September 1998 Volume 23, Number 3

Tinnitus Today
In This Issue:
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Education - Advocacy - Research - Support
Sound Sensitivity- Hyperacusis and Recruitment
Pulsatile Tinnitus
Can You Feel What I Hear?
New ATA-Funded Research
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Tinnitus T o d ~ y
Editorial and Advertising offices: American Tinnitus Association, P.O. Box 5, Portland, OR 97207 • 503/248-9985, 800/634-8978 •,
Execmive Director f.- Ediwr:
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
T'mnuus 'Tbday is published quarterly in
March, June, September; and December. li is
mailed to American Tinnitus Association
donors and a selected list of tinnitus suffer-
ers and professionals who treat tinnitus.
Circulation is rotated 10 80,000 annually.
The Publisher reserves the right co reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit-
able for Tinnitus 'Tbday. Acceptance of adver-
tising by Trnnuus 'Ibday does nor constitute
endorsement of the advertiser, its products
or services, nor does Trnnttt<s Tbday make
any claims or guarantees as 10 the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by comributors to Trnmtus
'Ibday 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 1998 by American Tinnitus
Association. No part of this publication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any means,
without t.he prior written permission of the
Publisher. ISSN: 0897-6368 Director
Gloria E. Reich, Ph.D., Portland, OR
Board of Directors
James 0. Chinnis, Jr., Ph.D., Manassas, VA
W. F. S. Hopmeier, St. Louis, MO
Gary P. Jacobson, Ph.D., Detroit, MI
Sidney Kleinman, Chicago, IL
Paul Meade, Tigard, OR. Chmn.
Philip 0 . Monon, Portland, OR
Stephen Nagler, M.D., F.A.C.S. , Atlanta, GA
Dan Purjes, New York, NY
Aaron I. Osherow, Clayton, MO
Susan Seidel, M.A. , CCC-A, Towson, MD
Jack. A. Vernon, Ph.D .. Portland, OR
Megan Vidis, Chicago, I L
Honorary Directors
The Honorable Mark 0. Hatfield,
U.S. Senate, Retired
Thny Randall, New York, NY
William Shatner, Los Angeles, CA
Scientific 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
John W, House, M.D., Los Angeles, CA
Gary P. Jacobson, Ph.D., Detroit, Ml
Pawel J. Jastreboff, Ph.D., Baltimore, MD
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D. , Portland, OR
Gale w. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Robert E. Sandlin, Ph.D., El Cajon, CA
Alexander J. Schleuning, n, M.D.,
Portland, OR
Abraham Shulman, M.D., .Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Robert Sweetow, Ph.D. , San Francisco, CA
Legal Counsel
Henry C. Breithaupt
Steel Rives Boley Jones &- Grey,
Portland, OR
The Journal of the American Tinnitus Association
Volume 23 Number 3, September 1998
Tinnitus, ringing in the ears or head noises, is experienced by as many
as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Table of Contents
7 ATA's New Board Members
9 Pulsatile Tinnitus
by John Risey, M.C.D., and Ronald G. Amedee, M.D.
11 A Tribute to the Chairman of the Board
by Cliff Collins
11 Introducing ATA's Board Chairman Paul Meade
13 New ATA-Funded Research
14 Sound Sensitivity
by Barbara Tabachnick
17 Can You Feel What I Hear? An Audiological Perspective
by Norma Rivera Mraz
19 A Self-Help Journey
by Carrol Jude
20 ATA Support Givers - Welcome!
21 Collectible Commemorates Quest for Silence
and Benefits ATA Cause
by Corky Stewart
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
5 Letters to the Editor
22 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Special Donors and Tributes
Cover: 'Exquisite• (28"x 36" oil on canvas) by Arletha Mueller Ryan, 15 Touchstone,
Lake Oswego, OR 97035, 503/636-8838
by Gloria E. Reich Ph.D.,
Executive Director
National Health Council which promotes the
health of all people by advancing the voluntary
health movement.
As summer draws to a close, A very interesting item came on our e-mail
ATA's activities gather momen- recently. It had to do with genetic research and
tum. Many hearing-related was entitled "What's Blond and Blue-Eyed and
societies have their annual Read All over?" Have you guessed? The answer
meetings in the fall and tradi- is Iceland DNA (deoxyribonucleic acid, the
tionally ATA attends these to basic genetic material of human life). In this
provide information about tin- example, Icelandic DNA data was said to be
nitus and tinnitus research to much sought after by pharmaceutical compa-
the attendees. This year will nies who have found that they are able to locate
be no different. We look forward to seeing many genes responsible for disease about four
of you at the International Hearing Society, the faster than from DNA in the general populat1on.
American Academy of Otolaryngology Head and Furthermore, geneology is a national pastime in
Neck Surgery, the Academy of Dispensing Iceland with most families being able to trace
Audiologists, and the American Academy of their roots back to about 900 A.D. Now, all we
Family Physicians meetings. have to do is to encourage
This year I will again be a research about hearing defects
guest speaker at the Sixth Annual using this fantastic database and
Conference on Tinnitus perhaps we'll get some of the
Management in Iowa City, IA, on breakthroughs we're all hoping
September 18-19. This year's guest for. Anyone in Iceland have
of honor will be Dr. Peter H. tinnitus?
Wilson, a psychologist from South We recently heard from Judy
Australia, who will be speaking Brivchik, our tinnitus support
about attention control and cogni- group leader in Lancaster, PA,
tive restructuring therapies for that July was, in Pennsylvania at
tinnitus. The conference is open least Tinnitus Awareness Month.
to professionals and patients. For _ What a great idea! You can con-
more information contact Richard ,2"_ tact your local city or state
'Jyler (319/ 384-9757). Tony Randall new son, officials about having tinnitus
The National Institute on Jefferson Salvmt Randall recognized for a special week or
Deafness and Other Communication Disorders month where you live.
(NIDCD) held a principal investigators meeting Honorary ATA board member Tbny Randall
about tinnitus in May. As an invited guest, I was is pictured here with his second child, Jefferso.n
very happy to hear these investigators discuss Salvini. Jefferson was born June 15, 1998 and 1s
the latest tinnitus research findings and their also welcomed by his mother Heather and sister
ideas for future studies. In general the National Julia, who was born Aprilll, 1997. Our congrat-
lnstitutes of Health (NIH), of which the NIDCD ulations to the entire family.
is a part, is attempting to engage the public to Lastly, I regret to report the deaths this sum-
help set research priorities. Right now your con- mer of two valued colleagues and friends,
gressional representative is the best person to let Donna Dickman, Ph.D., Executive Director of
know how you think the government the Alexander Graham Bell Association for the
agencies should be spending Deaf, and Aram Glorig, M.D., a leading authori-
research dollars. In the future
the NIH hopes to create an ty on the ear and its disorders. Dr .. Dickman
a strong voice for oral deaf education. Dr. Glong
office of public liaison to review first observed cases of severe hearing impair-
...... ,.. and respond directly to public ment and tinnitus caused from bomb and shell
input. ATA not only talks blasts while he was stationed in England during
directly with officers of the Second World War. Dr. Glorig addressed the
NIDCD but also Fifth International Tinnitus Seminar in 1995
participates in the about noise-induced hearing loss. B
4 Tinni tus Thday/ Septe mber 1998
Letters to the Editor
From tirne to tirne, we include letters
from our members about their
experiences with "non-traditional"
treatments. We do so in the hope that
the information offered might be helpful.
Please read these anecdotal reports
carefully, consult with your physician or
medical advisor, and decide for yourself
if a given treatment might be right for
you. As always, the opinions expressed
are strictly those of the letter writers and
do not reflect an opinion or endorsement
have been a long time member of your orga-
nization and an avid reader of your journal,
Tinnitus 7bday. A common theme I see in
your journal is a distinct frustration on the part
of your members with the medical profession. I
also believe that this frustration leads to consid-
erable disappointment and anger and potential
animosity towards our profession.
As you know, tinnitus is a very difficult,
challenging complaint. Unfortunately, the
majority of causes of tinnitus are idiopathic
(of unknown origin), despite very expensive
workups and evaluations.
What you need to know, though, is that it is
extremely frustrating for us as health care
providers also. Despite attending many semi-
nars and reading many journals and textbooks,
I still do not have an answer for many of the
causes of tinnitus I see daily in my practice.
Certainly I am not satisfied with this and hope-
fully in the future this will be resolved.
It is encouraging to me that such concepts as
Tinnitus Retraining Therapy bring hope to aU of
us. In addition, the recent identification of a
region of the brain that seems to register the
tinnitus is also encouraging. We in the profes-
sion do not have all of the answers nor do we
maintain that we do. We do, however, work
hand-in-hand with our patients, with mutual
respect and empathy. Please do not take our
inability to provide immediate resolution of the
tinnitus complaint as evidence of indifference
and arrogance. This is certainly not the case. We
all look forward to the day when we can provide
our tinnitus patients with a distinct and absolute
cure for their tinnitus.
Stuart A. Morgenstein, MD , 231 S. Ga1y, Suite
#110, Bloomingdale, TL 60108, 6301307-0088
y wife, who has had tinnitus for a number
of years, was getting very depressed
because of it. I took her to an otolaryngolo-
gist who said there was no cure for tinnitus and
to go home and learn to live with it. I then took
her to a TMJ dental surgeon. After $566 worth
of x-rays, he recommended treatment at a cost
of $1500 with no guarantees. Our insurance
wouldn't help.
I have been studying herbal medicines and
decided to have my wife try St. John's Wort for
her depression rather than the Zoloft our family
doctor prescribed. After a month of taking St.
John's Wort, her depression was much better
and the pounding has stopped. She is the best
she has been since the tinnitus first started.
Even the ringing is better. Perhaps this might
help someone else. Keep up your good work.
