ftp.pasteur.org/FAQ//ftp-pasteur-org-FAQ.zip/FAQ/medicine/tinnitus-faq

Text File | 1996-11-09 | 171.9 KB | 3,641 lines

Path: senator-bedfellow.mit.edu!bloom-beacon.mit.edu!news-ext.crl.dec.com!caen!uwm.edu!math.ohio-state.edu!howland.erols.net!vixen.cso.uiuc.edu!news.stealth.net!news.idt.net!news.cerf.net!news.cccd.edu!news.cccd.edu!not-for-mail
From: [e-mail] (Mark Bixby)
Newsgroups: alt.support.tinnitus,alt.answers,news.answers
Subject: Tinnitus Frequently Answered Questions v2.7
Supersedes: <medicine/[e-mail]>
Followup-To: alt.support.tinnitus
Date: 8 Nov 1996 09:00:10 -0800
Organization: Coast Community College District, Costa Mesa, CA
Lines: 3621
Sender: [e-mail]
Approved: [e-mail]
Expires: Fri, 13 Dec 1996 09:00:07 PDT
Message-ID: <medicine/[e-mail]>
Reply-To: [e-mail] (Mark Bixby)
NNTP-Posting-Host: spock.dis.cccd.edu
Summary: Questions and answers regarding tinnitus - ringing ears and other head noises
Keywords: faq tinnitus ear ringing
Xref: senator-bedfellow.mit.edu alt.support.tinnitus:10513 alt.answers:21687 news.answers:86392

Posted-By: auto-faq 3.3 beta (Perl 5.003)
Archive-name: medicine/tinnitus-faq
Posting-Frequency: monthly
Last-modified: 23 August 1996
Version: 2.7

Tinnitus Frequently Answered Questions

Last update v2.7, August 30, 1996

---------------------------------------------------------------------------

What's New

   * A new FAQ maintainer has stepped forward.  Stay tuned for a new and
     easier to use FAQ, coming soon.

---------------------------------------------------------------------------

What Was New In Recent Updates

   * In v.2.6-Updated German language Web Page URL. See: What online
     resources are available?
   * In v.2.5-What online resources are available?
        o http://www.ohsu.edu/ohrc-otda/ Oregon Tinnitus Data Archive- A
          reference source for those desiring quantitative information
          about clinically-significant tinnitus.
        o http://www.ucl.ac.uk/~rmjg101/tinnitus1.html "Tinnitus Retraining
          Therapy"- ..."tinnitus management in our clinics is a result of
          retraining and relearning"....
        o http://www.cdc.gov/niosh/noise2a.html NIOSH- Occupational Noise
          and Hearing Conservation page. Provides a basis for a recommended
          standard to reduce permanent noise damage.
   * In v.2.4-What online resources are available?
     http://www.teleport.com/~ata The Home Page Site (under construction)
     for the "American Tinnitus Association".
   * In v.2.4-What organizations can I turn to for more information? A new
     Tinnitus Organization in Spain: ASOCIACION DE PERSONAS AFECTADAS POR
     TINITUS(Ac·fenos)

---------------------------------------------------------------------------

About the Tinnitus FAQ

Welcome to the Tinnitus FAQ. At the present time, there are many questions
about tinnitus, but few definitive answers that apply to all sufferers. If
you have any additional insights not covered in this document, please help
your fellow tinnitus sufferers by contacting the FAQ Maintainer, Lee
Leggore, at [e-mail].

IMPORTANT DISCLAIMER: This document is not a substitute for advice from a
competent health care provider specializing in tinnitus. Many of the
underlying medical conditions can be serious, if not fatal, and several of
the listed treatments may have dangerous side-effects. Contact one of the
tinnitus organizations listed in this document if you are seeking a
referral to a skilled physician. The Tinnitus FAQ may contain material
contrary to opinions of the tinnitus research community.

---------------------------------------------------------------------------

About the Tinnitus FAQ Maintainer

I (Lee Leggore) began maintaining this FAQ in September of 1995. I was born
8/2/51. I have had Tinnitus and Hyperacusis since 1982. In 1985 I became a
member and contact person with, "American Tinnitus Association".

