June 2000 Volume 25, Number 2

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Education -Advocacy - Research - Support
In This Issue:
Advances in Tinnitus Research
Hormones and Tinnitus -
An Informal Study Opportunity
Tinnitus Treatment in Israel
Tinnitus 7bday Readership Survey
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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 • tinnitus@ota.arg, www.ato.org
Editorial and Advertising offices: American
Tinnitus Association, P.O. Box 5, Portland, OR
97207, 503/248-9985, 800/ 634-8978,
tinnitus@ata.org, www.ata.org
Executive Director: Cheryl McGinnis, M.B.A.
Editor: Barbara Thbachnick Sanders
1irmttus 'Tbday is published quarterly in March,
June, September, and December. It is mailed to
American Tinnitus Association donors and a
selected list of tinnitus sufferers and profes-
sionals who treat tinnitus. Circulation is rotat-
ed to 80,000 annually.
American Tinnitus Association is a non-profit
human health and welfare agency u11der 26
USC 501 (c)(3).
Copyright 2000 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 the prior written permission of the
Publisher. ISSN: 0897-6368
Execu(jve Director
Cheryl McGinnis, MBA, Portland, OR
Board of Directors
Paul Meade, Tigard, OR, Chairman
Joel Alexander, Park Ridge, NJ
Dhyan Cassie, M.A., CCC-A, Medford, NJ
James 0. Chinnis, Jr., Ph.D., Manassas, VA
W. F. S. Hopmeier; St. Louis, MO
Gary P. Jacobson, Ph.D., Detroit, Ml
Sidney Kleinman, Chicago, IL
Stephen Naglei; M.D .. Atlanta, GA
Kathy Peck, San Francisco, CA
Dan Purjes, New York, NY
Susan Seidel, M.A., CCG-A, Towson, MD
Tim Sotos, Lenexa, KS
Richard S. 'JYler. Ph. D., Iowa City, lA
Jack. A. Vernon, Ph.D. , Portland, OR
Megan Vidis, Chicago, !L
Honorary Directors
The Honorable Mark 0 . Hatfield, U.S. Senate,
Retired
Thny Randall , New York, NY
William Shatner, Los Angeles, CA
Scientific Advisors
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
Barbara Goldstein, Ph.D., New York, NY
John W. House, M.D., Los Angeles, CA
Gary P. Jacobson, Ph.D., Detroit, MI
Pawel J. Jastreboff, Ph.D., Atlanta, GA
William H. Martin, Ph.D. , Portland, OR
Douglas E. Mattox, M.D., Atlanta, GA
Mary B. Meikle, Ph.O., Portland, OR
Stephen M. Nagler; M.D., Atlanta, GA
J. Gail Neely, M.D., St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
The Journal of the American Tinnitus Association
Volume 25 Number 2, June 2000
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
4
8
10
From the Chairman of the Board
by Paul Meade
Advances in Tinnitus Research - A Report on the
Association for Research in Otolaryngology
by James 0 Chinnis, Jr. , Ph.D.
Combined Federal Campaign - It means so much!
by Pat Daggett
11 Hormones and Tinnitus
by Marsha Johnson, M.S. , CCC-A, TRTA, FAAA
13 Announcements
14 Climb Every Mountain
by Jessica Allen
16 Research Update - 'Ibwards the Cure
18 Building a Better Dishwasher
by Rachel D. Wray
20 Tinnitus Treatment in Israel - The Hope and the Reality
by Stephen M. Nagler, M.D.
22 Self Help Groups - We are on your side
by Dhyan Cassie, M.A., CCC-A
Regular Features
4
5
6
From the Executive Director
by Cheryl McGinnis, M.B.A.
From the Editor
Being Aware
by Barbara Thbachnick Sanders
Robert E. Sandlin, Ph.D., El Cajon, CA 23
Alexander J. Schleuning, II, M.D., Portland, OR
Michael D. Seidman, M.D.,
Letters to the Editor
Questions and Answers
West Bloomfield, MI
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith, M. D., San Jose, CA
Robert Sweetow, Ph.D., San Francisco, CA
RichardS. 'JYler. Ph.D., Iowa City, lA
Cover: *Hydrangeas, • oil on masonite,
16 x 20", by Gail Wells-Hess.
Inquiries to Gail Wells-Hess at
800-776-4245 or wells56@ibm.net.
by Jack A. Vernon, Ph.D.
25 Special Donors and 'Ii'ibutes
The Publisher reserves the right to reject or edit any manuscript received for publication
and to reject any advertising deemed unsuitable for Tinnitus 7bday. Acceptance of
advertising by Tinnitus 7bday does not constitute endorsement of the advertiser, its
products or services, 11or does Tinnitus Tbday make any claims or guarantees as to the
accuracy or validity of the advertiser's offer. The opinions expressed by contributors to
Tinnitus Tbday are not necessarily those of the Publisher, editors, staff, or advertisers.
Ameri can Tinnitus Association Tinnitus Today/June 2000 3
FroiTI the ChairiTian of the Board
by Paul Meade
I am very pleased to intro-
duce our new Executive
Director, Cheryl McGinnis.
Her background includes
primary health care planning
in partnership with the U.S.
Department of Health and
Human Services, establishing
continuing education for
clinicians, managing a crisis intervention program
in collaboration with the Federal Emergency
Management Agency, and managing conferences
and publications for university sports directors.
She has a Masters degree in Business Admin-
istration and a Bachelors degree in Audiology and
Speech Pathology. You may already be familiar
with Cheryl as ATA's Director of Research and
Support and from her past research update and
support program articles in Tinnitus Tbday.
Cheryl's professional background, plus her
interest in tinnitus, made the Board's selection
an easy one. As Executive Director, Cheryl will
continue the program improvements and changes
initiated by our previous director, Dr. Steve
Laubacher. We all wish Steve success in his new
endeavors. B
FROM THE EXECUTIVE DIRECTOR
by Cheryl McGinnis, M.B.A.
I am honored to serve the
American Tinnitus
Association as Executive
Director and am excited about
leading a team of dedicated
staff members, each of whom
is committed to improving
services for people with
tinnitus. We have many
opportunities to make a
difference.
The ATA Board of Directors and staff continue
to take on opportunities to increase awareness of
tinnitus. Over the last six months, ATA sponsored
three regional events to increase awareness of tin-
nitus including current research, beneficial treat-
ments, and available support programs. A public
forum was held in New Orleans during the fall
with four panel members presenting treatment
strategies and current research. In March, a
similar public forum was held in Chicago and
included a presentation about self-help groups
in addition to research and treatment strategy
presentations. Both of these events gave ample
opportunity for participants to ask questions of
the panel experts. Most recently, on April 1st, the
Mid-Atlantic Regional Tinnitus Conference was
held in Voorhees, New Jersey. Nearly 300 patients
and healthcare professionals attended this excep-
tional conference. I was delighted to have been a
guest speaker there.
4 Tinnitus 'Ibday!June 2000 American Tinnitus Association
We see opportunities to make a difference by
funding research into the mechanics and treat-
ments of tinnitus - with hopes of identifying a
cure. Within this issue, you will read about ATA-
funded research that was recently completed.
(See ''Research Update" on page ~ 6 . ) : c r ~ has a
twenty-plus year history of fundmg tmrutus
research projects. ATA's goal for research funding
during 2000-2001 is $500,000. With your help we
will meet and possibly surpass this goal.
Another article within this issue features a
self-help group leader and mountain climber
from Colorado who contacted the ATA to increase
awareness of tinnitus as she takes on the chal-
lenge of climbing 14,410-foot Mt. Rainier in
Washington State. We will experience the adven-
ture of a glacier summit ascent vicariously
through her. While raising awareness of tinnitus,
she also hopes to help ATA raise financial support
for research. (See "Climb Every Mountain" on
page 14.)
.ATA staff and Board of Directors are making
plans to recognize a leader who forged a direction
for this association over 20 years ago while
making a difference in the lives of people experi-
encing tinnitus. Gloria Reich, Ph.D., was ATA's
first Executive Director. She initiated the research
grant program as well as other programs that still
provide education, advocacy, and support for all
people with tinnitus. In November, we are host-
ing the first "Founders Dinner" to pay tribute to
Dr. Reich and to the many contributions she has
made to the American Tinnitus Association. You
are invited to join us as we honor Dr. Reich (see
"Save this Date" on page 7) and look to the future
with hope for finding a cure. Ill
From the Editor
Being Aware
by Barbara Tabachnick Sanders
It was the last thing I wanted
to happen.
I was putting the finishing
touches on our booth at a local
health fair - my first for ATA.
I set out the brochures and
Tinnitus 'Tbdays in an enticing
arrangement to attract passers-
by in the conference display
area. I straightened the linen, adjusted the
American Tinnitus Association sign behind me,
then snapped on the light that shone on the sign.
Just then, a man in the booth directly across from
me walked over to introduce himself. I was terri-
bly excited. We had so much to offer. His first
words to me were not what I expected, not "Hello,
I'm with the .... " They were instead, "I was doing
just fine until I saw your sign. My ears started to
ring like crazy the instant I saw the word 'tinni-
tus."' My heart sank. My first contact with the out-
side world was a flop.
By other measures, the health fair was a
success. I spoke with 100 people that day who
were grateful, and some really hungry for tinnitus
information. A hundred more picked up our
materials and read them as they wandered on.
The man in the booth across from me worked
the whole day for the organization he represent-
ed. Through the day we nodded to each other.
Occasionally through the day he'd catch my eye,
point to the sign behind me, and shake his head
with an unhappy smile. I went home that night
and thought not about the two hundred who I had
helped that day but about the one who I had not.
It's been seven years, and in some way, every
day, l still think about him.
Tinnitus is an enigma. On one hand, we work
so hard to help you focus your attention away
from the noises you hear. We want you to take up
pleasant distracting hobbies, exercise, meditate,
laugh, and relax. We want you to blend the inter-
nal sound you hear with external background
sounds so that the tinnitus moves to the back of
your mind. We want you to habituate it. It is not
important.
On the other hand, tinnitus is incredibly
important. It is so important that we need to warn
people who listen to excruciatingly loud music or
who work with their ears unprotected in factories
or sports arenas or on farms. We want them to
take urgent notice of what they're doing and help
them understand the consequences. We want to
tell them that tinnitus happens.
When people who do not have tinnitus learn
the truth about the physical, emotional, and
financial toll that it takes, they get the opportuni-
ty to care deeply about it. And if our legislators
are some of those people who learn the truth,
tinnitus stands the greatest chance ofbeing thrust
into the public eye, seen as the crucial public
health problem that it is, and funded accordingly.
Awareness is the key.
Over the next few months, we will be running
radio and TV spots and newspaper stories nation-
ally. If you see a story in the newspaper or hear a
spot on the radio about tinnitus, and your
renewed awareness of your tinnitus causes it to
spike, please know this:
+ Your tinnitus will go back to its previous
level shortly.
+ Every person who contacts us because of
a media story moves us one step closer to
a cure.
+ We are baffled about how to balance our
need to be vocal about tinnitus with your need
to not be reminded of it.
+ We never want anyone's tinnitus to get worse
because of something that we do.
+ We never want anyone to get tinnitus because
of something that we didn't do.
I wish I had told my friend at the health fair
to look the other way and to support .KIA so that
we could find answers for him. Oh, he did look
the other way from time to time. Sometimes
his head was down. He was reading the Tinnitus
'Tbday I gave him. Maybe he is reading this now.
