SEPTEMBER 1993 VOLUME 18, NUMBER 3

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To carry on and support research and educational activities reiating
to the treatment of tinnitus and other defects or diseases of the ear."
In this issue:
Tinnitus: How is it Generated?
Hypnosis as an Aid for Tinnitus Patients
Victims of "The Hum"
Slogan Contest (see page 1 0)
T-Shirts are here! (see page 7)
Regular Features
WANTED! HEARING-AIDS
AND I OR MASKERS
IN ANY CONDITION
If you have ever wondered what to do with those aids that are just sitting in the drawer, think no further.
AT A will be happy to receive them. Donations to AT A are tax deductible, and we' ll provide a receipt.
Simply package them up carefully (a small padded mailing bag is fine) and send to:
ATA, PO Box 5, Portland, OR 97207. If you are using UPS or another alternate shipper-
our street address is 1618 SW First Avenue,#417, Portland, OR 97201, telephone (503)248-9985.
What happens to the aids you turn in? In some cases they can be repaired and given to people in
underdeveloped countries. Even if they can't be re-used as is, the parts are needed for repairing other aids.
Also, the plastic can be recycled. Your old aid could give someone the gift of hearing! Here's a thank-you
letter from a patient of the Oregon Hearing Research Center where some aids are sent:
Dear Dr. Reich, I wish to express my appreciation for being the recipient of an Audiotone hearing aid with tinnitus masker. I
have had great loss of hearing in the past 5 years and have had no relief from conventional !zearing aid agents. I am ve1y
appreciative of Bob Johnson's thoroughness and expertise. He is ve1y knowledgable and helpful ro those of us without the ability
to resolve hearing problems in the marketplace. Sincerely, MG
Guidelines for Writers
Tinnitus Today, the Journal of the American Tinnitus Association welcomes submission of original articles about tinnitus and
related subjects. The articles should speak to an audience of people with tinnitus, audiologists, otolaryngologists, otologists,
hearing aid specialists, and other medical, legal, and governmental specialists with an interest in tinnitus.
Manuscripts should be typewritten, double-spaced, on plain paper and should include title; author(s) name(s) and biographi-
cal information; and when appropriate, footnotes, references, legends for tables, figures, and other illustrations and photo cap-
tions. Generally, articles should not exceed 1500 words and shorter articles are preferred.lfpossible, submit manuscripts on
diskette in WordPerfect format. Either 3.5" or 5.25" PC High density format can be read.
Please do not submit previously published articles unless permission has been obtained in writing (and attached to the article
submitted) for their use in Tinnitus Today.
All letters accompanying manuscripts submitted for publication should contain the following language: "In consideration of
Tinnitus Today taking action in reviewing and editing my (our) submission, the author(s) undersigned hereby transfer(s), or
otherwise convey(s) all copyright ownership to Tinnitus Today in the event that such work is published by Tinnitus Today."
Tinnitus Today also welcomes news items of interest to those with tinnitus and to tinnitus healthcare providers and informa-
tion or review copies of new publications in the field. All such items should contain the name and telephone number of the
sender or person to contact for further information.
Please address all submittals or inquiries to: Editor, Tinnitus Today, P. 0. Box 5, Portland, OR 97207-0005. Thank you for
your consideration.

tnnl
Editorial and advertising offices:
American Tinnitus Association, P.O. Box 5 Port
land. OR 97207
Executive Director & Editor:
Gloria E. Reich. Ph.D.
Editorial Advisor:
Trudy Drucker, Ph.D.
Advertising sales: AT A-AD. P. 0. Box 5, Port-
land, OR 97207 (800-634-8978)
Tinnitus Today is quarterly in Man:h.
June, September and December. It is mailed to
members of American Tinnitus Association and a
selected list of sufferers and professionals
who treat tinnitus. Circulation is rotated to 200.000
annually.
The Publisher reserves the right to reject or edit
any manuscript received for publication and to re-
ject any advertising deemed unsuitable for Tinnitus
Today. Acceptance of advertising by Tinnitus To-
day does not constitute endorsement of the adver-
tiser. its products or services. nor does Tinnitus
Today make any claims or gualliJ1tees as to the ac-
curacy or validity of the advertiser' s offer. The
opinions expressed by contributors to Tinnitus To-
day are not those of the Publisher. edi-
tors, staff, or advertisers. American Tinnitus
Association is a non-profit human health and wel-
fare agency under 26 USC 501 (c)(3)
Copyright 1993 by American Tinnitus Associa-
tion. No part of this publication may be repro-
duced. stored in a retrieval system. or transmitled
in any form. or by any means, without the prior
wrinen permission of the Publisher.
ISSN: 0897-6368
Scientific Committee
Ronald G. Amedee, M.D .. New Orleans, LA
Robert E. Brummett. Ph.D., Portland, OR
Jack D. Clemis, M.D . Chicago,IL
John R. Emmen, M.D., Memphis, TN
Barbara Goldstein, Ph.D., New York, NY
Richard L. Goode, M.D., Stanford, CA
Chris B. Foster, M.D .. San Diego, CA
John W. House, M.D .. Los Angeles, CA
W. F. S. Hopmeier, St. Louis. MO
Robert M. Johnson, Ph.D., Portland, OR
Gale W. Miller. M.D .. Cincinnati. OH
J. Gail Neely, M.D . St. Louis, MO
Jerry Northern, Ph.D., Denver. CO
Robert E. Sandlin, Ph.D., San Diego, CA
Abraham Shulman, M.D .. Brooklyn. NY
Mansfield Smith, M.D., San Jose, CA
Harold G. Tabb, M.D .. New Orleans, LA
Honorary Board
Senator Mark 0. Hatfield
Mr. Tony Randall
Board of Directors
Edmund Grossberg. Chicago. n..
Dan Robert Hocks, Portland, OR
Robert M. Johnson. Ph.D., Portland, OR
Philip 0. Morton, Portland, OR
Aaron 1. Osherow, St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
Thomas Wissbaum, C.P.A., Portland, OR
The Journal of the American Tinnitus Association
Volume 18 Number 3 September 1993
Tinnitus, ringing in the ears or head noises, is experienced by as
many as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Contents
4
s
6
8
11
12
14
20
From the Editor
by Gloria Reich
Meetings Update
by Rich Tyler, and Malvina Levy
Development Directions
by Brent Mower
Tinnitus: How is it Generated?
by Aage Mller
Book Review
by Trudy Drucker
Hypnosis As an Aid to Tinnitus Patients
by Janet Kaye, et al
I Am Only One ...
by Barbara Tabachnick
Victims of "The Hum"
by Leslie Sheppard
Regular Features
18
17
22
23
Questions & Answers
Media Watch: Tinnitus in the News
Tributes, Sponsor & Corporate Members, Professional
Associates, Special & Matching Gifts
Publications List, Donation Form
Cover painting, "Groundscape with Berries," by D. Churchill-Johnson, a Portland
artist represented by the Indigo Gallery (503) 636-3454.
From the Editor
by Gloria E. Reich, Ph.D.,
Executive Director, American
Tinnitus Association
MEETINGS:
Autumn begins the busy
season of professional meetings
at which AT A will be repre-
sented. We invite convention at-
tendees to visit our exhibit at the
International Hearing Society
meeting in San Diego, Septem-
ber 1-5; The American Academy of Otolaryngol-
ogy meeting in Minneapolis, October 2-6 and the
American Speech-Language Hearing
meeting in Anaheim, November 18-21. If you live
in one of these cities and would like to assist in the
AT A booth, please call us . We welcome your help.
. The Ford Hospital in Detroit is spon-
sonng a meetmg Current Concepts in the Evalu-
ation & Management of Patients with Tinnitus for
hearing health professionals on October 15-16. The
meeting is being organized by Dr. Gary Jacobson
and Dr. Craig Newman and promises to be inter-
esting and productive. Lectures will be given by an
internationally famous faculty on the latest devel-
opments in tinnitus research and patient care. Con-
tinuing education credit is available. To register
contact Henry Ford Hospital, Continuing Medical
Education, (313) 876-3073. A small ATA spon-
sored research meeting for invited scientists will
follow.
This writer will be a moderator for a confer-
ence to be held at Portland State University, No-
12, 1993, A Hearing for Deaf and Hard of
Heanng People: Understanding the Issues from
Infancy to Old Age as part of their series entitled
"Humanities Present: Current Ethical Issues in De-
bate". If you wish to attend, please contact Trish
Backlar, Project Director, at (503) 725-3499.
TINNITUS CENTER VISIT:
Earlier this year Dr. Pawel Jastreboff invited
me to visit the Tinnitus Center at the University of
Maryland. I was eager to make this visit because of
a great interest in Dr. Jastreboff's research and that
of his wife, Dr. Margaret Jastreboff. We also have
4 Tinnitus Today/September 1993
had many inquiries from patients who want to
know more about the Maryland tinnitus center.
