December 1991 Volume 16, Number 4

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To carry on and support research and educational activities relating
to the treatment of tinnitus and other defects or diseases of the ear."
!ffo{iday greetings from
a{{ of us at Jl:l and best
wislies for tlie
In this issue:
The IV International Tinnitus Seminar
Meetings report
Personal injury lawsuits involving tinnitus
I'
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Editorial and advertising offices:
American Tumitus Associatioo, P.O. Box 5
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Executive Director & Editor:
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Scientific Advisor y Board
Alfred Weiss, MD, Boston, MA
Abraham Shulman, MD, Brooklyn, NY
George F. Reed, MD, Syracuse, NY
John R Emmett, MD, Memphis, TN
Gale W. Miller, MD, Cincinnati, OH
Jack D. Clemis, MD, Chicago, IL
W. F. S. Hopmeier, St. Louis, MO
Harold G. Tabb, MD, New Orleans, LA
I. Gail Neely, MD, Oklahoma City, OK
Jerry Nonhem, PhD, Denver, CO
John W. House, MD, Los Angeles, CA
Robert E. Sandlin, PhD, San Diego, CA
Chris B. Foster, MD, San Diego, CA
Richard L. Goode, MD, Stanford, CA
Mansfield Smith, MD, San Jose, CA
Robert M. Johnsoo, PhD, Portland, OR
Honorary Board
Senator Mark 0. Hatfield
Mr. Tony Randall
The Journal of the American Tinnitus Association
Volume 16 Number 4 December 1991
Contents
4
9
10
12
15
16
The IV International Tinnitus Seminar
by Jonathan W. P. Hazell
Media Watch: Tinnitus in the News
by Clif!Collins
Meetings report
by Gloria E. Reich
Questions & Answers
bylackA. Vernon
Admonition (Poem)
by Jack Salant
Personal injury lawsuits involving claims of tinnitus
by Kevin M. Walsh
Regular Features
18 Tributes, Sponsor Members, Professional Associates
19 Books Available, Donation Form
IV International Tinnitus Seminar Report
by Jonathan W. P. Hazell, F.R.C.S. This ar-
ticle has also been published in "Quiet," the
newsletter of the British Tinnitus Association, to
whom we are most grateful.
The IV International Tinnitus Seminar "Tin-
nitus 91" took place in Bordeaux, France between
27 and 30 August. The conference was hosted by
Jean-Marie Aran, Ph.D. and Rene Dauman, M.D.
The conference took place under the auspices of the
George Portmann Foundation which has been or-
ganizing conferences and courses in otology and
audiology for over 50 years. The team at the
Pellagrin Hospital has been responsible for many
important innovations in audiology over the last 20
years, particularly the introduction and develop-
ment of electrical tests of hearing and the effects of
ototoxicity. It was an exciting time for 300 dele-
gates meeting again after 4 years since the Ill
Seminar in MUnster, Germany. The major problem
was a heat-wave throughout the week with temper-
atures up to ll0F; there was no air conditioning
in the lecture theater and virtually no ventilation.
These extremely high temperatures made it very
difficult for most people to think clearly and was
one of the factors which reduced the amount of
critical discussion.
As with the Ill Seminar in MUnster, there was
a prominent and extremely important involvement
of scientists in basic research; as well as a lot of
clinical papers. Dr. Aran had organized the meeting
around a series of invited half-hour lectures on
various subjects. Among the stars was Brian
Johnstone from Perth, Australia, who discussed the
way in which mechanical activity in the cochlea
could. contribute to tinnitus. He was the first person
to accurately measure the mechanical activity of
the basilar membrane and is one of the acknowl-
edged front-runners in the field of audiological
research. Eric LePage, also from Australia (Chats-
wood) gave an alternative view of tinnitus as a
result of disordered cochlear physiology. He sup-
ports the hypothesis that due to a change in length
in the outer hair cells, there is a consequent change
4 Tinnitus Today/December 1991
in the "operating point" of the outer hair cells and
only very tiny movements are required to change
the frequency place map in the cochlea. There is
continued friendly rivalry between LePage and
Johnstone over these mechanisms, whether they
are highly mechanically active, or the result of
adaptation of hair cell size and shape. Both mech-
anisms are likely to be involved (Jastreboff 1990).
The debate is far from being resolved. Remy Pujol
from Montpellier discussed his concept of neuro-
J
Ross Coles, MD., Mary Meikle, PhD., Thomas Lenan, MD.
transmitters, chemicals which carry the informa-
tion from hair cells to nerves in the cochlea and
vice-versa.Although some of the major neuro-
transmitters are known, the majority are still a
matter for conjecture. Drug treatment, both in tinni-
tus and some aspects of cochlear deafness, is likely
to become much more of a reality when we know
what these transmitters are and how they work.
Aage M0ller from Pittsburgh, PA, who has had an
interest in tinnitus for many years showed us elec-
trical recordings taken from the auditory nerve
during neuro-surgical procedures in the internal
auditory canal. He showed that there were differ-
ences in the speed at which electrical activity in the
nerve is conducted to the brain in patients where
tinnitus is present, and this may give us some
insight into the mechanism of some types of tinni-
tus generation in the cochlear nerve itself. Pawel
Jastreboff from Baltimore, MD, described his be-
havioral animal model of tinnitus in some detail.
This was a great help to delegates as the model
Vol.16No.4
IVth International Report, (Continued)
based on Pavlovian behavioral theory with which
many of us are unfamiliar is complex (but unique
and extremely valuable). It is possible to measure
quite low levels of tinnitus, induced in rats with
aspirin (an experiment which has been done many
times in humans without ill effect) and to measure
not only the presence of tinnitus but its loudness,
pitch and whether it responds to various anti-tinni-
tus therapies.
