Tinnitus Today September 1998 Vol 23, No 3

7/23/2019 Tinnitus Today September 1998 Vol 23, No 3

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September 1998 Volume 23, Number 3

Tinnitus TodayTHE JOURNAL OF TH E AMERICAN T INNITUS ASSOCIATION

In This Issue:

"To promote relief, prevention, and the eventual cure of tinnitus forthe benefitof present and future generations"

Since 1971

Education - Advocacy - Research - Support

Sound Sensitivity- Hyperacusis and Recruitment

Pulsatile Tinnitus

Can You Feel What I Hear?

New ATA-Funded Research



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Tinnitus T o d ~ y Editorial and Advertising ofices:American Tinnitus Association, P.O. Box 5, Portland, OR 97207 • 503/248-9985, 800/634-8978 • [email protected], http:fjwww.ata.org

Execmive Director f.- Ediwr:Gloria E. Reich, Ph.D.

Associate Editor: Barbara ThbachnickT'mnuus 'Tbday is published quarterly in

March, June, September; and December. li ismailed to American Tinnitus Associationdonors and a selected list of tinnitus sufferers and professionals who treat tinnitus.Circulation is rotated 10 80,000 annually.

The Publisher reserves the right co reject oredit any manuscript received for publicationand to reject any advertising deemed unsuitable for Tinnitus 'Tbday. Acceptance of advertising by Trnnuus 'Ibday does nor constituteendorsement of the advertiser, its productsor services, nor does Trnnttt<s Tbday makeany claims or guarantees as 10 the accuracyor validity of the advertiser's offer. The opinions expressed by comributors to Trnmtus

'Ibday are not necessarily those of the

Publisher, editors, staff, or advertisers.American Tinnitus Association is a nonprofit human health and welfare agencyunder 26 USC 501 (c)(3).

Copyright 1998 by American Tin nitusAssociation. No part of this publication may

be reproduced, stored in a retrieval system,or transmitted in any form, or by any means,without t.he prior written permission of thePublisher. ISSN: 0897-6368

Executi.ve DirectorGloria E. Reich, Ph.D. , Portland, OR

Board of Directors

James 0. Chinnis, Jr., Ph.D., Manassas, VA

W. F S. Hopmeier, St. Louis, MOGary P. Jacobson, Ph.D. , Detroit, MISidney Kleinman, Chicago, IL

Paul Meade, Tigard, OR. Chmn.

Philip 0 . Monon, Portland, ORStephen Nagler, M.D., F.A.C .S. , Atlanta, GADan Purjes, New York, NY

Aaron I. Osherow, Clayton, MOSusan Seidel, M.A. , CCC-A, Towson, MDJack. A. Vernon , Ph.D . Portland, ORMegan Vidis, Chicago, IL

Honorary DirectorsThe Honorable Mark 0. Hatfield,

U.S . Senate, RetiredThny Randall, New York, NY

William Shatner, Los Angeles, CA

Scientific Advisor yCommitteeRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland, ORJack D. Clemis, M.D ., Chicago, ILRobert A. Dobie, M.D., San Antonio, TXJohn R. Emmett, M.D., Memphis, TN

Chris B. Foster; M.D., La Jolla, CABarbara Go ldstein, Ph.D., New York, NYJohn W, House, M.D., Los Angeles, CAGary P. Jacobson, Ph.D., Detroit, MlPawel J. Jastreboff, Ph.D., Baltimore, MDRobert M. Johnson, Ph.D., Portland, ORWilliam H. Martin, Ph .D. , Portland, OR

Gale w. Miller, M.D., Cincinnati, OHJ. Gail Neely, M.D., St. Louis, MORobert E. Sandlin, Ph.D., El Cajon, CAAlexander J. Schleuning, n, M.D.,

Portland, ORAbraham Shulman, M.D., .Brooklyn, NYMansfield Smith, M.D., San Jose, CARobert Sweetow, Ph .D. , San Francisco, CA

Legal CounselHenry C. BreithauptSteel Rives Boley Jones &- Grey,

Portland, OR

The Journal of the American Tinnitus Association

Volume 23 Number 3, September 1998

Tinnitus, ringing in the ears or head noises, is experienced by as manyas 50 million Americans. Medical help is often sought by those whohave it in a severe, stressful, or life-disrupting form.

Table of Contents

7 ATA's New Board Members

9 Pulsatile Tinnitus

by John Risey, M.C.D., and Ronald G. Amedee, M.D.

11 A Tribute to the Chairman of the Boardby Cliff Collins

11 Introducing ATA's Board Chairman Paul Meade

13 New ATA-Funded Research

14 Sound Sensitivity

by Barbara Tabachnick

17 Can You Feel What I Hear? An Audiological Perspective

by Norma Rivera Mraz

19 A Self-Help Journey

by Carrol Jude

20 ATA Support Givers - Welcome!21 Collectible Commemorates Quest for Silence

and Benefits ATA Cause

by Corky Stewart

Regular Features

4 From the Editor

by Gloria E. Reich, Ph.D.

5 Letters to the Editor

22 Questions and Answers

by Jack A. Vernon, Ph.D.25 Special Donors and Tributes

Cover: 'Exquisite• (28"x 36" oi l on canvas) by Arletha Mueller Ryan, 15 Touchstone,

Lake Oswego, OR 97035, 503/636-8838



FROM THE EDITOR

by Gloria E. Reich Ph.D.,

Executive Director

National Health Council which promotes thehealth of all people by advancing the voluntahealth movement.

As summer draws to a close, A very interes ting item came on our e-maATA's

activitiesgather momen

- recently. Ithad

to do withgenetic

research antum. Many hearing-related was entitled "What's Blond and Blue-Eyed and

societies have their annual Read All over?" Have you guessed? The answ

meetings in the fall and tradi- is Iceland DNA (deoxyribonucleic acid, thetionally ATA attends these to basic genet ic material of human life). In this

provide information about tin- example, Icelandic DNA data was said to be

nitus and tinnitus research to much sought after by pharmaceutical compa-the attendees. This year will nies who have found that they are able to loc

be no different. We look forward to seeing many genes responsible for disease about four t i m ~of you at the International Hearing Society, the faster than from DNA in the general populat1American Academy of Otolaryngology Head and Furthermore, geneology is a national pastimeNeck Surgery, the Academy of Dispensing Iceland with most families being able to traceAudiologists, and the American Academy of their roots back to about 900 A.D. Now, all we

Family Physicians meetings. have to do is to encourageThis year I will again be a research about hearing defects

guest speaker at the Sixth Annual using this fantastic database anConference on Tinnitus perhaps we'll get some of theManagement in Iowa City, IA, on breakthroughs we're all hoping

September 18-19. This year's guest for. Anyone in Iceland haveof honor will be Dr. Peter H. tinnitus?

Wilson, a psychologist from South We recently heard from Judy

Australia, who will be speaking Brivchik, our tinnitus support

about attention control and cogni- group leader in Lancaster, PA,tive restructuring therapies for that July was, in Pennsylvaniatinnitus. The conference is open least Tinnitus Awareness Mon

I

to professionals and patients. For _ What a great idea! You can conmore information contact Richard ,2"_ tact your local city or state'Jyler (319/ 384-9757). Tony Randall new son, officials about having tinnitus

The National Institute on Jefferson Salvmt Randall recognized for a special week o

Deafness and Other Communication Disorders month where you live.

(NIDCD) held a principal investigators meeting Honorary ATA board member Tbny Randaabout tinnitus in May. As an invited guest, I was is pictured here with his second child, Jeffersvery happy to hear these investigators discuss Salvini. Jefferson was born June 15 , 1998 and

the latest tinnitus research findings and their also welcomed by his mother Heather and sisideas for future studies. In general the National Julia, who was born Aprilll, 1997. Our conglnstitutes of Health (NIH), of which the NIDCD ulat ions to the entire family.

is a part, is attempting to engage the public to Lastly, I regret to report the deaths this su

help set research priorities. Right now your con- mer of two valued colleagues and friends,gressional representative is the best person to le t Donna Dickman, Ph.D., Executive Director o

know how you think the government the Alexander Graham Bell Association for thagencies should be spending Deaf, and Aram Glorig, M.D., a leading authoresearch dollars. In the futurethe NIH hopes to create an ty on the ear and its disorders. Dr . Dickman w

a strong voice for oral deaf education. Dr. Glooffice of public liaison to review first observed cases of severe hearing impair-~ ~ ~ 4 ~ i } ~ G ~ ~ ~ ...... .. and respond directly to public ment and tinnitus caused from bomb and she

input. ATA not only talks blasts while he was stationed in England duridirectly with officers of the Second World War. Dr. Glorig addressed th

. .~ ~ ~ ~ ( l t h e NIDCD but also Fifth International Tinnitus Seminar in 1995participates in the about noise-induced hearing loss. B

4 T inn i tus Thday/ Septe mber 1998



Letters to the Editor

From tirne to tirne, we include letters

from our members about their

experiences with "non-traditional"

treatments. We do so in the hope that

the information offered might be helpful.

Please read these anecdotal reports

carefully, consult with your physician or

medical advisor, and decide for yourself

if a given treatment might be right for

you. As always, the opinions expressed

are strictly those of the letter writers and

do not reflect an opinion or endorsementbyATA .

Iave been a long time member of your orga

nization and an avid reader of your journal,Tinnitus 7bday. A common theme I see in

your journal is a distinct frustration on the part

of your members with the medical profession. Ialso believe that this frustration leads to considerable disappointment and anger and potentialanimosity towards our profession.

As you know, tinnitus is a very difficult,

challenging complaint. Unfortunately, themajority of causes of tinnitus are idiopathic(of unknown origin), despite very expensiveworkups and evaluations.

What you need to know, though, is that it isextremely frustrating for us as health careproviders also. Despite attending many seminars and reading many journals and textbooks,I still do not have an answer for many of the

causes of tinnitus I see daily in my practice.Certainly I am not satisfied with this and hope-

fully in the future this will be resolved.

It is encouraging to me that such concepts asTinnitus Retraining Therapy bring hope to aU of

us. In addition, the recent identification of aregion of the brain that seems to register the

tinnitus is also encouraging. We in the profession do not have all of the answers nor do wemaintain that we do. We do, however, workhand-in-hand with our patients, with mutual

respect and empathy. Please do not take our

inability to provide immediate resolution of the

tinnitus complaint as evidence of indifferenceand arrogance. This is certainly not the case. We

all look forward to the day when we can provideour tinnitus patients with a distinct and absolutecure for their tinnitus.

Stuart A. Morgenstein, MD , 231 S. Ga1y, Suite#110, Bloomingdale, TL 60108, 6301307-0088

M wife, who has had tinnitus for a number

of years, was getting very depressed

because of it. I took her to an otolaryngologist who said there was no cure for tinnitus and

to go home and learn to live with it. I then tookher to a TMJ dental surgeon. After $566 worthof x-rays, he recommended treatment at a costof $1500 with no guarantees. Our insurance

wouldn't help.

I have been studying herbal medicines and

decided to have my wife try St. John's Wort forher depression rather than the Zoloft our familydoctor prescribed. After a month of taking St.John's Wort, her depression was much better

and the pounding has stopped. She is the best

she has been since the tinnitus first started.Even the ringing is better. Perhaps this mighthelp someone else. Keep up your good work.