Accordingly, my husband and I went to Bal-
timore early in June where we spent the weekend
basking in the soft summer sunshine and enjoying
the waterfront activities and cultural and historic
sights. We were picked up punctually on the Mon-
day by the Drs. Jastreboff and taken first to the
tinnitus center where Dr. Jastreboff explained the
clinical procedures and rationale and introduced us
to his colleagues, including Dr. William Gray, the
physician in charge of tinnitus medical evaluation.
We were able to observe the various testing rooms
and equipment used for tinnitus evaluations, but
?id not intrude on actual patients undergoing test-
mg. Then we were shown the audiometric testing
area by clinical audiologist, Susan Gold, and
Brenda Manokey, who does the vestibular testing.
Patients attending this clinic are seen by a
variety of experts who then consult with one an-
other to plan an appropriate course of treatment. A
management technique utilizing therapeutic white
noise generators is popular at this clinic. This treat-
ment differs from conventional masking in that its
emphasis is on desensitization rather than on inhi-
bition. Full information may be requested by writ-
ing the Tinnitus Center, University of Maryland
School of Medicine, 419 W. Redwood St., Suite
360, Baltimore, MD 21201.
The remainder of the day was spent at the
tinnitus research laboratory a short distance away.
Here Dr. Jastreboff directs research projects having
to do with the basic mechanisms of tinnitus. His
development of an animal model for tinnitus has
provided a tool for identifying and testing possible
generating mechanisms for tinnitus and further
may be able to furnish a means of testing potential
tinnitus treatments before using them with humans.
The laboratory is well equipped, at least to our eyes,
and well staffed with enthusiastic young scientists.
The Drs. Jastreboff are especially interested in
recruiting new doctoral graduates to become inter-
ested in tinnitus research. Margaret Jastreboff, who
herself is pursuing basic biological research about
tinnitus, felt it important to persuade the medical
community to accept tinnitus as a legitimate re-
From the Editor
search area. The negative attitude accompanying a
problem like tinnitus which can't be "fixed", and
from which patients don't die, must be made posi-
tive through strong research papers in good jour-
nals. Courses in auditory physiology and related
subjects must be available to medical students in
order to attract new researchers, and these new
researchers must then be supported by dollars in
order for them to commit their lives to this work.
We will be writing from time to time in Tin-
nitus Today about various tinnitus research projects
and centers so that you may know this work is
progressing and so you '11 understand the impor-
tance of keeping these centers alive. We must sup-
port the scientists who are working to make our
lives better. They are our hope! Science no longer
is astonished by "breakthroughs" coming from one
person working in isolation. Modem research re-
quires complicated and expensive equipment only
likely to be found in university or medical settings.
MEETINGS UPDATE
by Rich Tyler, Ph.D., University of Iowa, Depart-
ment of Otolaryngology, 200 Hawkins Drive -
E230, Iowa City, lA 52242-1078, and Malvina
Levy, M.A., San Francisco Hearing & Speech
Center, 1234 Divisadero, San Francisco, CA
94115.
A workshop on the clinical management of
tinnitus was held at the University of Iowa on June
4th and 5th. Professor Ross Coles, from the United
Kingdom was Guest-of-Honor, and presented a
variety of talks on tinnitus, including information
from the epidemiology studies conducted by the
Institute of Hearing Research in the U.K. While
tinnitus affects a large number of people, it was
encouraging to hear evidence that the severity of
tinnitus does not increase with advancing age. Dr.
Coles also noted that hearing impairments cause dis-
ability and handicap, while tinnitus causes suffering.
Rene Dauman of the Hopital Pellegrin in Bor-
deaux, France, another special guest at the meeting,
CELEBRITIES:
New York members of AT A, Tony Randall
and Jerry Stiller, recently appeared in the play
"Three Men on a Horse". This Hirshfeld cartoon
depicts a scene from that play.
Left to right: Julie Hagerty, Jack Klugman, Tony Randall,
Ellen Green, Jerry Stiller.
spoke about the two part medical evaluation of
tinnitus. The first being the history of the onset of
tinnitus, a description of its location, character and
consequences. The second being a complete ENT
and neurological workup to rule out abnormalities.
The special guests were joined by a variety of
University oflowa speakers. Dr. Carol Bauer spoke
about the history of tinnitus, and about basic re-
search; Dr. Brian McCabe, stated that 20% of new
ENT patients present with tinnitus; Dr. Richard
Smith, discussed pediatric tinnitus; Dr. Paul Abbas
reported on physiological models of tinnitus and
the relationships of the inner and outer hair cells;
Dr. Richard Tyler recommended techniques for
measuring and reporting tinnitus pitch and loud-
ness; Dr. Robert Schum addressed psychological
concerns in two areas, problem-focused (medi-
cal,audiological, psychological), and emotion-fo-
cused (cognitive-behavioral modification, support
groups, depression management, and time). Surgi-
cal management was reviewed by Dr. Bruce Ganz,
hearing aids and maskers by Dr. Donald Shum.Ty-
ler reports the University of Iowa plans to sponsor an
annual tinnitus management workshop .
Tinnitus Today/September 1993 5
Development Directions
by Brent Richard Mower,
Development Director
GOVERNMENT RESEARCH
FUNDING CAMPAIGN
The generosity of AT A
supporters was again demon-
strated by the success of our
recent campaign to bolster
ATA's efforts to increase Fed-
eral spending for tinnitus re-
search. Thanks to everyone who
contributed and also to the hundreds of you who
took the time to write to your Senators encouraging
them to give greater consideration to tinnitus re-
search funding. Your dollars and your words will
definitely make an impact.
While changing the position of the National
Institute for Deafness and Other Communication
Disorders towards tinnitus research funding will be
a slow process, we are encouraged by. some recent
action. The NIDCD will have a representative at
our tinnitus research consensus conference to Pe
held in Detroit in mid-October. ATA repre-
sentatives will also meet with NIDCD officials in
Washington later this year to encourage greater
participation in funding tinnitus research. Your
actions and contributions make this possible.
Many of you wrote with concerns that our
efforts were contrary to goals ofreducing the fed-
eral deficit. Please be assured that AT A is only
striving to get a "bigger piece of the existing pie"
and not to increase federal spending. It is our belief
that tinnitus research in not funded adequately in
proportion to other hearing disorders and deserves
greater attention by the NIDCD than it is currently
receiving.
TURN YOUR EMPLOYMENT BENEFITS
INTO A GIFT FOR ATA
As you may know, employees who receive
employer-paid life insurance coverage must pay
income tax on the cost of coverage that's in excess
of $50,000. Since the insurance coverage is auto-
matically provided by many employers as a fringe
benefit, employees get the coverage- and many pay
the tax - whether they need it or not. But if you ( an
6 Tinnitus Today/September 1993
employee) designate your charity as sole benefici-
ary of any portion of the pol icy, the employee pays
no income tax on that amount of coverage.
If you find you don't need all or part of your
employer-provided insurance coverage, this type
of gift is an all-around winner. You make no cash
outlay, you cut your income tax bill and you help
fulfill AT A goals.
To make this kind of gift, notify your com-
pany's benefits department. You will need to fill
out a change of beneficiary form naming AT A as
beneficiary to all or part of your policy. Also, make
sure your company's payroll department is notified
to exclude the cost of the donated insurance cover-
age from your year-end W -2 form.
DOUBLE YOUR MONEY!
Do you work for an organization that matches
charitable gifts? Many corporations will match an
employee's gift to a charity, sometimes giving $2
for each employee-donated $1. Ask the personnel
office where you work. If your employer has such
a plan, get a matching-gift form and follow its
directions for initiating the match. A TA also has a
list of most corporations which make matching
gifts. Call or write me for assistance. Also, if
you've made a donation to ATA within the past
year, that donation may still qualify for a matching
gift. Ask your employer or contact me.
MAKING THE MOST
OF YOUR WILL POWER
Everyone reading this is a supporter of AT A
in one way or another. Do you know that you can
continue to help shape the future of the American
Tinnitus Association after your lifetime, with your
will? It has been said that a will is the final expres-
sion of a person's values. The persons, institutions,
and causes one chooses to remember in a will tell
quite a bit about the author.
It is comforting to realize that there is a way
to guarantee the continued services of those insti-
tutions we value. And to make sure that our assets
are distributed to those individuals and organiza-
tions that are important to us and those we really
want to help. That's why everyone, no matter what
the size of the estate, needs a will.
Development Directions
There are many ways to make a bequest which
we will be happy to discuss with you or your
attorney.
To honor and thank those thoughtful friends
who have made a provision for the American Tin-
nitus Association in their wills, we're forming a
new society - Champions of Silence. This group
will honor those wise supporters who recognize
that they can ensure, through their estate planning,
that A TA' s services of member support, public and
professional education, and research will continue.
By naming a specific sum or a percentage of your
estate to be left to AT A, you can provide ongoing
support for A TA and for the people who are impor-
tant to you.
Become a charter member of Champions of
Silence, and know that you have made the gift of a
lifetime by making a gift of a life well-lived. You
will receive a beautiful certificate, suitable for
framing, and regular reports just for Champion
partners.
Call Brent Mower at (503) 248-9985 (x 18) or
write to him for more information about
Champions of Silence.
ATA SUPPORTERS ARE THE KEY TO HOPE!
