June 1991

Volume 16, Number 2

Tinnitus Today
THE JOURNAL OF THE AMERICAN TINNITUS ASSOCIATION
"To carry on and support research and educational activities relating to the treatment of tinnitus and other defects or diseases of the ear."

In This Issue: "Searching for Answers," Articles from AT A members Book Review Questions & Answers Media Watch

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Editorial and advertising offices: American Tinnitus Association, P.O. Box 5 Portland, OR 97207 (503) 248-9985 Executive Director & Editor: Gloria E. Reich, Ph.D. National Chairman: Robert M. Johnson, Ph.D. Editorial Advisor: Trudy Drucker, Ph.D. Advertising sales: ATA-AD, P. 0. Box 5, Portland, OR 97207 (800-634-8978) Tinnitus Today is published quarterly in March, June, September and December. It is mailed to members of American Tinnitus Association and a selected list of tinnitus sufferers and professionals who treat tinnitus. Circulation is rotated to 175,000 annually. The Publisher reserves the right to reject or edit any manuscript received for publication and to reject any advertising deemed unsuitable for Tinnitus Today. Acceptance of advertising by Tinnitus Today does not constitute endorsement of the advertiser, its products or services, nor does Tinnitus Today make any claims or guarantees as to the accuracy or validity of the advertiser's offer. The opinicns expressed by contributors to Tinnitus Today are not necessarily those of the Publisher, editors, staff, or adver tisers. American Tinnitus Association is a non-profit human health and welfare agency under 26 USC 501 (c)(3) Copyright 1991 by American Tinnitus Association. No part 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 Scientific Advisory Board Alfred Weiss, MD, Boston, MA Abraham Shulman, MD, Brooklyn, NY George F. Reed, MD, Syrac.se, NY John R. Emmett, MD, Memphis, TN Gale W. Miller, MD, Cincinnati, OH Jack D. Clemis, MD, Chicago, IL W. F. S. Hopmeier, St. Louis, MO Harold G. Tabb, MD, New Orleans, LA J. Gail Neely, MD, Oklahoma City, OK Jerry Northern, PhD, Denver, CO John W. House, MD, Los Angeles, CA Robert E. Sandlin, PhD, San Diego, CA Chris B. Foster, MD, San Diego, CA Richard L. Goode, MD, Stanford, CA Mansfield Smith, MD, San Jose, CA Robert M. Johnson, PhD, Portland, OR Honorary Board Senator Mark 0. Hatfield Mr. Tony Randall

The Journal of the American Tinnitus Association

Volume 16 Number 2 June 1991

Contents
4 4
From the Editor by Gloria E. Reich It's Not a Problem, Just a Pain in the Neck by Sidney C. Kleinman Q.T. &D.B. Kaboom by James Salter Infinitude by Elizabeth Merritt Peavy Help is Where You Find It by Deanna Overstreet Research Highlights by Gloria Reich Questions & Answers by Jack Vernon How I Control Tinnitus by Jack Baldwin Book Review by Trudy Drucker Living With Hyperacusis by John Tice You Can Learn to Live With It by Joseph Sutherland Gould Veterans' Administration Information a le.tter from Thomas B. Ross Methods of Aural Hygiene by Leslie Sheppard Media Watch: Tinnitus in the News by Cliff Collins

6 6
7

9 9

10
11

13
14

15
17

Regular Features
16 16 18
Notices Classified Tributes, Sponsor Members, Professional Associates Books Available, Donation Form

19

Cover painting by Janet Louvau Holt, Portland, Oregon. Holt's work is in private and corporate collections nationwide.Inquiries may be directed to the Attic Gallery (503) 228-7830.

From the Editor

Gloria E. Reich. PhD., Executive Director, ATA.

It's Not a Problem, Just a Pain in theN eck

Sidney C. Kleinman, Chicago Illinois

Many of you have written to ATA asking for more articles about coping with tinnitus and self-help. The theme of this issue is Searching for Answers. Articles have been submitted by members who want to share their experiences. AT A does not endorse any pa1ticular tinnitus treatment and urges you to exercise both caution and common sense as you seek to find help for your own tinnitus. I was interested to read an article in the current issue of Modern Maturity warning readers of scams and swindles. The advice given there can easily be applied to people searching for health care. Here's how I translated their advice about sidetracking a scam so that it would be pertinent for tinnitus. If you are approached about tinnitus treatment you might ask the following questions: 1) Where did you get my name? 2) Will you explain all the risks and possible side-effects of the treatment? 3) Will you provide written material to back up your claims? 4) Will you explain your treatment fully to my doctor? 5) Are you licensed, certified, or otherwise supervised by government or other regulatory agencies? 6) How long have you been offering this treatment? 7) Exactly what am I paying for (professional time, drugs, overhead)? 8) Could you explain fully the financial arrangements including whether or not your treatment is covered by health insurance plans? 9) Who will be administering the treatment? What are their credentials? 10) Can you provide references from people (outside your company, family, and friends) who have actually undergone this treatment? A very important part of coping with tinnitus is remaining in control of the situation. We hope the stories in this issue of Tinnitus Today, along with other information you have received, will help you make informed decisions about your tinnitus and its treatment.

'*

Tinnitus is insidious, in that if you let it get you down, it only gets worse. On the other hand, if you discipline yourself, notwithstanding the toll tinnitus takes on you, life is an exciting, worthwhile adventure with every day truly being a gift to enjoy. (Sometimes the gift is not as good as that experienced the day before, but nevertheless it is still a gift.) A little history may be helpful. In 1952 as a starving self-supporting college student, one summer I operated an air-compressor from 11:00 p.m. to 7:00a.m. at Chrysler, blowing metal filings out of brake drums. In those days, no one thought about hearing damage and I experienced substantial ringing in my ears for a time after that job. In the mid-1960s, I began experiencing increasing amounts of tinnitus, along with a deteriorating middle-ear balance function. Finally, one day early in 1967, I lost the hearing in my right ear and suffered further Meniere's symptoms. Within a 24 hour period, my hearing was nearly gone because of the "sudden hearing loss syndrome." The hearing in my right ear continued to deteriorate rapidly, so that within a month or so, even at 125 decibels, I could hear no usable sounds, but actually felt the vibrations. The level of tinnitus increased substantially from that point on and continues to increase as my hearing loss in the right ear worsens. Thereafter, I began to experience more hearing loss in the left ear and finally in 1983 I was fitted with a hearing aid. As those of you with hearing loss know, it is a great shock, suddenly to hear all kinds of non-informing sound. I have been wearing a hearing aid since that time and the hearing in my left ear continues to deteriorate. Along with that deterioration, tinnitus generated from the left side has increased, which is, of course, not in sync with the much louder and internalized sounds from the right.
continued on page 5

