SEPTEMBER 1992 Volume 17, 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."
0
IN THIS ISSUE:
Some Comments About Tinnitus
Tales of Tinnitus and Recovery
A Decade of Helping Ourselves
An Industrial Noise Liability Case: Won for Our Side


"COPING WITH TINNITUS"
e STRESS Mf\NAGEMENT &' TREATMENT
e TINNITUS Mf\NAGEMENT IS OfTEN
COMPLICATED BY ANXIETY AND STRESS
e NOW A UNIQUE CASSETTE F'ROGRAM IS
AVAILABLE DESIGNED TO F'ROVIDE DAILY
REII'WORCEMENT AND SUPF'ORT FROM THE
STRESS OF TINNITUS WJTHOUf COMPLEX
INSTRUMENTATION &' VALUABLE OFFICE TIME
There is a growing interest in psychological methods of tinnitus
control such as systematic relaxation procedures which help the
patient cope with the tension of tinnitus.
Subjects with tinnitus are being taught ways to relax as part of a
total tinnitus program which may include hearing aids, tinnitus
maskers and progressive muscle relaxation based on principles of
conditioning. Relaxation procedures are usually easily mastered and can be performed daily in the
patient's home environment It has been demonstrated that the relaxation response can release musde
tension, lower blood pressure and slow heart and breath rates.
A relaxation method has been developed entitled Metronome Conditioned Relaxation (MCR) which
has successfully treated for many years chronic pain, tension headaches, insomnia and many other
conditions.
The program consists of one cassette tape of Metronome Conditioned Relaxation and two additional
tapes of unique masking sounds which have demonstrated substantial benefit whenever the patient
feels the need of additional relief. These recordings can be used to induce sleeping or as a soothing
backdrop for activity and can be played on a simple portable cassette player.
AU. ORDeRS MUST Be ACCOMPANIW 6Y
CHOCK. VISA. MASreK.ARD. OR INSTmmONAL P.O.
6796 MAR!mT ST., DARBY. PA 19082
Phone (215) 352-0600
WANTED! HEARING-AIDS
AND I OR MASKERS
IN ANY CONDITION
If you have ever wondered what to do with those aids that are just sitting in the drawer, think no further.
ATA will be happy to receive them. Donations to ATA are tax deductible, and we '11 provide a receipt.
Simply package them up carefully (a small padded mailing bag is fine) and send to:
AT A, PO Box 5, Portland, OR 97207. If you are using UPS or another alternate shipper -
our street address is 1618 SW First Avenue, Portland, OR 97201, telephone (503)248-9985.
What happens to the aids you tum in? In some cases they can be repaired and given to people in
underdeveloped countries. Even if they can't be re-used as is, the parts are needed for repairing other aids.
Also, the plastic can be recycled. Your old aid could give someone the gift of hearing!
Tinnitus
Editorial and advertising offices:
American Tinnitus Association, P.O. Box 5
Portland, OR CJ7207
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Editorial Advisor:
Trudy Drucker, Ph.D.
Advertising sales: AT A-AD, P. 0. Box 5,
Portland, OR CJ7207 (800.634-8978)
Tinnitus Today is published quarterly in
March, June, September and December. It
is mailed to members of American Tmnitus
Association and a selected list of tinniws
sufferers and professionals who treat tinnitus.
Circulation is rotated to 200,000 annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed unsuit-
able for Tinnitus Today. Acceptance of ad-
vertising by Tinnitus Today does not
constitute endorsement of the advertiser, its
products or services, nor does Tinnitus To
day make any claims or guarantees as to the
accu.racy or validity of the adverti.ser' s of-
fer. The opinions expressed by contributors
to Tinnitus Today are not necessarily those
of the Publisher, editors, staff, or advertis-
ers. American Tmnitus Association is a non-
profit human health and welfare agency
under 26 USC 501 (c)(3)
Copyright 1992 by American Tinnitus
Association. No part of this publication
may be reproduced, stored in a retrieval sys-
tem, or transmitted in any form, or by any
means, without the prior written permission
of the Publisher. ISSN: 0897-6368
Scientific Advisory Board
Jack D. Clernis, MD, Chicago, IL
John R. Emmett, MD, Memphis, TN
Richard L. Goode, MD, Stanfoni, CA
Chris B. Foster, MD, San Diego, CA
John W. House, MD, Los Angeles, CA
W. F. S. Hopmeier, St. Louis, MO
Robert M. Johnson, PhD, Portland, OR
Gale W. Miller, MD, Cincinnati, OH
J. Gail Neely, MD, Oklahoma City, OK
Jerry Northern, PhD, Denver, CO
Robert E. Sandlin, PhD, San Diego, CA
Abraham .Shulman, MD, Brooklyn, NY
Mansfield Smith, MD, San Jose, CA
Harold G. Tabb, MD, New Orleans, LA
Alfred Weiss, MD, Boston, MA
Honorary Board
Senator Mark 0. Hatfield
Mr. Tony Randall
Board of Directors
Edmund Grossberg, Olicago, IL
Dan Robert Hocks, Portland, OR
Robert M. Johnson, PhD, Portland, OR
Philip 0. Morton, Portland, OR
Aaron I. Osherow, St. Louis, MO
Gloria B. Reich, Ph.D., Portland, OR
Thomas Wissbaum, C.P.A., Portland, OR
The Journal of the American Tinnitus Association
Volume 17 Number 3 September 1992
Tinnitus, ringing in the ears or head noises, is experienced by as
many as 50 million Americans. Medical help is often sought by
those who have it in a severe, stressful, or life disrupting form.
Contents
4
10
12
15
16
18
Some Comments About Tinnitus
by Gary Jacobson
A Decade of Helping Ourselves
by Trudy Drucker
Self Help Update
by Laurie Bauer
Tales of Tinnitus and Recovery
by Elliot Wineburg
An Industrial Noise Liability Case: Won for Our Side
by James Salter
Guidelines for Writers
how to submit articles for "Tinnitus Today"
Regular Features
6 Questions & Answers
9 Media Watch: Tinnitus in the News
18 Tributes, Sponsor Members, Professional Associates
19 Books Available, Donation Form
Cover photo by Joanne Russell, Houston, Texas. Pictured is Don Lovell, long-
time self-help group coordinator in Carter Lake, Iowa (Omaha, Nebraska
area) race-walking to the finish of a marathon in an ATA t-shirt. See Page 13
for more.
Some Comments about Tinnitus
by Gary Jacobson, Ph.D., Director, of
Henry Ford Hospital and Science Center m Detrolt,
gan. He is the aUJhor and co-author of many scumtific
articles and book chapters in the areas of hearing, balance
and tinnitus and is the co-director of the Henry Ford Hos-
pital Tinnitus Clinic.
I receive many phone calls each week from
people who are distressed by tinnitus. I would like
to make some comments about tinnitus (being one
of approximate! y 10% of normal hearing persons
who have tinnitus) in the hope that those of you
who have tinnitus will understand why you have it,
why you are bothered by it, and finally, what work
is being done that might make it easier for you to
live with this annoying problem.
First, if you have tinnitus you are in a large
company. Tinnitus is an extremely common prob-
lem. In fact, by sample estimates (from the 1960s)
as many as 50 million Americans have thi.s symp-
tom. Tinnitus is also a common accompanunent to
hearing loss. Therefore, if you have a hearing loss
it is .common to also have tinnitus. Most of you
have seen an ear physician and have undergone
many tests including basic hearing tests and
tory evoked poten rial testing (this is auditory
brainstem response test-ABR or bnunstem
tory evoked potentials-BAEP) to determme
whether the nerve of hearing has been damaged. A
few of you also have undergone specialized X-ray
tests called CT scans or MRI scans so that your
doctor is able to determine whether your tinnitus is
caused by more sinister origins such as growths on
the nerve of hearing and balance. If you have
undergone all or some of these tests and your ear
doctor has stated to you that he can find no expla-
nation for your tinnitus you must believe that your
tinnitus does not mean that there is something
drastically wrong with you or that you are gravely
ill. Most likely your tinnitus is caused by damage
to the inner ear. The damage is done and it's
important to try to realize what caused
your own tinnitus so you can avoid being further
exposed. The cause of the damage could be
sure to loud noise, medications that are designed
to save lives but could also carry the risk of hurting
hearing, or trauma to the head.