Please send me information about:
D Establishing a named fund
D Making a gift of appreciated securities
D Providing for AT A in my will
D Making gifts of real estate
Send to:
Brent Richard Mower, Development Director
American Tinnitus Association
P. 0. Box 5
Portland, OR 97207-0005
(Please print, or paste mailing label below)
Your Name ____________________ __
Address, ________________________ _
City/State/Zip _________ _
They're here!
Our 100% cotton ATA T -shirts have ar-
rived. They are crisp white with a blue design,
available in large or extra-large sizes. The
front design is the AT A logo with the words
"American Tinnitus Association." The back
design is a dictionary pronunciation and defini-
tion of tinnitus: "a chronic ringing or other dis-
tressing noise in the ears or head." We are
very pleased with our new shirts and know
you will be too.
We can now accept Visa or Master Card for
your purchases. Please supply us with card
holder's name, address, phone number, credit
card number, and credit card expiration date.
The cost: $12.95 for members/ $14.95 for
non-members. US funds only, please. Ship-
ping in US is included, add $3.00 for ship-
ment outside the US.
Remember to indicate the size and number
of shirts you want. Send your order with
check payable to: American Tinnitus Association
T-Shirt
P.O. Box 5
Portland, OR 97207-0005
Tinnitus Today/September 1993 7
Tinnitus: How is it Generated?
by Aage R. Mller, Ph.D.,Department of
Neurological Surgery,University of Pittsburgh
School of Medicine, Pittsburgh, Pennsylvania
Address for Correspondence:Aage R. M0ller,
Ph.D.,Department of Neurological Surgery ,Suite
B-400 Presbyterian-University Hospital,Univer-
sity of Pittsburgh School of Medicine,DeSoto and
O'Hara Streets, Pittsburgh, PA, 15213
Treatment of tinnitus presents a formidable
problem in medicine, although it is an interesting
subject for research because tinnitus is an example
of how a sensory system generates a sensation that
is similar to the sensation it generates when an
adequate sound from outside the body reaches it.
More important maybe is that a better under-
standing of what has gone wrong in the ear or
auditory nervous system in patients with tinnitus
would facilitate the treatment of sufferers of tinnitus.
There are forms of tinnitus that are caused by
sound in the body that is generated by, for instance,
the flow of blood, but in this article I will discuss
the type of tinnitus that can only be heard by the
patient and not by an observer. This type of tinnitus
is usually known as "subjective tinnitus". Only
rarely is tinnitus caused by a specific disease and,
in most patients, tinnitus is the only symptom and
no cause can be identified. If a specific disease can
be identified that is ca1,1sing the tinnitus, the disease
should then be treated and hopefully the tinnitus
will disappear after appropriate treatment.
Before discussing how subjective tinnitus is
generated it is important to recognize that there are
many forms of (subjective) tinnitus and that these
different types of tinnitus may have different
causes. It is therefore not rational to look for one
single explanation for all types of tinnitus, nor is it
rational to seek a single treatment for all kinds of
tinnitus.
The weak "noise" most people experience
from time to time may not qualify for much atten-
tion, since it usually does not affect a person's
normal life. Tinnitus that is either persistent or
stronger may have a variety of effects on the life of
its victim, and it is important to study how this form
of tinnitus is generated.
8 Tinnitus Today/September 1993
Tinnitus that is of such an intensity that it se-
verely interferes with common daily activities and is
associated with a hypersensitivity to sound that makes
even moderately strong sounds unpleasant or even
painful probably has a much more complicated cause.
Such tinnitus may develop gradually or more abruptly
without any specific cause being found, but it may
begin after a head injury.
Where and How is Tinnitus Generated?
Tinnitus often seems to come from the ear
(one or both), but this does not mean that the
tinnitus is necessarily generated in the ear. Tinnitus
may be generated in the part of the brain that
interprets sounds that reach our ears. The reason
why tinnitus is often perceived to come from the
ear is that humans always experience the sensation
of sound in the ears. Some forms of tinnitus are
most likely generated in the part of the brain that
deals with hearing (auditory nervous system).
Different Causes of Tinnitus:
Strong sounds can give rise to tinnitus that
may be described as a "ringing" sound. The inten-
sity of such tinnitus normally decreases slowly and,
in most cases, disappears totally. This kind of tin-
nitus is most likely generated in the inner ear (cochlea).
Exposure to excessively strong sounds or long
term exposure to loud sounds may result in a more
persistent form of tinnitus that can be bothersome
and may disrupt sleep and interfere with various
activities. This form of tinnitus is most likely
caused by changes in the function of the cells in the
inner ear that convert sound into nerve impulses
(hair cells). This is also the case for tinnitus that is
caused by drugs such as aspirin and certain antibi-
otics. These kinds of tinnitus can often be covered
(masked) by a suitable sound. Tinnitus can also be
caused by injury to and/or irritation of the hearing
nerve. Tumors that affect the hearing nerve (acous-
tic neuroma) can give tinnitus on one side. This
type of tumor on or in the balance and hearing nerve
(eighth cranial nerve) is not cancerous, but it just
happens to grow in a place with little additional
space. With modem neurosurgical techniques such
a tumor can be totally removed with little risk.
Tinnitus that is localized to one ear may therefore
be the first symptom of a problem that needs medi-
Tinnitus: How is it Generated?
cal attention. However, this is not the common
cause of such tinnitus and in most cases no cause
can be found.
A blood vessel that is in close contact with the
hearing nerve can also cause a similar form of
tinnitus that is often accompanied by oversensitiv-
ity to sound. Injury to the hearing nerve from
surgical manipulations can in addition to hearing
loss, cause tinnitus of different degrees.
How is Tinnitus Generated?
In general, we may assume that tinnitus is
caused by nerve cells that generate the same pattern
of nerve impulses that our brain cannot distinguish
from the nerve impulses that are the result of a
sound reaching the ear. If we assume that relatively
weak tinnitus is generated in the ear or the auditory
nerve, then one would think that nerve impulses
would occur in the hearing nerve that were similar
to the nerve impulses that are evoked by normal
sounds. We do not completely understand how the
ear normally functions and how normal sounds
control the flow of nerve impulses in the many
thousands of nerve fibers of the hearing nerve. We
do not know what it is in the pattern of nerve
impulses in the about 30,000 nerve fibers of the
hearing nerve that tells the brain that a sound is
present and conveys information about the nature
of the sound.
Severe Tinnitus
Very severe tinnitus most likely has a different
and more complicated cause than mild tinnitus.
Such a form of tinnitus most likely involves not
only the ear but also the brain. It is probably nec-
essary that a series of events must occur in order to
cause severe tinnitus.
The brain has often been likened with a mod-
em computer. There are, however, many differ-
ences. The brain is far more complex than any
electronic computer, and the brain is not like a
computer that is "hard wired" to do certain func-
tions. The brain is flexible in its functions, which
can be changed by "feeding" it different informa-
tion. The auditory nervous system has hundreds of
thousands of nerve cells that are interconnected in
a very complex way. This naturally increases the
possibility that something may go wrong.
We believe some forms of tinnitus may de-
velop like this:
The first step in the series of events that are
necessary for the development of severe tinnitus
may be an irritation of the hearing nerve or possibly
a slight injury to the nerve from a blood vessel that
is in close contact with the nerve. While that in itself
may cause a slight, but hardly noticeable, hearing
loss and maybe a weak-to-moderate tinnitus, we
believe that something more is needed for the de-
velopment of the severe tinnitus that is often also
accompanied by an oversensitivity to sound.
The second step in the development of such
tinnitus may be changes in the functions of one or
more of the clusters of nerve cells (nuclei) that
information from the ear must pass before reaching
the cerebral cortex, which is the part of the brain
that makes it possible for us to comprehend the
meaning of a sound. We believe these changes
develop because the ear or the hearing nerve begins
to send the brain uncommon (wrong) information.
The wrong formation can be a result of an injury or
irritation to the ear or hearing nerve.
Thus we now believe that the development of
severe tinnitus and hypersensitivity to sound are
results of changes in the function of one of these
clusters of nerve cells that relay hearing informa-
tion. We do not know the exact form of these
changes. One possibility is that there may be "dor-
mant" connections (synapses) between nerve cells
in the hearing nervous system that normally do not
conduct nerve impulses in response to sound, but
such connections may become active if they for a
long time receive abnormal nerve activity that is
generated in the hearing nerve or the ear. Another
possible cause of severe tinnitus is that abnormal
nerve activity from the auditory nerve may shift the
balance between inhibition and excitation in a nu-
clei of the auditory nervous system. We know that
the nervous system depends on a correct balance
between inhibition and excitation. The result of
such changes may be that self-sustained nerve ac-
tivity is generated that is interpreted by the cerebral
cortex as being the same as a normal sound, result-
Tinnitus Today/September 1993 9
Tinnitus: How is it Generated?
ing in a person "hearing" a sound, despite the fact
that no sound has reached the ear-- thus the person
will have tinnitus.
