1v1arch 1998 Volume 23, Number 1

Tinnitus Today
THE JOURNAL OF THE AMERI CAN TI NNITUS ASSOCIATI ON
"To promote relief, prevention, and the eventual cure of tinnitus for
the benefit of present and future generations"
Since 1971
Research- Resources
In This Issue:
$1.5 Million
Awarded for
Tinnitus Research
Tinnitus Retraining
Therapy (TRT)
Cognitive-Behavioral
Therapy
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Tinnitus
Editorial and Advertising offices: American
Tinnitus Association, P.O. Box 5 Portland, OR
9i207, 503/248-9985, 800/ 634-8978,
http://www.ata.org
Executive Director & Editor:
Gloria E. Reich, Ph. D.
Associate Editor: Barbara Thbachnick
Tinnitus TOday is published quarterly in
March, June, September, and December. It is
mailed to members of the American Tinnitus
Association and a selected l ist of tinnitus suf-
ferers and professionals who treat tinnitus.
Circulation is rotated to 80,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit-
able for Tinnitus Thday. Acceptance of adver-
tising by Ttnnm..s TOday does not constitute
endorsement of the advertiser, its products
or services, nor does Ttnmn..s Thdtly make
any claims or guarantees as to the accuracy
or validity of the advertiser's offer. The opin-
ions expressed by contributors w Ttnnin..s
7bdtly are not necessarily those of the
Publisher, editors, staff, or advertisers.
American Tinnitus Association is a non-prof-
it human health and welfare agency under
26 usc 501 t c)(3)
Copyright 1998 by American Tinnitus
Association. No pan of this publication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any means,
without the prior written permission of the
Publisher. ISSN: 0897-6368
Executive Dinctor
Gloria E. Reich, Ph.D., Portland, OR
Board of Directors
Edmund Grossberg, Northbrook, lL
W. F. S. Hopmeier, St. Louis, MO
Sidney Kleinman, Chicago, IL
Paul Meade, Tigard, OR
Philip 0. Morton, Portland, OR, Chmn.
Stephen Nagler, M.D., Atlanta, GA
Dan Puljes, New York, NY
Aaron I. Osherow, Clayton, MO
Jack. A. Vernon, Ph.D., Portland, OR
Megan Vidis, Chicago. IL
Honorary Directors
The Honorable Mark 0. Hatfield
Tony Randall, New York, NY
William Shatner, Los Angeles, CA
Scientific Advisory Committee
Ronald G. Amedee, M.D., New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clcmis, M.D., Chicago. IL
Robert A. Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster, M.D., La Jolla, CA
Barbara Goldstein, Ph.D., New York, NY
John w. House, M.D., Los Angeles, CA
Gary P. .Jacobson, Ph.D., Detroit, MT
Pawel J . Jastreboff. Ph.D., Baltimore, MD
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Portland, OR
Gale W. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D .. St. Louis, MO
Robert E. Sandlin, Ph.D., El Cajon, CA
Alexander J. Schleuning, ll, M. D.,
Portland, OR
Abraham Shulman, M.D. , Brooklyn, NY
Mansfield Smith, M. D., San Jose, CA
Robert Sweetow, Ph.D., San Francisco, CA
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey, Portland, OR
The Journal of the American Tinnitus Association
Volume 23 Number 1, March 1998
Tinnitus, ringing in the ears or head noises, is experienced by as many
as 50 million Americans. Medical help is often sought by those who
have it in a severe, stressful, or life-disrupting form.
Table of Contents
5 ATA's New Board Member
8 A Giant Leap 'Ibwards Silence - $1.5 Million Awarded
for Tinnitus Research
9 ATA Funds New Tinnitus Research
10 Tinnitus Retraining Therapy - The Newest of the New
by Barbara Th.bachniclc
11 The Origins of Tinnitus Retraining Therapy
by Pawel J. fastreboff, Ph.D.
13 Tinnitus Retaining Therapy and the Neurophysiological
Model of Tinnitus
by Stephen M. Nagler, M.D., F.A.C.S.
16 The Time Line
by Barbara Th.bachnick
17 New ATA Support Contacts
18 The Role of Cognitive-Behavioral Therapy in Tinnitus
Perception
by Robert W: Ph.D.
23 Annual Meeting of the NVHA
by Patricia Daggett
23 Announcements
24 No Longer An Issue
by Stephen E Donahue
Regular Features
4 From the Editor
by Gloria E. Reich, Ph.D.
6 Letters to the Editor
20 Questions and Answers
by Jack A. Vernon, Ph.D.
25 Special Donors and 'Iributes
Cover: 'Field of Flowers (oil) by Sandro Negri. Inquiries to the Indigo Gallery Fine Art &
Jewelry, 311 Avenue B, Suite B, Lake Oswego, OR 97034, 5031636-3454
From the Editor
by Gloria Reich, Ph.D.,
Executive Director
How often do you ask me,
"Why can't they cure tinni-
tus?" How often I ask myself
the same question! Over the
last 20 years that I have been
working with you, I've seen
more of a change of attitude
towards tinnitus than a change
in tinnitus itself. In the late
1970's few people thought of taking charge of
their own situation. They wanted the tinnitus
"cure" to be administered by a clever break-
through either surgically or with drugs. While
there are still some who think that way, more
people are understanding that it is their response
to tinnitus that causes them to suffer. This is not
to say that tinnitus is not real. It is! Nor do I wish
to imply that it is trivial. It's not. What I want to
help you understand is that current strategies to
relieve tinnitus are working. I don't believe that
there is one single treatment for everyone who
has tinnitus, but I do believe that there are now
treatments that can help almost anybody who
has tinnitus. So, having said all that, why do so
many people continue to suffer?
First of all, remember that about one in five
Americans have tinnitus - at least a little. Based
on today's population that means that over 50
million people in this country have heard tinni-
tus sometime. Studies based on the census data
have shown that about one in five of those peo-
ple v,rho hear tinnitus at all are bothered enough
to consult a health professional. Then there is
the group, also one in five of these 10 million
who are true sufferers, which I take to mean that
their tinnitus is disabling, severely annoying,
debilitating, sometimes painful, or any of the
ways that people who are
experiencing the worst of
tinnitus describe it.
"""" Okay - we're down to
... l ~ about two million folks
~ who really need help.
''- ~ Why aren't they getting it?
~ ) \ ~ Part of the reason, of
{ i. \\ _ ' ~ course, is that the other
(I ~ ~ 48 million don't really under-
4 Tinnitus 10day/March 1998
stand that someone can have it worse than they
do. Another part of the reason is that tinnitus
doesn't show. Often by the time one acquires tin-
nitus, other health and social problems have a
much greater priority. Some people blame them-
selves for tinnitus, thinking it is the result of
something they've done. Well, so what?
Ruminating on it or berating yourself for it won't
help it get better. The answer lies in what you do
to start feeling better. I wish I could make a list
here that would take you step by step toward rid-
ding yourself of tinnitus. I can't. I have had my
tinnitus for at least 35 years. But I am fortunate
that I can ignore those pesky sounds almost all
of the time. Some things cause me to notice the
tinnitus, like flying, noisy parties, and sports
events. All are culprits. I still do these things
because they're important to me. But I try to
minimize the effect by protecting my ears from
excessive noise.
Over the years I've tried a lot of "unscientific"
remedies that people have suggested, like medi-
tation and diet modification. None of those have
been helpful to me so I tend to be skeptical of
them. I know that some of you have written
about various non-traditional and traditional
methods that have relieved your tinnitus. Great!
Just don't expect them to help everyone. By the
same token, medical professionals sometimes
insist that they can help patients with treatment
"x," when treatment "x" is their area of expertise.
Again, "x" might help some people but not neces-
sarily all people who have tinnitus.
We used to talk about professionals who were
both curious and creative. These were the people
who knew enough to help L11e tinnitus patient
get started along the way to recovery. They knew
the latest treatments and methods and could
help the patient decide which road to take. They
were creative in that when the road taken was
neither smooth nor straight, they could suggest
other methods to try. We also spoke of patients
who had reasonable expectations for treatment.
Patients who expect someone else to "cure" their
tinnitus will be bitterly disappointed. Those who
work with their selected professionals, however,
can expect to benefit greatly. The best effort is a
cooperative effort - between the tinnitus patients
and the professionals who treat them.
Here's where ATA comes in. We have collect-
ed information from the scientific literature and
from thousands of patients. This information is
From the Editor (continued)
passed along to you via this magazine and
through other published materials. ATA
brochures are widely distributed in doctors'
offices and hospitals. Books and tapes about tin-
nitus are available from our publications list.
Tinnitus support groups, nationwide and world-
wide, provide positive feedback from one
patient to another as well as specific informa-
tion about various tinnitus topics from invited
speakers. For health professionals, information
is distributed at annual conferences and educa-
tional seminars. For the ultimate benefit of all of
us, ATA is supporting scientific research about
tinnitus. 1 can't emphasize enough just how
important your part is in this effort. Through
your generous donations, ATA has been able to
fund a million dollars worth of research. I agree
with you, that's too little! That amount, how-
ever, has made it possible for scientists to build
on knowledge acquired and forge ahead to learn
more about tinnitus causes and mechanisms.
The National Institute on Deafness and other
Communication Disorders (NIDCD) has become
more interested in tinnitus and has held work-
shops to discuss the future of tinnitus research.
They have also funded in one study as much as
ATA has in a decade and a half, and more is in
Introducing Dan Purjes,
ATXs New Board Member
Dan Purjes is the CEO of two firms that
invest in and develop high-tech products for the
hearing-impaired and for tinnitus sufferers. His
involvement with tinnitus is a
personal one: he has had it for
33 years. Dan states, "My
interests lie in bringing a busi-
ness discipline and more fund
raising capabilities to the orga-
nization. I believe you need to
have a strong dose of business
reality to run any organiza-
tion. There are things ATA can
do to bring in more revenue,
Dan Purjes and I would like to ask the
questions to find out what
those things are." Dan's business acumen and
many years' experience with charitable organi-
zations are welcomed by ATA's board.
sight. This is another cooperative effort - this
time among all of you who support ATA, the
researchers who study tinnitus, and the federal
agencies that support medical research. Together
we've come a long way. Stick with us and we'll
reach our goal.
I know you want to forget about your own
tinnitus, but remember that it is important to
talk about tinnitus in general in order for
progress to be made. Get your friends to join our
efforts by making an annual donation. Make
sure the health professionals in your community
know about ATA and tinnitus. r:JYe can help
you!) Write to your legislators in the Senate and
House and let them know how important it is to
fund tinnitus research. Tell them your story -
they listen! Help us get the word to the school-
age children that ear protection is important. We
have materials you can use. Ask us. We also
have programs to help small businesses educate
their employees about hearing conservation.
There are many ways that you can persona11y
become involved. Our staff is small but we care
about you and will do as much as possible to
help you further the fight against tinnitus. Start
today by responding to the appeal for research
funds contained in this issue. Thank you!
