VOLUME 12, NUMBER 1, MARCH 1987 THE AMERICAN TINNITUS ASSOCIATION

TINNITUS AND THE TMJ

by John Summer, D.D.S.

For reasons we still don't fully understand, there is a clinical relationship in some of our patients between their tinnitus and a pathologic process involving the temporomandibular joint (TMJ). Those of us who treat dysfunction of the TMJ by dental and oral orthopedic means find that sometimes we also permanently relieve tinnitus. Other middle ear problems, including dizziness, hearing loss, and eustachian tube blockage may disappear as well. Dysfunction of the TMJ has recently been discovered to be extremely prevalent among modern populations. It is generally considered to be a syndrome involving primarily the bite of the teeth, the jaw joints, and the muscles of the head and neck. The most common symptoms are headache, face and neck pain, pressure felt deep behind the eye, ears which feel stuffy and difficult to clear after changes in altitude, dizziness, gradually progressive hearing loss, and tinnitus. However, these symptoms rarely appear all together. Often only one or two of them are reported by the patient. For this reason TMJ dysfunction has proven able to mimic so many other diseases that it has been referred to as the great imposter. It is also for this reason that the scope and cause of the problem has so long eluded investigators. Recently scientists have made some large epidemiological studies. We now know that a significant percentage of our population is affected, and that most of them are women. For reasons which have been widely speculated upon but never made clear, women suffer from the symptoms far more frequently than men do. Under careful inves-

tigation children also show definite signs and symptoms of TMJ dysfunction, and their prevalence increases with age, but those under the age of twenty rarely suffer enough to seek treatment. The problem begins with a strained position of the jawbone due to the bite of the teeth. Thousands of times each day, the teeth are interdigitated, and the jawbone is forced into whatever three-dimensional position is determined by the way they fit together. The teeth may appear straight and beautiful, yet their opposing steep inclines may force the jawbone too far back or off to one side. When the jawbone is forced into a strained position, everything attached to it goes there as well. Muscles, nerves, ligaments, joints, and sheets of connective tissue are all placed under strain to accommodate the bite of the teeth. The way the damage gets distributed among the components affected depends on the ability of each to resist the strain. Generally the weakest link gives out first. At the back ends of the jawbone on each side are bony knobs called condyles. These meet the temporal bones of the skull to form the TMJs immediately in front of the ears. In fact, the distance between the rear portion of the TMJ and the internal ear area is less than two millimeters. If the teeth force the jawbone directly backward, they also force the condyles directly backward against the front boundary of the middle ear. Furthermore, there is a little articular disc which forms the middle of the TMJ and is designed to behave like a cushion between the condyles and the bones of the skull. In many TMJ patients this disc has been dislocated so that it no longer separates the bones. Instead it "clicks" in and out of place, or simply remains out of place leaving the bones to grind directly against each other. In these cases of "internal derangement of the TMJ " the middle ear area seems particularly susceptible to traumatic stimulation from the jawbone. The actual mechanism by which TMJ dysfunction can cause tinnitus has been very much debated but is still quite unknown. Among investigators
(cont. on page 2)

TINNITUS, cont.

there are at least four popular explanations: The simplest blames direct traumatic mechanical stimulation of the condyle against the front of the ear; along y.tith the inflammation and increased tissue fluid pressure which always accompanies inflammation, and could be expected to exert its effects across the thin bony walls separating the TMJ from the ear. Such increased pressure may interfere with any kind of pumping of fluid that may be counted on as a result of normal function in the area, and may be in some way related to the increased fluid pressure found in endolymphatic hydrops. Evidence for the role of inflammation in tinnitus can be found in the ability of inflammatory ear disease or surgery of the middle ear area to produce tinnitus. Furthermore, inflammation in the form of retrodiskitis in the part of the TMJ closest to the middle ear is an almost constant finding in TMJ dysfunction. Another popular explanation blames increased trigeminal motor nerve tonus. High resting tensions in the jaw muscles are commonly found in TMJ patients. Furthermore, the little tensor tympani muscle, which forms part of the hearing mechanism, happens to be innervated by a branch of the same nerve which is motor to the jaw muscles. Thus if the spontaneous firing level of the whole motor root of the trigeminal nerve is elevated in TMJ dysfunction, the tension in the tensor tympani could be expected to be elevated as well. Arlen explains, "The tensor tympani muscle is a remnant of that which moved the jaw at the reptilian stage, and it continues to maintain its identity with the fifth cranial nerve or the basic nerve of the jaw apparatus. This . suggests that early in embryonic development, neural patterns are established within the brain stem where the jaw bone and ear bone movements are integrated. This is the key to the relationship between the jaw and ear dysfunction that is plaguing modern man, along with the deterioration of other parts of the jaw and dental apparatus." [ 1] Further evidence for the role of muscle tension in the cause of tinnitus is the relation in some patients between tinnitus and forceful eyelid closure.[2] Still others claim that the connection between the ear and the bite is due to a tiny ligament directly connection the malleus bone of the hearing mechanism with the condyle of the jawbone. In 1962 Pinto reported , "A tiny ligament was found spreading from the neck and anterior process of the malleus in a cone-shaped form forward, downward , and laterally to insert into the medioposterosuperior part of the capsule, the interarticular disc, and the sphenomandibular ligament through Hugier's canal together with the chorda tympani nerve."[3] This so called, "mandibular-malleolar ligament" has been found by some anatomists and not by others. Most recently it has been reported to consist of two separate ligaments, both passing

