VOLUME 13, NUMBER 1, MARCH, 1988

THE AMERICAN TINNITUS ASSOCIATION

THOUGHTS ABOUT TINNITUS
MANAGEMENT FROM THE UK
by Jonathan W. P. Hazell, F. R. C. S.
Consultant Neuro-Otologist to the RNID
(Editor's note: Dr. Hazell was the 1987 recipient of
the AT A- Hocks Memorial Award for distinguished
contribution to the field of tinnitus knowledge. The
article which follows was written as Dr. Hazell's
response to having received the award.)
In 1974 I began to take tinnitus seriously. The
Royal National Institute for the Deaf in London, of-
fered me a research fellowship with one proviso; I
must sort out the problem of tinnitus which ac-
counted for more letters of enquiry than anything
else. In the arrogance of youth I thought the matter
might take about eighteen months, after which I
would return to otolaryngology. The RNID stil l
generously support my work, of course I haven't
solved the problem, but I am older and perhaps a
little wiser!
As an otolaryngologist in training I was taught
1) tinnitus is a 'psychological problem'
2) there isn't anything you can do about it
3) reassure the patient and send them away with
a short homily.
In the UK the concept that tinnitus is psychological
was often interpreted by ENT surgeons as the tin-
nitus being completely imagined. This is almost
never true. Certainly I have learnt that many of my
tinnitus patients have other problems besides their
tinnitus. Often these problems are more important
in causing distress than the tinnitus itself. It does
not necessarily make them any easier to help but
it does raise the question of who is going to do
what. A distressed, often depressed and some-
times suicidal patient may need psychiatric or
psychological counselling, but first they need to
know about thei r ti nnitus and what can be done for
it. The problem is that no one in medicine, in the
UK at any rate, can do both these things properly.
There are very few psychologists or psychiatrists
who know much about the mechanisms of tinnitus,
and few otolaryngologists who are good at manag-
ing anxiety or depression. Fpr thjs reason both
groups had tended to develop a somewhat dismis-
sive attitude to a problem that many failed to under-
stand because their training could not encompass
the multifactorial aspects contributing to it. The an-
swer is relatively simple; as with many complex
medical problems a multidiscipl inary team is
needed and initial reports from Scandinavia indi-
cate that this approach can be very effective. In
the UK, with its National Health SeNice staNed of
resources, the introduction of such luxuries is rarely
practical. We must do what we can with what we
have. Many of you who have read this far will be
saying "but this is not me - I have a nasty noise in
my head and no problems!" That's another impor-
tant group too, tinnitus patients are far from homogene-
ous.
Americans were the first to really identify how
common tinnitus was. In 1968 a Government health
report based on the 1960 census showed over
36,000,000 Americans had tinnitus. However, was
the an experience or a "suffering"? As things pro-
gressed I became aware that some people could
have very quiet sounds that were only heard in the
absence of any environmental noise, indeed I be-
came aware that I had them myself! Other people
page 1
(Cont. on page 2)
THOUGHTS ABOUT TINNITUS, cont.
could have horrendous roars of diabolical machin-
ery 24 hours a day and that this could be associated
with loss of hearing, occasionally total deafness
but frequently no hearing loss at all (at least, of
which the individual was aware) . I realised that
these two groups did not neatly tie up with the
complainers and the non-complainers. Some
people with horrendous noises seemed to be able
to ignore them with equanimity, other people with
tinnitus which was barely perceptible became com-
pletely obsessed by it. There was a grain of truth
in that maxim that "tinnitus is psychological" . Not
that it was imagined by any means; we now have
proof of active mechanical processes within the
cochlea which may well be responsible for the gen-
eration of many of the tinnitus sounds that are
heard. The problem was one of the intrusiveness
of the tinnitus. Why did it cause some people dis-
tress and not others? By an unassisted process of
adaptation the tinnitus could be initially very terrible
and anxiety provoking, but after a period of time it
would go totally unnoticed. Many of the tinnitus
"experiencers" that I now see have high frequency
hearing losses, usually related to normal ageing
processes in the inner ear, or evidence of previous
noise exposure at work or play! One hypothesis
for this often tonal or band pass type of tinnitus is
that it relates to an area of neural or mechanical
hyperactivity in an area of the cochlea adjacent to
one of diminished activity. Three quarters of the
hair cells in the cochlea appear to have mechanical
properties concerned with reducing the dampen-
ing of the basilar membrane where sounds are de-
tected and frequency resolution occurs. Recent ex-
periments in the Karolinska Institute in Stockholm
show that these outer hair cells may vibrate at up
to 10,000 times a second when examined in an
isolated preparation. Evidence enough for the pre-
sence of real , rather than imagined, noise.
Perhaps many people who suffer from the same
problems I had with an elderly motor car in my
student days. It had many rattles, mostly relating
to degenerative processes (it was a lot older than
I was). Sometimes I could find a very smooth patch
of road (no freeways in those days) when it would
travel almost without noise (particularly if I turned
the engine off) but soon I was driving back over
the potholes again and the rattles were as loud as
ever. The mechanical processes in the inner ear
are controlled through special nerve endings (the
efferent nerves) by the auditory system, and also,
most probably by the autonomic nervous system
which controls our general state of arousal. Overac-
tivity of this system may promote great anxiety ("ad-
renaline highs"). In many patients it is possible to
identify a relationship between tinnitus levels and
the potholes of life! Of course the mechanism is
very complex so the relationship is never simplistic
or obvious.
