tinnitus today june 2000 vol 25, no 2

7/23/2019 Tinnitus Today June 2000 Vol 25, No 2

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June 2000 Volume 25, Number 2Tinnitus TodayTHE JOURNAL OF THE AMERICAN TINNITUS 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:Advances in Tinnitus ResearchHormones and Tinnitus -

An Informal Study OpportunityTinnitus Treatment in IsraelTinnitus 7bday Readership Survey

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Tinnitus T o d ~ y Editorial and Advertising offices: American Tinnitus Association, P.O. Box 5, Portland, OR 97207 503/248-9985, 800/6348978 [email protected], www.ato.orgEditorial and Advertising offices: AmericanTinnitus Association, P.O. Box 5, Portland, OR97207, 503/248-9985, 800/ 634-8978,[email protected], www.ata.orgExecutive Director: Cheryl McG innis, M.B.A.Editor: Barbara Thbachnick Sanders1irmttus 'Tbday is published quarterly in March,June, Septemberand December. It is mailed toAmerican Tinnitus Association donors and aselected list of tinnitus sufferers and professionals who treat tinnitus . Circulation is rotated to 80,000 annually.American Tinnitus Association is a non-profithuman health and welfare agency u11der 26USC 501 (c)(3).Copyright 2000 by American TinnitusAssociation. No part of this publication may bereproduced, stored in a retrieval system, ortransmitted in any form, or by any means,without the prior written permission of thePublisher ISSN: 0897-6368Execu(jve DirectorCheryl McGinnis, MBA , Portland, ORBoard of DirectorsPaul Meade, Tigard, OR, ChairmanJoel Alexander, Park Ridge, NJDhyan Cassie, M.A., CCC-A, Medford, NJJames 0. Chinnis, Jr., Ph.D., Manassas, VAW. F. S. Hopmeier; St. Louis, MOGary P. Jacobson, Ph.D., Detroit, MlSidney Kleinman, Chicago, ILStephen Naglei; M.D . Atlanta, GAKathy Peck, San Francisco, CADan Purjes, New York, NYSusan Seidel, M.A ., CCG-A , Towson, MDTim Sotos, Lenexa, KSRichard S. 'JYler. Ph .D., Iowa City, lAJack. A. Vernon, Ph.D. , Portland, ORMegan Vid is, Chicago, !LHonorary DirectorsThe Honorable Mark 0 . Hatfield, U.S . Senate,RetiredThny Randall , New York, NYWilliam Shatner, Los Angeles, CAScientific AdvisorsRonald G. Amedee, M.D., New Orleans, LARobert E. Brummett, Ph.D., Portland, ORJack D. Clemis, M.D . Chicago, ILRobert A. Dobie, M.D., San Antonio, TXJohn R. Emmett, M.D., Memphis, TNBarbara Goldstein, Ph.D., New York, NYJohn W. House, M.D., Los Angeles, CAGary P. Jacobson, Ph.D., Detroit, MIPawel J. Jastreboff, Ph .D., Atlanta, GAWilliam H. Martin, Ph.D. , Portland, ORDouglas E. Mattox, M.D., Atlanta , GAMary B. Me ikle, Ph.O., Portland, ORStephen M. Nagler; M.D., Atlanta, GAJ . Gail Neely, M.D., St. Louis, MOGloria E. Reich, Ph.D. , Portland, OR

The Journal of the American Tinnitus AssociationVolume 25 Number 2, June 2000Tinnitus, ringing in the ears or head noises, is experienced by as manyas 50 million Americans. Medical help is often sought by those whohave it in a severe, stressful, or life-disrupting form.Table of Contents48

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From the Chairman of the Boardby Paul MeadeAdvances in Tinnitus Research - A Report on theAssociation fo r Research in Otolaryngologyby James 0 Chinnis, Jr. , Ph.D.Combined Federal Campaign - I t means so much!by Pa t Daggett

11 Hormones and Tinnitusby Marsha Johnson, M.S. , CCC-A, TRTA, FAAA13 Announcements14 Climb Every Mountainby Jessica Allen16 Research Update - 'Ibwards the Cure18 Building a Better Dishwasherby Rachel D. Wray20 Tinnitus Treatment in Israel - The Hope and th e Realityby Stephen M. Nagler, M.D.22 Self Help Groups - We are on your side

by Dhyan Cassie, M.A., CCC-ARegular Features45

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From the Executive Directorby Cheryl McGinnis, M.B.A.From the EditorBeing Awareby Barbara Thbachnick Sanders

Robert E. Sandlin, Ph.D., El Cajon, CA 23Alexander J. Schleuning, II, M.D., Portland, ORMichael D. Seidman, M.D.,

Letters to the EditorQuestions and Answers

West Bloomfield, MIAbraham Shulman, M. D., Brooklyn, NYMansfield Smith, M. D. , San Jose, CARobert Sweetow, Ph.D., San Francisco, CARichardS. 'JYler. Ph .D. , Iowa City, lA

Cover: *Hydrangeas, oil on masonite,16 x 20", by Gail We lls-Hess.Inquiries to Ga il We lls-Hess at800-776-4245 or wells56@ibm .net.

by Jack A. Vernon, Ph.D.25 Special Donors and 'Ii'ibutes

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, 11or does Tinnitus Tbday make any claims or guarantees as to theaccuracy or validity of the advertiser's offer. The opinions expressed by contributors toTinnitus Tbday are not necessarily those of the Publisher, editors, staff, or advertisers.American Tinnitus Association Tinnitus Today/June 2000 3


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FroiTI the ChairiTian of the Boardby PulMeadeI am very pleased to introduce our new ExecutiveDirector, Cheryl McGinnis.Her background includesprimary health care planningin partnership with the U.S .Department of Health andHuman Services, establishingcontinuing education forclinicians, managing a crisis intervention programin collaboration with the Federal EmergencyManagement Agency, and managing conferences

and publications for university sports directors.She has a Masters degree in Business Administration and a Bachelors degree in Audiology aSpeech Pathology. You may already be familiarwith Cheryl as ATA's Director of Research andSupport and from her past research update andsupport program articles in Tinnitus Tbday.Cheryl's professional background, plus herinterest in tinnitus, made the Board's selectionan easy one. As Executive Director, Cheryl willcontinue the program improvements and changinitiated by our previous director, Dr. SteveLaubacher. We all wish Steve success in his newendeavors. B

FROM THE EXECUTIVE DIRECTORby CherylMcGinnis, M.B.A.I am honored to serve theAmerican TinnitusAssociation as ExecutiveDirector and am excited aboutleading a team of dedicatedstaff members, each of whomis committed to improvingservices for people wi thtinnitus. We have manyopportunities to make adifference.

The ATA Board of Directors and staff continueto take on opportunities to increase awareness oftinnitus. Over the last six months, ATA sponsoredthree regional events to increase awareness of tinnitus including current research, beneficial treatments, and available support programs. A publicforum was held in New Orleans during the fallwith four panel members presenting treatmentstrategies and current research. In March, asimilar public forum was held in Chicago andincluded a presentation about self-help groupsin addition to research and treatment strategypresentations. Both of these events gave ampleopportunity for participants to ask questions ofthe panel experts. Most recently, on April 1st, theMid-Atlantic Regional Tinnitus Conference washeld in Voorhees, New Jersey. Nearly 300 patientsand healthcare professionals attended this exceptional conference. I was delighted to have been aguest speaker there.

4 Tinnitus 'Ibday!June 2000 American Tinnitus Association

We see opportunities to make a difference bfunding research into th e mechanics and treatments of t innitus - with hopes of identifying acure. Within this issue, you will read about ATAfunded research that was recently completed.(See ''Research Update" on page ~ 6 . ) : c r ~ has atwenty-plus year history of fundmg tmrutusresearch projects. ATA's goal for research fundinduring 2000-2001 is $500,000. With your help wwill meet and possibly surpass this goal.

Another article within this issue features aself-help group leader and mountain climberfrom Colorado who contacted the ATA to increaawareness of tinnitus as she takes on the challenge of climbing 14,410-foot Mt. Rainier inWashington State. We will experience the adventure of a glacier summit ascent vicariouslythrough her. While raising awareness of tinnitusshe also hopes to help ATA raise financial suppfor research. (See "Climb Every Mountain" onpage 14.)

.ATA staff and Board of Directors are makingplans to recognize a leader who forged a directifor this association over 20 years ago whilemaking a difference in the lives of people experencing tinnitus. Gloria Reich, Ph.D., was ATA'sfirst Executive Director. She initiated the researgrant program as well as other programs that stprovide education, advocacy, and support for alpeople with tinnitus. In November, we are hosting the first "Founders Dinner" to pay tribute toDr. Re ich and to the many contributions she hamade to the American Tinnitus Association. Yoare invited to join us as we honor Dr. Reich (see"Save this Date" on page 7) and look to the futuwith hope for finding a cure. Ill


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From th e Ed i t o rBeing Aware

by Barbara Tabachnick SandersI t was the last thing I wantedto happen.I was putting the finishingtouches on our booth at a localhealth fair - my first for ATA.I se t out the brochures andTinnitus 'Tbdays in an enticingarrangement to attract passersby in the conference displayarea. I straightened the linen, adjusted theAmerican Tinnitus Association sign behind me,

then snapped on the light that shone on th e sign.Just then, a man in the booth directly across fromme walked over to introduce himself. I was terribly excited. We had so much to offer. His firstwords to me were not what I expected, no t "Hello,I'm with the ... " They were instead, "I was doingjust fine until I saw your sign. My ears started toring like crazy the instant I saw the word 'tinnitus."' My heart sank. My first contact with the outside world was a flop.