through the petrotympanic fissure and attached individually to the neck of the malleus.[ 4] Furthermore the petrotympanic fissure between the TMJ and the middle ear is open in children and only later closes. It is not unlikely to find at least remnants of structures bridging the gap between these areas. One more explanation implicates blockage of lymph flow. Fonder explains, "Young showed that lymph channels run from the internal ear through the petrotympanic fissure, the tissues of the articular fossa, and down the neck of the condyle. Seldin pointed out that interference with the flow of lymph could produce ear dysfunction. Muscle spasms could interfere with this flow of lymph and could also constrict the lumen of the eustachian tube. "[5] Whatever is the connection between the jaw and the ear, it comes as no surprise to anatomists. Weldon Bell explains: "In the important development of the craniomandibular articulation over eons of time, certain structures of the ear and TMJ became intimately related . The tensor tympani muscle,' which flexes the tympanic membrane (arising from the cartilaginous portion of the eustachian tube and inserting into the malleus bone) is innervated by the mandibular division of the trigeminal nerve, which also innervates the masticatory muscles. Likewise, the tensor palati muscle, which elevates the palate and opens the eustachian tube by straightening it (arising from the sphenoid bone and wall of the eustachian tube and, after passing around the hamular process of the pterygoid bone, inserting into the aponeurosis of the soft palate) also is innervated by the mandibular division of the trigeminal nerve. Thus, the eustachian tube, which connects the cavity of the middle ear with the nasopharynx for the purpose of maintaining equalized air pressure on the ear drum, is under control of muscles innervated by nerves that subserve mastication. During deglutition, the palate is elevated to valve off the nasopharynx and the eustachian tubes are simultaneously opened. Thus, normal auditory function is intimately related to masticatory function. At the same time, the tensor tympani muscles also flex the ear drums, the sound of which may be heard accompanying the act of swallowing". Another interesting structural relationship between the joint and the ear was brought to light by Pinto's discovery in 1962 of the mandibular-malleolar ligament. This structure connects the temporomandibular capsule with the malleus bone, which in turn attaches to the tympanic membrane. Thus, when the condyle is translated forward, the ear drum is flexed. The sound of flexion can be heard by protruding the mandible or moving it laterally from side to side. "The structural and functional relationship between the masticatory apparatus and ears is intimate indeed, and symptoms in . common should
(cont. on page 3)

TINNITUS,

cont.
We have been hearing from a number of readers asking about the Tinnitus Inhibitor that Dr. Vernon described in the September ATA NEWSLETTER For your convenience here is the address: Colin F. Ill KempBox99P. 0. Beecroft N.S.W. 2119AUSTRALIA

