VOLUME 7, NUMBER 1, MARCH 1982

THE AMERICAN TINNITUS ASSOCIATION

BOOK REVIEW
TINNITUS: CIBA FOUNDATION SYMPOSIUM 85, ed. David
Evered and Geralyn Lawrenson. London: Pitman, 1981.
Reviewed by Trudy Drucker
Ten years ago, when the American Tinnitus
Association was the fragment of an idea in the minds
of Charles Unice and Jack Vernon, it was hard to find
articles about tinnitus and hard to find physicians
who knew much or seemed to care much. Patients were
either misdiagnosed and subjected to much iatrogenic
misery, or they were sent away with a breezy
conclusion that the ear noise was a hopeless and
trivial condition that one could easily learn to live
with. With such dramatic, life-breaking problems as
cancer, heart disease, and mental illness to occupy
the attention of the medical establishment and the
public, who wanted to bother with "Just a little
noise"? Fortunately a handful of skilled audiological
scientists, Vernon notably among them, was indeed very
willing to bother.
Publication of two books on tinnitus (the
other is Proceedings of the First International
Tinnitus Seminar from London) in a sense celebrates
the progress of a decade that brought into existence
dozens of tinnitus clinics, many fine articles in the
medical and the lay press, and a means of treatment
(masking) that really helps about two of every three
patients who try it. More important even than all
this is the fact that seven million (at least)
American victims of tinnitus are now much more likely
to be taken seriously and managed rationally.
Research always precedes treatment, and in
Tinnitus many important research-related problems are
carefully examined. What is tinnitus and who gets it?
Douek sums up the various methods of classifying
tinnitus, concluding, as do his colleagues, that no
satisfactory system exists now. Too many unknown
physical and psychological variables cloud diagnoses.
A group of scientists at the Institute of Hearing
Research in England is conducting an epidemiological
study that might confirm significant correlations
between, for example, tinnitus and noise or tinnitus
and age . According to Graham, children with hearing
loss exhibit a considerable incidence of tinnitus.
Oddly, most children report their tinnitus as
intermittent whereas most adults report it as
constant. Hazell used electric audiometry, among
other modalities, to develop a very sophisticated
protocol for measuring tinnitus (including, of course,
pitch and loudness) and it remains to be seen if these
precise results will be significant clinically.
continued on page 2
$
We Need
Your Money I!!
The American Tinnitus Association is entirely
supported by private donations. He cannot afford to
send you a separate billing, nor do we think you would
want us to spend your money that way, so please
consider this your reminder that a contribution is in
order.
ATA does not have federal, state or local
government support. He are not part of a University
or any other group. We provide information,
education, referral and research services for over
40,000 people. We cannot do this job without your
support. We are proud to stand on our record of the
last ten years and will continue to do all in our
power to promote research for a cure for this
distressing afflict ion. Please allow us to continue
our work. This means that all of us must contribute.
~ THANK YOU.
Tinnitus continued
Investigation of acoustic and auditory
phenomena has been greatly stimulated recently by
development of extremely complex instrumentation.
Kemp studied minute spontaneous mechanical vibrations
within the cochlea as a possible source of tinnitus,
and he was able to associate these events with a few
eases of mild pure-tone tinnitus. Possibly this
mechanical factor is present also in some of the more
severe cases. According to Wilsoo and Sutton, types
of acoustic emission can be picked up externally and
the properties of these cochlear-echo phenomena are
clues to the mechanism of cochlear tinnitus, the
commonest type and the type most easily identified and
masked. Berlin and Shearer studied electrophysiologic
simulation with the expectation, not realized, that
specific reproducible brains tem phenomena could be
identified. Experiments in animals dosed with
ototoxic levels of noise or salicylates suggest,
according to Evans, Wilson, and Borerwe, that
overactivity rather than depression of cochlear nerve
fibers might be the underlying pathology of some types
of tinnitus.
A general discussion of factors that
predispose to tinnitus or exacerbate it summarizes a
good deal of well-known (but not always
well-disseminated) information. For example, it was
distressing to find in one signed article a
recommendation that antidepressants be used in place
of tranquilizers, and then to find in another signed
article some clear evidence that many antidepressants
will in fact worsen the primary complaint. Certainly
it is time for some of this knowledge to filter down
to patients. During the early years of my tinnitus, I
consulted four Board-certified otologists, not one of
whoa thought to caution me about loud noise or
excessive aspirin consumption.
Current knowledge about the commonest external
causes of tinnitus, ototoxic drugs and noise (each has
been shown to potentiate the other), is summarized by
Brown and colleagues. Persons with a pre-existing
cochlear defect are most clearly at risk. The fact
that aany tinnitus-causing drugs show convulsant
activity at high dosage reinforces a current
hypothesis that tinnitus might be a form of sensory
epilepsy. The pharmacology of managing tinnitus bas
always been, and continues to be, a thorny problem.
Lidocaine, which can briefly suppress tinnitus, can
worsen the condition if given in high doses.
