December 1998 Volume 23, Number 4

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Education - Advocacy -Research - Support
In This Issue:
Managing Meniere's Disease
Where Does Tinnitus Come From?
Ginkgo Biloba and Tinnitus
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Tinnitus
Editorial and Advertising offices: American Tinnitus Association, P. O. Box 5, Porrtand, OR 97207 503/248-9985, 800/634-8978 linnitus@ata.org, http:/ fwww.oto.org
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Tinmtus 7bday is published quarterly in
March, June, September, and December. It is
mailed to American Tinnitus Associat ion
donors and a selected list of tinnitus suffer-
ers and who treat tinnitus.
Circulation is rotated to 80,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit
able for Ti1mitus 7bday. Acceptance of adver-
tising by T!nmtus 7bda.y does not constitute
endorsement of the advertiser. its products
or services, nor does T!nmlus 7bday make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by r.ontributors to T!nnrtus
Today are not necessarily those of the
Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-
profit human health and welfare agency
under 26 USC SOl (c)(3).
Copyright I 998 by American Tinnitus
ASsociation. No pan of this publ ication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any means,
without the prior ,,,riuen permission of the
Publisher. ISSN: 0897-6368
Executive Director
Gloria E. Reich. Ph.D .. Portland, OR
Board of Directors
James 0. Chinnis, Jr., Ph.D., Manassas, VA
W. F. S. Hopmeier, St. Louis, MO
Gary P. Jacobson, Ph.D., Detroit, Ml
Sidney Kleinman, Chicago, IL
Paul Meade, Tigard, OR, Chmn.
Philip 0. Monon, Portland, OR
Stephen Nagler, M. D., F.A.C.S., Atlanta, GA
Dan Purjes, New York, NY
Aaron I. Osherow, Clayton, MO
Susan Seidel, M.A .. CCC-A, Towson, MD
Jack. A. Vernon, Ph.D., Portland, OR
Megan Vidis, Chicago, IL
Honorary Directors
The Honorable Mark 0. Hatfield, U.S.
Senate, Retired
Tony New York, NY
William Sbamer, Los Angeles, CA
Scientific Advisory Committee
Ronald G. 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 Amonio, TX
John R. Emmett, M. D., Memphis, TN
Chris B. Foster, M.D., La Jolla, CA
Barbara Goldstein, Ph.D., New York, NY
John w. House. M.D., Los Angeles, CA
Gary P. Jacobson, Ph.D., Detroit, Ml
Pawcl J. Jastreboff, Ph.D., Baltimore, MD
Robert M. Johnson, Ph. D., Portland, OR
William H. Martin, Ph.D., Portland, OR
Gale W. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Robert E. Sandlin, Ph. D., El Cajon, CA
Alexander J. Schleuning, ll, M.D.,
Pordand, OR
Abraham Shulman, M. D., Brooklyn, NY
Mansfield Smith, M.D., San Jose, CA
Robert Sweetow, Ph.D .. San Francisco. CA
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey,
Portland, OR
The Journal of the American Tinnitus Association
Volume 23 Number 4, December 1998
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.
Table of Contents
7 Announcements
8 Managing Meniere's Disease
by Barbara Tabachnick
11 Book Review: Meniere's Disease - What You Need to Know
by Barbara Thbachnick
13 Where Does Tinnitus Come From?
by Aage R. Mller; Ph.D.
17 Ginkgo Biloba: A Word of Hope and a Word of Caution
by Stephen Nagler; M.D. , FA.C.S.
18 Caring for Yourself Despite Tinnitus
by Reverend Radha
19 A Long-Thrm Look at Ginkgo
by Susan Seidel, M.A., CCC-A
21 Support Giving and Getting: In Our Own Time
21 Nordstrom/ ATA Partnership Puts Tinnitus Book in
Medical Libraries
by Cora Lee (Corky) Stewart
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
5 Letters to the Editor
23 Questions and Answers
by Jack A. Vernon, PhD.
25 Special Donors and 'fributes
Cover: 'Love Button' (watercolor and pencil on paper) by Gail Wells-Hess, wells56@ibm. net
or 800/ 776-4245. Represented by Chroma Gallery, Fair Oaks, California and the Seattle Art
Museum Rental Sales Gallery, Seattle Washington.
FROM THE EDITOR
by Gloria E. Reich, Ph.D.,
Executive Director
Another year has passed and
we at ATA wish you the best
ofholidays and a happy and
healthy 1999. Every day our
mail brings us news of discov-
eries that give us hope for
better treatments and even
possible solutions to hearing
and tinnitus problems. Even
a few years ago who would have dreamed that
a fully implantable hearing aid would be under
study? Could we have imagined that genetic
research would find ways to address the prob-
lems of familial deafness? Would we have
believed that scientists could "see" tinnitus in
the brain? Stay tuned everyone, because the new
millennium is going to bring big surprises and
hopefully solutions to problems such as those
we face with diminished hearing systems. ATA is
proud to have sponsored some of these seminal
studies and we'll be keeping you posted on the
latest happenings.
We hope you've noticed Tinnitus Tbday's new
look. Our graphic design consultant, Gail Wells-
Hess of Portland, has introduced several changes
designed to make the magazine more readable
and interesting. You'll also note that several new
advertisements have appeared. These are consis-
tent with our policy to offer our readers as many
sensible choices as we can find of items that
might possibly help them battle tinnitus.
We and you both know that ATA cannot offer
you a cure for your tinnitus. We'd like, however,
to help you make good decisions about your
care. What do you want to know? We'll gladly
research and write about topics that you'd like to
see covered in Tinnitus Tbday. Let us know by
writing to us, either by fax or e-mail, or snail
mail if that's your only choice. I'm
1.... I going to give you something to
" start with by listing topics
llr below. These are some of the
#' topics that were requested to
lil
be covered in the interna-
..,. tional meeting of support
groups that will take place
.,..., ' in Cambridge, England on
-..._ September 4, 1999. This is
7/' \ ,. one day prior to the Sixth
4 Tinnitus Today/ December 1998
International Tinnitus Seminar which will take
place in Cambridge from the 5th to the 9th of
September, 1999. Come yourselves or suggest
that your doctor or hearing professional attend.
Look for an announcement of this meeting in
this issue.
Possible topics for discussion about tinnitus:
Psychological impacts of severe and
persistent tinnitus
Development of new equipment to
objectively test tinnitus
Electronic contTol of tinnitus
Outcome measures for various tinnitus
treatments, including masking, retraining
therapy, drugs, non-traditional methods, etc.
Audiological examinations for tinnitus
Providing information about tinnitus: what
do people really want to know, and does it
bring relief?
Potential causes of tinnitus
Tinnitus in children, elderly
Management strategies by country:
USA, Germany, France, U.K., Scandinavia,
Japan, etc.
These are just a few ideas for you to start
with. I'm sure they will suggest more questions
that you would like to have answered. Direct
specific questions to the "Question and Answer"
column written by Dr. Jack Vernon. Your experi-
ences with helpful treatments can be used in
the "Letters to the Editor" column. And your
ideas about more general topics will be
researched for longer articles. Thank you for
helping us by making these suggestions.
As we approach the new year and the end of
this century it is important to look beyond our
personal desires for a tinnitus cure. We must
look for better treatments for those who have
tinnitus now and prevent people who don't have
it from getting it. The cure might come later,
perhaps to benefit us, but surely to benefit our
offspring. Join ATA, contribute what you can for
tinnitus research and volunteer vour time and
energies to our mutual goals. We need
you as much as you need us and we welcome
your involvement. Happy New Year! D
Letters to the Editor
From time to time, we include letters
from our members about their
experiences with "non-traditional"
treatments. We do so in the hope that
the information offered might be helpful.
Please read these anecdotal reports
carefully, consult with your physician
or medical advisor; and decide for
yourself if a given treatment might be
right for you. As always, the opinions
expressed are strictly those of the letter
writers and do not reflect an opinion or
endorsement by ATA.
I
n August of 1995, my right ear began to "ping"
very loudly over the top of my existing tinni-
tus which I had in both ears. In as little as two
days, the incessant pinging broke down my resis-
tance and frayed my nerves. As the days wore
on, sustaining my sanity became very difficult.
The pinging noise invaded every corner of my
life, interrupted every thought. This pulsatile
pinging noise was truly more bothersome to
me than my existing tinnitus which I had been
living with since 1988.
My subconscious couldn't quite ignore the
random, pulsatile sounds as I'd learned to do
with my tinnitus. My doctor couldn't find a con-
nection between the pinging and a biological
function such as pulse or breathing, and I began
to despair that this new noise would be a life-
long companion.
I ruled out medications such as Xanax,
Pamelor, and Elavi1 as the cause because l'd been
experimenting with them for years for my "regu-
lar tinnitus" before the pinging began. The med-
ications took the edge off of my tinnitus but they
also made me drowsy. I started to drink several
cups of coffee daily to counter the drowsying
effect of the medication. Simultaneously, I was
heavily salting my foods. My body seemed to
accept this regime until that afternoon in August
when I had finally overstepped my threshold
and my ears had had enough.
I chanced upon an Internet reference about
the profound impact that coffee and salt had on
tinnitus, and wondered if something as simple as
that could be responsible for my pinging noises.
Cold turkey, I stopped all caffeinated coffee and
salt. I couldn't maintain a coherent state of
mind on medication without coffee, so I stopped
the medication too. It was only a matter of days
before the pinging stopped and I found relief.
Since my discovery three years ago, I have
not taken any medications and I only drink
one half-cup of caffeinated coffee a day. I have
tinnitus in both ears, but over the years we have
become compatible. If my resolve cracks and I
test myself on an extra cup or I get careless and
over-salt my foods, the pinging returns. It seems
all too simple but the fact remains: my pulsatile
tinnitus was caused by too much caffeinated
coffee and too much salt.
Jeffrey B. Bell, 220 Old Tippecanoe Dr.,
Springfield, IL 62707, 217/787-4507
R:
ecent news media announcements have
given the impression that the Aurex-3 system
provides "tinnitus cancellation" technology
that can cancel, or nullify, tinnitus sounds. As
an audio and acoustics engineer, I would like to
explain why tinnitus cancellation is, in my opin-
ion and in the opinion of other experts in the
field, not possible.
The concept of tinnitus cancellation (some-
times referred to as "phase cancellation") is
based on the seemingly simple principle of
applying a sound wave or vibration that is
"equal-and-opposite" to the tinnitus sound,
thereby canceling it out. While this process is
feasible when the sound to be canceled exists as
an external sound, it is unfortunately not applic-
able to tinnitus for many fundamental reasons.
Principal among these reasons is the fact that
there is no actual"sound" present in the ear that
corresponds to the perceived tinnitus. In other
words, tinnitus involves the perception of sound,
not the presence of sound. Any attempt to soni-
cally cancel that which does not exist only
results in the introduction of extraneous sound
in the tinnitus frequency region. When extrane-
ous sound is applied, a totally unrelated process
called "masking" can occur to some extent,
although optimal tinnitus masking is generally
achieved by systems that are engineered for that
purpose.
continued on page 6
Tinnitus 1bday/ December 1998 5
Letters to the Editor (continued)
An analogy to tinnitus cancellation could be
illustrated by imagining an intoxicated person
asking his friend to stop, or cancel, the move-
ments of the room that he perceives in his mind
to be spinning. The room is not actually movi.ng,
so room movement cancellation is not neces-
sary, let alone possible.