present no surprise or problem to dentists or otolaryngologists. "[6] Treatment of a damaged TMJ usually involves wearing any of a great variety of bite appliances over the teeth . These interlock with the teeth or with each other to hold the jawbone in a new position. Thus, they are used to protect the delicate area between the condyles of the jawbone and the middle ear by bracing the jawbone and its condyles slightly forward from the position dictated by the natural teeth . This is essentially a means of protecting a damaged joint by not allowing the condyle to be rammed too far back against it. In any other part of the body a cast could be utilized to protect a damaged joint by immobilizing it. In the TMJ immobilization is dangerous because the joint can fibrose or ankylose so that the mouth may never be able to open normally again. Thus the joint is protected by a bite appliance which acts like a straight arm to hold the condyle safely away from the healing retrodiskal tissues. One result is that the resting tension exerted by the jaw muscles is decreased. Noxious stimulation to any joint increases the tension in the muscles controlling that joint. Protective splinting of the musculature can be seen in the way the joint functions. Once the TMJ is protected from the continuous traumatic bruising of the condyle against its rear surface, the muscles can relax. After allowing the muscles to readapt to more comfortable resting lengths and the jaw joint to heal for two to six months, the jawbone may still have to be stabilized in its new position by altering the biting surfaces of the teeth so that they no longer interlock in a manner which thrusts the condyle too far back in the joint. This may be performed by reshaping teeth, rebuilding teeth, replacing missing teeth, or orthodontics. [1] Arlen, H. Clinical Management of Head, Neck, and TMJ Pain and Dysfunction. In Gelb, H. (ed), The Otomandibular Syndrome, 181-194 Philadelphia: W.B. Saunders Co. , 1977. [2] Rock, E.H. Forceful Eyelid Closure Syndrome. In A. Shulman (Ed.), Proceedings of the 2nd Inti. Tinnitus Seminar. 165-169, New York: Journal of Laryngology and Otology, supp. 9, 1984. [3] Pinto, O.F. A New Structure Related to the Temporomandibular Joint and Middle Ear, Journal of Prosthetic Dentistry, 95-103, 1962, 12. [4] Komori , E. Sugisaki, M., Tanabe, H., and Katoh , S. Discomalleolar Ugament in the Adult Human, Journal of Craniomandibular Practice, Oct. 1986, 299-305. [5] Fonder, W. The Dental Physician, 178. [6] Bell, W. Clinical Management of Temporomandibular Joint Disorders, 9-10. Chicago: Year Book Medical Publishers, Inc., 1982.

For those of you who have been asking about the MCR taQes for relaxation and aid in coping with tinnitus that were described in the September ATA NEWSLETIER these are available from: Associated Hearing Instruments, Inc. 6796 Market Street Upper Darby, PA 19082 (215) 528-5222

OF ANECDOTES, TALES AND MYTHS

A recent article in the Journal of Laryngology and Otology, September 1986, Vol 100 #9, by Denzil N. Brooks, Ph.D. and entitled "An Onion in Your Ear" seeks to identify the sources of the folk remedies using onions and garlic for ear disorders. Two of the earlier authors that Brooks mentions cite the use of these preparations for tinnitus relief. Gunter's 1933 translation of Dioscorides Greek Herbal states that onion mixed with poultry grease is good for hardness of hearing, for noise in the ears, and for purulent ears. N. Culpeper (1616-1654) in English Physician; and Complete Herbal, XV Edition, 1813, extols the use of both garlic and onions saying "The juice is good--and dropped into the ears eases the pain and noises in them." Brooks postulates that the preparations of onion and garlic may be effective because 1. They are warm (thereby soothing the painful ear); 2. The possible muco-regulatory properties may act on middle ear effusions. 3. There may be antiseptic properties to the vegetables' essential oils. This juicy tidbit of information is offered for your interest and amusement. The American Tinnitus Association does not advocate the use of the above folk remedies for tinnitus relief. We do agree with Dr. Brooks. however, that sometimes these folk medications bear further inspection and scientific study.

SUGGESTIONS FOR A LOW-SODIUM DIET

A number of letters have been received from people who have asked us to suggest a sodium free diet. While such a d iet may not particularly benefit tinnitus sufferers in general, it may be helpful to some people. We offer the following diet for you to do with as you wish. From Arnold E. Katz, M.D. Manual of Otolaryngology-Head and Neck Therapeutics

to be influencing your tinnitus you must eliminate them systematically from your diet for a period of time long enough for the body to be clear of the substance. Keep a diary or journal recording what you eat. Foods that have been eliminated may be reintroduced one by one and their effect noted in your diary.
This is not an easy regime. You must be scientific about the way you choose your foods. It won't do you any good to eliminate salt from your morning breakfast by substituting something other than bacon and eggs if you go out and eat a ham sandwich and chocolate malted for lunch. A/so, you must remember that not all tinnitus sufferers are sensitive to food substances. You'll have to find out for yourself. Please remember also, that there are many other variables at work in the body that can be affecting tinnitus. How you cope with stress is one of them. Some theorists believe that there may be a connection between high-blood-pressure and tinnitus. Others believe that certain mineral or vitamin deficiencies are to blame. There is no general answer to fit all cases. and the research results in this area are insufficient for generalizing. Many tinnitus sufferers complain about spending hundreds or thousands of dollars for treatments that have not been effective. Here's your opportunity to try something for yourself for free.

