~ ~ ~ N E W S L E l l E ~ ON LOCATION ATA PUBLIC SERVICE ANNOUNCEMENT FILMED AT INDIANAPOLIS FEATURES 4-TIME RACE WINNER AL UNSER, SR. THE NOISE OF RACING IS EXCITING, BUT YOU PAY THE PRICE IF YOU DON'T PROTECT YOUR HEARING. During the early years of his 30-year racing career, AI Unser, like other drivers did not wear ear protection. As a result AI has had a noticeable hearing loss and tinnitus for the past five years. Fortunately, Indy drivers now wear custom earplugs that incorporate two way radio communication with the pit area allowing them to receive important messages while they are driving and at the same time protecting their ears. We are grateful to AI for having volunteered time from his busy racing schedule to make a public service announcement to help the American Tinnitus Association get the word out about hearing protection. The pictures accompanying this article were taken in May, during the filming sessions for the PSA. You can help ATA and AI Unser to "get the word out" by contacting your local Television station's public service director and asking them to air these announcements. We will be happy to send tapes to any TV station requesting them if they will let us know what size they can use. (Usually 1", 2", or 3/4") We have already mailed information directly to over 700 television stations so you should be seeing the announcements very soon. THOUGHTS ABOUT TINNITUS MANAGEMENT FROM THE UK by Jonathan W. P. Hazell, F. R. C. S. Consultant Neuro-Otologist to the RNID (Editor's note: Dr. Hazell was the 1987 recipient of the AT A-Hocks Memorial Award for distinguished contribution to the field of tinnitus knowledge. The article which follows was written as Dr. Hazell's response to having received the award.) Part I appeared in the March, 1988 ATA Newsletter. Part II My current scheme of tinnitus management goes as follows: 1) Proper otological investigation: Exclusion and reassurance about serious pathology. 2) A thorough explanation of how the tinnitus is produced 3) Discussions about methods of symptom control 4) Looking for other things that may be causing distress besides tinnitus. Proper investigation is vitally important for two reasons. Many people pay attention to their tinnitus only because it enjoys a heightened significance. If you have a strong feeling that the tinnitus means you have a brain tumour, psychiatric condition or are likely to have a stroke, then it is impossible not to listen to it. Proper reassurance may not be achieved without a lengthy process of medical investigation to exclude these possibilities, however unlikely they may be. Because of the relative confusion about what tinnitus is, a vast spectrum of different conditions exist which can result in the referral of a patient with a label "tinnitus". although the majority of patients seem to have mild inner ear degenerative problems, a growing number come with sounds produced by muscular contractions, open Eustachian tubes (patulous eustachian tube syndrome) and sounds transmitted from the vascular system and joints in the cervical spine and jawbone. Many of these conditions have a medical or surgical solution but will never be identified if they are labelled as just "tinnitus" and dismissed. Explanation takes time but is often all that is necessary to put the patient's mind at rest. The specialist needs a good working knowledge of the auditory system (not something that I acquired in my training in otolaryngology). The psychologists in one multidiscliplinary team treating tinnitus use what is called cognitive therapy. In its simplest form this means allowing the patient to understand what it is that is going on inside them. It works very well. Although some of the techniques are difficult to apply and require special skill, all tinnitus patients benefit from a basic understanding of their condition. Symptom control has been shown in our studies to help in the process of natural adaptation. It is probably more helpful to see it in that light, than to think of it as a treatment that needs to be continued for all time. Very soon after I started my research in 1974 I was extremely fortunate to have been put in touch with Professor Jack Vernon, who was at that 2 time developing the tinnitus masker in Portland at the then Kresge Hearing Research Laboratory. We started a programme of our own in London in 1976 and opened a tinnitus clinic at University College Hospital, where we began fitting tinnitus maskers. Jack's help and guidance over the years has been invaluable