It is my understanding that absolutely no
tinnitus treatment device is FDA-approved to
claim or infer tinnitus cancellation as a basis of
operation. Anyone wishing to contact the FDA
Enforcement Division regarding this matter
may do so at (phone) 301/ 594-4613 or
(fax) 301/594-4683.
Mike Petroff, Petroff Audio Technologies
I
t is our pleasure to donate the results of my
worker's compensation claim for the use of
your organization to further the cause of
research into this terrible condition.
In 1993, as my junior high students were
preparing to leave their field day activities to
go home on the last day of school, a student
prankster grabbed a large freon-powered boat
horn, sneaked up behind me, held the horn to
my right ear, and discharged the can. The dam-
age this event caused cannot be easily described.
There was a resultant loss of consciousness, tem-
porary blindness, speech and motor dysfunction,
distorted vision, and a screaming noise in my
head that would not go away.
The hospital emergency room staff really
could not understand the problems and eventu-
ally discharged me when I could walk. The rest
of the story is chapter and verse of most of those
I've read about in your publication. In addition
to the skewed double vision, I suffered from
severe debilitating tinnitus and hyperacusis with
all of their side effects. The attempts at therapy
were unsuccessful. Ultimately, I had to leave my
teaching profession which I had so dearly loved
for almost 30 years.
Finding your organization and its resources
was the life preserver I needed to survive the fol-
lowing few years. The worker's compensation
insurer decided that I was a malingerer when
my condition didn't improve in a year, and sent
me to a gamut of physicians who gave me
devices that made the tinnitus worse. I read your
publications and the Proceedings and tried many
things, but nothing helped. The sleep depriva-
tion took a terrible toll on my psyche and those
around me.
6 Tinnitus 1bday/ December 1998
Finally, in early 1998, a friend referred me
to a product called "Magna Bloc TM" - Magnetic
Flux Generator" (www.magnabloc.com) pro-
duced through Dr. Robert Holcomb in Nashville,
TN (615/ 321-2251). After attaching these mag-
nets just behind and below the ears at night, I
found an immediate (within 30 minutes) change
in my condition. After wearing the magnets
infrequently over the past several months, I've
begun to regain my life. I can actually tolerate
multiple conversations near me; I can go into
restaurants again; I can concentrate on things;
I can tolerate sounds again that would have
caused intense pain earlier. And most of all I
began to sleep again, now several hours at a
time. Although the tinnitus is extant, it is finally
habituated.
I hope that someday, somehow, health care
professionals can be made aware of the mental
anguish and suffering they sometimes add to an
already insufferable condition. With the help of
your organization I remain eternally optimistic.
E. Wayne South, PO Box. 91, 105 Hissim Rd.,
Hope, NJ 07844
I
suffered with tinnitus for about 20 years
although there were times when I was so busy
that the noise was not noticeable. But when I
thought about it, the noise was there! In my
case, I hear whistling sound at 6000 Hz.
About a year ago, I started taking Ginkgo
biloba (40 mg per day containing 24% ginkgo
flavonoid glycosides). Since then the noise has
subsided dramatically and there are days when
the noise disappears entirely.
Thomas W Donaldson, Claremont, CA
M
indful that people choose stapedectomies
for several reasons, I've put together a
checklist based on my personal and suc-
cessful stapedectomy experience and extensive
investigation into the topic.
Stapedectomies ARE for correcting otosclero-
sis which is causing a conductive hearing loss.
The hearing test results are obvious and your
surgeon will be able to counsel you accordingly.
The success rate is high, but a failure would be
devastating. I suggest that every stapedectomy
candidate first try a digital hearing aid for 30
days. Remember, the law says you have 30 days
to try it before you are obligated to pay for it.
Stapedectomies ARE NOT for curing tinnitus.
It didn't cure mine and it didn't cure the tinnitus
A-NNOUNCEMENTS
6th International Tinnitus Seminar -
Cambridge, England
September S-9, 1999
Hosted by the British Society of Audiology
The 6th International Tinnitus
Seminar will be held on the
grounds of the historic and
beautiful Selwyn College at
Cambridge University, with
full conference facilities and a
large modern 500-seat lecture
.._ ____ __, theater adjacent to the college.
We believe this is the perfect venue for this
important scientific meeting. Accommodations
will be provided for 300 in the college itself.
Nearby hotel accommodations are also available.
Plenary session topics: Mechanism and
Models of Tinnitus, Medical and Surgical
Treatments, Tinnitus Retraining Therapy, Role
of Psychologist, New Advances in Research, and
Methods of Tinnitus Detection.
For registration information, contact:
Mrs. Jackie Reid
32 Devonshire Place
London WlN lPE
United Kingdom
44 + (0) 171486 4233
FAX 171 486 2218
E-Mail: j .hazell@ucl.ac. uk
Web site: www.tinnitus.org
Letters to the Editor (continued)
of several of my Internet pals. In fact, some peo-
ple who did not have tinnitus before their opera-
tions have it now. There is no logic to it.
Find a doctor who performs several
stapedectomies in a year. An average of about
35 to 40 a year would be my minimum. It'll give
you more confidence that your operation will be
successful, though it doesn't guarantee it. If the
doctor utters the phrase, "You'll have to learn to
live with tinnitus," quickly run out of the office.
You are in the wrong place! Hopefully, you'll
find the professionals you need to help you
through the adventure.
Robert J. Luciano, RJL97@aol.com
The 19th European Instructional Course on
"Tinnitus and Its Management"
Sunday Aprilll - Thursday AprillS, 1999
Nottingham, United Kingdom
The 19th annual course addresses the
causes, scientific background, investigation, and
management of tinnitus. It will consist of lec-
tures, videos, practical demonstrations, and
workshop sessions. The course is suitable for
otologists, audiological physicians, scientists,
technicians, and hearing therapists who are
involved in, or are developing, clinical or
research work on tinnitus.
Venue
The course is held on the campus of the
University of Nottingham. Accommodation and
meals are provided. The campus is within easy
access of Nottingham city center.
Faculty
The course organizers are Jonathan Hazell
and Ross Coles. The faculty comprises Adrian
Davis, David Baguley, Jean Baskil1, Terry Buffin,
Lucy Handscomb, Laurence McKenna,
Catherene McKinney, and Jacqueline Sheldrake.
Enrollment
The course fee is 660 (residential), 580
(non-residential). Both fees include comprehen-
sive notes, lunches, dinners; the residential
option also includes bed and breakfast. Early
application is advised. There is an upper limit
of 80 delegates. The closing date for receipt of
applications is February 26, 1999, by which date
all fees must be paid. Scholarships (covering
course fee and accommodation, not travel) will
be awarded. Details will be supplied upon
request.
Registration details can be obtained from:
Julie Whittington, Conference Nottingham
Regent House
Clinton Avenue
Nottingham NG5 lAZ
United Kingdom
Tel: + 44 (0115) 985 6545
Fax: + 44 (0115) 985-6533
E-mail: info@confnottingham.co.uk
Tinnitus Thday/ December 1998 7
Managing Meniere's Disease
by Barbara Tabachnick,
Client Services Manager
Imagine that you are taking a
peaceful walk, engaged in
conversation. Five minutes
later, you are bent over, retch-
ing, spinning with uncon-
trolled dizziness, sick. You
hear roaring noises in your
head and notice that your
hearing is muffled. This out-of-the-blue "attack"
lasts two hours then slowly subsides. You are
weak and unsteady for several days after. And
for every day thereafter, you wonder what
happened, fearful that it might happen again.
For people with Meniere's, it will happen
again.
Unrelenting vertigo, roaring tilmitus, hear-
ing loss, and a sensation of fullness or pressure
in the ears are agonizing symptoms each unto
themselves. When they occur simultaneously,
they characterize Meniere's disease, named for
French otologist Prosper Meniere. In 1861,
Meniere first identified the condition and noted
it correctly as a dysfunction in the inner ear.
Causes
The cause of Meniere's disease is not
known. The physical manifestation of it, howev-
er, is well-known - a swelling of the inner ear
labyrinths, the organs that house the balance
mechanisms. This swelling, referred to as
endolymphatic hydrops, results from an over-
production or an inadequate reabsorption of the
natural fluids (endolymph) in the labyrinths.
The triggers for the swelling are still a mystery.
Some causes being considered: autoimmune
dysfunction, viral infection, hormonal influ-
ences, dietary deficiencies, and allergies. Called
"a disease of exclusion," Meniere's is the conclu-
sive diagnosis only when other causes - such as
inner ear infection, acoustic neuroma, a leak of
perilymph fluid (perilymphatic fistula), and
even syphilis - have been ruled out. When the
cluster of symptoms occurs in the absence of
endolymphatic hydrops, it is referred to as
Meniere's syndrome. (Some question the use of
the word "disease" when describing a subset of
symptoms, but "Meniere's disease" is the term of
choice in the U.S. and Europe.)
8 Tinnitus 1bday/ December 1998
The Progression of Meniere)s
Other than that the typical Meniere's patient
is 30-50 years old when the disease first appears,
Meniere's has its own timetable. In its early
stages (which can span a year or more), the
symptoms come and go unpredictably. The
episodes (with dizziness, nausea, one-sided tin-
nitus, etc.) can last from 10 minutes to all day,
with residual unsteadiness lasting days longer.
Symptoms generally disappear between attacks
although in rare cases, the dizziness is constant.
The intervals between attacks can be months or
sometimes years.
As the episodes continue, the patient's hear-
ing usually worsens and the tinnitus that was
episodic becomes permanent. Hearing loss often
begins in the lower frequencies but can spread
across all frequencies as the disease advances.
The tinnitus can progress similarly. Fortunately,
the violent attacks of vertigo usually lessen then
stop in the later stages of the disease, often to be
replaced with a mild, constant state of disequi-
librium. (However, not all cases of Meniere's sta-
bilize.) Doctors refer to these permanent, leveled
off changes as Meniere's "burnout."
Tests
The patient experiencing Meniere's-like
symptoms usuaUy faces a battery of tests to rule
out other disorders as the cause, and to "rule in"
subtle symptoms that suggest Meniere's. A pure
tone audiogram is a standard first test. It will
show if the lower frequencies of hearing, typical
for the early-stage Meniere's patient, have been
affected. Meniere's-related roaring tinnitus is in
the lower frequency ranges too.
Balance tests (on computerized platforms, in
rotating chairs) can determine if the dizziness
experienced by the patient is vestibular dizzi-
ness, the type associated with Meniere's. Eye
movement and head shaking tests are also
commonly used for this purpose. Magnetic
resonance imaging (MRI), auditory brainstem
response (ABR), and blood tests might be
ordered to look for other medical conditions
that produce Meniere's-like symptoms.
Treatments
"The best treatment is one that eliminates
the cause of a problem." writes P. J. Haybach.
But with Meniere's elusive origins, that is not
possible. Attending to the symptoms, Haybach
concludes, is the patient's and doctor's logical
goal for now.
Drugs
Medications for Meniere's are aimed pre-
dominantly at arresting the dizziness and the
accompanying nausea and vomiting. They
include diuretics, antiemetics, motion sickness
drugs, anti-anxiety drugs, niacin, and steroids.
Sere (betahistine hydrochloride) was once
available in the U.S. for relief of debilitating
Meniere's dizzy spells. It is still available in
Canada and Europe by prescription, and in
Mexico without prescription. Betahistine is
available by prescription in the U.S. but can
only be obtained at a compounding pharmacy.
(Histamine injections are an alternative to it.)
None of these medications is intended to allevi-
ate tinnitus or restore lost hearing. However,
patients report that these symptoms are less
troublesome than the vertigo, at least in the
early stages of the disease.
