March 1996 Volume 21, Number 1

Tinnitus Today
THE JOURNAL OF THE AMERI CAN T I NNITUS ASSOCI ATI ON
"To carry on and support research and educational activities relating to the treatment of
tinnitus and other defects or djseases of the ear."
In This Issue:
Tinnitus-In the Eyes of the Law
Otosclerosis
Research Report -
Since 1971
Research-Referrals-Resources
An Interview with Pawel Jastreboff
The Way of Peace
Sounds Of Silence
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- - -
Tinnitus
Editorial and advertising offices: American
Tinnitus Association, P.O. Box 5 Portland,
OR 97207
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Editorial Advisor: 'lhtdy Drucker, Ph.D.
Advertising sales: ATA-AD, P.O. Box 5,
Portl<lnd, OR 97207 (800-634-!1978)
Tlttn•cus 7bday is published quarterly in
March, June, September and December. It is
mailed to members of American Tinnitus
Association and a selected list of tinnitus suf-
ferers 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 publication
and to reject any advertising deemed unsuit-
able for Tlmuttts 7bday. Acceptance of adver-
tising by Tlnnrtu:; 7bday does not constitute
endorsement of the advertiser, its products
or services, nor does Tlnnitus 7bday make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by contributors to
Tbday are not necessarily those of the
Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-prof-
it human health and welfare agency under
26 usc 501 (c)(3).
Copyrightl996 by American Tinniws
Association. No part of this publication may
be reproduced, stored in a retrieval system,
or transmitted many form. or by any means.
without the prior written permission of the
Publisher. lSSN: 0897-6368
Scientific Advisory Committee
Ronald C. Amedee, M.D., New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clemis, M.D., Chicago, JL
Robert A. Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster, M.D., San Diego, CA
Barbara Goldstein, Ph.D., New York, NY
Richard L. Goode, M.D., Stanford, CA
John w. House, M.D., Los Angeles, CA
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia, PA
Gale W. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Jerry Nonhem, Ph.D., Denver, CO
Robert E. Sandlin, Ph.D., San Diego, CA
Alexander J. Schleuning, ll, MD,
Portland, OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Honorary Board
Senator Mark 0. Hatfield
Tony Randall
William Shatner
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey,
Portland, OR
Board of Directors
Edmund Grossberg, Chicago, IL
Dan Robert Hocks, Portland, OR
w. F. S. Hopmeier. St. Louis, MO
Philip 0. Morton, Portland, OR, Chrnn.
Aaron I. Osherow, St. Louis, MO
Gloria E. Reich, Ph.D., Portl;111d, OR
Timothy S. Sotos, KS
The Journal of the American Tinnitus Association
Volume 21 Number 1, March 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
4 From the Editor
by Gloria E. Reich
8 Calendar Al ert - ATA's 1996 Regional Meetings
by Corky Stewart
8 ATA's 1995 Hock's Memorial Research Award
9 Tinnitus - In the Eyes of the Law
by Barbara Tabachnick
15 Views from an Expert Witness
by James Salter
16 ATA's Support Network- Growing Stronger Yet
I 7 Otosclerosis
by Ian S. Storper M.D.
19 Research Report- An Interview with Pawel Jastreboff, Ph.D.
by Barbara Thbachnick
20 Book Review
by 'Irudy Drucker Ph.D.
23 Announcements
24 The Way of Peace
by Callum Elliot
Regular Features
5 Letters to the Editor
21 Questions & Answers
25 'fributes, Sponsors, Special Donors, Professional Associates
Cover: Detail of 3'x5' pastel painting by Margaret Ackerman, P.O. Box 1099,
Ignacio CO, 81137, 9701884-2603. Ms. Ackerman is a professional artist and ATA member:
From the Editor
by Gloria E. Reich, Ph.D ,
Executive Director
I'm pleased to report that 1996
is shaping up to be a good year.
Maybe it was the energizing
influence of last summer's Fifth
International Tinnitus Seminar
I
perhaps it is the realization that
our 25 years of existence has
been productive, or possibly it
is just a resurgence of interest on the part of sci-
entists that makes us feel so hopefuL
In January 1 attended the grand opening of
the California Tinnitus Assessment Center in
San Diego. About 150 people came to hear about
a very personalized therapeutic approach that
Dr. Robert Sandlin, Dr. John Vaughn, Debbie
Law-Cross and their colleagues are using for tin-
nitus patients. It is gratifying to see that more
and more hearing professionals are realizing the
best solutions come from a close collaboration
with their patients. Patients, too, are learning to
approach treatment with a realistic set of expec-
tations. These expectations properly include
working with a sympathetic and knowledgeable
clinician to find a way of lessening the annoy-
ance of tinnitus. They do not include expecting
to be "cured."
The center in California is not alone in pro-
viding comprehensive treatment strategies for
tinnitus. We've recently heard that a group at the
University of Buffalo Hearing Research
Laboratory is starting a tinnitus center. Some
other tinnitus centers or clinics have been offer-
ing multifaceted treatment since the 1970s. Our
referral network of clinicians treating tinnitus
patients has been in existence for over 15 years
and while all of these clinicians offer some treat-
ments, they vary widely in their approaches. Our
list of names is offered to you as a resource. You
must determine for yourself whether a particular
person or group is a good match for your needs.
Our referral list is dynamic in that it changes
constantly. We are always delighted to hear of
new clinics and hope you will let us know if you
4 Tinnitus Thday/ March 1996
hear of openings before we do. As usual, we're
also very interested in your experience with
providers on our network. We value your input
whether positive or negative.
This year marks an effort on the part of the
ATA board of directors to reassess our goals and
plan for the future. We are always eager to hear
from you about what you want from ATA and
what you think our priorities should be. In the
next issue of Tinnitus Today (June 1996) we will
be publishing a questionnaire which we hope
you will answer and return to us.
ATA staff will be taking our tinnitus message
to national meetings of health providers in a11
but two months of 1996. We think this new
thrust will help stimulate professional interest
in the problem. We'd like to call on you to join
us in this effort by talking about tinnitus to your
friends and colleagues and to social service
groups, schools, or retirement centers in your
locality. We'll be happy to provide suitable mate-
rials to enable you to be an ATA spokesperson.
Here are two ways you can help: 1) Present a
tinnitus informational display at a community
health fair. This can be a very rewarding experi-
ence. 2) Thke a Public Service Announcement
tape to your local TV station. PSAs delivered
personally stand a much better chance ofbeing
played than those we mail. Please let us know if
you will take an active part in our mutual fight
against tinnitus, and tell us what you'd be com-
fortable doing.
Finally, thanks to all who so generously
dipped into their pockets at year-end for addi-
tional dollars to support tinnitus research. We
are presently evaluating eight promis-
ing studies and will announce new
grants just as soon as that
process is
completed.
Letters to the Editor
The opinions expressed are strictly those of the
Ietter writers and do not reflect an opinion or
endorsement by ATA.
I
n my 40-year practice as an optometrist, my
patients who have tinnitus have always told
me about their condition as a matter of
course during the taking of a history. Through
the years I've met many patients with tinnitus,
and even worked and shared space for a number
of years with an audiologist and hearing aid
dispenser.
One case stands out in my mind and was
most unusual. She was in her late 30's, and com-
plained of ringing in her ears, dizziness, and fre-
quent headaches. A strange thing occurred
during the testing. As I moved my prisms to cre-
ate convergence and divergence (a test ofbinoc-
ular coordination) she reported an increasing
crescendo of the ringing, lowering as I reduced
it to zero, and increasing again the other direc-
tion. This occurred far and near and with
changes in accommodation as well. I talked of
referring her to an audiologist for testing, but
she never went. We did, however, institute a
series of eye exercises known as Vision Therapy
to build up her binocular coordination, and we
accomplished our goals. The results after 10
therapy sessions were: no more headaches, no
more dizziness AND no more ringing in her
ears! It was then that I was sorry she wasn't test-
ed by an audiologist or physician for basic find-
ings, and additional testing at the conclusion of
our therapy.
Since that time I have cleared up many
patients with dizziness and headaches, but have
not had the chance to work with tinnitus
patients as I haven't seen very many since.
A survey of optometrists to learn of any other
O.D.s with similar results might be interesting.
Byron Newman, O.D., Orange, CA
I
have been bothered by a high-pitched hiss-
ing noise in my right ear for over a year
now. This was possibly caused by the con-
cussive noise of a fence post driver. I have tried
a number of different therapies which were of
limited value, but two things definitely help.
One is the drug Amitriptyline which I take at
bedtime in the amount of 25-75 mg. depending
on the loudness of the tinnitus. At first, the drug
made me somewhat lethargic and groggy the
next day, but after 7-10 days I stopped having
this side effect. It also helps me to drink plenty
of fluids, especially water. I notice that on days
when I drink less, the tinnitus is more bother-
some. I have no explanation for this, but when I
make the effort to drink 8-10 glasses of water,
juice, or herb tea the noise in my ear is not as
persistent or loud. I avoid caffeinated drinks as
they definitely aggravate the condition. Even
decaffeinated coffee makes the tinnitus worse.
Bob Lacy, Ashland, OR
I
have found that when I eat foods high in
sodium, the volume of my ringing goes up. I
pass this along in the hope that others might
experiment with the food they eat to see if it
makes a difference.
Michael Sheehan, Universal City, CA
I
'm writing to express my gratitude and
appreciation for the article by Barbara
Thbachnick titled "The Miracle of Masking"
in the December 1995 issue of Tinnitus Tbday.
I've had tinnitus for 21 years and have been a
member of ATA since 1978, and in all that time
I cannot remember but a handful of articles that
I thought were as helpful and valuable as this
one. Ms. Thbachnick pulled together and sorted
through a great deal of useful information, and
put it in a form that people with tinnitus can
understand and use to help them make good
decisions and have realistic expectations about
masking. Her article is a definite "keeper."
Bob Bergstrom, Salem, OR.
I
t may be of interest to you to learn I flew to
Seattle on September 7th, and at 40,000 feet
lost all the tinnitus! To date, I have had no
recurrence. I also shed the heart palpitations I'd
been having for one year. The tinnitus was of
five years' duration. I suffered from dehydration
for three days post-arrival, so it took me a while
to realize the companion in the ears was gone.
Guess what you will. My conviction is it was the
flight. And to think I'd totally avoided flying for
five years because of tinnitus. All that ear-crack-
ing was miraculous for me - something was
pushed into the right niche.
Betty Tbusley, Niagara Fails, NY
Tinnitus Thday/ Marcll 1996 5
Letters to the Editor (continued)
ii D e-stressing-Your Way," a compendi-
um of ideas for relaxation published
in your December 1995 issue, omit-
ted a source of tinnitus abatement enjoyed by
thousands of people: computer communications.
Networking, provided by virtually all on-line ser-
vices such as the Internet, GEnie, America On
Line, and Prodigy, offers three forms of solace:
1) intellectual activity, which channels the mind
away from tinnitus, 2) access to tinnitus and
hearing-impairment support groups 3) availabili-
ty of technical information posted by research
groups.
The Internet is unique in its dissemination
of scientific research, as current studies from
around the world are posted. (Brush up your
German to read some of the articles from
abroad!) Particular mention must be made of
the Oregon Hearing Research Center, headed by
Dr. Jack Vernon, whose resources and investiga-
tions are shared liberally with colleagues and
the public on the Internet.
