the also new high-speed (and high-
noise) rotary drill. The drill became the dental
industry's standard despite its high-pitched
whine (above 4000Hz), associated pain, and the
need for local anesthetics with its use. Over the
years, patients grew more vocal in their demand
for less trauma in the dentist's chair, and an
interest in air abrasion was resurrected. Its wide-
spread acceptance throughout the U.S. began just
18 months ago.
In air abrasion cavity preparation, a small
device is held very near the cavity. From its tip,
a concentrated stream of pressurized air - from
45 pounds per square inch (psi) to 150 psi,
depending on the manufacturer - mixes with a
fine powder of aluminum oxide particles and is
aimed directly at the cavity. Excess powder is
sucked away by the in-the-mouth suctioning
tube, common to all dental work. Any airborne
particles can be removed by an intake air filtra-
tion device (like Kreativ's KleanAir) placed near-
by. These two devices produce the only audible
sounds during the procedure. The air filtration
motor makes a mild hum. The intermittent
in-the-mouth suctioning makes the loudest
sound of all.
In addition to being quiet, air abrasion is
essentially pain-free. Local anesthesia is usually
not required.
Micro-air abrasion technology has been
improved over the years though not yet to where
it can fully replace standard rotary metal drills.
Rotary drills are still the tool of preference for
extensive dental work: crown preparation, very
large or deep cavities that require root canal, and
removing old silver (amalgam) fillings. But not
in every case. Some dentists use air abrasion
only for the smallest pits and fissures, while oth-
ers will work it into deeper cavities. Apparently,
both the limitations of the equipment and the
variances among dentists play a part in deter-
mining the extent to which air abrasion is used.
18 Tinnitus 'Ibday/ September 1996
ATA member Craig Dennis needed serious
dental work. But because he couldn't bear the
thought of subjecting himself to the noise of a
drill, he put it off for more than five years. TWo
of his teeth were close to needing root canal
work when he learned about air abrasion den-
tistry, then found a dentist who used it. Robert
Windsor, D.D.S. in Thwson, Maryland, was able
to save Dennis' teeth using only the American
Technology's KCP air abrasion device. Dennis
needed no anesthesia for most of the procedure.
"I hate to applaud it as universally quiet," says
Dennis, "but I have extreme sound sensitivity
and tinnitus, and it worked for me!" The only
inconvenience he notes was that he had to close
his eyes to avoid the dust particles.
James Frohnmeyer, D.M.D., has had
Kreativ's MicroAir Abrasion unit less than two
weeks and already uses it for 20% of his prac-
tice. "It works marvelously, it's faster, and no
anesthesia is required," says Frohnmeyer, who
also notes that the time it takes for dentists to
learn the new technique is minimal.
Jerry Aso, D.D.S. uses Kreativ's devices to
keep the dental arena quiet for his patients. And
he uses something else - a philosophy of con-
cern for the physical and psychological needs of
each patient. When a sound-sensitive patient is
due to arrive, he will, for example, not run the
ultrasonic cleaner or other office machines that
generate noise. Says Aso, "When you know your
patients' needs, you can find the rhythm to the
dental work that works for them. Thking breaks
every 20 seconds is not a problem. It's possible
to do very complex work at that pace, at those
intervals."
Dr. Aso acknowledges the limitations of the
new technology. Air abrasion is not the preci-
sion tool he needs for cleaning out a deep cavi-
ty, so it loses out to the standard drill. But he
will use the air abrasion to the end point of its
usefulness so that some of the drilling time is
quiet. Aso notes that some rotary drills make
less noise than others, and he always opts for
the quietest one.
In the 1980s, hopes ran high that the sur-
geon's laser scalpel would make a successful
crossover into the world of cavity repairs. It took
little time, however, to uncover the problems
with that idea: 1) The heat from the laser was
Silent Dental Work At Last! (continued)
found to literally "cook" the nerve and conse-
quently kill the tooth. 2) The precision needed
for decay removal is not yet possible with lasers.
3) The price of the equipment is still out of
reach for most.
A new water-cooled laser is being tested, but
so far it's tooth cutting efficiency is "unimpres-
sive," according to Stewart Rosenberg, D.D.S.,
founder of the Academy of Laser Dentistry.
Lasers do have their place in the
- ,-.. dental office, says Rosenberg.
Argon lasers are used to harden the
composite tooth-colored filling
material, and they make the com-
posite filling twice as strong.
Carbon dioxide lasers are used in
soft-tissue surgeries in the mouth
because they eliminate bleeding and
the need for stitches. But the laser's usefulness
in the mouth ends there for now.
James Rademacher D.D.S., Ph.D., believes
that decay prevention awareness (fluoride treat-
ments, dietary changes, proper flossing, etc.) is
impacting dentistry as a whole. Statistically, cavi-
ties are fewer in number and smaller in size
than ever before. He speculates that in the near
future, air abrasion dentistry will be all that is
needed. Until then, it is logical for patients to
have cavities attended to early, when air abra-
sion stands its best chance at being the sole
treatment.