What about this process of adaptation? We can
see the same tinnitus in the same individual produc-
ing two quite different effects. Initially it is insupport-
able, eventually it is scarcely detected. Could it be
that the tinnitus was only distressing if certain other
factors were true? Those moving from the depths
of the country to a noisy town where a busy main
road runs past their bedroom have a hard time of
it to begin with, but may eventually not notice the
noise at all. Others move to a small apartment
where the noise of their (much disliked) neighbour's
television set causes them great distress, even
though it is only just audible and very often has to
be listened for. Why is the effect of the noise of
that television different when it comes through
much more loudly from the next door room, but in
this case the perpetrator is an elderly, perhaps
hearing impaired, but much loved .relative or friend?
Do these experiences of auditory adaptation or tol-
erance indicate mechanisms which we could apply
to tinnitus?
Some of you who have read this far will be won-
dering when I am going to get on to "the cure" .
Surely I must know that many people have tinnitus
which turns off completely from time to time. Why
can't researchers find out why this happens and
do it for all of us? Well in most cases, I think we
shall have to wait for the point where we can deal
with tinnitus in the same way as we deal with the
rattle in an old car and that is a long way off. We
certainly can help with avoiding some of the
potholes; relaxation techniques of one kind or
another have helped countless thousands of suffer-
ers, turning them into "experiencers" .
(This article will be continued in the June issue)

PHILADELPHIA REGIONAL
CONFERENCE NOTICE
Those people who live in the Northeastern part
of the United States have received with this issue
a registration form for a Regional Tinnitus Confer-
ence which is being hosted by the Delaware Valley
Tinnitus Group, with the assistance of tinnitus sup-
port groups from Maine to the District of Columbia,
in Philadelphia, PA, on October 22, 1988. Herb
Goldberg, planning chairman of the meeting says
that their goal is to learn from the leading experts
on various treatments of tinnitus, to suppQrt each
other, and to provide public and political aware-
ness of tinnitus.
If you live in another part of the country but think
you might wish to attend this conference, please
write us for a registration form.
page 2
NORM CROSBY NAMED
PRESIDENT'S AMBASSADOR FOR
1988 BETTER HEARING & SPEECH
EFFORT
Television and nightclub comedian Norm
Crosby was appointed by the Council for Better
Hearing and Speech Month to serve as President
Reagan's public information ambassador for the
May, 1988 campaign on behalf of 24 million Amer-
icans with communicative disorders. The President
is national Chairman of the public service program
sponsored by the Council of 19 leading non-profit
organizations. (ATA is one of these organizations.
You will recall that the last ATA Newsletter featured
a story about how President Reagan got tinnitus
and about how he obtains relief by wearing hearing
aids.)
Crosby, who also uses hearing aids to correct
a noise induced hearing loss, will assist the Presi-
dent by leading a May campaign kickoff parade in
Washington, appearing in a television public ser-
vice announcement with the Better Hearing &
Speech Month poster child, and in making special
media appearances during the campaign.

AT A's "NEWEST Ph.D."
Gloria Reich receives congratulations from husband,
Ted on her accomplishment.
GIFT GIVING IN 1988
Charitable giving laws have changed but the
need to support voluntary agencies is greater than
ever. Your tax deductible gift to ATA helps us to
provide services to an ever expanding list of tinnitus
sufferers and gives you the satisfaction of knowing
that you have helped. ATA needs your contribution
now!
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does not forward Newsletters - they provide us a
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RESEARCH AWARD ANNOUNCEMENT
Dr. Richard Tyler, Department of Otolaryngol-
ogy -- Head & Neck Surgery
University of Iowa, has been awarded a one-
year grant for the study of Binaural phase effects
for the masking of tinnitus.
page 3
AMERICAN TINNITUS ASSOCIATION
PUBLICATIONS
TINNITUS BROCHURES
1. American Tinnitus Association
2. Coping with the Stress of Tinnitus
3. Information About Tinnitus
4. Information from Tinnitus Patient Survey
5. Noise, Its Effects on Hearing and Tinnitus
(Brochure number 1 is free, brochures 2 thru 5 are
15 each.)
Note: Postage paid on brochure orders for prepaid
US orders only
US postage= $1.00for up to 100 brochures, $2.00
tor more than 100 brochures.
Foreign postage = $2.50 per order.
Single copies of the above brochures may be ob-
tained at no cost by sending us a self-addressed
stamped envelope with the name of the brochure
written in the lower left hand corner.
BOOKS
Proceedings of the 2nd International Tinnitus Semi-
nar $15.00 U.S., ($2.50 Foreign Postage).
BIBLIOGRAPHY
The American Tinnitus Association is now offering
a Tinnitus Bibliography service at the following
prices:
Complete Tinnitus Bibliography
(over 1300 references)
1987 Bibliography Supplement
(over 200 new references)
Subject Search
Some of the many available
subJects are: Masking, Noise.
Drugs causing tinnitus, Trauma,
Electrical Stimulation, Menieres)
$50.00 ($25.00 member's price)
+ $1.00 shipping and handling
$20.00 ($10.00member's price)
$5.001 subject ( + $0.251
(reference over 15 references)
+ $1.00 shipping and handli ng
Note: We do not have copies of all of the articles
listed in the bibliography and we have not trans-
lated articles in foreign languages (indicated by
square brackets "[]" around the titles) .
Periodic supplements will be offered. Notices will
be sent to subscribers.