By other measures, the health fair was asuccess. I spoke with 100 people that day whowere grateful, and some really hungry for tinnitusinformation. A hundred more picked up ourmaterials and read them as they wandered on.The man in the booth across from me workedthe whole day for the organization he represented. Through the day we nodded to each other.Occasionally through the day he'd catch my eye,point to the sign behind me, and shake his headwith an unhappy smile. I went home that night

and thought not about the two hundred who I hadhelped that day but about the one who I had not.It's been seven years, and in some way, everyday, l still think about him.Tinnitus is an enigma. On one hand, we workso hard to help you focus your attention awayfrom the noises you hear. We want you to take uppleasant distracting hobbies, exercise, meditate,laugh, and relax. We want you to blend the internal sound you hear with external backgroundsounds so that the tinnitus moves to the back ofyour mind. We want you to habituate it. I t is notimportant.

On the other hand, tinnitus is incrediblyimportant. It is so important that we need to warnpeople who listen to excruciatingly loud music orwho work with their ears unprotected in factoriesor sports arenas or on farms. We want them totake urgent notice ofwhat they're doing and helpthem understand the consequences. We want totell them that tinnitus happens.

When people who do not have tinnitus learnthe truth about the physical, emotional, andfinancial toll that it takes, they get the opportunity to care deeply about it. And if our legislatorsare some of those people who learn the truth,tinnitus stands th e greatest chance ofbeing thrustinto the public eye, seen as the crucial publichealth problem that it is, and funded accordingly.Awareness is the key.

Over the next few months, we will be runningradio and TV spots and newspaper stories nationally. If you see a story in the newspaper or hear aspot on the radio about tinnitus, and yourrenewed awareness of your tinnitus causes it tospike, please know this:+ Your tinnitus will go back to its previouslevel shortly.+ Every person who contacts us because ofa media story moves us one step closer toa cure.+ We are baffled about how to balance our

need to be vocal about tinnitus with your needto not be reminded of t.+ We never want anyone's tinnitus to get worse

because of something that we do.+ We never want anyone to get tinnitus because

of something that we didn 't do.I wish I had told my friend at the health fairto look the other way and to support .KIA so thatwe could find answers for him. Oh, he did lookthe other way from time to time. Sometimes

his head was down. He was reading the Tinnitus'Tbday I gave him. Maybe he is reading this now.Maybe we don't know how influential we are. B

American Tinni tus Association Tinnitus 'lbday!June 2000 5


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Letters to the EditorFrom time to time, we include lettersfrom our members about their experiences with "non-traditional" treatments.We do so in the hope that the information offered might be helpful. Please readthese anecdotal reports carefully, consultwith your physician or medical advisor,and decide for yourself if a given treatment might be right for you. As always,the opinions expressed are strictly thoseof the letter writers and do not reflect anopinion or endorsement by ATA.Ear Care ClearsTinnitus

After having tinnitus for six months, I finallywent to an ear, nose, and throat physician. Sheexamined my ears and found infections and fluidin both of my ears. r took antibiotics and had myears drained, and immediately afterwards mytinnitus was gone! r feel sure that other tinnitussufferers can have similar positive results.

ATA member, Boca Raton, FLGinkgo AgainI had a terrible case of tinnitus for at leastfive years. Thro years ago, I started taking Ginkgobiloba to help my memory. After taking theginkgo for about a year, the tinnitus suddenlydropped. I'd say that it gave me 95% relief fromthe tinnitus. I sti11 take on e 40 mg ginkgo tabletthree times a day with meals. I hope this messagewill help some people with severe tinnitus.

Stanley Jaffee, Norwood, NJ 07648[Editor's Note: Ginkgo biloba has not been clinicallyproven to reduce tinnitus. However, we continue tohear anecdotal reports like this one suggesting aconnection between ginkgo and tinnitus relief It'sbeen thought that i f tinnitus is not relieved after athree-month trial ofginkgo, it will likely not berelieved by ginkgo. This anecdotal comment suggeststhat tinnitus patients might benefit from a longertrial of the herb.]

6 Tinnitus 7bday/ June 2000 American Tinnitus Association

Stress Reduction ReducesTinn itusIn April1997, a shrill ringing in my headstarted, probably as a result of having taken higdoses of antibiotics and working 40 years in a

fiber board plant with a lo t of loud noise. I sawdoctors, audiologists, and ear specialists, andeventually went to the Mayo Clinic because Icouldn't sleep or eat an d because I was severelydepressed. In April1999, I had a heart attackthat damaged 50% of my heart. I have sincegone through cardiac rehabilitation.

Since that time, I have found that walking,mild exercise, an d losing some weight (35 pounhas helped my tinnitus. Also, I have not returneto work (I filed for Social Security disability),which seems to be keeping my stress and noiselevels down. Now, for the first time in two-and-ahalf years, I can sleep without having to mask ttinnitus with the sound of water.

I feel that walking an d exercising as much apossible can help a lo t of people overcome thisterrible disorder. 1 wouldn't object if you want tprint my letter. If it helps just on e person,I would be very happy.Marvin Ladsten, 304 8th St., International FaMN 56649, 218-283- 8124.

TMJ DysfunctionI commend ATA for publishing the article bDr. Ira K.lemons about tinnitus and TMJ dysfuntion in the June 1999 issue of Tinnitus Tbday.Dentists who treat tempormandibular disor

ders or TMD (the appropriate term, althoughTMJ is commonly used), observe that a large pecentage of their patients initially report tinnitusas a symptom. A significant percentage of peopwho receive treatment for TMD report tinnitusimprovement. Although the mechanism of linkabetween tinnitus and TMD is not established anthe published statistics are not consistent betwedoctors th e co-existence of TMD and tinnitus hbeen universally reported.

In a research paper that I presented at aTMD conference in May 1996, I noted that 38%of 3,681 TMD patients reported experiencingtinnitus. I treated 1,182 of these patients, 41% owhom had tinnitus. Of those patients, 28% repoed significant improvement in their tinnitus witin one month. Thirty-four percent who continutreatment reported in1provement or resolutiontinnitus at three months.


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Letters to the Editor rconrinuedJPeople who suffer from tinnitus are encouraged to first undergo a thorough medical ENTevaluation then to seek evaluation by a dentisttrained to treat TMD. IfTMD exists, it should betreated appropriately and hopefully will be

accompanied by an improvement in tinnitus.Barry C. Cooper, D.D.S., President,International College ofCranioMandibularOrthopedics, New York, NY, www.tmjtmd.comAnother look at Niacin

I developed tinnitus ten years ago at the ageof 74. After having the tinnitus for three months,I went to an otolaryngologist who prescribedniacin for the condition. I took it and in 48 hoursI had complete tinnitus relief. I continued takingthe niacin for three more years then finallystopped. Th e tinnitus has not reoccurred. Mydoctor has long since retired and the drug storehas changed hands, so I'm sorry that I cannot tellyou the amount of the dosage. I can tell you thatseveral relatives and friends who also had beenbothered by tinnitus found relief with niacin.

Pearl S. Serbus, 852 Stradford Circle,Buffalo Grove, IL 60089Chemicals - An Impact on Tinnitus?

I agree with everything stated in your March2000 ''From the Editor" article, "Putting i tTbgether." I also feel strongly that the ATA isremiss for no t including chemical toxicity as apossible cause of tinnitus. I am convinced thatchemicals do more auditory damage than currently anyone will admit to.

CorrectionIn ~ t e r n a t i v e Management of Tinnitus,

Part II," by Mich ael Seidman, M.D., in theMarch 2000 issue of Tinnitus Tbday, we misstated the results of the Birmingham, UKginkgo study. The results show that ginkgowas no better than the placebo in effectingtinnitus relief. (VVe had said that the resultswere inconclusive.) Th e researchers also notethat out of their large number of patients inthe study (about 540) there were practicallyno adverse responses to the herb. Therefore,they feel that i f someone is in reasonably goodhealth and not taking anti-thrombotic medication, it is safe to take ginkgo.

A quick Internet search for "ototoxicity" willsurprise you . Glance at the available informationfrom the Disease Registry's Public HealthStatement for xylene or the EnvironmentalProtection Agency's Chemical Fact Sheet's "symptoms" section for benzene. (You'll find tinnituslisted in both.) Then search around your house ,under the kitchen sink, an d in the garage, and listthe chemicals with which you come into dailycontact.

Does this mean that tinnitus prevention i.s assimple as avoiding chemicals? No. Th e noiseenvironment that we find ourselves in daily isstill a major factor. Apparently, we increase thepossibility of worsening our hearing impairmentsevery time we expose ourselves to these environmental toxins. Tbday, hea1ing loss and tinnitusare taken into consideration before medicationsare prescribed. But not too many years ago themedical profession scoffed at the idea that medicines could cause hearing impairments. In thearea of chemical toxicity, the medical professionmight st ill be 10 years behind the times.