Donald G. Haynes, 1040 Greenwood Dr. #JA,
Hendersonville, NC 28791-1912, 7041698-8686
ince the early '70s, I have suffered from a
neural damage/high tinnitus whine com-
pounded by a blood pulse that I hear every
waking moment. I haven't found a cure for
either of these conditions, but my reaction to
them could be useful to others, namely to look
for a positive side (believe it or not!) to this
I am a professional scientist and also, 1 am
told, a creative person. And fortunately so. I
need to keep my attention occupied so I don't
have to focus on the fun and games going on in
my head. Perhaps in keeping my mind active,
often to the point of exhaustion, I have also kept
myself sane.
There are two things T would like to share.
In 'Transcendental Meditation (TM), which I
studied in the 1970s, they teach each student a
special sanskrit word, the repeating of which
leads to a meditative state. From studying my
reaction to meditation, I found that with time, I
no longer need a magic word. Instead I focus on
my blood pulse and neural whine and after a
Tinnitus ibday/ Scptember 1998 5
Letters to the Editor (continued)
while, pass into a progressively deeper medita-
tional state. My tinnitus then gives me an infalli-
ble clue as to my level of meditation and mental
state: as I get deeper in, the tinnitus initially gets
louder, and then at a certain point drops away.
After 20 minutes or so, I return refreshed with-
out the tension I accumulate after a day of
listening to myself. I use my "defect" as a tool to
determine if I am entering calmer meditational
I have also found a way of listening to music
that provides me with a tool to help me ignore
my own "music." I play my favorite tapes (espe-
cially percussion) many times until I know them
by heart. By listening carefully, I noticed that
my mind anticipates each coming note, as if it
were grasping it, or checking it with its memory
of the musical piece. Then I need only try and
dislodge my attention from the music. If 1 am
successful, the music essentially fades out leav-
ing me in a meditation. This is also what I do
with tinnitus: I focus on it intently for a number
of minutes, and it tends to fade as my mind gets
tired ofbeing forced to grasp the noises. The
interesting thing is that the internal noises of
tinnitus are only unbearable when I allow an
invisible mental hand to grasp at the noise
instead of allowing the sound to pass through
my mind like the noise pollution it is.
I hope this can help. In any case, it will give
you some internal games to play with your
favorite record! I would be curious to hear
written reactions from others who try this.
John F Caddy, Via Cervialto 3, Aprilia 04011,
Latina, Italy
am beginning with carefully selected patients
to offer Tinnitus Retraining Therapy (TRT) in
my clinic. No, I have not taken one of the
courses at the University of Maryland and I dis-
agree with the implications that physicians and
audiologists who have not been formally trained
cannot adequately provide TRT. I do understand
the need to avoid the impression among practi-
tioners that TRT is as easy as placing devices in
people's ears. I have encountered some patients
wearing these devices (dispensed at other clin-
ics) who have no understanding of their tinnitus,
the use of the devices, or even of the ultimate
goal of the therapy. I believe that physicians
who have a sincere interest in treating tinnitus
patients, who are compassionate enough and
patient enough to hear their worries and who
6 Tinnitus 'll:lday/ September 1998
take the time to educate their patients and their
families, can provide TRT effectively.
I will be attending one of the courses in
Baltimore in the near future but this is in the
spirit of thoroughness and sincere interest in
this topic. Perhaps the message to ENT physi-
cians should be, if you don't have 80% or greater
success, learn from those with experience why
this might be.
Michael T Thixido, M.D., Family Ear;
Nose & Throat Physicians, Limestone Medical
Center, 1941 Limestone Rd., Suite #103,
Wilmington, DE 19808, 302/998-0300
n July 1995, I overpressurized my left middle
ear while trying to equalize underwater.
Immediately thereafter and ever since I
have had a high-frequency ringing in my ear.
Consultation with physicians at the time resulted
in a prognosis of one of two things happening:
either the ringing would go away, or I would
have to live with it. After three years of living
with it I obtained some literature from the
American Tinnitus Association and decided to
seek out a specialist.
The masker I now wear gives me a degree
of control that I never had before. The "shhh"
sound made by the device is certainly easier to
live with than the "eeee" that my ear produces
on its own. The ability to increase or decrease
the volume of the masker allows me to adjust
the contrast between the two sounds. I can
choose to hear a blend of the two sounds or I
can completely drown out my tinnitus sound
and bear only "shhh." Bedtime used to be the
time that my tinnitus annoyed me the most, but
now I can decide what sound I want to hear
when falling asleep. There is already a residual
soothing effect from the masker that makes the
ringing less noticeable even when I'm not wear-
ing it.
I hope you will relate my experience to other
patients so that they might be encouraged in
their struggle with this condition.
Neil A. Best, 1400 S. Joyce St., ffl511,
Arlington, VA 22202, 703/979-0169
n his "Questions and Answers" column in the
June 1998 Tinnitus Tbday, Dr. Vernon men-
tions that 25 dB is the loudest tinnitus he has
ever measured. I hope that readers will not
misinterpret this finding, which refers to the tin-
nitus decibel level over the threshold of hearing
ATA's New Board Members
Gary P Jacobson, Ph.D.,
Director, Division of Audiology,
Henry Ford Hospital & Medical
Center, 2799 W: Grand Blvd.,
Detroit, MI 48202-2689,
313/8 76-3280
Dr. Jacobson writes:
I became interested in t inni-
tus during the development
of a grant eight years ago. It
Gary P. Jacobson, Ph.D. became clear to me then that
there were few clinical centers that existed
solely to manage the millions of patients with
severe and disabling tinnitus. I am still dis-
mayed that although hearing loss, dizziness, ear
pain, and tinnitus are symptoms of ear disease,
all but tinnitus are discussed in detail in most
graduate programs in audiology. Because of this,
I have spent much time over the past seven
years lecturing in the area of tinnitus.
Due largely to the combined efforts of the
ATA and contemporary research scientists, there
has been significant progress made over the past
10 years in the understanding of physiological
mechanisms underlying tinnitus and in the
management of this disorder. My goals are for
the ATA to continue to support these endeavors,
to continue to lobby Congress to fund tinnitus
research, and to continue their superb efforts
informing the patient community of the fruits of
this research.
I accept this appointment in an attempt to
better represent to the Board the views of clini-
cians who are engaged in the management of
the tinnitus patient and of researchers who are
involved in the study of this disorder.
Dr. Jacobson is also a member of ATA's Scientific
Advisory Committee.
Susan Seidel, M.A., CCC-A,
Greater Baltimore Medical
Center, 6701 N. Charles St.,
Baltimore, MD 21204,
Ms. Seidel writes:
I have been an audiologist for
39 years, the last 24 with the
Greater Baltimore Medical
Center. For 15 years running,
Susan Seide" M.A. , CCC·A I have also facilitated the
Baltimore Area Tinnitus Self-Help Group with a
rolling membership of 200. (I have had severe
left-ear tinnitus for 30 years following a jet
engine exposure.)
As a newly-elected member to ATA's board,
I would like to help with two goals of focus for
the ATA. One, I would like to see tinnitus and
noise exposure preventive efforts included in
elementary school curricula throughout the
country. And two, I would like to see tinnitus
therapy approaches incorporated in all audio-
logy graduate school curricula.
I am very excited to help ATA reach its
goals - our goals - for the future. B
Letters to the Editor (continued)
(or dB SL) as opposed to the absolute decibel
reading on an audiometer matching tinnitus
loudness. Patients will not infrequently be told
by their audiologists that their tinnitus loudness
measures 55 dB, for instance, but they may have
a hearing loss of 50 dB, yielding a tinnitus loud-
ness measurement of 5 dB over threshold (or
5 dB SL). As Dr. Vernon observes, a tinnitus
loudness measurement as high as 25 dB over
threshold (25 dB SL) would be very unusual.
Stephen M. Nagler, M.D., F.A.C.S.,
Southeastern Comprehensive Tinnitus Clinic,
980 Johnson Ferry Rd., N.E., #760, Atlanta, GA
30342, 404/531-3979
60 Decibels
I Tinnitus
) Perceived
Hearing toss
Tinnitus 1bday/ Septentber 1998 7
The Search is Over!
Digital Tinnitus Mitigation ™
The FDA-approved Digital
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The DTM-4 system includes
two CDs with unique digital
sounds that gently distract
hearing attention away from
tinnitus; one CD that provides
proprietary auditory training
sound patterns and verbal
instructions to train the user
to focus on sounds other than
the tinnitus; one CD that pro-
vides methods and techniques
relating to stress-reduction,
coping skills and other factors
essential to successful tinnitus
alleviation; precision Sony
"ear bud" headphones for
optional private listening;
and a complete User
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system sells for $145 + $4 S/H
with a 30-day unconditional
money back guarantee.
8 Tinnitus Today/ September 1998
he DTM technology effectively eliminates unwanted sounds
produced below the tinnitus region, which to date has been
the major fault with conventional masking technology.
- Dr. Jack Vernon (one of the world's foremost experts on tinnitus)
am writing you to voice my unrestrained enthusiasm for
your DTM technology. I have to say I was completely over-
whelmed by the sample you sent me. For years I have tried vari-
ous devices in my practice. Personally, I suffer from tinnitus in
both ears. Your system alerted me to the potential that exists
with well-thought-out solutions to this perplexing problem.
- Dr. Steven M. Rouse (ENT)
have been a three-year sufferer of high-pitched tinnitus in
both ears. The condition reached a climax about six months
ago; at this time I could no longer achieve a good night's sleep
(despite the use of a
Sound soother' from the Sharper Image),
and would always awake feeling slightly nauseated and dizzy
with the condition continuing throughout the day. Throughout
this progression I have consulted among the best doctors in the
field. With failed treatments ranging from ginkgo biloba to hav-
ing tubes surgically implanted, these fine physicians have come
up empty with respect to tinnitus. My initial reaction once I
turned on the first CD was one of utter amazement; I simply
could not believe how low the volume level was while masking.
