Tinnitus Today September 2001 Vol 26, No 3

September 2001 Volume 26, Number 3
Tinnitus Today
THE JOURNAL OF THE AMERI CAN TI NNITUS ASSOCIATION
"To silence tinnitus through education, advocacy, research, and support."
Since 1971
Education -Advocacy - Research - Support
In This Issue:
New Tinnitus Research? Here it is!
Orchestras and Tinnitus - A View from the Podium
ATA's New Scientific Advisors
Founders' Gala Honoring Jack Vernon
Advertisement
Looking for a cost effective
treatment that really works?
Announcing the all-new Petroff Audio Technologies
DTM-6a home-use tinnitus mitigation system.
New advance in masking technology
FDA-cleared & proven user success
Endorsed by world's foremost expert
Selected for use in landmark VA study
Available from doctors or direct order
Affordable $139 system retail price
"I listened to all of the DTM audio COs and
I can unequivocally state that you have created the best
tinnitus masking sound with which I am experienced."
-Jack Vernon, Ph.D. (world's leading expert on tinnitus masking)
Following years of documented success
and leading professional endorsements,
Petroff Audio Technologies introduces an
improved version of its home-use tinnitus
mitigation system, the DTM-6a. Unique
dynamically changing digital sound provides
effective temporary relief, even for severe
tinnitus sufferers. Temporary relief on an
as-needed basis can offer a wide range of
meaningful benefits, including a reduction in
stress and tinnitus interference with relaxation
and falling asleep.
The DTM-6a is endorsed by experts including
the world's foremost authority on masking,
Dr. Jack Vernon, and has been selected for
use in a landmark Veterans Administration
study. The DTM-6a includes six audio COs
plus a Tinnitus Management Manual, and
effectively relieves tinnitus for most individuals
at surprisingly low volume. The system may
be played on virtually any small CD player
with speakers or headphones (not included) ,
and is sold with an unconditional 30-day
money back guarantee.
Order price: $139 + $6 SIH = $145 (CARes. add $11.12 sales tax).
Available from ENT doctors or by direct order.
We accept check or major credit card payment by mail, phone or on-line.
Petroff Audio Technologies, 23507 Balmoral Lane, West Hills, CA 91307
Ph: 818-716-6166 Fax: 818-704-9976 E-mail: petroffml@aol.com Web Site: www.tinnitushelp.com
Tinnitus Today
Editorial ond Advertising offices: American Tinnitus Association, PO Box 5, Porrlond, OR 97207 503-248-9985, 800-634-8978 tinnitus@oto.org, www.oto.org
Execu tive Director: Cheryl McGinnis, M.B.A.
Editor: Barbara Thbachnick Sanders
Tmnrrus 'Ibday is published quarterly in
March, June, September, and December. It is
mailed to American Tinnitus Association
donors and a selected Jist of tinnitus patients
and professionals who treat tinnhus.
Circulation is rotated to 80,000 annually.
American Tinnitus Association is a non-profit
human health and welfare agency under 26
usc SOl (c)(3).
02001 American Tinnitus Association. No part
of this publication may be reproduced, stored
in a retrieval system, or transmitted in any
form, or by any means, without the prior writ-
ten permission of the Publisher. lSSN: 0897-
6368 (print), ISSN: 1530-6569 (online)
Board of Directors
Stephen M. Nagler, M.D. , FAGS, Atlanta, GA,
Chairman
David R. Anderson, J . D., Lemont, lL
Dhyan Cassie, Au.D., CCC-A, Medford, NJ
James 0 . Chinnis, Jr., Ph.D., Warrenton, VA
Claude H. Grizzard, Sr., Atlanta, GA
W. F. S. Hopmcicr, St. Louis, MO
Gary P. Jacobson, Ph.D., Detroit, Ml
Sidney Kleinman, J .D., Chicago, tL
Paul Meade, Tigard, OR
Scott C. Mitehell, J.D., CPA, Houston, TX
Pbilip 0. Morton, Portland, OR
Aaron I. Osherow, St. Louis, MO
Kathy Peck, San Francisco, CA
Dan Pwjes, Ne1" York, NY
Susan Seidel, M.A., CCC-A, Sunset Beach, NC
Richard S.1Jler, Ph. D., Iowa City, lA
Jack. A. Vernon, Ph. D., Portland, OR
Honor:ary Directors
The Honorable Mark 0 . Hatfield, U.S. Senate,
Retired
'lbny Randall, New York, NY
William Shamer, Los Angeles, CA
Scien tific Advisors
Richard S. 1Jler; Ph.D., Iowa City, lA,
Chairman
Paul J. Abbas, Ph. D., Iowa City, lA
Anthony Cacace, Ph.D., Albany, NY
Robert A. Dobie, M.D., Bethesda, MD
Gary P. Jacobson, Ph.D. , Detroit, Ml
Pawel J. Jastreboff, Ph. D., Sc.D., Atlanta, GA
James A. Kaltenbach, Ph. D., Detroit, Ml
Paul R. Kileny, Ph.D., Ann Arbor, Ml
Robert A. Levine, M.D. , Brookline, MA
William H. Martin, Ph.D., Port.land, OR
Douglas E. Mattox, M. D., Atlanta, GA
Mary B. Meikle, Ph.D., Portland, OR
Stephen M. Nagler, M.D., FAGS, Atlanta, GA
C r a i ~ W. Newman, Ph.D., Cleveland, OH
Glona E. Reich, Ph. D., Portland, OR
Jay Rubinstein, Ph.D., Iowa City, lA
Roger A. Ruth, Ph D., Charlottesville, VA
Richard J. Salvi, Ph.D., Buffalo, NY
Michael D. Seidman, M. D., FAGS, Detroit, Ml
Robert W. Sweetow, Ph.D., San Francisco, CA
DonnaS. Wayner. Ph .D., Latham, NY
Cover: woman Gathering Lavender,
oil, 11 x 11", by Sandro Negri.
Inquiries to Indigo Gallery,
504 S. Main Street, EO. Box 728,
Joseph, Oregon 97846-0728,
541-432-5202.
The Journal of the American Tinnitus Association
Volume 26 Number 3, September 2001
Tinnitus, ringing in the ears or head noises, is experienced by as many
as 50 million Americans. Those who have it in a severe, stressful, or
life-disrupting form often seek medical help.
Table of Contents
8 New Tinnitus Research? Here it is!
by Barbara Thbachnick Sanders
12 ATA-Funded Research - 'lbward the Cure
by Pat Daggett
13 Cognitive-Behavioral Therapy for Tinnitus
by Shannon Robinson, M.D.
14 Orchestras and Tinnitus- A View from the Podium
by Joel Levine
16 New Directions from ATA's Scientific Advisors
19 Summertime ... and the Support Groups are Busy
by Rachel Wray
21 Are Doctors Listening? Tinnitus: The Discounted Malady
by H.J. Schulte, M.D. , FA.PA.
22 Founders Gala Honoring Jack Vernon
Regular Features
4
5
From the Executive Director
by Cheryl McGinnis, M.B.A.
From the Editor
What Do Audiologists Know About Tinnitus?
by Barbara Thbachnick Sanders
6 Letters to the Editor
23 Questions and Answer s
by Jack A. Vernon, Ph.D.
25 Special Donors and 'Itibutes
The Publisher reserves the right to reject or edit any manuscript received for publication
and to reject any advertising deemed unsuitable for Tinnitus Tbday. Acceptance of
advertising by Tinnitus Tbday does not constitute endorsement of the advertiser, its
products or services, nor does Tinnit!.i$ Tbday make any claims or guarantees as to the
accuracy or validity of the advertiser's offer. The opinions expressed by contributors to
Tinnitus 7bday are not necessarily those of the Publisher, editors, staff, or advertisers.
@ Printed on recycled paper
American Tinnitus Association Tinnitus 7bday/September 2001 3
FROM THE EXECUTIVE DIRECTOR
by Cheryl McGinnis, M.B.A.
I hope you experienced a
summer of good times with
family, friends, and neigh-
bors. Or, perhaps seeking
adventure was what you
sought for your summertime
break - whether the
extreme-sport kind or a more
relaxed focus on exploring
new sites. Whatever your experience, I hope you
feel rejuvenated.
Members of the ATA are known for having a
keen drive for furthering personal knowledge
about tinnitus. I wish to encourage you to fully
use the ATA as a resource in your quest.
Throughout the summer, ATA staff responded
to callers seeking support and information. We
welcome your calls toll free at 800-634-8978. We
urge you to refer potential members to the AT.A
and suggest they call us toll free also.
The ATA Web site (www.ata.org) is frequently
updated. In addition to getting information about
tinnitus, reviews on completed research, and
accounts of current ATA activities from our Web
site, you can get the information when you want
it. A new feature on our Internet site is a
Calendar of Events. The calendar includes
Self-Help Group information, hearing health
meetings, and tidbits of information pertinent to
tinnitus. For example, earplugs are encouraged
for hearing protection during fireworks displays
and during the opening of fall hunting for those
who patiicipate in rifle hunting. You can receive
Self-Help Group information by calling the ATA.
Information about each of ATA's program areas,
Education, Advocacy, Research, and Support, is
included on the Web site as '".,.ell.
In June, our Web site featured a real-time
question-and-answer session for members who
conversed with Dr. Jack Vernon. Over the
course of nearly an hour and a half, Dr. Vernon
answered questions from members on topics as
diverse as hearing protection, Meniere's Disease,
nutrition, pharmacology, and even motorcycle
use. 'Transcripts for the Chat with Jack are now
available (you can find a copy on the Web site or
you can request a copy by calling the ATA ).
4 Tinnitus Thday/September 2001 American Tinnitus Association
So beloved is Dr. Jack Vernon that we are dedi-
cating the 2001 Founders' Gala to pay tribute to his
life-long achievements. Jack is a tireless advocate
for tinnitus patients. Not surprisingly, as a co-
founder of the ATA and member of the Board of
Directors, he urges membership in the ATA to
aU of his callers. Jack began his basic tinnitus
research in 1968 when few scientists were
investigating the condition. Dr. Vernon founded
the first United States tinnitus clinic and, although
retired, continues to dedicate one working day
each week to receive patients' calls. From his ini-
tial tinnitus research, to his personal admonition
to every patient to use hearing protection in noisy
environments without exception; to his persistent
encouragement to pharmaceutical companies to
identifY a drug for tinnitus, Jack Vernon continues
to advocate for hearing health and innovative
research for the benefit of present and future
generations.! hope you can take part in the
Founders' Gala honoring Dr. Jack Vernon (see
page 22 for additional information).
Our genuine appreciation goes out to Tim
Sotos, a retiring member of the ATA Board of
Directors. He exemplified consummate care and
dedication to his service on the Board and as a
Program Committee member. He will be missed
but remains a valued association member. In the
next issue of Tinnitus 7bday, we will feature inter-
views with our new members of the ATA Board of
Directors. Join me in welcoming:
+ Sam Hopmeier is a returning Board member
and hearing aid specialist. Sam is chairperson
of the ATA Program Committee and led our
efforts in developing a three-year strategic
plan.
+ Aaron Osherow also returns to Board service.
He has expertise in membership services and
will be a resource in adding value to the
benefits of ATA membership.
+ David Anderson has been an active member of
the Program Committee and, showing interest
in furthering his commitment ofhis time and
expertise, joins the Board of Directors.
+ Scott Mitchell joins the Board of Directors as
well as the Resource Development Committee.
He enthusiastically steps up to assist us in
gaining grassroots awareness and support.
This issue of Tinnitus 7bday will hold your
interest in research. Read o n ~ 1'1
F r om the Editor
What Do Audiologists Know About
Tinnitus?
by Barbara Tabachnick Sanders
ATA Director of Educoffon
I sat in a room with 500
audiologists at the American
Academy of Audiology annual
meeting this past April. By my
guess, half of these clinicians
were about to hear their first
lecture on tinnitus. I found
their response to the lecturer, Craig Newman,
Ph.D., as interesting as the lecture itself.
Dr. Newman obviously knew his audience.
He began, "Yes, the scope of your practice does
include the treatment of tinnitus patients!" There
were a few moans in the room. He continued,
"It's vital to evaluate the tinnitus impairment with
loudness matching, pitch matching, minimum
masking levels, and residual inhibition to demon-
strate to the patient that the tinnitus is real." Dr.
Newman was clear that the results of these tests
do not, in and of themselves, measure the impact
that tinnitus has on a patient. Therefore, he con-
tinued, it is imperative to evaluate the degree of
the tinnitus-specific complaint - lack of sleep,
annoyance level, reduced concentration - as well
as the general complaints of depression and anxi-
ety. He described the Beck Depression Inventory,
the survey that he uses with patients to measure
the degree of their tinnitus severity.
I looked around. Most heads were down,
most hands moving in earnest note taking. I was
thrilled that this valuable information about
tinnitus was reaching so many important ears.
If only all 8,000 conference attendees could have
been packed into that standing-room-only audito-
rium! I noticed that the audiologist sitting to my
right was not taking notes. In fact, her arms
were folded; her face was stern. I made quick eye
contact with her and smiled. She shook her head
and whispered, "We send patients with tinnitus
away. We never know what to do for them. It's
so frustrating." I whispered back, "Imagine hov,r
frustrating it is for the tinnihls patients."
She uncrossed her arms very slowly as
Dr. Newman's lecture continued. "Use counseling
and education to demystify the tinnitus for your
patients. Remember, it's the patients' reaction to
the sound, not the sound itself, that they can gain
control over. Use instnunentation, such as mask-
ing devices, TRT devices, any assistive hearing
device. This will help the patient move the
tinnitus into the background." The audiologist's
face softened as she picked up a pen and began
taking notes.