As one approaches the portions of this book
that deal with treatments, the ground becomes even
shakier. Evidently anything will work for somebody
but nothing will work for everybody-- not medicines,
not surgery, not psychology, not even masking.
Everyone longs for a drug that will suppress
tinnitus, but, as Goodey points out, it is infinitely
easier to find medicines, roods, and drinks that are
much more likely to trigger the condition. But there
is some hope for an anti-tinnitus drug. Lidocaine and
its oral analogue, tocainide, have produced
interesting results and are now being extensively
investigated as a possible suppressive. Other
anticonvulsants such as Dilantin sometimes bring
relief. Combined use of masking and an anti-tinnitus
drug is a promising approach.
Surgery specifically for tinnitus usually
involved cutting the eighth nerve, and, as J. House
and Brackmann note, the results have not justified
this drastic procedure. Other operations on the ear
occasionally have as a pleasant side effect the
partial (very rarely total) relief of tinnitus. If
the tinnitus has been caused by a tumor, relief might
be anticipated from removal of the neuroma. The
cochlear implant developed for profoundly deaf people
has relieved tinnitus in a few. Aran and Cazals, also
working chiefly with profoundly deaf patients, tried
positive-current eleotric stimulation. Sometimes the
2
tinnitus is temporarily relieved but it will return
when the stimulus is withdrawn.
Many victims of severe tinnitus spend years on
the shuttle bus between otologist and psychiatrist,
usually coming out the same doors they walked in.
Articles about the psychology of tinnitus patients are
not greeted enthusiastically by people who are
unconvinced that their problem lies anywhere but in
their ears. Some patients, however, do benefit froa
psychological techniques, and P. House reports some
success with biofeedback and other aind-altering
relaxation techniques. No doubt this approach bas its
place. However, writing about the personalities of
tinnitus patients, she groups Aljpersons with serious
to debilitating tinnitus into three categories of
psychological malfunction. These conclusions should
be tested among a much larger series double-blinded
with an unaffected sample. Suffering is not of itself
an emotional illness.
At present the most effective and least
invasive means of managing tinnitus is with a masking
device. Trying to cover an unpleasant internal sound
with a pleasant external one has always been done by
tinnitus patients. The technique was formalized,
investigated, and i n s ~ t e d by Vernon, Meikle, and
their colleagues at the Kresge Hearing Research
Laboratory; it was a giant step. With a success rate
of 60 to 80 percent, the authors can reasonably claim
that most failures probably occur because of inability
to match the tinnitus with the proper inhibiting
sound.
This book concludes much as it began, with a
review of some intriguing unanswered questions arising
from current experience: Does tinnitus originate
centrally or peripherally? Why does masking often
induce residual inhibition? The reader is presented
finally with a teasing medico-legal question: Are some
cases or tinnitus so unequivocally related to noise
exposure that the condition is compensable?
Physicians and audiologists evidently want to stay
clear of courtrooms, and for the sake of completeness
an attorney might have been invited to make a brief
presentation.
Tinnitus is a published symposiu (London,
13-15 January 1981) and one of its attractive and
useful features is the lively casual discussion by all
participants that followed each formal presentation.
One senses in these interchanges a healthy candor, a
willingness to admit mistakes and acknowledge
limitations, and a productive free play of first-rate
scientific intelligence. The editors deserve much
credit for doing an immensely difficult job,
transforming the random conversation, probably taped,
into tight coherent mini-texts for the publication.
References follow each presentation and usually each
discussion. Collected, checked, and with repetitions
eliminated, the references could form the best
currently available tinnitus bibliography. The author
index, subject index, glossary, and appendices seea
carefully prepared.
Its highly technical language and its price
($35.00) will put Tinnitus beyond the interest and
reacb of most patients, but no otologist or
audiologist will want to be without it. Otber
health-care professionals with an interest in
tinnitus, such as nurses and hearing-aid dispensers,
might well find it useful and of course the book
belongs in every medical library. It is a fine piece
of work, broadly and fairly presenting the
state-of-the-art of tinnitus research and treataent.
One's best wish for it is that in another decade it
will be of historical interest only, having been made
obsolete by discovery of some universally effective
and safe way of treating a terrible and widespread
affliction.
Ms. Drucker is a patient of the Tinnitus Clinic of the Kresge
Hearing Research Laboratory. She holds a Ph.D. in English
and is a Fellow of the American Medical Writers Association.
--
POINT OF VIEW
MASKING FOR TINNITUS RELIEF
BJ Jack 1. leroon, Pb.D., Protesaor in Otolaryngology,
Oregon Bealtb Sciences UDiYeraity, Director, lresge
BeariDg leaearcb Laboratory.
Masking, in one of three different has
been available for the relief of tinnitus for a score
of years. Despite that fact however we constantly
encounter gross misunderstanding about masking.
