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XKFTBD 4& NK.detkr k h tg d \en Mid`k ]innitusFeakr>etkr>y . Gd ges addn en instr>uetkr> hkr> tg d E]E]innitus Pkr>csgkp ekur>sds enm i s e bdbadr> k h tgd E]EBdmiee_ Emviskry Akerm.

Es e bdbadr kh tgd t5dm i le 5 Emviskry Akerm kh tgdE.].E. i t ges addn by mistinlt pfdesurd tk kasdrvd& kvdrtt.l pest hdw yders& tget wgilg ges trenspirdm. Pgifd byv i d 5 ~ bey vdry wdff ad tdbpdrdm ay by ehhdltikn hkr tgksdV ~ g k mirdlt tgd lkursd wgilg tgd E. ]. E. ges pursudm& i tnknd t gd fdss bey rdhfdlt tgd lurrdnt stetus kh tgdtinnitus prk`reb.

]gdrd is nk mkuat in by tgincin` tget tgd E. ]. E.ges addn rdspknsiafd hkr tgd si`nihilent& rdndwdm intdrdstin tf5ksd guben prkafdbs essklietdm witg tinnitus. ]gdsdvdref prdss rdfdesds& lkupfdm witg tgd rdsderlg enmwkrcsgkp eltivitids ay tgd essklietikn& gevd arku`gt tktgd ettdntikn kh beny pdrskns tgd dxistdnld kh & enmprkafdbs rdsuftin` hrkb& tinnitus.]gd `dndref `uimenld kh tgd E.].E. ay Qkadrt Gklcs& Netiknef Lgeirben kh tgd E.].E.& enm tgd bkrdrdldnt lkntriautikns kh Mr. Qkadrt Okgnskn& gevd dngenldm tgd ibpkrtenld kh tgd E.].E. enm gi`gfi`gtdmtgd wkrc rdbeinin` tk ad mknd. 'Ktgdr tgen lrdetin` `dndref puafil ewerdndss kh tgis khtdn mdaifitetin`miskrmdr& tgd E.].E.& tgrku`g tgd sin`ufer dhhkrts kh Kr. Oelc Xdrnkn& mdvdfkpdm tgd hirst wdereafdbescin` mdvild wgilg prkbisdm rdfidh tk beny suhhdrin` hrkb tinnitus.)Pgdn knd rdvidws tgd lgeffen`ds prdsdntdm ay tinnitus enm tgd suasdqudnt trdetbdnt prk`rebs hkr tgismiskrmdr& tgdrd dbdr`d twk mistinlt bkmdfs kh petidnt bene`dbdnt3 tgd bdmilef enm tgd nkn"bdmilef.Ibpfilit witgin tgd bdmilef bkmdf bust ad tgd pkssiaifity kh e lurd. Dqueffy es leptivetin` witgintgis bdmilef bkmdf& is tgd prkaeaifity kh en dhhdltivd trdetbdnt prk reb. Tnhkrtunetdfy& tgd ve`erids khtgis miskrmdr gevd prdvdntdm& kr et fdest ibpdmdm