Computer support groups, which can be a
godsend to individuals suddenly afflicted with
tinnitus, also serve as a meeting house for
exchange of ideas, emotions, and laughter that
can lower the impact of ringing by several
notches. Compassion and knowledge, available
24-hours-a-day via bulletin boards, displace the
fear and isolation that are the hallmarks of
severe tinnitus.
Through computer use and networking, we
can gaze at the 21st Century with confidence
that we can manage tinnitus today and hope for
a cure in the future. What more potent de-stres-
sor could there be for the tinnitus sufferer?
Mary Holmes Dague, Carlisle, PA
---.
6 Tinnitus 1bday/ March 1996
I
wish to reply to the letter from Daphne
Suzanne Crocker in your June 1995 issue.
Nineteen years ago Motrin was prescribed
for me for extreme pain in the sternocleido-mas-
toideus muscle. Severe high-pitched ringing as
well as constant hissing has annoyed me ever
since 1 took the medication. I was told at that
time and many times since that Motrin was the
culprit. Ms. Crocker should be extremely cau-
tious in the use of Motrin.
Wanda E. Busharis, Basking Ridge, Nf
[Ed note: In the 1995 PDR, tinnitus is listed as a side effect of
Motrin at an incidence of greater than 1% but less than 3%.
Many other drugs, including Xanax, used for tinnitus remedia-
tion, also list tinnitus as a possible side effect. Extreme care
should be taken by rinnitus patients and their doctors wlth an
prescription and nonprescription dncgs.j
R!
cently I tried using a ginkgo supplement
for tinnitus relief. After two weeks my
innitus was unaffected but my blood
pressure was up 15 points. When I stopped the
ginkgo, my blood pressure returned to normal.
Thought you'd find this experience of interest.
Larry Harper, Milwaukie, OR
Al
though indubitably the airbag is an
mprovement for passive safety, it too
ncludes a risk for people with certain
health conditions, as the explosion produces a
noise of 130(!) dB at head level of the passenger
and causes, even in healthy people, a temporary
deafness. At the explosion center (near the
steering wheel) the noise is measured at 160 dB,
a rate that normally leads to a complete destruc-
tion of the hearing. Besides these facts, with
closed windows and a dual airbag, a high pres-
sure build-up is possible so that the eardrums
could be jeopardized.
Many tinnitus patients should know about
these risks. After thorough considerations, I
have had both airbags of my car switched off
as they already set off at a crash speed of
25km/h (15.5 mph), a speed where normal
means like safety belts are absolutely sufficient.
Stephen Peters. Reprinted from Tinnitus-
Forum, publication of the Deutsch Tinnitus-Liga
IV /94 (translated by R. Dees)
Letters to the Editor (continued)
T
he letter on airbags in Tinnitus-Forum
contains a very personal opinion and
decision. Here is mine. My son and his
girlfriend, who had a head-on collision in
California, wouldn't have survived without an
airbag. Despite the airbag, both had broken
bones but no life-threatening injuries or injuries
on their heads and necks. When my son came
home to Germany, his first action was to buy a
new car with a dual airbag. He thinks that dam-
aged hearing is not nice but being a cripple or
dead isn't nice either.
Rudolf Dees, Deutsche Tinnitus-Liga,
Germeri.ng, Germany
I
work as a crane operator on an offshore oil
platform where I'm exposed to a lot of noise.
I do use ear protection, but in doing so, have
a communication problem. I find some relief at
times taking 100 mg. of Elavil daily - 50 mg. i.n
the morning, 50 mg. at night. I also take ginkgo
biloba. I pray sometime in the near future I will
once again enjoy the beauty of silence.
David e c k e ~ Big Bear Lakes, CA
A
fter pursuing every potential source of
tinnitus relief, I have found some with
the drug Seldane. I take 60 mg. twice a
day. I still hear noise all the time but it is at a
livable level. Although I was treated for a num-
ber of specific allergies, my tinnitus did not
abate. It was only after several weeks on Seldane
that I noticed the noise had eased. I hope this
information is helpful to other sufferers.
Megan Vidis, Chicago, IL
M
y experience with tinnitus started with
a buzz in my left ear shortly after going
through extensive tests for a slight
hearing loss. During these tests, I was wrongly
told l'd had a brain tumor. (It was a film defect
on the first test, not a tumor.) It was devastating;
I spent many hours thinking about my two
young sons.
After returning home from the hospital with
the news that all I suffered from was a slight
hearing loss, I still felt the trauma of the experi-
ence along with a nagging buzz in my ear.
Although I regained my spirit and a partial trust
in doctors, the buzz went on for eight years.
Early this year I read a book by Shad
Helmstetter, Ph.D., What to Say When you Talk to
Yourself I used it to "control" my tinnitus, and
found out that my tinnitus was psychosomatic. I
still have my slight hearing loss, but the tinnitus
is gone. I may be in the minority, but I think the
methods suggested in the book can be helpful to
people who suffer from tinnitus.
Peggy D. Robichaud, Canton, MI
I
am pleased to provide to the readers of
Tinnitus Today additional information regard-
ing our clinical experiences with electrical
stimulation (ES) for attempting tinnitus control,
particularly for patients with tinnitus of the
severe, disabling type.
Historically, ES for tinnitus control has been
reported since 1801. The issue we consider is not
whether ES when applied to the head does or
does not have an efficacy for tinnitus control,
but rather: 1) what is (are) the underlying mech-
anism(s) of tinnitus control with ES; 2) what
diagnostic methodology can be used for patient
selection to assure an increased incidence of pos-
itive results with ES for tinnitus control; and 3)
what are the long-term effects of ES when
applied to the head. Specifically can a particular
clinical type of tinnitus be identified that
responds to ES?
Our experience with ES for attempting tinni-
tus control has been ongoing since 1983 and
includes the application of external and internal
systems. The external system of ES (Thera band/
Audimax) is effective in a limited number of the
total population of tinnitus patients. When
patients were screened to fulfill the specific cri-
teria of a primarily peripheral cochlear type tin-
nitus, the tinnitus control was greater than 60%.
An extensive review of the literature, and
specific results of our past experiences with ES
can be found in Tinnitus - Diagnosisi'TYeatment
by Shulman, Aran, Tonndorf, Feldmann, Vernon,
Lea and Febiger, Phila; PA; 1991. Our efforts for
ES are ongoing, and new results will be shared
with your readers.
Abraham Shulman, M.D.,FA.C.S.,
Martha Entenmann Tinnitus Research
Center Inc., Brooklyn, NY
Tinnitus Tbday/ March 1996 7
CALENDAR ALERT:
ATXs 1996 Regional Meetings
By Corky Stewart, Special Projects Coordinator
To celebrate ATA's twenty-fifth year of ser-
vice and to further the educational portion of
our mission statement, we are scheduling some
Regional Meetings. These will be one-day ses-
sions for .ATA members, tinnitus patients, hear-
ing professionals, and anyone else who wants to
know more about tinnitus. We'll talk about treat-
ments, self-help, and the latest research.
The first will be held on Saturday, May 11 at
the Arlington Park Hilton, Arlington Heights,
Illinois (near Chicago). The next will be in
Baltimore on September 25, 26, or 27. Don't
worry, West Coasters, there will be a meeting for
you too.
A special registration sheet for the first
meeting is included in this publication. Please
use it to reserve your space. Registration is $50
and includes lunch at the hotel. If you need to
stay overnight, the hotel is offering very special
rates - $109 weekdays, and $79 weekends. You
will need to make your room reservations
directly with them at (708) 394-2000. Be sure to
tell them you're with ATA. A detailed schedule
will be sent to each registrant in April. Details of
the subsequent meetings wi11
be included in future
issues of Tinnitus 7bday.
Needless to say, we
would be most appre-
ciative of under-
writers and/ or
sponsors.
ATA's 1995 Hocks Memorial Research Award
Robert E. Brummett, Ph.D., of
the Oregon Hearing Research
Center was given the 1995 Hocks
Memorial Research Award. This
award was presented to Dr.
Brummett on February 5, 1996
during the Association for Research
in Otolaryngology meeting in St.
Petersburg Beach, Florida.
Dr. Brummett, who is best
known for his work with ototoxic
drugs, has authored many studies
about the use of drugs to relieve
tinnitus. Most recently he co-
authored a double-blind controlled
study of the effects of Xanax on
tinnitus.
8 Tinnitus Thday/March 1996
Robert E. Brummett, Ph.D.
Dr. Brummett is a member of .ATA's
scientific advisory committee. We
hope he will continue in that capac-
ity after his retirement later this
year.
Previous Recipients of the Hocks
Memorial Research Award:
1986 Jack A. Vernon, Ph.D.
1987 Jonathan W.P. Hazell, M.D.
1988 John W. House, M.D.
1989 Abraham Shulman, M.D.
1992 Robert M. Johnson, Ph.D.
1993 Pawel & Margaret
Jastreboff, Ph.D.
1994 Ross R.A. Coles, M.D.
Tinnitus
In the Eyes of the Law
by Barbara Thbachnick, Client Services Manager
Tlw ma,onty of this information on legal issues specific to tin-
nitus was gathered through observation and i11terviews. We
gratefully thank tile health care professionals, attorneys, ser-
vice agency representatives, and ATA memiJers who generously
shared the1r experiences With us for this article.
The matter of legal recompense for the dis-
tress of tinnitus is in the front of many minds.
Those who experience disabling tinnitus won-
der: Is someone else responsible for this, and if
so, can I collect damages? Do I qualify for bene-
fits from Worker's Compensation, the VA, or
Social Security?
Legally, tinnitus is a recognized compens-
able disability. The Department of Veteran's
Affairs recognizes it; Social Security benefits
have been granted due to it; Worker's Comp-
ensation claims have been awarded based on it.
The road to successful collection of compensa-
tion, however, is often paved with untenable
delays, marginal awards, and understandable
frustration.
Many health professionals who are invested
in the search for tinnitus relief are concerned
about the mixing of medical and judicial mat-
ters. They know that over time patients can
improve in their capacity to ignore the tinnitus.
However, for as long as a tinnitus liability case
is pending, the person seeking reparation typi-
cally does not get better. Some "tinnitus experts"
are often reluctant to bear witness in these
cases feeling that prolonged legal focus impedes
the patient/claimant's physical and emotional
healing.
It is a conundrum. Legal entanglements can
create stress that in turn contribute to a persis-
tent tinnitus. Yet in the face of negligence, legal
recourse seems appropriate and is everyone's
constitutional right to pursue. Compensation for
that negligence is often what keeps victims and
their families financially afloat. And in countless
cases, appropriate heal th care is possible only
when legal action is taken.
It is also known that there are those who
will try to use any weakness in a system - in
this case, the subjective nature of tinnitus - to
their own advantage. It's a perturbing notion.
Would anyone actually feign the disorder? Yes,
according to Dr. Jack Vernon, they would. He
has personally been an expert witness in two
cases of "tinnitus fraud," neither of which was
successful for the claimant.
A 1987 study conducted in Ontario, Canada
examined 3,466 Worker's Compensation cases
where claimants reported noise-induced occupa-
tional hearing loss. Nearly 50% of those in the
study reported tinnitus - a significantly higher
percentage than reported by noise-exposed work-
ers at large or by non-claimant tinnitus patients.
