Tinnitus Today December 1996 Vol 21, No 4

December 1996 Volume 21, Number 4
Tinnitus Today
THE JOURNAL OF THE AMERICAN TI NNITUS ASSOCIATION
"To carry on and support research and educational activities relating to the treatment of
tinnitus and other defects or diseases of the ear."
Since 1971
Research- Referrals- Resources
In This Issue:
Air Bag Safety -
Air Bag Risk
Interview with Researcher
Jos J. Eggermont, Ph.D.
Thles of Tinnitus and
Recovery, Part IV
ATA's Regional Meeting -
A Success Story
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Tinnitus T o d ~ y
Editorial and advertising offices:
American Tinnitus Association,
P.O. Box 5, Portland, OR 97207
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Associ<tte Editor: Barbara 'l'<lbachnick
Editorial Advisor: 1Tudy Drucker, Ph.D.
Advertising sales: A'l'AAD, P.O. Box 5,
Portland, OR 97207, 800/634-8978
Timwus 'Ibday is published quarterly in
March, June, September and December. It is
mailed to members of American Tinnitus
Association and a selected list of tinmtus suf-
tcrers and professionals who treat tinnitus.
Circulation is rotated to 75,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for public.ation
and to rCJCCt any advertising deemed unsun-
ablc for Timmus Thday. Acceptance of adver-
tising bv Tmmws Thday does not constitute
endorsement of tl1e advertiser, its products
or services, nor does Timwus 7bday rnak(
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by contributors to Tinnitus
Thday arc not necessarily those of the
rubli;her, editors, staff, or advertisers.
American Tinnltw; Association is a non-prof-
it human health and welfare agency undet
26 USC 501 (c)(3)
Copyright 1996 by American Tinnitus
;\ssociation No part of this publication may
be reproduced, srorcd in a retrieval system,
or transmitted in any form, or by any means,
1\'ithout the prior written pennission of the
Publisher. !SSN: 0897-6368
Scientific Advisory Committee
Ronald G. Amedee, M.D., New Orleans, LA
Robert E. Rntmmett, Ph.D., Portland, OR
Jack D. Clemis, M. 0., Chicago, H.
Robert A Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster, M.D., La Jolla, CA
Barbara Goldstein, Ph.D., New York, NY
Richard L. Goode, M.D., Stanford, CA
John W. House, M.D., Los Angeles, CA
Roben M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia PA
Gale W Miller, M.D., Cincinnati, OJJ
J. Gail Neely, M.D., St. Louis, MO
Robert E. Sandlin, Ph.D., El Cajon, Ct\
Alexander J. Schleuning, II, MD,
Portland, OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith. M.D., San Jose, CA
Honorary Directors
Senator Mark 0. Hatfield
Tony Randall, New York, NY
William Shatncr, Los Angeles, CA
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey
Portland, OR
Board of Directors
Edmund <...rossberg, Northbrook, IL
W F. S. Hopmeicr, St. Louis, MO
Paul Meade, Tigard, OR
Philip 0. Morton, Portland, OR, Chmn.
Aaron L Osherow, Clayton, MO
Gloria E. Reicl1, Ph.D., Portland, OR
The Journal of the American Tinnitus Association
Volume 21 Number 4
1
December 1996
Tinnitus, ringing in the ears or head noises, is experienced by as many
as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Contents
9 Air Bag Safety - Air Bag Risk
by Barbara Thbachnick
13 Announcements
14 ATA Research Report- An Interview with
Jos J. Eggermont, Ph.D.
by Barbara Tabachnick
15 Self-Help and Support- The Network Grows!
16 'Thles of Tinnitus Recovery, Part IV - Thrri's Return
by Elliot Wineburg, M.D.
20 The "T" Word is Getting Out
by Corky Stewart
21 ATA's Regional Meeting in Maryland
by Barbara Tabachnick and Corky Stewart
22 ATA - On the Road Again
by Pat Daggett
23 Focus Is Manifestation, Part II
by Mayte Picco-Kline
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
6 Letters to the Editor
18 Questions and Answers
by Jack A. Vernon, Ph.D.
A Success Story
25 'lributes, Sponsors, Special Donors, Professional Associates
Cover: ' Poppies' (hand-painted photograph) by Karen Forkish. inquiries to the indigo Gallery
Pine Art & Jewelry, 311 Avenue B, Suite B, Lake Oswego, OR 97034, (503) 636-3454.
From the Editor
by Gloria. E. Reich, Ph.D.,
Executive Director
A few months ago, William
Shatner and I testified before
the House Appropriations sub-
committee in favor ofbudget
increases for the National
Institute on Deafness and
Other Communication
Disorders. Later I reported to
you that the NIDCD had set aside $750,000 for
tinnitus research and had called for proposals.
We have just heard that all five of the tinnitus
research grants submitted have been funded but
it will be a few weeks yet before those g r a n t ~ are
announced. In the meantime, congress has been
working on the 1997 budget and I'm pleased to
report that the funding for the National
lnstitutes of Health, of which NIDCD is a part,
has been increased by $820 million dollars, or
6.9%, over last year. This is wonderful news to
all of us who are committed to finding answers
to our health problems.
Please join me in sending our thanks to
those congressmen from both parties who have
worked so diligently to make this happen. A list
of the key names and addresses is included
below.
Senator Mark 0. Hatfield (also an Honorary Director of
the ATA since 1978)
1 World 'Itade Center
121 SW Salmon St., #1420
Portland, OR 97204
FAX: 503-326-2351
Senator Arlen Specter (R-PA)
United States Senate
530 Hart Senate Office Building
Washington, DC 20510
FAX: 202-228-1229
Senator Tom Harkin (D-IA) (has a deaf brother)
FAX: 202-224-9369
4 Tinnitus 'Thday/ December 1996
Representative John Porter (R-IL)
FAX: 202-225-0l 57
Representative David Obey (D- WI)
FAX: 202-225-3240
A big THANK YOU! to all who sent in the
patient survey from the June issue. We've been
overwhelmed with thousands of responses. Our
staff is valiantly trying to code and enter these
into our computers before year's end. We'll be
reporting the results in a future issue of
Tinnitus Today . If you wrote something on your
survey that requires a personal answer, please
be patient. We're trying to read and answer
those too.
L-R: Aaron Osherow and Jack Vernon, ATA Board Members
Our special and heartfelt thanks to Dan
Robert Hocks who recently resigned from ATNs
Board of Directors after serving for over eight
years. Dan's father, Bob Hocks, was one of the
original incorporators of ATA and served for
nearly 12 years as ATNs first national chairman.
Both Bob and Dan have been great ATA ambas-
sadors to the manufacturers and distributors of
hearing equipment. Thanks, Dan. We hope
you'll continue to help ATA.
Jerry Northern, Ph.D., recently resigned
from the ATA Scientific Advisory Committee
From the Editor (continued)
L-R: Megan Vidis, new ATA Board Member; Marc Smiley; Billy
Martin, Ph. D.; and Malvina Levy
after serving for nearly 20 years. Jerry helped
us organize and present training seminars for
several years in the late 1970's and early 1980's.
We wish him well in his new position with
HearX and hope we can call on him for special
projects in the future.
We have just completed a round of focus
group meetings both in Portland and in
Washington, D.C. We've telephoned people all
over the country who have an interest in tinni-
tus and our association. These meetings and
calls were for the purpose of eliciting informa-
tion about what people thought ATA was doing,
and most importantly what they thought it
should be doing. People were very forthcoming
with their ideas which included: find a cure for
tinnitus; lobby for broader health insurance cov-
erage for tinnitus; better educate the doctors
and other professionals who treat tinnitus; sup-
port research for tinnitus; provide more infor-
mation about tinnitus on the Internet; establish
better diagnostic procedures for tinnitus; mobi-
lize ATA members for tinnitus advocacy; and
provide more information to the public about
hearing protection and prevention of tinnitus
that is caused by excessive noise. There were
many other ideas but these were representative
of the concerns we heard. If we've missed ask-
ing you and you want to be heard, please write
us or contact us through fax or e-mail with your
ideas about the organization. We're always
happy to hear from you about what ATA can and
should be doing.
Our Fax number: 503-248-0024
Our e-mail address: tinnitus@ata.org
The information that has been collected
from the focus groups is currently being written
up in a pre-planning document. The first meet-
ing to draw up the plan for ATA's future took
place in Portland just days ago, but details will
have to wait one more issue. (I can say that
ATA will have two new board members as of
January 1, 1997 - Jack Vernon, Ph.D. and
Megan Vidis!) Eighteen people attended repre-
senting all the stakeholders in ATA - patients,
professionals, friends, employees, manufactur-
ers, government, and other hearing organiza-
tions. This is an exciting project and an
important one to help ATA find the best way to
spend its resources, both human and economic,
during the next decade. We look forward to your
participation as we face the new millennium.
All of the ATA staff join me in wishing you
the happiest of holidays.
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Tinnitus Thday/ December 1996 5
Letters to the Editor
From time to time, we include letters from our
members about their experiences with "rwn-tradi-
tional treatments. We do so in the hope that the
information offered might be helpful. Please read
these anecdotal reports carefully, consult with your
physician or medical advisor, and decide for your-
self if a given treatment might be right for you. As
always, the opinions expressed are strictly those of
the letter writers and do not reflect an opinion or
endorsement by ATA.
era very stressful Christmas in 1994,
became aware of a constant hissing in
y ears. I rushed to my ENT only to be
told, after an audiogram, that this condition
called tinnitus was caused by high frequency
hearing loss (inner ear nerve cell damage), part
of the normal aging process. He said, "There's
no cure. Go home and live with it." I wish doc-
tors knew how distressing this statement can be!
I tried living with it but was not doing very
well. The noises were getting worse and I was
hearing everything from chirping to the sounds
of a steam engine. 1 couldn't fall asleep without
medication and I had difficulty remaining
asleep. During the day I couldn't concentrate
and felt extreme anxiety and depression. I
thought I was going to lose my hearing and
my mind.
I ran from doctor to doctor, and tried unsuc-
cessfully the anti-depressants and tranquilizers
they prescribed. Out of desperation I started to
research alternative remedies: vitamins miner-
'
als, and herbs. I read a wonderful book
(Spontaneous Healing by Andrew Weil, M.D.)
which gave me the encouragement I so badly
needed. I then read a quote by Eugene S.
Wagner, Ph.D., a professor ofbiochemistry, who
wrote, "Vascular insufficiency may indeed be
the major causative factor accounting for these
so-called age-related cerebral disorders, versus a
true degenerative process." This quote led me to
look for herbs that improve circulation and oxy-
genation, that stimulate the central nervous sys-
tem and boost transmissions of signals through
deteriorating nerves, and that decrease fatigue,
depression, insomnia, and stress. One herb
alone did not give me relief. However when I
tried herbs and vitamins in combination (ginkgo
biloba from GinkGold, gotu kola from Nature's
Way, golden seal, Siberian ginseng, kelp,
6 Tinnitus 1bday/ December 1996
lecithin, and vitamin C), I began to notice a
change in my tinnitus. After two months, I
noticed that the intensity had lessened. I was
feeling more calm and not so fatigued or
depressed. I also found relief from my insomnia.