That hypersensitivity to sound often accom-
panying severe tinnitus supports the hypothesis that
the balance between inhibition and excitation may
be different in tinnitus patients. But why do such
patients often report that sounds are painful? We
have no answer for this, but it may involve a lack
of a certain kind of inhibition that shuts off the
activity of certain nerve cells a brief moment after
they are activated. This would result in the cerebral
cortex receiving a long burst of nerve activity,
whereas it normally only receives short bursts of
neural activity.
There are indications that tinnitus may be
generated in a way similar to certain forms of
chronic pain. Since only very few people seem to
acquire this severe form of tinnitus we believe that
a predisposition in the nervous system is also nec-
essary for such tinnitus to develop.
We presently have support from the American
Tinnitus Association to do research to try to find a
drug that can alleviate this type of severe tinnitus.
We must find out how inhibition in the nervous
system that we believe to be involved in such
tinnitus can be strengthened. Presently we are ex-
perimenting with two different drugs: Baclofen,
which is commonly used to alleviate spasticity, and
Klonapin, a "cousin" to Valium.
It may seem strange, but it has emerged during
the past few years that some patients with the severe
form of tinnitus I have described above, can in fact
be cured by an operation (microvascular decom-
pression). This is despite the fact that the cause of
this form of tinnitus is presumably more complex
than other forms of tinnitus for which we have been
unable to find a permanent cure. We have thus
shown in some of our own research that some forms
of this severe form of tinnitus can be cured by
moving a blood vessel off the auditory nerve at the
location where it enters the brain. Probably only
patients with tinnitus on one side can benefit from
such microvascular decompression operations, the
cure rate of which has so far been only about 40%.
However, those patients who have been cured have
10 Tinnitus Today/September 1993
been able to return to a normal life and now enjoy
undistorted sounds.
This operation was developed by Peter Jan-
netta, M.D., Professor and Chairman, Department
of Neurological Surgery), and it was originally
used to treat face pain and face spasm, which are
caused by a blood vessel that is compressing the
respective cranial nerve where it enters the brain.
The operation is now in use worldwide for treating
diseases such as spasm in one side of the face, face
pain, and, more recently, severe dizziness that is
caused by a blood vessel irritating the balance
nerve. For these disorders the cure rate is 80 to 85%.
Because the hearing nerve is more fragile than other
cranial nerves that are often affected by vascular
compression from a blood vessel, the operation is
more demanding and presently only performed by
very few surgeons. A special diagnostic work-up is
used to select those patients whose tinnitus is
caused by vascular compression of the hearing
nerve rather than those whose tinnitus has other
causes. This work-up has been developed by Mar-
gareta B. M1ler, M.D., Dr. Med. Sci. (Associate
Professor of Neurological Surgery and Otolaryn-
gology, University of Pittsburgh, School of Medicine).
We are convinced that basic research and
further experience gained from microvascular de-
compression operations to relieve tinnitus together
with basic research regarding the underlying causes
of this form of tinnitus will improve the possibility
to cure this very disturbing form of tinnitus.
ATA SLOGAN CONTEST
As part of our continuing effort to increase
public awareness about tinnitus, we are sponsor-
ing a bumper sticker slogan contest. We suggest
the slogan be five words maximum, but we'll
consider more if it's really catchy.
There is no limit to the number of ideas you
can submit.
One of our new AT AT -Shirts, and a bumper
sticker, will be given to the person whose slogan
is selected!
PLEASE SUBMIT YOUR ENTRIES
TO ATA BY OCTOBER 15, 1993.
Book Review
Leslie Sheppard. Tinnitus: When Silence is a
Stranger. Lower Gresham, England: Norfolk Tin-
nitus Society, 1993.( See back page for order info.)
Reviewed by Trudy Drucker
Leslie Sheppard previously collaborated with
Audrey Hawkridge on a book about their personal
experiences with tinnitus, called Learning to Live
With It. Now Sheppard has found a collaborator
and editor in his son, who is a physician and pre-
sumably checked and supplied the medical infor-
mation. The result is a more objective work
containing quite a bit of useful information about
tinnitus.
The book opens with an interesting summary
of tinnitus "treatments" during previous ages.
These, of course, ranged from the merely useless
to the truly bizarre. I hope our present efforts to
manage this nasty affliction won't seem so silly a
few centuries from now.
The subject of alternative medicine (here
called complementary medicine) is a touchy one,
and Sheppard is to be commended for his sensible,
fair, and inclusive account. It is always possible to
find someone who thinks tinnitus can be cured with
a "healing" stone, just as it's possible to find a
practitioner whose stonewalled mindset admits of
no possibility that has not been subject to the most
rigorous traditional studies.
A short chapter on maskers summarizes the
current experience with these devices. They are not
as widely helpful as was once hoped, but enough
patients have benefitted so that a trial in appropriate
cases is warranted. Electrical stimulation was an-
other promising treatment possibility that did not
fulfill original expectations.
Numerous psychologically based therapies
are available. These are at least noninvasive, and
certainly learning methods of relaxation and stress
management is potentially useful. Cognitive ther-
apy, yoga, hypnotherapy, homeopathy, biofeed-
back, and acupuncture have all been tried by people
with tinnitus, and occasionally there is anecdotal
evidence of success. Sleep is a problem for tinnitus
patients, and relaxation techniques are safer and
might be more effective than drugs.
Sheppard presents information about the
physical conditions that might cause or be associ-
ated with tinnitus, such as otosclerosis, Meniere's
Disease, ear wax, and various other and much rarer
conditions, such as acoustic neuroma.
There is a catch-aU chapter about aspects of
tinnitus that don't fit into the other chapters. Now
and then the author becomes a bit discursive and
wanders from his subject, but usually the organiza-
tion is good. A full chapter is devoted to self-help
groups; the author has been associated with one for
many years and is enthusiastic about these activi-
ties.
Epidemiological studies in England and in the
United States reveal some tantalizing inconsisten-
cies. Why, for example, is tinnitus more common
in men in England but in women in the United
States?
Attempts to measure the degree of loudness of
tinnitus have not been particularly successful. Tin-
nitus is much too subjective a phenomenon to yield
easily to quantitative description.
Until hearing loss and tinnitus forced him to
abandon the profession, Sheppard was a musicolo-
gist. He discusses both the positive and negative
effects of music. Even before the age of rock, ear
problems seem to have been a particular bane of
musicians.
The book ends on a note of mystery. A good
number of people in England are experiencing a
sound, described as a low-frequency hum, that is
perceived by the hearer to be external although
experts insist it is a form of tinnitus.
In a book whose author has aimed to be com-
prehensive, one misses a bibliography and an in-
dex. Studies are described without documentation.
Perhaps a second edition will repair these defects,
which are not serious.
H

.ypnosis as an I 0
Janet M. Kaye, Ph.D., Frank Marlowe, M.D.,
Steve Berman, Ph.D., Dilip Ramchandani, M.D.,
Barbara Schindler, M.D., and Grace Loscalzo,
B.S., Medical College of Pennsylvania, 3300
Henry Avenue, Philadelphia, PA 19129.
Ed. Note: What follows is an edited, abbrevi-
ated version of the described study. The authors
may be contacted at the above address for full study
reprints or further information.
INTRODUCTION: Hypnosis has been re-
ported as being valuable in alleviating symptoms
such as pain and nausea and vomiting and allowing
patients to function better with chronic conditions.
Hypnotherapy has been used successfully in
patients with tinnitus by one of the present investi-
gators as well as by others. However, these have all
been case reports with no objective measurements
obtained. In the only large series, Brattberg studied
32 patients, but no controls were used and patients
were not evaluated with standard instruments.
There is general agreement that a complex
interaction exists between stress and the exacerba-
tion of tinnitus. Studies have been tried to relieve
stress using progressive relaxation and biofeedback
relaxation training. Although positive results have
been obtained in some studies, long-term effects of
treatment have seldom been demonstrated.
It IS difficult to evaluate past studies due to
methodological flaws such as sampling bias and the
lack of structured psychiatric interviews.
The present study, using three well-known
standardized psychological tests, evaluated hypno-
sis versus stress management as a therapeutic mo-
dality in the treatment of tinnitus.
Participants were recruited from the local tin-
nitus association and from patients seen through the
Otolaryngology department ofthe Medical College
of Pennsylvania. Criteria for inclusion in the study
were the presence of subjective tinnitus, absence of
acute psychopathology and expressed willingness
to follow the study protocol. Psychiatric exclusion
was made on the advice of a psychiatrist who saw
all subjects as part of the initial assessment phase.
Sixteen subjects completed the initial evaluation
and 14 were enrolled in the study.
U Tinnitus Today/September 1993
JODI US t a 1en s
Characteristics of subject population
(N=14)
Male(9) Female (5)
Age Range 42-80 Mean age - 60 yrs.
yrs.
White (11) Black (3)
Married (8) Non-married(6)
Religion "none" or A religion
no (5) indicated ( 1 0)
Years of education- Mean years of
8-20 yrs. education - 15 yrs.