Surgery
The number one goal of surgical manage-
ment for Meniere's is also to control vertigo.
One group of operations was designed to reduce
the pressure in the endolymphatic sacs by the
insertion of shunts (a kind of tubing) or valves,
or by decompressing the sac. For some patients,
these surgeries offer long-term relief from verti-
go. Many shunt patients, though, experience ini-
tial relief then a recurrence of the symptom, or
no relief at all.
Ototoxic drugs, like gentamicin, can be
delivered by injection through the eardrum to
destroy inner ear vestibular hair cells and end
the vertigo. Miraculously, this procedure works
for 65-95% of patients although it often needs to
be repeated for long-term help. A complication
from this procedure that is difficult to avoid:
destroying cochlear hair cells at the same time
which permanently impairs hearing. One study
showed that 65% of patients reported some loss
of hearing after this procedure. A tiny implanted
catheter pump is now being tried to deliver oto-
toxic drugs through the eardrum. Theoretically,
it offers a more accurate and controlled aim to
the vestibular area.
Labyrinthectomy, a more dramatic surgery,
is the complete excision of the balance organs in
the affected ear. The operation causes total hear-
ing loss on the operated side and is wisely
reserved for patients with constant vertigo and
total or near-total deafness on the affected side.
Vestibular nerve section - cutting the bal-
ance nerve - is a more invasive procedure than
labyrinthectomy. This surgery necessitates going
beyond the ear, in fact through the lining of the
brain, to reach the vestibula-cochlear nerve. Ten
percent of patients who undergo this procedure
lose their hearing on the affected side. The rate
of long-term success in controlling vertigo for
both labyrinthectomy and vestibular nerve sec-
tion is high: 90%.
Radical removal or destruction of the balance
organs leads to an end of the jarring attacks of
vertigo, but patients are left with a new and
permanent balance impediment with which to
contend. And if the Meniere's begins to affect
the other ear, as is sometimes the case, then the
symptoms would return. Over and above the
risks associated with any surgery, complications
(like worsened tinnitus and hearing loss, and
facial paralysis) are uncomfortably common.
Surgery is an option, but usually the last option
to be considered.
Allergy Treatments
Allergies are suspected to contribute to the
onset of Meniere's and are the subject of new
research in this field. An allergic reaction -
whether to foods eaten or particles inhaled - is
a chemical reaction in the body that can lead to,
among other things, the deposit of microscopic
debris in the endolymphatic sacs. And if the sacs
become damaged, the mysterious chain of
events that leads to Meniere's disease could
begin. In 1997, one group of 113 Meniere's
patients, with a variety of allergies, underwent
allergy desensitization and dietary treatments.
Once treatments were completed, all of the
patients felt that their allergy and Meniere's
symptoms had significantly improved.
Do-It-Yourself
Diet plays an enormous part in human
health. Meniere's patients probably see the
effects of this more than most. They can also
participate to a greater extent in self care.
Avoidance of the food additive MSG and strict
reduction of salt in the diet (to a suggested 1500
mg daily maximum), in conjunction with the use
Tinnitus Today/ December 1998 9
Managing Meniere's Disease continued
of a diuretic, successfully lessens vertigo for a
majority of Meniere's patients. This regimen is
aimed at dehydrating the inner ear which could
reduce the amount of endolymph and therefore
the dizziness. (It's been noted that once patients
adjust to a low-salt diet, they become more
sensitive than before to salt excesses.)
Also, by eating several small meals through-
out the day, patients can help stabilize fluctua-
tions of the endolymph levels. For some, this
will reduce the frequency of Meniere's attacks.
Improved blood flow to the ear can accomplish
the same thing. Patients are encouraged to elimi-
nate use of nicotine, alcohol, anti-sleep medica-
tions, caffeine drinks, and chocolate - all of
which contain vein-constricting agents.
Tinnitus and Meniere>s
Howard Gutnick, Ph.D., likens tinnitus to a
forest fire. It begins, he says, with a spark -
excessive noise, physical trauma, hearing loss, or
any disease that damages outer rather than inner
hair cells. The tinnitus is then fueled by the
brain's failure to habituate it, and the flames are
fanned by environmental assaults, like alcohol,
caffeine, nicotine, and stress. Tinnitus associated
with active Meniere's is different, Gutnick states,
from other tinnitus in that it has a continual new
source of sparks that feed the fire. "A person with
active Meniere's disease has an unstable inner
ear that is continually undergoing trauma due to
hydrops," he says. As long as the disease process
is untreated, he believes that any therapy for the
accompanying tinnitus will have little effect. "As
soon as the Meniere's disease comes under con-
trol," I<VTites Gutnick, "and the individual does
not experience the symptoms of fullness, dizzi-
ness, (fluctuating) hearing loss, and worsening of
tinnitus, the tinnitus could be helped by habitua-
tion or other therapies."
In 10 cases of "burnt out" Meniere's at the
Oregon Health Sciences University's Tinnitus
Clinic, patients were left with either one-sided
(unilateral) low-to-medium pure tone tinnitus or
one-sided low-pitched roaring tinnitus. All had
unilateral hearing loss too. With carefully fitted
hearing aids and the addition of steady low-level
sounds to their environments, al1 of the patients
experienced tinnitus relief.
Meniere's and its attending cache of symp-
toms is frustratingly hard for doctors to diagnose.
And the emotional toll that it takes on many
patients is hard to imagine. They panic during
the attacks and live in fear of the one that will
10 Tinnitus 1bday/ December 1998
follow. They fret over their progressive and irre-
versible hearing loss and growing tinnitus. They
cannot predict the number of years that their
Meniere's will be "active,'' nor do they know
when the next attack will occur, how long it will
last, and how severe it will be. It is a rough ride.
But for most patients, some relief is possible
- when they give a fair dose of attention to their
diet and lifestyle; when they seek help from
skilled diagnosticians; when they give prescribed
treatments a chance to work; when they undergo
allergy testing and, if necessary, allergy treat-
ment; and when they cautiously consider surgi-
cal methods only if the severity of symptoms
warrants it. With hard work and sound guidance,
some relief is more than possible. It is likely. 1m
Resources
Legacy Good Samaritan Hospital, Food & Nutrition Services,
1015 NW 22nd Ave., Portland, OR 97210, 503/ 413-7152, The
Hydrops Diet Regime
Meniere's Australia Inc., PO Box 202, Moonah 'Thsmania,
Australia 7009, telephone (03)6234 1494
Meniere's Network, The Ear Foundation, 1817 Patterson St. ,
Nashville, TN 37203, 800/ 545-HEAR (voice/ tdd),
615/ 329-7867, www.theearfound.org
Vestibular Disorders Association, PO Box 4467, Portland, OR
97208-4467, 800/ 837-8428, 503/ 229-7705, www. vestibular.org
Internet Meniere>s discussion group
Send e-mail to: requests@smtp.cochlea.com
leave message: "subscribe menieres_talk"
References
Estrem, S.A., and W.E. Davis, Meniere's disease- recent
advances, Missowi Medicine, vol. 85, no. 3, p. 151-154, 1988
Goldenberg, R.A., and M. Justus, Endolymphatic mastoid
shunt for Meniere's disease: do results change over time?,
p. 141, La1yngoscope 100: Feb. 1990
Gutnick, H., Internet posting, Sept. 5, 1997
Haybach, P. J., Meniere's Disease, What You Need to Know,
Vestibular Disorders Association, Underwood, J., (ed.), 1998
Hughes, G.B., and Pensak, M. L., Clinical Otology,
2nd edition, Thieme Medical Publishers, Inc. , 1997
Pappas, D.G., Is there a relationship between Meniere's
disease and allergy or sinusitis, Steady, The Meniere's
Network, vol. 7 no. 4, 1995
Severtson, M., Current research in Meniere's disease,
Steady, The Meniere's Network, vol. 8, no. 3, Sept., 1998
Shoemaker, A., New research yields insights into Meniere's,
Advance, val. 6, no. 24, p. 8, June 17, 1996
Vernon, J.A., Conservative treatment of tinnitus in
Meniere's disease, American Journal of Otology, vol. 9, no. 3,
pp. 201-202, May 1988
Jim Chinnis for their assistance in the
preparation of this article.
BOOK REVIEW
by Barbara Tabachnick, Client Services Manager
Meniere's Disease - What You Need to Know
by P. J. Haybach, R.N., M.S., Vestibular Disorders
Association, 1998. 336 pgs., soft-cover $24.95,
hardbound $34.95
When Meniere's Disease - What You Need to
Know arrived on my desk this summer, I picked
it up, read it, then immediately called Jerry
Underwood, Ph.D., director of the Vestibular
Disorders Association (VEDA). I wanted to
thank him, and to tell him that P. J. Haybach,
as author, and he, as editor, have done us a huge
favor. They have produced a teaching tool for us
and a reassuring guide for people who have or
suspect they have Meniere's. I wanted to tell
him that he hit the mark.
Haybach begins the book with a rather fine
layman's lesson in ear anatomy, and auditory
and vestibular processes. She moves on to
describe Meniere's symptoms; the "attack" and
its aftermath; the details of tests (hearing, move-
ment, blood, and imaging) that might be ordered
and the reasons for them. Haybach then covers
the treatments: dietary changes (the most com-
mon treatment in the U.S.); an array of diuretics
and their differences; corticosteroid use; shunt
and decompression surgeries; drugs (like niacin
and histamines) to block symptoms temporarily;
and drugs (like transtympanic gentamicin injec-
tions, and streptomycin) for permanent symp-
tom alleviation.
Haybach discusses the process of selecting
qualified doctors and how to obtain health insur-
ance coverage for this complex problem. Also
included: first-person patient success stories,
research studies related to and specific to
Meniere's, a list of patient support organizations
worldwide, and questions to ask the doctor
(once you've found one who is Meniere's-savvy).
The author quiets the controversies - from the
number of accent marks in the name to whether
or not Meniere's is accurately labeled a disease.
Precise drawings, readable charts, references,
and a glossary appear in the volume just when
they're needed.
It occurred to me why this book would
appeal to someone beleaguered by hearing
complications, unsteadiness, and surprise
attacks of vertigo. Haybach's writing style and
the material's presentation are clear, calming -
and balanced.
Meniere's Disease- What You Need to Know is
a saving grace for Meniere's patients and their
families, and a satisfying addition to our
resource library. IBI
The book can be purchased directly from
VEDA, PO. Box 4467, Portland, OR 97208-4467.
800/837-8428, (fax) 503/229-8064,
www. vestibular.org.
Meniere's Disease
What You Need to Know
by P. J. Haybach, R.N., M.S .

This Important new book Includes:
symptoms of Meniere's disease
testing-what to expect, what you will learn
treatments w11at you can do tips on coping
anatomy and physiology of the Inner ear
diet research alternative treatments
insurance surgery drugs
other resources- organizations, support groups

'The authors have successfully accomplished the difficult
task of accurately and succinctly summarizing an Immense
amount of technical information for the nonscientist
reader.'
F. owen BlaCk, M.D., Director of Neurotology Research,
Holladay Park Clinical Research and Technology Center,
Legacy Health System

hardbound edition: $34.95 plus $4 shipping In USA, canada, Mexico
softbound edition: $24.95 plus $3 shipping In USA, canada, Mexico
1$10.00 shipping to all other countries tor either edition.)