I attended another session, this one on pre-
venting hair cell death. (Hair cells are tiny cells
inside the inner ear. Vestibular hair cells control
our balance. Cochlear hair cells send sound mes-
sages to the brain.) Three hundred audiologists
(plus me) filled the room. Richard Salvi, Ph.D.,
Donald Henderson, Ph.D., and Richard Dana
Kopke, M.D., discussed the life cycle ofinner ear
hair cells in such captivating ways that again I
was grateful that so many audiologists were get-
ting so smart along with me that day. We learned
the four major triggers of hair cell death: infec-
tion, inflammation, aging, and genetics. What
about noise and ototoxic drugs, I wondered?
Before I could raise my hand to ask, the doctors
explained. Immediately after extreme noise expo-
sure, the outer hair cells swell. Some will burst
and die. The swelling causes reduced blood flow
in the hair cells' tiny capil1aries. If the noise
exposure continues and the swelling is sustained,
the capillaries collapse and those hair cells will
die too. The result is hearing loss and probably
tinnitus. Because steroids can reduce inflamma-
tion, they are often prescribed for a two-week
course immediately after sudden hearing loss.
Steroids are generally taken by mouth but can be
delivered through the ear via a microcatheter, a
very thin tube that rests against the round win-
dow of the cochlea. The audiologists and I were
soaking this up.
The doctors continued. The ear actually tries
to repair its own noise-induced damage by
increasing its supply of glutathione, an anti-oxi-
dant. A variation of this anti-oxidant was tested in
an animal study where it was delivered directly
to the inner ear round window 40 minutes before
exposing the animals to a 150 dB noise. The
treated ears had essentially no inner ear hair cell
damage after the noise exposure. The untreated
and exposed ears had extensive hair cell damage.
This is highly experimental, but interesting!
We were taught that hair cells could be
"toughened" to be more resistant to noise dam-
age. In one study, animals were alternately
exposed to a 95-dB noise for three hours then
(continued on page 6)
American Tinnitus Association Tinmtus 'Zbday/ September 2001 5
Letters to the Editor
From time to time, we include letters
from our members about their experi-
ences with "non-traditional" treatments.
We do so in the hope that the informa-
tion offered might be helpful. Please read
these anecdotal reports carefully, consult
with your physician or medical advisor;
and decide for yourself if a given treat-
ment might be right for you. As always,
the opinions expressed are strictly those
of the letter writers and do not reflect an
opinion or endorsement by ATA.
I
have had a ringing in the ears ever since I was
in the service. About two months ago, I took
Neurontin (300 mg) for a month to help with a
What Do Audiologists Know About
Tinnitus? (continued)
placed in quiet for nine hours. After 15 days, these
toughened ears were exposed to 105 dB of noise
and showed very little hearing damage compared
to non-toughened ears exposed to the same noise.
Despite observing this successful outcome, the
researchers suspect that the conditioning itself
might cause some subtle damage to the hearing
mechanism. The phenomenon is still being
studied.
The auditory system is also being examined at
the genetic level. Scientists have discovered, for
example, that some genes are pre-programmed to
increase protein production after six hours of loud
noise exposure. Because some delicate parts of the
inner ear are made up of proteins, this excess
protein production might be the body's attempt to
repair itself. Scientists speculate further: Defective
genes might cause some people's ears to be more
susceptible to noise damage than others.
This exceptional audiologist's conference
featured a record 14 instructional sessions on
tinnitus. And our tinnitus brochures and Tinnitus
Thdays were grabbed up as fast as we could display
them. Audiologists have always been a clever lot.
Now with all this training and information under
their belts, I imagine they're more so than ever. B
6 Tinnitus 7bday/ September 2001 American Tinnitus Association
foot problem. I noticed my tinnitus volume
becoming less and less and that it finally
stopped while I was taking the medicine. But the
Neurontin caused me to have stomach pains so I
stopped taking it. After about two weeks, the
ringing started again. I thought ATA members
would like to know.
WE. Cushenberry, Jr. , 502-458-8680
T
hank you for your article on musical tinnitus
("Ringing, Hissing, Roaring, and, yes, Music
-the Sounds of Your Tinnitus," June 2001,
Tinnitus Thday). I am one of the chosen few who
has this form of tinnitus. Although I've worn
hearing aids for 20 years, my tinnitus began three
years ago. It was musical from the start and man-
ifests mostly as pop music from the 1950s and
1960s. The "rock & roll medley," I ca11 it. Tt can
also come from listening to a new song on the
radio. The nice part about my tinnitus is that
if one melody in my head gets really annoying,
I can, by concentrating, change the song to
another one. It's nice to know that I'm not the
only one with this unusual condition, although
my mother always did tell me that I was special.
Jay Weller, Oakland, N], 201-337-5215
I
am writing for two reasons, one - to publicly
thank Dr. Michael Seidman for his medical
expertise, compassion, and overall profes-
sional deportment and for helping me resume a
productive life, and two - to provide hope
through my personal example to those afflicted
with tinnitus.
I have had tinnitus, a "sshh" in both ears,
since 1988 due to the report of a small hand gun
while target practicing (the only time I ever tar-
get practiced). But I have managed a productive
life since that awful day. The shhh sound I hear
presently is not loud enough to greatly infringe
on my concentration, although it is always there
and it does influence my behavior around any
loud noises. Don't misunderstand me. My tinni-
tus initially was as loud as a teakettle, a constant
loud ring for 18 months, which nearly drove me
insane. Over time, the severity of the sound less-
ened and I learned to better cope with the noise.
I can testify that the initial shock of noise is quite
startling.
Last year, my right ear began to "ping" very
loudly overlaying the hush that I already hear.
The cadence of the pinging was sporadic, not in
anyway tied to my breathing or heartbeat. It
Letters to the Editor (continued)
went something like this: ping, -- ping, -ping,---
- ping, ping- constantly, all day and all night. It
was intolerable and maddening and not only
adversely affected my life, but the lives of my
wife and children as I became very irritable. I
began taking prednisone because my doctor
suspected Meniere's disease as the cause. After
researching Meniere's disease and talking with
Dr. Seidman and bringing myself to understand
the delicate nature of the inner ear and the com-
position of the cochlear fluids, I put myself on a
strict diet eliminating salt, caffeine, colas (even
decaffeinated), potato chips, crackers, chocolate,
and alcohol. I also forced myself to drink lots of
water. I took all these measures to bring the
cochlear fluids back into balance.
One day, shortly after the implementation of
my new diet, the pinging ceased. It is July 2001,
and so far I've had no further problem. To all of
those suffering from tinnitus and wondering if
you will ever experience relief, I pass along these
thoughts: Read and research your symptoms until
you can be fairly conversant with your doctor,
keep trying different approaches to your prob-
lem, and never lose hope.
Jeff Bell, 220 Old Tippecanoe Dr. , Springfield,
IL 62707, 217-787-4507, Jbell1218@aol.com
0
ver four years ago, I contracted tinnitus
from a motorcycle ride with loud exhaust
pipes. Since that time, I've been seeking a
remedy but was told there was no cure. I am an
instructor at the University of California San
Diego, so I turned to the cognitive sciences
department which was conducting some tinnitus
experiments.
I was interviewed, my hearing was tested,
and I was accepted as a test subject in a new
habituation therapy study. When I first started
the study, I sat down with a music professor,
who patiently worked with me and some special
computer software to recreate my particular tin-
nitus tone. When we were satisfied that we had
reproduced my tinnitus sound, the professor pro-
grammed a compact MP3 player with that sound.
I was told to wear my headphones as many hours
as possible, and to note the number of hours
and the volume at which I listened to it. I was
told to set the volume slightly lower than the
actual tinnitus level. My hearing and brainwave
responses were tested once a month. When I
began last August, my tinnitus was measured at
3500 Hz, a sound like crickets. Over the months
that followed, I listened to my MP3 player an
average of four hours a day at a steadily decreas-
ing volume level.
My tinnitus sound has now changed upward
in pitch. In February, it was at 8500Hz. As oflast
week it was at 9300 Hz, an extremely high tone.
Slowly but steadily, my tinnitus has increased in
pitch and decreased in volume. The hope is that
in a few more months, my tinnitus will move up
into an inaudible range - where I won't hear it at
all. This "customized sound therapy" is very
experimental, but seems to be working for me.
I just wanted to share my excitement.
Jay Whaley, 2435 Wilbur Ave., San Diego, CA
92109, 585-483-9197
I
n August 2000, I took a prescribed antibiotic
for a stomach problem, and apparently did not
take enough water with it. Within an hour, I
was vomiting rather violently. Afterwards, I
heard a whooshing, pulsing sound in my left ear.
Not knowing what was happening, I went to the
emergency room. They did a CAT scan, said all
appeared normal, and that the noise would go
away. 'Tb be safe, I went to an ENT who ran hear-
ing tests but could offer no explanation for the
noise. I went to another doctor who thought the
problem was a blocked eustachian tube. He blew
it out with air and put me on cortisone. I had an
MRJ and other tests run. I was referred to
another doctor who ran more tests, concluded
that I'd torn a membrane in the ear, and put me
on a special diet, a diuretic, and herbs to improve
blood flow. While at times things seemed to get
better, it never lasted. The noise was extremely
loud.
As time went by, my emotional state deterio-
rated to the point where I developed an anxiety
disorder. A specialist re-ran tests after three
months, and, after getting conflicting results, sug-
gested I'd have to live with the problem. I asked
for another referral and was given the name of
Aristides Sismanis, M.D., at the Virginia Medical
College. Dr. Sismanis' first act was to put a stetho-
scope to my ear, after which he said, "I can hear
it - that's good." Fearing a stroke, he suggested
that I have an angiogram as soon as possible. The
angiogram revealed a dissection of the carotid
artery behind my left ear which had caused the
artery to narrow, thus creating the noise. The
only practical treatment was the implantation of
a stent in the damaged artery. It was a difficult
New Tinnitus Research? Here it is!
by Barbara Tabachnick Sanders, ATA Director of Education
Is there research being done on tinnitus? Yes, you
bet, and lots of it all around the world. ATA's year-
round tinnitus research funding program now offers
$500,000 annually in grants to tinnitus researchers and
their projects of excellence. The National Institutes
of Health, a U.S. federal agency; the Tinnitus Research
Consortium, a private funding group; and independent
clinics, hospitals, and medical schools have joined
ATA in making tinnitus research an urgent priority in
the U.S.
How can you find out about tinnitus research on
an ongoing basis? The Internet's premier research site
is PubMed, a service of the National Library of
Medicine (www4.ncbi.nlm.nih.gov/PubMed/). Type
the word tinnitus in PubMed's "search for" line, and
you'll find brief reviews, or abstracts, of the newest
published research from all around the world. The
International Tinnitus and Hyperacusis Society in
London (www.iths.net) also publishes information
about international tinnitus research. Of course, we
keep you informed through Tinnitus Tbday and our
Web site (www.ata.org).
The studies highlighted here are very new projects
by scientists in the United States, J apan, Greece,
Germany, Sweden, Poland, England, The Netherlands,
and Australia. Many of these studies have just
concluded; others are experiments underway.
So take heart. Innovative researchers around the
world are at last seeing tinnitus as a rewarding field of
study. And they - and we - are giving it our all.
Rheumatoid arthritis drug used for ear disorders
USA, May 2001
In an open (non-double blind) study, researcher L. H.
Salley et al., at the Virginia Commonwealth University,
gave weekly doses of methot1exate, a rheumatoid
arthritis drug, to 50 patients with ear disorders
(vertigo, hearing loss, and/or tinnitus). Of the 42 who
had tinnitus, 11 experienced significant improvement
in their tinnitus as well as in their hearing loss and
vertigo.
New Technology to Study the Ear - Optical
Coherence Tomography
USA, June 200 1
Researcher C. Pitris et al., at the Massachusetts
Tnstitute of Technology, used the new medical imaging
technology of optical coherence tomography to generate
detailed cross-sectional images of the human middle
ear bones, eardrum layers, nerves, and tendons. This
technology displays images in real time and with
higher resolution than previously possibl e.
USA, Oct 2000
In an animal study, B. J. Wong et al., at the University
of California Irvine, was able to image the inner ear
and cochlea using optical coherence tomography. The
8 Tinmrns 7bday/ September 2001 American Tinnitus Association
result: the first live high-resolution image of inner
ear structures.
PET Scans Look at Changes in Tinnitus
USA, May 2001
According to R. Burkard at the University at
Buffalo, researchers at U of Band the Veterans
Administration Western New York Healthcare System
are recruiting patients for two PET imaging studies of
tinnitus. One study will image the brain during lido-
caine use. Another study will image the brain after
masking use to look at changes in the brain during
the period of residual inhibition - the temporary
cessation of tinnitus after masking sound is removed.
New Anticonvulsant Drug for Tinnitus
USA, May 200 I
R. Burkard also stated that researchers at the
University at Buffalo and the Veterans Administration
Western New York Healthcare System are beginning
a double-blind placebo-controlled study of an anti-
convulsant drug for tim1itus. Researchers found that
the anticonvulsant and the drug lidocaine have simi-
larities in their mechanisms of action. Researchers
also identified lidocaine as a drug with prominent
negabve side effects and therefore unsuited to
clinical use.
Customized Sound Therapy
USA, May 200 1
A. Kadner at the University of California, San Diego,
along with an interdisciplinary team of researchers,
is studying an approach to relieve tinnitus with MP3
technology. Patients listen to a personalized MP3
sound that matches their tinnitus. The therapy is a
variation of TRT and masking. Short-term results
have been positive.