After six months, the throbbing and feeling of
fullness in my head had dissipated. My super-
sensitivity to sound had also diminished. I've
noticed that if I stop taking the herbs for any
period of time, my tinnitus level increases.
I have no knowledge that herbs can cure tin-
nitus but they have certainly helped me to cope.
Each day I feel better knowing that I can man-
age my tinnitus without it managing me.
Joan Segarini, Novato, CA.
I
developed tinnitus and recruitment in
August of 1994 after I had undergone a
Magnetic Resonance Imaging (MR1) scan at
a local hospital. I was not forewarned about the
loud noise the MR1 makes. And it was loud! I
was given a head set with music to listen to dur-
ing the scan. But the MRI's noise was so loud I
couldn't hear the music. I felt like my head was
going to explode, and I complained about the
discomfort and the unbearable noise to the tech-
nician. The noise sounded like a jackhammer.
After the MRI scan was completed, I went
home, went to sleep, and woke up at 2:00 a.m.
with a high-pitched ringing sound in both ears. I
found out later after several hearing tests that I
had a threshold shift in my hearing, in addition
to tinnitus and recruitment caused by the noise
trauma. My ENT doctor prescribed Valium (Smg.
every eight hours) which helps keep the pitch of
the ringing down. Also I am currently trying
biofeedback. My doctor explained how part of
the MRl called the "gradient coils" produces the
loud noise I'd heard. He attributes my tinnitus to
the noise produced by these coils.
I was tested in a closed GE brand MRl
device, with a Tesla 1.5 magnet - a relatively
big one. I've learned that the bigger the magnet,
the better the picture - and unfortunately the
louder the noise.
If any of you have had a similar experience,
you can call MedWatch (800/FDA-0178) to report
your incident. This is the way the FDA monitors
the medical devices they have approved. Your
report is kept confidential.
Armando D. Soler, Miami, FL
Letters to the Editor (continued)
I
read with gratification your editorial in the
September 1996 issue of Tinnitus Tbday con-
cerning the training workshop at the
University of Maryland Tinnitus & Hyperacusis
Center. It was a good summary of our philoso-
phy and clinical protocol. ATA plays a critical
role in disseminating scientically-based informa-
tion such as this to its membership.
It is also rewarding to see that other profes-
sionals are seeking a comprehensive approach to
treating patients with tinnitus and/or hyperacu-
sis. We will be presenting more workshops and
will continue to lecture at professional meetings.
It is our hope that many others will avail them-
selves of this information.
Susan Gold, M.A./CCC-SF! A,
Senior Audiologist, University of Maryland
Tinnitus & Hyperacusis Center
A
s one who is afflicted by this physical
irregularity, I wish to express my
gratitude to the Tinnitus Tbday pubhca-
tion. There is a wealth of interesting input
expressed in scientific articles as well as personal
memoranda. All of this communication serves as
a source for palliating the troublesome nature of
tinnitus.
Dennis Bauman, Mequon, WI
M
y tinnitus started AprilS, 1996 when
my employer started an ear protection
plan for our company. As part of the
plan, we were all told to wear ear plugs. I did
what I was told to do and then it happened: I got
a right ear infection from the ear plugs. At our
company, we use chemicals and oil solvents that
can float in the air and contaminate the ear
plugs that we wear around our necks. This is
what started my ear infection and now 1 have a
high tension wire sound in my head. The infec-
tion was cured with antibiotics. But I have had a
buzzing noise in my right ear ever since.
The sorry part of this story, is that my
company did not show us how to use these ear
plugs correctly, to change them often and be
careful to avoid exposing them to the solvents or
chemicals.
In the future, I will ask questions first and
act second.
Jim Quisenberry, Burbank, CA
An open letter to Dr. Jack Vernon:
I
see from the latest Tinnitus that you
retired on August 15. Others w11l surely
carry the work forward, but I dare say none
will bring to it your unique combination of quali-
ties: knowledge, compassion, good humor, deep
and abiding patience, and the capacity to lend
hope.
I visited with you in person only once, on
May 11, 1978. Th this day, I remember that visit
welL You were the first person I'd met who could
explain and help me understand the noises in
my ears. You gave me your undivided attention
as I attempted to describe what was happening
inside my head, and you answered my questions
with a directness, kindness, and sincerity that
were comforting as well as informative.
So I'm writing this letter to thank you for the
knowledge and courage you've given me (and
thousands of others), and for the continuing
inspiration you provide through your personal
example and your "Questions and Answers" col-
umn in Tinnitus Today. I hope you will enjoy the
bounty and fulfillment of a long and healthy
retirement.
Bob Bergstrom, Salem, OR
Y
our magazine has been very enlightening
and informative. I cope with my "noise"
by keeping my radio tuned in to either
music or a talk show. For my insomnia, I have
been experimenting with different things such as
melatonin and Ativan, an anti-anxiety drug.
They both (not usually together) seem to help.
During the daytime, I keep busy and can put my
noises on the back burner for awhile.
I believe my problem is related to the fact
that I was a heavy quinine user for years (for leg
cramps). I now am using vitamin E and cayenne
for that problem which does a fairly good job.
Jeanne Lawson, Laguna Niguel, CA
I
have been taking a vitamin called "lecithin"
19 grams (choline supplement) and it truly
seems to help the noise in my ears. I quit
smoking years ago and believe me that really
helped to cut down the noise in my ears.
Thbacco is definitely a stimulant. Wearing a hear-
ing aid (for my deafness) also seems to lessen
the noise.
f. Marie Burgler, N. Tonawanda, NY
Tinnitus lbday/ December 1996 7
Letters to the Editor (continued)
W
hen I received the September 1994
issue of Tinnitus Tbday , I didn't read
any of the three TMJ articles because
I didn't think they applied to me, yet I was
exploring every other possible form of relief.
Without a medical diagnosis, I now believe TMJ
was a contributing factor to my tinnitus.
One year ago, I became a vegetarian and
began reading books on nutrition. I started
steaming vegetables and putting them in a
blender to make vegetable soup. My tinnitus
began improving noticeably. Then two months
ago I bought a juicer and started juicing one
meal a day using a variety of vegetables and
fruits. I was experiencing more relief. I now
'juice fast" one day a week and juice one meal a
day. I steam all other vegetables that I eat.
While talking with another tinnitus sufferer on
the phone she made the connection to chewing.
Suddenly, TMJ came to mind and I remembered
the issue of Tinnitus Tbday that featured TMJ
that I hadn't read. I finally read the articles and
identified with many of the symptoms. That
helped me understand why my tinnitus always
got worse after eating raw vegetables and
apples. To quote from "TMJ - A Profile " Yet in
light of the many successes this
span of time, we wonder what has kept TMJ-tinni-
tus treatment from taking the country by storm.
I will examine this TMJ connection even fur-
ther with the help of medical professionals.
Maybe someone reading my letter may relate to
my experience and also find relief.
Beverly Robinson, Norwich, NY
I
went to the audiology department of a large
HMO in San Diego for a simple hearing test.
In the course of the test, the audiologist said
"I am now going to make a loud noise in your
left ear for 10 seconds." Intuitively I knew this
was wrong but I didn't act quickly enough and
8 Tinnitus Thday/ December 1996
the noise test occurred. I'd told the audiologist
that I had very slight tinnitus in the right ear.
By the time I got home, I had raging tinnitus in
both ears.
The HMO claimed that the noise test had
not caused the tinnitus and further claimed that
the test "followed the American Speech and
Hearing Association guidelines to rule out any
retrocochlear pathology."
The data that might be obtained from this
test could in no way justify the risk of perma-
nent hearing damage or permanent tinnitus. In
my opinion, this is a bad test that should never
be administered. The incident occurred over
six months ago and I am still struggling with
tinnitus.
So if an audiologist proposes a noise test of
your hearing - just say no!
F James Ford, San Diego, CA.
[Ed note: The 10-second reflex decay test is
considered to be a "high level audiological test,
usually done when the basic audiological
assessment reveals something unusual. An unusual
assessment could be indicative of a serious
condition, such as a retrocochlear (or "beyond the
cochlea") tumor on the acoustic nerve. Holly
Kaplan, Co-Director of Audiology Services for
states that the reflex decay test is a quick,
m-the-office, accurate, and, yes, sometimes loud test
used to identify the presence or absence of a serious
disorder. The alternative to the reflex decay test: an
MR1 or a CAT scan. Audiologist Gail Brenner
reminds other audiologists to take complete histories
of their patients and to
establish the patients' most
comfortable and most
uncomfortable listening
levels before high level
tests are performed.
Other tests, like the ABR
and MR1 are also loud.
Brenner advises patients to
wear ear plugs for those.]
Air Bag Safety
by Barbara Thbachnick,
Client Services Manager
Air bags have given emotional
comfort to safety-hungry car
buyers since the 1980's. Air
bags have also been the darling
of car manufacturers for whom
the adage "safety sells" is a
marketing truth. But recent
media attention in USA Today,
U.S. News and World Report, the Wall Street
Journal, and on CNN has snapped the public
out of its air bag reverie. Jarring reports of the
deaths of children and small adults caused by
air bags has opened up the safety device to
severe public criticism, and has placed car
manufacturers and safety regulatory agencies
under serious scrutiny.
Air bags have never had a clean bill of
health. In a 1974 report entitled "An Invest-
igation of the Noise and Overpressure
Generated by the Safety Air Cushion," the
Society of Automotive Engineers states that
"noise resulting from the deployment of [air
bags] in automobiles has been of concern since
the use of[them] was envisaged. Coupled with
the inherently loud noise of the inflator system
is the sudden increase in pressure (called over-
pressure) in a closed passenger
Their tests with human volunteers showed that
single air cushion deployment could constitute a
hazard to human hearing. Multiple air bags
increase the hazard.
We first heard about the connection between
air bags and ears from Janet Garman.
On August 1, 1992, Janet Garman was a pas-
senger in an automobile that was struck from
behind and forced into a concrete median strip.
Both she and the driver were wearing seat belt
restraints which held them in place. The acci-
dent caused the car's only air bag - on the dri-
ver's side - to deploy. Although Garman was
not hit by the bag, and received only a minor
shoulder injury from the accident, her physician
believes that the explosive sound and sudden
increase in air pressure caused by the deploying
bag were responsible for her immediate ear
pain, muffled hearing, and severe tinnitus.
Hyperacusis set in the next day.
Air Bag Risk
Garman's post-accident tinnitus and extreme
sound sensitivity were so debilitating to her that
she could no longer work. She became reclusive
in her need to avoid noisy environments, and
began to fill her days by doing research on air
bags - the device she unequivocally blames for
the hearing damage she sustained and the drastic
lifestyle changes she has been forced to make as
a consequence.