It's Not a Problem (continued)

As a practicing attorney, I have found that clients are really uninterested in my "problems," which is as it should be. Clients want results. Clients want you to focus your attention on their problems and do not have much patience for someone who is feeling sorry for himself. After some thought and experimentation, I developed a philosophy which (although notalways easy to follow) helps make life an interesting exciting place and allows me to do new and different things as I enjoy the reality of my life. These principles are: 1. It is what is in the glass that counts, not what is missing. There is no one in this life who can escape from some form of physical or mental stress. Life enforces the rule that "there is no free lunch" and we all pay a price for our lives. It is not what we don't have that counts, but what we do have. Just look around you and you will see people who have much worse circumstances who are coping and living. As Nike says, "Just Do It!" 2. Appreciate life. We really have only this moment. Yesterday is history and tomorrow is just a word. This moment cannot be saved for sometime in the future. Life does not work that way, so - the way to deal with tinnitus is tO get through the moment. All problems do not have to be solved at the same time. 3. As Pogo once said, "I've seen the Enemy and It's Us." My ability to cope with the tinnitus came with the realization that there was nothing anyone could really do about it, except me! Because of the noise levels coming from both right and left sides, I am awakened by tinnitus between 3 and 5 times a night. That is the reality and there is no external, simple way tO deal with it except with my own internalized discipline; a discipline which says, "Okay you're up, try to go back to sleep again," or, "Oh - can't sleep, get up and read, do something useful." It is just a fact, and one has to deal with that reality. 4. Strengthen yourself, your resolve and discipline. The way I renew my "discipline" is to engage in physical exercise requiring some effort. The purpose of the effort (which virtually everyone can do if a program is designed for their own physical condition) is to be successful at dealing with it. If you can deal with that stressful exercise, then you can live through the continuing problems of day to day coping with tinnitus. After jogging and backpacking for many years, I have now switched to long distance bicycle riding and touring. I have found, for example, that riding around the islands of Hawaii and Tasmania gives me a wonderful opportunity to be outside, exercise my discipline and see areas that I would not otherwise see. It forces me to meet new people and cope. As a result, if I can ride a bicycle 85 miles in a day, I can live through a day and night of tinnitus. 5. You can do it, if you try. Human beings have the ability to deal with discomfort and be very productive members of society. You can do it, if you just try. The title of these thoughts is not original with me. A friend and contemporary of mine, who had meningitis at age 6 and has been totally deaf since that time, has lived his life tO the fullest and done everything from being a competitive swimmer to an administrator of 100 people. His outlook, which has helped me greatly, is a challenge for all, in that he lives with his deafness by the simple motto: "It's not a problem, it's just a pain in the neck. "~

"Q. T." and "D.B. Kaboom''

cigarette with a slash across it. But it is cuter, and the slash doesn't do the trick. These little stickers are made in Dallas by a major sign publisher. I have donated the idea to the American Tinnitus Association and would like to provide the balance of my present supply to groups which can use them. The master drawings can be loaned or duplicated for other purposes which might require a larger original. For the time being, until my present supply is exhausted, I will supply these at 4 cents each, including tax, to your address in North America. (Order from James Salter,(214) 328-1221.) Please send a self-addressed stamped envelope if you order small quantities. If reprinting becomes necessary, and large quantities are needed (I hope), I will develop prices directly from the printer at cost. I would not like them to be renamed or reprinted inaccurately, or modified without permission. I would like you to outdo one another in thinking of creative applications. I<

James Salter, Industrial Psychologist, Dallas, Texas

I designed these two figures (actual size shown above) on a scrap of paper and had them executed by a professional design artist, John Hagen, now a member of the staff at Walt Disney enterprises. The figure holding its ears I call "D.B. Kaboom." It pretty clearly signifies the pain of excessively loud sound- subjective or objective - and was intended to be used by sufferers and professionals in the hearing-health field. I have suggested and used it to signify that an area is too loud. It can be stuck on a door or elsewhere to warn the unsuspecting. I have attended stage plays where I learned that gunfire was part of the plot, and put the warning stickers in suitable places. They do not tend to deface and can be readily removed. They might also be used to give a not-too-subtle hint to managers of public places that are too loud. Until more cities generate laws and assign officers to police the ear-busting places (like my hometown does: San Antonio, Texas), we are not entirely out of line to affix stickers like this where we have not been able to get results (or even get word to the right person) by simpler methods. I could see a whole city begin to get the idea if these began to appear- particularly if a health editor of a newspaper ran a little article about hearing, tinnitus and sound. The figure holding up one finger I have called "Q.T." The idea of quiet comes across pretty well. The intent here is to signal the viewer to be quiet, as when entering a hospital zone, or any area where people with sensitive ears are present. It is the equivalent of the no smoking sign which has a circle showing a

INFINITUDE
I'm a rusty old truck, vintage 1932, loaded with cotton, Cotton picked by fingers long and burr nicked, fingers plump, so lately playing pat-a-cake. Rattling over grayish earth, gin house bound, a sudden breeze becomes a rushing wind that snaps and whips and flips the ragged tarpaulin cover. I am tinnitus, invading now the far left side. I am steam, hissing, sputtering forth from non-existent radiators. Changing sounds I'm now a regiment of creatures of the night - cicadas they are called - how beautiful their name - how unrelenting in their march toward endlessness. I am tinnitus, loudly claiming right and center.
E.M.P.4