One of the most exciting innovations came
some years ago from Munster, the work of Manfred
Hoke, showing that it was possible to measure
changes in the cortex which related to the percep-
tion of tinnitus measuring the tiny magnetic fields
that are generated by electric currents in the audi-
tory cortex. Sadly, further work by Hoke and also
by Colding-Jorgensen(Denmark) [and, in the U.S.
by Jacobson et. al] has not confirmed the early
findings, which seemed to indicate that it was pos-
sible to measure tinnitus from the auditory cortex.
Dai Stephens from Cardiff, Wales, presented
work on the psychological aspects of tinnitus. He
looked at the interaction of personality factors and
tinnitus complaint behavior and showed that the
first could influence the second. Personality mea-
sures in tinnitus sufferers who had not sought help
were less abnormal than in conplainers! Dr. Ste-
phens went on to present an analysis of six patients
with tinnitus who had committed suicide. We
looked at their case histories in some detail, and it
was clear from this (and other
cases that were mentioned later
in discussion) that depression
plays a vital role in the decision
of a tinnitus sufferer to contem-
plate taking his or her own life. It
is fortunate, however, that sui-
cide attempts are extremely un-
common in tinnitus sufferers.
lected by a process of peer review, and by no means
all of the submitted abstracts were accepted. This
meant that there were no "really bad papers," but
my overall impression was that neither was there a
great deal that was dramatically new or exciting.
This does not mean that people have not been
working hard and making good progress, but four
years is a short time when it comes to investigating
a difficult subject like tinnitus.
Lynn Penner, a psychologist and psycho-ac-
oustician, who has done excellent work on the
relationship of otoacoustic emissions (sounds
which are generated by the inner ear and audible in
the ear canal) and the perception of tinnitus pre-
sented two papers. There is a very small but import-
ant minority of tinnitus sufferers who have tinnitus
which relates to these detectable emissions, and in
some cases they are suppressible by small doses of
aspirin. Lynn Penner had been working for some
months at Nottingham, England, with Dr. Ross
Coles and Jean Baskil who also presented a paper
on the results of the Nottingham work on tinnitus
and oto-acoustic emissions. It seems that trouble-
some tinnitus is associated with fluctuating rather
than stable otoacoustic emissions. A paper was
given by Veuillet from Lyon, France, on tinnitus
and the medial cochlear efferent system. They were
measuring the amplitude of emissions with and
without stimulation of the opposite ear and the
results produced somewhat inconclusive evidence
Free Papers: The rest of the
papers (71 in all) were "free pa-
pers." Abstracts had been sub-
mitted and these had been se-
Alf Axelsson, MD., Richard Tyler, Ph.D., Soly Erlandson, Ph.D.
Vol16.No.4
Tinnitus Today/December 1991 5
IVth International Report, (Continued)
that the efferent system, which is thought to control
gain or volume in the cochlea, might be implicated
in tinnitus.
Treatment of tinnitus: Psychological man-
agement: What of treatment? There was an in-
creased interest in the psychological aspects of
tinnitus management and a whole day (albeit the
last day) was allocated to this important subject. To
pick on but a few, Dr. Goebel from Germany
showed how a luxurious residential clinic with a
multi-disciplinary and multi-factorial approach to
relaxation, cognitive therapy and psychotherapy
could have dramatic results on patients who were
extremely distressed by their tinnitus. It seemed an
excellent if expensive model for managing the
acute distress that many tinnitus patients feel. He
was not yet able to involve an otologist to complete
the multi-disciplinary team, although he is working
on this. Dr. Goebel is himself a cardiologist who
has trained in psychological medicine.
Several presentations were given by the Swe-
dish groups from Goteborg, Uppsala and Stock-
holm, who have long been known for their effective
use of psychological techniques in managing tinni-
tus. The Stockholm group made a comparison be-
tween tinnitus and chronic pain and its
management. A workshop on cognitive therapies
took place in the afternoon with eight presenters
followed by discussion. There was a whole session
on patient management and alternative therapies,
headed by Brian McCabe who discussed patient
management from the viewpoint of the otologist
and spoke about the use of hypnosis. Various "al-
ternative therapies" were discussed, from the re-
sults of powerful magnets in the external ear canal
(Ross Coles) to acupuncture (the Goteborg group)
and the treatment of tinnitus by putting Lignocaine
through grommets into the middle ear (Haifa, Is-
rael). None were shown to be effective.
Drug Therapy: As far as drug therapy was
concerned the papers were somewhat spread about
in the different sections of the conference. A dou-
6 Tinnitus Today/December 1991
ble-blind controlled trial was presented as a poster
by Johnson and Brummett (Portland, OR) on the
use of Xanax (alprazolam) in the treatment of tin-
nitus. This is the first repon I have ever seen of such
a trial showing significant results against placebo
apan from lignocaine. The measure of tinnitus
change was analog rated loudness, and audiometric
loudness matching. The levels at which tinnitus
was masked by white noise were not changed.
Details of the investigation were not available on
the poster, but we await further results with interest.
The main problem is that this drug is a valium type
tranquilizer and in some patients is highly addic-
tive. The group did not report any increased depen-
dency on the drug.