Donald G. Haynes, 1040 Greenwood Dr. #JA,Hendersonville, NC 28791 -1912, 7041698-8686

Snce the early '70s, I have suffered from a

neural damage/high tinnitus whine compounded by a blood pulse that I hear every

waking moment. I haven't found a cure foreither of these conditions, but my reaction tothem could be useful to others, namely to lookfor a positive side (believe it or not!) to this

condition.

I am a professional scientist and also, 1 am

told, a creative person. And fortunately so. Ineed to keep my attention occupied so I don'thave to focus on the fun and games going on in

my head. Perhaps in keeping my mind active,often to the point of exhaustion, I have also kept

myself sane.

There are two things Twould like to share.In 'Transcendental Meditation (TM), which Istudied in the 1970s, they teach each student aspecial sanskrit word, the repeating of which

leads to a meditative state. From studying my

reaction to meditation, I found that with time, Ino longer need a magic word. Instead I focus onmy blood pulse and neural whine and after a

Tinnitus ibday/ Scptember 1998 5



Letters to the Editor (continued)

while, pass into a progressively deeper meditational state. My tinnitus then gives me an infallible clue as to my level of meditation and mental

state: as I get deeper in, the tinnitus initially getslouder, and then at a certain point drops away.After 20 minutes or so, I return refreshed without the tension I accumulate after a day of

listening to myself. I use my "defect" as a tool todetermine if I am entering calmer meditationalstates.

I have also found a way of listening to music

that provides me with a tool to help me ignoremy own "music." I play my favorite tapes (especially percussion) many times until I know them

by heart. By listening carefully, I noticed that

my mind anticipates each coming note, as if itwere grasping it, or checking it with its memory

of the musical piece. Then I need only try and

dislodge my attention from the music . If 1 am

successful, the music essentially fades out leaving me in a meditation. This is also what I dowith tinnitus: I focus on it intently for a number

of minutes, and it tends to fade as my mind getstired ofbeing forced to grasp the noises. The

interesting thing is that the internal noises of

tinnitus are only unbearable when I allow an

invisible mental hand to grasp at the noiseinstead of allowing the sound to pass through

my mind like the noise pollution it is.

I hope this can help. In any case, it will giveyou some internal games to play with your

favorite record! I would be curious to hear

written reactions from others who tr y this.

John F Caddy, Via Cervialto 3, Aprilia 04011,

Latina, Italy

Im beginning with carefully selected patients

to offer Tinnitus Retraining Therapy (TRT) in

my clinic. No, I have not taken one of the

courses at the University of Maryland and I disagree with the implications that physicians and

audiologists who have no t been formally trainedcannot adequately provide TRT. I do understand

the need to avoid the impression among practitioners that TRT is as easy as placing devices in

people's ears. I have encountered some patients

wearing these devices (dispensed at other clinics) who have no understanding of their tinnitus,the use of the devices, or even of the ultimate

goal of the therapy. I believe that physicianswho have a sincere interest in treating tinnitus

patients, who are compassionate enough and

patient enough to hear their worries and who

6 Tinnitus ll:lday/ September 1998

take the time to educate their patients and thfamilies, can provide TRT effectively.

I will be attending one of the courses inBaltimore in the near future but this is in the

spirit of thoroughness and sincere interest inthis topic. Perhaps the message to ENT physicians should be, if you don't have 80% or gresuccess, learn from those with experience wh

this might be.

Michael T Thixido, M.D., Family Ear;Nose & Throat Physicians, Limestone MedicCenter, 1941 Limestone Rd., Suite #103,Wilmington, DE 19808, 302/998-0300

I

n July 1995, I overpressurized my left midear while trying to equalize underwater.Immediately thereafter an d ever since I

have had a high-frequency ringing in my ear.Consultation with physicians at the time resuin a prognosis of one of two things happeningeither the ringing would go away, or I wouldhave to live with it. After three years of livingwith it I obtained some literature from theAmerican Tinnitus Association and decided tseek out a specialist.

The masker I now wear gives me a degreof control that I never had before. The "shhh"sound made by the device is certainly easier live with than the "eeee" that my ear produceon its own. The ability to increase or decreasthe volume of the masker allows me to adjusthe contrast between the two sounds. I can

choose to hear a blend of the two sounds or Ican completely drown out my tinnitus sound

and bear only "shhh." Bedtime used to be thetime that my tinnitus annoyed me the most,now I can decide what sound I want to hear

when falling asleep. There is already a residusoothing effect from the masker that makes tringing less noticeable even when I'm not weing it.

I hope you will relate my experience to otpatients so that they might be encouraged in

their struggle with this condition.

Neil A. Best, 1400 S. Joyce St., ffl511,

Arlington, VA 22202, 703/979-0169

In his "Questions and Answers" column in tJune 1998 Tinnitus Tbday, Dr. Vernon mentions that 25 dB is the loudest tinnitus he h

ever measured. I hope that readers will not

misinterpret this finding, which refers to the nitus decibel level over the threshold of heari



ATA's New Board Members

Gary P Jacobson, Ph.D.,Director, Division ofAudiology,Henry Ford Hospital & Medical

Center, 2799 W: Grand Blvd.,Detroit, MI 48202-2689,313/876-3280

Dr. Jacobson writes:

I became interested in t innitus during th e development

of a grant eight years ago. ItGary P. Jacobson, Ph.D. became clear to me then that

there were few clinical centers that existed

solely to manage the millions of patients withsevere and disabling tinnitus. I am still dismayed that although hearing loss, dizziness, ear

pain, and tinnitus are symptoms of ear disease,

all but tinnitus are discussed in detail in mos tgraduate programs in audiology . Because of this,I have spent much time over the past seven

years lecturing in the area of tinnitus.

Due largely to the combined efforts of the

ATA and contemporary research scientists, there

has been significant progress made over the past

10 years in the understanding of physiologicalmechanisms underlying tinnitus and in the

management of this disorder. My goals are forthe ATA to continue to support these endeavors,to continue to lobby Congress to fund tinnitus

research, and to continue their superb effortsinforming the pa tient community of the fru its of

this research.

I accept this appointment in an attempt tobetter represent to the Board the views of clini-

cians who are engaged in the management of

the tinnitus patient and of researchers who areinvolved in the study of this disorder.

Dr. Jacobson is also a member ofATA's Scientific

Advisory Committee.

Susan Seidel, M.A., CCC-A,Greater Baltimore MedicalCenter, 6701 N. Charles St.,Baltimore, MD 21204,410/828-2142

Ms . Seidel writes:

I have been an audiologist for39 years, the last 24 with theGreater Baltimore MedicalCenter. For 15 years running,

Susan Seide" M.A.

,CCC·A

I have also facilitated theBaltimore Area Tinnitus Self-Help Group with arolling membership of 200. (I have had severeleft-ear tinnitus for 30 years following a jet

engine exposure.)

As a newly-elected member to ATA's board,I would like to help with two goals of focus forthe ATA. One, I would like to see tinnitus and

no ise exposure preventive efforts included inelementary school curricula throughout the

country. And two, I would like to see tinnitustherapy approaches incorporated in all audio

logy graduate school curricula.I am very excited to help ATA reach its

goals - our goals - for th e future. B

Letters to the Editor (continued)

(or dB SL) as opposed to the absolute decibelreading on an audiometer matching tinnitus

loudness. Patients will not infrequently be toldby their audiologists that their tinnitus loudness

measures 55 dB, for instance, but they may have

a hearing loss of 50 dB, yielding a tinnitus loudness measurement of 5 dB over threshold (or5 dB SL). As Dr. Vernon observes, a tinnitusloudness measurement as high as 25 dB over

threshold (25 dB SL) would be very unusual.

Stephen M. Nagler, M.D., F.A.C.S.,Southeastern Comprehensive Tinnitus Clinic,

980 Johnson Ferry Rd., N.E., #760, Atlanta, GA30342, 404/531-3979

60Dcibes

50

40

30

20

10

I Tinnitus

) Perceived

Tinnitus

Haring oss

)PerceivedTinntus

Tinnitus 1bday/ Septentber 1998 7



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Pulsatile Tinnitus

by John Rise'ft M.C.D., and Ronald G. Amedee, M.D.

Most people describe their tinnitus as being

constant or steady-state. A small percentage

(8-10%) of people, however, experience tinnitus

which they describe as rhythmic, beating,pounding, throbbing, or ''swooshing" in nature.Usually we are unable to hear the sounds causedby the heart forcefully pumping blood through

the arteries and veins. Attimes, however, these pulsations occur in or around

the middle ear or inner

ear, or near the hearing

nerve and become audibleto us. The perception of

the rhythmic flow of

blood through the head or

neck region is referred toas pulsatile tinnitus.These sounds become

audible as a result ofJohn Risey, M.C.D. uncontrolled high blood

pressure, erosion of bone

over an artery, certain benign vascular tumors,or crimped or constr icted blood vessels.

Pulsatile tinnitus can be classified as either

"objective tinnitus" if it can be heard by theexamining physician, or as "subjective" i f the tinnitus can only be heard by the patient. Pulsatiletinnitus usually occurs in one ear only and it isan important variant among tinnitus patients.One-sided tinnitus often indicates an underlyingmedical condition which can be quite serious but

which is usually correctable through medicine orsurgery.

Pulsatile tinnitus might occur as the person'sonly complaint or it might occur in conjunction

with other problems. The onset of pulsatile tinnitus is typically gradual and is often initially overlooked. The loudness of the pulsations might

grow somewhat over time. But most patients

report pulsatile tinnitus to be more of an annoyance than a severely intrusive experience.Possibly because pulsatile tinnitus does not

progress to a point where it is perceived as being

severe, only a small percentage of patients withthis complaint seek a medical evaluation withthis as their only problem. Patients are more

likely to seek medical attention when other complaints coincide with the pulsatile tinnitus.

Complaints of hearing loss, a sensation of

fullness in the ear, ear pain, drainage from theear in the form of pus or blood, and/or vertigo

might be experienced in addition to pulsatiletinnitus and require thorough medical and audiologic examinations. These additional symptoms

are associated with damage or disease affecting

either the middle ear,inner ear, and on occasion the hearing and balance nerves. A thoroughphysical examination by

an otolaryngologist can

reveal evidence of the

underlying cause in these

cases. The medical examination typically involvesvisual inspection of the

Ronald G. Amedee, M.D. eardrum and ear canal,

listening for pulsatilesounds through a stethoscope in various locations around the ear and head and neck, as wellas checking the blood pressure. In addition to

a medical examination, patients will undergo acomplete audiological examination. Hearingtesting is performed to determine what type(e.g. middle ear, inner ear, hearing nerve) of

hearing loss, if any, exists. In addition, tympanometry might be performed in an attempt to

record objective evidence of the pulsatile tinnitu s from the patient's ear canal. (Some typesof pulsatile tinnitus cause the eardrum to pulseevery time the tinnitus is heard by the patient.JYmpanometry tests how well the eardrumand bones behind the eardrum vibrate tosound.) Additional testing might be ordered if

the outcome of the physician's history-takingand physical examination or the audiologist'sexamination indicates a need for it.

These additional symptoms often indicatethe need for further workup: weakness or

numbness in the face, headache, double vision,or hoarseness. These complaints indicate that

the underlying cause of the problem could be

affecting more than just the hearing system.The specific combination of symptoms, and the

medical and audiologic exam results will help

the physician determine the need for further

evaluation(s).