In 1993, I became involved in computer science at, "Tacoma Community
College", where I previosly earned a diploma in Management. Other than,
"Basic First Aid and CPR", I am WITHOUT medical training. Everything in
this FAQ is the contribution of many, many people, who submitted via
private e-mail and indirectly via public postings to alt.support.tinnitus.
While I will always try to answer questions via private e-mail, you will
hopefully reach people with better expertise than I by posting publicly to
the newsgroup: alt.support.tinnitus (Be advised/warned that this newsgroup
has had obscene posting and you may be quite repulsed by them! Please! Do
not respond to them!)

---------------------------------------------------------------------------

In addition to being posted monthly to the Usenet newsgroups
alt.support.tinnitus, news.answers, and alt.answers, this FAQ can also be
found at:

   * http://www.cccd.edu/faq/tinnitus.html
   * http://www.cccd.edu/faq/tinnitus.txt
   * ftp://ftp.cccd.edu/pub/faq/tinnitus.html
   * ftp://ftp.cccd.edu/pub/faq/tinnitus.txt
   * ftp://rtfm.mit.edu/pub/usenet/news.answers/medicine/tinnitus-faq
   * And many other Usenet *.answers FAQ archive sites

To retrieve this FAQ in 150+K large, single message entirety via e-mail,
send a message to [e-mail], and in the body of the message use
one of the following commands:

get faq tinnitus.html
get faq tinnitus.txt

To retrieve this FAQ split into multiple smaller messages, send e-mail to
an ftp-by-mail server (there are many) such as [e-mail], and in
the body of the message ask for either the plaintext (.txt) or HTML version
of the FAQ as follows (note that ftpmail servers are very popular and
response time may range from several hours to several days):

open ftp.cccd.edu
get /pub/faq/tinnitus.txt
quit

---------------------------------------------------------------------------

Topics covered in this FAQ:

1) What is tinnitus?
2) What does tinnitus sound like?
3) How is tinnitus diagnosed?
4) What causes tinnitus?
5) How can I avoid getting tinnitus?
6) What are some ototoxic drugs?
7) What is Meniere's Disease?
8) What is hyperacusis?
9) What drugs, vitamins, and herbs are available for treating tinnitus?
10) What other treatments are available for tinnitus?
11) What is masking?
12) What types of ear plugs or other hearing protection are available?
13) What organizations can I turn to for more information?
14) What books can I turn to for more information?
15) What online resources are available?
16) What can I do when all else fails?
17) Where did the medical advice in the FAQ come from?
18) What clinics or physicians can I turn to for real medical advice?
19) Who are the contributors to this FAQ?

---------------------------------------------------------------------------

1) What is tinnitus?

Tinnitus can be described as "ringing" ears and other head noises that are
perceived in the absence of any external noise source. It is estimated that
1 out of every 5 people experience some degree of tinnitus.

Tinnitus is classified into two forms: objective and subjective. Objective
tinnitus, the rarer form, consists of head noises audible to other people
in addition to the sufferer. The noises are usually caused by vascular
anomalies, repetitive muscle contractions, or inner ear structural defects.
Subjective tinnitus is much less understood, with the causes being many and
open to debate. Anything from the ear canal to the brain may be involved.

Hearing loss, hyperacusis, recruitment, and balance problems may or may not
be present in conjunction with tinnitus.

---------------------------------------------------------------------------

2) What does tinnitus sound like?

Many sufferers in the online community report that their tinnitus sounds
like the high-pitched background squeal emitted by some computer monitors
or television sets. Others report noises like hissing steam, rushing water,
chirping crickets, bells, breaking glass, or even chainsaws. Some report
that their tinnitus temporarily spikes in volume with sudden head motions
during aerobic exercise, or with each footfall while jogging.

Objective tinnitus sufferers may hear a rhythmic rushing noise caused by
their own pulse. This form is known as pulsatile tinnitus.