A study performed jointly by a group from
Pavenna, Italy, and Berkshire, U.K., indicated that
a 50% reduction in subjective tinnitus intensity
could be achieved by the use of Vigabatrin which
inhibits the neurotransmitter GABA. It has been
postulated that this is involved in cochlear function
but it is also widely present throughout the central
nervous system. Vigabatrin is used as an anti-con-
vulsant drug. Ewan Davies from Birmingham,
U.K., who has been working for some years on
various pharmacological treatments of tinnitus,
talked about Taurine, an amino acid, with moderate
enthusiasm, but said that Nimodipine, a calcium
channel antagonist, (which had shown some early
promise in tinnitus therapy) had not proved effec-
tive in helping patients in clinical trials. Paul Guth
from New Orleans, LA, discussed the use of the
powerful diuretic Furosemide which produces
changes of the endo-cochlear potential. In an open
triall 0 out of 12 patients experienced a suppression
of their tinnitus as determined by self-rating and
loudness matching. Guth felt it might be useful as
a diagnostic tool to separate tinnitus of peripheral
and central origin as Furosemide is not thought to
have any effect on the central nervous system. The
doses used were quite high (up to 80 mgs three
times a day) although they did not report any im-
portant side effects. Jastreboff talked about his
Vol.l6No.4
IVth International Report, (Continued)
interest in calcium and calcium channel involve-
ments in tinnitus on a theoretical basis with data
from his animal model, and pointed the way for-
ward to correlation of these findings with electro-
physiological tests of cochlear function. Briner
from Los Angeles, CA, presented a paper on the
use of synthetic prostaglandin (Misoprostal) as a
tinnitus treatment. Several studies have shown that
prostaglandin levels can affect cochlear potentials.
These naturally occurring substances are active in
pain suppression mechanisms in the central ner-
vous system. A decrease in tinnitus severity was
reported in 26% though this required a high dose.
The design of the trial meant that the active drug
was exhibited late in the third and fourth weeks of
the trial and it is possible that these results may have
been influenced by natural habituation (comment
by Graham, U.K.). However, they said that none of
the patients responded while on placebo, which is
surprising in any trial. Prostaglandins undoubtedly
require further investigation as they play such an
important part in the chemical mechanisms of pain
perception, and would now appear to also be in-
volved with tinnitus.
Masking therapy: Talking to people at the
conference made it clear that every unit involved in
the clinical management of tinnitus uses masking
techniques to some degree or other. However there
were relatively few presentations concerned with
the results of therapeutic masking. Pauline Smith
et al from Nottingham, U.K., presented a paper on
different noise spectra which helped to answer the
question; is the exact frequency spectrum of mask-
ing noise important? White noise was marginally
more frequent! y preferred but no reliable individual
preferences could be found, and some patients
changed their minds during the investigation. The
study also found that most subjects chose to use
masker levels below the level at which tinnitus was
completely masked, i.e. "partial masking." Both
Tyler from Iowa and Johnson from Oregon pre-
sented papers on the use of dichotic masking of
tinnitus. This means that the masking sound is
Vol16. No.4
presented either as a separate white noise source for
each ear, or delivered to both ears simultaneously
from a single generator (diotic masking). It seems
that some patients prefer dichotic masking for tin-
nitus centrally located in the head, but Tyler con-
cluded that correlated binaural tinnitus may reduce
the masker level required for some patients.
Von Wedel from Germany helped patients
with severe sleep disturbance by fitting them with
a canal hearing aid containing a telephone coil and
transmitting a variety of sounds to the hearing aid
from a loop placed under the bed. This arrangement
allows various noise spectra and natural sounds like
music, water noise, or wind noise according to
patient preference. [This unit is manufactured by
the Starkey Mfg. Co. and is marketed in Europe
under the name "Silentina."] He found that deliver-
ing these sounds free-field was much less effective
than through the hearing aid via a loop system but
a significant number of the 30 selected patients
preferred 'natural' masking sounds via this system,
to classical devices. Sheldrake and Hazell from
London, U.K., compared the results (in a poster) of
hearing aids and maskers in suppressing tinnitus
over a ten year period and found that if these were
appropriately selected depending on patients'
needs the suppressive effect on the tinnitus was the
same for maskers or hearing aids.
Hyperacusis: Hyperacusis or sensitivity to
loud sound is a problem among a small group of
tinnitus sufferers. Two papers addressed this prob-
lem. An assessment of the characteristics of
hyperacusis patients based on a survey conducted
by the American Tinnitus Association, was pre-
sented by Gloria Reich and a paper by Hazell and
Sheldrake showed that hyperacusis could be re-
versed by a process of desensitization using mask-
ing devices (in a group of 30 patients). The
mechanism of hypersensitivity was thought to be
central.
Electrical tinnitus suppression: There was a
definite increase in interest in suppressing tinnitus
Tinnitus Today/December 1991 7
IVth International Report, (Continued)
by electrically stimulating the inner ear. Some stud-
ies looked retrospectively at the effects of cochlear
implantation to total deafness and the effect that
this had on patients' tinnitus. This ranges from
around 40% to 60% beneficial effect A small
number of cochlear implants for total deafness at
each center have resulted in increased tinnitus.
Ward et al from Sydney, Australia, presented the
preliminary results of a study of electrical stimula-
tion which is being undertaken by Cochlear AG.
They were looking at the effect of stimulation with
a promontory needle electrode and also an elec-
trode in the external ear canal on tinnitus ears with
bearing. They were looking for suppression with a
sub-threshold alternating current (i.e. one that did
not evoke a sensation of hearing). Prom-
ontory stimulation was more effective
than ear canal; 50% responded on the
promontory and 28% on the ear canal
electrode. A charged balanced offset rec-
>tangular wave was used for five minutes
on each occasion at various frequencies.
