Tinnitus Today September 1994 Vol 19, No 3

SEPTEMBER 1994 VOLUME 19, NUMBER 3
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:
NEW: Letters to the editor
TMJ - a Profile, and other TMJ articles
The Exploding Head Syndrome
Ototoxicity and Hearing
Sounds Of Silence
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Tinnitus Today
Editorial and advertising offices:
American Tinnitus Association, P.O. Box 5
Ponland. OR 97207
Executive Director & Editor:
Gloria E. Reich. Ph.D.
Editorial Advisor:
Trudy Drucker, Ph.D.
Advert.ising sales: AT A-AD, P. 0. Box 5,
Ponland, OR 97207 (SOQ-634-8978)
Ti1miws Today is published quarterly in March,
June. September and December. Jt is mailed to
members of American Tinnitus Association and a
selected list of tinnitus sufferers and professionals
who 1rea1 tinrtitus. Circulation is rotated to 100.000
annually.
The Publisher reserves the right to reject or edit
any manuscript received for publication and tore-
ject any advertising deemed unsuitable for Tinnitus
Today. Acceptance of advertising by Tinnitus To-
day does oot constitute endorsement of the adver-
tiser, its products or nor docs Tinnitus
Today make any claims or guarantees as to the ac-
curacy or validity of the advertiser's offer. The
opinions expressed by contributors to Tinnitus To
day are not necessarily those of the Publisher. edi
tors, statT. or advertisers. American Tinnitus
Association is a non-profit human health and wel-
fare agency under 26 USC 501 (c)(3)
Copyright 1994 by American Tinnitus Associa
lion. No part of this publication may be repro-
duced. stored in a retrieval system, or transmitted
in any fom1. or by any means, without the prior
written permission of the Publisher.
JSSN: 0897-6368
Scientific Advisory Committee
Ronald G. Amedee. M.D., New Orleans, LA
Roben E. Brummett. Ph.D .. Ponland. OR
Jack D. Clemis, M.D .. Chicago.IL
Roben A. Dobie, M.D .. SanAntonio, TX
John R. Emmert, M.D., Memphis, TN
Chris B. Foster, M.D., San Diego, CA
Barbara Goldstein, Ph.D., New York. NY
Richard L. Goode, M.D., Stanford, CA
John W. House. M.D., Los Angeles. CA
Robert M. Johnson. Ph.D .. Ponland. OR
Gale W. Miller, M.D. , Cincinnati. OH
J. Gail Neely, M.D., St. Louis. MO
Jerry Northern, Ph.D . Denver. CO
Robert E. Sandlin, Ph.D .. San Diego. CA
Alexander J. Schleuning,n. MD, Ponland.OR
Abraham Shulman, M.D., Brooklyn, NY
Mansfield Smith. M.D . San Jose. CA
Honorary Board
Senator Mark 0. Hatfield
Mr. Tony Randall
Board of Directors
Edmund Grossberg. Crucago. IL
Dan Robert Hocks, Ponland, OR
W. F. S. Hopmeier, St. Louis, MO
Philip 0. Monon, Ponland. OR. Cbnm.
Aaron I. Osherow, St. Louis. MO
Gloria E. Reich, Ph.D .. Portland, OR
Timothy S. SolOS. Lenexa, KS
Thomas Wissbaum, C.P.A., Portland. OR
The Journal of the American Tinnitus Association
Volume 19 Number 3 SEPTEMBER1994
Tinnitus, ringing in the ears or bead 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.
Contents
4
6
9
10
12
13
14
20
21
22
24
25
27
Regular Features
16
17
26
Envelope
Letters to the Editor
by Gloria E. Reich
TMJ - a Profile
by Barbara Tabachnick
Nutritional Approach to TMJ
by Jerome S. Mittelman
The Tinnitus Connection to TMJ
by Sharon Carr
Development Directions
by Brent R. Mower
Our Celebrities
by Barbara Tabachnick
by Max S. Chartrand
by Leslie Sheppard
Profiles: AT A Board.Member
W.F.S. Hopmeier
Spring Swing Through the Southeast
by Patricia Daggett
Self Advocacy 101
by Linda E. Dowell
Tributes - A Gift of Love for Life
Fifth International Tinnitus Seminar Announcement
Media Watch: Tinnitus in the News
Questions & Answers
Tributes, Sponsors, Special Donors, Professional Associates, etc.
Publications List, Donation Form
Cover artwork: "An Autumn Scene" photograph, by David Morowitz. M.D. Inquir-
ies to David Morowitz Photography, 106 Irving St. NW, Washington, DC 20010.
Letters to the Editor
This time instead of my comments,
I'd like to share sonze of our many
leners. The opinions expressed are
strictly those of the letter writers and
do not reflect an opinion or en-
dorsement by AT A. Gloria E. Reich,
Ph.D., Editor.
I n 1992 I was scheduled for a
rigorous cycle of chemotherapy
including Cisplatin, a platinum-
based agent that is far-and-away
first choice for treating cancers
like mine. Tinnitus is at the top of
Cisplatin' s list of known side ef-
fects. My tinnitus, which began
following surgery, had debilitated
me to the point that my recovery
had been retarded. The prospect
of exacerbated tinnitus was so
daunting that I considered declin-
ing the chemotherapy that prom-
ised to prolong my life.
Nevertheless, I tried to fol-
low my doctor's prescription and
learn to live with it. I proceeded
with chemotherapy. My tinnitus
became almost unspeakably
worse, in volume and pressure. I
had no choice but to keep trying
to find help. I read everything. I
talked with everyone.
I saw other physicians, each
of whom promised help, all of
whom were unable to deliver
symptom management. Treat-
ments included masking, mineral
supplements, acupuncture, re-
flexology, "natural medicine," vi-
tamins, ear-drops, various flora
from a variety of herbalists, and so
on. My tinnitus prevailed.
Then early last December I
made an appointment to see Dr.
John J. Zappia in Hinsdale, IL. He
4 Tinnitus Today/September 1994
prescribed 25 mg of Elavil at
bedtime. After three weeks to get
blood levels up, Elavil changed
my life. The sense of pressure has
lifted to a totally tolerable level.
The jet-engine noise I've been
hearing is less invasive. My life is
becoming far closer to normal.
Thanks to the state-of-the-art
skill and talent of Dr. Zappia, I
finally have learned to live with
my tinnitus, a condition which
had been far more totturous to me
than my cancer.
From Diane L. Estrin, Chi-
cago, IL
I would like to thank the AT A for
all the help and infonnation I have
received about tinnitus. If it were
not for the AT A I would probably
have bad a much longer route to
where I am today.
I am one of the lucky ones
whose tinnitus is not so bad and I
have a good idea of what is caus-
ing it. My problem is TMJ related
and none of the 5 doctors I saw
ever mentioned this as a cause
until I mentioned it. I can make
my right ear ring just by pushing
on the jaw muscle! I can make it
almost stop by moving my jaw a
certain way. I would have never
even considered these things if I
had not read about them in the
ATA books and literature.
From: Bill Creeden, Cedar
Falls, lA.
M y internist suggested I use a
drop or so of hydrogen peroxide
in the ear to dry up the wax. This
has helped with the noises (the
sound I had was like an engine of
a car running) but not with the
ringing. The ringing is tolerable
because the sounds of the day
block it out and at night I just tum
on my masking machine, and thus
I manage.
From: Evelyn Portnoff, Ball-
win, MO.
A s a sufferer of severe tinnitus, I
am writing to share a remarkable
event l have experienced which
may hold great promise in treating
this disorder. Although I have not
been "cured" of tinnitus, I no longer
experience its dreadful effects.
A medication prescribed by
my physician four years ago to
lower my blood pressure caused
me to experience tinnitus. The
medical community infonned me
that a cure did not exist to elimi-
nate the constant hellish roaring
within my head. I have been in-
formed that many individuals
who have high blood pressure
also suffer from tinnitus.
Approximately 18 months
ago, the medication Clonidine
was prescribed in tablet form by
my doctor as a treatment for my
high blood pressure. Clonidine
was effective in lowering my
blood pressure, but my tinnitus
was unaffected. Seven months
later I chose to use the patch form
of Clonidine known as Catapres-
TIS in order to receive a more
constant equally distributed dos-
age. The patch was initially
placed on my shoulders. As the
owner of a marina, I was con-
stantly getting the patch wet,
which necessitated frequent re-
placement. I then decided to place
the patch on my ear lobes. Within
24 hours I experienced a nearly
Letters (continued)
complete disappearance of the tin-
nitus. The roaring in my head that
I had lived with for four years was
now minimal. I tested the efficacy
of the Catapres-TTS being the
causative agent in eradicating the
tinnitus by removing the patch
from time to time. The relief from
tinnitus occurred only when the
patch was replaced. At a later
date, I positioned the patch on my
mastoid bone, located immedi-
ately posterior to the ear, in order
to conceal the patch. I experienced
several uncomfortable side ef-
fects, (severe dizziness, head-
aches, etc.), and consequently
reduced the size of the patch until
there were no side effects. Place-
ment of the patch on the mastoid
has proven more effective than on
the ear lobe.
I strongly caution individu-
als not to self-medicate with
Catapres-TIS. Serious damage
may occur if cardiac medication is
not monitored. In addition, an in-
terruption in blood flow could oc-
cur without medical supervision.
This medication has not been ap-
proved by the FDA for the treat-
ment of tinnitus. I hope that others
who suffer from severe tinnitus
could be helped by this medica-
tion, but I understand that formal
studies must be conducted to af-
ford this possibility.
From: Charles F. Hardison,
Jr., Key Largo, FL
I have benign intracranial hyper-
tension and have right-sided pul-
satile tinnitus. I welcome letters
from others with similar (pulsa-
tile) tinnitus so I could share with
them the avenues I tried. I finally
got a diagnosis after 10 years of
going from doctor to doctor. AT A
is responsible for all the excellent
research information available on
this subject through their bibliog-
raphy department.
Please let me help others with
the same problem as I am sure there
are those who feel that agonizing
emotion of annoyance, frustration,
and depression as I have felt.
From: Susan Pfautsch, 147-
15 35th Ave #2E, Flushing, NY
11354
T hank You! Ending the Silence
(December 1993) was excellent
and is appreciated. I understand
traditional medicine's concerns
when "alternative" medical solu-
tions are discussed. However,
your presentation and the qualifi-
cations provided should mitigate
those concerns.
I didn't see anything in the
article that's going to make me
jump up and chase one of the "al-
ternatives," but I am relieved to
think that I may be getting the best
information available. The pri-
mary beneficial result of your ar-
tkle is that I don't have to
personally chase down the real in-
formation on these "alternatives"
and the future "alternatives" that
will surely pop up.
Don't misunderstand, I'm
glad to hear that any avenue is
pursued, traditional or non-tradi-
tional. If someone wants to pursue
some long lost magical chanting
ritual from some long lost civili-
zation I'm all for it. And if they
claim a cure I hope you people at
AT A will be there on my behalf to
check it out and report back. Ed.