4 TIIDlitus Today I September 1992
I dislike the statement "You will have to learn
to live with tinnitus. There is nothing that can be
done for you." By itself, the statement could lead
anyone to despair. Tinnitus in many ways is like
other chronic conditions including headache and
back pain. Most times these conditions cannot be
"cured" but almost always these conditions can be
"managed." Tinnitus management is an area in
which many scientists/clinicians are interested.
Management in large part consists of a heavy dose
of education and counseling and a small dose of
electronics (see below). The more education you
have about your problem the easier it will be to live
with.
I say this from my own experience. Let me
give you an example. I think. I have had for
much of my life. However, 1t was only m the past
three years that I became acutely aware of its
presence. The more I thought the tinnitu.s, the
more intrusive and annoying It became. At rught I
could feel this sound was absolutely filling my
head. The most aggravating part was that I could
not "escape" it. The tinnitus followed me every-
where I went. Of course my initial reaction was to
assume the worst ("I must have some terrible dis-
ease to cause me to have tinnitus"). So I became
more educated. I began to read outside of my area
of research and soon found that I was part of a
group of individuals (albeit small) with normal
hearing but who had tinnitus. I underwent some of
the special audiology studies (described above)
that were normal. Also, I began to be more aware
of how much my attentional focus could either
make the tinnitus more or less annoying. More
importantly I saw that I could either increase or
decrease the loudness (and annoyance level) of the
tinnitus by directing my attention toward it. Now I
see myself as someone with a problem (but not .a
big one). I deal with it by keeping myself busy (this
is not very hard to do).
So to those of you with tinnitus I offer this
advice: become a sophisticated patient, read about
tinnitus and understand it as best you can. Once
you reallze your tinnitus signifies nothing more
than a malfunctioning inner ear, it will probably
Vol. 17 No.3
Continued
bother you less. Things bother us when we think
they mean something more than they do.
If you lead a sedentary life, get up and do
something! Exercise or take up a hobby or both.
The less time you have to think about tinnitus, the
less it will bother you. If you find there are times
that your tinnitus is intolerable, consider one or
more of the following three options: 1) obtaining a
masking device (see below), 2) consider joining a
self-help group and/or find someone else with tin-
nitus who you can talk with (It helps sometimes to
know of others with a similar problem who can
offer their own insights.), and, 3) visit a profes-
sional who is interested in the non-medical man-
agement of tinnitus (such as an Audiologist or a
Psychologist) if you are lucky enough to have a
Tinnitus Clinic in your region. I would add one
cautionary note. Now and then you will read of new
"cures" for tinnitus. Understand that there is no
"silver bullet" and it is unlikely that there will be
one in the imminent future. I would advise against
trying every one of these "cures" as they come
along. There is always the possibility with every
medical or surgical treatment that your tinnitus will
get better, stay the same, or, get worse. Wait and
see, then act!
Now, for the future. Tinnitus has not been an
easy problem to solve because it can be caused by
a deficit affecting the middle ear (the part of the ear
that carries sound vibrations to the inner ear), the
inner ear (the part of the ear that converts sound
energy into electricity), the nerve of hearing and
balance (the part of the auditory system that carries
the electricity to the brain), or the hearing "centers"
in the brain (that receive the electricity and inter-
pret it as sound). Part of the problem with the study
of tinnitus is that the perception of tinnitus is
entirely subjective (I cannot hear your tinnitus and
vice versa). The major topic of recent research has
been the development of animal "models" of tinni-
tus. By this I mean, in order to study tinnitus and
determine its sites of origin it is necessary to devise
a model whereby this information can be obtained
from other than living human subjects. The prob-
lem has been how to produce tinnitus in animals,
and, more importantly, how to know whether they
Vol. 17 No.3
have tinnitus when we think we have produced it.
A number of investigators (notably Drs. Pawel
J astreboff, William H. Martin and colleagues) have
pioneered the development of these models. Also,
at our laboratory we have been involved in the
development of non-invasive techniques to docu-
ment the presence of tinnitus using magneto-
encephalographic (MEG) recording techniques.
Unfortunately, to date our studies have not
been fruitful in the objective measurement of tin-
nitus in humans. However, we have hopes of join-
ing forces with the animal researchers to do
combined studies using :MEG techniques to meas-
ure tinnitus. Also, investigators in the past have
noticed that deafened individuals with tinnitus who
have been fitted with ear implants (cochlear im-
plants) have found their tinnitus diminished fol-
lowing implantation. This has opened a new
experimental avenue of study that is based upon
the idea of electrical stimulation of the auditory
nerve fibers in an attempt to eliminate or decrease
the intensity of tinnitus.
Our recent efforts are centered around under-
standing the effect that attention has upon the
perception of tinnitus (the American Tinnitus As-
sociation has funded this project and we are grate-
ful for their support). All of us who have tinnitus
have noticed when we think about the tinnitus it
becomes more prominent and louder. However,
when we are busy or preoccupied in everyday life
the tinnitus may be imperceptible. What is unclear
at present is why some individuals who have tinni-
tus of equivalent loudness can be bothered so dif-
ferently by it. One individual may adapt to it easily
and another may be driven to tears. We are attempt-
ing to understand the effects that attention (and
problems with attention) have on tinnitus annoy-
ance. We are hoping the results of our research will
help us to better select patients for different types
of tinnitus management techniques.
I am sure there are many of you who have
attempted to wear a tinnitus masker/instrument and
then given up on it. At first you may have felt the
sound was as distracting and annoying as your
tinnitus, and indeed this may be the case. However,
realize that the brain cannot ignore sound that
Tinnitus Today I September 1992 5
Comments, continued
changes. By this I mean if you are in a quiet room
and a sound begins you must pay attention to it
momentarily. The brain makes us respond this
way. Also, if that sound changes in loudness or
pitch we must be aware of it momentarily. For
many of us tinnitus may appear and disappear and
change in loudness and pitch over time in the same
way that our aches and pains may come and go and
change in intensity when present. The tinnitus
masker is designed to produce a "neutral" sound,
that is, a sound that we can adapt to that is constant
in intensity and pitch. Over time, the brain learns
to ignore this sound that covers up (or masks) the
tinnitus. It may require 3-4 weeks to be able to
make an informed judgement about how successful
you will (or will not) be with the masker. It is a
wise idea to give these a try if you are greatly
bothered by tinnitus. You may want to wear them
only when tinnitus is particularly intrusive.