The more data Garman uncovered, the angri-
er she grew. In her research, she found the pre-
viously mentioned 1974 government report
which detailed a warning about the physical
injuries (to ears and more) that air bags could
cause. She found two U.S. patents, one dating
back to 1979, for devices that vent the increased
air pressure in vehicles caused by air bag explo-
sions. Both patents cite injuries to the hearing
mechanism as aftereffects of air bag deployment.
Garman's research turned up more: She
learned that the angle of the bag's trajectory is
nearly constant, aimed at the chest of a belted
and upright person who is at least 5'9" and 165
pounds. (Shorter passengers would take the
brunt of the impact at head level .) She learned
that the driver's hands must be positioned at "9
and 3 o'clock" on the steering wheel to avoid
arm injuries. She learned that damage to ears is
not included in government air bag injury
statistics.
Garman has since filed suit against the auto
manufacturer for its failure to incorporate a
device to reduce or eliminate the increased
atmospheric pressure caused by the deploying
air bag, for its failure to warn consumers that air
bag deployment has the propensity to cause seri-
ous hearing impairment, and for the air bag
design itself that creates a combination of noise
and pressure of sufficient magnitude to damage
hearing. Her case is still pending.
Jim Heitz's t innitus is not air bag-related. But
his concern about the effects of air bag noise on
tinnitus and healthy ears too caused him to
mount a campaign to alert people about the
device and its potential hazard to human hear-
ing. He began by calling the National Highway
'ITaffic Safety Administration (NHTSA), then USA
Today after they featured an article about chil-
dren whose deaths were caused by exploding
passenger-side air bags. Remarkably he persuad-
Tinnitus 1bday/ December 1996 9
Air Bag Safety- Air Bag Risk (continued)
ed them to talk to each other, to Janet Garman,
to Dr. Pawel Jastreboff, to Dr. Jack Vernon, and
to ATA. (USA Tbday's first article discussing the
connection between tinnitus and air bag expo-
sure appeared on September 30, 1996.)
Heitz then heard that NHTSA was about to
make its recommendation to the Dept. of
'Itansportation that all new U.S.-made cars must
be equipped with driver and passenger-side air
bags by 1998. He also heard that there was a
small window of time - just days at that point -
during which NHTSA would consider additional
points of view. Heitz called us immediately.
We contacted NHTSA to make them aware of
the hazard posed to the auditory system by
excessive noise - dangers not only to the mil-
lions in this country who have tinnitus and
sound sensitivity, but to everyone. At the same
time, ATA's board chairman Phil Morton wrote a
personal letter to NHTSA asking the agency to
develop quieter safety devices, and in the
interim to allow installation of air bag on/ off
switches for people with medical conditions like
tinnitus that might be worsened by excessive
noise exposure.
Other ATA members have been vocal on this
issue as well. Joseph Wall has written to his con-
gressman, his newspaper, and to NHTSA asking
for the development of quieter and properly
vented air bags. Judi Lane is a short woman
who, because of her height, falls into a higher
risk category for air bag injuries. She has written
to NHTSA and to President Clinton demanding
that she be given a choice.
Susan Seidel, an audiologist at the Greater
Baltimore Medical Center, has seen three new
patients whose tinnitus and hearing Joss immedi-
ately followed exposure to air bag explosions. I
asked Susan how someone could determine that
the tinnitus resulted from air bag deployment
10 Tinnitus Today/ December 1996
and not from head trauma as a result of the acci-
dent. "You can't tell," she said. "All you can do is
listen to the patients." One of the "accidents" was
a five-mile per hour bump into a concrete park-
ing beam that triggered the dual bags to deploy.
The other two accidents were also minor. Each
patient was referred to Seidel by a physician who
determined that the ear damage and other
injuries (abrasions of face and chest, etc.) were
the result of air bag impact, noise, and pressure
change, but not from the accident. "We need to
look at the obvious pattern as a means of proof,"
says Seidel.
In 1995, James E. Saunders, M.D. published
the study, "Automobile Airbag Impulse Noise:
Otologic Symptoms in Six Patients." The patients
followed in this study all developed tinnitus,
hearing loss, and/ or disequilibrium as a result of
air bag explosions. Dr. Saunders still suspects
that the overall number of air bag-caused ear
injuries is small compared to the 96,000 air bags
that have deployed since 1986. (Actual ear injury
statistics are not available.) Saunders writes, "We
believe that the benefit [of air bags] in reducing
fatalities and serious injuries from motor vehicle
accidents exceeds the potential risk to hearing."
William Smock, M.D., head of the
Department of Emergency Medicine at the
University of Louisville, is outspoken on the
other side of this issue. He feels that air bags are
''bombs at the fingertips" of drivers. Smock and
his medical team treat one air bag injury per
month.
How loud? The decibel level of an explod-
ing air bag is estimated to be 160dB at its center;
l30dB at adult head level.
Why are air bags so loud? In the early
1970's, new federal regulation required U.S. car
manufacturers to devise ignition systems that
started only when vehicle seat belts were fas-
tened. The public vigorously opposed it and con-
gress repealed the legislation in 1973. Since that
time, U.S. car manufacturers have been required
to build air bags that are powerful enough
to protect unbelted passengers (who
account for 30% of the population).
These high-powered devices are
loud by default.
Air Bag Safety - Air Bag Risk (conti nued)
How long does the sound last? The
American Automobile Manufacturers
Association states that the deployment and infla-
tion of an air bag takes approximately 0.03 sev
onds. Vann Wilber, the AAMA's director claims
that the sound of a deploying air bag for that
short a period of time has not been identified as
harmful to human ears.
How fast? The bag's velocity at the time
of the explosion is estimated to be 200mph.
How safe? NHTSA reports that air bags
have saved 1136 lives in the past 10 years. The
passenger-side air bag is said to have saved 60 of
those lives.
How dangerous? To date, approximately
30 children, 19 small adults (16 of whom were
women), and one fetus have been killed as a
result of air bag deployment. NHTSA admits
that because children are often put in the front
seat, twice as many children are killed than are
saved by air bags. (The distance from the pas-
senger-side dash board air bag housing to the
front passenger is greater than the distance from
the steering wheel air bag housing to the driver.
Therefore the larger passenger-side bag must
deploy with more force to cover more ground.)
NHTSA concurs that air bags cause at least
as many injuries as they prevent. Air bag
injuries have included broken arms, necks,
facial bones; chest abrasions and punctures; eye
ruptures; and ear damage (tinnitus, hearing loss,
hyperacusis, and dizziness).
When do air bags deploy? Air bags in
General Motors vehicles have been standardized
to inflate if the vehicle hits a stationary object at
14 mph. Ford's standard is 13 mph; Chrysler's
standard: 11 mph. NHTSA recently reported that
five spontaneous air bag explosions have
occurred in GM cars. The auto manufacturer
and NHTSA are investigating the cause, and a
car recall is possible.
What about side bags? Because these
safety features are not required by law, their
design is not regulated. Car manufacturers are
consequently producing side bags that are more
"benign." These devices are standard equipment
in a few 1997 cars. The decibel level of a deploy-
ing side bag was not available from GM.
What can car owners do? It is against
federal law for car dealer or auto shop personnel
to disconnect air bags, or for that matter to dis-
connect any vehicle safety device, according to
attorney Ed Glancy of the U.S. Dept. of
Transportation. But federal law does not regulate
what individuals do to their own cars. It is prob-
lematic, though. Air bag wiTing is often hidden
to thwart disabling. Some people have been
injured by exploding air bags while attempting
to tamper with the apparatus. Janet Garman and
her husband were able to locate and disconnect
their car's air bag fuse without triggering the
device.
Glancy suggests that people with medical
limitations should write to NHTSA and ask for
an exemption that would allow for the profes-
sional disconnection of air bags. The agency has
exempted a few medical conditions so far, but
tinnitus and hyperacusis have not been among
them. (Glancy points out that even if exemption
is granted, state motor vehicle laws might still
require existing safety devices to be operative.)
Properly seat-belted passengers are at less
risk from air bag impact than are unbelted pas-
sengers.
Children under 13 years of age, and all sma11
people, are safest in the back seat of the vehicle.
Those who want to avoid exposure to air bag
deployment altogether might be obliged to buy
or keep older, pre-air bag era cars.
What are car manufacturers doing
to help? "Smart air bags" are in the develop-
ment stage. This safety system is being designed
to sense an occupant's weight and position in
the vehicle, and determine which bag to deploy,
when to deploy it, and with what amount of
force. This sophisticated technology could be
available in three years. Creating a venting sys-
tem to relieve the overpressurization is "techni-
cally feasible," according to GM's spokesman
Kyle Johnson.
What is the govermnent doing to
help? NHTSA is at this moment re-examining
its entire air bag policy based heavily on the
number and nature of grievances it received.
For now, it is considering "emergency air bag
action" which would mean distributing warning
Air Bag Safety Air Bag Risk (cont;nuedl
labels that tell parents to seat children in the
back seats. Installation of on/ off switches is
being considered (although it's heavily opposed
within that agency). Other changes in vehicle
safety regulations are being considered too, one
which would allow U.S. car manufacturers to
install "depowered" bags (bags that inflate with
30% less force) like those used in Canada. The
American National Standards Institute (ANSI) in
conjunction with the International Standards
Association is considering the formation of an
expert panel to study the subject of air bags.
1b the casual observer, a vehicle safety sys-
tem that unavoidably harms or kills some peo-
ple is a flawed system. But do the advantages
outweigh the risks? Should we have the right to
choose? Should engineers be working to perfect
seat harnesses, for example, instead of smarter
air bags that will still pack a decibel punch?
It's true that ATA has no official "position" on
this controversial issue. ATA also does not advise
PSYCHOACOUSTIC EQUALIZER
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SEA WAVE NOISE PROCESSOR
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TINNITUS DIAGNOSTIC CIRCUIT
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SEPARATE IN/OUT SWITCH FOR EACH SECTION
The Stereo Therapy nnnitus Masker unit contains five diHerent lvnction
sections. Each section con be used separately, or aft sections con be used ot
the same time. The various functions are easdy understood and controlled.
The live lunctionsectlons present mony diHerent sounds and noises criti<ol
in masking and treating tinnitus. Some of its major functions are:
A psydloocoosHc equalizer allows complete flexibility in the ol music for therapy
and reloxoHon. A seo-wove noise proceSSOI creates o wide vuriety of sun sounds. from plood
rolling waves to stormy seas, store-of.the-ort modulation make possible o wide variety
of sOtJnds. White noises or mtered noises ore mode possible through o 'lllrioble bondposs filter.