Maybe we don't know how influential we are. B
American Tinnitus Association Tinnitus 'lbday!June 2000 5
Letters to the Editor
From time to time, we include letters
from our members about their experi-
ences with "non-traditional" treatments.
We do so in the hope that the informa-
tion offered might be helpful. Please read
these anecdotal reports carefully, consult
with your physician or medical advisor,
and decide for yourself if a given treat-
ment might be right for you. As always,
the opinions expressed are strictly those
of the letter writers and do not reflect an
opinion or endorsement by ATA.
Ear Care Clears Tinnitus
After having tinnitus for six months, I finally
went to an ear, nose, and throat physician. She
examined my ears and found infections and fluid
in both of my ears. r took antibiotics and had my
ears drained, and immediately afterwards my
tinnitus was gone! r feel sure that other tinnitus
sufferers can have similar positive results.
ATA member, Boca Raton, FL
Ginkgo Again
I had a terrible case of tinnitus for at least
five years. Thro years ago, I started taking Ginkgo
biloba to help my memory. After taking the
ginkgo for about a year, the tinnitus suddenly
dropped. I'd say that it gave me 95% relief from
the tinnitus. I sti11 take one 40 mg ginkgo tablet
three times a day with meals. I hope this message
will help some people with severe tinnitus.
Stanley Jaffee, Norwood, NJ 07648
[Editor's Note: Ginkgo biloba has not been clinically
proven to reduce tinnitus. However, we continue to
hear anecdotal reports like this one suggesting a
connection between ginkgo and tinnitus relief It's
been thought that if tinnitus is not relieved after a
three-month trial of ginkgo, it will likely not be
relieved by ginkgo. This anecdotal comment suggests
that tinnitus patients might benefit from a longer
trial of the herb.]
6 Tinnitus 7bday/ June 2000 American Tinnitus Association
Stress Reduction Reduces Tinnitus
In April1997, a shrill ringing in my head
started, probably as a result of having taken high
doses of antibiotics and working 40 years in a
fiber board plant with a lot of loud noise. I saw
doctors, audiologists, and ear specialists, and
eventually went to the Mayo Clinic because I
couldn't sleep or eat and because I was severely
depressed. In April1999, I had a heart attack
that damaged 50% of my heart. I have since
gone through cardiac rehabilitation.
Since that time, I have found that walking,
mild exercise, and losing some weight (35 pounds)
has helped my tinnitus. Also, I have not returned
to work (I filed for Social Security disability),
which seems to be keeping my stress and noise
levels down. Now, for the first time in two-and-a-
half years, I can sleep without having to mask the
tinnitus with the sound of water.
I feel that walking and exercising as much as
possible can help a lot of people overcome this
terrible disorder. 1 wouldn't object if you want to
print my letter. If it helps just one person,
I would be very happy.
Marvin Ladsten, 304 8th St., International Falls,
MN 56649, 218-283- 8124.
TMJ Dysfunction
I commend ATA for publishing the article by
Dr. Ira K.lemons about tinnitus and TMJ dysfunc-
tion in the June 1999 issue of Tinnitus Tbday.
Dentists who treat tempormandibular disor-
ders or TMD (the appropriate term, although
TMJ is commonly used), observe that a large per-
centage of their patients initially report tinnitus
as a symptom. A significant percentage of people
who receive treatment for TMD report tinnitus
improvement. Although the mechanism of linkage
between tinnitus and TMD is not established and
the published statistics are not consistent between
doctors the co-existence of TMD and tinnitus has
I
been universally reported.
In a research paper that I presented at a
TMD conference in May 1996, I noted that 38%
of 3,681 TMD patients reported experiencing
tinnitus. I treated 1,182 of these patients, 41% of
whom had tinnitus. Of those patients, 28% report-
ed significant improvement in their tinnitus with-
in one month. Thirty-four percent who continued
treatment reported in1provement or resolution of
tinnitus at three months.
Letters to the Editor rconrinuedJ
People who suffer from tinnitus are encour-
aged to first undergo a thorough medical ENT
evaluation then to seek evaluation by a dentist
trained to treat TMD. IfTMD exists, it should be
treated appropriately and hopefully will be
accompanied by an improvement in tinnitus.
Barry C. Cooper, D.D.S., President,
International College of CranioMandibular
Orthopedics, New York, NY, www.tmjtmd.com
Another look at Niacin
I developed tinnitus ten years ago at the age
of 74. After having the tinnitus for three months,
I went to an otolaryngologist who prescribed
niacin for the condition. I took it and in 48 hours
I had complete tinnitus relief. I continued taking
the niacin for three more years then finally
stopped. The tinnitus has not reoccurred. My
doctor has long since retired and the drug store
has changed hands, so I'm sorry that I cannot tell
you the amount of the dosage. I can tell you that
several relatives and friends who also had been
bothered by tinnitus found relief with niacin.
Pearl S. Serbus, 852 Stradford Circle,
Buffalo Grove, IL 60089
Chemicals - An Impact on Tinnitus?
I agree with everything stated in your March
2000 ''From the Editor" article, "Putting it
Tbgether." I also feel strongly that the ATA is
remiss for not including chemical toxicity as a
possible cause of tinnitus. I am convinced that
chemicals do more auditory damage than cur-
rently anyone will admit to.
Correction
In Management of Tinnitus,
Part II," by Michael Seidman, M.D., in the
March 2000 issue of Tinnitus Tbday, we mis-
stated the results of the Birmingham, UK
ginkgo study. The results show that ginkgo
was no better than the placebo in effecting
tinnitus relief. (VVe had said that the results
were inconclusive.) The researchers also note
that out of their large number of patients in
the study (about 540) there were practically
no adverse responses to the herb. Therefore,
they feel that if someone is in reasonably good
health and not taking anti-thrombotic medica-
tion, it is safe to take ginkgo.
A quick Internet search for "ototoxicity" will
surprise you. Glance at the available information
from the Disease Registry's Public Health
Statement for xylene or the Environmental
Protection Agency's Chemical Fact Sheet's "symp-
toms" section for benzene. (You'll find tinnitus
listed in both.) Then search around your house,
under the kitchen sink, and in the garage, and list
the chemicals with which you come into daily
contact.
Does this mean that tinnitus prevention i.s as
simple as avoiding chemicals? No. The noise
environment that we find ourselves in daily is
still a major factor. Apparently, we increase the
possibility of worsening our hearing impairments
every time we expose ourselves to these environ-
mental toxins. Tbday, hea1ing loss and tinnitus
are taken into consideration before medications
are prescribed. But not too many years ago the
medical profession scoffed at the idea that medi-
cines could cause hearing impairments. In the
area of chemical toxicity, the medical profession
might still be 10 years behind the times.
Perhaps in 29 more years, we will look
back and be amazed to see that environmental
chemicals were as much a cause of the tinnitus
epidemic as was noise exposure, and we'll
wonder why we didn't see it then.
John Victor Shepherd, Sr. , 230 West Delano St.,
Elverta, CA 95626-9215, 916-991-9309,
jvs@inreach. com
SAVE THIS DATE!
Friday, November 10,2000
Join us for our first Founder's Dinner. This
year we are marking the occasion by honoring
Gloria Reich, who served ATA as Executive
Director for twenty years. The black-tie dinner
and dance will be held at the Governor Hotel in
Portland, Oregon. Members of the tinnitus com-
munity along with noted personalities from the
clinical and research fields will be there. Please
call Jessica Allen (800-634-8978 ext. 218) if you
are interested in attending the gala. B
American Tinnitus Association Tinnitus Thday/ June 2000 7
ADVANCES IN TINNITUS RESEARCH
A Report on the Association for
by James 0. Chinnis, Jr., Ph.D.,
Each year the Association for Research in
Otolaryngology hosts a major meeting for the
sharing and discussion of on-going research. This
year, over a thousand studies were presented.
Most of these dealt with the ear or with central
(brain) activity related to the ear. Tinnitus
research was a small part of all this activity, yet
many of the basic research studies help shed
light on tinnitus, and there was an important set
of studies that dealt specifically with tinnitus.
Electrical Stimulation
The brain and part of the inner ear operate
by means of electrochemical interactions. While
it is possible to use sound to affect tinnitus, such
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8 Tinnitus Tbday!June 2000 American Tinnitus Association
as with masking or tinnitus retraining therapy,
direct electrical stimulation of neural structures is
also possible. Electrical stimulation of the auditory
nerve can bypass a damaged cochlea and thus pro-
vide types of stimulation that sound cannot. Also,
it can be employed at a number of places within
the brain itself in an attempt to prevent the trans-
mission of tinnitus signals or to force key struc-
tures to produce neural firing patterns that are
interpreted as silence.
Jay Rubinstein, M.D., Ph .D., of the University
of Iowa Hospitals and Clinics talked about some
preliminary work that attempts to restore the per-
ception of silence by using electrical stimulation
of the cochlea. Using a small electrode placed
through the eardrum near the round window of
the cochlea, a rapid stream of electrical pulses was
delivered. Many theories about tinnitus assume
that tinnitus results from a lack of random sponta-
neous firing of auditory nerve fibers. Instead, the
fibers tend to fire together as a result of sensory
cell damage, or not at all. The random firing may
be what the brain looks for as a sign of silence.
The rapid electrical pulse should, in principle,
restore the fiber firing patterns to a more random,
disorganized state, which could be perceived as
silence. In early testing, there is evidence that
some patients achieve a disappearance of tinnitus
during the stimulation, with the stimulating pulse
train itselfbeing heard or "felt" by some but not
by others. Further tests are being conducted.
William Hal Martin, Ph.D., of the Oregon
Health Sciences University, also reported on
preliminary work with electrical stimulation, but
this time aimed at the thalamus, a structure deep
within the brain. Much evidence suggests that
the perception of chronic tinnitus is due to the
active involvement ofboth auditory and other
structures within the brain. While experimental
sti mulation of these sites has not been attempted
for tinnitus, deep brain stimulation has been tried
in the case of tremor and chronic pain with some
success. Dr. Martin tested the idea that stimulating
parts of the thalamus might disrupt abnormal
activity there and provide tinnitus relief. 1b do
this, he located patients with Parkinson's disease
and other movement disorders who had been
implanted with deep brain stimulators, and who
also happened to have tinnitus. Early tests show
that some patients experience quieter tinnitus
when the stimulators are turned on.
Research ln Otolaryngology

Location, location, location
The site in the ear or brain where chronic
tinnitus arises remains uncertain. Several papers
addressed this problem. Prof. Dr. Gerald Langner,
of the Thchnical University of Darmstadt, in
Germany, talked about a biochemical method
that was used to study the effects ofboth impulse
noise and salicylate (such as aspirin) on the audi-
tory system. The primary finding of this study was
that, although there was substantial activation of
the auditory cortex (implying tinnitus perception),
there was little or no activation oflower auditory
areas in the brainstem. Langner believes that this
is evidence that noise-induced and salicylate-
induced tinnitus are due to changes in higher
brain regions and not directly to effects within the
inner ear or brainstem. The researchers propose
that positive feedback between cortex and thala-
mus plays a crucial role. The strength of this feed-
back linkage is supposed to be under the control
of the limbic system. The normal function of this
feedback is to enhance signals that represent
dangers, but tinnitus peaks resulting from neural
interactions near the edges of damage and other
irregularities of the hearing system are also ampli-
fied. In turn, the tinnitus activity in the cortex
may activate the limbic system resulting in further
cortical stimulation in a vicious feedback cycle.
Effects of muscle contraction
Most of us know that jaw tension and pressure
against the head or neck can sometimes change
the loudness or character of tinnitus. But little
research has been done to determine how wide-
spread this is or how it takes place.