Quinine's Effect on Outer Hair Cells
USA, April 2001
High levels of quin ine are well known to damage the
mechanical working of the cochlea's outer hair cells.
Oregon Health and Science University researchers
Zheng et al., recently identified that even low con-
centrations of quinine can damage the function of
outer hair cells.
Long-standing vs. Transient Tinnitus
Canada, March 2001, ATA-funded pro;ect
Researcher J. Eggermont, at the University of
Calgary, is studying the changes in the hearing part
of the brain - the auditory cortex - when noise-
induced tinnitus is constant and when noise-induced
tinnitus disappears. From preliminary testing, there
is an increase in activity in the auditory cortex after
noise exposure. Surprisingly, the increased activity in
the brain remains even after tinnitus is no longer
detectible. Eggermont hopes to uncover the reason
for post-tinnitus increased brain activity, and possibly
find the way to decrease it.
Cochlear Implants
USA, March 2001
In a study by M. J. Ruckenstein et al., at the
University of Pennsylvania, 38 tinnitus patients who
met the criteria for cochlear implants rated their
tinnitus before and after implantation. Of the 38,
35 (92%) had a reduction in tinnitus intensity after
receiving the implant. None experienced a worsening
of tinnitus.
Anti-epileptic Drug for Tinnitus
USA, March 200 1, ATA-funded pro;ect
Loud sound initiates activity in the brain in certain
nerve cells. But the brain can quiet down this activity
by releasing gamma-aminobutyric acid (GABA), a
nahnal chemical in the brain. Researcher R. Harlan,
at Th1ane University, gave vigabatrin to animals
before they were exposed to loud sound. (Vigabatrin
is an anti-epileptic drug known to increase GABA in
the brain.) Pre-treatment with this drug apparently
reduced the amount of abnonnal brain activity that
would have resulted from loud noise exposure. The
researcher concludes that anti-epileptic drugs could
help some forms of tinnitus.
Gabapentin for Tinnitus Relief
USA, March 2001
Researchers C. Bauer (previously funded by ATA) and
T. Brozoski, at the Southern 111inois University School
of Medicine, induced tinnitus in rats by a single
intense noise exposure. Auditory testing and the
degree of cochlear trauma confirmed the presence
of tinnitus that, in these animals, persisted for 17
months. At that time, the researchers administered
gabapentin (Neurontin, an anticonvulsant), which
relieved the tinnitus.
USA,Feb 200 1
J.J. Zapp, at the Pain Institute of Northeast Florida,
reports a case study of a patient with tinnitus of 10-
month duration. The patient was given 500 mg/day
of gabapentin in divided doses, and shortly reported
that he was tinnitus-free for 23 days out of a month.
The patient had a 75% reduction in tinnitus during
tl1e remaining days. After two years of continuous
gabapentin use, he remained relatively tinnitus-free.
Inner Ear Infusions
German"' Feb 2001
Researchers T. Wilhelm et al., analyzed the results
of 123 tinnitus patients who received infusions of
dextrane/ procaine over five days, then 10-minute
lidocaine rv injections, then, if necessary, infusions
of glutamic diethylester and glutamic acid for three
days. Overall tinnitus relief reported: 95.3% of
sudden-onset tinnitus and 26.7% oflong-term
tinnitus. This was not a double blind placebo study.
Steroids for Meniere's
Japan, Feb 200 1
Researchers T. Kitahara et al., exposed the endolym-
phatic sacs (structures connected to the vestibular
organ in the inner ear) of 12 Meniere's patients to
high levels of prednisone and dexamethasone.
Steroid-soaked sponges were placed in and on the
sacs with biomedical adhesive to allow slow delivery
of the drug. After 6-14 months, all 12 had their
Meniere's attacks completely controlled. In 11 cases,
hearing improved and tinnitus decreased.
Neurofeedback
German"' Jan 2001
German researchers K. Gosepath et al., treated 40
patients with neurofeedback, a form of biofeedback
that measures specific electrical activity in the brain.
After 15 training sessions/ treatments, all 40 patients
had a "significant reduction" in their tinnitus based
on questionnaire scores. 1Wenty-four of these
patients whose tinnitus duration averaged one year,
had significant increases in alpha amplitudes after
neurofeedback. The remaining 16 patients, whose
tinnitus duration averaged seven years, had no alpha
activity but increased beta amplitudes after neuro-
feedback. A control group of 15 people without
tinnitus had no alpha or beta amplitude changes
during the same training.
Laterality of Tinnitus
Germany, January 2001
Researchers M. Reiss and G. Reiss studied seven
previous studies (a total of 4,634 tinnitus patients)
and detern1ined that tinnitus occurs more often in
both ears (48.8%) than on the left side (28%) or the
right side (23.2% ).
Ginkgo biloba special extract EGb 7 61 for
tinnitus
Germany, January 2001
Researcher N. Holstein looked at 19 clinical ginkgo
studies and found eight that looked specifically at
tinnitus caused by cerebrovascular insufficiency or
labyrinthine disorders. In those eight studies, Ginkgo
biloba special extract EGb 761 produced "statistically
significant superiority of treatment" for tinnitus over
the placebos and other control groups.
Letters to the Editor (continuedJ
procedure but was successful. By the time the
procedure was done, the artery had almost
completely closed. I had faced a serious risk of
a stroke.
As Dr. Sismanis points out, pulsatile tinnitus
is not like other forms of tinnitus. It can point to
serious underlying vascular problems. I've also
learned that not everyone is an expert. It is
important not to rely on one person's opinion
if it appears to be leading nowhere.
Roger D. Luchs, Gaithersburg, MD,
rluchs@knlaw. com
American Tinnitus Association Tinnitus 7bday/ September 2001 9
New Tinnitus Research? Here it is! (continued)
Pressure Treatment for Meniere's
Sweden, January 2001
Researcher L. Odkvist discusses the use of pulsated
pressure treatment in the ear canal for certain
phases of Meniere's disease. This treatment showed
significant improvement primarily of vertigo, but
also oftinnitus and hearing.
TRT for patients with and without hearing loss
Poland, 200 1
Researchers G. Bartnik et al., evaluated tinnitus
patients at the Tinnitus and Hyperacusis
Management Clinic at the Institute of Physiology
and Pathology of Hearing in Warsaw. Patients with
tinnitus and no hearing loss were compared to
patients with tinnitus and hearing loss in their
response to TRT One year into treatment, 70% of
tinnitus-only patients showed significant improve-
ment, whereas 90% oftinnitus-and-hearing-loss
patients showed significant improvement.
Tinnitus Relieved with Vestibular Disorder
Maneuver Therapy
Greece, 200 1
According to researchers G.J. Gavalas et al., 33.2%
of vertigo patients with tinnitus reported that their
tinnitus disappeared after using the Semont and/ or
Epley rehabilitative maneuvers for their benign
paroxysmal positional vertigo (BPPV). Interestingly,
when tinnitus-only patients used the maneuvers,
18% experienced tinnitus relief.
Cognitive Behavioral Therapy
USA, 2000, ATA-funded pro;ect
Researchers J. McQuaid and S. Robinson, at the San
Diego VA Healthcare System and the University of
California at San Diego respectively, are studying the
effectiveness of cognitive behavioral therapy as an
advanced skill of distraction for tinnitus. Patients are
given detailed activities, workbooks, and exercises to
do to help them learn new behavioral skills. This is
the first large-scale study of this therapy for tinnitus.
Tinnitus Retraining Therapy
USA 2000, ATA-funded pro;ect
Research R. 'TYler at the University of Iowa is study-
ing the effectiveness of tinnitus retraining therapy
(directive counseling with sound generators) as it
compares with the relief derived from directive
counseling only and from masking only.
Attention and Memory affected by Tinnitus
Australia, 2001, ATA-funded pro;ect
C. Stevens and G. Walker are examining the degree to
which tinnitus interferes with a person's memory
and attention. Based on the outcome ofthe study,
the researchers foresee proposing a variety of
psychological management treatments specific to
patients' needs.
1 0 Tinnitus 7bday/ September 2001 American Tinnitus Association
Brain Imaging of Tinnitus
USA, 2001, ATA-funded pro;ect
R. Folmer and W. Martin, at Oregon Health and
Science University, are using functional magnetic
resonance imaging (fMRI) scans to look at the specific
brain structures and pathways related to troubling
tinnitus. These researchers are looking for specific
sites or mechanisms of tinnitus, which could lead to
specific treatments.
J. Melcher is also using fMRI to study specific areas
of the brain as they relate to tinnitus. For example,
the fMRI can precisely detect the brain's responses
to sound and which part or parts of the brain are
behaving abnormally when tinnitus is present. The
researchers believe that fMRI scans might help doctors
determine the most beneficial treatment to give a
tinnitus patient.
Somatic Tinnitus
ResearcherS. Shore, at the Medical College of Ohio,
continues her study of somatic tinnitus - specifically
tinnitus that is made louder or softer by touching the
face, manipulating the head or neck, or clenching the
jaw. The researcher expects to identify the nerves,
auditory structures, and the brain chemicals responsi-
ble for this reaction. This, she believes, will set the
stage for the development of drug treatments to
relieve tinnitus.
Chemical Reverses Hyperactivity in Auditory
System
USA, November 2000
Researcher J. Kaltenbach, at Wayne State University,
reports of his team's continued search for drugs to
ameliorate tinnitus. Kaltenbach had worked with the
drug manufacturer, Pfizer, on this for a few years.
Kaltenbach took the knowledge he gained and contin-
u ~ s his investigations. He and his team have identified
a chemical compound that, when applied directly onto
the brainstem surface, reverses hyperactivity in the
auditory system. This is the same hyperactivity caused
by cisplatin, an anti-cancer drug knov-.rn to cause
tinnitus. Kaltenbach's conclusion: The hyperactivity
represents the presence of tinnitus, and the reduced
hyperactivity represents the quieting of tinnitus.
Alternative Treatments - Caroverine and
Magnesium
USA, 2001
Previous research has suggested that damaged
cochlear outer hair cells and inner hair cells cause a
release of the chemical glutamate in the inner ear.
Excess glutamate is a suspected cause of tinnitus.
Caroverine and magnesium are chemicals that all
have a nullifying effect on excess glutamate. Both are
being studied at the Henry Ford Health System for
their impact on tinnitus.
Aurex-3
The Netherlands, 2000
The Dutch Commission on Tinnitus and Hyperacusis
tentatively concluded that the Aurex-3, a mastoid
bone-conduction sound device, "seldom or never
has a positive effect on tinnitus," especially on high-
frequency tinnitus. Six patients, who were trained in
the use of the Aurex-3, each used a device for six
weeks. The researchers suggested the possibility that
Aurex-3 might show better results on patients with
low-frequency tinnitus.
United Kingdom, 2000
Leicester Royal Infirmary researchers have been
looking at the Aurex-3 and are hopeful that the
transmission of sound through the skull to the inner
ear will reduce the perception of tinnitus. An earlier
pilot study yielded encouraging results and a larger
investigation is currently under way. The aim is
to compare the effects of the Aurex-3 with both
conventional masking techniques and tinnitus retrain-
ing therapy. IB
References
Aurex-3 trial at Leicester Royal Infirmary (2000) (online)
available: http:/ / www.tinnitus-research.org/research/ aurex.html
Bartnik, G., Fabijanska, A., Rogowski, M. (2001) Effects of
tinnitus retraining therapy (TRT) for patients with tinnitus and
subjective hearing loss versus tinnitus only. Scand Audio! Suppl,
(52), 206-8.
Bauer, C., Brozoski, T. J. (2001) Assessing tinnitus and
prospective tinnitus therapeutics using a psychophysical model.
J Assoc Research Otolaryngol. [online] March 16, available:
http:/ / link.springemy. com/link/ service/ journals/ 10162/ contents/
00/ 10030/ paper/ body.html
Burkard, R. (2001) personal communication.
Eggermont, J. (2001) Are mechanisms for transient and
longstanding tinnitus different? Tinnitus Today, 26(1), 18.
Folmer, R., Martin, W.H. (2001) Functional magnetic resonance
imaging of brain activity associated with tinnitus severity and
residual inhibition. Tinnitus Today, 26(2), 10.
Gavalas, G.J., Passou, E.M., Vathilakis, J .M. (2001) Tinnitus of
vestibular origin. Scand Audiol Suppl. (52), 185-6.
Gosepath, K., Nafe, B., Ziegler, E., Mann, W.J. (2001)
Neurofeedback in therapy of tinnitus. HNO, 49(1 ), 29-35.
Harlan, R.E. (2001) Mechanisms of hyperexcitability in the
interior colliculus. Tinnitus 10day, 26(1 ), 18.
Holstein, N. (2001) Ginkgo special extract EGb 761 in tinnitus
therapy. An overview of results of completed clinical trials. Fortschr
Med., 118(4), 157-64.
Kadner, A. (2001) Customized sound therapy -Tinnitus research
at the University of California San Diego. Tinnitus Today, 26(2), 16.
Kaltenbach, J. (2001) Drug studies related to tinnitus. Tinnitus
Today, 26(1 ), 6.
Kitahara, T., Thkeda, N., l\lishiro, Y., Saika, T., Fukushima,
M., Okumura, S., Kubo, T. (2001) Effects of exposing the opened
endolymphatic sac to large doses of steroids to neat intractable
Meniere's disease. Ann Otol Rl1inol Laryngol. , 110(2), 109-12.
McQuaid, J., Robinson, S. (2000) Outcome of cognitive
behavioral therapy for tinnitus. Tinnitus 7bday, 25(3), 10.
Melcher, J.R. (2000) Imaging human tinnitus. Tinnitus 7bday,
25(3), 10.