Employed full Retired (4)
or part time ( 1 0)
Tinnitus onset 1-2 yrs.(3)
Tinnitus onset 2-3 yrs. (3)
Tinnitus onset 3-5 yrs. (2)
Tinnitus longer than 10 yrs. (6)
Sleep problems - Sleep problems -
yes (8) no (6)
INITIAL ASSESSMENT: otologic:
audiometric: pure tone audiogram, speech
audiometry, tympanometry, tinnitus matching, tin-
nitus loudness, tinnitus residual inhibition, tinnitus
masking, tinnitus severity. psychologic: Diagnostic
Interview Schedule, Beck Depression Inventory,
SCL-90-R, Sleep index.
Treatment protocol: group 1
Hypnosis followed by stress management
Treatment protocol: group 2
Stress management followed by hypnosis
Re-assessments: Beck Depression Inventory,
SCL-90-R, audiometric; following initial treatment
& after first 4-wk washout period, then following
second treatment & after second 4-wk washout
period
Hypnosis as an Aid to Tinnitus Patients
RESULTS: None of the subjects had any
significant changes in pure tone audiogram, speech
discrimination, or tympanogram type throughout
the study. Statistical significance was achieved be-
tween pre-test and follow-up in the declining scores
under hypnosis on the Beck Depression Inventory
(p=.O 17); and on declining scores under stress
management on the GSI (distress)(p = .046), PST
(num.of symptoms) (p = .012), and ANX (anxiety)
(p = .03).
There were no differences between hypnosis
and stress management in the amount of change
from pre to post treatment or from pretreatment to
follow-up. Sleep interference scores declined un-
der both treatments; hypnosis (p = .00 l) and stress
management (p = .012).
DISCUSSION:The subjects in this study are
unlikely to be representative of the general popula-
tion. It was observed, however, that improvement
was made on 5 separate scales, 2 of these were
global indicators of distress, but the other 3 ad-
dressed more specific symptomology. Both treat-
ment modalities alleviated sleep disturbances;
hypnosis lessened depression; and anxiety levels
were reduced by stress management.
The small number of significant results pro-
vide only tentative evidence for a treatment effect,
and because of the small sample size, interpreta-
tions must be made cautiously. The study results,
however, suggest two hypotheses: 1) there is true
benefit to both treatments, or 2) patients in both
groups improve due to nonspecific treatment fac-
tors.
Overall, the data reinforce the use of behav-
ioral techniques in treating the symptomology as-
sociated with tinnitus and further suggest that
different techniques may be more appropriate for
specific symptoms.
THE HUMAN RACE
AMERICAN
TINNITUS
ASSOCIATION
SPONSORED BY
(@Starkey
A team of walkers and runners representing the American Tinnitus Association participated in the Human Race,
a community fund raiser for non-profit organizations, in Portland, Oregon on August 1st. Congratulations to Ted Reich
who finished first in the Men's Division walking group. Very special thanks to Margaret Johnson who raised $250 for
ATA, the most of any ATA participant. Thanks also to Starkey Northwest for providing the team banner which was
proudly displayed by the team all along the walk route. We hope all of our friends and supporters in the Pacific
Northwest will join us next year for this fun event.
Tinnitus Today/September 1993 13
I Am Only One ...
by Barbara Tabachnick, Client
Services Coordinator
Several months ago, an
AT A support group coordinator
suggested that the schools across
the country would probably be
fertile ground for Tinnitus Pre-
vention information. I recog-
nized it for the great idea that it
was. But before suggesting it to
all of our other support groups, I
thought I'd try it here in Oregon first to see how it
worked.
I decided to start with my daughter's elemen-
tary school, suspecting that being a concerned par-
ent and a familiar face would carry a lot of weight.
As I collected lesson plans, posters, ear plugs, and
videos for AT A's emerging Hearing Conservation
and Tinnitus Prevention Program, I began to see
that visiting one school at a time would take a very
long time. Instead I called the school district's head
of health curriculum, explained the correlation be-
tween loud noises and tinnitus onset and the alarm-
ing degree of measurable hearing loss in teenagers
today, and got myself on the agenda for a district-
wide elementary school health teachers meeting.
Twenty-eight schools would hear about tinnitus at
once! From me!
Worry set in as I drove to the meeting. I am
only one person ... What can I accomplish alone? I
don't have tinnitus; will they listen to me? I began
to wonder if I could enlightenment my "students"
-- these teachers.
As I unpacked, set up the materials, and
watched the teachers file into the meeting hall, I
realized then that life is just one big classroom;
sometimes I teach and sometimes I learn and some-
times I don't pay attention but the lessons are going
on around me nevertheless. I also realized that even
though I have no obligation to educate others or to
be an "A" student in life's classroom, I cannot
discount the contribution I alone can make when I
really want to.
Everyone who has tinnitus has the capacity to
be an ambassador, an emissary, a support person,
14 Tinnitus Today/September 1993
an educator. As you tell your friends, family mem-
bers, neighbors, and co-workers about tinnitus --
your tinnitus -- you will inevitably teach about this
ailment, in words and in actions. You will also
reach people who need to hear about tinnitus (some
people with tinnitus have never heard the word),
about treatments available, about support groups,
and about the American Tinnitus Association. You
could become a one-person AT A support group.
To those of you who have the strength and
desire to make one phone call, write one letter, or
speak to one group, I offer these suggestions:
Write to your U.S. Senator or Representative
to elicit their support for tinnitus research funding.
They are your public servants and have much to
learn about the prevalence of tinnitus. Send us a
copy of the letter.
Call a local radio or TV station to see if they
will run one of our 30 second Tony Randall or
Crazy 8's Public Service Announcements. If they
say yes, we will send the PSA's directly to the
studio free of charge. (The radio PSA' s are on a reel
and are all one size; the videos are 3/4" in a cassette
and 1" on a reel.) Write and tell us the size needed
and the studio address.
Represent ATA at 2-4 meetings a year if you
live in or near the following cities:
Columbus OH ,Tampa FL , Birmingham
AL, Meriden CT, Atlanta GA, Columbia MO, Al-
buquerque NM, New York NY, J;.,exington SC,
Nashville TN, San Antonio TX, Richmond VA.
We receive funding from the Combined Fed-
eral Campaign (CFC), the federal employees'
equivalent of the United Way, when we have a
representative attend CFC meetings in these cities.
These meetings last usually no more than 2 hours
each. (Sometimes, lunch is included.) You need
only be a "presence" and will not be asked to speak
or report, just attend. This expresses to the CFC that
we do serve people in your state who have tinnitus.
When the meeting is over, a check will probably be
given to you to forward to us. It will represent
AT A's portion of your state's CFC donations.
Many towns have a local health fair. Send us
the date, place, and contact person's name. Or we
I Am Only One ...
can send our brochures to you to deliver in person.
You probably would not need to stay at a booth but
if you wanted to, we could supply you with appro-
priate materials.
Call a local school, perhaps one attended by
your child or grandchild. Tell them you have a
video (for grades 3-6), teacher lesson plans, ear
diagrams, a poster, and other tinnitus and hearing
conservation materials available free for the teach-
ers. (We can supply ear plugs to the schools at 15
cents a pair.) You might be invited to speak to a
class or an assembly. Feel free to accept. I can send
you an outline of what to say. Or call your local city
government office. Many cities have "Noise Abate-
ment" officers who like speak to elementary school
children about hearing protection.
Write and tell us about any medical profes-
sional who you would recommend to someone with
tinnitus. We are always looking for doctors, audi-
ologists, etc. who are empathetic and knowledge-
able about tinnitus for inclusion in our Medical
Referral Network.
I've learned that when a job at hand seems
overwhelming, it probably is. It's then that I remind
myself that although I am only one, I am one. A
very powerful one. It really doesn't matter whether
you and I work collectively or as individuals;
whether we facilitate a support group or make one
phone call. If we do anything at all to reach people
in our communities who need our support, we
cannot help but make a difference.
The Nation-wide Pen Pal Network has had
a few changes. First of all, it's growing. Lor-
raine' s nation-wide pen pal mailing list has
grown from five names to over two hundred
names. Secondly, because the volume has in-
creased so dramatically, Lorraine's costs to
make the network work and produce the news-
letter have also increased. The cost to join her
network is now $5 with no SASE required.
The third change is that Lorraine has gotten
married. (Congratulations!)
If you are interested in joining the Nation-
wide Pen Pal Network, send $5 to:
Lorraine Cherkas
P.O. Box 47172
St. Petersburg, FL 33743-7172
Support Groups -- Filling in the Gaps
Since the last issue of Tinnitus Today, we have had many requests for our new Self-Help Group
packet. We appreciate your willingness to set the wheels in motion to begin tinnitus support groups.
So far, because of these inquiries, three new groups,
one telephone contact person, and one mail-only con-
tact person have been added to the ranks.