Robert Levine, M.D., of the Massachusetts Eye
and Ear Infirmary, in Boston, described his
research on how muscle contractions can influ-
ence tinnitus. In more accurate, technical lan-
guage, he looked at the somatic modulation of
tinnitus. Dr. Levine examined 128 consecutive tin-
nitus clinic patients and tested each for response
to 16 different briefbut forceful isometric muscle
contractions. Sites tested included those around
the head, neck, and extremities. This testing
revealed that 76% of patients experienced a
change in their tinnitus during at least one of the
muscle contractions. Tinnitus was more likely to
decrease in loudness with somatic modulation for
patients with tinnitus heard in only one ear, as
compared with patients who heard their tinnitus
in both ears.
According to Dr. Levine, these results can
be understood in terms of known interactions
between the auditory and somatosensory (touch,
pressure, and other bodily senses) systems within
the brain. In particular, Dr. Levine believes that
one principal interaction site is within the dorsal
cochlear nucleus of the brainstem.
How much noise?
Neuroscientists have known for a while that
the inner ear utilizes ce11s that are always firing
at random, but which tend to resonate (fire in
time with an appropriate stimulus). This is a
property that improves sensitivity to faint sounds.
It also implies that introduction of a little noise
can make sounds seem louder. Pawel Jastreboff,
Ph .D., Sc.D., of Emory University in Atlanta, is
looking at the idea that adding a tiny bit of exter-
nal noise may enhance the tinnitus signal if it is
present in the auditory nerve. Thus the use of
noise generators set very near the threshold of
hearing may make tinnitus louder and interfere
with habituation.
Dr. Jastreboff cites data on the effectiveness
of directive counseling alone, counseling com-
bined with noise generators set at the threshold
of hearing, and counseling combined with noise
generators set at the mixing point, where partial
tinnitus masking begins. The most effective treat-
ment was counseling combined with noise at
about the mixing point, and the least effective
was counseling combined with noise set near the
hearing threshold.
All the rest
The few papers mentioned above are a sam-
ple of those aimed directly at tinnitus. But cures
are discovered both by studies aimed at specific
health conditions and by the general advance of
related knowledge and technology.
Quite a few studies concerned the faint
acoustic (sound) signals that are produced within
both normal and damaged inner ears. The under-
standing of these sounds produced within the ear
may lead to insights into inner ear function and
possible linkages with tinnitus.
(continued)
American Tinnitus Association Tinnitus 7bday/ June 2000 9
ADVANCES IN RESEARCH (continued)
An equally large number of studies dealt with
plasticity - the basic ability of the brain to reor-
ganize itself in complex ways following, among
other things, sensory damage or changes in stim-
ulation. Many studies confirmed and quantified
the types of changes that occur in the brain fol-
lowing changes in hearing. A number of these
showed that the auditory pathways in the brain
undergo substantial changes following both audi-
tory training of various kinds, and electrical stim-
ulation ofboth the cochlea and brain structures,
and helped to clarify the factors involved. This
reorganizing ability of the brain, already applied
in Tinnitus Retraining Therapy, may allow us to
devise ways to e1iminate tinnitus altogether.
Many of the studies focused on chemical and
drug mechanisms in the inner ear and auditory
pathways. Some examined the detailed effects of
various chemicals on specific inner ear cells.
Some explored immune system connections with .
Meniere's disease and other inner ear disorders
that cause tinnitus. Some addressed novel drug
delivery systems, such as a tiny catheter and an
implantable device.
Momentum
The problem of intrusive tinnitus is a com-
plex one. But the individual research projects
each add new insights and help to illuminate the
whole puzzle. And the pace of research related to
tinnitus is growing rapidly as researchers have -
at last- become intrigued by tinnitus and new
tools are enabling them to make real progress. Cl
Dr. Chinnis is a member of the American
Tinnitus Association Board of Directors. He can be
contacted at jchinnis@alum. mit. edu.
Combined Federal Campaign
It Means So Much!
by Pat Daggeff, ATA Director of Research and Program Associate
ATA is a member of the Community Health
Charities, a federation ofhea1th agencies that
coordinates employee payroll contributions and
campaigns for non-profit agencies like ATA.
I attended a recent meeting and learned
about some changes that directly affect donations
to .ATA. The Combined Federal Campaign (CFC),
one campaign that takes place through the
Community Health Charities, hopes to initiate
two major changes in its payroll deduction drive
for federal employees this fall: 1) online donation
capability, and 2) participation by federal
retirees.
We want to take this opportunity to thank al1
of you who contribute through the CFC for your
continuing support to insure that vital health ser-
10 nnnztus Thday/ June 2000 American Tinnitus Association
vices are available to all who experience tinnitus.
We hope that you are keeping up-to-date with our
research projects, hearing conservation efforts,
management strategies, and member activities
through Tinnitus Tbday. Remember to send us a
copy of your designation form so that you will
not miss any membership benefits. (Our national
CFC agency number is #0514)
Also, if your worksite has an appropriate spot
to post information about the .ATA and its ser-
vices, let us know and we'U be pleased to provide
something suitable. This need not be restricted to
campaign dates but could serve as a reminder
during the rest of the year. a
,\,
7/'Community
Health Charities
WORKING FOR A HEALTHY AMERICA
Hormones and TINNITUS
Exploring the links between female hormone shifts and tinnitus
-An informal study opportunity
by Marsha Johnson, M.S., CCC-A, TRTA, FAAA
T
he possible identification of a link
between female hormone cycles, or the
cessation of these cycles, and fluctuations
in tinnitus loudness perception deserves some
thoughtful consideration. As a tinnitus and
hyperacusis clinician, I have had the opportunity
to personally interview hundreds of individuals
since 1997. In response to these conversations,
and the number of anecdotal comments by many
individuals who have reported changes in tinni-
tus during pregnancy, menstrual cycles, after
hysterectomy, and while taking hormone replace-
ment therapy, 1 have compiled the following
informal questionnaire.
The intent of this article is twofold: to edu-
cate the readers of Tinnitus Thday about what is
kno·wn at this time about this subject, and to
promote the accumulation ofrecorded data in a
pilot study. This, in turn, may produce necessary
evidence to pursue a more formal study.
There seem to be several main questions
regarding this topic:
1) Do female hormone cyclic shifts affect the
ear in any way (including hearing acquity
and tinnitus)?
2) Does peri-menopause (or fluctuating
hormone shifts) affect tinnitus in any way
including changes in loudness perception?
3) Does menopause (or the cessation of these
hormone shifts) affect tinnitus in any way
including changes in loudness perception?
When perusing the literature of published
scientific studies, we find some tantalizing
findings. The question that has been partially
explored relates more to how female hormones
affect hearing in young healthy subjects.
I
t has been verified that the mammaliam
inner ear has receptors that are dedicated to
estrogen hormones, and therefore it was sus-
pected that estrogen may have a direct effect on
the functioning of the cochlea and on our hearing
(Stenberg et al., 1999). This is true for males as
well as females.
Researchers (Chen et al., 1996) found that
changes in the auditory systems relate to hor-
mone cycles in both men and women. They also
noted that these hormone changes were tied to
changes in blood pressure. But the change in
men's blood pressure was different from the
change in women's blood pressure. Women had
greater variances. Notably, women's hearing
sensitivity changed during menstrual cycles
(Swanson et al., 1988). Women also had changes
in acoustic reflex during hormone shifts (Laws et
al., 1986). Acoustic reflexes are the contractions
of small muscles in the middle ear space as well
as the function of the nerves that connect the ear
to the brainstem. These studies included women
of all ages.
Some researchers suspect that shifts in the
immune system are present during menstrual
cycles. I further suspect that these shifts directly
influence the health of the cochlear structures.
U
nfortunately, to date, there are no pub-
lished studies that demonstrate a link
to tinnitus and female hormone cycles.
Anecdotal evidence, however, collected in clinics
around the globe, support a connection and
demand further investigation.
Women have reported to me that menopause
significantly affects the loudness levels of their
tinnitus. Searching through the published studies,
we find that animal research demonstrates
significant changes in nervous system auditory
responses when ovaries were removed (Cooper
et al., 1999). There is also evidence that hearing
changes take place that prolong neural processing
of auditory signals in older female subjects.
These conclusions link estrogen levels measured
in the blood to auditory function in women.
Another animal study showed that removing
the ovaries produced changes in cardiovascular
function that produced changes in the blood flow
to the cochlea and therefore could potentially
cause changes in the function of the ear (Laugei
et al., 1987). Several research studies demonstrat-
ed differences in blood pressure between men
and women until women entered menopause,
when the differences shrank to non-significant.
It is widely known that women receive added
protection from cardiovascular diseases through
the age of menopause, after which their chances
of acquiring these diseases begin to equalize to
that of men.
The cause of tinnitus is unknown. And the
undetermined connection between conditions -
like hormone shifts - to the symptom of tinnitus
makes a conclusion impossible at this point in
time. It is my belief, however, that this question
bears examination: Do hormones have an effect
on tinnitus?
(continued)
American Tinnitus Association Tinnitus Thday/ June 2000 11
Hormones and TINNITUS (continued}
Perhaps one day, through careful accumula-
tion of data, we will have answers. Hence, I invite
you to participate in an informal study.
If you wish to participate, please read over
the instructions carefully and complete all of the
information. You must agree to keep daily records
for a period of at least 90 days. All women with
tinnitus are invited to participate. Your data will
be kept confidential and may be used to pursue
a formal study. Thank you very much for your
participation! Ia
References:
Chen YF: Sexual dimorphism of hypertension, Curr Opin
Nephrol Hypertens, 1996 Mar; 5(2):181-5
Stenberg AE, WanG 11, Sahlin L. IIulterantz M: Mapping of
estrogen receptions alpha and beta in the inner ear of
mouse and rat, Hear Res 1999 Oct; 36(1-2):29-34
Swansson SJ, Dengerink, HA: Changes in pure tone
thresholds and temporary thereshold shifts as a function of
menstrual cycle and oral contraceptives, 1 Speech Hear Res,
1988 Dec; 31(4):569-74
Laws DW, Moon CE: Effects of menstrual cycle on the
human acoustic reflex threshold, 1 Aud Res, 1986 Jul;
26(3):197-206
Angstwurm MW, Gartner R, Siegler-Heitbrock HW: Cyclic
plasma IL-6 levels during normal menstrual cycle, Cytokine
1997 May; 9(5)370-4
Cooper WA, Ross KC, Coleman JR: Estrogen treatment and
age effects on auditory brainstem responses in the post-
breeding Long-Evans rat, Audiology, 1999 Jan-Feb;
38(1 ):7-12
Langei GR, Degerink HA, Wright JW: Ovarian steroid and
vasoconstrictor effects on cochlear blood flow, Hear Res,
1987 Dec 31; 31(3):245-51
90-Day Study Protocol for Hormone Shifts and Tinnitus Loudness Perception
Age: ____ _
Sex: FEMALE
Tinnitus is in: Check One or More
0 left ear 0 right ear 0 both 0 in my head
When did your tinnitus begin? _______ _
What is the suspected cause of your
tinnitus? ________________ _
Date you begin recording data: ______ _
Date you end recording data (must be at least
90 days later than beginning date) : _____ _
Do you take hormone replacement medications?
Please list all including homeopathic or natural
remedies. _ ______________ ___
Have you had a hysterectomy? U Yes U No
Ovary removal? 0 Yes 0 No
Do you have any endocrine system (i.e., thyroid)
conditions? 0 Yes 0 No
You are:
0 pre-menopause
0 peri-menopause (entering menopause as evi-
denced by irregular periods, hot flashes, blood
tests, etc.)