ATA Expands Resources
and Reduces Prices
In the ongoing quest to provide current
and comprehensive information to those who
have or treat tinnitus, some new items have
been added to the ATA list of resources, includ-
ing: a book, Tinnitus: Treatment and &lief,
edited by Jack Vernon; a 60-minute video,
Tinnitus: Ringing in the Ears, from a Jack
Vernon lecture; and the new brochure,
Tinnitus Treatments - What's Ne;w, What Works,
especially for professionals.
In addition, some prices have actually been
lowered for ATA donors! Proceedings of the Fifth
International Tinnitus Seminar is now only $20;
the video Conversations with Drs. Vernon,
Hazell and Jastreboffhas been reduced to $12
(note: does NOT include information on TRT);
and the price for the Informational Video is now
$10. Be sure to check out the order form on the
inside back cover of this issue.
Tinnitus Today/March 1998 5
Letters to the Editor
From time to time, we include letters from our read-
ers about their experiences with "non-traditional"
treatments. We do so in the hope that the informa-
tion offered might be helpful. Please read these
anecdotal reports carefully, consult with your
physician or medical advisor, and decide for your-
self if a given treatment might be right for you. As
always, the opinions expressed are strictly those of
the letter writers and do not reflect an opinion or
endorsement by ATA.
A
fter a long day of begging, persistence,
and discussions with the staff at the "Star
Thek" convention here in Thmpa, I gave
an envelope to a convention staffer to hand to
William Shatner who was in town for the occa-
sion. The envelope contained a letter from me
explaining what help I could use to get more
publicity for tinnitus in the Thmpa area, and a
copy of the September 1997 Tinnitus 1bday with
my article - autographed by me! I was not too
hopeful that the package would make it into his
hands since he was only going to be at the con-
vention for two hours. I left it up to fate and
went home. That evening} I was shocked to
receive a call from Mr. Shatner, who had indeed
gotten my letter and was calling while on his
way to the airport! Mr. Shatner was extremely
compassionate and understanding of my goals to
get more publicity. And he was more than will-
ing to help. He agreed to do telephone inter-
views with the local media as well as set up a
teleconference from Los Angeles with our local
tinnitus support group.
I cannot express how grateful I am for ATA's
help and support. I now feel that a window of
opportunity has opened and I will do my best to
not let it close. This has been a tremendous emo-
tional payback for me and I will continue my
efforts with renewed spirit.
Tbm D'Aiuto, 7205 Kinsgsbury Circle
PO. Box. 292366, Tampa, FL 33687
813/628-6168
Editor's Note: William Shatner spoke and answered
questions for more than an hour via a speaker
phone at Tbm's September 30th support group meet-
ing in Tampa. Ninety-six. delighted people attended.
6 Tinnitus Today/March 1998
F
ive years ago I was having seizures and
had to have a craniotomy to remove a
benign tumor in my head. Since then, I
have been bothered by tinnitus. I found the arti-
cle "Food for Thought" (December 1997 Tinnitus
Today) by Gary Graybush very interesting. I, too,
have "almost" become a vegetarian. I had previ-
ously had a sensitive digestive system and after
one-and-a-half years on 400 mg. of Tegretol to
control the seizures, I ended up with irritable
bowel syndrome. I follow many of Mr. Graybush's
hints such as eating only fresh fruit first thing in
the morning. The more control I have over my
stomach, the better control I have over stress.
I have found stress causes my tinnitus to
increase greatly in volume. Now I will watch to
see if other foods seem to bother my tinnitus.
Thanks for your help.
Pat Prizzi, Cedar Glen, CA
G
inkgo biloba is an often-mentioned
tinnitus treatment, and I've been taking
it for that reason over a period of years.
I feel it gives some relief. However, there are
many types on the market. Some are "standard-
ized 24%" and range in strength from 40 mg. to
420 mg. each. Some are an extract of the leaves,
and others are the actual leaves. Some labeling
says to take one a day, others say three a day. It
also comes in the form of a tea. While I can
understand that Tinnitus Tbday does not want to
prescribe medication, it would seem appropriate
for the writers to mention the dosages they take
and over what period of time.
Walter Womick, Alstead, NH
Editor's Note: We agree, although not all writers
want to share the details. We include specifics when
they do. When the letter writers give permission to
do so, we include their addresses and phone num-
bers to assist our readers with additional details.
Note that ginkgo biloba is not a regulated medica-
tion. Therefore herbal and vitamin companies can
package and process the plant as they choose.
Who's using what? Dr. Pawel Jastreboff, director
of the University of Maryland Tinnitus Center sug-
gested Ginkgold (by Nature's Way), which is ginkgo
flavone glycosides, citing its purity. Audiologist
Susan Seidel and several hundred members of her
Baltimore tinnitus self-help group have been fans
of ginkgo phytosome, a leaf extract also processed
without fillers. The dosage Susan's group members
take: 120 mg. daily.
Letters to the Editor <continued)
I
t is legal for car owners to disconnect their
air bags. It's not that hard to do. I did it to
my 1993 Geo Prizm in about an hour. In
some cases, it can be as simple as pulling the
fuse labeled "air bag." But not all cars are that
easy. The best thing to do is go to your local
dealer's parts counter and buy the shop service
manual (not the "aftermarket" book) for your
car. It will cost about $40. The manual won't say
how to permanently disable the air bag, but it
will tell you how to temporarily disable it. I
decided that my air bag would be temporarily
disabled forever. (You'll read the safety precau-
tions service technicians must observe when
working on or around air bags: "Wear safety gog-
gles." "If carrying the air bag module, hold it at
arm's length with air bag cover facing away
from you." "When detonating an air bag, be at
least 20 feet away." Now I ask you, how many
drivers can abide by those requirements while
they're in their cars?) If it were my choice, I
would not get an air bag, bad hearing or not. It
is time for Congress to step in, before more of
us become deaf in the name of safety.
Bob Morrow, Middleton, WI
bob@msn. fullfeed. com
Editor's note: The company Airbag Service installs
factory on-off switches and deactivates air bags
when customers present them with authorization
from NHTSA. (For nationwide locations, call
2061391-9664, e-mail: airbag2@aol.com, website:
www.aitbagservice.com) Also, the Automobile
Clubs of America have on-off switch application
{otms available for their members.
C
heck your teeth, ladies and gentlemen!
I had a severe case of tinnitus and
Meniere's syndrome for more than 20
years. By the luck of the Irish, I had a bad tooth
pulled and presto - no more tinnitus and no
more Meniere's! I've been "clear" now for over
15 years.
Donelda Fazakas, Miami Beach, FL
Ai
a composer/pianist, I began to experi-
ence tinnitus as a result of my work with
oud electronic music. Initially, I was
conscious of a slight ringing in my left ear,
accompanied by a small degree of high frequen-
cy hearing loss. Over time the ringing increased,
spread to both ears, and manifested itself as a
cacophony of different sounds. I also developed
hypersensitivity to loud noise - a condition
exacerbated by my subsequent avoidance of any
loud noise. Although I was determined to con-
tinue my music career, I was generally demoral-
ized and vulnerable to bouts with depression.
I am thrilled to report that life has improved
dramatically for me since reading the
Proceedings of the Fifth International Tinnitus
Seminar. The many papers relating to new
developments in "tinnitus retraining therapy"
were of particular interest to me. Even though
1 have not yet formally participated in the thera-
py, I have been given a new, hopeful perspec-
tive on the mechanisms behind, and thus the
cure for, my tinnitus. Although I am still aware
of my tinnitus, I am no longer threatened by it
nor do I feel unreasonably nervous about envi-
ronmental sounds.
As for my music career, I have reentered the
world of performing and recording with
renewed vigor. My latest CD project is a collec-
tion of original piano solos called "Meditations
for Piano." I dedicate this recording to my fellow
tinnitus sufferers and I would like to offer it to
Tinnitus 'Ibday readers. Many of my listeners
report that this music helps reduce stress and
relieve anxiety. I will happily donate 20% of
sales profits from your readers in support of
ATA's further research. Thanks so much for your
work.
Thor Anderson, Sonic Honey Music
16245 18th Ave.N, Plymouth, MN 55447
8001699-5191
e-mail: thoryara@pro-ns. net
web site: www.pro-ns. net/rv thoryara/thor.htm
Editor's note: We've listened. Mr. Anderson's music
is as relaxing as it is beautiful.
The American Tinnitus Association and the
editors of Tinnitus 'Ibday welcome your letters.
Please let us know in advance if we can include
your address and phone number \'\
7
ith your let-
ter in the event it is selected for publishing.
Tinnitus Today/March 1998 7
A Giant Leap Towards Silence
$1.5 Million Awarded for Tinnitus Research
Research scientists at the State
University ofNew York
University of Buffalo and the
VA Western New York Health-
care System in Buffalo, NY
have just received a $1.5 mil-
lion grant from the National
Institutes of Deafness and
other Communication
Disorders (NIDCD), one of the
L-..;..:::........,=:=..-- National Institutes of Health
Alan Lockwood, M.D. (NIH). This five-year grant will
allow the continued investigation of the func-
tional neuroanatomy of tinnitus and hearing
loss. This is the largest tinnitus grant ever fund-
ed by the NIH.
The research team, headed by Alan
Lockwood, M.D., of the Center for Positron
Emission Tomography and Richard Salvi, Ph.D.,
and Robert Burkard, Ph.D., at the Center for
Hearing and Deafness, will use
positron emission tomography
(PET) to measure cerebral blood
flow in different brain regions in
quiet and during stimulation of
the auditory system with sounds.
PET imaging is a powerful tool for
looking at the function of the
human brain. The goal of these
studies is to identify regions of the
brain which are associated with
the phantom sound of tinnitus.
The research team has made
PET seem of Brain
significant progress using a special population of
tinnitus patients who can regulate the loudness
or pitch of their tinnitus by jaw movement or by
touching parts of the face. By comparing the
images of the brain obtained during periods of
loud and soft tinnitus, the research team has
been able to identify regions of the auditory
brain where activity changes in response to
changes in tinnitus loudness.
The team also found evidence of activation
in the limbic system, an emotion control and
memory center, in tinnitus patients but not in
normal control subjects (non-tinnitus patients).
"This may explain why tinnitus is so debilitating
to some patients," says Lockwood. One of the
8 Tinnitus Today/ March 1998
hallmarks of the central ner-
vous system is that it is
extremely plastic, that is, it
can adapt to the information it
receives - in this case, from a
damaged inner ear. Salvi
notes, "When the inner ear is
damaged by noise, surgery,
aging, or ototoxic drugs, we
expect to see changes in the
. . way the central parts of the
Richard Salvl, Ph.D. auditory brain processes
acoustic information." "The degree of neural
reorganization that takes place in the central
auditory brain," says Burkard, "may be an
important factor that contributes to the sensa-
tion of tinnitus, much like it does in phantom
limb pain."
Future studies will involve patients with
more typical forms of tinnitus as well as those
======- who can regulate their tinnitus
in other ways such as moving
their eyes (gaze-evoked tinnitus)
or touching the forearm, listen-
ing to sounds (residual inhibi-
tion), or after administration of
various drugs.
Dr. Salvi comments: "Dr.