More extensive diagnostic testing might be

ordered, including aCT scan, MRI, lumbar

puncture, and possibly an angiography. CTscans are computerized x-rays of the bony structures within the head and neck and are oftenuseful in cases of pulsatile tinnitus. These x-rays

Tinnitus lbday/ September 1998 9



Pulsatile Tinnitus (continued)

are ordered to establish if the problem is associated with erosion of bony structures within the

ea r and/or head. MRI is magnetic resonanceimaging, another computerized procedure whichis used to look at ''soft" (e.g. non-bony) tissue in

the same area and is especially helpful indetecting the presence of brain tumors. Lumbar

puncture is a procedure designed to detect the

presence of increased intracranial pressure. Aneedle is inserted at the base of the spinal column and a small amount of spinal fluid is

removed. Angiography is sometimes recommended to obtain a view of the blood vesselsin the head and neck looking for abnormalitiesin the arteries and veins which may be the

underlying cause of pulsatile tinnitus. Any or

all of these procedures might be required in

order to determine the underlying cause for the

complaint and to help establish a diagnosis.

Pulsatile tinnitus can be caused by many

medical conditions (see Thble 1). Some, such as

previously undiagnosed and untreated highblood pressure (hypertension), might be relatively easy to diagnose and treat. Other conditions might require surgery or the use of

radiation and chemotherapy. Conditions such ashardening of the arteries (atherosclerosis),benign intracranial hypertension1 and heart

Table 1.Causes of Pulsatile Tinnitus

Aberrant carotid artery

Arteriovenous malformations

Arnold-Chiari malformations

Benign Intracranial hypertension

Cervical venous hum

Glomus tumors

Heart murmur

Hypertension

Increased intracranial hypertension

Jugular bulb abnormalities

Neurovascular compression of hearing nerve

Patulous Eustachian tube

Persistent muscular contractions

Sigmoid sinus abnormalities

1 0 Tinnitus 1bday September 1998

murmur can be effectively treated with medictions and often, though not always, result in

elimination or dramatic reduction in pulsatiletinnitus. Other conditions such as aberrant

carotid artery, arteriovenous malformations,

venous hums, and jugular bulb abnormalitiesrepresent unusual anatomical conditions whicmay not be medically treatable. Glomus tumoPaget's disease, benign intracranial hypertension, increased intracranial pressure, and sigmoid sinus abnormality might require surgeryA thorough medical and audiological assessmcan determine which option would offer thebest prognosis for each patient.

Pulsatile tinnitus is a specific type of tinnitus complaint which occurs in a relatively smnumber of tinnitus patients. I t arises from

abnormalities directly or indirectly associatedwith circulating blood through the body. The

underlying cause of pulsatile tinnitus can oftebe determined and successfully treated. Carefclinical examination and early detection offerthe best opportunity for a complete recovery.

References

Goodhill, V. (1979). Tinnitus. In V. Goodhill (Ed.) Ear

diseases, deafness and dizziness. Hagerstown: Harper & R

731-739.

Rothstein, J., P.A. Hilger, L. Boies, (1985). Venous hum acause of reversible facetious sensorineural hearing loss.Annals ofOtology, Rhinology & Laryngology 97: 267-268.

Sismanis, A. , F.M. Butts, G.B. Hughes, (1990). Objectivetinnitus in benign intracranial hypertension: an update.Laryngoscope 100: 33-36.

Sismanjs, A., G.B Hughes, E. Abedi, G.H. Williams, L.A

Isrow, (1985). Otologic symptoms and findings of thepseudotumor cerebri syndrome: a preliminary report.Otolaryngology Head and Neck Surgery 93: 398-402.

'!yler, R.S., R.W. Babin, (1993). Tinnitus. In c.w.

Cummings, J.M . Fredrickson, L.A. Harker, C.J. Krause,D.E. Schuller (Eds.), Otolaryngology -Head and NeckSurgery, Vol. 4, 2n d Ed. St. Louis: Mosby Year Book.

John Risey, M.C.D., is a clinical instructor

at Thlane University School ofMedicine,New Orleans, LA.

Ronald G. Amedee, M.D., is a professor andChairman of the Department ofOtolaryngologyHead & Neck Surgery, Thlane University SchoolMedicine, New Orleans, LA, and a member ofATA's Scientific Advisory Committee.



ATribute to the Chairman of the Board

by Cliff Collins

In June 1998, Philip 0. Morton stepped asideas Chairman of ATA's Board of Directors after

four years of service. Phil has served on the

board for ten years. I believe ATA members andsupporters should know

something about the levelof dedication Phil has

shown to the organization.

As noted in the June

1998 issue of TinnitusTbday, Phil was solelyresponsible for persuading

a national publisher of

high school textbooksto include mention of

tinnitus in their books. I t

.. is a prime example of thePhthp 0. Morton issue that is closest to his

heart: preventing young people from acquiringthe ear damage he himself did earlier in life.

Phil is in his mid-50s now, bu t he is still paying for the many years he spent as a guitarist in

a local rock band. In 1980, Phil came down withsevere tinnitus and hyperacusis, an oversensitivity to sound. He contacted the ATA to try to findhelp. Within a short time, he had taken it on as

his personal mission to warn young people about

the dangers of loud noise and loud music.In the service of that goal, he has gone to

schools to speak in classrooms, taking alongmemorabilia such as his old electric guitar and alarge photograph of his band taken the nightthey opened for the Beach Boys in Portland in

the 1960s. Phil knew if he could speak to kids on

their level, they would be more inclined to hear

his message.

He's also submitted to the public spotlightand appeared on talk shows, speaking openly of

his condition. He has encouraged others who

experience tinnitus to do likewise.

Undoubtedly Phil's most enduring legacyat ATA will be his creation of the Mission 2000plan, a carefully thought-out timetable for ATA's

growth and development. Mission 2000 ultimately was incorporated into what is now

called ATA's Strategic Plan, which encompasses

the organization's specific priorHies and reasonsfor being.

Fortunately, Phil will remain on the ATA

board for one more year, which gives the board

the benefit of his experience and also gives the

rest of us time to thank him for his years of service. Despite his tinnitus, Phil decided that the

best way to survive it was to take action. We canall gain inspiration from his example. a

Cliff Collins, of Aloha, Oregon, is a freelance writer.

INTRODUCING

ATA's Board Chairman

Paul Meade

Generally voluntary board

members have a vestedpersonal or professionalinterest in the non-profitorganization they're serving.Paul Meade doesn't havetinnitus; nor is he a hearing

heal thcare professional, but

he is the newly-electedChairman for the American

Tinnitus Association.

"I've seen the impact tinnitus has had on the

lives of friends. I never want to experience it

and I want to do all I can to further publicawareness and hearing protection activities,especially for youngsters," explains the 34-yearold father oftwo.

Phil Morton, retiring chairman, says of Paul,"He's a bright individual. And even though he

doesn't have tinnitus - maybe especiallybecause he doesn't have tinnitus - he looks atthings with a better and broader perspective."

As Chief Financial Officer for Oregon-basedGaylord Industries, Meade looks forward tohelping ATA "capitalize on the momentum

developed over the past few years through EARS

(the association's strategic action plan), research

funding, and recent publicity." Ill

Tinnitus Thday / September 1998 11



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NEW ATA-FUNDED RESEARCH

We are pleased to announce the

American Tinnitus Association's

support of the following tinnitus

research projects:Principal Invesigator: Kejian Chen , Ph.D.

Medical College of Ohio , Toledo , Ohio$33 ,000 for the study of spontaneous activity in

the dorsal cochlear nucleus following exposureto high intensity sound.

This study is expected to offer insight intothe mechanisms ofloud sound-induced tinnitus .The proposal aims to elucidate the cellular and

pharmacological mechanisms for the observedincreases in spontaneous firing rate in the dor

sal cochlear nucleus (part of the auditory pathway to the brain) after exposure to loud sound.The results will be useful for further experimental studies aimed to treat tinnitus with more specific drugs.

Principal Investigator: George M. Gerken , Ph.D.

Un iversity of Texas at Dallas, Callier Center for

Communication Disorders , Dallas, Texas

$30,000 for the study of auditory evoked potentials in tinnitus, hyperacusis, and hearing loss.

The experiments involve the auditory brain

responses that are evoked by brief sounds. In

problem-tinnitus patients, in hyperacusispatients, and in certain hearing-loss patients, it

is predicted that larger evoked potentials will be

obtained from some brain regions related tohearing. This research proposes to show that

some types of tinnitus and hyperacusis may be

caused by what are essentially mis-adjustmentswithin brain mechanisms. Previous research has

provided a handle which may permit some evaluation or even manipulation of the central auditory mechanism. If so, it may be possible to

alter or relieve tinnitus of central origin.

Principal Investigator: Mary B. Meikle, Ph.D .

Oregon Hearing Research Center, Oregon Health

Sciences University and Portland VA Medical

Center, Portland, Oregon$22,500 for the ATA National Tinnitus Data

Registry Project (NTDR).

The present registry contains detailed medical and audiological data from over 2600patients of the Oregon Hearing Research Center.

Over the next few years the registry willbecome national as it is expanded to include

information from other sites. The NTDR willprovide a systematic, well-documented, wellorganized basis for planning curriculum in med

ical and audiological training environments,increase public access to tinnitus informationfor their own health care needs, offer documentation concerning the relation between tinnitus

and disability, and provide data needed by

researchers in planning investigations about

tinnitus. This information will be useful to

major health care providers as well as the U.S.

government for public health care planning.

For a grant application and instructions,please send a request to ATA, P.O Box 5.

Portland, OR 97207-0005, call 800/634-8978, or

view the material on our website: www.ata.org.Click on "Tinnitus Research" for an on-lineapplication. Ill

WANTEDHEARING AIDS AND/OR

MASKERS IN ANY CONDITIONIf you have ever wondered what to do

with those aids that are just sitting in the

drawer, think no further. ATA will be happy

to receive them. Donations to ATA are taxdeductible, and we'll provide a receipt.Package them carefully (a small padded mailing bag is fine) and send to:

ATA, PO Box 5, Portland, OR 97207.If you are using UPS or another shipper,ship to our street address:

1618 SW 1st Ave., #417

Portland, OR 97201

What happens to the aids that you turn

in? In some cases they can be repaired and

given to needy people or used in charitablemissions to underdeveloped countries. Evenif they can't be re-used as is, the parts areneeded for repairing other aids. (And the

plastic is recycled.) Your old aid could givesomeone the gift of hearing!

Tinnitus 'Tbday/ September 1998 13



Sound Sensitivityby Barbaro Tabachnick,

Client Services Manager

Sound sensitivity has twoaccepted medical names -

hyperacusis and recruitment.However, people who havesound sensitivity describe the

experience with wide variation. Some sound-sensitivepatients are intolerant of a

particular appliance hum or the tone of a certainvoice. Some are devastated by any external sound

above a whisper. Some believe that they reallyhear too well (e.g., very quiet sounds in distantrooms) even when their measurable hearing losslogically negates the possibility. Some sound sensitive patients have no hearing loss; others have

significant hearing loss. Some have tinnitus -mild or incapacitating, with or without hearing

loss. Some have no tinnitus. Clinicians who treat

these patients define sound sensitivity with an

equal lack of consensus. Like tinnitus, sound sensitivity is a subjective experience an d is studiedbased primarily on the stories and observed reactions of the patients who have it.

