Vol. 2 No.

2
October 1976 N E\WS U
Doct or Larry Thomas i s helping ata conquer tinnitus
ATA is seeking sustaining contributions of $100 or more. When ATA was begun
four years ago, neither the Tinnitus Masker nor the Tinnitus Clinic were
realities. Now, ATA can say to the tinnitus patient,
11
Yes, there is hope
11

In acknowledgement of contributions exceeding $100, ATA will present the donor
wi th the handsome plaque pictured above. The photograph of the plaque was
taken by Dr. Catherine Smith with a scanning electron microscope at 24,000
ti mes magnification. It is a high contrast black and white photograph of
a cochlear hair cell, the actual organ of hearing within the inner ear. The
hair cell is an appropriate subject for the plaque since it could very well
be the culprit causing tinnitus. Inscribed on the border of the plaque will
be the donor's name. Dr. Larry Thomas is an otolaryngology resident who was
the first person to contribute the $100. A contribution form is enclosed.
-2-
THE PHARMACOLOGY OF TINNITUS
The following is an interview with Dr. Robert Brummett. Or. Brummett is an
Associate Professor of Otolaryngology and Pharmacology at the University of
Oregon Health Sciences Center.
Q. Dr. several drugs
are known to induce tinnitus.
By what mechanism(s) are drugs
The causative agents of
tinnitus?
Q. Tinnitus then can be induced
by anything that damages the
ear?
Q. You mentioned that tinnitus
isn't always associated with
permanent hearing loss. Which
drugs that induce a temporary
hearing loss produce tinnitus?
Q. Can tinnitus be associated
with permanent hearing loss
from drugs?
Q. Because these drugs are still
being used, despite their
known may it be
assumed that there are no
equally good substitutes?
Q. Do all hearing losses have
an associated tinnitus?
*harmful to the ear
A. Tinnitus is usually recognized as
a symptom that accompanies hearing
loss. It often occurs when people
are treated with drugs that cause
either permanent or temporary hearing
loss. The mechanisms by which drugs
that cause hearing loss produce
tinnitus is still unknown.
A. That's right. Tinnitus can occur
after people are exposed to loud
noises or trauma to the ear or even
infections that cause hearing loss.
A. Aspirin is a classic example.
Large doses of aspirin will induce
tinnitus.
A. Very definitely. One group of anti-
biotics are noted in particular
for their The amino-
glycoside family of antibiotics,
kanamycin, streptomycin, neomycin,
tobramycin, etc., all cause permanent
hearing loss and all can induce
tinnitus. These drugs are sometimes
referred to as the "mycin" anti-
biotics, but this is a poor term
because some drugs such as erythromycin
are not aminoglycoside in nature and
are not ototoxic.
A. Yes. These are drugs that save hun-
dreds of lives every day. There are
no drugs equally effective as the
aminoglycosides for certain infections
and for that reason the hearing loss
from them must be considered in the
light of their life-saving ability.
A. No.
Q. There is some speculation that
excessive smoking or coffee
consumption can induce tinnitus.
Is there any evidence to sub-
statiate this?
Q. Heavy metals are often used to
treat certain diseases. Aren't
they implicated as inducing
tinnitus?
Q. Do some anesthetics cause
tinnitus such as lidocaine?
Q. Are there any drugs currently
being used to treat tinnitus
and are they effective?
Q. I thought nicotinic acid was
very effective with tinnitus?
Q. Isn't a great deal of tinnitus
considered by authorities to be
vascular in nature a n d ~ if s o ~
how applicable would vascular
drugs be in treating tinnitus?
Q. Does a majority of tinnitus
sufferers have drug-induced
tinnitus?
Q. Some people maintain that
glycerine will relieve tinnitus.
Is this true?
Q. Don't sedatives help alleviate
tinnitus?
-3-
A. None of which I'm aware, only
speculation.
A. Yes, heavy metals such as mercury,
lead, arsenic very possibly in-
duce tinnitus . However, much more
investigation is needed here.
A. Not to my knowledge .
A. Yes, there are currently several
drugs being tested on tinnitus .
