tinnitus today december 2000 vol 25, no 4

7/21/2019 Tinnitus Today December 2000 Vol 25, No 4

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December 2000 Vo lume 25, Number 4

Tinnitus TodayTHE JOURNAL OF THE AMER ICAN TINN ITUS ASSOCIATION

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

Since 1971

Education -Advocacy - Research - Support

In This Issue:Hair Cell Regenerat ion - Implications for Tinnitus Relief

Health Insurance and Tinnitus

Tinnitus Spouse Survival

When th e Brain has Re-wired Itself

Tinnitus Today Readership Survey Results



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Tinnitus T o d ~ y Editorial and Advertising ofices: Amercan nnnitus Association, P.O. Box S, Portland, OR 7207 • 503/248·9985, 800/634·8978 • tinnitus@ataorg, www.oto.org

Executive Directo r: Cheryl McG innis, M B.A.

Ed itor: Barbara Tabachnick Sanders

Tinnitus 'lbda]J IS published quarterly in March,June, September, and Dec ember ll is mailed toAmerican Tinnitus ASsociation donors and aselected list of tinnitus patients and professionals who treat tinnitus Circulation is rotated to80,000 annually.

American Tinnitus Association is a non-profithuman and welfare agency under 26

USC 501 (c)(3).

czooo American Tinnitus Association. No partof this publicat ion may be reproduced, storedin a retrieva l system, or transmitted in anyform, or by any means, without the prior writ·ten permission of the Publisher. ISSN : 0897-6368 (print). ISSN : 1530-6569 tonline)

Bo ar d of DirectorsStephen Nagler. M.D., Atlanta, GA, Chainnan

Dhyan Cassie, M.A ., CCC-A, Medford, N.l

James 0 . Chinnis, Jr. , Ph.D. , Manassas, VAClaude H Gri7Mtrd, Sr., Atlanta, GA

Gary P Jacobson, Ph.D., De troit, MlSidney Kleinman, J.D., Ch icago, !LPaul Meade, Tigard, ORKathy Peck, San francisco, CA

Dan Purjes, New York, NY

Susan Seidel. M.A., CCC-A, 'lbwson, MD

Tim Sotos, Lenexa, KS

RichardS. 'JYier, Ph.D., Iowa City, lAJack A. Vernon, Ph.D., Portland, OR

Honorary Directo rsThe Honorable Ma rk 0 . Hatfield,

U.S. Senate, Retired'lbny Randall, New York, NY

William Shatner, Los Angeles, CA

Scientific AdvisorsRichard S. 'JYier, Ph.D , Io, ..,a City, lA,

ChainnanRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland. ORJack D. Clemis. M.D . Chicago, ILRobert A. Dobie, M.D., Bethesda, MD

John R. Emmett, M.D., Memphis, TNBarbara Goldstein, Ph. IJ., New York, NYJohn W House, M.D., Los Angeles , CAGa ry P. J,,cobson, Ph.D., Detroit, MlPawel J. Jastrebofl: Ph.D., Atlanta, GAWilliam H. Martin, Ph.D., Portland, ORDouglas E. Mattox, M.D., Atlanta, GA

Mary B. Meik le, Ph.IJ., Portland, ORStephen M Nagler, M.D., Atlanta, GA

J. Ga il Neely. M.D., St. Louis, MO

Gloria E. Reich, Ph.D., Portland, ORAlexander J. Schleuning, !1, M.D.,

Portland, ORMichael D. Seidman, M.D.,

West Bloomfield, Ml

Abraham Shulmnn, M.D., Brooklyn, NYMansfield Smith, M.D ., San Jose, CA

Robert Sweeto w, Ph .D., Sa n francisco, CA

Cover: French Door Series #J,(mixed media on wood, lO "xll ),by Sher Davidson.

Inquiries to: Indigo Gallery

504 S. Main Street

P.O. Box 728

Joseph, Oregon 97846-0728

541432-5202.

The Journal of the American Tinnitus Association

Volume 25Number 4, December 2000

Tinnitus, r inging in the ears or bead noises, is experienced by as manyas 50 million Americans. Medical help is often sought by those whohave it in a severe, stressful, or li fe-disrupting form.

Table ofContents

7 Announcements

8 Health Insurance and Tinnitus: Thking Small Steps

by Rachel Way

10 Tinnitus 'Ibday Readership Survey Results

by Barbara Tabachnick Sanders

12 Medical Intervention for Tinnitus

by Betty G. Weiss, M.S.

13 New ATA Member Benefits

by Jessiea A llen

13 On Board! Introducing Board Member Susan Seidel

14 Tinnitus Spouse Survival

by Ten'i Nagler, R.N.

15 Wben the Brain has Re-wired Itself

by Aage R. M@ller, Ph.D.

17 Annual Report

18 ATA's 'Thlephone, Letter, and E-mail Help Network

20 Expedition Hopeful Cure - My Adventure on Mt. Rainier

by Donna Brown

21 Research Update - 'Ibward the Cure

by Pat Daggett

Regular Features

5 From the Editor

Hair Cell Regeneration - Implications for Tinnitus Relief

by Barbara Tabachnick Sanders

6 Letters to the Editor23 Questions and Answers

by Jack A. Vernon, Ph .D.

24 Special Donors and n:ibu es

The Publisher reserves the right to reject or edit any manuscript received for publicationand to reject any advertising deemed unsuitable for Tinnitus 7bday. Acceptance ofadvertising by Tinnitus 7bday does not constitute endorsement of the advertiser, itsproducts or services, nor does Tinnitus 7bday make any claims or guarantees as to theaccuracy or validity of he advertiser's offer. The opinions expressed by contributors toTinnitus 7bday are not necessarily those of the Publisher, editors, staff, or advertisers.

@ Printed on recycled paper

American Tinnitus Association Tinnitus 7bday/December 2000 3



FROM THE EXECUTIVE DIRECTOR

by CherylMcGnnis, MB.A.This is a time for us to reflecton our past while anticipatingan even brighter year ahead.

At the first Founders' Gala inNovember; we paid tribute toDr. Gloria Reich, a pioneer intinnitus services. Gloriaserved as ATA's ExecutiveDirector for 20 years and

~ o l u ! l t c e r e d in the earliest years. She developedtmmtus program services including education,advocacy, research, and support. These programsb.enefit people with tinnitus, healthcare professJOnals serving tinnilus patients, as well as the

public at large. Our programs raise awareness andstrive to help prevent tinnitus for future genera

tions. This wonderful event drew members andwell-wishers from across the U.S. and abroad.Dr. Reich continues to assist other countries asthey establish tinnitus associations.

During the spring and summer, ExpeditionHopeful Cure high1ighted a Colorado member's

climb of Mt. Rainier. Donna Brown offered to raisetinnitus awareness as she met the challenge of aglacial climb along with the challenges of tinnitus.T h a ~ k you all for your contributions in responseto this event. Over $85,000 was raised forresearch. Helped by this, we expect to reach this

year's goal of $500,000 for research grant projects.Current research grant projects are reported ineach issue of Tinnitus Tbda.y (see page 21 ).

Four public forums were held at sites in NewO ~ l e a ! l s ~ Louisiana (September 1999), Chicago,Illm.Ols 111 March 2000, Voorhees, New Jersey inApnl 2000, and Washington, D.C. in September2000. ATA forums include ample interaction~ m o n g guests and speakers. Presentation topicsmcluded current research, treatment options, and

support networks. These public forums are promoted in Tinnitus 7bclay, in local papers, and

through announcement flyers.The ATA Web site has a new look. Many of

you may have already noticed the changes. Whilethe look has changed, all the featured sections areretained with updated information. The site willreceive monthly updates as a service to members

and to people looking for information abouttinnitus. ln addition, we plan to open an ATA

4 Ttnmtus Thdlly/ l)ecember 2000 American Tinnitus Association

"members only" section on our Web site inFebruary. Find us on the Internet at vv-ww.ata.o

.Another new benefit is a membership pin,which \-\ e wtll send to all renewing members

beginning with those of you renewing your mem

berships in January 2001. The ATA pin will present conversation openers for each of you to raawareness of tinnitus. We know that not everyone with tinnitus is aware of our organizationand the services ATA provides. A recent

survey of Tinnitus Tbday readers revealed thatof 1,518 respondents, 89% ranked public aware?ess of tinnitus to be important to extremelyImportant (turn to page 10 for a summary of ther ~ s u l t s ) . Our combined efforts to make the pubhe, heallhcare professionals, and researchersmore aware of tinnitus are stronger than any

single voice - yours or your Association's.These new membership benefits are in

addition to the longstanding services ATA pro~ i d e s : e d ~ c a t i o n a l packets sent to people seekinmformattan about tinnitus, telephone support fpeople who call our toll-free number, 50 self-hegroups throughout the country, tinnitus healthcare provider listing, tinnitus bibliographyservice, catalogue of publications and videosfor purchase, a textbook program that includestinnitus education in high school health curriculums, and Hear for a Lifetime, an educational pr

gram offered to elementary classes providingearly prevention information to children. We alsaward research grants to further the study of

tinnitus ;md provide tinnitus information tohealthcarc professionals. ATA provides theseprograms because of your generous support.Thank you.

. We wish you the very best of holidays alongwith good health, prosperity, and happiness inthe New Year! D

Advertrseme11t

TINNITUS RESEARCH

Volunteers Sought for Drug Study

Contact:Un iversity of Californ ia, San Diego

Depts of Otolaryngolog yand Psychiatry

Thornton Hospital & Perlman Clinic

(858) 657-8596



From t h e E d i t o r

Hair Cell RegenerationImplications for Tinnitus Relief

by Barbara Tabachnick SandersWhenever science invents aprocedure or discovers a drug

or a gene that can correct

something wrong vvith the ear,people with tinnitus get veryexcited. And they have goodreason: Tinnitus relief has

been an unintentional outcome of some of these inventions and discoveries. For

instance, in 1976 a cochlear implant patient

reported that, along with he r improved hearing,

her tinnitus was relieved when the electricalimplant was activated. Dr. John House followedup with a study and learned that 34 out of 64 (or

53%) former!.)- deaf cochlear implant patients

were experiencing tinnitus rel ief after the implant

surgery.

Otosclerosis is a disease of the middle ear

bones that ultimately causes hearing loss.Stapedectomy is a surgery that replaces diseasedmiddle ea r bones with a prosthetic device, and in

more than 90% of cases, hearing is restored.Probably by virtue of this procedure's ability to

restore hearing, some stapedectomy patientsreport that their tinnitus is better after surgery.

Gentamicin, a drug that is toxic to the ear, issometimes used to relieve the chronic vertigoassociated with Meniere's disease. A high doseof this drug is delivered into the inner ear through

a tiny tube aimed at the vestibular (or balance)organ. The goal is to destroy vestibular hair cellsand knock out the dizziness, and for many vertigopatients it works. Even though 30% or so of

patients have diminished hearing after undergoing this procedure, tinnitus relief is an occasionalresult of it.

In 1988, the news of hair cell regeneration in

the cochleas of chickens had "breakthrough" written all over it. (Cochlear hair cells enable animals

to hear.) Then we looked closer at the research

and saw that scientists hadn't discovered how toregenerate, or regrow, damaged hair cells in chickens. They had discovered that chickens - and

other birds, fish, and amphibians, for that matter

-have inner ear hair cells that automaticallyregenerate if damaged or destroyed.

Bird and mammal cochleas are similar in

structure in that both contain hair cells. Both alsocontain supporting cells that physically hold up

and nourish the hair cells. But there is an important difference: When mammalian cochlear haircells die, they do not grow back. When bird

cochlear hair cells die, nearby supporting cells fill

in the space of the dead cells and grow into new

hair cells and new supporting cells. ResearchersRyals and Dooling have shown that a bird's ability to hear and understand sounds is restored after

hair cells die and then regrow. Amazingly, the

process is repeatable throughout the animal's

lifetime. But somehow it seems unfair. Birds do

it. Why can't we do it?Mammals do have a somewhat related

regenerative ability. Although mammals cannot

regenerate damaged cochlear hair cells, some

mammals can regenerate damaged vestibularhair cells. This ability is not directly related to

hearing, but it is a first cousin to it. Scientistssee the relationship too. One research idea being

considered is the transplantation of healthy

vestibular hair cells into a damaged cochlea.According to longtime hair cell regenerationresearcher Douglas Cotanche, Ph.D., scientists

are also giving thought to transplantation ofnon-human cochlear hair cells into the human

cochlea. Also, a chemical called heregulin isbeing studied because it appears to increaseproduction of supporting hair cells in mammals.