Note: Watch for an upcoming is-
sue of Tinnitus Today featuring
alternative treatments.
From Robert Roper,
Healdsburg, CA
H aving found no relief through
traditional medicine, approxi-
mately six months ago I visited a
naturopathic physician. He pre-
scribed a modification of my eat-
ing habits, an increase in some
vitamin supplements, and an
herbal supplement, which is said
to be helpful in strengthening the
immune system. As at least most
of these were tailored to my needs
specifically I will not list them
here, but I have had such an im-
provement that I would whole-
heartedlyreconunendthatanyone
suffering from tinnitus consult
with a naturopathic physician.
From: Bill Rossi, Seattle,
WA.
M y tinnitus problem has less-
ened considerably due to an un-
usual reaction to Klonopin. It was
prescribed for my "restless legs"
and has truly given me good
nights of sleep. While in my doc-
tor's office, I suddenly realized
that my tinnitus problem seemed
to be disappearing too. He said it
was due to Klonopin.
From: Gladys Murray, Albe-
querque, NM.
Tinnitus Today/September 1994 5
TMJ - a Profile
by Barbara Tabachnick, Client Services Coordinator
Douglas Morgan DDS, president of the TMJ
Foundation, bas been a proponent ofTMJ therapy for
tinnitus for nearly 30 years. Irving Bernstein DDS,
Jerome Mittleman DDS, Elias Costianes DDS, Ar-
nold Greene DDS, and others have likewise been
treating TMJ-related tinnitus for decades. Their
amassed case histories of tinnitus successes are con-
siderable. Yet in light of the many successes over this
significant span of time,
we wonder what has
kept TMJ-tinnitus
treatment from taking
the country by stonn.
jaw or mandible. A cushioning disc sits between
the ball and socket.
1
A disorder of this joint, the
jaw muscle, or a combination of the two is inter-
changeably referred to as TMJ, TMD, TMJD, MPD
(myofascial pain dysfunction), and even CMD
( craniomandibular disorder).
WHAT DOES TMJ FEEL LIKE?
For most people, it hurts. Referent pain can be
felt in the bead, neck, mouth, face, and ears. Head-
aches, jaw clicking or
popping, andjawlock-
ing are symptoms typi-
cally experienced by
those with TMJ. Asso-
ciated symptoms of
UpJ)et Jaw
tinnitus, dizziness, dif-
ficulty swallowing,
numbness in arms or
hands, and fatigue can
also occur. It is com-
mon for many symp-
toms to be present at
the same time.
As an outsider to
the dental profession,
AT A has for years
been observing the po-
lite but ever-present
infighting among TMJ
specialists - esteemed
professionals all, who
nevertheless maintain
that their own way is
really the way. We can
speculate that this in- Press, PO Box 573, Santa Fe, NM_ TMJ- .Jaw
sistence on individualConnectwn by Greg Goddard, D.D.S. reprmted wtth permrsswn.
TEETH AND
OTHER TMJ
CULPRITS
In his book, TMJ
- The Self-Help Program, John Taddey DDS states
that "the teeth have a profound influence on the
position of the ball and socket as well as on the
amount of stress placed on the joint. If the bite
between the teeth is not stable, the slight move-
ments within the joint, repeated over and over
again, may wear down the shock-absorbing disc as
you chew, eventually producing painful bone-on-
bone contact and TMJ damage."
"rightness" and another's "wrongness" is one rea-
son that TMJ has been stalled in gaining a wider
national acceptance.
We very gratefully acknowledge those who
have contributed material for use in this issue.
Through the following articles, we will present a
variety of TMJ methodologies and outline areas of
commonality in the TMJ field. In doing so, we hope
that TMJ specialists everywhere will finally find
their similarities more intriguing than their differ-
ences - for the sake of the millions who stand to
gain so much from such an alliance.
WHAT IS "TMJ?"
The initials "TMJ" stand for the temporo-
mandibular joint, the jaw joint in front of each ear.
The upper socket of the joint, called the fossa, is
part of the temporal bone. The ball that fits into the
socket is called the condyle and is patt of the lower
6 Tinnirus Today/September 1994
Ill-fitting dentures, or misaligned, worn
down, or missing teeth can cause TM joint stress.
Physical trauma, as in the case of whiplash, can
affect the nerves and muscles in the head, neck, or
jaw and cause the disc between the condyle and
fossa to slip out of position. Taddey lists otherTMJ
causes: arthritis in the TM joint, poor posture,
benign tumors in the jaw area, infection, teeth
grinding, nutritional deficiency, genetic predispo-
TMJ (continued)
sition, and emotional stress. Gender is also a factor:
three times more women than men have TMJ.
TREATMENTS
The essential TMJ treatment begins, of course,
with the mouth. The bite may require realignment, not
with ''braces" per se, but with a removable appliance
that fits over either the upper or lower molars and
pre-molars. Initially these "orthotics" or splints are
made of plastic to allow for easy modification of the
splint as the patient's bite slowly adjusts. As the
muscles in spasm relax, usually after several months
of appliance wear, the patients' s bite stabilizes and symp-
toms are either reduced or eliminated. At that point, some
dentists suggest that the splint be re-cast out of a more
permanent material,
2
that crowns for the teeth be made,
or that other permanent treatments be tried.
Because the jaw clenches instinctively as a
first reaction to stress, the control of stress is criti-
cally important for the TMJ patient. Meditation,
exercise, stretching, massage, deep breathing, and
counseling can help. Other therapies include moist
heat and cold treatments, nutritional/allergy analy-
sis, cold laser therapy, ultrasound, anti-inflamma-
tory drugs, and in some cases surgery.
The pterygoid muscles inside the cheek are
painful to the touch if they are in spasm (a TMJ
indicator) and a clicking in the jaw can be heard.
To detect these, many dentists use stethoscope
examination and hand palpation of the jaw for
diagnostic purposes. Computerized diagnostic
"jaw tracking" equipment is also available. Myo-
Tronics and BioResearch have both developed sys-
tems that generate graphs of patients' jaw
movement and muscle activity.
Whether a patient's bite measurement is done
by hand or by computer, Dr. Costianes emphasizes the
importance of allowing the mandible to relax before a
splint is fitted. Electronic devices such as the T.E.N.S.
(Transcutaneous Electrical Nerve Stimulation) unit are
used to attain an optimum relaxed-jaw state.
Some dentists prefer the new technology; oth-
ers swear by the manual technique. All agree on the
importance of having patients complete extensive
medical and symptom questionnaires before any
tests or treatments begin.
TMJRESEARCH
As early as the 1920's, clinicians associated
symptoms such as tinnitus, "stuffy" ears, ear aches,
and dizziness with the dysfunctioning temporo-
mandibular joint. At that time, Dr. J. Costen, an
ENT physician, observed that by repositioning the
jaw to relieve masticatory problems, the ear-related
problems of the same patients were also relieved.
Pain in the TMJ became known as "Costen's Syn-
drome." The search for a proven connection be-
tween the jaw joint and the ear, however, would
take another 40 years.
In 1962, a researcher named O.F. Pinto dis-
covered, via dissection, a ligament connecting the
TMJ to the malleus bone, one of the three bones in
the middle ear. This seemed to confirm Dr. Cos-
ten's claim. Research in 1977 by Dr. H. Arlen, an
otolaryngologist, established that the basic nerve of
the jaw (the fifth cranial or trigeminal nerve) was a
major nerve in the auditory structure. Arlen' s re-
search also demonstrated a connection between the
trigeminal nerve and the tensor tympani and the tensor
veli pala:fni - two muscles that impact the auditory
system. As a whole, though, clinicians remained
skeptical of Dr. Pinto's pioneering work.
Then in 1986, Dr. E. Komori successfully
duplicated Pinto's early research. And again in
1993, Goode and Murikami of Stanford repeated
this research confirming that "Pinto's ligament"
does pass from the malleus to the TMJ, and that
"movement in the joint tissue produce! a move-
ment of the ligament and the malleus."
The discovery of this tiny ligament and the struc-
tures it connects is a big one. It links an area of
correctable physical dysfunction directly to the mecha-
nism of the ear, and very possibly directly to tinnitus.
But this assertion still needed clinical verification.
Dr. Morgan' s concurrent research in 1988
described the effects of a teflon-coated jaw joint im-
plant taken off the market after patients experienced
severe post-surgical reactions. Aside from its danger-
ous material, the implant was over-sized and covered
the opening through which ''Pinto' s ligament" passed.
Morgan' s research noted that the patients who had not
had tinnitus before surgery, did so after surgery. When
the teflon implants were removed and replaced by
TMJ ( continued)
smaller ones that did not cover the opening, the
tinnitus was "eliminated or greatly improved."
5
Clinical research continued. In 1992, Robert
Chole MD, PhD and William Parker DMD, PhD
conducted an extensive study involving 338 TMJ
patients and 694 non-TMJ patients who made up two
control groups. The researchers found that tinnitus
was a common enough symptom in the control groups
(13.8% in one group and 32.5% in the other). But ~ e
prevalence of tinnitus in the TMJ group was 59%.
CASE HISTORIES
Dr. Bernstein shares the case histories of two
tinnitus sufferers who experienced relief after cor-
rection of their improperly aligned jaws. "The first
patient was a 57-year-old female who complained
of ear infections accompanied by loud hissing and
ringing noises in both ears. Visits to several ear
specialists revealed no organic cause. Brain and
hearing tests, and medication administered by a
tinnitus specialist were of neither diagnostic nor
therapeutic value. Dental x-ray examination of the
mouth was uneventful. Clinical examination re-
vealed overdosed dentition and bruxism (teeth
grinding). The second patient was a 30-year-old
female who complained of an earache accompa-
rued by chronic pounding and ringing in her left
ear. She was treated unsuccessfully several times
for an inner ear infection and even had the ear drum
surgically pierced to drain the proposed fluid build-
up. No fluid was found. Dental x-ray examination
of this patient revealed no abnmmalities. Clinical
examination revealed malocclusion caused by
missing and poorly positioned teeth.
The treatment for both patients consisted of
restoring the jaw to a normal position with a removable
appliance. The first patient experienced total relief from
her earaches within hours after the mandibular appli-
ance was inserted The loud hissing and ringing sub-
sided after several months of treatment. After seven
years, she is completely free of her former complaints.
The other patient has been free of ear pain forfour years.
The pounding and ringing have considerably lessened
and appear to be slowly fading."
DENTIST, ORTHODONTIST, ENT, or ...
By design, our health care system is compartmen-
talized Teeth are in the domain of the dentist. Ears are
entrusted to the ENT. Neck muscles often fall to the
chiropractor's care. But because the jaw joint affects or is
affected by all of these, the disciplines overlap
Who then is best suited to offer this care? Primarily,
DMD's, DDS's, and orthodontists are appropriate TMJ
caregivers - if they have special training and education in
TMJ. A small number of dentists have practices limited to
TMJ exclusively. (Note: There is no degree program for
TMJ as a dental specialty, and very little is taught in either
dental or medical schools about it. Dentists must attend
training seminars to get current TMJ information.)