INTERNATIONAL TINNITUS SEMINAR
The IV International Tinnitus Seminar will be held
in Bordeaux, France in 1991. The publication of
the proceedings of the Ill International Tinnjtus
Seminar, which was held in Muenster, West Ger-
many in June 1987, will be available sometime in
1988. Further information about how to obtain the
book will be published in the A TA Newsletter as
soon as it becomes available.
NORWEST TINNITUS
SYNTHESIZERS NEEDED
AT A has received a number of requests from
people wishing to obtain Norwest Tinnitus Synthe-
sizers for use in testing and evaluating tinnitus.
Because this equipment is not currently being mar-
keted, ATA has offered to help prospective users
find second-hand Norwest Synthesizers that may
be available for resale. A TA is also able to accept
used synthesizers as a tax-deductible donation. If
you have a Norwest Synthesizer (see photo) that
you are not using, write or telephone ATA. (503-
248-9985)
SYNTHESIZER UPDATE: February, 1988
Thank you Dr. G. Donald Ohmart for your syn-
thesizer. AT A is g ratefu I for the donation and will
put the synthesizer to good use. Several other
people with unused synthesizers have been put in
touch with clinicians who want a synthesizer. A TA
is happy to provide this service so that tinnitus
patients may find more clinics able to provide tin-
nitus evaluation and treatment.
Are there any more out there?

FIRST GREATER NEW YORK REGION
TINNITUS FORUM
A public forum about tinnitus was held in New
York City on March 8, 1988. More than 200 people
attended this meeting which featured speakers on
the adaptation to, and the control and understand-
ing of tinnitus. Information was offered about AT A's
role in obtaining government recognition and re-
search funding for the problem of tinnitus. After the
guest speakers concluded a lively discussion
period followed.
Delay in delivery of our Forum announcement
by the U.S. Post Office resulted in a large number
of subscribers not being able to attend.
If you were unable to attend the New York meet-
ing you will have another chance.
Another public forum about tinnitus will be held
in Washington, DC, on September 26, 1988. Details
will follow in the next ATA Newsletter.
page 4
TRIBUTES
The ATA tribute fund is designated 100% for re-
search. Thank you to all those people listed below
for sharing your memorable occasions in this help-
ful way. Contributions are tax deductible and will
be promptly acknowledged with an appropriate
card for the occasion. The gift amount is never
disclosed.