si`nihilentfy& tgd dbdr`dnld kh e lurd. ]gdrd mkds nkteppder& et tgis writin`& tk ad e `dndref lknsdnsus kh tget wgilg bust ad invdsti`etdm tk dhhdlt e lurd.Pgdtgdr knd pursuds tgd invdsti`etivd dhhkrts tgrku`g bdmiletikn kr sur`ilef prkldmurds& tgdrd ges nktydt dvkfvdm e prkldss& wgilg wgdn ellkbpfisgdm& rdsufts in tgd easkfutd dfibinetikn kh kn`kin` tinnitus.]get is tk sey& nk knd prkldmurd `uerentdds easkfutdfy tget tinnitus wiff ad lurdm.Hrkb e trdetbdnt pkint kh vidw& tgd bdmilef bkmdf inlfumds witgin it s lfinilef erbebdnteriub tgdusd kh verikus tgdrepdutil rd`ibdns. Hkr dxebpfd& ent ilknvufsent mru`s gevd addn dbpfkydm yidfmin`fibitdm rdsufts in prkvimin` rdfidh hrkb tinnitus. ]gd usd kh endstgdtil e`dnts& pertiluferfy fimkleind'e bdbadr kh tgd prklein `rkup) ges prkvdn tk ad bkst adndhilief tk skbd wgk gevd sdrvdm es wiffin`suaodlts. Bkrd rdldntfy& kref fimkle ind ges addn usdm& kn e rdsderlg kridntdm aesis& tk mdtdrbind itsdhhdltivdndss in prkvimin` rdfidh hrkb suaodltivd tinnitus. Aikhddmaelc& wgifd nkt ndldsserify rdstriltdmtk bdmile f preltild& ges addn usdm tk bkmihy tgd suaodltivd ewerdndss kh tinnitus kr tgd petidnt'sdbktiknef enm psylgkfk`ilef rdeltikns tk it. Hkr skbd& aikhddmaelc ges prkvdn tk ad dhhdltivd inprkvimin` veryin` md`rdds kh rdfidh. Kavikusfy& tgdsd erd knfy e hdw kh tgd beny prk`rebs kh bdmilefintdrvdntikn tget gevd addn stumidm. \kbd gevd addn suhhilidntfy lkbpdffin` tk werrent lkntinudminvdsti`etikn& wgifd ktgdrs gevd addn eaenmkndm in hevkr kh bkrd prkbisin` prk`rebs.]gd epperdnt adndhit kh tgdsd inquirids& dspdlie ffy tgd bkrd rdldnt knds& is tgd ewerdndss tgettinnitus mkds lknstitutd e si`nihilent prkafdb hkr e `rdet beny inmivimuefs enm tget bdmile f intdrdst inrdskfvin` tget prkafdb is gi`g. Knd wkufm gkpd tget lkntinudm invdsti`etikn wiff yidfm si`nihilentadndhit tk tgd tinnitus petidnt. 'ekntinudm insimd)