Lockwood and I really appreciate
ATA's support. [ATA funded the
original "seed" grant for this
research. See "New ATA-Funded
Research," Tinnitus Tbday
September 1996.] ATA kept the project alive
when we were having difficulty convincing the
NIH about the merits of the research. Your grant
made the difference." On January 23, 1998, the
Discovery Channel featured an interview with
Dr. Lockwood about this research.
For further information contact:
Alan Lockwood, M.D. (fax 716/ 862-3462,
alan@promo.nucmed.buffalo.edu)
Richard Salvi, Ph.D. (fax 716/ 829-2980,
salvi@acsu.buffalo.edu)
or write to: Richard Salvi, Ph.D.,
Hearing Research Lab, 215 Parker Hall,
University of Buffalo, Buffalo, NY 14214
ATA Funds New Tinnitus Research
.A.TA's "seed" grants have propelled many
successful tinnitus research studies into the
limelight. Having done so, the studies and their
researchers have gone on to successfully attract
significantly larger pools of funding from the
government, universities, pharmaceutical com-
panies, and other funding bodies to further the
research. ATA's newest seed grants are described
below.
Title: THE MECHANISMS OF QUININE-
INDUCED TINNITUS
Principal Investigator:
Richard J. Hallworth, Ph.D.
University ofThxas Health Science Center,
San Antonio, TX
Amount of Award: $16,000
Purpose: To describe effects of quinine on
outer hair cell force generation and to test
theories of its mechanism.
Statement: Quinine, long used as an anti-malar-
ial agent, is known to produce a reversible mod-
erate hearing loss and tinnitus. The mechanism
of quinine's action on hearing has been unclear
but severa11ines of evidence suggest that it has
substantial effects on the cochlea, the peripheral
organ of hearing. A substantial body of recent
work suggests that outer hair cells generate
force in response to electrical stimulation. Force
generation by outer hair cells is important in
the sensitivity and tuning of the cochlea.
Treatments such as overstimulation and salicy-
late, that are known to cause tinnitus and loss of
hearing sensitivity, also modify outer hair cell
motility. Studies in this laboratory using isolated
cochlear outer hair cells have now shown that
quinine has a direct action on outer hair cell
force generation. Thus quinine's action on hear-
ing may be a direct consequence of its action on
outer hair cell motility. In this proposal, qui-
nine's effect on outer hair cell motility will be
quantified and two hypotheses about its mecha-
nism at the cellular level will be tested. The
clinical application of the potential discoveries
in this proposal is necessarily indirect at this
stage. However, any information that illumi-
nates the mechanism of a reversible tinnitus
source at the periphery will contribute to our
overall understanding of tinnitus mechanisms
and therefore eventually to its amelioration.
Title: A CELLULAR MODEL FOR QUININE-
INDUCED TINNITUS
Principal Investigator: Xi Lin, Ph.D.
House Ear Institute, Los Angeles, CA
Amount of Award: $40,500
Purpose: To investigate the mechanism of
quinine-induced tinnitus on the cellular level.
Quinine effects on ion channels and action
potential will be directly examined.
Statement: This proposal directly examines
how quinine, a tinnitus-inducing drug, affects
the neural signaling process in the peripheral
auditory organ. We hypothesize that quinine
enhances the neural transmission (thus result-
ing in tinnitus) by action potential broadening.
Data gathered by direct monitoring of the qui-
nine interaction with the voltage-gated channels
and intracellular calcium homeostasis will pro-
vide critical information on new therapeutic
targets for the design of tinnitus-relieving drugs
since it provides a rational basis for alleviating
some forms of tinnitus through action potential
shortening. For example, a class of potassium
channel openers that have already been used
clinically as antihypertensive and antianginal
agents could be tested on this model to see if
they reduce neural transmission (presumably
reducing tinnitus as well) by shortening the
action potential duration.
Title: MASKING CURVES AND
OIOACOUSTIC EMISSIONS IN SUBJECTS
WITH AND WITHOUT TINNITUS
Principal Investigator: Curtin Mitchell, Ph.D.
Oregon Hearing Research Center, Portland, OR
Amount of Award: $35,300
Purpose: 1b identify inner ear hair cell dys-
function which can result in tinnitus.
Statement: In recent studies, abnormal mask-
ing curves and otoacoustic emissions (sounds
generated in the inner ear and measured in the
ear canal) were found in people with tinnitus.
This evidence strongly suggests that specific
hair cells in the inner ear were damaged and
may be the cause of tinnitus in these subjects.
This evidence for the location and type of dam-
age is important to understanding the origin of
tinnitus and could possibly lead to new treat-
ments for tinnitus. The research proposed will
study a greater number of subjects with differ-
ent types of tinnitus to confirm and extend
these findings.
Tinnitus Today/ March 1998 9
Tinnitus Retraining Therapy
The Newest of the New
by Barbara Thbachniclc,
Client Services Manager
Tinnitus Retraining Therapy
(TRT) is the newest break-
through in tinnitus treatment
care. And like most
"overnight successes," TRT
has spent many years on the
road, working out the kinks,
paying its dues, proving and
improving its efficacy. This therapy, when care-
fully administered and faithfully followed, offers
the tinnitus patient a true potential for long-
term relief. There is a tradeoff: the relief is not
immediate. TRT can take upwards of two years
to produce its full effect. For some patients, it
takes less time; for others, more. Like all current
tinnitus treatments, TRT does not help everyone
who uses it. Just most, according to Pawel
Jastreboff, Ph.D., its originator.
Developed by Jastreboff in the U.S. in the
mid-1980's, TRT has been used clinically by Dr.
Jonathan Hazell in the U.K. since 1988 and in
Jastreboffs own clinic at the University of
Maryland since 1990. The protocol requires the
patient to be exposed to directive counseling
(defined by tinnitus clinician Dr. Stephen Nagler
as "an intense interactive educational event")
and an enriched environment of sound usually
aided by behind- or in-the-ear sound devices.
According to Jastreboffs and Hazell's prelimi-
nary data, 80% of patients improve within
24 months. The subjective responses from
tinnitus patients - before, during, and after TRT
treatments - constitute the basis of Jastreboffs
and Hazell's results.
The inability to test the effects of TRT in a
double-blind study (patients, of course, know if
they've been counseled or are wearing devices)
is a problem for scientists who rely on blind
studies for unequivocal proof. Those attending
the Fifth International Tinnitus Seminar in
Portland might recall the light grumble in the
audience when two naturopathic physicians
presented their papers. The audience of Western
medical professionals challenged the natur-
opaths: "How can you say that anything you
do actually works? Diet, herbs, and so on. You
haven't produced any double-blind placebo
studies!" One of the naturopaths responded,
10 Tinnitus 'Ibday/ March 1998
"How can we do a double-blind placebo study on
mung beans? We can't! Patients know when
they've eaten them and when they haven't. But
when people consistently report that they feel
better after having made consistent changes in
their diets, we can conclude with some degree
of confidence that these changes were responsi-
ble for the improvement." The same courtesy
and a similar leap of faith are required when
gauging the results of TRT and most treatments
for subjective tinnitus.
Dr. Nagler admits that he sees a skewed tin-
nitus patient population. "The ones who were
helped by maskers, ginkgo, vitamins, or biofeed-
back don't come to us for TRT," he states. He
and other TRT clinicians also do not see tinnitus
patients who cannot travel long distances to
their clinics, or who do not have the means to
purchase the treatment. (It is a lamentable truth
in this country in all areas of health care: a por-
tion of every patient population is unreachable.)
Could it be that most or all tinnitus patients
would respond positively to TRT if administered
by charismatic healers, like Drs. Jastreboff and
Hazell? Ironically, 20 years ago, when masking
was the newest of the new, when the Oregon
Hearing Research Center's Tinnitus Clinic was
the "Tinnitus Mecca," and when Dr. Robert
Johnson and Dr. Jack Vernon were the national
tinnitus heros, the clinic's success rate with
masking was 70-80%. People felt so much better
after talking with these compassionate giants.
Perhaps the actual masking devices were
secondary.
TRT clinician James Henry, Ph.D., says, "As
clinicians, we are naturally biased. We 1ike what
we do. I'm familiar with both TRT and masking,
and both are useful." Dr. Henry is applying for a
grant to measure and compare the outcomes of
these two treatments.
The proof of TRT will likely be in the repro-
ducibility of its success at other centers. A treat-
ment becomes credible when others - and
ideally many others - can administer it with
effectiveness equal to the originator's success.
Jastreboff-trained TRT clinicians are opening
clinics around the world in growing numbers.
Many hopeful eyes are upon them.
Tinnitus Retraining Therapy will be described in the
articles that follow - from the viewpoints of a clinician,
a patient, and Dr. Pawel Jastreboff.
The Origins of
Tinnitus Retraining Therapy
by Pawel J. Jastreboff,
Ph.D., Sc.D.
Fifteen years ago I barely
knew the term tinnitus. At
that time I undertook the
challenge to create an ani-
mal model of tinnitus and
to work on the mecha-
nisms of this phenomenon.
In the mid-1980s, while
working at Yale University,
I created the neurophysiological model of tinni-
tus, which postulated the involvement of the
limbic (emotional) and the autonomic nervous
systems in tinnitus, pointing out the crucial
role played by the limbic system. This essential
postulate of this model was confirmed 12 years
later by the result of the PET study by
Lockwood and Salvi, which was just published
in January 1998.
As with many basic scientists, I always
thought about the possible implementations of
my theoretical and experimental work in prac-
tice. From this dream came the idea of the
implementation of the neurophysiological
model of tinnitus - now known as Tinnitus
Retraining Therapy (TRT) - in clinical practice.
Only a basic scientist like myself can under-
stand the frustration and difficulty involved in
finding someone who is ready to take a risk and
use someone else's idea in practice. I was lucky
to find not one but two such people, to whom I
am very grateful, who were ready to take the
risk. In 1988, I presented TRT and the neuro-
physiological model oftinnitus to Dr. Jonathan
Hazell and audiologist Jacqui Sheldrake in
London. They adopted TRT as the dominant
treatment approach to their tinnitus patients at
once. Soon after, it was obvious to them that
patients were improving much more rapidly
than when they used a program of partial mask-
ing and coping strategies.
The model and outline of TRT were pub-
lished in 1990 (Jastreboff, P.J., Phantom audito-
ry perception [tinnitus]: mechanisms of
generation and perception, Neuroscience
Research, 1990; 8:221-254). In the same year, I
established the University of Maryland Tinnitus
& Hyperacusis Center. Since then, we have seen
about 1000 patients, more than 80% of whom
have shown significant improvement. This suc-
cess rate reflects the efforts of many hardwork-
ing and dedicated people in our center and our
close collaboration with Jonathan and Jacqui.
All of us in London and Baltimore became very
excited seeing the positive treatment outcomes.
TRT has been refined over the years both in
Baltimore and in London, and undergoes contin-
uous modifications aimed at shortening its dura-
tion and enhancing the effectiveness.
In the past two years, we have offered three
training courses in TRT at the University of
Maryland in Baltimore, and about 80 people
have thus far participated. Of these participants,
about 50 are now beginning, or have begun, to
implement TRT throughout the U.S. Thus far
over 90 additional clinicians have expressed
interest in attending future training courses. We
will try to fulfill this obligation this year.