Dr. Rosenberg feels that the future of air
abrasion dentistry looks brighter yet. New pow-
ders are being developed to improve air abra-
sion's capabilities. Professionals who use air
abrasion equipment agree that, despite its limita-
tions, it's a great start. For people who have
shied away from the dentist's noisy drill for fear
of worsened tinnitus, it should come as a
tremendous relief.
Call or write to the manufacturers fbr the names of
local dentists who use these products.
+ American Dental Technologies, KCP "Whisper Jet"
1000 PAC - Air Abrasive Cavity Preparation System,
922 Harmony Hill Rd, West Chester, PA 19380,
800/ 359-1959
+ f<l·eativ Inc. , Advanced Particle Beam Cavity
Preparation Device "Mach 4.0," KleanAir air
filtration system, 15J 7 Industrial Way SW, Albany,
OR 97321, 800/ 573-2848
Resources:
Jerry Aso, D.D.S., 1707 NE 122nd, Portland, OR 97230,
503/ 255-7222
James Frohnmcyer, D.M.D., 5228 N. Lombard,
Portland, OR 97203, 503/ 289-7043
Mu1tnomah Dental Society, Portland, OR, 503/ 223-4738
Oregon Health Sciences University Dental School,
Portland, OR, 503/ 494-8867
James Rademacher, D.D.S., Ph.D, Portland OR,
503/234-1218
Stewart Rosenberg, D.D.S., 9101 Cherry Lane, #202,
Laurel, MD 20708, 301/ 776-3300
References:
Bahannan, S. , El-Hamid, A., Bahnassy, A., Noise level of dental
handpieces and laboratory engines, Journal of Prosthetic
Dentist1y, Oct. 1993, vol.70, no.4, p. 356-360
Feinman, R.A., High velocity air microabrasion for conserva-
tive tooth preparation: The principal and the clinical proce·
dure, PP & A, vol.7, No.8, 37-42
Goldstein, R.E, Parkins, F.M., Using air-abrasive technology to
diagnose and restore pit and fissure caries, JADA, Vol. 126,
June 1995, 761-766
Rosenberg, S., Air-abrasive microdentistry: A new perspective
on restorative dentistry, Dental Economics, Sept. 1995, 96-7
Stanford, C. M., Fan, P.L., Stanford, J.W., Assessment of noise-
reducing devices for the dental office personnel, Quintessence
International, Nov. 1987, vol.l8, no.ll, p.789-792.
ATA's New Support
Contacts -Welcome to
our ((Net"!
New Tinnitus Support Groups
Lois Cohen, MSW, 152 Lewis Rd.
Northport, NY 11768, 516/754-6249
Steve Ratner, 5797B Brook Bound Ln.,
Boynton Beach, FL 33437, 561/ 495-2002
(day), 561/743-4853 (eve)
Maria Helena U. Caetano, R. Franco Pinto 275,
#43, Sao Paulo, SP 04016-031, BRAZIL,
phone: 55-11-5704536
New Tinnitus Telephone/Letter Contacts
Susan Grant, 9510 Cayuga Dr.,
Niagara Falls, NY 14304, 716/298-5074
Michael O'Malley, 8505 S. Kedvale,
Chicago, IL 6062, 312/284-2211
Warren Thdor (phone calls only),
Jackson, NJ 908/928-1639
Tinnitus Thday/ September 1996 19
Questions and Answers
by Jack A. Vernon, Ph.D., Oregon Hearing
Research Center
Dear Readers.·
As many of you know, I am retiring as of August 15,
1996. However, I will still be available to answer your
questions. Questions can be sent to me c/o ATA. If you
need to talk with me directly, I will take calls on
Wednesdays from 9:30am - noon and 1:30 - 4.30 pm
(5031494-3675) starting September 4th.
[Q]
Ms. D. from New Jersey writes that her
tinnitus fluctuates. Some days she can
hardly hear it; other days it is very loud.
When it is quiet, the only thing that turns it
back on is sleep. Even a very brief nap will pro-
duce very loud tinnitus. She asks, "Why?"
There is a group of tinnitus patients for
whom sleep is the trigger that turns
their tinnitus from good to bad, or from
bad to good. One has to guess that there is some
brain mechanism involved with sleep control
which affects the brain center involved with tin-
nitus but, unfortunately, we do not know the
identity of these centers. There is one sugges-
tion I would make to you and it is to use mask-
ing while you sleep. Marpac makes a tabletop
tinnitus masker advertised in this journal, and I
would suggest that you use it, or one like it, for
sleeping to see if it is possible to disrupt the
sleep effect without disrupting the sleep. Will it
work? I don't know, but try it and let's see.
[Q]
Ms. B. in California writes that she has
hyperacusis and that her attending
doctor instructed her to wear ear plugs
all the time. He said if you wear them aU the
time the hyperacusis will gradually go away. She
said she did just that and the hyperacusis got
worse. Why was that?
The sure way to make hyperacusis
worse is to over protect the ears. When
exposed to normal environmental
sounds it is important to wear no ear protection.
1b do so will make the hyperacusis worse. That
is exactly what happened to you - but all is not
lost. In the future, do not over protect your ears.