Help is Where You Find It

Deanna Overstreet, Alamogordo, New Mexico If someone were to ask me how best to deal with tinnitus, I think I might suggest a trip to the public library and a perusal of Alcoholics Anonymous' famous twelve step program, along with a description of the theory behind the Lamaze technique of natural childbirth. Sound peculiar? After six years of personal experience, I have concluded that the individual afflicted with tinnitus has much in common both with alcoholics and women giving birth: the alcoholic admits he is powerless to stop drinking; the mother-to-be cannot stop her labor contractions; the tinnitus victim cannot stop that damnable noise in his or her head. In one way or another, all are prisoners of their own bodies. However, alcoholics have found ways to stay sober, and expectant mothers have learned methods of alleviating the pain of childbirth. I believe some of those same methods can help people with tinnitus . Let me explain myself. I'm not an alcoholic (in fact I don't even drink), but someone very dear to me once had a drinking problem, so I've had some exposure to the principles behind AA. The first of their renowned Twelve Steps is: "We admitted we were powerless over alcohol and our lives had become unmanageable;" the second is: "We came to believe that a power greater than ourselves could restore us to sanity." Ifl substituted "tinnitus" for alcohol in step one, I felt perfectly identified with the alcoholic. I had faith in God before I had tinnitus, but I had a most difficult time reconciling myself to the idea that, for whatever reason, I was not--in this mortal body at any rate--going to be delivered from my auditory affliction. I felt doomed that first year. Not only was I apparently being denied the abundant life I felt was my heritage, but because of indescribable fatigue brought about by countless sleepless nights, I had lost all hope of leading even a normal life. It seemed God had sentenced me to martyrdom,

and I felt He had made an exceptionally poor choice.

After several months of alternatively moaning, crying, and screaming, one morning my attitude changed. It was time to get up and I lay in bed exhausted, as usual. I remembered a phrase of St. Paul's, "I can do everything through him who gives me strength," and I got up and did it. It wasn't at all easy, but I did the work that needed doing and even indulged myself in a little reading and sewing--things I might have done during a typical day before that fateful earache so many months before. Incredibly, I did them without complaining or lamenting my fate; when I felt the urge to groan I reminded myself, "I can do all things through him who gives me strength." At day's end, I was amazed. I had accomplished worthwhile objectives and had experienced at least moments of genuine pleasure. The experience proved repeatable. By relying on God's strength instead of my own, I could have good, albeit difficult, days. If only I could sleep at night! At this point I remembered my Lamaze training. It had proved quite helpful during the birth of our four children, so I decided to apply the same principle to a new situation. The Lamaze theory holds that the human brain cannot consciously respond to two different stimuli simultaneously. To the extent a woman can focus her attention on something other than the pain of her contractions, she can mitigate her discomfort. When I lay in bed with my ringing ear upon my pillow, I tried to focus my attention on something else, something comforting. "The continued on page 8

Help (continued)
Lord is my shepherd; I shall not want.. .. " At first it was very difficult. I kept shifting my attention back to that horrid noise, but each time I forced my thoughts back to David's meditation. Eventually it worked and I fell asleep. I counted it a veritable miracle. The procedure became a nightly routine, and it proved effective when I awoke in the middle of the night as well. I soon had hopes of leading a truly normal life again. Five years later those hopes have materialized. I've gone back to school and feel my future offers many delightful options. Some periods are better than others; sometimes it's harder to "tune it out" than usual, but I feel now more like a conqueror than a victim. That first year I saw doctors in three different states and went through a battery of tests at a reputable ear clinic. I was left not with any real p'ractical help but merely a diagnosis. If someone had suggested then that I uy the principles of AA or go back to a Lamaze class, I would certainly have been astonished. Today, however, that would be my first and best advice to anyone with a similar problem. It's cheaper than chasing all over the counuy for virtually non-existent medical help, and far more palatable than being depressed. It's no cure, but for me at least, it's been a terrific treatment.

Research (continued)
Topics covered included Epidemiology and prevalence of tinnitus; Characterization of tinnitus and the psychophysics of tinnitus sensations; Treatments for tinnitus, including pharmacological and electrical stimulation and masking approaches; Measurements to aid in diagnosing tinnitus, such as electrophysiological and psychological; Comparisons of bilateral and unilateral tinnitus. The principal speakers about tinnitus were G .A. Axelsson, J.W.P. Hazell, M.B. Meikle, R.E. Brummett, A.R. Moller, P.S. Guth, M.J. Penner, P.J. Jastreboff, Y.S. Sininger, M.D. Sullivan, J.A. Vernon, D. McFadden, S.C. Brown, C.R. Mitchell, R.S. Tyler, E.M. Burns, and W.H. Martin. We'll be publishing articles by these and other authors in future issues of Tinnitus Today. While in St. Petersburg, Pat and I also enjoyed visiting with self-help group volunteer Vic Jovan. One afternoon we left the ARO meeting long enough for a visit with Dr. Harvey Abrams and his staff, who are shown in the photo below. Jack Vernon accompanied us on a tour of their extensive audiological facility at the Veterans Administration Hospital in Bay Pines, Florida. The trip provided a chance to gather information and to become better acquainted with people in our tinnitus network.

Research Highlights
Gloria Reich, Ph.D.

The Association for Research in Otolaryngology (ARO), met in St. Petersburg, Florida during the first week in February. ATA was represented by Pat Daggett and myself. The meeting provided an opportunity to discuss tinnitus with those directly active in research and to let them know how much we appreciate their efforts. One entire symposium was devoted to tinnitus research and there were other tinnitus related papers and posters presented throughout the meeting.

Questions & Answers

Jack Vernon. Ph.D . Director. Oregon Hearing Research Center

How I Control Tinnitus

Jack Baldwin, Tucson. Arizona

Q uestion: Due to hyperacusis and tinnitus I wear my silicone ear plugs 24 hours a day. I'm frequently pushing and poking at them to adjust and/or alleviate the pain of incoming noise. Will my ear canal be damaged by the buildup of moisture and wax and the constant pressure of the plugs? Ms. B., Aloha, Oregon. A nswer: Many users of in-the-ear hearing aids react to the ear molds. ln some cases, it is anallergic reaction and thus non-allergic molds should be used. Most patients have no canal reaction to the ear molds because those used for hearing aids are usually vented. Your ear plugs are not vented, and you should be careful to watch for any possible tenderness or reactions. Q uestion: One of the most perplexing . problems with my tinnitus is the tremendous Increase in its intensity when I doze off during the day. This does not happen when 1 go to sleep at night. Mr. T., Morton Grove, lllinois. A nswer: Some of our patients have a similar problem. They have fluctuating tinnitus and whenever the tinnitus changes, either to good or bad, it is always during sleep. For them it does not matter whether the sleep is a daytime nap or a full night's sleep. Your case, Mr. T., is different and it prompts me to ask: 1) Does the tinnitus always flare up after a daytime nap? 2) When it flares up, is the change in intensity or pitch or both? 3) Where is your tinnitus normally located? 4) How long does the tinnitus stay elevated during these episodes? 5)Does it go down when you next sleep? 6) Is the daytime nap while sitting up? 7) Could you abstain from daytime naps for a month or two to see if any change in your tinnitus is produced? Another idea is to provide some constant background noise during your daytime naps, such as the noise of a fan or the FM static of a radio to see if that makes a difference. '