Interestingly enough the misunderstanding comes from
professionals and laymen alike. It is excusable that
the layman should be confused and not understand but
it is unforgivable that the professional can be a
source of misinformation.
Time and again tinnitus patients have
indicat9d to us that one or more ENT physicians have
told them that masking will not work for them.
we ask the patient if masking was tried on them they
always reply "no, he didn't try anything, be just said
-tt would not work. n II It is true that masking is not
appropriate or will not work for all patients but
there is only way to find out whether it will or
will not work in a given case and that is by actual
trial of masking. I would consider it immoral if I
denied a patient relief of their tinnitus because of
my own ignorance or because of some preconceived
prejudice that I held, If the professional is
uninformed then the proper response is to admit tba t
fact instead of prejudging. Arrogance of that sort is
bard to understand and for masking it is essential
that an actual trial be made and even then there is
room for lots of errors. For example I remember one
patient who came to our clinic after having been
fitted (?) for a masker in another state. The patient
was clearly in desperate straits and adamant in his
claim that masking would not work for him because it
had been tried and it had failed. As it turned out be
had bilateral tinnitus but masking had only been
placed in one ear, his better ear. When properly
fitted with two maskers it was very easy to completely
relieve his tinnitus.
Another common error is that of neglecting the
patients' hearing loss. When the tinnitus is located
in a hearing region for which there is substantial
bearing loss it is almost always the case that masking
alone is not sufficient. In such cases a tinnitus
instrument (the unit that combines the tinnitus masker
and hearing aid into a single case but with
independent volume controls) is required. In our
tinnitus clinic we find that the tinnitus instrument
is recommended 75% of the time to those for whom some
of recommendation is made.
We find several confusions among the
professionals concerning tinnitus instruments (called
"tinnitus aids" by some manufacturers). Because a
hearing aid is included many professionals jump to the
erroneous conclusion that it is the bearing aid alone
that relieves the tinnitus. We have repeatedly
encountered tinnitus patients with hearing who
have been told that nothing can be done for their
tinnitus since a hearing aid could not be Prescribed.
Note that once again a decision has been made based on
the clinician's knowledge (actually the lack of
knowledge) and not on the empirical results of an
actual testl It is essential that testing with actual
units be conducted prior to making any
recommendations. In the above case it would have been
desirable to have tested the patient with a masker and
then with a bearing aid (yes, even on normal hearing
ears) to determine if either produced relief of the
tinnitus In an area where we know so little it is
absolutely essential to conduct trials with actual
units. We try every conceivable arrangement and
combination of units before admitting failure.
3
Sometimes I think our failures are due more to the
lack of our own imagination than to the intractable
nature of the tinnitus.
Another confusion about tinnitus instruments
which also involves the hearing loss of the patient is
present when the hearing loss is severe. So severe
that the speech discrimination results mitigate
against the use of a hearing aid. Because of this,
the clinician then concludes that the combination unit
cannot be recommended forgetting that it is the
tinnitus for which relief is sought. Once again a
decision is rendered without the benefit of an actual
test. I recall a patient with low frequency (low
pitch) tinnitus for whom a hearing aid completely
relieved her tinnitus despite the fact that it did not
help her hearing one bit.
There is one prevalant confusion about masking
which appears in the mind of the patient and the
professional alike. Moreover it is a very logical
confusion. The patients say something like this: "I
already have enough noise in my ears, I certainly
don't want any more noise." (Note once again a
decision is made in the absence of knowledge.)
It is certainly the case that we do not know
why masking works. But the unassailable fact remains
that some 15,000 patients utilize maskers to relieve
their tinnitus. Originally I had the mistaken notion
that masking would reduce the tinnitus so that the
patient would be listening to .tG low volume sounds
rather than QW1 high volume sound. That would make
sense--it would be better to listen to two low volume
sounds rather than one high volume sound. But,
unfortunately masking does not work that way. The
intensity of the tinnitus does not decrease as the
masking intensity increases; instead the tinnitus
remains stable until the masking sound has risen above
it and masked it.
As I said, we do not know bow masking works
but here are some comments about masking which are
relevant. In the first place, the masking sound is an
external sound. In our everyday existence we
consistently ignore many external sounds providing
they are continuous, monotonous, not interesting and
not too loud. We consistently ignore ventilator
sounds, beating noises, traffic din, office clatter
and the like. Internal sounds such as tinnitus are
not nearly as easily ignored. Masking then, when it
is successful, is an external sound which is easily
ignored and since it covers up the tinnitus when it is
ignored the tinnitus is automatically ignored. It
seems to me that masking is a way of helping the
patient to live with their tinnitus.
Another comment on masking made by many
patients is this: "My tinnitus means there ia
something wrong with my auditory system,
sound is a man-made sound and thus is more
acceptable." To a person when they make such a
comment as this they all say, masking sound.
Another very frequent comment is something like this:
"Before masking my tinnitus controlled me, but now I
can control it. I can decide when I will and will not
hear my tinnitus." Such an element of control is of
psychological value to the patient.