0 post-menopause (no period in past 4 months
or 120 days).
12 Tinnitus Today/June 2000 American Tinnitus Association
Study data: (Use a separate sheet of paper for this chart)
+ Evaluate your tinnitus once in the morning
and once in the evening for 90 consecutive days.
Try to record the data at exactly the same time
every day. Be sure to listen to the tinnitus in a
quiet place for a few seconds until you feel
confident about rating its loudness.
+ Rate the loudness perception of the tinnitus
on a 0-10 scale, where "0" would be completely
silent and "10" would be as loud as a jet engine.
Note on the chart the dates of the onset of your
menstrual cycle if present.
For menopausal women, note any changes in
medications or other symptoms as needed.
Example Study Form:
A. M. PM.
Tinnitus Tinnih1s
Date Scale Scale Comments
5/31/00 2 3
6/ l /00 3 7 Cycle began today
612/00 5 8
613100 4 6
6/4/00 5 4
and so on for 90 days.
Ret urn the completed questionnaire and 90-day chart to:
Marsha Johnson, M.S., Director
Oregon Tinnitus & Hyperacusis Treatment Clinic
545 NE 47th, Suite 212
Portland, OR 97213
If you have questions, call me at 503-203-5858.
Announcements
New Choir of the Scientific Advisory Committee
Richard S. 'IJjler, Ph.D., Professor of Otolaryn-
gology and Director of Audiology in the Dept. of
Otolaryngology-Head and Necl<: Surgery at The
University of Iowa in Iowa City.
In the March 2000 issue of
Tinnitus Tbday, Dr. 'TYler was
introduced as a new member
of ATA's Scientific Advisory
Committee (SAC). However,
his association with ATA spans
nearly two decades. His
appointment as Chair of the
SAC is welcomed by all mem-
bers of the committee and the
Richard s. Tjjler, Ph.D. Board of Directors.
When we asked Dr. 'TYler to
describe his personal goal as new SAC Chair, he
was quick to respond. He wants to help the
Scientific Advisory Committee explore new
ways that it can be of service to the association.
We are very excited about that prospect, about the
renewed energy of this committee, and especially
about Dr. 'TYler's new role with ATA.
Additional Thanks
+ A warm welcome back to Mansfield Smith,
M.D., as a Scientific Advisory Committee
member.
+ A thank you to Stephen Nagler, M.D., for
acting as Chair pro tern of the SAC.
+ A fond adieu to John Nichols who served
as an ATA Board member for one year.
Mr. Nichols continues as coordinator of the
Phoenix Tinnitus Support Group.
Eighth Annual Conference on the Management
of the Tinnitus Patient
Date: September 21-23, 2000
Location: The University of Iowa, Iowa City, IA
Tbpics: For professionals and tinnitus patients
Guest of Honor: Robert A. Dobie, M.D.
Speakers: Michael Block, Ph.D.; Cheryl McGinnis,
M.B.A.; Meredith Eldridge; Stephen Nagler, M.D.;
Norma Mraz, M.A.; Anne Mette-Mohr; Eva Brix;
Paul Abbas, Ph.D.; Jay Rubenstein, M.D.; Brian
McCabe, M.D.; Richard 'TYler, Ph.D.; David Young,
M.A.; Christy Novak, Ph.D.; Richard Smith, M.D.;
Catherine Woodman, M.D.
Contact: Richard 'TYler or Jay Rubenstein,
319-356-24 71, fax 319-353-6739
E-mail: rich-tyler@uiowa.edu or
jay-rubenstein@uiowa.edu
Web: www.medicine. uiowa.edu/ otolaryngology
Kudos to Speakers of Mid-Atlantic Tinnitus
Conference
The Mid-Atlantic Tinnitus Conference
Committee wishes to thank the following speakers
for generously sharing their time, knowledge, and
experience with those who suffer from tinnitus.
You provided encouragement and hope to many.
+ Frederick J . Evans, Ph.D., Princeton Medical
Center
+ Cheryl McGinnis, M.B.A., Executive Director,
American Tinnitus Association
+ Stephen Nagler, M.D., Director of the Alliance
Tinnitus and Hearing Clinic
+ Max L. Ronis, M.D., F.A.C.S., Professor
Emeritus, Temple University Hospital
+ Richard Salvi, Ph.D., Researcher, UniversHy
of Buffalo
+ Susan Seidel, M.A., CCC-A, Audiologist,
Baltimore Medical Center
+ James Sumerson, M.D., F.A.C.S., Medical
Director of Ciell Institute for Hearing and
Speech
+ Val Thdor, wife of tinnitus patient
ATA expresses appreciation to the Conference
Committee and its three coordinators:
Linda Beach, Hearing Aid Dispenser, Ciell
Institute; Dhyan Cassie, M.A., CCC-A, Audiologist,
The College of New Jersey; and Gail Brenner,
M.A., CCC-A, Audiologist, Hearing Technology
Associates
Organizations That Can Help
Hearing Education and Awareness for Rockers
(H.E.A.R.)
P.O. Box 460847
San Francisco, CA 94146
415-409-3277
E-mail: hear@hearnet.com
Web: www.hearnet.com
American Hyperacusis Association
P.O. Box 4229
Vancouver, WA 98682
Web: www.hyperacusis.org
The Hyperacusis Network
Dan Malcore
444 Edgewood Dr.
Greenbay, VVI54302
E-mail: malcore@netnet.net
Web: www.hyperacusis.net
Vestibular Disorders Association
P.O. Box 4467
Portland, OR 97208-4467
503-229-7705
Fax: 503-229-8064
E-mail: veda@vestibular. org
Web.· www.vestibular.org
American Tinnitus Association Tinnitus Thday/ June 2000 13
Climb Eve
by Jessica Allen, Director of Resource Development
Sometimes struggling
with tinnitus can be like
climbing a mountain
and never reaching the
SUmmit. Donna Brown, a tinnitus
support group leader in Denver since
1997, has had t innitus for the past four
years. She says,
11
There is a person
under the tinnitus who still loves life
and loves to climb mountains." And
this time she is climbing one for
everyone experiencing tinnitus.
rrExpedition Hopeful Cure" will take
place on July 29, 2000 on Mt. Rainier,
a 14,410-foot glaciated peak located in
Washington State. Donna will use her
climb to promote tinnitus awareness
and to help raise money toward
research for a cure.
We are very proud of and grateful
to Donna and our other support group
leaders for their energy, resourceful-
ness, and courage in handling their
tinnitus. Donna's letter is as follows:
14 Tinnitus 7bdayl June 2000 American Tinnitus Association
My name is Donna Brown and my tinnitus
started in 19.96 after undergoing a surgical
procedure.
The past four years have been an ordeal.
Tinnitus has affected my sleep, concentration, and
relationships with family, friends, and especially
my husband. I've run the gamut from MRis, CAT
scans, spinal taps, hearing tests, and blood work to
ginkgo, Chinese herbs, acupuncture, and seeing one
uncompassionate doctor after another who told me
to '1eam to live with it !H
I still have bad days. But due to the TRT
devices I've been wearing for the past 16 months
and my twice-a-week vitamin B-12 injections, I'm
having longer and longer periods of good days
when my tinnitus is hardly noticeable.
My fondest childhood memories are of the
numerous hiking and camping trips I took. Those
rustic experiences made me an avid climber, run-
ner, hiker; and skier. Some of my greatest athletic
achievements include climbing Long's Peak and
other "14, 000 footers• in Colorado and running in
numerous marathons, road races, and triathlons.
I feel so alive when I'm climbing mountains! There
is such a great sense of accomplishment in reaching
the summit, not to mention the incredible view I see
from on top of the world.
A few years ago my husband, Gary, and I
were camping in Mount Rainier National Park in
Washington State. When I first caught a glimpse of
Mt. Rainier, I knew I had to climb this awesome
peak. At first I was going to cli.mb the summit as a
personal challenge, but then I read an inspiring
book called No Mountain Too High. The story
recounts the courageous adventure of 17 women, all
breast cancer sw1livors, who generated thousands
of dollars for cancer research by climbing Mt.
Aconcagua in Argentina. I thought, "Why not do
the same thing for tinnitus?"
ountain
This is the best way I can think of to not only
raise funds for tinnitus research, but to raise public
awareness of tinnitus and protect more unaware
ears from the same fate.
Thanks to you all for believing in me and
enabling me to make this "climb for a cure" giving
hope to everyone experiencing tinnitus.
Namaste
(from my heart to yours),
Donna Brown
Not everyone can climb mountains. But you can
make a gift to ATA toward the treatment and
cure of tinnitus in honor of Donna's climb. If
you haven't already responded to our May mail
appeal, please cut out or copy and return the
reply card below. If you have already responded
to our mailing, thank you!
""'J: es fl want to help ATA find a cure for tinnitus.
~ I • Enclosed is my gift for research.
AMERICAN
TINNITUS
ASSOCIATION
PO. Box 5
Portland, OR 97207
503-248-9985
800-634-8978
0 $25 0 $50 0 $100 0 Other __
Name
Address
City
State Zip
Telephone
Method of Payment
0 My check is enclosed, payable to
the American Tinnitus Association
0 Please bill $. ____ to my
0 Visa 0 MasterCard
Card No.
Exp. Date
Signature
Thlephone
Thank y ou. Please return this slip
with your contribution. Your gift is
tax-deductible.
American Tinnitus Association Tinnitus ?Oday/June 2000 15
RESEARCH UPDATE
Towards the Cure
Articles about ATA's research grant program are
regular features in this journaL But you may have
wondered how research projects are selected. Here's
how it works: Tinnitus researchers submit their
applications to ATA. The applications are reviewed
by assigned readers on ATA's Scientific Advisory
Committee (SAC). The readers make their recommen-
dations to the entire SAC which in turn makes its
recommendations to the Board of Directors. The
Board of Directors makes its final decision, grant
applicants are notified, and, finally, the checks are
cut. That is the end of the process for ATA but it is
just the beginning of the process for the researchers.
Most of the studies that we fund take one to two
years to complete. We are pleased to share the results
of two recently completed ATA-funded studies.
Spontaneous activity in brain slices of
dorsal cochlear nucleus following exposure
to high intensity sound by Kejian Chen, Ph.D.,
Kejian Chen, Ph.D.
Principle Investigator;
Department of Otolaryn-
gology- Head and Neck
Surgery, Medical College of
Ohio; Donald A. Godfrey,
Ph.D., Medical College of
Ohio; and James A.
Kaltenbach, Ph.D.,
Wayne State University
Loud sound exposure is
considered the cause of
more than half of all
tinnitus. Previous studies have suggested that
animals exposed to loud sound may have tinnitus
resembling that in people and therefore may be
useful models for studies aimed at finding treat-
ments for human tinnitus sufferers. With this
animal model, earlier studies found that, in the
dorsal cochlear nucleus (the first brain center of
the hearing system), the spontaneous activity
recorded from groups of nerve cells increased
after sound exposure.
This project assessed electrical activity
changes of individual nerve cells in slices of the
dorsal cochlear nucleus after exposure of rats to
sounds loud enough to produce hearing loss and
tinnitus in people. There are basically three types
of spontaneous activity in the dorsal cochlear
nucleus - regular, irregular and bursting. They
are related to different types of nerve cells.