AR effem con be heord or modified tfvough lhe psydloocoosHc equalizer. olong with
! individual volume senings. The sin&Wove genetotm con produce single tooes hom 85Hz up to
20 kHz wilh completely isolated frequency and volume conhol. A OIOIJnostic circuit makes it
2 possible to set the ootput Yobne of lhe created noise ood tone in periect harmony to the
roosic progrom masking lhe "nnitus. The dynamic headphone omp coo be set in boklnce and
volume. Rear mounted switches Uled for vurious left/ right listening Aho o switch for
:: COjline sensitivity (high/low level) to recording cxm (Stereo) for tuping indMduolly toilored
i masking programs.
Thestate-ofllle-art design Incorporated throughout the Synphonie Relax 2
makes it the most innovative and effective tinnitus masking and therltpeuticJ
system available anywhere.
infOfmation or to place an order.
mlwcarno g. campbell route #2 p.o.box 288 vinton, VA 24179
anyone to disconnect or discontinue use of any
vehicle safety device. Were we to suggest any-
thing, it would be that you write to your elected
officials, to NHTSA, to ANSI. Would these agen-
cies have stopped to give this matter a second
thought without the letters and persistent calls?
I doubt it. Is it too late to add your voice to the
deliberations? I doubt that too.
If you have an opinion, express H. There are
some mountains to move.
"Never doubt that a small group of
committed citizens can change the world.
Indeed it's the only thing that ever has."
Margaret Mead
Resources
American Auto Manufacturers Assoc.
1 401 H St. NW #900
Washington, D.C. 20005
202/ 326-5500
202/ 326-5567 FAX
American National Standards Institute (ANSI)
11 W 42nd St
New York, NY 10036
212/ 642-4900
212/ 398-0023 FAX
Auto Safety Hotline
(U.S. Dept. ofTransportation)
Washington, D.C.
800/ 424-9393
Ricardo Martinez, M.D., Director
National Highway Traffic Safety Administration
(NHTSA)
400 7th St SW
Washington D.C. 20590
Re: Docket 11 74-14, Notice tt 100,
Federal Motor Vehicle Safety Standard H208
202/ 366-1836
202/ 366-2106 FAX
202/ 366-7800 TDD
Special thanks to Janet Garman and Jim Heitz
who were indispensable in the preparation of
this article.
Announcements
Dr. Jack Vernon to Speak at Prestigious
Oregon Health Sciences University's
Marq uam Hill Lecture Series
One of the first in the world to study and
advocate for people with tinnitus, Jack A.
Vernon, Ph.D., has been active in hearing
research for many years. A graduate of the
University of Virginia, Charlottesville, where he
received his Ph.D., Dr. Vernon was a professor of
experimental psychology at Princeton University
before coming to Oregon in 1966 as professor of
otolaryngology and director of the Oregon
Hearing Research Center. In looking for the
cause and cure of tinnitus, Dr. Vernon pioneered
the development of "maskers," which reduce the
debilitating effects of ringing in our ears. He has
become outspoken in his concern about noise
in the environment as a cause of tinnitus and
hearing loss.
Dr. Vernon's lecture, entitled "Tinrutus:
Ringing in the Ears," will take place in the
OHSU Auditorium at Oregon Health Sciences
University, Portland, Oregon, on Thursday,
January 16, 1997, at 7:30p.m. Admission is free
and there is no need to pre-register. The lecture
wi11 be broadcast live on the Oregon EdNet
satellite system, and video tapes of the lecture
can be ordered by calling 503/494-7686. (Video
cost: $15)
For further information, please call the
Lecture Hotline, 503/494-4312; or Mark Kemball,
Director, Community Relations, 503/494-7686.
The 17th European Instructional Course
on Tinnitus and Its Mangagement -
Aprill3-17, 1997- Nottingham,
England
The 17th annual course addresses the causes,
scientific background, investigation, and manage-
ment of tinnitus. It will consist of lectures with
case discussions, practical demonstrations, and a
workshop session. The course is suitable for otol-
ogists, EN'Ts, scientists, technicians, and hearing
therapists involved in, or planning to become
involved in, clinical or research work on tinnitus.
The course fee is 590 (residential) or 510
(non-residential). Both fees include comprehen-
sive notes, lunches, dinners; the residential
option also includes accommodation in a univer-
sity hall of residence. Attendance will be limited
to 80 delegates.
The course organizers are Jonathan Hazell
(Middlesex Hospital and RNID, London) and Ross
Coles (forn1erly of MRC Institute of Hearing
Research, Nottingham). The faculty includes
Adrian Davis, David Baguley, Jean Baskill, Altan
Kayan, Thrry Buffin, Laurence McKenna,
Catherine McKinney, Jacqueline Sheldrake, and
Dafydd Stephens.
This event is being organized in collaboration
with the Centre for Continuing Professional
Development (CCPD) at the University of
Nottingham.
For registration details, contact: Mrs. Eileen
Moxon, Centre for Continuing Professional
Development, University of Nottingham,
University Park, Nottingham NG7 2RD, UK.
Tel: + 44 115 9513700
Fax: + 44 115 9513722
E-mail: eileen.moxon@nottingham.ac.uk
Research Subjects Sought for Brain
Imaging Study of Tinnitus
Subjects are still needed to participate in
a study whose purpose is to identify regions
of the brain that are activated or involved
with tinnitus. We are seeking individuals who
can alter the loudness (intensity) or pitch
(frequency) of their tinnitus by: (1) moving
or pressing on their jaw, tongue, teeth, face,
neck or head or (2) moving their eyes (gaze
evoked tinnitus). Brain regions activated by
tinnitus will be identified by Positron
Emission Tomography (PET).
For details, contact:
Richard Salvi, Ph.D.: Hearing Research
Lab, SUNY University of Buffalo, Buffalo, NY
14214, Ph: (716) 829-2001, FAX (716) 829-2980
or E-mail: Salvi@acsu.buffalo.edu
or
Dr. Alan Lockwood: PET Center,
VA Hospital, Buffalo, NY 14215,
Ph: (716) 862-3450; FAX (716) 862-3462,
E-mail: alan@promo.nucmed.buffalo.edu
Tinnitus 'Thday/ December 1996 13
ATA Research Report -
An Interview with Jos J. Eggermont, Ph.D.
by Barbara Tabachnick, Client Services Manager
fos J. Eggennont, Ph.D., from the Dept. of Psychology at the
University of Calgary, in Alberta, Canada, is nearing comple-
tion ofhi.s ATA-funded study, Effects of Salicylates and
Quinine on Neural Activity in the Auditory Cortex, and dis-
cusses his research.
JE: An analogy might help here. Assume
that 100 people are in a room and they are given
the task of raising their hands when they hear a
sound above the always-present background
noise. Occasionally, some will raise their hands
when no additional sound is present (normal
BT: Dr. Eggermont, what is your goal in spontaneous activity). How does someone who
-:-c searching these two drugs? is monitoring this crowd but who does not know
JE: My research aims to find "common" when the sound is presented decide that there
changes in the activity of neurons in the audita- was an extemal or additional sound? It is likely
ry cortex produced by tinnitus-inducing drugs that when two or three people raise their hands
that have otherwise different pharma- ------- simultaneously, such a sound is pre-
cological effects. sent. One is almost assured of it when
BT: What is the benefit of identi- 10 people raise their hands simultane-
fying these common changes? ously. I propose that this nerve cell
JE: Many tinnitus-inducing drugs synchrony is the neural indication of
have a large number of other effects an external sound or abnormal sponta-
on the nervous system. For instance, neous activity as in tinnitus.
aspirin in high dose also causes visu- BT: Are you able to measure this
al experiences (visual noise), as does abnormal activity?
quinine sulfate. There are many JE: Yes, synchrony in neural activity
changes in the activity patterns of can be measured. In my research I
auditory nerve cells when they are have seen that there is always a cer-
exposed to these substances, and not tain percentage of synchrony under
all of these changes (maybe even ]os f. Eggennonr, Ph.D. no sound conditions - say 5% of the
none ofthese changes) are related to time -but it increases to 20% when
tinnitus. (There are of course many changes in sound is presented.
the activity patterns of auditory nerve cells BT: What is the connection between the
when they are exposed to outside sound.) neural activity and the tinnitus-inducing drugs in
Because it is difficult to understand the mecha- your research?
nisms that cause tinnitus, we must search to find JE: My research is designed to investigate if
correlates in the auditory system that relate to this increase in synchrony is also present when
tinnitus. tinnitus-inducing drugs (sodium salicylate and
BT: Can you differentiate between tinnitus- quinine sulfate) are administered to experimental
induced and outside sound-induced neural animals. These drugs have very different pharma-
activity? cological properties. Where quinine blocks potas-
JE: Yes, but first of all, one has to have a sium channels in nerve cells, salicylates increase
concept of what is the neural activity that the potassium flow through the membrane chan-
accompanies sound. In most parts of the audita- nels. Both drugs, however, increase the flow of
ry system, an increase in the firing rate of nerve calcium ions in a similar way. So whatever we
cells results from exposure to sound. A problem find in common for both drugs is unlikely to be
arises in the case of tinnitus: There is no exter- caused by potassium flow, and likely the result
nal reference (a sound) and therefore nothing to of calcium. This would give us an indication as
measure the nerve cells' response against. to where potential medical interference would
Furthermore, the auditory nervous system is have to take place to initiate tinnitus relief
highly spontaneously active, that is, the nerve Our findings so far indicate that, indeed,
cells fire in the absence of any sound. In a nor- administering salicylate and even more so
mal situation, this spontaneous activity is quinine increases the synchrony of nerve cell
ignored and one does not hear anything. firings in the absence of any sound. It is as if the
BT: How can you tell when normal or abnor- cells react to an external sound that is not there! I
mal spontaneous activity is occurring? think that this is the neural correlate of tinnitus.
14 Tinnitus 'Ibday/December 1996
Self-Help and Support -
THE NETWORK GROWS!
With sincere thanks to all of our support
givers- "old" and new- for the immeasurable
gift they give to their communities - the gift
of themselves. Whether they offer help on the
telephone or as a support group leader, they
make a very real difference in the lives of very
real people.
A fond goodbye to Shirley Rosenhaft,
Washington D.C. area's support group leader for
11 years, and Mort Rosenhaft, her righthand
man. Shirley is turning the group over to Ann
DePaolo in January, but will continue to take
phone calls and serve as ATA's regional repre-
sentative to the National Voluntary Health
Agencies. Thank you, Shirley and Mort!
If you would like to join ATA's Support
Network as a help-giver, please write for our
Self-Help Packet of information. ATA, PO Box 5,
Portland, OR 97207.
Shirley and Mort Rosenhafi
New Support Groups
Dhyan Cassie
131 Rockview Ave.
Plainfield, NJ 07060
908/754-6043
Ann DePaolo
8218 Wisconsin Ave #102
Bethesda MD 20814
301/ 656-0257
Benjamin Franklin
PO Box 174
Saginaw, AL 35137-0174
205/664-9409 (voice or fax)
Frank Agosta
Family Hearing Center
32500 Van Dyke
Warren, MI 48093
810/939-5000
Milly Walker
2001 Wynchwood Dr.
Austin, TX 787 46
512/327-1593
New Telephone/Letter Contacts
Robert Ehrmann, M.D.