"The masking noise is not unpleasant like my
tinnitus." This kind of comment is almost universal
and it is easily understandable. A shrill high
pitched tone, which most patients with severe tinnitus
have, is a very unpleasant sound whereas a high
pitched band of noise is esthetically much more
acceptable. In part then, masking is trading an
unpleasant sound for a pleasant one and that makes
sense. What does not make sense is the case where the
tinnitus is not a tone but a high pitched band of
noise usually described as a "hissing". Even in such
cases, where the tinnitus and the masking are nearly
identical sounds, the patient often finds the masking
sound more desirable and is thus able to obtain relief
from their tinnitus. continued
Masking continued
Residual inhibition is another area of gross
confusion. Some patients think that the purpose of
masking is to produce residual inhibition. Residual
inhibition, you will recall, is the temporary
reduction or cessation of tinnitus after a period of
appropriate masking. I recall one lady who repeatedly
insisted that masking was not working for her because
her residual inhibition was cons is tent.ly brief. It
was not possible to convince her that the masking was
effective and that residual inhibition, when it
occurs, is only a bonus.
There are some few professionals who have also
misunderstood residual inhibition. In one case no
recommendations for maskers were made unless the
patient displayed residual inhibition during the
clinical testing. It is true that people who display
residual inhibition usually do well with masking but
by no means is this an iron-clad rule. We have even
seen some patients who initially displayed no residual
inhibition but began to do so after several months of
using the masker.
Many patients, perhaps most, understand that
the purpose of masking is not to produce residual
inhibition. Nevertheless, these folks cannot but hope
that residual inhibition will accumulate over time as
masking is continued. And indeed this does seem to
happen to some patients. On the other hand, there are
some patients who find no accumulation or extension of
residual inhibition regardless of the duration of
masking.
The idea of expanded residual inhibition is an
extremely interesting one and for the reason that it
addresses the problem of a cure for tinnitus. That
is, of course, what most patients urgently wish for.
There are several interesting comments about residual
inhibition which have not been taken into account in
current masking programs. One comment is the fact
that residual inhibition rarely occurs when hearing
aids alone are utilized to mask tinnitus. Let me
explain: In a small number of cases (about 1 O%) the
tinnitus is sufficiently low pitched as to respond to
the use of a hearing aid. This is probably a matter
of elevating the volume of ambient environmental noise
in the region of the tinnitus frequency so as to
produce masking. The interesting fact for the problem
of residual inhibition is that such masking by a
bearing aid while completely covering the tinnitus
nevertheless does not produce residual inhibition.
Why is this? Is it that the hearing aid produces too
widespread effect extending too far into the lower
frequencies? Does that mean that a masking sound
precisely located at and only at the tinnitus
frequency will produce maximum residual inhibition?
There was one attempt a few decades ago to "burn out"
tinnitus by overstimulation at the tinnitus frequency.
It not only did not work but exacerbated the tinnitus
tor most oases. But then they may have used the wrong
frequency of stimulation since they did not check for
"octave confusion". Unless specifically and correctly
checked, about 7 out of 11 patients will misidentify
the pitch of their tinnitus by one octave. When
attempting to burn out tinnitus they may have used too
great an intensity, that is to say, perhaps a less
intense tone might have produced residual inhibition.
In any event, we have not used pure tones at the
frequency of the tinnitus in an attempt to produce
extended residual inhibition and such an idea is worth
trying.
Another and related point which has not been
taken into account involves the pitch of the external
tone. If one wants to maximally overstimulate a
specific frequency region of the ear one does not
sitmulate with that specific frequency. Instead one
utilizes a stimulus which is 1/2 an it.
Maximal energy in a overstimulating stimulus shifts
upward by about 1/2 an octave. Therefore if we were
to attempt to use pure tones to extend residual
4
inhibition we should select as a stimulating tone one
whose frequency is 1/2 an octave lower than the pitch
of the tinnitus.
But these are things for the future, let us
return to items and confusions of the past and
hopefully prevent them from becoming items of the
future.
The use of FM-masking has created lots of
confusion and misuse . Some clinicians have so
misunderstood that they have recommended the use of FH
radio to mask tinnitus. To be sure a radio program of
interest might provide some distraction from the
tinnitus, and while that sort of distraction may be
helpful in some cases, it is not what is meant by
FM-masking. FM-masking means use of the static
between FM stations as a masking sound. But it can
only work when the hearing ability at the region of
the tinnitus is the same as for the entire frequency
spectrum. FH static contains all frequencies--it is
white noise. Now, suppose one has a profound high
frequency hearing loss plus high frequency tinnitus
but also has normal low frequency hearing. In such
cases when the radio volume is sufficient for the high
frequency portion of the static to mask the tinnitus
the low frequency portion of stxtic-will be
excessively loud and thus totally unacceptable to the
patient.