(In a survey of 38,725 noise-exposed workers in
Western Australia, 27.9% reported tinnitus.)
Since Worker's Compensation in Ontario awards
extra pension money if tinnitus is present with
hearing loss, researchers speculate financial
motivation on the part of the claimant.
Our litigious nature as a society is conspicu-
ous - nearly a quarter of a million civil lawsuits
went to the U.S. District Court in 1994. And as
such, we may have set up our own road blocks
to legitimate legal redress. The overflow of court
cases, compounded by the subjective nature of
tinnitus, have forced judges and juries to look
long and hard for absolute proofbefore awards of
any size are made.
For those anticipating tinnitus-related legal
pursuits, we offer an outline of what could hap-
pen in your quest for compensation. The infor-
mation presented is intentionally general; laws
not only vary by state, but each legal claim has a
unique array of factors to be considered. It is
best to consult with an attorney about your indi-
vidual case.
Social Security
The Social Security Administration (SSA)
divides benefits into two categories: Retirement
and Disability. The disability benefits are again
divided in two: Disability Insurance and
Supplemental Security Income (SSI). The SSA
defines "disability" as the inability to do any sub-
stantial gainful activity by reason of any medical-
ly determinable physical or mental impairment.
To qualify for Disability Insurance, an individ-
ual needs to have worked 20 "quarters" (of a
year) out of the last 10 years. Payments from this
fund are based directly on what an individual
has already paid into Social Security. SSI is a
benefit for those who can demonstrate financial
need. Recipients need not have paid into Social
Security to receive SSI.
To qualifY for either benefit, the claimant
must be totally unable to work (a partial or short-
term disability is not recognized), and must
somehow demonstrate that the condition will
Tinnitus 1bday/March 1996 9
Tinnitus - In the Eyes of the Law (continued)
last for at least 12 months. These benefits are
available to disabled people of any age (and to
some family members of the disabled person)
but convert to retirement benefits when the dis-
abled person reaches age 65.
For tinnitus sufferers, a question persists:
How can the tinnitus that only I hear be "med-
ically determined?" Doctors and audiologists
have another question: How can I predict the
future course of a patient's incapacity?
A disability claim begins with the review of
the claimant's file by an examiner. (The claimant
is not present.) If an unfavorable decision is
reached, the claimant can ask for a reconsidera-
tion - a second review by a different examiner.
If the decision is again unfavorable, the claimant
can ask for a hearing before an administrative
law judge. It is the first time the disabled person
is actually seen during the claim process. The
face-to-face contact may account for the abun-
dance of decision reversals that happen that at
this stage. If the decision remains unfavorable,
an appeal can be made. A case could advance
beyond appeal to the Federal District Court.
Because of the massive backlog, it is suggested
that people apply for disability benefits as soon
as they can no longer work.
Pitch and Loudness Matching
Factors most closely examined by the
courts are the verifiability of tinnitus' exis-
tence, its intensity, its potential for relief, and
the claimant's ability to continue employ-
ment in any capacity.
To answer the first concern, the Tinnitus
Reliability Test was developed by Jack Vernon,
Ph.D. at the Oregon
Hearing Research Center
in an attempt to establish
the loudness of a
patient's tinnitus. In the
test, patients are asked to
identify the volume of their
tinnitus from a range of
~ external pure tone
sounds presented. Then
I over the course of an
10 Tinnitus Tbday/ March l 996
In round one with Social Security in the state
of New York, Bob Luthmann battled examiners
who rejected his tinnitus claim based on the
results of a routine hearing test - the only test
they gave him. He writes, "When persons with
the maddening maelstrom of tinnitus apply for
Social Security disability, they are often rejected
on the basis of this test alone - because their
hearing is okay. It's like if your toilet bowl is
overflowing and an intervening governmental
agency says you don't need a plumber because
your water meter is okay!" Luthmann eventually
won his case in appeal.
The problem is likely linked to the Code of
Federal Regulations (CFR), the book that
describes award policy for Social Security.
According to the CFR, tinnitus in and of itself
does not qualify as a disabling, and therefore
compensable, condition. The word tinnitus is
mentioned only as a symptom of Meniere's and
vestibular disorders. There are provisions, how-
ever, in the CFR that could help people garner
compensation for their "non-observable impair-
ments." For example, if enough evidence is sub-
mitted showing "a high degree of probability"
that the claimant is disabled, a claim could be
legitimized. The CFR also recognizes that a per-
son's ability to meet the demands of a job may
hour, they are asked six to eight times to re-
select an external tone that is at the loudness
level of their tinnitus. In further testing,
Vernon found that it was impossible for people
without tinnitus to repeatedly match a volume
without the standard of tinnitus in their heads.
Says Vernon of his non-tinnitus test subjects,
"They just couldn't come up with it." He feels
that if patients can repeatedly choose a vol-
ume within 2dB of their established loudness,
then the test verifies the tinnitus volume
unequivocally.
Th find the pitch, Vernon introduces two
separate tones - for example, 1000 and
2000Hz - to the non- or lesser-tinnitus ear of
the tinnitus patient. The patient is then asked
to select the tone that is closer to the tinnitus.
(The tones used in this test are set at the vol-
ume first established from the Tinnitus
Reliability Test.) If 2000Hz is chosen, then he
Tinnitus - In the Eyes of the Law (continued)
be affected by "non-exertionallimitations" such
as nervousness, depression, and the inability to
concentrate.
Although the claim process can take months
and sometimes years to reach conclusion, bene-
fits are usually paid retroactively to the date of
disability. (Social Security rules and definitions
are actually quite complex. Contact your local
SSA office for a thorough explanation.)
Worker's Compensation
The Worker's Compensation law defines "dis-
ability" as an impaired person's inability to
remain employed at full wages. Even though
every state has its own Worker's Compensation
system, any worker who is injured on the job -
accidentally or otherwise - has the right to file
a claim. (Railroad workers, federal employees,
longshoremen, and other selected groups are
not covered by Worker's Compensation in their
states, but instead by separate plans that go
beyond state boundaries.)
With tinnitus matching tests and other eval-
uations gaining some legal acceptance, the pres-
ence of tinnitus is usually not in doubt. "It is
easy to accept that a patient may have tinnitus,
but often difficult to establish that the work
experience and only the work experience pro-
offers that tone again plus 3000Hz and asks the
patient to select once more. If 3000Hz is chosen,
then that tone and 4000Hz are offered. If
3000Hz is re-selected at that point, it could be
that the tinnitus is around the 3000Hz range.
Vernon suggests that when a frequency is re-
selected, patients should be offered another
forced choice - this time between the selected
frequency and one octave above it, in this case
3000Hz and 6000Hz. "Octave confusion" is a fair-
ly common occurrence. Patients usually identify
the higher octave tone as the closer match
(although they almost never say it's an exact
match). Vernon notes that a reliable matching is
still possible even if the tinnitus is fluctuating,
since it will rarely fluctuate in the span of the
testing hour. Loudness matching, he feels, is still
the more accurate test and the one he is more
confident using in court.
duced the condition," says Jack Vernon. He
points out that other noise exposures from con-
certs, shooting, or from previous employment
may have contributed to the tinnitus.
There was no speculation about the cause of
Bill Haskin's tinnitus: a steel mill co-worker, in
horseplay, set off an explosion next to Haskin's
head. The tinnitus was sudden and severe.
Worker's Compensation paid all medical expens-
es related to the incident. But when Haskin's
tinnitus-related problems (sleeplessness, loss of
concentration, hyperacusis) worsened to where
he could not work, he found that collecting lost
wages would not come easily. Worker's
Compensation no longer viewed his doctor's
statement as sufficient evidence of the disabili-
ty, and instead required an examination by one
of their doctors. Contrary to what was expected,
their doctor also recommended that Haskin stop
working. He was awarded a settlement within
weeks.
Concurrently, Haskin pursued an SSI claim
but was denied the first two times. For the hear-
ing, he hired an attorney who suggested that he
find a way to verify his tinnitus and thereby sat-
isfy Social Security's requirement for "medical
proof."
Will legal compensation for tinnitus,
then, become a matter of ''dollars for deci-
bels" as Dr. Alf Axelsson speculates? Ideally
not. The degree of severity experienced by
each person with tinnitus is as individual as
the people themselves. What is tolerable to
one can be unbearable to another. Successful
tinnitus matching could in fact backfire for
the claimant: the noise may not seem too
objectionable when played back in court.
(Some judges and jury members have been
unable to hear the "evidence" due to their
own high frequency hearing loss.)
So once done, what could these test
results do for one's court case? "It is evi-
dence that they have tinnitus," says Vernon,
"but it does not say how severe it is, if it's
permanent, or if it can be relieved."
Tinnitus 1bday/March 1996 11
Tinnitus - In the Eyes of the Law (continued)
In an effort to help, Dr. Vernon's office in
Oregon phoned Haskin's audiologists at the
Michigan Ear Institute to discuss the Tinnitus
Reliability 'lest protocol. Haskin was then able to
be tested at MEl, where he produced five exact
matches. Based heavily on those results, he was
awarded SSI. (There is usually a coordination of
benefits among agencies to assure proper com-
pensation - and avoid over-payment - to the
claimant.)
Haskin made an incident report immediate-
ly after the explosion, documented all related
events that followed, and kept a meticulous
paper trail of medical and legal records. He
believes that his careful record-keeping helped
his case.
The Department of Veteran's Mfairs
(VA)
Veterans with service-related, medically
provable disabilities can receive compensation
from the VA. Tinnitus (''persistent, as a symp-
tom of head injury, concussion, or acoustic trau-
ma") was first acknowledged by the VA as a
separate disability in the 1970's. The Code of
Federal Regulations (CFR) for Veteran's Relief
assigns a 10% rating for tinnitus. (Currently,
10% compensation is $91 per month.) All poten-
tially service-related impairments, including
hearing loss and psychological distresses, have
their own additive ratings.
The claim process begins at a state or region-
al office, or at a local VA medical center.
Organizations like the Veterans of Foreign Wars,
Vietnam Veterans of America, and the American
Legion provide free claim-filing assistance. What
to bring with: discharge papers, summaries of all
related hospital stays and doctor visits, a list of
the medications being taken, and a statement
from the veteran's doctor.
Tinnitus might not appear for years after a
head injury or noise trauma. But inclusion of
the accident report in the veteran's military
~
record will help establish the connection
of later-onset tinnitus to previous mili-
tary service. Harvey Abrams, Ph.D.,
an audiologist for the VA, strongly
recommends that veterans request
medical evaluation of their tinnitus as
soon after discharge as possible.
12 Tinnitus Today/ March 1996
The authors of Veterans Benefits - The
Complete Guide admit that c1aims and appeals
can take years to resolve. Lester Lemke, a WWII
veteran whose tinnitus began as a result of
acoustic trauma during his military service, was
awarded the initial 10% compensation for tinni-
tus. But it took him 10 more years to collect an
additional 30% for his other tinnitus-related
symptoms. (Veterans who collect a 50% or
greater disability are entitled to full medical cov-
erage through the VA. This is believed by many
to be the reason why few awards reach that
magical number.) The authors encourage veter-
ans to approach the claim process with patience
and realistic expectations.