Perhaps in 29 more years, we will lookback and be amazed to see that environmentalchemicals were as much a cause of the tinnitusepidemic as was noise exposure, and we'llwonder why we didn't see it then.

John Victor Shepherd, Sr. , 230 West Delano St.,Elverta, CA 95626-9215, 916-991-9309,jvs@inreach. com

SAVE THIS DATE!Friday, November 10,2000Join us for our first Founder's Dinner. Thisyear we are marking the occasion by honoringGloria Reich, who served ATA as ExecutiveDirector for twenty years. The black-tie dinner

and dance will be held at the Governor Hotel inPortland, Oregon. Members of the tinnitus community along with noted personalities from theclinical and research fields will be there. Pleasecall Jessica Allen (800-634-8978 ext. 218) if youare interested in attending the gala. B

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ADVANCES IN TINNITUS RESEARCHA Report on the Association fby James 0. Chinnis, Jr., Ph.D.,

Each year the Association for Research inOtolaryngology hosts a major meeting for thesharing and discussion of on-going research. Thisyear, over a thousand studies were presented.Most of these dealt with the ear or with central(brain) activity related to the ear. Tinnitusresearch was a small part of all this activity, ye tmany of the basic research studies help shedlight on tinnitus, and there was an important setof studies that dealt specifically with tinnitus.Electrical Stimulation

The brain and part of the inner ear operateby means of electrochemical interactions. Whileit is possible to use sound to affect tinnitus, such

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8 Tinnitus Tbday!June 2000 American Tinnitus Association

as with masking or tinnitus retraining therapy,direct electrical stimulation of neural s tructuresalso possible. Electrical stimulation of the auditonerve can bypass a damaged cochlea and thus pvide types of stimulation that sound cannot. Alsit can be employed at a number of places withithe brain itself in an attempt to prevent the tranmission of tinnitus signals or to force key structures to produce neural firing patterns that areinterpreted as silence.

Jay Rubinstein, M.D., Ph .D., of the Universiof Iowa Hospitals and Clinics talked about somepreliminary work that attempts to restore the peception of silence by using electrical stimulatioof the cochlea. Using a small electrode placedthrough the eardrum near the round window ofthe cochlea, a rapid stream of electrical pulses wdelivered. Many theories about tinnitus assumethat tinnitus results from a lack of random sponneous firing of auditory nerve fibers. Instead, thfibers tend to fire together as a result of sensorycell damage, or not at all. The random firing mabe what the brain looks for as a sign of silence.The rapid electrical pulse should, in principle,restore the fiber firing patterns to a more randodisorganized state, which could be perceived assilence. In early testing, there is evidence thatsome patients achieve a disappearance of tinnitduring the stimulation, with the stimulating pultrain itselfbeing heard or "felt" by some bu t notby others. Further tests are being conducted.

William Hal Martin, Ph.D., of the OregonHealth Sciences University, also reported onpreliminary work with electrical stimulation, buthis time aimed at the thalamus, a structure deewithin the brain. Much evidence suggests thatthe perception of chronic tinnitus is due to theactive involvement ofboth auditory and otherstructures within the brain. While experimentalstimulation of these sites has not been attemptefor tinnitus, deep brain stimulation has been triin the case of tremor and chronic pain with somsuccess. Dr. Martin tested the idea that stimulatparts of the thalamus might disrupt abnormalactivity there and provide tinnitus relief. 1b dothis, he located patients with Parkinson's diseasand other movement disorders who had beenimplanted with deep brain stimulators, and whoalso happened to have tinnitus. Early tests showthat some patients experience quieter tinnituswhen the stimulators are turned on.


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esearch ln OtolaryngologyLocation, location, location

The site in the ea r or brain where chronictinnitus arises remains uncertain. Several papersaddressed this problem. Prof. Dr. Gerald Langner,of the Thchnical University of Darmstadt, inGermany, talked about a biochemical methodthat was used to study the effects ofboth impulsenoise and salicylate (such as aspirin) on the auditory system. The primary finding of this study wasthat, although there was substantial activation ofthe auditory cortex (implying tinnitus perception),there was little or no activation oflower auditoryareas in the brainstem. Langner believes that thisis evidence that noise-induced and salicylateinduced tinnitus are due to changes in higherbrain regions and not directly to effects within theinner ear or brainstem. The researchers proposethat positive feedback between cortex and thalamus plays a crucial role. The strength of this feedback linkage is supposed to be under the controlof the limbic system. The normal function of thisfeedback is to enhance signals that representdangers , bu t tinnitus peaks resulting from neuralinteractions near the edges of damage and otherirregularities of the hearing system are also amplified. In turn, the tinnitus activity in the cortexmay activate the limbic system resulting in furthercortical stimulation in a vicious feedback cycle.Effects of muscle contraction

Most of us know that jaw tension and pressureagainst the head or neck can sometimes changethe loudness or character of tinnitus. But littleresearch has been done to determine how widespread this is or how it takes place.Robert Levine, M.D., of the Massachusetts Eye

and Ear Infirmary, in Boston, described hisresearch on how muscle contractions can influence tinnitus. In more accurate, technical language, he looked at the somatic modulation oftinnitus. Dr. Levine examined 128 consecutive tinnitus clinic patients and tested each for responseto 16 different briefbut forceful isometric musclecontractions. Sites tested included those aroundthe head, neck, and extremities. This testingrevealed that 76% of patients experienced achange in their tinnitus during at least one of themuscle contractions. Tinnitus was more likely todecrease in loudness with somatic modulation for

patients with tinnitus heard in only one ear, ascompared with patients who heard their tinnitusin both ears.

According to Dr. Levine, these results canbe understood in terms of known interactionsbetween the auditory and somatosensory (touch,pressure, and other bodily senses) systems withinthe brain. In particular, Dr. Levine believes thatone principal interaction site is within the dorsalcochlear nucleus of the brainstem.How much noise?Neuroscientists have known for a while thatthe inner ear utilizes ce11s that are always firingat random, bu t which tend to resonate (fire intime with an appropriate stimulus). This is aproperty that improves sensitivity to fa int sounds.I t also implies that in troduction of a little noisecan make sounds seem louder. Pawel Jastreboff,Ph .D., Sc.D., of Emory University in Atlanta, islooking at the idea that adding a tiny bit of external noise may enhance the tinnitus signal i f it ispresent in the auditory nerve. Thus the use ofnoise generators set very near the threshold ofhearing may make tinnitus louder and interferewith habituation .

Dr. Jastreboff cites data on the effectivenessof directive counseling alone, counseling combined with noise generators se t at the thresholdof hearing, and counseling combined with noisegenerators set at the mixing point, where partialtinnitus masking begins. The most effective treatment was counseling combined with noise atabout the mixing point, and the least effectivewas counseling combined with noise se t near thehearing threshold.All the rest

The few papers mentioned above are a sample of those aimed directly at tinnitus. But curesare discovered both by studies aimed at specifichealth conditions and by the general advance ofrelated knowledge and technology.

Quite a few studies concerned the faintacoustic (sound) signals that are produced withinboth normal and damaged inner ears. The understanding of these sounds produced within the earmay lead to insights into inner ear function andpossible linkages with tinnitus.

(continued)Am e rican Tinnitus Association Tinnitus 7bday/ Ju ne 2000 9


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ADVANCES IN RESEARCH (continued)An equally large number of studies dealt withplasticity - the basic ability of the brain to reorganize itself in complex ways following, among

other things, sensory damage or changes in stimulation. Many studies confirmed and quantifiedthe types of changes that occur in the brain fol-lowing changes in hearing. A number of theseshowed that the auditory pathways in the brainundergo substantial changes following both auditory training of various kinds, and electrical stimulation ofboth the cochlea and brain structures,and helped to clarify the factors involved. Thisreorganizing ability of the brain, already appliedin Tinnitus Retraining Therapy, may allow us todevise ways to e1iminate tinnitus altogether.

Many of the studies focused on chemical anddrug mechanisms in the inner ear and auditorypathways. Some examined the detailed effects of

various chemicals on specific inner ear cells.Some explored immune system connections wiMeniere's disease and other inner ear disordersthat cause tinnitus. Some addressed novel drugdelivery systems, such as a tiny catheter and animplantable device.Momentum

The problem of intrusive tinnitus is a complex one. But the individual research projectseach add new insights and help to illuminate thwhole puzzle. And the pace of research relatedtinnitus is growing rapidly as researchers haveat last- become intrigued by tinnitus and newtools are enabling them to make real progress. C

Dr. Chinnis is a member of the AmericanTinnitus Association Board ofDirectors. He can becontacted at jchinnis@alum. mit. edu.