As expected, the role of genetics is being

investigated as a means of restoring hearing.Scientists have identified the Mathl gene that isresponsible for the creation of auditory hair cellsin mice. Mice born without this gene are alsoborn without hair cells.

The scientists' underlying hope of ali this

study is twofold: to discover what inhibits haircell regeneration naturally in mammals and to

discover what makes hair cell regeneration occur

naturallv in non-mammals. We are keeping aclose on hearing restoration and hair cellregeneration research too. Tinnitus alleviation isa possibility at any turn in these advancing fieldsof study - and no t just for the birds. U

American Tinnitus Association Tmnrtus 1(Jday! December 2000 5



Letters to the Editor

From time to time, we include letters from our

members about their experiences with •nontraditional• treatments. We do so in the hope thatthe information offered might be helpful. Please readthese anecdotal reports carefully, consult with your

physician or medical advisor, and decide for yourselfifa given treatment might be right for you. Asalways, the opinions expressed are strictly those of

the letter writers and do not reflect an opinion orendorsement by ATA.

Tank you for th e story, "Acoustic Neuroma:

A Success Story" by Rachel Wray (September

2000 Tinnitus Tbday). Like Mari Quigley, I,

too, have an acoustic neuroma. And also likeMari, my ow n story is a success. My AN is very

small, about l em. When l was diagnosed, l was

devastated. Everything that I read regardingsurgery was terrifying. So I searched the Internet

for an alternative treatment for my AN and found

it - fractionated stereotactic radiotherapy -which I learned about on the Acoustic Neuroma

Archive Web site (www.ANarchive.org). This wonderful site is full of information, treatments,

names of doctors, and patient stories (mine

included). Thday, 18 months after my last treatment, I am doing great. My last MRI showed that

my tumor is "dead," and my hearing is 92% in

my AN ear. Tinnitus is the only side effect. But I

have successfully completed tinnitus retraining

therapy, and tinnitus is no longer an issue in my

life. I am so grateful to everyone at the ATA, the

Acoustic Neuroma Association, the AN Archive,and to God and my family. Without them, and

you, 1 would not have recovered as fast as I did.

Robin L. Moyer, 2934 Old Welsh Rd.,Willow Grove, PA 19090, 215-659-2243,[email protected]

I ave had tinnitus for over 30 years, which I

believe resulted from playing the trumpet in

bands through my school years and during

military service. I have been moderately successful in reducing the level of my tinnitus with

niacin, magnesium, ginkgo, and kava kava.

I have noticed a definite elevation of my

tinnitus when I use a cellular phone. In fact, my

tinnitus screams for several days after I use the

cell phone, but eventually it calms back down

to its usual level. I now limit my cell phone use

to times of true emergency.

6 Tinnitus 7bday/ Dccember 2000 American Tinnitus Association

I understand that the cell phone is basically

radio transmitter and receiver that exposes the

user to microwave radiation. This radiation coupossibly be impacting tinnitus, at least my tinnitus. Ce11 phones have received some negative

reviews, connecting them to health problems likbrain tumors and headaches, but the research

findings are inconclusive. My ce11 phone experience has lead me to consider using a hands-freeheadset to keep the phone away from my head

and ears.

Jerry Miller, [email protected]

I ave benefitted from the research that

Dr. Susan Shore has conducted in somatic

tinnitus. Thank you for providing the grant ther. I was involved in a rear-end auto accident.

Thereafter, I began hearing a ringing at 12,000Hz, constant and centered. I can modulate the

volume by clenching my jaw or tilting my head

all the way back. The insurance company sug

gested that the ringing was from a deviated septum and not the auto accident, even though I

have never had a headache, an ear infection, or

head trauma, and the ringing started after the

accident.

Dr. Shore discussed her work and my condition with me at length, and introduced me to D

Richard Salvi and Dr. Robert Levine who provid

ed me with additional somatic tinnitus help. Ihope you continue your relationship with Dr.

Shore and continue funding her efforts.

Jerry Axton, Las Vegas, NY,

jerryaxton@msn. com

Editor's Note: A summary ofDr Shore's ATA-funderesearch project is on page 22.

Oe day, after I put ~ w o peppermir:t c ~ n d i e s

in my mouth, I not1ced that my bnmtus

seemed more intense. l t calmed down in

about four hours. I tried the candies again to see

what would happen, and it started the loud ringing again . I find that peppermint in any form-candy, mints, etc. - aggravates my tinnitus.

Spearmint isn't as bad, but it does aggravate it

too. r pass this along in the hopes that it may

help.

Alice Best, Butler, PA, 724-477-8748

Secial thanks to the ATA staff. They were of

great help to me as I prepared a claim fordamages that I suffered (increased tinnitus

(continue



Letters to the Editor rcontinuedJ

and other problems) fol1owing a hi t-and-run accident. 1b help my case, 1 purchased Dr. Vernon's"Sounds ofTinnitus" audio tape, fo und an accurate representation of my sound on it, and

re-recorded it onto a CD which saved the day

and the case. The settlement judge was initiallynegative and said that he'd had tinnitus and

"cured" it by stopping the use of aspirin.However, I played the CD at a volume just below

what I hear. Apparently it was loud enough an d

sufficiently disturbing to cause the judge to say,"1\.lrn that of£1 Mine was nothing like THAT."Although this proof of injury was subjective and

not scientific, i t did convey my agony and we

successfully settled for $50,000. The judge and

the insurance company had initially offered nothing, so I attribute the results to Dr. Vernon's tape,your staff, and the CD that we prepared to support my case.

Beverly DiGregorio, San Diego, CA,619-224-4891Ill m alone with the beating of my heart ... "

Lui Chi

I had pondered these words many timesbefore. But when I got tinnitus, they took on arather unexpected meaning. They so accuratelydescribe the feeling ofbeing totally alone with

only the inner sounds of tinnitus, trapped insidea body with constant noise, with never a moment

of relief from it. For a while you feel panic an d

despair. But, no matter what you are feeling,life and those awful sounds go on anyway, day

after day.Soon after my diagnosis, I decided my goal

was to get used to the noises so that tinnitus

wouldn't disturb my concentration or daily functioning. When I learned it gets better over time

for most people, I felt encouraged. I did worry

that the dizziness, hyperacusis, and tinnituswould ge t worse and that I would lose my hearing. But when an audiologist told me that my

hearing might get worse over time, I felt that

someone had acknowledged my worry and I wasno longer alone with it. I feel lucky because my

tinnitus has gotten softer, and I have adapted.As you struggle with your tinnitus, just know

that there are others who know what it is 1ike. It's

important to acknowledge the pain, the grief, the

fears, an d the anger. It's also a lot easier to bear if

you can find people who listen and understand,so that you are not alone with it. That makes a11

the difference in the world. And when you getbetter, make a pact with yourself to le t othersknow that there is hope.

ATA member, Cleveland, Ohio

Announcements

The 7th International Tinnitus SeminarThis research conference offers the opportunity

for doctors, audiologists, an d scientists from allover the world to exchange treatment ideas, an d

research and clinical findings related to tinnitus.Posters and papers are invited.

Date: March 5-9, 2002

Where: Esplanade Hotel in Fremantle,Western Australia

Seminar Chairperson: Pam Gabriels

For more information, contact :2002 International Tinnitus Seminar

P.O. Box 581, Cottesloe, Western Australia 6011

Thlephone/fax: + 61-8-9384-1249

Web: www. tinnitus. com.au

Free Captioned Video Lending ProgramThe National Association of tl1e Deaf providesvideos free to the hard-of-hearing publ ic. These

videos are "open-captioned" - meaning that theydisplay English text like a subtitle right on the

screen. These videos will play in any VCR. Nospecial decoding device is necessary.

Contact: Captioned Media Program/ NationalAssociation of the Deaf, 1447 E. Main St.,Spartanburg, SC 29302

Th lephone: 864-585-1778 ext. 214, 800-237-6213

(voice), 800-237-6819 (TTY), 800-538-5636 (fax)

E-mail: [email protected]

Web : www.cfv.org

American Tinnitus Association Tinmtus Thday/ December 2000 7



Health Insurance and Tinnitu

by Rachel Wray, Director ofAdvocacy and Support

When health insurance is cliscussed in the media,the focus is usually on who has it and who doesn't.In early October, for example, the Census Bureau

reported that for the first time in 12 years, the number of people in the United States with health insurance coverage increased, although 42.6 mill ionpeople-about one in six Americans-still had no

coverage at all. But health insurance is much more

complex than a debate on the have's and have not's.

The majority of people who responded to the

Tinnitu..<; Tbday readership survey - 94.5 percent

have some kind of health insurance. Only 44.4 per

cent, however, have had tinnitus services covered by

their insurance companies-an unfortunate number

considering the costs associated with diagnosing and

treating tinnitus. Apparently, payment for tinnitus

related care is not a priority for most health plans.But for most tinnitus patients, attempting to secure

payment for healthcare is a frustrating necessity.Hopefully, this can be made easier by understanding

why insurance companies make certain coveragedecisions, an d ho w you ca n appeal those decisionsfor healthcare reimbursement.

Private health insurance in America is relativelynew, a byproduct of the competitive post-WorldWar II labor market. Employers attracted skilledworkers by offering what we today call traditionalindemnity plans or fee-for -service plans. Onlylater did managed care plans-which includePreferred Provider Organizations (PPOs) and Health

Maintenance Organizations (HMOs), just to name afew-enter the market. Tbday, managed care plans

cover nearly three-quarters of Americans with healthinsurance.

Unlike Medicare, which is adminis tered nationally, individual and group health plans are regulatedon a state-by-state basis. Mohit Gose, from the

American Association of Health Plans, explains,

"Health plans have to be licensed in every state

through an insurance commissioner. The states

determine who ca n be in business and what compa

nies must cover." And each state has different regulations-like coverage for mammograms or emergency

services. Hearing related services, however, arerarely mandatory, so every insurance company within each state is free to make its own decisions on

how much or how little to cover.

Far too often, patients who tr y to receive coverage from their health insurance companies find that

their tinnitus treatments are cons idered "experimental" or, worse, "not medically necessary," an ambigu-

8 Tinmtus Thday/ December 2000 American Tinnitus Association

ous term that, according to Susan Scheperle of theNational Association of Insurance Commissioners,many organizations and companies "have not been

able to define." And even those companies that

attempt a more concrete definition still leave much

to guess. For example, Cigna HealthCare offers thescriteria for medical necessity: "the services are essetial, approptiate for your condition, meet generalmedical standards, and are provided at the correctlevel, time, and setting"-but does not specify howessential m· appropriate are measured.

How do healthcare companies decide what tocover? Insurance companies solicit professional opiions from doctors, evaluate clinical research, and paclose attention to what other insurance companiesoffer. Offering services that the competition does no

can distinguish a carrier in the competitive managecare market. Companies also carefully balance thecosts and benefits of service coverage-i.e., if thecompany does not cover a particular health service.could it result in future health problems that might

cost more?

Obviously, coverage is an inexact science. Max

Ranis, M.D., an otolaryngologist from Pennsylvaniaand longtime proponent of insurance coverage forti1mitus services, describes the complexity of theissue. He laments, "Most insurance companies don'

Common CPT CodesAccording to the American Speech

Language Hearing Association (ASHA), thereare no specific CPT codes for tinnitus assessment. These are common examples of CPTcodes for audiological services, and your

provider may have ideas for adding moredescriptive suffixes to identifytinnitus services.