315 Wood ward St
Waban, MA 02168-2021
617/527-8426
Yolanda Kapalo
1940 Michigan Ave.
West Mifflin, PA 15122
412/466-0963
Myrna M. Calkins
1409 Girard Blvd. SE
Albuquerque, NM 87106
505/268-8754
Letters Only
Dawn Michelle Wilson
2429 23rd St #103
Spirit Lake, IA 51360
New International Contacts
Thm Orr
Ulster Tinnitus Assoc.
9 Glebe Gardens
Glengormley
Belfast BT36 6ED
IRELAND
Mrs. Ursula Beurgin Gadient
Schweizerische Tinnitus-Liga
Postfach
Zurich CH-8052
SWITZERLAND
Christopher Fentum (support group)
50 Rose hill Ave #611
Toronto ON M4T1G6
CANADA
416/926-9267
Phone Number Correction:
Steve Ratner, Boynton Beach, FL, 561/734-4853
Tales of Tinnitus and Recovery,
Part N- Terri's Return
by Elliot Wineburg, M.D.
Through my two decades of medical practice
specializing in stress-related disorders, I have
learned to be open-minded about diagnoses - in
particular about the diagnosis of tinnitus.
Patients have taught me more than any text
book.
This young woman's story is an example of
how a hidden symptom can influence a patient's
ability to return to health, comfort, functioning,
and peace of mind.
Thrri is an Ivy League law graduate, working
for the first time in a new metropolitan environ-
ment. Somewhat in contrast to her staid educa-
tional background, her greatest after-hour joy
was singing with a small rock group. Her tinni-
tus began four years ago when she had been
working with a band for several months. After a
particularly intense session, she began to notice
a faint hissing in the ears.
She continued singing for another two
months but used ear plugs to reduce the sounds
of the amplified instruments. The tinnitus did
not abate and finally a year later, much to her
regret, she quit the group. The hissing continued
in both ears and then a new tone began on the
right side. She was obliged to wear ear plugs
when riding New York subways and when going
to bars that had only moderate background
noise. Within a few months, the hissing became
louder and all outside sounds seemed to be too
loud. Even the telephone at times was unbear-
able. She found that ear plugs were necessary all
ofthe time.
At the same time, Terri had a sense of melan-
cholia. She did not feel normaL Interest in out-
side activities and work was diminished.
Consultations with audiologists and otolaryn-
gologists showed her hearing was "normal." The
only advice she received was for her to protect
her ears as much as possible and
reduce stress. A sense of dread
increased as a depression
gained hold. She became
obsessively concerned with
health. Ideas of major bodily
disorders could not be shaken.
She would feel for breast cancer again and again
in the shower although there were no lumps.
A standard diagnostic test for depression was
administered. Specifically queried, Thrri replied
that she felt downhearted and blue most of the
time. She felt hopeful about the future none of
the time and was more irritable than usual most
of the time. Highly indicative of depression was
her answer to: "I feel that others would be better
off if I were dead" - a thought she had a good
part of the time.
One of our standard questions often yields
the most revealing answers: "How would your
life change if the tinnitus left completely?" Her
response was immediate: "Sheer joy and exuber-
ance for a while and then an increased capacity
for moving on with my life and destroying the
negative aspects.'' Diagnostically, the patient
presented a duality of syndromes not unusual,
namely tinnitus superimposed on true depres-
sion. Our approach has always been to assist the
patient both pharmacologically and behaviorly.
A modern antidepressant in the grouping called
SSRI's (serotonin selective reuptake inhibitors)
was given. As always, a small dose was inaugu-
rated to be increased if the symptoms of depres-
sion did not abate with time. Antidepressants,
the patient was told, do not work instantly the
way an aspirin or a sleeping pill can. They may
not
11
kick in" for a month or more.
In addition, depression does not lift over-
night. She was told that a depression clearing is
something like clouds on a very bleak and over-
cast day, that move to allow a little bit of sun to
peek through at first, then give way to pro-
longed periods of brightness. Finally, the clouds
are rare and the normal light of day is present.
Terri's behavioral treatment commenced
with biofeedback. Electrodes were placed over
her jaw area. She was then instructed to relax
the complex muscles that tighten up the jaw. By
gently putting a pinky finger into each ear and
moving her jaw up and down, she reported
being aware of the temporomandibular jaw joint
(TMJ) movement right within the ear canaL
The electrical sensors over the jaw pick up the
minute electrical impulses associated with mus-
cle activity beneath the skin, somewhat analo-
gous to electrocardiogram readings from the
Tinnitus Poetry Book- Available now!
Never Again To Know A Noiseless Shooting Star
edited by Daphne Crocker- White, Ph.D.,
paperback, 32 pgs.
From the editor's preface to the book: "It
has been my privilege to be the recipient of so
many valiant poems ... The courage and tenaci-
ty of the authors' quest to understand their
suffering, to make a personal truce with their
unrelenting noise and in many cases to
surrender to the inevitable with good humor,
has been awe inspiring .. .I salute the authors
of this anthology."
The title Never Again 7b Know A Noiseless
Shooting Star comes from a Lucille Whitehurst
poem, which is included in the book.
To order, send $10 plus $1.50 shipping and
handling to:
Daphne Crocker-White
1290 Howard Ave. #323
Burlingame, CA 94010
Make checks payable to:
Tioga 'Irading Company
(California residents, add 85<J; tax per book.)
D1: Crocker-White is generously donating aU proceeds
from this book to ATA.
Tales of Tinnitus and Recovery, Part N (continued)
heart. Watching her response on a dedicated
computer, Terri observed increased lines on the
computer screen corresponding to more tension
and fewer lines corresponding to reduced ten-
sion when she relaxed. She learned quickly to
relax and noted a definite decrease in the tinni-
tus level as a result.
Her music training proved an excellent
support for biofeedback therapy. She learned to
do deep diaphragmatic breathing which is a
most effecbve way of reducing overall tensions.
When the tinnitus was threatening, the deep
breathing was an effective way of controlling the
apprehension.
The antidepressant began to take effect after
the second week. She noted then that she felt
less oppressed, that her anxiety was lightening,
and that she was more optimistic about her
future. As the tinnitus became more manage-
able she ventured again to concerts and even
rejoined her rock group, albeit with ear plugs
in place.
This case history brings up the question of
which came first: the tinnitus or the depression?
Whichever is true, therapy was successful when
both conditions were treated simultaneously.
Biofeedback is offered by some physicians,
by biofeedback specialists, and by other health
professionals such as physical therapists.
Biofeedback alone is effective wHh many tinni-
tus patients. But when there is a possible bio-
chemical imbalance causing depression, a
pharmacological approach must be considered.
Modem antidepressants have far fewer side
effects than the older drugs and are well-tolerat-
ed by most patients. In the case of a dual diag-
nosis like Thrri's, two specialists in close
consultation with each other - one to adminis-
ter medication and one to provide biofeedback
therapy - may be required to provide adequate
treatment.
Terri remains in therapy but mainly for the
purpose of having her medication monitored.
Every few weeks she reports continued
improvement and lack of notable side effects
from the drug. It is anticipated that she will be
weaned off the medicine soon. Her prognosis is
excellent. She has definitely returned - to the
joy of music, and to life.
Media Noise
The French Parliament recently gave final
approval to a measure that limits the volume on
personal (Walkman-type) stereo players. The
measure prohibits the sale in France of personal
stereos that produce sounds louder than 100
decibels. (Some personal stereos have an output
as high as 126 decibels.) The French govern-
ment accompanied the measure with the warn-
ing that loud music was creating a generation of
deaf people.
Tinnitus Today/ December 1996 17
Questions and Answers
by Jack A. Vernon, Ph.D., Oregon Hearing Research
Center
[QJ
Ms. L. from Washington, D.C. sends a
report that states that artificial flavorings
contain sodium salicylate, the ingredient
in aspirin that exacerbates tinnitus. The report
estimated that the average person consumes
about 125 mg. of sodium salicylate daily in the
form of artificial flavorings. Ms. L wonders if
these flavorings could be affecting her tinnitus.
A baby aspirin contains 80 mg. of
sodium salicylate which is not enough to
influence tinnitus. I would guess that 125
mg. of sodium salicylate would have little or no
effect upon tinnitus for most people. If, however,
125 mg. of sodium salicylate did exacerbate tinni-
tus, the effect would be temporary. It would be a
matter then simply to avoid artificial flavorings.
[QJ
Mr. F. from Arizona asks, "Is my hearing
aid dispenser just trying to sell me a
$1000 hearing aid or are his claims of tin-
nitus relief with the hearing aid correct?
It all depends upon the pitch of your
tinnitus and the location of your hearing
loss. For example, if you have a hearing
loss in the relatively low frequencies and if you
also have relatively low-pitched tinnitus then the
hearing aid may do exactly what he claims. On
the other hand, if you have a high-pitched tinni-
tus it is likely that the hearing aid will be of little
relief to the tinnitus. We have referred many tin-
nitus patients to hearing aid dispensers for the
fitting of tinnitus maskers only to have the dis-
penser insist upon fitting hearing aids which
offered little or no help. You can determine
almost immediately if the hearing aid will work
to relieve your tinnitus by simply putting it in
your ear and listening for your tinnitus in that
ear. Conduct this test in an area of normal envi-
ronmental sounds and not in a sound-shielded
room.
You indicate that your dispenser said that the
hearing aid would also produce residual inhibi-
tion, that is, reduction of tinnitus for a period of
time after removal of the hearing aid. That is not
true. Residual inhibition occurs in about 85% of
those using a tinnitus masker but never from
use of a hearing aid even when the hearing aid
effectively masks the tinnitus. We did a study of
592 tinnitus patients, all of whom could be effec-
tively masked by one or more of the three forms
of maskers: hearing aids, tinnitus maskers, and
tinnitus instruments (combination units of hear-
ing aid and masker). In 16% of the cases, hear-
ing aids alone were effective; in 21%,
tinnitus maskers were effective; and in 63%,
the tinnitus instruments were effective. In these
592 patients, residual inhibition only occurred in
those using either the tinnitus masker or the
tinnitus instrument. Because so many tinnitus
patients have hearing loss, we usually try
hearing aids first as a relief procedure for
tinnitus but, as you can see, hearing aids alone
are effective in a relatively small number of
cases and most frequently the tinnitus instru-
ment is required.
[QJ
Mr. J. in Michigan asks if aspartic acid
and phenylalanine in the vitamin supple-
ment he takes could have caused the
rather sudden increase in his tinnitus. He indi-
cates that at the same time the tinnitus went up
he also suffered an additional 30% loss ofhis
hearing for unknown reasons. He has been diag-
nosed as having Meniere's Disease.