Odkvist, L. (2001) Pressure treatment versus gentamicin for
Meniere's disease. Acta Otolaryngol. , 121 (2), 266-8.
Pitris, C., Saunders, K.T., Fujimoto, J.G., Brezinski, M.E.
(2001) High-resolution imaging of the middle ear with optical
coherence tomography: A feasibility study . .Arch Otolaryngo1 Head
Neck Surg, 127(6), 637-42.
Provisional conclusion of the Dutch commission on tinnitus
& hyperacusis: Tinnitus is not cured by the Aurex-3 (2001)
[online), available: http: / / www.nvvs.nlltinnitus/ aurex3_1_en.htm
Reiss, M., Reiss, G. (2001) Laterality of tinnitus: Relationship to
functional assymetries. Wien Klin Wochem;chr, 113(1-2),45-51.
Ruckenstein, M.J., Hedgepeth, C., Rafter, K.O., Montes,
M.L., Bigelow, D.C. (2001) Tinnitus suppression in patients with
cochlear implants. Otol Neurotol, 22(2), 200-4.
Salley, L.H. Jr., Grimm, M., Sismanis, A., Spencer, R.F.,
Wise, C.M. (2001) Methotrexate in the management of immune
mediated cochleovestibular disorders: Clinical experience with 53
patients. J Rheumatol, 28(5), 1037-40.
Seidman, M.D. (2001) Caroverine and magnesium, personal
communication.
Shore, s. (2001) Generation & modulation of tinnitus: The role of
the trigeminal ganglion-cochlear nucleus connection. Tinnitus
7bday, 26(2), 10.
Stevens, C., Walker, G. (2000) Tinnitus and its effect in attention
and memory. Tinnitus 7bday, 26(2), 10.
'JYler, R. (2000) A preliminary investigation on the effectiveness
of tinnitus retraining therapy. Tinnitus 7bclay, 25(3), 11.
Wilhelm, T., Agababov, V. , Lenarz, T. (2001) Rheologic infusion
therapy, neurotransmitter administration and lidocaine injection
in tinnitus. A staged therapeutic concept. HNO, 49(2), 93-101.
Wong, B.J., de Boer, J.F., Park, B.H., Chen, Z., Nelson,
J .S.(2000) Optical coherence tomography of the rat cochlea.
J Biomed Opt., 5(4), 367-70.
Zapp, J.J. (2001) Gabapentin for the treatment of tinnitus: A case
report. Ear Nose Throat J., 80(2), 114-6.
Zbeng, J., Ren, T., Parthasaratbi, A. , Nuttall, A.L. (2001)
Quinine-induced alterations of electrica1Jy evoked otoacoustic
emissions and cochlear potentials in guinea pigs. Hear Res.,
1 54(1-2), 124-34.
Vllth International Tinnitus Seminar
Fremantle, Western Australia
March S-9, 2002
The VIIth International Tinnitus Seminar will be
held at the Esplanade Hotel Fremantle. The Auditory
Laboratory of the Physiology Department at the
University ofWestern Australia hosts this special
event.
Scope and focus of the Thchnical Program:
This seminar will provide a forum for researchers,
audiologists, manufacturers of technical equipment,
specialists in all fields related to the treatment of
tinnitus and related health conditions, and members
of tinnitus associations worldwide.
Prominent international speakers include:
Robert Dobie, M.D. - Director of Research at the
National Institute on Deafness and other
Communication Disorders, USA
Dennis TUrk, Ph.D. - Professor of Anaesthesiology
and Pain Research at the University of Washington
School of Medicine, Seattle
Robert Patuzzi, Ph.D. - Physiology Department,
The University of Western Australia
Pawel Jastreboff, Ph.D., Sc.D. -Emory University,
Atlanta, Georgia
Jonathan Hazell, FRCS - The Tinnitus and
Hyperacusis Centre, London.
A complete registration brochure will be available
in September 2001.
Visit: www.tinnitus.com.au
Seminar Chairperson:
Pam Gabriels
Tel: + 61 8 9321 4999
e-mail: Pam@tinnitus.com.au
American Tinnitus Association Tinmtus 7bclay/ September 2001 11
ATA-Funded Research
Toward the Cure
by Pat Daggett,
ATA Director of Research
I am pleased to announce
that nine new ATA research
grant proposals were received
by the June 30th deadline. It is
gratifying to see continued
interest in tinnitus research!
Projects selected for ATA funding will be awarded
grants in January 2002. Research projects identi-
fied for funding will be listed on the ATA Web site
and in the March 2002 issue of Tinnitus Tbday.
A subcommittee of the Scientific Advisory
Committee was given the task of drafting two-tier,
multi-year criteria for grant proposals. This will
support one of ATA's new research strategies:
"To provide grants as a catalyst to help new
researchers and new research ideas." Expanded
parameters include: $50,000 per year for up to
Workplace Giving Campaigns
Community
Health Charities
The Community Health Charities is a
national federation whose objectives are to
facilitate the collection of donations through
workplace giving and to distribute funds to its
63 health agency members. The American
Tinnitus Association is one of these members
approved for participation in various donor
choice options:
The Combined Federal Campaign: An annual
fund drive for Federal employees.
State Employee Campaigns: An annual fund
drive for local government employees.
Public Sector Campaigns: Businesses offering
employee opportunities to designate charitable
donations at their work sites.
We thank all of you who have supported the
ATA through one of these options. If you choose
to continue your support in the future, send a
copy of your designation form so that you don't
miss any issues of Tinnitus Tbday. B
12 Tinnitus Today/ September 2001 American Tinnitus Association
two years; $100,000 per year for up to three
years. Grant recipients are also required to report
annually on the status of the project and in
language readily understood by the public for
Tinnitus Tbday. Criteria for ATA research grant
applications will be incorporated into a new
brochure describing the ATA grant application
procedure.
ATA will also be soliciting proposals from the
scientific community to study residual inhibition
- the temporary cessation of tinnitus after mask-
ing - and what can be done to extend it. We will
announce this research request on our Web site
and solicit inquiries from members of the
Association for Research in Otolaryngology.
The final report on the results of an ATA-
funded research project, "Outcome of Cognitive
Behavior Therapy for Tinnitus,'' by Drs. McQuaid
and Robinson follows. 9
WHAT'S NEW ON THE WORLD WIDE WEB?
The latest on www.ata.org, ATA's Web site:
+ The transcript of "Chat With Jack"
Read ATA's inaugural online Question and
Answer session between Jack Vernon, Ph.D.,
and ATA members. The Chat transcript is
available in Adobe Acrobat for easy reading
and printing.
+ A new Calendar of Events
Keep track of the latest events, self-help group
meetings, and research deadlines. Submit
information about your own tinnitus-related
event with our online form.
And in the Members Only section:
+ Tinnitus 'Ibday archive articles
Popular articles from past issues are added each
month. Visit often!
+ Other hearing news
Read interesting reports on tinnitus, noise,
Meniere's, and other hearing-related topics from
around the world.
+ Tinnitus Tips
Some tips you know; some will be new.
COGNITIVE-BEHAVIOR THERAPY FOR TINNITUS
by Shannon Robinson, M.D., and John McQuaid, Ph.D.
Cognitive behavioral therapy (CBT) is as good
as medication in the treatment of depression and
anxiety disorders (Hollon, 1993 and Robins, 1993).
CBT has also been effectively used to improve
coping with a number of chronic physical condi-
tions like temporomandibular joint disorders,
irritable bowel syndrome, and rheumatoid
arthritis. There are several reasons why patients
with tinnitus may also benefit from cognitive-
behavioral therapy. First, how people think about
their tinnitus effects how badly they feel about
their tinnitus. CBT teaches patients to critically
look at their thoughts, question if they are
accurate, and devise more accurate or helpful
thoughts. Second, research has found that the
more people pay attention to their tinnitus the
worse they feel. CBT should be an effective inter-
vention because it teaches people to choose what
they pay attention to. Third, CBT teaches people
coping techniques to deal with negative feelings
and distress.
There is a growing body of literature that
suggests that cognitive behavioral therapies can
decrease tinnitus patient distress, annoyance,
irritation, anxiety, and depression, and increase
activities. However, the studies done thus far
have significant limitations (small sample size,
difficulty determining how the treatment was
designed). This research project addressed these
limitations by using a patient manual, using relax-
ation training, having a wait-list control group,
and having a large enough sample size to see
effects between groups.
Thirty-four men and 31 women with tinnitus
were recruited from the Veterans Administration
San Diego Healthcare System Audiology Clinic
and the University of California, San Diego
Otolaryngology (ENT) Clinic. Their ages ranged
from 35 to 77 (average age: 55); they had tinnitus
from one month to 42 years (average duration:
10 years).
Participants were randomly assigned to begin
treatment either immediately or after an eight-
week waiting period. The therapy consisted of
eight weeks of group cognitive-behavioral therapy
using a manual. We emphasized the importance
of changing how one thinks about tinnitus,
increasing pleasant activities that distract from
tinnitus, and increasing social activities and
relaxation training.
Participants completed questionnaires about
well being, disability caused by tinnitus, physical
problems, focus on internal sensations, and
depression at the beginning of the study and at
eight, 16, and 52 weeks. In our preliminary
analysis, we found that
patients in CBT, compared to
the wait-list control, experi-
enced less distress due to
tinnitus at the end of treat-
ment. In addition, there was a
trend for patients in CBT to
experience less depression.
We are following all patients
for one year and will test to
see if these results are main-
Shannon Robinson, M.D. tained over time. In addition,
group members often noted that even if the
severity of their tinnitus was not better, they felt
better. This seems to suggest that participants are
learning to cope with tinnitus more effectively.
We hope to continue cognitive behavior ther-
apy and other research focused on helping those
with tinnitus learn to cope, as well as research
investigating possible cures for tinnitus. At the
University of California, San Diego, Dr. Shannon
Robinson and Dr. Erik Viirre are studying a med-
ication that may be helpful for treating tinnitus.
Dr. Viirre is also looking at specialized sound
therapy for helping patients with tinnitus. In the
future, we hope to compare treatments such as
these and identify which treatment works best for
which patients.
In the long run, this research provides us with
not only a better understanding of how to help
our patients, but also a better understanding of
how tinnitus works and how people with tinnitus
cope. By learning if patients with tinnitus can
change their thinking, and if changing their think-
ing helps them feel b e t t e 1 ~ we have the chance to
develop better treatments for tinnitus and a range
of other related problems.
We appreciate the American Tinnitus
Association's generous support of this project. IC':J
References
Hollon, S.D, Shelton, R.C., Davis, D.D. (1993). Cognitive
therapy for depression: Conceptual issues and clinical
efficacy. Journal of Consulting and Clinical Psychology,
61(2), 270-5.
Robins, C.J., Hayes, A.M., (1993). An appraisal of cognitive
therapy.foumal of Consulting and Clinical Psychology,
61(2), 205-14.
American Tinnitus Association Tinnitus 7bday/ September 2001 13
Orchestras and
by Joel Levine
The telephone conversation began with
regret and ended with a surprise. I was calling a
colleague to withdraw from an invitation to guest
conduct his orchestra because I had just been
diagnosed with tinnitus. I was stil1 reeling from
the emotions we all encounter - the realization
that this constant ringing is not going away. The
surprise was his confession that he, too, shared
this burden and understood my need to withdraw
and try to find my way back from the edge of
panic. He also swore me to secrecy. I was not to
discuss his condition because he feared career
repercussions. Fortunately, my outcome has been
positive and is one that I wish to share.
I am the music director of the Oklahoma City
Philharmonic Orchestra. Until December 1993, I
had never considered that my wonderful hearing
might be at risk. I had always been proud of my
ability to hear the highest sounds in the human
spectrum- the ultra high frequencies used in
some department store burglar alarms, for exam-
ple, that went undetected by my friends. Now at
the age of 53, I look back at my university years
and realize that J subjected myself to the kind of
loud sounds that would inevitably damage my
hearing.
?f
ow well I remember seeking relief
from the pressures of college life by
listening to my favorite music wearing
headphones with the volume turned
up. What ecstasy! Now I wonder how much dam-
age I did in my early twenties as the hours of
high-volume listening piled up.
My exposure to really loud sounds began in
1976 when, as a graduate of the Eastman School
of Music, I came to Oklahoma City to conduct
musical theater. For 15 years, I spent my sum-
mers in the orchestra pit at Lyric Theatre as the
producer of professional summer musicals. The
orchestras, ranging from 15 to 24 players, all had
two things in common - loud brass and drums.
Th understand the level of volume generated
in an orchestra pit, put on your favorite Broadway
Original Cast recording and listen to the overture.
It is designed to be loud enough to excite the audi-
ence. Pointing straight at the conductor, and other
nearby players, are several trumpets, trombones,
and saxophones. Closer yet are the drums, electric
guitar; and keyboards - with amplifiers.
14 Tinnitw; Thday/ September 2001 American Tinnitus Association
My New York colleagues who conduct on
Broadway and on national tours listen to these
sound levels eight performances a week. J can
only wonder what danger they are in. The trend
in musical theater since the 1960s has been
toward louder orchestrations to accommodate the
changing musical tastes of the public. The intro-
duction of the wireless microphones worn by the
actors has also permitted orchestrations to
become louder since they do not cover up the
performers' voices.
y career changed in 1980 when I
became the assistant conductor of
the Oklahoma Symphony Orchestra.
The symphony's rehearsal room was
built in 1937, with a ceiling only 14 feet above its
concrete floor. From archival photographs, it is
clear that generations of musicians had tried to
solve the loudness problem. Some had even
stapled egg crates to the walls' By the time I
arrived on the scene, even the acoustical tiles
had been rendered useless after someone decided
to "spruce up the place" by painting them.