You can also desensitize your ears with a pink
noise audio tape. (For a copy, write to: Tinnitus
Clinic c/ o Oregon Hearing Research Center-
NRC04, 3181 SW Sam Jackson Park Rd.,
20 Tinnitus Today/ September 1996
Portland, OR 97201.) For about two hours each
day, listen to pink noise at the maximum com-
fort level, and very gradually your tolerance for
loudness will return.
[Q]
Mr. M. in Missouri is concerned about
the possible damage from sounds he can
not hear, specifically the noise of power
tools such as routers.
Ear protection should be worn whenever
you are exposed to loud sounds, whether
or not you can hear them. It is possible
to exacerbate your tinnitus with loud sounds that
you are unable to hear. I would encourage you to
continue to use those tools (I am well aware of
how much fun it is to use them!) but to always
protect your ears when you do so. In my shop I
have five pairs of Thunder 29 ear muffs - one
pair for each tool that makes loud noise.
[Q]
Ms. P. from Pennsylvania writes a most
interesting account of her pulsatile
tinnitus. I would like to present it here
and ask our medical colleagues to give their
opinions of her treatment.
Ms. P. was diagnosed as having hydro-
cephalies, that is, an increase in the
intracranial pressure causing the pul-
satile sounds she heard. The corrective proce-
dure that she'd had drained off some of the
cerebral fluid via a craniotomy and shunting,
which resulted in the disappearance of her pul-
satile tinnitus. The question remains whether or
not it is a permanent solution.
Increased intracranial pressure is only one of
the ways that pulsatile tinnitus can be produced,
but it is an unusual one that requires the atten-
tion of a neurologist and a neurosurgeon.
fRl Ms. H. from Colorado asks if Thnocard is
~ a recommended treatment for tinnitus.
Some years ago, five centers across the
U.S. (Oregon Hearing Research Center
was one) were se]ected to evaluate the
effectiveness ofThnocard, an ora] analog oflido-
caine, on tinnitus. Each center was instructed to
test 20 patients in an open study. It was not a
double-blind, placebo-controlled study. We
found we needed to introduce Tonocard to 60
patients before we found 20 who could tolerate
Questions and Answers (continued)
the drug. (The side effects were so great.) Of the
20 who took the full course of the Thnocard med-
ication, only one patient had his tinnitus
relieved. The other four centers got about the
same results as we did, that is, a 5% success rate.
The study of Thnocard was motivated by the
successes with IV lidocaine. In an IV injection,
lidocaine will eliminate tinnitus in 23 of 26
patients but only for about 30 minutes. It's long
been thought that an oral form of lidocaine could
be an effective tinnitus therapy. As you can see
from the above results, Tbnocard is not the
answer.
[Q]
Ms. S. from North Dakota asks, "I need
to have some dental work which will
involve drilling. Is the dental drill noise
loud enough to raise my tinnitus? Should I wear
ear plugs?"
The high-speed dental drill is very loud.
Some dentists have acquired hearing
loss and tinnitus themselves as a result
of using the high-speed dental drill. One dentist,
who was a tinnitus patient in our clinic, did a
survey of dentists in the Northwest and Northern
California and found that every dentist who had
purchased the high speed dental drill now had a
hearing loss. Over half of them had moderate to
severe tinnitus. Those dentists were exposed to
that noise for a very long time (years) whereas
you will be exposed for a relatively short time
(minutes). Nevertheless I think that the noise
from a dental drill may, for some people, pro-
duce an increase in tinnitus. Remember, it is
easier to exacerbate tinnitus than to acquire it.
The fact that the dental drill is in contact
with the teeth means that its sound is transmit-
ted to the ear by bone conduction as well as by
air conduction. Because bone conduction is the
primary route of dental drill noise to the ear,
wearing ear plugs will not help much but it will
help some. I would suggest that you explain
about vour tinnitus to your dentist and request
that the drilling be done in short spurts with
many brief intervals of no drilling. (See Silent
Dental Work- At Last!, p. 18)
[Q]
Mr. A. from Thxas writes that he is a
reformed alcohol and drug addict and
wonders if it would be safe for him to try
Xanax for his tinnitus. He goes on to say he is
desperate and is struggling with a very severe
bilateral noise-induced tinnitus.
Since there is a history of substance
abuse, I think it would not be ~ a f e t ~ try
Xana-'< which for some people 1S habit
forming. I further suggest that you question the
use of all drugs that have any habit-forming or
addictive characteristics.
I would also recommend a very thorough
exploration of masking (hearing aids, or combi-
nation units of hearing aids and in-the-ear
maskers called tinnitus instruments) as a possi-
ble relief procedure.
[Q]
Mr. B. from Pennsylvania is an attorney
with a client who has head trauma-
induced tinnitus. He asks if there are any
objective tests of tinnitus which might be of
value to his client? Would the tinnitus be dis-
played on X-ray, CT scan, or MRI scan?