Okusa from Japan used the promontory
stimulator provided by the Cochlear Cor-
poration in tinnitus patients of varying
etiologies. The best results were obtained
in unknown sudden deafness with tinnitus,
followed by ototoxic deafness and
Meniere's disease (86% and 80% respec-
tively). Of 54 patients, 13 reported resid-
ual inhibition lasting from several hours to a few
weeks. In Los Angeles, 17 patients with bilateral
acoustic neuromas who have had both auditory
nerves cut, have received cochlear implants placed
near the brain stem which stimulate the cochlear
nucleus directly. Of the 17 patients, 1 had a total
suppression of tinnitus and 6 had some reduction
in tinnitus loudness. One was made worse.
Hazell et al from London presented the results
of their management of unilateral deaf ears with
severe tinnitus. A CROS hearing aid was effective
in reducing tinnitus in the deaf ear of 35% of
patients. Three patients had received cochlear im-
8 Tinnitus Today/December 1991
plants in their deaf ear and were experiencing con-
tinued tinnitus relief from stimulation with low
frequency sinusoid. It is important to differentiate
between the electrical stimulation of an ear with
hearing in which there are remaining hair cells
producing an electrophonic effect and the direct
stimulation of the nerve of hearing where there is
no hearing and no hair cells are present.
Bordeaux hosts demonstrated their legendary
hospitality. Three wonderful banquets were ar-
ranged, one in the wine caves deep under the hill-
sides of St. Emilion, (one of the cool events of the
week). A mayoral reception ended in a presentation
of the "keys of the city." At Chateau Vayres, five
Chateau de Vayres honorees: Doctors Vernon,
Shulman, Axelsson, Feldmann, & Portmann
of our participants were awarded the honor Les
Bailles de Lalande Pomerol.
Next Conference: The next conference (the
Vth International) will be hosted in Portland, Ore-
gon under the direction of co-chairmen Professor
Jack Vernon and Dr. Gloria Reich. That meeting
will take place July 12-15, 1995. In 1999 the meet-
ing will be held in the U.K. under the direction of
Mr. Jonathan W. P. Hazell, FRCS. *
Vol.l6No.4
Media Watch: Tinnitus in the News
by Cliff Collins, an Oregon freelance writer. Please send
clips, including source and date, to Media Watch,
PO Box5, Portland, OR 97207-0005.
What a high-profile year it's been for tinnitus
in the news! With such biggies as Time, U.S. News
& World Report and CBS-TV all spotlighting ears,
noise and ear noise, 1991 can be counted a success
in getting the word out about these long-neglected
topics.
In fact, AT A members sent in so many reports
since last issue, we can only highlight some here.
But a big thanks to everyone for the large response.
The lead stories: In September, a Port Wash-
ington, NY, real-estate broker appeared on CBS-
TV'S "Entertainment Tonight" after he filed suit
against rock singer David Bowie and a New York
arena. Charles Walker, 39, said he sustained per-
manent damage to his hearing after exposure to
perhaps 120-125 decibels at a Bowie concert last
year. The damage included tinnitus and -- accord-
ing to newspaper accounts -- hyperacusis, which
Walker's lawyer said "makes him hypersensitive to
certain sounds." Walker's is hardly the first legal
action taken against loud bands, though it could be
significant if the lawsuit ends up going to court;
similar cases have been settled out of court, which
helps divert attention from defendants. But Walker
told interviewers he wasn't suing to get money but
to bring attention to the fact that there are no legal
restraints on sound levels at concerts, and as a
result, people are being hurt. The general public is
slowly becoming familiar with noise ordinances,
but few are aware that such laws don't apply to the
inside of arenas, where anything goes, even if the
roof flies off from the blast.
Time magazine's two-page story August 5 on
the dangers of noise pollution echoed similar
themes to the Bowie case, quoting a scientist: "We
have laws to protect the hearing of workers in noisy
workplaces, but there are no laws covering recrea-
tional noises." And, of course, the latter are what
affect a huge portion of the population today. The
Voll6. No.4
article was welcome and did a serviceable job, but
plowed familiar turf, with too much emphasis on
hearing loss and what might happen up the road.
Readers agreed and said so in follow-up letters
printed August 26. One woman wrote: "In addition
to hearing loss, excessive exposure to noise can
cause ... tinnitus and hyperacusis (extreme, painful
sensitivity to any sounds). These conditions can be
just as disabling as noise-induced deafness."
U.S. News & World Report's September 9
two-pager covered technologies being developed
to cancel loud noises. The magazine says a half-
dozen companies are competing to develop "anti-
noise" technology, both to cancel sound at its
source and to create havens of quiet in areas such
as the interior of cars and airplanes. It's heady,
exciting stuff, so could they please hurry up?
National roundup: In July, numerous media
reported that hearing experts testified before a Con-
gressional committee about the widespread de-
struction of young ears from personal stereos and
loud music. Witnesses said toddlers and small chil-
dren are sustaining hearing damage -- 21 million
personal stereos were sold last year. Experts called
for public education and noise warning labels on
noisy products ... An interview with AT A board
member Phil Morton, discussing how he acquired
tinnitus from playing 20 years in a rock band,
appeared August 4 in The Sunday (Portland) Ore-
gonian ... Executive Health's Good Health Report
(August) carried a detailed story on tinnitus, as did
Current Comments; and the Kansas City Star's
magazine featured tinnitus July 21.
In New Jersey, Richard Epstein penned an
insightful piece in The Sunday Record titled "Liv-
ing with a Disability" that anyone with tinnitus
would appreciate. He probes the difficulties "hid-
den disabilities" pose, offers accurate information
on tinnitus and hyperacusis, and calls for greater
public empathy for people with invisible physical
limitations. *
Tinnitus Today/December 1991 9
Meetings, Reports
by Gloria Reich, Ph.D., Executive Director
A.TA.