When I rehearsed the orchestra in that room,
I used to ask the brass and percussion to play
softly. But it was an uphill battle. After all, a
trumpet is a trumpet. And if you have to play a
certain way for an audience, you have to rehearse
it. I used to watch the string and wind players put
in foam earplugs and wondered how they could
play if they couldn't hear themselves. Oh, how I
wish that I had done the same.
Loudness was an issue onstage as well. No
one wanted to sit in front of the brass or percus-
sion sections. Orchestras soon began using an
increasingly common industry solution: plexiglass
shields mounted on music stands and placed
behind musicians' heads. This helped to minimize
direct sound blasting. Putting the orchestra on
risers also helped by creating levels. But it can't
be done on every stage.
In 1989, I became the music director of the
Oklahoma City Philharmonic, and enjoyed having
my own orchestra until a fateful day in December
1993. I was onstage at a rehearsal when I sud-
denly felt very dizzy. I recovered and wrote it off
as stress from overwork. As the days went on,
however, the episodes became more frequent and
I could not tie them to any specific activity or
lifestyle trigger.
I saw my doctor plus several neurologists and
ear specialists, and finally had an MRI. No cause
was found; everyone said I was suffering from
overwork. So, I cancelled guest conducting
View from the Podium
engagements including (painfully) my debuts in
Spain and Mexico City, and reduced my local
commitments. Still nothing helped, and I was
beginning to seriously worry about how I could
continue in my profession since there is not
much of a future for a conductor with random,
severe vertigo. Fortunately, a friend who had per-
sonal experience with bouts of dizziness pointed
out that caffeine is the "enemy of the ear." I had
been drinking diet drinks loaded with caffeine,
and removing them from my diet helped enor-
mously. Finally, after five months, the episodes
faded and I began to feel like my old self again.
And then the ringing started.
At first, 1 heard a faint, soft high-pitched
sound that started in the morning and disap-
peared in an hour. But in a few days, the sound
grew louder, and it did not go away. The ear
specialists were not as optimistic this time.
Tinnitus is much more difficult to treat than
dizziness, they said.
Most of us have gone through the "what
comes next" phase, and it is a long road. I could
not imagine living the rest of my life with this
noise in my head. Eventually, I found my way
to the ATA and to Dr. Jack Vernon, who to my
delight is a classical music fan. Dr. Vernon helped
me get over the fear that tinnitus meant the end
of my career.
T
he tinnitus started in May 1994 near the
end of that orchestra season, which left
me with the entire summer to adjust,
try biofeedback and other ideas, and
worry about what would happen when I got in
front of the orchestra in the fall. At an arts
fundraising event that summer, I was introduced
to Dr. Jack Hough, a foremost ear specialist in
Oklahoma City. He told me something that
changed the whole way I looked at tinnitus.
Where the other doctors had simply said to "live
with it" (which seemed impossible at the time),
Dr. Hough explained that after about 11 months,
my brain would start to "tune out" the sound so
that I would be far less aware of it so that I could
live with it. His words made a major difference in
my perspective. And he was right. After about a
year, I realized that for parts of days and then for
entire days I forgot I had tinnitus. I also began
taking xanax (alprazolam) at a dosage of 0.5 mg,
three times a day. After approximately one
month, the ringing level was noticeably quieter.
I am one of the lucky ones who can tolerate the
medication without sleepiness. l still take Xanax
at the same 0.5 mg-three-times-a-day dosage
usually at 9 a.m., 5 p.m., and 10 p.m. There is no
question that it works for me. If I forget to take a
pill, the ringing goes up and reminds me!
W
ow I am very careful about my own
hearing, and the hearing of other
musicians. I wear earplugs in risky
situations (you'd be surprised at how
many Broadway musicals have gunshots in them)
and have been much more willing to move musi-
cians out of the way of loud colleagues. It is not
an easy task. A symphony orchestra generates a
lot of sound onstage, and someone is always at
risk. Just playing the violin itself takes a toll with
those high frequencies being pumped directly
into the left ear.
This fall, the Oklahoma City Philharmonic
will perform in a new $51 million performing arts
center where the rehearsal room ceiling is 25 feet
high and the walls and floor have appropriate
sound-absorbent coverings. I have not kept my
condition a secret from the players because it in
no way interferes with my ability to do the job. I
can still hear all the things I need to - and they
know it! In fact, when I am conducting, I am
completely unaware of the tinnitus. I do, how-
ever, want them to know that I am very aware of
the risks to our ears in this business and that I
encourage them to come to me vvith their con-
cerns. And I thank the ATA and Drs. Vernon and
Hough for making it possible to get safely to the
other side of this hill we all must climb. ID
Maestro Levine is the Music Director of the
Oklahoma City Philharmonic Orchestra and can be
contacted at JLMus@aol.com.
New Directions from ATXs
Scientific Advisors
ATA Scientific Advisory Committee
members serve as stewards of our
research program. These esteemed
scientists read research grant proposals
submitted to ATA, identify the
exceptional projects, then make their
funding recommendations to ATA's Board
of Directors. Each committee member
has a professional connection to tinnitus.
Each also has a passion to find answers
and deliver relief to people with tinnitus.
We extend our gratitude to the following
scientists who have completed many years of
service as Scientific Advisory Committee
members: Ronald Amedee, M.D.; Robert
Brummett, Ph.D.; Jack Clemis, M.D.; John
Emmett, M.D.; Barbara Goldstein, Ph.D.; John
House, M.D.; J. Gail Neely, M.D.; Alexander
Schleuning, II, M.D.; Abraham Shulman, M.D.;
and Mansfield Smith, M.D.
The newest Scientific Advisory Committee
members, introduced below, have diverse science
and medical backgrounds. It is a diversity that
enriches our pool of knowledge and keeps us
moving closer to a cure. Here are their answers to
questions about their own research, their vision
for ATA, and their world vision of the future for
tinnitus research.
Paul Abbas, Ph.D.,
University of Iowa
In our basic research, we are
trying to understand how electrical
stimulation of the auditory nerve is
accomplished and how electrode
configuration, specific waveforms,
and state of hair cell degeneration affect the
response. That research has led to other research
to improve the ability of cochlear implants to
transmit information to the auditory nerve. This
could have implications for tinnitus in two ways.
The first is very general: The more we understand
about different ways the auditory nerve can be
excited, the better we will understand pathologies
[diseases or changes] of the cochlea. The second
is more direct, in that various modes of electrical
stimulation of the ear have been used to treat
tinnitus. In fact, this research, done in conjunc-
tion with my colleague Dr. Jay Rubinstein, has
led to the evaluation of electrical stimulation as a
treatment for tinnitus patients. Our goal is to
determine why some patients have better results
than others, and then develop ways to stimulate
the auditory nerve differently to improve the
outcomes.
I am very new to ATA's Scientific Advisory
Committee, so I come into it with few precon-
ceived notions. A group of researchers and
clinicians with a relatively broad range of interests
could best advise the ATA regarding directions for
research. Researchers Hke me who come in with a
slightly different viewpoint on tinnitus will hope-
fully help ATA develop a broad perspective for
where funding could best be used. B
Anthony T. Cacace, Ph.D.,
Albany Medical College
This is a very exciting time for
tinnitus research since many power-
ful tools are becoming available to
study this condition in humans. We
used a technique called "functional
magnetic resonance imaging" (fMRI), which is a
non-invasive way to image or localize brain activ-
ity associated with different sensory, motor, cogni-
tive, or linguistic conditions. However, to apply
the technique effectively, it requires one to alter-
nate between tinnitus activation and no activation
conditions. Because tinnitus is typically present
continuously, applying this methodology becomes
much more challenging. However, seven years
ago, we began to study patients who could switch
their tinnitus on and offby changing eye posi-
tions. This condition is known as gaze-evoked
tinnitus. The ability to turn tinnitus on and off
provided the conditions necessary to apply the
fMRI technique. We also studied patients with
fMRI who could activate their tinnitus with skin
stimulation, or cutaneous-evoked tinnitus.
We've demonstrated that tinnitus-related activ-
ity could be detected and localized in the nervous
system in very selected groups of individuals. This
sets the stage for developing techniques to study
more common forms of tinnitus that affect mil-
lions of people. Presently, many different labs
around the world are either involved or planning
to become involved in this type of research and
are developing novel techniques for studying
tinnitus. To effectively treat this complex condi-
16 Tinnitus Thday/September 200J
tion, we need a better understanding of its
American Tinnitus Association
neurobiological basis. This is one way to improve
our understanding and add another piece to the
puzzle.
One vision I have for tinnitus research is to
facilitate development of imaging technology, and
combine it with other methods for studying and
successfully treating tinnitus. Progress is clearly
being made, and I am optimistic that further
developments are on the horizon.
Clearly, ATA has assembled a very impressive
group of clinicians and scientists to serve on this
committee, and I am honored that I was asked to
be part of it. 19
James A. Kaltenbach, Ph.D.,
Wayne State University
Our ability to measure tinnitus-
related changes in brain activity has
two implications for the tinnitus
patient. First, we now have a good
model in which to test and screen
drugs for their ability to reverse the hyperactivity
of auditory nerve cells. Drugs that reverse this
hyperactivity may be good candidates for tinnitus
treatment. We hope that our studies in animals
will identify a handful of compounds that can
eventually be taken to the next step, that of clini-
cal trials. Second, our model allows us to study
the mechanism of tinnitus. Understanding the
mechanism is important because it is the only
way to identify the precise chemicals that under-
lie tinnitus. Once we know the chemicals to
target, we will be in a better position to develop
new and alternate strategies for the treatment of
tinnitus.
As a researcher with a special interest in
tinnitus, I bring a new perspective to the grant
review process and to discussions dealing with
scientific issues. The Advisory Committee has
done a fine job of focusing ATA support in the
best directions. However, given the seriousness
of the condition and the prevalence of tinnitus
in the American population, it is a problem that
remains grossly understudied. I hope I can stimu-
late researchers in the auditory neuroscience
community and show them that this is a fertile
field ripe for discovery.
Tinnitus is a disorder that has something in
common with many other health disorders. It is
something present (sound) that does not belong
there. It is very different from hearing loss, which
is the absence of something that should be there.
In most instances, it is a lot easier to get rid of
something that does not belong there, than to
restore something that has been lost (hearing).
The increases in funding from ATA, the National
Institutes of Health, and other private foundations
have already resulted in the formation of a solid
nucleus ofbasic researchers studying the biology
of tinnitus. This is a radical change from just a
few years ago when there were only one or two
labs focused on this issue. There is also an
increasing realization among drug companies that
tinnitus research is an area of high potential for
scientific breakthroughs. B
.,- .-, . .. l
I ~ 4
. I
- - - - - ~
Paul R. Kileny, Ph.D.,
University of Michigan Health
System
Results from my research with
lidocaine delivered through the
eardrum and other similar studies
could be used to diagnose tinnitus.
In particular, such studies along with functional
brain imaging studies could help us distinguish
tinnitus originating in the inner ear and/ or the
cochlear nerve from tinnitus originating from
the brain. For instance, temporary suppression
of tinnitus by delivery of lidocaine near the round
window of the inner ear may indicate that the
source of the tinnitus is the inner ear. Better and
more accurate diagnoses will result in improved
and more effective treatments. I also believe
there wil1 be advances in drug treatments for
tinnitus, some involving direct drug delivery to
the inner ear.
Traditionally, ear specialists in otology and
audiology have been involved in tinnitus research.
It appears, however, that tinnitus is not necessar-
ily only an "ear problem." I believe that a multi-
faceted approach including many disciplines
(some ofwhich are seldom involved in tinnitus
research) may turn out to be effective. Teams
could be composed of traditional hearing scien-
tists and clinicians, as well as neurologists and
neurosurgeons (experts in electrical stimulation),
mental health professionals, brain imaging
experts, and bio-engineers. Perhaps a think tank
with such a composition may redefine the diagno-
sis and treatment of tinnitus for the benefit of our
patients. I believe we need to actively recruit non-
traditional investigators to this area of research, to
bring some innovative thinking to the solution of
this problem affecting millions of individuals. Cl
Robert A. Levine, M.D.,
Massachusetts Eye & Ear
Infirmary
One important direction I think
ATA should take is to develop tinni-
tus training for physicians. There's a
paucity of doctors who know what to
do for tinnitus patients. Also, as a neurologist, I
bring a neurology perspective to the work of the
Scientific Advisory Committee that no one else
on the committee has. Because the stress associ-
American Tinnitus Association Tinnitus 7bday/ September 2001 1 7
New Directions from ATA's Scientific Advisors (continued)
ated with tinnitus is the real clinical problem
of tinnitus, I also feel that we're sorely missing
people with a psychiatry background in the field.
They could make a great contribution to our
understanding of why some people are greatly
distressed by tinnitus and others not. From this
improved understanding will follow new insights
into helping patients deal with the stress associ-
ated with tinnitus.
It's interesting that most people without
tinnitus will hear a faint sound of tinnitus if they
are put in a soundproof room. But what is it that
makes tinnitus become so troubling in regular
surroundings for some people and not for others?
I'm of the belief that some threshold has to be
crossed in the brain to make the phantom
auditory perception of tinnitus become obvious.
I really buy into the concept that our research
group originally proposed 30 years ago and that
has received more recent support from cochlear
implant patients and Dr. Jim Kaltenbach's obser-
vations. The concept is that activity in the dorsal
cochlear nucleus (the part of the brain where the
nerve from the ear goes) increases when activity
in the nerve from the ear decreases. That's another
very interesting direction for ATA to follow. B
Craig W. Newman) Ph.D.)