1. Sit or lie quietly. Not necessarily in silence, but without distractions such as driving the car. Lying in bed just before falling asleep is an excellent setting, where the procedure will probably bring on sleep. 2. Concentrate on listening to the tinnitus. Identify the ear where the sound is weaker. 3. Now try to raise the pitch (the frequency) of the ringing in the weaker ear. 4. Raise it gently, by imagining you're listening a note or two higher. Gradually work it up several notes. Don't force or push it up- . pretend you are trying to sing a high note by lifting the pitch. 5. When it doesn't appear to move up more, listen to the other ear to see if it has come up too. If not, gradually lift it up to the same pitch as the first ear. 6. Return to the weaker ear and lift the pitch up a bit more, repeating the process alternating between ears. 7. From time to time the sound may become louder or softer. Occasionally the pitch may seem to drop back an octave. These impressions are normal and do not mean the process is not working. 8. You can stop the exercise at any time, whether from fatigue, interruption or discouragement. On returning it will be easy to pick up where you left off. A delay of even several hours doesn't seem to prevent continuing. 9. The procedure may take many sessions to catch on to, and practice will make it much easier. A session can last from 5 minutes to a half hour. 10. Success is moving the pitch of the ringing up, even the least amount. When the mind is on other things the noise of the tinnitus will be less annoying if it is higher pitched. The ultimate goal is to raise the ringing to a point where it becomes more of a high hiss than a ringing.
continued on page 10

Control (continued)
Variation: Occasionally the tinnitus takes another form, such as a pulsating hiss or chirp. The above procedure should be followed until the pitch is quite high. At that point it is possible to imagine lightly grasping the sound between the chirps and lifting it. Success at this can result in the chirps gradually becoming a steady high hiss, as in the successful process with ringing. (Ed. note: You may not have tinnitus that is different in each ear, and you may not agree that high pitched tinnitus is less annoying; this is, after all, just one man's opinion.)

Book Review (continued)

hearing aid. If a new user expects an aid to work like a pair of eyeglasses --put it on, and it works - there will be disappointment that might cause the aid to be rejected. The best of aids needs time and patience and practice, but the rewards can be great. I've used a hearing aid during all my adult life, but I still need a honeymoon with every new device. Hearing-aid users will welcome the clear and well-illustrated instructions for maintaining the instrument and making minor trouble-shooting repairs. Such information is usually packaged with a new aid, but Staab's version is especially clear and detailed. Self-tests, a list of relevant organizations, and other odds and ends of information add to the value of this good little book. ORDER FROM: Wayne J. Staab, Ph.D., 512 East Canterbury Lane, Phoenix, AZ 85022. (602) 942-4939. COST: (US Dollars) $15.00 + $1.50 postage & handling. Canada, add $1.00 per book, other countries, add $4.00 per book. (Volume discounts - write or call for rates.) EDITOR'S NOTE: Readers are urged to seek help for their hearing problems from qualified, licensed professionals. Your physician can refer you to them. Following are three other sources of hearing aid information. 1) To receive a detailed brochure entitled "Facts About Hearing Aids," send your request with $1 plus a long, self-addressed, stamped envelope with 75 cents in postage to: The Publication Department, Council of Better Business Bureaus Inc., 4200 Wilson Blvd., Arlington VA 22203. 2) Further information may also be obtained from the American Association of Retired Persons (AARP), (Dl3766) Fulfillment, 1909 K St. NW, Washington, DC 20049. 3) Hearing aid information by telephone is available through the Hearing Aid Helpline of the National Hearing Aid Society, 1-800-5215247. (Michigan residents call1-313-478-2610).

Book Review
Trudy Drucker

Wayne J. Staab. Hearing Aids: A User's Guide The author of this handy little text obviously intends it to be sold or given by hearing-aid dispensers, but its circulation probably will be broader than that. With its specific information, and at the modest price of $15.00, the book will be good value for any user-- and, especially, a new user -- of the highly sophisticated assistive devices that are now available for the hearingimpaired. Very little is said about tinnitus (and it is not included in the index) so the book will not be helpful to tinnitus patients who do not have hearing loss. Tinnitus is noted only as a possible warning of impending loss or as the consequence of exposure to very loud noise. Staab is an audiologist with a doctoral degree in Hearing and Speech Sciences. He knows his subject thoroughly and in general he writes well. Enlarged boxed quotations placed randomly in the text, and the lively artwork, add interest and clarity. The book has good summarized information about the anatomy of the ear and the mechanism of sound perception, but the slant of the book is clearly practical rather than theoretical. Of particular value is the hour-by-hour, dayby-day plan for making friends with a new 10

Living With Hyperacusis

John J'ice,Jndian Harbour Beach, Florida

I am a church organist and play for the Sunday morning services. However, I can't attend the services or listen to the music even as I am playing it. Although this situation is unusual and interesting, the tragic causes are more important to understand and are something that every person needs to know and take precautions against. Hyperacusis. What is it? Well, it is a life-altering super-sensitivity to sound. Imagine hearing everything, even little sounds, as if they were picked up by a microphone and amplified to 120 decibels, causing hearing pain. That is what a person with hyperacusis experiences with all of the everyday sounds. If a glass and a plate happen to touch one another, it sounds as if one were standing in a bell tower with the bell striking at such a volume as to cause hearing pain. How small a sound hurts? Even pouring pills out of a bottle causes the ear to jump in pain of loudness. Also, along with hyperacusis came tinnitus (a constant ringing in the ears, aggravated by additional noise exposure.) Therefore, the person with hyperacusis must wear ear plugs all of the time, and many things are still impossible to tolerate even with those. Power tools, boating, walking by a highway und eating in a restaurant are all out of the question for a person with hyperacusis. When this first happened to me, I quit playing the organ altogether. About a year and a half later, the idea formed that I could still play the organ, I just couldn't tolerate listening to it. So, now I set the organ and play the music with no sound coming out (it is an electric organ), but with the organ connected by wire to a tape recorder. The recorded music is then played on Sunday morning at the services. Those in attendance have said that if they didn't look over to see the organ with no player, they would think I was still there just as before.