16 Tinnitus Thday/ June 2000 American Tinnitus Association
Regular activity is characteristic of a major
type of nerve cell, called the fusiform cell, that
sends information about sounds to a higher audi-
tory center in the brain called the inferior collicu-
lus. Bursting activity is characteristic of another
type of nerve cell, called the cartwheel cell, that
communicates with fusiform cells. Both types of
cells are also influenced by other brain centers.
We found that several weeks after loud sound
exposure, bursting activity increased, while regu-
lar activity decreased. We consider that these
changes may be related to interactions between
the cochlear nucleus and other hearing centers in
the brain.
In order to explore the chemical basis for
the spontaneous activity changes, we tested
several drugs related to chemical communication
between nerve cells. We found changes in sensi-
tivity to a drug that resembles acetylcholine.
Acetylcholine is known to be involved in chemi-
cal communication to cochlear nucleus nerve
cells by nerve fibers coming from higher brain
centers. These results suggest that, after loud
sound exposure, there may be changes not only
in the ear and in the cochlear nucleus, but also in
the higher brain centers. Such changes may play
a role in the generation of tinnitus.
Masking curves and otoacoustic emissions
in subjects with and without tinnitus
James A. Henry, Ph.D.
by James A. Henry, Ph.D. ,
Veterans Administration
Medical Center; National
Center for Rehabilitative
Auditory Research
This study was designed to
investigate a potential cause
(or mechanism) of tinnitus
that has been proposed by
many tinnitus researchers.
Several theories of tinnitus
generation are based on the
premise that dysfunctional outer hair cell activity
results in abnormal neural activity (Vernon,
1995). The outer hair cells are located in the
inner ear (inside the snail-shell-shaped cochlea)
where sound is ''tranduced" into nerve signals
that are then sent to the brain. There are thou-
sands of outer hair cells, all lined up in three
rows inside the cochlea. At the base of the
cochlea, the outer hair cells are responsive to
higher-pitched sounds (like the right-hand side of
a piano). Hair cells further from the base are
responsive to lower-pitched sounds. The most
interesting aspect of the outer hair cells is that
they are each like little muscles, which "amplify"
soft sounds that enter the cochlea. The amplified
signals are then sent to the inner hair cells that
then send the signals to the brain. It is thought by
some that damage to the outer hair cells (which
can occur by loud noise) disrupts their normal
activity, resulting in abnormal nerve-impulses
that are perceived by the brain as sound.
There have been varied efforts to show that
outer hair cells are involved in tinnitus genera-
tion, but thus far results have been inconclusive
(Mitchell et al., 1995 and Mitchell et al., 1996).
The goal of the present study was to determine
whether dysfunctional outer hair cells are associ-
ated with tinnitus. Two procedures that assess
outer hair cell function are masking audiograms
(or masking "curves") and distortion-product otoa-
coustic emissions (DPOAEs). Masking audiograms
are obtained by first presenting tones at a series of
frequencies and finding the lowest level (thresh-
old) that a person can hear each tone. This estab-
lishes the standard audiogram such as a patient
would receive from an audiologist when measur-
ing hearing sensitivity. Then, a fixed "masking"
tone is presented and the hearing thresholds are
measured again. The difference between the
unmasked and the masked thresholds provides
the masking curve. Certain changes in the mask-
ing curve are an indicator of outer hair cell dys-
function.
DPOAEs are a direct measure of outer hair
cell function that does not require a behavioral
response. A probe tip is inserted into the ear
canal, and tones are presented to the ear. When
the tones are presented, other tones ("distortion
products") bounce back from the cochlea. These
cochlear "echoes" are thought to reflect the outer
hair cells' amplification activity. The strength of
each response is a measure of the health of the
outer hair cells.
For this study, masking curves and DPOAEs
were obtained from two groups of 12 subjects
each - one with and one without tinnitus. All of
the subjects had normal hearing sensitivity. By
selecting subjects with normal hearing, the only
difference between groups was that one had tinni-
tus and the other didn't. Thus, any differences
observed in the results between groups would
most likely be due to the tinnitus.
For some of the masking curves, a trend was
seen that might indicate a hypersensitive masking
effect for the group with tinnitus. This effect
would be consistent with damage to the outer hair
cells, which was observed in a similar study con-
ducted previously by Dr. Curtin Mitchell. The
DPOAEs also showed differences between groups
at the highest frequencies tested. Also, when
DPOAE results were displayed as "input-output
functions," there was a consistent reduction in
the size of the DPOAEs for the tinnitus subjects
compared to the non-tinnitus subjects.
In summary, the findings of this study did
not confirm previous findings, yet differences
between groups were evident. These results sug-
gest the need for a larger-scale study to evaluate
for outer hair cell dysfunction in individuals with
normal hearing and tinnitus. m
Acknowledgments: Funding for this study was
provided by the American Tinnitus Association
and the United States Government Veterans
Affairs Rehabilitation Research and Development
Service (RRE1'D C93-693AP).
References
Vernon JA, M0ller AR: Mechanisms of Tinnitus. Needham
Heights: Allyn & Bacon, 1995.
Mitchell CR, Creedon TA: Psychophysical tuning curves in
subjects with tinnitus suggest outer hair cell lesions,
Otolaryngology- Head and Neck Surgery, 1995; 113:223-233.
Mitchell CR, Lilly OJ, Henry JA: Otoacoustic emissions in
subjects with tinnitus and normal hearing. In: Reich GE,
Vernon JA, eds. Proceedings of the Fifth International
Tinnitus Seminar, Portland: American Tinnitus Association,
1996: 180-185.
ATA's Scientific Advisory Committee and the Board
of Directors has just approved funding for three
new tinnitus research studies totaling $170,250.
We will report fully on this new research in the
next issue ofTinnitus Today.
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American Tinnitus Association Tinmtus Thday/ June 2000 17
Building a Better Dishwasher
by Rachel D. Wray,
ATA Director of Advocacy and
Information 8 Resources
Robert Key has had enough.
Last March, the lawmaker
' introduced a bill to the
British Parliament to ban
Muzak and other instru-
mental background music
from being broadcast in
public spaces. Involuntary listening is a dangerous
"plague," Mr. Key told the Parliament, adding that
it's just one more piece of an ever-increasing
noise pollution problem facing industrialized
countries.
Muzak might not rank too highly on your list
of audio pet peeves, but Mr. Key has a point. Like
airplanes, traffic, and other sources of noise pollu-
tion, piped-in music can raise blood pressure and
cholesterol levels, lower work productivity, cause
your eyes to dilate, and change your digestive
process. But repetitive noise has other negative
effects. If too loud, it can contribute to noise-
induced hearing loss, which afflicts at least 10 mil-
lion Americans, and a worsening of tinnitus. If too
persistent, it can have a cumulative negative
effect on your hearing. For those with hyperacu-
sis, it can be downright painful. And, if nothing
else - even for those with normal hearing - it
can be a terrible nuisance.
In public, like in elevators or on city streets,
this can be bothersome, but there's something
even more psychologica1ly troubling about annoy-
ing noise in the home. After a long day at work, a
chaotic commute, and all the errands filling up
our busy lives, it's nice to relax in a quiet house-
hold. But when that household i.s rife with noise
- dishwashers, washing machines, telephones,
garbage disposals, not to mention televisions and
stereos - relaxation seems impossible.
Fortunately, there are ways to reduce and
improve the noises to which we're exposed. For
starters, "quiet appliances" have become an
important marketing niche, and consumers have
more product choices than ever before. Visit your
local appliance store and you'll see "Almost
Noiseless!" and "Whisper Quiet!" on dozens of
products, including dishwashers, washing
machines, dryers, and even vacuums.
Manufacturers are looking for new ways to
quiet other appliances, often relying on experts in
the field of acoustics engineering. Employees at
18 Tinnitus 7bday/ Junc 2000 American Tinnitus Association
the R.H. Lyon Corporation in Cambridge, Mass.,
are some of the leading researchers in this field.
They spend their days listening to sewing
machines, vacuum cleaners, car doors, and dish-
washers, trying to pinpoint, reduce, and improve
various noises. This latter point - the improve-
ment of sound - is significant. Explains Gladys
Unger, R.H. Lyon consultant, "The sound level
doesn't tell the whole story. The quality of the
sound is also very important. We've seen fans
with low dB ratings, but whose sound quality is so
terrible that you would cringe if you had to listen
to them."
Sound quality is the underlying principle of
psychoacoustics. Noise has two components:
physical and emotional. Physically, noise is made
up of vibrations per second (also called frequen-
cy) that are measured in hertz (Hz). Humans per-
ceive sounds between 20 and 20,000 Hz. The
emotional quality of noise, however, has no mea-
surement save individual perception. When it
comes to product design, manufacturers want you
to like the sounds you hear. They want those
sounds to convey quality, power, and reliability.
Still, even when companies are serious about
noise reduction in their products, they often
approach it in a piece-meal, after-the-fact sort of
way. Instead of addressing noise at the source,
manufacturers resort to sound-deadening materi-
al, which adds to the consumer costs. Ms. Unger
counters, "Skilled acousticians can determine the
cause of the noise and modifY the product itself"
She laughs, "It's kind of like being a detective."
But all too often, she says, "We're brought in at the
last minute" to simply apply an audio Band-AidT''.
Whirlpool, Kenmore, and Maytag have all
introduced quiet dishwashers and washing
machines with no negative effect on performance.
Technology has improved the noise from vacuum
cleaner motors over the years, but vacuum design
has relied increasingly on lightweight plastics,
which vibrate more than older metal casings.
Plus, vacuums have become more powerful, and
as the vacuums' amps have increased, so, too, has
the noise. According to Consumer Reports, noise is
the number one complaint from customers about
full-sized canister vacuums, some of which can be
as loud as 85 dB.
While manufacturers should consider exces-
sive noise during the design process for all their
appliances, consumers also have a responsibility
to speak up about what they prefer- and let
their purchases reflect those preferences. Ms.
Unger says manufactures are more responsive
than one might think. "Many of the appliances we
use in the U.S. cannot be sold abroad because
they are too noisy. For the European or Asian
markets, the manufacturers will go to extra trou-
ble to quiet the devices [because the demand is
there]."
The mentality toward noise is certainly
different in other parts of the world - the ban on
Muzak is but one example. The International
Eurotechnical Commission has an acceptable
decibel output ( 42 dB) for refrigerators and freez-
ers, which have both a motor and a compressor.
Indoor appliances with just a motor aren't regulat-
ed. In Germany and England, there are limits on
how much noise outdoor appliances can make.
Belgium is considering a similar directive. In
Australia, just driving a car that's too loud can
get you a ticket.
In America, there are no federal regulations
on noise output for home appliances. Twenty
years ago, the Noise Abatement and Control
Office, a sub-department of the Environmental
Protection Agency, handled this issue. But the
Reagan Administration elin1inated the depart-
ment, and no other federal agency has focused
on the effects of excessive noise even though
Americans rank it a bigger concern than crime.
(The Noise Control Office is making a comeback:
the Quiet Communities Act of 1999 has been
introduced in Congress; if passed, it will reestab-
lish the office.)
Underwriters Laboratories (UL), the nation's
independent product safety testing and certifica-
tion organization, has noise standards for warning
systems like smoke alarms and specific outdoor
appliances like chainsaws, but there are no stan-
dards for indoor appliances. Dr. Thomas Childers
of UL says, "With the new E[fficiency]-type
motors, the technology will let you do more work,
and yet the motor is much quieter." He continues,
"When we test a product, we ask 'does it function
safely?' and 'does it fail safely?' Audio levels just
aren't considered a threat [for most appliances],
but [theyJ can be abrasive." And that abrasiveness,
he suggests, is something all consumers need to
consider when purchasing a product.