Cleveland Clinic Foundation
Interestingly, patients whose
tinnitus pitch and loudness are
similar, often differ widely in
the extent to which the tinnitus
sensation bothers them in everyday
life. Over the last few years, I have been inter-
ested in exploring some possible reasons to
explain this fascinating phenomenon. By using
various questionnaires, we were able to divide
a group of patients with tinnitus into two sub-
groups. The first group was comprised of
individuals who were more inwardly focused on
the tinnitus (we classified these people as "high
self-attenders"). The second group included those
who were more outwardly focused and less
attentive to the tinnitus (classified as "low self-
attenders"). The high self-attenders were more
distressed by their tinnitus than the low self-
attenders even though both groups rated the pitch
and loudness of their tinnitus in a similar manner.
These observations are important because
they may help direct clinicians to management
strategies that may be most helpful for a particu-
lar type of person. For example, low self-attenders
might benefit from informational/ educational
counseling about tinnitus and the use of instru-
18 Tinnitus Thday/September 2001 American Tinnitus Association
mentation (such as hearing aids or noise genera-
tors) . In contrast, high self-attenders may require
the use of additional therapeutic interventions
(such as cognitive behavioral therapy and biofeed-
back) aimed at reducing depression and stress and
improving coping skills.
I believe that ATA's Scientific Advisory
Committee has the responsibility to advise the
ATA staff and Board of Directors about current
scientific advances in all possible disciplines
related to tinnitus. In fact, the Scientific Advisory
Committee should play a major role in acting as a
"filter" to all members of ATA (including you -
those with tinnitus). In this way, individuals affili-
ated with ATA can be assured that information
provided by the Association represents the most
contemporary thinking in the scientific commu-
nity. It is also critical that the Committee foster
programs among novice and seasoned investiga-
tors alike to stimulate innovative basic and
applied research projects.
Over the next few years, I believe that tinnitus
research will be directed toward developing an
objective measure, or marker, of tinnitus. This
may include application ofbrain imaging tech-
niques. In turn, this would help locate the genera-
tor(s) oftinnitus and the potential underlying
mechanisms. This basic understanding of tinnitus
is critical to the development of appropriate
treatments. a
Jay T. Rubinstein) M.D., Ph.D.)
University of Iowa
I am a neurotologic surgeon and
biomedical engineer who has been
trying to answer the question "How
do cochlear implants work?" for
the last 20 years. In the process of
trying to develop better signal processing for
cochlear implants, I have determined a means by
which electrical stimulation may be used ration-
ally for the treatment of tinnitus. This potential
treatment is based on an idea suggested by Drs.
Nelson Kiang and Robert Levine 30 years ago.
With modern cochlear implant signal processing,
it may be possible to suppress tinnitus without
producing an audible sound. (Electrical stimula-
tion typically produces its own sound.) Our goal is
to do better than masking by suppressing tinnitus
with a stimulus that does not produce sound, or
that only produces a transient sound with ongoing
tinnitus suppression. Dr. Rich 1Yler and I have
been funded by the Tinnitus Research
Consortium and by Braintronics, Inc. to test
this concept, which appears promising in some
tinnitus sufferers.
SUMMERTIME ... AND THE SUPPORT
PROGRAM IS BUSY
by Rachel Wray,
ATJ1 Director of Advocacy and
Support
At the American Tinnitus
Association, the lazy days of
summer are a myth. Instead,
ATA staff has been busily
preparing for new self-help
groups across the country to
begin meeting this fall while
providing existing groups with helpful resources.
Though our work is hardly completed, the
results thus far should prove meaningful not
only to hardworking group leaders, but to group
participants too.
I
n May, we hosted a series of roundtable con-
ference calls with self-help group leaders
across the country. The discussions focused
on issues both big and small related to self-help
group facilitation: finding guest speakers, mem-
bership retention, researching new discussion
topics, even room acoustics and ambiance.
Participating facilitators showed an almost
scholarly interest in improving their groups.
Some hoped to focus on reaching out to the
community, others on educating local healthcare
providers. And some just wanted consistent
involvement from their group participants.
The conversations reflected that the group
facilitators took their volunteer positions - and
their commitment to tinnitus patients - seri-
ously. And all agreed with ATA staff that ongoing
telephone conferences should be held as a way to
stimulate new ideas, support group dynamics,
and reinforce to facilitators that they're not in a
vacuum. Many facilitators had the same concerns
or questions and were pleased to find helpful
advice from an empathetic crowd.
While existing group leaders continue to
incorporate successful ideas into their meetings,
new self-help group leaders are popping up
around the country. June and July yielded
several enthusiastic people eager to give back
to the community by sta1iing a tinnitus support
program in their cities. Fortunately for tinnitus
patients, four of these volunteers are in states
that previously had no formal groups.
'Ibnya Barlow, an audiologist in Louisville,
Kentucky, is set to begin her new group October
15, 2001. She and her colleague Ingrid Edwards
will facilitate the bimonthly meetings. Call
800-525-0414 for more details.
'Ibbie Levine is starting up a new group in
the Boston, Massachusetts, area. Tbbie does not
have tinnitus, but her children experience it, and
her husband, Robert Levine, M.D., is a neurologist
in Boston and a member of the ATA Scientific
Advisory Committee who frequently treats
tinnitus patients. This personal connection
inspired her to start the group. For more
information, contact her at 617-734-1948 or at
tobieglevine@yahoo.com.
Marlene Meltzer is planning her first meet-
ing, which is also scheduled for October. Marlene
lives just outside of Las Vegas, Nevada. Reach her
at 702-407-6897.
In the Raleigh, North Carolina, area, Scott
Hartquist is slated to begin a new group this fall
too. Meetings will be held at the Eva H. Perry
Regional Library in Apex. Contact Scott for more
information at 919-303-7064 or at shartquist@
integrian. com.
The Broward Tinnitus Support Group, facili-
tated by Alexandra Merner, holds its first meet-
ing on Sunday, September 9, 2001, from 2-4 p.m.
Meetings will be held on the second Sunday of
each month in Fort Lauderdale, Florida. For more
information, contact Alexandra at 954-763-4784.
These new facilitators have very individual
reasons for starting a group in their cities: profes-
sional interest, personal connection, or success
managing their own tinnitus. But like our current
support facilitators, they all share the same drive
to educate, support, and interact with others who
are touched by tinnitus.
A
1998 U.S. Surgeon General's office publica-
tion reported on the benefits and impor-
tance of self-help groups. Drawing from
several studies, the Surgeon General cited a litany
of positive outcomes from attending a support
group, including reduced feelings of isolation,
increased understanding of the condition, and
improved coping abilities. Specific examples
included a University of Chicago Medical School
study that looked at older men with diabetes.
Men who participated in a peer-run support group
were less depressed, less stressed, and reported a
higher quality of life than those diabetics who
were not involved with the group. Other studies
American Tinnitus Association Tinnitus Thday/September 2001 19
New Directions from ATA's Scientific Advisors (continued)
We are at an exciting time for tinnitus
research. Tinnitus is achieving greater research
funding than in the past, and the tools avaHable
to address it are more powerful than ever. A
number of recent grants funded by both the ATA
and the Tinnitus Research Consortium strike
right at the critical questions of what goes wrong
in the ear and central auditory system of those
with tinnitus. Such work should soon pay off in
both a better understanding of how tinnitus
occurs and what can be done to alleviate it.
Richard Salvi, Ph.D.,
University of Buffalo
Positron Emission Tomography
(PET) and fMRI imaging of tinnitus
and other auditory phenomena
are still in their infancy. Many
advances in the imaging of tilmitus,
both unusual types such as gaze-evoked tinnitus
as well as more common types, are likely to be
forthcoming. One of the major advances I expect
to see in the future is being able to identify spe-
cific regions of the brain that are associated with
It's easy to join ATA
Membership is $25 per year and
includes 4 issues of Tinnitus 'Ibday.
Please call 800-634-8978 ext. 219, or sign up
on our Web site - www.ata.org.
You may also mail us a check made out
to ''ATA Membership."
P.O. Box 5
Portland, OR 97207-0005
20 Tinnitus 7bday/ September 2001 American Tinnitus Association
tinnitus in an individual patient. We could use
this objective information to develop an individ-
ual treatment strategy and then see if the
treatment alters the pattern of brain activity.
(Currently, most PET imaging is limited in that
it allows us only to average the information we
collect from many brain images.) In the next few
years, I plan to investigate the physiological,
anatomical, and biochemical basis of tinnitus in
the brain using an animal model that can report
when tinnitus is present or absent.
My vision for A T ~ s Scientific Advisory
Committee is really very straightforward: first, to
attract excellent research scientists to work on
tinnitus, and second, to try to fund as many good
basic science and clinical research projects as
possible so that we make progress in understand-
ing tinnitus and ultimately developing good treat-
ments for eliminating tinnitus altogether or at the
very least attenuating its symptoms. m
Drs. Roger Ruth and Donna Wayner, new ATA
Scientific Advisors, wil1 be introduced in the Dec.
2001 issue ofTinnitus Today.
S Ullllll ertilll e . . . (continued)
also attested to the value of an empathetic sup-
port system, which is reflected in better survival
rates, increased motivation for seeking treatment,
and less emotional and social disturbance.
These aren't just words in a government
literature review. From self-help group leaders,
we hear how these outcomes are reflected in the
lives of their group participants. Patients are
calmed by the knowledge that they're not the
only ones hearing noises in their ears and head,
which for some carries a social stigma. They
learn how to replace self-defeating thoughts or
actions with awareness of treatment choices and
relaxation activities. Perhaps most importantly,
groups offer hope-people leave with improved
self-esteem, a belief that they can improve
their tinnitus, and the information to make that
happen.
With this kind of testimony from group facili-
tators, and with this kind of opportunity to reach
out to tinnitus patients, ATA staff is eager to pur-
sue new ways of supporting our support network.
Through telephone conferences, newsletters, and
the promotion of groups in Tinnitus Tbday and on
our Web site, we look forward to helping existing
and new groups have the most positive effect on
tinnitus patients across the country. B
Are Doctors Listening?
Tinnitus: The Discounted Malady
by H. J. Schulte, M.D., F.A.P.A
"He was listening, but he did not hear me!"
Most often that applies to spouses, but not uncom-
monly it describes doctors as well. Many patients
with disabling tinnitus accurately feel that their
doctors really do not hear their plight. I ask my
professional colleagues to imagine what it would
be like to hear a loud click, hiss, or buzz that pre-
occupied their every waking minute and from
which they could not escape. I know what it's
like because I had a brief episode of tinnitus that
caused me a great deal of alarm and anxiety.
All health professionals need to understand how
extremely invasive and disturbing tinnitus can be.
Approximately fifteen percent of the popula-
tion has experienced tinnitus at some time in their
lives. Hearing threshold is the single most impor-
tant factor affecting the prevalence of tinnitus. As
hearing ability decreases, the incidence of tinnitus
often increases. 'TWo percent of the population
report significant social and work disability result-
ing from their tinnitus. It is not just the severity
of the tinnitus that causes severe psychological
reaction and results in disability. A personal or
family history of depression or anxiety as well as
the amount of stress in one's life can significantly
contribute to the severity of the emotional reac-
tion that one may have from tinnitus.
In a study at the University of Washington
Medical School, researcher Mark Sullivan observed
that 60% of patients who were seen at ENT clinics
for their disabling tinnitus also had major depres-
sive disorders. Tinnitus disability was strongly
associated with major depression, and treatment
of this depression significantly decreased the suf-
fering because of tinnitus. Another researcher,
Richard Budd, noted that despite the high preva-
lence of tinnitus, only a small group ended up
with a disabling condition. There is no direct
correlation between the loudness and the distress
of the tinnitus. As in chronic pain syndrome and
other illnesses, we see that the coping style of the
individual plays a significant role in learning to
live with tinnitus.
Major depressive disorder is not just sadness
or having a bad day, but a biological illness that
affects the whole person. Depression affects about
20 million Americans in any given year. Women
have a lifetime risk of 20-25%; men have a life-
time risk of 7-12%. Depression occurs approxi-
mately a quarter of the time in patients who have
had a stroke, heart attack, or cancer. In many of
those patients, depression is missed just as it is
frequently missed in patients with tinnitus. The
criteria for major depressive disorder includes
depressed mood all day, nearly every day for two
weeks, and/ or markedly diminished interest or
pleasure in activities. In addition to that, to meet
the diagnostic criteria, one would need to have
a change in weight, sleep, and activity level.
Frequently fatigue, worthlessness, difficulty with
concentration, and even recurrent thoughts of
death are present. Some individuals may not feel
sad but may feel irritable and have a loss of inter-
est or pleasure. This is a highly treatable illness
and can significantly affect the disability due to
tinnitus.
I recently evaluated a 48-year-old man who
had hearing loss due to his previous hobbies of
firing guns and riding motorcycles, and from
being around large machines. He had a 50% hear-
ing loss. He had episodes of sizzling, high-pitched
buzzes or hissing that changed from day to day
and not uncommonly would be so severe that he
felt trapped - like he was going to go out of his
mind. He experienced severe anxiety and depres-
sion as well as insomnia and could not concen-
trate. In desperation he said, "The tinnitus has
taken over." He responded well to antidepressant
medication and cognitive behavioral therapy.
In conclusion, it is important to remember
that since tinnitus cannot be seen or measured, it
frequently ends up being discounted. But it can
be a severely painful condition that can lead to ill-
nesses such as major depression and anxiety dis-
orders. It is my hope that physicians will increase
their awareness of the complications of tinnitus,
and that patients who have disabling tinnitus will
pursue getting appropriate treatment. a
Resources
1. Sullivan, M.D., Katon, W., Dobie, R., Sakai, C., Russo, J.,
Harrop-Griffiths, J. (1988). Disabling tinnitus. Association
with affective disorder. General Hospital Psychiatry, 10(4),
285-91.