ENT' s are beginning to refer their patients to TMJ
dentists after other organic causes have been eliminated
for symptoms of tinnitus, dizziness, and ear pain. It is
often appropriate for dentists to refer TMJ patients to
other professionals like physical or neuro-muscular
therapists, chiropractors, biofeedback specialists, and
even back to ENT' s for secondary care.
WHERE TO BEGIN
Dr. Taddey's book, TMJ- The Self-Help Pro-
gram, leads the reader confidently through the
extensive TMJ terminology, causes, exercises, and
treatments. While the book does cover TMJ com-
prehensively, it is not tinnitus-specific. AT A's bib-
liography contains 38 TMJ/tinnitus-related articles
for those who want a more targeted and technical
perspective.
The impact that TMJ therapy has on tinnitus
is variable and at the moment highly subjective.
Not every case of tinrutus is a result of TMJ; not
every case of TMJ results in tinnitus. Some TMJ
dentists regularly recommend surgery; others warn
against it. Some report astonishing tinrutus relief
with TMJ treatments; others report minimal and
unpredictable results. Although the empirical evi-
dence is compelling, it is probably wise to keep
your expectations realistic, and to be clear about
and comfortable with your particular dentist's ap-
proach to TMJ before the first appointment.
References
1. Taddey. John: TMJ the Self-help Program. Surrey Park Press. 1990.
2. Greene, Arnold: TMJ and the Test of Time; Quintessence International, November
1982.
TMJ (continued)
3. Bernstein, Irving: Tinnitus; Maimonides Alumni Associa-
tion Journal, 1993.
4. Morgan, Douglas: Tinnitus caused by a temporomandibu-
lar Disorder, unpublished, 1994.
5. ibid.
6. Chole, R., Parker, W.: Tinnitus and Vertigo in Patients
with Temporomandibular Disorder, Archives Otolaryngol-
ogy Head and Neck Surgery Vol 118, August 1992.
The following resources can help you
locate a TMJ dentist in your area.
TMJ & Stress Center,Sharon Carr, Pres.
PO Box 803394
Dallas TX 75380
(800) 533-5121
International College of Crania-
Mandibular Orthopedics
Suzanne Woodruff, Executive Secretary
17236 140th Ave SE #600
Renton WA 98058
(800) 446-1763 (206) 255-4727
FAX: (206) 255-1049
American Tinnitus Association
PO Box 5, Portland, OR 97207
(503) 248-9985
The Yellow Pages under "Dentist"
Those who treat TMJ say so.
Resources for this article
Irving Bernstein DDS
350 91st St
BrooKlyn NY 11209
(718) 833-9191
Elias N Costlanes DDS
384 Rotary St
Morgantown WV 26505
(304) 5983557
Arnold R Greene DDS
16260 Ventura Bl #620
Encino CA 91436
(818) 789-6252
Samuel J. Higdon, D.D.S
2250 NW Flanders #111
Portland OR 97210
(503)227 -4844
Douglas Morgan DDS
The TMJ Foundation
3043 Foothi ll Bl #8
La Crescenta CA 91214
(818) 248-1283
Barbara Rubenstein,Ph.D.
Dept.Stomatognathic Physiology Univ. Goteborg,
Medicinaregatan 12, S-41390, Goteborg, Sweden
John Taddey DDS, TMJ- The Self-Help Program;
(This book is available from ATA)
Surrey Park Press
PO Box 2887, La Jolla CA 920382887
(619) 5518010
TMJ & Stress Center
PO Box 803394, Dallas, TX 75380
8005335121
NUTRITIONAL APPROACH TO TMJ
by Jerome S. Mittelman, D.D.S. , a retired dentist in New York City, with 37
years of experience - mostly treating TMJ, is now the editor of the Holistic
Dental Digest newsletter. Write to him c/o The Once Daily, Inc. , 263 West
End Ave #2A, New York, NY 10023.
TMJ bas many causative factors. But consider this. Why can two
people have the same etiologic factors, yet one may suffer from
symptoms and the other may not? The answer lies in the difference in
host resistance," the resistive capacity of the individuals. One has the
ability to adapt to a shifting tooth that throws off the bite and sets off
abnormal jaw closure. The other is in horrible pain.
Common treatments for TMJ symptoms like headaches, tinnitus,
dizziness, etc., are usually mechanical, pharmaceutical, or psychologi-
cal. Rarely do we see nutrition mentioned in the management of TMJ.
My experience with TMJ confirms the idea that there are many causes
involved, that they inten-elate, and that nutrition plays a vital role.
Indeed, in almost every case of TMJ I've seen, hypoglycemia was
involved. Further, in several cases ofTMJ referred to me, the correction
of patients' nutritional status alleviated the symptoms within days.
The ftrst step in the alleviation ofTMJ symptoms should be a good
protein breakfast. Patients need to eliminate refined sugar, caffeine, and
alcohol from their diets as well. The rest will follow more easily.
What nutritional supplements are best? Here is a brief list of the
ones !feel are mosti mportant to supply the body and mind with elements
necessary for healing:
Magnesium 1000 mg_and Calcium 500 m_g a day are needed for
muscle metabolism. This is the reverse OJ the traditional bal-
ance. Magnesium helps muscles relax; magnesium deficiency
can lead to muscle cramps. When you are out of balance or
magnesium is low, you will find an increased tendency to clench
and grind teeth.
Manganese helps the ligaments to heal.
Vitamin B Complex is needed for the stress reaction of TMJ.
Vitamin Cis required for the health ofthe connective tissue and
for its anti-inflammatory effect.
Proteolytic enzymes help defuse inflammation when taken on an
empty stomach.
Coenzyme-Q-10 is necessary for more rapid healing.
D-Phenylalanine, an amino acid, is excellent for natural pain re-
lief and mood improvement.
The Omegq 3 fatty acids and Omega 6, GLA, are helpful anti-in-
flammatorzes.
Valarian Root, Wood Betony, Lady's Sljpper, Chamomile, Skull-
cap, qnd Passion Flower are all herbs ;or powerful, natural
ca1mzng.
Tinnitus Today /September 1994 9
The Tinnitus Connection To TMJ
by Sharon Carr, founder and president of the TMJ
& Stress Center in Dallas, Texas. Since 1989 she
has been helping others by sending out FREE
information on TMJ, helping patients find quali-
fied doctors and handling suicide calls. (Patients
can call (800)533-5121 to receive information.)
She is also president ofMyoData where she writes
and distributes TMJ educational materials for
health professionals internationally.
Pain, excruciating headache pain 24 hours a
day, seven days a week, drove me from doctor to
doctor in search of relief. I suffered from an often
misdiagnosed and misunderstood condition, TMJ
-- temporo mandibular joint. I learned a lot of facts
about TMJ like: It's the "most used" joint in the
entire human body because it performs a myriad of
functions. This painful disorder affects one in every
four persons. Many times, TMJ may be the answer
to other unexplained physical ailments.
It all began when I started having headaches
that normal medications wouldn't touch. Like
many TMJ sufferers I went to see an ENT doctor
for the ringing and shrieking sounds in my ears. I
was sure it was either infected ears or I was on my
way to a severe hearing problem. My hearing be-
came so sensitive, I could hear sounds about the
same time our dog did. It was a little weird to have
my husband ask, "Honey, why is the dog barking?"
My answer was usually something like, "Oh, some
people down the block are talking." He was
shocked that I could hear something so far away
(including phones ringing in other houses). Some
mornings, the sounds of running water would leave
me crumpled in tears holding my ears.
The ENT diagnosed me as having tinnitus and
TMJ disorder. He explained TMJ sufferers often
experience sounds in their ears and may either have
a slight hearing loss or super-sensitive hearing.
This is because the jaw is so close in proximity to
the ears. Problems with the bite and the muscles
that control the jaw affect the ears. The nerve that
controls the tensor tympani is the same nerve that
controls our chewing muscles. Therefore, signals
sent through this nerve affect both the muscles of
the jaw and those of the ear.
The good news is that many times when the
TMJ problem is corrected, ringing in the ears dis-
sipates and sometimes ceases completely. Thank
goodness my tinnitus nearly ceased with treatment.
Besides ringing in the ears, my other symptoms
were: headaches, dizziness, neck, face and shoul-
der pain, ear congestion, clicking, grating sounds
in joint, pain behind eyes, locking jaw (opened or
closed), difficulty swallowing.
So began my long journey to conquer this
stress-related, debilitating pain. I began going from
doctor to doctor trying to find treatment and was
told everything from, ''Take Valium to relax" to
"See a psychologist -- it's all in your head" before
I finally found a trained, experienced TMJ doctor
who understood what I was going through. Even
though TMJ is a medical disorder, dentists are
usually the primary health care providers for this
ailment. Many dentists in the country now limit
their practice to TMJ, head, neck and facial pain.
Dentists have to take special training in order to
diagnose and treat TMJ because TM joint disorder
wasn't taught in dental (or medical) schools as a
mandatory course.
Besides praying for relief, I researched, stud-
ied, and applied every piece of information I could
get my hands on. By this time, I was in 24-hour a
day pain which stayed with me for three years. I
spent $12,000 in uninsured medical expenses,
which placed a financial burden on our entire fam-
ily and added to the stress level. When I was told
surgery was the only answer, with only a 50%
chance of pain relief, I elected to resolve the prob-
lem without an operation and kept looking for
conservative treatment techniques. Finally, be-
tween wearing a mouth appliance (also known as a
dental splint or orthotic), working with a physical
therapist, and having chiropractor adjustments, I
was out of pain. The mouth appliance helped tre-
mendously. I wore it at night over my bottom teeth
to take pressure off the joint and reduce the impact
of grinding and clenching teeth -- an unconscious
reaction to frustration and stress.
Early treatment makes a tremendous differ-
ence. And though doctors do all they can to help, I
realized how critical it was to participate in my own
Tinnitus To TMJ (continued)
care. This meant changing my lifestyle and learning
self-help methods such as:
managing stress
eating small bites of food
drinking liquids through a straw
breathing while chewing
sitting/standing straighter
sleeping on the back or side -- never on the stomach
never chewing gum, ice, or crunchy foods
adding calcium to my diet
refraining from holding phone between chin and
neck
refraining from carrying a heavy handbag
and remembering the all important position; LIPS
TOGETHER, TEETH APART.
THE BIG FACTOR: STRESS
I learned that stress had a great bearing on my jaw
problem. For instance, I recently found myself in an
extremely stressful situation. Within seconds my ears
made loud shrieking sounds, the TM joint began getting
tight with muscle spasm and my head started pounding.
Of course, I pulled out all the stops trying everything I
bad ever learned to control the stress my body was
undergoing and finally worked through it. TMJ sufferers
who have to deal with pain know that it's difficult to get
through each day without throwing something at the
boss or shouting at a loved one. Often it was all I could
do to make it through the day, handling responsibilities,
trying to be personable and smile at work without grab-
bing my head in pain and running out of the building.