I can vividly remember having to turn the CD player on and off
again several times to make sure I still had tinnitus! With the
DTM process, I no longer hear the ringing (unless I concen-
trate). For the first time I have been able to get through a day
without Advil and I have even been known to attend a few
movies (with earplugs, of course). Thanks again."
- Paul Pedrazzi
For information or to order at $145 + $4 S/H (Calif. res. add 8
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Web site:
Pulsatile Tinnitus
by John Rise'ft M.C.D., and Ronald G. Amedee, M.D.
Most people describe their tinnitus as being
constant or steady-state. A small percentage
(8-10%) of people, however, experience tinnitus
which they describe as rhythmic, beating,
pounding, throbbing, or ''swooshing" in nature.
Usually we are unable to hear the sounds caused
by the heart forcefully pumping blood through
the arteries and veins. At
times, however, these pul-
sations occur in or around
the middle ear or inner
ear, or near the hearing
nerve and become audible
to us. The perception of
the rhythmic flow of
blood through the head or
neck region is referred to
as pulsatile tinnitus.
These sounds become
audible as a result of
John Risey, M.C.D. uncontrolled high blood
pressure, erosion of bone
over an artery, certain benign vascular tumors,
or crimped or constricted blood vessels.
Pulsatile tinnitus can be classified as either
"objective tinnitus" if it can be heard by the
examining physician, or as "subjective" if the tin-
nitus can only be heard by the patient. Pulsatile
tinnitus usually occurs in one ear only and it is
an important variant among tinnitus patients.
One-sided tinnitus often indicates an underlying
medical condition which can be quite serious but
which is usually correctable through medicine or
Pulsatile tinnitus might occur as the person's
only complaint or it might occur in conjunction
with other problems. The onset of pulsatile tinni-
tus is typically gradual and is often initially over-
looked. The loudness of the pulsations might
grow somewhat over time. But most patients
report pulsatile tinnitus to be more of an annoy-
ance than a severely intrusive experience.
Possibly because pulsatile tinnitus does not
progress to a point where it is perceived as being
severe, only a small percentage of patients with
this complaint seek a medical evaluation with
this as their only problem. Patients are more
likely to seek medical attention when other com-
plaints coincide with the pulsatile tinnitus.
Complaints of hearing loss, a sensation of
fullness in the ear, ear pain, drainage from the
ear in the form of pus or blood, and/ or vertigo
might be experienced in addition to pulsatile
tinnitus and require thorough medical and audi-
ologic examinations. These additional symptoms
are associated with dam-
age or disease affecting
either the middle ear,
inner ear, and on occa-
sion the hearing and bal-
ance nerves. A thorough
physical examination by
an otolaryngologist can
reveal evidence of the
underlying cause in these
cases. The medical exam-
ination typically involves
visual inspection of the
Ronald G. Amedee, M.D. eardrum and ear canal,
listening for pulsatile
sounds through a stethoscope in various loca-
tions around the ear and head and neck, as well
as checking the blood pressure. In addition to
a medical examination, patients will undergo a
complete audiological examination. Hearing
testing is performed to determine what type
(e.g. middle ear, inner ear, hearing nerve) of
hearing loss, if any, exists. In addition, tympa-
nometry might be performed in an attempt to
record objective evidence of the pulsatile tinni-
tus from the patient's ear canal. (Some types
of pulsatile tinnitus cause the eardrum to pulse
every time the tinnitus is heard by the patient.
JYmpanometry tests how well the eardrum
and bones behind the eardrum vibrate to
sound.) Additional testing might be ordered if
the outcome of the physician's history-taking
and physical examination or the audiologist's
examination indicates a need for it.
These additional symptoms often indicate
the need for further workup: weakness or
numbness in the face, headache, double vision,
or hoarseness. These complaints indicate that
the underlying cause of the problem could be
affecting more than just the hearing system.
The specific combination of symptoms, and the
medical and audiologic exam results will help
the physician determine the need for further
evaluation( s ).
More extensive diagnostic testing might be
ordered, including aCT scan, MRI, lumbar
puncture, and possibly an angiography. CT
scans are computerized x-rays of the bony struc-
tures within the head and neck and are often
useful in cases of pulsatile tinnitus. These x-rays
Tinnitus lbday/ September 1998 9
Pulsatile Tinnitus (continued)
are ordered to establish if the problem is associ-
ated with erosion of bony structures within the
ear and/ or head. MRI is magnetic resonance
imaging, another computerized procedure which
is used to look at ''soft" (e.g. non-bony) tissue in
the same area and is especially helpful in
detecting the presence of brain tumors. Lumbar
puncture is a procedure designed to detect the
presence of increased intracranial pressure. A
needle is inserted at the base of the spinal col-
umn and a small amount of spinal fluid is
removed. Angiography is sometimes recom-
mended to obtain a view of the blood vessels
in the head and neck looking for abnormalities
in the arteries and veins which may be the
underlying cause of pulsatile tinnitus. Any or
all of these procedures might be required in
order to determine the underlying cause for the
complaint and to help establish a diagnosis.
Pulsatile tinnitus can be caused by many
medical conditions (see Thble 1). Some, such as
previously undiagnosed and untreated high
blood pressure (hypertension), might be rela-
tively easy to diagnose and treat. Other condi-
tions might require surgery or the use of
radiation and chemotherapy. Conditions such as
hardening of the arteries (atherosclerosis),
benign intracranial hypertension
and heart
Table 1.
Causes of Pulsatile Tinnitus
Aberrant carotid artery
Arteriovenous malformations
Arnold-Chiari malformations
Benign Intracranial hypertension
Cervical venous hum
Glomus tumors
Heart murmur
Increased intracranial hypertension
Jugular bulb abnormalities
Neurovascular compression of hearing nerve
Patulous Eustachian tube
Persistent muscular contractions
Sigmoid sinus abnormalities
1 0 Tinnitus 1bday / September 1 998
murmur can be effectively treated with medica-
tions and often, though not always, result in
elimination or dramatic reduction in pulsatile
tinnitus. Other conditions such as aberrant
carotid artery, arteriovenous malformations,
venous hums, and jugular bulb abnormalities
represent unusual anatomical conditions which
may not be medically treatable. Glomus tumors,
Paget's disease, benign intracranial hyperten-
sion, increased intracranial pressure, and sig-
moid sinus abnormality might require surgery.
A thorough medical and audiological assessment
can determine which option would offer the
best prognosis for each patient.
Pulsatile tinnitus is a specific type of tinni-
tus complaint which occurs in a relatively small
number of tinnitus patients. It arises from
abnormalities directly or indirectly associated
with circulating blood through the body. The
underlying cause of pulsatile tinnitus can often
be determined and successfully treated. Careful
clinical examination and early detection offer
the best opportunity for a complete recovery. B
Goodhill, V. (1979). Tinnitus. In V. Goodhill (Ed.) Ear
diseases, deafness and dizziness. Hagerstown: Harper & Row.
Rothstein, J., P.A. Hilger, L. Boies, (1985). Venous hum as a
cause of reversible facetious sensorineural hearing loss.
Annals of Otology, Rhinology & Laryngology 97: 267-268.
Sismanis, A. , F.M. Butts, G.B. Hughes, (1990). Objective
tinnitus in benign intracranial hypertension: an update.
Laryngoscope 100: 33-36.
Sismanjs, A., G.B Hughes, E. Abedi, G.H. Williams, L.A.
Isrow, (1985). Otologic symptoms and findings of the
pseudotumor cerebri syndrome: a preliminary report.
Otolaryngology Head and Neck Surgery 93: 398-402.
'!yler, R.S., R.W. Babin, (1993). Tinnitus. In c.w.
Cummings, J.M .. Fredrickson, L.A. Harker, C.J. Krause,
D.E. Schuller (Eds.), Otolaryngology -Head and Neck
Surgery, Vol. 4, 2nd Ed. St. Louis: Mosby Year Book.
John Risey, M.C.D., is a clinical instructor
at Thlane University School of Medicine,
New Orleans, LA.
Ronald G. Amedee, M.D., is a professor and
Chairman of the Department of Otolaryngology
Head & Neck Surgery, Thlane University School of
Medicine, New Orleans, LA, and a member of
ATA's Scientific Advisory Committee.
A Tribute to the Chairman of the Board
by Cliff Collins
In June 1998, Philip 0. Morton stepped aside
as Chairman of ATA's Board of Directors after
four years of service. Phil has served on the
board for ten years. I believe ATA members and
supporters should know
something about the level
of dedication Phil has
shown to the organization.
As noted in the June
1998 issue of Tinnitus
Tbday, Phil was solely
responsible for persuading
a national publisher of
high school textbooks
to include mention of
tinnitus in their books. It
.. is a prime example of the
Phthp 0. Morton issue that is closest to his
heart: preventing young people from acquiring
the ear damage he himself did earlier in life.
Phil is in his mid-50s now, but he is still pay-
ing for the many years he spent as a guitarist in
a local rock band. In 1980, Phil came down with
severe tinnitus and hyperacusis, an oversensitivi-
ty to sound. He contacted the ATA to try to find
help. Within a short time, he had taken it on as
his personal mission to warn young people about
the dangers of loud noise and loud music.
In the service of that goal, he has gone to
schools to speak in classrooms, taking along
memorabilia such as his old electric guitar and a
large photograph of his band taken the night
they opened for the Beach Boys in Portland in
the 1960s. Phil knew if he could speak to kids on
their level, they would be more inclined to hear
his message.
He's also submitted to the public spotlight
and appeared on talk shows, speaking openly of
his condition. He has encouraged others who
experience tinnitus to do likewise.
Undoubtedly Phil's most enduring legacy
at ATA will be his creation of the Mission 2000
plan, a carefully thought-out timetable for ATA's
growth and development. Mission 2000 ultimate-
ly was incorporated into what is now
called ATA's Strategic Plan, which encompasses
the organization's specific priorHies and reasons
for being.