Welcome to our new Group Coordinators:
Guy Avenell, Omaha, NE 402/292-3203
Jim Morris, Powder Sprgs, GA 404/943-3648
Teresia Guinn, Humboldt, TN 901/787-7019
Welcome to our new telephone contact:
Arlene Jewell, Pensacola, FL 904/453-1041
Welcome to our new mail-only contact:
Gladys Jackson, Rural Rt 2 Box I 05
Franklin Park, IL 62638
If you live in Arkansas, Alaska, Delaware, New Hampshire, Mississippi, North Carolina, North
Dakota, South Dakota, Utah, Wisconsin, or Wyoming, WE REALLY NEED YOU. There are no ac-
tive self-help groups or telephone contacts anywhere in these states. Write to me for our new Self-
Help Group packet. Let us help you start a group as we cover the country with tinnitus support!
Tinnitus Today/September 1993 15
. ..:! . . .............. ...
. : ; . : IT WASN'T
' EPILEPSY

But was it tinnitus?:
Or Meniere's?:
' . .
. Vmcent van Gogh.. .
A definitive study from
a definitive magazine.

hearing health
pobox 2663
corpus christi, tx




.
78403


: 0 VAN GOGH ISSUE + TWO FUTURE ISSUES $2 :
0 JUST THE TWO FUTURE ISSUES ... $1
I
(PIHe allow uP to 8 weeka lor delivery.) ..1

ATA Telephone System
For those of you who have need to contact
AT A by telephone, the following explanation of
our infonnation system may be helpful.
When you dial any of ATA's numbers, you
will first hear our greeting which is followed by the
main menu of program selections. You may :
w Touch 1 to receive information about ATA and
our services
w Touch 10 to speak with the receptionist (or sim-
ply hold on until you are automatically con-
nected with her.)
w Touch the specific 2-digit code of the person you
are trying to reach.
For example, Touch 18 to talk to Brent Mower,
Director of Development; Touch 16 for Self-
Help Group help; and Touch l2for Bibliog-
raphy orders.
16 Tinnitus Today/September 1993
"COPING WITH TINNITUS"'
e STRESS I\1AMGEMENT &' rtu::ATMENT
e TINNITUS MANAGEMENT IS OFTEN
COMI'UCATF:D BY ANXIETY /\NO STRF:SS
e NOW A LINIQUE CASSETI'E FROGRAM IS
DESIGNED TO PROVIDE ()/\IU'
REINFORCEMENT AND SUFtORT FROM TilE
STRESS Ot' TINNITUS WITIIOUT COMftt:X
INSTRLIMf:N'IiUION &' VAI.UAIU.E Ol' nCE TIME
The program consists of one cassette tape of Metronome Conditioned
Relaxation and two additional tapes of unique masking sounds which
have demonstrated substantial benefit whenever the patient feels the
need of additional relief. These recordings
can be used to induce sleeping or as a
soothing backdrop for activity and can be
played on a portable cassette player.

;J'B) ALL OfiDUS MUST Be ACCOMPAMIW BY
01r.a\ VIM. HAS'T'eRCARD. OR IMSTrTU1101W. P.O.
6796 MARKET ST., UPnR DARBY. PA 19082
Phone (216) 3520600
SPECIAL PILLOW CAN
RELIEVE EAR NOISES
AND AID SLEEP
Your sleeping habit may be robbing you of a
proper night's sleep. The Ear Relaxer can change your
life. Austin Skaggs. the inventor of the Ear Relaxer
Pillow, reports that it has helped him and many other
people who have tried it. It is comfortable for those who
wear their hearing aids or maskers to bed. Testimonials
are available on request from Mr. Skaggs.
To order, send $17.95 (postpaid) , ide U.S. send
$20.95 (U.S. funds), for postage paid shipment
to:
EAR RELAXER
PO BOX SX>
VICIDR WV 25938
Replacement pillow slips are available
for $5.00
Media Watch
by Cliff Collins, Oregon freelance writer. Please
send clips, noting source and date, to Media
Watch, PO Box 5, Portland, OR 97207.
Since last issue's column, which opened with
a brief account of Gordon Hempton, the nature-
sound recorder who was searching the country for
the "last quiet places," two related pieces came to
our attention. One was a lengthy profile, a cover
story of Hempton, in Pacific, the Sunday magazine
of The Seattle Times (June 20).
Also, Backpacker magazine (Aug.) ran an ar-
ticle listing many of the quietest places remaining.
Many were national parks in the western United
States. Average daytime decibel ratings were be-
tween 20 and 30 dB-- imagine that, urban dwellers!
The story says the National Park Service is placing
"new emphasis ... on minimizing human-originated
sounds in the backcountry." "We want to preserve
the quiet, just as we preserve other natural re-
sources," says a Park Service staffer. Hallelujah!
The author quotes Thomas Carlyle: "Silence
is the element in which all great things are fash-
ioned."
Skewed priorities: Pete Townshend, the ear-
damaged British guitarist, justifiably has been
praised for going public with his hearing loss,
tinnitus and recruitment a few years back-- all, he
says, a result of years of earsplitting decibels. Now
Townshend is set to debut his new musical in
London this November, and a news-wire short
says, "Theatergoers have been warned that it will
a high-volume show ... Townshend is supplying
hts own sound system to the Young Vic theater."
This irony might be laughable if it weren't so
troubling.
Could someone explain to me why the media
fall all over themselves warning children and par-
ents about the dangers associated with fireworks-
without ever mentioning danger to the ears?
Oregonian (July 1) ran half a page of
arttcles outlining various risks of fireworks, with-
out once mentioning the noise. Yet ear specialists
tell us they see many instances each year of people
permanently damaging their ears from the sounds
of firecrackers and related objects. It's a common
cause of tinnitus.
Given that polJs often indicate that the public
would label deafness the sensory defect they would
least like to acquire, it defies logic why, with fire-
works, yard machines, leaf blowers, etc., people
sometimes may wear eye but (usually) not ear
protection. Go figure.
News roundup: Oodles of readers inquired
about the National Enquirer article (June 29) "New
drug treatment can relieve ringing in the ears." (Not
that a lot of ATA members regularly read the
tabloid; most said, "An acquaintance of mine sent
me this article," or "I saw this article on a bus seat."
Ha, ha -- right.) Anyway, the ATA has copies of
the study "Treatment of Depressed Tinnitus Pa-
tients with Nortriptyline," available through its bib-
liography service for $1.00. (The AT A is directing
questions about nortriptyline to Dr. Mark Sullivan,
Department of Psychiatry RP-1 0, University of
Washington Medical Center, Seattle, WA 98195;
(206) 543-3555, ext.l5.) The study, aided in part
by the AT A, found encouraging results when a
population of depressed patients with severe tinni-
tus was treated with the drug.
Another attention-grabber was an Associated
Press report citing a study on restoration of cells of
the inner ear, this time with a derivative of vitamin
A, in lab rats. Dr. Thomas Van De Water of Albert
Einstein College of Medicine in New York says he
is hopeful the research eventually can be applied to
human hearing loss. However, Van De Water pre-
dicted clinical trials on humans are 10 years away,
and he cautioned people not to experiment with
vitamin A supplements, which can be toxic in high
dosages.
Tinnitus continues to be a topic in medical
advice columns, from the good ("The Medical Ad-
viser," produced by the Palo Alto Medical Founda-
tion) to the uninformed (Dr. Peter Gott, who stilJ
doesn't get it. He writes of tinnitus: "Patients sim-
ply have to put up with this harmless annoyance").
Tinnitus Today/September 1993 17
Questions & Answers
by JackA. Vernon, Ph.D., Director, Oregon Hear-
ing Research Center,Portland, OR, 97201-2997.
NORTRIPTYLINE FOR TINNITUS
Since so many of you have written or called
about the article by Richard Baker on Nortriptyline
which recently appeared in the Enquirer, I thought
I w o u l ~ make a few comments about that report.
First of all, With Your Physician's Consent
And Guidance, I see no reason why you should not
give it a try if you wish. But, if you do try it, please
inform me of the results.
The Enquirer is in the business of attracting
your attention and so they tend to dramatize their
reports. It is, I hasten to add, not exactly an out-
standing medical journal. The article quotes Dr.
Wayne Katon, a professor of psychiatry at the
University of Washington in Seattle. The creden-
tials sound good. The following quotation may be
taken out of context but consider it: "Approxi-
mately 80 percent of the patients said they felt
better, and the majority reported relief of their ear
ringing as well." That term "felt better" bothers me.
Is it that when one feels better less attention is given
to things like tinnitus? Of those who reported relief,
was that a majority of the 80% or of all patients so
treated? These patients, 46 of them, ... were suffer-
ing from severe chronic ear ringing and depression.
That kind of report does not indicate the details of
how their study was conducted. To my way of
thinking, we need the results of properly controlled
studies (double-blind, placebo controlled) in order
to have confidence in our recommendation for
tinnitus therapy or in our evaluation of reports.
Now, gentle reader, don't misunderstand, I pay
attention to reports provided by patients, and often
those reports lead us to perform the proper study.
That is exactly what happened in the case of Xanax.
The rationale offered by the investigators of
Nortriptyline was that tinnitus is often accompa-
nied by depression and thus, they reasoned, to
relieve the depression would also relieve the tinni-
tus. To me, that has the cart before the horse. It is
certainly true that tinnitus can cause one to be
depressed but the way to correct that depression,
18 Tinnitus Today/September 1993
(the depression accompanying tinnitus) is to relieve
the tinnitus.