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ZKIN] KH XIDP lkntinudmHrkb e nkn"bdmilef bene`dbdnt pkint kh vidw&tgd bein tgrust ges addn tk prkvimd e trdetbdntprk`reb wgilg rdmulds& epprdlieafy& tgd untkwermrdeltikns tk kn`kin` tinnitus. Pgifd tgdrd gevd

a d d ~ e nubadr kh bene`dbdnt bkmdfs prkpksdm&witg skbd lurrdntfy adin` utifizdm& tgd usd khtgd tinnitus bescdr wkufm sddb tk ad lgidhebkn` tgdb.]gd kavikus emvente`ds kh !bescin`! gevdfkn` addn rdlk`nizdm es e bdens ay wgilg tgdtinnitus petidnt lkufm hinm rdfidh hrkb tgdpdrsistdnld kh tgdir gdem nkisds . It is nktunusuef hk r e petidnt tk rdp:rt tget gd kr sgdkhtdn sddcs !nkisy! dnvirknbdnts tk mrkwn kut&es i t wdrd& tgd ewerdndss kh tgd kn`kin` tinnitus. ]gd pribery lkntriautikn kh tgd E.].E.&adyknm tget kh lkntriautin` tk tgd puafilewerdndss kh tgd prkafdb& ges addn tgd mdvdfkpbdnt enm suasdqudnt invdsti`etikn kh bescdrdhhdltivdndss.Eftgku`g& hrkb e lfinilef pkint kh vidw&tgd bescdr ges addn en dhhdltivd mdvild hkr enubadr kh inmivimuefs& tgd hrustretin` enmpdrpfdxin` helt rdbeins tget tgd rdeskns hk rsulldss kr heifurd erd nkt lfderfy unmdrstkkm.Es en dxebpfd& fd t us lknsimdr twk petidnts wgkgevd sibifer gderin` fkssds enm rdpkrt tgdprdsdnld kh tinnitus. Fdt us essubd hurtgdrtget tgd mie`nkstil dvefuetikn su``dsts tinnitus kh sibifer kri`in es wdff es sibiferhrdqudnly enm intdnsity vefuds .In knd instenld& tgd petidnt rdspknmdmpksitivdfy tk tgd bescdr mdvild enm prdhdrrdmtgd prdsdnld kh e nerrkw aenm kh nkisd kvdr tgdkn`kin` tinnitus. Hurtgdr& tgdrd wes si`nihilent rdsimuef ingiaitikn ehtdr e pdrikm khbescdr usd. In tgd ktgdr instenld& tgd petidntrdspknmdm tk tgd bescdr mdvild bkst nd`etivdfy1stetin` tget tgd nerrkw nkisd aenm wes esmislknldrtin` es tgd kn`kin` tinnitus. Emmitikneffy& rdsimuef ingiaitikn lkufm nkt ad bdesurdm&dvdn ehtdr e prkfkn`dm dvefuetikn pdrikm .Pget is ibpkrtent gdrd is tgd unldrteinkutlkbds witg bescdr mdvilds. Pd sibpfy mk nktgevd dnku`g mete& kr wd er d felcin` in suhhilidntmie`nkstil skpgistiletikn et tgis pkint& tkprdmilt prkaeafd kutlkbds kh bescdr mdvild usd .Hurtgdr lkbpfiletin` tgd issud kh dhhdltivdpetidnt bene`dbdnt is tgd kavikus rdlk`nitikn khtgd helt tget wd mkn't tgkrku`gfy unmdrstenm tgdnduref `dndretkrs kh suaodltivd tinnitus . Kndis nkt ldrtein ih tgd prkafdb is witgin tgdinndr der& skbdwgdrd efkn` tgd esldnmin`eumitkry petgwey& kr dvdn ih tgd ewerdndss khtinnitus is rdfetdm ndldsserify tk tgd eumitkrysystdb& dvdn tgku`g tinnitus is pdrldivdm es endvdr prdsdnt enm pdrsistent elkustil sdnsetikn.Es en dxebpfd kh tgd lkbpfdxity enm pdrpfdxity kh tgd prkafdbs essklietdm witg dhhdltivdenm lknslidntikus petidnt bene`dbdnt& lknsimdrtgd petidnts wgk gevd tinnitus in delg der. Inskbd& prdsdntin` witg tgd aifetdref lkbpfeint&e sin`fd bescdr mdvild tk ditgdr der wiff bescdhhdltivdfy tgd kn`kin` tinnitus. Hkr ktgdrswitg e sibifer lkbpfeint& bescin` bust adeppfidm tk delg der tk lkbpfdtdfy !lkvdr! tgdkn`kin` tinnitus. ]k lkbpfiletd bettdrs skbd"wget hurtgdr& tgdrd erd tgksd petidnts gevin`e rin`in` kr !gissin`! tinnitus hkr wgkb ebescdr mdvild wiff nkt besc tgd kn`kin` prkafdb&dvdn tgku`g& hrkb e mie`nkstil pkint kh vidw&tgd tinnitus mihhdrs f i t t fd hrkb tget rdpkrtdmay e petidnt wgk len ad&kr ges addn)& sulldsshuffy bescdm.It is nkt tgd intdnt kh tgis rdpkrt tkinmilt kr mislrdmit tgd usd kh tgd bescdrmdvild . Uuitd tgd lkntrery is tgd lesd& I'bbkst ibprdssdm witg tgd sulldss kh tgd bescdrmdvild hk r tgd beny petidnts wgkb wd gevd sddn.I'b ibprdssdm& dqueffy& witg tgd tdlgnkfk`ilef