IN MEMORY OF
Emagene Faye Veal
Ernest LJohnson
Everard Houghland
Hyman Silbovitz
M/M S. Rosenthal
Rev. Walter Holcomb
Dorothy Livingston
Mary Rapoport
Melvin Pressman
Lucy Moms
Delia Bille
Andrew
Carl Schwartz
Edgar Tunsc!l
Josephine Poarch
MichaelS. Monte
Mrs. Bell"s sister
Laura B. Johnson
Edward Betker
Isabel Deters
Marion Mazzone
Parents of
Harry Rosenwasser ,MD
Josephine Uter
C. W.Gamer
Ethel M. Palmer
Esther Feldman
Coi. J.O. Ciemens
Eva Brown
Mary Hockenson
Patty
Richard A. Markley
Lou Tinker
Bobby Hudson
ThomasG.SmHh
O.C. Brlscoe
BelsyOme
Martha Scott
Florence Davis
Leo Kindred
David B. Barnes
J. Copner Webster,MD
Wm. Forsberg
Roger D. Weinstein
Alma Sehnewald
Charles T. Bailey
Calvin C. Thompson
Mary Canny
George Selcer
Harry Kirsc!lbaum
Louis & Lucy lmposlmato
Sheila D. Hinrichs
Alexander Soney
David H. Rubin
D. E. Flinchbaugh
Jo Alexander
George Nichols
Kay Watkins
Bernard Brown
Lorraine Weiss
Phil Keefer
Isidore Greenbaum, MD
W. E. Wamstedt,Sr.
CONTRIBUTOR
Christine Helland
Mary E. Eyre
Jay & Rosemary Quast
VadaWeagle
Bernice M. Noah
Mary Bachman
Mrs. A. Houghland
Alice & Bob Cammann
Adolph Berg
David Wessler
Ellen/Anthony Ricciardelli
William R. Stone
Eva&Adolph Matz
Dorothy Curtis
David Hoffman
Ruth & Paul Deals
Thomas & Kathryn Tracy
C. Lorraine Holcomb
Mrs. Rudy Jacobson
Pauline A. Yoong
NancyE. Nye
William F. Peper
lraAmowich
Milly & Paul Attberger
Rosina Dl Paola
Lucy & Betty Acerra
MIM John Addeo
Abe & Miriam Upkin
Caroline Silbovftz
Marion Saxe
RobertBufe
Rose Phillips
Ida S. Berger
Augusta Tunsch
Joyce Ferguson
Hanry Vogelfanger
Jean & Joe WoHson
Rachel J. Walker
E. B. Betker
M a ~ o r i e Sylvester
Yvonne Mazzone
E. H. Sullivan
Rosenwasser family
EdnaW. Fisher
Marie E. Shafer
AbbyW. Asbell
Pearle C. Feldman
Robert L Johnson
Uta Rosner
Shirley Borus
Mrs. C. A. Johnson
David F. Williams
John A. Veglla
Don Bowman
Loise Smith
Grace Briscoe
Jeannine T. Reid
Basil Scott
Stephen Davis
Maxine Kindred
Mary E. Barnes
Randolph G. Szabla
Mrs. Wm. Forsberg
Raymond Weinstein
Edward V. Cerulli
Anne M. Bailey
Katherine E. Richards
Larry & Dotty Maher
MIM Elrom Abramson
MIM Elrom Abramson
Antoinette lmposimato
Betty Krigbaum
Elisabeth T. Soney
WiiAamA. Rubin
Dawson E. Flinchbaugh
Emily S. Kerley
Lucy Nichols
George E. Watkins
Betty Brown
Paul Weiss
Norma Keefer
Beatrice Greenbaum
W. E. Warnstedt,Jr.
IN MEMORY OF
Esther Mastey
Parents
Robert Ahrens
Michael Esposito
Mrs. Feldman' s dad
BettyUkes
Ludwig Schwalbe
Chantlcler
Cat.herine Cass
Slst.er Stella
Lena Vignola
E. Saunders Mom
JultaBeard
Herman Bykofsky
Mac McDowell
Dorthea S. Arnold
NeiiZukor
Thomas Come
SteveVegh
Anna Melnick
Fred Cramer
S. Klapper Mother
Margaret Willis
Evelyn J. Merson
John G. Jaser
Victor Sirchia
Joseph Donlon
Kathryn Waring
OvieCrowe
Sue Foley
Lewos 0 . Kohlhaas
Isabella Warren
Joshua Stocum
Jens Jacobsen
FredGaun
Brian McNeil
Constance Patterson
Madeline Donofrio
Toby Hoyt
Irene Harper
James Bullocl<
Gertrude/Nat LeKashman
Ruth' s mother
Howard Balzer
IN HONOR OF
U.S. Military Vets
tinnitus Is due to
The Deal
ATA
Myra Rowe
Abraham Shulman, MD
Jaok Vernon, Ph.D.
Sandy Schlater
Trto Korenaga
JamesBelim
Mr. &Mrs. M. Talch
WoiiLevy
Dr. Delbert Nowell
Mrs. N. McNamar
Mattie Martin
Donna Fijolek
Lenny Rush
Florence Hostetler
Fred L. Orner
Dwight C. Henicl<
Frank Calderone
John Kveton, M.D.
Michael Goodin
Ronald w. Place
Donald F. Regan
Ruthann Schaeffer
GlennGoveia
Angie Sablone
Gladys Ruppert
SadieShor
Marion Wanslng
Anna Kulik
Loretta LaMalfa
Stanley Cannon, MD
M/M Jacl< Fogel
- BE litH IIARII8
&SPERHMMTII
CONTRIBUTOR BIRTHDAY CONTRIBUTOR
Mark Levy Trudy Drucker Mary & Patrick Tully
R. L Slaugenhaupt Trudy Drucker Joseph G . Alam
MaxChessin Trudy Drucker AdeleAiam
J.Aiam& T. Drucker Trudy Drucker Chucl< Hopper
Jean&JoeWoHson Trudy Drucker Her Friends al ATA
Edith Phillips Irvin Massell Irvin Massell
Elsa Schwalbe Dr.& Mrs. A. Sohmer Jean & Joe Wolfson
Sam & Sylvia Eisenberg
Mary C. Shields
Sam & SyMa Eisenberg
Harold E. Wyer Faith B. Wyer
Theresa Gwizdala J. Gwizdala
James Cerminaro Carmella Gerchman
MIM Alfred Vignola
Jean & Joe Wolfson
J. Alam & T. Drucl<er
RobynVIIIany
Mrs. Ray Henell
A. Del Villar
ANNIVERSARY CONTRIBUTOR
Mik.e&Helen Mills Sylvia Grown
Bertha W. Rimbach Paul H. Rimbach
MIM Louis Ogull Judith Kennedy
A.L.Norton
Marjorie Apple RETIREMENT CONTRIBUTOR
Elmer S. Vegh Samuel Wolfson Jean & Joe Wolfson
Paul Melnick
Louise Hawkins
Sam & Sylvia Eisenberg
Sam Goldberg
Ernest Merson
J. Jaser
Marie Spector
Ann Donlon
GET WELL CONTRIBUTOR
Goldie Belkin M/M E. Abromson
Martha Sohmer Jean & Joe Wolfson
Stacie Khouri Jean & Joe Wolfson
Mrs. L. Greenfield Jean &Joe Wollson
Ms. Billie Murphy Jean &Joe Wolfson
Barbara Waring
George M. Crowe
Bill Foley
Mrs. L. 0 . Kohlhaas
Juanita Westcott
Fred Carlson
Henrietta Jacobsen
M/M Clarence Gault
Howard G. McNeil
LeRoy Patterson
Alexander Donofrio
Harry Hoyt
M.O. Holmes
Joan Tmovsky
Jacques R. Simon
SPONSOR MEMBERS: NOV., DEC. 1987, JAN. 1988.
Ronald c. Allen VICtor M. Aguaro
Frank E. Babb Allen R. Bernstein
Lawrence A. Brenner James L. Bryan!, MD
Frank Calderone StanlyJ. Cannon, MD
Rudolph S. Cardreon Mary loo Carey
Louis Carro Stephen Chandler
Robert Cole MIM Willard L. Crawford
Claude E. Davis Robert L Davis
Charles Dedrich, Jr. Edwin P. DierdOrl. MD
Lrscum Diven Leonard Drescher
Frederick Elkind Charles Epstein
Julius D. Feigelson Jerry N. Fetter
Lou Fockele Chris B. Foster, MD
Theodore Kowaleski
Evelyn Santo
Francine Foster Ralph D. Friedlander
VeraJ. Gibbard Nathan Gibson
Max F. Goldberg Richard C. Hart
CONTRIBUTOR
Joseph T acoogna
gunfire like mysen
Ruth A. Smith
Alvin Foigelman
TheAremeCiub
Frederick Elkind
Francine Foster
Cliff Collins
Louise Consalo, Jr.