I thank the good Lord that this awful experience is
over and my TMJ is under control. With positive think-
ing and finding the proper care, I feel like a new person.
If I can conquer TMJ and the stress that causes it (or that
it causes), others can too. Because of my experience and
because I don't want anyone to feel alone going through
what I did, I founded the TMJ & Stress Center in Dallas
to offer help and hope to other TMJ sufferers.
"NEW" BOOK AVAILABLE FROM ATA
Some time ago Richard Hallam's book called
Living With Tinnitus went out of print. It is good
news to learn that HarperCollins Publishers,
through its subsidiary, Thorsons, is once again
printing the book under the title Tinnitus: Living
with the ringing in your ears.
Essentially the book remains the same as the
fust edition. There are some updates to the appen-
dices such as a "Further Reading" section rather
than a Bibliography, and some new addresses and
contacts for support groups internationally.
Its primary value is in helping readers discover
new ways of looking at their tinnitus and learning to
cope with it. It also includes some self-analysis ques-
tionnaires and useful instructions for starting, keeping,
and interpreting a (tinnitus) diary.
Richard Hallam, Tinnitus: Living with the
ringing in your ears, (London, England) Thorsons
Publishers, 1993. The book is available from ATA
at the members price of $11.00 (non-members
$14.00) including shipping. See insert for ordering
information.
PAID ADVERTISEMENT
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 it has helped him and many
other people who have tried it. It is comfortable for
those who wear their hearing aids or maskers to
bed. Testimonials are available on request from Mr.
Skaggs.
To order, send $17.95, outside the U.S., send
$20.95 (U.S. funds), for postage paid shipment to:
EAR RELAXER
POBOX90
VICTOR WV 25938
Replacement pillow slips are available for
$5.00.
PAID ADVERTISEMENT
Tinnitus Today/September J 994 11
Development Directions
By Brent Richard Mower
Director of Development
One of the best ways for
AT A to grow and for tinnitus to
become more of a household
word is through public aware-
ness of both the condition and the
existence of our organization to
provide help.
Substantially increased
publicity, such as that ATA re-
ceived from Barbra Streisand's recent donation,
helps increase public awareness of the condition
and its prevention. But it does one other thing
equally as important. It reaches the millions of
other Americans who experience or suffer from
tinnitus who do not know about the American
Tinnitus Association.
Once people know aboutATA, they, like you,
are eager to join and utilize the benefits of mem-
bership. They become valuable supporters, just like
you, and substantially increase the number of peo-
ple contributing to a search for better relief or a
cure. It makes raising the millions needed for in-
creased research a much more easily obtainable
goal.
Many of you may have heard about AT A
through a public service announcement on televi-
sion, on the radio or in a printed periodical. While
placement of public service announcements in the
media is free, professional production and effective
distribution of public service announcements is
not. It takes tens of thousands of dollars just to get
a spot produced and into the hands of television and
radio stations nationwide. One of our goals for the
next year is to raise enough extra funds to produce
and disseminate new broadcast and print public
services announcements.
Tony Randall has agreed to donate his time as
celebrity talent in the spots. We are also working
with Barbra Streisand's publicist and other celeb-
rities' agents in hope of getting additional talent to
appear in the announcements. Fortunately, the tal-
ent and much of the creative process to develop the
publicity will be without cost to AT A.
But production and distribution takes money.
That's where we need your extra support.
Hiring a production crew for preparation of
sets, lighting, and studios or location, filming the
spots and tearing sets down, costs nearly $11,000
for one thirty-second commercial. Rental of pro-
duction equipment such as cameras and recording
systems is nearly $6,500. Film, tape and audio
stock cost another $1,500. Studio or location fees
take another $1,000. Editing, mixing, and adding
graphics add over $5,000. Even with graciously
donated talent time and creative planning, the cost
of a thirty-second spot is about $25,000.
Once we have a public service announcement
on film, it takes another $25,000 to reproduce the
spots and disseminate them to the over 400 televi-
sion and 1,000 radio stations across the country.
We also want to release three or four stories
about ATA to the 10,000 daily and weekly news-
papers in the U.S. during the next year. That will
cost about $8,000.
While the expense of this effort is significant,
so are the benefits. A standard national release of
public service announcements should yield 200-
500 million documented audience impressions.
The results means ATA will grow substantially and
every member will benefit by the added support
generated.
Please consider joining us in this endeavor by
sending a little extra with your annual membership
contribution. Or you can use the envelope in the
center of this issue to send your contribution right
away. The quicker you are able to respond, the
quicker we'll get the spots on the air and reach the
many more people with tinnitus ready to join and
support our research and education efforts.
Donors who contribute $100 to $499 will
receive an autographed photograph of the celebrity
who appears in AT A's spots. Donors who contrib-
ute $500 or more to this special appeal will also
receive a personal copy of a videotape of the spots.
We need more people like you ... thousands
more. Please help us reach them.
Our Celebrities
Joe A lam & Trudy Drucker,
Rivervale. NJ
Betty Mathis, Portland, OR
A
Judy Brivchik, Lancaster, PA
by Barbara Tabachnick,
Client Services Coordinator
The faces pictured here represent a diversity
of lifestyles, backgrounds, and locales. They are
also part of a greater, cohesive w h o l e ~ a collection
of good souls, ageless and incredibly special,
brought together by tinnitus and by something
more. Through letters, telephones, and support
groups, these luminaries and hundreds like them
have chosen to help others with tinnitus.
When it first appears, many tinnitus sufferers
need to talk with people who've been in the same
boat. They may find a support group to attend or
a person on the other end of a phone who will
listen. They learn that although the boat may be
rocking wildly at first, it will not sink. They slowly
learn that coping is possible. Then sometimes, in
time, they start to offer support of their own.
Others help by extension -contacting schools
with our tinnitus educational materials, attending
CFC meetings to help raise research dollars, ask-
ing local TV stations to run our PSA's, taking
brochures to hospitals and health fairs. All are
roads paved with gratitude.
We had long suspected that some of the most
beautiful people in the world made up our tinnitus
support network. Now we have proof!
Susan Seidel. Baltimore,MD & Bob Luthmann,
Staten Is .. NY
Paul Yamashige (r.) & group members, Honolulu, HI
Mary Jo Love (&Andrew),
Canton. OH
Teresi a Guinn, Humboldt, TN
Joyce Knapp. Columbus. OH
Virginia Fitzgerald, Phoenix, AZ
Celebrities (continued)
Our circle of support has expanded
again. We send kudos to our newest ce-
lebrities.
Self-Help Groups
Ann Andruchiw, 2822 George Ave,
Parma OH 44134, (216) 886-4228
Ruth Middleman, 3148 Sunny Lane,
Louisville KY 40205, (502) 458-4427
Sharon Hepfner, MA/CCCA, Univ ENT
Specialists, 222PiedmontAve#5200, Cincin-
nati OH 45219, (513) 475-8453
Telephone & Letter Contacts
Jack Fuller, 6528 Glen Oak NE, Albu-
querque NM 87111, (505) 294-4206
Lynn Haddon, 5118 Long Shadow Ct,
Midlothian VA 23112 (804) 744-3393
Letter Contacts
Phyllis Flesher, 9534 Royalton,
Shreveport LA 71118
Terrance Stiles, 21297 Meteor Dr,
Cupertino CA 95014
If you are interested in establishing a
support group, becoming a telephone or letter
contact, or doing other community outreach,
please write to me for our "Self-Help Packet"
or information on AT A volunteer opportuni-
ties.
Information on A TA volunteer opportunities.
Tinnitus/Meniere' s Pen Pal Network is
now International! Pen pals from outside the
United States can send $10 US to Lorraine
Cherkas, PO Box 47172, St Petersburg FL
33743-7 172 USA for worldwide list and
newsletter. Include your age, interests, and
brief explanation of your condition.
References for following Ototoxicity article
Bernstein, D. A., & McAlister, A. "The modification of smoking behavior: Progress
and problems", Addictive Behavior, 1 :891 02, 1973.
Chartrand, M.S., 'Allergies: The hearing link", Hearing Health, Jun/Jul1992.
Haschek, W. M .. & Rousseau. C. G., Handbook of toxilogic pathology, San Diego:
Academic Press, 1991.
Jerger, S., & Jerger J., Auditory disorders: A manual for clinical evaluation, Boston:
Little, Brown and Company, 1981.
Vicellio, P. Handbook of medical toxicology, Boston: Little, Brown and Company,
1993.
14 Tinnitus Today/September t994
by Max S. Chartrand, Ph.D., Aural Rehabilitation
Concepts, Gainesville, Texas
Like Body/Like Ears
There is virtually no health problem that does not
affect the human hearing mechanism at least to some
degree. For example, if one is suffering from a ph
balance malady such as diabetes, hypo- or hypergly-
cemia or acidosis, the ear will likewise be affected
(Chartrand, 1992). Hypertension or high blood pres-
sure, will also have a deleterious effect on the fluid
levels of the inner ear and balance mechanism.
Vascular disease can cause even more problems
with the ear: infection, tinnitus, epithelial atrophy,
tumor growth, etc. (Jerger & Jerger, 1981). Stroke,
which can cause paralysis of nervous systems and/or
brain function, may likewise impair the neural system
of hearing and communication ability. And, corre-
spondingly, the remedies used to solve each ofthese
problems can cause even more new risks for the ear.
Literally volumes have been published in re-
gards to the toxic effects of such common substances
as food preservatives, pesticides (both natural and
artificial), alcohol, tobacco, caffeine, refined sugar,
legal and illegal narcotics, certain dyes, and petroleum
products. But very little is said of these same toxins
relative to the ear.
Ototoxic substances that are poisonous to the
organs of hearing include common substances such
as caffeine, alcohol, nicotine, lead (and other heavy
metals), mercury, cyanide, arsenic, sulfur, and benzol.
Admittedly, each of these take a different tack in their
effects upon hearing, and to lesser or greater degrees
on certain individuals. In most cases, the body's abil-
ity to eliminate toxins has a direct bearing on their
effects (Haschek & Rousseau, 1991).
Moreover, there arises in the medical opinion the
question of risk/benefit in many cases. The question
must be asked, "Will the lifesaving benefit outweigh
the possible deleterious consequences of this medica-
tion?" A case in point is the use of the drug digitalis
in the treatment of congestive heart failure. Another
is the use of cobalt in cancer x-ray therapy.
For older Americans, common causes of oto-
toxicity existed in the days when sulfa drugs and
quinine were used routinely to combat various pan-
Ototoxicity and Hearing (continued)
demic diseases. Household products and paints,
which contained large amounts of lead and mer-
cury, not to mention an array of early petrochemical
substances, had significant effect on later hearing
ability (Vicellio, 1993).
The toxic effects of certain antibiotics (ami-
noglycosides), have been found to cause deafness
in individuals who have a predisposition toward
renal weakness or disease.
Another family of prescription drugs that has
been found to have significant ototoxic effects in
some individuals are diuretics as used in control of
high blood pressure and water retention. Some of
these have variously been identified as mannitol,
furosemide, and hydrochlorothiazide.