When we look up Nortriptyline in the Physi-
can's Desk Reference (PDR) of 1993, we find that
Nortriptyline is a tricyclic anti-depressant which
Jists tinnitus as one of its side effects. We have
certainly seen tinnitus patients whose tinnitus has
been increased by Nortriptyline when it was unwit-
tingly prescribed for depression. That exacerba-
tion, however, was temporary. Thus, it is for that
reason that I say it probably will not hurt to try it--
but only with your physician's consent. Also, per-
mit me to remind you that we have recommended
the use of Xanax (Alprazolam) for tinnitus despite
the fact that PDR lists tinnitus as a side effect of
Xanax. However, our recommendation is based
upon the results of a properly controlled study.
I need to repeat one thing which I hope is clear.
I do not ever blame any tinnitus patient for asking
about medications or procedures which they have
heard might bring relief for tinnitus. Moreover, I
appreciate the opportunity to discuss these matters
with you. Remember, I always say that we only
learn from you the patients.
Now, some specific questions from readers.
Q. Recently Mr. C. from Florida asked for our
comments indicating that he gets relief from his
tinnitus by taking Niacin.
A . In the past, Niacin was the drug of choice for
tinnitus but was discontinued due to absence of
positive responses. Mr. C. reports a dramatic reduc-
tion in his tinnitus upon first taking Niacin. When
he stops taking Niacin, the tinnitus returns. When
he starts taking Niacin again, the tinnitus goes
away. And, as he says, "All of this is too consistent
to be merely a psychological reaction." The ques-
tion I have for you readers is this: How many of
you have tried Niacin and with what result?
To Mr. C. I say continue using what works for
you and thank you for sharing your good fortune
with us.
Q. Mr. L. in Nevada relates a very interesting
experience. He has had tinnitus for 5 years which
Questions & Answers
started with a head cold and an airplane flight.
Recently, he had another cold and drove over some
mountains where his ears would not "pop", hearing
was reduced and his tinnitus completely disap-
peared! Sometime later upon returning to reduced
altitude his ears did pop, the hearing returned to
normal and the tinnitus returned. Mr. L. then asks
the interesting question, "What happened?"
A Mr. L. I don't know what happened, but I will,
nevertheless, make some guesses. First, however,
if I were you, I would repeat that trip to see if the
tinnitus can be reduced even if you have to tolerate
some lessened hearing ability. Maybe it would be
best to repeat the trip over the mountains when you
d ~ not have a cold. If my guesses are correct, you
w1ll reduce the tinnitus but not the hearing.
I think it was the pressure change that caused
the tinnitus to disappear. We have seen a host of
patients whose tinnitus is altered by atmospheric
pressure changes. In our Tinnitus Clinic, we delib-
erately decreased the standing pressure in the ex-
ternal ear canal of 639 patients with severe tinnitus.
For 511 patients (80% ), the altered pressure had no
effect upon the tinnitus; for 19 patients (3% ), the
altered pressure caused the tinnitus to increase in
loudness; and for 108 patients ( 17% ), the altered
pressure caused a reduction in the loudness of the
tinnitus. In no case did the tinnitus completely go
away but you, Mr. L., may be one rare patient
whose tinnitus is completely reduced by reduction
of pressure in the ear canal. Another puzzle about
your experience is the fact that when hearing is
reduced, as it was for you due to the difference in
t?e r e s s u r e in your ear canal and your middle ear,
tmmtus usually increases in loudness but yours did
the reverse. Well, as I said, Ire-
ally cannot offer a reasonable ex-
planation for your experience but
I sure would repeat it.
() Mr. L. in California writes,
-'Jtrst one more word on
GINKGO. Just one dose of this
widely touted Chinese herb, in its
liquid form, was the cause of my
tinnitus."
A. I have heard from patients whose tinnitus was
exacerbated by Ginkgo but this is the first account,
to my knowledge, where Ginkgo caused tinnitus.
If there are others of you who have had the
same experience, may I hear from you telling me
the details?
Q. Mr. D. from California asks if work is being
done on RESIDUAL INHIBITION as a possible
way to relieve tinnitus or to permanently reduce it.
A. Let me remind our readers that residual (RI)
is that period after masking when the tinnitus is
either temporarily gone or reduced. The answer is
that a great deal of work is ongoing on this topic.
However, I hasten to add, I do not understand at all
what is happening to produce residual inhibition.
In as much as the effect is produced by introduction
of a masking sound to the ears, we have explored
a variety of masking sounds. I reported some of our
results at the Fourth International Tinnitus Seminar
which met in Bordeaux in 1991 but, if I may, I'd
like to briefly repeat some of those findings here.
We investigated five different masking arrange-
ments where each condition was presented at the
minimum masking level plus 10 dB for 60 seconds.
The resulting residual inhibition was measured as
the duration of the suppressed effect. Masking with
a tone which was 1/2 octave below the frequency
(pitch) of the tinnitus yielded 56 seconds of RI;
masking with a tone which duplicated the tinnitus
gave 58 seconds of RI; masking with 1/2 an octave
above the tinnitus produced 71 seconds of RI;
masking with a narrow band of noise centered at
the tinnitus frequency yielded 44 seconds of RI;
and masking with two tones placed closely on
either side of the tinnitus gave 74 seconds of RI.
Although these data are preliminary, having been
collected on only 13 patients, they nevertheless,
point out some areas of investigation which may be
promising. Work in this fascinating and challeng-
ing area continues, and when we come to know
more about the mechanisms which underlie tinni-
tus, we may be better able to arrange for extended
residual inhibition. I firmly believe it will, in the
future, come to offer extended relief of tinnitus.
Tinnitus Today/September 1993 19
by Leslie Sheppard, Chair-
manNorfolk Tinnitus Society,
Wingfield, Lower Gresham,
Norfolk NRJJ 8RE England
A Mysterious low fre-
quency humming noise has
been severely disturbing the
lives of thousands of people in
Britain for the last decade. The
number is now becoming
alarmingly high. The latest es-
timate puts the number of peo-
ple affected at I 00,000.
Quite a few had consulted
E.N.T. Specialists and had been
assured they did not have tinni-
tus and that their hearing was
normal.
This is precisely the same
phenomenon that appears to
have recently hit the headlines
in New Mexico and has be-
come known there as the "Taos
Hum."
Leslie Sheppard
Dr. Geoffrey Leventhall,
head of the Acoustic Section of
Chelsea College University in
London has been investigating
various isolated cases of "The
Hum." He says "We have never
before known the scale and ex-
tent of the phenomenon" and
goes on to point out that this
mysterious hum affects people
throughout the country. It does
not matter whether they are
young or old, live in city cen-
ters, on the coast, or in the
depths of the country. He states
"These people are certainly Victims of "The Hum" in
Britain have formed their own
association, "The Low Frequency Noise Sufferers'
Association," and appear to have a large member-
ship covering all parts of the country. They keep in
contact by means of their own newsletters, and
many of them have small private circles in which
they phone one another regularly exchanging com-
parisons.
I first became involved in 1986 when a televi-
sion program drew attention to numerous com-
plaints of a low humming noise that was disturbing
many people. This was particularly centered
around the small village ofWorlingham in Suffolk.
I visited Worlingham at the time, and inter-
viewed several dozen people involved in the com-
plaints. They were all sensible, articulate people as
they described their experiences and reactions.
They were certainly not weird.
Possibly by reason of my close association
with tinnitus at the time I wondered if some of them
were suffering from a low frequency type of this
symptom, yet there were a number whose experi-
ences and descriptions left me with serious doubts
even about this, and ever since I have kept a very
open mind on the matter.
20 Tinnitus Today/September 1993
hearing something. "The Hum"
exists alright. We know its there but we don't know
where its coming from."
Unfortunately, appeals for he! p in locating the
reasons for "The Hum" to various Government
departments merely draw the reply that if the noise
is not considered a nuisance under the control of
the Pollution Act there is nothing that can be done.
Numerous theories have been put forward as
to the cause. The most popular theory is that under-
ground gas pipes are to blame. The large turbines
employed to pump the gas over wide areas through
large pipes at very high pressure are thought to
cause these pipes to vibrate rather like those of a
large church organ. This theory has been investi-
gated repeatedly by experts, but there is no evi-
dence whatever that the gas pipe-lines are a source
of low frequency noise.
Other theories put forward revolve around
such as electric pylons, water mains, factories, and
electromagnetic fields around radio and T.V. trans-
mitters. Electro-magnetic expert Roger Coghill is
of the opinion that the energy from radar causes the
tiny hair cells of the cochlea to vibrate which the
brain then interprets as sound.
Victims of "The Hum"
A strange feature of "The Hum" is that this
phenomenon can so often suddenly strike without
any former build-up or warning, and it appears that
once so sensitized, a person becomes attuned to it.
It is a well known fact that sensitivity to
different frequencies varies from person to person,
and that this variation is particularly wide at the
lowest frequencies. It is not uncommon that a noise
audible to one person can be quite inaudible to
another.