Professor Ross Coles salutes formation of I.T.S A.
A new organization was born in Bordeaux!
Representatives from tinnitus support organiza-
tions worldwide met to form International Tinni-
tus Support Association (ITS A).
ITSAfounders: Axelsson, Saunders, Reich, DesRochers,
Pratt-Hepworth, Eayrs, Coles, Andersson, Shapiro.
The purpose of ITSA is to encourage re-
search, raise public awareness, share information
and ideas, and to help and encourage other coun-
tries in forming associations and groups. Mrs. Joan
Saunders, coordinator for this meeting was unani-
10 Tinnitus Today/December 1991
mously elected to serve as ITSA coordinator for the
next four years until the group meets again in 1995
at the Vth International Tinnitus Seminar in Port-
land, Oregon.
The International Tinnitus Study
Group met during the annual convention of
the American Academy of Otolaryngology
Head and Neck Surgery in September in Kan-
sas City, Missouri.
The topic for this year's meeting was
"Attempts to objectivize tinnitus for diagnosis
and treatment."
Leading off the diagnosis session with a
discussion of objective tinnitus was A.
Sismanis, MD. of the University of Virginia.
Dr. Sismanis described a number of audible
somatic sounds that can be used to diagnose
an arterial pulsatile tinnitus. The next speaker,
G. Hughes, M.D., focused on Palatal Myoclo-
nus and demonstrated with recordings of a dis-
tinctly metallic click. He commented that for some
patients thus troubled, frontalis muscle biofeed-
back has been helpful. A. Shulman, M.D. followed
with a report of work he is presently doing using
SPECT (Single Photon Emission Computed To-
mography). This method allows comparisons of
different brain views to examine abnormalities
which may help diagnose tinnitus. C. Claussen,
M.D. discussed another form of brain mapping
called BEAM (Brain Electrical Activity Mapping)
in which assymetry is also a possible pointer for
tinnitus. B. Goldstein, Ph.D., discussed
otoacoustic emissions and their relationship to tin-
nitus. D. Nielsen Ph.D.'s topic was electrophysio-
logical testing. J. House, MD., updated the group
on the recently completed study of the drug
Misoprostal. Plans ~ o r a larger study are underway.
The session on treatment began with R. Dobie,
M.D.'s report of a study of tinnitus and depression
where tricyclics were used and found to provide
improvement by lessening depression associated
with tinnitus. R. Amadee, M.D. reviewed a recent
Vol.16No.4
Meetings, Reports, (Continued)
study of the drug furosemide which may have
use in helping determine where the person's
tinnitus arises as well as having a therapeutic
effect. J. Pulec, M.D. spoke of surgical proce-
dures, pointing out that tinnitus may be im-
proved when a person undergoes surgery for
other hearing problems. P. Rigby, Ph.D., re-
ported a study of electrical stimulation which
shows promise for tinnitus. J. Vernon, Ph.D.,
in a discussion of masking observed that the
Starkey company had recently introduced
newly improved masking instruments. Ver-
non also described two bedside units that have
been helpful, one made by Marsona (see ad-
vert. this issue), and another being developed
by Microtek which shows great promise. Ver-
non also reported the recent completion of a study
of the drug Xanax in which a large majority of the
subjects experienced relief of their tinnitus and a
reduction in its loudness.
Kansas City participants: Sam Hopmeier, Gloria Reich,
Charles Abegg & Joseph West
Emmett, Smith, Reich and Johnson, Mr. Hopmeier,
and guests Dr. West, Mr. and Mrs. Moeller, Mr.
Abegg, and Mr. Lovell. *
The Kansas City Hyatt
Regency was the location for
the AT A public forum about
tinnitus. More than 50 people
came to hear presentations by
the panel, comprised of Donna
Wayner, Ph.D., Albany Medi-
cal Center; Barbara Goldst-
ein,Ph.D.,and Abe Shulman,
both of SUNY Brooklyn, Sam
Hopmeier, Hopmeier Hearing
Aids, Robert Johnson, Ph.D.,
Oregon Hearing Research
Center. A lively question
and answer period followed.
Self-help group representatives: Dorothy & Ernest Moeller,
Don Lovell, and Charles Abegg
A second public forum was held in Atlanta,
Georgia on November 22, in conjunction with the
annual meeting of the American Speech-Lan-
guage-Hearing Association, (ASHA).
The medical advisory board of A TA met for
breakfast during the AAO-HNS convention. Pres-
ent were Drs. House, Reed, Shulman, Goldstein,
Voll6. No.4
Notice
NorWest Tinnitus Synthesizers are needed.
These units are no longer in production. Anyone
who has one that is not being used is urged to
contact AT A and we will put you in touch with
someone who wants one. Thank you! *
Tinnitus Today/December 1991 11
Questions & Answers
by Jack A. Vernon, PhD., Director, Oregon
Hearing Research Center
Recently I requested information from those
of you who experience a change in your tinnitus
only after sleeping. Many of you wrote in and I
thank you. From your letters several things
emerged. Most indicated that after a nap if a
change occurred it was always for the worse, more-
over, changes after naps produced louder tinnitus
than did changes after a night's sleep. One person
took the trouble of setting an alarm in order to
estimate the level of tinnitus after various durations
of sleep during the night Upon awaking he usually
found the tinnitus to be reduced in volume or absent
but if he remained awake for a short time the
volume increased to a level which was greater than
usual. Almost all of you report that taking a nap
during the day does not convert a bad day into a
good one and yet a night's sleep can have a good
effect. One p a ~ i e n t finds that awakening about an
hour before arising brings loud tinnitus and then
returning to sleep for the additional hour usually
produces relief of the tinnitus. This is an easy thing
to try and I'd like to encourage others to try it and
report the results.
