VOLUME 5, NO.

3, JULY 1980
THE AMERICAN TINNITUS ASSOCIATION
POINT OF VIEW
by Robert E. Sand.Un, Ph. D.
Bob Sandlin is the Dir>eator of the San Diego Tinnitus
Labor>ator>y . He has been an instr>uator> for> the ATA
Tinnitus Wor>kshop aour>ses and is a member> of the ATA
MediaaZ Advisory Board.
As a member of the t1ed i ca 1 Advisory Board of the
A.T.A. it has been my distinct pleasure to observe, over
tt.c past few years, that which has transpired. While my
may very well be tempered by my affection for those
direct the course which the A. T. A. has pursued, it
none t he less may reflect the current status of the
tinnitus program.
There is no doubt in my thinking that the A. T. A.
has been responsible for the significant, renewed interest
in tl1ose human problems associated with tinnitus. The
several press releases, coupled with the research and
workshop activities by the association, have brought to
the attention of many persons the existence of, and
problems resulting from, tinnitus.
The general guidance of the A.T.A. by Robert Hocks, National Chairman of the A.T.A., and the more
recent contributions of Dr. Robert Johnson, have enhanced the importance of the A.T.A. and highlighted
the work remaining to be done. (Other than creating general public awareness of this often debilitating
disorder, the A.T.A., through the singular efforts of Or. Jack Vernon, developed the first wearable
masking device which promised relief to many suffering from tinnitus.)
When one reviews the challanges presented by tinnitus and the subsequent treatment programs for this
disorder, there emerge two distinct models of patient management; the medical and the non-medical.
Implicit within the medical model must be the possibility of a cure. Equally as captivating within
this medical model, is the probability of an effective treatment program. Unfortunately, the vagaries of
this disorder have prevented, or at least impeded significantly, the emergence of a cure. There does not
appear, at this writing, to be a general consensus of that which must be investigated to effect a cure.
Whether one pursues the investigative efforts through medication or surgical procedures, there has not
yet evolved a process, which when accomplished, results in the absolute elimination of ongoing tinnitus.
That is to say, no one procedure guarantees absolutely that tinnitus will be cured.
From a treatment point of view, the medical model includes within its clinical armamentarium the
use of various therapeutic regimens. For example, anticonvulsant drugs have been employed yielding
limited results in providing relief from tinnitus. The use of anesthetic agents, particularly lidocaine
(a member of the procain group) has proven to be most beneficial to some who have served as willing
subjects. More recently, oral lidocaine has been used, on a research oriented basis, to determine its
effectiveness in providing relief from subjective tinnitus. Biofeedback, while not necessarily restricted
to medica l practice, has been used to modify the subjective awareness of tinnitus or the patient's
emotional and psychological reactions to it. For some, biofeedback has proven to be effective in
providing varying degrees of relief. Obviously, these are only a few of the many programs of medical
intervention that have been studied. Some have been sufficiently compelling to warrant continued
investigation, while others have been abandoned in favor of more promising programs.
The apparent benefit of these inquiries, especially the more recent ones, is the awareness that
tinnitus does constitute a significant problem for a great many individuals and that medical interest in
resolving that problem is high. One would hope that continued investigation will yield significant
benefit to the tinnitus patient. (aontinued inside)
POINT OF VIEW continued
From a non-medical management point of view,
the main thrust has been to provide a treatment
program which reduces, appreciably, the untoward
reactions to ongoing tinnitus. While there have
a number of management models proposed,
with some currently being utilized, the use of
the tinnitus masker would seem to be chief
among them.
The obvious advantages of "masking" have
long been recognized as a means by which the
tinnitus patient could find relief from the
persistence of their head noises . It is not
unusual for a patient to rep0rt that he or she
often seeks "noisy" environments to drown out,
as it were, the awareness of the ongoing tin-
nitus. The primary contribution of the A.T.A.,
beyond that of contributing to the public
awareness of the problem, has been the develop-
ment and subsequent investigation of masker
effectiveness.
Although, from a clinical point of view,
the masker has been an effective device for a
number of individuals, the frustrating and
perplexing fact remains that the reasons for
success or failure are not clearly understood.
As an example, let us consider two patients who
have similar hearing losses and report the
presence of tinnitus. Let us assume further
that the diagnostic evaluation suggests tin-
nitus of similar origin as well as similar
frequency and intensity values .
In one instance, the patient responded
positively to the masker device and preferred
the presence of a narrow band of noise over the
ongoing tinnitus. Further, there was signifi-
cant residual inhibition after a period of
masker use. In the other instance, the patient
responded to the masker device most negatively
2
stating that the narrow noise band was as
disconcerting as the ongoing tinnitus. Addition-
ally, residual inhibition could not be measured,
even after a prolonged evaluation period .