There are no completely objecti:e t ~ s t s
of tinnitus. And unfortunately, tmmtus
is not revealed on X- Ray, CT scan, or
MRI scan. You will find a discussion of
"Litigation and Tinnitus" in the Proceedings of
the Fifth International Tinnitus Seminar which
can be ordered from the American Tinnitus
Association.
For your information, courts of inquiry usu-
ally ask four questions regarding tinnHus:
1. Does the plaintiff really have the tinnitus he
claims to have?
2. Was the tinnitus caused by that indicated by
the plain tiff?
3. Is the tinnitus as severe as the plaintiff
claims?
4. Is the tinnitus temporary or permanent?
Of these four questions, there is a test for
the first question which is somewhat objective
and which has been accepted by other courts in
the past. The test is the reliability of repeated
loudness of tinnitus tests. If the plaintiff can
repeatedly match the loudness of his or her tin-
nitus within 2 dB, that performance is accepted
as evidence that the plaintiff has the tinnitus he
or she claims to have. There are no objective
tests for the other three questions.
Send your questions to:
Dr. Vernon c/o ATA, Tinnitus Thday/Q&A,
PO Box 5, Portland, OR 97207-0005
Tinnitus Today/ September 1996 21
Profile: New ATA Board
Member Paul J. Meade
Paul Meade
Paul Meade, a Certified
Public Accountant and
Chief Financial Officer for
Gaylord Industries in
Oregon, joined ATA's Board
of Directors on June 11,
1996. Paul's connection to
tinnitus is not professional
but it is personal. Both Paul
and Phil Morton, ATA's
board chairman, work for the same company.
His proximity to Phil on a daily basis has given
Paul the opportunity to see a person's struggle
with tinnitus first hand. Paul writes, "Witnessing
the difficulties Phil Morton has in conducting
his job has helped me to understand the magni-
tude of the problem and how challenging it can
be. l also have a desire to give back to the com-
munity, to help the millions of people affected
with tinnitus."
We gratefully thank Paul for his willingness
to serve on ATA's Board of Directors.
WANTED!
HEARING-AIDS AND/ OR
MASKERS IN ANY CONDITION
If you have ever wondered what to do ~ " l i t h those
aids that are just sitting in the drawer, think no
further. ATA will be happy to receive them.
Donations to ATA are tax deductible, and we'll
provide an acknowledgement. Simply package
them up carefully (a small padded mailing bag is
fine) and send to:
ATA, PO Box 5, Portland, OR 97207.
If you are using UPS or another shipper, ship to
our street address:
ATA, 1618 SW 1st Ave., #417, Portland, OR 97201.
What happens to the aids that you turn in? In
some cases they can be repaired and given to
needy people or used in charitable missions to
underdeveloped countries. Even if they can't be
reused as is, the parts are needed for repairing
other aids. (And the plastic is recycled.) Your old
aid could give someone the gift of hearing'
SPACE STILL AVAILABLE- CALL OR FAX TODAY!
Targeting
1111
.-
1111
.-
1111
• Tinnitus
ATA REGIONAL MEETING
FOR PATIENTS AND PROFESSIONALS
SEPTEMBER 26, I 996
COLLEGE PARK, MD
YES! I WILL AlTEND THE ATA REGIONAL MEETlNG SEPTI:MBER 26, 1996
AT THE INN AND CONFERENCE CENTER UNIVERSITY OF MARYLAND UNIVERSITY COLLEGE, COLLEGE PARK MD
NAME: ______________________________________________________ TEL: ______________________ __
BUSINESS NAME: _______________________ FAX: ___________ _
ADDRESS: _________________ CrTY ___________ STATE
ZIP
ENCLOSED IS A CHECK FOR MY $75 REGISTRATION FEE
CHARGE MY $75 REGISTRATION FEE TO MY VISA/MASTERCARD
ACCOUNT#
- - - - - - - - - - - - - - - - - - - - ~ ~ - - - - - - - - - - - - -
ExPIRATION DATE TELEPHONE #
--------- --------------
SIGNATURE __________________ __
I AM ATTENDING BECAUSE:
I HAVE TINNITUS
A FAMILY MEMBER HAS TINNITUS
I TREAT TINNITUS PATIENTS
OTHER. ________ _
THE INN AND CONFERENCE CENTER HAS A UMITED NUMBER OF GUEST ROOMS AVAILABLE AT $74 SINGLE, $89 DOUBLE
CALL (800) 727-8622 TO MAKE ROOM RESERVATIONS DIRECTLY WITH THE CENTER
PROFESSIONALS PLEASE INDICATE CONTINUING EDUCATION CREDITS (CEUs) DESIRED: ASHA NIH IS STATE
FAX THIS FORM TODAY TO: (503) 248-0024 OR CALL (503) 248-9985 EXT I 8
22 Tinnitus 1'bday/September 1996
Rising Above the Cacophony
by Mary Holmes Dague
Cupping your hands over your ears, you
confront the most feared question: can tinnitus
get worse? Indeed it can. In the forty-three
years I've lived with the malady, the sounds in
my head have developed from mere whispers to
sirens, now approximately as loud as a lawn
mower with pitch double the highest piano key.