To those who are bothered greatly by tinnitus,
take heart. There is a group of highly skilled re-
searchers who are attempting to understand this
problem. You will not see these individuals on TV
or hear them on the radio; however, they are work-
ing "behind-the-scenes" in the clinic or laboratory
to help develop better methods of managing tinni-
tus. You can help us by writing to your legislators
telling them of the need for more money to be
allotted to research in tinnitus (the present amount
allotted is truly insufficient). Your voice will be
heard in this election year. You can help yourself
by becoming highly informed about tinnitus. There
are excellent books available on the subject (the
one authored by Richard Hallam, Ph.D. called
Living With Tinnitus is my favorite).
can help you by being accessible when you have
questions and trying to find better ways of dealing
with tinnitus.O
American Tinnitus Association
is a participant in the
Combined Federal Campaign
#0514 in the CFC Brochure
Thank You For Helping
To Fight Tinnitus
6 Tirmitus Today I September 1992
Questions & Answers
by Jack Vernon, Director, Oregon. Hearing Research Gen.-
ter
Before turning to your questions allow me to
comment. Some questions from you have gone un-
answered, and I hope that in each such case you will
submit your questions again. Some questions, due to
limited column space and the length of the answer
required have been answered directly rather than
through this column. If my answers have provoked
unresolved questions, please feel free to submit
those additional questions. WE HAVE LEARNED
ABOUT TINNITUS PRIMARILY FROM TINNITUS
PATIENTS. Thus, you may have experiences or
comments that inspire questions which should be
included in this column. If so, send them in.
O uestion: "How long will it take for tinnitus to
away, if it is going to do that, and will niacin
help?" Mrs. T from Dlinois.
Answer: Tinnitus can and often does simply fade
away. I tend to say that tinnitus is permanent when
it has remained unchanged for two years. As long as
the tinnitus is fluctuating, it is not yet established. I
do not recommend, however, that one sit around and
do nothing hoping the tinnitus will go away. I think
it is better to obtain partial relief than to do nothing.
I realize niacin has often been prescribed for tinnitus
on the theory that, as a vasodilator, it would improve
the blood supply to the ear. I have never seen a
tinnitus patient who has been helped by niacin. But
then, if they had been helped, they would not have
sought my help. Would they? To recommend niacin
is to suggest the tinnitus is actually located in the
inner ear when, in fact, we do not yet have tests
which can determine the actual location of the prob-
lem generating the tinnitus.
Q uestion: "I am 84 years old. Does my age make
it impossible to relieve the tinnitus with acupuncture
treatments?" Mrs. G from California.
Answer: The answer, Mrs. G., is no. Your age
does not prevent you from getting relief from your
tinnitus. That you are going to seek relief with
acupuncture is another matter. ff the acupuncture
fails to give relief it will not be due to your age. You
have only had your tinnitus for five months, and it
Vol. 17 No.3
Questions & Answers
is just as likely that it will simply go away in time
as it is that it will remain with you.
Q uestion: "Is hyperacusis a disorder or a _symp-
tom? What is the difference between recrmtment
and hyperacusis? I don't understand why you ad-
vocate desensitization if hyperacusis is a collapse
of tolerance." Mr. J from Minnesota.
Answer: Hyperacusis is a symptom of a disor-
der. It is only that we do not know what the disorder
is. Current theory suggests the sound regulating
part of the auditory system has failed in its function
and it is that failed part we are trying to activate by
desensitization. While recruitment is defined as a
rapid growth of loudness; it is not necessarily an
unpleasant sound. Recruitment occurs when there
is damage to the inner ear. The diagram below is
an attempt to illustrate the difference between re-
cruitment and normal growth of loudness as well
as hyperacusis.
_.-- Hypencuslc Ear

Normal Eor--._. ,
/
/
/
I
/.
,
/
1 _.-- Recruiting Eor
/
Physical Intensity ol Sound
The rest of your question, Mr. J., is a matter of
semantics. I am suggesting that the desensitizing
process is an attempt to reestablish normal toler-
ance for everyday sounds. I would like to make the
distinction that the problem is not a matter of
hypersensitivity but rather a matter of severely
reduced tolerance. Hypersensitivity would imply
the patient had unusually acute or keen and
that is not true. In fact, many hyperacus1s panents
Vol. 17 No.3
have hearing loss which is the opposite of elevated
sensitivity. It is a matter of the quantity of sound
once a threshold has been exceeded. It is here that
we have some real problems in that the hyperacusic
patient cannot describe what it means to be hyper-
acusic beyond saying, "I cannot stand that sound. "
I suspect there are several gradations or categories
of hyperacusis, but that will require a great deal
more quantification and knowledge than is pres-
ently available. I continue to recommend desensi-
tization, and I feel it is absolutely essential that
hyperacusic patients not over protect their ears for
to do so is to increase the lack of tolerance. Our
English colleagues use tinnitus maskers on hyper-
acusic patients and recommend they be used for
eight or more hours per day. They indicate normal
or nearly normal tolerance is reestablished in sev-
eral months or less. I am sure we will be hearing
more about this in the future.
Q uestion: "Can you provide any information
about auditory training for autism?" Mr. M from
Wisconsin
Answer: Autism is not in my area of effort,
nevertheless, I would like to make a comment
about auditory training as used for autism. As I
understand it, the clinician determines which par-
ticular frequencies (pitches) are most disturbing to
the autistic patient. These disturbing frequencies
are then filtered out of recordings of speech and
music which are played at a loud level to the
patient. I think we might consider the reverse of
this approach for hyperacusis patients. That is,
determine which kinds of sounds are most disturb-
ing to the patient and then repeatedly present those
sounds to the patient under carefully controlled
loudness after having filtered out the less objec-
tionable sounds. Some of you will recognize this
proposal as similar to the desensitizing program for
hyperacusis.
Q uestion: "My tinnitus came_on It is
pulsatile and pressure on the Jaw stop the
tinnitus. Is there any treatment for this type of
tinnitus?" Mr. S from Ohio.
Tinnitus Today I September 1992 7
Questions & Answers
Answer: Pulsatile tinnitus can, in some cases, be
masked by using a low-pitched noise, such as that
provided by the Marsona-1200 set on "waterfall"
with the tone control on full bass. Because pressure
?n the jaw has relieved the tinnitus, a 1MJ problem
ts suggested. I would advise consulting your local
dentist about TMJ tests and possible corrective
measures. Dr. Douglas Morgan is a dentist versed
in 1MJ and tinnitus with whom you might want to
consult. (Douglas Morgan, DDS, The TMJ Re-
search Foundation, 3043 Foothill Blvd. #8, La
Crescenta, CA 91214). IfTMJ disorder is the cause
of your tinnitus then, in my opinion, it would be
better to try to solve the causal problem than to
relieve the tinnitus by masking.
Q uesti?n:. " W , ~ l l jaw surgery to correct the bite
reheve ttnrutus? Mr. M from California
Answer: It is possible that tinnitus can be due to
misalignment of the jaw. However, we humans can
have several things wrong with us at the same time.
We can have fallen arches and dandruff at the same
time, but it is highly unlikely those two events are
related. Mr. M. states his tinnitus stems from head
trauma in a car accident, and it is also possible the
head trauma produced the misalignment of the jaw.
Mr. M, you might want to consult with Dr. Morgan
(address above) or your regular dentist.
Q uestion: "Will the decreased blood flow be
harmful when I apply light pressure to the side of
the neck to relieve my pulsatile tinnitus?" Mrs. Me
from California
Answer: Since pressure to the side of the neck
can stop the tinnitus, it strongly suggests that Mrs.
Me has found the site of her problem. I do not think
additional damage will occur, nevertheless, I think
she should see a cardiologist, or cardiac surgeon,
and describe her symptoms and pressure effects.
Mrs. Me, if you are worried about loss of hearing,
routine hearing tests at intervals of six months
would answer that problem for you. Moreover, it
may be possible to surgically intervene and relieve
the tinnitus. Whether or not surgery is justified
depends upon how much the tinnitus bothers you.
I think it is somewhat comforting to know where
8 Tinnitus Today I September 1992
the problem lies so that should things become
worse one could rely on surgical intervention. No,
Mrs. Me, I do not expect your tinnitus to get worse.
Q uestion: "Is there any information about the
effect of altitude upon tinnitus?" Mr. S from Kan-
sas.
Answer: Yes, we have a small group of tinnitus
patients who can accurately predict a change in the
weather due to the change in atmospheric pressure.