Demanding reliable appliances with reduced
and improved sound is just the first step you
should take when trying to make your home less
noisy and improving your quality of life. Being a
smart shopper can help too. Read Consumer
Reports and other consumer advocacy publica-
tions. Contact appliance companies and ask them
for specific decibel outputs from their products-
and carefully read product literature, which
often specifies the particular noise level. Hold
on to your receipts and return products that are
too loud.
And perhaps most importantly, protect your
hearing - even if you don't think the noises are
over the potentially harmful threshold of 85 dB.
Donna Wayner, Ph.D., an audiologist in New
York, explains, "Something that's benign or inno-
cent-if it's used too much-can have a cumula-
tive effect." Instead, she urges, we need to
change the thinking around noise to stop it at
its source. "People wear protective eye glasses
when they use power tools. Why not [use] ear
protection?"
When using a loud appliance, even one that
seems tolerable at first, Wayner recommends
ear protection. She also suggests making such
protection part of the routine so there's no excuse
(continued)
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American Tinnitus Association Tinnitus 7bdayl June 2000 19
Tinnitus Treatment
in Israel
The Hope and
the Reality
by Stephen M. Nagler, M.D.
The September 1999 issue
of Tinnitus Tbday contained
a report written by Ray
Ennis, a gentleman from
Hawaii, who had traveled
to Jerusalem to see Dr.
Zecharya Shemesh for treat-
ment of his severe tinnitus
at Hadassah Medical Center.
The results of that treat-
ment were incredibly grati-
fying to Ennis, and his report in Tinnitus Tbday
quickly led to a flood of phone calls to my office
(presumably also to the offices of others who treat
tinnitus patients) and to the ATA. Numerous dis-
cussions on tinnitus Internet sites ensued as well.
Part of the flurry surrounding the article was due
to the fact that the specifics of Dr. Shemesh's pro-
tocol for tinnitus treatment were unpublished.
Part of the flurry was due to the fact that the pro-
tocol often included the administration of a secret
compound in pill form. And part of the flurry was
due to the fact that reports of 90% cure rates
using this unpublished protocol and secret com-
pound had begun to surface.
I was subsequently invited to present a formal
lecture on tinnitus at Hadassah Medical Center,
to meet extensively with Dr. Shemesh, and to
observe him at work. I went to Israel in early
February 2000 for the sole purpose of the
Hadassah visit. I represented only myself, not the
ATA. The trip went well in some respects, and it
was disappointing in others.
I am satisfied that Dr. Shemesh is an incredi-
bly dedicated physician with a true passion for
treating people with tinnitus. His treatment proto-
col is complex, and sometimes improvement is
not seen for 12-18 months. Dr. Shemesh feels that
the auditory system is acutely sensitive to meta-
bolic imbalance, and he devotes considerable
effort to evaluating and correcting nutritional and
endocrine deficiencies and excesses. The protocol
results in a highly individualized approach. Even
the composition of the unidentified compound
mentioned above varies from patient to patient.
Dr. Shemesh is compassionate, warm, sincere,
committed, and intelligent. I truly found it uplift-
ing to be in his presence.
But uplifting aside, I had to ask myself, "What
are the facts?"
Some of Dr. Shemesh's patients apparently
succeed in treatment. The Hadassah program is
not unique in this respect; indeed, all tinnitus
centers can boast of successes. However, a success
Building a Better Dishwasher (continued)
not to be safe. Keep a pair of earplugs in the
same drawer as your hair dryer. Hang a pair of
earmuffs over your 1awnmower or snow blower.
Consider low-tech options, like using a rake
instead of a leaf blower. Turn down the volume
on your telephone.
It's to be expected that certain environmental
noises are bound to increase as population
increases - there are simply more of us driving,
flying, weed-whacking. But when it comes to
your own home, you control what you hear,
and knowing how to exercise that control is an
important step toward being a smart customer
and listener. a
20 Tinnitus Thday/ June 2000 American Tinnitus Association
Resources
• The Association of Home Appliance Manufacturers has
a "Just for Consumers" page at www.aham.org. Or call
202-872-5955 for more information.
• Underwriters Laboratories offers a Consumers Resource
Guide and videos. Check out the Web site www.ul.com,
or call 847-272-8800 to reach Consumer Affairs.
• For more information on the Quiet Communities Act
of 1999, go to http: / / thomas.loc.gov or contact your
Representative or Senator.
• The September 1999 issue of Consumer Reporrs focuses
on noise and noisy appliances. Also, check out the
August 1999 issue for a report on refrigerators, July 1999
for washing machines and dryers, and March 2000 for
dishwashers. Visit www.consumerreports.org, call
800-208-9696, or visit your local library.
story alone cannot be the statistical gauge in
determining if an individual with tinnitus should
invest time, effort, and money on a particular
treatment. In order to make that kind of decision
rationally and responsibly, the patient should
have access to data and know the clinic's success
rates for the treatment. Moreover, the patient
needs to know how the clinic in question defines
the term "success." Is it a total cessation of
tinnitus? Is it any appreciable drop in tinnitus
loudness? Is it the ability to more effectively
participate in activities of daily living?
I asked Dr. Shemesh for the data. However,
he does not keep track so he could not provide
me with it. I also asked him for his definition of
success in the context of his treatment protocol,
but he does not have a formal definition of
success. It is my hope that in the near future
Dr. Shemesh will begin to collect and evaluate
his data prospectively, and while I was there I
enthusiastically encouraged him to do so. I can-
not help but wonder, though, how any reference
to "cure rates" can be made when there is no
formal definition of success and no data from
which to draw a conclusion.
As a physician, I have to take another factor
into account. Almost all of Dr. She mesh's patients
receive a secret medication as part of the treat-
ment protocol. They are told that the medicine
is tailored to their specific metabolic needs.
Dr. Shemesh informed me that the purpose of
the medicine is to enhance cerebral metabolism
- brain function. This medication is not offered
by prescription at a local pharmacy. Rather,
Dr. Shemesh brings the capsules into his office
and dispenses them to his patients in containers
marked only with a code. His patients get their
refills from Dr. Shemesh by mail. As 1 consider
this situation, a very real practical concern arises
in my mind. What if the patient goes home and
has a medical emergency - a heart attack, an
aneurysm, an automobile wreck - any emer-
gency requiring urgent medical decisions? In
such emergencies, the treating physician will
always inquire about current medications, know-
ing the seriousness of drug interactions. One
medication might cause harm or even a fatality
if administered in the presence of another. But
Dr. Shemesh's patients cannot tell their doctors at
home what they are taking because they do not
know nor can they find out - nor can their doc-
tors find out. For this reason above all, I realize
that as a physician I cannot currently recom-
mend the program, lack of data notwithstanding.
On a personal note, I certainly understand
how someone with severe intrusive tinnitus,
struggling daily with a gorilla on his or her back,
might be tempted to go to Israel and "give it a
shot" based upon the anecdotal success stories
alone. In fact, a few years ago had I not achieved
the tinnitus relief I was seeking through another
treatment approach, I myself might have called
Dr. Shemesh to discuss what benefit I might
expect from such a program. Finding him to be a
very kind, affable, and accessible doctor, I might
indeed have decided to become his patient.
I know all about that gorilla.
And this February I did go to Israel - not as a
patient, but as a doctor. I went hoping that Dr.
Shemesh's tinnitus program held the key to a
cure. I came home truly impressed with Dr.
Shemesh's dedication, but with significant con-
cerns and even more unanswered questions
about a protocol still very steeped in mystery. B
Dr. Nagler is the Director of the Alliance Tinnitus
and Hearing Center in Atlanta, Georgia. He is a
member of ATA's Board of Directors.
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American Tinnitus Association Tinnitus 7bday/ June 2000 21
Self-Help Groups
We Are On Your Side
by Dhyan Cassie, M.A., CCC-A
"Go home and live with it."
What does that mean? And
when you have screaming
tinnitus, how do you do that?
Such advice leaves patients
feeling helpless and out of
control. When they feel help-
less, their treatment efforts
decrease and their anxiety
and depression increase.
Does it have to be this way?
Absolutely not.
There are people on your side ready to pro-
vide coping mechanisms, treatment plans, and
support. The American Tinnitus Association has
SO self-help groups in the United States and 200 +
telephone volunteers. When people are given a
message without hope, ATA is there to share the
information that there is help. It is true there is
no one cure for tinnitus, but there are many
methods for alleviating it.
In a self-help group, patients learn about
Tinnitus Retraining Therapy, relaxation tech-
niques, hypnosis, Reiki, nutrition, tinnitus allevi-
ating CDs, and sound machines. They discover
there is extensive tinnitus research and advocacy.
They find out that there is a national organiza-
tion dedicated to finding solutions. Tinnitus is
not a "go home and live with it" problem. Support
groups can get a bad rap if people think of them
as a place where the "horrors of tinnitus" are
shared. We know that dwelling on tinnitus is not
helpful in retraining the response of the brain's
reaction to tinnitus. However, "self-help" is taking
control and finding alternative approaches to
health. Self-help is learning opportunities for
intervening and making things better.
Studies have shown that self-help group par-
ticipation can positively affect the quality of life
regardless of the condition or disease. Coping
strategies are offered that many professionals
don't provide. A vicious cycle of despair and
annoyance can be broken by finding coping
mechanisms that can lead to relief.
22 Tinnitus Thday/ June 2000 American Tinnitus Association
Tinnitus often makes patients feel that
they've lost control; that they are powerless.
Studies show that those who learn self-care tech-
niques and gain more knowledge and control rate
the quality of their lives higher than those who
don't take such actions. If we give our patients
the methods to approach this problem, they can
regain some measure of control. There are a
myriad of opportunities for intervening to make
things better.
If you attend or join a self-help group, it is
best if it is not for the purpose of finding someone
or something that will save you. You will continue
to assume the full responsibility for changing
your life. Instead, it is a way of getting ideas and
encouragement to manage your life better.
Impressive and growing research shows that.
self-control is important to our mental and physl-
cal health. Self-help attitudes and skills are
becoming major factors in the treatment of physi-
cal mental emotional and interpersonal prob-
l e ~ s . Self-help is a positive response. It is looking
for better solutions. It is analyzing carefully. It is
improving our coping skills. It is finding purpose
and expecting to succeed. It is joining a group to
get ideas and encouragement and hopefully find-
ing the treatment or the professional who can
offer you help. You may not be able to do this on
your own, but you can choose who is going to be
by your side.
If you have started Tinnitus Retraining
Therapy, you may have been told to avoid self-
help groups. Yes, I agree with that. If you choose
a treatment plan and you are committed to H,
follow through. You have found your technique.
There is no method that works for everyone.
Every self-help approach is just a possible path-
way to success. Experiment with an open mind.
Use what works for you. If it doesn't work for
you, don't blame yourself. There would only be
one diet pill if it worked for everyone. Keep on
seeking, stay busy, help others, and be gentle
on yourself. 9
Resource
Gilden, Janice, et al.: Diabetes Support Groups Improve
Health of Older Diabetic Patients, Journal of the Amencan
Geriatrics Society, vol. 40 pp. 147-150 January 1992.
Dhyan Cassie is an audiologist, selfhelp group
leader, and member of ATA's Board of Directors.
QUESTIONS AND ANSWERS
Jack Vernon's Personal Responses to Questions from our Readers
by Jack A. Vernon, Ph.D., Professor Emeritus,
Oregon Health Sciences University
Q
Dr .. E. from Alabama
writes about her
husband who had a
stroke. After the stroke, he
immediately began hearing
the sound of running water
in his right ear. She reports
that soft music helps him get
to sleep, but she wants to
know if there are other peo-
ple who had their tinnitus
start as a result of a stroke.