Recently, it has become a significant prob-
lem, to patients and to us, that some people
claim to offer TRT without possessing sufficient
knowledge of the method. TRT seems to be
easy, but in reality it is complex, and it requires
specific understanding, knowledge, and instruc-
tion. We see patients who believe they were
offered TRT, but were disappointed with the
treatment outcome. While talking with them it
became readily apparent that either they
received improper counseling, or improper
instruction on how to use sound generators in
their particular subtype of tinnitus. Others were
simply given devices without any counseling
at all!
Because of the patient demand for T R ~ we
have to refer more than 70% of potential
patients to other centers. I choose to refer tinni-
tus sufferers only to the centers where there is
at least one person who learned TRT in
our course in Baltimore and 1
who has had subsequent ~
interactions and discussions of ......._
cases with us. By doing this, we ' '
feel reasonably confident that
they are implementing procedures
that contain all of the essential
components of TRT. I am not in a ..
position to evaluate the '-
qualifications of those offering \ ~
Tinnitus 1bday/ March 1998 11
The Origins of
Tinnitus Retraining Therapy (continued)
TRT, those whose work I am not sufficiently
familiar with, since currently there is no objec-
tive method for assessing tinnitus (the new PET
study offers only a possibility) and there are no
published data presenting the results of this
therapy offered at other centers.
TRT is still a new and developing procedure
and not enough published information describ-
ing it in detail has yet been presented.
Moreover, the complexity of TRT makes it
unlikely to learn it by reading papers - the situ-
ation is similar to attempting to learn surgery by
studying literature. We have found that even the
participants jn our courses (which we believe
provide a solid basis for treating the majority of
tinnitus cases with TRT), still need at least a
year of clinical work with TRT and many addi-
tional interactions with us before they become
proficient in TRT.
Media Sponsor:
12 Tinnitus Thday/ March 1998
I do not claim that TRT is the only effective
method for treating tinnitus, but I strongly
believe that it is the best method available at
this t ime. The fact that TRT works well in the
treatment of hyperacusis is an added advantage.
Moreover, TRT works regardless of pathology,
tinnitus description, or trigger. We do have diffi-
culty with some patients who have severe psy-
chiatric illnesses, who are on heavy
psychotropic medications, who have language
difficulties, or who are just not following the
protocol. We continue to improve our approach
to tinnitus and hyperacusis patients and to
refine our research with the ultimate goal of
eventually finding a true cure.
Dr. Jastreboff is Director of the University of
Maryland Tinnitus & Hyperacusis Center; 410/706-4339,
Fax: 410/706-4004, www.tinnitus-pjj.com
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Tinnitus Retraining Therapy and the
Neurophysiological Model of Tinnitus
by Stephen M. Nagler, M.D.,
F.A.C.S.
Tinnitus Retraining
Therapy (TRT) is one of
many approaches currently
available for the treatment
of tinnitus. The overall goal
in TRT is for tinnitus to
cease being an issue in the
life of the individual. In
this regard, it cannot truly
be viewed as a technique for coping with or
"learning to live with" tinnitus, since one nei-
ther needs to cope with nor learn to live with an
entity which is no longer an issue in one's life.
TRT- sometimes called auditory habituation
therapy - was developed in the late 1980's by
Pawel Jastreboff, Ph.D., Sc.D. in clinical consul-
tation and association with Jonathan Hazell,
FRCS. It is based upon Dr. Jastreboffs "neuro-
physiological model of tinnitus," a model
described, studied, and published in detail.
Tinnitus Retraining Therapy depends upon
the natural ability of a person to "habituate" a
signal, to make it so much a part of the subcon-
scious mind that it does not reach conscious
perception. We become unaware of many audi-
tory signals. For instance, we initially hear
sounds from ah conditioners, computer fans,
refrigerators, and gentle rain only to have their
signals rapidly disappear from conscious aware-
ness unless we purposely seek them out. (A few
seconds after a refrigerator "kicks on," we no
longer hear it.) The two elements that air condi-
tioners, computer fans, refrigerators, and gentle
rain have in common are that the signals they
emit have no importance, and that the signals
are not perceived as "loud."
The signal of tinnitus has great meaning
to the tinnitus sufferer, and it is, indeed, per-
ceived as loud. The entire thrust of TRT is:
1) to remove the meaning from the signal, and
2) to convert it from a loud sound to a soft
sound so that habituation can naturally
take place.
The neurophysiologic model of tinnitus
holds that the patient assigns importance and
meaning to the tinnitus signal in a subconscious
(subcortical) area of the brain near the medial
temporal lobe called the "limbic system." The
limbic system is comprised of the hippocampus,
amygdala, mamillary bodies, and associated
structures. It is a major seat of emotion, and
it attaches importance and meaning to the tinni-
tus signal for one (or a combination) of three
reasons:
1) fear of an unknown danger (Why did this
happen? Will it get worse?)
2) '
1
negative counseling" (You'll just have to
learn to live with it. r knew someone who
had it so bad she committed suicide.)
3) continuous repetition of a meaningless sig-
nal (like "Chinese water torture," in which
incessant drops of water evenly spaced apart
fall upon the head of a prisoner thereby dri-
ving him to such distraction and torment
that he will divulge any and all secrets.)
In Tinnitus Retraining Therapy, the intimate
bond between the limbic system and the tinni-
tus signal is cleaved by removing importance
and meaning from the signal using a process
called "directive counseling." This type of coun-
seling has little in common with psychotherapy,
which is generally a process of increasing one's
self-awareness. Rather, directive counseling
involves a series of intense educational sessions
- including an initial session and three or four
follow-up sessions over a 12-18 month period.
During directive counseling the tinnitus sufferer
participates in an in-depth discussion in which
the source and meaning of his or her tinnitus is
detailed through demonstrations of anatomy
(structure), physiology (function), and real
examples in story format to make the tinnitus
phenomenon understandable and demystified.
Essential in directive counseling is a thorough
explanation of the rationale and importance of
healthy neutral non-masking sound in the ulti-
mate resolution of the problem. The directive
counseling structure remains basically the same
in each of the sessions. However, the nature and
detail of the explanations and the analogies used
change as the patient's view of his or her tinni-
tus matures during the process.
Prior to commencement of directive coun-
seling, the tinnitus patient must undergo thor-
ough ENT and audiological evaluations (and
preferably a complete medical evaluation as
Tinnitus 1bday/ Marcb 1998 13
Tinnitus Retraining Therapy and the Neurophysiological
Model of Tinnitus (continued)
well) to rule out any of the rare causes of tinni-
tus which might require medical/surgical atten-
tion or, if found and treated, which might result
in a true cure. Once these factors have been
eliminated, it is then not inappropriate to
address the symptom of tinnitus itself irrespec-
tive of etiology. Until potential medical causes
are resolved, any attempt to remove importance
from the tinnitus signal will be met with failure.
The directive counseling sessions themselves
can last two hours or more. This is in addition to
the time spent in evaluation, testing, and (if
indicted) the fitting of devices. Dr. Jastreboff
stresses that these sessions are highly personal-
ized, taking into account cultural and education-
al background, and the impact of tinnitus on the
patient's life and the lives of family and friends.
The implications of hearing loss and hyperacu-
sis, if either is a factor, must be analyzed and
discussed. It is preferable that a spouse or "sig-
nificant other" attend the counseling session
with the tinnitus sufferer in view of the amount
and complexity of the material presented - and
in view of the fact that a person's tinnitus in vari-
ably affects his or her meaningful relationships.
Under no circumstances are tinnitus patients
counseled in a group setting. The patient
deserves (and the situation demands) the
undivided attention of the individual doing the
counseling.
It should be apparent that directive counsel-
ing is largely an art. Its success is highly depen-
dent upon the ability of the clinician to convey
the important principles of it to the tinnitus suf-
ferer in a relevant fashion. It is dependent upon
the ability of the sufferer to absorb and apply
the information thus presented. And it is depen-
dent upon the rapport established and main-
tained between clinician and patient.
Thus, directive counseling is used to gradual-
ly remove the meaning from the tinnitus signal.
But if the signal is still perceived as "loud," it is
incredibly difficult to habituate. (Note how
much easier it is to habituate the meaningless
sound of a refrigerator in the kitchen than the
meaningless sound of an "express" subway train
screaming by.) The key to converting the per-
ception ofloud sound into a much softer sound
lies in the neurophysiological principle that the
conscious brain interprets sensory signals in
terms of contrast rather than absolute magnitude.
14 Tinnitus Thday/ March 1998
Dr. Jastreboff uses the example of a candle
on a birthday cake to elegantly illustrate this
point. In a dark room, when a birthday cake
with its lighted candle is introduced, two impor-
tant things occur. First of all, the pupils in the
celebrant's eyes dilate (an event beyond con-
scious control) as the "gain" on their visual sys-
tems is automatically increased to take in all
possible visual stimuli in a state of heightened
awareness. Secondly, the birthday candle is
interpreted as "bright." Now, if the same birth-
day candle is brought into a room where the
lights are on instead of off, the celebrant's pupils
do not dilate (no unconscious effort is made to
seek out more visual stimuli - the "gain" is not
increased) and the candle does not appear as
bright. So, one candle giving off an identical
magnitude of energy in two different environ-
ments will be interpreted by the visual centers
of the conscious brain as ''bright" in one
instance and "not particularly bright" in the
other. Our conscious brain interprets sight, taste,
touch, smell, and - most importantly for our
purposes - sound in terms of sensory contrast
rather than absolute magnitude.
In TRT, non-masking sound is used both to
decrease the contrast between the tinnitus sig-
nal and the environment and to allow the audi-
tory system to "turn down the gain" so that
auditory signals are not unnecessarily magni-
fied. Thus the principle of sensory contrast is
used physiologically to decrease the "loudness"
of the tinnitus. The non-masking sound can be
supplied in one of three ways:
1) In some cases, the tinnitus patient is
instructed to place some sound source
everywhere he or she goes. The source can
be a radio, CD player, TV, tabletop "sound
machine," etc. The type of sound is not criti-
cal but white noise, soft music, or sounds of
nature are generally preferred since these
sounds are soothing and have little meaning.
A "Walkman" device is not well-suited for
this purpose because the headset tends to
block environmental sounds. The intensity
of the sound is exceedingly important. The
sound should not mask (cover) the tinnitus
signal, for one cannot habituate a signal one
does not hear.
2) When a tinnitus patient has a significant
hearing impairment, amplification (hearing
aids) is provided to augment the environ-
Tinnitus Retraining Therapy and the Neurophysiological
Model of Tinnitus (continued)
mental sounds. Effort must still be made to
avoid environmental silence.
3) Most frequently, the tinnitus patient finds
that if he or she wears white noise genera-
tors, the effort to avoid environmental
silence is no longer as crucial since it is
done automatically by the wearable devices.
Open molds are used with the white noise
generators so that the ear canals are not
blocked. Such wearable devices are strictly a
convenience, but often a welcome one. They
are set at an intensity below that which
would be necessary to achieve masking.