All foods contain sodium. Meat, eggs, fish, and milk have greater amounts than fruit vegetables, and cereal. On a low-sodium diet, no salt should be added to foods in cooking or at the table. Foods high in sodium that should not be used are: ham, bacon, and processed meat such as bologna and frankfurters; fat from meat; duck and goose; canned, salted, or smoked meat or fish; shellfish; cheese, except unsalted cottage cheese; canned baked beans or soup; pickles, olives, and prepared sauces; soft drinks and prepared beverage mixes; candy; baking powder and soda; and salted potato chips, popcorn, corn chips, pretzels and peanuts. Vegetable oil or margarine can be used in place of butter. (or look for unsalted butter or margarine) Meat and fish should be restricted to two servings daily of meat, fish, or poultry. Eggs should be limited to three per week. Foods may be flavored with herbs, spices, fresh lemon juice, onions, pepper, vinegar. dry mustard, or garlic. Special attention should be paid to reading the label of any canned or prepared food before use.

TINNITUS BOOK NOW AVAILABLE
The American Tinnitus Association offers the Proceedings of the 2nd International Tinnitus Seminar, New York, NY, June 10-12, 1983. 62 Papers - 323 pages MECHANICS: facts & theories DIAGNOSIS TREATMENT: psychological medical surgical suppression with electrical stimulation ORDER NOW - SPECIAL CLOSEOUT PRICE $17.50 U.S. FUNDS POSTPAID IN THE U.S. ADD $2.50 U.S. FUNDS FOR POSTAGE OUTSIDE U.S.

Additional notes: (Not all tinnitus sufferers notice changes in their tinnitus that are related to food consumption. It may be that people who feel fullness of the ears, or dizziness, or have fluctuating tinnitus, might benefit from the above suggestions. In addition to food restrictions one can limit the intake of caffeine, alcohol, and nicotine in order to determine whether or not any of those substances have an effect on the tinnitus.) This is by no means an exhaustive list of foods that can affect tinnitus. If you suspect food or d rugs

PREPAID ORDERS ONLY: check to: ATA, P.O. Box 5, Portland, OR 97207

AMERICAN TINNITUS ASSOCIATION ANNUAL SCIENTIFIC ADVISORY BOARD MEETING

The annual meeting of the American Tinnitus Association Advisory Board was held at the Hyatt Regency Hotel in San Antonio, Texas, on September 16, 1986. Board members present were Jack Clemis, Richard Goode, Howard House, Robert Johnson, Gail Neely, Abraham Shulman, Mansfield Smith, and Harold Tabb. Also present were several members of the American Tinnitus Association from Texas and nearby states, including two officers from the Brook Army Medical Center in San Antonio. Gloria Reich opened the meeting by thanking those members in attendance for taking time from a busy schedule to come to the meeting. She then reported on several activities which ATA has been involved with during the past year. These include: 1. Mail from Ann Landers Column Over 100,000 letters were received as the result of a letter from Gloria Reich in the Ann Landers Column of January 20, 1986. Replies to these letters were accomplished through the use of volunteer help from the Portland community. Each time a letter such as this appears in the newspaper, ATA receives a large number of requests from tinnitus sufferers regarding possible treatments for the condition. They are sent a list of names of health care providers involved in tinnitus treatment as well as a list of tinnitus self-help groups in their local area. 2. Combined Federal Giving Campaign Ms. Reich informed board members that ATA's participation in the Federal Campaigns was growing slowly but surely with more public awareness about the problem of tinnitus. Approximately $37,000 has been received during the 1986 fiscal year as a result of our efforts in this project. 3. Research Funding Ms. Reich indicated that several research projects have been funded during the past year but that ATA was not receiving many applications. She encouraged board members to solicit research projects dealing with the evaluation and treatment of tinnitus and submit them to the national office. She suggested that budgets for proposed projects be limited to approximately $10,000. Following Ms. Reich's report, several members and guests described research activities ongoing in their respective facilities. Dr. Soraya Hoover, Houston, Texas, explained her involvement in a research project whereby tinnitus patients were examined for allergy problems and treated accordingly. Dr. Hoover reported that several patients had obtained relief through this procedure and encouraged its use in treatment.