Tinnitus became my companion when I was
four years old, the result of taking antibiotics. In
the history of medicine, the development of
antibiotics ranks as one of the highest accom-
plishments, comparable to today's elusive search
for a cure for AIDS. But in the early 1950s, the
full risks of antibiotics were not known
although the benefits were. Who could fault a
pediatrician for prescribing Aureomycin for ear
infections at doses known now- but not then
-to be too high?
I knew a year before starting kindergarten
that I didn't hear as well as others and I knew
also that little sounds scurried about my ears.
Neither frightening nor annoying, the tones
swayed through me, often taking shapes of
music in my in1agination. Since I was already
studying modern dance, the constant flow of
notes seemed almost a gift to inspire new
movement.
Never once did I consider telling the doctor,
my parents, or my best friend that my percep-
tions of the world differed a bit from theirs. The
hearing problem was minor and the tinnitus, a
word I was not to understand for many years
yet, seemed insignificant.
My elementary school career began brilliant-
ly. A natural lip-reader; I found little impedi-
ment to hearing in the classroom. The annual
hearing test was performed en masse, at card
tables. But in third grade, the school purchased
my nemesis: a huge, gray, Beltone audiometer.
The school nurse began testing students individ-
ually, and I was caught. Before informing my
parents, the nurse tested me at least fifteen
times, challenging me each time "to do better" ,
an impossibility. Now my imagination was rac-
ing not dancing: I could see myself admitted to
some school for the deaf, ostracized from my
friends. Suddenly I'd become, to my own mind,
something of a freak.
Nightmares began to become true as the
local otolaryngologist to whom I was referred
quickly prescribed a tonsillectomy. So disap-
pointed was the doctor when post-operative
hearing tests showed no improvement, that
he recommended further surgery - a
mastoidectomy.
The pediatrician stepped forward, sending
me for a second opinion to Edmund P Fowler,
Jr., M.D., Chief of Otology at Columbia-
Presbyterian Medical Center in New York City.
Dr. Fowler, internationally famous as an otolo-
gist and researcher, dismissed the specter of
mastoidectomy within a moment of our meet-
ing. My hearing loss was clearly caused by
nerve deafness, and he was certain the
Aureomycin prescribed earlier was the cause.
Dr. Fowler's mind ran at the speed of light; I
sometimes marveled that even he could keep up
with his thought processes. Yet, his compassion
invoked the finest qualities of a healer. The doc-
tor ran me through several weeks of testing at
the Speech and Hearing Clinic (which is now
named for him) before the audiologist discov-
ered my lip-reading. Dr. Fowler greeted that
information with a characteristic hearty laugh,
congratulated me on my good work, and
ordered the evaluation re-done.
On the very last day, after the very last test,
the audiologist asked me one question: "Do you
have ringing in your ears?" At last. Someone had
asked the forbidden question. For seven years,
I'd kept this secret. I responded with my own
question: "Is there any surgery for it?"
The answer of course was no, and for the
first time I acknowledged the condition.
Tinnitus. By withholding information about tin-
nitus, which is often the first sign of nerve deaf-
ness, I'd managed to push away the diagnosis
for years, caused myself one unnecessary
surgery, and came close upon another!
My hearing loss then was
about 25%, and the tinnitus non-
invasive. Luckily, Dr. Fowler was
a tinnitus researcher, and he
talked with great enthusiasm
about the subject, always trying to
learn something new from me,
sharing his knowledge in return; his posi-
tive attitude infused me. Asking questions
Tinnitus 'TOday/ September 1996 23
Rising Above the Cacophony (continued)
about my dancing, the novel in my hand, plans
for college, Dr. Fowler wanted to know how my
life was progressing; my healing and tinnitus he
could evaluate himself. Never would he say, as
otolaryngologists often do, "Just live with it!"
This otologist's message was simple and
humane: "Live!''
Before his sudden death when I was 16 years
old, Dr. Fowler admonished me never to take up
cigarettes, and suggested I may not experience
further development of tinnitus. I had lost a
great friend and ally, and tried to memorize
every moment we had shared as doctor-patient.
I had never met anyone who had tinnitus or a
juvenile with hearing loss; this great physician
had understood my journey and made me feel I
was not alone.
Although I never smoked a cigarette, tinnitus
did increase as my hearing declined. In addition
to severe tinnitus, my hearing loss is now about
90%. There's no cause for sadness, though: I
wear two programmable ReSound hearing aids,
Developed by Speech
Pathologist. Mary Kleeman,
the I See What You Say
program provides an
interesting. new approach to
acquiring speechreading
skills for the hard of hearing.
"Instruction and
practice are
imaginative,
easy to follow and
enjoyable."
Journal Self Help for
Hard of Hearing People
Learn Lip Reading
with this Fun,
Self-Help,
Easy to Use,
Lipreading Course
Video & Manual
• Compensate for Noise & Tinnitus
• Aid Speech Discrimination
• Enhance Communication
• Stop Feeling Isolated
This clearly presented format of
inst.ruction includes practice activities
for single words to stories. Sixteen
speakers arc presented.
****
American
University
Wa$ltlngton, D.C.