Fortunately, Phil will remain on the ATA
board for one more year, which gives the board
the benefit of his experience and also gives the
rest of us time to thank him for his years of ser-
vice. Despite his tinnitus, Phil decided that the
best way to survive it was to take action. We can
all gain inspiration from his example. a
Cliff Collins, of Aloha, Oregon, is a freelance writer.
ATA's Board Chairman
Paul Meade
Generally voluntary board
members have a vested
personal or professional
interest in the non-profit
organization they're serving.
Paul Meade doesn't have
tinnitus; nor is he a hearing
heal thcare professional, but
he is the newly-elected
Chairman for the American
Tinnitus Association.
"I've seen the impact tinnitus has had on the
lives of friends. I never want to experience it
and I want to do all I can to further public
awareness and hearing protection activities,
especially for youngsters," explains the 34-year-
old father oftwo.
Phil Morton, retiring chairman, says of Paul,
"He's a bright individual. And even though he
doesn't have tinnitus - maybe especially
because he doesn't have tinnitus - he looks at
things with a better and broader perspective."
As Chief Financial Officer for Oregon-based
Gaylord Industries, Meade looks forward to
helping ATA "capitalize on the momentum
developed over the past few years through EARS
(the association's strategic action plan), research
funding, and recent publicity." Ill
Tinnitus Thday/ September 1998 11
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We are pleased to announce the
American Tinnitus Association's
support of the following tinnitus
research projects:
Principal Investigator: Kejian Chen, Ph.D.
Medical College of Ohio, Toledo, Ohio
$33,000 for the study of spontaneous activity in
the dorsal cochlear nucleus following exposure
to high intensity sound.
This study is expected to offer insight into
the mechanisms ofloud sound-induced tinnitus.
The proposal aims to elucidate the cellular and
pharmacological mechanisms for the observed
increases in spontaneous firing rate in the dor-
sal cochlear nucleus (part of the auditory path-
way to the brain) after exposure to loud sound.
The results will be useful for further experimen-
tal studies aimed to treat tinnitus with more spe-
cific drugs.
Principal Investigator: George M. Gerken, Ph.D.
University of Texas at Dallas, Callier Center for
Communication Disorders, Dallas, Texas
$30,000 for the study of auditory evoked poten-
tials in tinnitus, hyperacusis, and hearing loss.
The experiments involve the auditory brain
responses that are evoked by brief sounds. In
problem-tinnitus patients, in hyperacusis
patients, and in certain hearing-loss patients, it
is predicted that larger evoked potentials will be
obtained from some brain regions related to
hearing. This research proposes to show that
some types of tinnitus and hyperacusis may be
caused by what are essentially mis-adjustments
within brain mechanisms. Previous research has
provided a handle which may permit some eval-
uation or even manipulation of the central audi-
tory mechanism. If so, it may be possible to
alter or relieve tinnitus of central origin.
Principal Investigator: Mary B. Meikle, Ph.D.
Oregon Hearing Research Center, Oregon Health
Sciences University and Portland VA Medical
Center, Portland, Oregon
$22, 500 for the ATA National Tinnitus Data
Registry Project (NTDR).
The present registry contains detailed med-
ical and audiological data from over 2600
patients of the Oregon Hearing Research Center.
Over the next few years the registry will
become national as it is expanded to include
information from other sites. The NTDR will
provide a systematic, well-documented, well-
organized basis for planning curriculum in med-
ical and audiological training environments,
increase public access to tinnitus information
for their own health care needs, offer documen-
tation concerning the relation between tinnitus
and disability, and provide data needed by
researchers in planning investigations about
tinnitus. This information will be useful to
major health care providers as well as the U.S.
government for public health care planning.
For a grant application and instructions,
please send a request to ATA, P.O Box 5.
Portland, OR 97207-0005, call 800/634-8978, or
view the material on our website:
Click on "Tinnitus Research" for an on-line
application. Ill
If you have ever wondered what to do
with 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 a receipt.
Package them carefully (a small padded mail-
ing 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:
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 re-used 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!
Tinnitus 'Tbday/ September 1998 13
Sound Sensitivity
by Barbaro Tabachnick,
Client Services Manager
Sound sensitivity has two
accepted medical names -
hyperacusis and recruitment.
However, people who have
sound sensitivity describe the
experience with wide varia-
tion. Some sound-sensitive
patients are intolerant of a
particular appliance hum or the tone of a certain
voice. Some are devastated by any external sound
above a whisper. Some believe that they really
hear too well (e.g., very quiet sounds in distant
rooms) even when their measurable hearing loss
logically negates the possibility. Some sound sen-
sitive patients have no hearing loss; others have
significant hearing loss. Some have tinnitus -
mild or incapacitating, with or without hearing
loss. Some have no tinnitus. Clinicians who treat
these patients define sound sensitivity with an
equal lack of consensus. Like tinnitus, sound sen-
sitivity is a subjective experience and is studied
based primarily on the stories and observed reac-
tions of the patients who have it.
Recruitment is a fairly common form of
sound sensitivity which can occur as a conse-
quence of sensorineural hearing loss, ear surgery,
or ear-related illness, and which occasionally
resolves on its own. A person with recruitment
finds that sounds at specific frequencies are
uncomfortably loud, and that the sounds at those
frequencies seem to increase in loudness quite
rapidly. The loudness growth appears to occur in
the frequency range of that person's hearing loss.
The condition of recruitment - which gener-
ally co-exists with hearing loss - can be uncom-
fortable and unnerving. It is often labeled
erroneously as hyperacusis, a more intrusive
Hyperacusis is an abnormal intolerance to
ordinary sounds. For the person with a severe
form of this condition, an everyday noise - like
that from a dish being placed on a table - can be
far too loud, even excruciatingly loud. Hearing
loss and hyperacusis seldom occur simultaneous-
ly. Statistically, though, 90% of those who have
hyperacusis also experience tinnitus - a constant
ringing or other distressing noise in the ears or
head. A few researchers regard hyperacusis as a
"pre-tinnitus state" since tinnitus frequently
enough follows its onset.
14 Tinnitus Thday / September 1998
Patients who are troubled by everyday envi-
ronmental sounds predictably have Loudness
Discomfort Levels (LDLs) that measure below
100 dB - often well below. Patients with severe
hyperacusis can have LDLs in the 40-60 dB range.
The exact number of patients with hyperacusis
is unknown, perhaps because the definition of
hyperacusis and the ability to diagnose it vary so
greatly. The probability is also high that some
patients with concurrent disorders (like headache,
depression, or chronic pain) fail to report it.
What Causes Hyperacusis?
Excessive noise appears to be a bonafide cul-
prit of this disorder. Some people report that their
hyperacusis began immediately following a single
exposure to intense noise, like that from a gun
shot blast or an air bag deployment. Others
became sound-sensitive from long-term noise
exposure. Head injury, Bell's Palsy, chronic fatigue
syndrome, epilepsy, Lyme disease, and drug side
effects have all been associated with hyperacusis.
Josephine Marriage, Ph.D., audiological scien-
tist in Cambridge, England, makes a distinction
between "central" and "peripheral" hyperacusis.
She states that peripheral hyperacusis, seen for
example in Bell's Palsy patients, results from dam-
age to a mechanism (the acoustic reflex) in the ear
itself. Central hyperacusis results from an abnor-
mality in the mechanism in the brain that controls
the amount of sound coming in. Marriage's 1995
research examined the brain chemistry of patients
with various neurological disorders (depression,
migraine, chronic fatigue, vitamin B-6 deficiency,
some forms of epilepsy, and others) - disorders
all known to co-occur with hyperacusis - in
search of a common feature in brain chemistry.
Her research indicates that a "disturbance," likely
a deficiency, in serotonin function in the brain, is
common to all of these disorders.
Although the exact point of injury and the
mechanism responsible for hyperacusis are not
definitively known, most researchers believe that
the brain - not the ear - is the site of the prob-
lem and that sound sensitivity is the result of a
dysfunction in the brain's sound regulatory mech-
anism. Dr. Jonathan Hazell, tinnitus and hypera-
cusis specialist in London, states that the cochleas
of hyperacusis patients are often completely nor-
mal. From the patient's point of view, however -
particularly patients whose hyperacusis began
immediately after a sudden exposure to very loud
noise - the ears have it! These patients common-
ly experience ear fullness, ear pain, and muffled
hearing immediately preceding the onset of the
Marriage offers another view on noise-
induced hyperacusis: excessive noise could dam-
age the hearing mechanism "at the point where
the brain's 'efferent system' - the huge bundle of
nerve fibers that brings information from the
brain to the cochlea -joins up with the cochlea."
She acknowledges that this is speculation, that
current research can neither refute nor confirm
it. Elliot Rosenberg, M.D., summed it up:
precise nature or location of this sound adjust-
ment mechanism is not yet known, but the
hyperacusis patient has clearly lost it."
What Makes Hyperacusis Worse?
It is a maddening enigma for hyperacusis
patients who find that their condition is wors-
ened not only when they are exposed to noise,
but also when they go too far to protect their ears
from it.
Silence is the major factor enhancing
both hyperacusis and tinnitus," says Pawel
Jastreboff, Ph.D., Director of the University of
Maryland Tinnitus and Hyperacusis Center.
Our sense of sight affords us an analogy.
When we wake in the middle of the night, our
eyes are sensitive to all but very low-level light. If
we stay awake, we find that we can gradually
adjust to a slightly brighter light, then in time to
normal-level ambient light. Sensory organs that
are under-stimulated (like the eyes when we
sleep) experience normal stimuli as excessive
stimuli. When hyperacusic ears (or healthy ears
for that matter) are habitually protected with
earplugs or earmuffs, they will experience nor-
mal sound as excessive sound when the muffs or
plugs are removed.