What is important here is the uncertain
outcomes with masker devices. We simply do not
have enough data, or we are lacking in sufficient
diagnostic sophistication at this point, to
predict probable outcomes of masker device use .
Further complicating the issue of effective
patient management is the obvious recognition of
the fact that we don't thoroughly understand the
neural generators of subjective tinnitus . One
is not certain if the problem is within the
inner ear, somewhere along the ascending
auditory pathway, or even if the awareness of
tinnitus is related necessarily to the auditory
system, even though tinnitus is perceived as an
ever present and persistant acoustic sensation.
As an example of the complexity and per-
plexity of the problems associated with effective
and conscientious patient management, consider
the patients who have tinnitus in each ear. In
some, presenting with the bilateral complaint,
a single masker device to either ear will mask
effectively the ongoing tinnitus. For others
with a similar complaint, masking must be
applied to each ear to completely "cover" the
ongoing tinnitus. To complicate matters some-
what further, there are those patients having
a ringing or "hissing" tinnitus for whom a
masker device will not mask the ongoing problem,
even though, from a diagnostic point of view,
the tinnitus differs little from that reported
by a patient who can be,(or has been), success-
fully masked.
It is not the intent of this report to
indict or discredit the use of the masker
device . Quite the contrary is the case, I'm
most impressed with the success of the masker
device for the many patients whom we have seen.
I'm impressed, equally, with the technological
advance in masker design which permits the
practicioner to more finely adjust the response
of the device to the specific needs of the
tinnitus patient.
There is a need, in the scheme of things,
to pause occasionally and look at where we are,
where we have been and where we are going.
There is no doubt, both from a medical and non-
medical management point of view that what we
have been engaged in over the past few years is
an exciting, intellectual and clinical venture.
Each patient management scheme clearly reflects
the renewed interest in resolving those human
problems associated with persistant, subjective
tinnitus. New drugs have held promise, for the
most part. New advances in masker devices por-
tend an effective increase in the number of
successful patient fittings.
However at the moment, we would appear to
be in a state of indecision. That is, where do
we move next? What changes in diagnostic or
therapeutic approaches would permit predictable
outcomes? From the existing data, we pretty
much have a handle on the number of patients who
may have some degree of tinnitus. We are
reasonably aware of the incidence of tinnitus
among male and female patients. We are fairly
secure in our knowledge as to the subjective
frequency (pitch) and intensity (loudness)
of an individual's ongoing tinnitus. We profess
to be reasonably certain that the vast majority
of tinnitus sufferers can be effectively masked.
On the other hand, we are equally uncertain as
to why masking does not occur for some. We are
conscious that the masker device is rejected by
many even though effective masking of the
tinnitus is apparent.
Much has been accomplished over the past
few years which has produced useful and clini-
cally applicable information. Where we are now
__ l:c. . n:..__; thi s of thi nos" reflects the exce ll.eni_
work undertaken and accomplished by the A. T.A.
staff. From needed publications to effective
workshops, the A.T.A. has made significant
contributions.
The question remains, "Where do we go from
here?" This, hopefully, is not a rhetorical
question, but one usggesting the necessity to do
more. To find answers is of paramount impor-
tance. The challenges, as awesome as they may
appear, are there and need to be faced head on
and dealt with intelligently.
Although my crystal ball is no clearer
than others, I see a need to analyze existing
data to find what new directions we should take.
I see a need to generate a new set of data based
upon questions suggested by analysis of exist-
ing data. There is a strong need to mount a
multi-disciplinary effort to establish common
ground so that patients can be directed to the
most appropriate course of treatment. There
is a need to develop an agreed upon method of
clinical measurement from which emerges the best
method of patient assessment and management.
There is a need for advances in technological
applications to deal with the disorder effec-
tively. There is a need to undertake these
things without interdisiplinary haggling over
who should do what, to whom, and for what
purpose.
In the final analysis there is a need for
funds with which to conduct the needed inves-
tigations. In my view, admittedly a biased one,
the A.T.A. is in a unique position to assume
leadership. Its avowed purpose (reason d'etre)
is to deal exclusively with problems of tinnitus,
its causes, cures, and treatment. The tasks be-
fore it are monumental and of sufficient magni-
tude to test the mettle of even the most
vigorous researcher .
Perhaps, then, this paper serves as a plea
for support of the A. T.A. It matters little
POINT OF VIEW continued
whether this support comes from state or federal
agencies granting funds for research or from
individual and private contributions. It is
important that the activities of che American
Tinnitus Association not be terminated but
continue as vigorous and energetic programs
which may contribute to unravel ing the mystery
of tinnitus. Your individual support would
further that intent.