Another common misunderstanding about masking
put forth by some clinicians concerns speech
discrimination. They tell patients, "You can wear a
masker if you wish, but it will prevent you from
hearing." Such a statement reflects a total
misunderstanding as to the composition of the masking
sound. If the masking sound were a white noise, that
is including all frequencies, then their claim might
have merit. For example try this simple test. Turn
on the water faucet full force at the kitchen sink and
stand near it. With the water running try to bear
what someone is saying to you from another room. You
will find that the sounds of the runn.ing water (white
noise) interferes with the sound of speech. The
speech frequencies are primarily from about 300 Hz to
about 3000 Hz. The most prevelant forms of severe
tinnitus pitched, well above 3000 Hz, in our
patient population they are mostly from 4000 to 12000
Hz. The masking noise utilized in the tinnitus masker
is also high pitched and primarily above the speech
frequencies so that it does not have much of. an
opportunity to interfere with the hearing of
speech--the masking sound is misaligned with and
placed above the speech frequencies.
By the way, when you were standing near the
kitchen sink with the water running, could you hear
your tinnitus? Didn't think to notice? Go back and
try it again. If the sound of running water covered
up or masked your tinnitus there is a good chance that
some form of tinnitus masking may be made to work for
you. That's not a guarantee but nevertheless it is
information worth attention. On the other hand, if
the sound of running water did not mask your tinnitus,
that does not necessarily preclude you from a masking
program. If you have a high frequency hearing loss
and high frequency tinnitus, the sound of running
water may not mask your tinnitus whereas a tinnitus
instrument (that combination of a hearing aid and a
masker) might be able to produce the desired effect.
An actual test is the only way to find out. That
"faucet-test" is a simple way for you to gain some
information about your tinnitus.
Not infrequently patients will ask, "Does
tinnitus mean I'm going deaf?" The answer is no for
the vast majority of cases. Tinnitus does mean that
something is wrong with the auditory system, not just
the ear, though the fault can lie there t .oo, but the
entire auditory system including the neural tracts
extending into the brain. It is for this reason that
all tinnitus patients should see anENT physician in
order to determine if possible what is causing the
tinnitus. And usually if a cause can be found, it can
be corrected.
continued
Masking continued
Often patients ask, "Will my tinnitus get
worse?" The answer is Xes. if vou do not orotect
those ears from loud soyndatl That is almost a
guarantee--loud sounds make tinnitus worse. If loud
sounds make tinnitus worse, will not masking
ultimately make my tinnitus worse? No is the answer
and for the reason that masking is not a loud sound,
Tinnitus for the vast majority of patients is only 5
to 10 dB above their ability to hear and that is a low
volume or low sensation level. Thus the intensity of
sound required to mask the tinnitus is also low, if it
were otherwise the patient would not accept it as a
substitute for the tinnitus.
On a closing note let me repeat that word
AubAtitute. That is as good a definition of masking
of tinnitus as I know. The masking sound is an
acceptable substitution to the patient for their
tinnitus.
All of this makes it sound like I think
masking is the only answer for tinnitus. I don t. I
think ultimately we will find medications that help as
well as other therapies. I know that biofeedback has
helped some patients. It is very clear in my mind
that to properly deal with tinnitus it will be
necessary to have a variety of different relief or
therapeutic procedures. After all, tinnitus is a
symptom associated with a great variety of problems in
the auditory system. No one single procedure could be
expected to take care of all cases.
It seems highly unlikely that I have answered
all questions about masking that are in the m i ~ d s of
all of you. Please feel free to contact me if you
have QUestions and/or comments.
The American Tinnitus Association
St atement of Assets and Fund Balance
October 31, 1981
Current Assets
Cash in bank-Tribute
Cash in bank FNB
Marketable Securities
(Merrill Lynch Ready Assets)
~
$751 .67
871.82
15,904.55
$ 17,528.04
Fixed Assets
Equipment
39,739.00
(19,240.00) Accumulated Depreciation
(Accelerated method)
Fixed Assets, Net
Total Asseh
20.499,00
$ 38,027.011
Liabilitiea aR4 Fund Balance
Current Liabilities
Total Current Liabilities
Fund Balance
$55,352.97
(17,325.93)
$ .oo
Fund Balance-beginning
Fund Increase (Decrease)
Total Fund Balance 38.027.0g
Total Liabilities and Fund Balance
$ 38,027.011
The above a1e numbers that !Jere e:r:tr:lcted from the
audited year end statement of the American Tinnitus
Assoaiation.
5
TRIBUTES
Our thanks go to the f ollowing people who have
contributed to the tribute fund f or tinnitus research.
IN MEMORY OF
Thelma Pugh
Hr. Harry Haag
Mr. Leo Barber
George Valos
My Parents
Frank Spina
James Harding
Anthony Calderone
Brother of Al Finklestein
John (rawec
Madeline Chicchi
Joseph Impellizzeri
Jennie Impellizzeri
William Conklin, Sr.