To order, please send check or credit card Information to:
vestibular Disorders Association
PO Box 4467
Portland, OR 972084467
www.vestibular.org
Tinnitus 1bday/ December 1998 11
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WHERE DOES
TINNITUS
COME FROM?
by Aage R. Melle" Ph.D., University of Texas at Dallas,
Callier Center for Communication Disorders,
1966 Inwood Rd., Dallas, TX 75235
P
hysicians often examine patients with tinni-
tus only to find that there is nothing wrong
with the patients' ears. This does not help
the patients who might only get confused by the
information and perhaps think that the tinnitus
they hear is not reaL
The ear tells the brain everything about the
sounds we hear. But the brain makes it possible
to perceive sound, to hear the
difference between sounds,
making it possible to under-
stand speech, enjoy music,
etc. Tinnitus could occur not
only because of an alteration
in how the ear works, but
also due to an alteration in
11 h
how the brain works. It is
Aage R. M0 er; P .D.
necessary to know where tin-
nitus is generated in order to find treatments for
it and to find ways to prevent it.
We know much about what parts of the brain
are involved in hearing normal sounds but they
might not be the same parts of the brain that
cause tinnitus.
Which parts of the brain are involved in hearing
and tinnitus?
Studies of which parts of the brain generate
tinnitus recently got national attention when it
was shown by Lockwood and co-investigators
1
that a certain part of the brain became active
when a patient heard tinnitus. Lockwood's study
used an imaging technique known as PET scans
to study which parts of the brain became more
active when a person's tinnitus changed from
weak to strong. PET stands for "positron emis-
sion tomography" and it was used to measure
changes in the blood flow in different parts of
the brain. Increase in blood flow in a part of the
brain is a sign that it is consuming more energy,
that it has become more active. PET scans show
a picture of the brain that is similar to the CT
scan or MRI scans. In a PET scan, areas of
increased blood flow light up, similar to thun-
derstorms on a weather map on television.
PET scans show which parts of the brain
become active when for instance a person hears
a tone or speech. Even if sounds reach only one
ear, it will cause the auditory cortex to become
active on both sides of the brain. This "lights up"
the PET scan on both sides of the brain.
Lockwood, et al, found that only the auditory
cortex on one side "lights up" on the PET scan
when patients with tinnitus experience an
increase in their tinnitus. Lockwood concluded
that the neural activity that caused tinnitus did
not come from the ear because that would have
caused the auditory cortex on both sides to
become active. These investigators also found
other differences between the way tinnitus
and ordinary sounds activate the brain in the
patients they studied. Regions of the brain nor-
mally involved in emotions and memory were
active when people heard their tinnitus but
these portions of the brain did not become
active when sounds reached one ear.
'
hese studies can only be done in patients
who can change their tinnitus from loud to
soft voluntarily. Few people with tinnitus
can do that. The PET studies therefore had to be
done in people who had a special kind of tinni-
tus that they could turn on and turn off when
they wanted. The results of this study therefore
might not be valid for other kinds of tinnitus.
Other methods have been used to find out
which parts of the brain cause tinnitus. Some
years ago, we found that tinnitus in some
patients seemed to come from parts of the brain
that are normally not activated by sound.
2
The
auditory nervous system is similar to an infor-
mation highway that connects the ear with the
part of the brain that interprets sounds. On the
way, the information is sorted with regard to its
frequency (spectrum) and many other qualities
of a sound. Sorting of information occurs in
clusters of nerve cells called nuclei. This part of
the brain is called the classical auditory pathway
and it is the information highway that normal
sounds travel to reach the (primary) auditory
cortex where we believe sounds, such as speech,
are interpreted.
(
continued on page 14
Tinnitus 1bday/ December 1998 13
WHERE DOES TINNITUS COME FROM? continued
T
his information highway in the brain
branches out to other systems, one of which
is called the adjunct auditory system. That
route does not lead to the primary auditory
cortex but to other parts of the brain, some of
which are involved in emotions. That adjunct
system not only receives its information from
the ear but also from the skin, muscles and
joints (somatosensory system), and from the
eyes. Little is known about the adjunct system
except for the fact that it does not seem to be
much concerned about what kinds of sounds
reach the ears.
We wondered if this adjunct system might be
involved in tinnitus. Th study whether this is the
case, we made use of the fact that the adjunct
system receives information from the nerves
that go to the skin all over the body (somatosen-
sory system). Information from these nerves
can either increase or decrease the neural activi-
ty of some nerve cells in that adjunct system. If
the adjunct system is involved in tinnitus, stim-
ulation of such nerves would then act as a vol-
ume control that could either turn the volume
of the tinnitus up or down. Th test that, we
placed electrodes on the wrist and stimulated a
large nerve by weak electrical impulses to see if
we could change people's tinnitus. Indeed such
stimulation changed the tinnitus in some of the
people we studied. The electrical stimulation
was felt as a tingling. Six out of the 26 people
we studied felt that the tinnitus became weaker
and less annoying during the electrical stimula-
tion of their wrist. Four of our patients felt that
the tinnitus worsened. These changes occurred
only while stimulating the nerve, and the tinni-
tus returned to its normal value a short time
after the stimulation was stopped. We interpret-
ed these findings to show that the adjunct sys-
tem is involved in tinnitus in some people with
tinnitus. This means that neural activity that
caused tinnitus in these people must travel in
routes in the brain that are not normally trav-
eled by sound.
2
Th find out if the adjunct system is normally
involved in hearing sounds, we tested people
who did not have tinnitus, using the same tests
as used with people with tinnitus. We presented
a sound to one ear and asked them if the vol-
ume of the sound was altered when we stimulat-
14 Tinnitus Thday/ December 1998
ed their median nerve electrically. The non-
tinnitus sufferers experienced no change or only
very small changes. This means that the adjunct
auditory system is probably not involved in per-
ception of ordinary sounds. In some tinnitus
patients, parts of the brain thus seem to have
made new connections with parts that normally
are not connected.
What can cause the connections in the brain to
change?
When the information travels from the ear to
the auditory cortex, it passes several clusters of
nerve cells - nuclei - that function as switch-
ing stations where each nerve cell has many
connections to other nerve cells, and that allows
nerve cells to communicate with each other.
This communication between nerve cells makes
it possible to analyze sounds and direct the
information of different kinds through different
routes on its way to more central parts of the
brain. We believe that there are also connections
that are normally closed. These closed connec-
tions - called dormant synapses - may open in
unusual situations. When that occurs, informa-
tion can travel through new routes and reach
parts of the brain that sound normally does not
reach. Such a change in the "wiring" of the brain
might cause tinnitus. And the unpleasant nature
of tinnitus might occur because parts of the
brain that are usually not involved in hearing
are active.
How can the wiring of the brain change?
Many studies have shown that connections
between nerve cells in the brain are not static
but can change. That is called "neural plasticity."
Earlier, neural plasticity was believed to exist
only in young individuals, but more recently, it
has been found that even the adult nervous sys-
tem can change. Neural plasticity is probably a
normal phenomenon of the brain that gives it
resilience. However, it is becoming evident that
neural plasticity going wrong may be the cause
of many different disorders. Changes in the
function of the nervous system through neural
plasticity does not mean that new connections
grow out from nerve ce11s, but it can occur
because unused and existing connections are
opened. Many connections between nerve cells
(synapses) are normally closed. That means that
it should be possible to reverse these changes
and restore the normal function of that portion
of the brain.
What can cause changes in the brain?
One of the most powerful means is lack of
stimulation such as may occur when the ear is
injured. Normally, sounds of different frequen-
cies activate different regions of the auditory
nervous system. In a person with hearing loss at
certain frequencies, the regions of the brain nor-
mally occupied by these once-perceived fre-
quencies will be taken over by frequencies
where hearing is not reduced. This is accom-
plished by opening connections between nerve
cells that are normally closed. In this process,
however, the parts involved may become more
sensitive than normal.
5
uch increased sensitivity might make nerve
cells become active without any sound
reaching the ear thus creating the sensation
of a sound, thus creating tinnitus. Gerken3 has
shown in animals that certain nerve cells
become more active if the ear is damaged so
that it cannot send information to the brain.
Jastreboff
4
has proposed that lack of stimulation
can cause tinnitus and restoration of stimulation
(low-level masking) may reduce tinnitus. This
has proven an effective treatment for some tin-
nitus sufferers.
The nervous system normally works with a
balance between inhibition (''brake") and excita-
tion ("accelerator") and the over-sensitivity may
occur because inhibition has not kept up with
the excitation in these areas that have been
taken over. It is like driving an automobile by
holding one foot on the brake and the other on
the gas pedal. If the brakes become weak and
the same pressure is placed on the gas pedal,
the car will accelerate. With financial support
from the American Tinnitus Association, we
have shown in experiments that some nuc1ei in
the brain become more active than normal after
exposure to strong sounds
5
and the function of
these parts of the brain could be restored by
medication.
6
The medications we used in this
study were bac1ofen and others in the family of
benzodiazepines. Clinical experience has shown
that medications that are similar to those we
studied can help some people with severe tinni-
tus, most likely because they restore the balance
between inhibition and excitation.
None of these discoveries alone cure tinni-
tus. But together they bring us forward towards
the goal of being able to help people with tinni-
tus to live a better life. 9
References
1. Lockwood, A. H.; Salvi, R. J.; Coad, B. A.; Townsley,
M. A.; Wack, D. S.; and Murphy, M. S. The Functional
Neuroanatomy ofTinnitus. Neurology, 50: 114-120. 1998.
2. M0ller, A. R.; M0ller, M. B.; Yokota, M. Some Forms of
Tinnitus May Involve the Extralemniscal Auditory
Pathway. Laryngoscope, 102: 1165-1171. 1992b.
3. Gerken, G. M.; Saunders, S. S.; Paul, R. E. Hypersensi-
tivity to Electrical Stimulation of Auditory Nuclei Follows
Hearing Loss in Cats. Hear. Res. 13: 249-260. 1984.
4. Jastreboff, P. J. Tinnitus as a Phantom Perception:
Theories and Clinical Imp1ications, Chapter 8. In:
Vernon, J. A.; M0ller, A. R.; eds., Mechanisms of Tinnitus.
Allyn & Bacon. Boston. pp. 73-93. 1995.
5. Szczepaniak, W. S. and M01ler, A. R. Evidence of
Neuronal Plasticity Within the Inferior CoUiculus After
Noise Exposure: A Study of Evoked Potentials in the Rat.
Electroenceph. Clin. Neurophysiol. 100: 158-164. 1996.
6. Szczepaniak, W. S. and M0ller, A. R. Effects of (-)
Baclofen, Clonazepam, and Diazepam on Tone Exposure-
induced Hyperexcitability of the Inferior Colliculus in
the Rat: Possible Therapeutic Implications for Pharma-
cological Management of Tinnitus and Hyperacusis.
Hear. Res. 97: 46-53. 1996.
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16 Tinnitus Today/ December 1998
TESTIMONIALS ON DTM EFFECTIVENESS
T
he DTM technology effectively eliminates unwanted sounds
produced below the tinnitus region, which to date has been
the major fault with conventional masking technology.
-Dr. Jack Vernon (one of the world's foremost experts on tinnitus)
I
am writing you to voice my unrestrained enthusiasm for
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with well-thought-out solutions to this perplexing problem.