Some hyperacusis patients have found that
caffeine, and a few antidepressant medications
like Zoloft and Paxil, will make hyperacusis
worse. (Fortunately, there are other medications
that can alleviate depression and not aggravate
Which Sounds Really Are Too loud?
Many people with hyperacusis experience
palpable, legitimate pain from noise exposure -
any noise exposure. So how can a person for
whom all sounds seem too loud determine which
sounds will actually cause damage? The debate
lingers. Some doctors define excessive sound to
be sound at a level known to damage healthy
ears (100 dB and above). Hyperacusis patients say
excessive sound is any sound that hurts, even if it
is 60 dB (the sound level of normal conversation)
and they cite their reason: they do not have
healthy ears. Many sound-sensitive patients wear
earplugs and/ or earmuffs 12 or more hours a
day. It is understandable though ill-advised.
Dr. Hazell acknowledges the difficulty hyperacu-
sis patients have accepting that "sound which can
be uncomfortable or even painful to the hearing
can be quite harmless to the ear."
Day-in and Day-out with Hyperacusis
The toll taken by hyperacusis on one's daily
life is significant, and in some cases dramatic.
Scores of people with this condition avoid conver-
sations above a whisper, shun all outside enter-
tainment, decline attending family events, and
quit their jobs as they struggle to quiet down
their lives.
Nighttime for many is marred with sleepless-
ness. Daytime is punctuated with avoidance of
and accidental encounters with loud noise. A
utensil against a dish, one's head rustling against
the pillowcase, voices - including one's own -
can drive the new hyperacusis patient to distrac-
tion. A desperate few have resorted to barricad-
ing themselves in their homes for fear of
accidental exposure to a dog's bark or a car's
horn. If it has progressed to this level, then
phonophobia - a fear of sound - is added to the
hyperacusis patient's list of woes. It is a difficult
spiral to unwind.
Dan Malcore was overvv-helmed by the sud-
denness and intensity of his hyperacusis when it
first appeared in 1991. Eight months along his
arduous road towards getting better, Malcore
founded the Hyperacusis Network, and began
publishing a newsletter filled with everything he
could find on the subject. He encouraged his
readers to write and submit stories about their
experiences which they did, and the network
flourished. It is from this bank of collected sto-
ries, and from his own experience, that he speaks
out on the subject of hyperacusis.
Malcore believes strongly that when sound
tolerances collapse suddenly and severely, and
most especially when the trauma is fresh,
patients should use ear protection and refrain
from sounds they cannot tolerate - at least for
the first few months - even if the sounds are at
"normal" levels. "People have to stabilize some,
and realize that they aren't going to get worse,"
says Malcore. When a 40 dB whisper causes phys-
ical pain, people experiencing it cannot be con-
vinced that 70 dB won't hurt them. He advises
patience and that in time, "they will slowly wean
themselves back into sounds."
Can Hyperacusis be Treated?
Hyperacusis is many things: abnormal,
inexplicable, and - with much forbearance -
treatable. Some patients have anecdotally
reported hyperacusis relief with blood pressure-
reducing drugs like metopropol and popranolol,
Tinnitus 1bday/September 1998 15
Sound Sensitivity (continued)
and with the anti-anxiety medication, Xanax.
(Before beginning Xanax or any drug therapy, it
is wise to weigh the potential benefit against the
potential for unwanted side effects.) In Goldstein
and Shulman's 1996 study of patients with dis-
abling tinnitus and hyperacusis, audiological tests
point to the probable existence of several types of
hyperacusis. They write, "This could explain why
some individuals respond to treatment and others
do not."
Tinnitus clinicians Jack Vernon, Ph.D., and
Pawel Jastreboff, Ph.D., Sc.D., concurrently dis-
covered other workable treatments for hyperacu-
sis while they were pursuing clinical care for
their tinnitus patients. Their desensitizing treat-
ment techniques have helped many hyperacusis
patients become more tolerant of sound. Vernon's
low frequency (200-6000 Hz) "pink noise" proto-
col requires the hyperacusis patient to listen to
pink noise set at a volume just below the individ-
ual's discomfort level for two hours per day. The
two hours need not be consecutive. (A pink noise
CD is available from the Oregon Hearing
Research Center.) Vernon informs patients that
the process of sound desensitization is a long
one, that improved loudness tolerance might not
be seen for many months. Jastreboffs tinnitus
retraining therapy (TRT) necessitates a patient's
willingness to wear two hearing aid-like noise
generators, set initially at a "barely audible" broad
band level, for 8-10 hours per day for up to 24
months. Patient counseling is part of the TRT
Dan Malcore, who used a sound desensitiza-
tion protocol himself with success, knows very
well why many patients with severe hyperacusis
are reluctant to try the program, or - having
tried it - stay with it. He comments: "For people
with hyperacusis, 'sound desensitization' is a hard
sell. They can't imagine putting more sound -
even quiet sound - into their ears at all let alone
for 8-10 hours a day. It's a marathon-long therapy.
There's so much time to get discouraged." On the
other hand, the improvement is significant for
many of those who persevere with the program.
"The principles of TRT helped stabilize my ears.
I'm back in the mainstream of my life," says
Malcore. Jastreboff notes that for his patients
with both hyperacusis and tinnitus, the symptom
of hyperacusis improves more quickly - usually
within six months.
The Future for Sound-Sensitive Patients
Malcore recalls his own unhappy "self-talk"
that immediately followed the onset of his severe
hyperacusis: I am in a corner. I can't work. I miss
my family. I miss my life. His perspective is now
16 Tinnitus 1bday/September 1998
one of optimism. "Compared to 20 years ago,
there is so much hope for people with hyperacu-
sis. Back then, things were bleak, but no more.
Most of us don't have the ability to come back
100%. But we all have the ability to come back."
Sound desensitization protocols have changed
over their few years in use, apparently for the
better: the percentage of improved patients is
climbing. Experience still cautions us that no
single treatment can offer relief to all sound-
sensitive patients. However, for the tens of
thousands who were previously considered not
treatable, sound desensitization success is the
new hope and a growing reality. B
Goldstein, Barbara. and Abraham Shulman: Tinnitus-
hyperacusis and the loudness discomfort level test - a
preliminary report. International Tinnitus Journal 2: pp. 83·89,
Hall, James A.: Hyperacusis ... it's real and it can hurr. Hearing
Journal, vol. 51: no. 4, Apri11998.
Hazell, Jonathan: Hypersensitivity of Hearing, Internet
posting, www.ucl "'rmijg101/hypl.htm, Nov. 30, 1996.
Jastreboff, Pawel, and Jonathan Hazell: A neurophysiological
approach to tinnitus: clinical implications. British Journal of
Audiology, 27: pp. 7-17, 1993.
Marriage, J., and N. Barnes: Is central hyperacusis a symptom
of 5-Hydroxytryptamine (5-HT) dysfunction? Journal of
Laryngology and Otology,vol. 109: pp. 915-921, 1995.
Reich, Gloria, and Susan Griest: A survey of hyperacusis
patients. Proceedings of the Fourth lntemational Tinnitus
Seminar, Aran and Dauman, (eds.), pp. 249-253, 1992.
Rosenberg, Elliot: The eye as a model for understanding the
disability of hyperacusis. Hyperacusi$ Network newsletter,
June 1995.
Vernon, Jack: Recruitment - when noise spells pain. The
Voice, June/July: 12-13, 1991
Vernon, Jack: Tteatment for hyperacusis. Hyperacusis Nerwork
Newsletter, March 1998.
Pawel J. Jastreboff, Ph.D., Sc.D., University of Maryland
Tinnitus and Hyperacusis Center, 419 W. Redwood St. #360,
Baltimore, MD 21201-1734, 410/706-4339
Dan Malcore, The Hyperacusis Network, 444 Edgewood Dr.,
Green Bay, WI 54302, 414/468-4667,
Stephen M. Nagler, M.D., F.A.C.S., Southeastern
Comprehensive Tinnitus Center, 980 Johnson Ferry Rd. NE
#760, Atlanta, GA 30342, 404/531-3979,
Oregon Hearing Research Center, 3181 SW Sam Jackson Park
Rd., NRC04, Portland, OR 97201-3098, 503/494-8032,
http:/ /
Jack A. Vernon, Ph.D., Oregon Health Sciences University,
Oregon Hearing Research Center, 503/494-2187 (available by
phone on Wednesdays, 9:30 a.m.-noon and 1:30 p.m.-4:30
Thanks to a generous grant from James L.
this article is available as a reprint. Reprints avail-
able free while supply lasts. Send $1 slh for one
reprint, $3 s/h for five reprints to: ATA, P.O. Box 5,
Portland, OR 97207-0005.
Can You Feel What I Hear?
An Audiological Perspective
by Norma Rivera Mraz, M.A./CC·A
The relationship between the healer and the
patient has a major impact on the healing. We
know this scientifically and intuitively. The
human touch, for example, and expressions of
understanding and compassion have been
shown in numerous studies to be effective tools
in the healing process.
We need only to think
back on our own lives to
recall how a soothing
word has eased a pain or
lessened a fear. It is
therefore important that
hearing health profes-
sionals communicate
wisely, compassionately,
and accurately with
patients from the very
first meeting, whether
Norma Rivera Mraz, M.A., CCC-A that communication
occurs by phone or in
person. Because we all form our first impres-
sions in a matter of seconds, we as audiologists
must be acutely aware of- and ready to use -
our abilities and power to build a healing rela-
tionship at the very first meeting.
Many people who experience illness or a dis-
order like tinnitus automatically feel that no one
- especially their health care providers who do
not have or have never had tinnitus themselves
- can comprehend the magnitude of their pain
and suffering. If this were the case (which fortu-
nately it is not), many of us in the hearing
health community would not be able to cultivate
the relationships necessary for positive, effective
results ·with patients.