92506: Counseling and evaluation

92557: Comprehensive audiologicalevaluation

92567: 'IYmpanogram92568: Acoustic reflexes

92587/ 92588: Otoacoustic emissions test(limited/ comprehensive)

92590: Hearing aid evaluat ion

92599: Pitch and loudness match

92599: Speech and pure pone tolerance

99358: Pro1onged evaluation and

management service



Small Stepseven pay for hearing aids or maskers. The b teratureis re plete with evident iary ma terial, but [healthplans] consider them cosmetic ." And even whe nhealth plans consider covering tin nitus-re la ted services, the chronic nature of tinni tus- and the lack of

a universal cure-can be seen as problemat ic. Dr.Ronis explains, "The heal th plans ask, 'Do these people still have tinnitus when you finish?' The answer

is yes, but less ."

When insurance companies fail to cover tinnitus

services, most patients are forced to cover the coststhemselves. In 1997, Americans spent $187.6 billionout-of-pocket for h ealthcare services-roughly 5.3

percent more than they spent in the late 1980s. A1995 study states that despite managed care's controlled costs, "Consumers may actually pay more dueto higher premiums, co-payments, an d deductibles,or full payment for services no t covered ." Plus, some

providers do not even try to bill insurance companies

and require payment up front for services received,leaving the paperwork to you.

All of this adds up to a frustrating an d potentiallyexpensive process. And because of different state

ru les, insurance company reason ing, and a lack ofclinical studies on treatments like tinnitus re train ing

therapy, there is no sure-fire method for securing

paymen t. But that does no t mean you shouldn't try.

Gather your receipts, patient reports, and theCurrent Procedure Th rminology (CPT) codes thatyour provider uses for treatment to submit to your

insurance companies . CPT codes are common codesused by doctors, hospitals, an d insurance companies

to identify audiological services. Also, read your ben efits handbook carefully, noting which servkes arecovered and which are not. If your primary carephysician decides whether or not you can see a specialist, make sure he or she understands the benefits

of the treatment you seek, and provide research documentation if necessary.

Doing so does no t guarantee your healthcare ser

vices will be covered. But in the process of trying,you have the opportun ity to educate your health

insurance company and doctor on potentially useful

treatments for tinnitus. Plus, the old adage about thesqueaky wheel is true : sheer numbers of tinn ituspatients making strong, informed arguments isbound to impress even the most cost-conscious company. Finally, as treatments are studied in controlled, clinical settings, the "experimental" tag willbe replaced with proven results that in time willerase any doubts that such treatments are medicallynecessary for improving the quality of tinnituspa tients' lives. a

Tips for Appealing

an Insurance ClaimIf your insurance company denies your tinnitus

related medical se rvices claims, here are suggestionsto help you appeal the decision:

+ Managed care organizations are required to

publish procedures for filing an appeal Checkyour member benefits handbook, the plan Website, or call the health plan administrator. Followthe rules and timelines outlined in the appealrequirements.

+ Find out why your claim was denied. Th e reason

will help determine the thrust of your letter. Wasit because the services were experimental, notmedically necessary, or simply not coveredunder the member benefits?

+ 1alk to your primary care physician. Does

he / she understand the effects of and treatments

for tinnitus? Is he / she willing to write a letter in

support of your treatment choice?

+ 1b whom should your letter be sent? Check your

handbook to find the correct address and

recipient or department, an d send the letter

certified mail with return receipt to guarantee

delivery.

+ For you r appeal, the Center for Health CareRights (CHRC) suggests including clinicalinformation, doctors' opinions, an d studiespublished in medical journals. "Be sure to showhow the treatment you want is the best choice,"they advise. "The opinions of doctors whospecialize in trealing your condition will be givenmore weight than those of non-specialists.

Opinions of doctors who specialize in trea tingsimilar conditions are relevan t also ."

+ Discuss the potential costs of not treating yourtinnitus. For example, many people with tinnitusreport increased stress or sleeplessness, whichcan affect other bo dy func tions as well as quality

of life.

+ Be direct. State specifically what you would likeyour health plan to cover. Also, include a br ie f

synopsis of what steps you have taken to treat

you r t innitus, when you first experiencedtinnit us, and other pertinent health history.

+ CHCR su ggests a brief statement about "why you

b elieve the trea tment yo u seek is medicallynecessary or, if it appl ies, is not an experimentaltreatmen t."

+ Attach any relevant correspondence between you

and your insurance company or doctor.

+ Finally, if you encoun te r problems with your

insurance company's appeals p rocess, contactyour state's insurance department. For a listingof s tate insura nce regulatory agencies, visitwww.hiaa.org/cons/sta te_insurance.htrnl.

Ameiican Tinnitus Association Timntus Thday/ December 2000 9



Tinnitus Today Readershby Barbara Tabachnick·Sanders, ATA Director ofEducation

We want to heartily thank the 1,518 people whor e t u ~ n e d the Tinnitus Tbday readership survey, which

was mcluded in the June 2000 issue. The 1,518surveys returned represent an 8.4% response rate.(A total of 18,024 surveys were sent.) You have givenus a terrific heads-up on what you want from ATAfrom Tinnitus Tbday, from your doctors, and for 'yourselves. Here is a synopsis of your comments .

(Note: A survey was accepted as valid if at least76% of its questions were answered. Therefore, the

total for each answer might not add up to 100% .)

Demographics. !he m a ~ o r i t y of survey respondents (96%) are

unmtus patwnts, 4% are family members or friends,and 3% are health professionals. That totals 103%.

Some p r o ~ e s s o n a l s who responded to the survey alsohave_ mmtus. Seventy-two percent report having

heanng loss, and 39.5% say they have hyperacusis.

Length of ATA membership

Over 7 years: 26%6-7 years: 10%2-5 years: 45%0-1 years: 16%not a member: less than 1%

Age Gender

Under 25 yearsless than 1%

70t years28%

40-55years

25%

Level of education completed

Postgra duate(5+ years)

33%

Vcational ortechncal school

5%

Grade school1%

High school14%

Female Mole32% 59%

Current employment status

Disabled4%

Part-time9%

Full- ime32%

Not employed outsideof the o r n e 3%

Unemployed2%

Retired46%

10 Tinnitus 7btlay/ December 2000 American Tinnitus Association

Causes of tinnitusNearly 50% of survey respondents identify nois

- from work, recreation, or military activities - asth e cause of their tinnitus. Although 39% indicate~ h e y have served in the armed services, only 17%

mdicate that their tinnitus was caused by militaryservice. Other tinnitus causes identified are: medication (14%), illness (12%), head trauma (7%), air bag(less tJ:tan 1% , and others (19%) including TMJ,acoustic neuroma, barotrauma, surgery, heredity,stress, menopause, ear cleaning, neck injury, radiation, marijuana, allergies, and flying with a cold.Thirty percent state that they do not know the caus

How you rank the importance of AlA's servicesThis chart shows the combined number of

responses of very important and extremely important.

BbliographicService 30%

Self HelpGoups 44%

PublcationSoles 44%

RgionalMettingSO%

Conservation/Prevention54%

Medkol Referrals 66%

tnformotion endReferrol70%

Workshops for Professionols 71%

PublicAworness71 %

TinntusToday83%

Research94%

Research

0 300 600 900 t200 150

As seen in th e previous chart, 94% of surveyrespondents overwhelmingly rank research as ATA'smost important service. They identify treatments forelief (87%) as the research area of most interest,followed by pharmacology (65%), how the brainworks (56%), and alternative approaches (55%).

Other survey responses echo this preference.Responders choose research as the most importanttopic addressed in Tinnitus 7bday. Also, 26% wantinformation about vo lunteering for research studies

Tinnitus TodayRespondents rank Tinnitus 7bda.y as ATA's secon

most important service, with 33% asking for morefrequent issues. For 94% of respondents, TinnitusTbday is their primary source of tinnitus informatio

What you usually or always read in Tinnitus TodayNinety percent of respondents usually or alwayread Dr. Vernon's Q&A column, confirming what whad suspected. Respondents also read researchupdates (87% ), Letters to the Editor (86% ), From thEditor (65%), From rhe Executive Director (59%),advocacy artic les (56%), support network updates(53%), advertisements (36% ), and the t ributes list(29%).



Top ics you want to see addressed in Tinnitus Today

Tinnitus 7bday readers rate new research, medications for tinnitus, and alternative therapies at the topof topics of interest. In answering this question, mostsurvey responders selected more than one topic.

New research: 8696Medications for tinnitus: 81 96

Alternative therapies: 69%

Coping strategies: 5296

Medical insurance: 3596

Hearing aids 'Hearing loss: 33%

Social Security/ Veterans benefits: 3196

Hyperacusis: 26%

Volunteering for research studies: 26%

Meniere's disease: 20%

TM.J: 18%

Legal issues: 17%

Hypnosis: 17%

Acoustic. neuroma: 12%

Other: 796

- TRT, cures, nutrition, pulsatile tinnitus,cognitive therapy, prevention, hair cellregeneration, gene therapy, sleep, surgicaltreatment, masking devices, chemical toxicity,quiet appliances, analysis of productsadvertised in Tinnitus 7bday, and jokes.

Most, but not all, Tinnih1s 7bday readers welcomeadvertisements in the journal. We continue the practice for a few important reasons: Ads have been veryuseful to some patients, doctors, and audiologistSthrough the years. Ads also generate income for ATA.Although we do not endorse the products that are

advertised as a matter of policy, we do only acceptads from advertisers who offer a full money-backguarantee on their products.

More than half of respondents (54%) would likeads for relaxati011 and self-hypnosis tapes and CDs.Book ads were selected by 42%, educational tape/CDads by 39%, and sound device ads by 29%. Otherssuggest ads for earplugs, hearing aids, noise cancellation devices, and natural therapies.

ATA Membership Benefits\s additional benefit s of ATA membership,

responders would like to receive monthly newsletters(43%), how-to advocacy guides (35%), more frequent

publications of Tinnitus 7bday (33% ), and membershipcards (33%). 111ey also suggest more support groups,chapters, 24-hour hotline, political action, informationto give to doctors, a chat room, more research, a moretechnical version of Tinmtlls 7bday, and a less technical version of Tinnitus 7bday Some want no additionalsen'ices preferring that resources go to more research.

We are pleased to report that a total of 9696 of

respondents are satisfied to extremely satisfied withtheir AT/\ membership. Of those who have personallycontacted ATA for information, 94% rate the customersenricc they received as good to excellent.

InternetSixty-six percent of respondents have Internet

access, but only 36% say they use it to find information about tinnitus. Interestingly, only 32% havevisited our Web site ('www.ata.org.). Almost half of

the survey respondents (47%) want us to sponsoran Internet message board. (We're considering it.)

The question about receiving Tmmtus 7bday overthe Internet rather than through the mail drew quitean emotional response from the vast majority (89%)

opposed to the idea of an ·e-Tinmtus 7bday." The

"no's" were underlined and rewritten in capital letters wi th exclamation points al the end. We got themessage! Tinnitus 7bday will continue to be printedand mailed to all members (which was always our

intent). We will also post current issues of Tinnitus

7bday on our site's "member's only" section, due toopen in February.

InsuranceA total of 1,434 survey respondents (94%) have

health insurance. Of those, 637 report that some tinnitus-rrlated services are covered by their insurancepolicies. These covered services include: hearing

tests (622), hearing aids (119), masking devices (47),

and TRT therapy (39). Other services (107) are covered too: surgery (for acoustic neuroma, cochlearimplants, etc.), MRis, CAT scans, drugs, office exams,electrical stimulation, counseling, acupuncture,biofeedback, and ear cleaning.

Advocacy &SupportIf support groups were available in their areas,

an encouraging 37% of respondents say they wouldatt<·nd. If local training were offered to become a tinnitus support group leader, 33% say they would seektraining.

Seventy-seven percent of respondents feel thattinnitus public forums are important to extremelyimportant. In addition, 23% would travel to a national tinnitus conference 200 miles awav or funher.

1\velve percen t of respondents h ~ v e alreadycontacted an elected official about tinnitus or noiseabatement issues. Many more (73%), however, saythat they want ATA to take a role in influencingfederal budget allocations for tinnitus research.