Caution should be exercised in the use of these
diuretics in cases where progressive sensorineural
loss, Meniere' s disease, vertigo, tinnitus, or, most
of all, renal disease or weakness exist. Further-
more, there is a close association between blood-
potassium levels (Rowan, 1986) and the use of
these and other diuretics which can have a profound
effect on cochlear potentials and balance.
Listed as one of the ototoxic substances, caf-
feine has also received attention as a causative
factor in cases of Meniere's disease (vertigo, tinni-
tus, and hearing loss) and in causing or exacerbat-
ing tinnitus conditions. Since it is found in such
common substances as coffee, tea, cola drinks,
chocolate, and diet pills, its use is quite widespread.
Nicotine, on the other hand, is a virtual poison
to the body affecting every organ. But because of
its fat solubility, it particularly finds quick entry
into the brain. Because of high nicotine concentra-
tions in the brain, withdrawal causes depression,
ilritability, poor concentration, anxiety, and sleep
disturbance, all of which have a deleterious effect
on auditory perception (Bernstein & McAlister,
1973).
Now, the Challenge
Good hearing health is actually predicated on
good heaJ th habits in general. What is good for the
mind and body is good for the ears. Here are some
important protective guidelines:
Have your hearing tested at least once each
year, especially prior to and following a hos-
pital stay.
Where possible, avoid substances to which
you are known or suspected to be allergic.
A void tobacco and use caffeine
only in moderation.
If you have predisposition toward renal dis-
ease, avoid aminoglycoside antibiotics and
certain diuretics.
Observe good health habits in nutrition, exer-
cise, sleep, and positive mental attitude.
Following these guidelines will provide your
best shield for protection against ototoxicity and
will promote good hearing health at the same time.
"COPING WITH TINNITUS"
e STRESS MANAGEMENT &. TREATMENT
e TINNITUS MANAGEMENT IS OfTEN
COMPLICATED BY ANXIETY AND STRESS
e NOW A UNIQUE CASSETTE PROGRAM IS
AVAILABLE DESIGNED TO PROVIDE DAILY
RDNFORCEMENT AND SUPPORT FROM THE
STRESS OF TINNITUS WITHOUT COMPLEX
INSTRUMENTATION&. VALUABLE OffiCE TIME
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
9 f) recordings can be used to induce
$f) 9 et sleeping or as a soothing back-
p05'-"l)f- drop for activity and can be played
''l on a portable cassette player.
A.
ASSOOATED
HEARING
CENTERS
6796 MARKET ST., UPPER DARBY, PA 19082
Phone (215)
Media Watch: Tinnitus in the News
by Cliff Collins, Oregon freelance writer. Please send clips,
noting source and date to ATA. Media Watch, PO Box 5,
Portland, OR 97207-0005.
If you check this corner of the magazine regu-
larly, or even occasionally, you know that a recur-
ring theme is the prevention of noise damage,
through both awareness and control. I preach,
sometimes probably beyond your point of patience,
for us all to pitch in to try to quell the cacophony
of a mindlessly noisy society.
Thus, it was with (quiet) glee that I received
word from Robert C. Nelson of Rockford, Ill., that
his fair burg has seen fit to slap offending roving
boom wagons (vehicles causing a bass sound that
can be heard from 75 feet away) a $500 fine! And
it was with even further delight to hear that Nelson
took an active part in the ordinance's passage. He
wrote a letter to an alderman, who read the letter
before the City Council.
"I am not naive enough to think this letter I
wrote would be the cause of this ordinance to pass,
but I do believe it did help," Nelson wrote AT A.
"We can and must do whatever we can at local,
state and federal levels to make people more aware
of this serious problem." He is so right, and, as
AT A's Pat Daggett told Nelson, itjustgoes to show
that "one person gm make a difference!"
Anthropologist Margaret Mead once said:
"Never doubt that a small group of thoughtful,
committed citizens can change the world. Indeed,
it's the only thing that ever has."
Speaking out: Each one of us has a story about
how, or at least when, we came down with tinnitus.
Some take the hard step of tellino- their stories
publicly. When they do, those o/'us who have
tinnitus can relate instantly; and even if we think
w_e_'ve heard it all before, the heartbreaking recog-
nitiOn of the person's plight hits borne.
Three such recountings ran earlier this year.
The first, in The Philadelphia Inquirer, told of
ex-TV reporter Meg Grant, and how she acquired
Meniere's Disease, along with severe tinnitus, at
the peak of her career. Just after reaching a national
position in journalism, Grant, 38, woke up one
morning to the internal sounds of roaring noises.
To her horror, external sounds were muted. With
her diminished hearing, Grant had to give up her
work. Now she is trying to refashion a new life and
fights self-pity by volunteer work helping others.
Larry Barter, 39, told the Worcester (Mass.)
Sunday Telegram of the moment 21 years ago
when, after work while waiting for a bus: "I looked
up at the clock ... and suddenly I heard this loud,
high-pitched whistling sound. I assumed every-
body on the Common could hear it, but ... I figured
out in a matter of minutes that I was the only one
hearing it." Next day an ear specialist told him the
sound might go away tomorrow or never. It never
did, and silence became just a memory.
In the story, the ATA's Brent Mower, who
was interviewed, said, "We get a lot of calls from
people who are just desperate for relief,"and noted
that an estimated 10-12 million Americans have
tinnitus severe enough to prompt them to seek
medical help.
The Sun City, Ariz., Daily News-Sun carried
a piece about Marie Sybenga's tinnitus. Sybenga
(who is retired, age not given), said that one day
she heard the wail of a fire engine. When the noise
grew louder and louder and didn't go away, she saw
a doctor. To deal with it, she stays occupied by
hobbies, and she and her husband, John, helped
found a local self-help group for people with tinni-
tus, and, according to the story, concentrates on
coping while stayi ng abreast of developments in
the tinnitus-therapy field.
Wrap-up: In The New York Times, columnist
Jane E. Brody reported that a researcher has linked
the jarring and bouncing associated with high-im-
pact aerobics to inner-ear damage. The excessively
loud music present in such workouts apparently
worked in combination with the jarring to harm the
ears, resulting in vertigo, hearing loss, tinnitus and
other problems. Recommended were low-impact
aerobics and turning down the volume.
The ATA heard that the radio program "All
Things Considered" on National Public Radio
broadcast a story around June 18 on the subject of
tinnitus, or at least in which a man with tinnitus was
interviewed. Anyone hear it? Please let us know.
Questions & Answers
by Jack A. Vernon, Ph.D., Director Oregon
Hearing Research Center
Q. Mr. P. from IL states, "I went to see my family
doctor and, as it ended up, that was the end of my
life as I had known it. During the irrigation process
to remove ear wax, I heard a loud explosion in my
head with intense pain and bleeding. I was rushed
to an ENT specialist and treated with medication.
The final outcome is a severe case of tinnitus. The
doctor feels this is a traumatic condition that can be
relieved. However, from aU I bad read and heard ,
once tinnitus is diagnosed, it's too late to do any-
thing."
A. NOT SO, Mr. P!! Your tinnitus may have been
due to an injury (trauma) to the ear drum and, if so,
once that injury has properly healed, the tinnitus
should either go away or be markedly reduced but
it may take a long time. As you probably know, I
do not recommend aspiration to clean out wax in
the ears of tinnitus patients because it is usually
loud enough to temporarily exacerbate tinnitus. In
your case, the tinnitus appears to have been pro-
duced by the aspiration. The presence of pain and
bleeding all the more suggests a major trauma to
your ear or ear drum. Sometimes the healing can be
an exceedingly slow process, don't give up hope.
While waiting for that recovery, I see no reason
why you should not try some relief procedures for
tinnitus. For example, you might want to discuss
with your physician the possibility of a trial period
with Xanax, or you might want to try masking.
Because it is less invasive, I would suggest trying
the masking first. Does the sound of running water
at the sink cover-up your tinnitus? (This is the
"Faucet-Test") If so, it may be possible to use a
wearable tinnitus masker to relieve your tinnitus.
Remember, one advantage of masking is that it puts
the control of tinnitus with you. You can determine
when you will and when you will not hear your
tinnitus. If you have questions, call me.
Q. From Ms. T. in New York State, comes the
inquiry, "Will Sulfasalazine increase my tinnitus?
It has been prescribed for my arthritis."
A. Sulfasalazine contains salicylic acid, the ele-
ment in aspirin known to temporarily exacerbate
and/or cause tinnitus. The PDR lists tinnitus as a
possible side effect from Sulfasalazine. But tinnitus
that is produced by sodium salicylate, is very easily
masked, and usually goes into rather extended re-
sidual inhibition. Therefore, I would follow your
physician's directions. If your tinnitus is increased,
try masking to relieve it. You might want to try the
"Faucet Test" prior to seeing someone who dis-
penses maskers to determine if the tinnitus can be
relieved by maski ng as easily as I expect. I hope,
Ms. T., you will write and share these experiences
with us.
Q. Ms. G. in illinois states that as a result of
surgery for Meniere's disease, one ear is totally
deaf and, of course, that is the ear with tinnitus. Ms.
G. wonders what she can do.
A. Patients who are one-eared can benefit from
the hearing aid arrangement called a CROS AID.
This unit places a microphone on the side of the
deaf ear and pipes the sound received from that side
to the other ear (the hearing ear). In this manner,
the patient can hear sound from either side and does
not always have to put the person or thing to be
heard on the "good" side. They stop missing that
which is said on their bad side. In addition, receiv-
ing sound from both sides helps the patient locate
the source of the sound and, as a consequence, they
can better understand speech in noise. I' m told that
it takes a bit of getting used
to and that the CROS ar-
rangement is not to the liking
of all one-eared patients. It is
recommended that decisions
about the CROS be deter-
mined by an actual trial with
it. When tinnitus appears in a
deaf ear, there are two things
we usually recommend.
First, it is possible to use con-
tralateral masking, that is,
from the side of the good ear.
There are four different
places where the hearing
Questions & Answers (continued)
nerve tracts in the brain cross over so that what
happens in one ear can affect the other ear. If that
does not work, we recommend a trial period with
Xanax.
Q. Mr. M. in Oklahoma indicates movement of
his head either to the left, right, up or down causes
the introduction of an added tone to his regular
on-going tinnitus. He asks, "What causes this?" He
suggests that perhaps the fluid level in his inner ear
is low.
A. Idon'tthink that you aremnningon a low fluid
level in the inner ear. Were that the case, you would
probably have some serious balance problems as
well as various hearing problems. Nature provided
us with a generator to supply endolymph and per-
ilymph which are the fluids of the inner ear. My
guess is that your tinnitus effect is produced by
some neck muscle activity. We see patients whose
tinnitus is exacerbated (which admittedly is differ-
ent from the addition of a second tone) by exercise
and, in some rare cases, a specific muscle move-
ment or strain will temporarily increase the tinnitus.