Combined Federal CampaignIt Means So Much!by Pat Daggeff, ATA Director ofResearch and Program Associate

ATA is a member of the Community HealthCharities, a federation ofhea1th agencies thatcoordinates employee payroll contributions andcampaigns for non-profit agencies like ATA.I attended a recent meeting and learned

about some changes that directly affect donationsto .ATA. The Combined Federal Campaign (CFC),one campaign that takes place through theCommunity Health Charities, hopes to initiatetwo major changes in its payroll deduction drivefor federal employees this fall: 1) online donationcapability, and 2) participation by federalretirees.We want to take this opportunity to thank al1of you who contribute through the CFC for yourcontinuing support to insure that vital health ser-

10 nnnztus Thday/ June 2000 American Tinnitus Association

vices are available to all who experience tinnituWe hope that you are keeping up-to-date with oresearch projects, hearing conserva tion efforts,management strategies, and member activitiesthrough Tinnitus Tbday. Remember to send us acopy of your designation form so that you willnot miss any membership benefits. (Our nationCFC agency number is #0514)

Also, if your worksite has an appropriate spto post information about the .ATA and its services, let us know and we'U be pleased to providsomething suitable. This need not be restricted campaign dates but could serve as a reminderduring the rest of the year. a,\,7/'CommunityHealthCharitiesWORKING FOR A HEALTHY AMERICA


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Hormones and TINNITUSExploring the links between female hormone shifts and tinnitus-A n informal study opportunityby Marsha Johnson, M.S., CCC-A, TRTA, FAAAT he possible identification of a linkbetween female hormone cycles, or thecessation of these cycles, and fluctuationsin tinnitus loudness perception deserves somethoughtful consideration. As a tinnitus andhyperacusis clinician, I have had the opportunityto personally interview hundreds of individualssince 1997. In response to these conversations,and the number of anecdotal comments by manyindividuals who have reported changes in tinnitus during pregnancy, menstrual cycles, afterhysterectomy, and while taking hormone replacement therapy, 1 have compiled the followinginformal questionnaire.

The intent of this article is twofold: to educate the readers of Tinnitus Thday about what isknown at this time about this subject, and topromote the accumulation ofrecorded data in apilot study. This, in turn, may produce necessaryevidence to pursue a more formal study.There seem to be several main questionsregarding this topic:

1) Do female hormone cyclic shifts affect theea r in any way (including hearing acquityand tinnitus)?2) Does peri-menopause (or fluctuatinghormone shifts) affect tinnitus in any wayincluding changes in loudness perception?3) Does menopause (o r the cessation of thesehormone shifts) affect tinnitus in any wayincluding changes in loudness perception?

When perusing the literature of publishedscientific studies, we find some tantalizingfindings. The question that has been partiallyexplored relates more to how female hormonesaffect hearing in young healthy subjects.

I t has been verified that the mammaliaminner ear has receptors that are dedicated toestrogen hormones, and therefore it was suspected that estrogen may have a direct effect onthe functioning of the cochlea and on our hearing(Stenberg et al., 1999). This is true for males aswell as females.Researchers (Chen et al., 1996) found thatchanges in the auditory systems relate to hormone cycles in both men and women. They alsonoted that these hormone changes were tied tochanges in blood pressure. But the change inmen's blood pressure was different from thechange in women's blood pressure. Women ha d

greater variances. Notably, women's hearingsensitivity changed during menstrual cycles(Swanson et al., 1988). Women also had changesin acoustic reflex during hormone shifts (Laws etal., 1986). Acoustic reflexes are the contractionsof small muscles in the middle ea r space as wellas the function of the nerves that connect the ea rto the brainstem. These studies included womenof all ages.

Some researchers suspect that shifts in theimmune system are present during menstrualcycles. I further suspect that these shifts directlyinfluence the health of the cochlear structures.

U nfortunately, to date, there are no published studies that demonstrate a linkto tinnitus and female hormone cycles.Anecdotal evidence, however, collected in clinicsaround the globe, support a connection anddemand further investigation.Women have reported to me that menopausesignificantly affects the loudness levels of theirtinnitus . Searching through the published studies,we find that animal research demonstratessignificant changes in nervous system auditoryresponses when ovaries were removed (Cooperet al., 1999). There is also evidence that hearingchanges take place that prolong neural processingof auditory signals in older female subjects.These conclusions link estrogen levels measuredin the blood to auditory function in women.Another animal study showed that removingthe ovaries produced changes in cardiovascularfunction that produced changes in the blood flowto the cochlea and therefore could potentiallycause changes in the function of the ea r (Laugeiet al., 1987). Several research studies demonstrated differences in blood pressure between menand women until women entered menopause,when the differences shrank to non-significant.It is widely known that women receive added

protection from cardiovascular diseases throughthe age of menopause, after which their chancesof acquiring these diseases begin to equalize tothat of men.The cause of tinnitus is unknown. And theundetermined connection between conditions -like hormone shifts - to the symptom of tinnitusmakes a conclusion impossible at this point intime. I t is my belief, however, that this questionbears examination: Do hormones have an effecton tinnitus?

(continued)American Tinnitus Association Tinnitus Thday/ June 2000 11


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Hormones and TINNITUS (continued}Perhaps one day, through careful accumulation of data, we will have answers. Hence, I inviteyou to participate in an informal study.If you wish to participate, please read overthe instructions carefully and complete all of the

information. You must agree to keep daily recordsfor a period of at least 90 days. All women withtinnitus are invited to participate. Your data willbe kept confidential and may be used to pursuea formal study. Thank you very much for yourparticipation! IaReference s:Chen YF: Sexual dimorphism of hypertension, Curr OpinNephrol Hypertens, 1996 Mar; 5(2):181-5Stenberg AE, WanG 11, Sahlin L. IIulterantz M: Mapping ofestrogen receptions alpha and beta in the inner ear ofmouse and rat, Hear Res 1999 Oct; 36(1-2):29-34

Swansson SJ, Dengerink, HA: Changes in pure tonethresholds and temporary thereshold shifts as a functionmenstrual cycle and oral contraceptives, 1Speech Hear R1988 Dec; 31(4):569-74Laws DW, Moon CE: Effects of menstrual cycle on thehuman acoustic reflex threshold, 1Aud Res, 1986 Jul;26(3):197-206Angstwurm MW, Gartner R, Siegler-Heitbrock HW: Cycliplasma IL-6 levels during normal menstrual cycle, Cytok1997 May; 9(5)370-4CooperWA, Ross KC, Coleman JR: Estrogen treatment anage effects on auditory brainstem responses in the postbreeding Long-Evans rat, Audiology, 1999 Jan-Feb;38(1 ):7-12Langei GR, Degerink HA, Wright JW: Ovarian steroid anvasoconstrictor effects on cochlear blood flow, Hear Res,1987 Dec 31; 31(3):245-51

90-Day Study Protocol for Hormone Shifts and Tinnitus Loudness PerceptionAge:____ Sex: FEMALETinnitus is in: Check One or More0 left ear 0 r ight ear 0 both 0 in my headWhen did your tinnitus begin? _______What is the suspected cause of yourtinnitus?________________Date you begin recording data:______ _Date you end recording data (must be at least90 days later than beginning date) :_____Do you take hormone replacement medications?Please list all including homeopathic or naturalremedies. _ ______________ __Have you had a hysterectomy? U Yes U NoOvary removal? 0 Yes 0 NoDo you have any endocrine system (i.e., thyroid)conditions? 0 Yes 0 NoYou are:0 pre-menopause0 peri-menopause (entering menopause as evi

denced by irregular per iods, hot flashes, bloodtests, etc.)0 post-menopause (no period in past 4 monthsor 120 days).

12 Tinnitus Today/June 2000 American Tinnitus Association

Study data: (Use a separate sheet ofpaper for this cha+ Evaluate your tinnitus once in the morningand once in the evening for 90 consecutive dayTry to record the data at exactly the same timeevery day. Be sure to listen to the tinnitus in aquiet place for a few seconds until you feelconfident about rating its loudness.+ Rate the loudness perception of the tinnituson a 0-10 scale, where "0" would be completelysilent and "10" would be as loud as a jet engine .Note on the chart the dates of the onset of yourmenstrual cycle if present.

For menopausal women, note any changesmedications or other symptoms as needed.Example Study Form:

A.M. PM .Tinnitus Tinnih1sDate Scale Scale Comments5/31/00 2 36/ l /00 3 7 Cycle began today612/00 5 8613100 4 66/4/00 5 4and so on for 90 days.Re tur n the completed questionnaire and 90-day chartMarsha Johnson, M.S., DirectorOregon Tinni tus & Hyperacusis Treatment Clin545 NE 47th, Suite 212Portland, OR 97213If you have questions, call me at 503-203-5858.


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AnnouncementsNew Choir of the Scientific Advisory Committee

Richard S. 'IJjler, Ph.D., Professor o f Otolaryngology an d Director of Audiology in the Dept. ofOtolaryngology-Head and Necl


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ClimbEveby Jessica Allen, Director of Resource DevelopmentSometimes strugglingwith tinnitus can be likeclimbing a mountainand never reaching theSUmmit. Donna Brown, a tinnitussupport group leader in Denver since1997, has had t innitus for the past fouryears. She says, 11There is a personunder the tinnitus who still loves lifeand loves to climb mountains." Andthis time she is climb ing one foreveryone experiencing tinnitus.

rrExpedition Hopeful Cure" will takeplace on July 29, 2000 on Mt. Rainier,a 14,410-foot glaciated peak located inWashington State. Donna will use herclimb to promote tinnitus awarenessand to help raise money towardresearch for a cure.