and our two departments enjoy close links and a frequent exchange of visitors. As we found out how to use maskers and learnt how to counsel and instruct masker wearers, our "success rates" improved dramatically. It is still the most effective means of symptom control that we know, although of course not everybody is helped, and we constantly need to look to new techniques, and new strategies of masking, e.g. instruments which will specifically induce residual inhibition. With tertiary referrals, we still find the commonest cause of failure of masking is wrong fitting, or lack of counselling. This does not mean to say that other units who were not fitting maskers did any less well, and one of our nearby hospitals in London had a team of psychologists headed by Dr. Richard Hallam, (ATA Newsletter, January 1986) who were using psychological techniques including relaxation and cognitive therapy to extremely good effect. We got very enthusiastic about drug therapy at one point, particularly the use of membrane stabilizers like carbomazipine or Tegretol and tocainide, which has since been withdrawn from general use in the UK. Although we had some spectacular results in the early days, these were not maintained. We have a programme of electrical stimulation using a cochlear implant with a round window electrode which has been developed in the UK and we have patients who are using low frequency sinusoids to produce electrical suppression (or is it electrical masking?) We are constantly examining new possibilities, even areas of alternative medicine where claims have been made. The problem with symptom control, by whatever means, is that if it is not seen as part of a process of natural adaption then there is bound to be disappointment. Our most recent masker study looked at the long term results after some five or six years. 43% were still using their maskers for more than an hour a day. In those who were still wearing maskers 26% had not adapted to the tinnitus and found it worse, or a least as bad as when it first started on their life and the annoyance it caused. In this group there was a general increase in masker use compared to the start. In those who had completely adjusted to the tinnitus, were rarely worried by it, and often unaware of it ( 14%) the masker usage had dropped by over half in terms of hours per day. Those people no longer wearing their maskers at all (44%) were divided into two groups. 27% of this group professed not to have been helped or to have tinnitus which was just as annoying as when it started. 63% had adapted to their tinnitus over this period and were no longer worried by it. It is very important to take this into account when assessing the effect of any treatment on tinnitus. It would be very easy (but inaccurate) to say that those who no longer use their maskers had not been helped. The long term continued use of any treatment which brings about an abrupt change in the tinnitus may militate against the natural adaptive process. Adaptation requires the individual to ignore the tinnitus and this may be more difficult if efforts are constantly being made to vary its intensity. Nevertheless there is a third group, somewhere in the middle of the two previously described where adaptation to the tinnitus occurs only as long as a masker is available for use. It was also interesting that of those no longer using their maskers in this study, 48% said that they were not prepared to return them even if their money was refunded. Like having an aspirin in the cupboard in case of headache, the possession of a device which can control or at least moderate the symptom gives added confidence for coping. In some 40% of the patients we see there are other problems adding to the distress caused by tinnitus. Often the other problem is the major one. For instance there may be a recent bereavement, domestic or work difficulties, financial problems or other unrelated illnesses. Often there have been previous periods of depression and the onset of tinnitus is yet another "last straw to break the camel's back". In some patients (very often those where there is no abnormality on the audiogram) the tinnitus seems to us to be of quite low intensity but there is a great deal of distress and these "other factors" turn out to be supremely important. The tinnitus may be used as a "flag waving exercise" to attract attention. The individual is very distressed, and the tinnitus is very evident so it gets identified as the cause of the problem. It is often easier to