24 Tinnitus Thday/ September 1996
1ip-read well, conduct business by TTY and com-
puter, and boast a sensitive family and self-
appointed hearing-ear dog. The worlds of theater
and music are now closed to me in the chaos of
extreme tinnitus, but life has a way of compen-
sating for losses; closed captioning, for example,
connects me to television drama, news, and
videotapes.
In recent years, I've had to stare down guilt
feelings. What might I have done to prevent the
advancement of tinnitus? How about those gal-
lons of coffee that pulled me through college,
graduate school, and the years of raising two
children? Did the increasingly powerful hearing
aids I needed to remain in the hearing world
actually destroy more hair cells over the years?
Had I over-indulged my love of classical music,
listening at unsafe volume levels? Did a period
ofheavy drinking, which seemed to alleviate tin-
nitus temporarily, actually increase the ringing?
These questions required some sorting out
with two professionals, a therapist and an audiol-
ogist. The answers of course, weren't clear,
although the audiologist is fairly certain that the
Aureomycin had set an irreversible course of
progressive hearing loss and tinnitus increment.
The therapist, who had studied effects of tinni-
tus, focused on quality of coping skills, render-
ing the guilt feelings to smithereens.
All that remained to deal with was sleepless-
ness. After a decade of tinnitus-induced sleep
deprivation, I contacted Dr. Jack Vernon at the
Tinnitus Clinic of the Oregon Hearing Research
Center in Portland, for a successful trial of
Xanax. The drug ameliorated somewhat the
screeching pain. Normal sleeping patterns
returned and I resumed a writing career which
had been thwarted by chronic fatigue. 'IWo years
later, I still take Xanax under Dr. Vernon's c.1irec-
tion and feel, as Charles Dickens wrote in A Tale
ofTwo Cities, "recalled to life."
Like you, I cup my hands over my ears and
confront the great question: can tinnitus get any
worse? I really don't know. At times, when I
leave my hearing aids at home to walk beside
my dog, I hear no sound but the unrelenting
sirens in my ears. Yet, I sense the contentment
of rising above the cacophony. Perhaps I am
learning what Dr. Fowler wished for me long
ago: simply, to live.
Tributes, Sponsors, Special Donors,
Professional Associates
Champions of Silence are a select group of donors demonstrating their commitment in the fight
against tinnitus by making a contribution or research donation of $500 or more. Sponsors and
Associates contribute at the $100-$499 level. ATA's tribute fund is designated 100% for research.
We send our thanks to all those people listed below for sharing memorable occasions in this hopeful
way. Contributions are tax deductible and are promptly acknowledged with an appropriate card.
The gift amount is never disclosed. GIFTS FROM 4-15-96 to 7-15-96.
Champions of Silence
Julia R. Amaral
Robert w. Booth
Thomas W. Buchholtz, M.D.
George Crandall, Jr.
Rob M. Crichton
Glen R. Cuccinello
T. Dubonnet
Bobbie Gamble
W. F. Samuel Hopmeier, BC-HIS
Gary P. Jacobson, Ph.D.
Alice R. Lovvorn
John Malcolm
Estate of Louise M. Pope
Steven A. Rothstein
Marion H. Schenk
Edwin McMahon Singer.
President
Jacob & Sophie Rice Fdn.
Jerry R. Thompkins
Sponsor Members
James D. Arden
Kathy Bai
Joseph M. Baria
Mr. and Mrs. Jules Belkin
Francine & Jules Belkin
Philanthropic F'nd.
Sam Berkman
Allen R. Bernstein
Walter T. Bolick Ill
Ronald R. Bowden
Michael L. Bowen
Lauran Bromley
Blaine Bronson
William E. Brown, Jr.
J. Stephen Brugler
Richard Burnat
Raymond L. Buse, Jr.
A. Paul Camerino
Pat Carroll
Salvatore Cascone
Kerry Chatham, D.V.M.
Barry G. Conner
Michael L. Connolly
Richard W. Cooper
Anthony G. A. Correa
Esther Cronson
Joseph Decker
Bilt-Rite Contractors
Robert R. Deskovick
Brenda D. Deweese, Chair
NYC Transit Authority/
Exc. Charity
Kit Dickerson
Kathryn M. Dobrinski
Randall C. and Elise Ducote
John Dunlop
Josephine M. Elias
David E. F'latow
Julius Flores 11
Paul M. Flowerrnan
Mary A. Floyd
Joy A. Fogarty
Francine and Ray Foster
Robin R. Fuller
Arthur Gelh
Charles W. Gilbert
Harriet L Glazer
Marlene Greenebaum
Josephine K. Gump
Paul R. Haas
James and Colleen Hartel
Avis s. Hartley
Chal'les B. Hauser
William F. Hendren
Lorraine Hizami
Thd Hofmeister
T. Hofmeister Distrib. Co.
Robert B. Horn
Shirma M. Huizenga
William H. Hurt
H. June Ivins
Larry C. James, Jr
Harold S. Karpe
Donald King
Robert A. Kirkman
Waldemar Kissel, Jr.