Mrs. H. Hegarty
Hr. Lovic N. Thomas
Mrs. Dell Thomas
Robert Conner
Victoria Kowaleski
Edward Horney
Mrs. Jean Winder Jones
Frederick J . Binda
Teresa Grotz
Calvin Michael
Etta Rayman
Ann Weiser
Victor F. Bolanda
BIRTHDAY
John G. Alam, Jr.
Helen Beattie Thorp
Nina Novich & Max Novich
Jacqueline Doyle
Charles Vogelfanger
Eve Shaw
Arlene Levy
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
Trudy Drucker
J(atherine Sadock
Carolyn Traver
Arletta Dimberg
Rick Tb011as
IN HONOR OF
Mr. & Mrs. Curtis Bowman
E.B. Moss, new home without
Rock Noise
Promotion of Dean Lopez-Isa
Phyllis Pugh
Mr.& Mrs. Ken Ellerbrock
Doris & Henry Adams
Richard Adams
Gertrude Hunrath
Audrey Heillller
Hal & Florence Linden
Audrey & Frank Holbrook
Florence Linden
Mrs. Anna K. Szwec
August L. Chicch1
S. F. Impellizzeri
s. F. Iapellizzeri
Mr. & Mrs. Hac Lamb
Lawrence & Dorothy Maher
Hs. Marie Thomas
Ms. Marie Thomas
Theodore J(ovaleski
Theodore Kowaleski
Shirlie Kesselm.an
Harriet & John Waychua
Eugenia H. Jacoby
J(enneth Grotz
Nancy E. Spagnoli
Burton Zitkin
Florence & Hal Linden
Saverio F. Iapellizzeri
J. Alam & T. Drucker
J. Alam & T. Drucker
J. Alam & T. Drucker
J. Alaa & T. Drucker
Harry Vogelfanger
J. Alam & T. Drucker
J. Alaa & T. Drucker
Eve. D. Shaw
Mary & Pat Tully
Peg & Jia Doyle
Jules H. Drucker
Max Novich, M.D.
Esau T. Joseph
Arlene Levy & Sandy Caaael
The Travers
Joseph & Claire lauttman
Adele B. Alam
Joseph G. Alam
J. Alam & T. Drucker
J. Alaa & T. Drucker
Daniel & Pamela Diaberg
Paaela & Daniel Diaberg
Donald H. Bowman
J. Alam & T. Drucker
Trudy Drucker
Ears are our interest but sometimes we have to
pay through the nose . If you don't notify us
of your change of address the Postal Service
r>eturns the Newsletter to us and charges us an
additional 2 59. We have to pay and you don ' t
get your Newsletter. Please, let us know
bef ore you move.
INSURANCE SURVEY
While our primary interest is in finding a cure
for tinnitus, as a national organization we
sometimes are presented with opportunities that
look interesting. We'd like to know if you'd be
interested in a group Medicare Complement insur-
ance plan. If enough eligible members say it's
important to you to have this type of coverage
the association can arrange for it. For less
than $28 a month this type of insurance fills the
spaces created by Medicare - with no lifetime maxi-
mum on benefits you can receive.
If you're 65 or older - and you're worried about the
financial bite of hospital and doctor expenses not
covered by Medicare - please drop us a line. But
act today. If this is in fact a valuable membership
benefit we want to know quickly. In order to tabu-
late your responses in a timely way, we ask that
you give us your opinion no later than April 30,1982 .
If we expect our
hearing problems
to be solved 'We
must help spread
the word.
Please do what you
can in your
community.
For further info
write to ATA or to
the address on the
picture.
Charitable Gifts and Your IRA
Did you know that you have the opportunity to name
a charitable institution to receive part or all of
the funds from your IRA if you die before your
retirement payments start? Or, if your payments
have commenced, you can name the institution to
receive any payments you or your other beneficiaries
don't receive prior to death.
Other pension and profit-sharing plans have similar
provisions. You can name ATA as a beneficiary of
any of them.
We'll be happy to supply additional information to
anyone considering these options .
6
A PERSONAL EXPERIENCE
time to time ATA publishes aaaounts of a
patient ' s with tinnitus . This aaaoun t,
of interest we believe, has been written
by a man who is a praatiaing psychiatrist and
whom tinnitus has been a aonsiderabZe
"The following is a brief account of experience
with tinnitus. It does not depict the severe and
protracted stress that this affliction has caused me.
It is very difficult to be open and truthful in an
account such as this, but I can tell you that I have
suffered a great deal and I am confident that without
relief I could not have continued living. Prior to
getting some relief, I had noticed that suicidal
thoughts entered my mind more and more and also I
developed stress related physical problems such as
irritable bowel syndrome. Thank God much of that has
changed since I got the masker about four months ago.