How did the hyperacusis happen? About two years ago my wife and I attended a madrigal concert at church. I was expecting a light, enjoyable affair until the first chord that came out, a full complement of voices pierced through the church at 120 decibels. The sound was well beyond the threshold of pain for me. My initial reaction was to get up and leave, but I didn't, thinking that it would probably be turned down shortly. However, the damage had already begun. I stayed for the whole concert. It was very loud all the way through, but it seemed that my ears were taking it all right with the exception of a few notes during which I had to cover my ears. My ears were ringing after the concen. They are still ringing two years later! They ring enough to make sleep impossible without some medication. My ears grew steadily more sensitive to sound after that incident, until now, almost all sounds are intolerable. Strangely enough, on a hearing test, I show no unusual hearing loss. This is the way it is with hyperacusis. Can anyone get hyperacusis? Everybody has different tolerance levels and some people are more sensitive than others. At sound pressure levels above 90 decibels, most people will gradually sustain some damage to their ears, and at levels over 130 decibels, that damage is certain and rapid. However, what may cause tinnitus and hyperacusis in one may not in others, but everyone should take precautions before noise exposure. My main goals in bringing this story to public view are as follows: 1. Ear plugs should be "standard equipment" for everyone to have with them in case they are needed. (Ed. note: Remember, your fingers are great emergency earplugs.) Ear plugs should routinely be used when engaging in such activities as lawn mowing, using power equipmenr, and attending loud concerts or loud
continued on page 12

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Living With Hyperacusis (continued)

sports events. Hearing damage is cumulative; your tolerance for sound is slowly reduced and hearing problems can creep up before you are aware of them. 2. I would like the public to become familiar with the terms hyperacusis and tinnitus. Although hyperacusis is rare, tinnitus is not. The most common cause of tinnitus is noise. Prevention before damage occurs is the best way to prevent these hearing problems. Many people who are willing to risk high frequency hearing loss might not be so willing if they knew about tinnitus and hyperacusis. 3. I believe hyperacusis should be recognized as a disabling condition. It affects every aspect of a person's life, including working, communicating, sleeping, and eating. Tinnitus in severe cases may also be disabling and can cause loss of sleep, lack of concentration, and the inability to enjoy and function in day to day activities. For anyone who already has hyperacusis or tinnitus, consulting an ear doctor, or a hearing research facility, may be helpful.If

American Tinnitus Association is a participant in the Combined Federal Campaign #0514 in the CFC Brochure

Thank You For Helping To Fight Tinnit us

"COPING WITH TINNITUS"c

e e
STRESS MANAGEMENT &' TREATMENT TINNITUS MANAGEMENT I S OfTEN COMPLICATED BY ANXIETY A.ND STRESS NOW A UNIQUE 0\SSETIE PROGRAM IS AVAILABLE DESI GNED TO PROVID E DAILY REINFORCEMENT AND SUPPORT FROM THE STRESS OF TINNITUS WITHOUT COMPLEX INSTRUMENTATION &' VALUABLE OFFICE TJME

12

A.

ASSOOATED HEARING

CENTERS

There is a growing interest in psychological methods of tinnitus control such as systematic relaxation procedures which help the patient cope with the tension of tinnitus. Subjects with tinnitus are being taught ways to relax as part of a total tinnitus program which may include hearing aids. tinnitus maskers and progressive muscle relaxation based on principles of conditioning. Relaxation procedures are usually easily mastered and can be performed daily in the patient's home environment. It has been demonstrated that the relaxation response can release musde tension, lower b lood pressure and slow heart and breath rates. A relaxation method has been developed entitled Metronome Conditioned Relaxation (MCR) which has successfully treated for many years chron ic pain, tension headaches. insomnia and many other conditions. The program consists of one cassette tape of Metronome Conditioned Relaxation and two additional tapes of unique masking sounds which have demonstrated substantial benefit whenever the patient feels the need of additional relief. These recordings can be used to induce sleeping or as a soothing backdrop for activity and can be played on a simple portable cassette player.
ALL ORDeRS MUST 6E ACCOMPANI W 6Y 010CK. VISA ~PC\RD. OR INSTm.TriONAL P.O.

6796 MARKET ST., UPPeR DARBY, PA 19082

Phone (215) 528-5222

You Can Learn To Live With It

Joseph Sutherl011d Gould, Yorktown //eights, New York When the sonic circuit burst in my ears in September, 1988, starting an almost continuous current of head buzzing, like almost all tinnitus sufferers, I began my odyssey in search of a cure. Since there isn't one yet, it meant facing the simplistic truth, "learn to live with it." My family doctor just pulled up the comers of his mouth into a snicker and plainly announced that I could expect a lifetime of continual head noises. In his commanding manner, the fonner World War li Army officer snapped, "You'll have to learn to live with it." As this was the first time I was to hear this repeated admonition, he waited for the shock wave of disappointment to disappear from my face. Then he explained, "I've had tinnitus since I was 32. Most of the time I am not aware of it. But, I'm one of the people who has to sleep with the ractio on." I Ie offered a sympathetic smile now that I had my helpful therapeutic introduction into tinnitus survival. I then remembered my wife telling me about her aunt who could only sleep when the radio was playing. I never knew why. I knew now. Still not entirely convinced that these noisy phantoms had permnnently taken possession of my head, I embarked upon a pointless pilgrimage to find a doctor who could flip my buzz switch into the off position. Except for learning that the probable cause for my tinnitus was life-long usc of antihistamines for my allergies, I was given the same advice about coping with the insistent sound in my ears. But now, how to actually manage living with it? I needed to get an expectancy awareness of my ailment Was my sound always screeching? Did it moderate from time to time? Perhaps it went into remissiOn occasionally. I had been so preoccupied with my medical quest I had never noticed. For one month I recorded the daily levels of the acoustical onslaught to my head.