Due to the physical properties of low fre-
quency sound it is possible for the sound waves to
travel over long distances (often underground) be-
ing quite inaudible until they are picked up by a
structure such as a room or building, which then
amplifies it.
On the other hand however, the medical pro-
fession is stating that the vast majority of those who
think they are suffering from "The Hum" (which
they describe as low frequency hearing sensitivity)
actually have low frequency tinnitus, and state that
the condition can be helped by the use of a wide-
band tinnitus masker set at a low level thus reducing
the sensitivity of the hearing mechanism to external
sounds. This suggested management is in line with
the latest management for hyperacusis.
Unfortunately this opinion on the part of the
medical profession only seems to antagonize the
people concerned who are adamant that the noise
is reaching them externally.
One expert has categorically stated "Every-
body who has tinnitus thinks initially that the sound
is coming from outside their head and some people
can never be persuaded of the truth of the matter,"
but my own experiences with some 600 members
of the Norfolk Tinnitus Society, all with tinnitus
certainly does not support this statement. Quite the
contrary in fact.
One lady working in Shepton Mallett who
suffers very badly from "The Hum" regularly
spends her dinner hour in the limestone caves of
Wookey Hole near her home in which she states
she finds perfect peace. Such reports as this only go
to emphasize that the problem could not be tinnitus.
There have been a number of similar cases re-
ported.
A man who lives in St. Helens, in times of the
worst intensity of "The Hum," kneels upon a settee
with his hands holding pillows to his ears. Sleep is
impossible, yet upstairs his wife will be enjoying a
good night's rest. He says "She told me I was going
mad and that we were not to tell anybody else about
it. During a bad spell I camp out in the town center
and my wife brings me food and a flask of drink.
I've slept a number of times on the park bench
where it is always blissfully free of the noise."
Its a strange feature of "The Hum" that many
sufferers are able to find certain locations where
they are similarly free of it. These can be certain
localities, large stone cathedrals or similar build-
ings, or even the humble garden shed. Such means
of escape are certainly not the province of those of
us with tinnitus, a clear demonstration of the dif-
ference.
The problem appears to be world-wide. In
both my published books about tinnitus I have
included a chapter on it and have received letters
from practically every part of the globe on this
matter.
While noise experts admit to being com-
pletely baffled, thousands of people continue to
suffer from this phenomenon and are being made
ill by untraceable sounds which the other members
of their families cannot hear. Such a situation
merely adds to their misery and feeling of isolation.
Their only hope at the moment is that public
opinion will in time force the issue until sufficient
research discovers the reason, and so releases them
from a life which is little more than a living hell in
many cases.
In early 1992 the British Government donated
the rather paltry sum of 50,000 for research into
"The Hum" but since that time there have been no
reported fmdings. Let us hope that one way or
another something positive will soon emerge to
solve the mystery of "The Hum".
Tinnitus Today/September 1993 21
Tributes, Sponsors, Special Donors
The A TA tribute fund is designated 100% for research. Thank you to all those people listed below for
sharing memorable occasions in this helpful way. Contributions are tax deductible and are promptly ac-
knowledged with an appropriate card. The gift amount is never disclosed.
GIFTS FROM 5-1-93 to 8-1-93
IN MEMORY OF
Sol Altman
Dr. Herbert & Marlene Levin
Leo Bloomgarden
Albert & Mae Feluren
Cecilia Captain
Beatrice & Erwin Frish
Louis Caiman
Anne & Bernard Silverman
Wanda Carpenter
Pamela Burrow
Alfredo Castro
Ana VWade
Eugene Kirsch
Joseph Alam!Trudy Drucker
Melvi n M Macheel
Dorothy M Macheel
Loui Mariani
Alice & John Souroumanis
Kunigunda Meindl
Andrew Meindl
Rose Novick
Dr Herbert A Levin
Rae Scaglione
Jean Baldwin
Arthur B White
Bernard & Rita Fallon
Faye & Jack Gingold
The Poller Family
David & Robin Schlusselberg
Aviva Taubenfeld
Thelma White
Gordon Belt
Marjorie Youngen
J Richard Youngen Jr
IN HONOR OF
John G Alam-Birthday
Joseph Alam!Trudy Drucker
Jo N Alexander
David M Alexander
Mary Blome MD
Trudy Drucker
Ronald Burnham- Recovery
Helene & Mac Herbst
Jack Harary-Father's Day
Michael & Cynthia Harary
Marl ene Levi n-Retirement
Dr Herbert A Levin
Sandy
John & Faye Schlater
SPONSOR MEMBERS
Joseph Alam!Trudy Drucker
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Robert H Boerner
Ronald R Bowden
Ira F Breiter
Charles T Brown
Jean Cinader
F Lawrence Clare MD
Andre J Codispotti MD
Walter Z Davis
Joseph F Delia
Robert Entenmann
Robert S Epstein
David Flatow
Louise F Frank
Dr William S Gartner
Bill & Shirley Gittelsohn
James Gold
Donna & Harold Graham
Josephine K Gump
George C Juilfs
Lawrence E Happ Sr
James lrvina
Fred Jenkins
L Craig Johnstone
Harry & Marion Keiper
Norman Korff
Dr Stuart Krasney
E Joseph Kubat
Lakeshore ENT
Alfred A Levin
Dr Herbert A Levin
Ullian Unka
Gary L Lombardi
Marian B Lovell
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Barjona Meek
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Jerry N Tobias
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Kirby M Watson
Sheldon Weinig
Frank A West
James & Claudia Zinser
HEARING AID DONATIONS
256 pre-owned Hearing Aids
and Maskers have been re-
ceived and processed. Many
were reusable with only minor
refurbishing and have been do-
nated to the Oregon Hearing Re-
search Clinic for patients unable
to afford new aids. Thank you.
We'll be glad to receive morel
RESEARCH FUND
Lucille J Jantz
PROFESSIONAL ASSOCIATES
Bruce Bloom MD
Anne Curtis Galloway MS/CCCA
Barbara Goldstein PHD
Norman Goldstein MD
Robert R Harmon
Patrick D Hastings
Renee Hock Bas BC-HIS
William Lee Parker PHD
Robert E Sandlin PHD
Abe Shulman MD
MATCHING GIFTS
You might be able t o double
or t riple the size of your gift
to the American Tinnitus
Asso ci ation by t aking ad-
vant age of your empl oyer's
Matching Gift Program. Many-
companies have matched con-
tributions to ATA. We urge
you to ask if your employer
will match Y9Ur gift. Or call
AT A for t he names of compa-
nies t hat match contributi ons.
American Tinnitus Association (#0514) is a
participant In the
Combined Federal Campaign .
ThankyouforyourannuaiCFC
pledge to help fight Tinnitus
The 1993-1994 Combined Federal Campaign will soon be underway across the United States and in
many overseas locations. This marks the tenth year that AT A has participated in the CFC along with 64
other agencies who comprise the National Voluntary Health Agencies. Our group, the NVHA, represents
health agencies which support research and provide direct services to those people suffering from various
diseases and conditions. Federal employees have always been generous in their support for health-care and
we hope this year, even with a fragile economy and military base closures, your support will continue.Please
remain involved and pledge on whatever level you can afford. Be part of the healthy solution! Thank you .
22 Tinnitus Today/September 1993
Lalle Sh<pp rd
_.,
Dk Q.MSH!PPA.RD
KA.UII.IOIIr(OlM).JG'OP

THE SELF-HELP
PROGRAM
-
-
John Taddey, D.D.S.
..
-
TllllliTUS
IW H llU lllE I IJI[V!

JIH 11111111

Living with Tinnitus
Dealing with the ringing in your ears
through better understanding and changing
beliefs.
by Richard Hallam
Tinnitus: When Silence is a
Stranger
Useful information about tinnitus causes
related problems and treatment methods:
Includes discussion of alternative medi-
cine, maskers, and psychologically based
treatment techniques.
by Leslie Sheppard
TM.I the Self-Help Program
How to recognize a TMJ problem, relieve
pain and restore health. When to seek pro-
fessional help.
by John Taddey
Tinnitus: What is that Noise in
My Head?
Clear information about causes and treat-
ments, both medical and non-medical. In-
cludes an affecting personal account by the
author, who has battled severe hearing loss
and tinnitus since childhood.
by Joan Saunders
Complete Bibliography; listing over 2,500
titles.
$75.00 non-members/$40.00 member
Specific Subject Search:
$10.00 non-memberl$5.00 member per
subject.
Information about Tinnitus
Provides factual answers to the most cc
mon questions about tinnitus, includ
causes, treatments and effects.
Coping with the Stress
of Tinnitus
Includes coping tips for reducing stres:
list of tinnitus self-control techniques,
information about how to seek help.
Noise: Its Effects on Hearing
and Tinnitus
Explains how noise can cause tinnitus
how to avoid it. Defines permissible lev
of noise exposure.
Hyperacusis
Describes hyperacusis, the problem of
per-sensitivity to sound, and explains h
those who have it are affected. Urges p
tection from noise.
Tinnitus Family Information
Provides supportive and useful infon
tion for families and friends of people'
have tinnitus.
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