A list of attorneys who represent veterans
before the U.S. Court of Veterans Appeals is
available from the National Organization of
Veterans Advocates, PO Box 42334, Washington
DC, 20015.
The Americans with Disabilities Act
(ADA)
The ADA is designed to ensure non-discrimi-
natory hiring practices for disabled people, and
to protect and provide for the needs of disabled
workers while they are on the job. (The injury
need not have occurred in the workplace.) A
person with tinnitus can, for instance, petition
his or her employer to accommodate a need for
a quiet work place or a less stressful job if the
present work environment contributes to a
worsening of the disability. As of July 1994,
employers with 15 or more employees are
required to make "reasonable accommodations"
for their disabled workers.
The width and breadth of this five-year-old
law are being tested on a case by case (and dis-
ability by disability) basis. According to the
Bureau of National Affairs, no case mentioning
tinnitus as a primary complaint has yet gone to
court under this law. Although no current prece-
dent under the ADA exists that recognizes tinni-
tus as a disability, its omission suggests the
possibility that no one has had to pursue a law-
suit because of an employer's failure to accom-
modate for it.
Recently, Speaker Newt Gingrich established
a task force to examine the scope of services for
the disabled in this country. The goal is laud-
able, but the task force's use of the phrase "truly
disabled" has raised concerns for people with
Tinnitus In the Eyes of the Law (continued)
invisible disabilities like hearing loss and tinni- Others share Spellman's optimism. Attorney
tus. The task force is still welcoming input. Kevin Walsh concedes that it may not be possi-
(Write to: Disability Thsk Force, The Speaker's ble to prove absolutely that there was a single
Office, Room H232, U.S. Capitol, Washington reason for tinnitus. A car accident victim, for
D.C. 20515.) example, may work in a noisy environment. But
a close, "more probable than not" connection
Going to Court between accident and injury can be shown and
Alan Speilman is an attorney who frequently successfully rewarded.
represents claimants with tinnitus as the prima- In England, several liability cases that were
ry injury. He attributes his success in these inclusive of tinnitus (but not exclusively tinnitus)
cases to being honest with potential clients have been won for the plaintiff. Attorney
about which cases can be won. "You can't collect Chuang Wei Ping noted that those positive deci-
for every tinnitus claim," says Spellman. "But sions were based on the associated effects of tin-
there are many that you can." Certain types of nitus, that the "social assessment" seemed more
incidents, like a blow to the head or exposure to important than the "medical assessment." One
excessively loud noise, are accept- judge stated, "Above all I accept the
ed causal agents of tinnitus. consequent tension and irritation
Other parameters used in and the resultant frequent
past successful litigation: headaches by reason of this di.s-
+ If it can be shown that the tressing affliction."
claimant has a sudden Hearing health profes-
onset of sen- sionals, sensitive to the
sorineural hearing """"'•Ill••.._ impact a lawsuit can have on
loss immediately after the a patient's health, are still willing
event, usually tinnitus will be to help. Carl McLemore, M.D. feels that
allowed as a corresponding symp- being an expert witness is an otolaryn-
tom. It is ideal if "before" and ~ ~ 3 i l i i i l ~ ~ ~ ~ gologist's obligation to the litigant and
"after" audiograms can be pro- &: to the public. Dr. Ross Coles writes,
duced demonstrating this. "Dealing with legal issues is poten-
+ Loudness and pitch matching tests are per- tially part of the overall management of any
formed by an audiologist versed in these pro- patient." The American Medical Association's
cedures. If the test produces a match, Guides to the Evaluation of Permanent
Speilman uses the results in court. If it Impairment, a nationally recognized reference
doesn't, he addresses the variability of tinni- for compensation, omits tinnitus as a stand-
tus openly in the courtroom. (When tinnitus alone impairment. However, Abraham Shulman,
patients at the University of Iowa were asked M.D. notes that for nonmeasurable ear disor-
if their tinnitus ever changed in pitch, 28% ders, the AMA guide allows the physician to
reported that it not only changed, but it assign the degree of impairment "based on
changed suddenly.) severity and importance."
+ When permitted, Speilman plays an audio We are aware that the legal playing field in
replication of the claimants' tinnitus for the this country is uneven, that the wait to get what
court. is due can drain resources and break spirits, that
Opposing attorneys always look for prior ignorance about tinnitus abounds. We are also
exposure (noise, drugs, etc.) as the cause of the on the verge of a shifting national paradigm, one
tinnitus. Speilman's response: Look closely at that is heading us towards a new view on all
changes in the claimant's lifestyle since its disabilities. Hopefully with it will come a truer
onset. Tinnitus usually sends a person from doc- and more meaningful justice for all who have
tor to psychologist to support group; from sound tinnitus.
machine to herbal remedies. This, he feels, is
the most telling indicator and what he works
hardest to show ajury.
Tinnitus Thday/March 1996 13
Tinnitus - In the Eyes of the Law (continued)
References
Axelsson, A. , How severe is his tinnitus and what is its
prognosis?, Proceedings from the Fifth International Tinnitus
Seminar, ed. Reich & Vernon, 1995.
Code of Federal Regulations - Employee's Benefits (SSA), vol
20, parts 400-499, 1994.
Code of Federal Regulations - Pensions, Bonuses, &
Veteran's Relief, vol. 38, part 4.87, p.388, 1994.
Gabriels, P., Noise exposed workers: Is tinnitus being
ignored?, Proceedings of the Fifth International Tinnitus
Seminar, ed. Reich & Vernon, 1995.
Guides to the Evaluation of Permanent Impairment, American
Medical Association, 1994.
Lowery, D. , Social Security Newsletter, Dec. 1994.
McLemore, C.S. , The otolaryngologist's responsibility in the
evaluation of claims of loss of heari ng from hP-ad injury,
Laryngoscope, 78:840-844, 1968.
Modica, S.V., Cottona, J.A., Social security disability bene-
fits -basic facts, practical advice, Challenge Magazine, pp.
38-41, vol 2, issue 4.
Ping, C. W., Forensic audiology, J Otolaryngol. Otol. (Suppl)
pp. 37-8, 1986.
Shulman, A., Impairment, handicap, disability, and tinni-
tus, Tinnitus - Diagnosis and Treatment, Lea and Febiger,
Phila., pp. 431-447, 1991.
Snyder, D. A., The Americans With Disabilities Act, 1991.
Snyder, K., O'dell, R., Veterans Benefits - the complete guide,
HarperPerennial, l 994.
'T)rler, R., The psychophysical measurement of ti nnitus,
Proceedings of the Fourth International Tinnitus Seminar, ed.
Aran & Dauman, 1991.
Vernon, J., Is the claimed tinnitus real and is the claimed
cause correct?, Proceedings of the Fifth International Tinnitus
Seminar, ed. Reich & Vernon, 1995.
Vernon, J., Legal aspects of tinnitus, Ciba Found. Symp.,
1981.
Vernon, J ., Tinnitus: a legal problem with a familiar ring,
Oregon State Bar Bulletin, 1993.
Walsh, K., Personal injury lawsuits involving claims of tin-
nitus, Tinnitus Tbday, pp.l6-17, Dec. 1991.
14 Tinnitus 'Tbday / March 1996
Technical and Legal Consultants on
Tinnitus and Other Hearing Issues
(fees for services may be required)
Gregory Fra7..er, Ph.D.
Hearing Care Assoc.
18531 Roscoe Blvd., 11201
Northridge, CA 91324
818/ 727-7000
Robert M. Johnson, Ph.D.
Jack A. Vemon, Ph.D.
Oregon Heari ng Research Center - Tim1itus Clinic
3181 Sam Jackson Park Rd.
Portland, OR 97201
503/ 494-8032
Dav id Lipscomb
Correct Services Inc.
PO Box 1680
8715 271st NW, #1
Stanwood, WA 98292
360/ 629-4865
J ames Salter
11040 Creekmere Dr.
Dallas, TX 75218
214/328-1221
Michael F. Seidman, Ph.D.
Audiological Associates, Inc.
3901 Williams Blvd, #34
Kenner, LA 70065
504/ 443-5670
Lawyers with Past Successful
Tinnitus Cases
Alan Spellman, Esq.
2037 Pine St.
Philadelphia, PA 19103
215/732-0471
Kevin M. Walsh, Esq.
McCullough, Stievater, & Polvere
121 Main St.
Charlestown, MA 02129
61 7/241-8332
American Medical Association 800/ 621-8335
Bureau of National Affairs (ADA) 800/ 452-7773
Social Security Administration 800/772-1213
Acknowledgements
Harvey Abrams, Ph.D., Bay Pines, Florida VA Center
Bob Adams, ATA member
Carol Avard, Esq.
Bill Haskin, ATA member
Lester Lemke, ATA member
Jerry Sue Lent, Esq.
Bob Luthmann, ATA member
Susan Megerson, Tmpact Health Services
Sarah Thomas, Social Security Administration
Jack Vernon, Ph.D., Oregon Hearing Research Center
Views from an Expert Witness
by James Salter
As a self-help group leader and legal advo-
cate to people with tinnitus for more than 15
years, I have encountered an increasing number
of cases where negligent causation of tinnitus is
claimed in industrial or other circumstances.
There are obstacles in the path of the victim
seeking such awards, and there are some things
that can be done.
Modern societies all provide for insurance
against catastrophic losses of property, life and
limb. The insurance agent is sometimes govern-
mental, sometimes private. The operation of
these systems depends on the existence of clear
and complete definitions of the kinds of losses
to be covered, and some schedule of awards for
payment.
Ordinarily, if you lose some valuable part of
your life as a result of negligence on the part of
a person or organization, you may be due com-
pensation for the damage. Such awards may
come through private law suits against the
offending party, or by claims you make through
existing agencies dedicated to providing or over-
seeing such remedies. In seeking awards, you
may encounter insurance companies, the
American Medical Association, the Veteran's
Administration, or the Worker's Compensation
system. You will very likely need the services of
a lawyer, hopefully one experienced in liability
cases and aware of medical liability law. A good
lawyer should be willing to dedicate the time to
become acquainted with tinnitus. You must be
prepared to help.
If you have pursued a liability claim, you
may have had great difficulty in its pursuit. The
agencies that you need are likely to be unhelp-
ful. The lav.ryers that you need to represent you
may reject your case for a number of reasons:
l.They may have never heard of tinnitus and
can find no prior cases.
2. They may have learned that the prospect of
winning significant awards is very 1ow. (A per-
cent of a small award is not a motivator.)
3. They learn that there are only a few med-
ical/psychological authorities on tinnitus.
4. They learn that there is no common cause for
tinnitus, that its causes and effects are variable
I
and that there is no commonly recognized way
to measure it.
All major agencies who pass judgment on
industrial injuries and accident losses will likely
refer to the American Medical Association's
Guides to the Evaluation of Pennanent Impainnent.
A recent version of this (1994) says nothing
about specific awards for tinnitus, although
some attempts to allow tinnitus awards are
slipped in under provisions for hearing loss.
As of January 1996, I have testified as an
expert witness in five cases for persons seeking
tinnitus awards. I am beginning to see more
attention from attorneys as the nature and
severity of tinnitus is published by ATA and oth-
ers. A little information in the right places sets
off a chain reaction which must be continued.