In a database of 1544 tinnitus patients, 79% characterized the sound as
"tonal" with an average loudness of 7.5 (on a subjective scale of 1-10).
The other 21% characterized the sound as "noise" with an average loudness
of 5.5. When compared to an externally generated noise source, the average
loudness was 7.5dB above threshold. 68% of patients were able to have their
tinnitus masked by sounds 14dB or less above threshold. The internal
origination of the tinnitus sounds was perceived by 56% of the patients to
be in both ears, 24% from somewhere inside the head, 11% from the left ear,
and 9% from the right ear.

---------------------------------------------------------------------------

3) How is tinnitus diagnosed?

The following flowchart from the Cecil Textbook of Medicine, 1992 (19th
ed.), W.B. Saunders, shows the logic for diagnosing the common causes of
tinnitus (note that this chart omits some causes such as TMJ disorders):

ear exam--->(audible sounds)-+-->sync w/respiration--->patent eustachian tube
   |                         |
   |                         +-->sync w/pulse--->aneurysm, vascular tumor,
   v                         |                   vascular malformation,
(no audible sounds)          |                   venous hum
   |                         |
   |                         +-->continuous--->venous hum, acoustic emissions
   v
neurological exam-->(normal)-->audiogram
   |                             |
   |                             +-->normal--->idiopathic tinnitus
   |                             |
   |                             +-->conductive hearing loss
   v                             |             |
(brain stem signs)               |             v
   |                             |     impacted cerumen, chronic
   |                             |     otitis, otosclerosis
   v                             |
multiple sclerosis,              +-->sensorineural hearing loss
tumor, ischemic                                  |
infarction                                       v
                                             BAER test
                                                 |
                                                 v
                                       +---------+--------------+
                                       |                        |
                                       v                        v
                                    abnormal (neural)      normal cochlear
                                       |                        |
                                       v                        v
                                    acoustic neuroma       noise damage
                                    other tumors           ototoxic drugs
                                    vascular compression   labyrinthitis
                                                           Meniere's Disease
                                                           perilymph fistula
                                                           presbycusis

---------------------------------------------------------------------------

4) What causes tinnitus?

In a database of 1687 tinnitus patients, no known cause was identified for
43% of the cases, and noise exposure was the cause for 24% of the cases.

   * overexposure to loud noises

     Repeated exposure to loud noises such as guns, artillery, aircraft,
     lawn mowers, movie theaters, amplified music, heavy construction, etc,
     can cause permanent hearing damage. Some people report auditory
     fatigue from driving automobiles long distances with the windows down.
     Anybody regularly exposed to these conditions should consider wearing
     ear plugs or other hearing protection (see below).

   * MRI, CAT, and other non-invasive scanning machines

     These high-tech machines may take great images, but they are very,
     very LOUD. Do not attempt this type of imaging without wearing
     approved earplugs; any competent imaging facility should be able to
     supply the earplugs. [Note: Mark Bixby reports that he had knee MRIs
     done, and even with earplugs and his head outside the bulk of the
     machine it was very loud.]

   * wax/dirt build-up in the ear canal

     If you're experiencing tinnitus, this is one of the first things you
     should check for. NEVER try digging or suctioning the ear canal
     yourself or allow a physician to do it as SERIOUS damage may result.
     Numerous over-the-counter chemical washes are available from your
     drugstore which will clean the ear canal in a safe and gentle manner.

   * acoustic neuromas

     Acoustic neuromas are small, slow growing benign tumors that press
     against or invade the auditory nerves. If your tinnitus is only in one
     ear, you should see your physician to rule this one out. An MRI will
     probably be required for a definitive diagnosis, but one contributor's
     ENT felt that an MRI wasn't warranted unless frequent dizziness was
     present. Acoustic neuromas are removable by surgery but involve a risk
     of hearing loss. Doing nothing should be considered an option by
     elderly patients since these tumors grow so slowly.