I am a 49 year old physician specializing in
adult and child psychiatry. I have high frequency
tinnitus in both ears. The tinnitus in the left ear
is about 53 decibels at approximately 8000 Hz units
and the right ear is about 60 decibels and 8000 Hz
units. This has been measured recently here in Topeka
and I think it is fairly accurate. I have had
tinnitus since I suffered trauma to my ears when I was
24 years old while in the United States Army while
firing the H-1 rifle which bad a very high frequency
ping to it. I think the reason my right ear is
effected more than the left is because I fired mainly
from the right side, but as good soldiers, we were
taught to shoot from the left as well. I became aware
of a low intensity, high frequency tinnitus and a
slight hearing loss while in medical school after my
serving in the army. I remember that I could not hear
diastolic murmurs. While a student, I asked the
professor of otolaryngology what could be done and he
said that the only thing to try was vasodilators which
I did and they did not help. This was the first of a
series of quests for help from my otolaryngology
colleagues which resulted in disappointment for me and
the realization that they did not know much about it
at that time. Host of them told me that nothing could
be done and none of them told me how to prevent
further deterioration. For example, I was not warned
not to use alcohol, caffein, nicotine, marijuana,
aspirin, trycyclic antidepressants, and above all to
protect my ears from loud noises in an overkill
fashion. Through the years the tinnitus increased in
intensity perhaps as a result of not doing what I have
recently learned to do to prevent further damage .
After up to five or six consultations with
otolaryngologists, I basically gave up expecting that
anything could be done to help me, so I had to cope
with it the best way I could. It was very difficult.
Tinnitus is extremely distracting and preoccupying and
when severe is so distressing that the sufferer does
anything he can to rid himself of this affliction. I
am certain there are a large number of suicides in
this country and other countries because of this
problem. In professional practice, I have had some
patients with tinnitus tell me that they often felt
like taking an ice pick and poking it in their ears
just to stop the noises.
It was in 1979, when I was about 46 years old
that I happened to find the article in the
Sunday paper, The Mysterious Ear Noises That Afflict
Millions, by Lawrence Galton. The article featured
the work of Dr. Jack Vernon at the University of
Oregon Health Sciences Center. A tinnitus masker was
noted in the article to be a definite help for
tinnitus sufferers. At that time, I was unable to go
to Oregon for various reasons but I remember
experiencing a sense of gladness and thankfulness that
7
at least someone was doing something about the
problem. I kept the article and I treasured it. My
tinnitus continued and in July of 1981 I realized that
I had to do something to get help or I could not
continue to function at all and I was on the verge of
disorganization. I called the American Tinnitus
Association who encouraged me and referred me to
Sharon Robinson who gave me further encouragement and
she had me call Dr. Jack Vernon and Dr. Bob Johnson.
All of the people at the American Tinnitus Association
and at the University of Oregon Health Sciences Center
have been wonderful and are knowledgeable people, who
have consistently helped me by way of long distance
phone calls. They gave me the name of a man, J.
Hanford Barber, Ph.D., in Topeka who had some training
at the University of Oregon. He admitted to me that I
was his first tinnitus patient but together we got the
tinnitus masker 3 and later the tinnitus masker 5 from
Starkey Laboratories. These maskers have helped me a
great deal, and even though they are not a cure for
the problem, the masking noise and the problems in
wearing the masker are much less a problem than the
tinnitus itself. I have experienced some residual
inhibition but not enough to get excited about. I
expect to continue to consult by phone with Dr . Vernon
and to modify the maskers to emphasize the high
frequency noises. I continue to pray for further
definition of the anatomical and physiological
pathology of tinnitus and I am confident better
treatment will natural'ly follow this.
In the meantime, will all physicians who read
this believe it and pass it on and let's hope we can
get more and more tinnitus clinics around the country.
Direct help is presently available by using tinnitus
maskers for the many millions of people who have this
malady.
Thank you and I thank the American Tinnitus
Association."
Edward G. Mehrhof, M.D.
Topeka State Hospital
Topeka, Kansas
Efficaciousness Clinic
Do you treat tinnitus patients?
Are you concerned with results?
If you answered yes to the above questions you
will want to come and hear presentations by those
clinicians who are successfully treating tinnitus
patients. Learn from them. Learn by doing.
A tinnitus workshop for clinicians who are
working with tinnitus patients and for those who are
interested in getting started in this work. Working
sessions will be held on July 16th and 17th. Fly in
on the 15th and out on the 18th to take advantage of
excursion fares. Tuition discount available for early
registrants. Call or write before May 1st to take
advantage of the saving.
Space is limited -- call for information now.
Gloria Reich, ATA, 503-248-9985, or
Sam Hopmeier, Coordinator, 314-726-3344
If you wish to present a scientific paper at this
meeting and have not yet been contacted; please call
Sam Hopmeier.
Travel and housing arrangements, pre and post
meeting vacation in Oregon arrangements and general
information about the extra-curricular recreational
opportunities available may be obtained by calling
Gloria Reich.