Recruitm entRecruitment is a fairly common form of

sound sensitivity which can occur as a consequence of sensorineural hearing loss, ear surgery,

or ear-related illness,and which

occasionallyresolves on its own. A person with recruitment

finds that sounds at specific frequencies areuncomfortably loud, and that the sounds at thosefrequencies seem to increase in loudness quiterapidly. The loudness growth appears to occur in

the frequency range of that person's hearing loss.

Th e condition of recruitment - which generally co-exists with hearing loss - can be uncomfortable and unnerving. I t is often labeled

erroneously as hyperacusis, a more intrusivedisorder.

HyperacusisHyperacusis is an abnormal intolerance to

ordinary sounds. For the person with a severeform of this condition, an everyday noise - likethat from a dish being placed on a table - can be

far too loud, even excruciatingly loud. Hearing

loss and hyperacusis seldom occur simultaneously. Statistically, though, 90% of those who havehyperacusis also experience tinnitus - a constant

ringing or other distressing noise in the ears or

head. A few researchers regard hyperacusis as a"pre-tinnitus state" since tinnitus frequently

enough follows its onset.

14 Tinnitus Thday September 1998

Patients who are troubled by everyday envronmental sounds predictably have LoudnessDiscomfort Levels (LDLs) that measure below100 dB - often well below. Patients with sevehyperacusis can have LDLs in the 40-60 dB ra

The exact number of patients with hyperais unknown, perhaps because the definition o

hyperacusis and the ability to diagnose it varygreatly. The probability is also high that somepatients with concurrent disorders (like headadepression, or chronic pain) fail to report it.

What Causes Hyperacusis?Excessive noise appears to be a bonafide c

prit of this disorder. Some people report that thyperacusis began immediately following a siexposure to intense noise, like that from a gu

shot blast or an air bag deployment. Others

became sound-sensitive from long-term noiseexposure. Head injury, Bell's Palsy, chronic fasyndrome, epilepsy, Lyme disease, and drug seffects have all been associated with hyperacu

Josephine Marriage, Ph.D., audiological sctist in Cambridge, England, makes a distinctiobetween "central" and "peripheral" hyperacusiShe states that peripheral hyperacusis, seen foexample in Bell's Palsy patients, results from age to a mechanism (the acoustic reflex) in thitself. Central hyperacusis results from an abnmality in the mechanism in the brain that conthe amount of sound coming in. Marriage's 19

research examined the brain chemistry of patwith various neurological disorders (depressiomigraine, chronic fatigue, vitamin B-6 deficiensome forms of epilepsy, and others) - disordall known to co-occur with hyperacusis - in

search of a common feature in brain chemistrHer research indicates that a "disturbance," lika deficiency, in serotonin function in the braicommon to all of these disorders.

Although the exact point of injury and themechanism responsible for hyperacusis are nodefinitively known, most researchers believethe brain - not the ear - is the site of the prlem and that sound sensitivity is the result ofdysfunction in the brain's sound regulatory manism. Dr. Jonathan Hazell, tinnitus and hypecusis specialist in London, states that the cochof hyperacusis patients are of ten completely nmal. From the patient's point of view, howeveparticularly patients whose hyperacusis beganimmediately after a sudden exposure to very noise - the ears have it! These patients comm

ly experience ear fullness, ear pain, and muffhearing immediately preceding the onset of thhyperacusis.



Marriage offers another view on noiseinduced hyperacusis: excessive noise could damage the hearing mechanism "at the point where

the brain's 'efferent system' - the huge bundle ofnerve fibers that brings information from the

brain to the cochlea - joins up with the cochlea."She acknowledges that this is speculation, that

current research can neither refute nor confirmit. Elliot Rosenberg, M.D., summed it up: 11Theprecise nature or location of this sound adjustment mechanism is not yet known, but the

hyperacusis patient has clearly lost it."

What Makes Hyperacusis Worse?I t is a maddening enigma for hyperacusis

patients who find that their condition is worsened not only when they are exposed to noise,but also when they go too far to protect their ears

from it.11

Silence is the major factor enhancingboth hyperacusis and tinnitus," says PawelJastreboff, Ph.D., Director of the University ofMaryland Tinnitus and Hyperacusis Center.

Our sense of sight affords us an analogy.When we wake in the middle of the night, our

eyes are sensitive to all but very low-level light. Ifwe stay awake, we find that we can graduallyadjust to a slightly brighter light, then in time to

normal-level ambient light. Sensory organs that

are under-stimulated (like the eyes when wesleep) experience normal stimuli as excessivestimuli. When hyperacusic ears (or healthy ears

for that matter) are habitually protected withearplugs or earmuffs, they will experience normal sound as excessive sound when the muffs orplugs are removed.

Some hyperacusis patients have found that

caffeine, and a few antidepressant medicationslike Zoloft and Paxil, will make hyperacusisworse. (Fortunately, there are other medicationsthat can alleviate depression and not aggravatehyperacusis.)

Which Sounds Really Are Too loud?Many people with hyperacusis experience

palpable, legitimate pain from noise exposure -any noise exposure. So how can a person forwhom all sounds seem too loud determine whichsounds will actually cause damage? The debatelingers. Some doctors define excessive sound to

be sound at a level known to damage healthy

ears (100 dB and above). Hyperacusis patients say

excessive sound is any sound that hurts, even i f t

is 60 dB (the sound level of normal conversation)and they cite their reason: they do not havehealthy ears. Many sound-sensitive patients wear

earplugs and/ or earmuffs 12 or more hours a

day.I t

is understandable though ill-advised.Dr. Hazell acknowledges the difficulty hyperacu-

sis patients have accepting that "sound which can

be uncomfortable or even painful to the hearing

can be quite harmless to the ear."

Day-in and Day -out with Hyperacusis

The toll taken by hyperacusis on one's dailylife is significant, and in some cases dramatic.Scores of people with this condition avoid conversations above a whisper, shun all outside enter

tainment, decline attending family events, and

quit their jobs as they struggle to quiet down

their lives.

Nighttime for many is marred with sleeplessness. Daytime is punctuated with avoidance of

and accidental encounters with loud noise. Autensil against a dish, one's head rustling againstthe pillowcase, voices - including one's own -can drive the new hyperacusis patient to distrac

tion. A desperate few have resorted to barricading themselves in their homes for fear of

accidental exposure to a dog's bark or a car'shorn. I f it has progressed to this level, thenphonophobia - a fear of sound - is added to the

hyperacusis patient's list of woes. I t is a difficultspiral to unwind.

Dan Malcore was overvv-helmed by the suddenness and intensity of his hyperacusis when it

first appeared in 1991. Eight months along hisarduous road towards getting better, Malcorefounded the Hyperacusis Network, and beganpublishing a newsletter filled with everything he

could find on the subject. He encouraged hisreaders to write and submit stories about their

experiences which they did, and the network

flourished. It is from this bank of collected stories, and from his own experience, that he speaksou t on the subject of hyperacusis.

Malcore believes strongly that when sound

tolerances collapse suddenly and severely, and

most especially when the trauma is fresh,patients should use ear protection and refrainfrom sounds they cannot tolerate - at least forthe first few months - even i f he sounds are at

"normal" levels. "People have to stabilize some,and realize that they aren't going to get worse,"says Malcore. When a 40 dB whisper causes physical pain, people experiencing it cannot be convinced that 70 dB won't hurt them. He advisespatience and that in time, "they will slowly wean

themselves back into sounds."

Can Hyperacusis be Treated?Hyperacusis is many things: abnormal,

inexplicable, and - with much forbearance -treatable. Some patients have anecdotallyreported hyperacusis relief with blood pressure

reducing drugs like metopropol and popranolol,Tinnitus 1bday /Septembe r 1998 15



Sound Sensitivity (continued)

and with the anti-anxiety medication, Xanax.(Before beginning Xanax or any drug therapy, itis wise to weigh the potential benefit against the

potential for unwanted side effects.) In Goldsteinand Shulman's 1996 study of patients with dis

abling tinnitus and hyperacusis, audiological testspoint to the probable existence of several types of

hyperacusis. They write, "This could explain why

some individuals respond to treatment and othersdo not."

Tinnitus clinicians Jack Vernon, Ph.D., and

Pawel Jastreboff, Ph .D., Sc.D., concurrently discovered other workable treatments for hyperacusis while they were pursuing clinical care fortheir tinnitus patients. Their desensitizing treatment techniques have helped many hyperacusispatients become more tolerant of sound. Vernon'slow frequency (200-6000 Hz) "pink noise" proto

col requires the hyperacusis patient to listen topink noise se t at a volume just below the individual's discomfort level for two hours per day. The

two hours need not be consecutive. (A pink noiseCD is available from the Oregon Hearing

Research Center.) Vernon informs patients that

the process of sound desensitization is a long

one, that improved loudness tolerance might not

be seen for many months. Jastreboffs tinnitusretraining therapy (TRT) necessitates a patient's

willingness to wear two hearing aid-like noisegenerators, set initially at a "barely audible" broad

band level, for 8-10 hours per day for up to 24

months. Patient counseling is part of the TRTprotocol.

Dan Malcore, who used a sound desensitization protocol himself with success, knows very

well why many patients with severe hyperacusisare reluctant to tr y the program, or - havingtried it - stay with it. He comments: "For peoplewith hyperacusis, 'sound desensitization' is a hard

sell. They can't imagine putting more sound even quiet sound - into their ears at all le t alone

for 8-10 hours a day. It's a marathon-long therapy.There's so much time to get discouraged." On the

other hand, the improvement is significant formany of those who persevere with the program."The principles of TRT helped stabilize my ears.I'm back in the mainstream of my life," saysMalcore. Jastreboff notes that for his patients

with both hyperacusis and tinnitus, the symptom

of hyperacusis improves more quickly - usuallywithin six months.

The Future for Sound -Sensitive Patients

Malcore recalls hi s own unhappy "self-talk"that immediately followed the onset of his severehyperacusis: I am in a corner. I can't work. I missmy family. I miss my life. His perspective is now

16 Tinnitus 1bday/September 1998

one of optimism. "Compared to 20 years ago,there is so much hope for people with hyperacsis. Back then, things were bleak, but no moreMost of us don't have the ability to come back100%. But we all have the ability to come back

Sound desensitization protocols have chanover their few years in use, apparently for thebetter: the percentage of improved patients isclimbing. Experience still cautions us that no

single treatment can offer relief to all soundsensitive patients. However, for the tens of

thousands who were previously considered no

treatable, sound desensitization success is the

new hope and a growing reality. B

ReferencesGoldstein, Barbara. and Abraham Shulman: Tinnitushyperacusis and the loudness discomfort level test - apreliminary report. International Tinnitus Journal 2: pp. 83·1996.

Hall, James A.: Hyperacusis ..it's real and it can hurr. HearJournal, vol. 51: no. 4, Apri11998.

Hazell , Jonathan: Hypersensitivity of Hearing, Internet

posting, ww w.ucl .ac.uk/ "'rmijg101 /h ypl.htm, Nov. 30, 199

Jastreboff, Pawel, and Jonathan Hazell: A neurophysiologiapproach to tinnitus: clinical implications. British Journal oAudiology, 27 : pp. 7-17, 1993.