John & Faye Schiefer
FloreneD. Pel!
Betty Bellm
Sayde S. Linke
Martin Monas
John Farmer
Bev Junkerman
Troy C. Martin
James Fijolek
Jeanne Wineblatt
Shirley Ann Hostetler
Marlha Orner
Sue A. Maccalllni
Angela Calderone
Michele Tanguay
Evelyn M.Goodin
Janice Place
Mrs. R.T. Regan
Ullian Schaeffer
Constance Goveia
AISablone
H. E. Ruppert
Mollie Manus
Mrs. AnnaHess Dan Hocks
D. Lorraine Holcomb Jac Holzman
SamHopmeier,Jr. Mrs. A. Houghland
Philip H. Ingber Karen A. Jacobs
Jasper J . Jaser Kenneth R. Johnson, Ph.D.
Gerald R. Joyce James G. Kaloris
Harry Keiper Dennis S. Kelliher
RobertA. Kirkman M"tehaell. Korpal
JohnS. Lampman Willard Uttlehale
B. J. Meek Phyllis E. Meie<
Joseph L. Meneghel Steven Millen. MD
Martin Movias, Esq. William Morett,Jr. MD
George A. Padgett John R. Patterson
Henry B. Peacock, Jr. Henry F. Peters
Garthowen Pitcairn John F. Pfeiffer
Mrs. C. M. Rains Margaret H. Rau
New1on A. Reynolds Ken Ritter
Kenneth Romney Ira D. Rothfeid, MD
DominiC D. Sabia William B. Salsgiver
NelsonSaridge MIMJohnH. Scheter
Herbert c. Schwank George E. Seagroves
Kit Sears Mrs. A. B. Shields
HenryW. Shields K, Thomas Shipley, Jr.
MIM Jacques Simon Marvin Singleton, MD
J. Thomas Somers. Jr. Lila M. Sowards
DorisE. Stamm 0 . W. Styve
Fred D. Thompson Mabel J. Ulery
John W. UHers Unda Uniatowski
Margaret C. Verharen Cari VerhOiek
Henry J. Voremberg Christopher J. Weiss
Delmar D. Weisz W. Harvey Wilson
Keith C. Winlers Larry W. York
In Min Young, MD
Mrs. Max Mileur
Isabel E. Vrta
Loretta LaM alia
Cpt. AHred M. File
Carolyn Werner
page 5
ATA: HISTORICAL HIGHLIGHTS
1971 - AT A IS BORN ... Thanks to Dr. Charles
Unice of Downey, California. Dr. Unice has tinnitus
and recognizes the need for an organization to
raise money to support tinnitus research. In its first
year ATA is nursed along by about 25 members ....
1973 - AT A MOVES TO OREGON ... Growth is
spurred by meeting of Dr. Unice and Dr. Jack Ver-
non, Director, Kresge Hearing Research Labora-
tory of the University of Oregon Medical School
... The Med School agrees to sponsor AT A as an
affiliated non-profit association ... AT A now num-
bers about 50 loyal souls.
197 4- ATA GOES NATIONAL . . . acquires its first
National Chairman, Mr. Robert Hocks of Hocks
Laboratory, Portland, Oregon ... the ATA mem-
bership starts to climb into 3-digit numbers.
1976- ATA GATHERS MOMENTUM . . . Expert
administrative assistance arrives in the person of
Mrs. Gloria Reich ... Under her guiding hand,
membership grows to 10,000 in the next 3 years
. . . AT A acquires a national advisory board of
prominent Ear, Nose and Throat Specialists and a
Scientific Advisory board of auditory research sci-
entists. . . Educational Workshop program in-
itiated .. . . Information for professionals interested
in evaluation and management of the tinnitus
patient. . . . Development of masking techniques
for relief of tinnitus . . .. Seed money for develop-
ment of the computerized Tinnitus Data Registry
granted to the Tinnitus Clinic at Oregon Health
Sciences University.
1979- ATA TAKES OFF ON BIGGEST CHALLENGE
SO FAR ... Decides to "go it alone" .. .. Becomes
legally incorporated as separate non-profit organi-
zation, no longer under guardianship of the Health
Sciences Center of the University of Oregon ....
This step was made possible by support from many
of the 33,450 members. Excellent news coverage
during 1978 and 1979 (PARADE magazine; NEWS-
WEEK magazine; many others) increased member-
ship dramatically. First International Tinnitus Semi-
nar takes place in New York City.
1980-ATA STARTS INTO THE '80's ... Com-
pletes its Educational Workshop program whereby
more than 1200 professionals have been trained
to evaluate and manage tinnitus problems. Reports
results from patients who have benefitted from AT A
programs. . .. Rock group, the STYX, contribute
proceeds of the "Golden Record" for tinnitus re-
search (ATA is beginning to hear from more and
more young people with noise induced tinnitus.)
1981 -RESEARCH EFFORTS GROW ... CIBA
devotes its 85th Symposium, held in London, Eng-
land, to the topic of Tinnitus .. . Results published
in first widely available reference work on tinnitus.