Strategic planning efforts are just beginning thatw il l decide ATA's activities for the next three years.111ese survey responses are now part of the dialoguethat will help determine ATA's future. Thank you forspeaking out.mWe want to thank Susan Gnest, M PH , from the Oregonllcan11g Research Center, for her help with the compila-tron of his survey.

American T innitus Association Tinmtus Tbdc1y. December 2000 11



Medical Intervention for Tinnitus

by Betty G. Weiss, M. 5.

Max Ronis, M.D., Professor Emeritus atTemple University Hospital in Philadelphia,Pennsylvania, is a renowned researcher and

lecturer on medical intervention for tinnitus. He

believes that since tinnitus is a symptom and nota disease, a very careful examination of the

patient should start with an in-depth history. In

his own words, "Evaluate the patient from A to Z."

Tinnitus is defined in terms of its location (inone ear, in both ears, in the head), its characteristics (continuous, intermittent, pulsatile, clicking),and its impact on a person's l ife (tolerable or

intolerable) . In order to determine any contributing factors and an appropriate treatment, the

patient should be examined in order to rule ou t allactive disease processes or conditions that can be

managed by medical intervention.

Dr. Ronis also suggests exploring other areasthat are associated with tinnitus, such as :

+ D ie t: Eliminate use of caffeine, salt, cidervinegar, soft drinks, and alcohol.

+ Household produ c ts : Eliminate use of perfumes, antiseptics, cleaning chemicals, and

suntan lotions.+ Prescription medications: Reduce or elimi

nate use of drugs that list tinnitus as a sideeffect or have a toxic effect on the ear.

+ Over-the-cou nter drugs: Reduce or eliminate use of aspirin or aspirin-type products

(Empirin, Ecotrin, Bufferin, ibuprophen,Anacin, Midol, Pepto Bismol, and Aleve) and

some antihistamines.+ Social activ ities: Have weight lifting, scuba

diving, and hunting caused or worsened your

tinnitus? Is there a history of related conditions, like stress, vigorous strain, head or barometric trauma, decompression, emotionalproblems, pain, or blackouts? Do you have afamily history of hearing loss and/or tinnitus?

The otolaryngologic examination may revealmedical and non-medical conditions that contribute to tinnitus. In the external and middleears, there may be interference in the mechanicalconduction of sound. These include obstructivecerumen (earwax), foreign bodies or excessivehair in the ear canal, inflammation and/or infection, abnormal air pressure from a blockedeustachian tube, growths, perforations, or achange in the mobility of the eardrum and/or

ossicular chain (middle ea r bones). Medicaland/or surgical management may reduce thefrequency or intensity of tinnitus or cause it todisappear completely.

12 Tinnirus '10day/ December 2000 American Tinnitus Association

Contractions of the muscles (the tensor

tympani and the stapedius) in the middle ear in

response to loud sound have been shown to resin spasms. Th e muscles of the palate can alsospasm, which could produce tinnitus similar tosounds of swallowing. The treatment options

include cutting the tendons of the muscles orinjecting medicines into the palate.

Thmporal mandibular joint dysfunction(referred to as TMJ or TMJD) exacerbated by ja

movements often mimics an ear problem sinceis characterized by pain in the ear, a sensationfullness, and clicking no ises. Relief may be

obtained through the use of dental appliances.

The otic capsule that houses the inner ear ha single blood supply with separate branches goto the auditory (hearing) and vestibular (balancsystems. Many individuals with vascular condi

tions have reported tinnitus that beats in rhythwith their pulse. This type of tinnitus (pulsatileoften difficult to treat since it can occur when

there are ch anges in blood flow to the heart

and/or to the neck, a glomus jugularis (blood)tumor in the middle ear, inflammation or consttion of blood vessels, increased blood viscosity,diseases of the red cells or the white cells.

The audiologic evaluation provides importainformation that enables the ENT physician tomake diagnoses about the function of the inner

ea r and the auditory pathways. Permanent healoss and damage to the neural structures involvin the transmission of sound waves may occursimultaneously with tinnitus and with other sytoms such as fullness in the ears, dizziness, lossbalance, and headaches.

According to Dr. Ronis, treatment of tin nituhas four components:

1. Resolve medical/surgical issues2. Implement acoustic therapies3. Counseling and educat ion

4. Pharmacological management

Focusing on the last component, tinnitus istreated with many pharmacological products.

Anti-anxiety medications, anticonvulsants, a

tricyclic antidepressants are groups of drugs usto treat various conditions including depressionanxiety, seizure, panic, pain, muscle spasms, dness, and tinnitus. 'Trade names include AtivanKlonopin, Tranxene, Thgretol, Librium, Xanax,Wellbutrin, Paxil, Triavil, Elavil, Zoloft, Atarax,Sinequin, and Valium. Varying degrees of succehave been reported with these drugs for tinnituCaution should be exercised. Some of these drucan be habit-forming or addictive.

(continu



NEW ATA MEMBER BENEFITS

by Jessica Allen, ATA Director of

ResourceDevelopment

ATA Members receive lapelpins!Renewing members willreceive a very special ATA

lapel pin with their renewalsstarting January 1, 2001.

Please proudly display your ATA pin on your

jacket, dress, coat, or hat to bring more awareness to your friends and neighbors about tinnitus

and about our search for new methods of treatment and relief. We hope that when you wear the

pin, it will remind you that you are not alone and

that ATA is working for you to find a cure.

More good news for ATA membersATA will be launching its revised Web site in

December. Along with a new look, the site willalso contain some new features. One of them -which will open in February- is a "membersonly" section. This section will contain specialupdates and information only available to ATA

members. To gain access to that section of our

site, each member will be given a personal num

be r to enter. Your special number will be listedon your new ATA membership card. Th e cardswill be mailed to all current members beginning

January l, 2001. Th e membership card will alsocontain ATA's phone numbers, fax number, and

Internet address. You will no w have your ATA

contact numbers an d Web site passcode on on e

convenient card. We are very excited to make thisbenefit available to all our valued members. B

On Board!Introducing Board Member

Susan SeidelATA Board Member and

Board Secretary Susan Seidel,M.A., CCC-A, was an audiologist for 41 years and a tinnitus self-help group leader in

Baltimore for 15 years. Sheretired from audiology and

her support group last year

but definitely not from helping ATA. Seidel shares he r

vision for this organization:

"I hope to be able to share whatever expertiseI have to further ATA's self-help program. I'd alsolike to see ATA become the organization that allaudiologists and ENTh reach ou t to for their con

tinuing education. And we're doing it. A few universities now require course work in tinnitus

management for their doctoral programs in audiology. This is a first. I think i t happened because

of the research dollars that we've made availableand because we're becoming more visible. Ibelieve that th e more we get Tinnitus 'Ibday and

our phone number out there, the closer we get tobecoming the resource for tinnitus. Our next stepis to push the medical field to require tinnituseducation in the ENT curriculum. We can do that

too!" 0

Medical Intervention for Tinnitus (continued)

Medical intervention in the treatment of tinnitus has gone beyond the realm of traditionaltreatments. Other treatments include ultrasoniccurrent applied to th e mastoid bone, electrical

stimulation of the eardrum, acupuncture, hypnosis, and the placement of magnets near the ear.These treatments are not proven effective scientifically, bu t some patients report that they help.Some people are finding relief from tinnitus

through the use of herbs such as Ginkgo bilobaand kava kava, hormones like melatonin, and

with megadoses of vitamins and minerals. Dr.

Ronis cautions that these products may vary in

their stability since they are not subject to FDAcontrol, that there are questions about the appropriate doses, and that some of them do not differin effectiveness from placebos. Ronis advises

patients to weigh the "gain versus risk factors" in

determining which options to use in the treatment of tinnitus. He further suggests that apatient has a better chance of achieving maxi

mum benefit from a treatment if there is ahealthy and respectful interaction between thepatient and his or her health care provider. B

Ms. Weiss is an audiologist with Ear, Nose, and

Throat Consultants, P.C., in Philadelphia,Pennsylvania.

Dr. Ranis's lecture is featured on ATA's Mid-AtlanticTinnitus Conference video, Part I. See order fonnon inside back cover.

American Tinnitus Association Tinni tus Tbday/ December 2000 13



Tinnitus Spouse Survival

by Terri Nager, RN.Day 1:

"You know, my ears are ringing."

"Really? Botl1 of iliem?""Yeah."

"Hmm. Maybe it was the red wine. I t alwaysmakes me feel stuffy."

Day2:"I still have that buzzing in my head today."

"Hmm, maybe it was the curry ...or the pollen."

"Yeah, maybe. Hope it's th e pollen. I'll never gjveup Thai food!"

Day3:

"The noise is pretty loud now."

"Hmm, maybe it's the Relafen. I think tinnitus is

a possible side effect of non-steroidals."

"Yeah, 1 think I'll stop it.

Four months and thousands of miles, dollars,an d prayers later, my husband, Stephen, and Istarted to come to grips with the fact that an

unwelcome visitor had taken up residence his

head and in ou r home. We elin1inated the

possible offenders: alcohol, caffeine, spices,herbs, medications. We blamed everything from

the leafblower to rock concerts. We sought helpan d advice from a score of specialists - frominternist to acupuncturist. Every physiologicalan d psychological cause was explored.

We had the ultimate good news/bad news

diagnosis - tinnitus. It won't kill you, but at

times you just might want to kill yourself. One

noted specialist concluded ou r unsuccessful visitto his clinic with, "You've got a beautiful familyan d a lo t to live for. Go home and get on with

your life." Easier said than done.

Over the ensuing months, Stephen suffered a

host of psychological an d physical symptomsrelated to this severe intrusive tinnitus including

pwfound depression, a 30-pound weight loss,insomnia, overwhelming nausea, bruxism (teeth

grinding), fearfulness, increasing inability tofunction at work, and an uncertainty that fueled

his sense of despair about himself and his future.

As spouses, we must appreciate the real physical and psychologjcal toll that tinnitus takes on

those who have it. Tinnitus is invisible - no cast,

14 Tinnitus 7bday/ December 2000 American Tinnitus Association

no limp, no cough, no definitive way to measu

its presence or severity. This left my husband

with th e added burden of continually explaininhis head noise, defending his sanity, and justify

ing his misery.As a nurse, I understood th e impact that tin

nitus was having on Stephen. I t is much the sa

with any life-altering illness or injury. Howeve

found myselfbecoming impatient, weary, and

annoyed with the incessant questions, our red

dant conversation, and his constant need for resurance. At one point I actually thought, "Howbad can this really be?" I decided to find out.

I placed a portable radio in a purse with ashoulder strap. I t was "tuned" to white noise -the static between FM radio stations - at the

level of loudness that roughly matched histinnitus. Then I carried it around with me as Iperformed several routine household functionsWithin iliirty minutes I noticed that I was clen

ing my teeth and feeling irritable. After an houI turned the !%?$# thing off and tended to my

full-blown headache.

It's easy to become a bi t blase about their

suffering when th ey look so normal. But imagjwhat it would be like if you had to endure ascreaming vacuum, siren, or kettle following y

from room to room. Could you think creatively

make critical decisions, do anyiliing substantivin an atmosphere of unabated noise? How wouthe loss of silence and its uncertain return affeyour day, your work, your relationships, and

your life? The importance of supportive human

contact cannot be overemphasized.

Meeting his or her psychological needs ma

be the greatest challenge for the spouse. I persally focused on three areas that I felt complicamy husband's recovery and affected our familylife.

First, 1 redirected what I viewed to be fault

or distorted thinking. Cries of "I can't get out obed! My ears ring all the time! I'm useless, I ca

do anyiliing!" were met with reality-charged

responses like, "I'm changing the sheets, NOW!

You seemed to enjoy watching th e Braves lastnigh t. You can feed the cat and drive carpool."When I h eard, "I don't think that I'll ever get b

ter!" I pointed out what he did accomplish whireminding him that there was no finite time lin

for recovery an d that we would continue to wotowards resolution.

(continu



WHEN THE BRAIN HAS RE-WIRED ITSELF

by Aage R. Meller, Ph.D.The brain is "plastic" (changeable) and the connectionsbetween the different parts of

the brain can change. This isknown as neural plasticity -which means that the brain isnot "hard wired" like electricalequipment. Pain, musclespasm, and tinnitus can be the

results of changes in the wjring of the brain.