They are used in both ears, even in the case
of one-sided tinnitus, so that the entire audi-
tory system can be exposed to the sound. In
the case of tinnitus in a deaf ear, a single
white noise generator can be used in the
non-deaf ear since we actually hear with our
brains and not with our ears. Crucial in this
concept is the presence of numerous "cross-
over fibers" in the auditory pathway; sound
waves entering any one ear or tinnitus sig-
nals generated in any one cochlea (or fur-
ther up the auditory pathway) are
appreciated on both sides of the brain. One
further advantage of using wearable white
noise generators to decrease sensory con-
trast lies in the fact that the unobtrusive
meaningless sound produced by such
devices is itself very easily, effortlessly, and
naturally habituated.
What is the desired result of TRT? Ideally,
the tinnitus sufferer will initially habituate the
response to tinnitus (tinnitus will not be annoy-
ing) and ultimately habituate the perception of
tinnitus (tinnitus will not be heard unless it is
sought). At the conclusion of TRT, there is no
need to continue to use any wearable white
noise generators, if such devices have previous-
ly been chosen as the method for decreasing
sensory contrast. Dr. Jastreboff specifically
defines "success" to be a decrease of at least 30%
in the level of annoyance and in the percent of
time the patient is aware of tinnitus, in addition
to improvement in the ability to perform at least
one task previously prevented by tinnitus. The
majority achieve a level much greater than 30%.
(Questionnaires are completed by patients prior
to starting TRT, during treatment, and at the
conclusion of treatment.) For the purposes of
reporting success rates in a meaningful fashion,
the above criteria must be met in less than 24
months. Success rates were reported by Dr.
Jastreboff in Baltimore to be approximately 84%.
Dr. Hazell has observed similar results in his
program in the U.K.
Drs. Jastreboff and Hazell have obtained
their gratifying results with TRT through dili-
gent work and meticulous attention to detail.
They personally devote an extraordinary
amount of time to one-on-one patient contact
and directive counseling. The role of individual-
ized directive counseling in TRT as developed
by Jastreboff and Hazell cannot be over-empha-
sized. For this treatment to be effective, a
tremendous investment of time and spirit is
required. Anything less is most assuredly not
TRT, and the results cannot be expected to be
those of Jastreboff and Hazell. A note to hearing
health professionals interested in offering this
treatment to patients: attend high-quality cours-
es, learn the material thoroughly, and devote
the necessary empathy, enthusiasm, and time to
one-on-one patient care. Both you and your
patients will flourish.
TRT is not a cure for tinnitus. It is a treat-
ment approach designed with the goal of tinni-
tus ceasing to be an issue in the patient's life. It
is designed with the goal of making tinnitus into
a pair of pants. Ninety percent of the time, peo-
ple are unaware of their pants. The 10% of the
time they are aware, they do not "cope" with
their pants, they do not "deal" with their pants,
they do not "learn to live" with their pants, and
they most certainly do not spend any time wor-
rying whether or not the following day will be a
"good pants day" or a "bad pants day." They sim-
ply wear their pants; and when the goal of TRT
has been met, tinnitus should be just like that!
Dr. Nagler is Director
of the Southeastern
Comprehensive Tinnitus
Clinic, Atlanta, GA,
404/531-39 79, www. tinn. com
I
-
- ~
Tinnitus Thday/March 1998 15
Gloria Stanetti
Joshua 1Yee, CA
Lainie Ganley
Bergenfield, NJ
Dhyan Cassie
Somerville, Nf
Yolanda Kapalo
West Mifflin, PA
Georgia Smith
Indianapolis, IN
Edna Young
Lee's Summit, MO
Wilber Klotz
S. Williamsport, PA
John Nichols
Phoenix, AZ
Sarnell Ogus Shirley Perry
East Hampton, NY Powder Springs, GA
16 Tinnitus Today/ March 1998
Bob Luthmann
Staten Island, NY
Harvey Pines
Buffalo, NY
Milly Walker
Austin, TX
The Time Line
by Barbara Thbachnick, Client Services Manager
Most people remember the exact day their tinnitus
arrived. Some, the exact hour. From that moment forward,
the life plan of an individual with tinnitus veers- some-
times sharply - off its original course. The length of time
and the degree to which it stays off course will vary. What
varies very little are the stages along the new tinnitus time
line.
The time line often looks like this:
A time for talking ... when the tinnitus is new, unre-
lenting, unexplained, worrisome.
A time for talking to someone who has been in
your shoes ... when family members, friends, employers
have grown weary of hearing about what you hear and
they don't.
A time for assurances of what you hope is true ...
that you are not crazy and that you are not alone.
A time for questions ... when your need to under-
stand the mechanism of tinnitus is now as great as your
need to gain control over it.
A time for answers .. . when you seek medical testing
to rule out tumors or other physical conditions as the root
of the problem; when you are ready to accept that you
might find out only what isn't the cause.
A time for treatment ... when you decide what you
are going to do; when therapies (conventional, alternative,
or a combination of the two) are offered and fashioned
around your particular needs.
A time for patience ... when you invest the necessary
weeks or months or sometimes years in the healing
process, and then slowly begin to collect on your invest-
ment.
A time for moving on .. . when you are ready to dis-
engage from tinnitus and get back to living your life.
Then there are those who, having made it through part
if not all of the time line, return to help as they once were
helped. For them, it is a time for giving back.
In retrospect, ATA can help at almost every turn.
When you need to talk to someone who has been in your
shoes, look on our support network list that was sent to
you. If it's been a few years (or you can't find the list), ask
Steve Ratner
Boynton Beach, FL
E11en Ratner
Boynton Beach, FL
Ben & Shirley Cohen
Lauderdale Lakes, FL
us for a new one. A good support person will assure you
that you are allowed to feel everything you feel, that your
tinnitus can stop being a problem, that you can feel better,
that while your doctor might not understand your tinnitus
there are doctors who do.
Run your questions through our bibliography on any
tinnitus-related topic (Meniere's, otosclerosis, hyperacusis,
etc.). We can do a "subject search" through the thousands
of research articles we have on hand. Also, ask your
health care provider questions from the list in our First
Steps Tb Take brochure, and wait for the answers.
Discussions on a multitude of treatments are included in
Tinnitus Tbday and, of course, in the bibliography.
Patience takes practice and, ironically, lots of
patience! Call a support contact or a sympathetic health
professional. Tinnitus Tbday carries articles on stress
reduction and relaxation techniques. Do the things that
you enjoy, and do them often. 1Ty to do one thing again
that tinnitus had prevented you from doing to see how far
you've come.
People with tinnitus fare best when they are exposed
to accurate information; when they are surrounded by tin-
nitus-savvy health care providers, understanding family
members, and considerate friends. Your personal circle of
support and your own determination to get well can help
you move along to the point of moving on.
A good number of people are motivated to repay the
comfort they received along their own tinnitus time lines.
Other people give back as part of their treatment plan: it
makes them feel better to do it. This giving back takes
several forms. Some people write articles for this journal;
others submit their art work for the cover. Some join ATA's
telephone network; others gather their wits about them,
take the organizational plunge, and start support groups. A
few donate their creative ad writing talents. Some write
letters to their representatives in Washington. Some work
at health fairs. A few who are health care providers make
tinnitus their priority, or their new specialty. A few come
on board as board members. And many financially sup-
port ATA and tinnitus research. Whether it is a check writ-
ten or an hour given, the gift is always clear.
Oh yes, the faces on these pages. They belong to just a
few of those who've traveled the length and breadth of the
time line, and who for private reasons have chosen to give
back. There are beauties in our midst. Thke a look.
Jim Salter
Da11as, TX
Kevan van Herd
Kelowna, BC
New ATA Support Contacts
-A Warm Welcome!
New Support Group Facilitators
Eric Eliason, M.S. CCC-A
55 Morris Ave. ff304
Springfield, NJ 07081
973/379-3330
Suzanne Kowalczyk
c/o Aurora of Central NY
518 James St.
Syracuse, NY l 3203
315/422-7263
Larry Strom
In Balance - Vestibular Wellness
Support Group
P.O. Box 1135
Los Gatos, CA 95031-1135
408/395-7334
New 'Thlephone/Letter Contacts
Jeff Bassett
533 Queen Ann's Place
Wadsworth, OH 44281
330/335-8064
Miriam Bloomfield
79 Florence St. #l04S
Chestnut Hill, MA 02167
617/244-2357
Jessica Moore (letters only)
7 Galloway Terrace
Kinnelon, NJ 07 405
Shirley Perry
3497 Mustang Dr.
Powder Springs, GA 30127
770/943-0059
Mari Quigley
1161 Packers Circle #100
Tustin, CA 92780
714/505-6861
Jo Hazelby
2 Viscount Rd., Stanwell Staines
Middlesex TW197RD,
United Kingdom
phone/fax 01784-255485
Interested in becoming part of ATA's sup-
port network? Call us. Write us. Join us!
Tinnitus 1bday/ Marcb 1998 17
The Role of Cognitive-Behavioral Therapy in
Tinnitus Perception
by Robert W Sweetow, Ph.D.
Tinnitus is a symptom an
of underlying disorder.
Identification and correc-
tion of the underlying dis-
order is the principal goal
of the health professional.
Unfortunately, it is often
difficult to identify the
cause of a person's tinnitus
even with comprehensive
testing. And, when the cause is found, it may be
related to damage for which there are no known
cures. Thus, most current efforts have been
aimed at controlling the symptom. Strategies
have included tinnitus retraining therapy (TRT),
masking (with home devices, tinnitus maskers,
tinnitus instruments, and hearing aids), nutri-
tional counseling (including the use of herbs
such as ginkgo biloba), and vitamin supple-
ments such as niacin and zinc. Lasting success
with these procedures has been inconsistent.
This frustrating lack of achievement leads to
the question ofwhy symptom management has
not been more successful. Ts it because the
symptom of tinnitus is so diverse both in terms
of its underlying cause and its physical manifes-
tations? Perhaps, but another possibility is that
attempts at symptom control have been directed
at the wrong manifestation of tinnitus.
'Traditionally, attempts have been directed
toward the elimination or reduction of the loud-
ness of the perceived sound. Conceivably, man-
agement attempts would be more successful if
they were directed toward a tinnitus-related
attribute that is more manageable. A common
characteristic shared by tinnitus patients is an
unhealthy (though not necessarily abnormal)
attitude to this unwanted auditory annoyance
which leads to a maladaptive reaction. A reac-
tion is a learned behavior, and all behaviors are
subject to modification.
It is reasonable to assume that regardless of
the cause, or perceived auditory characteristics
of the tinnitus, the ultimate problem is how the
patient reacts to the tinnitus. If a person is not
"bothered" by the tinnitus, it ceases to be a prob-
lem. This is not to say that attempts should not
be made to identify and, if possible, rectify the
underlying disease process. But given that most
cases of subjective tinnitus are idiopathic (of
18 Tinnitus Thday/ March 1998
unknown origin), psychological intervention to
reduce the stress, distress, and distraction asso-
ciated with tinnitus can be very productive.