Mr. J., I think it is highly likely that your
increase in tinnitus is due to your
hearing loss and not to the vitamin sup-
plements you are taking. As hearing goes down,
tinnitus almost always appears to increase. If
you insert an ear plug in your tinnitus ear, you
will probably perceive a marked increase in the
loudness of your tinnitus in that ear. The tinni-
tus, in this case, has not actually increased but
rather your hearing ability has been decreased
so that the distracting and interfering effects of
ordinary environmental sounds are not as effec-
tive as usual. It might be a good idea to cease
taking the vitamin supplement for a period of
time to see if the tinnitus level drops. Obviously,
if cessation of the vitamin supplement reduces
the tinnitus loudness then continued cessation
would be in order.
We find that tinnitus in the majority of Meniere's
patients is easily masked. I'd encourage you to
try it. You can get some idea about masking by
Questions and Answers (continued)
conducting what I call the "faucet test." Stand
near the kitchen sink with the water running
full force. If the sound of the running water
makes it difficult to hear your tinnitus then it is
likely that wearable tinnitus maskers will pro-
vide tinnitus relief for you. In the presence of
tinnitus plus hearing loss it is almost always nec-
essary to use a tinnitus instrument.
[Q]
Mr. P. from Illinois asks, "I have been on
Xanax for six weeks and my tinnitus is
all but gone. Do I continue on this drug?"
Whether or not you will continue to
require Xana.x is not known at this point.
With your prescribing physician's con-
currence, I would recommend the following:
Continue taking Xana.x at your present dose
level for one month and then taper off. To taper
off, take 0.5 mg twice a day for three days, and
then take 0.5 mg once a day for three days, and
then stop altogether. Wait one month and at the
end of that time go back on the Xanax, if neces-
sary. If you do return to Xanax, it would be best
to alternate one month on and one month off.
Let me repeat, it is essential that your prescrib-
ing physician concurs with this program.
[Q]
Ms. K. from Virginia states, "I have heard
the term 'residual inhibition' but I do not
know what it means or the significance
of it. Is it an indication that masking is working
and thus that masking would be a proper
approach for relief of tinnitus?"
Residual inhibition is the temporary
and brief reduction or disappearance of
tinnitus after a period of masking. Even
though residual inhibition is not the purpose of
masking, it could be viewed as a simple bonus
when it occurs.
In a study of 1,451 tinnitus patients attending
the Tinnitus Clinic at the Oregon Hearing
Research Center, a standard test for residual
inhibition revealed that 33% had paTtial residual
inhibition, 53% had complete followed by partial
residual inhibition, 2% had complete residual
inhibition not followed by partial inhibition, and
12% had no residual inhibition at alL Combined
data indicate that 88% of a rather large sample
of tinnitus patients displayed some form of
residual inhibition.
The test for residual inhibition used in our
Tinnitus Clinic is to apply a band of noise (3000
Hz through 12,000 Hz) at the minimum masking
level plus 10 dB for 60 seconds after which the
quality and duration of residual inhibition is
measured. In the 1,451 patients indicated above
the average duration of residual inhibition was
64 seconds.
We do not know what meaning to attach to
residual inhibition but it does not indicate
whether or not masking should be attempted.
[Q]
Mr. T. in Thxas asks the following: "I
have been diagnosed as having "noise-
type" tinnitus. I thought tinnitus was
tinnitus. Are there different kinds of tinnitus
and do the different kinds have different caus-
es?"
"Noise-type" tinnitus simply means that
your tinnitus is best matched by a band
of noise rather than a single tone. A
single tone is like hitting a single key on a
piano. A noise is like hitting many keys on the
piano simultaneously. Most forms of noise tinni-
tus are best described as a hissing sound which
means that the center of the noise band is locat-
ed at a high frequency. Thnal tinnitus is more
prevalent than noise tinnitus. In a sample of
1,544 patients seen here in our Tinnitus Clinic,
79% had tonal tinnitus, 21% had noise tinnitus,
and some patients have both a tone and a noise.
When those same 1,544 tinnitus patients were
asked to rate the severity of their tinnitus on a
10 point scale where 10 is the most severe tinni-
tus imaginable, those with noise type tinnitus
had an average rating of 5.5 while those with
tonal tinnitus had an average rating of 7.5. From
these results I would conclude that tonal tinni-
tus is perceived as being more severe than noise
tinnitus.
A long time ago we thought that the description
of tinnitus might be related to the cause of the
tinnitus. Unfortunately that is not the case.
The "T" Word is Getting Out!
ATA PSAs Hit the Airwaves
by Corky Stewart, Special Projects Coordinator
It has taken a long time and the participa-
tion of a great many ATA members and support-
ers but the American Tinnitus Association
Public Service Announcements (PSAs) are now
in use.
From Thmpa to Seattle, Houston to Syracuse,
in Grand Rapids, Providence, and Ottumwa, TV
viewers have been treated to Thny Randall,
Jerry Stiller, and William Shatner discussing "the
T word." For many it was the first time they'd
William Shatner
heard that there can be help
for their tinnitus.
Moving with the times, the
PSAs were transmitted by
satellite feed to more than
700 TV stations. This was
augmented with the distribu-
tion of hard copies to the 100
stations with the largest audi-
ences. So far, there have been nearly 400 usages.
But we're hoping for thousands and need your
help to make that happen.
WANTED!
HEARING-AIDS AND/OR
MASKERS IN ANY CONDITION
If you have ever wondered what to do with those
aids that are just sitting in the drawer, think no
further. ATA will be happy to receive them.
Donations to ATA are tax deductible, and we'll
provide an acknowledgement. Simply package
them up carefully (a small padded mailing bag is
fine) and send to:
ATA, PO Box 5, Portland, OR 97207.
If you are using UPS or another shipper, ship to our
street address: 1618 SW 1st Ave., 11417,
Portland, OR 97201.
What happens to the aids that you turn in? In
some cases they can be repaired and given to
needy people or used in charitable missions to
underdeveloped countries. Even if they can't be
reused as is, the parts are needed for repairing
other aids. (And the plastic is recycled.) Your old
aid could give someone the gift of hearing!
20 Tinnitus 1bday/ Oecember 1996
Contact your
local station and
encourage them
to show the ATA
Public Service
Announcements.
(If they've
already used
them this will
reinforce that Tony Randall and Jerry Stiller
use.) Thll them
they should have all three on file from the
11
Galaxy 4/Transponder 7 Satellite Distribution"
on May 23 and 30. If they don't have a file copy,
they can fax us at (503)248-0024 and we'll send
a tape directly to them. Since each station has
specific size requirements, this is the most cost-
effective method for filling requests.
Once again, special thanks are in order to
Messrs. Randall, Shatner, and Stiller for donating
their time and that of their crews; to Megan
Vidis for facilitating final production; and to all
the ATA members who contributed funding for
the project. You truly made it possible for ATA to
reach tinnitus patients everywhere
Questions and Answers (continued)
[Q]
Ms. H. in Michigan asks if Evening
Primrose Oil (EPO) is known to be help-
ful for tinnitus. She has taken it on three
different occasions and each time the tinnitus has
disappeared for extended periods. She included
an article written about EPO which was highly
laudatory.
I need to reserve comment on EPO until
we have more information. I would like
to ask our readership to share any
experiences they may have had with Evening
Primrose Oil.
Dr. Vernon is available to take phone calls on
Wednesdays, 9:30a.m.- noon and 1:30- 4:30p.m.
(503/ 494-2187). Please send your questions to:
Dr. Vernon c/o ATA, Tinnitus Today PO Box 5,
Portland, OR 97207
A Success Story
ATA's Regional Meeting in Maryland
by Barbara Tabachnick, Client Services Manager
and Corky Stewart, Special Projects Coordinator
Our second Regional Meeting for patients
and professionals was held on September 26,
1996 at the University of Maryland's Inn and
Conference Center in College Park, Maryland.
Ninety-nine people packed the session room to
hear Gloria Reich, Ph.D., Stephen Epstein, M.D.,
Pawel Jastreboff, Ph.D., Nancy Good, MSW,
Susan Seidel, M.A./CCC-A, Trudy Drucker, Ph.D.,
and Barbara Thbachnick, ATA Client Services
Manager. The discussion during the morning ses-
sion, which was a combined session for patients
and professionals, covered the theoretical and
probable causes of tinnitus; current treatments
including auditory habituation, biofeedback, and
masking; an update of research; and a look at the
professional's and patient's joint responsibility to
effective health care.
L-R: Dhyan Cassie, M.A./CCC-A; Susan Seidel, M.A./CCC-A
L-R: Stephen Epstein,M.D.; Pawel fastreboff, Ph.D.
After lunch, two simultaneous sessions were
offered - a self-help workshop of support giving
and getting techniques plus a biofeedback
demonstration, and a professional's session with
hands-on fittings and patient management dis-
cussions. The attendees were free to choose
their preferred session. (Many wanted to attend
both!) The participants' evaluation of the meet-
ing was overwhelmingly positive.
The purpose of ATA's continued regional out-
reach is to create a greater basic understanding
of tinnitus, to improve the dissemination of
information about treatments that work to
I
attract additional researchers and research funds
to the study of tinnitus, and to expand ATA
membership and support. We feel we were suc-
cessful on all counts.
Next ATA regional Meeting: California.
Details in March 1997 Tinnitus Tbday.
ATA On the Road Again
by Pat Daggett, Assistant Director
Fall, as always, is a busy season for hearing-
related meetings, and ATA staff members repre-
sented our organization at many of them.
The ATA booth at The International Hearing
Society (IHS), held August 28-31, attracted old
friends - Diane Bootz, Jacksonville, FL self-
help group coordinator and her family; Nancy
Ahrens, professional referral from New Jersey;
Executive Board member, Sam Hopmeier; and
hundreds of new friends who were attending
this annual meeting. IHS President-elect Kathy
Harvey is a long-time volunteer for the ATA.
The American Academy of Otolaryngology
(AAO) celebrated its lOOth year anniversary this
September. Among the awards presented at this
annual convention was the Percy Memorial
Research Award presented to Carol A. Bauer,
M.D. for her study, "A behavioral model of
chronic tinnitus in rats." Dr. Bauer's earlier work
about tinnitus was supported by ATA. We con-
gratulate her on this latest effort. ATA volun-
teers Mort Rosenhaft and Ann DePaolo assisted
Gloria and me in the AAO exhibit hall. Their
efforts were most appreciated!
Gloria Reich also attended the American
Neurotology Society annual meeting in
September for their presentation "Tinnitus
1996." This program was organized by ATA advi-
sory committee member; Robert Dobie, M.D.
Tinnitus-related presentations were made by
. - ,---- ------
i" '>!
- - ~
~ .. ! ! f ) ' , ~ . ~ - .