Tinnitus can cause great distress for thosewho have it as well as for those who treat it. Oneproblem is that conventional tests usually do not

show any sign of disease, and the only information that the physician has is the patient'sdescription of his or her trouble. The lack of teststhat can help to diagnose the problem and find

out where the problem is located naturally makes

treatment difficult. Tinnitus is intuitively associated wjth the ear and it is therefore oftenassumed that it is caused by something goingwrong with the ear. While it is true that some

forms of tinnitus indeed are caused by disordersof the ear, many forms of tiimitus, particularlythe more severe fonns, are caused by changes in

the nervous system. I t is the nervous system that

makes it possible to hear the sounds that reach

our ears.

I t has been known for many years that children's brains change as they grow. We now know

that the function of the adult brain can alsochange, and that connections between differentparts of the brain can open and close and par ts of

the brain can become more sensitive or more

(continued)

Tinnitus Spouse Survival (continued)

Second, I sought to combat his inertia by

encouraging simple, purposeful tasks that couldbe achieved within the framework ofhis shortened attention span. These included short-termcommunity projects as well as household chores.

Several times each week I insisted that he joinme for a simple outing - a trip to the park or the

bookstore - to break his routine and demonstrate that he could "do something."

Third, I found it necessary to se t some limitswith regard to the discussion of tinnitus. While he

was consumed with every facet of it, I still needed to attend to many other aspects of our dailylife and it was no t always convenient to stop midstream to chat or listen - again. Devoting a specific time to talk about tinnitus allowed me tolisten without distraction, and it let him know

that he had my undivided attention to expressthe anger, fear, and isolation that he felt.

Over time, I compiled a list of "Tinnitus

Spouse Survival Tips" that are based on my notso-scientific research with a patient population of

one. They are, however, the result of my objective observations as a nurse and my subjectiveexperience as a wife. I hope that the reader mightfind value in them as well.

+ Learn as much about tinnitus as possible.+ Thke notes and ask questions. Become your

spouse's medical liaison and advocate.+ Don't underestimate the value of good psychi

atric or psychological intervention for your

spouse and for you.+ Challenge distorted thoughts. Accentuate what

is positive, and acknowledge bu t redirect negative thinking.

+ Get your spouse moving. Exercise, outings, and

chores will build a resume of success that youcan use to fight feelings of worthlessness.

+ Decrease as much extraneous stress in your

lives as possible. (This may no t be the year to

make quilts for everyone on your Christmaslist.)

+ Be compassionate and commiserate on occa

sion, but be tough when there is too muchwhining.+ Be patient. Successful treatment is probable

bu t this is not strep throat! No 10-day course of

Amoxil here.+ Maintain your social contacts and outside

interests. Without any personal outlet you willbecome less effective in your supportive role.

+ Keep yourself physically and emotionally fit.Your spouse and your family need you and youdeserve it! R

American Tinnitus Association Tinnitm 7bday/ December 2000 15



WHEN THE BRAIN HAS RE-WIRED ITSELF (continued

active. This is mainly caused by changes in the

ability of nerve cells to transfer information fromone part of the brain to another. Recently, we'velearned that the mature brain can grow new

nerve cells - something that was regarded as

impossible just a few years ago. This new insighthas thus revealed that the mature brain is "plastic" and can change the way it functions in waysthat are similar to learning. This discovery has

changed our view on tinnitus as well as on pain

and some forms of muscle spasm.

Normally the ea r is connected to parts of the

brain that can distinguish different sounds such

as speech. After that, the information is sent toolher parls of the brain Lhal are involved in

understanding the meaning of speech. Musicsounds are interpreted by parts of the brain that

are involved in enjoyment of sounds. The different parts of the brain must be connected to theea r in the right way in order for our hearing tofunction normally.

Many people with tinnitus hear sounds asunusually loud or unpleasant or that evoke fear.I t is possible that the information is being sent to

the wrong part of the brain because the wiring of

the brain has changed. One known factor that

can cause these changes is a lack of input from

the ear, like in silence or when hearing has been

damaged.

We normally use only one of the two routes

that connect the ea r with the parts of the brain

that perceive sound. The route we use is calledthe classical ascending auditory pathway and it

leads from the ear to the auditory part of the

cerebral cortex where some interpretation of

sounds is done. From the cerebral cortex, the

information about sounds is sent to brain centers

that can extract the meaning of sounds. As the

information about sounds travels along this"information highway" it is analyzed in the different clusters of nerve cells (called nuclei) that are

located along this pathway.Tinnitus may be caused by some nerve cells

in these nuclei being too sensitive so that they

act on their own instead of waiting for sounds toarrive. That could explain some forms of tinnitus.When sounds appear to be stronger than normal

(hyperacusis), it may be a result of nerve cellsbeing too active. When sounds are unpleasant or

cause fear, it is possible th at information is reaching parts of the brain that are not normally

involved with sound.

16 Tinnitus Thday/December 2000 American Tinnitus Association

Tinnitus could reach other parts of the braiby way of the other route - the non-classicalascending auditory pathway. Although little isknown about this part of the brain, we do knowthat it processes sounds differently and it con

nects to completely different parts of the brainthan does the classical pathway.

This non-classical pathway connects the eato parts of the brain that deals with emotions.While the classical pathway only deals withsound, input from other senses mixes with souin the non-classical pathway. Nerve cells in thapart of the brain not only respond to sound but

also to touch of the skin, which may affect the

way lhese nerve cells conduct information abosound. We have earlier shown that electricalstimulation of a nerve in the wrist can change

the way tinnitus sounds and that was taken as sign that the non-classical auditory nervous system is involved in some forms of tinnitus. I t m

be that the opening of this non-classical pathwcauses sounds to become unpleasant and sometimes evoke fear. Dr. Richard Salvi's researchgroup in Buffalo, New York, has recently show

evidence that this area in the brain, generallyknown as the limbic system, is activated by sofo rms of tinnitus.

The involvement of the non-classical pathwin tinnitus also explains why some people with

tinnitus can change their tinnitus by touchingtheir skin or by making muscle contractions or

changing their gaze, as has been shown by A.T.

Cacace, Ph.D., and co-workers.

I t should be possible to reverse the changesthe brain since they are not caused by damagetissue. But as yet, we do not know exactly how

do that. We do know that silence and strongsounds can cause changes in the connections i

the brain. This fact should make us avoid theseconditions as much as possible. People with tintus should avoid silence, too, even if sound is

unpleasant.This new understanding of how the auditor

nervous system works and how connectionsbetween different parts of the brain can changehas helped us understand tinnitus better. Suchprogress naturally improves our possibilities totreat and prevent tinnitus. 1mDr. M ~ l l e r is a researcher at the University of Texa

at Dallas, Callier Center for CommunicationDisorders.



ATA's Telephone, Letter, andE-mail Help Network

ATA's Help Network consists of compassionate individuals who vo lunteer their time, experiences, an d guidance to tinnitus pabents. Whether

they participate by phone, letter, or email, theHelp Network volunteer s are part of a vital support link that offers advice and empathy. Call or

write today for information about coping tech-

niques, local healthcare resources, or just to he

from a helping friend who knows what you'regoing through. The next issue of Tinnitus Tbday

will include the listing for the U.S., Canadian,and international tinnitus self-help groups.

Alabama Mitzi Cahn Larry S. Brown Hawaii Indiana

Benjamin C. Franklin1439 Bonita Ave. Raymond James &

Paul Yamashige Georgian.n K. Malon

118 Nolen Ln.Berkeley, CA 94709 Assoc., Inc.

Honolulu , HI 221 Oakridge Pl.

Alabaster, AL 35007510-527-9075 1200 N. Federal Hwy.

808-526-1405 Decatur, lN 4673311100

205-664·9409 'Ierrance L. StilesB. Clark 219 -728-9941

Donna L. CoDins21297 Meteor Dr. Boca Raton, FL 33432

Honolulu, Hl 96815Cupertino, CA 95014 561-750-3315 Iowa

1109 Union Chapel Rd. lbrownl@32z. rjf.com 808-923-8768Harvey Joanning,

Union Grove, AL 35175 B. Martin Brinitzer

256-753-2222 Penn Valley, CA Mort Gulden Idaho Ph.D.

Herbert Hilton 530-432-35075179G Europa Dr.

Alvin WhitehouseAmes, lA

Geraldine A. BuschBoynton Beach, FL Rt. 4, Box 251 515-232-4831

3521 Countrywood Ln.Chico, CA

33437 Old 'Ibwn, ID 83822 [email protected], AL 35243

916-343-5625561-369-0831 208-437-2158 Ray Thylor

205-234-4215

ColoradoMiriam G. Bloomfield

Illinois36 3rd St. S.

Arizona 6435 Mill Pointe Circle P.O. Box 219

Paul Murphy F. P. Pete Clements Del Ray Beach, FL 33484 Bruno Bertucci Central City, TA 5221

PO. Box 1184 Louisville, CO 561-496-4967 Highland Park, IL 319-438-1814

Sun City, AZ 85372 303-665-7990 [email protected] 847-432-7161Kentucky

602-407-6945 Edith V. Phlllips Thomas J. D'Aiuto Ma..,.; an d Jean

Robert C. Fay2221 19th St. Thrnpa, FL Thnnenbaum Barbara S. McQuear

Boulder, CO 80302 Morton Grove, IL 60053 R.N.Dewey, AZ 813-925-0011

Radcliff, KYNaomi M. Anderson [email protected] [email protected]

Colorado Springs, CO Walter J . Czarnecki502-351-6715

CaliforniaLorraine F. Cramer

719-392-1054Pen Pal Network 1303 N. 17th Ave. Ruth R. Middleman

Vicki Kadosh Connecticut Coordinator Melrose Park, IL 60160 Ed. D.

Tarzana, CAWilliam S. Brill 434 Lewis Blvd. SE

708-345-7642 4600 Bowling Blvd. 1t

818-525-3416161 Maplewood Ave.

St Petersburg, F'L 33705 Myrtha Castellvi Louisville, KY [email protected] 502-458-4427

Milford, CT 06460 727-823-4240 Bolingbrook, ILNorman Baker 203-878-1999 lenn i_cramer@yahoo. 630-739-2872 Mark Goodan

403 s. Mesita Pl.Raoul Wagman

com Marion H. SchenkSomerset, KY

W. Covina, CA 91791403 Elm St. Alex Ravetti 1 Bank One Plaza II lLI-

meg52@gate,\7ay.net

626-967-8815New Haven, CT 06511 Cape Coral, F'L 0103 Louisiana

Gloria Stanetti 203-865-3226 941-772-8956 Chicago, IL 60570 Phyllis B. FlesherJoshua 'free, CA

Steven J . [email protected] 773-281-3750 9534 Royalton

760-369-820323 Pequot Dr. Lester H. Lemke Michael O'Malley, O.D. Shreveport, LA 71118

Bob Lewicki E. Norwalk, CT 06855 Cape Coral, FL 8505 S. Kedvale Ave. EDis E. AuttonberryBlue Jay, CA 203-866-9405 941-945-2759 Chicago, IL 60652 2520 Swiss [email protected]

FloridaJeffrey P. Caine 773-284-2211 West Monroe, LA 7129

Ji m R. Camomile 36141 US Hwy . 19 N. Gladys Jackson 318-396-43487853 Standish Ave. Thna E. Spence Palm Harbor, F'L 34684 RR 2, Box 105

Maineruverside, CA 92509 6909 Plum Lake Ln. E. 727-785-5554 Franklin, IL 62638

909-681-9859 Jacksonville, FL 32222 Georgia 217-484-6444 Linda E. DowellJ RCa mom ile@world- 904-779-2975 Judith Schwegman PO. Box 1076

net.att.net Arlene M. Jewell Shirley G. Perry3500 W. Chautauqua Rd. Gardiner, ME 04345

Lola C. Wilson Keystone Heights, FL Powder Springs, GACarbondale, IL 62901 207-582-9482

Thstin, CA 352-473 -0010 770-943-0059618-457-6637 Katharine Olga Dut

714-731-0933 cjewell@southeast. [email protected]@midwest.ne t P.O. Box 1027

gulf.ne com Warren, ME 04864John Rhodes

COTOna, CA Ben an d Shirley Cohen James A. Morris 207-273-2197

[email protected] t 2871 Somerset D ~ : ltH411 Powder Springs, GA

Lauderdale Lakes, FL 707-943-3648Wayne E. Maxon

Oxnard, CA 33311 Perry L. Carter, Jr .