emvenld in bescdr mdsi`n wgilg pdrbits tgdpreltilikndr tk bkrd hindfy emoust tgd rdspknsdkh tgd mdvild tk tgd spdlihil nddms kh tgdtinnitus petidnt.]gdrd is e nddm& in tgd slgdbd kh tgin`s&tk peusd kllesikneffy enm fkkc et wgdrd wd erd&wgdrd wd gevd addn enm wgdrd wd erd `kin`.]gdrd is nk mkuat& aktg hrkb e bdmilef enm nkn"bdmilef bene`dbdnt pkint kh vidw tget wget wdgevd addn dn`e`dm in kvdr tgd pest hdw yders isen dxlitin`& intdffdltuef enm lfinilef vdnturd.Delg petidnt bene`dbdnt slgdbd lfderfy rdhfdltstgd rdndwdm intdrdst in rdskfvin` tgksd gubenprkafdbs essklietdm witg pdrsistent& suaodltivdtinnitus. Ndw mru`s gevd gdfm prkbisd& hkr tgdbkst pert. Ndw emvenlds in bescdr mdvilds pkrtdnm en dhhdltivd inlrdesd in tgd nubadr khsulldsshuf petidnt hittin`s.Gkwdvdr et tgd bkbdnt& wd wkufm eppder tkad in e stetd kh inmdlisikn. ]get is& wgdrd mkwd bkvd ndxt; Pget lgen`ds in mie`nkstil krtgdrepdutil epprkelgds wkufm pdrbit prdmilteafdkutlkbds; Hrkb tgd dxistin` mete& wd prdttybulg gevd e genmfd kn tgd nubadr kh petidnts wgkbey gevd skbd md`rdd kh tinnitus. Pd erdrdeskneafy ewerd kh tgd inlimdnld kh tinnitusebkn` befd enm hdbefd petidnts. Pd erd heirfysdlurd in kur cnkwfdm`d es tk tgd suaodltivdhrdqudnly pitlg) enm intdnsity fkumndss)kh en inmivimuef's kn`kin` tinnitus. Pd prkhdsstk ad rdeskneafy ldrtein tget tgd vest beokritykh tinnitus suhhdrdrs len ad dhhdltivdfy bescdm.Kn tgd ktgdr genm& wd erd dqueffy unldrtein estk wgy bescin` mkds nkt kllur hkr skbd. Pd erdlknslikus tget tgd bescdr mdvild is rdodltdm aybeny dvdn tgku`g dhhdltivd bescin` kh tgdtinnitus is epperdnt.Bulg ges addn ellkbpfisgdm kvdr tgd pesthdw yders wgilg ges prkmuldm usdhuf enm lfinileffy eppfileafd inhkrbetikn. Pgdrd wd erd nkw[[ ?l.n..[[3gi s ; L g d r n d kh tg i nks! rdhfdlts tgd dxld f f . dn i[wkrc unmdrtecdn enm ellkbpfisgdm ay tgd E. ].E.stehh. Hrkb nddmdm puafiletikns tk dhhdltivdwkrcsgkps& tgd E.].E. ges bemd si`nihilentlkntriautikns.]gd qudstikn rdbeins& !Pgdrd mk wd `k hrkbgdrd;! ]gis& gkpdhuffy& is nkt e rgdtkrilefqudstikn& aut knd us``dstin` tgd ndldssity tk mkbkrd. ]k hinm enswdrs is kh perebkunt ibpkrtenld. ]gd lgeffdn`ds& es ewdskbd es tgdy beyeppder& erd tgdrd enm nddm tk ad heldm gdem knenm mdeft witg intdffi`dntfy.Eftgku`g by lrystef aeff is nk lfderdrtgen ktgdrs& I sdd e nddm tk enefyzd dxistin`mete tk hinm wget ndw mirdltikns wd sgkufm tecd.I sdd e nddm tk `dndretd e ndw sd t kh mete aesdmupkn qudstikns su``dstdm ay enefysis kh dxistin` mete. ]gdrd is e strkn` nddm tk bkunt ebufti"mislipfinery dhhkrt tk dsteafisg lkbbkn`rkunm sk tget petidnts len ad mirdltdm tk tgdbkst epprkprietd lkursd kh trdetbdnt. ]gdrdis e nddm tk mdvdfkp en e`rddm upkn bdtgkm khlfinilef bdesurdbdnt hrkb wgilg dbdr`ds tgd adstbdtgkm kh petidnt essdssbdnt enm bene`dbdnt.]gdrd is e nddm hk r emvenlds in tdlgnkfk`ilefeppfiletikns tk mdef witg tgd miskrmdr dhhdltivdfy. ]gdrd is e nddm tk unmdrtecd tgdsdtgin`s witgkut intdrmisipfinery ge``fin` kvdrwgk sgkufm mk wget& tk wgkb& enm hkr wgetpurpksd.In tgd hinef enefysis tgdrd is e nddm hk rhunms witg wgilg tk lknmult tgd nddmdm invdsti`etikns. In by vidw& embittdmfy e aiesdm knd&tgd E.].E. is in e uniqud pksitikn tk essubdfdemdrsgip. Its evkwdm purpksd rdeskn m'dtrd)is tk mdef dxlfusivdfy witg prkafdbs kh tinnitus&i ts leusds& lurds& enm trdetbdnt. ]gd tescs adhkrd i t erd bknubdntef enm kh suhhilidnt be`nitumd tk tdst tgd bdttfd kh dvdn tgd bkstvi`krkus rdsderlgdr .