Dr. William Meyerhoff informed the group that he had surgically treated three patients using Dr. Janetta's procedure which involves decompression of blood vessels in the cranium. He has noted some success with this procedure but warned that it is still very experimental. Dr. Charles Norris, a Pharmacologist at Tulane University, discussed the use of Aminooxyacetic Acid (AOAA) as a relief treatment for tinnitus. Tulane scientists conducted a pilot study which proved successful enough to warrant further study. They presently have a two-year grant and will study the effect of this drug on 75 patients afflicted with tinnitus. Dr. House was questioned about the effect of electrical stimulation on tinnitus with those patients fitted with a cochlear implant. He reported that, indeed, some patients do obtain relief from their tinnitus from this procedure. He indicated, however, that they had implanted a patient with normal hearing and there was no relief from the tinnitus. Dr. Abe Shulman reminded board members that the third international tinnitus seminar was scheduled for Munster, West Germany in June, 1987. Dr. Harald Feldmann is the program chairman for this seminar. The meeting was adjourned at 9:35 a.m. Respectfully submitted, Bob Johnson

THANK YOU FROM ATA STAFF AND VOLUNTEERS
Thank you to the many people who sent us their kind Holiday wishes. It is especially heartening to know that someone appreciates what we spend our lives trying to accomplish. We only wish we had time to thank each of you personally for your cards and letters.

1987: THE YEAR FOR GIVING.

Giving to favorite organizations always brings personal gratification and a sense of being part of the solution. This year, 1987, is a time when you can help with programs to promote tinnitus research and bring comfort to tinnitus sufferers. We'll be happy to put your dollars to work fighting tinnitus. Thank you for caring, and sharing. LIMITED OFFER, WHILE THEY LAST- WE WILL SEND A FREE COPY OF THE 323 PAGE, FULLY ILLUSTRATED BOOK :"PROCEEDINGS OF THE II INTERNATIONAL TINNITUS SEMINAR" TO ALL NEW CONTRIBUTORS OF $100 OR MORE.

TINNITUS TERZANELLE
How I wish that noise would go away Have neighbors turned a stereo on? There's a cacophony night and day.

Meals Watching TV Reading Other Standing Standing Dressing Showering Other Walking Slow walk Moderate speed Very fast walk Occupational Housework, light physical work

hours hours hours hours hours hours hours hours hours hours hours hours hours

(total sitting x 1.5)

@ 2 points/hr.

I can't identify a tune. Amidst the ding and dong of notes, When neighbors turn their stereo on And leave to buy root beer floats Somewhere along the village mall Amidst the clang of Muzak notes.

(total standing x 2)
@ 3 points/hr. @ 4 points/hr. @ 5 points/hr.

I surely must give them a call; Hope that they are near a phone Down there upon the village mall.

hours

@ 3 points/hr.

It's getting so I dread being alone For fear bell tones might change to voices I would rather hear come through a phone.

Bell tones are less fearful than voices; How I wish they all would go away. Allowing me to have some choices; Stop interfering night and day.

Heavy total body physical exertion Rapid calisthentics hours @ 4 @ 6 Slow run Uog) hours @ 7 Fast run hours Recreational @ 8 racket sports hours @ 9-10 Competitive sports hours @ 8 Stair climbing hours

points/hr. points/hr. points/hr. points/hr. points/hr. points/hr.

by Kathleen Juday England, Seattle, WA

REGULAR EXERCISE MAY HELP!

Use this self assessment test to determine your level of activity! It may help you manage your tinnitus!

24 Total points: Total hours: Do you have an exercise outlet Yes for stress buildup? Yes Do you use it? Do you exercise regularly for its preventive rewards? Yes Have you discovered the intangible Yes quality of exercise?

No No No No

ACTIVITY SELF ASSESSMENT The following self-assessment of your activity level lists activities which are daily routine for many people. In addition, a sample of other activities are given. If you engage in activity other than that listed, try to approximate that activity with one given here and use the points accorded to it. After completing the exercise, you will have 24 hours of activity listed. For each hour or partial hour, multiply the weighted score given for the activity and then total the points. This is your physical activity score. After filling out the activity assessment, answer the four questions dealing with your motivational state and physical activity. How many hours per day do you spend:
Sleeping Sitting Riding/driving Study/desk work hours hours hours
@ .85 points/hr. @ 1.5 points/hr.

If you score below 40 points, you are a very sedentary person and should consider engaging in an activity which is higher in the point system than the activities you usually engage in. If you score above 55, you are probably enjoying the benefits of physical activity. Everyone who is physically able should have some regular activity which is worth more than 5 points per hour. To be a "regular" you should perform that activity five times a week for at least a half hour per session. Concerning the last four questions on the exercise, if you do not use physical activity to burn off stress products. try it. Choose an activity compatible to you and your lifestyle and try it out the next time you can't seem to calm down after a confrontation. Do it long enough for it to be physically effective-you'll need to walk longer than you would run to use up similar energy products. If you find you can tolerate this activity, try doing it regularly so you can keep a low stress profile. And if you really learn to love the activity, you will recognize the rewards and want to pass them on to others.