- Dr Steven M. Rouse (ENT)
I
have been a three-year sufferer of high-pitched tinnitus in both
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this time I could no longer achieve a good night's sleep (despite
the use of a "sound soother" from the Sharper Image), and would
always awake feeling slightly nauseated and dizzy with the con-
dition continuing throughout the day. Throughout this progres-
sion I have consulted among the best doctors in the field. With
failed treatments ranging from ginkgo biloba to having tubes sur-
gically implanted, these fine physicians have come up empty
with respect to tinnitus. My initial reaction once I turned on the
first CD was one of utter amazement; I simply could not believe
how low the volume level was while masking. I can vividly
remember having to turn the CD player on and off agajn several
times to make sure I still had tinnitus! With the DTM process, I
no longer hear the ringing (unless I concentrate). For the first
time I have been able to get through a day without Advil and I
have even been known to attend a few movies (with earplugs, of
course). Thanks again.
-Paul Pedrazzi
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GINKGO 8/LOBA A WORDOFHOPEANDA WORDOFCAUTION
by Stephen Nagler, M.D., fA.C.S.
Many individuals who are significantly
affected by tinnitus encounter the maidenhair
tree along their inevitable odyssey in of
relief from incessant ringing. Some walk quickly
by, some stop and ponder, and some remain t?
partake of the fruits (actually extracts dned
leaves) of this tree, which is the oldest hvmg
species of tree on earth, having been present
since the days of the dinosaur. Ginkgo biloba,
the maidenhair tree, was believed at one time
to have magical powers. Today ginkgo is felt by
many to have a legitimate medicinal role. The
extract can be taken in pill form, as a liquid, or
intravenously, and is administered for many
reasons - among them, to improve cerebral
insufficiency by increasing blood flow to the
brain, improving neurotransmission, and acting
as a free-radical scavenger. Symptoms of cere-
bral insufficiency can include difficulties of cog-
nitive skills, decreased energy and physical
performance, depression, anxiety, dizziness,
headache, and ... tinnitus.
1
Some members of the tinnitus population
swear by Ginkgo biloba; others feel that it is inef-
fective for this condition. The question of the
true value of this agent should be answered con-
clusively within the next year, however, when
the results will be published of the first large-
scale double-blind randomized prospective study
(1000 volunteers at Birmingham University in
the U.K.) on the efficacy of ginkgo in tinnitus
treatment. Regardless of the outcome of the
study, the many affected by tinnitus who believe
that ginkgo has improved their symptomatology
will undoubtedly continue to use it. Indeed, if
the study does clearly demonstrate efficacy,
lions with tinnitus will use it on a regular bas1s.
As a tinnitus treatment, ginkgo has some
appealing aspects: 1) it is inexpens.iv.e,
and 2) its sWe effects are beheved to be neghgt-
ble. The purpose of this article is to explore
one particular side effect of ginkgo, which has
recently appeared in the medical literature,
and which may be under-reported.
Many patients do attribute their tinnitus
relief to Ginkgo biloba, and many others discon-
tinue its use because their tinnitus fails to
improve. Infrequently ginkgo is stopped because
of an apparent propensity for epistaxis - nose-
bleeds.
2
The vast majority of individuals on
ginkgo have no problems with nosebleeds or
any other side effects.
In terms of mechanism of action, the most
important components of Ginkgo biloba are
flavenoids and terpenoids. Ginkgolide B, a
terpenoid which is not known to exist in .
other living species, has been shown m mtro (m
the laboratory) to inhibit the action of Platelet
Activating Factor (PAF).
3
PAF is a crucial ele-
ment in initiation of platelet aggregation, an
early essential step in the coagulation
the blood dotting mechanism. The potential
exists, therefore, that in vivo (in real life) ginkgo
might adversely affect blood clotting.
Herein lies a potential explanation for the
few anecdotal reports of nosebleeds among
individuals taking ginkgo.
A question then arises:
if we assume that Ginkgo
biloba does, indeed, cause
nosebleeds in some cases,
then what might it be
doing inside the body?
In the June 1996 issue of
the journal Neurology, a
case report appeared of
a woman in her thirties,
who had been taking
120 mg of Ginkgo biloba
Stephen Nagler, M.D., fA.C.S. daily for two years and
who presented with large bilateral
hematomas - bleeding beneath the covenng
of the brain, compressing the brain matter
itself.
4
There was no history of head trauma,
and the patient's only other medications were
acetaminophen and a very brief trial of ergota-
mine/ caffeine tablets. The patient had not taken
anticoagulants, aspirin, or non-steroid_al
inflammatory medications. Her bleedmg t1me
was prolonged, but returned to normal when it
was re-checked a month after cessation of the
ginkgo. (She underwent surgical evacuation of
the subdural hematomas and made a complete
recovery.) Nine months after this case was pub-
lished, a case appeared in the literature .report-
ing spontaneous bleeding into the
chamber of the eye, a rare occurrence, m a
man who was taking ginkgo.
5
Ordinarily isolated reports such as the ones
just described would arouse little interest. These
reports, however, were somewhat bothersome
for three reasons:
1. Most individuals, when asked by a physi-
cian to list "current medications," would tend
not to list ginkgo.
Tinnitus Today/ December 1998 17
Ginkgo Bi/oba A Word of Hope and a Word of Caution (continued)
2. Most physicians tend not to explore a "cur-
rent medication" list further to see if agents such
as ginkgo, not typically considered by Western
doctors to be medications at all, might have been
inadvertently left off the list.
3. Most physicians do not appreciate ginkgo's
anticoagulant properties.
These three factors might potentially con-
tribute to under-reporting of a problem of some
significance.
What, then, would be a prudent position to
take if one were considering initiating a course
of ginkgo or if one were already taking this
extract? It seems reasonable to assume that
regardless of its efficacy with respect to tinnitus
treatment, Ginkgo biloba might in certain cases
predispose one to bleeding, not necessarily limit-
ed to nosebleeds. Fortunately there is a simple
laboratory test (called the '1Jleeding time") which
is a fairly sensitive measure of platelet function
and which can put every patient's and physi-
cian's mind at ease.
There is general agreement that if Ginkgo
biloba has not been effective for tinnitus relief
within three months, it will not become effective
thereafter. Thus, it is best to discontinue ginkgo
if no improvement is noted by that point. If
patients want to continue taking ginkgo for
longer than three months, their bleeding time
should be monitored at six-month intervals. If the
bleeding time is prolonged, patients should con-
sult with their physicians about continuing the
ginkgo. Ifbleeding gums, nosebleeds, bruising,
etc. are noticed while taking ginkgo, patients
should obtain a bleeding time and then decide
with their physicians whether or not to continue
the ginkgo. If any individual is already taking
anti-coagulants (blood thinners) and considering
starting ginkgo, the decision whether or not to
start the ginkgo should be made in consultation
with the physician. If an individual taking gink-
go is contemplating elective surgery, a bleeding
t ime should be obtained, and a decision should
be made in consultation with the physician and
the surgeon about discontinuing the ginkgo
prior to the surgery. In all cases, physicians
should be informed that Ginkgo biloba can inter-
fere with platelet aggregation.
Ginkgo biloba is a commonly used agent
which may be helpful in tinnitus therapy. The
Birmingham study will hopefully shed light on
its true efficacy, and the guidelines above will
hopefully increase the margin of safety. B
1. Kleijnen, J. and Knipschild, P.: Ginkgo biloba. The Lancet
340: 1136-1139, 1992.
2. Personal communications; non-published anecdotal
reports.
3. Campbell, W. B. and Halushka, P. V.: Lipid-Derived
Autacoids. Goodman & Gilman's The Pharmacological
Basis of Therapeutics, 9th ed., McGraw-Hill, New York,
1996, pp.601-616.
4. Rowin, J. and Lewis, S. L.: Spontaneous Bilateral
Subdural Hematomas Associated with Chronic Ginkgo
Biloba Ingestion. Neurology 46(6): 1775-1776, 1996.
5. Rosenblatt, M. And Mindel, J.: Spontaneous Hyphema
Associated with Ingestion of Ginkgo Biloba Extract.
The New England Journal of Medicine 336(15): 1108, 1997.
Dr. Nagler is the Director of the Southeastern
Comprehensive Tinnitus Clinic in Atlanta, Georgia,
and a member of ATA's Board of Directors.
CARING FOR YOURSELF DESPITE TINNITUS
by Reverend Rodho, reprinted and adapted with permission
from Tinnitus-Forum, the Deutschen TinnitusLiga e. V.
journal, August 1998
In his lecture at the 1997 Tinnitus
Symposium in Germany, Dr. Ed. Mathu Patel
said very rightly that while one can make a con-
scious decision to listen and pay attention to a
sound or voice among others ("the cocktail-
party effect"), one cannot make the decision not
to hear something. And of course, this applies to
tinnitus. But even though we hear it all the
18 Tinni tus Today/ December 1998
time, it is possible to avoid
being disturbed or, worse,
dominated by it.
You have almost cer-
tainly experienced a some-
what similar situation; you
want to go out but cannot
find your car keys. You
look everywhere, but can-
not see them. Suddenly -
there they are on the table,
where you've already
looked half a dozen times. Reverend Radha
A LONG-TERM LOOK AT GINKGO
by Susan SeideL M.A. cec-A
Ginkgo biloba and what it
is doing to the blood: It's
an important topic but it
isn't a new one. Since
1965, ginkgo has been
widely used in France
and Germany to increase
blood circulation in
patients' limbs. Its added
benefits have been to
help improve memory
and concentration - and
tinnitus.
Most of my Baltimore tinnitus self-help
group members, along with other volunteers, are
part of my Ginkgo biloba project. Many of the
512 participants have been taking 120 mg. per
day, three tablets of 40 mg in phytosome form,
for seven years. (The phytosome is a bonding
agent that allows the ginkgo to be absorbed
more slowly.) And during these years, I have
heard only one complaint about it - from a
man who took ginkgo on an empty stomach and
got an upset stomach. People regularly report to
me that they feel a sense of well-being, warmth
in their hands and feet, and for some, a reduc-
tion in tinnitus that they attribute to the ginkgo.
I have always advised my group members and
my audiology patients to have blood thinning
tests done and to not take ginkgo with other
blood thinning drugs.
From my reading of the case study published
in Neurology, the woman who'd had subdural
What has happened? The image of the keys fell
on your retinas and signals were transmitted to
the brain, but you did not see them. Your mind
did not "focus" on the keys.
Most tinnitus sufferers have a habit of "zoom-
ing in" on it, so that it becomes the center of
their attention. Even when they distract them-
selves by working, listening to music, watching
TV, or talking to people, the tinnitus affects their
mood and feelings. Can we "overlook" tinnitus so
that it no longer has these effects? Only you can
find the answer to this question. And I would like
to show you a way of training yourself to do so.
hematomas had also taken excessive amounts of
acetaminophen along with the ginkgo. Many
prescription and over-the-counter remedies can
cause bleeding time to lengthen. And if any of
these substances is taken with ginkgo (or with
other medications) and bleeding does occur, the
cause will not be known. It is very hard to draw
conclusions from one case.
Ginkgo has been studied for more than a
decade in Europe. In those studies, ginkgo was
found to be effective as a free radical scavenger,
effective for improvement in macular degenera-
tion, and helpful with asthma and allergic reac-
tions in addition to its use as a blood thinner.
Ginkgo biloba will be a hot topic at the 6th
International Tinnitus Seminar in England next
year. In addition to a report about the 1000-tinni-
tus patient/ ginkgo study in Birmingham, I will
be making a full presentation about my 512
long-term "ginkgo takers." Right now, though,
I can say that they've been helped by it. And so
have I. ID
Susan Seidel is an audiologist at the Greater
Baltimore Medical Center and a member of ATA's
Board of Directors.