Another possibility is that the movement may
involve the jaw joint (TMJ). Disturbances to the
jaw joint can cause tinnitus or alter tinnitus, I would
suggest you see a dentist in your area who special-
izes in TMJ. (See TMJ article this issue.)
Q. Mr D. from California asks if work is being
done on residual inhibition as a possible way to
relieve tinnitus or to permanently reduce it.
A. Residual Inhibition (Rl) is that period after
masking when the tinnitus is either temporarily
gone or reduced. The answer is that a great deal of
work is ongoing on this topic although I hasten to
add I do not understand at all what is happening to
produce residual inhibition. Inasmuch as the effect
is produced by introduction of a masking sound to
the ears, we have explored the effect of a variety of
different masking sounds. I reported some of our
results at the Fourth International Tinnitus Seminar
in Bordeaux in 1991 and I'd like to repeat some of
those findings here. We investigated five different
masking arrangements where each condition was
presented at the minimum masking level plus 10
dB for 60 seconds. The resulting residual inhibition
was measured as the duration of the suppressed
effect. Masking with a tone that was l/2 octave
below the frequency (pitch) of the tinnitus yielded
56 seconds of RI; masking with a tone that dupli-
cated the tinnitus gave 58 seconds of RI; masking
with a tone 1/2 octave above the tinnitus produced
71 seconds of RI; masking with a narrow band of
noise centered at the tinnitus frequency yielded 44
seconds of RI; and masking with two tones each
placed closely on either side of the tinnitus ("edge-
masking") gave 74 seconds of RI. Although these
data are preliminary, having been collected on only
13 patients, they, nevertheless, point out some ar-
eas of investigation that may be more promising
than others. Work in this fascinating and challeng-
ing area continues, and when we come to know
more about the mechanisms underlying tinnitus,
we may be better able to extend residual inhibition.
Like you, Mr. D., I am not only fascinated with this
phenomenon but firmly believe it will, in the future,
offer extended relief of tinnitus.
Q. Mr. B. in NY states, "I hear my every heart
beat as well as a hissing noise. I could tolerate the
hissing noise but I cannot cope with the pulsations.
I have tiied acupuncture (14 treatments) and my
acupuncturist told me that after 30 treatments I
should feel better. I'd like your opinion on that."
A. Mr. B. I guess I would have felt better about
your acupuncturist if he had given you a money-
back guarantee the same as hearing aid dispensers
do. Since it is the pulsatile sounds which bother you
the most, I would recommend masking. However,
because they are low-pitched sounds, a special
form of masking sound is required. Let me recount
my own personal experience with being able to
hear my heart beats. I have an artificial heart valve
(a ball in a cage), and I can hear that ball rattling
around in its cage when it gets quiet. I also have an
irregular heart beat which makes it all the more
difficult to ignore, especially at bedtime. I find I can
mask the heart beat with the Marsona 1200A Sound
Generator. I set it on "waterfall" with full bass,
adjust the volume to just cover up the pulsatile
Questions & Answers (continued)
sounds, and I sleep uninterruptedly. This approach
does not get at the reason for your pulsatile sounds,
and for that I think you should consult with your
physician. On the other hand, pulsatile tinnitus can
be an indicator of Benign Intracranial Hyperten-
sion. An expert on Benign Intracranial Hyperten-
sion is Aristides Sismanis, M.D., Department of
Otolaryngology, Medical College of Virginia, Box
146, Richmond, VA 23298.
Q. Mr. B. from CA writes, "Mter reading Q&A
for several issues, I have two questions. What dose
of Xanax has been found most effective? Have you
had any reports of adverse effects resulting from
acupuncture treatment of tinnitus."
A. Keep in mind that you must have your physi-
cian's concurrence for Xanax and, if you do, we
recommend the following dose schedule which was
used in the study. Remember, no alcohol at all with
X an ax.
1. For the first two weeks take 0.5mg in the
evening. This is not enough Xanax to relieve tinni-
tus for most patients but it will determine whether
or not Xanax has too much of a drowsy effect on
you.
2. For the next two weeks take 0.25mg in the
morning and again at noon and 0.5mg in the eve-
ning. For some patients, this is enough to reduce
tinnitus.
3. If phase two above did not reduce the
tinnitus, or reduced it only slightly, then take 0.5mg
three times a day for two weeks.
4. To stop Xanax, always taper off so as to
reduce the opportunity for withdrawal effects. Take
0.5mg twice a day for three days, then 0.5mg once
a day for three days and then stop.
REMEMBER, IT IS ESSENTIAL THAT
YOU HAVE YOUR PHYSICIAN' S CONSENT
AND CONCURRENCE IN ORDER TO CON-
DUCT A TEST WITH XANAX.
Mr. B. , the answer to your second question is
that I have not heard of any adverse effects from
acupuncture except for two patients who were elec-
trically stimulated through the acupuncture nee-
dles, as you were, and that procedure significantly
exacerbated their tinnitus. So I agree with you that
perhaps a word of caution is in order here.
A SPECIAL REQUEST
From Jack Vernon, Ph.D. Oregon Hearing Research
Center, OHSU, 3515 SW Veterans Hospital Road,
Portland, OR 97201-2997
Once again I seek your help. We need information
about the drug PA.Xll.... A few patients have indicated
PAXIL was prescribed for their depression and that it
also helped their tinnjtus. One patient indicated PAXIL
eliminated their hyperacusis and another said P AXIL
made their tinnitus worse. PA.XIL is a fairly new drug
and thus not a lot of information has accumulated about
it. Naturally the question arises: Should we do a formal
study of this drug?
If you have taken PAXIL, will you please answer
the following questions:
1. Why was PAXILprescribed? __________ _
2. How much PAXIL was prescribed? ______ _
3. How long did you take PAXIL? _________ _
4. Did PAXIL relieve your tinnitus and if so how much relief?
D a. Completely removed the tinnitus.
D b. Reduced the tinnitus - could hear it only
in a quiet room.
D c. A minimum reduction in loudness.
D d. Altered the pitch but not the loudness.
5. How long did you take PAXIL before it affected your tinnitus? __ _
6. Did PAXIL exacerbate your tinnitus? _yes; __ no.
7. What side effects did you experience with PAXIL ? _____ _
a. Additional comments. ___________ _
Whether or not we do a formal study with P AXll.
will depend, in large part, on the answers you provide.
Thank you for the time and attention you give this request.
Leslie Sheppard, Chairman & Counsellor to the
NOJfolk (England) Tinnitus Society. Letters re-
garding this article may be sent to AT A for trans-
mittal to Mr. Sheppard.
Are you a sufferer?
A letter from a member of our society recently
brought to the surface a phenomena that I have
since discovered exists with a number of our mem-
bers with fairly severe tinnitus.
Although I have experienced this problem
myself for some years I have not until now found
anything in medical literature referring to it.
The member who flrst wrote to me told me
that he is often suddenly woken up dming the night
by what he describes as a "loud explosion" in his
head and asks if any reason can be given for this.
For my own
part the noise
sometimes takes
the form of a high
pitched yell, or the \I
sound of someone ~ I
"breaking in". On ~ " '
the flrst few occa-
sions when it hap-
pened to me I
thought it was my
wife calling to me,
only to discover
on rushing to her
bedroom that she
was not at all
pleased at being
woken up at that
Drawing by Pamela Richardson
hour of the night and had but little praise for my
misplaced gallantry.
Under the title "Do you suffer from Nocturnal
Explosions?" I included a short feature in one of
our monthly newsletters asking if anyone shared
this experience.
The result was that I received numerous letters
from members all experiencing this phenomena in
various forms. One lady reported that she regularly
had this problem usually just as she was going to
sleep. It would happen three or four times a week
- she described it as sometimes a very loud "ping"
- sometimes a "bang".
Another man bas described it as sounding
"like someone dropping a very large metal bar in a
large empty aeroplane hanger." A lady reports that
at these times she actually yells herself, much to the
annoyance of her husband.
The interesting point to my mind is that the
common problem binding these people together is
tinnitus. Maybe other dysfunctions of the auditory
system can bring about a similar experience but this
is another matter.
When I first reported this phenomena I had a
few hazy ideas related to its possible cause but
these may be wildly wide of the true cause. I
wondered if it could be connected in some way with
the natural "jerk" which so many of us experience
just as we enter
sleep. Or I won-
dered if it might be
connected with a
spasm in the tiny
muscles that exist in
the auditory system.
~ In the absence
of any supportive
medical literature
on the subject, we
"Nocturnal Explo-
sive" types can
surely be excused
for feeling we were
somewhat out on a
limb.
But suddenly out of the blue an article in the
prestigious Medical Journal The Lancet, by J.M.S.
Pearce of the Department ofNeurology, Hull Royal
Infirmary, came to light. This appeared in the July
30, 1988 issue and bore the headline "Exploding
Head Syndrome" and I obtained permission to
reprint the article in our newsletter.
The article refers to "a sense of explosion in
the head which receives no mention in standard
texts ... this harmless but frightening condition
should be recognised." It gives details of three
Exploding HeadrcontinuedJ
specific cases. In one the patient describes her
experiences as being wakened by a sudden bang in
the head "as if my head was bursting with a flash
oflight over both fields of vision. I would be dazed,
terrified and my heart thumping."
Another man described bouts of such explo-
sions in the head over four years with no identifi-
able precipitants. He described it as more of a
thunderclap than a pain, adding "you never know
when its coming, except that its always when you
are asleep."
The article continues: "The complaint occurs
exclusively when asleep. The victim is woken by a
violent sensation of explosion in the head which
occurs abruptly and with great force. Patients are
so alarmed that at first they may inaccurately de-
scribe it as a pain. But closer questioning shows that
the awareness is not of a hurt but of a noise deep in
the centre or back of the head.
"The sensation is gone by the time the sufferer
is wide awake, but not surprisingly it causes con-
sternation and sometimes tachycardia and sweat-
ing. The sensation occurs infrequently with months
or years of freedom and no precipitating cause can
be identified.
''The syndrome is entirely benign, and I sus-
pect common and under-reported. The cause of the
bomb-like noise remains a mystery; no known
vascular or hydrodynamic changes in the brain,
labyrinths, or cerebrospinal fluid would cause such
a symptom although a momentary disinhibition of
the cochlea or its central connections with the
temporal lobes, or a sudden involuntary movement
of the tympanum or tensor tympani might be the
explanation. The syndrome does not seem related
to neurosis. Firm reassurance is essential, but drug
therapy seems unwarranted."
The exploding head syndrome has not, so far
as I am aware been brought to the attention of those
with tinnitus. I would personally be most interested
in any further reports or details especially if likely
to be of help in tinnitus or any other auditory
research.