How? Write your governor, your representa-
tives and the heads of the AMA VA and
I
Worker's Compensation in your state. If you
don't know the governor's address, just write to
"THE GOVERNOR OF YOUR STATE, CITY." It
will get there. I have seen this have a major
effect when one sufferer wrote a Governor who
has tinnitus! Insist that tinnitus be recognized
and represented in awards schedules along the
lines of those for hearing loss, yet distinguished
from hearing loss. Insist that tinnitus measuring
methods be reviewed and standardized for adop-
tion by all adjudicating agencies.
The most promising recent breakthrough, to
me, is the discovery that courts will accept sim-
ulation of a complainant's tinnitus demonstrated
in a courtroom. This has been part of my last
three experiences, and seems to appeal to
lawyers and be accepted by judges (but not the
defense!) .
If you need an attorney, here is a list of
steps you can take.
l . Select a lawyer and begin or continue his or
her education on tinnitus. Prompt the laV\ryer to
search for precedent cases in your state. Prime
your lawyer to plead your case primarily on the
grounds of "total bodily damage," and not nar-
rowly or exclusively on the tinnitus experience
alone.
Tinnitus Thday/ March 1996 15
Views from an Expert Witness (continued)
2. Collect all the evidence you can that bears on
your changes in behavior resulting from and
beginning at the time of the tinnitus onset, e.g.,
stopped noisy activities, started using ear plugs,
curtailed social affairs, experienced medica11y
verifiable stress-related disorders.
3. Get a complete physical including audiogram.
(Proceed cautiously with any MRI test as these
often involve dangerously loud sounds.) Have a
tinnitus matching test done by an expert who
performs repeated matches. (See "Pitch and
Loudness Matching.") You may have to shop for
an audiologist who is trained to do this. Collect
aU prior hearing or related medical records,
including those from military or employment in
the past. Have your history of drug usage
reviewed to include any that may be influencing
tinnitus.
AT.Ns Support Network-
Growing Stronger Yet!
Our network of support groups, telephone
contacts, and letter writers has been growing
steadily. We send our deepest thanks to all who
give their time to this very special cause.
New Support Groups
Wilma Ruskin
130 Spruce St., Princeton, NJ 08540
609/683-4650
Samell Ogus
49 Sandra Rd., East Hampton, NY 11937
516/324-6218
Earl Schmidt
80 Woodhill Rd., St. Cloud, MN 56301
612/252-5448
and
Brad Kuhlman PhD
St. Cloud Hospital
1406 6th Ave N., St. Cloud, MN 56303
612/255-5679
16 Tinnitus Thday/ March 1996
4. Develop a list of your hobbies and other activ-
ities that could possibly contribute to tinnitus.
(Your opponents could cite them; it's best if you
mention them first.) Don't fabricate anything.
I arnCa'dl:o believe that it will be lawyers,
victims, rncrfamilies who put tinnitus on the
map - not medical or insurance servicing agen-
cies. A few breakthroughs here and there can
snowball, leading to proper recognition by the
right agencies that tinnitus is a serious and real
disorder. It is entirely proper to observe that
there are no "bad guys" out there suppressing
cooperation. This vacuum is an artifact of the
obscure nature of tinnitus.
We have a tough battle to get tinnitus elevat-
ed to its proper awards status. But we are only at
the beginning of the effort. Some very remuner-
ative cases have been won; more doctors,
lawyers and judges are becoming aware. Let's
get going!
Cheryl Raisanen
1913 Nottingham Rd., Woodridge, IL 60517
708/910-1073
and
Myrtha Castellvi
484 Nassau, Bolingbrook, IL 60440
708/739-2872
Telephone and Letter Contacts
Earl ("AndyH) Anderson
PO Box 363, Lopez Island, WA 98261-0363
360/468-2145
Elaine Blaire
2001 Ponderosa Pl., Loveland, CO 80538
970/203-9543
Paul Sestito
312 Pleasant St., Paxton MA 01612
508/798-8453
Rosemary Hartman
111 Red Fox Pl., Media PA 19063
610/356-6816
Please write for a free 'Self-Help Packet" of information if
you are interested in being part our Support Network.
Otosclerosis
by Ian S. Storper M.D.
In order to hear, sound pressure waves in
the air are converted to nerve impulses on the
auditory nerve by the ear. These impulses are
then relayed to the brain. The ear does this in
an ingenious way: first sound waves arrive at
the outer ear and are funnelled into the ear
canal. When they reach the end of the canal
I
they hit the eardrum and set it into vibratory
motion. The eardrum is connected to a series of
three tiny bones - the malleus, incus, and
stapes - which are therefore also set into
motion. The stapes normally rests on the inner
ear, a fluid-filled chamber enclosed in bone
I
which has the ability to convert pressure waves
which the moving stapes
generates into nerve
impulses on the auditory
nerve, allowing us to hear
sound. The area where the
stapes meets the inner ear
is called the oval window.
Otosclerosis is a condi-
tion where normal bone of
the ear is replaced by
abnormal, spongy bone.
This abnormal bone can
get in the way of normally
functioning ear compo-
nents. There is no known
cause of this condition, although a number of
factors have been implicated in the past. In
approximately 12% ofpatients with otosclerosis
the oval window becomes involved with abnor- '
mal bone. This bone interferes with the normal
motion of the stapes, resulting in hearing loss.
In the vast majority of these patients, the prob-
lem is treatable.
Historical Aspects
The history of otosclerosis dates back to 1735
in Venice, when the pathologic process of this
disease was described by Valsalva, from the
autopsy of a deaf patient. The actual involve-
ment of the stapes by this process was first
noted by von Tholtsch in 1881. The earliest sur-
gical attempt to improve the hearing loss associ-
ated with otosclerosis was performed by Kessel
in 1876. He attempted to break it free of its
abnormal bony attachments to restore the hear-
ing mechanism. If the stapes could not be freed
from its attachments, it would be removed. The
first American attempts to improve this type of
hearing loss were performed by Blake and Jack
of the Massachusetts Eye and Ear Infirmary, in
1892 and 1893 respectively. Due to complica-
tions associated with breaking the stapes free,
these operations were largely abandoned at the
turn of the century.
Barany and Holmgren attempted a different,
safer operation in Germany in 1923 to improve
the hearing loss associated with otosclerosis.
They did this by opening the inner ear and
allowing sound to be transmitted directly to this
area. Partial hearing
improvement was fre-
quently noted. In 1938,
Julius Lempert of New
York devised a simplified
and soon-to-be standard-
ized method of perform-
ing this operation, which
he called the fenestration.
The next major advance-
ment occurred in 1952,
when Samuel Rosen inad-
vertently jarred a stapes
loose of its surrounding
attachments during a fen-
estration procedure. There was an immediate
improvement in hearing, repopularizing this
mobilization operation from the nineteenth cen-
tury. Unfortunately, the abnormal bone of oto-
sclerosis often regrows, producing recurrent
hearing loss, after one of these procedures. After
Shambaugh applied the operating microscope to
ear surgery in 1954, the stapedectomy operation
was redeveloped in 1958 and remains the gold
standard to this day. In this operation, the fixed
stapes is removed and bypassed by a prosthesis
connecting the incus to the inner ear. By using
the operating microscope, the complication rate
decreased dramatically.
Signs and Symptoms
Otosclerosis most commonly presents as
progressive hearing loss over many years. The
hearing loss is occasionally accompanied by tin-
Tinnitus Thday/ March 1996 17
Otosclerosis (continued)
nitus. Unsteadiness is present only in very rare
instances. Over 60% of the time, it is found to
occur in other family members. After many
years, the inner ear may also become involved
with abnormal bone. If this does occur, unser-
viceable hearing loss may develop.
Diagnosis
Otosclerosis is usually diagnosed by the
symptoms which a patient experiences. Any
patient who has a slowly-progressive hearing
loss in both ears in a family with similar symp-
toms is likely to have this condition. The diagno-
sis is confirmed by the hearing test, results of
which are highly suggestive of a process fixing
the bones of the middle ear. The diagnosis can-
not be completely established unless the ear is
explored and the disease process visualized.
Treatment
There are three treatment options for oto-
sclerosis. If the hearing loss is mild, no treat-
ment may be initially necessary; hearing tests
should be performed yearly to follow this condi-
tion, with further treatment imposed if the hear-
ing worsens.
A hearing aid is an acceptable treatment for
this disease, even with severe hearing loss. The
advantage of this option is that it is nonsurgical.
The disadvantages include the facts that the dis-
ease process can continue to grow to involve the
inner ear and that the hearing aid must be con-
tinually worn for the patient to gain benefit.
The third method of treatment is surgical.
The standard procedure is done directly through
the ear canal. In this operation, the eardrum is
lifted up and the stapes is maneuvered to assure
that it is fixed. If it is, it is removed and replaced
with a small prosthesis which connects the
incus to the inner ear, reconnecting the chain.
Overall, 91% of patients can have their hear-
ing improved to an excellent level by operation.
If hearing improvement is not inHially noted
and revision surgery is performed, a total of
96% of patients can have their hearing restored
to an excellent level. As a result of this proce-
dure, there is no need for a hearing aid and the
disease process is essentially removed from the
inner ear. The risks of this procedure are signifi-
18 Tinnitus 'Tbday / March 1996
cant, but few: 1% of patients develop an
eardrum perforation which must be repaired,
1% lose the hearing in that ear completely, 0.3%
develop partial hearing loss or dizziness, and
0.3% experience a worsening of their tinnitus.
My honest belief is to not do this surgery for
any reason other than hearing loss, even though
70- 90% of my otosclerosis patients have tinni-
tus as an associated symptom. While the surgery
can improve the tinnitus, and many patients do
report that their tinnitus bothers them 1ess
because their hearing is improved, most of the
time the tinnitus stays the same. There are no
guarantees.
Conclusions
When otosclerosis develops in the middle
ear, it can result in hearing loss. There is an out-
standing chance for hearing improvement when
surgery is performed for this disease. A viable
alternative, especially in patients who will not
or cannot tolerate surgery, is the use of a hear-
ing aid.
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 a receipt. Simply package them
up carefu11y (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., #417,
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
re-used as is, the parts ar·e needed for repairing
other aids. (And the plastic is recycled.) Your
old aid could give someone the gift
ATA Research Report-
An Interview with Pawel J. Jastreboff, Ph.D.
interview by Barbara Tabachnick,
Client Services Manager
Pawel J. jastreboff, Ph.D., Sc.D. , Director of the University of
Maryland's T i m ~ i t u s and Hyperacusis Center, talks about his
current ATA-funded research project, •Tinnitus associated with
sound-induced hearing loss. •
B'n Dr. Jastreboff, what is the nature of this new
research?
PJ: The first stage of our research involves the
development of an animal model for sound-
induced hearing loss. Once that model is estab-
lished, we can begin stage two
- with the same animals -
to develop a model for sound-
induced tinnitus.
B'n What is the correlation
between sound-induced hear-
ing loss and sound-induced
tinnitus?
PJ: That is a very important
question, one which I am try-
ing to answer with the help of
ATA. This research is based
on the hypothesis that tinni-
tus and hearing loss result Pawel J. fastreboff, Ph.D
from damage to structures of
the inner ear. A more specific
hypothesis is that tinnitus originates from the
area within the inner ear where the outer hair
cells are damaged and the inner hair cells are
reasonably functional. This is the typical sce-
nario in noise-induced hearing loss.
B'n How long do you estimate the two research
stages will individually take?