This monitoring process revealed that there are variations in sound intensity from day to day. A comforting revelation was that I did get a day or two of remission from time to time. In fact, I discovered the quiet time that came before peak buzzing periods. This was the beginning of my psychological acceptance of "learning to live with it." Next came my Project Discovery which helped complete the adjustment to my affliction. How are other people with tinnitus managing to live with their endless sounds? Since long time head noise sufferers have made their adjustment to their ear lodgers, they rarely speak about it. What then? Simple. Ask people you are in contact with if they have ever heard of this disorder. A bonanza suddenly surfaced. My literary agent told me he had it from age 14 and for a long time believed this was a normal component of the auditory system. His explanation about finding a cure was a recital of my own experience. He constders it no more disturbing now than wearing a wrist watch. He never notices it. The wife of one of my friends got it from a mastoid operation when she was a teenager. The son of another friend got tinnitus by overdosing on aspirin. I have known couples who both suffered with it. A fonner football jock with tinnitus at my gym flatly declared "I ignore it" When I requested that the blasting rock music scarring the walls of my dentist's reception room be turned down, the young receptionist told me that her husband suffered from tinnitus. Then she turned off the maddening music completely. Nearly all the members, covering a wide age range, of a local allergy suppon group have tinnitus. My surprising discovery after rwo years into my affliction came from my brother who told me that he remembered, "Mom had
continued on page 14

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You Can Learn (continued)

head noises. It came after she punctured her ear drum." After completing my inventory of 50 tinnitus sufferers, it was clear that coping with this annoying ailment requires a commitment to have the mind prevail over the body. It's being done. You can do it too.~

VA Info (continued)
$76.00 per month- and retroactive payment back to the date of my first appeal in 1988. I do not know why the award was not made retroactive back to the date that Congress authorized payment for tinnitus ("Tinnitus: persistent as a symptom of head injury, concussion or acoustic trauma."), but intend to find out. Anyone with claims going back to 1976 should make note of this. Other legislation in 1987 established a new hearing-loss rating criteria, which may allow an increased benefit, particularly for cases of profound deafness. Reference: VA Regulations -Title 38 Code of Federal Regulations. Part 4 Schedule for Rating Disabilities- Trans. Sheet 23, October 22, 1987, and Trans. Sheet 24, December 15, 1988 [Section 6260, Tinnitus; Section 8046 Cerebral arteriosclerosis; and Section 9305, Multi-infarct dementia with cerebral arteriosclerosis.] Additionally, Code 3310 Title 38 of Veteran's Benefits makes it possible to claim for chronic fatigue, depression, and anxiety problems that result from a compensated ailment. My advice to anyone with service-connected tinnitus or hearing loss is this: 1) Enlist the assistance of a veterans' organization, or a state or county Veterans' Affairs office at once. (A representative from the VA will help you fill in forms, but my opinion is that the real help comes from the political influence of veterans' organizations.) All branches of service have representatives located at VA regional offices, whose duty and pleasure it is to assist you without charge. 2) Document your physical exams; get statements from your doctors. 3) Prepare a written statement describing the service conditions that caused your problems. 4) Do not give up when your application and appeals are denied; persist until you are granted a hearing. A large percentage of claims at hearings are granted. I hope this may be of help to some readers of Tinnitus Today, as the December 1989 article was to me.*

Veterans' Administration Information

A teller to ATA from Thomas B. Ross

I joined your association several years ago on the recommendation of a friend. Some time later, I read with interest an article in the December 1989 issue of Tinnitus Today about Veterans' Administration disability claims for service-connected tinnitus.(Ed. note: For convenience, these references have been repeated in this article.) This was of great interest because I have suffered from tinnitus and hearing loss since serving as a mortarman in the second World War in the 1940s. When leaving the Army in 1946, I applied for a disability rating for these conditions, and was denied. In 1988, I re-applied for a disability rating through a VA representative. This application, and several appeals were all denied by the VA. The article mentioned above gave me new hope for pursuing the claim, and I researched the references cited. In late spring of 1990 I enlisted the help of the local county Veterans' Affairs Office, and again appealed the VA rejection. After several more rejections, I finally was granted a hearing at the regional VA office, and was assisted at the hearing by a representative of the Marine Corps League (my service was with the US Army!). As part of the hearing, I presented a statement describing my service experiences in detail. The result of all this was the award of a 10% disability rating - at present worth 14

Methods of Aural Hygiene

Leslie Sheppard, Chairman of the Norfolk Tinnitus Group, England and author of the book "TinnitusLearning to livt with it."

In normal circumstances ear wax (cerumen) is continually being moved outward by the movement of the jaw bones and the natural shedding of our skin. Cerumen is made up of the oil secretions of the modified sweat glands in the outer part of the ear canal, plus scales from the skin and dust particles that have entered the canal. Cemmen is harmless unless it starts to accumulate, when it can so easily cause hearing problems. This accumulation is more likely to occur with people working in dusty occupations. It can also easily occur with those people having an excess of hair in their ears, or inflammation of the skin or scalp. An accumulation of cerumen may cause a variety of symptoms. In attempting to relieve the problem people seem to do just the WRONG THING. They try to remove it with the aid of such things as matches, cotton wool buds (Q-Tips), hairpins or other implements. The effect of this will most often be that the wax becomes impacted at the narrowest part of the ear canal, which in itself can cause irritation and often tinnitus.

Similarly, hearing problems can result from swimming or even taking a shower. This is caused by water entering the ear canal and swelling any wax that may be there. In such cases a person can additionally feel very dizzy. The accepted remedy for wax removal has for far too many years been syringing with warm water; the operator aiming the jet to the upper part of the canal so that it brings the wax forward and out. It is my finn opinion that such syringing should never be carried out on any persons with tinnitus or those likely to be susceptible to it. We have in our Norfolk Tinnitus Group several dozen members who have presented to their physician with a wax problem, had their ears syringed in this way and developed tinnitus almost immediately. It is a story I hear repeatedly on our Helpline. In fact, one of our lady members had both her ear drums pierced by the nozzle of a syringe operated by a doctor's nurse and has suffered from very bad tinnitus ever since. I appreciate that syringing has been going on for many years and that many people have had this done quite frequently without any bad effect. I also accept that a pre-existing impairment is often the underlying factor in the emergence of tinnitus, but the incidence of tinnitus so quickly following syringing for so many people is also extremely convincing. It is surely better to be safe than sorry. The danger of this happening to YOU can be easily avoided by stating that you wish the wax to be cleared by "The Suction Clearance Method," but unfortunately the majority of General Practitioners (in the U.K.) do not have the necessary equipment. It is therefore essential for you to ask to be referred to a specialist. In cases where wax has accumulated in considerable quantities it is important to have this attended to without syringing. (Ed. Note: Please note that these are
continued on page 16