2. Budd, R.J., Pugh, R. (1996). Tinnitus coping style and its
relationship to tinnitus severity and emotional distress.
Journal of Psychosomatic Research, 41 ( 4), 327-35.
3. Anders, G., McKenna, L. (1998). Tinnitus masking and
depression, Audiology, 37(3), 174-82
Dr. Schulte is a psychiatrist in private practice in
Scottsdale, Arizona. He can be reached at
480-941-9004
American Tinnitus Association Tinnitus 'TOday/ September 2001 21
Hand-Carved
Jack vernon
The totem carving pictured
here is one-of-a-kind, just like
the artist who carved it- Jack
Vernon. Jack has a passion
for many things: tinnitus
research, reading, his wife
Mary, caring for patients, and
woodworking - probably not
in that order. Nevertheless,
his love for woodworking is
evident in the exquisite house-
boat, cabinetry, and furniture
that he and Mary built by
hand. Jack has donated this
signed totem carving to raise
money to support ATA's
programs and tinnitus
research. In so many ways,
the highest bidder wins'
You can place a bid for Jack's
hand-carved totem in one of
two ways: online or through
the mail.
Online: Go to www.ata.org,
then to Founders' Gala 2001.
Click on 7btem Auction then
complete the bid form with
your name, address, phone
number, e-mail address,
and bid amount. Click Submit.
By Mail: Write to ATA with your name, address, phone
number, e-mail address, and bid amount. Write "Totem
Auction" on the outside of the envelope.
This is a closed-bid auction. Please do not enclose
a check, cash, or any communication needing
immediate response since your envelope will not
be opened until Wednesday, Nov. 7, 2001.
All bids must be received no later than 5 p.m. on
Thesday, Nov. 6, 2001, to be considered for the auction.
The auction winner will be notified by Nov. 12, 2001.
+ Minimum Bid: $1000. In the event of a tie, the first
highest bid received will win.
Winning bidder assumes shipping and handling costs.
Thtem Dimensions: 50" tall, 6" wide, 11" widest at base.
Thtem wood: Douglas Fir
Cap and base wood: Sugar Pine
Epoxy satin finish
Weight: 28 pounds
Look on our Web site (www.ata.org) for a full-color
picture of the totem carving.
~
22 Tinnitus Thday/ September 2001 American Tinnitus Association
Founders' Gala
Honoring Jack Vernon
The Board of Directors of the
requests the pleasure of your company
Saturday, November 10, 2001, at six-thirty in the
evening for cocktails, dinner, and silent auction at
The Hilton Hotel, 921 Southwest Sixth Avenue,
Portland, Oregon
Black tie optional
Entertainment: pianist 7bm Grant
Please join us for our second Founders' Gala.
We will honor Jack A. Vernon, Ph.D.,
tinnitus clinician, researcher, patient advocate,
and Emeritus Professor of Otolaryngology,
Oregon Health and Science University.
ATA guests will be offered special rates at
the Hilton Hotel.
In addition, a presentation on the latest tinnitus
research and on beneficial treatments is scheduled
for Saturday morning, November 10, 2001,
from 9:30a.m. - 11:30 a.m.
Seating is limited, so please RSVP by October 5, 2001.
Seats: $150 each includes dinner, wine, silent auction,
and Saturday morning tinnitus research presentation.
Ifyou have any questions, please call
800-634-8978, extension 219.
We look forward to celebrating Dr. Vernon a11d
his contributions to tinnitus with you.
If you are unable to attend the Gala to honor Jack,
you can still let Jack know that he has touched your
life. Send us a letter of thanks or praise of Jack.
We will present the letters to him at the Gala event.
QUESTIONS AND ANSWERS
Jack Vernon's Personal Responses to Questions from our Readers
by Jack A. Vernon, Ph.D., Emeritus Professor,
Oregon Health and Science University
Q
Mr. K. from Argentina
asks if it is possible for
tinnitus to produce
twitching and vibrating of the
eyes or vice versa.
A
The eyes can get
involved with tinnitus,
but as far as I know it
is not twitching. There are
some folks for whom changing
the gaze from side to side can
reduce or increase their tinni-
tus. Next time your eye starts twitching or vibrating,
rate your tinnitus on a 0 to 10 scale and then rate it
when your eye is not twitching to see if there is a
constant difference. And let me know the result.
Q
Mr. G. in West Virginia writes that his doctor
has prescribed anti-inflammatory drugs for
his osteoarthritis, but that all of the drugs
have the side effect of tinnitus. "Is there anything I
can take that will not increase my tinnitus?"
A
First of all, you need to know that almost all
of us will have some form of osteoarthriti.s as
we age. Secondly, side effects are determmed
during the original testing of the drug for the Food
and Drug Association. If as many as 2% of the test
people list a given side effect, it is from then on
recorded as a side effect. That means that for most
drugs, 90% or more people who used them did not
experience the listed side effects. If any medicine
that you take increases your tinnitus, come off the
drug immediately. The increased effect will be a
temporary condition. If and when you take such
action, be sure to inform your physician so that he or
she might prescribe an alternative medicine.
Q
Mr. G. from lllinois indicates that many years
ago he was fitted with a tinnitus masker by
the late Dr. Robert Johnson of the Oregon
Hearing Research Center's Tinnitus Clinic.
Everything was fine until recently when wax was
cleaned from his ears with a very loud suction
device. Since having that procedure, he has a new
tinnitus sound, one that is considerably louder. His
old maskers no longer serve their purpose. He asks if
there is anything he can now do to get relief.
A
It is possible that the new sound will gradu-
ally fade to a lower and less noticeable level
and maybe go entirely away. It is not unusual
for such events to take many months to settle back
down. If that does not occur, then you can begin
anew and get fitted with the new and greatly
improved form of tinnitus maskers. They are digitally
constructed and have adjustable volume and pitch
controls. Ear cleaning by vacuum or water under
pressure are both too loud, especially for tinnitus
patients, and should not be used. For the future I
suggest that you find a doctor who will remove the
wax manually, safely, and quietly.
Q
Mr. G. in Mexico says that his tinnitus is
relieved with Xanax, and that it is fairly effec-
tive. But when he tapers off the drug, he has
to wait a month before going back on the drug. He
writes, "That waiting period without Xanax is very
difficult to endure. Is there any other drug I can take
in the interval?"
A
Mr. C., there is no reason for you to taper off
the drug. Tapering off was stated in the dose
schedule only in case the drug did not work
for you and you needed to quit taking it altogether.
Many patients stay on xanax continually, some for
many years. On the other hand, after the tinnitus
cycle is broken by taking the usual dose of xanax,
some patients can then use less xanax in order to
maintain the lowered tinnitus. The next time you get
your tinnitus under control and have had it that way
for one month, see if less Xanax will work for you
just as well. Instead of 0.5 mg three ti:nes a day,
0.5 mg twice a day, once in the mornmg and once m
the evening. If that level works to relieve tinnitus,
continue at it. If it does not work as well, go back to
0.5 mg three times a day and stay there.
Q
Ms. P. in California writes that her tinnitus
and hyperacusis just suddenly appeared,
and for no reason that she can discern.
The hyperacusis bothers her more and, thus, she
would like to try to relieve it first . She ordered the
Moses/Lang CD (from the Oregon Hearing Research
Center, 503-494-8032) in order to have a source. of
pink noise and wants to know how best to use 1t.
A
Using pink noise to reestablish your normal
loudness tolerance is very simple ..
First, however, why pmk n01se and not whtte
noise? Pink noise includes all the frequencies
(pitches) that you will encounter in
environment, from 200 to 6000 Hz. Wh1te n01se
includes all audible frequencies, from 20 to 20,000
Hz most ofwhich are above environmental sounds.
TYPically, the higher the pitch of a sound, the. greater
the sensitivity the hyperacusis patient has to 1t. As
for pink noise, first listen to it through earphones so
that the volume will not change during a listening
American Tinnitus Association Tinnitus Thday/ September 2001 23
QUESTIONS AND ANSWERS (continued)
period. For each listening period, start with the
volume turned to zero and gradually increase the
volume until you feel you are very close to the
discomfort level. Back off very slightly and maintain
that level for the entire listening period. At the end
of the listening period, turn the volume all the way
back to zero. It is essential that you establish a new
listening level every time. The Moses/ Lang CD has
only ten minutes of pink noise on its fiTst track. 1b
reach the necessary minimum of two-hours-per-day
of listening time, you can repeat the track or listen
for twelve different 10-minute periods to gain the two
hours. The other important part of reestablishing
normal loudness tolerance is to Nar OVER PRO-
TECT THE EARS. I can guarantee that overprotec-
tion will make the condition progressively worse.
Since all sounds to you are too loud, you are proba-
bly confused as to when to protect and when not to
protect. Radio Shack sells an inexpensive sound level
meter with which you can measure the loudness of
everyday sounds. For the first month, do not use
hearing protection for any sound under 65 dB. Then
for the second month, do not use hearing protection
for any sound under 70 dB. Move up in 5-dB steps
each month. If there are problems with any aspect of
this procedure, I hope you will feel free to contact
me. Finally, don't worry about finding the cause for
your tinnitus and hyperacusis. We have seen over
7,000 tinnitus patients at the Oregon Hearing
Research Center, and for 49% of them we never
determine the cause. We just simply get on with
finding the relief.
Notice: Many ofyou have left messages requesting that 1
phone you. I simply cannot afford to meet those requests.
Please feel free to call me on any Friday [NOTE NEW
DAY), 9:00a.m. - noon and 1:00- 5:00p.m. Pacific
Time (503-494-2187). Or mail your questions to:
Dr. Vernon c/ o Tinnitus Thday, American Tinnitus
Association, PO. Box S, Portland, OR 97207-0005.
Or send e-mail to: vemonj@ohsu.edu.
Advertisement
Now, masking Tinnitus
won't keep either
of you awake.
Tired of Tinnitus keeping you awake? Is masking keeping your spouse awake?
Finally, here's the product that will help you both sleep--THE SOUND PILLOW.
Let two wafer-thin micro-stereo speakers nestled within a plush full-size
pillow ease your Tinnitus troubles today. With a speaker jack that fits most
radios, cd players, and televisions, the Sound Pillow delivers the soothing
masking sounds you need (and your partner will really like this} without
disturbing others. Finally, a sound device that allows you to comfortably
and affordably mask tinnitus. Call and order your Sound Pillow today so
both of you can sleep better tonight.
www.sou ndpillow.com
24 Tinnitus Thday/ September 2001 American Tinnitus Association
$39.95
(for A.T.A. members)
$49.95 regular price
TOLL FREE
(877) TINNITUS
(8466488}
SPECIAL DONORS AND TRIBUTES
ATA"s Champion Members are a remarkable group
of donors who have demonstrated their commitment in
the fight against tinnitus by making a contribution or
research donation of $1000 or more. Sustaining
Members have given memberships or research donations
at the $500-$999 level. Contributing Members have
given memberships at the $250-499 level. Supporting
Members have given memberships at the $100-499level.
Research Donors have made research-restricted contri-
butions in any amount from $100 to $499.
Contributions to .KJ.'P.:s 'fribute Fund will be used to
fund tinnitus research and other ATA programs. If you
would like this contribution restricted for research,
please indicate it with your donation. Tribute contribu-
tions are promptly acknowledged with an appropriate
card to U1e honoree or family of the honoree. The gift
amount is never disclosed.
Our heartfelt thanks to these s pecial donors.
All contributions to the American Tinnitus
Association are tax-deductible.
GIFTS FROM 4-2-0l to 7-1-01
Champion Members Edgar P. Bailey
(Conmbunons of $!000 Joseph M. Baria
and abotc) Ellie Barnard
Julia R. Amaral T. Larry Barnes
Amhonv G.A. Correa Dee H. Barnett
Robert f.. fuller Ned K. and Jane L.
.Richard E. Haney Banhelmas
WF.S. Hopmeier, BC-HIS Sara Rouse Batchelor
Susan Laimbeer-Ford Peter Baumann
John Malcolm Dan Beach
Peter A. Marrinan Muriel Beery
Bruce Martin David E. Berl
Don and Mary Beth Deborah and Charles
McMahon Bern
Stephen M. Nagler, M.D.. William D. Bethell
FACS Ronald Bissinger
Randall Phillips Hetty L. Bixby
Kenneth A. Preston Phil Bohnenkamp
Rttdi Schulte family Frank Boland
Foundation Dawn S. Boomhower
Timothy S. Sotos John W. Borden
George Thlbot Jim Bowman
Jack A Vernon, Ph.D. Dorothy M. Brahm
Helene Wilson Don Brice
S
. . b Laird C. Brodie
usta.trung Mem ers Carol A Brown
of $500-999) Harry A. Bruhn
'Rob M. Cnchton John A. Burrell
Jean and Lou fockele Lee Burton
Jeanna L. french Leffic Bunon
Sukey Garcetti . Raymond L. Buse. Jr.
Seymour Greenstem cl1arles G. Bush
Scott Johnson . Curtis E. Calhoun
Harry G. and Manon Beverly Callahan
Gladys Justin carr
Phtlhp and Stephen Case
Lt:'dsley-.Rill Dhyan Cassie. Au.D.
Manan B. Lovell Robert D. Chambers
Paul J. Meade Pamela D. Chandler
Loren Parmley Kerry N. Chatham, DVM
Tony Randall Shu N. Chau
Contributing Members
(ComYibuttOns of $250499)
frederick J. and Jane C.