Pat Daggett at Bremerton, WA health fair
22 Tinnitus Thday/ December 1996
other ATh advisory committee members John
House, M.D.; Alexander Schleuning, M.D.;
Abraham Shulman, M.D.; and Robert Dobie,
M.D., plus Douglas Mattox, M.D.; Richard
Miyamoto, M.D.; Aristides Sismanis, M.D.;
and Wallace Rubin, M.D. A renewed interest in
tinnitus was indicated by the packed room and
the many questions from the audience. This
society is formulating protocols for tinnitus treat-
ment that will be available both as a resource for
physicians who treat the problem, and as infor-
mation for health maintenance organizations.
erican Tinnitus
L-R: Diane Bootz, Pat Daggett
More than five thousand doctors attended the
convention of the American Academy of Family
Physicians, October 3-6. This is a relatively new
meeting for ATA, but clearly an important one.
With the changes in HMOs, the family physician
will more and more be the first point of contact
for the tinnitus patient. The doctors' overwhelm-
ing response to our materials substantiated the
need for more professional education.
The Bremerton, Washington, Naval Shipyard
Combined Federal Campaign Health Fair sur-
vived high winds and threatening rains to
launch that charitable drive for this year. Similar
CFC activities are taking place across the coun-
try and we want to thank all the volunteers who
act as our spokespeople! (Remember to send a
copy of your designation pledge form to our
office if you contribute to ATA through the
CFC. We don't want you to miss any copies of
Tinnitus 'Ibday.)
Focus is Manifestation, Part II
by Mayte Picco-Kline
"What can I truly do?" l wondered in desper-
ation when both tinnitus and hyperacusis were
unbearable. My initial reaction two years ago
was of rejection and denial - I didn't want to
believe my life had changed so drastically. Then
I went through a stage of chaos and confusion.
After ten weeks of high emotional stress, I knew
nobody was going to be able to help me unless I
truly allowed myself to be helped. This was a
turning point, my determination to take charge
of my healing process as much as I possibly
could. By focusing on wellness, I was ready for
wellness to manifest.
My process thereafter involved three major
elements: meditation, an aspect of human prac-
tice used throughout the ages; the desensitiza-
tion program developed by Dr. Jack Vernon,
former director of the Oregon Healing Research
Center at Oregon Health Sciences University;
and the process of auditory retraining proposed
by Dr. Pawel Jastreboff, Director of the Tinnitus
& Hyperacusis Center at the University of
Maryland.
Meditation -A Way to Concentrate
on Wellness
I wondered. But I persisted. Not too long after-
wards I discovered that silence could have a dif-
ferent meaning when I totally focused on my
inner thoughts. I discovered that my thoughts
were even more profound and powerful than
tinnitus! I was experiencing a different "kind" of
silence!
In a few weeks, I found that I was more and
more relaxed throughout the day, that I could
think with more clarity, and that I was beginning
to pay attention again to my usual goals and
activities.
Meditation has helped me greatly to concen-
trate my prayers and to gai.n self-knowledge
about my life and the areas in which I needed to
heal. I still discover wonderful insights many
mornings.
Desensitization -A Way to Manage
Hyperacusis
Not being able to leave the house for the lack
of tolerance to the sounds of the road due to
hyperacusis, in my search for additional
resources to counteract the devastating effects of
hyperacusis, I contacted Dr. Jack Vernon who
suggested desensitization exercises. His approach
was kind, encouraging and full ofhope.
According to Dr. Vernon, retraining the ears
to tolerate normal sounds can be accomplished
by listening to a low frequency (200Hz-6000Hz)
pink noise audio tape. The idea is to listen to the
tape at the highest possible comfort level for two
hours each day. During the retraining program it
is important not to over-protect the ears with
earplugs, for to do so is to increase the intoler-
ance to sound. It can be possible to gradually
establish higher listening levels until loudness
tolerance is back to normal. It could take two
years to achieve retraining.
I decided to follow this protocol to the best of
my understanding. Listening to the tape was
very difficult in the beginning, but with time it
became easier. For the first five or six weeks I
engaged in the desensitization exercises four to
five days a week, 45 minutes to several hours a
day - as much as my ears seemed to tolerate.
And it worked! Soon I noticed that a few of the
previously very unpleasant sounds were not dis-
tressful anymore. T was able to go out and
Focus is Manifestation, Part II (continued)
enjoyed the sounds of the streets and enclosed
places again. I was healing.
Dr. Vernon recommended to continue using
the tape on a regular, but reduced schedule. As
things became better and better, I used the tape
only every other day for several weeks, then for
one hour at a time, one-half hour, etc. Three
months later I didn't feel the need to use the
tape anymore, and I haven't since. Improvement
continues to show.
Auditory Retraining - A Way to
Manage Tinnitus
Three months later - and after a 14-month
waiting period - I finally visited the Tinnitus &
Hyperacusis Center of the University of
Maryland in my attempt to alleviate the tinnitus.
The Center employs a unique, multi-disciplinary
approach to the treatment of tinnitus and hyper-
acusis. Personal and continuous attention from
Dr. Pawel Jastreboff, Dr. William Gray, and
Susan Gold, Audiologist, has been a trademark.
Although there is no way currently to correct
the damage in the cochlea that causes genera-
tion of the tinnitus signal, it is possible to modifY
the way the brain responds to the tinnhus signal.
Habituation to tinnitus could be accomplished
by a combination of counseling and the use of
therapeutic broad band noise devices with very
low levels of noise stimulation. As time goes on,
the brain can habituate to the sound of the tinni-
tus and find it less intrusive. The idea is to use
the devices for at least six hours a day, prefer-
ably longer, for a period of one to two years. It is
recommended also to avoid total silence either
by wearing the devices or by experiencing a con-
tinuous exposure to a mild level of environmen-
tal sound, or both.
From 1988 to 1995, Dr. Jastreboff and associ-
ates have seen over 600 people at their clinic in
Baltimore. One hundred and thirty of them, who
received treatment for at least six months, were
surveyed to assess results. Over 80% of them
show significant improvement, both in
decreased annoyance induced by tinnitus, and in
developing clear habituation. A number of them
have stopped using the devices because tinnitus
ceased to be a problem. Recent long-term results
showed that about 20% of the people report they
24 Tinnitus 'Tbday/ December 1996
are unable to hear tinnitus and have had no
relapses in four years. About 2,000 people have
been seen in a similar program in London for
the last five years with similar results.
After listening to this evidence I knew what r
needed to do. My initial purpose was to wear the
noise devices for at least eight hours daily. Using
them wasn't easy in the beginning. My ears felt
tired after a short while, but again I persisted.
After three or four months, the devices were like
contact lenses - a part of my morning routine,
and I could wear them all day long. A few weeks
after that I realized that I could totally forget tin-
nitus for hours at a time!
Now, one year later, my level of concentra-
tion is fully recovered. I sleep very well (after
having experienced major insomnia) and am
reintegrated into all my personal and business
activities. I am beyond tinnitus.
On a scale of 1 to 10, tinnitus has dropped
from 9-10 (extreme severity) to 1-3 (often not
aware of it with brief periods of no tinnitus at
all). Regarding hyperacusis, discomfort level to
normal sounds has dropped from 7-9 (very
affected in work, sports, social) to 1-3 (minimum
effect to no effect at all). According to Dr.
Jastreboff, the treatment is almost complete. He
has recommended that I use the devices for six
more months to assure no recurrence.
Focusing on what I would like to see mani-
fested - my wellness - has been a key element
in the healing process. And through the practice
of meditation I have a better understanding of
my responsibility for my health. My deep appre-
ciation to Dr. Pawel Jastreboff and associates,
and to Dr. Jack Vernon, for their exceptional
medical contributions to my process.
WANTED
Want To Buy:
Microtek 321 Q Tinnitus Masker
Please call Major Doug Melton
502/766-1097
Tributes, Sponsors, Special Donors,
Professional Associates
Champions of Silence are a select group of donors demonstrating their commitment in the fight
against tinnitus by making a contribution or research donation of $500 or more. Sponsors and
Associates contribute at the $100-$499 level. ATA's tribute fund is designated 100% for research. We
send our thanks to all those people listed below for sharing memorable occasions in this hopeful
way. Contributions are tax deductible and are promptly acknowledged with an appropriat e card. The
gift amount is never disclosed. GIFTS FROM 7-1 6-96 to 10-15-96.
Champions of Silence
Vince Majerus Betsey Decker Ronald C. Bricker
Thomas w. Buchholtz, M.D.
Vince A. Mangus Mr. and Mrs. Nathan Markowitz Janie Brooks
Jack D. Clemis, M.D.
Anne Holmes McKay
J ohn E. Greve (twin brother)
August Brown
Rob M. Crichton
Ed Leigh McMillan II
Mr. and Mrs. James Cooper
Charles T. Brown
Glen R. Cuccincllo
Douglas L. Melton
Rut h Heel
Donna F. Brown
Michael D. Deakin, C.P.A.
Stewart Mott
Roberta Thornburg
Barbara J. Calandri
Sukey Garcetti
Robert E. Naser
Cathe rine J acobsen (wi fe)
DouglasS. Campbell
Roth Family Foundation
Bobby R. Payne Peter 1::. Campbell, C.F:X.
C. Rod Granberry, Jr.
Loretta M. Rose
Robert Jacobsen
Mildred Capelin
Edmund ,J. Grossberg, C.L.U.
James L. Schiller Peter Kalian (brother), Erwin Caraballo
Khairy A. Kawi, Ph. D.
Alan I Segan
Cl a ude Pa rsons ( husband):
Evelyn M. Carlson
Ann Klimc7.ak, Pres.
Patricia and Richard Smith
Doreen D. Parsons
John P. Charles
The Barn Sale, Inc.
Martin V. Socha Mary T. Laskas, Dario 0. Chiarini
Marian B. Lovell
Richard V. Sowa and
S. N. "Dyke" Thlkas: Gerald E. Cieslinski
Gloria E. Reich, Ph. D.
Ms. Sam Churchman
Margaret Levcntis Patsy Cilurzo
Robert Gerard Sullivan
J oseph Schellenberg
Rose E. Cordero
Sponsor Members Anne M. Thomas
Dr. Anthony Greis.
John l. Cordy
F. Edwin Adkins J. E. Tinney
Dr. J. Brian Greis, and staff
Lillian E. D'Amato
Joe H Anderson, Jr. J.E. Tinney Family 'Ihlst
of Lake County Women's Health
.Mary Holmes Dague
John J. Banavige Patricia A. Thcalino
Care and Infertility Institute
Kevin W. Davidson
M. Craig Bell John D. Thrmedis
Edward 'Thubman
Ralph Davidson
Maurice Berk Dan and Sally Vallimarescu
Sam and Sylvia Eisenberg
Angela F. Delvillar
Deborah and Charles Bern Megan Vidis Jeffrey J. Derossette
Diarmuid Baran Thomas K. Webb
Agnes Van Patten
Joseph Dichristina
Ronald R Bowden Theodore M. Wight
Elizabeth Van Patten
Scott Dtebold
E. Ayres Boyd Brian and Karen Woolsey
In Honor Of
Ellen D. Dietz
Richard W Brunner Paul W. Zerbst Eva A. Dimitrov, M.D.