Masker developers, Vernon & Hocks, present
patent to ATA.. . . Board member Dr. David
DeWeese appointed to NIH committee .... ATA
co-sponsors Public Service Announcement featur-
ing Lou Ferrigno.
1982- TINNITUS SELF-HELP MOVEMENT
STARTED .... ATA presents guidelines and tips
for people to get together to help themselves with
tinnitus problems7 First group started in Bergen
County, New Jersey, by Dr. Trudy Drucker. . ..
others foll ow in rapid succession. Reich visits new
group in Louisiana. ATA membership grows by
over 6,000 during first 6 months of 1982.
1983-ATA PRODUCES FIRST RADIO PSA'S ...
William Christopher, Dr. Mulcahey of M* A *S*H stars
in series of announcements about tinnitus. Senator
Mark Hatfield is co-star .... 2nd International Tin-
nitus Seminar takes place in New York City .... 1st
Tinnitus Self-Help Group Convention takes place
in Wycoff, New Jersey. . . . New AT A Brochure:
Coping with the Stress of Tinnitus .... Dear Abby
mentions tinnitus bringing more than 20,000 letters
to ATA.
1984-ATA ENTERS THE FEDERAL FUND RAISING
CAMPAIGN .... Certified as a National Voluntary
Health Agency ATA is now qualified to receive
payroll donations from Federal, State and Local
Government employees in al l 50 states and federal
installations overseas. Research funding continues
for Tinnitus Data Registry and new grant is made
for tinnitus research at University of Iowa.
1985-ATA LOSES LOYAL FRIEND .... Bob
Hocks dies but his inspiration remains through fam-
ily memorial research award. ATA produces first
series of TV PSA's which focus on protection of
hearing. Research grant to Kresge Laboratory for
electrical stimulation work and work on effects of
salicylates.
1986-ATA DELUGED WITH MAIL . . . Ann Landers
mention of tinnitus in January column brings record
number of letters to ATA (more than 120,000) .. ..
Oregon volunteers work for 4 months to process
huge volume of mail. .. . Four new medical advisory
board members enter the fight against tinnitus . . ..
Dr. Bob Johnson accepts temporary chairmanship
of AT A and speaks to group of over 300 in Denver.
... Tony Randall stars in new ATA PSA's about
tinnitus. Gloria Reich appears on Me Neil Lehrer
(Cont. on page 7)
page 6
ATA: HISTORICAL HIGHLIGHTS, cont.
News Hour for ATA . .. Tinnitus self-help groups
now number over 150. AT A board members speak
to self-help groups in California, Maryland, New
York, New Jersey . ... Board member Dr. Francis
Sooy of San Francisco dies.
1987- ATA INFLUENCE SPREADS .... ATA joins
coalition of other organizations concerned with
hearing problems to further the process of hearing
research. Thousands of ATA members write letters
to legislators in support of bills to create separate,
new National Hearing Institute . ... 3rd International
Tinnitus Seminar takes place in Muenster, West
Germany . ... Program of public forums initiated
with fi rst meeting in Chicago, Illinois. . . . ATA
creates ti nnitus bibliography of more than 1500 re-
ferences.
1988 - PROGRESS CONTINUES . .. . President
Reagan accepts appointment as chairman of Bet-
ter Hearing and Speech Month ... . A TA one of the
sponsoring organizations. Reagan acquired tin-
nitus from noise of a gunshot during filming of
1930's movie ... . New ATA Brochure about Noise.
... Tinnitus public forum in New York City in March,
in Washington, D.C. in September, and regional
conference in Philadelphia, PAin October .... ATA
now providing services to more than 150,000
people.

TINNITUS SUPPRESSION USING
ELECTRICAL STIMULATION
AT THE EARDRUM
by Francis K. Kuk, Ph.D. , RichardS. Tyler, Ph.D.,
and Lee A. Harker, MD.
The University of Iowa Hospitals and Clinics,
Iowa City, Iowa
KUK TYLER HARKER
The use of electricity to treat tinnitus has a long
history. It was reported that back in 1801 , Grapen-
giesser used direct current (DC) to effectively sup-
press tinnitus in some sufferers. It was not until the
mid to late 1970's that interest in using electricity
to treat tinnitus re-surfaced when it was observed
that a number of cochlear implant patients reported
tinnitus relief with their implants. The cochlear im-
plant is a device that is surgically implanted i.nto a
profoundly deaf individual's head. It electncai!Y
stimulates the individual's hearing nerve to rega1n
some of the lost hearing sensation.
Subsequent research by different centers used
different places of stimulation, and different kinds
of electricity to stimulate the patients. The success
rate varied from 10% to 80% across centers.
At the University of Iowa we have just completed
a preliminary study on the effectiveness of
stimulation to suppress tinnitus. The quest1ons we
asked were: (1) Will electrical stimulation be effec-
tive in suppressing tinnitus? {2) What are
characteristics of the electricity that produce tin-
nitus suppression? (3) What are the characteristics
of the patients who can benefit from such treatment
approach?
We had 10 volunteers, 5 females and 5 males.
The ear that they reported as having the most tin-
nitus was chosen as the treatment ear. For individu-
als who reported equal tinnitus in both ears, we
arbitrarily chose one ear as the treatment ear. We
first measured the characteristics of the patients'
tinnitus-its loudness, its pitch and its susceptibility
to masking noise. We then placed a thin wire (with
a conductive sponge at its tip) into the patient's
ear canal so that the sponge touched the patient's
eardrum. The wire was encased in a 2 mm vinyl
tube. A conductive pad was pasted onto the
forehead as reference. No anaesthesia was used,
and patients reported only minor discomfort when
the wire was first placed on the eardrum.
page 7
The patients were then connected to our test
equipment and computer. We first determined if
electricity can be effective in suppressing the pa-
tients' tinnitus. We tried different electncal
waveforms (square, triangular and sinusoidal) and
different rates of stimulation (frequencies) to deter-
mine if the patients were responsive to electrical
stimulation, and if so, to what kind of electricity.