However, and I underscore this,
none have proven to be effective.
A. Nicotinic acid nor any other drug
has been proven to be effective .
What you have are cases where a
patient with tinnitus was given
nicotinic acid, the tinnitus went
away and the drug got the credit.
This, however, is a testimonial
not a scientific study.
A. Some tinnitus is believed to be
vascular in origin, that is, it may
be caused by hypertension or some
unusually formed blood vessel. The
best way to cure this type of tin-
nitus would be to correct the under-
lying anomaly on elevated blood
pressure and the tinnitus will pro-
bably go away.
A. No, most of the patients that come
to the tinnitus clinic have sound
induced tinnitus. Very few are re-
lated to drugs. It may be that when
the tinnitus is drug related it may
be hard to determine it as such.
A. I know of no pharmacological basis
for this.
A. Not really. A person who is sedated
may have tinnitus of equal intensity
but because he is sedated he doesn 't
care as much and hence the tendency
to claim it is better or that it
doesn't bother him.
Q. What about the use of anesthetics
to block nerves as a means of re-
lieving tinnitus?
Q. Isn't cortisone known to induce
tinnitus?
Q. Aren't dilatin and other anti-
convulsant drugs being tested
for tinnitus treatment?
Q. Dr. Brummett, Qne mechanism
believed to be responsible for
a hearing loss which induces
tinnitus is otosclerosis. Are
there any drugs that might slow
down this process or are such
drugs to be found only with
the Foundain of Youth?
-4-
A. That's something we've looked at
but not with any success yet.
A. Yes it does. This is probably
due to an increase in blood
pressure when on the drug or to
fluid and salt retention.
A. Yes they are. One theory as to
the mechanism of tinnitus involves
the rapid and random firing of the
auditory neurons. Hopefully, these
drugs might be effective in modi-
fyi ng this firing behavior. How-
ever, it is still too early to tell.
A. There is currently a drug being
tested which appears to slow down
the otosclerotic process. The
drug is sodium fluoride. Inter-
estingly enough, when otosclerosis
patients have an operation to cor-
rect the bone fixation their tinnitus
usually disappears.
ATA Statement For The Month Ending
June 30, 1976
Beginning balance (July 1, 1975)
Revenue
General contributions
Expenses
Prototype tinnitus maskers (2)
1975 AAOO display
$3,027.50
500.00
551.00
Educational material: printing, postage,
posters, stationery, envelopes 3,071.58
$4,122.58
Total Balance
$2,119.75
$1,024.67
Notes: The current monthly contributions total $1,125, with no current expenses.
Todate, all research has been accomplished on a voluntary basis. The 8 masking
units now being researched were purchased through other sources. (AAOO - refers
to the American Academy of Opthalmology and OtolaryngologyJ see Vol. 2, No. 1).
9/1/76 Herlene D. Benson
-5-
ANESTHESIA OF THE AUDITORY NERVE
At the Kresge Hearing Research Laboratory
(University of Oregon Health Sciences
Center) an attempt to temporarily block
the auditory nerve in guinea pigs is being
made. The problem is that the auditory
nerve lies deep within the bone of the
inner ear. However, if a method can be
found, anesthesia of the auditory nerve
may prove to be an effective treatment
for tinnitus.
We have been only partially successful.
A nerve impulse to a 15,000 cps (cycle
per second) tone (A) is blocked (B) by
iontophoresis of the local anesthetic
lidocaine. Iontophoresis is a method
of driving a drug into tissue by means
of a weak electrical current. The
current is not felt by the patient.
At three hours after treatment, the
response of the nerve has returned to
normal (C).
B
c
--vv--
However, the response to a 10,000 cps tone (D) is only partially reduced (E).
This response also returns to normal (F). The problem is that the nerve
fibers that carry the 10,000 cps tone lie deeper within the inner ear than
those carrying the 15,000 cps tone.
We are currently attempting to drive the anesthetic deeper into the inner ear.
Our hope is to provide a complete but temporary block of the auditory nerve.
Such a block will have definite research and diagnostic value and it may even
prove to be an effective treatment for tinnitus.