Marriage, J., and N. Barnes: Is central hyperacusis a sympof 5-Hydroxytryptamine (5-HT) dysfunc tion? Journal ofLaryngology and Otology,vol. 109: pp. 915 -921, 1995.

Reich, Gloria, and Susan Griest: A survey of hyperacusispatients. Proceedings of he Fourth lntemational TinnitusSeminar, Aran and Dauman, (eds.), pp. 249-253, 1992.

Rosenberg, Elliot: The eye as a model for understanding thdisability of hyperacusis. Hyperacusi$ Network newsletter,June 1995.

Vernon, Jack: Recruitment - when noise spells pain. TheVoice, June/July: 12-13, 1991

Vernon, Jack: Tteatment for hyperacusis. Hyperacusis NerwNewsletter, March 1998.

ResourcesPawel J. Jastreboff, Ph.D., Sc.D., University of MarylandTinnitus and Hyperacusis Center, 419 W. Redwood St. #360Baltimore, MD 21201-1734, 410/706-4339

Da n Malcore, The Hyperacusis Network, 444 Edgewood DrGreen Bay, WI 54302, 414/468-4667, [email protected]

Stephen M. Nagler, M.D., F.A.C.S., Southeastern

Comprehensive Tinnitus Center, 980 Johnson Ferry Rd. NE#760, Atlanta, GA 30342, 404/531-3979, [email protected]

Oregon Hearing Research Center, 3181 SW Sam Jackson PaRd., NRC04, Portland, OR 97201-3098, 503/494-8032,http:/ ww w.ohsu.edu.ohrc /

Jack A. Vernon, Ph.D., Oregon Health Sciences University,Oregon Hearing Research Center, 503/494-2187 (availablephone on Wednesdays, 9:30 a.m.-noon and 1:30 p.m.-4:30p.m.), [email protected]

Thanks to a generous grant from James L. S c h i l lthis article is available as a reprint. Reprints avaable free while supply lasts. Send $1 slh for onereprint, $3 s/h for five reprints to: ATA, P.O. Box

Portland, OR 97207-0005.



Can You Feel What I Hear?

An Audiological Perspectiveby Norma Rivera Mraz, M.A./CC·A

The relationship between the healer and thepatient has a major impact on the healing. We

know this scientifically and intuitively. The

human touch, for example, and expressions ofunderstanding and compassion have been

shown in numerous studies to be effective toolsin the healing process.We need only to think

back on our own lives torecall how a soothingword has eased a pain or

lessened a fear. I t istherefore important that

hearing health professionals communicate

wisely, compassionately,and accurately with

patients from the very

first meeting, whether

Norma RiveraMraz, M.A., CCC-A that communication

occurs by phone or inperson. Because we all form our first impressions in a matter of seconds, we as audiologistsmust be acutely aware o f - and ready to use -our abilities and power to build a healing rela

tionship at the very first meeting.Many people who experience illness or a dis

order like tinnitus automatically feel that no one

- especially their health care providers who donot have or have never had tinnitus themselves- can comprehend the magnitude of their pain

and suffering. If this were the case (which fortunately it is not), many of us in the hearing

health community would not be able to cultivatethe relationships necessary for positive, effectiveresults ·with patients.

When a t innitus patient is on the receivingend of empathy , I often hear them say, 11You can

feel what I hear!" They are amazed to learn that

I do no t have tinnitus and that even so, I genuinely understand the abyss they are in and the

despair and loneliness they are feeling. Whentinnitus patients come to you, know that they

will notice your professionalism and the degreeto which you care - even through all of their

confusion and concerns, even before they begin

to tell their story. They can see it and keenly

sense it.

Expressions of empathy can be easily communicated through body language - relaxed

posture, uncrossed arms, leaning forward to thepatient, and eye contact - steady and wari?,all executed naturally and without mechamcal

effort. Most health professionals are no t prepared

to offer this focused attention to their tinnitus

patients at every encounter, perhaps because of

tight schedules or other factors (like a b a ~ hair

day). But it is crucial that.we do so e a c ~ tuneand every time we come mto contact w1th our

tinnitus patients.

Another vital role the audiologist must play

is as an "active listener." Active listening is

absolutely necessary when working with andcounseling tinnitus patients and their families.I t is not a matter of parroting what your patients

say to you then nodding your head in responseto their comments. I t is instead hearing what

your patient is saying to you, taking those statements in compassionately just as you would dofor a close friend or family member who was in

distress. Active listening is another step in the

healing process, and it creates hope for the

future.

Tinnitus patients appear to have a height

ened sense of awareness of everything aboutthemselves and any change that might occur

within their bodies. Every word uttered by their

audiologists or their doctors takes on heightened

significance as well. For many patients, just

being told, "There's nothing we can do foryour tinnitus" can greatlydistort their sense of reali-ty and tragically their

peace of mind.Consequently, it is imper-

ative that we choose our

words and the overallmessage we wish to convey with precision.Negative comments, such

as "Go home and learn tolive "rith it," can sound

just as loud and intrusiveas any tinnitus signal.And besides, they havealready tried to live 'i\riththeir tinnitus and have found

Tinnitus 1bday/September 1998 17

•/



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Con You Fee/ What I Hear? (continued)

unfavorable results, hence their visit to your

clinic. Patients often feel like they are failures or

weak in character because they can't just "forgetit." I t is even more problematic when health

care providers fail to advise patients on how toaccomplish this daunting task.

What DO they need to hear from us i f we donot have the answer? How about, "There areoptions available elsewhere that can better

address your tinnitus issues. Unfortunatelythese options are not available at this clinic

today." Suggest other clinics, the ATA, theInternet. Tinnitus patients can easily accesstrue (and false) information, especially via the

Internet. But even true information can be

misinterpreted or misrepresented and can lead

individuals with tinnitus down a lonely and dismal road unnecessarily. Inform them that there

are viable treatments that work. Be a wealth of

good information. I t is not the audiologists' and

doctors' responsibili ty for tinnitus patients to ge t

better; but it is the audiologists' and doctors'responsibility to be a source of guidance forthese patients.

18 Ti nnitus 1bday/ September 1998

This paper is based on my professionalriences as an audiologist and the personal vsystem I bring to each of my patients. I am

gratified by the comments from my patient"You really do understand me and my tinniissues." "I thought no one could comprehenwhat was happening with me, especially i f

didn't experience tinnitus themselves." "Yospeak as if you've lived in my home." "Youdescribed me in great detail." "You are an oin the desert."

I have seen tinnitus patients begin to fereassured, educated, enlightened, and inviged because of the time and patience I've githem. Personally or professionally, it is onemy greatest achievements . IBl

Norma Rivera Mraz, M.A., CCC-A, is AssociaDirector of the Southeastern Comprehensive

Tinnitus Clinic, 980 Johnson Ferry Rd., N.E .,

Atlanta, GA 30342, 4041531-3979,norma@tinn. com, www. inn. com



A Self-Help Journey

by Carrol Jude

What does it take to start a Tinnitus Self-HelpGroup? Not as much as you might think. For me,i t was mainly the desire to help another human

being who might be walking in the shoes I'mweating.

December 10, 1995, 9:28a.m. I was going into arestaurant across from Wichita State University. I t

was cold that Sunday morning, but there was no

moisture on the ground or in the air. I went toreach for the door and the next thing I heard wasmy head cracking on the tile of the entrance.

Someone had mopped in front of the door and

with the temperature at 19 degrees, a thin sheet

of ice had formed on the tile. That was the

moment I became acquainted with tinnitus -severe tinnitus in both ears.

The story from here has been experienced bymany of you. I went to five doctors here in

Wichita an d was told "learn to hv e with it" by allof them. No testing was done because, they said,there was nothing that could be done about thetinnitus. Now, three years later, I have maskers in

both ears, an d I have rejoined society. For this Ithank God, the American Tinnitus Association,and Sam Hopmeier of the Hopmeier Hearing

Centers in St. Louis, Missouri.

I first contacted ATA in 1996 about starting aself-help group an d was sent a packet of helpful

information. I read through it, but my ears werestill screaming at me an d I was just not ready. In

1997, I got my maskers, then recontacted BarbaraThbachnick and she sent another packet. Still, Ihad no idea how to pull this off. I knew there

were other people in my community who had

tinnitus but I could not name anyone. I calledBarbara again and she said ATA would help me

get started by sending out information to approximately 300 other "tinnitus people" in my area.

Next I needed to find a place to have our

meetings. I had been working for Inter-FaithMinistries as a manager of the Emergency Over

flow Shel ter for the Homeless. I t was a temporaryjob for the winter. One day while I was in the

general office of Inter-Faith, I asked the

Executive Director, Sam Muyskens what I wouldhave to do to have an office for a tinnitus support

group in that building. Sam asked, "What is your

budget?" Budget, what budget? I knew I ha d tokeep looking.

In April, when taking my two-year-old granddaughter to the park, I passed by the Deaf an d

Hard of Hearing Center coincidentally across the

street from Inter-Faith Ministries. I went into the

hearing center and asked the secretary i f hey ha d

a space I could use for a tinnitus self-help group.The answer was yes, an d at no cost.

My next step was to call Barbara and give herthe location, date (May 7th) an d time. ATA and

Barbara did their jobs well. They made and

mailed the flyers an d sent me materials to hand

ou t to people who would attend the meetings. In

the meantime, I talked with other people in the

community who worked with hearing-impairedpeople.

May 7, 1998, 6:00p.m. I went to the Deaf and

Hard of Hearing Center an hour ahead of time to

get ready. When I arrived I was told there had

Carrol Jude

been a scheduling mix-upan d we would be sharing

the space with a group of

hearing-challengedchildren. Oh no! There

was only one thing to doan d that was to take my

group across the street to

Inter-Faith Ministries. Iwent over to IFM and

talked to Sam and KathyFreed, the Administrators,an d told them of my

predicament. Kathy said,"You're a staff member (I

had stayed on as a receptionist) so, yes, you can

use the building." I thought we might use thesmall staff room so I se t it up hoping I might have

ten people. I walked across the street an d there

waiting for me were 24 people who had been contacted by ATA. I was overwhelmed!! I asked them

to walk across the street with me to Inter-FaithMinistries just for that night. The staff room wastoo smal l so I marched them an down the hall tothe conference room and there we held ou r firsttinnitus self-help meeting.

From that evening on, my life changed againdue to my tinnitus. The most wonderful peopleare sharing in my life journey as I am sharing in

theirs. People had no hope coming into the firstmeeting for we had all gone to the same doctors.Everyone left with something that could help

them live a little better an d no one felt alone. It

was agreed that we would meet on the firstThursday of every month. Everyone wanted to

continue to meet at Inter-Faith Ministries, so thatwas that. I had the key.

In the days to follow I talked with Barbara,made plans for the next meeting and sent flyersout to everyone. Barbara saw to it that I was

Tinnitus 1bday/ September 1998 19



ASelf-Help Journey (continued)

named a contact person for ATA. People started

calling from other states. At this point the funding for flyers and materials was coming out of mypocket. I talked with a lo t of people on the phone

and sent literature to them.