Arthur Cellint
Professional Associates
George Abelscth
Lynn Ditlove
Frederick w. Champ
(80t h birthday)
Evelyn Dolinko
Kenneth R. Cherry
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s 1 996 draws to a c lose, tl1e Board and Staff of AlA
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ith your :;upporl, ATA accomplished much in 1996, includini!:
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We greet 1997 with renewed energy and enthusiasm
because we have "auld acquaintances" like you. Tlzank you!
Most patients who have a long history of noise exposure
complain of tinnitus which is tonal in quality and high-pitched.
Of 153 clinic patients who reported having tinnitus as the
result of being exposed to high intensity noise, 141 or 92.2%
of them matched their tinnitus to external tones above 3000
Hz. Most often, the tinnitus is bilateral but occasionally
patients observe tinnitus only on one side.
HEARING CONSERVATION PROGRAM
WHAT YOU CAN DO
1) Reduce the amount of time you are exposed to
the noise (avoid noise whenever possible).
2) Reduce the noise at its source.
3) Use personal hearing protection (ie: ear
plugs . .. ear muffs).
OSHA has mandated that Hearing Conservation Programs
be initiated if noise levels exceed 85 dBA. Many companies
have developed programs within those guidelines but others
have not. Furthermore, due to differences in susceptibility to
noise, some people may develop hearing loss and/or tinnitus
from noise levels below 85 dBA. There are no published
levels of noise which are known to induce tinnitus but, again,
these levels appear to vary from patient to patient It is also
common for patients who already have tinnitus to observe an
exacerbation of their tinnitus whenever they are exposed to
noise Shortly after being removed from the noise, the
tinnitus will retum to its original level. However, over time the
loudness level of the tinnitus can gradually increase unless
the ear is protected. Therefore, It Is Important for people
who begin to observe a mild loss of heari ng or tinnitus
to take the Initiative to Implement a hearing conservation
program for themselves. Personal hearing protective
devices are available from safety equipment suppliers and
also from hearing product distributors. These devices come
in many different forms and are reasonably priced. If used
properly, they can help safeguard the ears against further
damage.
HOW TINNITUS AFFECTS YOU
Many people with tinnitus report that they have had to curtail
social activities. Some tinnitus suHerers have had to quit
work or change their jobs. Many report that they can no
longer attend functions known to be noisy such as concerts
(all kinds), dances loud parties, and sporting events. They
sometimes are unable to utilize various forms of
transportation such as motorcycles, speedboats, airplanes,
trucks, busses, and sports cars. They may not be able to use
chainsaws, lawnmowers, vacuum cleaners, food processors,
electrical tools, and noisy appliances.
OTHER HEALTH CONSEQUENCES OF NOISE
EXPOSURE
Noise is thought to have harmful effects on more than just
hearing. Noise contributes stress to our circulatory,
respiratory, and digestive systems as well . Continued
exposure to noise may cause increased respiration, pulse rate
and blood pressure, headaches, fatigue, and stomach
problems. Noise has also been shown to interfere with
children's learning and even to affect an unbom child. These
effects can remain even when the people think they have
become used to the noise!
Anytime you can contnbute to reducing the volume of noise,
do sol Your ears, and a whole lot more, will appreciate it
SUMMARY
Conserve your hearing and prevent tinnitus!
Avoid exposure to noise when possible.
Use hearing protection.
SCE.NT1RC ADVISORYCOMIITlEE Harokl G. Tabb, M. D.
Jadt D. ClellliS, M.D.
Chicago, IDinois
Robel! A. Dobie, M.D.
San ArD!io, Texas
John R. Enmall, M. D.
Mal!llM, Tennessee
Chris B. Risler, M. D.
San Diego,
Richard L. Goode, M.D.
Stanbrd,
W. F. S. Hopmaler
St. Louis, Missouri
John W. House, M.D.
Los Angeles, california
Robert M. Johnson, Ph.D.
Portland, Oregon
Gala w. Miller, M.D.
CinciMali, Ohio
J. Gai Nealy, M. D.
Oldahoma City, Oklahoma
Jelly Noftham, PhD.
OenY81", Colorado
Robert E. Sandl1n, Ph.D.
El cajon, Calilomia
Alexander J. ScHeuring, M.D.
Portland, Oregon
Abraham Shulman, M. D.
Brooklyn, New Y 0111
Mansfield F. W. Sm1th, M. D.
San Jose. California
New 0!1eans. Louisiana
HONORARY DIRECTORS
The Honorable Mall\ 0. Halleld
Uni18d Slates Senalll
Mr. Tony Randal
New Y 0111, New Y0111
LEGAL COUNSEL
HanlY C. Bletthaupt
Stoel, Rves. Boley. Jones &
Grey,Portland, Oregon
BOARD OF DIRECTORS
Edmund J. Grossberg
NorthbrOOk, lknois
Dan Robart Hodl:s
Portland, Oregon
Philip 0. Morton
Chalnnan
Portland, Oregon
Aaron I. Osherow
Sl Louis, M1ssouri
Gloria E. Reich, PhD
Ex8ClJliva
Portland, Oregon
Timothy S. Solos
Lenexa, Kansas
Thomas S. Wissbaum, CPA
Portland, Oregon
M-.d 1n USA
AMERICAN TINNITUS ASSOCIATION
PO BOX 5, PORTLAND OR 97207-0005
(503)248-9985
A non1)rolit voluntary human health and welfare agency
under 26 USC 501 (c )(3)
I

rNJOIISIE
ITS EFFECTS
ON
HEARING
AND
TINNITUS
THE PROBLEM
Noise is, by definition, unwanted sound. It varies in its
composition in terms of frequency, intensity and duration.
Sounds which are pleasing to some people may be
unpleasant to others. For example, loud rock music is
enjoyable to some but others find it offensive. Thus, for a
sound to be categorized as noise, it must be judged as such
by the listener.
PROTECT YOUR EARS FROM NOISE!
Many of the sounds in our environment which we classify as
noise are annoying but are not loud enough to cause
damage to our hearing. Other sounds, however, are of such
high intensity that they are potentially dangerous to the ear
and may cause permanent hearing loss and or tinnitus.
Noise is everywhere! We cannot always escape being
exposed to it. However, when noise can't be avoided,
preventive measures can be taken to limit the chance of
damaging our ears from exposure to excessively loud noise.
NOISE INDUCED HEARING LOSS
Common knowledge indicates that continuous exposure to
high levels of noise can cause hearing impairment in some
individuals. There is considerable variation from person to
person regarding susceptibility to noise; however, standards
have been established which, on the average, indicate how
much sound a person can tolerate without experiencing
damage to their hearing. Although this level remains
somewhat controversial, it has been established that most
people will not experience a hearing loss if the noise levels
do not exceed 85 to 90 dBA. Therefore, the Occupational
Safety and Health Act (OSHA) established criteria based
upon an 8 hour duration of exposure to a 90 dBA level of
continuous noise. It was felt that this criteria would protect
approximately 90% of the people exposed to 90 dBA levels
for a significant part of their lifetime. For shorter durations of
exposure, higher noise levels are permissible under this
regulation.
Dllfation per
TABLE 1
PERMISSIBLE NOISE EXPOSURES
day (hours)
8
6
4
3
2
1
1
/2
1 .
3/4
1
/2
1
/ or less
Noise level
(dBA)
90
92
95
97
100
1.02
105
107
110
115
DANGER! NOISE CAN HURT YOU
Many sounds in our environment exceed the OSHA standards
and continuous exposure to these sounds could cause loss of
hearing. A sample of common noise sources is shown in
Figure 1 along with their approximate sound pressure levels.
Sound Pressure
The typical hearing loss observed with patients who have a
long history of noise exposure is characterized by a loss of
hearing in the frequency range between 3000 and 6000 Hz
(see Figure 2.) In the early stages of exposure, a temporary
loss will be observed at the end of a working period but will
disappear after several hours. Continuous exposure to the
noise will result in a permanent hearing loss which will be
progressive in nature and become subjectively noticeable to
the employee over time. These changes in hearing thresholds
can be monitored through audiometric testing and will alert
dinicians that preventative measures should be initiated. In its
advanced stages, a loss of hearing in the high frequencies will
seriously affect the person's ability to understand normal
speech. In general, patients with hearing losses limited to the
high frequencies will not experience difficulty detecting
speech, but have trouble understanding conversation.
-1 0
0
..
.! 1 0
~ 2
0
E 3 0
! 4
, 5
0
~ 6
..
.<: 7
...
G
0
0
0
~ 8
: 9
0
0
:r
100
11 0
Frequency tn Hz
125 250 500 1000 2000 4000 8000
:<
P-
I\
\ J,
\ II
~ Iff
v -
, 1gure 2 - Typ1cal Aud1ogram ol Pa11ent w1th NoiSe Induced Heanng Loss
(Note Hz = Hertz. a umt or freQuency eaual to one cvcle oe1 second\
NOISE INDUCED TINNITUS
Although the exact cause of tinnitus is unknown, many
patients who have a history of noise exposure have tinnitus.
Noise is by far the most probable cause of tinnitus, and it
may or may not occur simultaneously with hearing loss.
Most patients who have tinnitus also have hearing
problems, but a small percentage (fewer than 10%) have
hearing sensitivity within normal limits. Since many patients
have hearing losses without tinnitus, it is not surprising that
some patients with tinnitus have no hearing impairment.
It is reasonable to assume that any one of the four
symptoms associated with ear pathologies - hearing loss,
tinnitus, dizziness, or a feeling of fullness in the ear - could
occur individually or without other symptoms.
The onset of tinnitus resulting from noise exposure can
occur suddenly or very gradually. A very loud sound in the
near vicinity of a person can result in tinnitus which can be
either temporary or permanent. When tinnitus occurs
suddenly, it is often perceived at a fairly loud volume and
may persist at that level.
More commonly, the onset of tinnitus is gradual and is most
often intermittent in its early stages. Patients report hearing
a mild form of tinnitus for a short period of time following a
lengthy exposure to loud sounds. Once removed from the
noise source, the tinnitus soon disappears and is inaudible
until the next exposure. This intermittent pattern often
continues for months or years with the periods of tinnitus
becoming longer and longer until the tinnitus eventually
becomes constant. Further exposure to the noise will often
aggravate the problem and oftentimes continued exposure
will cause the tinnitus to become increasingly loud.

Tinnitus Today December 1996 Vol 21, No 4

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Tinnitus Today December 1996 Vol 21, No 4

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December 1996 Volume 21, Number 4

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