EDITOR'S NOTE: The assumptions regarding
ginkgo presented in both Nagler's and Seidel's
articles are based on anecdotal reports, not on
clinical research. For additional information
about ginkgo and tinnitus research, see JJEnding
the Silence - the Lowdown on Alternative
Treatments" and "Ginkgo - Fact or Fiction?" in
Tinnitus Thday, val. 18, no. 4, December 1993.
Tinnitus is in some ways like pain. It results
from an injury or trauma to some part of the
brain or hearing apparatus. If we view the expe-
rience of tinnitus as being similar to that of
pain, then, when all medicine fails, there is
still a way we can reduce or even eliminate its
effects on us.
Much of the time we are simply not aware
of what we are doing. We live a large part of our
lives unconsciously reacting to events without
knowing why we do, or even without realizing
that we are reacting. Unconsciously we can
continued on page 20
Tinnitus 1bday / December 1998 19
CARING FOR YOURSELF DESPITE TINNITUS (continued)
become angry, depressed, anxious, or physically
and mentally tense. It is this tension that causes
pain or tinnitus to be even worse.
But we can take control of our lives, so that
our tinnitus (or pain) no longer dominates our
feelings and emotions. We do this by training
ourselves systematically in "mindfulness." Put
simply, mindfulness is moment-to-moment
awareness without reacting automatically to
what happens. It is cultivated by purposefully
paying attention to things to which we ordinarily
never give a moment's thought. Breathing is one
example.
One way to think of mindfulness is that
it is a lens, focusing on things you are doing,
thoughts you are at the moment thinking. What
happens to the tinnitus? It falls into the back-
ground. It goes out of focus. It loses its impor-
tance which allows us to get on with the business
of moment-to-moment living. In the course of
time the sounds pounding or whistling in our
heads become like the keys we could not find.
Training ourselves in mindfulness requires
a systematic approach to developing new kinds
of control and wisdom in our lives. It requires
active learning, in which we build on the
strengths we already have. In this learning
process we can assume from the start that so
long as we are breathing, there is more right
with us than there is wrong, no matter how loud
the tinnitus or how hopeless we feel.
The problem of tinnitus does not submit to
simple-minded solutions or quick fixes. It is a
natural part of life (if not everybody's, then at
least yours and mine!). And so there is no more
escape from it than from the human condition
itself. The bottom line is that truly facing our
problems is the only real way to get rid of them.
Practicing mindfulness
If you were to look in on our tinnitus group,
you would probably find us with our eyes closed,
sitting quietly or lying motionless on the floor.
This can go on for up to forty-five minutes at a
stretch. To the outside observer this might seem
strange. lt looks as though nothing is going on,
and in a way this is true. But these people are
not just passing time or day-dreaming. You can-
not see what they are doing, but they are work-
ing hard. They are practicing non-doing. They
are actively tuning in to each moment in an
effort to remain awake and aware from one
instant to the next. They are not thinking about
what happens next or when it will be time for
20 Tinnitus Thday/ December 1998
the coffee-break. They are not thinking about
their tinnitus and how bad it is. They are not try-
ing to solve problems. They are practicing mind-
fulness - stopping all the "doing" in their lives
and allowing body and mind to come to rest, no
matter how loud the tinnitus or how they feel.
Seeing things as they are
When I first became a Buddhist monk, I
asked my teacher what was the most basic pur-
pose of Buddhism. He told me that it was "to see
things exactly as they are," to see a noise in the
head, a pain, a feeling, or a thought just as it is,
without immediately "doing" something about it,
such as thinking, "I wish it would go away," or,
"How terrible this is." These thoughts b1ing the
tinnitus into the foreground and into focus,
which is exactly where we don't want it. The
more you attach your thoughts to the tinnitus
and the more importance you give it, the
stronger it gets. But if you can, so-to-speak
"starve" it, it matters much less, and is no more
a real disturbance than the police sirens you
hear from the street. This process of letting tin-
nitus "lose weight" takes place through practicing
mindfulness.
Caring for yourself
You cannot, however, learn to do this over-
night, nor in the few days spent in a seminar.
You have to make a firm personal commitment
to spend some time each day practicing "just
being." Then you will learn how to make time
for yourself, slow down, become calm, and how
to observe what is going on in your mind.
The more systematically and regularly you
practice, the more the power of mindfulness will
grow, and the more you will come to understand
how valuable it is. And no matter how much
your doctor, relatives, or friends want to help
you in your efforts to move towards greater lev-
els of health and well-being, the basic effort still
has to come from you. No one's care for you
could or should replace the care you can give to
yourself. G
Reverend Radha (an Irishman!) has been living in
Munich, Germany for 13 years where he practices psy-
chotherapy with special emphasis on stress. He learned
and taught vipassana and Zen meditation during 4 years
in Sri Lanka. Later he explored what meditation could do
for his tinnitus and found after a while that he could live
with it far better. He can be contacted at:
Destouchestrasse 67a, 80796 Munich, Germany;
radha@imt. m. isar. de
SUPPORT GIVING & GETTING:
In Our Own Time
The following names and
numbers belong to our newest
support-giving volunteers.
They join the many hundreds
of others who've stepped for-
ward over the years and said,
"I want to help."
What do they do? They
receive calls from people trou-
bled by their tinnitus. They
start and often lead local tinni-
tus self-help group meetings
for patients and their families.
They contact us for informa-
tion and assistance whenever
they need to.
What do they give) They
give a few hours a month or
maybe a week to others with
tinnitus who are out of
strength or out of ideas.
What do they get) They say
they get back two-fold, and
sometimes ten-fold, in friend-
ships, satisfaction, and pur-
pose. ( We say we could not do
without them.)
A list of current volunteers
in your area was sent to you
when you joined ATA. Please
refer to it if you need someone
nearby with whom to talk.
Remember to call only during
reasonable day or evening
hours. Do you need another
list? Call or write to us for a
new one. Are you interested in
being a local support volun-
teer? Ask us for a Support
Giver's Packet. We'll send it
right away.
And if you are not ready
today to offer help - or even
ask for help - then maybe
someday. m
Our heartfelt 1toliday wishes
and year 'round thanks
to all of our amazing
help givers.
New Support Group
Mark Gulliver, MSC
Nova Scotia Hearing & Speech
QE2 Health Services Center
Dickson Bldg., 3rd floor
5820 University Ave.
Halifax, NS B3H 1 V7
CANADA
902/473-4366
New Telephone and E-mail
Contacts
Herbert Hilton
3000 Marcus Dr., #P-307
Aventura, FL 33160
305/ 792-0861
Kathleen Krivak
145 Burton Ave.
Hasbrouck Heights, NJ 07604
201/ 288-3038
Dorothy Lewis
360 Richboro Rd.
Richboro, PA 18954-1710
215/ 357-6047
Paul Murphy
P.O. Box 1184
Sun City, AZ 85372
602/ 972-5907
John Reyes
347 42nd St.
Brooklyn, NY 11232
reyes@mci2000. com
Patricia Shippey
204 Creamery Rd.
TUnkhannock, PA 18657
717/ 333-4945
Ri chard C. Speedy
765 N. 9th St.
Harrisburg, OR 97 446
541/ 995-8608
Robert Zeckleman
16 Riverside Dr., Apt. F2
Cranford, NJ 07016-2235
973/ 425-2613
New Letter Contact
Chris Martin
151 Wall St.
Eatontown, NJ 07724
Nordstrom/
ATA
Partnership
Puts Tinnitus
Book in
Medical
Libraries
by Cora Lee (Corky) Stewart,
Program Development Manager
With the assistance of volun-
teers from Nordstrom, many ATA
staff members, and an unexpect-
ed bequest, ATA has been able to
distribute complimentary copies
of the Proceedings of the Fifth
International Tinnitus Seminar to
every medical library in the
nation - all 2,911 of them.
During the Fifth International
Tinnitus Seminar (co-sponsored
by ATA and the Oregon Hearing
Research Center in 1995), nearly
300 researchers, clinicians, and
patients from 25 countiies
explored every aspect of tinnitus
- from diagnosis to treatment,
from personal concern to
professional interaction. The
papers from this quadrennial
meeting were published as the
Proceedings. (Individual copies
are still available for purchase
from ATA.)
Volunt eering on the United
Way "Day of Caring," the
Downtown Nordstrom team
continued on page 22
Tim'litus Today/ December 1998 21
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Nordstrom/AlA Partnership continued
cheerfully provided the extra
people-power necessary to pack-
age the two-pound books. Cost of
the mailing, another obstacle
delaying the long-planned pro-
ject, was covered by receipt of
an unrestricted bequest from a
thoughtful , long-time ATA sup-
porter, Frances T. Merz from
Lees Summit, Missouri.
Completion of this project
addressed several of ATA's
Strategic Plan goals including
professional outreach, medical
school curriculum, corporate
partnership, global presence,
and possibly fostering future
tinnitus research. All involved
deserve a hearty "well done!" 9
22 Tinnitus Thday/ December 1998
Despite packaging over two thousand books for medical libraries,
Nordstrom volunteers (left to right) Gail Cooper, Katie James, Mary
Branagan, and Deborah Allen can still smile with ATA staffer Robin
Jennings (with poster) during the 1998 United Way Day of Caring.
Questions and Answers
Jock Vernon's Personal Responses to Questions from Our Readers
by Jack A. Vernon Ph.D., Professor Emeritus,
Oregon Health Sciences University
I would like to reverse the order for our first
Q& A. I have asked the questions and he, the
patient, has provided the answers. The patient
is Mr. D. who lives in Israel. He is a cochlear
implant patient to whom I sent a Moses/Lang
masking sampler CD in order to determine if
playing the masking tracks through his cochlear
implant could effect a masking of his tinnitus.
Q
When the Moses/ Lang CD is played through
your cochlear implant, is the tinnitus still
detected in the implanted ear?
A
No, the tinnitus in the implanted ear is com-
pletely masked.
Q
That is a surprising answer and an impor-
tant one. When the tinnitus in the implant-
ed ear is completely masked, can you hear any
tinnitus in the opposite and unimplanted ear?
A
Yes, the tinnitus in the unimplanted ear is
not affected.
Q
Which track on the Moses/Lang CD is most
effective in masking your tinnitus in the
implanted ear?
A
Track #S is best, although there is some
masking from several other tracks. ['Ifack #S
is a band of noise from 6000 Hz through 12,000
Hz. Mr. D.'s tinnitus has not been measured but
I would guess that it is high-pitched and some-
where in the 6k to 12k Hz range.]
Q
When the tinnitus in the implanted car is
masked does residual inhibition occur?
A
I am not sure. I need more time to experi-
ment with it.
Q
When you played the Moses/Lang CD to
your implant what did you hear?
A
It's hard to describe but as best as I can do I
heard a sound, a noise, not necessarily a
pleasant sound but it's better than the tinnitus.
Q
When the masking sound is present are you
able to appreciate other sounds such as
speech or music?
A
The answer is yes, but a very strange thing
happens while the masking noise is present:
speech and music sound much clearer than
when it is absent.
Q
Are you sure that it is not that you are
learning more about how to respond to the
cochlear implant? I'm told that often a great
deal of training is necessary before one becomes
really proficient in using the cochlear implant.
A
No, it is not a matter of training. I have test-
ed this effect many times by simply turning
the masking sound off and each time it is off,
speech and music are not as clear as when it is
on. I have repeated this test many times and
always with the same effect.