805-486-6460 954-733-7960 126 Steeplechase Rd.

[email protected], GA 31405912 -238-1 700

18 Tinnitus 7bday/ December 2000 American Tinnitus Association



Mary land Missour i Judith Dunne, MA, Oregon TennesseeGeorge E. Scott, Jr . Dick Viney

CCC-A

1246 Chesape ake Dr. 19 Maple Ct IIA 55-19 Metropolitan Ave.Betty .Mathis Joseph L. Akins

Churchton, MD 20733 Branson, MO 65616Ridgewood. NY 11385

Milwaukie, OR 1802 Knickerbocker Ave.

301-261-5259 417-334-7685718-381-8696

503.059-1618 Chattanooga, TN 37405

Shirley an d Mort [email protected] Jean Lavagn.ino 423-756-4160

RosenhaftIr a F. Broiter

121 E. Hilliard Ln. Tcresia Guinn

Silver Spring, MDDa,rid A. Barber 48 Hamlet Dr.

Eugene, OR 97404 345 Hwy. 79 N.

301-438-2034Carson City, NV Hauppauge, NY I I788

541.089·8076 Humboldt, TN 38343

Barbara J. Williams775-882-8814 516-626-1017 Richard C. Speedy 901-787-7019

2704 Summerview Wa} New HampshireSamell (Sarme) Ogus 765 N. 9th St. Texas

11202 John WashutaEast Hampton NY Harrisburg, OR 97446

James R. Salter

Annapolis, MD 21401

631-324-6218 541-995-8608

410-224-83301276 Route 9 sogus@suffblk li b.ny.us Michael H. Ayers

11040 Creekmere Dr

Stoddard, NH 03464Dallas, TX 75218

Massachusetts 603+l6-7077George Malchow Bend, OR 214-328-1221

Susan Rezen, Ph.D.roadrunner@cheshirc.

26 Footbridge Rd 541-389-3937

ne tP.O. Box 70 Pennsylvania

Carlton Dale Mobley

W o r r ~ ~ t e r State College Columbraville, NY 120503805 Hollis

486 Chandler St. Shirley Baldasaro 518-828-3218Yolanda Kapalo Ft. Worth, TX 76111

Worcester. MA 0160220 Palmer St ~ i c o l e Hoffman

1940 Michigan Ave 81"'-831.0146

508-929-8551Claremont, NH 037-13

63 Gansevoort Rd.W. t-lifflin PA 15122 Sa m Urso

srezcn(a worcester.edu603-542-4889 S. Glen Falls, NY 12803

412-466-0963 1005 Laredo Ct.

Ernest B. Johnson New Mexico 518-793-2422Timothy F. Hreboc il< Co llege Station, TX

54 Pembroke St. Jack C. Fuller Elaine 1\1. l"airbankMcKeesport, PA 77845

41 2-673-I513 409-696-6280

Mitrlhorough, MA 01752 1\l buquerque, NM 16 Pine Cir.

Shirma \t . Huizenga 505-294-4206 Sauquoit, NY 13456Mark A. Rains Irene Duffield

Franklm, MA jacfull@aol com 315-737-0522358 Lamp Post Ln. 4923 Rollingfield Dr.

508-520-6641 New Jersey Tberis AldrichHershey, PA 17033 San Antonio, TX 78228

Linda \1. Hastie 2357''

MainRd.

717-533-8366 210.084-5609

Jamaica Plain. MA Robert Zecklcman Silver Creek, NY 14136 Wilbur E. Klotz Utah617-524-2329

16 Riverside Dr Apt. F2 716-934-1837S. Williamsport, PA Aaron Remley

Mike M. MillsCranford, NJ 07016

Susan M. Grant570-323-5873

65 Riverside Ave. tt30973-425-2613 [email protected]

Payson, UT

t-lcdford, MA 02155-4604Jessica Moore

Niagara Falls, NYKathleen l\tunley

rem lcys_west@yahoo.

7 Galloway 'Thrr.716-298-5074

com

[email protected] North CarolinaArchibald, PA

Robert L. Ehrmann,Kinnelon, NJ 07405 717-876-2747 Virginia

~ J . D . Kathleen Krivak Barry Whitesell munleyg@microserve. Lynn Haddon

Waban, MAHasbrouck Hts, "' J 4410 Brookhaven Dr. ne t 5ll8 Longshadow Ct.

617-527-8426201-288-3038 Greensboro, NC 27406 Rosemary E. Hartman Midlothian. VA 23112

Mich iganChris Martin 336-674-1885 111 Red Fox Pl. 804-744-3393

151 Wall St. An n N. 1bcado Media, PA 19063 Richard R. Frampton

Dorothy Blair Eatontown, NJ 07724 9228 Fairway Ridge Rd. 610-356-6816 4248 Botetourt Rd.

Southfield Ml Warren F. Thdor, Jr . Charlotte, NC 28277 George KellyFincastle, VA 24090

248-354-3384 Jackson NJ Susan S. Partin 1622 Winton Ave. 540-473-2325

William J. Haskin 732-928-1639 Elktn.NC Havertown, PA 19083 [email protected]

1408 Surrev Dr Wilma Ruskin 336-835-3438 Morris Rubinoff WashingtonWestland, Ml 48186 Acoustic Neuroma North Dakota

Wynnewood, PA

7'34-595-4927 Association610-642-7145

Keith R. Field

Frank E. Weaver Princeton, NJDorothy M. ll out moruby@ li nc.cis.upenn.

1609 NW 85th St. tt205

14810 Sama Rosa 609-683-4650PO. Box 226 cdu

Seattle, WA 98117

Detroit, Ml 48238 wruskin33@'aol.comWyndmere, ND 58081

206-783-71OS

f<•w7164(.(l--aol.com John R.-ry, M.S., M.A.,701-439-2630 Rhode Island [email protected]

Mnnesota f-A <\.A OhioWilliam J. Lynch, Jr . Richard D. Curtis

Garden State Balance & ) la ry Jo Lo\'eP.O. Box 329 251 Rainier Ln.

Dolores L. Carcl.inalNarragansett, RI 02882 Port Ludlow WA 98365

20 E. Exchange St.,Hearing Centt:r 838 Suntree Dr. -101-295-2-132 Stellajoe E. Staebler

83 Rt. 37 West Westerville, OH 43081ki\302

1bms River, NJ 08755 South CarolinaPO. Box 594

St. Paul, MN 5510161-1-846-8810 Centralia, WA 98531

li51-215-4620732·818-3610 Joyce A. Knapp Barbara Uyeda frank H. Se11

Robert Aurandtllarry F. Hochman 2631 Millrace Dr. Pelion, SC Liberty Lake, WA

Maplewood, MNWhitehouse Station, NJ Columbus, 01 143207 803-894-4764

(;12-771-9948908-832-7641 614-497-2631 ruyeda(!;' pbtcomm.net

unstoppable.sell@·big-planet.com

llonce and Efrom New YorkJeffery P. Bassett Ralph D. Gentry

Wisconsin

Abramson Sharon WcinhausP.O. Box 328 135 Edgewater Dr.

711 Oak Ridge Rd. New York, N\Wadsworth, OH 44282 Anderson. SC 29624 Jeffrey J. Selles

Hopkins, MN 55305 212-758-0791 Richard J. Compton864-224-8578 1605 Norse Pkwy.

612-935-0757 Robert J. Luthmann70 E. Galbraith Rd. tt3

Barbara S. Raper Stoughton, WI 53589

Bonita \t . Kucala Box It ) AnnandaleCincinnati, OH 45216 107 Moore Ct. 608-873-8825

13657 74th Pl. N. Staten Island, NY 10312Simpsonville, SC 29681 jsc:[email protected]:om

864-963-891 5.Maple Gro,·e, MN 55311 718-948-2659

612-194-3554 John RC.)CSSouth Dakota

Harold L. Larson J47 42nd St Helen J. llersrud

St Cloud, Ml:\ Brooklyn, NY 11232 Rapid City SO 57701

320-253-2160 718-768-2451 waldoh@ rapidnet.com

harry lars@·hotmail.com r ( ~ y e s @ • m c i 2 0 0 0 . c o m

American Tinnitus Association Tinniws fb<Wyl December 2000 19



EXPEDITION HOPEFUL CURE

MY ADVENTURE ON MT. RAINIER

by Donna Brown

I decided to climb Mt. Rainier for a number ofreasons:

I. to raise funds fo r tinnitus research

2. to increase public awareness of tinnitus

3. to fulfill a personal goal

4. for adventure and challenge

5. because I got tired of hearing "learn to live

with it" from doctors and decided to take

back some control and do something posi

tive in spite of having tinnitus.

In one way or another, I met

all of these goals.Th e journey started on my

birthday, July 29, 2000. I headed

up the trail with a 40-pound pack

on my back filled with food,water, clothing, gear, and an

anticipation of reaching the

14,410-foot summit that weighedheavier than the pack. Also sharing this dream were 22 other

climbers and 7 guides. Ou r firstgoal was to reach Camp Muir at

the 10,000-foot level where we

would camp overnight and awaken early the next morning to continue ou r summit climb.

I started ascending, roped to five other climbeand had the feeling ofbeing pulled up the mounta

I kept up despite my tendency to get tangled in thrope while coordinating the dance of "rest step, prsure breathe, huff puff, pant, pant" and trying notstab myself in th e foot with my axe.

We crossed snowfields, jumped over huge

crevasses, and made ou r way over rocks and loosegravel, scraping and slipping at every step. We

stopped to rest after 21/2 hours, and l threw my pac

and myself down in the snow in a state of exhaustion. We'd reached 12,000 feet and l feared I hadreached my limit. Just sitting on my pack was an

effort. On any climb, the decisto proceed or turn around is a

challenging one, and one neveeasy to make. I needed to makthat decision fairly quickly; my

companions were already packing to head up the mountain.

But I could barely stand up.

Th e decision was made for meA guide helped me stand up an

said he was sending me back

with another guide and other

exhausted climbers. Their decision to send me back down waprobably a wise one, since the

ha d to consider the safety of thgroup as a whole.

Th e trek started on a paved

trail that eventually turned intoan immense, steep snowfield. Th e

ascent up Muir Snowfield was an

arduous six-hour trek, and despiteusing poles and heavy moun- Donna Brown and ATA flag on Mt. Rainier.

As l roped into the descending

team, feeling sick in stomach aheavy of heart, I glanced backover my shoulder for one last

look at the majestic panorama

above me . This one sight, as if

Rainier was giving me consolation, came in the form of anaineering boots, I was soon wind

ed and lagged behind my companions. Each step was

a supreme effort due to the altitude and steep slopeof the snowfield. Suddenly, when I thought I couldn't

take another step,I

heard the guide yell, "We'rehere!" I couldn't believe my eyes or my ears for that

matter: No tinnitus the whole climb! There wasCamp Muir only a few feet away. I made it to my

first destination.

After a quick supper, it was early to bed but I

didn't get much sleep. All 23 of us were packed intoa tiny hut like sardines, side by side in ou r sleeping

bags. At midnight, we got the wake up caU and I

quickly sprang into action, donning warm clothing,headlamp, boots, crampons (spikes attached to bootsfor traction on ice and snow), harness, and ice axe.

20 Tirmitus Thday/ December 2000 American Tinnitus Association

orange glow from my former companions' headlamilluminating lhe darkness and winding up the moutain as far as the ey e could see. I t was an incredibl

sight.The descent from Muir was a bi t easier than th

ascent, as we glissaded (slid on our bottoms) down

th e snowfield. When I got back to my room, I refleed back on the climb and was upset with myself fonot reaching the summit, even though only 13 out

23 climbers made it to the top.