We deliberately altered the pressure in the ear canal
of 639 patients which produced a change in the
tinnitus for 128 (20%). For 17% the pressure
change reduced the tinnitus and for 3% it worsened
the tinnitus. Mr. S, you are considering moving to
a higher elevation. I would suggest you conduct a
trial run of a month or so at that altitude. If your
tinnitus remains unchanged or is improved during
that time, then such a move would be indicated.
Q uestion: "How common is it for tinnitus to be
produced by sudden hearing loss?" Mr. S from
New Hampshire.
Answer: It can happen but it is extremely rare.
In a survey of 873 patients attending our Tinnitus
Clinic, 7 (0.8%) associated their tinnitus with sud-
den hearing loss. Even though rare, this type of
tinnitus is treatable.
Q uestion: "Did coming off prednisone produce
the tinnitus I now notice? I also have a bit of
difficulty hearing." Mr. S from Ohio.
Answer: I doubt coming off prednisone pro-
duced tinnitus for you; perhaps it was even helping,
and now what you notice is the lack of that help.
Since the tinnitus is not bothering you, I would
advise ignoring it. Most folks tend to grossly un-
derestimate their own hearing loss and since you
admit to a "bit of hearing difficulty," I would
suggest a hearing check-up with a possible view to
acquiring hearing aids if so indicated.O
Vo1.17No.3
Media Watch: Tinnitus in the News
by Cliff Collins, Oregon freelance writer. Please address
clips, including source and date, to Media Watch, PO Box
5, Portland, OR 97207-0005.
Funny, isn't it, how often news topics run in
torrents? Over the summer there was a steady stream
of stories relating to noise: how it annoys, how it
injures-- not just the ears but also health and quality
of life.
"Noise experts agree: America has become the
land of battered eardrums," proclaimed a headline
in The New York Times. The story, describing a
meeting of professionals concerned with acoustic
problems, notes that European countries are taking
legal steps to hush noise. It says the United States,
by contrast, has a bigger problem than ever.
Some experts at the meeting attribute much of
the regression to the dismantling of the federal gov-
emmen t' s noise-abatement office by the Reagan and
Bush administrations. Since 1981, funding for such
programs has been slashed. According to the article,
"Some experts here argued that unless the federal
government acted to halt the national plague of
noise, there was little hope for improvement."
In European countries, even those formerly
under the Iron Curtain, people can look forward to
protection under a set of standards for noise protec-
tion. "Unless the United States begins making qui-
eter machinery to comply with the environmental
standards being worked out in Europe, America's
sales in the European market could sharply decline,"
the story concluded.
More noise: A Seattle Times columnist penned
an excellent piece emphasizing the dangers of in-
door noise at events such as arena concerts and ball
games in domes. She cites yet another lawsuit filed
by a concert-goer against a rock group he blames for
his permanent hearing loss, and she says the Koss
Corporation has been handing out free foam ear-
pi ugs at public events as part of a hearing-awareness
program (1-800-USA-KOSS).
The Boston Globe carried both a news story on
Tokyo, Japan (described as "the city that never shuts
up ... where unbroken sleep is nearly impossible"),
Vol. I7No.3
and a column lamenting the proliferation of "un-
attended car alarms" (in other words, alarms that
go on hours or days when cars are left parked
somewhere). Hmm ... maybe that's what those
annoying neighborhood noises are that I some-
times hear but can't pin down.
The Associated Press ran a story bannered
"Doctors urge Americans to protect their hear-
ing," and interviewed ear specialists who said
"teen-agers addicted to rock concerts, boom
boxes and personal stereos running at top blast are
literally deafening themselves." The Arizona Re-
public carried a sad story describing a 94-year-old
man who was sentenced to prison for killing two
neighbors after he suffered two years of bombard-
ment by their loud music and his complaints to
police failed to stop it.
Just in the nick of time, the increased number
of news articles on "anti-noise" technology is
noticeable. The Richmond Times Dispatch, Popu-
lar Science (April) and the Associated Press cov-
ered developments in this exciting field, which
promises to tum much noise on its ear, rendering
it less offensive and damaging. The technology
won't be just welcome, it will be revolutionary.
It's hard to think of areas and applications where
it won't be useful, important--- and needed.
Hearing things: That's the title of a piece in
The Washingtonian magazine, which describes a
typical case of an older man who goes to an ear
doctor and complains of a hissing sound in his
ears. The writer
notes that so many of
us now live in cities
or metropolitan ar-
eas that we sustain
hearing damage dec-
ades earlier than
folks did previous! y.
American Health in
June gave good in-
formation on tinni-
tus in its Q & A
column, as did "The
Doctor is In," a col-
umn in The Fresno
(California) Bee.O Tinnitus Today / September 1992 9
A Decade of Helping Ourselves
by Trudy Drucker
In the early Eighties, self-help groups and sup-
port groups (there is a distinction, but it's rather
blurred) were springing up in America like mush-
rooms after a rainstorm. Some of these groups fol-
lowed the twelve-step program developed by AA for
people with addictions; other groups, for people
fighting through loss or illness, were essentially
supportive. Inevitably, ATA Executive Director
Gloria Reich wondered if the self-help movement
would have something to offer people with tinnitus.
She asked if I would be interested in starting a pilot
project in my area, northeastern New Jersey. Indeed
I would.
Announcements of the first meeting were sent
out by ATA after I had provided a list of the zip
codes in Bergen County. The Oregon office pro-
duced the selected mailing from its own lists.
The Bergen County Tinnitus Self-Help Group
met for the first time on 10 March 1982, in a large
meeting room of the college at which I taught. I came
armed with ATA literature and with forms for those
who wished to register for future meetings. More
than one hundred people showed up, which some-
what overwhelmed me.
At this first meeting, the pastor of a local Lu-
theran church, who has tinnitus and was present,
offered us use of the church meeting room, and we
have held all but one of our meetings there ever
since. When the pastor retired, we discovered a
fortunate coincidence: the new pastor had a long
interest in audiology and an aunt with tinnitus! We
were assured that our group would always be wel-
come in the spacious and beautiful meeting room of
the church.
We meet every other month except July and
August. Usually we alternate meetings featuring a
speaker with open meetings available for free dis-
cussion. Often participants make excellent sugges-
tions for speakers or topics, and I try to fulfill these
requests. Our group bas become known in the area,
and it's not unusual to get letters from professionals
in various fields who offer themselves as speakers.
We certainly will schedule some of these people for
the coming year.
10 Tmnitus Today I September 1992
Our open meetings are characterized by the
sharing of experience, and there's little doubt that
tinnitus can provoke some highly idiosyncratic and
even bizarre effects. Among topics that come up for
discussion fairly frequently are noise exposure, the
effect of medications (those that might help tinnitus,
and those that might worsen it), the possible value
of masking, the effect of sleep, stress and stress-re-
duction techniques, and the quality of available
medical care.
To my surprise, we often get almost as many
attendees for the unstructured meetings as we do for
meetings with a speaker and formal program. Evi-
dently the opportunity to chat with others about
common or uncommon problems is welcome to
many. On average, a distinguished speaker or an
unusual program will attract as many as fifty people.
Open meetings usually attract about thirty, and I
can't remember a meeting with fewer than twenty
participants.
Our lectures and lecture-demonstrations have
been provided over the years by experts from many
disciplines. The lecturer was a psychiatrist six times,
a psychologist three times, an audiologist four times,
and an otolaryngologist six times. We also heard
from two attorneys, a physician-acupuncturist, a
pharmacologist, a hearing-aid dispenser, a business-
man who was involved in the electrical-stimulation
experiment, and a specializing librarian who serves
the state's hearing-impaired and visually impaired
population. We even had a "speaker" who crashed a
meeting -- but perhaps the details of that unique (I
hope) evening are best left unrecorded.