When a tinnitus patient is on the receiving
end of empathy, I often hear them say,
You can
feel what I hear!" They are amazed to learn that
I do not have tinnitus and that even so, I gen-
uinely understand the abyss they are in and the
despair and loneliness they are feeling. When
tinnitus patients come to you, know that they
will notice your professionalism and the degree
to which you care - even through all of their
confusion and concerns, even before they begin
to tell their story. They can see it and keenly
sense it.
Expressions of empathy can be easily com-
municated through body language - relaxed
posture, uncrossed arms, leaning forward to the
patient, and eye contact - steady and wari?,
all executed naturally and without mechamcal
effort. Most health professionals are not prepared
to offer this focused attention to their tinnitus
patients at every encounter, perhaps because of
tight schedules or other factors (like a b a ~ hair
day). But it is crucial that.we do so e a c ~ tune
and every time we come mto contact w1th our
tinnitus patients.
Another vital role the audiologist must play
is as an "active listener." Active listening is
absolutely necessary when working with and
counseling tinnitus patients and their families.
It is not a matter of parroting what your patients
say to you then nodding your head in response
to their comments. It is instead hearing what
your patient is saying to you, taking those state-
ments in compassionately just as you would do
for a close friend or family member who was in
distress. Active listening is another step in the
healing process, and it creates hope for the
Tinnitus patients appear to have a height-
ened sense of awareness of everything about
themselves and any change that might occur
within their bodies. Every word uttered by their
audiologists or their doctors takes on heightened
significance as well. For many patients, just
being told, "There's nothing we can do for
your tinnitus" can greatly
distort their sense of reali-
ty and tragically their
peace of mind.
Consequently, it is imper-
ative that we choose our
words and the overall
message we wish to con-
vey with precision.
Negative comments, such
as "Go home and learn to
live "rith it," can sound
just as loud and intrusive
as any tinnitus signal.
And besides, they have
already tried to live 'i\rith
their tinnitus and have found
Tinnitus 1bday/September 1998 17

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Con You Fee/ What I Hear? (continued)
unfavorable results, hence their visit to your
clinic. Patients often feel like they are failures or
weak in character because they can't just "forget
it." It is even more problematic when health
care providers fail to advise patients on how to
accomplish this daunting task.
What DO they need to hear from us if we do
not have the answer? How about, "There are
options available elsewhere that can better
address your tinnitus issues. Unfortunately
these options are not available at this clinic
today." Suggest other clinics, the ATA, the
Internet. Tinnitus patients can easily access
true (and false) information, especially via the
Internet. But even true information can be
misinterpreted or misrepresented and can lead
individuals with tinnitus down a lonely and dis-
mal road unnecessarily. Inform them that there
are viable treatments that work. Be a wealth of
good information. It is not the audiologists' and
doctors' responsibility for tinnitus patients to get
better; but it is the audiologists' and doctors'
responsibility to be a source of guidance for
these patients.
18 Tinnitus 1bday/ September 1998
This paper is based on my professional expe-
riences as an audiologist and the personal value
system I bring to each of my patients. I am
gratified by the comments from my patients:
"You really do understand me and my tinnitus
issues." "I thought no one could comprehend
what was happening with me, especially if they
didn't experience tinnitus themselves." "You
speak as if you've lived in my home." "You have
described me in great detail." "You are an oasis
in the desert."
I have seen tinnitus patients begin to feel
reassured, educated, enlightened, and invigorat-
ed because of the time and patience I've given
them. Personally or professionally, it is one of
my greatest achievements. IBl
Norma Rivera Mraz, M.A., CCC-A, is Associate
Director of the Southeastern Comprehensive
Tinnitus Clinic, 980 Johnson Ferry Rd., N.E.,
Atlanta, GA 30342, 4041531-3979,
norma@tinn. com, www. tinn. com
A Self-Help Journey
by Carrol Jude
What does it take to start a Tinnitus Self-Help
Group? Not as much as you might think. For me,
it was mainly the desire to help another human
being who might be walking in the shoes I'm
December 10, 1995, 9:28a.m. I was going into a
restaurant across from Wichita State University. It
was cold that Sunday morning, but there was no
moisture on the ground or in the air. I went to
reach for the door and the next thing I heard was
my head cracking on the tile of the entrance.
Someone had mopped in front of the door and
with the temperature at 19 degrees, a thin sheet
of ice had formed on the tile. That was the
moment I became acquainted with tinnitus -
severe tinnitus in both ears.
The story from here has been experienced by
many of you. I went to five doctors here in
Wichita and was told "learn to hve with it" by all
of them. No testing was done because, they said,
there was nothing that could be done about the
tinnitus. Now, three years later, I have maskers in
both ears, and I have rejoined society. For this I
thank God, the American Tinnitus Association,
and Sam Hopmeier of the Hopmeier Hearing
Centers in St. Louis, Missouri.
I first contacted ATA in 1996 about starting a
self-help group and was sent a packet of helpful
information. I read through it, but my ears were
still screaming at me and I was just not ready. In
1997, I got my maskers, then recontacted Barbara
Thbachnick and she sent another packet. Still, I
had no idea how to pull this off. I knew there
were other people in my community who had
tinnitus but I could not name anyone. I called
Barbara again and she said ATA would help me
get started by sending out information to approxi-
mately 300 other "tinnitus people" in my area.
Next I needed to find a place to have our
meetings. I had been working for Inter-Faith
Ministries as a manager of the Emergency Over-
flow Shelter for the Homeless. It was a temporary
job for the winter. One day while I was in the
general office of Inter-Faith, I asked the
Executive Director, Sam Muyskens what I would
have to do to have an office for a tinnitus support
group in that building. Sam asked, "What is your
budget?" Budget, what budget? I knew I had to
keep looking.
In April, when taking my two-year-old grand-
daughter to the park, I passed by the Deaf and
Hard of Hearing Center coincidentally across the
street from Inter-Faith Ministries. I went into the
hearing center and asked the secretary if they had
a space I could use for a tinnitus self-help group.
The answer was yes, and at no cost.
My next step was to call Barbara and give her
the location, date (May 7th) and time. ATA and
Barbara did their jobs well. They made and
mailed the flyers and sent me materials to hand
out to people who would attend the meetings. In
the meantime, I talked with other people in the
community who worked with hearing-impaired
May 7, 1998, 6:00p.m. I went to the Deaf and
Hard of Hearing Center an hour ahead of time to
get ready. When I arrived I was told there had
Carrol Jude
been a scheduling mix-up
and we would be sharing
the space with a group of
children. Oh no! There
was only one thing to do
and that was to take my
group across the street to
Inter-Faith Ministries. I
went over to IFM and
talked to Sam and Kathy
Freed, the Administrators,
and told them of my
predicament. Kathy said,
"You're a staff member (I
had stayed on as a receptionist) so, yes, you can
use the building." I thought we might use the
small staff room so I set it up hoping I might have
ten people. I walked across the street and there
waiting for me were 24 people who had been con-
tacted by ATA. I was overwhelmed!! I asked them
to walk across the street with me to Inter-Faith
Ministries just for that night. The staff room was
too small so I marched them an down the hall to
the conference room and there we held our first
tinnitus self-help meeting.
From that evening on, my life changed again
due to my tinnitus. The most wonderful people
are sharing in my life journey as I am sharing in
theirs. People had no hope coming into the first
meeting for we had all gone to the same doctors.
Everyone left with something that could help
them live a little better and no one felt alone. It
was agreed that we would meet on the first
Thursday of every month. Everyone wanted to
continue to meet at Inter-Faith Ministries, so that
was that. I had the key.
In the days to follow I talked with Barbara,
made plans for the next meeting and sent flyers
out to everyone. Barbara saw to it that I was
Tinnitus 1bday/ September 1998 19
A Self-Help Journey (continued)
named a contact person for ATA. People started
calling from other states. At this point the fund-
ing for flyers and materials was coming out of my
pocket. I talked with a lot of people on the phone
and sent literature to them.
At our next meeting, only five of us showed
up. Oops! You know, we had a great meeting any-
way -real quality. And I realized what hap-
pened. I had not followed through. So, I got on
the phone and called everyone - even after the
fact! Most of them had just forgotten and the time
had slipped by. They said they would be at the
next meeting.
I called the local paper and asked if they
would be interested in doing a story on our tinni-
tus self-help group. The answer was yes. Karen
Schideler came out from the Wichita Eagle with a
photographer. I was quite nervous about this but I
got through the interview easily because the pho-
tographer has tinnitus. Karen said they would
print the article close to our next meeting date.
The Eagle came out with the article a week
before our meeting. In one week I had 68 phone
calls and the caUs have not let up. I also average
several visits a week from people who just walk
into the office.
For the next meeting, I sent out flyers, fol-
lowed by post cards a week before and made
phone calls to everyone the day and evening
before the meeting. We had 30 attend.
July 9, 1998, 12:10 p.m. The newly-formed
Wichita Tinnitus Association became a member
of Inter-Faith Ministries, voted on by their Board
of Directors. We are now a non-profit 501 (c)(3)
organization with all the privileges (like photo-
copying and mailing services) of the Inter-Faith
Ministries. Now we are ready to move forward.
If you think you want to start a group, search
your soul. Then contact ATA and they will do all
they can to help. Find yourself a place to meet
and get on with it. 'Trust the process. Get the
word out any way you can. You will find a lot of
help you didn't expect. Don't get discouraged if
the group is small. Great things happen in small
groups! Make it interesting and make it fun. I
invited a hypnotist to our last meeting and we
became the most relaxed people in Wichita. For
the next meeting, Elmer Jennings, long-time ATA
support contact, will take over. This is not a one-
woman show. Delegate, delegate, and delegate
some more. I asked for donations last time and
the group was very glad to give.