A
We do not know of cases of tinnitus being
produced by stroke. A stroke is essentially
the death ofbrain tissue caused by a lack of
blood flow and insufficient oxygen to the brain.
But we do know of several different parts of the
brain - like the thalamus, the limbic system, the
frontal lobe, and of course the auditory cortex -
that are involved to varying degrees in the percep-
tion of tinnitus. If the stroke involved any one of
those, most especia1ly the auditory portion of the
brain it is reasonable to assume that tinnitus
could we11 be produced. Fortunately, your hus-
band has found that playing soft music helps him
get to sleep. Since the quiet music works for him,
I'd also suggest that he test a tinnitus masker in
his right ear to see if it could help him during the
daytime.
Q
Mr. S. from Pennsylvania indicates that his
physician has recommended that he take
an aspirin a day for possible prevention of
heart problems. He states that his tinnitus is at
present bearable but he does not want it to get
any louder. He asks if an aspirin a day will
increase his tinnitus.
A
I am fairly confident that a single aspirin a
day will not increase the loudness of your
tinnitus. If it does, however, stop taking the
aspirin immediately. The tinnitus will return to
its present level.
I would like to introduce a new idea about
aspirin. Some time ago, we used aspirin to delib-
erately induce tinnitus in some non-tinnitus test
subjects. First of all, we found that it took a great
deal of aspirin to induce tinnitus. More important-
ly, we found we could not study aspirin-induced
tinnitus for the reason that every test we used -
even a simple hearing test - to study the tinnitus
effectively masked the tinnitus and then put it
into extended residual inhibition! Ever since then
I've wondered what would happen if we purpose-
ly exacerbated tinnitus with aspirin. Would the
masking easily cover the entire tinnitus and not
just the increase? Would it produce extended
residual inhibition? For those who cannot be
masked, it might be worthwhile to attempt such
an experiment.
Q
Mr. P. from Wisconsin reports that his
tinnitus was perceptibly increased by the
sound of a billiard ball breaking a rack of
billiard balls. He asks if anyone has measured the
intensity of the break sound and what form of ear
protection would be best for this activity.
A
You are correct. The sound of the billiard
rack being broken is quite loud. The loud-
ness depends upon the force used to exe-
cute the break, but in most cases the sound is
from 105 to llO dB. Fortunately it is for a brief
amount of time. Nevertheless you have experi-
enced an exacerbation of your tinnitus from this
sound and thus I recommend that during the time
of the break you use ear protection. "Thunder 29"
earmuffs made by the Howard Leight company
(800-543-0121, www.howardleight. com) work quite
well. Billiards and pool are generally quiet games
so you would only need ear protection during the
break. Using earmuffs seems preferable to giving
up this interesting and challenging pastime.
Q
Mr. K. in California reports several experi-
ences when he has worn earplugs and ear-
muffs while attending football games and
when using his r iding tractor. In both instances,
he perceived low-pitched soft rumbling sounds
which seemed to send his tinnitus into residual
inhibition (a temporary cessation of tinnitus after
masking is discontinued) lasting several hours.
[As you can imagine, we are always interested in
those forms of masking that produce residual
inhibition, especially the long-term variety.]
Mr. K. experienced the rumbling sound for several
hours in each case. The resulting residual inhibi-
tion also lasted for several hours. Mr. K. asks, "Is
the duration of the residual inhibition determined
by the duration of the sound exposure?"
(continued)
American Tinnitus Association Tinnitus Thday/June 2000 23
QUESTIONS AND ANSWERS (continued)
A
In the tests we conducted at the Oregon
Hearing Research Center, the duration of
the residual inhibition is not determined
by the duration of the sound exposure. Having
said that , however, allow me to state that several
patients have experienced very prolonged resid-
ual inhibition aft er having had a long experience
with masking, say several years. I can r eport that
if I mask my tinnitus for 30 or 40 minutes, I may
have several days of complete residual inhibition
and sometimes many weeks of partial residual
inhibition. We wish we knew how to produce
prolonged residual inhibition for every one.
As a general rule, the soft low-pitched sounds
described by Mr. K. are precisely the ones that
we thought did not produce residual inhibition.
Our experience with hearing aids caused us to
discredit low-pitched sound as a possibl e produc-
er of residual inhibition. Here is why: There are
some tinnitus patients with hearing loss who find
that properly fitted hearing aids relieve their
tinnitus. But these patients do not experience
residual inhibition when the hearing aids are
taken off. The sounds that are being amplified by
the hearing aids are relatively low-pitched since
most of our environmental sounds are below
4000 Hz. Mr. K's. experience simply points out
how little we know about residual inhibition!
Notice: Many of you have left messages requesting
that I phone you. I simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:00a.m. -noon and 1:00 - 5:00p.m.
Pacific Time (503-494-2187). Or mail your questions
to: Dr. Vernon c/o Tinnit us Thday, American
Tinnitus Association, PO. Box 5, Portland, OR
97207-0005.
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radios, cd players, and televisions, the Sound Pillow delivers the soothing
masking sounds you need (and your partner will really like this) without
disturbing others. Finally, a sound device that allows you to comfortably
and affordably mask tinnitus. Call and order your Sound Pillow today so
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24 Tinnitus Tbday/ J une 2000 American Tinnitus Association
$39.95
(for A.T.A. members)
$49.95 regular price
TOLL FREE
(877) TINNITUS
(846-6488)
SPECIAL DONORS AND TRIBUTES
ATA's Champion Members are a remarkable
group of donors who have demonstrated their com-
mitment in the fight against tinnitus by making a con-
tribution or research donation of $1000 or more.
Sustaining Members have given memberships or
research donations at the $500-$999 level.
Contributing Members have given memberships at
the $250-499 level. Supporting Members have given
memberships at the $100-499 level. Research Donors
have made research-restricted contributions in any
amount up to $499.
Contributions to ATA's 'Iribute Fund will be used
to fund tinnitus research and other ATA programs. If
you would like this contribution restricted for
research, please indicate it with your donation.
'lli.bute contributions are promptly acknowledged
with an appropriate card to the honoree or family of
the honoree. The gift amount is never disclosed.
Our heartfelt thanks to all of these special
donors.
An contributions to the American Tinnitus Association
are tax-deductible.
GIFTS FROM 1-16-00 to 4-01 -00
Champi on Members
(Comributions of
$1000 and above)
Robert w. Booth
Matthias B. Bowman
Charles T. and
June Brown
James 0. Chinn is, Jr.
John M. Grillos
Joel B. and
J udith L. Konicek
Hubert G. Phipps
Dan Purjes
Stephen M.
Schwarcz, D.D.S.
Delmer D. Weisz
Sustaining Members
(Comrihutions of
$500-999)
Ida J. Beebe
Barbara F. Brown
Jerome Ott
Schoenstadt Family
Foundation
Marvin J. Weinberger
Delbert W. Yocam
Arnold Zousmer
Contributing
Me mbers
(Conoibution.s of
$250-499)
Sam Berkman
John J ay Ginter, III
Nicholas T. Giorgiamti
Richard P. Gross
Eric F. J anle
Advertisement
George Kean
Thomas C. Lusty
Cameron R. Murray
Gai l L. Neale
Abraham
Shulman, M. D.
Helena Solodar, M.S.
Richard W. Sullivan
Daniel K. Thrkington
Miriam Winner
Supporting Members
(Contributions of
SI00-249)
Debra Abel, M.A.
David Ament
Gerald w. Ape!
Robert K. Ashworth
fan 1l:aquair Ball
Jesse Ball
James R. Bamey
Alliance Tinnitus and Hearing Center
Stephen M Nagler, M.D., FAGS - Clinic Director
introduces a two-hour educational videotape
"Tinnitus: Learn to Live WithOUT It"
Thoughts on Tinnitus Retraining Therapy
This video is not merely a vision for the future,
but it discusses very practical approaches to
tinnitus treatment today. It is designed primarily
as a source of information for the tinnitus patient
and family, yet it contains material of value for
the hearing healthcare professional as well.
To purchase your copy today call
404-531-3979, visit our website: www.tinn.com,
or mail a check payable to:
Alliance Tinnitus and Hearing Center
980 Johnson Ferry Road, NE, Suite 760
Atlanta, GA 30342
$40 plus $4 S/H (Georgia residents add sales tax)
M. Lloyd Baum
Anson Hill Beard
Philip Benedict
Richard Berkvam
R. John Bishopp
Richard Bouthiette
Arthur H. Bragg
Robert L. Bro,.rn, Jr.
Sharon B.T. Buchan
William T. Burke
Barbara Young Camp
Anne H. Carmack
Farouk Chaouni
Kerry N.
Chatham, DVM
Kenneth R. Cherry
Clary Childers
Charlotte M.
Christensen-Johnson
Chip Conla n
Maryanne Cornelius
Patrick M. Costiga11
Patrick Coughlin, M.S.
Elizabeth J. Curtis
Ronald D'Arcangelo
Ali Danesh
Fay L. Davis
Walter Z. Davis, Jr.
Deirdre M. Desmond
Glen L. Edwards
Bernard Fishman
Kathryn E.
Fitzsimmons
Margaret Fleming
Mary A. Floyd
Martin E. Fassler
Rose Mary Gabler
Veva J. Gibbard
Barbara
Goldstein, Ph.D.
J ames A. Gomes
Bob Goodman
Donald D. Guito
Lila Hambleton
Mary E. Harker
Paul w. Hastey
'Thm Hattrup
Diana G. Haver
Richard H. Haws
W. A. Hayward
Mark Herritz
Paul G. Hill
James R. Hoffman
Andrew Hrivnak, Ill
Anita Jane Hull
Joan Imber
Roben C. lncerti
Wayne G. Jakobs
Nils P. Jensen
Grant Jones
Q. What's the most effective and
affordable tinnitus masker
on the market today?
''The most effective and enjoyable, clinically· proven
tinnitus relief product on the market today."
Micheal LaRouoro, M.D.
Michigan Ear Institute
• Provides Tinnitus Relief • 15 Different Selections
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in my opinion. Thanks! "
Rick Stern, Lincoln, NE
For a free CD or for more information call:
1-800·551-4467
or check us out on the web:
www.tinnitus-relief.com
American Tinnitus Association Tinnitus TOday/ June 2000 25
SPECIAL DONORS AND TRIBUTES <continued)
Kenneth W. Jones Max and John J. Burke J. R. Grieser James D. McClure Zulma M. Ruiz Chris Zamora
Michael Kamenca Jean Thnnenbaum Paul Buterbaugh Jack l. Groom Joseph P. Michael P. Rummel Doug Zerull
Fawzi Kawash Sidney B. Tartark.in H. Thomas Butler Richard P. Gross McDermott Thomas R. Saia Francis Zofay
floyd Kearns Gino 'lbzzi Walter G. Murray Lo·is R. Mcfadden Francine Saltz Gertrude Zokal
Ronald J. Komiski Scott Thmer Butterworth Crossan, M.D. Delores M. Grace Sanders
TRIBUTES
Walter P. Kulpinski John C. John J. Calli Jacob Hagopian McFarland Lori Sanner
IN HONOR OF
Clide V. Sonny Vaughan, M.D. Peter E. Campbell Elsie Louise Hahn Jack W. McGaughy Janet B. Sategna
Stephen M.
Landreth, lli Julian and Rachel H. Capes Mark 0. Halverson Dan McGervey Jean A. Schneider
Nagler, M.D.