   * ototoxic drugs

     Many prescription and over-the-counter drugs may cause tinnitus and/or
     hearing loss that may be permanent or may disappear when the dosage is
     reduced or eliminated. Before starting treatment with any prescription
     drug, tinnitus sufferers should always ask their physician and/or
     pharmacist about the potential for ototoxic side effects. See the next
     section for more detail. These drugs include:

     salicylate analgesics (higher doses of aspirin)
     naproxen sodium (Naprosyn, Aleve)
     ibuprofen
     many other non-steroidal anti-inflammatories
     aminoglycoside antibiotics
     anti-depressants
     loop-inhibiting diuretics
     quinine/anti-malarials
     oral contraceptives
     chemotherapy

   * severe ear infections

     Many tinnitus cases onset after severe ear infections. But this may
     also be related to the use of ototoxic antibiotics (see above).

   * high blood cholesterol

     High blood cholesterol clogs arteries that supply oxygen to the nerves
     of the inner ear. Reducing your cholesterol level may reduce your
     tinnitus.

   * vascular abnormalities

     Arteries may press too closely against the inner ear machinery or
     nerves. This is sometimes correctable by delicate surgery.

   * Temporo-Mandibular Joint (TMJ) syndrome

     This jaw disorder may cause tinnitus and is characterized by many
     symptoms, including headaches, earaches, tenderness of the jaw
     muscles, dull facial pain, jaw noises, the jaw locking open, and pain
     while chewing. For a good online document on TMJ, see:

     http://www.uiuc.edu/departments/mckinley/health-info/dis-cond/misc/tmj-diso.html

     One contributor has this to say about the TMJ/tinnitus connection:

          The Sternocleidomastoideus muscle connects on your sternum
          by the collar bone on both sides and goes back to the back
          of the ear. It's about 6-10 inches long and when it gets
          tight, it can pull on the TMJ area thereby creating a pull
          on the muscles and ligaments around the inner ear area.
          Almost certainly the final "pull" is the sphenomandibular
          ligament which connects the ear drum and TMJ. An osteopath
          can work with this. Xanax or other benzo's can provide
          tension relief as well. The masseter and temporalis muscles
          (those in front of the ear and above the ear can cause the
          same TMJ/tinnitus problems. If a person wants to know if
          their tinnitus is connected to their TMJ in some way, have
          them 1) clench their teeth- does it change the tinnitus? 2)
          push in hard on the jaw with your palm. Does the tinnitus
          change? (Get louder/softer, pitch or tone change) 3) Push in
          on the forehead with your hand hard. Resist with the head.
          Any changes? In about half the people I talk to, they find a
          TMJ correlation they never even dreamed of...

     There is a highly recommended dentist knowledgable about TMJ/tinnitus
     cases who has 30 years of experience and has authored/co-authored
     several papers on the subject:

     Doug Morgan, DDS
     308 Foothill Boulevard
     Glendale, CA USA 91214
     [phone]

     For more information about TMJ, visit the TMJ Foundation (a California
     public nonprofit corporation) WorldWideWeb site at
     http://www.tmjfound.com/ , or contact them at:

     TMJ Foundation
     P.O. Box 28275
     San Diego, CA USA 92128-0275
     fax [phone]

   * traumatic head injuries

     Some automobile crash victims have reported a sudden onset of
     tinnitus.

   * cochlear implant or other skull surgeries

     Sometimes poking around inside the skull will accidentally damage the
     hearing system. Tinnitus can result, or even profound deafness caused
     by severe inner ear infections.

   * stress

     Stress is not a direct cause of tinnitus, but it will generally make
     an already existing case worse.

   * diet and other lifestyle choices

     Like stress above, a poor diet can worsen an existing case of
     tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat,
     high sodium can all make tinnitus worse in some people.

   * food allergies

     Specific foods may trigger tinnitus. Problem foods include red wine,
     grain-based spirits, cheese, and chocolate. One contributor reported
     hearing tones after consuming honey. Another contributor notes that
     these same foods are on the list known to trigger migraine headaches;
     additional migraine foods include soy and anything including soy, MSG,
     very ripe bananas, avocados, and citrus fruits.