Silence is a problem for tinnitus victims, but
people's silence about their tinnitus is an even
bigger problem. Thlk about your tinnitus because
the person you're talking to just might have tinni-
tus too.
My personal motto in life is "Empower anoth-
er to move an inch." That's your job if you want
to start a tinnitus self-help group. And when we
empower others, we empower ourselves. Ia
Carrol Jude is an ATA support group leader and
founder of the new Wichita Tinnitus Association.
She can be contacted at 1030 N. Market #204,
Wichita, KS 67214-2936, 316/ 264-8853.
New ATA Support Givers WELCOME!
The volunteers listed here and hundreds of
others worldwide offer their time and talents as
telephone contacts and/ or tinnitus support group
leaders. We couldn't do without them.
What would happen if you volunteered too?
For starters, we would add your name, address,
and telephone number to the Support Contacts
List that we send to all new ATA members, then
marvel at our growing network. You would expe-
rience an increase in your knowledge base about
tinnitus. (People with the disorder are excellent
teachers about it.) And you would receive grati-
tude from new acquaintances and, in some cases,
20 Tinnitus Thday/ September 1998
new friends - something you'd just have to learn
to deal with!
If you are you interested, able, and ready to
help, call 800/634-8978 or write to us for a free
Support Givers Packet. You can also access the
packet on our web site ( and apply
on-line. Click on "Tinnitus Self-Help/Support."
A huge thanks to our support network
people - veterans and current additions alike. D
When one is helping another, both are strong.
- German proverb
Collectible Commemorates Quest for Silence
and Benefits ATA Cause
by Corky Stewart, Program Development Manager
Not thinking about the December holiday sea-
son yet? Well, we're not trying to rush you, but we
do want you to know about Silent Night 1998, a
very special and highly collectible ornament that
is available - in limited quantity - right now.
Designed to create
awareness of the tinnitus
sufferer's quest for
silence, this exquisite
European glass orna-
ment was hand crafted
in Poland and is the first
in a series of three limit-
ed editions created entirely for the benefit of ATA
by Joy to The World Collectibles,." Inc.
William Shatner, ATA Honorary Director, not
only endorses the ornament, he participated in the
design. When told that the ATA staff wanted to use
Silent Night as the theme, he immediately suggest-
ed an angel covering its ears and this year's piece
of art evolved. The 1999 and 2000 editions will be
variations on the concept, thereby increasing value
of the series to collectors.
Priced at $54 plus shipping and handling, each
boxed ornament includes an attractive card from
William Shatner. They can be ordered toll free by
calling 877-0RNAMENT 877 /676-2636) and are also
available at Christmas shops, gift and collectibles
outlets, catalogs, and other fine retailers nation-
wide. Th find a location near you, check the web
New Support Group Leaders
A very few of the ATA ornaments are "ultra-
collectible" because they have been autographed
by Mr. Shatner to be used to raise further funds
for the fight against tinnitus. One of tbese "ultras"
is offered through an on-line auction ( Another wilJ be the object
of spirited bidding at the November 21, J 998 Star
Trek Convention in Los Angeles ATA will also
auction a signed ornament online; watch our web
site ( for details on that and other
special events.
Not a Web Surfer? Never mind- we've saved
one of the autographed "ultras" for a mail-in,
sealed-bid auction. The rules are simple: entries
must be postmarked no later than September 30,
1998· all bids will remain sealed until the close of
the auction; highest offer above the minimum
wins (earliest postmark will determine the winner
in case of duplicate bids); minimum bid is $1,000.
Mail your name, address, daytime telephone num-
ber, and ATA ID number along with your tax-
deductible bid (just the figure, not the money) to
ATA Ornament Auction, PO Box 5, Portland, OR
97207-0005. The envelopes will be opened on
October 5, and all participants will be immediate-
ly notified of the winning bid.
Remember that the number of ornaments
available is limited and that ATA will receive a
donation from every sale. Solve that search for a
special gift or add to your own heirloom collec-
tion and help fund further tinnitus education and
research by purchasing Silent Night 1998 today. B
New Telephone Contacts
Becky Blankenship
Touma Ear & Balance Center
1616 13th Ave. #100
Huntington, WV 25701-1692
Susan V. Rezen, Ph.D
Worcester State College
Speech Language
Steven Mann
23 Pequot Dr.
Norwalk, CT 06855
Marl Quigley
1161 Packers Cir.
Thstin, CA 92780
Hearing Clinic
486 Chandler St.
Worcester, MA 01602
Linda Z. Gilk
1845 Palisades Dr.
Carlsbad, CA 92008
Barry Whitesell
4410 Brookhaven Dr.
Greensboro, NC 27406
Harry Larson
3015 18th St. South
St. Cloud
MN 56301
Tinnitus 1bday/ September 1998 21
Questions and Answers
by Jack A. Vernon, Ph.D., Professor Emeritus,
Oregon Health Sciences University
Before going to the questions, I would like to
thank the tinnitus patients who have written to
us. I have said it many times in the past and will
undoubtedly say it many times in the future:
everything we know about tinnitus has been
taught to us by tinnitus patients. Thus I am most
grateful to you all.
Mrs. H. from South Dakota informs us
that as a result of an air bag explosion
she has high-pitched tinnitus and high
frequency hearing loss. She has suffered loss of
concentration, loss of sleep, and loss of social
enjoyment. She asks if tinnitus produced by an
air bag explosion can be relieved with masking?
Undoubtedly you were exposed to a lot of
noise from the air bag, but you were also
exposed to a violent pressure change. So
it's hard to know what is responsible for the tin-
nitus. We've found that tinnitus induced by noise
exposure is more readily relieved by masking
than is tinnitus induced by head trauma or med-
ications. But it is never possible to predict in
advance if masking will be successful. The only
way to find out is to actually try it and that
means to be fitted by a professional who is com-
petent in fitting tinnitus maskers. You might get
an idea of whether or not masking will work for
you by doing the "faucet test" (stand near a
faucet of running water and listen for a reduc-
tion in your tinnitus) . Since your tinnitus is bilat-
eral it is likely that masking devices will be
required in both ears.
Mr. P from Kentucky indicate. s that upon
ascent and descent in airplanes he is
temporarily deaf for a few moments.
Would continuing to fly cause permanent hear-
ing loss?
I assume that what you experience is a
failure of the eustachian tubes to function
properly and if that is so then it will not
produce any permanent hearing loss. If it is a
matter of pressure changes during take-off and
landing you can correct the problem by wearing
tightly fitted earplugs (foam plugs do nicely) for
both of these events.
22 Tinnitus Today/ September J 998
Ms. W. from Ohio indicates that descent
in commercial flight produces pain in her
ears. She asks if this result is due
to her tinnitus? She also asks if the noise of a
turboprop plane could be a problem?
The pain in the ears upon descent in
aircraft is most likely due to pressure
changes. During the majority of flights
aircraft are pressurized at a level of 6000 feet.
Thus on descent if the pressure equalization is
not correctly controlled, one could experience
some major pressure changes and that in turn
could cause pain in the ears. But no, it has noth-
ing to do with your tinnitus. See the answer to
Mr. P from Kentucky for a corrective measure.
As to the noise of the turboprop, earplugs might
provide sufficient protection but you may also
want to try active noise cancellation. Earplugs
provide passive attenuation which is greater for
high-pitched sounds than low-pitched sounds.
But the active noise cancellation devices provide
more complete noise cancellation of low fre-
quency sounds like those heard on planes. For a
little less than $200 you can obtain a ProActive
3000 noise cancellation device. It is sold by Noise
Cancellation Technologies, Inc., One Dock Street,
Suite 300, Stamford, CT 06902, 203/961-0500.
Write or call Ms. Donna McLevy, the sales
manager. The unit is sold with a two-week
money-back guarantee.
Mr. B. from New Hampshire has read an
article about DMSO and tinnitus in the
World Wide Encyclopedia of Natural
Healing. The article claims that nine of 15
patients treated with DMSO experienced tinnitus
relief. Mr. B. asks if he should try this treatment.
You might have trouble obtaining DMSO.
That article was published in 197 4 and
since then, the FDA has regulated that
DMSO is only available to veterinary physicians
for use with animals. (Somehow, though, some
patients are still able to acquire DMSO.) DMSO
has the property of penetrating the skin without
imparting any damage to the skin and thus its
original use was to carry pain suppressors into
affected joints of arthritic patients. The 197 4
study cited could be faulted in that there was no
mention of the tinnitus severity of the patients
selected for treatment and that unfortunately
there was no placebo-control group. Mr. B., I
would recommend that you try other treatments
and will gladly discuss this with you if you are
interested. (For more on DMSO, see also
"Alternative Therapies - Another Look" in the
December 1994 Tinnitus 'Ibday.)
Mr. L. from Minnesota writes that he
has experienced depression and has had
tinnitus in his deaf left ear for many
years. He is currently taking St. John's Wort
which to date has not helped his depression or
his tinnitus.
I have seen several patients who were
told that they were deaf in one or the
other ear. But all that means is that the
hearing is so impaired that the ear cannot profit
from a hearing aid. Being able to hear and under-
stand speech from a hearing aid is vastly differ-
ent from being able to successfully mask that
ear. J would encourage you to do the "faucet test"
with the left ear pointing toward and near to the
sink. If the water sound has any suppression
effect at all on your tinnitus it is likely that a
wearable tinnitus instrument can provide some
relief for you. You indicate that until you became
a member of ATA you had not considered any
possible connection between your t innitus and
your depression. Yet such a connection is very
common and it might be possible to relieve your
depression if we can relieve your tinnitus. It is
clearly worth a try.
Also, if your depression is severe, it is not
likely that St. John's Wort will relieve it. On the
other hand, if your depression is mild to moder-
ate, then you could try the herb. (Give it at least
four weeks.)
and A. Mrs. H. in Michigan writes to say
that the use of Evening Primrose Oil
(EPO) has completely relieved her pul-
satile tinnitus. (Unfortunately she did not specifY
the dosage.) In 1982, Mrs. H. consulted an oto-
laryngologist who informed her that her mild
hearing loss would progress to deafness in five
years if she did not have an operation he recom-
mended. (He ignored the tinnitus problem.)