Current neurophysiological models suggest
that the ultimate perception of tinnitus is not in
the ear, but rather in the brain. Evidence sup-
porting this theory comes from the fact that
patients having tinnitus with a presumed
peripheral generator (such as the inner ear)
may not experience relief even when the audito-
ry nerve (connecting the ear to the brain) is sur-
gically destroyed. More recently, research using
Positron Emission Tbmography (PET scans)
show altered activity in the areas of the brain
relating to emotion and perception. Thus, even
though the tinnitus has a true physical cause,
treatment might need to be directed toward the
reaction, rather than the physical location of the
disorder.
An analogy can be drawn to another invisi-
ble, highly personal symptom: pain. Pain treat-
ment differs from tinnitus treatment in that the
underlying cause of pain is often identifiable
and treatable. As a result, drugs can be pre-
scribed to attack the causes of the pain, or at
least the structures in the brain responsible for
interpreting that sensation. When the cause of
pain cannot be pharmaceutically controlled, or
when medication cannot be tolerated due to side
effects, there are several well-tested psychologi-
cal procedures available for altering a patient's
reaction to pain. In addition, PET scans have
revealed altered structural functions following
psychological treatments. It is reasonable to
assume, then, that a psychological approach to
modifying a patient's reaction to tinnitus might
eventually produce a true, physical alteration in
the brain.
Cognitive-Behavioral Therapy (CBT) has
been successfully used for patients suffering
from chronic pain and is one of the most widely
used and accepted psychological strategies for
coping with intractable disorders. CBT can be
defined as the modification of negative thoughts
and behaviors associated with an aversive disor-
der like tinnitus. There are two main compo-
nents to this approach. One is cognitive
restructuring, which helps a patient think differ-
ently and adopt a different attitude about their
problem. The other component is behavioral
modification which identifies factors that con-
tribute to the problem and the subsequent reac-
The Role of Cognitive-Behavioral Therapy in
Tinnitus Perception (continued)
tion, then finds ways to modify them through
actions. The combined approach assists the
patient in identifying and correcting maladap-
tive behaviors, distorted conceptions, and irra-
tional beliefs. Patients can then monitor the role
that negative thoughts play in maintaining their
adverse reactions to their unwanted symptoms.
Changing cognitive patterns and learned
behavior requires systematic reconditioning, not
simply a determination to do well! Just saying,
"you can learn to live with it" is not sufficient.
Cognitive-behavioral therapy does not attempt
to modifY the patient's personality. And it cer-
tainly does not imply that the patient is unstable
or that the problem is
01
all in the head." Instead,
the consequences of the behaviors and thought
patterns are the central issue. When treating a
patient with CBT, a thorough assessment of the
patient's problem must first be undertaken.
Assessment is both diagnostic and therapeutic.
Procedures to alter maladaptive behaviors and
thoughts should be agreed upon mutually.
Progress should be measurable and monitored
regularly and follow-up is essential.
The flow of therapy entails the following
steps:
1) Define the problem. For example, realistical-
ly and specifically describe when the tinni-
tus presents a problem (i.e. is it only
bothersome at night?) and in what manner
other behaviors are affected (does the
patient stay at home when the tinnitus is
loud?).
2) IdentifY the behaviors and thoughts affected
by the tinnitus. Is there anger? Fear that a
tumor might be causing the tinnitus? Is
there suicidal tendency or clinical depres-
sion?
3) List the maladaptive strategies and cognitive
distortions currently employed. All humans
indulge in cognitive distortions. Among the
more common are: all or nothing thinking,
over-generalization, jumping to conclusions,
emotional reasoning, labeling, disqualifYing
the positive, and "catastrophizing."
4) Distinguish between the tinnitus experience
and the maladaptive tinnitus behavior. For
example, a refusal to socialize is a result of
the maladaptive reaction, not the tinnitus
itself.
5) Identify alternate thoughts, behaviors, and
strategies. The goal is to recognize that as a
rational human being, irrational thoughts,
even those long ingrained by virtue of previ-
ous attitudes, cannot persist when scruti-
nized logically. For every thought, there is
an alternative thought.
6) Devise and rehearse strategies that can be
measured. Cognitive-behavioral intervention
is highly interactive. The patient must
assume responsibility for becoming an active
partner in restructuring thoughts and behav-
iors. Homework assignments may be given
and structured to allow the patient to test
the progress (or lack thereof) being made.
Homework assignments may consist of
maintaining a daily loudness and annoyance
chart, diaries, as well as recording of critical,
maladaptive thoughts, their corresponding
cognitive distortions, and alternative, ratio-
nal responses. Severity scaling may be used
to further assess progress.
7) Regularly assess success or failure of coping
strategies. Initial goals should be modest and
success should be achievable with reasonable
ease. When a strategy fails to produce success, it
should not be looked at as a failure. Rather, it
teaches what will and will not work for that par-
ticular individual. Cognitive-behavioral therapy
should produce success within 8 weeks. If no
progress has been made in that time, this
approach is probably not going to be successful.
The vehicle currently employed at UCSF for
determining which treatment strategy is most
appropriate for a given tinnitus patient is the
use of a multi-disciplinary team approach. A
core team (including an otologist, an audiologist,
and a psychologist) evaluates each patient, then
determines the appropriate treatment plan and
whether or not additional professionals should
be consulted.
Cognitive-behavioral therapy is seldom the
sole strategy utilized in a tinnitus patient man-
agement program. It is usually combined with
other approaches such as tinnitus retraining
therapy, education, amplification, medication,
masking, and relaxation therapy. A comprehen-
sive diagnostic/treatment program offers the
greatest likelihood of dealing with this complex
problem.
Dr. Sweetow is Director of Audiology at the
University of California, San Francisco.
This is the first in a series of articles by ATA's
Scientific Advisors.
Titmitus Today/ March 1998 19
Questions and Answers
by Jack A. Vernon, Ph.D.
[Q]
Mr. A. in California asks if we have any
information about a new implantable
hearing aid:
We have been working with an ear
surgeon in Oklahoma on such a device.
It is one of five recently approved by the
FDA. I have no doubt that implantable devices
of this sort will improve hearing capability.
Note, however, the device requires a receiver
(that is, a microphone) which needs to be worn
on the outside of the scalp and held in place by
a magnet implanted under the scalp. It is esti-
mated that the implantation surgery plus the
device will cost $10,000. If vanity is the motiva-
tion then I would say it is a high price to pay.
On the other hand, if these implantable devices
are proven to perform better than conventional
hearing aids, then they might be worth the
price. Until more data is available on
implantable hearing devices, I recommend
using conventional hearing aids. Remember: if
both ears are hearing impaired it is almost
essential to have two hearing aids.
[Q]
Mr. S. from Ohio sent in a newspaper
announcement that surgery could stop
seizures. The young child being dis-
cussed had been hyperactive and very sensitive
to noise. Neurosurgery removed the offending
portion of the child's brain (it was found to be
either dead or non-functioning) so that noise no
longer disturbs him. Mr. S. asks if the future
might hold such hope for hyperacusis patients.
A brief explanation about neurology is
needed in order to answer the question.
Realize that there are two general types
of nerves in the body. There are afferent nerves
and efferent nerves. Afferent nerves take neuro-
logical signals from the sensory organs such as
the eyes and ears up to the brain where they are
interpreted as sight and sound, etc. The efferent
nerves arise in the brain and go out to muscles
and glands effecting their activation. Oddly
enough, there is one bundle of efferent nerves
which arise in the brain (in the olive of the
20 Tinnitus Thday/ March 1998
brain) passing outward to the inner ear (it's
known as the olivocochlear bundle). Since there
are no muscles or glands in the inner ear, what
is the function of this olivocochlear bundle of
nerves? Best evidence indicates that activity in
this bundle of nerves reduces the loudness of
input sound. Presumably it is the non-function-
ing or impaired function of the olivocochlear
bundle which causes hyperacusis, the collapse
of loudness tolerance.
That is the theory and for the moment it is the
best we can do. Unfortunately, that olivocochlear
bundle of nerves is entwined and intermixed
within the afferent auditory nerve (the 8th cra-
nial nerve) so that the only way to surgically
remove the olivocochlear bundle would be to cut
the entire eight nerve resulting in total deafness.
I realize that there are some severe hyperacusis
patients who would select total deafness over
their hyperacusis condition. It is very important
for those patients to understand that the olivo-
cochlear bundle can be retrained to function
normally and thus relieve hyperacusis.
[Q]
A flock of patients sent in the news-
paper account of President Clinton's
hearing aids. There is no doubt that use
of hearing aids by the President will help
remove the stigma associated with them. One
patient, Mr. H. from Florida, not only sent in the
newspaper account but asked, "What is hearing
impairment?"
Hearing impairmenl can have a variety
of definitions. Usually it is taken to
mean that a person has difficulty under-
standing human speech. Unfortunately one can
have the kind of hearing loss that only operates
when the person is in the presence ofback-
ground noise. The rest of the time they hear
perfectly well and that leads them to believe that
they do not have any hearing impairment. They
tend to blame the speakers for mumbling. Ifyou
have difficulty understand speech under most
conditions, you should have a hearing test just as
you would have an eye test if your vision were
impaired. If you have difficulty understanding
speech in the presence of background noise you
should have a hearing test. Based on the results
Questions and Answers (continued)
of the hearing test, your hearing health will be
explained to you. Be sure you retain a copy of
the test results for future reference.
[Q]
Mr. L. in Oregon, who has had tinnitus
for 40 years, recently had a hearing
test. Before the test he indicated to the
technicians that he had tinnitus, but they pro-
ceeded to do an ABR test where the clicks were
excessively loud. After the test, Mr. L.'s tinnitus
increased in loudness significantly. He wants to
know if the increase is permanent.
The ABR test (auditory brainstem
response) determines if you have a
tumor on the hearing nerve. In my opin-
ion the only time one tests for auditory nerve
tumors is when the tinnitus is in one ear only
and when there is no known cause for it. When
these conditions are met it is better to have an
MRI (magnetic resonance imaging) test. (Wear
ear plugs when you do it.) We know of a number
of patients for whom the ABR test exacerbated
their tinnitus. In some cases the exacerbation
was permanent; for others it was temporary. Mr.
1., you may find that your tinnitus will gradually
and very slowly decrease. Even if it does begin to
decrease I would recommend that you attempt a
relief procedure to see if your tinnitus can be
helped. Do the ''faucet test." If the sound of run-
ning water makes it impossible for you to hear
your tinnitus then it is likely that wearable tinni-
tus maskers can help you. Contact me if you
think I can help you (503/ 494-2187). I take
patient telephone calls every Wednesday.
~ Mrs. H. in PA requests any source of
~ information on pulsatile tinnitus.
The expert on pulsatile tinnitus is
Aristides Sismanis, M.D., who practices
in Richmond, VA. He wrote an excellent
chapter on pulsatile tinnitus included in the
book, Tinnitus: Treatment & Relief, which I recent-
ly edited. (See back inside cover of this magazine
for order form.) In his chapter, Dr. Sismanis indi-
cates a variety of diagnostic tests for pulsatile
tinnitus, such as MRis, MRAs (magnetic reso-
nance angiography), and radiologic testing,
and the various treatments available depending
upon the diagnosis. I would recommend
Dr. Sismanis' chapter to anyone with pulsatile
tinnitus. (Editor's Note: Dr. Vernon is donating all
proceeds from his book to ATA.)