In his last letter to me, Mr. D. indicated that
once again he had taken up playing the violin
and found that he could play Vivaldi rather well
with the masking noise present. From this inter-
change I conclude that it is possible to effect
tinnitus masking and thus tinnitus reliefby
playing masking sounds into the cochlear
implant for at least this one patient. Mr. D. had
found that the action of his implant by itself
only provided slight and partial masking where-
as the masking noise afforded complete tinnitus
relief. His observation that the masking sounds
made speech and music clearer is a very sur-
prising observation, one about which we need
to learn more.
Now, back to our regular Q & A format.
Q
According to Mr. P. in New Jersey, the
Internet reveals that ADM Tronics offers
a new device for the relief of tinnitus. The
device, which has FDA approval, is termed the
AUREX-3. While not specifically so stating, the
AUREX-3 rather strongly implies that tinnitus
control will be effected by "phase cancellation"
much the same way that the ProActive 3000
actively cancels incoming sounds. (See "Noise
Cancellation Devices Given a 'Thst Drive" in the
June 1998 Tinnitus Tbday.) Mr. P. asks if I think
phase cancellation of tinnitus is possible.
A
There are two things I would like to report
as to the possibility of canceling tinnitus by
phase manipulation. First of all, this was tried
years ago. Using 100 patients with a single, clear
tone tinnitus, we introduced the exact same tone
at the exact tinnitus loudness manipulating it
slowly through 360 degrees of phase change.
There was no effect upon the tinnitus. The
second point is that even when two physical
sounds are present, phase cancellation is possi-
ble only up to about 1500Hz and not above. The
Tinnitus Thday/ December 1998 23
Questions and Answers (continued)
average tinnitus pitch of the patients seen in the
Oregon Tinnitus Clinic is slightly over 7000 Hz.
In my opinion, phase cancellation of tinnitus is
not possible for the simple reason that there is
no physical sound present that is generating the
tinnitus.
Q
Mrs. B. in Maine indicates that she is taking
Ginkgo biloba, 160 mg per day, and it has
helped her tinnitus. She asks how long she can
continue taking ginkgo and are there any side
effects from taking it.
A
Mrs. B., I hope you will continue to keep us
apprised of your progress with ginkgo. 1b
my knowledge you can take it as long as you
wish, but there is possibly one rare side effect
which in certain cases can be serious. Ginkgo
might alter bleeding time (see "Ginkgo Biloba -
A Word of Hope and a Word of Caution" by Dr.
Stephen Nagler, p. 17). Thus were you to require
surgery or to receive an injury, special care may
be necessary.
Q
Mr. L. from Florida indicates that despite
30 years as an engineer working with
gas/ turbine engines, he has almost no hearing
loss. That is due to the fact that he used both
earplugs and earmuffs to protect his ears. The
faucet test works for him but his major problem
is getting to and maintaining sleep. When he is
successful in getting to sleep, his tinnitus will
awaken him after an hour or so making it diffi-
cult to go back to sleep. Other than taking sleep-
ing pills is there an answer to his problem?
A
Mr. L., I would like to suggest that we do a
small experiment with you. In as much as
masking seems to work for you, I would like to
recommend that you try a "sound pillow."
The pillow is available from R. Scott Armbuster
of Phoenix Promotional Products, 2335
Thousand Oaks, #6-269, San Antonio, TX 78247.
You can play any kind of sound into the pillow:
music, masking noise, nature sounds, etc. In
your case I would recommend that you play
rain or water sounds into the pillow. This pillow
is arranged so that when your head is lifted off
the pillow, the sound level decreases by about
20 dB and thus would probably offer little or no
disturbance to your spouse. Give this a try and
let us know the results for there are many tinni-
tus patients who feel that if they could only get
a decent night's sleep, they could cope better
with their tinnitus.
24 Tinnitus 1bday / December l 998
Q
Mr. R. from Florida reveals that he is 84
years old living only on Social Security.
His tinnitus seems to be getting worse by the
month. He asks if there is any hope for him.
A
The increase in the loudness of your tinni-
tus may be due to a gradual decline in your
hearing ability. Ifyou are experiencing difficulty
understanding the speech of others, it is possible
that a hearing aid would not only improve
your hearing ability but your tinnitus as well.
Expense, of course, is the problem, but try
contacting a local Lion's Club through your
Chamber of Commerce or library. Or call the
Lion's Club International (630/571-5466) and
tell them of your financial situation and that
you need a hearing aid. They are usually quite
happy to help.
Q
Mr. F. in Oklahoma makes the following
statement: The recent work in Buffalo
which identified the brain area responsible for
the perception of tinnitus is most interesting.
Would it be helpful to study what goes on in this
perceptual area during residual inhibition?
A
Mr. F., you have asked one of those critical
questions. Clearly if we know what goes on
during residual inhibition (the temporary cessa-
tion of tinnitus produced after masking sound is
turned off), we might then be able to increase
its magnitude as well as its duration. Let's make
some guesses. Suppose you find that the percep-
tual area in the brain is still active during com-
plete residual inhibition. That would suggest
that some other, possibly lower, brain area is
producing the residual inhibition. On the other
hand if the perceptual area went silent during
complete residual inhibition, we then need to
learn what procedures or chemicals make this
area go silent. All of these things are much easi-
er said than done. Clearly much work is needed.
Dr. Salvi, one of the Buffalo researchers on this
study, indicates that they hope to do this experi-
ment. Can you help? Yes, indeed you can. Help
increase the membership in ATA so that more
support is available for this kind of research.
Notice: Many of you have left messages requesting
that I phone you. I simply cannot afford to meet
those requests. Please feel free to call me on any
Wednesday, 9:30a.m. -noon and 1:30 - 4:30p.m.
Pacific Standard Time (503/ 494-2187). Or mail
your questions to: Dr. Vernon c/ o Tinnitus Today,
American Tinnitus Association, PO Box 5,
Portland, OR 97207-0005.
SPECIAL DONORS AND TRIBUTES
ATA's Champions of Silence are a remarkable
group of donors who have demonstrated their
commitment in the fight against tinnitus by
making a contribution or research donation of
$500 or more. Sponsors and Professional Sponsors
have contributed at the $100-$499 level. Research
Donors have made research-restricted contribu-
tions in any amount up to $499.
acknowledged with an appropriate card to the
honoree or family of the honoree. The gift
amount is never disclosed.
Our heartfelt thanks to all of these special
donors!
A ll contributions to the American Tinnitus
Association are tax-deductible.
ATA's Tribute Fund is designated 100% for
research. Tribute contributions are promptly
GIFTS FROM 7-1 6-98 to 10-15-98.

Champions of Silence
(Contributions oj'$500
and above)
Robert W. Booth
John Buchman, M.D.
Michael D. Deakin, CPA
Cornelius R. Duffie
Jeanna L. French
Sukey Garcert:i
Roth Family Foundation
Kenneth M. Jones
Stephen R. Karp
Marian B. Lovell
John E. Meehan
Prances Merz
Jerry Monnin
Don Morse
Stephen M. Nagler, M.D.,
F.A.C.S.
Robert Pence
Hubert G. Phipps
Ann L. Price
Brian Rayer
Thrry N. Sherman
E. Wavne South
K. Struckmeyer
Sponsors
(Individual Contributwns
from $100$499)
F. Edwin Adkins
Brian Alexander
Arthur Altarac
Ronald G. Amedee, M.D.
Duane A. Baird
William C. Beatty
David D. Bedworth
Muriel Beery
Ivan H. Behrmann
Mrs. fran Belkin
M. Craig Bell
Mrs. M. H. Bergreen
Allen R. Bernstein
Larry Birenbaum
Alain G. Boughton
George S. Bovit
Benjamin Boykin, II
Malcom K Brachman
John F'. Brogowicz
Charles Buckner
A. Paul Camerino
Peter E. Campbell
Frank T. Carnella
Frederick W. Champ
Farouk Chaouni
Kenneth R. Cherry
Mary Kay H. Davis
H. Renwick Dunlap
Josephine M. Elias
Jeffrey A. Ferenz
Willia;, D. Finnell
Sylvia Forein
Elliot S. Frankfort
Joe Galando
Richard J. Gambatese
Carol . Garris, CPA
William A. Gerrells
Harriet L. Glazer
I. Larry Gol dman
Agnes Goss
C. Lee Gough
Jane Green
The Irvin Green Family
Foundation
Norman and Gilda
Greenberg
James and Colleen Hartel
Avis S. Hartley
David Hayes
Gene Herritz
Manny Hillman
Roger w. Hollander
Shirma M. Huizenga
Charlotte M. Jacobson
Jean Pierre Jaffeux
Larry C. James, Jr.
L. Craig Johnstone
Sam Jordan
Jo Ann Karkenny
Virginia Knight
William J. Knight
Peter Kobelansky
Dennis S. Kohara
Joseph Koppelman
David J. Kovacic
Al lan S. Kushen
Elizabeth G. Lampen
John Lazopoulos, Sr.
Dr. Herbert A. Levin
Ken D. Lewis
Romulus Z. Linney
Matt Lowen
Anthony R. Magana
Aaron J. and Jean Martin
The Jean and Aaron
Martin Fund
Pittman T. Mayse
Anne Holmes McKay
Jack A. McKay
Ed Leigh McMillan, II
Thomas F. McNulty
Pamela S. McNutt
Robert J. McTigue
Bill McWilliams
Jimmy C. Meyer
Gary J. Miller
Ron Moran
Donald and Jane Morse
Larry A. Mowrer
Clifford A. Nelson
Eamon O'Brien
Michael O'Mal ley, O.D.
Charles T. Ohlinger, Til
John K. Oscarson
Warren Palmer
Wilhelmina A. Parker
Janis T. Pedersen
Mary Ann Pcrper
Donald E. Pullen
Dan Ptujes
Ruth Rasor
Nancy M. Rosen
Joann Rosenberg
Beverly and Mel Rosenthal
Andrew J . Rosser
Ernest Sagues
Huseyin Saka
Randall J. Schoenberg
Richard S. Schweiker
Evelyn J. Schwertl
Ed Scott TI'easurer
Thelma M. Sjostrom
Joel Smith
Sheila C. Smi th
Ronald E. Snow
Henry M. Sottnek
Joseph Souto
Guy Spiller
Walter P. Strumski
Pat Thuer
John D. 'Tbrmed.is
Eli7..abeth VanPatten
Thomas K. Webb
Shirley L. Weddle
Fred and Sharon Weinhaus
Pat Wollowick
Douglas Wright
Robert B. Wright
Larry W. York
Michael K. Zakoor
Paul W. Zerbst
Professional Sponsors
(Professional Contribullons
from $100-$499)
Sidney N. Busis, M.D.
Richard A. Chole
Prof. Giancarlo Cianfrone
F. Lawrence Clare, M.D.
Kathlee11 Costa, M.A.,
CCC A
Elaine DeSilva, Ph. D.
Stephen Epstein, M.D.
Bj orn Eriksen, M.S.
Elio J . Fornatto, M.D.
Anne Curtis Gal loway, M.S.
Michael Higgins
Thomas Jung, M.D., Ph.D.
Edward W. Keels
Robert J. Kohlenberg, Ph.D.
Barbara Kruger, Ph.D.
WarrenS. Li ne, Jr., M.D.
Cary . Lurie
Sol Marghzar, M.S., CCC-A
Ernest E. Mhoon, Jr., M. D.
Maurice H. Miller, Ph.D.
Stephen E. Mock, Ph D
John T. Murray, M.D.
Donald H. Rice, C.H.
J . Thomas Roland, Jr., M.D.
'Thnit Ganz Sanchez, M.D.
Helena Solodar, M.S.
Dr. Blair R. Swanson
Corporations with
Matching Gifts
Bank America Foundation
Chase Manhattan
Foundation
CPC International, Inc.