PJ: To know "how long" in the case of any
research is impossible. A breakthrough might
come in a matter of months or a year or never!
However, I am hopeful that within the next few
months we will finish the first stage of the
study, and then begin the second stage.
B'TI Will the results of this study be helpful for
those who have sound-induced tinnitus without
hearing loss?
PJ: Yes! This new animal model wi11 be useful
for studying both peripheral and central corre-
lates of tinnitus - with or without hearing loss.
BT: How is tinnitus measured in animals?
PJ: In the mid 1980's we developed an animal
model of tinnitus that was induced by salicylate.
In very general terms, rats were trained to fear
silence while associating any type of sound
(including tinnitus) with safety. By observing
their behavior, and by measuring the biochem-
istry and the electrical activity of neurons and
neurotransmitters in the
brain, we were able to mea-
sure the animals' perception
of tinnitus.
B'n How do you apply the
results from these animal
studies to the study of
human auditory health prob-
lems?
PJ: We know that the audito-
ry systems of animals and
humans have a lot in com-
mon, including structures in
the cochlea, hair cells, and
centers in the neuronal path-
ways. Additionally, our animal model evaluates
the PERCEPTION of tinnitus without human
subjectivity, which is the best way to scientifi-
cally measure tinnitus.
B'n What is your intended outcome from these
combined studies?
PJ: Once an animal model for hearing loss-relat-
ed tinnitus is established, the changes in the
auditory and neuronal pathways specific to
these problems can be studied. This should help
us discover which types of inner ear damage are
related to tinnitus and which are related to hear-
ing loss. We also hope to learn which neuro-
transmitters and receptors could be targets for
new drug treatments. Last but not least, we will
be able to test new approaches for alleviation of
sound-induced tinnitus, and ultimately create
the basis for human trials.
Tinnitus Thday/ March 1996 19
Book Review
by Trudy Drucker, Ph.D.
Vertigo, Nausea, Tinnitus, and Hearing Loss in Cenrral
and Peripheral Diseases. Claussen, Glaus-Frenz,
Eij i Sakata, and A.kinori ltoh, eds. New York (Amsterdam):
Elsevier, 1995.
Tinnitus can and often does appear as an
isolated symptom with no discernable causality
- a circumstance that provokes much frustra-
tion among researchers and clinicians groping
for clues that might aid diagnosis and treatment.
When head noise presents as part of the classic
triad in Meniere's Disease, or when there is a
probable causal sequence such as noise expo-
sure, systemic illness, or certain medications,
the matter is simplified. The authors of this new
book have been trying to find a link between
tinnitus and other vestibular disorders, and an
ocular phenomenon, nystagmus (involuntary
eye movements) that occurs in normal subjects
and in certain pathological states.
The book is a collection of about one hun-
dred short papers that were presented last April
at a conference in Japan. After an introductory
chapter, the papers are grouped rather loosely
into five sections: the nystagmus signal - a key
for the analysis of equilibrium disorders; recent
developments in modern neuro-otological thera-
py; a short section on sports medicine and
another on space medicine; and a fifth section
called simply "other" in which there is a miscel-
lany of brief reports on such subjects as MRI
testing, various surgeries, sequelae of meningi-
tis, and analyses of posture and gait in normal
and abnormal subjects.
Tinnitus is not the primary focus of interest
for the contributors to this book, who seem con-
cerned chiefly with equilibrium disorders that
might incidentally be accompanied by noise in
the ears or head. The editors describe the con-
tents as essentially studies of the neurology of
eye movements. The opening special
lecture/chapter dealt with the possible role of
the basal ganglia in the physiology of eye move-
ment. It was noted that long-standing hearing
loss can be associated with vestibular and ocular
phenomena.
20 Tinnitus 1bday/March 1996
One investigator found an increased inci-
dence of vertigo in an aging population. Other
scientists examined a possibly causative role of
vestibular dysfunction in some cases of multiple
sclerosis and cerebral palsy. A profusion of new
tests and techniques will permit closer study of
these possible concurrences. Experiments with
cochlear implants, acupuncture, and electrical
stimulation continue to be performed.
The editors note that the book appeared
very soon after the conference was held, and
the rush to publish is evident in the numerous
typos and errors of spelling and grammar.
Oddly, many of the papers appear as photo-
copied typescripts rather than in the book's
typeface. A little article on Van Gogh's hypothe-
sized Meniere's Disease might have been inter-
esting if someone had vetted the deplorable
English. The book is important enough to sur-
mount its defects, but one misses the benefits
that would have been conferred by the invest-
ment of a competent editor's time and skill.
This book is not for lay people; its concepts
and terminology are extremely complex.
Perhaps some specialists in private practice will
not be daunted by the book's high price, but for
the most part this is a volume that belongs in
the medical libraries of universities and hospi-
tals. It is a moderately useful addition to the
growing literature about disorders associated
with eighth-nerve pathology.
Questions and Answers
by jack A. Vernon, Ph.D., Oregon Hearing
Research Center
[Q]
Mr. L. in Illinois asks: "When ears are
cleaned with a syringe, can anything be
pushed back beyond the eardrum?"
The ear drum provides a physical sepa-
ration between the outer ear and the
middle ear space. Under most conditions
cleaning the ears with a syringe would not drive
anything beyond the ear drum. On the other
hand, if the ear drum is perforated then syring-
ing the external ear can cause all manner of
problems such as debris in the middle ear space,
infections, and other complications. Excessive
pressure in the external ear may even cause a
rupturing of the ear drum. Several tinnitus
patients have reported that the noise produced
by syringing the external ear made their tinni-
tus worse. I guess the safe conclusion is to avoid
any extreme conditions involving the ear.
[Q]
Ms. H. in New Jersey writes: "I have
been told that I do not suffer from
hyperacusis because I have some hear-
ing loss, and that what I have is recruitment.
Can you comment?
Some time ago, ATA conducted a survey
of their membership to determine how
many patients experienced hyperacusis.
The survey revealed that of the 112 patients who
stated they had hyperacusis, 65 (58%) indicated
some degree of measured hearing loss. The
question is, did all these responding patients
have true hyperacusis? We don't know but the
incidence of hearing loss was so pronounced
that I think we must conclude that at least some
hyperacusis patients have hearing impairment.
Many patients mistake recruitment for
hyperacusis. Recruitment occurs in the pitch
region where hearing impairment is present,
meaning that loudness tolerance is intact for the
portion of the ear that hears norn1ally. (Recruit-
ment has an interesting though negative effect
upon communication. A typical example: a
woman calls to her husband. He does not hear
her so she, assuming inattention, repeats the
call. He still does not hear her so she raises her
voice for the third call, and he says, "You don't
have to shout. I can hear you.")
Recruitment is a rapid growth of loudness so
that many sounds are indeed too loud. That,
however, is not hyperacusis where all but the
quietest sounds are uncomfortably loud.
Hyperacusis is also inversely related to pitch;
that is, the higher the pitch, the less the loud-
ness tolerance.
[Q]
Mr. C. In Florida writes: "Many years
ago, I was involved in military action in
which a mortar shell exploded very near
me. It didn't damage me at all, but for days
afterward I could not hear and my ears rang
loudly. Gradually the hearing returned and the
ringing went away. Thirty years have passed
and now my ears have started to ring again. I've
searched my lifestyle and can find nothing that
might have started the ringing this time. I have
not been exposed to loud sounds, and I am not
taking any medications. Can you explain the
return of the tinnitus?"
That your tinnitus has returned after
such a long time and for no apparent
reason is a story we have heard before.
My conjecture is that you may have had some
level of tinnitus all along but your hearing was
good enough for ambient environmental sounds
to mask it. As you're growing older, your hear-
ing may be declining allowing your tinnitus to
reappear. I tend to view tinnitus as a piling in
the ocean; when the tide is in we can see little
or perhaps none of the piling but when the tide
goes out, we can see a great deal of that piling
despite the fact that the length of the piling has
not changed. As hearing goes up tinnitus goes
down, and as hearing goes down tinnitus goes
up -just like the piling and the tide. Have you,
for example, noticed any difficulty understand-
ing speech when in a noisy situation such as a
party or social gathering? If you have, it could
be an indicator of some hearing loss in the
upper frequencies.
[Q]
Mr. R. In Illinois writes: "I have had
manageable cochlear Meniere's disease
with some tinnitus, hearing loss, and
fullness in the ear. Then this summer, I took
three two-week regimens of Biaxin, Prilosec
(acid suppressor) and pepto tablets. Since this
summer, the tinnitus has been extremely bad
Tinnitus Thday/ March 1996 21
Questions and Answers (continued)
and I've developed hyperacusis. Can I deter-
mine medica1ly if hair cells have been damaged
or destroyed?"
According to the Physicians Desk
tinnitus is not included as a
s1de effect for Biaxin. Prilosec, on the
other hand, does list hearing loss and tinnitus as
possible side effects. Generally, these side
effects disappear when drug use is discontinued.
If you have acquired some hearing loss, that
might also display some recruitment. (It is easy
to confuse recruitment with hyperacusis.) The
pepto tablets contain salicylates and instructions
indicate that if taken with aspirin and the ears
start to ring, use should be discontinued.
Because aspirin is sodium salicylate, one would
get a double dose of salicylates ifpepto tablets
were taken with aspirin. Aspirin-induced tinni-
tus is temporary and, in time, will decline to the
original level of your tinnitus. I should also
point out that tinnitus associated with Meniere's
disease is usually easily masked. If you have a
hearing test that was taken before you started
the medications you can now have another
hearing test to determine if any more hair cell
damage (hearing loss) has occurred, but I doubt
that it has. I would guess that if you still have
any additional hearing loss and increased tinni-
tus, they are temporary and will return to their
pre-medication levels.
O NE LAST THOUGHT ...
There has been some misunderstanding
about comments I made in a previous Q & A
regarding a possible tinnitus cure. What I had
proposed - using functional Magnetic
Resonance Imaging (fMRI) to locate the brain
center responsible for the perception of tinnitus
and then removing that portion of the brain
with stereotaxic lasers - was pure speculation.
We do not now know if it is possible to identify
or locate the brain area responsible for the per-
22 Tinnitus lbday/ March 1996
ception of tinnitus. I understand the urgency
and the despair with which some tinnitus
patients grapple, but the procedures I have spec-
ulated about do not yet exist.
Nor did I mean to imply that drug therapy
for tinnitus was impossible. Far from it. Drug
therapy, to my way of thinking, holds a great
deal of promise for the future. You are already
familiar with the positive effects the drug Xanax
has upon tinnitus, and it is only one of a class of
drugs that has yet to be tested. I have often
commented upon the fact that 23 of 26 patients
who had been given intravenous (IV) injections
oflidocaine (a local anesthetic) had their tinni-
tus disappear for about 30 minutes. Clearly, IV
lidocaine is not a practical therapy for tinnitus
but it's action does strongly suggest that some
form of drug therapy for tinnitus is possible.
Send your questions to Dr. Vernon c/ o ATA
Tinnitus Tbday!Q&A, PO Box 5. Portland OR
97207-0005.