Almost all patients indicate that their tinnitus
does not change in either direction at any time when
awake. When it does change it is always after sleep.
In one case the tinnitus shifted permanently for the
better and now it is no longer affected by sleep. If
you have more observations I'd welcome them.
Better still, if you have any ideas what is going on
with this sleep effect share them with me.
Q uestion: "We live in an atmosphere of hun-
dreds of radio, television and telephone signals.
Has anyone considered the possibility that we
sufferers of tinnitus might be hearing these elec-
tromagnetic signals?" Mr. H. in Missouri.
Answer( that is, attempted answer): Mr. H. you
have posed an interesting and a difficult ques-
tion. I think the answer to your question is that
12 Tinnitus Today/December 1991
tinnitus is not the reception of electromagnetic
signals but I do not totally discount that possibil-
ity. The reason I think tinnitus is not the recep-
tion of electromagnetic signals, even in some
select patients, is that when tinnitus patients are
taken into a radio frequency (RF) shielded room
the tinnitus is not eliminated or reduced; instead,
the tinnitus appears louder than normal. Mr. H.,
I hope my answer does not convince you and
that you will come up with a way to test your hy-
pothesis. It is precisely this kind of unusual
thought from which progress often follows.
Q uestion: "Do you foresee medical technology
developing to the point where doctors may look
inside nerves in the same manner as heart pa-
tients have arteries and hearts examined by
catherization?" Mr. D. from California.
A nswer: There is absolutely no doubt in my
mind that medical technology will develop to the
point that all manner of neurological dysfunction
will be detectable and defined. Man may never
come to visually look inside nerves nor does he
need to, but he will be able to evaluate the func-
tioning of those nerves. My science fiction
dream of the future is that the neurophysiologist
will one day be able to pinpoint an area in the
brain responsible for the perception of tinnitus
which will indicate where microsurgery can re-
move the cause of the tinnitus. Yes, Mr. D., the
combination between electronics and biology has
just begun and the prom-
ises for the future in many
areas of medicine are
mind-boggling. Stay
tuned, as they say.
Q uestion: Since the re-
port in Tinnitus Today
about the drug Xanax
there have been several let-
ters concerning Xanax, in-
cluding this comment
Vol.l6No.4
Questions & Answers, (Continued)
from Ms. H. of Santa Clara. "I took 0.25mg a
day for four weeks which produced no effect on
my tinnitus."
A nswer: The dose level used by Ms. H. was
probably too low to be effective. Please keep in
mind that we all vary one from another and that
the proper dose level needs to be worked out for
each of us. First it is necessary that each patient
obtain consent and a prescription from their pri-
mary physician. After that we recommend start-
ing with 0.5 mg each evening at bedtime for two
weeks. Remember that Xanax has the side effect
of making some patients (not all, just some)
drowsy and thus one should be careful about driv-
ing cars or working around machinery. Upon re-
quest we will gladly provide your physician the
dose schedule used in the study conducted in our
laboratory. Let me remind you of the results of
that study done here. It was a double-blind pla-
cebo-controlled study wherein 5% of the patients
on the placebo got relief of their tinnitus and
76% of the patients on Xanax got relief of their
tinnitus. Relief of tinnitus was defined as a re-
duction in the loudness of the tinnitus by 40% or
more. I know of no study of drugs to relieve tin-
nitus with data as promising as these data. There-
sults of this study have not yet been published
but they were recently presented at the IVth Inter-
national Tinnitus Seminar in Bordeaux and will
be published in the proceedings of that meeting.
Permit me to repeat; it is essential that you confer
with, and obtain the consent of, your primary
physician before taking the drug Xanax. If for
any reason you happen to have this drug on hand
do not take it until you have discussed this matter
with your doctor.
Q uestion: "I am taking T-Bio which has im-
proved my tinnitus considerably. I wonder if any
research is going on with T-Bio?" Ms. L. from
Arizona.
Vol16. No.4
A nswer: T-Bio is advertised as a "food supple-
ment" and contains the following: Bio-
Flavinoids-200mg, Niacin-50mg, Ginger
Root-50mg, Ascorbic Acid-200 mg, Ginkgo-
75mg and Dimenhydrinate-25mg. I know of no
study of this compound for tinnitus although one
of its components, Ginkgo, is currently under in-
vestigation. T-Bio was displayed at the recent
meeting of the Academy of Otolaryngology in
Kansas City. The display claimed that T-Bio re-
lieved tinnitus and hearing loss. I would be less
than honest if I did not say to you that such
claims greatly bother me. Neurosensory hearing
loss is permanent and no medication is going to
repair that condition. Whether or not T-Bio can
relieve tinnitus will depend upon the outcome of
a properly conducted study---a double-blind pla-
cebo-controlled study. Should any of you take
this compound you need to know that Dimenhy-
drinate is Dramamine, the sea sickness drug,
which can cause drowsiness so be careful about
driving a car and around machinery. Also I
would like to hear of your experiences with T-
Bio should you elect to try it.
Q uestion: "My family berates me if I try to
back out of weddings or noisy functions. How
can I convince my family that I have this life
altering condition without hurting their feel-
ings?" Mr. S. from New York.
A nswer: Harry Truman often said "You cannot
make an omelette without breaking some eggs."