At this writing, I still feel disappointed in that

might have le t people down who were pulling for m

in this climb. But then I remind myself of what I daccomplish. First, I took tinnitus (and myself) to anall-time high. I've climbed many "fourteeners" inColorado where I live, but have always started the



Research Update

by Pat Daggett,

Ali1 Director of Research

The following reports are fromtwo researchers whose ATAfunded tinnitus studies are now

completed. Three new grantproposals are being evaluatedby ATA's Scientific AdvisoryCommittee for funding consideration at the end of this year.

Tinnitus researchers are invited to download acopy of the grant application from our Web site(www.ata.org). The next deadline for submission ofgrant applications to ATA is December 31, 2000.

Using auditory reorganization to minimizeperception and facilitate habituation of

tinnitusPrincipal Investigator:

Robert W. Sweetow, Ph .D.

University ofCalifomia

San Francisco, CA (UCSF)

An abundance ofresearch indicates that certain procedures can

be used to modify the function of

portions of the brain used in hearing. This ability of the brain to

reorganize itself is termed cortical plasticity. In thisinvestigation funded by the ATA, we tested the

Toward the Curetheory that tinnitus can be eliminated or minimizedby altering the way sound is perceived (organized) in

certain regions of the brain, specifically the auditorycortex.

Our approach differs from the traditionalapproaches ofbiofeedback, counseling, habituation,

and masking. For example, when sound generatorsare used in combination with directive counseling asis done in tinnitus retraining therapy, the goal is toalter the patient's cognitive response to tinnitus andeventually allow for habituation. It can take 18 to 24months before patients recognize changes with thisapproach.

Our research project was based on studyingchildren with language impairments. Children withlanguage impairments often have auditory temporalprocessing problems. (Understanding speech is basedon the ability to differentiate one speech sound fromanother in a time sequence.) Computer exercises

were used to train the children to attend to specificauditory stimuli. Their temporal processing abilitiesimproved, as did their language comprehension. The

finding that attention was necessary to cause thesechanges has potential significance to the treatment

of tinnitus.

We hypothesized that similar methods could be

used to retrain the auditory cortex to minimize tinnitus perception in a shorter period of time than by

current approaches. We used computer controlledauditory tasks with game-like interfaces that focused

(continued)

EXPEDITION HOPEFUL CURE (continued)

climb from a higher elevation - 8000 to 10,000 feetabove sea level. In terms of actual elevation gain on

Mt. Rainier, f climbed 7000 feet starting at the .5000-foot elevation and reaching the 12,000-foot. elevation.J helped ATA raise over $85,000 to continue researchfor an eventual cure for tinnitus thanks to all of youwho contributed so generously to Expedition HopefulCure. In that respect, I accomplished my main goal.

And besides, if my climb inspired at least one personto make his or he r own dream come true and not lettinnitus interfere with doing the things they love todo, then I reached my summit after all. B

A lot of people were instrumental in helping tomake this dream a reality. 1 wish to thank the following people and companies for their media andfinancial support for my climb:

Jo e Southern, reporterDaily Times Call, Longmont, CO

Barbara Byrnes Lenarcic, reporterNorthglenn-Thornton Sentinel, Northglenn, CO

Claudia Hibbert-BeDan, reporter

Broomfield Enterprise, Broomfield, CO

Marian Jones, reporterFox News, New York, NY

Gary Massaro, rep01ierRocky Mountain News, Denver, CO

The North Face, Boulder, CO

Also, my heartfelt thanks to the follo,>\Tlng peopleat ATA: Barbara Thbachnick Sanders for being receptive to my hair-brained idea in the first place, toJessica Allen and Cheryl McGinnis for all their

encouragement and support, and to Lisa Freeman forhe r creativity and energy in coming through with theATA flag and T-shirts.

Last, all my love and appreciation to my husband,Gary, who stood by me every step of the way.

Ms. Brown is a tinnitus self-help group leader - and amime - in Denver, Colorado, and can be contacted at

303-469-1683.

American Tinnitus Association Tinnirus Thday/ December 2000 21



Research Update (continued)

on timing and pitch/loudness characteristics to directthe reorganization ofbrain functions. Each research

subject was asked to do these exercises for one hour

per day, five days a week for a six-week period. The

exercises required each participant to listen to asound, and either reconstruct the sound from short

auditory segments, or recognize the sound from a

series of similar sounds. The sounds were adjustedbased on the subject's individual tinnitus match

characteristics and consisted of chords, frequencysweeps, shaped noise, and tones. Th e sounds weregenerated from a computer program and were then

transmitted via high quality earphones and se t to acomfortable listening level.

Of the 16 participants who began the project,a total of nine completed the six-week trainingprogram. Eight of the nine subjects had varyingdegrees of hearing loss.

While none of the subjects reported a substantialdecrease in the level of tinnitus, one indicated a sub

stantial change in the quality of her tinnitus: three ofthe four "sounds" disappeared entirely. It was interesting to note that the one subject whose tinnitus

loudness match and minimum masking levelchanged substantially for the better did not reportsubjective improvement in the loudness, annoyance,or quality of life items on the questionnaire.

We were unable to learn if the lack of change intinnitus was related to a lack of achieving corticalplasticity. If it did not o c c m ~ several variables might

have been involved. For example, while the learning

exercises we employed have been proven to facilitatechanges in the way the brain reorganizes itself, we

might not have used the best stimulus to achievethese changes for tinnitus. In addition, the durationof the training cycle (SL'< weeks) might not have been

long enough. Furthermore, the full range of the training stimuli might not have been audible to those with

hearing loss. Despite the lack of apparent positiveresults from this experiment, we believe that thisgeneral approach to attain tinnitus reduction isworthwhile and should be further explored. The

authors wish to thank the American Tinnitus

Association for its generous support of this project.

The Role of the Trigeminal Ganglion -

Cochlear Nucleus Projection in the

Modulation of TinnitusPrincipal Investigator.

Susan E. Shore, Ph.D.,Medical College ofOhio

The aim of this project was todetermine i f an established pathway between the trigeminal ganglion and the cochlear nucleus

(from the facial nerve to the

brain) plays a role in the generation and/or modulation of somatic tinnitus. Somatictinnitus is the kind that can be altered by manipulat

ing regions of the head and neck, as in clenching the

22 Tinnitus 7bday/ December 2000 Ametican Tinnitus Association

jaw. According to researcher Robert Levine, appromately two-thirds of patients have a somatic compnent to their tinnitus.

The first part of this study further explored thanatomical pathway to the ventral cochlear nucle(VCN) from the trigeminal ganglion. In an earlierstudy, we demonstrated that the ganglion sends a

projection to the cochlea in addition to its projectto the cochlear nucleus. The question remained: Dthe same cells project to the two regions? We werable to show that trigeminal ganglion cells in thesame region project to both places. We think that,in some cases, the same cell may project to both

regions.

We then wanted to determine if by electricallystimulating this pathway we would produce changin the spontaneous rate of its neurons. (An increain spontaneous rate of cochlear nucleus neurons h

been associated with the presence oftinnitus.)

Electrical stimulation was applied to the trigemina

ganglion at levels ranging from 10 - 1000 mA (thsandths of an amp). An increase in spontaneousactivity was observed in the majority of VCNneurons. Spontaneous nerve activity increased asthe level of current was raised.

These results support our hypothesis that thetrigeminal ganglion-cochlear nucleus pathway maplay a role in the generation and/or modulation o

somatic tinnitus. Future pharmacological studies aneeded to determine if intervention with chemicain the brain (agonist and antagonist neurotransmiters) can also change the spontaneous activity inthe cochlear nucleus and perhaps reduce tinnitus,

ultimately in the human. II

Publications Resu lting From this Work:Shore, S.E., Vass, Z., Wys, N. and Altschuler, R.A. The

trigeminal ganglion innervates the auditory brainstem.Journal ofComp. Neurol. 419:271-285, 2000.

Shore, S.E., Vass Z, Wys, N and Altschuler, RA. The

trigeminal ganglion innervates the auditory brainstem.Abstracts of he Association for Research in OtolaryngologySt. Pe tersburg Beach, FL, p. 37. 2000.

Shore, S.E., Lu, J. 1bgeminal ganglion effects on neuroin the cochlear nucleus: Spontaneous activity. Abstractsthe Society for Neuroscience, November, 2000.

A Special Thank You to

Personal Growth TechnologiesPersonal Growth Technologies is donating a

portion of the proceeds from the sale of each

Tinnitus Relief System to the ATA to furthertinnitus research. The generosity of PersonaGrowth Technologies in assisting ATA's

research efforts is deeply appreciated.



QUESTIONS AND ANSWERSJack Vernon 'sPersonal Responses to Questions from our Readers

by JackA. Vernon, Ph .D, Pofessor Emeritus,

Oregon Health Sciences University

Qr. 0. in Minnesota

writes that a patient

of his has tinnituswhich was induced by the

antibiotic Thbramicin. In

addition, his patient has

chronic and severe pelvicpain. Dr. 0. writes, "Mypatient has been treated with

Ativan which has significantly improved his pain and histinnitus. His family and I

want to continue him on Ativan but his psychiatrist wants to treat him with electroshock therapy.Can you comment?"

An as much as your patient is obtaining

relief with Ativan, I see no reason to stopits use. My ph ilosophy is to stay with what

works. Ativan is an anti-anxiety drug that requires

monitoring but is most likely enhancing his

sleep, something that electroshock therapy most

assuredly would not do. If the Ativan treatment

for tinnitus is less than complete, perhaps you

could prescribe an increased level of it.

QMr. W. from N01ih Dakota is atinnitus/hyperacusis patient who hasread about the Star 2000, a special hearing

device designed for hyperacusis patients. He asksmy opinion about obtaining a Star 2000 .

Ahe Star 2000 had a problem. I t was tested

by one hyperacusis patient who gave ravereviews. But it was also tested by another

- Dan Malcore of the Hyperacusis Network -who, in contrast, gave the Star 2000 a negativereview because it produced an audible mechanicalsound that could annoy people with hyperacusis.This had the effect ofinspiring the individualwho made the Star 2000 to improve it - and

make the Star 2001! According to Jim Fenwick(800-464-9714), the audio engineer who built the

Star 2000, the new Star 2001, devices are 100%digital, with four programmable memories that

can be adjusted by remote control to accommodate and compress a variety ofbackground

sounds. And they are mechanically much quieter

than their predecessors. Because of the new technology involved in their design, they're quite

expensive: $2295 per pair including the remote

control. But th ey do come with a money-back

guarantee .

In many ways, the Star 2001 is ideal forhyperacusis patients. I t seals the ea r canal,which, I know, goes against the theory that

hyperacusic ears must not be over protected. Butit will allow people who are supersensitive to

sounds to go out into the real word and interact

without fear of being exposed to a sudden shriek

or siren. If a loud sound comes along, the devicecompresses it to 65 dB so that the ear is not overst imulated. To compensate for sealing the ear

canal, the Star 2001 amplifies low-level sounds up

to 65 dB, which is not over-protection. To my way

of thinking about hyperacusis, the Star 2001 isdoing exactly what is required to effect recoveryofhyperacusis provided the patient also listens topink noise at a maximum comfort level for twohours a day (without wearing the Star 2001devices). The pink noise will help the ears slowlyadjust to regular environmental sound.

Q Mr. R. of New Jersey writes that he is 78years old and cannot remember when he

has not had tinnitus in both ears. He

recounts a history of working in very noisyplaces which most likely caused his tinnitus and

some of his high-frequency hearing loss. He hasbeen seen by several otolaryngologists and neurologists and by a few audiologists, all of whom

told him that there was nothing that could be

done for tinnitus. Then he saw the audiologistwho conducts the self-help group he attends . Shetold him to get fitted with two hearing aids which

she said would relieve the tinnitus and might

even make it go away. As a result, he purchasedtwo hearing aids which cost $2000 only to findthat they had no effect upon his tinnitus and sohe returned them. He asks, "Why didn't the hear

ing aids relieve the tinnitus?" He also indicatesthat lack of sleep is his main problem.