15

Methods of Aural Hygiene(continued)

instructions for people in England. You '11 need to consult with your own physician regarding procedures in the U.S. and Canada.) In the "Suction Clearance Method," which is without doubt the safest method of all, the patient lies on his or her back with the head turned to the side and the specialist looks into the ear with a microscope having high magnification and illumination. Then, using either a metal or plastic speculum, the ear is examined through the microscope. Any debris or wax can then be lifted out carefully with fine forceps, and, should soft wax exist, this is drawn out by a small suction tube attached to a little vacuum pump. All those who have had this treatment have reported on it favorably. I'd like to make one final point. Let us be fair to our doctors. Those of us who have tinnitus should always mention it when visiting our doctors. Foolishly, so many do not. Please don't expect your doctor to remember your tinnitus from your last visit. You are the one with the constant reminder! *

COMPUTER COMPETITION
Are there any computer geniuses out there who can devise something helpful for those of us with tinnitus? Here's your chance to make your ideas pay off. The Johns Hopkins National Search for Computing to Assist Persons with Disabilities is offering a grand prize of $10,000 and more than 100 other prizes for the best ideas, systems, devices and computer programs developed by professionals, amateurs, and students. Entry deadline is August 23, 1991. For more information write: Computing to Assist Persons with Disabilities, POB 1200, Laurel, MD20723.

MENIERE'S CONFERENCE
International Conference of Meniere's Societies is planning a meeting in England for the autumn of 1993. Further information may be obtained by writing: Meniere's Society, 98 Maybury Road, Woking, Surrey, GU215HX, ENGLAND.

SELF -HELP GROUPS

Contact ATA National Office for information about joining, or guidelines for forming a group.*

Notices
TINNITUS STATISTICS AVAILABLE
In the September, 1990 issue of Tinnitus Today we published a summary of "Older Americans and Tinnitus: A Demographic Study;" by Scott Campbell Brown. This study, which was funded by the American Association for Retired Persons' Andrus Foundation, resulted in a monograph containing considerable valuable demographic data about tinnitus. These monographs are available from Gallaudet University Research Institute Center for Assessment and Demographic Studies, Kendall Green, 800 Florida Ave NE, Washington, DC 200023695. (202) 651-5575 [V!IDD] The cost is $10.00 each. 16

Classified
SPECIAL PILLOW CAN RELIEVE EAR NOISES AND AID SLEEP Your sleeping habit may be robbing you of a proper night's sleep. The Ear Relaxer can change your life. Austin Skaggs, the inventor of the Ear Relaxer Pillow reports that it has helped him and many other people who have tried it. To order, send $14.95 + $3.00 Shipping/Handling to: EAR RELAXER POBOX90 VICTOR, WV 25938

Media Watch: Tinnitus in the News

Cliff Collins

Speaking of which: The January 26, 1991

Chicago Tribune carried a piece describing

First, thanks to readers from all over the country who sent in news repons on tinnitus-related subjects. Response has been large enough that we can't include them all, but isn't it encouraging that more and more newspapers, magazines, TV and radio stations finally are devoting time and space to this important topic? It's about time. Heavy-circulation pulps may not pull Pulitzers, but they attract millions of readers nationwide. Thus, what a relief to discover that some of their stories impart useful information. Take the Woman's World (January 8, 1991) short on tinnitus: It addresses noise dangers and their role in causation, recommends examining any medical problem that might be connected, and says that some people get relief from "listening to competing sound," including tinnitus maskers. Basic stuff, but welcome because the media so often miss the main points, even in long stories, and thus much of the public remains uninformed. The December 25, 1990 National Enquirer contained another tabloid entry titled, "Here's the dirt on why vacuum cleaners are so noisy." "Ever wonder why vacuum cleaners are all so darn noisy?" the article asks. "The startling answer is that people wouldn't buy them if they didn't make such a racket-- because they think quieter machines are less powetfu1!" The U.S. Environmental Protection Agency fmmd in a study that manufacturers deliberately make vacuums, lawn mowers, leaf blowers, hair dryers and other mechanical horrors much noisier than they need be. The reason, says an EPA scientist: People equate noise with power, and think a quieter machine doesn't do as good a job My, what the people now working on noise-cancellation technology are up against!

Northwestern University's attempts to build a better hearing aid. Engineering professor Janet Rutledge says "digital signal-processing chips" within a few years may provide noise canceling for the internal noise of tinnitus, as well as for the technological cancellation of external noise. Audio magazine added to the growing list of articles mentioning musicians felled by loud music, noting that former rock bassist Jay Morse's ears became so sensitive that he must wear earplugs to walk down the street. Other publications mentioning tinnitus included VFW (March), Modern Maturity (December-January) and The Las Vegas Review Journal. No medical center has a more lofty profile than the Mayo Clinic, but The Mayo Clinic Health Leuer' s stab at tinnitus (October 1990) contained dubious facts, such as the explanation for tinnitus (which, despite the confident description, scientists don't understand); it also would be interesting to see documentation of the Letter's words on masking ("most wear them for no longer than a week"), and its contention that "as many as 75 percent of people with tinniLus claim their symptoms improve with time." The respective newsletters of the University of Michigan and Washington University, St. Louis, chronicled studies noting that hearing damage is cropping up in children as well as teenagers. Researchers also reported that sounds emanating from video arcades, stereo headsets and rock concerts far exceed noise levels of workplaces where employees are required to wear ear protection. Cliff Collins is an Oregon writer. Send clips, with source and dare, to Media Watch, ATA, PO Box 5, Portland, OR 97207.

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Tributes, Sponsors & Professional Associates