You may have to disregard the feelings of your
family and become more concerned about their
knowledge. There are probably two things in
your life which make attendance at noisy func-
tions undesirable. In the first place some of these
noisy functions can exacerbate tinnitus in the ex-
treme and thus you should avoid them or you
might wear ear protection and attend. The sec-
ond problem, and I suspect the more important
problem, is that with hearing loss it is very diffi-
cult or impossible to understand the spoken word
Tinnitus Today/December 1991 13
Questions & Answers, (Continued)
in the presence of background noise. The decep-
tive aspect of this situation is that usually you
can probably understand speech very well in the
quiet and one-on-one. Thus your family comes
to the conclusion that there is nothing wrong
with your hearing ability and that you are just in-
venting excuses to not attend various functions.
The problem is this: normally speech is heard by
that part of the ear devoted to the middle and
lower frequencies. It is precisely these frequen-
cies which make up the ambient noise of activi-
ties such as social gatherings and the like. Thus
this ambient noise comes to dominate that part of
the ear which would normally decipher speech
signals. In totally normal hearing ears the speech
deciphering task in noise is shifted to the high
frequency portion of the ear and that works very
well providing one has unimpaired high-fre-
quency hearing ability. I am guessing here about
you Mr. S., but I'd guess that you have high fre-
quency hearing impairment which means that
you have lost the ability to understand speech
when it is in the presence of noise but that in the
quiet you can hear and understand very well.
There are several things you can do. One thing
is to try some properly fitted hearing aids. An-
other is to instruct your family and those about
you that the best way to talk with you is to estab-
lish eye contact first. Tell others not to shout at
you but rather to speak more slowly and to never
start a conversation with you when you are not in
the same room. If your family persists in mis-
judging you have them call me, perhaps I can
help make them understand. One final comment,
in my opinion people with impaired hearing do
not have the right to inflict that impairment on
others if it can be alleviated with hearing aids.
Thank you for taking the time to write to us.
Ifl have not answered your question please submit
it again. Remember, the primary source of infor-
mation about tinnitus and the way we learn is from
you, the patient. *
14 Tinnitus Today/December 1991
TINNITUS:
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reviews the basic science of the
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identifies the site of lesion and
the clinical types of tinnitus
distinguishes between treatment
and control of tinnitus with medical,
surgical and diagnostic modalities
evaluates the future directions of
diagnosis and treatment.
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Vol.16No.4
Admonition
Classified
Jack Salam
Distrust your eye, your hand, your ear,
Reject their specious evidence
TINNITUS STRESS MANAGEMENT, an
audio cassette tape developed by a registered
hypnotist who has tinnitus.
For what you see or touch or hear
Will oft delude your keenest sense.
Tape side A: Tinnitus Stress Management Meditation
Tape side B: Relaxing Masking sounds with subliminal
messages for acceptance and relaxation.
This program can help manage the stress of
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If you would penetrate the screen
That hides the truth, the absolute,
Pay heed instead to the unseen,
To the impalpable and mute. *
To Order, send $12.95 (Outside U.S. send $14.95
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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 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
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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
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Tinnitus Today/December 1 1 15
Personal injury lawsuits involving claims of tinnitus
by Attorney Kevin M. Walsh
As those who have studied tinnitus know,
tinnitus has many potential causes. One common
cause of tinnitus is head trauma associated with
some type of accident. This type of head trauma
results when one' s head comes into forceful con tact
with some other hard object.
If someone has an accident involving head
trauma which results in a lawsuit, the injured
person's attorney faces the problem of proving that
any claimed onset of tinnitus was caused by the
accident, and not by some other, unrelated cause.
This article examines these causation issues. It also
suggests ways in which an injured person can work
with his or her attorney to develop proof to over-
come the problems these issues present.
Most lawsuits resulting from accidents which
involve head trauma-induced tinnitus are based
upon the general legal theories of negligence and/or
product liability. While the elements needed to
prove these legal theories can vary from state to
state, some general rules s h o ~ l d apply to almost
every case regardless of where one lives.
In general, when someone alleges in a lawsuit
that their tinnitus condition resulted from an acci-
dent, the injured person must prove that the onset
of the tinnitus is causally related to injuries suffered
in the accident, and not to some other cause.
The term "causally related" is a legal phrase,
the meaning of which is discussed at great length
in many law books. In essence, this legal rule
requires that there be a close enough connection
between an accident and an injury to show that the
accident set into motion events which resulted in
the condition. When applied to tinnitus injuries,
this "causally related" test can present troubling
problems of proof. Frequently, several of the com-
mon causes of tinnitus might apply to one person
at the same time.
For example, the person who believes a tinni-
tus condition has resulted from head trauma suf-
16 Tinnitus Today/December 1991
fered in an automobile accident may also work at a
job where loud noises are common, and may also
have a history of allergies or alcohol use. If this is
the case, and if the person's tinnitus first develops
a few weeks after the auto accident, how can some-
body establish what actually caused the tinnitus?
While absolute proof of a single reason for the
tinnitus may never be possible to achieve in a
situation such as this, there are things which can be
done in most cases to show that one's tinnitus is
more probably than not due to head trauma suf-
fered in the automobile accident. An injured person
can assist his or her attorney to prove the necessary
"causal relation" in such cases.
First, the attorney needs to learn as much as
possible about the tinnitus sufferer's habits, back-
ground, and medical history, in addition to the facts
surrounding the accident in question.
The client can help the attorney by obtaining
as many of the following items as possible:
Gather one's own medical records, preferably for one's
entire adult life, as well as childhood records, if relevant
and still available.