[Q]
Mrs. S. in New Hampshire asks what
anti-inflammatory medication can be
used by the tinnitus patient. She also
asks if cortisone shots exacerbate tinnitus.
First of all, side effects from medications
vary greatly from patient to patient.
Some patients are excessively sensitive
to medications and experience all manner of
side effects while others fail to experience any
side effects. I doubt that Advil would exacerbate
your tinnitus. And even if it did, that exacerba-
tion would be temporary. I also doubt that corti-
sone shots would exacerbate your tinnitus. Some
patients have even reported a temporary reduc-
tion in their tinnitus after receiving cortisone.
The best thing would be to evaluate your tinni-
tus on a ten-point scale every day using the
same environmental conditions to conduct that
evaluation. If you find there is even the slightest
increase in your tinnitus, inform your primary
physician to see if an alternate medication is
available. Also remember that these side effects
are temporary and the earlier they are detected
the shorter the duration. One of the best anti-
inflammatory medications is aspirin. It might be
possible for you to gain the anti-inflammatory
effect from aspirin at a level below that which
would exacerbate your tinnitus. If you try
aspirin, discontinue it at the first sign of any tin-
nitus increase.
Notice: Many of you have left messages request-
ing that I phone you. I simply cannot afford to
meet those requests. Please feel free to call me
on any Wednesday, 9:30 a.m. - noon and
l :30 - 4:30 p.m. (503/ 494-2187). Please send
your questions to: Dr. Vernon c/o Tinnitus
Tbday, American Tinnitus Association,
PO Box 5, Portland, OR 97207-0005.
Tinnitus 1bday/ March 1998 21
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ANNOUNCEMENTS
MARCH 19-25, 1998. The Neuro-otological and
Equilibriometric Society (NES) is holding its
25th Congress in Bad Kissingen, Germany, on
March 19-25, 1998. The meeting has been orga-
nized by Barbara Goldstein, Ph.D., New York, NY.
This association welcomes members worldwide
and promotes clinical neuro-otology in practice
and in the field of clinical research. This year's
meeting will feature a day of tinnitus papers in
honor of Abraham Shulman, M.D., New York, NY
Awards will be presented to Dozent Mans
Magnusson, M.D., Lund, Sweden; Prof. Dr. Otto
Ribiar, M.D., Budapest, Hungary; and Prof. Dr.
Juin Ichi Suzub, M.D., Thkyo, Japan. The 26th
Congress will be held in 1999 in Los Angeles, CA,
and will be organized by Jack Pulec, M.D. The
society's website: http/ / www.vertigo-
dizziness.com.
APRIL 29, 1998. International Noise
Awareness Day. Sponsored by the League for the
Hard of Hearing in the U.S., this day is being set
aside to bring public attention to the hazards ofliv-
ing in excessively noisy environments. Many orga-
nizations worldwide, including ATA, are lending
support to the activities planned for that day. The
League asks that everyone observe "60 seconds of
no noise from 2:15 to 2:16p.m. - wherever you
are." For more information, contact Nancy Nadler
at 888/ NOISE-88 or http:/ / www.lhh.org/noise.html.
SEPTEMBER 18-19, 1998. The Sixth Annual
Conference on the Management of the
Tinnitus Patient will be held at The University of
Iowa, Iowa City, on September 18-19, 1998.
Professionals who provide tinnitus management
and patients with tinnitus are invited to attend.
Guest of Honor will be Professor Peter H. Wilson,
Ph.D., a psychologist from Flinders University in
Australia. Other guest speakers include Gloria
Reich, Ph.D., Director of the American Tinnitus
Association; and Michael Block, Ph.D. To register,
contact Richard JYler, Ph.D., Director of
Audiology, The University of Iowa Department of
Otolaryngology - Head & Neck Surgery, 200
Hawkins Drive C21GH, Iowa City, IA 52242,
319/ 356-2471; Fax 319/353-6739;
e-mail: rich-tyler@uiowa.edu.
SEPTEMBER 5-9, 1999. The 6th International
T innitus Seminar will be held at Cambridge
University, U.K. from the 5th through 9th of
September, 1999. Accommodations will be avail-
able in the lovely period college of Selwyn, close
to the river Cam. The conference will be held in
the adjacent Lady Margaret Hall with modern con-
ference facilities for up to 500 registrants. The
Seminar will be hosted by the British Society of
Audiology.
1b register, contact Ann Allen, Bristish Society of
Audiology, 80 Brighton Rd., Reading RG6 IPS. Tel:
44 + (0) 118 966 0622. Fax: 44 + (0) 118 935 1915. E-
mail: bsa@cityscape.co.uk
For additional information, contact conference
organizer Jonathan Hazell, e-mail:
j.hazell@ucl.ac.uk
Annual Meeting of the National Voluntary Health Agencies
by Patricia Daggett, Administrative Director
Representatives from 53 health agencies, includ-
ing ATA, and 27 state coordinators ofthe Combined
Federal Campaign (CFC) attended a three-day con-
ference December 7-9 in Washington, D.C.
The Director of CFC Operations at the U.S.
Office of Personnel Management, Carol Hill Lowe,
reported that although the amount of the average
donation increased to $150 during the last cam-
paign, the number of Federal employees is being
reduced. Therefore, one of the main issues
addressed was the possibility of extending the
Combined Federal Campaign into the private sector.
While there, we also attended the meeting of
the National Capital Area Council of NVHA, the
largest campaign in the country. The ATA has once
again been approved for participation in the 1998
National Campaign, and applications are underway
for local campaigns across the U.S. as well.
We want to take this opportunity to thank all of
you who contribute through the CFC for your con-
tinuing support to insure that vital health services
are available to all those who experience tinnitus.
Remember to send us a copy of your designation
form so that you will receive Tinnitus Tbday. Also,
if your worksite has an appropriate spot to post
information about the ATA and it's services, let us
know and we'll be
pleased to provide
something suitable.
(This need not be
restricted to cam-
paign dates but
could serve as a
reminder during the
rest of the year.)
Tinnitus 'Ibday/ March 1998 23
SPECIAL DONORS AND TRIBUTES (continued)
Alfred Levin Danny R. Bibb Apollonia Frien Larry B. Lowe Anne M. Ryan
Jeanette Levin George S. Bingham Doris E. Frost Henry E. Ludwig Ohannes Salibian
Doris Miles Janet T. Birkenhead Jim Ray Fugate Robert A. Lukey William B. Salsgiver
Arlo and Phyllis Nash Edward Bloom John M. Garinther Sebastian Manganello Victor 0. Sandberg
Jack Reich (Husband) James L. Boardman Janet and Glenn Garrison Ernest V. Marsh James Saulsbury
Florence Reich Robert A. Bowler Stephen P. Gazzera Anthony G. Martillotti Joseph J. Schall
The Shennan Family Donald M. Bowman Nick Georgeoff Douglas E. Martin Valerie A. Schauer
Florence Reich Elsie J. Breidegam Abraham Gevorgian Nancy C. Martin Randall J. Schoenberg
Wesley Thren Raymond J. Brejcha Myra J. Gibson A. Helen Mauro Steven C. Seal
Mrs. James W. 'Ibren Kay M. Breyer William L. Ginkel Irvin A. McClung Mrs. Trandokht Sebastian
Mr. and Mrs. Chester 'lbren David S. Bromberg Howard Ginsberg John E. McCotter Robert R. Sfire
Arthu.r B. Wltite Mattie J. Brooks F. K. Gleason Peter J . McDonagh Bernard H. Shapiro
Marcye B. White Billie H. Brown Seymour Goldberg Colin W. McKay Gil Sharkev
In Honor Of
James D. Brown Benny Goodman Joan D. McKeegan Lilburne D. Sheats
Susan Brumfield Ronnie Gousman Jared McLaughlin Alan R. Sherman
Nick Andrews
Michael W Burnham Charles Mark Grabinski Kenneth R. Medor Robert H. Silk
Paul Holbrook
Cordell B. Burzych Richard M. Greene, Jr., Robert and Kathleen Phil Simpson
Ernest C. Auer, J r.
Priscilla K. Bush Ph.D. Megginson Mary K. Smith
Ernie and Bena Auer
Sara L. Bush Richard P. Gross Nick Melloy Thnya M. Smith
Patrice Auer
Sheila M. Bush Abraham I-labenstreit Allan M. Metcalf Jennifer L. Snyder
Mr. and Mrs. Daniel
Myl'la Caldwell Larry D. Hall Verna V. Meyer John R. Sorge
Cappelli
Leo Caluori Hannah L. Hammel Carolyn B. Miller Marsha I. Sorotick
Esther Kornfeld
Douglas S. Campbell Mary C. Hankey Gary L. Miller Larry Spoden
Dr. J ohn R. Emmett
Joseph L Cariglia George A. Hare Mark Minton Joseph J. Srednicki
Dr. Luther Smith, UI
Mildred Carluccio Paul w. Hastey Sonia Miskjian Dean L. Stahl
Jack R. Ha.rary
Johanna K. Carmassi Dr. Jess Hayden Dr. Wayne H. Mitchell Ed and Annetta St. Clair
(Happy Birthday)
Barbara Cenl7in Ray Haydock, Jr. Ernest M. Moeller WHliam D. Stedman
Bob and Debbie Harary
Loretta C. Choy Katherine R. Hazelwood Thomas R. Moffette Arthur F. Stlouis
Mike, Cindy, and Adrian
Jess Clanton D. W. Heineking Christopher Montgomery Samuel C. Stoughton
Harary
Dennis J. Clark Abby Herman Martine Naeve Mrs. Sedalise S. Stoute
M.r. and M.rs. Jack R.
Donald B. Coe Stephen M. Herrell Samuel R. Newsom Georgia Strifas
Harary
PhilipS. Collins Bertha M. Hertz, Ph.D. Phyllis G. Nexon Dolores . Sullivan
(Happy Hanukkah)
Linda M. Colucci E. Alan Hildstrom Peter J Nikolai Patrick SuUivan
Bob and Debbie Harary
Gary G. Conlee Lynda M. Hoffmann Margaret Nowacki Ruth M. Swan
Mr. and Mrs. Eri c and
Kathleen J. Converse Margaret J. Hoffmann David Ober Loretta L. Sweers
Doreen Hogan
Donald J . Cook Melba B. Hoover Shelly M. Oliva Lawrence J. Sykora
Don, Janet, and Elizabeth
Nellie Copeland Stanley M. Hordes Jean Ann Olsen David P. Sywak
Seaquist
Anthony M. Crisa Jane Power Hughes Frances M. Pabon ,Judy 'Thrt
Michael Holbrook
Mary A. Crouse Jerry lnfeld Geneva Y. Pace Leonard S. Thtore
Paul Holbrook
Glen R. Cuccinello Robert E. lrwin Carol L. Padilla Albena Thnukas
Dr. Paul R. Lee
Michael Curci Les Tsaacowitz Joseph s. Park Douglas Thsler
(Merry Christmas)
Eli7.abeth J. Curtis Rev. Thomas B. lwanowski Sandra C. Parsons, Allen and Genvieve
Laura Lee
Mary Holmes Dague Anthony F. Jahn, M.D. Burton R. Parsons Family Timms
Peter Lee
Eileen M. Darnbis Erik Jakobsen Trust Naila T. 'Irani
(Merry Christmas)
Yvette H. David Lucille J. Jantz Joseph Passalacqua Anthony Tropeano
Laura Lee
Anthony Davis Barbara L. Jensen relicia A. Passero Eugene F. 'fruax
Charles Locking
J. Lynne Deal Esther W. Johnson John R. Patrick Geraldine Uhlhorn
(Uncle)
John Delaura Wilber E. Johnson Jean L. Paulson John A. Unfred
William Haskin
Francis Deleone Leslie C. Jones Raymond F. Pauser Dr. Robert D. Utsey, Sr.