We seek, and get, good local publicity, and at
each meeting one finds as many as a dozen newcom-
ers who learned about the group from newspapers
or the local cable station. Notices of our meetings
are sent to all the otolaryngologists in the county and
to the heads of audiology and otolaryngology de-
partments in the local hospitals. A number of people
have been referred by these professionals, some of
whom sometimes attend themselves.
Some years ago, I found that our mailing list
had grown to the point where it became extremely
difficult for me to type out meeting-notice enve-
lopes. I turned our list over to a mailing service,
Vol. 17 No.3
Decade, continued
which bas proved very efficient. The group has no
formal dues or admission cost. We "pass the hat" at
meetings and the sums collected help defray mailing
costs. The balance comes from a private tax-deduct-
ible donation. This informal method works for us,
because we have no hospital or organizational affili-
ation, but might not be feasible for other groups that
must devise other methods of funding their activi-
ties. Of course, all our speakers donate their time and
use of the meeting site is free.
We have some people who attend quite regu-
larly, including some who have been attending al-
most since we started up. Others attend only once or
a few times. Our mailing list now has about 350
entries. I try to prune it from time to time, hoping
that those who are no longer interested will identify
themselves and save us some postage. Notices go
out two weeks in advance of the meeting date.
Originally we met on weekday evenings but some
participants found this difficult. Since 1988 we have
met on Saturday afternoons, generally between three
and five p.m. We don't have a calendar of advance
dates because our schedule must accommodate the
availability of speakers.
The group has a close but informal association
with ATA. The national organization helps us con-
tinually with literature, advice, and many other
kinds of assistance. In tum, we try to be helpful to
ATA. Our mailing list was made available to the
planners of the several regional conferences that
have been held in the northeast. Every time I get the
eyes or ears of our participants, I strongly urge ATA
membership. Many times, members of our group
have been able to look to ATA for answers and
solutions we couldn't provide for ourselves.
Because meetings five times yearly might seem
too few for some people, a few years ago I started a
written "network" publication for people who
shared their names and telephone numbers and
might be interested in between-meeting contact with
others. The list went only to those who were on it
themselves, and had consented to distribution. (As
in every medical situation, privacy is an important
consideration.) It became obvious after a few years
that not many people used the network or wanted to
be listed, so I abandoned the project two years ago,
Vol. 17 No.3
but perhaps not permanently. The meetings evi-
dently provide enough opportunity to make contacts
for any desired between-meeting exchanges.
Recently I felt the need for a back-up group of
experts to advise me and the participants from time
to time. Last year a psychiatrist, a psychologist, an
audiologist, an otolaryngologist, and an attorney
were invited to form the group's advisory board. I
hope to add a hearing-aid dispenser, an internist, and
a neurologist. I am also collecting the names of
people who will eventually become a layman's ad-
visory board. Our professional advisory board mem-
bers are previous speakers who seemed particularly
appealing to the group.
My spouse, Joseph Alam, has functioned al-
most as a co-facilitator. He takes informal minutes
at each meeting (which made this article possible),
and fields most of the telephone inquiries because I
don't like to spend much time on the telephone. He
has spent many hours licking stamps and sealing
envelopes when he would much rather have been
solving crosswords.
Questions of ethics or propriety arise occasion-
ally. Should I, if asked, recommend a physician or
other practitioner who I know is competent and
compassionate? Should I, if asked, steer a partici-
pant away from a practitioner known to be incom-
petent or worse? To both questions, I answered "yes"
and always make clear that my opinion is only an
opinion unless I have some specific useful facts.
Many participants in the group know which physi-
cians, audiologists, and hearing-aid dispensers are
trustworthy; this knowledge is often gained by trial
and error and sometimes with some distress. Partici-
pants can, and do, exchange a good deal of useful
information, and I think this constitutes a very im-
portant part of our self-help.
Is participation in a tinnitus self-help group
always helpful and desirable? No, notal ways. A few
people manage their tinnitus best by ignoring it; they
have somehow taught themselves to push the tinni-
tus to the back of consciousness. Reading or talking
about it brings the affliction into focus and obvi-
ously worsens the situation.
As I look back on our history, I remember our
most notable event, in June of 1983, that attracted
Tinnitus Today /September 1992 11
Decade, continued
about 140 people. Our guests were Jack Shapiro of
th.e London Tinnitus Group and four of our great
friends from Oregon: Executive Director Gloria
Reich, the late Robert Hocks who was Chairman of
ATA, and Doctors Jack Vernon and Mary Meikle of
the Kresge Hearing Research Laboratory. Some
self-help leaders visited from New York, Boston,
Philadelphia, and southern New Jersey. At this
meeting, we introduced our LOUD NOISE HURTS
bumper stickers that provided some revenue for the
group for several years. Some members of our group
kindly provided a wine-and-cheese postlude.
Our tenth-anniversary meeting last March was
another memorable event as well as a milestone for
us. Our guest was a prominent psychiatrist who has
tinnitus and also has some provocative views about
how to deal with it. He is well known to many of our
participants, and attracted a near-capacity crowd of
almost one hundred people.
Obviously the Bergen County Tinnitus Self-
Help Group is thriving, and I look forward to many
more years of helping each other and helping our-
selves.O
It was standing-room only at the meeting of the Bergen County
Tinnitus SelfHelp Group in March 1992. Dr. Richard A.
Gardner, a psychiatrist in Cresskill, New Jersey, addressed
the meeting, which marked the tenth anniversary of the
group's founding.
12 Tmnitus Today I September 1992
Self-Help Update
Bringing People Together
Calling all Computer Users: On-line Self-Help!
ATA Member David Biddle of Franklin Wis-
consin suggested a brilliant idea for further network-
ing people with tinnitus: On-line "Bulletin Boards."
David currently uses both COMPUSERVE and
PRODIGY, and has already been in contact with
several others about tinnitus through these systems.
He explains "this is an excellent way for people with
common interests to share their thoughts, concerns,
anxieties and questions with others that can empa-
thize with their problems." The obvious advantage
is that it's not limited at all by geographic location
(he has already heard from someone in Australia!).
If you use either of these systems and are
interested in participating, please contact David:
0
0
0
0
0
/
"
l I I ~ I U I I I I I U I I ~ I = = J - = FIIICJ
~
//&18F.wss:e-&\\
His CompuServe address: 75070,2005
His Prodigy address: NDCK63A.
Depending upon response, a "Question and
Answer" type forum has been suggested, which
would allow several people to conduct a conversa-
tion on-line, like a telephone conference call.
Together with the recently formed pen-pal net-
work, these unique support system ideas serve to
remind us how nice it is to have others so genuinely
interested in listening and helping. We should all
feel honored that our neighbors with tinnitus care
about our well-being and offer their support so
openly. Any other ideas? Please let us know! ATA
is grateful to all of you for your willingness to
help!O
Vol. 17 No.3
Self-Help Update, continued
A Warm Welcome to New Self-Help Groups
in:
Evansville, Indiana.
Contact Patty John: (812) 424-4903
Wichita, Kansas.
Contact Elmer Jennings: (316) 682-6033
Neighborhoods of Philadelphia, PA.
Contact Morris Rubinoff: (215) 895-5561
Sharon PA/Youngstown OH.
Contact Barbara Cogley: (412) 983-3911, x 4002
Simpsonville, South Carolina.
Contact Barbara Raper: (803) 963-8915
Tacoma, Washington.
Contact Lee Leggore: (206) 565-6120
For information on the group's plans or to
become involved, contact the local coordinator
listed.