IN MEMORY OF

CONTRIBUTOR

DEAR FEDERAL EMPLOYEES: CIVILIAN, MILITARY AND POSTAL

ATA is a participant in your combined federal giving campaign. We are members of the National Voluntary Health Agencies and are fully qualified to receive all or part of your annual charitable gift. We hope that you will think of us when it comes time to fill out your pledge card for the fall campaign. While we welcome your direct gift to ATA we are cognizant of the fact that many of you like to make all of your charitable gifts through payroll withholding. ATA is not notified of your individual gift through the CFC so we are not able to thank you personally, but your gift is sincerely appreciated. You must notify us. however, if you want to continue to receive the ATA NEWSLETTER. Ordinarily your individual record would show no donations to ATA but we can flag your record as a CFC giver if you will inform us of your CFC gift. Thank you for helping support ATA through the CFC.

TRIBUTES
The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for sharing your memorable occasions in this helpful way. Contributions are tax deductible and will be promptly acknowledged with an appropriate card for the occasion. The gift amount is never disclosed.

IN MEMORY OF
OR FRANCIS SOOY
ECSTEARNSJR

CONTRIBUTOR
JESS BUSTAMANTE MRSOORISNICITA GERTHUOE LEWIS WMTERRENCE COX WRZWIGARD MARK WEINTRAUB MTMCGAHAN RICHARD CAMPBELL DR/MRS P KOTCH DRBRUCESORRIN SALlY HALPERT JUDYR061NS CAROLYN MORMILE WMSKENDIS WMBEHRMAN WMJWOLFSON MRSEWHORL WMMFISHER MRSFKATZ WMHAOAMS JACK PLEVINSKY RICHARDJKING MRSHTGOWER WMLMAHER

DEPARTED RELATIVES FLORA BOYNTON MAAYADEFORD CONNIE SANTORO DR A ZACCANTI HERBERT JENKINS JOHN MANDARANO M/MPGORDON BONNIE PIPKIN PHILIP SPECTOR HELENMDELK ANNALUNNING JJBONFANTI AMZWELLING CHARLIE SHARIETT MONTE BRIEF IRVING MARKS JACK REICH JMBULLOCK MRSMSABATINO JTHEVITHICK RAY SHAW DRWMATTERN MS SALLY SHERE MARY BRIDGES JOHNLOIZZO LENORA REIMAN PHILIP G MILONE NELLIE VERNON GARY MASTERS J BARTASEVICH ESTHER DRUCKER JEANDIPERT CLAIRE MARTINEZ HILMA HARDY MARGARET GEORGE BERNARD BROWN RONALD KAWECKI NEAL BLACKBURN EDNA SHAPIRO MARTHA SCHAFFER JACK BLOOM THERESA SEMPREVIVO MY LOVING HUSBAND RICHARD MYSZKA PARENTS RICHARD NORMART HOWARD BECKWITH F J WAYCHUS EDNAMMADDOX GEORGE LAWTON SADIEKUTIK ALBLODGETT JREIGHARD TINA HEARD G KE.L EMANN MD JUDY SERLIN MIMSSMOLIN MRSWBLAREWSA J B MCCULLOUGH EDWARD KOMER LYDIAMBALL BILL FARMER EDITH LIEBOWITZ DENNIS A JONES TADHOMANJA RUTH MILAZZO GEORGE WBETTS CARL KRIEG W INIFRED SANDERS MATHEW SCHWARZ MADGE LESLIE WBGAMBLE LEONARD FREUND FAMILY/FRIENDS

JGEAAITS WM G SCHAFFER ELAINEBOBO BEVEALYSANTOAO OONCMOORE ELSIE JENKINS SIDNEY KAPLAN ROSE COTTRELL M1M HENRY ADAMS DONALD KROHN JAMESHDELK MIMJTHOMPSON MASJBONFANTI MRSAZWELLING JOHN M THOMAS MIMMKIASCH BESS MARKS FLORENCE REICH JOAN TANOVSKY LSABATINO M/MWOLFSON LGEAGLE MARYLMCGURK JOSEPH SHERE HELEN RICHARDS LUIGILOIZZO MIM S EISENBERG CHARLES MILONE PAUL VERNON LORAINE MASTERS M/MJJSULCJA ISADORE DRUCKER A E SCHROEDER MIMAANOEASON JMHAROY WJGEOAGE BETTY A BROWN MIMAJKAWECKI A E BLACKBURN RICHARD SHAPIRO ELMER SCHAFFER ED BLOOM ASEMPAEVIVO GHIRTLE AJMYSZKA RLSLAUGENHAUPT MIM HENRY ADAMS M!MSHAYWARD HWAYCHUS MIM OON MADDOX EVANDEASON STEPHAN POSSNEA M/MAPEAKE MASCDALFINO ADELMAN FAMILY A H BRITTON MD RICHARD SERLIN M!MJSIMON WBLAREW MAS MCCULLOUGH JEKOMER DORIS HUEBNER JAMES FARMER JMUEBOWITZ MRS NELL JONES MASKGHOMAN BMILAZZO HAROLD BETTS SYLVIA KRIEG KATHY SANDERS MIMJRSIMON JOHNWMARS CHARLOTTE GAMBLE M!MWSWAATZ WBKOIJBEK