A. J. Klekcrs
Larry Kopel
David J. Kovacic
Marvin Kowit
E. Joseph Kubat
Henry G. Largey
Fred R. Lawson
.John R. Luca::;
Peter A. Marrinan
M. Richard May
Carol P McCurdy
Bruce McGregor
Ed Leigh McMillan ll
Thomas F. McNulty
Andrew Metrick
Alexander Miller
Matt Minninger
Philip 0 . Morton
Edward J. Nierman
Caroline S. Nunan
Teresa L. O'Halloran
Ruth E. Ochs
Thomas R. Ogren
All an F. Pacela
Phil R. Pearcy
Mary Ann Perper
Lemae Peterson
Emil A. Pfitzer
Ruth M. Philpott
Harvey A. Pines, Ph.D.
Bruce K. Powell
Kenneth A. Preston
Jennifer Priebe
Jerome A. Rich
Ludie G. Richard
Lynn Rosemurgy
Andrew J. Rosser
Ernest Sagues
Donna Scheckla
Scheckla Company
William T. Schreitmueller
Richard S. Schweiker
Evelyn J. Schwertl
Robert R. Sfire
Wi ll iam Shatner
Marshall C. Smith
Raymond and Sylvia Smith
Howard C. Stidham
Robert L. Szabo
James C. 'Tbtten
Gordon K. Washburn
Edward R. Weiss
J. Michael Wiggins
Rex Winn
Larry W. York
Adelaide W. Zabriskie
Paul W. Zerbst
Professional Associates
Elliott H. Berger
John Berry
Gay Yvonne Carley
Roberta M. Case, M.D.
Joel G. Cohen, M.D.
Laurie Cowell
John R. Emmett. M.D.
Bjorn Eriksen, M.S.
Lawrence T. Eschelman, M.D .
RobertS. Feehs, M.D.
Anne C. Galloway, M.S./CCC-A
Norman Goldstein, M.D.
Kenneth Greenspan, M.D.
Robert R. Harmon
Sharon T. Hepfner, M.A./FAAA
Soraya Hoover; M.D.
Walter L. Hunt, M.D.
Kenneth M. Jones
Esther Lee
Sol Marghzar, M.S./CCC-A
Stephen Martinez, M.A.
Patri cia J. Michaels
Stephen E. Mock, Ph.D.
William H. Moretz, Jr., M.D.
Terrence P. Murphy, M.D.
Dorothy Muto-Coleman, M.A.
Stephen M. Nagler, M.D.
Scott M. Nelson, M.D.
Jerry L. Northern, Ph.D.
Thomas J. Norwood,
M.S. P.A./CCC-A
Anne O'Neill, M.S./CCC-A
R. H. Perry, Ph.D.
Dr. Otis D. Rackley, Jr.
Gloria E. Reich, Ph.D.
Richard S. Reikowski, M.A.
Philip A. Rosenfeld, M.D.
Thnit Ganz Sanchez, M.D.
David J. Sand, M.D.
Mitc:hell K. Schwaher, M.D.
Frank A. Skinner
Helena Solodar; M.S.
Dr. Blair R. Swanson
Jack A. Vernon, Ph.D.
Elliot Wineburg, M.D.
In Memory Of
Gary Chatillon
Mr. and Mrs. Leon Chatmon
James W. Dickson
James F. Dickson
Frederick Fontanella
Anthony De Biase
Arthur J. Gittus
John and Faye Schleter
Selma and Alan Rothenberg
Susan R. Ericson
Burt Willdnson
Christina Wilkinson
In Honor Of
Dr. Sob Johnson,
Professor Jim Nunley,
Dr. Jack Vernon:
Richard Burnat
Harry Hoffman
Sylvia Eisenberg
Dan Leib
Peter and Judy Jonas
Dr. Douglas Morgan
Patty John
Ed Van Put
James Newton
Corporations with
Matching Gifts
Automatic Data Processing, Inc.
(ADP)
BankAmerica
Chase Manhattan
Citibank
The Equitable
John Hancock Mutual Life
Insurance Co.
Hoechst Celanese
Johnson & Johnson
Philip Morris
Polaroid
Tinnitus Today/ September 1996 25
Tributes, Sponsors .. . (continued)
Research Donors
William C. Altmann, Jr.
Mark Anderson
Sally A. Anderson
Patty Andrews
Calvin Artke
Lou Bachus
Ruth V. Baer
Richard K. Bailey
Bill Bannister
Anthony P. Bartiromo
Philip L. Baselice
Ronald Berger
Howard G Bernett
Allen R. Bernstein
Lillian Bertin
Lorraine E. Blake
Joyce C. Bodig
Richard C. Borella
Henry L. Boyd
Betty Branchini
Marianne Brandon
Journeys End
Kathleen M. Brock
Delbert E. Broughton, Jr.