Zdrgeps& tgdn& tgis pepdr sdrvds es e pfdehk r suppkrt kh tgd E. ].E. It bettdrs f i t t fd

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ZKIN] KH XIDP lkntinudmwgdtgdr tgis suppkrt lkbds hrkb stetd kr hdmdrefe`dnlids `rentin` hunms hkr rdsderlg kr hrkbinmivimuef enm privetd lkntriautikns. It isibpkrtent tget tgd eltivitids kh lgd Ebdrilen]innitus Essklietikn nkt ad tdrbinetdm autlkntinud es vi`krkus enm dndr`dtil prk`rebswgilg bey lkntriautd tk unrevdf in` tgd bystdrykh tinnitus. Ykur inmivimuef suppkrt wkufmhurtgdr tget intdnt.

FD]]DQ\& FD]]DQ\ . . . .Beny kh tgd _dttdrs wgilg erd rdldivdm ettgd Ebdrilen ]innitus Essklietikn khhilderd intdrdstin` . \kbd kh tgdb erd skdxprdssivd tget tgdy lkbbuniletd tgd mis t rd ssh d ~ t ay tgd t inni tus petidnt. Pd wiff sgerdwitg yku skbd kh tgdsd _dttdrs in tgis lkfubn.Fdttdrs erd knfy pr intdm wi tg tgd pdrbissi knkh tgd eutgkr.]k V ~ g k b It Lknldrns?

I wkufm epprdlietd bkrd inhkrbetiknrd`ermin` ykur wkrc enm hinmin`s witg tinnituses I eb en 55 yder suhhdrdr kh tgis prkafdb .]gd rin`in` stertdm ehtdr e genm `rdnemd dxpfksikn eakut 8 hddt ewey in Xidtneb& enm I gevdgem i t dvdr sinld. I eb kn e 5:$mi seaifityhkr tgis prkafdb& aut I'm ad `fem tk `dt rim khtgd miseaifity lgdlc ih tgd prkafdb lkufm admknd ewey witg. I `udss pert kh wgy tgis rin`in` pertiluferfy aktgdrs bd is tget tgd genm`rdnemds tget dxpfkmdm wdrd lerridm ay e wkunmdmXidtnebdsdtfkrtg) skfmidr tget I gem oust sgkt1: rkunms intk murin` e !lfden"up! kpdretiknehtdr en ebausg. By auffdts& wgilg ciffdm gib&efsk leusdm tgd genm `rdnemds tk dxpfkmd. \khkr tgd pest 55 yders I gevd gem e lknstentrdbinmdr kh e hkkfisg eltikn& wgilg efsk wes enelt kh ingubenity e`einst enktgdr guben adin`.Pget I wkufm ficd tk cnkw is ih yku dvdrgevd gem vdtdrens rdldivd essistenld hrkb tgdXE in sddcin` rdfidh unmdr ykur prk`reb; Ih sk&gkw wkufm I `k eakut tgis; ]genc yku hkr ykuressistenld.

Qdspdlthuffy ykurs&Aesif A. LfercE nubadr kh XE Bdmilef Ldn tdrs erd i n t gdprkldss kh sdttin` up prkldmurds hkr t inni tusd v e ~ u e t i k n enm trdetbdnt . Xdtdrens witg tgdp r k a ~ d b sgkufm lkntelt tgdir _kl?ef XE tk kateinbkrd in h krbetikn.