Deb and Ron Orlasky
Timothy Dorn Lois M. Jund J . Robert Persons Nance Vacca
Susan Lang and Robert
Roberta J. Dorway Lynn R. Kaeding Carolyn H. Peters John R. Veglia, Sr.
Levenson
Jerome C. Dougherty Bemard Kaminsky Donald E. Peters Mary Jane Voll
Shirley Rosenhaft
Barbara Douglas, M.A., David Kaplan Lucille M. Petersen Julie Johnston Walter
(Happy Birthday)
CCC A R. L. Kchcley David G. Peterson Leo G. Ward
Mrs. Naomi
Vallory Douglass Leon A. Keith Ruth Pfeiffer Gerda Wassermann
Doran T. Seaquist, J r.
Thelma D. Dry James G. Keller George Phillips Donald L. Watrous
Don, ,Janet, and Elizabeth
Sherman E. Dugan Catherine A. Kellit Ann S. Pittenger Kirby M. Watson
Seaquist
Howard 0. Dugger Richard A. Kennedy Joel H. Plotkin Shirley L. Weddle
Dr. Jack A. Vernon
Mr. and Mrs. Harold F. John B. Kent Jvanell Presley Robert G. Weigand
John Mercer
Ealer Linda K. Kieft Bonnie C. Pyatt Paulette A. Weill
Jack Salerno
Susan H. Earl William C. Kim Michele Quere Mr. and Mrs. Raymond L.
Research Donors
George E. Earley Peter Kobelansky Major Leonhard Raabe Wells
Henry J . Alexander Henry Eason Steven E. Koch Robert L. Ralston Gary White
George A. Anderson .To E. Egger Barbara L. Kohn Valerie E. Rasmussen Warner Whitney
Harold M. Anderson
Eleanor G. Egli Laura J. Kolinek Shirley Ravenshorst Douglas W. Willard
Elizabeth A. Artandi
Marjorie M. Ellis Bert Krashes Allison H. Rayman Antonella Wilson
Dee E. Bagdasarian Kerstin Ellstrom Honnie Krill Judith M. Redding Dennis F. Winkler
Nancy L. Bardach Louis S. Emanuel Irena Kudirka Eleanor Regula Herman D. Witherow
Roy Bama Ann R. English Kenneth F. Kushner Gerald B. Renyer Peter R. Wojtkiewicz
Jack Barnett
Joaquim Forte Faria Peter M. Kusian Mike M. Reynolds Nadena Wonkka
James R. Barney
Francis C. Farwell Florence Langevin Philip N. Rice Richard Woodbury
Katharine P. Beal
William L. Ferrara Christina Laubscher Richard C. Rice Joseph R. Wozniak
McLaren Beatty John w. ringer Richard A. Layton w. Roberts Richmond Richard D. Wright
Rudolph Beck Regina Fiore Edwin S. Lee, Jr. John A. Richter E. Burdett Yeoman, liT
Adele Engel Behar
Lauren Fisch Alfred A. Levin Paul Richter, M.D. Jackie 0. Young
Bruce H. Bell
Janet Florentin Stanley D. Levin 1bm Rifai Mrs. John H. Yuen
Robert F. Bell
William N. f'orsstrom Bernice Levitt Juan R. Rodriguez Michael Zakoor
Martin Berenberg
Harvey M. Fox Barbara N. Lewellen Saul H. Rowen Werner E. Zarnikow
Elizabeth Berry Herbert Frank Mary Jane Lill is Jay T. Rubinstein, M.D., Edwin J. Zieroth
Jack R. Bertram
D. Jeanne Frantz Carmen J. Lipuma Ph.D
Donald J. Lisio Amelia Rugala
26 Tinnitus Thday/March 1998
Proceedings

Is a
11
must have" for professionals and laypersons ... anyone concerned about tinnitus!
Proceedings is now available at the very special rate of
only $20 - including shiJ?ping & handling
Don't miss this opportunity to order the most current and
comprehensive source of Tinnitus information available.
Proceedings contains:
over 100 different chapters
+ from 230 authors, representing 23 counties
on topics including:
+ Tinnitus Retraining Therapy
+ Drug Treatment
+ Masking Techniques
+ Alternative Remedies
+ Self-Help & Support
And, much more!

Send check or money order to:
Proceedings + ATA PO Box 5 + Portland, OR 97207 + or
call with your credit card information: 800/ 634-8978
U.S. Dollars Only + Please allow 4-8 weeks for delivery
+ Call about volume discounts +
AMERICAN TINNITUS ASSOCIATION
P.O. Box 5, Portland, OR 97207-0005
Forward and Address Correction
along
the
Tinnitus
Research
Path ...
THANK YOU! Your gifts toward research enabled
the American Tinnitus Association to surpass
$1 Million in research grants! That's right; the gifts
made by concerned ATA supporters, motivated by
the common desire to propel tinnitus research toward
an eventual cure, enabled ATA to reach- and sur-
pass-the million dollar mark by the end of 1997.
Now, you're invited to join us as we take a stroll down
the MILLION DOLLAR RESEARCH PATH. We'll
highlight important milestones in tinnitus research,
visit projects made possible by ATA research grants,
take some detours to check out research funded due
to ATA seed money, and explore the future of tinnitus
research.
ATA TINNITUS RESEARCH
GRANT RECIPIENTS:
Carol A. Bauer, M.D.
Wayne Briner, Ph.D.
Anthony T. Cacace, Ph.D.
Robert A. Dobie, M.D.
Jos J. Eggermont, Ph.D.
Donald A. Godfrey, Ph.D.
Paul S. Guth, Ph.D.
Richard J. Hallworth, Ph.D.
Margaret M. Jastreboff, Ph.D.
Pawel J. Jastreboff, Ph.D., Sc.D.
Gary A. Jacobson, Ph.D.
James A. Kaltenbach, Ph.D.
Paul R. Kileny, Ph.D.
Xi Lin, Ph.D.
Alan Lockwood, M.D.
Frank Marlowe, M.D.
Curtin Mitchell, Ph.D.
Mary B. Meikle, Ph.D.
Aage R. Mtllller, Ph.D.
Douglas H. Morgan, D.D.S.
Richard Salvi, Ph.D.
Robert W. Sweetow, Ph.D.
Richard S. Tyler, Ph.D.
Jack A. Vernon, Ph.D.
Donna Wayner, Ph.D.
lan M. Windmill , Ph.D.
The American Tinnitus Association's
Million
Dollar
Research
Path
ATA supporters
who donated
ATA grants $52,000
to Jos J. Eggermont,
a University of
Calgary researcher
-the first grant
outside of the U.S.
to research have
made 45 proj ects
possible. Here are
some milestones:
Tinnitus & spon-
taneous cochlear
activity funded
with $15,000 ATA
grant to James
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Kaltenbach, at
Wayne State
University.
The medical College of Ohio's
Donald Godfrey receives
$10,000 from ATA to study the
neurochemistry of the cochlea.
Jack Vernon, OHRC, receives the
largest ATA grant to date-$20,000
for research into electrical suppres-
sion of tinnitus.
Richard Tyler at the
University of Iowa
receives $9,600 from
ATA for his work with
masking.
$12,000 to Mary Meikle at the Oregon 6
Hearing Research Center (OHRC) for the
Tinnitus Data Registry. t
\leil..-le's Tinnitus Data Re{(istry project
awarded grant by the 1\ational Department
of Education.*
* Other funding {{rtlrratrd !Jy IPI urd money.
__.. 1997: Lockwood & SaM a
$1.5 \Jillion b.l' tile MDC
continue this rcsearc/1- r
made pO$$ible by the ITI
grantr
Pji:.er Pharmaceutical grants 1\.allenbaclz $202,000
for his research into spontaneous cochlear aclivil,r,
complimenting a $260,000 grant from NIDCD-
and the 01iginal n /1 grant.* '-""
Tinnitu
with sc

$111,5:
...
...
-::--- ; ,, ..
The drug Lasix (furosemide) is
studied by Robert Dobie at the
University of Texas, San Antonio,
with a $9,975 ATA grant.
Tulane University's
Paul Guth receives
$10,000 for his work
with the drug
furosemide as a
Pawel
Largest
grant tc
L
Robert /,evine htads a res1
1\ational institute on Deqf
(1\/DCDJfor rwt \JRJ res1
June, 1996: Alan Lockwood &
Richard Salvi, researchers at the
Hearing Research Lab in SUNY.
Buffalo, receive $46,145 from
ATA for their research into the
parts of the brain involved in
processing the sounds
of tinnitus.
.__.. 1997: Lockwood & Salui awarded
$1.5 Million by the NIDCD to
continue this research - research
made possible by the ATA seed
grant!*
.- Pfizer Pharmaceutical grants Kaltenbach $202,000
for his research into spontaneous cochlear activity,
complimenting a $260,000 grant from N!DCD-
and the original ATA grant.* . ~ ~ . ~
Pawel Jastreboff, University of Maryland,
receives $20,000 for studying objective
measures for tinnitus - and goes on to
develop tinnitus retraining therapy.
....
The drug Lasix (furosemide) is
studied by Robert Dobie at the
University of Texas, San Antonio,
with a $9,975 ATA grant
Tinnitus associated
with sound-induced
hearing loss-Part II.
$111,536 granted to
Pawel Jastreboff.
Largest, single ATA
grant to date!
L NJDCD awards
.lastreboff
another $170,000
.for his research
into tinnitus
associat.ed with
sound-induced
hearing loss.*
Tulane University's
Paul Guth receives
$10,000 for his work
with the drug
furosemide as a
Hypnosis & tinnitus is
studied by Frank
Marlowe at Temple
University, funded with
$10,000 ATA grant
ATA heads toward the next
millennium seeking another
million doJiars for tinnitus
research, but we need
your support in order to
continue this journey.
Please give generously to
the ATA Research Fund.
December, 1997:
The American
Tinnitus Association
exceeds $1 Million
in grants made to
tinnitus researchers.
Thank you ATA
research donors!
Clearly, this path can lead to a
cure for ti nnitus . ..
Robert Sweetow at UC, San Francisco
receives $7,500 ATA grant to study
maskers & earmolds.
Robert Levine heads a research team that is awarded $ 149,000 ]rom the
National fnstitute on Det{/hess & Other Communication Disorders
(NIDCD) for new MJU research ...
ATA
~
3198