Pod from the Costa Rican 'Ear
ANNOUNCEMENTS
The 16th European Instructional
Course on <<Tinnitus and Its
Management"- Aprill4-18, 1996
This 16th annual course to be held at the
University of Nottingham, England, addresses
the causes, scientific background, investigation,
and management of tinnitus. It will consist of
lectures with case discussions, practical demon-
strations, and a workshop session. The course is
designed for otologists, ENT's, scientists, techni-
cians, and hearing therapists involved in or
planning to become involved in clinical or
research work on tinnitus. The course fee of
£500 includes comprehensive notes, accommo-
dation in a University residence hall for four
nights, lunches, and three dinners. Attendance
will be limited to 48 delegates.
The course organizer is Jonathan Hazell
(Middlesex Hospital and RNID, London).
For registration information, contact:
Dianne Rooksby, OPIT, University of
Nottingham, University Park,
Nottingham NG7 2RD, United Kingdom,
Tel: (0115) 9513763, Fax: (0115) 9513722.
International Noise Awareness Day
- April24, 1996
Sponsored by the League for the Hard of
Hearing in the U.S., this day is being set aside to
bring public attention to the hazards of living in
excessively noisy environments. Many organiza-
tions, including ATA, are lending support to the
activities planned for that day worldwide -
such as the dissemination of hearing protection,
media coverage about the hazards of noise expo-
sure, and observing "60 seconds of no noise
from 2:15 to 2:16pm- wherever you are.
11
For
more information, contact Nancy Nadler at the
League for the Hard of Hearing at 212/741-7650.
May is Better Hearing and
Speech Month!
ATA is a member of the council for Better
Hearing and Speech Month, a coalition of 25
national non-profit organizations committed to
heightening public awareness about the
resources available for people with speech and
hearing problems. For information about the
BH&SM Resource Catalog, contact Beth Morin or
Michele Poltar at 703/ 836-4444.
T•I•N•N•I•T•U•S
When Silence is a Stranger
by Leslie Sheppard
edited by Dr. Clive Sheppard MA, MB,
Bchir (Camb), MRCGP
Endorsed by the American Tinnitus
Association as "recommended reading"
ATA member price - $16.50
(see order form on inside back cover of
Tinnitus Today)
THE INTERNATIONAL
TINNITUS JOURNAL
Editors-In-Chief
Prof. Dr. Claus-Frenz Claussen
Abraham Shulman, M.D., F.A.C.S.
Barbara Goldstein, Ph.D.
The International Tinnitus Journal - a
"peer review" journal featuring research
papers in the fields of audiology, otolaryngol-
ogy, neurophysiology, otology, and neurotol-
ogy - is published twice yearly by the
Tinnitus Center, the State University of New
York, Health Science Center at Brooklyn, in
cooperation with the Neurootologisches
Forshungsinstitut der 4-G Forschung e.V. , Bad
Kissingen, Germany.
Subscription information:
Subscription rate for two issues is $49.50
in US currency. For Canada, Mexico, and
other foreign delivery, the rate is $56.00 US.
Please send subscription orders to:
Barbara Goldstein, Ph.D.,
Tinnitus Center, the State University of New
York, Health Science Center at Brooklyn,
Box 1239, 450 Clarkson Ave,
Brooklyn, New York 11203, USA.
Fax: (718) 465-3669, Thl: (718) 773-8888
Tinnitus 1bday/ March 1996 23
The Way of Peace
by Callum Elliot
Reprinted with pel'mission from the Online RNID
Tinnitus Helpline Newsletter, March 1994
Seven years ago a siren sounded, screaming
at me to Stop and Listen, pounding its message
on the mettle of my nerves, bringing me to the
edge ofbreakdown, seven years ago.
In those early years of despair and isolation,
the sound in my ears was my enemy. At times
of punishing exasperation I would curse my life
for this cruel turn of chance: l
was a young man. I researched
enough to know that tinnitus
was a symptom, and my tests
had shown that there was no
physical cause for the hissing in
my ears. It took time for me to
'hear' this, to let myselfbelieve
that, if there was no damage,
then there was hope of a full
return to normal - to beloved
silence.
In my reading I came across
the Japanese fighting principle
of Cloth against Stone. Simply,
this is a way of defeating an
enemy by 'yielding' - of rolling
with an attack rather than meet-
ing it head to head. This princi-
ple is exemplified in Aikido, The Way of Peace.
And did I want peace! So I stopped beating
myself up and changed strategy. In a sense, I
surrendered to the sound. This meant letting go
of the plans 1 had for my life and putting all my
attention into the present. With one aim -
liberation.
This shift in perception enabled me to act
and to take responsibility for changing my life.
This was a time of acceptance and readjust-
ment. I began to let the sound "speak," and I
opened to the new possibility that perhaps the
sound and I were one. Much influenced by Zen
Buddhism, I meditated on the sound as a monk
meditates on the meaning of a Koan (a seeming-
ly absurd question that in answering is the way
to enlightenment). By being one with the sound,
perhaps I could influence it.
24 Tinnitus 1bday/ March l996
Sometimes solutions can be as obtuse as
their problems. Certainly in this case I had
accepted that the sound that was within me was
my sound, that somehow I had created it. It was
what I now call the "i-sound." And the i-sound
spoke, and the more I listened the more I let it
lead me. [t was no longer my enemy, but a
strange - even perverse - ally.
I took the alternative route on my quest for
healing: acupuncture, homeopathy, spiritual
healing and psychotherapy. In isolation, none
presented a cure, but after a
time I understood the essence
of the whole-istic approach and
broadened beyond the short-
sightedness of simply following
results.
"Ultimately you must forget
about technique. The further
you progress, the fewer teach-
ings there are. The Great Path
is really No Path." (Morihei
Ueshiba, The Art of Peace, trans,
John Stevens).
My focus shifted from the
sound. I looked to exploring my
health as a whole. And from
this web of experience one sin-
gle thread began to emerge -
that love has the power to heal.
And if there is a message, then it is simply this:
Remember Me, Remember Love.
I am well, and have experienced a steady
decrease in the intensity of the sound. As I
describe it to my dearest friend - on a scale of l
to 10, I'm marking 2 ... and dropping! Th gain
insight I went within, and in my efforts to
understand I emerged with a richer understand-
ing of myself. And with the wisdom that mind,
body and spirit are one. Disease can be seen as
an expression; it surely has something to say. If
allowed to speak, it can become a call to self
( re )discovery.
My journey thus far has been one of trans-
formation. Seven years ago a siren sounded,
calling me to stop and listen ...
canum Elliot lives in Nottingham and works as a healer and
freelance writer:
Original painting by Roxana Villa, Los Angeles, CA
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. AT.A:s trib-
ute fund is designated 100% for research. We send our thanks to all those people listed below for sharing memorable occa-
sions in this hopeful way. Contributions are tax deductible and are promptly acknowledged with an appropriate card. The
gift amount is never disclosed. GIFTS FROM 10-25-95 to 1-19-96.
Champions of Silence
Robert L. Feller John M. McNamara Vern Willaman
.Joseph G. Alam and 'lrudy
Richard J. Filanc Richard McWilliam Keith C. Winters
Drucker
John W. Finger Dr. Duane D. Mead Adelaide w. Zabriskie
Robert H. Boerner
Eldin L. Fisher Robert J. Mermuys Richard A. Zubrycki
Thomas w. Buchholtz M.D.
Robert Flaherty Sarah P. Minges Professional Associates
Stephen Chandler
D. Jeanne Frantz Blake Mitnick Alan J. Arnold M.D.
Rob M. Crichton
Lewis and June A. Freedman Glenn A. Morton Carol A. Bauer M.D.
Michael Deakin C.P.A.
MelvinJ. Garno Thomas F. Mottard Bruce S. Bloom M.D.
Katherine A. Elberfeld
Johnie Mae Gilmore Phyllis G. Nexon Knox Brooks
Li!Jian Godell
F. K. Gleason Jim Ed Norman Lawrence J. Danna M.D.
Claude H. Grizzard
Andrew Good Curtis S. Olson Williams. Gartner M.D.
Edmund J. Grossberg C.L.U.
W.J. and Helen Gotschall Aaron [. Osherow Barbara Goldstein Ph.D.
Dan Robert Hocks
Charles Mark Grabinski Paul Overby Dr. Ribhi F. Jarrar
Ann Klimczak, Pres. -
Donna Graham R. J. Palombit Paul J. Jones M.D.
The Barn Sale, Inc.
Alfred R. Greene John R. and Sara A. Patterson Richard S. Kaufman D.D.S.
Legislative Correspondents
John R. Hafer David D. Pearce Paul R. Kileny Ph.D.
Association of New York
Robert Hager Roger J. Peters and Stephanie Robert J Kohlenberg Ph.D.
State, Inc.
Dwayne R. Hall Moulton Peters Artine Kokshanian M.D.
Marshall P. McDonald
James L. Harkins Richard A. Phillips Robert J. Kramer M.D.
Stephen and Billie Moksnes
William A. Hart Jr. Margaret S. Powell David L. Mehlum M.D.
Gerald and Wanda M. Shannon
William J. Haskin A.O. Quinn Dr. Robert J. Meitus
Timothy S. Sotos
John E. Held James K. Quire Douglas H. Morgan D.D.S.
Agnes Varis
Alfred E. Heller Matjorie Quisenberry Randy Morgan - Westone
Donald L. Herman Stephen M. Reece Laboratories Inc.
Sponsor Members Mark E. Hethcote Patricia R. Reuter Meredith K. L. Pang M.D.
Lew F. Allyn Steven Hoffman Cornelia Rich Benjamin Pereira D.D.S.
Patty Andrews Julian Hoogstra Barbara A. Rickard - Peacock Max L. Ronis M.D.
Ernest C. Auer David W. Hopkins Foundation Inc. Ira D. Rothfeld M.D.
Mark Ayesh Jonathan S. Horwitz Mr. and Mrs. William P. Roberts Arthur Rudd D.D.S.
Thelma Batchelder Christopher V. Houghton Lee D. Robinson Dean Edward Schanen M.D.
Jeffrey R. Bauder
Jack Huang David K. Roller Abraham Shulman M.D.
McLaren Beatty James Irving Thny Rooney H. Ben Stone Ill M.D.
David P. Becker Howard G. Jacobs Edward P. Rosenberg James F. Wuth M.S.P.A.
M. Craig Bell Eric F. Janie Jerome Roth
In Memory Of
Ronald Berger
Edith J. Johnson Howard Rothenstein
Danny R. Bibb Lois Keeney Richard Rush Dr. N.K. Basile
Mario J. Bonello R.L. Keheley Thomas J. Ryder IV Joseph G. Alam and 'lrudy
Robert A. Bowler Robert A. Kirkman William B. Salsgiver Drucker
James 0. Boyce
Laura P. Kleppick Joseph A. Sampson
Sam Eisenberg
Richard W. Brunner
Katherine C. Kline Joseph J. Schall
Ann and John Carro
Robert B. Budelman Jr. Barbara L. Kohn AndreN. Schipper
Muriel Cohn
William A. Burgin James Krasno Don T. Seaquist
Bernard Goldin
William R. Cagney Ph.D. Dr. Ed Krol Myron L. Semrad
Harry Lewis
Peter E. Campbell C.F.X.
Robert S. Kurz Mrs. Alice L. Shields
Philip and Ruth Rubinstein
Joseph Capasso Clide V. Sonny Landreth III Saul N. Silbert Charitable Trust
Mr. and Mrs. Lee Samuelson
Daniel J. Carda Milton Leak Don L. Six Sr.