On the cover:
Don Lovell, self-help group coordinator,
wearing an ATA t-shirt, race-walks across the fm-
ish-line of the Houston -Tenneco Marathon held
January 26, 1992 in Houston. Don explains that
anything requiring attention and concentration helps
him deal with his tinnitus. "Exercise helps more than
anything else I've tried," he says. Besides the benefit
of physical fitness, it brings a sense of accomplish-
ment, which boosts self-esteem and general mental
well-being. An avid race-walker, Don advocates the
sport for its health benefits and also the fun, friendly
group of people involved. Recently he won 2 silver
Vol. 17 No.3
medals at the Senior Olympics in Des Moines for
race-walking the 1500-meter and 5000-meter
events. This qualifies him for the Nationals, which
will be next year in Baton Rouge. Congratulations
and Good Luck, Don!
The t-shirt on the cover is one of a few Don had
made for himself, to publicize tinnitus and ATA
while race-walking. A few of you have already
expressed an interest in such at-shirt, and we would
like to make them available to you, provided there
are enough orders to justify having them made.
As a source of income for ATA, the short-
sleeved 100% cotton t-shirts would be sold for
$14.95. The shirts are white, with the ATA logo and
definition of tinnitus printed in blue. If you are
interested in ordering an ATA t-shirt, send a POST-
CARD with the word "T-SHIRT" to us, and beneath
it clearly print your name and complete mailing
address: (see example below)
POSTCARD - SEND TO AT A, POB 5,
PORTLAND, OR 97207-0005
T-SHIRT
Your Name
Your Address
Your City, State, Zip
Your response will allow us to purchase an
appropriate number of the shirts, and send you an
order form. We look forward to your postcards! 0
tinnitus (tl nl' Ius) a noi se
In the ears, I.e. rln,ing,
buzzing, roaring, d1ckfng, etc.
Tinnitus Today I September 1992 13
Notices
W e encourage you to copy and share information
from any issue of Tinnitus Today, but please give
credit to Tinnitus Today, the Journal of the American
Tinnitus Association.
A e you an A TA member who has excellent con-
tact with a research hospital or institution, or major
drug company? If so, would you be willing to pre-
sent our concerns about tinnitus to them in hopes of
stimulating new research? Please write to us for
further information.
P eople have inquired about donating their ears to
medical research. A new form-- The Medical Direc-
tive, now addresses the types of medical measures
people may want to specify in catastrophic situ-
ations. These forms may be obtained for $1.00 each
by sending a self-addressed stamped envelope to
"Medical Directive," Harvard Medical School
Health Letter, 164 Longwood Avenue, 4th Floor,
Boston, MA 02115. Several Universities and Medi-
cal Centers around the U.S. have temporal bone
banks for hearing research. There are four regional
centers for temporal bone donations. 1) Massachu-
setts Eye & Ear Infirmary, Boston, MA; 2) Baylor
College of Medicine, Houston, TX; 3) University of
Minnesota, Minneapolis, MN; 4) UCLA School of
Medicine, Los Angeles, CA. Contact one of these
centers for further information if you are comtem-
plating such a bequest.
W e have received this additional information re-
garding the use of Xanax for the treatment of tinni-
tus: 1) Always consult your personal physician
up one morning with a bad tinnitus and pop a tablet
for quick relief. 5) If you've been taking Xanax and
need to stop, it is very important to taper off slowly.
6) The dosage used for tinnitus is much less than the
dosage used for psychological problems.
A limited number of copies of Robert Slater's
book A Layman's Guide to Tinnitus and How to Live
With It are available from the A TA office. The cost
is $5.00postpaid. Prepaid orders in US funds (drawn
on US Banks only), please. Checks or International
Money Orders should be made payable to American
Tinnitus Association.
H ear's to the ADA, a 23-minute video to educate
people with hearing loss about the types of commu-
nication accommodations they can expect under the
provisions of the Americans with Disabilities Act
(ADA), is available from SHHH Publications, 7800
Wisconsin Avenue, Bethesda, MD 20814. (301)
657-2248 Voice, (301) 657-2249 TT. Costis$35 for
SHHH members and $40 for others, plus $2 postage
and handling.
Dr. Jastreboff at the University of Maryland in-
forms us that the distortion product system de-
scribed in the June issue provides interesting and
useful results that allow detection of which part of
the cochlea has disturbed micromechanical proper-
ties, which might be related to tinnitus. "Further-
more," he states, "this is a method which allows for
differentiation among patients with the same
audiogram and present or absent tinnitus."O
Classified
before taking any drug. Xanax, for instance, adds to .-----------------------.,
the effect of other drugs you might be taking (includ-
ing alcohol!) 2) Xanax can be habit forming, it is not
meant to be taken for long periods of time. 3) When
you first use Xanax, you may experience daytime
sedation. This effect may go away in a week or so,
or the dosage schedule may need to be modified. 4)
If Xanax isn't working for you don't take more!
Tinnitus Stress Management Audio Cassette Tape
$12.95 Postage Paid ($14.95 US, Foreign Orders)
Ernest B. Johnson R.H.
54 Pembroke Street
Marlboro, MA 01752
Also, it takes a week or more before you notice the L__ _ _ _ _______ _ _____ _..
effect on your tinnitus (if any). You can'tjust wake
14 TIIIDitus Today /September 1992
Vol. 17 No.3
Tales of Tinnitus & Recovery
by Elliott Wineburg, MD., Director, The Asso-
ciated Biofeedback Medical Group, New York, NY
The patient is a striking woman of 45, slim, a
competitive tennis player and hospital administrator.
Her husband is a successful litigator, a specialist in
malpractice defense.
Sammi (a fictitious name) enjoyed robust
health, a brilliant career, and a good marriage. Each
of life's stresses was met head-on and conquered by
this energetic woman until five years ago. Following
a "normal" cold she developed a middle ear infection
(otitis) followed in two days by the onset of a rushing
noise in one ear. The infection was nicely managed
with antibiotic but the sound continued.
Subsequent tests (audiograms, etc.) showed a
constant 25% hearing loss. A sizable number of
specialists were consulted in her own prestigious
hospital and other highly regarded medical centers.
No help.
Gradually Sammi became angry and distrustful
of doctors. Frustration turned to antipathy as each
physician said, "Don't worry, it will go away." A
highly motivated person, her private resources now
failed. She found herself more and more despondent
due to the insistent noise, the now-persistent insom-
nia, and the lack of functioning at work. The increas-
ing dosage of prescription sleeping medication was
viewed with alarm.
Excursions into other medication regiments
were unsuccessful. Neither diuretics, niacin, ster-
oids, nor low doses of antidepressants moderated the
intolerable noise.
As Sammi related her history, tears rolled
down: she described her heretofore successful life
now in shambles. She could not sleep. Nights were
barely endurable with a "noise machine" producing
an external masking sound. Her fear of passing a
night without this minimal aid was so great that her
husband was cajoled into purchasing a backup unit
for her. Concentration at work was becoming impos-
sible. Her husband accused her of becoming a "de-
pressed neurotic".
Although a trial course on a full dosage of
antidepressant was offered, she adamantly refused
Vol. 17 No.3
all drugs. "Nothing helped before." She was not
about to start again with medication.
Consequently a noninvasive, nonchemical plan
was adopted. Sammi was to develop a management
program allowing her to put her hand on the volume
control and turn down the noise. Relaxation at night
would be developed and a tension reduction tech-
nique implemented for daytime use. A safe tech-
nique was accepted by the patient: Biofeedback. Her
feedback therapy was orchestrated to reduce stress
both in the facial muscles particularly about the TMJ
(temporomandibular or jaw joint) and the internal
"fight-or-flight" emergency response (sympathetic
nervous system). The muscle treatment was effected
through placement of sensors on the skin not unlike
the EKG attachments which signal the patient's
level of electrical muscular tension on a TV screen
and with sound and color (EMG feedback). The
changes over the involuntary sympathetic nervous
system were taught by observing the temperature of
a fingertip. (Consider that cold clammy hands are
often a sign of high level anxiety and stress. The
converse is true: warm hands show inner repose.)