At our next meeting, only five of us showedup . Oops! You know, we had a great meeting anyway - r ea l quality. And I realized what happened. I had not followed through. So, I got onthe phone and called everyone - even after the

fact! Most of them had just forgotten and the timehad slipped by. They said they would be at the

next meeting.

I called the local paper and asked if theywould be interested in doing a story on our tinnitus self-help group. The answer was yes. KarenSchideler came out from the Wichita Eagle with aphotographer. I was quite nervous about this but Igot through the interview easily because the photographer has tinnitus. Karen said they wouldprint the article close to our next meeting date.The Eagle came out with the article a week

before our meeting. In one week I had 68 phone

calls and the caUs have not let up. I also averageseveral visits a week from people who just walkinto the office.

For the next meeting, I sent out flyers, followed by post cards a week before and made

phone calls to everyone the day and eveningbefore the meeting. We had 30 attend.

July 9, 1998, 12:10 p.m. The newly-formedWichita Tinnitus Association became a member

of Inter-Faith Ministries, voted on by their Board

of Directors. We are now a non-profit 501 (c)(3organization with all the privileges (like photocopying and mailing services) of the Inter-FaMinistries. Now we are ready to move forward

If you think you want to start a group, sea

your soul. Then contact ATA and they will dothey can to help. Find yoursel f a place to meeand get on with it. 'Trust the process. Get the

word out any way you can. You will find a lothelp you didn't expect. Don't ge t discouragedthe group is small. Great things happen in smgroups! Make it interesting and make it fun. Iinvited a hypnotist to our last meeting and webecame the most relaxed people in Wichita. Fthe next meeting, Elmer Jennings, long-timesupport contact, will take over. This is not a owoman show. Delegate, delegate, and delegatsome more. I asked for donations last time an

the group was very glad to give.Silence is a problem for tinnitus victims, b

people's silence about their tinnitus is an evebigger problem. Thlk about your tinnitus becathe person you're talking to just might have titus too.

My personal motto in life is "Empower aner to move an inch." That's your job if you wa

to start a tinnitus self-help group. And when wempower others, we empower ourselves. Ia

Carrol Jude is an ATA support group leader and

founder of the new Wichita Tinnitus AssociatioShe can be contacted at 1030 N. Market #204,Wichita, KS 67214-2936, 316/ 264-8853.

New ATA Support Givers WELCOMThe volunteers listed here and hundreds of

others worldwide offer their time and talents as

telephone contacts and/or tinnitus support groupleaders. We couldn't do without them.

What would happen if you volunteered too?For starters, we would add your name, address,and telephone number to the Support ContactsList that we send to all ne w ATA members, then

marvel at our growing network. You would experience an increase in your knowledge base abouttinnitus. (People with the disorder are excellentteachers about it.) And you would receive gratitude from new acquaintances and, in some cases,

new friends - something you'd just have to l

to deal with!

If you are you interested, able, and ready

help, call 800/634-8978 or write to us for a freSupport Givers Packet. You can also access the

packet on our web site (www.ata.org) and appon-line. Click on "Tinnitus Self-Help/Support.

A huge thanks to our support networkpeople - veterans and current additions alike

When one is helping another, both are stro

- German proverb



Collectible Commemorates Quest for Silence

and Benefits ATA Cause

by Corky Stewart, Program Development Manager

Not thinking about the December holiday season yet? Well, we're not trying to rush you, but wedo want you to know about Silent Night 1998, avery special and highly collectible ornament that

is available - in limited quantity - right now.Designed to createawareness of the tinnitus

sufferer's quest forsilence, this exquisiteEuropean glass ornament was hand craftedin Poland and is the firstin a series of three limit

ed editions created entirely for the benefit ofATA

by Joy to The World Collectibles,." Inc.William Shatner, ATA Honorary Director, no t

only endorses the ornament, he participated in the

design. When told that the ATA staff wanted to useSilent Night as the theme, he immediately suggested an angel covering its ears and this year's pieceof art evolved. The 1999 and 2000 editions will be

variations on the concept, thereby increasing valueof the series to collectors.

Priced at $54 plus shipping and handling, each

boxed ornament includes an attractive card from

William Shatner. They can be ordered toll free by

calling 877-0RNAMENT 877 676-2636)and

are alsoavailable at Christmas shops, gift and collectiblesoutlets, catalogs, and other fine retailers nationwide. Th find a location near you, check the website: www.joyworldcollectibles.com

New Support Group Leaders

A very few of the ATA ornaments are "ultracollectible" because they have been autographedby Mr. Shatner to be used to raise further funds

for the fight agains t tinnitus . One of tbese "ultras"is offered through an on-line auction (www.joyworldcollectibles .com) . Another wilJ be the objectof spirited bidding at the November 21, J998 StarTrek Convention in Los Angeles ATA will alsoauction a signed ornament online; watch our website (www.ata.org) for details on that and other

special events .

Not a Web Surfer? Never mind- we've savedone of the autographed "ultras" for a mail-in,sealed-bid auction. The rules are simple: entries

must be postmarked no later than September 30,1998· all bids will remain sealed until the close of

I

the auction; highest offer above the minimumwins (earliest postmark will determine the winner

in case of duplicate bids); minimum bid is $1,000.Mail your name, address, daytime telephone number, and ATA ID number along with your taxdeductible bid (just the figure, not the money) toATA Ornament Auction, PO Box 5, Portland, OR97207-0005. The envelopes will be opened onOctober 5, and all participants will be immediately notified of the winning bid.

Remember that the number of ornaments

available is limited and that ATA will receive a

donation from every sale. Solve that search for aspecial gift or add to your own heirloom collection and help fund further tinnitus education andresearch by purchasing Silent Night 1998 today . B

New Telephone Contacts

Becky BlankenshipTouma Ear & Balance Center

1616 13th Ave. #100Huntington, WV 25701-1692304/522-8800

Susan V. Rezen, Ph.DWorcester State CollegeSpeech Language

Steven Mann23 Pequot Dr.Norwalk, CT 06855203/866-9405

Marl Quigley1161 Packers Cir.Thstin, CA 92780714/505-6861

Hearing Clinic486 Chandler St.Worcester, MA 01602508/929-8551

Linda Z. Gilk

1845 Palisades Dr.Carlsbad, CA 92008760/434-6688

Barry Whitesell

4410 Brookhaven Dr.Greensboro, NC 27406336/674-1885

H arry Larson

3015 18th St. SouthSt. Cloud1 MN 56301320/253-2160



Questions and Answers

by Jack A Vernon, Ph.D., Professor Emertus,

Oregon Health Sciences University

Before going to the questions, I would like tothank the tinnitus patients who have written to

us. I have said it many times in the past and willundoubtedly say i t many times in the future:everything we know about tinnitus has been

taught to us by tinnitus patients. Thus I am most

grateful to you all.

QMrs. H. from South Dakota informs us

that as a result of an air bag explosionshe has high-pitched tinnitus and high

frequency hearing loss. She has suffered loss of

concentration, loss of sleep, and loss of socialenjoyment. She asks if tinnitus produced by an

air bag explosion can be relieved with masking?

Andoubtedly you were exposed to a lot of

noise from the air bag, but you were alsoexposed to a violent pressure change. So

it's hard to know what is responsible for the tinnitus. We've found that tinnitus induced by noiseexposure is more readily relieved by masking

than is tinnitus induced by head trauma or medications. But it is never possible to predict in

advance i f masking will be successful. The only

way to find out is to actually try it and thatmeans to be fitted by a professional who is competent in fitting tinnitus maskers. You might getan idea of whether or not masking will work for

you by doing the "faucet test" (stand near afaucet of running water and listen for a reduc-tion in your tinnitus) . Since your tinnitus is bilateral i t is likely that masking devices will be

required in both ears.

Q

Mr. P from Kentucky indicate s that upon

ascent and descent in airplanes he is

temporarily deaf for a few moments .Would continuing to fly cause permanent hearing loss?

Aassume that what you experience is a

failure of the eustachian tubes to functionproperly and if that is so then it will no t

produce any permanent hearing loss . If it is amatter of pressure changes during take-off and

landing you can correct the problem by wearing

tightly fitted earplugs (foam plugs do nicely) forboth of these events.

QMs . W. from Ohio indicates that descin commercial flight produces pain in

ears. She asks if this result is due

to he r tinnitus? She also asks if the noise of a

turboprop plane could be a problem?

Ahe pain in the ears upon descent in

aircraft is most likely due to pressurechanges. During the majority of flight

aircraft are pressurized at a level of 6000 feetThus on descent if the pressure equalizationnot correctly controlled, one could experiencsome major pressure changes and that in tur

could cause pain in the ears. But no, it has n

ing to do with your tinnitus. See the answer

Mr. P from Kentucky for a corrective measur

As to the noise of the turboprop, earplugs mprovide sufficient protection but you may alswant to try active noise cancellation. Earplugprovide passive attenuation which is greater

high-pitched sounds than low-pitched soundsBut the active noise cancellation devices promore complete noise cancellation of low frequency sounds like those heard on planes. Flittle less than $200 you can obtain a ProActi3000 noise cancellation device. I t is sold by NCancellation Technologies, Inc., One Dock StSuite 300, Stamford, CT 06902, 203/961-0500.Write or call Ms. Donna McLevy, the salesmanager. The unit is sold with a two-week

money-back guarantee .

QMr. B. from New Hampshire has read

article abou t DMSO and tinnitus in thWorld Wide Encyclopedia ofNatural

Healing. The art icle claims that nine of 15patients treated with DMSO experienced tinnre lief. Mr. B. asks if he should try this treatm

Aou might have trouble obtaining DMS

That article was published in 1974 and

since then, the FDA has regulated tha

DMSO is only available to veterinary physicifor use with animals. (Somehow, though, sompatients are still able to acquire DMSO.) DMS

has the property of penetrating the skin with

imparting any damage to the skin and thus ioriginal use was to carry pain suppressors intaffected joints of arthritic patients. The 1974study cited could be faulted in that there was

mention of the tinnitus severity of the patien



selected for treatment and that unfortunately

there was no placebo-control group. Mr. B., I

would recommend that you try other treatments

and will gladly discuss this with you i f you are

interested. (Formore on DMSO,

see also"Alternative Therapies - Another Look" in the

December 1994 Tinnitus 'Ibday.)

QMr. L. from Minnesota writes that he

has experienced depression an d has had

tinnitus in his deaf left ear for many

years. He is currently taking St. John's Wortwhich to date has not helped his depression or

his tinnitus.

Ahave seen several patients who were

told that they were deaf in one or the

other ear. But all that means is that the

hearing is so impaired that the ear cannot profitfrom a hearing aid. Being able to hear and under-

stand speech from a hearing aid is vastly different from being able to successfully mask that

ear. J would encourage you to do the "faucet test"with the left ear pointing toward and near to the

sink. If the water sound has any suppression

effect at all on your tinnitus it is likely that awearable tinnitus instrument can provide some

relief for you. You indicate that until you became

a member ofATA you had not considered an ypossible connection between your t innitus and

your depression. Yet such a connection is very

common an d it might be possible to relieve your

depression if we can relieve your tinnitus. I t isclearly worth a try.

Also, if your depression is severe, it is not

likely that St. John's Wort will relieve it. On theother hand, if your depression is mild to moderate, then you could try the herb. (Give it at least

four weeks.)