LETTERS, LETTERS ....
Many of the Zetters which are received at
the American Tinnitus Association office
are interesting. Some of them are so
expressive that they communicate the dis t ress
by the tinni tus patient. We will share
with you some of these Zetters in this column.
Letters are only pr inted wi th the permissi on
of the author.
To It Concerns:
I would appreciate more information
regarding your work and findings with tinnitus
as I am an 11 year sufferer of this problem.
The ringing started after a hand grenade explo-
sion about 6 feet away in Vietnam, and I have
had it ever since. I am on a 10% di sability
for this problem, but I'd be glad to get rid of
the disability check if the problem could be
done away with. I guess part of why this ring-
ing particularly bothers me is that the hand
grenades that exploded were carried by a wounded
Vietnamese(tlorth) soldier that I had just shot
20 rounds into during a "clean-up" operation
after an ambush. My bullets, which killed him,
also caused the hand grenades to explode. So
for the past 11 years I have had a constant
reminder of a foolish action, which also was an
act of inhumanity against another human being.
What I would like to know is if you ever
have had veterans receive assistance from the
VA in seeking relief under your program? If so,
how would I go about this? Thank you for your
assistance.
Respectfully yours,
Basil B. Clark
A number of VA Medical Centers are i n t he
process of setting up procedures for tinnitus
and treatment . Veterans with the
should contact their Zoc:al VA to obtain
more inf ormation.
UO YOU KNOW SOMEONE WHO HAS TINNITUS AND
WOULD LIKE TO RECEIVE OUR NEWSLETTER?

Address -----------------------
State. _ ___________ Zi pcode __ _
NEW BROCHURE NOW AVAILABLE
TINNITUS FOLLOW-UP
by GLoria E. Reich
Executive Director, A. T. A.
RESULTS OF A QUESTIONNAIRE THAT WAS INCLUDED
IN THE JANUARY 1980, NEWSLETTER.
This questionnaire was an attempt to determine
whether the information we send out is being
used. Secondly, it was an attempt to evaluate
the results of tinnitus treatments over a diverse
population group.
417 persons responded to our questionnaire. Of
those responding, 269 had contacted someone on
the ATA ref err a 1 1 i st. i'lost of those who were
contacted did seem to be actively working with
tinnitus patients. The next question, " Were
you tested to determine the pitch and loudness of
your tinnitus?", however, was answered by only
164 of those responding. Of these 164, 155 were
male. This was a significant difference in the
total responses and especially in the female
responses which leads us to question whether the
patient's complaint was actually evaluated.
Treatments were recommended to most patients,
even to those who not tested, and consisted
of:
t1askers 41%
Hearing Aids 20%
Tinnitus Instruments 10%
Biofeedback 6%
Drugs 16%
Other 7%
About 80% of the patients utilized the treatments
that recommended and of these 41% were
improved while 44% reported no change and 15%
were worse. Of the patients who utjlized some
kind of masking treatment the overall figures
v1ere 56% improved, 33% no change and 6% worse.
It v1as unclear whether the respondents who
reported no change meant no change while wearing
the or no change when the masker was off.
A hearing aid, for instance, would be expected to
provide some masking relief for tinnitus but only
during the time it is actually in use.
Our questionnaire results compare favorably with
followup studies of controlled patient populations
in specific clinics. Because we sampled a much
greater population who had received a great variety
of treatments we feel that our study shows that
the information program is successful. ATA will
continue to provide information and referral to
tinnitus patients and information and education
to the hearing professional.
ATA is currently in the process of purging and
updating its referral list. If you are presently
on this list and have not responded to our recent
letter, you will be removed. Patients who wish
to receive a current list of places and/or
persons whom they may contact about their tinnitus
may send a self addressed stamped envelope with
the notation "REFERRAL LIST" written on the front
and we will be happy to send one to you. Please
hold these requests until September when the list
revisions will have been completed.
INFORMATION ABOUT TINNITUS, a new brochure from ATA containing facts about tinnitus is now available fo1
maiLing. This is a 3- 1/2" x 8- 1/2", 6 panel brochure, designed to fit into a number 10 envelope . These
br>ochures wiU also fit into the "Ringi ng i n the E:ars?" post er for> office d1:stribution. The new
brochur>es, whi ch ar>e tan in color, will not replace the orange ATA brochures but do offer more information
about tinni tus for the patient . There be a small charge for defraying the cost of printing and mailing.
Quantities of the brochur>es may be or>dered f rom ATA at $. 05 per copy plus . 50 postage up to copies, and $1 .
for 50 to zoe copies .