Patients who reported a change in their tinnitus
were further treated with the "optimal " electrical
waveform for 10 minutes. During that time, we also
measured their tinnitus loudness and its suscepti -
bility to masking noise. We also measured the pa-
tients' tinnitus after the treatment procedure. These
measurements were taken to evaluate the effective-
ness of the electrical stimulation. All treatments
were completed on the same day.
The results of our study are encouraging. Of
the 10 patients who participated, 5 received tempo-
rary relief from their tinnitus in the treated ear. These
patients reported a reduction in their tinnitus during
the treatment phase. For some (2/5), a total abolish-
ment of tinnitus was reported. The effectiveness of
the treatment was measured by comparing the pa-
tient's psychophysics and subjective tinnitus
(Cont. on page B)
TINNITUS SUPPRESSION, cont.
characteristics during and after the treatment to
those obtained prior to the treatment. The duration
of the relief ranged from less than 1 minute to about
4 hours. None of the 10 patients reported that their
tinnitus became worse after the treatment.
We studied the characteristics of the electrical
signals that were effective in producing the tinnitus
suppression. In addition, we examined the charac-
teristics of the patients' tinnitus. Our preliminary
findings indicate that triangular and square waves
are more effective in suppressing tinnitus than sine
waves. The specific waveform and rate of stimula-
tion depends on the characteristics of the patient's
tinnitus.
Electrical stimulation can be effective in tinnitus
reduction in individuals with different degrees of
hearing sensitivity. In one case, the tinnitus could
be reduced at low levels that were inaudible to the
patient. Of the five patients who reported benefit
from the electrical stimulation, four of them have
tinnitus that was pitch-matched to above 9000 Hz
(very high pitch). In addition, these patients' tinnitus
can be masked with noise more readily than pa-
tients whose tinnitus cannot be electrically sup-
pressed. Furthermore, all five patients could iden-
tify one ear as the predominant tinnitus ear.
Because of the small number of patients we
have tested, we want to emphasize the preli minary
nature of our findings and guard against any over-
interpretation of our results. However, we feel that
our results offer hope to the treatment of tinnitus.
At this point, the use of electrical stimulation to
suppress tinnitus is still experimental in nature. We
will continue specifically the patient characteristics
for whom this approach is appropriate. At the same
time, we need to refine the approach so that a small
wearable device can be used.

WE
SUPPORT
For more 1nformat1on write to
AMERICAN TINNITUS ASSOCIATION
PO Box 5. Portland. OR 97207
A private non-profit corporation under the taws of Oregon
AOORESS CORRECTION REQUESTED
Write the word NOISE in the lower left corner
of your self-addressed stamped envelope
to receive a free single copy of the brochure.
For multiple copies see ordering information
onpage4
CALLFORRESEARCHPROPOSALS
Research proposals for clinical studies of tin-
nitus are requested for the year beginning
November 1, 1987. There is no deadline, proposals
are acted on by the AT A board at varying times
during the year.
AT A has budgeted funds to support up to 5
proposals with budgets up to $10,000 during the
current fiscal year. Write to ATA for the outline of
grant application procedures if you are a qualified
research scientist and desire to submit a proposal.
NON-PROFIT ORG
US POSTAGE
PAID
PERMIT NO 1792
PORTLAND. OR
GREATER NEW YORK REGION
TINNITUS FORUM-MARCH 8, 1988
Greater New York Tinnitus Forum participants, many thanks
Left to right; Robert J. Luthmann, Barbara Goldstein, Ph.D., Abraham
Shulman, M.D., Gloria Reich, Ph.D., E. Robert Libby
Abraham Shulman, M.D., Gloria Reich, Ph.D., Robert J. Luthmann,
Barbara Goldstein, Ph.D.
E. Robert Libby
Abraham Shulman, M.D., Gloria Reich, Ph.D .. Barbara Goldstein, Ph.D.
Gloria Reich, Ph.D., Executive Director ATA
Joe A/am, Bergen County (NJ) Self-help group
Photos Courtesy of Vito Torelli
The First Regional Conference on Tinnitus, a one-day seminar providing education and increased advocacy for people with ringing in
the ears and head noises, is being hosted by the Delaware Valley Tinnitus Association (DVT A) at their Elwyn Institutes, Philadelphia,
Pennsylvania headquarters on October 22, 1988.
The conference will generate community and public support while providing a forum for tinnitus sufferers from the northeast and
mid-Atlantic states, offering information on the latest developments, advances and research in this area, and suggested therapies for the
alleviation of tinnitus.
Concurrently with specially planned, professional! y staffed workshops will be a "Drop- in Center" featuring continuously running
videotapes, refreshments, a tinnitus library and other items of interest and help. Attendees will provide for their own travel arrangements
and hotel accommodations.
PLEASE CUT ON DOTTED LINE
TO REGISTER, COMPLETE THE REGISTRATION FORM BELOW AND RETURN AS DIRECTED
REGISTRATION FORM
(Complete a separate registration form for each attendee. Limit- 3 registrations per family. If additional forms are required, photo copy.)