Qnd A. Mrs. H. in Michigan writes to say

that the use of Evening Primrose Oil

(EPO) has completely relieved her pul

satile tinnitus . (Unfortunately she did not specifYthe dosage.) In 1982, Mrs. H. consulted an oto

laryngologist who informed her that her mild

hearing loss would progress to deafness in five

years if she did not have an operation he recom

mended. (He ignored the tinnitus problem.)

Mrs. H. did not have the operation and 16 years

later she hears as well as ever. In the ensuing

years her pulsatile tinnitus has returned several

times but each time it does, treatment with EPOhas always relieved it. Have any of you readers

with pulsatile tinnitus tried Evening PrimroseOil? I f so, please le t us know the results. I rec

ommendthat

patients with unrelievedpulsatiletinnitus contact Aristides Sismanis, M.D., in

Richmond, VA 804/786-3965). Not only is he

knowledgeable about this condition but he is avery compassionate and caring individual.

QMs. F. of North Carolina asks i f it is possible to cancel tinnitus with active noise

canceling devices.

As. F., these devices cancel external

sounds such as the drone of an aircraft or

other low-pitched environmental noises.

They achieve this cancellation by a set of microphones in the earphones that listen to the exter

nal sounds. The external noise is then fed intoan electronic circuit that analyzes the sound

wave and reverses it producing a completely

opposite sound which is played back against theincoming sound. This produces a cancellation of

both sounds. Technically, the cancellation is aphase reversal. Currently these devices are only

effective for sounds below 1500Hz. (The BoseCo. indicates that they are working on noise

cancellation technology that will cancel soundsup to 10,000 Hz.)

Now, can active noise canceling devicescancel tinnitus? The simple answer is no they

cannot, and for this reason: there is no actualsound in tinnitus (tinnitus is merely a soundlike perception - like the phantom limb phenomenon) and thus there is nothing physical tobe detected or played back against itself to effectcancellation.

Qr. B. in Illinois indicates that they have

two small fans running all night in theirchildrens' bedroom, because the fan

noise masks outside noises thus preventing disturbances of sleep. Mr. B. asks i f the fan noise

going all night long will ultimately damage his

children's hearing.

Acompliment you, Mr. B., for being sensi

tive to the hearing health of your chil

dren. I hope that same concern carries

over to that future time when they will be

tempted to attend amplified rock concerts.

Unless your fans are louder than any with



Guidelines for Writers

Tinnitus Tbday, the Journal of the

American Tinnitus Association welcomes submission of original articles about tinnitus and

related subjects. The articles selected for publi

cation are those that speak to an audienceof people with tinnitus, and to audiologists,otolaryngologists, otologists, hearing aid specialists, and other medical, legal, and governmental specialists with an interest in tinnitus.

Submit typewritten, double-spaced manuscripts on plain 81/zxll" paper with one-inch

margins all around. Include title; author(s)name(s) and biographical information; and,when appropriate, footnotes, references,legends for tables, figures, and other illustrations and photo captions. Our readers like to

"see" you. Please include a reproducible photo.Articles not exceeding 1500 words are preferred. If possible, submit manuscripts on 3.5"disk in WordPerfect 5.1 or higher format (PCcompatible).

Please do not submit previously publishedarticles unless permission has been obtained in

writing for their use in Tinnitus Tbday. ( P l e a sattach a copy of the written release to the artcle submitted.)

Include and sign the following release: "I

consideration of Tinnitus Tbday taking actionreviewing and editing my (our) submission,the author(s) undersigned hereby transfer(s)or otherwise convey(s) all copyright ownershto Tinnitus 7bday in the event that such work

published by Tinnitus Tbday."

Tinnitus 7bday also welcomes news items

interest to those with tinnitus and to tinnitus

health care providers, and information or

review copies of new publications in the fieldInclude your name, street and e-mail addresses, telephone and fax numbers, and those of

any others the editors might want to contactfor further information.

Please address all submissions or inquirieto: Editor, Tinnitus Tbday, P. 0. Box 5, PortlanOR 97207-0005.

Thank you for your consideration.

Questions and Answers (continued)

which I am familiar I seriously doubt that they

could cause any hearing impairment. However,

let's not guess. I recommend that you purchase

a sound level meter and measure the actualsound intensity of the fan noise. Radio Shacksells a small sound meter for about $35 which isamazingly accurate. With such a sound levelmeter, measure the intensity of the sound at thechildrens' ea r level. If the sound level is 85 dB

or more, that would be reason to purchase quieter fans. Otherwise, all is well.

Q Dr. S. from Hawaii writes to explain his

use of masking. He points out that sometimes the masking sound can become an

irritant even when it is preferred over the tinnitus sound. When this happens, he adds in theenvironmental sounds from the Marpac TSC 350

sound generator in order to effect "masking the

masker." Why, he asks, doesn't Starkey produce

the same sounds in their wearable maskers?

24 Tinnitus Thday/ September 1998

An some cases, a very high-pitched

tinnitus requires a very high-pitched(and unacceptable) sound to mask it.

Your invention of "masking the masker" is agreat idea and clearly another way to enhanc

the masking effect for patients with high

pitched tinnitus. Keep in mind that the masksignal does not always have to be at the sam

high frequency as the tinnitus signal to bringrelief. Only with proper testing can this be

determined.

Notice: Many ofyou have left messages requestithat I phone you. I simply cannot afford to meethose requests. Please feel free to call me on any

Wednesday, 9:30a.m. - noon and 1:30- 4:30p.m. 503/494-2187). Or mail your questions to:

Dr. Vernonc/o Tinnitus TodayAmerican Tinnitus AssociationPO Box 5

Portland, OR 97207-0005



SPECIAL DONORS AND TRIBUTES

ATA's Champions of Silence are a remarkablegroup of donors who have demonstrated their

commitment in the fight against tinnitus by

making a contribution or research donation of

$500 or more. Sponsors and Professional

Sponsors have contributed at the $100-$499 level.Research Donors have made research-restrictedcontributions in any amount up to $499.

acknowledged with an appropriate card to thehonoree or family of the honoree. The giftamount is never disclosed.

Our heartfelt thanks to all of these specialdonors!

All contributions to the American TinnitusAssociation are tax-deductible.

ATA's 'Tribute Fund is designated 100% forresearch. 1tibute contributions are promptly

GIFTS FROM 4-16 -98 to 7-15-98.~ · ~ Champions of Silence So l Charen Roben B. Horn Bruce K. Powell Ju dith K. Horning, M.A.

(Contributions of$500 Michael D. Childs Andrew Hrivnak, lf l Marceline Powell CCC·A

and above) Jean Cinader Gilben Hudson Otis D. Rackley, Jr., D.D.S. Martin H. Kulick, D.M.D.

Julia R. Amaral C. Dennis Clardy William H. Hurt Daniel D. Retchin David T. Malicke, D.O.

Peter D. Bonanno Bob Cobe H. June Ivins Jeffrey A. Ristlne Frank M. Melvin, M.D.

Robert Alvin Bowler Emory w. Cook Ray Jahn Jeffery A. Rbc Ernest E. Mhoon, Jr., M.D.

Joseph Decker Jack S. Cooley Thm Johnston Robert W. Roper Frank A. Skinner

John J. Delucca Capt. Thomas C. Crane, George C. Ju ilfs Lynn Rosemurgy Martin Smith

Joseph J. Demty USN, Ret. Harold S. Karpe Jennie E. K. Rosenblum Steven Strong. M.D.

Joel Garris, M.D. Robert H. Crittenden Emma L. Kellahcr Jo n M. Rundle Bradley S. Thedinger, M.D.Irene M. Glancey Roy W. Cronacher Stephen J. Kennedy Barbara L. Sanders Joseph B. Touma, M.D.

Seymour Greenstein Esther Cronson Dennis S. Kohara Esther Schoenfeld Ralph R. 1Yner, M.D.

Edmund J. Grossberg, CLU Sean Culkin Marvin Kowit Bruce Schommer J. Dan Weathers, M.D.

Norman Hascoe Eddie Cusheenberry Ronald T. Krasnitz William T. Schreitmueller Edwin F. Weaver, D.D.S.

W. F. Samuel Hopmeier, Martin L. Davidson E. Joseph Kubat Cindy SchtenCorporationswith

BC-HIS Marvin N, Demchick Susan R. Lallak Evelyn J . Schwenl

Gary P. Jacobson, Ph.D. Mary Ann Desutter Henry G. Largey Richard S. Shapiro Matching GiftsJohn Malcom Richard S. Dirkes Donald J. Larivee Robert J. Shapiro Boston Foundation/Polaroid

Bruce Martin Kathryn M. Dobrinski Fred R. Lawson John v. Shepherd, Sr. Fund

Steve Martin Charles Dolnick Rose Lee F'orrest Shook CitiCorp Foundation

Ray Matheny Robert E. Doran Jacques Leviant Michael Shorts Eastern Enterprises

Philip 0. Morton Jerry Down Gary w. Lightner Dawn T. Smith F'oundation

RJR Nabisco Irene Duffield Virginia A. Lobsinger Douglas H. Steves Equitable Foundation

Louise Parmley Joseph H. Eagan Philip J. Longo Lloyd Stockel Fannie Mae Foundation

Kenneth A. Preston Mary D. Eggers Catherine M. Lynd Barbara F. Sturtevant Hoechst Celanese

Dan Purjes A T. Evans Don Macaborski Richard W. Sullivan Foundation

N. Schaefer Jo y A. Fogarty Constantine J. Malfese Robert L. Szabo Johnson & Johnson

Martin F. Schmidt Francine and Ray Foster Peter A. Marrinan June M. Thblak J.P. Morgan Charitable Trust

James W. Soudriette Char Fowler Andy Matthiesen Harrison Thomas Millipore Foundation

Elsebeth S. Stryker Carol Fredrick Wayne E. Maxon William J. Tillman NGM Charitable F'oundation

Donald v. Thompson Arlene Friedman Mr. and Mrs. M. Richard James C. Thtten Pfizer

Jack A. Vernon, Ph.D. Robert F. Fuller May Elizabeth VanPatten Reader's Digest F'oundation

Patricia A. Zapp Robin R. Fuller Krist in E. McAbier Gary Yoyten US West Fou ndation

SponsorsRandall Gardner Romulus E. McCoy, Jr. Linda A. Wainhouse BequestsGerald Otis Gates Carol McCurdy Bernard J . Weber

(Individual Contributions Larry L. Gentry Angus McLeod Sheldon WeinigEstate of Irene M. Glancey

from S/00-$499) Dorothy E. Gilman Paul J. Meade David P. Wl1istler, Ph.D.TRIBUTESev. Alvin A. Andrus Bob Goodman Juerg Meng Henry J. Williams

Calvin Artke Gordon R. Goody Robert J. Mermuys David Winn In Memory OfElizabeth Bailey Marlene Greenebaum John M. Meyer James G. Winn Ken Berman's fatherJoseph M. Baria Elizabeth Grisbaum Bruce F. Meyers Robert E. Wolons Claire and Jacques SimonT. Larry Barnes Philip J. Gutentag Mildred Miller Brax Wright Lattie May BlytheEric Bartl1ell Paul R. Haas R. G. Miller Carter Wu rts Elaine E. BlantonNed K. and Jane L. John E. Hall Malt Minninger Paul W. Zerbst Sandy Delucca