By the end of the eighth treatment Sammi and
her husband took an extensive back country holiday
in Southern Spain. Her nightly use of the noise
machine (she only took one) "died" after landing in
Europe and in spite of anticipated insomnia she slept
well and reported "the intensity of the tinnitus is
less."
After two more biofeedback sessions she ter-
minated treatment. With her depression gone, she
was functioning well, and sleeping without pills. Six
months later she reported by phone "I am doing
well."
More informa-
tion about the use of
biofeedback for tin-
nitus is available
through the AT A
bibliography.O
Tinnitus Today I September 1992 15
An Industrial Liability Case: Won for our Side
Winning a lawsuit involving company liability for causing
tinnitus may be a bit easier now, due to the courage and
persistence of a young woman in Texas, named Carole. ATA' s
contact and counselor in Dallas, Jim Salter, tells this story,
which began when Carole called him for advice.
About two years ago, I answered a call which
was an anxious pleading request for help with a
problem concerning tinnitus, as I have in scores of
cases for the last 20 years. The call was from Carole,
a young woman who developed severe tinnitus as a
result of protracted immersion in a highly damaging
noise environment caused by her former employer,
a major defense contractor.
Beyond the usual hope for something which
would help her tinnitus, Carole wanted information
to help in the pursuit of a law suit against her former
employer. I had no experience or advice to give in
this suit or so I thought at first.
Among the first things Carole told me was that
her lawyer was very pessimistic about the case. It
seems that the history of Worker's Compensation
cases for industrially induced damage to hearing is
limited to cases claiming hearing loss. Legitimate
hearing loss cases are regularly given awards based
on the scope of the damage, following expert audi-
ological examination. But, there is no history in
Texas law for successful suits with the claim of
tinnitus. The word TINNITUS appears twice in
the legal search, unrelated to a suit such as
Carole's. I suggested a meeting with Carole, want-
ing to get into this case more than I normally would.
I had a premonition that this could be a landmark
case, if won, and soon found Carole was the right
kind of person to win if anybody could.
I found a tearful, frightened, distressed woman
who nonetheless was determined to do something
about this terrible violation and the insult she had
suffered. What happened in her job is simply this:
the company decided to make extensive structural
additions to the building in which she and a few
other clerical personnel worked. They were located
in the middle of the building, which was to have a
second floor added. They worked in open offices,
with nothing more than topless cubicles. They re-
mained there week after week, while fork lifts deliv-
ered materials around them, and while the usual
16 Tmnitus Today /September 1992
sawing, riveting, hammering and other extremely
loud noises continued much of the time. Complaints
from the women, including Carole, were ignored
and taken as "troublemaking." Supervisors to whom
she complained worked in enclosed offices and
never stayed in the noisy environment for any ex-
tended time. Among the most damaging noise was
that of reinforcing steel bars being dropped from
considerable height onto concrete floors.
There is more detail, but it is painful even to
recount. Carole and two companions were ulti-
mately released from the company with conven-
tional citations of "reduction in force," after having
been unofficially characterized as "troublemakers."
Two of her companions had complained of hearing
impairment, which was demonstrated by audiologi-
cal examination. Carole retained nearly normal
hearing, but gained severe tinnitus. The three hired
a lawyer to seek compensation. I volunteered to
help.
I quickly learned that the lawyer lacked any
basic definition of tinnitus and its potential debili-
tating effects, which could be effectively described
to a judge or jury. There was no known precedent
by which to approach the issue of making an award.
Just how bad can tinnitus be? How much does it
interrupt normal life and productivity? What award
amount would be fitting, in light of historical awards
for hearing loss (the nearest comparison) or in light
of impairment of earning power for the remainder
of a normal career. Behind this set of uncertainties
was the continued pessimism of her lawyer that any
meaningful award could be won. At one time she
recommended settling for $1000.00.
Carole was directed by the court to have an
expert audiological examination and to see a psy-
chological specialist in hearing. The psychologist
called me. We reviewed the case history I had taken
with Carole, including a novel attempt to measure
the impact on adjustment of her tinnitus. I had given
her a standard personality questionnaire and asked
her to answer it first as she would "now," and then
repeat it, answering the way she would have before
the tinnitus. Granted, this is short of perfect meth-
odology, but it was a way to gauge how this had
changed her life. The results were very clearcut. I
Vol. 17 No.3
Liability Case, continued
then wrote two papers which I gave to the psycholo-
gist, to the lawyer and to Carole. They treated these
issues:
1. What is tinnitus and what may its impact be
on life and work. This included an estimate of life-
quality impact on Carole and an estimate of the
amount of disability she had suffered, in terms of
probable future earning potential.
2. A comparison of tinnitus with hearing loss
from the viewpoint of ~ n e r a l life impairment and
eligibility for compensation. The core thesis was
that the tradition of overlooking tinnitus as a com-
pensable impairment is an error; that while hearing
loss is of major significance, it is (barring deafness)
subject to some correction, while tinnitus is usually
untreatable and a more or less intolerable intrusion
and interference in life. In short, it is just as "bad" as
hearing loss, or worse, granting that no possible way
could be found to equate a given hearing loss with
a certain level of tinnitus.
The exact role of these writings in the case is
not known to me. The psychologist expressed appre-
ciation for the viewpoints. He subsequently wrote
a paper for the court which basically upheld Carole's
reports of her disorder and its debilitating effect. A
medical doctor did the same. The case went to
arbitration. Carole says the company lawyer virtu-
ally sided with her, after sensing what she had
suffered. Carole decided to raise the amount being
asked far above what she had first been told there
was any prospect of getting.
The outcome? Carole was given a substantial
award, many thousands of dollars (the amount is
restricted in the terms of the settlement), not nearly
enough by my view of the damage but I am very
biased. The two co-workers with hearing impair-
ment were given substantially smaller awards. It is
probably critical that the tinnitus case was argued as
a general physical impairment and not just as a
hearing related impairment.
Carole is a remarkable woman. She still has
tinnitus. It is about the same. But she has become
her own best manager and has taken my advice to
avoid stress, noise and to find pleasing activities
which absorb attention. She now runs a small
arts/crafts shop in a sleepy Texas town where a
Vol. 17 No.3
supportive husband and friends work together to
restore what they can of tranquility to a person
horribly violated by ignorance, insensitivity and
industrial crime.
I talk to Carole on the phone from time to time.
She is o.k. She will give data to those legitimately
interested in this case as a landmark decision. I
agreed to keep what might be a rush of inquiries
from stressing her by answering (for her) questions
about her case from those interested. At a certain
point, she may want to answer them, something I
will put to her when the inquiry suggests doing so.
I would appreciate an addressed, stamped en-
velope with any inquiry. I would like to hear of
similar cases. You are welcome to either or both of
the two papers I wrote if they could be of help.
Jim Salter is an Industrial Psychologist in Dallas, Texas.
He developed tinnitus 20 years ago in an airplane depressuri-
zation accident, has represented ATA much of the time since
as group coordinator and telephone/correspondence counsel-
lor and has done some research in tinnitus. His address is 11040
Creekmere Drive, Dallas, Texas 75218. Phone (214)-328-
1221; FAX (214 )-328-8899. 0
Classified
SPECIAL Pll.LOW CAN RELIEVE EAR
NOISES AND AID SLEEP
Your sleeping habit may be robbing you of a proper
night's sleep. The Ear Relaxer can change your life. Austin
Skaggs, the inventor of the Ear Relaxer Pillow, reports that
it has helped him and many other people who have tried it.