We are very proud of and gratefulto Donna and our other support groupleaders for their energy, resourcefulness, and courage in handling theirtinnitus. Donna's letter is as follows:

14 Tinnitus 7bday lJune 2000 Am erican Tinnitus Association

My name is Donna Brown and my tinnitusstarted in 19.96 after undergoing a surgicalprocedure.

The past four years have been an ordeal.Tinnitus has affected my sleep, concentration, anrelationships with family, friends, and especiallymy husband. I've run the gamut from MRis, CAscans, spinal taps, hearing tests, and blood workginkgo, Chinese herbs, acupuncture, and seeing ouncompassionate doctor after another who told mto '1eam to live with it!H

I still have bad days. But due to the TRTdevices I've been wearing for the past 16 monthsand my twice-a-week vitamin B-12 injections, I'mhaving longer and longer periods ofgood dayswhen my tinnitus is hardly noticeable.

My fondest childhood memories are of thenumerous hiking and camping trips I took. Thosrustic experiences made me an avid climber, runner, hiker; and skier. Some of my greatest athleticachievements include climbing Long's Peak andother "14, 000 footers in Colorado and running innumerous marathons, road races, and triathlonsI feel so alive when I'm climbing mountains! Theis such a great sense ofaccomplishment in reachthe summit, not to mention the incredible view I from on top of the world.

A few years ago my husband, Gary, and Iwere camping in Mount Rainier National Park inWashington State. When I first caught a glimpseMt. Rainier, I knew I had to climb this awesomepeak. At first I was going to cli.mb the summit aspersonal challenge, but then I read an inspiringbook called No Mountain Too High. The storyrecounts the courageous adventure of 17 women,breast cancer sw1livors, who generated thousandofdollars for cancer research by climbing Mt.Aconcagua in Argentina. I thought, "Why not dothe same thing for tinnitus?"


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This is the best way I can think of o not onlyraise funds for tinnitus research, but to raise publicawareness of tinnitus and protect more unawareears from the same fate.

Thanks to you all for believing in me andenabling me to make this "climb for a cure" givinghope to everyone experiencing tinnitus.

Namaste(from my heart to yours),

Donna Brown

Not everyone can climb mountains. But you canmake a gift to ATA toward the treatment andcure of tinnitus in honor of Donna's climb. Ifyou haven't already responded to ou r May mailappeal, please cut out or copy and return thereply card below. If you have already respondedto our mailing, thank you!

""'J:es fl want to help ATA find a cure for tinnitus.I Enclosed is my gift for research.

AMERICANTINNITUSASSOCIATIONPO. Box 5Portland, OR 97207503-248-9985800-634-8978

0 $25 0 $50 0 $100 0 Other_ _NameAddressCityState ZipTelephone

Method of Payment0 My check is enclosed, payable to

the American Tinnitus Association0 Please bill $.____ o my0 Visa 0 MasterCardCard No.Exp. DateSignatureThlephoneThank y ou. Please return this slipwith your contribution. Your gift istax-deductible.

American Tinnitus Association Tinnitus ?Oday/June 2000 15


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RESEARCH UPDATETowards the Cure

Articles about ATA's research grant program areregular features in this journaL But you may havewondered how research projects are selected. Here'show it works: Tinnitus researchers submit theirapplications to ATA. The applications are reviewedby assigned readers on ATA's Scientific AdvisoryCommittee (SAC). The readers make their recommendations to the entire SAC which in turn makes itsrecommendations to the Board of Directors. TheBoard of Directors makes its final decision, grantapplicants are notified, and, finally, the checks arecut. That is the end of the process for ATA but it isjust the beginning of the process for the researchers.

Most of the studies that we fund take one to twoyears to complete. We are pleased to share the resultsof two recently completed ATA-funded studies.

Spontaneous activity in brain slices ofdorsal cochlear nucleus follow ing exposureto high intens ity sound by Kejian Chen, Ph.D.,

Kejian Chen, Ph .D .

Principle Investigator;Department of Otolaryngology- Head and NeckSurgery, Medical College ofOhio; Donald A. Godfrey,Ph.D., Medical College ofOhio; and James A.Kaltenbach, Ph.D.,Wayne State UniversityLoud sound exposure isconsidered the cause ofmore than hal f of alltinnitus. Previous studies have suggested thatanimals exposed to loud sound may have tinnitusresembling that in people and therefore may beuseful models for studies aimed at finding treatments for human tinnitus sufferers. With this

animal model, earlier studies found that, in thedorsal cochlear nucleus (the first brain center ofthe hearing system), the spontaneous activityrecorded from groups of nerve cells increasedafter sound exposure.

This project assessed electrical activitychanges of individual nerve cells in slices of thedorsal cochlear nucleus after exposure of rats tosounds loud enough to produce hearing loss andtinnitus in people. There are basically three typesof spontaneous activity in the dorsal cochlearnucleus - regular, irregular and bursting. Theyare related to different types of nerve cells.16 Tinnitus Thday/ June 2000 American Tinnitus Association

Regular activity is characteristic of a majortype of nerve cell, called the fusiform cell, thatsends information about sounds to a higher audtory center in the brain called the inferior colliclus. Bursting activity is characteristic of anothetype of nerve cell, called the cartwheel cell, thacommunicates with fusiform cells. Both types ocells are also influenced by other brain centers.We found that several weeks after loud soundexposure, bursting activity increased, while regla r activity decreased. We consider that thesechanges may be related to interactions betweenthe cochlear nucleus and other hearing centersthe brain.

In order to explore the chemical basis forthe spontaneous activity changes, we testedseveral drugs related to chemical communicatiobetween nerve cells. We found changes in sensitivity to a drug that resembles acetylcholine.Acetylcholine is known to be involved in chemical communication to cochlear nucleus nervecells by nerve fibers coming from higher braincenters. These results suggest that, af ter loudsound exposure, there may be changes not onlyin the ear and in the cochlear nucleus, bu t alsothe higher brain centers. Such changes may plaa role in the generation of tinnitus.Masking curves and otoacoustic emissioin subjects with and without tinnitus

James A. Henry, Ph .D.

by James A. Henry, Ph.D. ,Veterans AdministrationMedical Center; NationalCenter for RehabilitativeAuditory ResearchThis study was designed tinvestigate a potential cau(or mechanism) of tinnituthat has been proposed bymany tinnitus researchersSeveral theories of tinnitugeneration are based on th

premise that dysfunctional outer hair cell activresults in abnormal neural activity (Vernon,1995). The outer hair cells are located in theinner ear (inside the snail-shell-shaped cochlea)where sound is ''tranduced" into nerve signalsthat are then sent to the brain. There are thousands of outer hair cells, all lined up in threerows inside the cochlea. At the base of thecochlea, the outer hair cells are responsive to


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higher-pitched sounds (like the right-hand side ofa piano). Hair cells further from the base areresponsive to lower-pitched sounds. The mostinteresting aspect of the outer hair cells is thatthey are each like little muscles, which "amplify"soft sounds that enter the cochlea. The amplifiedsignals are then sent to the inner hair cells thatthen send the signals to the brain. I t is thought bysome that damage to the outer hair cells (whichcan occur by loud noise) disrupts their normalactivity, resulting in abnormal nerve-impulsesthat are perceived by the brain as sound.

There have been varied efforts to show thatouter hair cells are involved in tinnitus generation, but thus far results have been inconclusive(Mitchell et al., 1995 and Mitchell et al., 1996).The goal of the present study was to determinewhether dysfunctional outer hair cells are associated with tinnitus. Two procedures that assessouter hair cell function are masking audiograms(or masking "curves") and distortion-product otoacoustic emissions (DPOAEs). Masking audiogramsare obtained by first presenting tones at a series offrequencies and finding the lowest level (threshold) that a person can hear each tone. This establishes the standard audiogram such as a patientwould receive from an audiologist when measuring hearing sensitivity. Then, a fixed "masking"tone is presented and the hearing thresholds aremeasured again. The difference between theunmasked and the masked thresholds providesthe masking curve. Certain changes in the masking curve are an indicator of outer hair cell dysfunction.

DPOAEs are a direct measure of outer haircell function that does not require a behavioralresponse. A probe tip is inserted into the earcanal, and tones are presented to the ear. Whenthe tones are presented, other tones ("distortionproducts") bounce back from the cochlea. Thesecochlear "echoes" are thought to reflect the outerhair cells' amplification activity. The strength ofeach response is a measure of the health of theouter hair cells.

For this study, masking curves and DPOAEswere obtained from two groups of 12 subjectseach - one with and one without tinnitus. All ofthe subjects had normal hearing sensitivity. Byselecting subjects with normal hearing, the onlydifference between groups was that one had tinnitus and the other didn't. Thus, any differencesobserved in the results between groups wouldmost likely be due to the tinnitus.