Profiles: Board Member W. F. S. (Sam) Hopmeier
Sam Hopmeier has been effective in helping tinnitus patients for nearly
three decades. After graduating from the Harvard School of Business and
serving as Captain in the U.S. Army Reserves, he entered the hearing aid field
through the business that his father, W. H. Hopmeier, founded in 1953. He was
among the first hearing professionals to be involved with the American Tinnitus
Association referral network, having completed continuing education courses
specifically relating to tinnitus management. He has served on the AT A
Scientific Advisory Committee since 1988 and is now starting a term as an
Executive Board member. Sam is well known in the hearing field both as an
able businessman and as an experienced clinician and instructor. Since he first
instructed students of the Hearing Instrument Institute at the University of
Maine almost 20 years ago, he has taught hundreds of aspiring clinicians the
art and science of proper hearing aid fittings. He has been instrumental in
upgrading the certification standards for hearing-aid dispensers nationally andw. F. s. (Sam) Hopmeier, St. Louis, MO
has chaired national committees working on hearing aid specifications and
standards. He is currently a Governor of the International Hearing Society. Sam
and his wife Pat live in St. Louis and are active in civic affairs. His corporation, Hopmeier Hearing Centers,
has nine offices in the St. Louis metro area. We welcome Sam to the AT A board and look forward to the
benefit of his extensive knowledge and experience.
Spring-Swing through the Southeast
by Pat Daggett, Executive Assistant
The itinerary followed during a 3-week tour
to meet with Combined Federal Campaign repre-
sentatives and support-group coordinators, attend
the annual convention of The American Academy
of Audiology, the Spring meeting for the National
Voluntary Health Agencies and kickoff activities
for Better Hearing and Speech Month may sound
more like a travelogue than anything else.
Most of you are aware, from reading Tinnitus
Today, that the ATA receives substantial contribu-
tions through the Combined Federal Campaign, (an
annual workplace charitable pledge drive for Fed-
eral and military employees). The National Volun-
tary Health Agencies is a federation of sixty some
health associations, including ATA, which coordi-
nates the CFC. The NVHA meets twice a year in
W ashlngton, DC, providing an opportunity for
agency representatives and state directors to ex-
change information and strategies for expanding
the Campaign.
Since the ATA is headquartered in Oregon,
we have asked volunteers from various states to
represent us at local NVHA/CFC meetings, health
fairs and other events. Many thanks to those of you
who are volunteering for this task:
Shirley Rosenhafl, Pat Daggett, Doug Melton
Ellis Branch (KY);Charles Gilbert (AL); Jim
Keyes (AZ); John Mundy (CT); Shirley Rosenhaft
(DC); Col. Charles Ohlinger (FL); Walter
Czarnecki (IL); Johanna Lyons (LA); Susan Seidel
(MD); Ben Jacobs (MA), who has just published a
memoir - "The Dentist of Auschwitz"; Guy
Avenell (NE); Bee Johnson (NJ); John Mundy
(NY); Phil Jones (NC); Deborah Manchester, PhD
(OH); Dan Shrader (PA); Barbara Uyeda (SC);
Tracy Armstrong (TX); Lynn Haddon & Cleo
Shawn (VA); Fleta Smith (WA).We still need a
representative in Nashville, Tennessee. Come on
y'all, give us a call!
We met with state directors of NVHA com-
mittees and ATA representatives on this trip in-
cluding: Ron Combs (SC); Roger Wolfe, Cleo
Shawn & Lynn Haddon (VA); NVHA National &
District of Columbia office, Shirley Rosen-
haft(DC); and Susan Seidel (MD). It was disap-
Cleo Shawn. Pat Daggett. Roger Wolfe
pointing that Barbara Uyeda and I got our signals
crossed and missed each other. Hopefully, we'll
have another chance. And, alas, we missed our
lunch with Don Andrews and Phil Jones (NC)
because of road construction.
We are very grateful for contributions re-
ceived through the CFC and look forward to the
start of the 1994 campaign throughout the US and
overseas. We would suggest that people participat-
ing in this campaign include our designation #0514
when filling out their pledge card and then send
ATA a copy of the completed form so that our
records will be up-to-date. Often we do not receive
notice of contributions from local authorities for
periods of up to a year. In the meantime, member-
ship might run out and issues of the journal would
be missed. We don't want that to happen so take a
minute to let us hear from you!
Spring Swing (continued)
Ly1m Haddon Diane Bootz
Visits with support group coordinators in-
cluded: Diane Bootz, (Tallahassee); Lynn Haddon,
(Richmond); Doug Melton, (Alexandria); Shirley
Rosenhaft, (Silver Spring) & Susan Seidel, (Balti-
more). It was a real pleasure to see such enthusi-
asum on the part of these people, who have
committed their efforts to helping others with tin-
nitus. Thank you all!
The American Academy of Audiology Con-
vention in Richmond was attended by 3,400 audi-
ologists, exhibitors and interested people. Our
booth was well-attended and the enthusiasum for
our information and services made standing, smil-
ing and talking about tinnitus for hours on end,
seem very worthwhile. Two presentations on tinni-
tus were included in the AAA program: "Current
concepts in the managements of patients with Tin-
nitus" Gary Jacobson, PhD, and Audiology Depart-
ment staff; & "Tinnitus Aurium: Origins,
management, research" Robert Sweetow, PhD and
Richard Nodar, PhD.
Continuing education credits are available to
audiologists who attend these presentations, which
helps keep them up-to-date on current treatments.
The AT A is heartened to see evidence of more
interest on the part of hearing professionals in the
management of this complex and frustrating disor-
der.
AT A is a member of The Council for Better
Hearing & Speech Month, (which has been set for
May each year). Kickoff activities traditionally
feature a spokesperson and poster child (a new
team is chosen each year). This year Lionel Hamp-
ton and members of his band had the 'joint jump-
ing" at The Duke Ellington School for the Arts, but
in a statement about his own hearing loss and
tinnitus, after more than 50 years on the bandstand,
he encouraged future jazz musicians to "tum the
volume down."
The object of all this activity was to spread the
word about tinnitus and strengthen relationships
with those who are committed to assist us with this
goal. Personal contacts and communication can go
a long way in making it possible for people to "get
a life" even though they are burdened with tinnitus.
The ATA staff is continually encouraged and ener-
gized by feedback from all of you - it makes it
possible to come up with new ways of educating
and coping. We pledge to keep trying!!
ATA
#0514
NATIONAL IDWNTARY
HEALTII A G E N C ~
Tinnirus Today/September 1994 23
Self Advocacy 101
by Linda E. Dowell, M.S., L.S. W. Linda Dowell is
a support contact (receiving postcards and calls
only) at PO Box 1076, Gardiner, Maine 04345
Telephone: (207) 582-9482
When I was in high school, some thirty years
ago, I was impressed by initials following some-
one's name. The obvious thought was that the
person KNOWS something. At that time in my life
it didn't matter what the initials stood for, and I
never expected to earn them myself.
Now I look at the M.S. after my name and
think of Meniere's Syndrome. The L.S.W. stands
for loud, swishing water, because that describes my
tinnitus. Those high school impressions mean little
now that I cope daily with L.S.W. and M.S.
The credentials of a medical doctor may not
mean that he or she knows everything about
Meniere's Disease. He or she may actually have an
M.M.A. (mild medica] approach.) An M.M.A. is a
medically trained person who knows how ears and
hearing works, but does not understand the stress
and depression that is a very significant part of
tinnitus and Meniere's Disease. (For all we know
the E.N.T. could stand for "Enjoying no tinnitus.'')
I think that as patients, we expect all M.D.'s
to be able to ease the stress, lift the depression, and
give medications so that we may continue the life
we knew before we earned ill!!: initials.
It's important to remember these three ap-
proaches towards empowerment:
We have the right to ask technical questions
of professionals.
We do not have to accept the Mild Medical
Approach if we want more clinical informa-
tion.
We must ask for the facts we need in order
to grow in our understanding of tinnitus.
How to earn your own initials: an ''M.S.", or
Master of Self.
T
N
N
I
T
u
s
Tense? Know what relaxes you,
and do these things daily.
Insight. Know what experiences ag-
gravate your condition.
Never depreciate your self-worth
because of your suffering, or any
reason.
Never expect all your answers to
problems to come from medical sci-
ence.
Introduce yourself to others coping
with ear disorders.
Try to let go of anxiety-producing
self expectations.
Understand how you would treat
someone with your condition.
See that someone as YOU.
DO YOUR EARS RING?
As a concerned member of the American Tinnjtus Association, I'm seeking letters from others whose ears never hear si-
lence and who would like to share their experiences in an upcoming AT A-sponsored book.
Do you remember when you were first told that "you'll have to Jearn to live with itT I remember feeling anxious. de-
pressed, fearing my future, and alone. I learned about tinnitus causes and different treatments, but I wanted to know how other
people coped and managed to live with noise that just won't go away.
For those who are not within commuting distance of a support group, it would be extremely comforting to read ac-
counts of others who have come to grips with their tinnitus, who've had some improvement, or even had their tinnitus disap-
pear. Your experiences, combined into a book, might give others courage to continue living life as they'd lived before.
Please send your Jetter, preferably with an upbeat message, to me at either of the addresses listed below. (I am living in
Japan now; mail sent there will get to me sooner.) You may remain anonymous if you wish, but please include your occupa-
tion, age and city.
All proceeds from this book will go directly to AT A for tinnitus research. Thank you in advance for your help.
Please send letters to either address:
John B. Schuetze, 3904 Bel Pre Rd #4,
Silver Spring MD 209062825, USA
John B. Schuetze, Seki Heights #203, HimemiyaCho
2745, Mizuhoku Nagoya, 467 JAPAN
Tributes - A Gift of Love For Life
A contribution to the American Tinnitus As-
sociation, as a tribute to someone you care about,
is a most rewarding gift. It recognizes the recipient
in a profound and everlasting way. It also enables
you to help A TA at the same time.
Some events in life are so meaningful that they
will forever be remembered. It may be seeing your
baby or grandchild walk for the first time or being
recognized by your peers for an outstanding ac-
complishment. It may simply be an extended hand
of friendship during a particularly difficult time.
Whatever the occasion, you may wish you could
give special recognition to those who have made
such a difference in your life.
The answer to your wish is not always in a
material gift. Such gifts are appreciated but often
forgotten. Yet, there is a way to pay lasting tribute
to your special friends and loved ones ... with a gift
to ATA in their honor or memory.
All tribute gifts to ATA are acknowledged
with a special note of honor sent to the individual
you wish to recognize. Additionally, all tributes are
published in Tinnitus Today. Gift amounts are
never disclosed.
The opportunities for paying tribute to ftiends,
family and loved ones are many ... holidays, birth-
days, anniversaries, and other special occasions.
The gift options vary, often providing you signifi-
cant tax savings.
Cash
A gift of cash may be your easiest and most
beneficial option. Immediately effective and sim-
ple to give, this contribution is deductible up to
50% of your adjusted gross income. Any excess
deductions can be carried forward into five addi-
tional tax years.
Appreciated Property
If you own property which has increased in
value you will want to consider the following:
The sale of stocks, bonds or mutual funds
that have appreciated in value generate a
capital gain which is taxed.
A contribution of such property can be used
as a tribute gift and also enables you to
avoid the capital gains tax.
Gifts of appreciated property can be de-
ducted at their full market value if held
longer than twelve months.