   * foods rich in salicylates

     There is a long list of foods that are supposed to be "rich" in
     salicylates. See the Shulman book listed below for details. [Ed. note:
     I'm not listing the foods here since no data is given on exactly how
     rich the foods are, i.e. "13 mangoes = 1000mg aspirin" as a
     hypothetical example.]

   * glaumous tumors

     These tumors can cause pulsatile tinnitus. They are confirmed with a
     CAT scan or other imaging, and may be surgically removable by a
     delicate procedure.

   * mercury amalgam tooth fillings

     Researchers June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7
     2PT, U.K.) have found a possible connection between mercury tooth
     fillings and tinnitus. They publish a booklet on the subject available
     for 6 International Reply Coupons, and they also have a questionnaire
     that interested people can fill out. Their research suggests following
     a vegetarian diet, plus eating 2 raw African green chillies one day,
     followed by 1 chilli the next day for temporary relief.

     But a prominent American tinnitus specialist says that no such link
     has been established.

   * marijuana

     Marijuana usage may worsen pre-existing cases of tinnitus.

   * Lyme Disease

     Lyme is a parasitic, tick-borne disease, which in the United States is
     most commonly seen in eastern states. In some cases, tinnitus has been
     a side-effect of Lyme.

     Lyme disease deserves special mention partly because it is so
     difficult to diagnose objectively; the commonly available serological
     tests have very high rates of false negatives. In the only study (by
     McDonald) in the literature which used objective measures
     (histopathology) to confirm test results, over 50% of currently
     infected patients were negative by ELISA and/or Western Blot. False
     positives are infrequent, occurring primarily in pts. exposed to other
     nasties such as syphilis or rocky mountain spotted fever. So
     serologies can be used to confirm but not to rule out diagnosis.

     The Lyme Urine Antigen Test is a useful supplement test to serologies;
     it tests for current infection, as opposed to a history of exposure.
     It has some problems with low sensitivity; these can be improved by
     the following regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5
     take and test first-in-the morning urine specimens. The LUAT can be
     ordered by your MD from Immugenex, 1-415-424-1191. Other, better tests
     (including PCR) are under development, expected to be available for
     clinical use within the next few years.

     For further online information about Lyme Disease, you may send the
     following command in the body of an e-mail message to
     [e-mail]:

     subscribe LymeNet-L yourfirstname yourlastname

     A regular newsletter is published here, and patients & physicians may
     exchange their stories.

   * dental procedures

     Certain dental procedures such as difficult tooth extractions and
     ultrasonic cleaning can cause hearing damage via bone conduction of
     loud sounds directly to the ear. Wearing ear plugs will not guard
     against bone conduction.

   * intracranial hypertension

     Intracranial hypertension can cause pulsatile tinnitus. If you can
     stop your tinnitus by slight pressure to the neck on the affected
     side, that is an indication. The definite way to find out is if you
     get a spinal tap and your Opening Pressure is higher than 200.

   * otosclerosis

     Otosclerosis is a bony growth around the footplate of the stapes (one
     of the 3 middle ear bones). This footplate forms the seal that
     separates the middle ear space from the inner ear. When the footplate
     moves normally, the sound vibrations are passed from the middle ear
     "chain" of bones into the fluid of the inner ear. If the footplate is
     fixated, the vibrations cannot pass into the inner ear as well and
     hence a resulting hearing loss. Tinnitus may also be involved.
     Treatment is by surgery, as one poster to alt.support.tinnitus
     explains:

          When should surgery be performed? Well IMHO, it all depends
          upon the amount of loss (or progression of the condition)
          and the amount of difficulty that the patient experiences.
          If the amount of loss caused by the otosclerosis is 40 dB or
          more, then surgery may be an option that you may want to
          think about. But remember that surgeries can be complicated
          and can always end up with no real improvement.

          Stapedectomy involves removal of the stapes, along with the
          fixated footplate, and insertion of a prosthetic stapes into
          the window that contains the oval window.