Joan and Dick Sanger
Mary Lou Carey Evelyn Schrader Lee Robert P. Smith
Bea Sonnett
Arthur Cellini
Gerald E. Lemenager Martin V. Socha
Herbert and Thelma Yanco
Stephen Chandler Sharon Ann Lemke Maxwell Solomon
Uncle - Sam Eisenberg
Gary M. Chase Donald Lemmons Morton and Norma Steele
Niece and cousin - Roxy Ciers
Glen Heather Clark Stephen W. Lewis Orloff W. Styve
Gardner C. Cole
William C. Licht Ruth M. Swan
Twin Brother -
Robert W. Cole Mary Jane Lillis Lee and Carol Thger
J obn E. Greve
Diana Connolly John W. Linley David Hollis Thylor
Jim and Joanne Cooper
Bryant Conway HI Lorraine M. Love William R 1bwer Jr. J ohn G. Jaser
Anthony G. A. Correa William Don Lovell Dr. Robert D. Utsey Sr. Jasper J. Jaser
Patrick M. Costigan Maid For Excell ence, lnc. Alan L. Wal ters Virginia Kelly
George Crandall Jr. Vince Majerus Kirby M. Watson Anne S. Birch
Mary Holmes Dague Annette D. Mallory Robert F. Weimer
Col onel John B. Sampson
Pierre David Douglas Marshall Rita Weisner
R.ichard and Melba Dickerson
A.J. Diani Michael T. Matherly Delmer D. Weisz
Joh n B. Sampson
Helen L. Duffy Matrix Development Beverly .J. Wells
Douglas C. Erikson Corporation Harold E. Wells
Thayne and Pat Green
Thomas J. Fallon Jim H. McElroy Robert M. Whittington
Residents of Horizons West
Tinnitus Thday/March 1996 25
Tributes, Sponsors.
• •
(continued)
In IO\ ing memOT) of Father
- John B. Sampson
.Joseph A. Sampson
Husband - Ronald Vieira
Alice Vieira
In Honor Of
Recovery of Julie A lam
.Joseph G. Alam and 'li'udy
Drucker
Holiday gift for Joseph
Decker
Brenda Pint, Carol Moore, Linda
Berry Brenda Bossen of
Bilt·Rite Contractors
Ann OeLazzcr
Blythe Steever
Or. 'li'udy Drucker's Birthday
Ms. Adele Alam
.Joseph G. Alam
.Jules H. Drucker
Mora Emin
Ros;the and Jim Traver
!llr. and Mrs. Mary and Patrick

Birthday of Ludwig W. Halk
.Joseph G Alam and nud')'
Drucker
J ack Harary•s Birthday
Bob and Debbie Harary
l!nppy Hanukkah to 1\•lr. and
Mrs. Jack Harary
Bob and Debbie Harary
Mr. and Mrs. Eric and
Doreen Hogan
Don, Janet, and Elizabeth
Seaquist
J. \lichael Holbrook
Kathi Holbrook
Berniece Hull
William Haskin
l'llr. and Mrs. Ginge and
Evelyn Lipson's 55th
Wedding Anniversary
Mrs. Anne Grodsky
Bob Luthmann
Dennis Sherman
of 1bny Randall
a nd Heather Harlan
'Trudy Drucker
\Jr. Doran Seaquist Jr., for
Christmas
Don Janet, and Elizabeth
Seaquist
Or. John R. Emmett
Dr. and Mrs. Luther Smith II
Shirley Rosenhaft's Birthday
Naomi Swerdlin
In appreciation of Jack
Vernon
Ronald C. Allan
Corporations with
Matching Gifts
American Express Foundauon
Hocchst Celanese
Philip Morris
U.S. Banrorp
26 Tinnitus 1bday/March 19!lfi
Bequests
Lillian Codell
Research Donors
lol a P. Abood
Joseph G. Alam anciThucly

Ellen R. Albury
Rich Alger
LI'W F. Allyn
Helen M. Anderson
George A. Anderson
Marjorie Arnold
Alan J. Arnold M.O
Fifi 0. Badeaux
Deborah Balmuth
Mary Lou Barlow
Greg A. Behnke
H. D. and Mary Benson
Ronald Berger
.Jack R. Bertram
Cary A. Billey
Jim Birkenseer
.James L. Boardman
David L. Bothamly
Robcn A. Bowler
.John J. Burke
Priscilla K. Bush
Douglas S. Campbell
Frances H. Campbell
James A. Carmichael
Barbara Cenvin
Carol .Jean Chatterton
Mary K. Christiansen
MDrit' Christofano
Hyman and Shirley Cohen
Philip S. Collins
Diana Connolly
Bryant W Conway II
Donald J. Cook
Rose Cottrell
Bob J. Crow
Glen R. Cuccinello
Lee 0. Cunningham
Mary Holmes Dague
Ruth B. Danning
Pierre David
Claude E. Davis
Bruno Delorenzo
S. Derick
Max Desfor
Pauline R. Dibella MS CCC-A
Frederick S. Oornblatt
Patricia S. DostaJek
Thelma D. Dry
Eli7.abeth Eberling
Daniel Ehrich D.D.S.
Doy le K. Ellis Sr.
M. Ellis
Elt'.a Peld
Mrs. Alben A. Feldman
Joseph W. Ferioli
Thomas P. Fidance
Richard J. Filanc
Stanlev Fiore
Robert E. Flahenv
Geraldine R. Fole-v
Curry E. Ford II .
Francine and Ray Foster
Lewis and June A. Freedman
Arlene Friedman
Doris E. Frost
Jim Ray Fugate
Evelyn C. Gabriel
Vincent D. Gallucci
Frank L. Giancola
E:ric M. Gibber
Myra J . GibSOJl
Mrs. Rhoda E. Gibson
Maurice J. Gifford
Mrs. Lillis Gilmartin
Robert A. Cold
Bill Cordon
Ciro P. Granatini
Claude H. Grizzard
Irene S. Groner
Anhur C. Cross
Betty J. Cross
David M. Halpern
Frances Hansen
Nancy A. Hartnett
Mary K. Hemphi ll
Minni Heyen
Mrs. Shirley !Iickman
1:.. Alan Hildstrom
Lynda M. Hoffmann
Anne S. Holmes Holland
Culielrna T. Hooper
Jeffrey Horlick
Donald E. Hostetler
Christopher v. Houghton
Gerald Hug
Elizabeth M. Huttrer
Betty Ippolito
Sharon B. Jacob
Harry .Jacobsen
Etta Marie James
Esther w. Johnson
Wayne J. Johnston
Lynn R. Kaeding
Bernard Kaminsky
Jo Ann Karkenny
Lois S. Keeney
R. L. Keheley
John T. Kennedv
Millard F. Kirk -
Ronald and Glenda KlinC'
Michael L. Korpal
James D. Koutny
Dr. Ed Krol
Peter M. Kusian
Blanche A. Lagasse
Florence Langevin
Stella Lapame
Marcia E. Lengnick
Stanley D. Levin
Ann Lingos
Donald J. Lisio
Willard Littlehale
Frank L. Long
Vince Loporchio
Norman B. Lucas .Jr.
Julia F'. Lunsford
Michael T. Matherly
Dr. Angelita M. May
Michael McAllister
Peter J. McDonagh
Marshall P. McDonald
.Jean Mentis
Diane E. Meyers
P. June Miller
Carolyn B. fo.iiller
Dr. Wayne H. Mitchell
Joe Ann Morris
.Jean Moss
John and Louise Myers
Morris Newmark
James D. Newton
Elisabeth J. Nicholson
Peter J. Nikolai
Carol Nilles
Harris A. Oehler
Jean Ann Olsen
Bob Olson
John K. Oscarson
Roger W. Parian
Barbara B Pearson
Vera J. Pech
Cram Perkins
Roger J. Peters and Stephanie
Moulton Peters
Lucille M. Peten;en
James C. Petrowicz
Richard A. Phillips
Leonard Pivnick
Steven J. Poplin
Emma ,Jean Poucher
Roger E. Powlison
lvanell Presley
Jessie N Quinn
Rowena Rand
Kay Reeves
Eleanor Regula
Michael H. Rehmus
Susan E. Roof
Shirley K. and Mort Rosenhaft
Jerome Roth
Robert Rusignola
John R. Russell
Richard E. Schade
Dean Edward Schanen M.D.
Phyllis Scher M.D.
William Schwartl
Leo W. Seal Jr.
Calvin SeU
Gloria E. Senne
\1ichael H. Sepcde
Nicky Sheats
Harry Shook
Vincent SilvcstTJ
Arty B. Smith
Clvde and Darleen Smith
La;·ry Spoden
Thomas J. Stefanik M.D.
James J. Steponik
Mrs. Sedalise S. Stoute
Naomi R. Sweeney
f\lary Tederman
Alfredo C. Thti
Marilyn L. 1brgrimson
John D. 1brmedis
Alfred A. 1brre M.D.
Barbara L. 'Iterice
Joseph W. Ullmann
John R. Veglia
Gerda Wassermann
Robert Watson Jr
Anna-Maria Weathers
Marvin J. Weinberger
Chris Werkley
Warner Whitnev
James H. Winzenburg
Lvnn Wolf
H. Dale Wolfe
Frank C. Wonderly Jr.
Cecilia Yeo
Werner E. Zarnikow
.Julie A. Zelez
ATA's 25th Anniversary
Regional Meetings
May & September 1996
(see inside for details)
AMERICAN TINNITUS ASSOCIATION
P.O. Box 5, Portland, OR 97207-0005
Forward and Address Correction
A PERSONAL MESSAGE
TO YOU FROM THE
CHAIRMAN OF THE BOARD ...
March, 1996
Dear ATA Members:
Like so many of you I suffer from tinnitus. I have had it since 1980 and over the years the
ringing has become much worse. Tinnitus has drastically affected my family, social, and
occupational life. However, I do consider myself lucky in that I live in Portland where
AT A is headquartered, and where tinnitus is better known and understood than in other
parts of the country.
When I first acquired tinnitus, I was very frustrated to find that there was no cure or even
much that could be done to give me some relief. It was out of this frustration that I began
doing volunteer work for ATA and formed a Portland self-help group. In 1988 I joined the
Board of Directors and in January 1994 became Chairman of the Board. Knowing that I
have had some influence on ATA programs and direction, as seen from a sufferer's point
of view, has made my board experience gratifying. However, I am still frustrated.
I am convinced that our only hope in finding relief and an eventual cure is through in-
depth research. This last year, ATA was able to give over $196,000 in research grants.
That may sound good to some people, but its not nearly enough for me.
My goal is to fund as much research as possible, as quickly as possible. And, frankly,
I need your help.
We currently have three excellent research proposals in front of us that we would like to
sponsor right away. It will take at least $200,000 to fund them and I am appealing to you
for a donation to help raise that amount. Your tax deductible contribution will be used
specifically for these three proposals or, should we raise more than they require, will go
into our dedicated research fund for future projects.
Please join me in fighting tinnitus by contributing to this critical research appeal today.
Sincerely,
Philip 0. Morton
P.S. Remember that a minimum annual membership contribution is required to receive Tinnitus Today. Those
donations make possible AT A's day-to-day operation and development of educational materials and important
publications. Thank you for that support also.

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