Philip Morris
Companies, Inc.
Bequests
Estate of Dorothy M. Horn
Estate of Frances T. Metz
TRIBUTES
In Memory Of
Mr. and Mrs. Jerry
Blumberg's son
Edna Heller's mother
Sylvia Eisenberg
Cur tis E. Bowman
Donald M. Bowman
'Ihtdy Drucker
.Joseph G. Alam
Sandy Delucca
Benjamin Boykin
Nancy A. Brown
Deutsch Bank Securities
Andrew and J ulie Hascoe
Foundation
James E. and
Sandra J. Healey
Michael Pignatello
Salomon Smith Barney
Raymond G. Schuville
Thomas J. Sklens
John Utendahl
Arthur and Sandra Williams
Mike Enlmann
Robert Fitch
Arlo and Phyllis Nash
Pota Leventis
Margaret Leven tis
Grace Wishan
Claire and Jacques Simon
In Honor Of
Joseph Alam
(Happy Birthday)
Adele Alam
Jim and Rosalie Traver
Ernest C. Auer
(Happy Birthday)
Patrice Auer
Mr. and Mrs. Daniel Drolc
(25th Wedding
Anniversary)
Arlo and Phyllis Nash
Mr. and Mrs. Ruben Drolc
(50th Wedding
Anniversary)
Arlo and Phyllis Nash
Joe Lev
(Happy 60th Birthday)
Martin and Pat Butensky
Gloria Reich
Stephen M. Nagler, M.D.,
F.A.C.S.
Dr. Jack A. Vernon
John R. UIJerich
Matjorie Youngen
J. Richard Youngen, Jr.
Research Donors
Rod Abele
John J. Accordino
George A. Anderson
Sally A. Anderson
William Apostolides
Harold Arlen, M.D.
Mary Amheim
Richard W Baizer
Joshua S. Barclay
F. Margaret Barnes
Richard M. Bennett
John P Bergan
Thrun Bhatia
Mary Lou Biddlestone
Diarmuid Boran
Richard C. Borella
Garrison Botts
Dennis D. Boyle
Adelia Bratsos
Carol A. Brown
Nancy A. Brown
Susan Brumfield
Elizabeth C. Bryan
Anita C. Burdette
Michael W. Burnham
Marianne Carlsen
Alyce J. Carlson
Kate Carolan
Gladys Justin Carr
Marcia Carter
Dianne Caughell
Elizabeth Cesario
Charlotte A. Cochran
Joseph R. Cohen,
D.D.S., PC
Eli:?:abeth W. Craver
Josephine Crowley
Glen R. CuccineiJo
Mr. and Mrs. Daniel
Dallacroce
Dennis M. Daly
Jacqueline M. Dancer
Eileen Deitch
Kay Dewi t
Ana Miron Dezuniga
Thomas P Dixon
George F: Dolinac
Tinnitus 1bday/December 1998 25
SPECIAL DONORS AND TRIBUTES (continued)
Shirley Drabinsky
Heyman C. Duecker
Michael F. Duffield
Glen L. Edwards
Robert w. Eichert
Jim W. Eubanks
Thm E. Fawcett
Maurice A. Feldman
Maria F. Figueroa
Ronna Fisher, M.S.
Harriet L. F'laccus
Franklin L. Fountaine
Diane E. Freedman
Joana L. Prick
Irving Gamza
Stephen P. Gazzera
Elaine M. Germont
Leonard Green
Herbert Greenberg
Richard C. Greene
Bob Halpern
Robert W. Hamilton
Frances E. Hammack
Shonie Hannah, M.A.
Dr. Gorm P. Hansen
Clayton R. Harris
Dean Harris
Sharon M. Hart
James E. and
Sandra J. Healc
F:W. Hees
Margaret P. Heppe
Sandra H. Hernandez
Humberto Hernandez,
M.D.
Michael Higgins
E. Alan Hildstrom
George R. Hoffman
Lynda M. Hoffmann
David W. Hollmeyer
Betty D. Huebner
Linda A. Hughes
Cyril D. Jalon
Shirley J. Keckler
R. L. Keheley
Heinz Kleuker
Mary Klonda
Doris L. Knecht
Charles Knepp
Mary R. Kokes
Kit Kolenda
David J. Kovacic
Martin K.rasnitz
Steve K.reizel
Thrn Kuehle
JudiS. Lane
Mary A. Leeman
Gail H. Leslie, M.S., CCC-A
Romulus Z. Linney
Monique Lipham
Virginia A. Lobsingcr
Virginia Longo
Alice E. Maisev
Richard L. Marr
Richard L. Martin
Steve Martis
A. Helen Mauro
Mary J. McAlindon
Kathy L. McCain
Tommy D. McComas
Frederick F. McGauley
Freddie J. McGowen
Gail M. Miller
John Daniel Mitchell
Charles R. Moretz
Wayne A. Mowry
A. J. Murphy
Donald E. Nace
E. J. Nace
Emil Natelli
Ira Newman
Regie R. Nexsen
Charles D. Nicolaus
Louis M. Nigro
Terence E. Nixon
Roger A. Olayos
Shelley M. Oliva
Convin R. Otte
Karl E. Owen
Marc J. Palumbo
Roxanne G. Parker
Jackie Pavich
Brenda B. Person
Huben G. Phipps
Judith Piepsney
Robert D. Powell
Matthew Pritchett
Mary T. Pugh
Maj. Leonard Raabe
Keiko M. Rao
Barbara Raven
George A. Rebh
Patricia Renaud
Irvin A. Renz
Jordi Ribas
Myron L. Roth
Andrew P. Rowjohn
William L. Russelburg
Lynn Rustebakke
Jack Salerno
Manuel Sanchez
Frank A. Scafuri
James R. Schlauch
D. Michael Schmitz
Raphael F. Segura, .Jr.
Richard Seguso
Marlene K. Shaw
Frank Shekosky
Robert Silk
Lan-y Simmons
Roger J. Simpson, M.D.
Elmer E. Smith
Lois I. Spafford
Eugene Stengel
Dorothy T. Strain
Mireya Sucre
George Sutherland
Ronald Swidler
D. Keith Thomas
Robert N. Tiley
Helen Til linger
Richard W. Veeck
John R. Veglia, Sr.
Eleanor R. Wagner
Barry Weeks
David P. Weiner
Ruth F. West
Garv White
Martin G. Wild
Miriam H. Wilson
Emil A. Wolf
Jamee Wolf
Pat Wollowick
Russell J. Wolpert
Virginia S. Wood
Mildred L. Woodhouse
Henry H. Young
Michael K. Zakoor
Frederick A. Zimmerman
Harry Zimmerman, CCC-A
ATTENTION TINNITUS TODAY READERS
Researchers at the University of
Buffalo are using a brain imaging
technique called positron emission
tomography (PET) to study patients
who've developed an unusual form of
"ringing or buzzing, " known as gaze-
evoked tinnitus.
Patients with gaze-evoked tinnitus can
significantly alter the loudness or pitch of their
tinnitus by moving their eyes. The proj ect is
intended to determine the brain regions activat-
ed by tinnitus and eye movements and to
26 Tinnitus 1bday/ December 1998
understand how the brain functions after unilat-
eral hearing loss. This research is supported by
grants from the National Institutes of Health
and is approved by the Institutional Review
Board at the University of Buffalo and the VA
Medical Center. Patients participating in the
study will have a comprehensive hearing test
and PET scan. Persons interested in participat-
ing or learning more about this medically
important research proj ect should contact:
Richard Salvi, Ph.D.
Phone: (716) 829-2001
Fax: (716) 829-2980
E-mail: salvi@acsu.buffalo.edu
Al an Lockwood, M.D.
Phone: (716) 862-3459
Fax: (716) 862-3462
E-mail: alan@promo.nucmed.buffalo.edu
Benefit ATA and solve that search for a special gift,
or add to your own heirloom collection.
((Silent Night 1998"
Only $54 plus shipping (includes attractive gift box and special card from
William Shatner, ATA Honorary Director)
This is the first in a series of three, limited edition, European glass ornaments.
All proceeds will benefit tinnitus education and research.
'Ib order or to find a dealer near you:
Call toll free: 877-0RNAMENT (877-676-2636)
Check the Internet: www.joyworldcollectibles.com
AMERICAN TINNITUS ASSOCIATION
P.O. Box 5, Portland, OR 97207-0005
Address Service Request ed
American Tinnitus Association
Working throughout the year to silence tinnitus
1999
January February March April
S M T W T SSM TW T F SSM TW T F SSM TW T S
12 123456 23456 2345
3 4 5 6 7 8 9 7 8 9 10 11 12 13 7 8 9 10 11 12 13 6 7 8 9 10 11 12
10 11 12 13 14 15 16 14 15 16 17 18 20 19 14 15 16 17 18 20 19 13 14 15 16 17 18 20
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24 25 26 27 28 29 30 28
31
June
28 29 30 31 27 28 29 30
August
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May
T W T s S M TW T F SSM
July
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1 2 3 4 5
2 3 4 5 6 7 8 6 7 8 9 10 11 12
9 10 11 12 13 14 15 13 14 15 16 17 18 20
16 17 18 19 20 21 22 20 21 22 23 24 25 26
23 24 25 26 27 28 29 27 28 29 30
30 31
September October
123 234567
4 5 6 7 8 9 10 8 9 10 11 12 13 14
11 12 13 14 15 16 17 15 16 17 18 20 19 21
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25 26 27 28 29 30 31 29 30 31
November December
S M T W T S S M W T S S M T W T S S M T W T s
12345 2 2345 1234
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AMERICAN
TINNITUS
ASSOCTATlON
Post Otfice Box 5, Portland, OR 97207-0005
Tel. (503) 248-9985 (800) 634-8978
Fax. (503) 248-0024
e-mail: tinnitus@ata.org www.ata.org
REMINDERS:
e Make my annual contribution to
ATAon ________
e Watch for Tinnitus T6Qa.y in: March,
June, September(' December
e
.9L
s 1998 draws to a close and we look forward to a new year,
the ATA Board of Directors, Scientific Advisory Committee,
and Staff would all like to thank you for your valuable sup-
port and extend our warmest wishes to you for 1999.
Your support is what makes ATA's existence possible. With each renewal contri-
bution, you help us further our goals of Education, Advocacy, Research, and
Support. But the need is great and to that end, we ask that you consider includ-
ing a little extra for ATA in your holiday or year-end giving plans.
Perhaps you could solve gift problems by making personal tribute donations (all
Thibute funds go entirely for research) or by giving ATA "membership" to others.
Remember, ATA is a 501(c)(3) non-profit agency so your gifts are tax deductible
regardless of use. Please use the attached form to send your donation today.
We hope you share our pride in ATA's accomplishments and the commitment to
continue the effort until we silence tinnitus. In the meantime, with your help, we
can offer the following to make 1999 a more peaceful year for many of the
50,000,000 Americans who experience the sounds of tinnitus:
Seed Grants for research of tinnitus causes, treatments, and potential
cures (over $1,085,500 have been given since 1980)
Quarterly publication of Tinnitus TOday to provide current information
about tinnitus treatments and research developments, explanations of
various aspects of tinnitus and related problems,
and personal experiences
Support provision through support groups, written materials,
telephone contact, and the internet (ATA staff responded to at least
101,541 first-time requests for information in 1998 alone)
Hearing conservation and protection programs for classrooms and
presentations in the workplace
Advocacy and public awareness programs
Professional support and development
Public Forums
Thanks for making all this possible!