For some of the masking curves, a trend wasseen that might indicate a hypersensitive maskingeffect for the group with tinnitus. This effectwould be consistent with damage to the outer hair

cells, which was observed in a similar study conducted previously by Dr. Curtin Mitchell. TheDPOAEs also showed differences between groupsat the highest frequencies tested. Also, whenDPOAE results were displayed as "input-outputfunctions," there was a consistent reduction inthe size of the DPOAEs for the tinnitus subjectscompared to the non-tinnitus subjects.

In summary, the findings of this study didnot confirm previous findings, ye t differencesbetween groups were evident. These results suggest the need for a larger-scale study to evaluatefor outer hair cell dysfunction in individuals withnormal hearing and tinnitus. m

Acknowledgments: Funding for this study wasprovided by the American Tinnitus Associationand the United States Government VeteransAffairs Rehabilitation Research and DevelopmentService (RRE1'D C93-693AP).ReferencesVernon JA, M0ller AR: Mechanisms ofTinnitus. NeedhamHeights: Allyn & Bacon, 1995.Mitchell CR, Creedon TA: Psychophysical tuning curves insubjects with tinnitus suggest outer hair cell lesions,Otolaryngology- Head and Neck Surgery, 1995; 113:223-233.Mitchell CR, Lilly OJ, Henry JA: Otoacoustic emissions insubjects with tinnitus and normal hearing . In: Reich GE,Vernon JA, eds. Proceedings of the Fifth InternationalTinnitus Seminar, Portland: American Tinnitus Association,1996: 180-185.

ATA's Scientific Advisory Committee and the BoardofDirectors has just approved funding for threenew tinnitus research studies totaling $170,250.We will report fully on this new research in thenext issue ofTinnitus Today.

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- - - - - - ----- --- -American Tinnitus Association Tinmtus Thday/June 2000 17


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Building a Better Dishwasherby Rachel D. Wray,ATA Director ofAdvocacy andInformation 8 ResourcesRobert Key has had enough.Last March, the lawmaker' introduced a bill to theBritish Parliament to ba nMuzak and other instrumental background musicfrom being broadcast inpublic spaces. Involuntary listening is a dangerous"plague," Mr. Key told the Parliament, adding thatit's just one more piece of an ever-increasingnoise pollution problem facing industrializedcountries.

Muzak might not rank too highly on your listof audio pet peeves, but Mr. Key has a point. Likeairplanes, traffic, and other sources of noise pollution, piped-in music can raise blood pressure andcholesterol levels, lower work productivity, causeyour eyes to dilate, and change your digestiveprocess. But repetitive noise has other negativeeffects. If too loud, it can contribute to noiseinduced hearing loss, which afflicts at least 10 million Americans, and a worsening of tinnitus. If toopersistent, it can have a cumulative negativeeffect on your hearing. For those with hyperacusis, it can be downright painful. And, i f nothingelse - even for those with normal hearing - itcan be a terrible nuisance.In public, like in elevators or on city streets,this can be bothersome, but there's somethingeven more psychologica1ly troubling about annoy

ing noise in the home. After a long day at work, achaotic commute, and all the errands filling upour busy lives, it's nice to relax in a quiet household. But when that household i.s rife with noise- dishwashers, washing machines, telephones,garbage disposals, no t to mention televisions andstereos - relaxation seems impossible.Fortunately, there are ways to reduce andimprove the noises to which we're exposed. Forstarters, "quiet appliances" have become animportant marketing niche, and consumers have

more product choices than ever before. Visit yourlocal appliance store an d you'll see "AlmostNoiseless!" and "Whisper Quiet!" on dozens ofproducts, including dishwashers, washingmachines, dryers, and even vacuums.Manufacturers are looking for new ways toquiet other appliances, often relying on experts inthe field of acoustics engineering. Employees at

18 Tinnitus 7bday/ Junc 2000 American Tinnitus Association

the R.H. Lyon Corporation in Cambridge, Massare some of the leading researchers in this fielThey spend their days listening to sewingmachines, vacuum cleaners, car doors, and diswashers, trying to pinpoint, reduce, and improvarious noises. This latter point - the improvement of sound - is significant. Explains GladyUnger, R.H. Lyon consultant, "The sound levedoesn't tell the whole story. The quality of thesound is also very important. We've seen fanswith low dB ratings, but whose sound quality iterrible that you would cringe i f you had to listo them."

Sound quality is the underlying principle opsychoacoustics. Noise has two components:physical and emotional. Physically, noise is mup of vibrations pe r second (also called frequecy) that are measured in hertz (Hz). Humansceive sounds between 20 and 20,000 Hz. Theemotional quality of noise, however, has no msurement save individual perception. When itcomes to product design, manufacturers wantto like the sounds you hear. They want thosesounds to convey quality, power, and reliabilit

Still, even when companies are serious abonoise reduction in their products, they oftenapproach it in a piece-meal, after-the-fact sortway. Instead of addressing noise at the source,manufacturers resort to sound-deadening mateal, which adds to th e consumer costs. Ms. Ungcounters, "Skilled acousticians can determinecause of the noise and modifY the product itseShe laughs, "It's kind of like being a detective."Bu t all too often, she says, "We're brought in atlast minute" to simply apply an audio Band-Aid

Whirlpool, Kenmore, and Maytag have allintroduced quiet dishwashers and washingmachines with no negative effect on performaTechnology has improved the noise from vacucleaner motors over the years, but vacuum deshas relied increasingly on lightweight plastics,which vibrate more than older metal casings.Plus, vacuums have become more powerful, anas the vacuums' amps have increased, so, too,the noise. According to Consumer Reports, noisthe number on e complaint from customers abfull-sized canister vacuums, some of which canas loud as 85 dB.

While manufac turers should consider excessive noise during the design process for all theappliances, consumers also have a responsibilito speak up about what they prefer- and lettheir purchases reflect those preferences. Ms.Unger says manufactures are more responsive


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than one might think. "Many of the appliances weuse in the U.S. cannot be sold abroad becausethey are too noisy. For the European or Asianmarkets, the manufacturers will go to extra trouble to quiet the devices [because the demand isthere]."The mentality toward noise is certainlydifferent in other parts of the world - the ban onMuzak is but one example. The InternationalEurotechnical Commission has an acceptabledecibel output (42 dB) for refrigerators and freezers, which have both a motor and a compressor.Indoor appliances with just a motor aren't regulated. In Germany and England, there are limits onhow much noise outdoor appliances can make.Belgium is considering a similar directive. InAustralia, just driving a car that's too loud canget you a ticket.In America, there are no federal regulationson noise output for home appliances. Twentyyears ago, the Noise Abatement and ControlOffice, a sub-department of the EnvironmentalProtection Agency, handled this issue. But theReagan Administration elin1inated the department, and no other federal agency has focusedon the effects of excessive noise even thoughAmericans rank it a bigger concern than crime.(The Noise Control Office is making a comeback:the Quiet Communities Act of 1999 has beenintroduced in Congress; i f passed, it will reestablish the office.)

Underwriters Laboratories (UL), the nation'sindependent product safety testing and certification organization, has noise standards for warningsystems like smoke alarms and specific outdoorappliances like chainsaws, bu t there are no standards for indoor appliances. Dr. Thomas ChildersofUL says, "With the new E[fficiency]-typemotors, the technology will le t you do more work,and yet the motor is much quieter." He continues,"When we test a product, we ask 'does it functionsafely?' and 'does it fail safely?' Audio levels justaren't considered a threat [for most appliances],but [theyJ can be abrasive." And that abrasiveness,he suggests, is something all consumers need toconsider when purchasing a product.

Demanding reliable appliances with reducedand improved sound is just the first step youshould take when trying to make your home lessnoisy and improving your quality of life. Being asmart shopper can help too. Read ConsumerReports and other consumer advocacy publications. Contact appliance companies and ask them

for specific decibel outputs from their productsand carefully read product literature, whichoften specifies the particular noise level. Holdon to your receipts and return products that aretoo loud.And perhaps most importantly, protect yourhearing - even i f you don't think the noises areover the potentially harmful threshold of 85 dB.

Donna Wayner, Ph.D., an audiologist in NewYork, explains, "Something that's benign or innocent-if it's used too much-can have a cumulative effect." Instead, she urges, we need tochange the thinking around noise to stop it atits source. "People wear protective eye glasseswhen they use power tools. Why not [use] earprotection?"

When using a loud appliance, even one thatseems tolerable at first, Wayner recommendsea r protection. She also suggests making suchprotection part of the routine so there's no excuse

(continued)

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Tinnitus Treatmentin IsraelThe Hope andthe Reality

by Stephen M. Nagler, M.D.The September 1999 issueof Tinnitus Tbday containeda report written by RayEnnis, a gentleman fromHawaii, who had traveledto Jerusalem to see Dr.Zecharya Shemesh for treatment of his severe tinnitusat Hadassah Medical Center.The results of that treatment were incredibly gratifying to Ennis, and his report in Tinnitus Tbdayquickly led to a flood of phone calls to my office(presumably also to the offices of others who treattinnitus patients) and to the ATA. Numerous discussions on tinnitus Internet sites ensued as well.Part of the flurry surrounding the article was due

to the fact that the specifics of Dr. Shemesh's protocol for tinnitus treatment were unpublished.