          One "nice" thing about people with conductive hearing loss
          (i.e. otosclerosis) is that they are excellent candidates
          for hearing aids. They often do not experience the
          overwelming loudness that people with sensorineural hearing
          loss often report, and speech is not distorted.

          If your condition involves a 40 dB loss *DIRECTLY* due to
          otoscelerosis, you may want to thnik about surgery, but if
          it is less than that, you may want to try a hearing aid, and
          think about surgery in the future (if the condition develops
          further).

   * aspartame

     Some people allege (quite controversially) that the artificial sugar
     substitute aspartame is linked to tinnitus, vertigo, and many other
     serious problems (I agree). To retrieve further information about the
     allegations against aspartame, send e-mail to [e-mail] and
     include the lowercase command "info mp" in the body (not the Subject:)
     of the message.

   * Arnold Chiari Malformation (ACM)

     An *unscientific* response of 30 ACM patients revealed that 14 had
     ringing in the ears (significant) and 9 had a whooshing sound in their
     ears (also significant). The survey of patients was conducted by
     Darlene Long-Thompson, RN, MHSc.

     Essentially there is (in ACM) extra cerebellum crowding the outlet of
     the brainstem/spinal cord from the skull on its way to the spinal
     canal. This crowding will commonly lead to headaches, neck pain, funny
     feelings in the arms and/or legs, stiffness, and less often will cause
     difficulties with swallowing, or gagging . There are those that
     believe it can cause tinnitus. Often the symptoms are made worse with
     straining.

     Untreated, the chronic crowding of the brainstem and spinal cord can
     lead to very serious consequences including paralysis. There are many
     ways to treat Chiari malformations, but all require surgery.

     When the diagnosis is suspected the study of choice is an MRI scan.
     These malformations are very difficult to see on CT scans and
     impossible to see on plain x-rays.

     If you are intending to have an MRI for another reason, e.g., Acustic
     Neuroma, the MRI technicians should be alerted to the possibility of
     ACM (if you are showing any symptoms listed above) since the "MRIing"
     will have to concentrate on the brain stem/cerebellum area to detect
     the problem.

     Most of the preceding (ACM) information provided courtesy of: Bernard
     H. Meyer

     Arnold Chiari Malformation involves the herniation of the cerebellum
     and/or brainstem through the foramen magnum. This can cause problems
     in the areas of cerebellar compression and dysfunction, cranial and
     spinal nerve (including trigeminal and acoustic nerve) compression and
     inflammation, CSF blockages and increased intracranial pressure
     (constant or intermittent), and brainstem compression and
     inflammation. ANY of these components can cause symptomology
     associated with tinnitus...(Think of the ringing in the ears or
     buzzing sound associated with light headedness or fainting...many ACM
     sufferers experience this either due to acoustic nerve involvement or
     to fluid and pressure dynamics).

     Because hard data on ACM is difficult to find (and often
     contradictory) it is difficult to find a source that says specifically
     any one symptom is related to ACM...but the symptoms are often
     categorized as...cerebellar syndrome, brainstem deficits, CSF
     obstruction, and cranial nerve deficits. Due to the close proximity of
     the acoustic nerve to the hindbrain region it would be one of the
     primary cranial nerves involved in the compression/inflammation
     syndrom.[sic]

     Two of my references on this are as follows...

     Tinnitus and Neurosurgical Disease
     Journal: Journal of Laryngology & Otology
     Authors:  WA Shucart
                      M. Tenner
     Citation: (4): 166-8
     ISSN0144-2945

     Tinnitus from Intracranial Hypertension
     Journal: Neurology
     Authors: KJ Meador
                    TR Swift
     Citation: 34(9): 1258-61
     ISSN 0028-3878

     Preceding (ACM) information provided courtesy of: Darlene
     Long-Thompson, RN, MHSc.

---------------------------------------------------------------------------

5) How can I avoid getting tinnitus?