AltZ
Gerald Aus
John H Ball
:-laney Benevento
Dwight W. Fawcett
Michael B. field
Joana L. frick
Daniel E. Horgan
Philip H. Ingber
Ladis and Jane Kristof
Cameron R. Murrav
Thomas R Ogren
Kathy Peck
Shirley R. Perry
.Richard E. Popovits, Jr.
Dan Purjes
Gloria E. Reich, Ph.D.
Osvaldo Rodriguez
Jennie E. K. Rosenblum
Alan L. and Sandra
Scharff
Bn1ce A. and Grace
Schommer
Jack Wallner
Thomas K. Webb
Supporting Members
(Comnlnttions of $100-249)
John J Accordino
Dorothy Allen
Patry Andrews
Joseph F. Bader
Robert A. Bailenson
David S. Bailey
Darrell Clark
Kathleen M. Coates.
M.A.,CCCA
JohnS. Conklin
James L. Cook
Thomas C. Crane, USN
Ret.
Floyd Cross
Lori Cunningham
Dennis M. Daly
Robert A. Daniels
Pierre David
Patricia E. Davis
Marvin N. Demchick
A.J. Diani
Jack Dickens
John Dimakopolous
Bryant Douglas
Jerry Down
Ralph C. Duchin
Irene Duffield
Thomas D. and Lillie
Duke
Edward B. Easter
Bill Esarey
Randal Evans
John Finesilver
David E. flato\v
Joy A. Fogany
francme and Rav Foster
Lawrence Gelb
Charles w. Gilbert
Richard and Barbara
Gilbert
Barbara Goldstein, Ph.D.
James A. Gomes
Andrew Good
Herbert Greenberg
Marlene Grecnebaum
Richard P. Gross
Harold P. Gmut
Donald D. Guito
Roy A. Gummersheimer
Paul R. Haas
Gary W. Hahnert
'lbni Hakim
James P. Hammitt
Robin M. Hanna
Penny Harmening
Cynthia Sperry Harris
'lbm Hatttup
John E. Hayes. Jr.
Lynn Heiter
Nancy J. Herin
Elizabeth B. Hill
Loren G. Hinkelman
Roland F. Hirsch
James R. Hoffman
Kevin Hogan
Max Horn
Raymond Houghland
John W. House, M.D.
Kenneth A Hovland
Gilbert Hudson
DavidS. Hurst, M.D.
Joan Imber
Gary P. Jacobson, Ph.D.
Lucille J. Jamz
Elmore Jenkins
Eldon F. Johnson
Bob Jones
Thomas Jung. M.D .
Ph.D
Jo Ann Karkenny
Paul A. Karns
fawzi l<awash
MarcJ. Kayem, M.D
Charles Keane
Edward w. Keels
Lois S. Keeney
Bernard 0. Killoran
Carl Koos
David J. Kovacic
Joseph Kreit
Walter P. Kulpinski
Allan S. Kushen
Neil Kuslansky
Harris Laskey
Arran Latt
Gabrielle M. Levasseur
Gary L. Lombardi
Catherine M. Lynd
Bruce J. Maclean
Vince Majerus
Dan R. Malcore
Vince A Mangus
Charles Martin
.Richard L. Martin
Norma M. Masella
Curtis L. Mathis, Jr.
Wayne E. Maxon
Kristin E. McAbier
Carol I' McCurdy
George W. McKenna, Ill
Edward F. McLaughlin
N.A. McLaughlin, Ph.D.
Andrew J. McMahon
Josephine B. McMeen
Annette Meskin
Frank Milgrom
Alexander Miller
Michael Mizutani
Sidney Moore
Guillenno Morales-
Orozco
James S. Mott
James C. Murphy
Dorothy MutoColeman,
M.A. CCC-I\
Margaret Nau
Paul Noe
Reed Norwood
Donata Oertel, Ph.D.
Charles T. Ohlinger, Ill
Phyllis R. Ongert
Mark Owyang
Alfred J. Pandiani
George A. Pappy, Jr.
James L. Paradise
William Lee Parke, Ph.D.
Sandra C. Parsons
William R Patterson
Barbara B. Pearson
Janis T. Pedersen
Ronald W. Perry
Ruth M. Philpott
i u bert G. Phipps
James B. Pittleman
Joseph L. Podolsky
Jay L. l>omrenze
Marcel ine Powell
Edwin S. Presnel l
Maxine M. Price
Katherine Prokop
Isabel C. Puff
0. D. Rackle. Jr.
J. Andrew Rahl
Ra.lph Rebain
Hollis T. Reed, M.D.
Douglas Reilly
Edward M. Resovsky
Bernard Richards
Ric Richardson
Chris Richied
James T. .Riley
Edward P. Rosenberg
Gregory Saig
Robert E. Sandlin. Ph.D.
Anthony F. Sansone, Sr.
Susan P. Schindelar
James R. Schlauch
Alexander J. Schleuning,
M.D.
William G. Scott
Michael D. Seidman.
M.D., FACS
Robert W. Selig
William Shamer
Abraham Shulman, M.D.
Sharon Siegel
David V. Skillman
Larry L. Smith
Regina P. Smith
Susan Spencer
Harold J . Stein
Thomas C. Strafuss
Elsebeth S. Stryker
Barbara F. Sturtevant
S. Jerome Thmkin
Sidney B. 1'l!rtarkin
Steve and Jill Teffs
Judith J. Tharrin,aton
Lois Theissen
Chuck Thurber
James C. 'lbtten
William R. Thwe, Jr.
Humberto Urqui?..a
Jeffrey VanSchaick
Christina L. Vanfossan
Jerome Vanzeyl
Thomas F. Verba
John Verel
1\. Gary Voyten
Eliot Wagner
Richard C. Wal ker
J. Dan Weathers, M.D.
Robert F. Weimer
fred and Sharon
Weinhaus
Rita Weisner
Phillip Weisser
H. A. Wheeler
John Whyte
David Winn
Randy Wohlers
Michael Wolf
Jin-Yul Woo
Gena Lou Woywood
Sandra K. Wright
John A Wunderlich
Jack B. Young
Gregory Zitkus
Marvin Kowit
Jerry Ladd
Eric C. Larson
Harris Laskey
fred R. Lawson
Paul Lembo
Mary Jane Lillis
Palmer R. Long
Michael J. Lurey
John H. Macfarlane
Vince Majerus
Walter W. Malinowski
L .. V.Manm
W. Gordon Martin
Norma M. Masella
Marira Maxcy
Mike and Bonnie
Research Donors McCann
(Comnbunons o{$100499) Michael c. McCullough
H. E. (Bud) Adams Pearl McDermott
Lloyd T. Amaral h 1 G' 1
David R. Anderson MIC ac E:. Me m ey
.Richard w. 13aizer Ed Leigh McMillan, ll
John L. Mercer
Stephen Barlow George A. Meyer
James R. Barney Michael Milligan
Anson Hill Beard
Warren S. Bender Matt Minninger
Howard G. Bernett Nancy W. Munroe
Carl V. Musser
Dan G. Best Teresa L. O'Halloran
Gordon J. Birgbauer, Jr. Jean Ann Olsen
Sanford Blaser Allan F. Pacela
Berle f. Bowen Thomas Panno
Nancy S. Brangaccio Randy L. Parks
Carol A. Brown Lawrence w. Peterkin
Helen S. Burkey .Richard E . Popovits, Jr
John L. Caffall Grace M. Rememer
Kenneth R. Cherry Jerome A. .Rich
Mary K. Christiansen Rick Rims
Jean Cinader francis E. Robinson
Jay Collura Roben B. Roemer
Mary F. Crosier D
1
w R
C
. D' o ores . ogers
anmne \'\scen_co . Ira D. Rothfeld, M.D., PC
Kathryn M. Jay T. Rubinstein, M.D.,
Anne M. Drangm1s, Ph.D. PhD
H. Renwick Dunlap Sandman
Robert w. E1che!t Larry Schaub
Raymond E. Elhs Theodore Schechter
Dw,ght W Fawcett Esther Schoenfeld
'Tl?m Fawcett Brvan Schwab
Rtchard filanc Dale Scott
Eunice Ftzell Richard Shoup
D. Jeanne Frantz Richard Silerri
Kathenne L. french Hal Sitowitz
Jeny P. Gaston John s. and Sheila C.
Leshe A. Golan Smith
Roy Goodloe . Ralph B. Smith
Stephen C. Goodnch Raymond and Sylvia
Jeannette E. Smith
Norman and G1lda Ronald E. Snow
Greenberg John A. Sofranko
Donald F. Gru ndler Georgia Spry
James Hartmann Walter l!. Stover
'Thm Hattrup Norene Stucka
John E. Hayes, Jr. Ruth M. Swan
Ch'!rles M. !ielzberg David P. Sywak
L. Hirschfeld Gino Tozzi
Dame! E. Horgan Linda A. Wainhousc
Gaye V. Hunt Dorothy Lee Walshe
Joan Imber Ronald Weinert
Pierre Jaffeux Steve Weston
J. Jantz David P. Whistler, Ph.D.
M1chael E. Johnson w. Williams
'Y Jones, Jr. Al E. Witten
Kawash Brax Wright
Lots S. Keeney Dan P. Wright
Wayne M. Glenn D. Wvkoff
Waldemar Kissel, Jr.
Ronald R. Kleczka (continued)
David J. Kovacic
American Tinnitus Association Tinnilt<s Thday/September 2001 25

Now masking tinnitus won't
keep either of you awake.
2 wafer-tflln mlcroereo
speakel'IID a plush
ful1.a pdlowr----
Tired of tinnitus keeping you awake? Is masking keeping your spouse awake?
Finally, here's the product that will help you both sleep - The Sound Pillow.
Let two wafer-thin micro-stereo speakers your partner will really like this} without
nestled within a plush full-size pillow ease disturbing others. Finally, a sound device
your tinnitus troubles today. With a speaker that allows you to comfortably and
jack that fits most radio. cd players. and affordably mask tinnitus. Call and order your
televisions. the Sound Pillow delivers the Sound Pillow today so you can both sleep
soothing masking sounds you need (and better tonight.
Sound Pillow.
The comfortable
solution.
Only $39.95
Plus shipping and handling for A TA members
$49.95 regular price
plus snipping and handling.
Quantity discounts available.
Also available in a smaller
travel size pillow.
TOLL FREE
877-TINNITUS (846-6488)
www.soundpil low.com
Q. What's the most effective and
affordable tinnitus masker
on the market today?
A. The Tinnitus Relief Svstem
SPECIAL DONORS
AND TRIBUTES (continued)
Recomme11ded by NTs and Audiologists worl'dwide.
" The most effective and enjoyable, clinically-proven
tinnitus relief product on the market today:'
Mlcheal LaRouere, M.D.
Michigan Ear Institute
Provides Tinnitus Relief 15 Different Selections
Relieves Stress Portable
Induces Sleep MoneyBack Guarantee
"The Tinnitus Relief System has
provided me a great deal of relief
and a period of relaxation I have
not received from other
Barbara Rakish, Madison, MS
there is no cure for
yet, your system is the
next best thing for tinnitus relief
in my opinion. Thanksl"
Rick Stem, Lincoln, NE
For a f ree CD or for more information call:
1800-5514467
or check us out on the web:
www.tinnitus-relief.com
26 Tinnitus 'lbday/ September 2001 American Tinnitus Association
Daniel Yeager
Marilyn C. Zekaria
Cicely L. Zeppa
Francis Zofay
TRffiUTES
In Honor Of
Col. Victor P. Bxacl.ford, D.D.S.
Paul A. Bauml
Jack A. Vernon, Ph. D.
Dennis M. Daly
Milton Lang
Carol A. Brown
Stephen M. M.D., FACS
Michael D. Se1dman, M.D., FAGS
Steve Weston
Nancy Thomas
David W. and Ruth Sltillman
In Memory Of
William Copeland
Mr. and Mrs. Michael Best
Mr. and Mrs. Frank Coviello
Lois Krechmer
Mr. and Mrs. James Malone
David Plessett
Rita and Ellis Rifkin
Mark and Deborah Walker
Jonathan J uneau
Stephen M. Nagler, M.D., FACS
Stephen Klein
Marion Alexander
Harold Barkan
Linda Berger
Ben and Marilyn Bierman
Gloria Bloomer
Alyce and Vincent Bonano
Lana Burshtyen
Neome and Malcolm Cooper
Bell and Martin Cooperman
Herbert and Ardythe R. Fichtelberg
Leon Klein
Robert Klein
Lois A.Krechmer
Joseph Kreit
Rhoda and Howard Lazarus
Annette Louis
Oscar and Barbara Machlis
Cindy and Howard Pollack
Elliott C. Prival
Miriam Solomon
Liela Weber (National Council
Jewish Women)
Nancy Roth
Hartford Insurance Co (Customer
Interface Group)
Carol L. and Philip I. Pasternak
Steve & Jill Thffs
The Greeley family
Bequest
William A. Hornig 'Thlst
Matching Gifts
The Chase Manhattan Foundation
Chicago Tnbune Foundation
fllinois 1bol Works Foundation
John Hancock Financial Services,
[nc.
Mobil Foundation, Inc.
Philip Morris Companies, Inc
1\dvcrnsement

Tinnitus Today September 2001 Vol 26, No 3

Încărcat de

Informații document

Drepturi de autor

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Tinnitus Today September 2001 Vol 26, No 3

Încărcat de

Drepturi de autor:

September 2001 Volume 26, Number 3

S-ar putea să vă placă și