Send away to a federal government records center
for any military medical records, and for information
about the type of work and surrounding conditions that
were experienced. (For example, a Pentagon paper-
pusher and an artillery commander present drastically
different concerns of proof.)
Develop a family medical history and consult any
available family genealogies to help discover informa-
tion that could rule out any inherited ear disorders as the
possible tinnitus cause.
Gather employment records, job descriptions, and em-
ployment medical records for all current and prior jobs.
Obtain school medical records wherever possible.
Childhood records, in particular, may contain hearing test
results which can be compared with current test results.
Write a list of hobbies and interests. All other con-
ditions being equal, stamp collectors and hunters pres-
ent much different risks of incurring tinnitus.
While a lawyer can obtain some of these items
once he or she begins representing an injured per-
Vol.l6No.4
Personal injury lawsuits involving claims of tinnitus
son, it is wiser if the client obtains as many of these
records as possible before flrst consulting with a
lawyer about a possible lawsuit. Doing this re-
search as soon as possible saves time and expenses,
and also enables the attorney and physician to
assess more accurately one's claim of an accident-
related tinnitus condition.
Once all this information is obtained, the at-
torney will probably schedule the injured person
for a medical examination to determine the severity
and the cause of the tinnitus. The doctor needs as
much background information as possible when
examining a tinnitus sufferer, particularly when the
onset of the tinnitus symptoms are not immediately
concurrent with the accident-related head trauma.
To the extent possible, the lawyer needs to
assemble all available evidence, both medical and
factual, to prove that an injury caused one's tinnitus
condition. For example, suppose a person has a
negative history of family ear disease, minimal
exposure to loud noises, consistent hearing exam
results over as long a period of time as possible
before the accident, and a lack of other tinnitus-
causing medical problems. All this evidence would
point to the more likely conclusion that a sudden
onset of tinnitus was caused by one recent, clearly
identifiable cause (i.e. head trauma), rather than by
other possible, but less causally related, reasons.
Once the non-accident causes of tinnitus are
determined to be unlikely sources of the problem,
an attorney can better focus on the circumstances
of the accident as they relate to any head trauma
suffered in an accident. A precise description of
what hit a person's head, the location of the head
pains, the speed of the object or vehicles involved,
and the direction of the impact are all important
parts of the proof puzzle. The location of head cuts
and bruises, photographs of everything involved in
the accident (from several different angles), and
statements from witnesses to the accident will help
round out the additional evidence needed. The law-
yer must gather this evidence to complete the puz-
Voll6. No.4
zle in a way which points to a forceful head impact
as the most likely cause of such post accident
complaints as head buzzing noises, ringing sounds
in the ear, and sudden partial hearing loss.
After a head trauma injury, sometimes there
may be no obvious outward signs of a head injury.
On other occasions, the force of one's head impact
injury may seem relatively minor in nature, result-
ing in just a head bump or bruise.
In either of these situations however, the acci-
dent victim should still seek prompt medical atten-
tion. This is particularly true if various symptoms,
including those associated with tinnitus, are present
after the injury.
If these various guidelines are followed, a
tinnitus sufferer stands a better chance of recover-
ing proper compensation for an injury which causes
tinnitus to develop.
KevinM. Walsh is an attorney with the Boston, Massa-
chusetts law firm of McCullough, Stievater & Polvere. He
received both his undergraduate and law degrees from the
University of Notre Dame, and has practiced personal injury
law for the past ten years. Some of his clients have included
tinnitus sufferers.*
Tinnitus Today/December 1991 17
Tributes, Sponsors & Professional Associates
The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for
sharing memorable occasions in this helpful way. Contributions are tax deductible and are promptly ac-
knowledged with an appropriate card. The gift amount is never disclosed.
IN MEMORY OF
Dorthea Arnold
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MIM Sam Hayward
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Sheldon Forman
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MIM Sam Hayward
Kunlgunde Meindl
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Kunlgunda Meindl
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MIM Harry Vogelfanger
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Gloria Nina Salant
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Self Help Information:
Send# 10 SASE clearly marked SHG in lower
left comer for a list of support groups in your area.

Introductory Offer
for
Tinnitus Sufferers
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18 Tinnitus Today/December 1991
ATA SPONSOR MEMBERS
AUGUST to NOVEMBER 1991
Guenther C Back
Matthew P Berger
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Notice:
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ASSOCIATES
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The Tinnitus Bibliography 1991 Sup-
plement (Update #4) now available. Price:
$10.00 U.S. funds.
American Tinnitus Association
is a participant in the
Combined Federal Campaign
#0514 in the CFC Brochure
Thank You For Helping
To Fight Tinnitus
Vol.l6No.4
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A New Generation of
Reliability. The 7 Series intro-
duces a whole new generation of
design excellence. A completely
new faceplate with isolated mi-
crophone and amplifier position-
ing increases manufacturing
efficiency while virtually elimi-
nating mechanical feedback.
The smaller, more stable high
tensile gold-plated contacts
along with the new, ultra-durable
VC and socket assembly both
ensure a more reliable perfor-
mance with virtual elimination
of intermittency problems.
Welcome to the New Gener ..
ation. Never before has the in-
dustry experienced this level of
amplification excellence - all
designed to enhance your own
high standards of service excel-
lence. Because we are dedicated
to providing the very best for you
and those you serve, we believe
ALL your patients should benefit
from this newest generation of
unequaled sophistication, no
matter what they presently wear.
Starkey products, including
tinnitus maskers, are available
from your local hearing
health care professional listed
in the Yellow Pages under
"hearing aids".
NON-PROFIT ORG.
U.S. POSTAGE
PAID
American Tinnitus
Association