MURRAY PEARLMAN

American Tinnitus Association

KENNY LIGHT

MA8ELINEVIN DOLL RAE BETWENIK WILLIAM VICTOR MRS C BENNEYAN ANNA FELDMAN WELCOME CKING

HAZEL ACHESON
MRCASCO

SPONSORS ATA THANKS THESE SPONSOR MEMBERS WHO HAVE CONTRIBUTED $100 or more during
the period September, 1986 to January, 1987
ALEXANDER ALEX DAVID M ALEXANDER ROBERT J ARCHITECT FRANK ARMATA RALPH ARNOLD GERALD A AWES EVADNE A BAKER SHERWIN A BASIL WILLIAM F BEILSTEIN ALLEN R BERNSTEIN HAROlD W BETTS BRUCE S BLOOM. MD EDWARD BLOOM MRS JOE J BONFANTI KNOX BROOKS WARREN BRANOES. 00 SIDNEY N BUSIS, MD STANLEY J CANNON. MD LAUREL W CASEY JAMES M CLARKE MARY E CLEARY ROBERT W COLE CONTINENTAL ELECTRONICS EMP CHARITY FUND JEAN C CRAWFORD LORA LEE DAVIS CHARLES A DECKER CHARLES DEDERICH. JR RANDALL C DUCOTE EDWARD L DUMOND IRWIN DURBEN FREDERICK ELKIND JEANILDU FOCKEL.E ELIO J FORNATTO. MD CHRIS B FOSTER, MD RAPHAEL 0 FRIEDLANDER JOHN A FUSHMAN JOHN GATELY JUUUS GERSON WILLIAM GIBB NORMAN GOLDSTEIN, MD WILLIAM R HALE PAUL K HALSTEAD C MARK HAMBLEY ROBERT R HARMON DALE G HART DORIS F HELMS DAN HOCKS CHARLOTTE S HOOKER SHOOVER, MO JOHN W HOUSE, MD R08ERT JONES, MD GEORGE W JULIFS JAMES G KALORIS OR KAIRY A KAWI THE KIRBY FOUNDATION CHARLES W KIKER, JR ARTINE KOKSHANIAN. MD LESLIE P LEALE GERALD E LEMENAGER MURL W LEONARD C ROBERT L188Y BRUCE 0 LINOENMAN WILLARD UTTLEHALE JAMES P LOCKWOOD J PLYNCH. MD TIMOTHY B MAHER JUDITH A MARLOWE. MA JEANNE L MARSH FREDERICK MARTIN PATRICIA & HOWARD MATHESON

TRIBUTES, CONT.

IN HONOR
OR JACK VERNON MICHAEL STONE HELENE LAMBRECHT JMBLOCKMO AANOSOA GRACE RICHMAN SEN MARK HATFIELD MARJORIE YOUNG EN CLAIRE DUSCH ANDREW MITCHEll ELOISE GATELY MISSY OANIELGCASEY ABRAHAM SHULMAN MD BARBARA GOLDSTEIN ORIMLTAICH M/MT SCHALICK JAC08 TURETSKY MRS FRANK WILSON JENNY PERKINS WOALDPEACE SR M BERNADETTE LEEBCANTOR NIKOLA TESLA LOUISEKAUOSE MY MOTHER OR DELBERT NOWEll LEONARD C DIXON VIRGINIA NIKOLAI CRYSTAL CASTLES ROBERT WETHERALL JON ALEXANDER BARBARA BRENT FOR SANOY REUBEN Pl.EVINSKY MMTOMSKI-cRANE FATHER RACHAELKOLB CASSEL RECOVERY ATA RESEARCHERS OR CHRIS FOSTER WilliAM KOI.SUN