35 mi 11 ion
tinnitus sufferers
Contributions may be sent to:
American Tinnitus Association
3515 S. W. Veterans Hospital Rd.
Portland, Oregon 97201
Advisory Board
CHARLES UNICE, M.D.
10601 Hottty Avenue
Downey, California 9V241
DAVID DeWEESE, M.O.
Chairmen Oept. Otolaryngology
Untvers"lty of Oregon
Health Sc:tences Center
ALBERT A TTYAH, M.D.
Vice President ATA
DEL CLAUSEN
House of Representatives
Ututed States Cong:ress
BOB McLENNAN. M.D.
Assemblyman
C8hfornia Legislature
HARD LO WILKINS, M.O.
MerN>er California Suue Soard or
Medicat Examinets
TONY HABEEB
Vice Presi<ftnt Metro Media
Corporation
KAYTQMA,M.O.
Q)lifornia State Soard o f Medical
E11aminers
ROBERT HOCKS
Hocks l.abora.tortes
Portland, Oregon
-6-
THE TINNITUS CLINIC
The following is an interview with Dr. Alexander Schleuning II. Dr.
Schleuning is on the clinical faculty in the Department of Otolaryngol ogy
at the University of Oregon Health Sciences Center, and he has been the
physician primarily associated with the tinnitus clinic.
Q. How many patients do you see in the Tinnitus Clinic each week?
A. At the present time we are seeing 6 to 7 patients in the Tinnitus Clinic
weekly. It is our hope that in the future we will be able to accommodate
more patients as our s c h e d ~ l e has been filled well in advance.
Q. What tests and observations are made on the patients?
A. Actually, three studies are undertaken. First, the patient has a thorough
otologic examination and a neurologic examination when necessary. Second, the
patient has a complete audiologic evaluation with special audiologic studies
to determine the remaining function in the ear and the type of hearing loss
which is present. And, third, attempts are then made to duplicate the patient's
tinnitus by means of noise producers, whether these be a broad-band type of
noise or a pure-tone sound. In addition, the pitch and intensity of the
tinnitus is measured and attempts are made to suppress it with external noise.
Q. What types of treatments are commonly recommended:
A. Many of the patients we've found are benefited by just the simple policy
of fitting with hearing aids. Many patients with tinnitus have a high-tone
neurosensory hearing loss and have been told in the past that this type of
hearing is not correctable. The tinnitus associated with this loss is very
annoying and often we have found patients who are benefited by the use of
the hearing aid, both in the fact that it masks out the tinnitus and secondly
that it does improve hi gh frequency hearing and their ability to understand
speech. On many 9atients who have relatively normal hearing or hearing which
is not correctable, we have used a tinnitus masker, which is an attempt at
duplication of the patient's sound. It is interesting to note that these
patients feel the noise that is generated external to the ear is much more
satisfactorily tolerated than the internally generated tinnitus. The patients
are often quite delighted and not the least annoyed to have a sound which is
1 ouder than their mm tinnitus masking it out. The masker does not affect
the ability to understand speech.
Q. What are the clinical indications for recommending the masker?
A. The usual clinical indications for the masker have been a patient with a
high-pitched tinnitus who has a normal hearing or hearing which is not cor-
rectable.
(interview continues on page 7)
-7-
Q. Are there any contradictions?
A. There are no significant contradictions of the use of the masker, al-
though it is not useful in all patients.
Q. Are medications or changes in diet recommended?
A. Occasionally, we have found that patients have had poorly controlled
diabetes or poorly controlled hypertension (high blood pressure) and in
these patients the management of their medical problems often aids in relief
of their tinnitus, particularly if it is of a pulsating nature. Basically,
vasodilators are occasionally used but only a very small percentage of
patients we see with tinnitus have benefited by such treatment. Occasionally,
a low-salt diet is suggested on those patients who have tinnitus and associated
inner ear disease.
This issue of the Tinnitus Newsletter was compled by:
James Fenwick
Richard Walloch, Ph . D.
Herlene Benson
American Tinnitus Association
3515 S. W. Veterans Hospital Road
Portland, Oregon 97201