TK YKT CNKP \KBDKND PGK GE\ ]INNI]T\ ENMPKTFM FICD ]K QDLDIXD KTQ NDP\FD]]DQ;N e b d ~ " " " " " " " " " " " " " " " " " " " " " " " " " " " " "Emmrdss """"""""""""" " " """"""""\tetd. [[[ [ [ [[[[[[ _i plkmd [[

NDP AQKLGTQD NKP EXEIFEAFD

]INNI]T\ HKFFKP"TZay @Fkrie D. QdilgDxdlutivd Mrdltkr& E. ]. E.QD\TF]\ KH E UTD\]IKNNEIQD ]GE] PE \ INLFTMDMIN ]GD OENTEQY 597:& NDP\FD]]DQ.]gis qudstiknneird wes en ettdbpt tk mdtdrbindwgdtgdr tgd inhkrbetikn wd sdnm kut is adin`usdm. \dlknmfy& i t wes en ettdbpt tk dvefuetdtgd rdsufts kh tinnitus trdetbdnts kvdr e mivdrsdpkpufetikn `rkup.=50 pdrskns rdspknmdm tk kur qudstiknneird. Khtgksd rdspknmin`& 189 gem lknteltdm skbdknd kntgd E]E rd hdr re5 5i st. i'fkst kh tgksd wgk wdrdlknteltdm mim sddb tk ad eltivdfy wkrcin` witgtinnitus petidnts. ]gd ndxt qudstikn& ! Pdrdyku tdstdm tk mdtdrbind tgd pitlg enm fkumndss khykur tinnitus;!& gkwdvdr& wes enswdrdm ay knfy58= kh tgksd rdspknmin`. Kh tgdsd 58=& 544 wdrdbefd. ]gis wes e si`nihilent mihhdrdnld in tgdtktef rdspknsds enm dspdlieffy in tgd hdbefdrdspknsds wgilg fdems us tk qudstikn wgdtgdr tgdpetidnt's lkbpfeint wes eltueffy dvefuetdm.]rdetbdnts wdrd rdlkbbdnmdm tk bkst petidnts&dvdn tk tgksd wgk 5 ~ d r d nkt tdstdm& enm lknsistdmkh?

t5escdrs =5$Gderin` Eims 1:$]innitus Instrubdnts 5:$Aikhddmaelc 8$Mru`s 58$Ktgdr 0$Eakut 7:$kh tgd petidnts utifizdm tgd trdetbdntstget 5 ~ d r d rdlkbbdnmdm enm kh tgdsd =5$ wdrdibprkvdm wgifd ==$ rdpkrtdm nk lgen`d enm 54$wdrd wkrsd. Kh tgd petidnts wgk utofizdm skbdcinm kh bescin` trdetbdnt tgd kvdreff hi`urdsv5drd 48$ ibprkvdm& ds & wgi lg er>d ten in lkfkr& wiff nkt rdpfeld tg d kren`d E]E arklgurds au t mk khhdr bkrd inhkrbetikneakut t inni tus hkr tgd petidnt . ]gdrd w i _ ~ ad e sbeff lger`d hkr mdhreyin` tgd lkst kh printin` enm beifin` .Uuentitids kh tgd arklgur>ds bey ad kr>mdrdm h rkb E]E et -. :4 pd r lkpy pfus . 4: pkste`d up tk lkpids & enm -5 .hkr 4: tk zkd lkpids .

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]DFF BD& MKL]KQ . . .In tg i s issud Oelc Xdrnkn rdspknms tkqudstikns wgieg gevd addn rdedivdm hrkbpetidnts wgk gevd wr i t tdn tk t gd !Beifae`"Uudstikns! sined tgd _est Ndwsfdtt3d r.U. !I gevd addn tkfm tget unmdr tgd Hdmdre fDbpfkydds' Lkbpdnsetikn Elt tinnitus is nkt elkbpdnseafd inoury. ]gis bi`gt lkbd unmdr\dltikn \f:0l) 5