Part of the flurry was due to the fact that the ptocol often included the administration of a seccompound in pill form. And part of the flurry wdue to the fact that reports of 90% cure ratesusing this unpublished protocol and secret compound ha d begun to surface.

I was subsequently invited to present a forlecture on tinnitus at Hadassah Medical Centeto meet extensively with Dr. Shemesh, and toobserve him at work. I went to Israel in earlyFebruary 2000 for the sole purpose of theHadassah visit. I represented only myself, not ATA. The trip went well in some respects, andwas disappointing in others.

I am satisfied that Dr. Shemesh is an incredbly dedicated physician with a true passion fortreating people with tinnitus. His treatment procol is complex, and sometimes improvement isnot seen for 12-18 months. Dr. Shemesh feels tthe auditory system is acutely sensitive to metbolic imbalance, and he devotes considerableeffort to evaluating and correcting nutritional aendocrine deficiencies an d excesses. The protoresults in a highly individualized approach. Evthe composition of the unidentified compoundmentioned above varies from patient to patientDr. Shemesh is compassionate, warm, sincere,committed, and intelligent. I truly found it upling to be in his presence.

But uplifting aside, I had to ask myself, "Ware the facts?"

Some of Dr. Shemesh's patients apparentlysucceed in treatment. The Hadassah program ino t unique in this respect; indeed, all tinnituscenters can boast of successes. However, a succ

Building a Better Dishwasher (continued)not to be safe. Keep a pair of earplugs in thesame drawer as your hair dryer. Hang a pair ofearmuffs over your 1awnmower or snow blower.Consider low-tech options, like using a rakeinstead of a leafblower. Turn down the volumeon your telephone.

It's to be expected that certain environmentalnoises are bound to increase as populationincreases - there are simply more of us driving,flying, weed-whacking. But when it comes toyour own home, you control what you hear,and knowing how to exercise that control is animportant step toward being a smart customerand listener. a20 Tinn itus Thday/ June 2000 American Tinnitus Association

Resources The Association of Home Appliance Manufacturers haa "Just for Consumers" page at www.aham.org. Or cal202-872-5955 for more information. Underwriters Laboratories offers a Consumers ResourGuide and videos. Check out the Web site www.ul.comor call 847-272-8800 to reach Consumer Affairs.

For more information on the Quiet Communit ies Actof 1999, go to http: / / thomas.loc.gov or contact yourRepresentative or Senator. Th e September 1999 issue of Consumer Reporrs focuseon noise and noisy appliances. Also, check out theAugust 1999 issue for a report on refrigerators, July 19for washing machines and dryers, an d March 2000 fordishwashers. Visit www.consumerreports.org, call800-208-9696, or visit your local library.


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story alone cannot be the statistical gauge indetermining if an individual with tinnitus shouldinvest time, effort, and money on a particulartreatment. In order to make that kind of decisionrationally and responsibly, the patient shouldhave access to data and know the clinic's successrates for the treatment. Moreover, the patientneeds to know how the clinic in question definesthe term "success." Is it a total cessation oftinnitus? Is it any appreciable drop in tinnitusloudness? Is it the ability to more effectivelyparticipate in activities of daily living?

I asked Dr. Shemesh for the data. However,he does not keep track so he could not provideme with it. I also asked him for his definition ofsuccess in the context of his treatment protocol,but he does not have a formal definition ofsuccess. I t is my hope that in the near futureDr. Shemesh will begin to collect and evaluatehis data prospectively, and while I was there Ienthusiastically encouraged him to do so. I cannot help but wonder, though, how any referenceto "cure rates" can be made when there is noformal definition of success and no data fromwhich to draw a conclusion.As a physician, I have to take another factorinto account. Almost all of Dr. She mesh's patientsreceive a secret medication as part of the treat

ment protocol. They are told that the medicineis tailored to their specific metabolic needs.Dr. Shemesh informed me that the purpose ofthe medicine is to enhance cerebral metabolism- brain function. This medication is not offeredby prescription at a local pharmacy. Rather,Dr. Shemesh brings the capsules into his officeand dispenses them to his patients in containersmarked only with a code. His patients get theirrefills from Dr. Shemesh by mail. As 1 considerthis situation, a very real practical concern arisesin my mind. What if the patient goes home andhas a medical emergency - a heart attack, ananeurysm, an automobile wreck - any emergency requiring urgent medical decisions? Insuch emergencies, the treating physician willalways inquire about current medications, knowing the seriousness of drug interactions. Onemedication might cause harm or even a fatalityif administered in the presence of another. ButDr. Shemesh's patients cannot tell their doctors athome what they are taking because they do notknow nor can they find out - nor can their doctors find out. For this reason above all, I realizethat as a physician I cannot currently recommend the program, lack of data notwithstanding.

On a personal note, I certainly understandhow someone with severe intrusive tinnitus,struggling daily with a gorilla on his or her back,might be tempted to go to Israel and "give it ashot" based upon the anecdotal success storiesalone. In fact, a few years ago had I not achievedthe tinnitus relief I was seeking through anothertreatment approach, I myself might have calledDr. Shemesh to discuss what benefit I mightexpect from such a program. Finding him to be avery kind, affable, and accessible doctor, I mightindeed have decided to become his patient.I know all about that gorilla.

And this February I did go to Israel - not as apatient, but as a doctor. I went hoping that Dr.Shemesh's tinnitus program held the key to acure. I came home truly impressed with Dr.Shemesh's dedication, but with sign ificant concerns and even more unanswered questionsabout a protocol still very steeped in mystery. BDr. Nagler is the Director of the Alliance Tinnitusand Hearing Center in Atlanta, Georgia. He is amember of ATA's Board ofDirectors.

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American Tinnitus Association Tinnitus 7bday/ June 2000 21


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Self-Help GroupsWe Are On Your Side

by Dhyan Cassie, M.A., CCC-A"Go home and live with it."What does that mean? Andwhen you have screamingtinnitus, how do you do that?Such advice leaves patientsfeeling helpless and out ofcontrol. When they feel helpless, their treatment effortsdecrease and their anxietyand depression increase.Does it have to be this way?Absolutely not.

There are people on your side ready to provide coping mechanisms, treatment plans, andsupport. The American Tinnitus Association hasSO self-help groups in the United States and 200+telephone volunteers. When people are given amessage without hope, ATA is there to share th einformation that there is help. I t is true there isno one cure for tinnitus, bu t there are manymethods for alleviating it.In a self-help group, patients learn about

Tinnitus Retraining Therapy, relaxation techniques, hypnosis, Reiki, nutrition, tinnitus alleviating CDs, and sound machines. They discoverthere is extensive tinnitus research and advocacy.They find out that there is a national organization dedicated to finding solutions. Tinnitus isnot a "go home and live with it" problem. Supportgroups can get a bad rap i f people think of themas a place where the "horrors of tinnitus" areshared. We know that dwelling on tinnitus is nothelpful in retraining the response of the brain'sreaction to tinnitus. However, "self-help" is takingcontrol and finding alternative approaches tohealth. Self-help is learning opportunities forintervening and making things better.

Studies have shown that self-help group participation can positively affect the quality of liferegardless of the condition or disease. Copingstrategies are offered that many professionalsdon't provide. A vicious cycle of despair an dannoyance can be broken by finding copingmechanisms that can lead to relief.

22 Tinnitus Thday/ June 2000 American Tinnitus Association

Tinnitus often makes patients feel thatthey've lost control; that they are powerless.Studies show that those who learn self-care techniques and gain more knowledge and control rathe quality of their lives higher than those whodon't take such actions. If we give our patientsthe methods to approach this problem, they canregain some measure of control. There are amyriad of opportunities for intervening to makethings better.

I f you attend or join a self-help group, it isbest i f t is not for the purpose of finding someoor something that will save you. You will continto assume the full responsibility for changingyour life. Instead, it is a way of getting ideas anencouragement to manage your life better.

Impressive and growing research shows thatself-control is important to our mental and physcal health. Self-help attitudes an d skills arebecoming major factors in the treatment of phycal mental emotional and interpersonal probl e ~ s . Self-help is a positive response. I t is lookifor better solutions. I t is analyzing carefully. Itimproving our coping skills. I t is finding purposand expecting to succeed. I t is joining a group toget ideas and encouragement and hopefully finding the treatment or the professional who canoffer you help. You may no t be able to do this oyour own, but you can choose who is going to bby your side.

If you have started Tinnitus RetrainingTherapy, you may have been told to avoid selfhelp groups. Yes, I agree with that. If you choosa treatment plan and you are committed to H,follow through. You have found your technique.There is no method that works for everyone.Every self-help approach is just a possible pathway to success. Experiment with an open mind.Use what works for you. If it doesn't work foryou, don't blame yourself. There would only beone diet pill if it worked for everyone. Keep onseeking, stay busy, help others, and be gentleon yourself. 9ResourceGilden, Janice, et al.: Diabetes Support Groups ImproveHealth of Older Diabetic Patients, Journal of he AmencanGeriatrics Society, vol. 40 pp. 147-150 January 1992.Dhyan Cassie is an audiologist, selfhelp groupleader, and member ofATA's Board ofDirectors.