Avoid the causes listed above. Really. The number one cause of tinnitus is
exposure to excessively loud noise. Either avoid these noisy situations, or
wear hearing protection as described below. Rock concerts, movie theaters,
nightclubs, construction sites, guns, power tools, stereo headphones and
musical instruments are just some of the things that can be hazardous to
your ears. Damage can result from either a single exposure or cumulative
trauma. There are "tough" ears, and there are "weak" ears; what may be safe
or dangerous for one individual may not be the same for you. If you ever
experience temporary ringing after a sound exposure, YOU ARE AT A SEVERE
RISK FOR TINNITUS AND/OR HEARING LOSS.

If you already have tinnitus, educate your family, friends, and neighbors
so that they can keep their ears healthy.

---------------------------------------------------------------------------

6) What are some ototoxic drugs?

All tinnitus sufferers should ask their physician and/or pharmacist about
the potential for ototoxic side effects BEFORE starting a new prescription.

In her book _When the Hearing Gets Hard_ (Insight Books 1993, ISBN
0-306-44505-0), author Elaine Suss names several potentially ototoxic
substances. She lists them in three categories: (1) substances that most
physicians consider ototoxic; (2) substances that many physicians consider
potentially ototoxic; and (3) substances that may be ototoxic in rare
cases. The ototoxic effects of the substances in the third list are
considered to be reversible--the effects diminish when you stop taking the
drug. Ms. Suss does not list dosages.

The first group includes a few antibiotics and several diuretics. Not being
a physician, I don't recognize them all, though Capreomycin, Gentamicin ,
Kanamycin, Neomycin, Streptomycin, Tobramycin sulphate, Vancomycin, and
Viomycin are obviously antibiotics. Ms. Suss mentions that Streptomycin is
used only for certain cases of tuberculosis.

The first group also includes aspirin--ototoxic at higher doses and whose
effects are usually reversible--and other salicylates such as Oil of
Wintergreen (Ben Gay). The other substances in the first group are:
Amikacin, Amphotericin B (Fungizone), Bumetanide (Bumex), Carboplatin
(Paraplatin), Chloroquine (Aralen), Cisplatin (Platinol), Ethacrynic acid
(Edecrin), Furosemide (Lasix), and Hydroxychloroquine (Plaquenil).

The second group includes the analgesic Ibuprofen (Advil) and the tricyclic
anti-depressant Imipramine (Tofranil), along with Chloramphenicol
(Chloromycetin), lead, and quinine sulphate.

The third group includes alcohol, toluene, and trichloroethylene, as well
as Chlordiazepoxide (Librium), Chlorhexidene (Phisohex, Hexachlorophene),
Ampicillin, Iodoform, Clemastin fumarate (Tavist), Chlomipramine
hydrochloride (Anafranil), and Chorpheniramine Maleate (Chlor-trimeton and
several others).

Ms. Suss points out that the _Physicians Desk Reference_ (PDR) did not list
ototoxic drugs until the 1989 and later editions. She refers to a separate
document, _Drug Interactions and Side Effects Index_, which is keyed to the
PDR. She then points out that the Index is incomplete: several problem
drugs are not listed there.

Although the lists of ototoxic drugs are useful, I cannot recommend this
book to tinnitus sufferers in general because it is devoted almost entirely
to the problems of the hearing impaired and methods for ameliorating them.
The book mentions tinnitus primarily as a precursor to hearing loss. (I do
not believe that is the general case.)

The book _Tinnitus: Diagnosis/Treatment_ (Lea & Febiger, 1991, ISBN
0-8121-1121-4) adds that ototoxic symptoms may arise days or even weeks
after the termination of aminoglycoside antibiotics. Some of these
aminoglycosides not listed above are Netilmycin and Erythromycin. Other
trouble antibiotics include Colistimethate, Doxycycline and Minocycline.