Ar. R., I assume that you have high

pitched tinnitus which is usual for patientswith your history of noise exposure. In a

survey of 1514 tinnitus patients, 73% had tinnitusat pitches between 4000 and 16000 Hz. Most of

those pitches are above the level of sounds thatwe hear in our environment. And environmental

sounds are what hearing aids amplify. So, it is my

guess that your hearing aids were amplifying

(continued)

American Tinnitus ASsociation Tinnitus 7bday/ December 2000 23



SPECIAL DONORS AND TRIBUTESATA's Champion Membe.rs 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 hav-e given memberships or research donations at the $500-$999 leve l. Contributing Members

have given memberships at the $250-499 level.

Supporting Members have given memberships at the$100-499 level. Research Donors have made researchrestricted contributions in any amount from $100 to$499.

Contributions to ATA's 'I iibute Fund will be usefund tinnitus research and other ATA programs. If yowould like this contribution restricted for research,please indicate it with your donation. n·ibute contribtions are promptly acknowledged with an appropriatcard to the honoree or family of the honoree. The gifamount is never disclosed.

Champion Members(Contributions of$1000 and

above)Cornelius R. DuffieClaude H. Grizzard, Sr.Dan Robert HocksW F Samuel Hopmeier,

BC-HISBruce MartinH. George MoellenhoffStephen M. Nagler, M.D.,

FACSRandall PhillipsHubert G. PhippsSustaining Members(Contributions of

SS00-999)Warren S. BenderThomas W. Buchholtz, M.D.John Buchman, M.D.Dwight w. FawcettRaymond GadueVan Joe LuomaSara Beall NealAlfred L. Nuttall, Ph.D.Dan Pmje s

Alexander J. Schleuning,M.D.

Susan Seidel, M.A.,CCC·A

Joel SussmanEdmund G. Thussig

Contributing Members(Contributions of$250-499)Ronald G. Amedee, M.D.Elisabeth L. BruheimRobert E. Brummett, Ph.D.Donald C. CalarcoJames 0. Chinnis, Jr., Ph .D.Rob M. CrichtonJohn E. Hayes, Jr.William J. KnightAnthony R. MaganaGeorge A. MeyerStephen M.Nagler, M.D.,

FAGSWilfred Palmer

Richard PurdyMichael R. ShepherdWalter P. StrumskiJoseph P. Wechselberger

Supporting Members(Contributions of$10()..249)Betty AdamsF. Edwin AdkinsWendell M. AhemArthur AltaracBetty J. Anderson

David R. AndersonFrederick J . and Jane C.

Artz

Charles AshLane AyresByron and Patricia BackJarBruce G. Barndt

Dee H. Ba rnet t

David D. BedworthMu r ie l BeeryReed A. BellElliott H. BergerMark D. BixbyErnest BonyhadiRobert J. Bradley

Gail B. Brenner, M.A.,CCC -A

Laird C. BrodieJeffrey Brown, M.D., Ph.D.Charles BrownoldTed Bryan

Glen PowellA. Paul Ca.merinoGladys Justin CarrC. Scott CarterDhyan Cassie, M.A., CCC-ARobert D. Chambe rsFrederick W. ChampLaruent CharriereMary K. Christ ia nsenC. Dennis ClardyGuy R. ClarkBob CobeChristine ColemanJohn A. Coleman, Jr.Donald J . CookBill CreedenChris GronbergRonald H. DaileyDennis M. Daly

Lillian Dangott, Ph.D.Robert A. DanielsPierre DavidDonald W. DavisElizabeth DavisPatricia E. DavisJerry DownH. Renwick Dunlap

Theodore J. Eckberg, M.D.John R Emmett, M.D.Ann R. EnglishDouglas FabickDwight W. FawcettJames T. FehonGail A. FlemingDavid E. FlintElio J. Fornatto, M.D.

Our heartfelt thanks to all of these special donor

All contributions to the American Tinnitus Associatare tax-deductible.

Gifts from 7-2-00 to 10-1-00

Benjamin C. franklinKa therine L. FrenchJames L. Frisk, M.D.Robin R. f'ullerRichard J. GambateseLawrence GelbLaiTy L. GentryJoseph M. GillisShirley GittelsohnL Larry GoldmanW.J . and Helen Gotschall

C. Lee GoughJ. Douglas Green, Jr.Jeannette E. Green

Paul GreenWilliam E. GromenEdmund J . Grossberg, CLUKenneth M. Grundfast, M.D.John F. HallgrenFrank M. Hanna

Mary E. Harke r

Ricki HarrisonFloya D. HawkinsJo HazelbyDennis D. Heindl

Jacob w. Heller

William F. HendrenS. Dale HessManny Hillman'Thd HofmeisterKevin HoganRoger W. HollanderJudith K Horning, M.A.,

CCC -ARaymond HoughlandJohn W. House, M.D.Eric JacobsenGary P. Jacobson, Ph.D.Judith A. JacobsonAnthony F. Jahn, M.D.Lucille J . Jan tzElias JironMa rsha Johnson, M.S.,

CCC-ARuth M. JohnstonThm Johnston

Bob JonesHarold S. Karpe

Lois S. KeeneyMichael KeltonKatherine C. KlineMarvin KowitE. Joseph KubatFloyd E. and J<aren

Kuehnis, Jr.Stacey Ku persmithJed A. Kwart!er, M.D.Tissot Pascal LalaR. Gregory LambFred R. LawsonGerald A. LeoneHerbert A. LevinFrances H. LewisShuN. Chau LiRa ndolph Lundberg

Michae l J. Lurey,Jimmie Mae HengDavid R. MarshallStuart l. MayerRichard MayesEdward MazzaJohn McDonaldAnne Holmes McKayPaula Lee McLeanThomas F. McNultyRichard Melms

Jimmy C. MeyerRober t L. MinelliWilliam F. MorrisseyAndrew J . Mu rphyJames C. MurphyJeffrey Nobel'Teresa L. O'HalloranMichael O'Malley, O.D.Ayo A. Ogunlusi, M.C.D.,

CCC-ACurtisS . OlsonJustin Osteen.Burt OttersonKarl E. OwenMark OwyangJoseph G. OylerWilliam E. PalandOwen M. FannerJames L. ParadisePhil R PearcyWilliam J. PedersenJean E. PepperDow V. PerryHuber t G. PhippsViktor PokornyStephen and Linda PressMarilyn E. PriggeDan PurjesAn ne M. RandisiBrent ReppBill RetherfordRober t ReynoldsLee and Margaret RicheyJoseph RingelsteinJeffrey A. RistineRay RobidouxJoel Rollins

Lynn RosemurgyNancy M. Rosen

Bradley RossRichard L. Ruggles, M.D.Eileen SahakianLarry SchaubDonna SchecklaSusan P. Schindelar

Evelyn J. Schwert.!Susan Seidel, M.A.,CCC·AThomas F. Sheehan, O.F.M.Ronald C. Sheffey, M.A .

CCC -AFrank ShekoskyJohn ShochFrank A. SkinnerKimberly Skinner. M.S.

John s. and Sheila C. SmRobert R. SmithWillian1 P. SmithEugene J. SobelMartin V. SochaHenry M. SottnekJoseph SoutoThomas B. SpeerShirley StockflethDr. S. Je rome 'ThmkinDaniel K. Thrkington

Bradley S. Thedinger, MWilliam J. TillmanJohn D. ThrrnedisChristina L. VanfossanMa rc R. VincentMirko B. VukovichRita WeisnerJohn L. Werner, Ed.D.David P. Whistler, Ph.D.Rosalie WiesenthalAllan P Wolff, M.D.Virginia S. WoodWilliam R. Wrigh•Larryw. York

Research Donors(Contributions of$100 ro 499)Gerald AusJohn Seymour BerryWalter BloodSharon E. BowyerRosalie Dav is-Green

Michael D. Deakin, CPAThelma D. DryElza FeldD. Jeanne FrantzRichard and Barbara Gilb'Thd HofmeisterAnn KlimczakWalter L. LarsenDennis ManarchyEdward F. McLaughlinJohn R. Patrick.Bert PearlBradley RossRichardS. Schweiker

Joel SmithLawrence S. WickJohn A. WunderlichCarter Wurts

TRIBUTESIn Honor OfJoseph G. Alam

Jim and Rosa lie Traver

Charles Goldste inMarvin A. and Frances

Welsch

Stephen M. Nagler, M.DGreg Armstrong

Jack A. Vernon, Ph.D.Mary Jane Lillis

24 Tinnitus Thday/December 2000 American T innitu s Association



QUESTIONS AND ANSWERS (coninued)

sounds well below the pitch of your tinnitus an d

thus had little chance of masking or relievingyour tinnitus. There is, however, a special devicecalled the tinnitus instrument - a combination

of a high-frequency hearing aid and a tinnitus

masker. You adjust the high-frequency hearingaid first in order to get your high frequencyhearing up to the best level possible an d thenadd in the masking sound which contains highfrequency sounds. This should mask and thus

relieve your tinnitus. Since sleeping is also aproblem, I would recommend that you wear twoin-the-ear tinnitus instruments and try sleepingwith them. The Sound Pillow by PhoenixProductions (877-846-6488) might also help

you solve your sleep problems.

QMr. W. from Texas wrote to say that he had

an unusual tinnitus, which he did not

understand. He described it as a "cricket"tinnitus. He also explains that he has a high frequency hearing loss and he knows many other

people who also have hearing losses but do not

have tinnitus. What, he asks, is wrong with him?

Airst of all, Mr. W., your cricket type tinni

tus is probably a combination of two tones.We have found that cricket tinnitus is most

SPECIAL DONORS AND TRIBUTES(continued)

In Memory OfFlorence Benaszek

Shirley Majcrcak

Elizabeth (Becky) CapriottiEleanor B. Gordon

Sylvia GordonShelly Forman

Eli7.abetb (Betsy) HagemannHans and Sally SOlmssen

Anna ;'.lcDonough

James A. and Lyn S. 'TrembleIrving lllirmanJudith Snyderman

Jack MoodyRichard and June BlackburnKimberly and Jay BlainJohn and Beverly BambinoSylvia BrownCarolyn C. CarppIrene T. FranettLucy B. Ha nGavl L. HenzeJacobson, Lawrence, & Assoc.,PLLC

Thm and Nancy JensenConstance A. and Michael E.

l\lcLeanLarry Murante

Karen OmahenMarlene ParryJim and Larry ThggleJohn and Cleo WebbDoris Wolfstone

Father of Jo e and DeniseMaggio

Stuart and Marcy Fe ldman

Ccilia WilsonMarcy Feldman

Sister of Mr. and M IS . Leonard

ZaretskySylvia Eisenberg

Corporations With MatchingGifts

American ExpressARCO FoundationBP Amoco CorporationCelanese Americas FoundationChase Manhattan FoundationFannie Mae FoundationJohn HancockJohnson & JohnsonPhillip MorrisUnion Pacific ResourcesUS Borax, lnc.US West Foundation

likely a combination of 4000 Hz and 4060 Hz.That combination of tones almost always matches what other tinnitus patients describe as crickets. We also find that cricket tinnitus is a bit on

the unusual side. In one survey of over 2000

patients, cricket tinnitus appeared less than 10%of the time. However, we should also point out

that cricket tinnitus is usua1ly easily relieved by

masking. There is nothing especially wrong withyou, and your hearing loss may or may no t be

related to your tinnitus. There are many folkswho, with age, acquire hearing loss without

tinnitus. Mr. W., ifyou have not tried masking torelieve your tinnitus, may I suggest that you doso. Because the pitch of your tinnitus is in the

upper region of our environmental sounds, hearing aids alone might provide the masking you

need for tinnitus and, at the same time, improveyour ability to hear. I t is clearly worth a try.

Notice: Many ofyou have left messages requestingthat I phone you. I s imply cannot afford to meetthose requests. Please feel free to call me on anyWednesday, 9:00a.m.- noon and 1:00-5:00 p.m.Pacific Time (503-494-2187). Or mail your questionsto: Dr. Vernon c/o Tinnitus Today, AmericanTinnitus Association, P.O. Box 5, Portland, OR97207-0005.

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tinnitus today december 2000 vol 25, no 4

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