THE FIRST REGIONAL CONFERENCE ON TINNITUS
A oneday seminar providing education and increased
advocacy for people with ringing in the ears and head
noises. All tinnitus sufferers and interested persons
in the northeast and mid-Atlantic states invited.
SATURDAY, OCTOBER 22,1988
THE ELWYN INSTITUTES
4040 MARKET STREET, PHILADELPHIA, PA
PREREGISTRATION IS REQUIRED!
DEADLINE- AUGUST 31,1988
FEE (Incl udes coffee, refreshments and lunch)
$10.00 per person Now thru june 30, 1988
(Discount for early registration.)
$15.00 per person - j uly 1 thru August 31, 1988
I plan to attend the tinnitus seminar and understand I must report to the registration desk (between 8:30AM and 9:30AM) upon arrival.
In payment for registration of _____ person(s), I enclose my check in the amount of$----- made payable to: TINNITUS CONFERENCE '88
DO NOT SEND CASH! SEND PAYMENT, ALONG WITH COMPLETED REGISTRATION FORM, TO:
TINNITUS CONFERENCE '88, P.O. BOX 351, VOORHEES, NEW JERSEY 08043
NAME (PLEASE TYPE OR PRINT PLAINLY)
ADDRESS
'CITY
NAME & LOCATION OF SUPPORT OR SELF HELP GROUP
( .,1) PLEASE CHECK APPROPRIATE BLOCKS
0 ATA MEMBER 0 I AM NOT A MEMBER OF
ANY TINNITUS ORGANIZATION
0 I DO NOT HAVE TINNITUS BUT AM
REGISTERING AS:
0
A FAMILY MEMBER 0 OTHER
OR FRIEND
WORKSHOPS (Please check NO MORE THAN 3 workshops)
PLEASE SCHEDULE ME FOR THE FOLLOWING WORKSHOPS:
0 ELECTRICAL STIMULATION
0 AUTO SUGGESTION
0 DRUG THERAPY
0 EXERCISE & NUTRITION
IN TREATMENT OF TINNITUS
0 STRESS THERAPY
(Psychological approaches to)
0 MASKERS & HEARING AIDS
D RESEARCH:
WHATS NEW IN TINNITUS
RESEARCH
I NICKNAME
'STATE I ZIP CODE
0 PLEASE SUPPLY ME WITH THE NAME
& ADDRESS OF A SELF -HELP OR
SUPPORT GROUP NEAR MY LOCALE
0 SUPPORT FACILITIES
(One training session only)
L I MITED TO CURRENT AND/OR
PROSPECTIVE INITIATORS
AND COORDINATORS
0 FAMILY SUPPORT
(CONFIRMATION OF YOUR WORKSHOP(S) WILL BE PRESENTED TO YOU AT THE REGISTRATION DESK)
I WOULD APPRECIATE YOUR SENDING ME LITERATURE ON THE FOLLOWING:
0 LOCAL TRANSPORTATION
AND PARKING
(LOCAL BUSES/TRANSIT LINES
REQUIRE EXACT CHANGE)
0 RECOMMENDED LOCAL
HOTELS/MOTELS
0 LOCAL EVENTS
0 AREA MAPS
D LOCAL RESTAURANTS
D CITY SERVICES
WHAT:
A Regional Conference on Tinnitus '88 is being planned by American Tinnitus
Association support groups from Maryland, District of Columbia, Maine, New
York, New jersey, Connecticut and Pennsylvania.
WHEN: WHERE: (details on reverse side)
The day long conference will be in Philadelphia on October 22, 1988 from
9:00a.m. to 5:30p.m.
WHY:
The goal of the conference is to learn from the leading experts about various
treatments of tinnitus, to support each other, and to provide public and
political awareness of this problem.
WHO:
Dr. Abraham Shulman will speak on the identification of clinical types of
tinnitus and recent advances in electrical stimulation. Dr. Robert Libby will
speak on maskers and hearing aids. Dr. Max Ronis will present a workshop
on recent developments in tinnitus research. Dr. Louis Dubin will give a
workshop on hypnotherapy. Dr. Robert Sataloff is scheduled to speak about
the medical aspects of tinnitus. Dr. Robert Luthmann, will speak about family
support. Dr. Gloria Reich, Executive Director of the American Tinnitus Associ-
ation, will provide updated information about ti nn it us and about the American
Tinnitus Association.
YOUR PARTICIPATION IS NEEDED!
1. JOIN THE AMERICAN TINNITUS ASSOCIATION.
SUPPORT RESEARCH AND EDUCATION FOR TINNITUS BY SENDING
YOUR DONATION TODAY. MAKE CHECKS FOR MEMBERSHIP ($15.
or more, tax deductible) PAYABLE TO AMERICAN TINNITUS ASSOCIA-
TION AND MAIL TO: ATA, P.O. BOX 5, PORTLAND, OR 97207. YOUR
SUBSCRIPTION TO THE QUARTERLY ATA NEWSLETIER WILL BEGIN
IMMEDIATELY.
2. COME TO THE REGIONAL CONFERENCE. IT WILL BEAN ENJOYABLE
EXPERIENCE AND YOU WILL LEARN MUCH ABOUT HOW TO HELP
YOURSELF TO COPE WITH TINNITUS. IF YOU CAN ATIEND, OR
WOULD LIKE MORE INFORMATION, USE THE REGISTRATION FORM
ON THE REVERSE SIDE OF THIS PAGE.