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QUESTIONS AND ANSWERSJack Vernon 'sPersonal Responses to Questions from our Readersby Jack A. Vernon, Ph.D., Professor Emeritus,Oregon Health Sciences UniversityQDr. E. from Alabamawrites about herhusband who had astroke. After the stroke, heimmediately began hearing

the sound of running waterin his right ear. She reportsthat soft music helps him getto sleep, but she wants toknow if there are other people who had their tinnitusstart as a result of a stroke.A We do not know of cases of tinnitus beingproduced by stroke. A stroke is essentiallythe death ofbrain tissue caused by a lack ofblood flow and insufficient oxygen to the brain.But we do know of several different parts of the

brain - like the thalamus, th e limbic system, thefrontal lobe, and of course the auditory cortex -that are involved to varying degrees in the perception of tinnitus. If the stroke involved any one ofthose, most especia1ly th e auditory portion of thebrain it is reasonable to assume that tinnituscould we11 be produced. Fortunately, your husband has found that playing soft music helps himget to sleep. Since the quiet music works for him,I'd also suggest that he test a tinnitus masker inhis right ear to see if it could help him du ring thedaytime.QMr. S. from Pennsylvania indicates that hisphysician has recommended that he takean aspirin a day for possible prevention ofheart problems. He states that his tinnitus is atpresent bearable but he does not want it to getany louder. He asks if an aspirin a day willincrease his tinnitus.A am fairly confident that a single aspirin aday will not increase the loudness of yourtinnitus. If it does, however, stop taking theaspirin immediately. The tinnitus will return toits present level.

I would like to introduce a new idea aboutaspirin. Some time ago, we used aspirin to deliberately induce tinnitus in some non-tinnitus testsubjects. Firs t of all, we found that it took a greatdeal of aspirin to induce tinnitus. More importantly, we found we could no t study aspirin-induced

tinnitus for the reason that every test we used -even a simple hearing test - to study the tinnituseffectively masked the tinnitus and then put itinto extended residual inhibition! Ever since thenI've wondered what would happen if we purposely exacerbated tinnitus with aspirin. Would themasking easily cover the entire tinnitus and notjust the increase? Would it produce extendedresidual inhibition? For those who cannot bemasked, it might be worthwhile to attempt suchan experiment.Q Mr. P. from Wisconsin reports that histinnitus was perceptibly increased by thesound of a billiard ball breaking a rack ofbilliard balls. He asks if anyone has measured theintensity of the break sound and what form of ea rprotection would be best for this activity.A ou are correct. The sound of the billiardrack being broken is quite loud. The loudness depends upon the force used to execute the break, but in most cases the sound isfrom 105 to llO dB. Fortunately it is for a briefamount of time. Nevertheless you have experienced an exacerbation of your tinnitus from thissound and thus I recommend that during the timeof the break you use ear protection. "Thunder 29"earmuffs made by the Howard Leight company(800-543-0121, www.howardleight. com) work quitewell. Billiards an d pool are generally quiet gamesso you would only need ea r protection during thebreak. Using earmuffs seems preferable to givingup this interesting and challenging pastime.Q r. K. in California reports several experiences when he has worn earplugs and earmuffs while attending football games andwhen using his r iding tractor. In both instances,he perceived low-pitched soft rumbling soundswhich seemed to send his tinnitus into residualinhibition (a temporary cessation of tinnitus aftermasking is discontinued) lasting several hours .[As you can imagine, we are always interested inthose forms of masking that produce residualinhibition, especially the long-term variety.]Mr. K. experienced the rumbling sound for severalhours in each case. The resulting residual inhibition also lasted for several hours. Mr. K. asks, "Isthe duration of the residual inhibition determinedby the duration of the sound exposure?"

(continued)American Tinnitus Association Tinnitus Thday/June 2000 23


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QUESTIONS AND ANSWERS (continued)A n the tests we conducted at th e OregonHearing Research Center, the duration ofthe residu al inhibition is not determinedby the dura tion of th e sound exposure. Havingsaid th at, however, allow m e to state that severalpatients have experien ced very prolonged residual inhibition after having had a long experiencewith masking, say several yea rs. I ca n report thatif I mask my tinnitu s fo r 30 or 40 minutes, I mayhave several days of compl ete residual inhibitionan d som etimes many weeks of partial residualinhibition. We wish we knew how to produceprolonged re sidu al inhibition for every on e.As a general ru le, th e soft low-pi tche d soundsdescribed b y Mr. K. are precisely th e on es th atwe thought did not produ ce residual inhibition.Our experience with hearing aids caused us todiscredit low-pitched sound as a possible produ cer of re sidual inh ibition. Here is why: There aresom e tinnitus patients w ith hearing loss who find

that properly fitted hearing aids relieve thei rtinnitus. But th ese patients do not experienceresidual inhibition when the hearing aids aretaken off. The sounds th at are being amplified bthe hearing aids are re latively low-pitch ed sincemost of our environmental sounds are below4000 Hz. Mr. K's. experien ce simply points ou thow little we know about residual inhibition!Notice: Many of you have left messages requestingthat I phone you. I simply cannot afford to meetthose requests. Please feel free to call me on anyWednesday, 9:00a.m. -noon and 1:00 - 5:00p.mPacific Time (503-494-2187). Or mail your questioto : Dr. Vernon c/o Tinnitus Thday, AmericanTinnitus Association, PO. Box 5, Portland, OR97207-0005.

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SPECIAL DONORS AND TRIBUTESATA's Champion Members are a remarkablegroup of donors who have demonstrated their commitment in the fight against tinnitus by making a contribution or research donation of $1000 or more.Sustaining Members have given memberships orresearch donations at the $500-$999 level.Contributing Members have given memberships atthe $250-499 level. Supporting Members have givenmemberships at the $100-499 level. Research Donorshave made research-restricted contributions in anyamount up to $499.

Contributions to ATA's 'Iribute Fund will be usedto fund tinnitus research and other ATA programs. Ifyou would like this contribution restricted forresearch, please indicate it with your donation.'lli.bute contributions are promptly acknowledgedwith an appropriate card to the honoree or family ofthe honoree. The gift amount is never disclosed.Our heartfelt thanks to all of these specialdonors.An contributions to the American Tinnitus Associationare tax-deductible.

GIFTS FROM 1-16-00 to 4-01 -00Champion Members(Comributions of$1000 an d above)Robert w. BoothMatthias B. BowmanCharles T. andJune BrownJames 0. Chinn s, Jr.John M. GrillosJoel B. andJ udith L. KonicekHubert G. PhippsDan PurjesStephen M.Schwarcz, D.D.S.Delmer D. Weisz

Sustaining Member s(Comrihutions o f$500-999)Ida J . BeebeBarbara F. BrownJerome Ot tSchoenstadt FamilyFoundationMarvin J . WeinbergerDelbert W. YocamArnold ZousmerContributingMe mber s(Conoibution.s of$250-499)Sam BerkmanJohn J ay Ginter, IIINicholas T. GiorgiamtiRichard P. GrossEric F. J anle

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George KeanThomas C. LustyCameron R. MurrayGail L. Nea leAbrahamShulman, M. D.Helena Solodar, M.S.Richard W. SullivanDaniel K. ThrkingtonMiriam WinnerSupporting Members(Contributions ofSI00-249)Debra Abel, M.A.David AmentGerald w. Ape!Robert K. Ashworthfan 1l:aquair BallJesse BallJames R. Bamey

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"Tinnitus: Learn to Live WithOUT It"Thoughts on Tinnitus Retraining Therapy

Th is video is not merely a vision for the future,but it discusses very practical approaches totinnitus treatment today. It is designed primarily

as a source of information for the tinnitus patientand family, yet it contains material of value forthe hearing healthcare professional as well.To purchase your copy today call404-531-3979, visit our website: www.tinn.com,

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Maryanne CorneliusPatrick M. Costiga11Patrick Coughlin, M.S.Elizabeth J. CurtisRonald D'ArcangeloAli DaneshFay L. DavisWalter Z. Davis, Jr.Deirdre M. DesmondGlen L. EdwardsBernard FishmanKathryn E.FitzsimmonsMargaret FlemingMary A. FloydMartin E. FasslerRose Mary GablerVeva J. GibbardBarbaraGoldstein, Ph.D.

J ames A. GomesBob GoodmanDonald D. GuitoLila HambletonMary E. HarkerPaul w. Hastey'Thm HattrupDiana G. HaverRichard H. HawsW. A. HaywardMark HerritzPaul G. HillJames R. HoffmanAndrew Hrivnak, Il lAnita Jane HullJoan ImberRoben C. lncert iWayne G. JakobsNils P. JensenGrant Jones

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"The Tinnitus Relief System hasprovided me a great deal of reliefand a period of relaxation I havenot received from other s o c e Barbara Rakish, Madison, MS

"Although there is no cure fortinnitus yet,your system is thenext best thing for tinnitus reliefin my opinion. Thanks! "Rick Stern, Lincoln, NE

For a free CD or for more information call:1-800551-4467or check us out on the web:www.tinnitus-relief.com

American Tinnitus Association Tinnitus TOday/ June 2000 25


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SPECIAL DONORS AND TRIBUTES

tinnitus today june 2000 vol 25, no 2

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