TELL ME, DOCTOR . . .
In thi s issue Jack Vernon responds to
questions whiah have been reaeived from
patients who have wr itten to t he "Mailbag-
Questions" sinae the Zast Newslett;er.
Q. "I have been told that under the Federal
Employees' Compensation Act tinnitus is not a
compensable injury. This might come under
Section Sl07(c) (13). Do you know if this is
accurate? Also, do you know of any legisl at i on
being considered that wou l d amend the Act to
incl ude tinnitus for compensation?"
A. No knowledge here but predict t hat
compensation will depend upon objecti ve evidence
whi ch to date is not avai l able.
Q. The patient ' s t i nnitus, which is usua lly quite
bearable and low grade, becomes extremely prom-
inent when he becomes fatigued . With adequate
r est, it gets better. "Oo you have any suggestions?"
ATA STARTS TRIBUTE FUND
by Trudy Druaker, Ph. D., Editorial Consultant to ATA
A. Clear ly this pat i ent shoul d not become fatigued.
I wou l d suggest having blood pressure carefull y
checked as thi s may be the underlying cause.
Q. The patient has norma l hearing in t he 250-2000 Hz .
range yet feel s that because of tinnitus he cannot
hear sounds in thi s range as well as the average
person wit hout t inni tus. "Does the audiogram t ell
t he whole story, or i s i t possibl e I really do have
l ess t han average abi l i ty to hear t hese sounds?"
A. No , the tinnitus itself probably does not
interfer e wi t h speech r eception - most likely it is
t he distraction of t he t innitus which interferes
with attention .
Q. "Has acupuncture been i nvestigated as a poss ible
treatment of t i nnitus? I have become aware of acu-
puncture through Chinese friends. Any information
concerning acupuncture woul d be deeply appr eciated . "
A. No documented cases of where controlled studies
have been conducted using acupuncture. There are
some few r epor ts of help which might have been due
to something else.
The American Tinni tus Associ ation is happy to announce format ion of its new Tribute Fund. Ma ny of you have
already received Tribute Fund Booklets , and we hope you wi l l use t hem often. They serve a doubl e purpose:
you can honor or commemorate someone who is important to you and at t he same t ime make a donation i n any
amount you wish to the ATA.
Al l funds from t hi s project wi ll be used exclusi vely for research i nto causes and cures of t inni tus. Your
donation is tax deductible. The amount you donate wil l not be mentioned i n t he card we send to your rel ative
or friend unless you ask us to do so. ---
If you haven't gotten your Tribute Fund bookl et yet, pl ease ask for one. You ' l l enj oy using it! And you'll
be doing lots of good d e e ~ s ! (Editors note: Beaause of l aak of spaae,the list of tribut es reaei ved will
appear in the next NeW'! letter. J
ANNUAL CONTRIBUTION I AMERICAN TINNITUS ASSOCI ATION
Regular Member $10 or more Professional Member $100 or more
Benefactor $500 or more Sustaining Member $25 or more
Published by the
AMERICAN TINNITUS ASSOCIATION
A privat e non-profit corporation
under the l aws of Oregon
Robert W. Hocks ... National Chairman
Glori a E. Reich .. Execut ive Director
IIEOICAL ADVISORY SOARD
ROGER SOLES, M.D.
San Francisco. Cal iforni a
HOIIARO P. HOUSE , H. D.
los Al'lgeles , Ca l iforn i a
ROSERT 1\. JOHNSON, Ph. D.
Pon. I ;lnd. O,.egon
MERLE LAWRENCE, Ph. D.
Ann Ar'bor, Hi ,hi gan
JERRY NORTHERN, Ph. D.
Derwer , Colorado
GUNNAR 0 . PROUD, 1\, D.
Kansas Ci ty , Kansas
GEORGE F. REED. M. 0.
Syracuse , !few Yor'k
ROBERT SANDLIN, Ph . D.
San Diego, Californi a
HAROLD G. TA.SB, M. D.
Hew Or l eans , Loui siana
ADVI SORY BOARD
HONORABLE OEL CLAWSON
Uni t ed States
House of Representat i ve$
DAVI D D. DeWEESE, H.D.
Ponland , Or'egon
HONOAASLE HARk HATFI ELD
Un i ted Sta te $ Senate
ROBERT W. HOCXS
Port l and , Oregon
CHARLES UNIC, M.D.
Downey , Ca 11 forn i a
YOUR GIFT IS TAX DEDUCTIBLE
The American Ti nnitus Associat ion
Post Office Box 5
Portland, Oregon 97207
(503) 248-9985
Non-Profit Organ.
U.S. Postage
PAID
Permit No. 1792
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