go to a physician complaining about a noise in your ear, than contemplate visiting a psychologist or a psychiatrist because of feelings of depression or anxiety about less well defined problems or difficulties. The physician or specialist should see this as an opportunity to sort out what may be a very long standing problem or anxiety and point the patient in the direction of appropriate and expert help, rather than lose interest because the whole thing appears to be "psychological". In the UK there are now special clinics for tinnitus sufferers in hospitals all around the country, and over 100 self-help groups belonging to the British Tinnitus Association, the AT A's sister organisation (the BTA was started by Jack Ashley, the deaf Member of Parliament with severe tinnitus, in 1979.) The British Tinnitus Association has undoubtedly given enormous support and help to tinnitus sufferers throughout the country, just as the AT A has in the USA. Things have been slow to get under way on the other side of the English Channel, although in the last five years there has been excellent work in Scandinavia and the start of the German Tinnitus League was closely associated with the Third International Tinnitus Symposium in Munster, organised by Professor Harald Feldmann. More clinicians are becoming aware of what is available, and increasing 3 numbers of papers reporting conscientious research continue to appear in the professional literature. For the future we can at least anticipate the same sort of advances in masking devices as have been achieved in hearing aid technology over the past 50 years. We can identify increasing numbers of small groups who have surgically manageable conditions, previously presenting as tinnitus without any obvious cause. The big leap comes when we begin to be able to repair the rattles in the old motor car! Will we be able to replace damaged hair cells in the cochlea with colonies grown from human foetal ears which have not yet developed antigenicity? Such a concept which has never been tried anywhere fills many of us with revulsion, and in many countries such experimentation is banned. However transplantation of similar material is feasible in animals, and eventually such techniques will be tried (though of course not by us!). In the meantime keep smiling and drive round the potholes. SOURCE REFERENCES Hazell, J. W. P., Wood, S.M., Cooper, H. R., Stephens, S. D. G., Cocoran, A. L., Baskill, J. L., Sheldrake, J. B. 1985 A clinical study of tinnitus maskers. Brit. J. Audiol. Vol. 19 Hazell, J. W. P. 1987 "Tinnitus" Ed. Hazell. Pub. Churchill Livingstone, London, UK and New York, USA. Hazell, J. W. P., Sheldrake, J. B., Meerton, L. J., 1987 Tinnitus masking - is it better than counselling alone? Proceedings of the 3rd International Tinnitus Seminar, Munster, GDR. COMBINED GIVING CAMPAIGNS AND ATA by Harvey Abrams, Ph.D. (Veterans Administration) Federal and State employees have a unique opportunity to make charitable gifts to the AT A through the Combined Federal Campaign for Federal and Military Employees and the State Employee Campaign for Municipal and State Workers. Contributions can be made as a one time gift or through payroll deduction. Participants in the combined campaigns have a choice of designating up to 5 individual recipient agencies from among hundreds participating. If an employee does not designate, then over 85% of the undesignated gift will be distributed among United Way agencies. Although UW represents many deserving agencies, AT A is not one of them. AT A is a member of another umbrella organization - the National Voluntary Health Agencies (NVHA)- which counts among its 50-plus members, the Arthritis Foundation, American Lung Association, the Muscular Dystrophy Association, and American Diabetes Association. The important thing to remember is that if you do not specifically designate the AT A as a recipient, little, if any of your contribution will be received by ATA. When it comes time for the next Combined Campaign at your workplace, please consider participating and remember -Designate! ADDITIONAL INFORMATION FROM THE 1986 PATIENT SURVEY The pamphlet "Infonnation from the AT A Tinnitus Patient Survey" reported the percent of people answering for each of the items in the questionnaire. Two of the questionnaire items related to specific helpful treatments for tinnitus. Item #22 "Have you tried any fonn of treatment for your tinnitus?", where 67.7% of the people responding answered 'no', 30.6% answered 'yes', and 63 specified relief from another fonn of treatment; and Item #23, "Is there anything else you know of that helps to relieve your tinnitus?" where 695 people answered yes, and listed one or more treatments. What follows is the breakdown of the helpful "other" interventions that were reported by these 758 people. PHYSICAL IN1ERVENTIONS ............. ......... . Number Reporting .............................. . Description 189 .. . ................................ MASKING, includes background noise, running water,radio, white noise. 28 . ......................... HEARING AID OR AIDS 18 ..................................... MASSAGE, includes myotherapy, acupressure, positional changes 17 .................................. DENTAL-TMJ, includ.es use of dental splint, regular dental work 16 .................................... EARPLUGS, includes all kinds 15 ........................... EAR WAX REMOVAL 14 ....................... EXERCISE, Physical activity 12 ............................ PRESSURE CHANGE, includes Valsalva maneuver, atmospheric change 8 ...................................... SURGERY, includes stapedectomy, shunt, cochlear implant 8 .................................. CHIROPRACTY 7 .................... HEAT/COLDAPPLIEDTOEAR DRUG AND DIET IN1ERVENTIONS Number Reporting .............................. . Description 47 .......................... DIET MODIFICATION, includes low sugar, low salt, low fat 26 ............................. USE OF VITAMINS, includes minerals 25 ......................... CAFFEINE A VOIDANCE 20 .................. USE OF ALCOHOL, WINE, BEER 19 ......................... ALCOHOL A VOIDANCE 15 ........................... USE OF NARCOTICS, includes sleeping pills, Valium 13 .......................... ASPIRIN A VOIDANCE, includes other similar drugs 8 ....................... USE OF ANTI-HISTAMINE, and other allergy controls 8 ................................ USE OF ASPIRIN, and similar drugs 4 3 .................... BLOOD PRESSURE CONTROL 2 ......................... WEIGHT, GAIN OR LOSS 2 ......................... USE OF OTHER DRUGS, includes anti-biotics, penicillin 1 .............................. USE OF DIURETICS 1 .................... USE OF CNS ACTIVE DRUGS, includes tegretol, mysoline etc. 1 ............................ DIABETES CONTROL PSYCHOLOGICAL IN1ER VENTIONS Number Reporting .............................. Description 144 ......... IGNORE IT, KEEP BUSY, DISTRACTION 104 .................... SLEEP, REST, RELAXATION 43 ................................. AVOID STRESS 37 .......................... QUIET ENVIRONMENT 28 ........................... POSITIVE THINKING, includes hypnosis, self-hypnosis, meditation, relaxation tapes, psychological counseling SURVEY,RESULTS::NOWAVAILABLE TO RECEIVE A FREE COPY OF THE SURVEY RESULTS MENTIONED IN THE ABOVE ARTICLE, SEND A L ~ ( } E S E L F ~ ADDRESSED STAMPED (25) ENVELOPEWITH THE WORD 'SURVEY' WRITTEN IN THE LOWER LEFf HAND CORNER. FEDERAL AGENCIES' RESEARCH AND TREATMENT ACTIVITIES FACT SHEET ON TINNITUS prepared for the Honorable Daniel P. Moynihan, U.S. Senate, March 1988, may be requested from: U.S.General Accounting Office, P.O.B. 6015,Gaithersburg, MD20877 The frrst five copies are free. Additional copies $2.00 each. ATA FELLOWSHIP BRINGS NOTED RESEARCH SCIENTIST TO OHSU TINNITUS CLINIC Dr. Pawel Jastreboff of Yale University spent several days sharing tinnitus information with the staff of the Oregon Hearing Research Center and the American Tinnitus Association. Dr. Jastreboff's current research relates to understanding the physiological correlates of tinnitus. A special seminar sponsored by AT A was presented at the Oregon Hearing Research Center in which Dr. Jastreboff spoke about "An animal model for tinnitus". There are currently several articles by Dr. J astreboff about this topic in press. Watch for one in the next ATA Newsletter. the condition. He called it hyperacusis, or hypersensitive hearing. His clinic had seen a handful of others with the condition, and most had also had tinnitus. What was unusual was that none of the patients had any measurable hearing loss, most -- like this 32-year-old -- had no impressive noise history, such as years of exposure to loud sounds in the workplace. In some cases, hyperacusis came on suddenly, without any discernable provocation. The patient corresponded with others who had hyperacusis, some living in other countries. He and his parents contacted ear specialists and other doctors throughout the country, hoping to . obtain information that