Harry A. Bruhn
Elizabeth C. Bryan
Heidi Burgoyne
James G Burke
Angel Island State Park
Richard Burnat
Mary H. Call
Carolyn M. Carr
David H. Cato
Lorimer T. Christensen
J. R. Claridge
Glenn D. Claypoole
Laura A. Comrie
Lisa L. and Denis Connor
Corienne Cotter
Rose Cottrell
Harry G. Courson
Rob M. Crichton
Mary A. Crouse
Louis N. D'Ascoli
Walter R. Dallas
Mary Ann Davidson
George M. Dawson
Marian R. Dawson
Robert C. Delollis
Robert J. Digisi
Ro.land v. Dinger
Dinger Photography
Avlee E. Dodson
Cheryl K. Dolesh
T. James Donnelly
Otto J. Drescher
George M. Drew
Randall C. and Elise Ducote
Richard E. Dye
Linda K. Edgar
Eugene C. Edminster
Miriam Eidlitz
Robert J. Emig
Nancy Essington
Frederick w. Feedore
James T. Fehon
Michael A. Ferraro
Mary Thulouse Fett
Frances Finney
Paul M. Flowerman
Sandy L. Frary
Alan J. Frenkel, O.D.
Abraham and Hanna Fried
Joyce M. Friesen
Irving Garnza
Elaine Gannon
Joseph M. Garber
Harold P. Garner
John H. and Donna Gary
Mark S. Geller
Leo A. Gendron
Otto Genoni
Pearl and Julius H. Gerson
Marion R. Gillespie, M.D.
Gayle Goldglantz
Peggy B. Gouldman
Daniel M. Gowans Ill
Ciro P. Granatini
Ellen Greif
Elsie Louise Hahn
Suzanne Hanson
David W. Harrison, Jr.
Helen liawbaker
Alice R. Hawley
Irene R. Heymann
E. Alan Hildstrom
Louise M. Hirasawa
George R Hoffman
Eva Hofman
Julian Hoogstra
Shirma M. Huizenga
Gaye v. Hunt
Gloria Hunter
Martha E. Iacobucci
Dorothy Ikemeyer
Rein lse
Gladys L. Jennings
Arlene M. Jewell
Barry V. Johnson
Mark A. Jones
Howard R Katz
R. L. Keheley
Emma L. Kellaher
Frank L. Kellogg, Jr.
Jessie M. Kembro
Richard King
Robert A. Kirkman
.Jan M. Koci
Shirley E. Kodmur
Frank V. Koenig
Mary R. Kokes
Steve M. Konneman
Virginia C. Kuehner
Thomas B. Lake
Richard Larosa
Gwendolyn F. Layman
Frances L. Lerch
Roland J. Lewis
Dale E. Lien
Henrietta Lieschefski
Mary Jane Lillis
Ann Lingos
lnna Lorents
JoyS. Mankoff
Jon P. Maunders
Nancy M. McFadyen
Brenda R. McFarland
Edward W McManus
26 Tinnitus Thday/September 1996
Josephine B. McMeen
Harold Mechanic
Jean Mentis
Ernest C. Messinger
Andrew Metrick
Kenneth J. Meyer
Justeen F. Mills
Suzanne H. Mindnich
Kenneth E. Mooney. M.D.
Chiyoko M. Nakayama
lan L. Natkin
Robert Nichols
Andrew Nowak
Donald G. O'Brien, Sr.
James O'Buck
'Ihesa L. O'Halloran
Michael O'Malley, O.D.
Wi ll iam D. Odbert
Robert J. Oliver
Mac D. Olson
Michael F. Otero
Mark Owyang
Helen .J. Parkerson
Robert C. Parsons
Felicia A. Passero
Roi N. Peers
James W. Peterson
Judith Picpsney
Nancy Pirro
Monica M. Pogozelski
Jennifer Priebe
Leonhard Raabe
Charles L. Rager
Betty Ramsey
David Rapaport
Timothy J. Ratkie ...vicz
Mirka M. Ray
John B. Redman
Neal L. Remler
Nellie C. Restivo
Daniel Revnolds
Richard c ~ Rice
Joseph D. Richards
Lolly Rickert
Douglas Robinson
Steven P. Rocco
Thomas H. Roddey
Shirley R. Roos
Lynn Rosemurgy
Nancy M. R. Rotenberry
Robert W. Roush
Joann J. Rozier
Alfrieda A. Russell, R.N.
Jack Salerno
Annie Muriel Salinas
Deborah Saunders
Phyllis Scher, M.D.
Martha E. Scholler
George and Bernice Schroeder
Eileen Schuettinger
Leonard Schwab
Roland Schwartz
Raphael F. Segura, Jr.
Shawn Selders
Eve Sil verman
Raymond C. Simon
David M. Sisson, BC·HIS
Bruce L. Skinner
Dawn T. Smith
Larry L. Smith
Roslyn Smith
William K. Sonnemann, Jr.
Lois I. Spafford
Elizabeth H. Spencer
Maureen T. Sprohge
James J. Steponik
David L. Sweet
Frances Szeman
Heinz G. Thubenberger
Helen K. Taylor
Judy E. Thewes
Sandra S. Tillou
Anthony ·rropeano
Geraldine 1. Thrkenik
Phyllis W. 1\"iss
Floy C. Ubil
Len Ufland
Thomas E. Underhill, D.D.S.,
M.D.
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