SELF-HELP GROUP COORDINATORS
Those people who are listed here have volunteered to start self-help groups in
their areas. If you want to help or to join, please call them. If you want to be listed
here, call or write ATA. Our next issue will have news of the groups. The first tinnitus
self-help group met on March lOth in Bergen, NJ. Talking about it can help! We're anxious
to see more of these groups formed where people can get together and share both their troubles
and their solutions. Who knows? Maybe the answer for tinnitus problems will come from one of
these meetings .
Dr. William Crausman
100 Highland Avenue
Providence, RI 02906
401-273-0333
Trudy Drucker
39 Holiday Court
Rivervale, NJ 07675
201-664-7644
Michael Devlin
502 Pillow Ave
Cheswick, PA 15024
Mrs. Charles R. Haaf
18 Rarris Lane
Woodstown, NJ 08098
Marvin Weinberger
3118 Michael Drive
Louisville, KY 40120
502-581-4200
Roy Schutte
616 Edna Ave
Kirkwood, MO 63122
Sam Rappaport
9031 Pico Blvd.
Los Angeles, CA 90035
Mike M. Mills
3600 Mystic Valley Pkwy
Medford, MA 02155
Jules Gilbert
345 East 58th Street
New York, NY 10022
Carmel Duval
8 Lloyd Avenue
Malvern, PA 19355
Frank Scotchlass
5145 Hidden Branches Dr.
Dunwoody, GA 30338
404-952-2414
Kathy roltner
1319 E. Michigan Ave.
Lansing, MI 48912
517-372- 6725
Emma Matthews
1138-103 N.Foster Dr.
Baton Rouge, LA 70806
504-924-3461
Betty Belke
4380 Caminito Pintoresco
San Diego, CA 92108
JOIN THE FIGHT AGAINST TINNITUS!
JOIN ATA NOW!!!
Your donations are needed to continue ATA 's
services such as the production of this Newsletter.
Please help! I
Published by the
Margo Scott
37 Valley Rd
Shelton, CT 06484
203-929-3609
Al Mandarino
157 Davis Ave
Inwood, NY 11696
516-239-2087
Gustavo Joppert
Av.L. Paula Machado 82t
Rio de Janiero
Brasil
Dale Bonnycastle
2100 Marlowe
Montreal, Quebec
CANADA H4A3L6
Ruth Jones Aileen Burr
1608 Trailridge Rd. 816 Main St .
Charlottesville,VA 22903 Lead, SD 57554
Mrs. Clyde Jones Dwight W. Black
900 Orange Ave.
Winter Park, FL
305-647-6040
517 Margarette St.
32789 LakeHills, WI 53551
414-648-8157
Mrs. Richard Richter Thomas A. Butts
3567 N. Otter Creek 1730 Tiffany Ct .
Monroe, MI 48161 Peoria, IL 61614
Robert E. Collawn
1578 Emerson
Denver, CO 80218
303-399-9215
Mrs. Anna Green
Rt1 Box 198
Dalhart, TX 79022
806-249- 2943
Al Berger 415-421-4874 (94105)
693 Mission St. #305, San Francisco, CA
ANNUAL CONTRIBUTION AMERICAN TINNITUS ASSOCIATION
Regular Member 15 or mor< 0
Sustaining Member $ 25 or more 0
Professional Member $100 or more 0
Benefactor $500 or more 0
YOUR GIFT IS TAX DEDUCTIBLE
AMERICAN TINNITUS ASSOCIATION
A private non-profit corporation
under the laws of Oregon
The American Tinnitus Association
Post Office Box 5
Non-Profit Organ.
U.S. Postage
PAID
Permit No. 1792
Portland, Oregon
Medical Ad\tieory BoArd
.Roger l!oles, H. D.
Son Prancisoo, california
Jack D. Clemis, H. D.
Chicago, Illinois
David D. DeWeese, M. D.
1\:>rt.J.ana,Oreqon
Jom 1\, l?mnett, M. D.
foleqbis, Tennessee
Boward P, llOUse, M, D.
LOs Angeles, california
R<lbert M, Johnson, l'h.D.
1\:>rtland, Oreqon
Merle Lawrence, l't!.D.
linn Arbor, Michigan
Jerry N)rtbern, l't!.D.
Denver, Colorado
Geot9fl P, lleed, M, D.
Syracuse, New York
R<lbert E. 5andlin, Ph.D.
Son Dieqo, california
Abraham ShulJMn, M, D.
New York, New York
Racold G. Tahb, M, D.
New Orleans, LOOisiana
Roard of pirectors
R<lbert Hocks, Chairman
oregon
Gloria E. Reich, Exec.Dir.
1\:>tUand, Oregon
0\arles unice, M. D.
[))..mey 1 california
'ih:lmas Wissbaum, C.P.A.
Portland, Oreqon
HonQrary Di res;tors
Del Clawson, House of Rep.Ret.
Downey, California
Honorable Mark Hatfield
Onited states Senate
tcgal Cosmsel
Henry c. Breithaupt
Stoel,Rives,Boley,Fraser & WySe
Portland, Oregon 97207
(503) 2489985
ADDRESS CORRECTION REQUESTED