Mrs. H. did not have the operation and 16 years
later she hears as well as ever. In the ensuing
years her pulsatile tinnitus has returned several
times but each time it does, treatment with EPO
has always relieved it. Have any of you readers
with pulsatile tinnitus tried Evening Primrose
Oil? If so, please let us know the results. I rec-
ommend that patients with unrelieved pulsatile
tinnitus contact Aristides Sismanis, M.D., in
Richmond, VA 804/786-3965). Not only is he
knowledgeable about this condition but he is a
very compassionate and caring individual.
Ms. F. of North Carolina asks if it is pos-
sible to cancel tinnitus with active noise
canceling devices.
Ms. F., these devices cancel external
sounds such as the drone of an aircraft or
other low-pitched environmental noises.
They achieve this cancellation by a set of micro-
phones in the earphones that listen to the exter-
nal sounds. The external noise is then fed into
an electronic circuit that analyzes the sound
wave and reverses it producing a completely
opposite sound which is played back against the
incoming sound. This produces a cancellation of
both sounds. Technically, the cancellation is a
phase reversal. Currently these devices are only
effective for sounds below 1500Hz. (The Bose
Co. indicates that they are working on noise
cancellation technology that will cancel sounds
up to 10,000 Hz.)
Now, can active noise canceling devices
cancel tinnitus? The simple answer is no they
cannot, and for this reason: there is no actual
sound in tinnitus (tinnitus is merely a sound-
like perception - like the phantom limb phe-
nomenon) and thus there is nothing physical to
be detected or played back against itself to effect
Mr. B. in Illinois indicates that they have
two small fans running all night in their
childrens' bedroom, because the fan
noise masks outside noises thus preventing dis-
turbances of sleep. Mr. B. asks if the fan noise
going all night long will ultimately damage his
children's hearing.
I compliment you, Mr. B., for being sensi-
tive to the hearing health of your chil-
dren. I hope that same concern carries
over to that future time when they will be
tempted to attend amplified rock concerts.
Unless your fans are louder than any with
Tinnitus Tbday/ September 1998 23
Guidelines for Writers
Tinnitus Tbday, the Journal of the
American Tinnitus Association welcomes sub-
mission of original articles about tinnitus and
related subjects. The articles selected for publi-
cation are those that speak to an audience
of people with tinnitus, and to audiologists,
otolaryngologists, otologists, hearing aid spe-
cialists, and other medical, legal, and govern-
mental specialists with an interest in tinnitus.
Submit typewritten, double-spaced manu-
scripts on plain 8
/zxll" paper with one-inch
margins all around. Include title; author(s)
name(s) and biographical information; and,
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Questions and Answers (continued)
which I am familiar I seriously doubt that they
could cause any hearing impairment. However,
let's not guess. I recommend that you purchase
a sound level meter and measure the actual
sound intensity of the fan noise. Radio Shack
sells a small sound meter for about $35 which is
amazingly accurate. With such a sound level
meter, measure the intensity of the sound at the
childrens' ear level. If the sound level is 85 dB
or more, that would be reason to purchase qui-
eter fans. Otherwise, all is well.
Dr. S. from Hawaii writes to explain his
use of masking. He points out that some-
times the masking sound can become an
irritant even when it is preferred over the tinni-
tus sound. When this happens, he adds in the
environmental sounds from the Marpac TSC 350
sound generator in order to effect "masking the
masker." Why, he asks, doesn't Starkey produce
the same sounds in their wearable maskers?
24 Tinnitus Thday/ September 1998
In some cases, a very high-pitched
tinnitus requires a very high-pitched
(and unacceptable) sound to mask it.
Your invention of "masking the masker" is a
great idea and clearly another way to enhance
the masking effect for patients with high-
pitched tinnitus. Keep in mind that the masking
signal does not always have to be at the same
high frequency as the tinnitus signal to bring
relief. Only with proper testing can this be
Notice: Many of you have left messages requesting
that I phone you. I simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:30a.m. - noon and 1:30- 4:30
p.m. 503/494-2187). Or mail your questions to:
Dr. Vernon
c/o Tinnitus Today
American Tinnitus Association
PO Box 5
Portland, OR 97207-0005
ATA's Champions of Silence are a remarkable
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Our heartfelt thanks to all of these special
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(Contributions of $500
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and above)
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Steve Martin
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Martin F. Schmidt
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from S/00-$499)
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In Memory Of
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Ken Berman's father
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T. Larry Barnes
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Eric Bartl1ell
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Larry E. Hall Perry Mitch ell Richard D. Zujko, M.D. William Apostolides
David M. Banlert
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Professional Sponsors
Nancy Cuccurullo
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Sam Berkman
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Charles B. Hauser Robert Odie
from $100-$499)
Steven F. Goldstone
Robert B. Berry
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Natan Bauman, Ed. D.
Norman Hascoe
William D. Bethell
Heindl Family Foundation Julian M. Olf
Marcus Boehm
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Constance Brown Hearing
John w. MacMurray
Richard A. Bolt
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Carol J. Makovich
Richard Bouthiette
Elizabeth B. Hill Mark O'vyang
Mark Brumback, ACA
RJR Nabisco
Art Bragg
PatTicia Hines Allan F. Pacela, Sc.D., P.E.
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Thomas J. Pierce, Jr.
William A. Burgin
Lorraine Hizami v.tilJiam R. Patterson
Lois N. Cohen, CSW, ACSW,
Ed G. RobertieUo
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Huntley and Lynne Witacre
M. Cappelletti Construction,
Thd Hofmeister Dow V Perry
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Jason H. Wright
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W. F. Samuel Hopmeier,
Arthur H irshberg's sister
Barbara Young Camp
Julian Hoogstra Jay L. Pomrenze
Claire and Jacques Simon
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Max Horn Robert L. Pope
Tinnitus Thday/September 1998 25
Danny Isakson
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Robert Janus
Mr. and Mrs. John H.
Lee J. Rowe
Thelma P. Batchelder
Hilda Sanford
Arlo and Phyllis Nash
Martin L. and Grita N.
Martin F. Schmitd/Kate
Schmidt Moninger Fund
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Mr. and Mrs. John H.
Max Spickel
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South Jersey Tinnitus
Support Group
In Honor Of
Ernest Auer
(Happy Father's Day)
Patrice Auer
Marion carver
(35th anniversary of
E A R Services)
Dorothy Muto-Coleman.
Ralph Dawson
(90th birthday of my
Donald E. Nace
Sherman Devitt
(For being a thought·
ful cousin)
Charles M. Selsberg
David and Pearl
(50th Wedding
Judith Pilz
Alfred and Doris Schwartz
Jack Harary
(Happy Father's Day)
Mike. Cindy, & Adrian
Dr. Jack A. Vernon
Jack Salerno
Barry Whitesell
(Our son)
Mr. and Mrs. E. D.
Whitesell, Jr.
Research Donors
James Adams
Joel Alexander
Earl W. Alvord, Jr.
Dennis B. Anderson
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Georgina Arbing
Frank Amal
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Calvin Artke
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Mary Austin
Lorraine L. Bachmann
Claire U. Bagley
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Doloris w. Baker
Eileen F. Barrette
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De albuquerque
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Harry Floersheim
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Richard Fowler
Thllervo Frankel
26 Tinnitus 'Ibday/September 1998
Rhea Fried
Viola L. Fuchs
James H. Fulcher
Nancy E. Galeza
Stephen P. Gazzera
Dr. Arthur Gelb
Mark S. Geller
Jennifer Gerhard
James Giordano
Howell R. Gnau
Barry S. Goldberg
Linda B. Goodwin
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Jeannette E. Green
Dr. Judith L. Green
Judy A. Griffin
Ralph Gugeler
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Norma M. Hammerberg
Michael P. Hanson
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Jeff Hellman
Ida G. Hibbard
E. Alan Hildstrom
John L. Hilgers
Roland F. Hirsch
Thd Hofmeister
Kay Hoiby-Griep
W.F. Samuel Hopmeier, BC-
Mary Kay Horner
Chet Hosac
Robert K. Hoy
Jack Huang
RDsa Huang
E. C. Huckabee
Rachel Hudock
Gilbert Hudson
Donald E. Huebl
Janet v. Hughes
Nathan V. lyer
Ann Jackson
Perry Jamieson
Roger Johnston
Barry Jordan
George Joseph
R. L. Kcheley
Donald J. Kellenberger
Joseph Kellner
Frank L. Kellogg, Jr.
Robert A. Kirkman
Waldemar Kissel, Jr.
Roberta Kitzmiller
Frank V. Koenig
Steve M. Konneman
Egon Kot, BC-HIS, FNAO
Jeffrey Kot, M.A.
Gloria J. Koz1osky
Virginia C. Kuehner
Joseph A. Kuhn
Gary J. Kutzler
Erna Ladage
Jerry J. LaForgia
Susan R. Lallak
Neil Lambert
Judith Larson
Jeannette Lawrence
Arthur Laxer
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Frederick S. Leimer
Stanley D. Levin
Charles B. Levitin
Harry Levitt, Ph.D.
David Long
Agnes Longtin
lnna Lorents
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Ernest A. Lucci
Nick Luis
Anthony C. Lunn
Robert G. Lyon
Don Macaborski
Dan R. Malcore
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Carol A. Markey
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Wayne E. Maxon
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'furry 0. Norris
Donald G. O'Brien, Sr.
William D. Odbert
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Robert Orosz
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'Ibm Pechtel
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l.ollv Rieken
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.John Souroumanis
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Frederick B. ZOok
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"Silent Night 1998"
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