The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for sharing memorable occasions in this helpful way. Contributions are tax deductible and are promptly acknowledged with an appropriate card. The gift amount is never disclosed.
IN MEMORY OF Wilfred An fang John & Faye Schlater Helen Bartko Betty Bartko Helen Bartko Chiyoda International Kathryn B. Dilworth Celina M. Dilworth Mr. Mike Eggnatz Jean & Joe Wolfson Sylvia Goldman Mae & Albert Feluren Mr. Gomez Len & Marisue Mayer Mr. Ed Gonzales Len & Marisue Mayer Nana Hablnger D. and J. Smith VIrginia Hellman MIM Efrom Abramson Raymond D. Higdon Annie F. Percival Don Lindberg Dr. & Mrs. George Carr Donald Lltln M/M Efrom Abramson Joseph Meneghel Don Williams Henry Owczarzak Joseph Alam!rrudy Drucker Elmer Penney TheW. L. Penney Family Dennis A. Roberts Marjorie Porter Norman Rosen Dolores M. Hall Shirley Rosenberg Melvin & Marilyn Kirsch Jack Rubin A. Paul Camerino Wallace F. Schlater John & Faye Schlater Jack Schneiderman Frank & Frances Yaffee Grace Selmon Dr/Mrs Philip Silverstein Nancy Shaffer John & Faye Schlater Angela Sorrenti Maria Fishman Mrs. Anna Weisberger Zelbie & Carole Trogden Irwin Yeckes MIM Sam Eisenberg Mrs. Evelyn Zaron Jean & Joe Wolfson Herbert Ziner Ellie Ziner IN HONOR OF Joel Bernstein Birthday Nettie & Israel Bernstein Wade Brody Dolores M. Hall Dr. Robert Brummett Virginia A. Lobsinger Ann Byrnes Theresa Aston William Consalo, Jr. Kathy & Bert Bifulco, Ill Mary Cook-Son's Marriage Jean & Joe Wolfson Men/Women of Desert Storm Philip M. Coston Dr. Meyer Eggnatz Jean & Joe Wolfson M/M Elperin-Costa Brava Mr. and Mrs. Wolfson Mora C. Emln Birthday Joseph Alamrrrudy Drucker Denny Ferguson Birthday Mr. and Mrs. Wolfson Dr. Alan Frankel-In Thanks Mr. and Mrs. Wolfson Dr.Richard Gardner-Birthday Joseph Alam!rrudy Drucker Dr.Richard Gardner-Birthday Marlyn Friedberg Dr.Richard Gardner-Birthday Mrs. Helen Ross Dr.Richard Gardner-Birthday Dan/Barbara Sugarman Mrs. Lewis Gillingham Jean & Joe Wolfson Mark Elliott Graham Donna Graham Mark Elliott Graham Harold Graham Greenfield-Larry's Success Jean & Joe Wolfson Nicole Guttermuth Jean & Joe Wolfson Dr. Herschmann Good Luck Jean & Joe Wolfson Mr. Jerry Katzman Jean & Joe Wolfson The House of Kendls "Mamacita & Gramps Jeffrey Kendls "Mamacita & Gramps Sherman Kendls "Mamacita & Gramps Mr. Martin Klein Jean & Joe Wolfson Mrs. Harry Korn Jean & Joe Wolfson Ms. Sharon Korn Aunt Jean & Uncle Joe Dr. & Mrs. M. Kronick Jean & Joe Wolfson Rita Londoner Jean & Joe Wolfson M/M Clarence Lovitch Jean & Joe Wolfson Rappahannock Community College Library Staff Mrs. Ann Revere Ralph Revere Mrs. Ann Revere The House of Rosenthal "Mamacita & Gramps Dr. & Mrs. Eugene Sayfie Jean and Joe Wolfson Sayfie Lisa's Ranking Jean and Joe Wolfson Dr. Abraham Shulman Francine Foster Dr. Joseph Singer Jean & Joe Wolfson Bernard Smolin75th Birthday Claire & Jack Simon Dr. & Mrs. Abram Sohmer Jean & Joe Wolfson A. Sohmer 78th Birthday Jean & Joe Wolfson Sam Spivak Birthday Joseph Alamrrrudy Drucker Splvak-Engagement of Bill & Roberta Joseph Alam!rrudy Drucker Renee Stone New Home Joseph Alam!rrudy Drucker Charles Whited Great Writing Jean & Joe Wolfson ATA SPONSOR MEMBERS FEBRUARY to MAY 1991 Jesse Alexander Robert C. Backus Betty Bartko Carl Bellero M/M Arnold Ballowe Elliott Berger Harold E. Bergsma Sanford Blaser Charles T. Brown A. Paul Camerino James Clarke Tony Correa Robert J. Corwin W. S. Cowling, II Lawrence J. Danna, M.D. Frederick Dreier George R. Dvorak Robert J. Feiertag Patricia S. Fink Francine Foster Larry Fureigh Dr. WilliamS. Gartner, Jr. Mac Geschwind Veva J. Gibbard Donna Graham Harold Graham John P. Griesbach John Hafer Richard R. Harlow Max Horn Douglas Kees Barbara L. Kohn David J. Kovacic Lillian Linka Barry 0. Maisel, M.D. Vince Mangus John M. McNamara John Meehan Alexander B. Miller Clara M. Mueller Jeanne O'Donnell Edward Palin Otis D. Rackley, D.D.S. Ann E. Revere Harry L. Ricketts William D. Riley Daniel Ross Dennis Roth Rick Sarkisian Sylvester/Gladys Saunders Ruth M. Swan Daniel K. Tarkington Arthurl. Teague James/Pat Totten Scott Turner James M. Wade Frederick/Erdean White Robert M. Whittington Kathleen M. Williams Adelaide W. Zabriskie ATA PROFESSIONAL ASSOCIATES Sean R. Althaus, MD Knox Brooks Emmett E. Campbell, MD Jack D. Clemis, MD Joel G. Cohen, MD M. Monica Dietsch Marco Elisabetsky, MD Bruce A. Feldman, MD Michael G. Genz, MS Claude Hobeika, MD W.F.S. Hopmeier Kathy Mellott, MS Peter and Connie Meroola David R. Nielsen, MD Alan Nissen, MD Robert I. Oberhand, MD Richard J. Osborn, MA Meredith K.L. Pang, MD Philip A. Rosenfeld, MD Ira D. Rothfeld, MD Mansfield F.W. Smith, MD Thomas E. Sonne, MD Hollis Underwood

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Welcome To The New Generation of plification Excellence.

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A New Generation of Reliability. The 7 Series introduces a whole new generation of design excellence. A completely new faceplate with isolated microphone and amplifier positioning increases manufacturing efficiency while virtually eliminating mechanical feedback. The smaller, more stable high tensile gold-plated contacts along with the new, ultra-durable VC and socket assembly both ensure a more reliable performance with virtual elimination of intermittency problems. Welcome to the New Gener.. ation. Never before has the industry experienced this level of amplification excellence - all designed to enhance your own high standards of service excellence. Because we are dedicated to providing the very best for you and those you serve, we believe ALL your patients should benefit from this newest generation of unequaled sophistication, no matter what they presently wear.

Starkey products, including tinnitus maskers, are available from yo ur local hearing health care professional listed in the Y ellow Pages under "hearing aids".
AMERICAN TINNITUS ASSOCIATION
P.O. BOX 5, PORTLAND. OR 97207 ADDRESS CORRECTION REQUESTED

NON-PROFIT ORG. U.S. POSTAGE PAID American Tinnitus Association