might help in treating hyperacusis. It would be more reassuring if noise was the only apparent cause, but contact with other sufferers and doctors revealed that was not the case. In fact, several medical instances of hyperacusis turned up. Oral surgeons say that hyperacusis is seen frequently in patients who undergo jaw and facial operations, but its duration generally ends a few weeks after the surgery. Dentists who specialize in treating TMJ syndrome (temporomandibular or jaw- joint problems) report that hyperacusis and tinnitus are sometimes symptoms associated with TMJ disease. In addition, neurologists say they see hyperacusis in Tay-Sachs disease, a rare, inherited disorder of the central nervous system seen in infants and small children. In addition, audiologists and otolaryngologists report cases of hyperacusis in patients who have been exposed to noise, frequently a single event or a single blast, such as from a gunshot or a cordless phone. The general feeling among medical specialists is that hyperacusis is a comparatively rare problem, one that sometimes improves or resolves itself over time. During its acute phases, however, it can be devastating, disrupting lives and psyches, and costing patients jobs, money, and relationships. In that way, of course, it is like severe tinnitus, and those unfortunate enough to have hyperacusis frequently have tinnitus also, a double threat to their peace of mind. But just the fact that it sometimes does improve over time 'is reason to hope. Today, the 21-year-old is 34, and after reaching their zenith nearly three years ago, his hyperacusis and even his tinnitus have diminished in severity -- extremely slowly -- certainly -- but surely. Dr. Vernon and other experts believe hyperacusis differs from a condition known as recruitment, an abnormal growth in the perception of loudness that is not uncommon in people with hearing loss. For them, loud noises are painful. For those with hyperacusis, all sounds are uncomfortable. - What is it that makes a small percentage of the population develop hyperacusis while the vast majority does not? Does this patient's increased sensitivity to light, making night driving almost impossible, relate neurologically to hyperacusis? Why do people with no history of hearing problems, no exposure to abnormally loud sounds, and even no hearing loss, sometimes develop the disorder inexplicably? These questions can be answered only if enough researchers take an interest in the problem to seek answers. If noise was the only factor in causing hyperacusis, everyone with noise exposure, tinnitus or hearing loss would also have hyperacusis. Fortunately, that is not the case, but science must take heed of the few who do. Page 5
BEST WISHES NEIGHBORS! We have recently had word from Elizabeth Eayrs of Toronto, Ontario, that the incorporation of the Tinnitus Association of Canada has been completed. We wish you great success and look forward to exchanging news and views often. Canadians are welcome to continue their membership in AT A and we are quite sure that the TAC will welcome members from the states. ATA TINNITUS BIBLIOGRAPHY A GROWING DATABASE FOR YOUR USE The ATA now offers a Tinnitus Bibliography containing nearly 1700 references listed in alphabetical order by author. It is available to ATA members for $25.00 (plus $1.00 shipping and handling for orders from outside the United States). We also offer a bibliography search service from which members may obtain listings of articles on a particular subject area of tinnitus. Some of these subject headings are TMJ, physical trauma, noise, diving & tinnitus, and hearing loss. For these and other subject listings, there is a basic search fee of $5.00 plus an additional charge of .25 per source over 15 sources. For more information contact: this office, mentioning "Bibliography". A quick tally of publications about tinnitus during 1987 revealed the following numbers of papers on these named topics: NUMBER ... .... . ...... .. ......... ... .... SUBJECT OF PAPERS 1 ............ ...... . ...... .. .. . .. .... ANIMAL MODEL 1 ..... ........... .......... ... .... .. ......... . ATA 1 . ........ ..... ............ .. .. . ...... . . . ... ... BIOFEEDBACK 1 ............................................. EPIDEMIOLOGY 2 ...... ... . . ...... ... . . . ... . . ..... GENERAL TINNITUS TOPICS 2 .. .. ...... ........ . ..... .. . ............... HISTORY, THEORY 10 ............ ... .... .. . . .... . ... MANAGEMENT OF TINNITUS 4 .. ......... .... ..... . MEDICAL, AUDIOLOGICAL EVALUATION 2 .. ................ . .... . . . ........... . .. ...... . NEUROLOGIC 4 ... ........ . ......... . . . .. .. ...... NOISE INDUCED TINNITUS 2 ......... . ............ . . . ... . ........... .. .. .. OTOTOXICITY 1 ....................................... OBJECTIVE TINNITUS 11 ....... .. ...... .... .... ... ....... PSYCHOLOGICAL ASPECTS 6 .......... .... ... . . ..... .. ... ....... . . ....... .... PULSATILE 1 .................................................. SELF-HELP 3 .......... .. . .. ... .. . .. ........ . ..... TINNITUS IN CHILDREN 1 ......................... TINNITUS WITHOUT HEARING LOSS 5 ......................................... TMJ DYSFUNCTION 2 . ........... .. .......... TREATMENT OF TINNITUS: ALLERGY 2 ........... . . ...... . . ........... .. .. .... COCHLEAR IMPLANT 1 ... . .......... .. ..... . ....... . ... .. ......... .. ... . ..... DIET 31 . ............. . ............ DRUG MANAGEMENT- MEDICAL 5 ................................. ELECTRICAL STIMULATION 7 . . ........... . .. ..... .... . ... . .... HEARING AIDS - MASKERS NEW ATA BOARD MEMBER Philip 0. Morton, Portland, Oregon, Vice President of Gaylord Industries, has been elected to serve on the AT A Executive Board. Phil, himself a tinnitus sufferer, has been instrumental in establishing one of the Portland self-help groups and is an active campaigner for noise control. Welcome aboard, Phil! 6 MARK YOUR CALENDAR FOR SEPTEMBER & OCTOBER MEETINGS TINNITUS FORUM September 26, 1988, Washington, DC, Grand Hyatt Hotel, 7:30p.m. Discussion of medical and social aspects of tinnitus featuring prominent ear, nose & throat specialists who will be attending the annual meeting of the American Academy of Otolaryngology. Come and hear AT A's advisors speak about the latest treatments and techniques for relieving tinnitus. No reservation needed. TINNITUS CONFERENCE October 22, 1988, Philadelphia, PA, Elwyn Institutes, 9:00 a.m. to 5:30p.m. Day long meeting featuring well known speakers about tinnitus and short workshops where you may learn more about how to understand and cope with your tinnitus. You may correspond directly with the conference organizers. Your registration will cost $10 if completed before June 30th, $15 from July 1 to the deadline of August 31. "Tinnitus Conference '88", P. 0. Box 351, Voorhees, NJ 08043. Or, write to ATA for a registration form. ANNUAL GIFTS FOR 1988 ARE DUE ONLY WITH YOUR SUPPORT CAN ATA CONTINUE TO PROVIDE INFORMATION ABOUT TINNITUS AND FUND TINNITUS RESEARCH. PLEASE BE GENEROUS! In order to continue to receive the AT A Newsletter I am enclosing my annual contribution to support tinnitus research and education ___ $15- $24 Contributing Member ___ $25 - $49 Supporting Member ___ $50 - $99 Sustaining Member _ __ $100 or more Sponsor Member Your contribution in any amount will be greatly appreciated but we are unable to send receipts for amounts less than $10. Donor's Name _____________ _ Admess. _______________ ___ City, State, Zip ______ ___ __ _ OPTIONAL: Tribute Fund gifts This special gift is in the name of: In Memory of __ (please check category) In Honor of ___ Birthday ___ Anniversary ___ Other (explain). ______________ _ Card in recognition of the occasion to be sent to: Name. _____________ ___ Address. _ ___________ _ City, State, Zip. _ _ _ ____ _ ___ Do you know of someone else who would like to receive the AT A Newsletter? Nrune ____________________________________ _ Adilless. ______________________________ ___ City, State, Zip ______________________ _ PLEASE: Help us to keep your Newsletter coming to you on time by providing us with a change of address in advance of your move. The post office does not forward Newsletters- they do provide us with a new address (at 30 each)- but you usually don't receive that issue. TINNITUS TODAY ATA NEWSLETTER TAKES ON NEW LOOK With the December 1988 issue, the ATA Newsletter will become known as Tinnitus Today. The new magazine will be more colorful and will contain even more information to help people with tinnitus. You will be seeing more advertisements because it has become necessary for us to find additional sources of funds to produce the Newsletter. It turns out that this new policy will benefit AT A members. First, it means that your donations will be able to be directed toward research projects, and second, you will be able to read about items that can make life easier and more pleasant. 