The fair market value can be deducted up to
30% of your adjusted gross income and ex-
cess deductions can be carried forward into
as many as five additional tax years.
A Bequest
A memorial gift can be outlined in your will
or added as a codicil. This allows you to perpetuate
your personal dedication to AT A and remember
that special person. You can leave:
A percentage of your estate;
The residue of your estate;
Identified property;
A specific dollar amount.
These are only a few of the ways that you can
continue to support AT A and honor a loved one or
friend. For more information about tribute gifts,
please write to us or call Brent Mower at 1-503-
248-9985, ext. 18.
This information is not intended as specific
legal or tax advice. Consult your attorney or ac-
countant when considering any legal or financial
matter. State laws which govern wills and contracts
vary and are subject to change.
Cutoff Date for Receiving
Tinnitus Today
The 15th of the month previous to publication
is the last day we can receive your dues renewal and
assure you will receive the next issue. Example: If
your donation arrives after November 15, you will
miss the December issue. The first issue you will re-
ceive is March.
Tinnitus Today/September J 994 25
Tributes, Sponsors, Special Donors
Champions of Silence are a select group of donors demonstrating their commitment in the fight against
tinnitus by making annual contributions of $500 or more. Sponsors and Associates contribute at the
$100 and above level. The AT A tribute fund is designated 100% for research. We send our thanks to all
those people listed below for sharing memorable occasions in this helpful way. Contributions are tax de-
ductible and are promptly acknowledged with an appropriate card. The gift amount is never disclosed.
GIFTS FROM 4128194 TO 7/15194 IN HONOR OF Lawrence E. Happ, Sr. RESEARCH SPONSORS
John G AlamBirthday Charles B. Hauser George Barnes
CHAMPIONS OF SI LENCE Joseph Alam!Trudy Drucker John E. Held Lauran Bromley
Jo Nell Kerley Alexander Dorothy R. Hiltner Peter E. Campbell
Ronald Berger Emily S. Kerley Lorraine Hizami Florence H. Clough
Robert H. Boerner Dr Robert BrummettResearch Ted Hofmeister Anthony G. A. Correa
Thomas W. Buchholtz, MD Morgan Phillips Robert B. Horn Glenn Cuccinello
Bob Cannon Jules H Drucker-Birthday Andrew Hrivnak Ill Arthur Epstein
Sukey Garcetti Joseph Alam!Trudy Drucker William H. Hurt Jean Frymire
Mr .!Mrs. Ronald K. Granger Jack Harary-Father's Day H. June Ivins Helen Gleason
James C. Hansberger Robert & Deborah Harary John H. Jessen, Sr. Cyrus 0. Harper
Elizabeth K. O'Halloran Cindy & Michael Harary Douglas Kees Manny/Ruth Hillman
Mr .!Mrs. Steven Moksnes Bebe & Jay NovichBirthdays Harry G./Marion Keiper Teresa L. O'Halloran
Anne E. Revere Joseph Alam!Trudy Drucker Emily S. Kerley George M. Paschall
James L. Schiller Mr & Mrs Hugo L Olarte-Wed Mary P. Kladis Erik Schmidt
N. Schaefer ding Laura P. Kleppick Morton/Norma Steele
Wanda M. Shannon Joseph Alam!Trudy Drucker Barbara L. Kohn James Tomarelli
Ron Spagnardi Mike Sawicki Dr. Neta Kolasa Delmer D. Weisz
Jerry R. Thompkins Edward & Helen Sawicki David J. Kovacic
William R. Wenerick Seymour Shinder 70th Birthday Dr. Stuart Krasney PROFESSIONAL ASSOCIATES
Pearl Gerson Henry G. Largey Alan J. Arnold, MD
IN MEMORY OF Thomas Shirley Jr Gary L. Lombardi George Atkins, DMD
Ann Albertino Marie DePaul Marian B. Lovell Jin-Soo Bahk, MD
Virginia Fitzgerald Kent Taylor-Birthday Alex G. Margevicius Douglas Beck, MAICCCA
John E Greve Joseph Alam!Trudy Drucker David J. Masters Lisa A. Blackman, MA
Jim & Joanne Cooper Mary Tully-Birthday John M. Me Namara Warren Brandes, DO
Jerry Crane/Decatur News Joseph Alam!Trudy Drucker Alexander Miller Gerhard Goebel, MD
Publishing Co Martin Monas Dr. William C. Gray
Kay & Jim Donnelly SPONSOR MEMBERS Glenn A. Morton W.F. Samuel Hopmeier, BC-HIS
Daisy & Hector Greve Caroline S Nunan Terrence P. Murphy, MD
Cecile & Victor lanno Julia R. Amaral Ruth E. Ochs Dr. Otis D. Rackley, Jr.
Kevin & Patricia McGovern Patty Andrews Mary Ann Perper Elliott Regenbogen, MD
Howard & Ethel Post Bob Baldi Ruth M. Philpott Kathy Schauer
Marvin & MJ Schoenike John J. Banavige Kenneth A. Preston Jack A. Vernon, PHD
Village of Ridgewood Employees Ned K. Barthelmas Glen Provenzano Donna S. Wayner, PHD
Kathleen & Stephen Warwick Terrie Bergman Stephen M. Reece Gentry Yeatman, MD
Ruth Johnson Allen R. Bernstein William D. Riley Howard D. Zipper, MD
Priscilla Baggesen Ira F. Breiter Arlene/Dennis Roth
Jerome Kempler's Sister Lydia Chan Thomas J. Ryder
HEARING AID DONATIONS
Claire & Jacques Simon Walter Z. Davis J. Virginia Schurz 542 pre-owned Hearing Aids
Roy McFarland Rick Dilsizian Richard S. Schweiker and Maskers have been re-
Arlo & Phyllis Nash Nancy Doyle Robert S. Senteneri ceived and recycled. Thank you.
Norma Irene Duffield Jeff Slavitz We'll be glad to receive more!
Claire & Jacques Simon Robert D. Earp Earl LJSybil P. Small
Hilbert Olson Donna G. Fijolek Maxwell Solomon MATCHING GIFTS
Arlo & Phyllis Nash Richard J. Filanc Richard V. Sowa You might be able to double
Delwin Pedersen David E. Flatow Douglas H. Steves or triple the size of your gift
Arlo & Phyllis Nash William K. Friedman Donald V. Thompson to the American Tinnitus
Owen Pedersen Pearl/Julius Gerson James Tomarelli Association by taking ad
Arlo & Phyllis Nash Nathan L. Gibson James C. Totten vantage of your employer's
Jack Pritchard Andrew R. Gillin Aziz B. Ucmakli Matching Gift Program. Many
Shirley & Bud James James S. Gold Rita Weisner companies have matched con
Harry & Sue Paul W. J./Helen Gotschall Kathleen M. Williams tributlons to ATA. We urge
Jeanette Pritchard Catherine K. Greve Adelaide W. Zabriskie you to ask if your employer
Gail C. Griffin will match your gift. Or call
William E. Gromen ATA for the names of compa-
Josephine K. Gump nies that match contributions.
Fifth International Tinnitus Seminar
Next Year in Portland, Oregon
Reo-istration forms and hotel information will
Fifth quadrennial meeting, July 12-15, 1995,Port- be automatically to those people presenting
land Marriott Hotel,_ Oregon, Spon- papers or posters or they may also be requested by
sored bv the Amencan Tmmtus Assoc!atwn. callino- the ATA office after January 1, 1995. (Tel:
The Fifth International Tinnitus Seminar (503t248-9985, Fax: (503) 248-0024), E-Mail:
brings you the best in the field of tinnitus- most reichg @ ohsu.edu
distinguished speakers, the most provocatJVe_ ad- The most important component of the Fifth
dresses and panels, and the latest in research fm_d- International Tinnitus Seminar is the participation
ings. This meeting is the preeminent quadrenmal of those involved in tinnitus research. New campo-
event for all scientific investigators, because we nents for 1995, featuring legal issues and self-help
offer a carefully crafted program that have been included by popular demand. The Inter-
the boundaries of specialties and explores tmmtus national Tinnitus Advisory Committee is con-
from a variety of perspectives. stantly looking to improve the quadrennial
The 1995 Tinnitus Seminar features cutting by incorporating your ideas, recommendatiOns,
edo-e research while at the same time integrating and submissions. For more information on pro-
findings to clinical treatments. Diverse o-rammatic issues, or to seek advice on your sub-
poster presentations highlight specific research ;1ission, please contact Jack A. Vernon, P_h.D. ,
questions and findings, all in a format allows Co-Chairman, at (50_3) 494-8032, or Glona E.
the audience time to absorb, react, and d1scuss the Reich, Ph.D., Co-Chairman, at (503)248-9985.
data one-on-one with individual presenters. See you in Portland in 1995!
In addition to the impressive scientific pro-
gram, the Fifth International Tinnitus Semi-
nar offers exhibits featuring the latest
equipment, publications, and services,
and opportunities to network with col-
leagues at social events. Another key at-
traction is the satellite meeting of the
International Tinnitus Support Associa-
tions; the self-help group leaders work-
shop; and the special sessions devoted to
leaal issues related to tinnitus.
Don't forget the lure of the Pacific Northwest
itself. Portland has a splendid array of museums,
monuments, restaurants, theaters, and most of all
its sunounding natural attractions; the Columbia
River Gorge, Mt. St. Helens, now 13 years past her
great eruption; the Pacific coast; Hood, where
you can probably ski in July; the h1gh desert
try of Eastern Oregon; gateway to AI crlllstng
or California entertainments. These are JUSt a few
of the special attractions you can enjoy with yom
entire family.
Yes! 1' m looking forward to being part of the
Fifth International Tinnitus Seminar. Please send
me the following information.
D I am an investigator and wish to present a paper
about my tinnitus studies. Please send specific in-
structions for proposal preparation.
D 1 am a Self-Help Group leader or member and
would like to attend the sessions about tinnitus sup-
port. Please send me information about how to en-
roll in the Self-Help workshop.
D 1 am a lawyer representing clients with tinnitus:
I'm interested in attending the Legal Aspects of Tm-
nitus presentations. Please send me information.
D I'm an AT A member who would like to register for
the entire Tinnitus Seminar, attend all the meetings
and ancillary activities, but I will not be presenting a
scientific paper.
Name __________________________ ___
Affiliation ____________ _
Street Address ------------------
City/State/Zip--------------
Phone (with area code) _________ _
FIFTH INTERNATIONAL TINNITUS SEMINAR
JULY 12-15, 1995
PORTLAND, OREGON, USA
AMERICAN TINNITUS ASSOCIATION
P.O. BOX 5, PORTLAND, OR 97207-0005
FORWARD & ADDRESS CORRECTION
Non- Prolit Org.
U.S. Postage
PAID
American T i n n i t u ~
Association

Tinnitus Today September 1994 Vol 19, No 3

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Tinnitus Today September 1994 Vol 19, No 3

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SEPTEMBER 1994 VOLUME 19, NUMBER 3

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