Richard Lanham G. G.Verdina Ralph Carmen Robert w. Hamilton Edward ,T. McGrath Kurt Schoppmann
Lyla Berkoff
Shirley C. Conrad Vidrine Nora Casas Darius D. Handrich John W. McKinney Marion E. Schuttler
Marvin Weinberger
Lavenberg Dorothy R. Waiste Aurelita Cherven Richard E. Haney Glenda McKnight Robert I.
Gloria E. Reich,
Norman M. Leonard Jack Wallner Jim Chesnut Walter C. Carlyle H. Schwendner
Pb.D.
John P. Leopold William Wang Flossie Anita Clark Hardebeck Meierdiercks 'Tracy J. Sciandra
Mary Holmes
Harold Leviton J. Dan Bruce D. Clow Cynthia Sperry Sarah Melamed Alan J. Segal
Dague
Abraham D. Levitt Wealhers. M.D. E. Landon Collins Harris Louise and frene M. Selinger
Barbara
John Lundsten Bernard J. Weber Alicia A. Combes Scott L. Hartquist Robert Mello Mark H. Setala
Thbachnick
John H. Macfarlane Edward R. Weiss James J. Contrada Virginia and Homer Raghauan P. Menon Norma T. Sheld
Sanders
JoyS. Mankoff Charles White Barry D. Cooper Havermale Martha Methot ,John V.
Jack A. Vernon,
Robert E. March Neil E. Williams Virginia M. Cornet Emiko Hazama Evelyn Michaelis Shepherd, Sr::
Ph.D.
Grace P. Maresca Laura Winston Marcia Cox.head Paul G. Hein Ernest G. Michel Guenther E.
Jack A. Vernon,
John w. Mars Shirley L. Wireman Bob Crockford Doris Heppler Joan Michelland Siemert
Ph.D.
George W. Raymond Z. Linda J. Curran Peter Heyne David W. Miller Charles Siess
Rich Alger
McKenna, Ill Wqjtusiak Louis N. D'Ascoli Dorothy R. and Eugene A. Miller Raymond C. Simon
Lyla Berkoff
Colin L. McMaster Brian and Anna M. D'orso John Hiltner Lillie M. Minshall J. Scott Simons
Betty Webber
Richard L. Meiss Karen Woolsey Raymond M. Dabler AnneS. Holmes Elsa Moore Al<hilesh Singh
The Entire ATA
Juerg Meng W. Terry Young Theodore A. Holland Rebecca Morrison Frances .J. Smith
Self-Help
B. Ray Mize Sam Youngblood Dahlstrom, Jr. George Homa, Jr. Shirley J. Mott Judith E. Smith
Network
Mary T. and J. Richard You rtee Fay L. Davis Bobbie Jean Huff Fritz Muller John Sowers
Lyla Berkoff
James Moran Joe 2ehr Phyllis R. Davis Wiltrud E. Hughes Pauline J. Munk Robert Sparling
IN MEMORY Or
William H. Paul W. Zerbst Christine De Erik Jakobsen James L. Murphy Thomas K Splayt
Norman Allen
Moretz, Jr., M.D. Brad Zerman Keersmaeker Diane L. Jones Donald E. Nace Karen J. Stinehelfer
Marcy Feldman
Jeff Morse
Research Donors
Debora A. DeReadt Paul and E. Joann Nace H. C. Stove!
Margaret
Larry A. Mowrer
(Contributions of
Bill L. Deering Helen Kairis Jerry Nagel Walter H. Stover
Buckmeier
Margaret Nau
$499 and below)
Rubye M. Dewitt Fawzi Kawash Consuela Navarro Virginia E. Strange
Arlo and
Robert M. Nelson
Richard Aaron
Beverly J. Harry G. and Paul M. Neakrase Thelma R. Stresak
Phyllis Nash
Samuel R. Newsom
Philip Abbott
Digregorio Marion Keiper Ralph B. Neal Roger B. Sturgis
Mrs. Charlotte
William F.
Virginia L. Adams
William M. Dixon Wayne M. Kern Robert M. Nelson Raben L. Szabo
Clark
O'Halloran
Marian H. Agee
Helen Dovick· Michael w. John P. Nese Max and Jean
Elsie Louise Hahn
Ruth E. Ochs
Paul H. Ahrens
Pattereson Kersch en Irma E. Newman Thnnenbaum
Vivian Cordes
Robert c. Odle
Anthony M. Alba
Murray Dow PaulS. Ruth Nicholas Kathryn Taran
Robert M. Vassel!
Bernice R. Pardue
David H. Allard
Keith C. Duff Killingsworth Dennis Nichols Ted Thrgosz, Jr.
Esther Erickson
Randy L. Parks
Earl W. Alvord, Jr.
Davy L. Duhigg Jim King Marion Nichols Barbara R. Thylor
Arlo and
Michael Patterson
David R. Anderson
Jerry C. Duke John E. Kinney Carol A. Nilles Lynn and
Phyllis Nash
Bert Pearl
Frederick Anderson
Arthur L. Eardlev Heinz Kleuker Caroline S. Nunan Robert Thy lor
William Clark
Adelio Percic
Sally A. Anderson
Edward B. Easter Henry C. Kolpin Ethel S. Oberg Martha U. Theroux
Hiller
Shirley R. Perry
Donald W. Angel
Ronald L. Ede James D. Koutny Ernest Oerly Ben H. Thngue
Elizabeth Hiller
Harvev A.
Gerald w. Ape!
Muriel Eldtidge Mildred A. Kunkel Karen M. Oliveri DomenickT.
Robert M.
Pines, Ph.D.
Lee Atwell
Wayne R. Enders Mancil R. Laidig Don C. Overly lbrrillo
Johnson, Ph.D.
Dan Pu.rjes
Roy Baker
Eleanor I. Faccenda Len Lamson Ivan R. Packard, Jr. Stephen P. Trostorff
Nils C. Bmbaker
Jessie N. Quinn
Benjami11 Baldwin
Edgar M. Feathers Richard R. Landon William D. Paradis Barbara Thoy
Martin Kaplan
Gary L. Reed
John J. Banavige
Stephanie A. Fecko Kenneth I ~ and Jean L. Paulson Michael Valenri
Marcy Feldman
Carl F. Rench
Martin Baumann
Evan Feldman Karen Laurel Ronald G. Pearson Ralph J. Valine
Doris Houghton
Mamita M. Riddle
Peter B. Baylinson
Betty L. Ferdinand Lynn Lautz Janet Penney Van Vangele
Nash
Philip L. Robinson
Fabio G. Bazzani
Virginia S. Fiorito Jeannette Lawrence Barbara Perrin Margaret L. Venzke
Arlo and
AnnaS. Roemer
David Beason
Robert E. Flaherty Edwin G. Lebutt Rita Hundt Pincsak Nell Vermeulen
Phyllis Nash
J. Lewis
Rebecca R. Belcher
Marion H. Flint James G. Leddy Al S. Polito, Sr. Margorie Vincent
Mary F. Peters
Romett. M.D.
August Belmont
Larry C. Focht Andrew J. Leginze Constance M. Porter Maxine Vincent
Linda Ronaldson Ruth M. Fontenot Irene K. Lehman Linda Sue Potter Michael Vucelich
Rosemary M. Peters
Arnold Rowe
Kim A. Berger
Ralph E. Ford Ronald David Charles Poulson Linda L. Wade
Bess Rubin
Edward H.
Sylvia Eisenberg
Frederick J . Ryan
Bergstrom
Bernice Foster Joseph Lemay David A. Patricia A. Walsh
Myron Schiffman
Frances Sacco
Julie Bernard
Francine and Barbara Lemming Preves, Ph.D. Dorothy M. Weibler
Marcy Feldman
Ernest Sagues
Howard G. Bernett
Ray Foster Sandra G. Levine Gilbert B. Sheldon Weinberg
Jack Salerno
Jeanne B. Betcher
Kent Foyer Manny Linares Quintanilla JeffWeisend
BEQ.lJ.ES'l'S
Eugene Saporito
Douglas Biagi
Hugh Fraser Jung Liu Michael Lewis Raab Ronald S. Weiss
Estate of Ann
Marie Saxe
Richard C. Binder
Phil Frazier Mary Jo Lloyd Edward L. Ramsey Maxine B. and
Simon Spencer
Jeffrey R.
James R. Bingham
Rhea Fried Anthony Lombardo David Rapaport Lionel C. Welch
The Gerald J. and
Schlesinger
Stanley L.
Arlene Friedman Palmer R. Long Margaret W. Phoebe Welch
Dorothy R.
Evelyn J. Schwerrl
Bise, M.D.
Michael Gaines Robert S. Long Ratchford Geraldine Wells
Friedman New
1Tacy J. Sciandra
Jackie W. Bishop
John M. Garinthcr Philip J. Longo Tamara 'Rath Helen I. Wells
York Foundation
Robert R. Sfue
David Black
Arlie M. Garmon Mac Lowson Alfred Ravel Darrell D. Wheeler
for Medical
Kenneth
Maria J. Black
John H. and Anthony C. Lunn Matthew T. Read Joseph F. Wl1etstone
Research
Shamordola
Mike Blackaby
Donna Gary Eric M. Luntta John Reyes Valerie V. Whitcu p CORJ>oRATIONS wrrn
Donald Shoemaker
Mark A. Bleich
Stephen P. Gazzera Sam W. Curt W. Rhodes Ronnie F. Whitmore MATCHING GIFTS
Tom Shuford
Michael P. Bogumill
Douglas G. Lytchfield, Jr. Marcy R. Carol J. Wilcox Adobe
Terry Blair Sidwell
John W. Borden
Geertgens Mary Lou Madsen Richardson Collin Wild Advaced Micro
Jeffrey Simkowitz
Jeffrey B. Bottner
Robert C. Geier Charles L. Malone Carlos E. Richter Fred H. Wilken Devices
Sandra J. Siraco
Lowell L. Bouchard
FTederic B. Gibbs Penny Malone Paula Rigano Joseph W. Arco Foundation
Raymond M.
William Robert
Esther E. Gigante Byron R. Mann Steve Ritzinger Wilkinson Celanese Americas
Smith, m
Brandt
Reynaldo S. Gil Lilian E. Manning Ann Rizzetto Theta Wilkinson Foundation
Robert Lee Smith
Frank M. Brewster
BenjaminS. Carol A. Markey Margaret Roberts Mark E. Williams Johnson & Johnson
Theodore R. Stanley Lee Bronson Goldfarb ChristOpher M. ThomasM. James G. Winn Millipore
Louis C. Steffano Tina B. Brosnahan I. Larry Goldman Mastrangelo Robertson Laura Winsron Pfizer. Inc.
Sheldon Stein
Onno Brouwer
Larry L. Goldman Thomas F. Mazur Philip L. Robins011 Linda Worley Phillip Morris
Daniel J. Sullivan
Robert L. Brown, Jr.
Kristina Goodson Barbara B. Wayne Robinson Josephine A. US West Foundation
Michael M. Sullivan
Vera E. Buckley
Dolores J. Gott Mazurkiewicz Martha Jo Rodgers Yeisley Union Pacific
Steven M. Swanson
Arthur C. Bunnell
Bernard Granadier Yvonne E. Marianne Ross Frances M. Young Resources
Dorothy Buonomo
Seymour Greenblatt McAlpine Willis Ann Ross Robert L. Young
James G. Rudd 'lbm Young
26 Tinnitus 'lbday/ June 2000 American Tinnitus Association

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