Bartheltnas Larry E. Hall Perry Mitchell Richard D. Zujko, M.D. William ApostolidesDavid M. Banlert Thomas P. Hall Edward A. Moos Professional Sponsors Nancy CuccurulloSusan Bently Stephen C. Harris Robert E. Naser Deloitte & Touche, LLPSam Berkman Dorothea E. Haskins Sara Beall Neal

(Professional C o n t r i b u t i o n . ~ John J. Delucca

Deborah an d Charles Bern Charles B. Hauser Rober t Odiefrom $100-$499)

Steven F. GoldstoneRobert B. Berry Dennis D. Heindl Lawrence Ohmer

Natan Bauman, Ed.D.Norman Hascoe

William D. Bethell Heindl Family Foundation Julian M. OlfMarcus Boehm

Kenneth J. LapiejkoMary B. Bolen Harold J. Henderson Curtis S. Olson Constance Brown Hearing

John w. MacMurrayRichard A. Bolt William F. Hendren Phyllis R. Ongert

CenterCarol J. Makovich

Richard Bouthiette Elizabeth B. Hill Mark O'vyangMark Brumback, ACA

RJR NabiscoArt Bragg PatTicia Hines Allan F. Pacela, Sc.D., P.E. Linda A. Burba, M.S.,

Joseph PalumboCharles T. Brown Loren G. Hinkleman Harry J. Papajohn CCC·A

Thomas J. Pierce, Jr.William A. Burgin Lorraine Hizami v.tilJiam R. Patterson Lois N. Cohen, CSW, ACSW,

Ed G. RobertieUoTimothy P. Caire James R. Hoffman Phil R. Pearcy BCD

Huntley an d Lynne WitacreM. Cappelletti Construction, Thd Hofmeister Dow V Perry Norman Frankel, Ph.D.

Jason H. WrightInc. David G. Holmes Ron Perry W. F. Sa muel Hopmeier,

Arthur H irshberg's sisterBarbara Young Camp Julian Hoogstra Ja y L. Pomrenze BC·HIS

Claire and Jacques SimonPamela D. Chandler Max Horn Rob ert L. Pope

T in nitus Thday/September 1998 25



SPECIAL DONORS AND TRIBUTES (continu

Danny Isakson

Arlo and Phyllis NashRobert JanusMr. an d Mrs. John H.

Schleter

Lee J . Rowe

Thelma P. Batchelder

Hilda Sanford

Arlo an d Phyllis Nash

Martin L. an d Grita N.Schmidt

Martin F. Schmitd/Kate

Schmidt Moninger Fund

Phyllis Sharp

Mr. an d Mrs. John H.

Schleter

Max Spickel

Lena Clapham

Alfredo ThtiSouth Jersey Tinnitus

Support Group

In Honor OfErnest Auer

(Happy Father's Day)

Patrice Auer

Marion carver(35th anniversary of

E A R Services)

Dorothy Muto-Coleman.

M.A.Ralph Dawson

(90th birthday of myfather-in-law)

Donald E. Nace

Sherman Devitt

(For being a thought·

fu l cousin)

Charles M. SelsbergDavid an d Pearl

Greenberg

(50th Wedding

Anniversary)

Judith Pilz

Alfred an d Doris SchwartzJack Harary

(Happy Father's Day)

Mike. Cindy, & Adrian

Harary

Dr. Jack A. Vernon

Jack Salerno

Barry Whitesell

(Our son)

Mr. an d Mrs. E.D.Whitesell, Jr.

Research DonorsJames AdamsJoel Alexander

Earl W. Alvord, Jr.Dennis B. Anderson

Sally A. Anderson

Georgina Arbing

Frank Amal

Mary ArnoldCalvin Artke

Adelle H. Ausburn

Mary AustinLorraine L. Bachmann

Claire U. Bagley

Christine B. BakerDoloris w. Baker

Eileen F. BarretteTheodore w. Sayler

Peter B. Baylinson

Ida J. Beebe

Susan BentlyHoward G. Bernett

Jeanne B. Betcher

Lorraine E. Bieber

Jerome V. Biodolillo

Jackie w. BishopJean A. BlackSusan Black

Mildred S. Bom.,.itLouis G. BougieSt Antoinette BoykinEleanor P. BoyleMildred L. Bramley

Carol J . Branscomb

Elaine F. BrodeyCorrine Bmoks

Harry A. Bruhn

Ernest J. BucklesLewis BullardPatricia L. Buntele

Michael W. Burnham

Joan K. Bynaglc

Kelyne Campbeli-

'TbvmsendThrry R. Canter

Faye Cartmell

Mark A. CashEllis CaudillEdwin R. Chapman

Howard C. Chase

David and Debra Chatfield

Mildred Cherry

Susan P. Chizeck

Charles F. Clark

Mary L. CollinsElizabeth A. Conyers

Marilyn G. Cooperman

Eileen T. Corcoran

Esther Cronson

Richard J. D'AmbrosioCarl D'AquinoTheodore A. Dahlstrom, J t

William Michael Daniels

Fabio Romeiro

DealbuquerqueBarbara S. Derick

Rubye M. Dewitt

Rosa an d William Dixon

Ed Dobrinski

Cynthia A. DodsT. James Donnelly

Shirley DorazioAnne M. Dranginis, Ph.D.Marlene Drescher

Dr. George M. Drew

Virginia M. Dublanc

Charles B. EfirdMiriam EidlitzAda Eisenberg

Wayne Engel

Lawrence R. England, Jr.Laura R. Enright

Charlotte EricksonRon an d Joyce Evans

John 0 . Felt

Kathleen A. FerelloVirginia K. Fish

Leonard M. Fisher

Johnston K. FiteDonald FlachHarry Floersheim

Susan E. FoilesDolores S. FoleyRichard Fowler

Thllervo Frankel

26 Tinnitus 'Ibday/September 1998

Rhea FriedViola L. FuchsJames H. Fulcher

Nancy E. GalezaStephen P. Gazzera

Dr. Arthur Gelb

Mark S. Geller

Jennifer Gerhard

James GiordanoHowell R. Gnau

Barry S. GoldbergLinda B. Goodwin

Donna M. Graves

Jeannette E. Green

Dr. Judith L. Green

Judy A. GriffinRalph Gugeler

John Haleston

Norma M. Hammerberg

Michael P. Hanson

Penny Harmening

Don Heinz

Jeff Hellman

Ida G. Hibbard

E. Alan Hildstrom

John L. Hilgers

Roland F. HirschThd Hofmeister

Kay Hoiby-GriepW.F. Samuel Hopmeier, BC-

HlS

Mary Kay Horner

Chet Hosac

Robert K. Hoy

Jack Huang

RDsa Huang

E. C. Huckabee

Rachel Hudock

Gilbert Hudson

Donald E. Huebl

Janet v. Hughes

Nathan V. lyer

Ann Jackson

Perry Jamieson

Roger JohnstonBarry Jordan

George Joseph

R. L. Kcheley

Donald J. KellenbergerJoseph Kel lnerFrank L. Kellogg, Jr.

Robert A. Kirkman

Waldemar Kissel, Jr.

Roberta KitzmillerFrank V. KoenigSteve M. Konneman

Egon Kot, BC-HIS, FNAOJeffrey Kot, M.A.Gloria J. Koz1oskyVirginia C. Kuehner

Joseph A. Kuhn

Gary J. Kutzler

Erna LadageJerry J. LaForgia

Susan R. LallakNeil Lambert

Judith LarsonJeannette Lawrence

Arthur LaxerMarjorie Lazarus

Marilyn LeggFrederick S. Leimer

Stanley D. LevinCharles B. Levitin

Harry Levitt, Ph.D.

David LongAgnes Longtin

lnna Lorents

Fay J. LouieErnest A. LucciNick Luis

Anthony C. Lunn

Robert G. Lyon

Don Macaborski

Dan R. Malcore

Grace P. Maresca

Carol A. Markey

Gregory P. Markowiec

Lillian P. Markowitz

Julianne Mattimore

Robert L. Mauer

Wayne E. Maxon

Helen l. May

Edward MazzaJohnathon R. McCartney

Harold Mechanic

Ruth L. Meier

Carol A. MeiseNick Mendoza

Annette Meskin

Gary Mitchell

Craig G. MoffatPatricia A. MooreVirginia C. MorettiJulie Morin

Mr. an d Mrs. James G.

Mulhern

Betty Murray

Emogene Myers

Mae Nachman

Ian L. Natkin

Shoshana Noily'furry 0. NorrisDonald G. O'Brien, Sr.

William D. Odbert

Sally M. Oldham

Robert OroszLeonard J. PacificoKathleen Pacini

Jeffrey PaukerReginald J. Pearce

Ronald G. Pearson

'Ibm Pechtel

Milton Pentzer

Sara J. Peters

Linda M. Peterson

Shirley PeytonJudith Phillips

Susan G. PhillipsDorothy D. PiersonMarjorie M. Piscopo

Elaine T. PlattMichael M. Platt

Robert D. PoetaPam Pratt

Norma Price

Raymond w. Pritzke

Muriel S. QuintalMichael ReindlDonald L. Reinking

Charles R. Renegar

Gerald B. Rcnyer

Vernon T. RichardsSteve Richardson

l.ollv Rieken

Kydeen RiddleLoretta M. RoseMatthew P. RossGemma M. Rozich

Ron Ruda

Ruby L. RutherfordMike RutlandJuanita A. RyanMaria K. Sadlowska

Grace Sanders

Rae L. Savett

Edward Saydeh

Edna Schachter

Carol A. ScheiderDawn Schoenholz, Ph.Gus Schwandt

William Schwartz

Arlan R. Schwoyer

Thacy J. Sciandra

Cary Setzer

Norma T. Sheld

Wendy Shenker

Brooksie SilvaKatherine L. Simmons

Raymond C. Simon

Thomas J. SimsThelma M. SjostromLinda M. Slater

Jerry M. Smalley

Regina P. Smith

Walter A. Snell

.John SouroumanisDavid D. SouzaLaura J. Spear

Elizabeth H. Spencer

Harvey Spivack

Ed and Annetta St. ClaJames L. Stewart

Janet M. Stramaglia

Ernest E. Strickland

Richard W. SullivanGwendolyn D. Theriot

David Thomas

Greg Thompson, M.D.Joyce A. Thompson

Beth Ann Thompson

Gregory Thrner

Jan Vanroessel

Melvin J. Veldhuizen

Michael VucelichCarol WalkerJi m Walker

Walter W. Walker

John M. WardellWilliam K. Warren, Jr.William Warren

Foundation

Manha E. WayteWilliam J. and Sally J.

WebbDeanne L. Weir

Charles A. WellsJeane K. Wheeler

Frank Whitelam

Lawrence S. WickBarry WilliamsLev D. Willis, Jr.

Wendi WilsonGloria W. Wingfield

Sh irley L. Wireman

Dorothy A. WiseWilliam A. Yost. Ph.D.Mary Zakarian

Doris D. ZerbyFrederick B. ZOokFlorence Zuchowski



"Silent Night 1998"ce- European Glass Ornament to benefit ATA &>

Endorsed by William Shatner, ATA Honorary Director

Limited Edition(See page 20 inside)

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Tinnitus Today September 1998 Vol 23, No 3