7 Watch for articles and information you can use about new products. Contact us if you wish to advertise a product having potential benefit for tinnitus patients. The AT A board has set advertising guidelines. Products advertised in Tinnitus Today are not endorsed by AT A but the advertisers will have conformed with these guidelines. COMING NEXT The next AT A Newsletter will include a research article about work being done at Yale University to develop techniques for measuring the electrophysiological correlates of tinnitus. There will be an article directed toward the consumer to help you make more informed choices regarding tinnitus treatment. We will also be reviving a popular column "Tell me doctor ... ", in which your questions about tinnitus are answered. Authors may submit articles to AT A for possible publication in the Newsletter. These articles should be double spaced on 8 x 11 inch paper and should not be longer than about 1500 words. It is desirable to send a black and white glossy photo of the author or of the subject of the article for publication. A TA retains the right to select and edit articles as it sees fit. Scientific articles must conform to generally accepted styles and be properly referenced. "COPING WITH TINNITUS" e STRESS MI\NAGEMENT & TREATMENT e TINNITUS MI\NAGEMENT IS OFTEN COMPLICATED BY ANXIETY AND STRESS e NOW A UNIQUE CASSETTE PROGRAM IS AVAILABLE DESIGNED TO PROVIDE DAILY REINFORCEMENT AND SUPPORT FROM THE STRESS OF TINNITUS WITHOUT COMPLEX INSTRUMENTATION & VALUABLE OFFICE TIME There is a growing interest in psychological methods of tinnitus control such as systematic relaxation procedures which help the patient cope with the tension of tinnitus. Subjects with tinnitus are being taught ways to relax as part of a total tinnitus program which may include hearing aids, tinnitus maskers and progressive muscle relaxation based on principles of conditioning. Relaxation procedures are usually easily mastered and can be performed daily in the patient's home environment. It has been demonstrated that the relaxation response can release muscle tension. lower blood pressure and slow heart and breath rates. A. ASSOCIATED HEARING CENTERS A relaxation method has been developed entitled Metronome Conditioned Relaxation (MCR) which has successfully treated for many years chronic pain. tension headaches. insomnia and many other conditions. The program consists of one cassette tape of Metronome Conditioned Relaxation and two additional tapes of unique masking sounds which have demonstrated substantial benefit whenever the patient feels the need of additional relief. These recordings can be used to induce sleeping or as a soothing backdrop for activity and can be played on a simple portable cassette player. ALL ORDERS MUST BE ACCOMPANIED BY CHECK VISA, MASTERCARD. OR INSTITUTIONAL P. 0. 6796 MARKET ST., UPPER DARBY, PA 19082 Phone (215) 528-5222 TRIBUTES The A TA tribute fund is designated 100% for research. Thank you to all those people listed below for sharing your memorable occasions in this helpful way. Contributions are tax deductible and are promptly acknowledged with an appropriate card for the occasion. The gift amount is never disclosed. IN HONOR OF CONTRIBUTOR Margaret Pfister ...... ..... . . ...... .......... . Edward Pfister John F. Grove .... .... . ..... .. . .. .. ... ....... . Martha Grove Larry Morgan ................................ Susan Morgan John Brady ... .... ............. ....... .... . Elizabeth Brady Jos. J. Pappas, M.D ... .... .. ....... ....... Mrs. M.J. Friedman Eric M. Kraus, M.D ... ......... ..... ........ Madalyn Mancuso Mrs. Lew Kern ........................... Jean & Joe Wolfson Fortunato Barquero ............ .. . . ......... Peggy M. Salazar Sam Kaplan ......................... Mr & Mrs Sam Eisenberg Donna L. Gary .................................... Mr. Gary Marjorie Youngen ........................ J. Richard Youngen Mary Cassel ........................... J. Alam & T. Drucker Carolyn E. Packer .... .................. . J. Alam & T. Drucker Amber N. Perc .......... ......... .. .... J. Alam & T. Drucker Maria V. Rivero .......................... Mrs Mario A. Luque Dr.Jack Vernon .. .. . ....... ....... ..... ...... . ..... M.Lang Peg & Jim Doyle ........................ J. Alam & T. Drucker Ron Savio ........ .. ...... ... . ............ . Ronald A. Savio David Ney . ..... (: .: ......................... .. Wilma Ney Mrs. S1dney Zaron , ! , t: .... Jean & Joe Wolfson Bruce Julien, M.D .. ......... ... . .. .. .. .. .. Jean & Joe Wolfson Samson A. Mandell ................... Mr & Mrs Sam Eisenberg Charlette J. Snyder ...... . .. .. .... .. ...... Rose & Alfred Polen Karen's Birthday ; ........................... Rosalie K. Erlich Michelle A. Stone ....................... J. Alam & T. Drucker Carol Kaplan .. . ....... .. ..................... Helen Kaplan Nancy Poindexter . ..... . ... .. .................. Flora H. Bell Dr,Jack Vernon ............................ James L. Shapley Louis Lytton, M.D ......................... Jean & Joe Wolfson Dr. Jack Vernon ... .... . . . . ........... . ..... Pearl Silverstein Father's Day ............................... Anthony Sciveres Velma C. Carl . .... .... .. ... ..... . ..... . ... . .. Velma C. Carl IN MEMORY OF CONTRIBUTOR Margaret Willis ... .. .... . ..... .. .............. Sam Goldberg Alois Kabacinski .... ... . . .. .. . ........... .. Harry Kabacinski Ruth Milazzo ..... . ............. . ............ .. Ben Milazzo Edgar Tunsch .. .... . ..... ... ... . ........ . Mrs. Edgar Tunsch Inez Farina .......................... ..... . . . Daniel Farina Lawrence H. Sanders .................... .. . Kathy M. Sanders Winnie DeYoung ............................ Myrtle D. Hardin Winnie DeYoung .. . ........................... Winnie Jones John N. Christos ............................ Norma Christos Lou Tinker .......... . .. ............. .. . ..... John R. Veglia Bill Dennis .. .... . .. ..... .... . . . ............... Edith Dennis H. J. Jax Pieser .. .... ..... ..... .... . Mr & Mrs Efrom Abramson Dr. A. B. Baker ..................... Mr & Mrs Efrom Abramson For more tnformation wrtte to AMERICAN TINNITUS ASSOCIATION P.O. Box 5. Portland. OR 97207 A corporatton under the laws of Oregon ADORESS COAAECTION REQUESTED ISSN: 0897-6368 8 William Wertchafter ................... . . Mr & Mrs Joe Wolfson Mark Blumenfeld . . ....... . ......... . .. Claire & Jacques Simon Mrs. Marion Ogull ........ ... .. ..... .. .... ... ... . Louis Ogull Gertrude Westphal ....................... Antoinette Westphal William Behlke ..................... Mr & Mrs Efrom Abramson M. Arnold Lyons ......... . ....... .. . Mr & Mrs Efrom Abramson Phil Theilen ........................ Mr & Mrs Efrom Abramson Nat Weissberger .. ... .................... Jean & Joe Wolfson Leibowitz' sister .... . . .. ............. . ... Jean & Joe Wolfson Walter Holcomb ... ... ... ......... ..... Jessie M. Jones-Cobb Edward Camiel ......................... Mr & Mrs Mike Kriger Ida Elefson . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr & Mrs Mike Kriger Irving Soroka . . . . . . . . . . . . . . . . . . . . . . . . . . Mr & Mrs Mike Kriger Rose & Jacob Berliner .... .. .... ........ ... . . .. Mrs. M Manus Edyce S. Rubin ............................ Sarla W. Samson Florence S. Press .. .. .... ....... ..... .. .... Sarla W. Samson Gisella Huppert ..... .. ........ . .. ....... ... Sarla W. Samson Lew Kern .......................... .. .. Jean & Joe Wolfson Milt Rutledge . . . ..... ............ . .. .. .... Leona M. Rodwell Max Gold .... .. .... ... .... . ..... . . Mr & Mrs Efrom Abramson Jules Gerstel .. ........... . ......... Mr & Mrs Efrom Abramson Burt Horowitz ........ .. . ..... . ..... Mr & Mrs Efrom Abramson Beth Ross'father .......................... Ms Rhoda P. Levin William F. Cramb . ... .... .. ... .. .... .. .. Mrs Harold L Nuckolls Lee Guber ............................. Jean & Joe Wolfson Amy Olson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phyllis Nash Leonora Maldarelli ....... ... ............ .. .. Ralph Maldarelli Edwin Hattori . ..... . ... . . . ........ .. ......... . Lillian Hattori Jack & Richard Plevinsky ............ . ... . .... Ida C. Plevinsky SPONSOR MEMBERS: FEBRUARY to MAY, 1988 Alexander Alex Lynda J. Martin H. R. Matern, M. D. Alice A. Bauer Sidney Cobb Jessie Jones-Cobb Gardner C. Cole Dwight De Sheng Dr. Trudy Drucker Sidney Gall Michael Gilman Raymond H. Grenier Lynda Hoffman Marie D. Jeffrey Fdn. Edward G. Kalinowski Mrs. Norman C. Kinsey Laura P. Kleppick Richard D. Zujko, M.D. Alan B. McDaniel, M.D. Patrick S. McGuinness Stanley E. Moore W. S. Nelson Ronald A. Palmieri Elmer Richter Daniel Ross Nelson L. Savidge Marion Schenk Benjamin A. Trustman Duane D. Walters Antoinette Westphal Thomas W. Winstead ATA GRATEFULLY ACKNOWLEDGES RECENT BEQUESTS FROM THE ESTATES OF PEOPLE WHO HAVE PROVIDED SUPPORT FOR TINNITUS RESEARCH BY MENTIONING ATA IN THEIR WILLS. Emagene Faye Veal, Oregon Valverda Knight, California Gilbert L. DeRosia, New York NON PROFI T ORG US POSTAGE PAID PERMIT NO 1792 PORTLAND. OR