CONTRIBUTOR
MIMGSKLEES W C LEONARD JALAWTORUCKER MRS PW BECKENHAUER JEAN & JOE WOLFSON MJM JOE WOLFSON PENELOPE DUMAS J E POINTERJR JRYOUNGEN LLOYD JENKIN STUART MITCHELL JOHN GATELY TKOWALESKI LAUREL WCASEY FREDERICK ELKINO FREDERICK ELKIND SAYDELINKE MIMCESHARP

HELEN M MCCOU.OUGH
CLEMENS B MCGARA JOSEPH L MENEGHEL STUART M MITCHELL C RANDALL NELMS, JR MD JAMES J ORTASIC AARON I OSHERON THOMAS R OTTENSTEIN GEORGE A PADGETT DAVID PAVLUCIK J E POINTER, JR MRS CATHERINA M RAINS ELMER B RICHTER ALFRED J RONALDSON MAX L RONIS, MD PHILIP A ROSENFELD, MD MRS JEAN ROWLETT JUNE H SCHUERCH KENNETH 0 SCOTT RICHARD S SHAPIRO ELIZABETH SHERARD THOMAS E SHONKASEN LAURENCE L SHOW FRECH SIEMS CARMALITA SOLITO JOSEPH G SMIGELSKI J THOMAS SOMERS, JR STEVEN J STALLER DANIEL J STANGE RAYMOND A STASSEN JOAN M STEVENS AU STRICKLAND ANDREWS TARLOW ARTHUR L TEAGUE SUSAN THOMAS JIM THOMPSON HOLLIS UNDERWOOD MRS NORMAN VAI.SVIG ROBERT W VANEK ARLENE VAN NORDEN JOSPH P VEL.EK PAULGWAOE HAROLD E WELLS AUBREY 0 WENTWORTH OR HERBERT WESTBY-GIBSON ANTOINETTE WESTPHAL BARBARA WOLFORD VELMA W WRIGHT ERNEST ZELNICK, PH 0

A ROSS
JUSTINE SNIPES JAMES E PERKINS DOLORES PROSEK MJM F KIKUCHI ALCANTOR ORRLRIEM ER JULIUSKAUOSE THOMAS BUTTS ORJAFARMER OR L BURDETTE PETER NIKOLAI MARK ALPIGER MRSRWETHERALL DAVID ALEXANDER WAYNE ASH JHSCHL.ETER JACK PLEVINSKY MAMUELLER M/M LOU MARKS BETHOMSTAO J ALAWT DRUCKER M/M J BACHMAYER OPR ROOM NURSES TOMLAGA

ANNIVERSARY
MERCIE BROUWER MIME STAUB 40TH ANNIVERSARY

CONTRIBUTOR
DAVID BROUWER M/M E WALLENSTEIN MIMA WERSHAW

BIRTHDAY
TRUOYORLICKER

CONTRIBUTOR
MIMPTULLY THE 'ffiAVERS G&MCASSEL MABEL HOPPER ABALAM JULES DRUCKER JOEALAM SEYMOUR SPECTOR PEARUROBTIOAVIO T ORUCKER/J ALAM JEAN & JOE WOL.F SON JEAN & JOE WOLFSON TDRUCKE.R /JALAM

Anyone who is listed above as a sponsor member is entitled to a complimentary copy of the Proceedings of the //International Tinnitus Seminar. To receive your free copy please send a postcard with your name and address and the word "SPONSOR". Your book will be sent immediately.

MARIE SPECTOR OR P SILVERSTEIN BILLHOUTT MICHAEL MEASEL MRSMICHAELMERSEL CHRISTOPHER BOYD

HAPPY 60TH BIRTHDAY WILLIAM CONSALO JR WE LOVE YOU

BERT & KATHY, UMBERTO & KATHLEEN

The AT Nf. WSLE TTf.R IS published quarte rly and mailed directly to ATA A contnbu tors and hearing health ca re p rofessonals th roughout the world Ctrculatton IS 145.000 Edttor Glona E Retch CtrculatJon ManagtH Patrrcta Daggett Arucles submttted for posstble publication should be typewrltlen. double-spaced on one stde of regular 8 '12 x 11 paper Preferred lenglh s 1000 words or less ArtiCles are selected for edt!tng and publtcauon wtth the help of the ATA sctenttltc advtsory board. For more tnformat ton wrrte to AM ERICAN TINNITUS ASSOCIATION P 0 . Box 5. Por tland. OR 97207 A private nonproftl corporation under the laws of Oregon
ADDRESS CORRECTION REQUESTED

NON -PROFIT ORG U.S POSTAGE

PAID
PERMIT NO 1792 PORTLAND. OR