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 (postpaid) , outside U.S. send
$20.95 (U.S. funds), for postage paid shipment to:
EAR RELAXER
POBOX90
VICTOR, WV 25938
Tinnitus Today /September 1992 17
Tributes, Sponsors, Professional Associates
The ATA tribute fund is designated 100% for research. Thank you to all those people listed below for
sharing memorable occasions in this helpful way. Contributions are tax deductible and are promptly ac-
knowledged with an appropriate card. The gift amount is never disclosed.
IN MEMORY OF
R. Scott Bryngelson
John & Faye Schlater
Tom Fagemess
Jerry Fagemess
Marlon Flasconaro
Dr. & Mrs. Philip Silverstein
Robert J. Green
Naomi Green
Natalie Kumln
Mike M. Mills
David Malamud
Mr. & Mrs. Sam Eisenberg
Seymour Mazer
Mr. & Mrs. Sam Eisenberg
Mother
Mr. & Mrs. Sam Eisenberg
Ida Plevlnsky
Mr. & Mrs. Stephen Luongo
Teddy Rothenberg
Sally Rice
Mike Shapiro
Albert C. Ostberg
Anita G. Weiss
Joseph Alam & Trudy Drucker
IN HONOR OF
John G. Alam-Birthday
Joseph Alam & Trudy Drucker
Daniel Cslderwood-Birthday
Joseph Alam & Trudy Drucker
Susan & Rob Christopher-An-
niversary Ann E. Revere
Trudy Drucker-congratulatlons
pending publication In Anthology
Joseph G. Alam
Betty Ford
Nancy Cowell
Jack A. Harary-Father'a Day
Robert & Deborah Harary
Michael Harary
Bob Johnson, Ph.D
M. Bernice Dinner
Esau Joseph-Recovery
Joseph Alam & Trudy Drucker
Jay & Nina Novlch-Birthdays
Joseph Alam & Trudy Drucker
Ralph Revere
Ann E. Revere
Ralph Revere-Birthday
Ann E. Revere
Shlr1ey & Mort Roaenhaft-50th
Wedding Anniversary
Laura & Harry Feinberg
Kate Rosenhaft
Mr. & Mrs. Harry Rothman
Martin Waxman
Ro & Jim Traver-Birthday
Joseph Alam & Trudy Drucker
SPONSOR MEMBERS
MAY TO JULY 1992
John Adel Sr.
Joseph G. Alam
Julia Amaral
Arco Indonesia Inc.( R. Bowden)
Ned K. Barthelmas
Hal Blaine
Bob Boemer
Thomas W. Buchholtz
Robert B. Budelman Jr.
Mary Lou Carey
Laura A. carson
Avon C. Coffman, DO
Continental Emp.'s Charity Fund
Tony Correa
Norman Cressey
John W. Crlsanti Sr . MD
Jon C. Dattorro
Shahn A. Dlvorne/Ear-Tee
Patrick & Helen Duffy
David Escoe
Patricia S. Fink
Jean Schabinger
Fockele/Gainesville Comm. Fn.
C. W. Gehris, Jr. MD
Hilda A. Gottschalk
John P. Griesbach
Jospehine K. Gump
Paul R. Haas
John & Jeannette Harrington
James & Colleen Hartel
Jeffrey Hoffman
Christopher V. Houghton
Barry V. Johnson
Paul S. Kaytes
Walter Kisiel
Donald Lemmons
Alfred A. Levin
Ed Leigh McMillan II
Robert J. Mermuys
Michael J. Morgan
Henry N. Nelson, MD
Charles R. Nicholson
Ruth E. Ochs
Robert Para
Albert A. Petrulis
Guidelines for Writers
Ruth M. Philpott
Gaston de Prat Gay
Sue B. Query
Ann E. Revere
Ludle G. Richard
William D. Riley
Daniel Ross
Fred Sellers
Marlene K. Shaw
Harry J. Shehlanian
Harvey D. Silberman, MD
Michael W. Smith
Helena Solodar
Jonsie M. Sturgis
Orloff W. Styve/Wis. Electric
Morton Tabak
Kirby M. Watson
Delmer D. Weisz
Robert M. Whittington
Kathleen M. IMIIiams
PROFESSIONAL ASSOCIATES
APRIL TO JULY 1992
Sidney N. Busis, MD
Robert R. Cooper, MD
Linwood W. Custabw, MD
Roger Fagan, MS
Gregory J. Frazer, PhD
Sirron H. Friedman, MD
Lawrence R. Grobman, MD
Murray Grossan, MD
J. Patrick Lynch, MD
Joseph L. Petrusek, MD
Kurt T. Pfaff, MA
Keith Sedlacek, MD
Charles E. Swain, Jr . MD
Tinnitus Today, the Journal of the American Tinnitus Association welcomes submission of original articles about tin-
nitus and related subjects. The articles should speak to an audience of tinnitus experiencers, audiologists, otolaryngologists,
otologists, hearing aid specialists, and other medical, legal, and governmental specialists with an interest in tinnitus.
Manuscripts should be typewritten, double-spaced, on plain paper and should include title; author(s) namc(s) and bio-
graphical information; and when appropriate, footnotes, references, legends for tables, figures, and other illustrations and
photo captions. Generally, articles should not exceed 1500 words and shorter articles are preferred.
Please do not submit previously published articles unless permission has been obtained in writing (and attached to the
article submitted) for their use in Tinnitus Today.
All letters accompanying manuscripts submitted for publication should contain the following language:"In considera-
tion of Tinnitus Today taking action in reviewing and editing my (our) submission, the author(s) undersigned hereby trans-
fer(s), or otherwise convey(s) all copyright owneiShip to Tinnitus Today in the event that such work is published by Tinnitus Today."
Tinnitus Today also welcomes news items of interest to those with tinnitus and to tinnitus healthcare providers and in-
formation or review copies of new publications in the field. All such items should contain the name and telephone number
of the sender or person to contact for further information.
Please address all submittals or inquiries to: Editor, Tinnitus Today, P. 0. Box 5, Portland, OR 97207-0005. Thank
you for your consideration.
18 Tmnitus Today /September 1992
Vol. 17 No.3
4. Describes
Hyperacusls,
the problem of
super-sensitive
ears and how
those who have
it are affected.
Urges protection
from noise.
llfih 1/r

RICHARD
LIVING WITH TINNITUS
1. Information
is given in the
form of
questions and
answers about
tinnitus.
Covers causes,
treatments,
and effects.
5. A TA Patient
Survey presents
Results
describing
statistical
information
on 30 tinnitus
topics.
LEARNING
TO LIVE WITH IT
LESLIE SHEPPARD
<Vld
AUDREY HAWKRIDG
<:!>
2. Presents
coping tips
for reducing
stress. Lists
ways for self-
control of
tinnitus, and
how to seek
help.
American
Tinnitus
Association
TINNITUS
PATIENT
SURVEY
3. Describes
how norse can
cause tinnitus
and how to
avoid it.
Presents levels
of permissible
noise exposure.

TIIE SELF-HELP
PROGRAM
John Taddey, D.D.S.
..
TINNITUS- LEARNING TO
LIVE WITH IT
TMJ THE SELF-HELP PROGRAM
Dealing with the ringing How to recognize a TMJ
in your ears through better Suggestions and advice problem, relieve pain and restore
understanding and changing from authors who overcame health. When to seek profes-
beliefs. much of their misery. sionat help.
SEE INSIDE BACK COVER FOR FULL PUBLICATION LISf AND ORDERING INFORMATION.
AMERICAN TINNITUS ASSOCIATION
P.O. BOX 5. PORTLAND. OR 97207
ADDRESS CORRECTION REQUESTED