The following is a list of drugs that have demonstrated Tinnitus side
effects as indicated in the 1995 "Physicians Desk Reference" and
distributed by the American Tinnitus Association:

Accutane [less than 1%]                 Mazicon [less than 1%]
Acromycin V                             Meclomen [greater than 1%]
Actifed with Codiene Cough Syrup        Methergine [rare]
Adalat CC [less than 1%]                Methotrexate [less common]
Alferon N  [one patient]                Mexitil [1.9% to 2.4%]
Altace [less than 1%]                   Midamor [less than or equel to 1%]
Ambien [infrequent]                     Minipress [less than 1%]
Amicar [occasional]                     Minizide [rare]
Anatranil [4-5%]                        Mintezol
Anaprox and Anaprox DS [3-9%]           Moduretic
Anestacon [among most common]           Mono-Cesac
Ansaid [1-3%]                           Monopril [0.2-1%]
Aralen Hydrochloride [one Patient]      Monopril [0.2-1%]
Arithritis Strength BC Powder           Motrin [less than 3%]
Asacol                                  Mustargen [infrequent]
Ascriptin A/D                           Mykrox [less than 2%]
Ascriptin                               Nalfon [4.5%]
Asendin [less than 1%]                  Naprosyn [3-9%]
Asperin [among most frequent]           Nebcin
Atretol                                 Neptazane
Atrofen                                 Nescaine
Atrohist Plus                           Netromycin
Azactam [less than 1%]                  Neurontin [infrequent]
Azo Gantanol                            Nicorette
Azo Gantrisin                           Nipent [less than 3%]
Azulfidine [rare]                       Nipride
BC Powder                               Noroxin
Bactrim DS                              Norpramin
Bactrim I.V.                            Norvasc [0.1-1%]
Bactrim                                 Omnipaque [less than 0.1%]
Blocadren [less than 1%]                Omniscan [less than 1%]
Buprenex [less than 1%]                 Ornade
BuSpar [frequent]                       Orthoclone OKT3
Cama                                    Orudis [greater than 1%]
Capastat Sulfate                        Oruvail [greater than 1%]
Carbocaine Hydrochloride                P-A-C Analgesic
Cardene [rare]                          PBZ
Cardioquin                              Pamelor
Cardizem       [less than 1%]           Parnate
   ''      CD  [less than 1%]           Paxil [infrequent]
   ''      SR  [less than 1%]           Pedia-Profen [greater than 1% less than 3%]
Cardura [1%]                            Pediazole
Cartrol [less common]                   Penetrex [less than 1%]
Cataflam [1-3%]                         Pepcid [infrequent]
Childrens Advil [less than 3%]          Pepto-Bismol
Cibalith-S                              Periactin
Cinobac [less than 1 in 100]            permax [infrequent]
Cipro [less than 1%]                    Phenergan
Claritin [2% or less]                   Phrenilin [infrequent]
Clinoril [greater than 1%]              Piroxicam [1-3%]
Cognex                                  Plaquenil
Corgard [1-5 of 1000 patients]          Platinol
Corzide [       ''           ]          Plendil [0.5% or greater]
Cuprimine [greater than 1%]             Pontocaine Hydrochloride
Cytotec [infrequent]                    Prilosec [less than 1%]
Dalgan  [less than 1%]                  Primaxin [less than 2%]
Dapsone USP                             Prinvil [0.3-1%]
Daypro [greater than 1% less than 3%]   Prinzide [0.3-1%]
Deconamine                              Procardia [1% or less]
Demadex                                 ProSam [infrequent]
Depen Titratable                        Proventil [2%]
Desferal Vials                          Prozac [infrequent]
Desyrel & Desyrel Dividose [1.4%]       Questran
Diamox                                  Quinaglute
Dilacor XR                              Quinamm
Dipentum [rare]                         Quinidex
Diprivan [less than 1%]                 Q-vel Muscle Relaxant Pain Reliever
Disalcid                                Recombivax HB [less than 1%]
Dolobid [greater than 1% in 100]        Relafen [3-9%]
Duranest                                Rheumatrex Methotrexate [less common]
Dyphenhydramine [Nytol, Benydrl, etc]   Rifater
Dyclone                                 Romazicon [less than 1%]
Dasprin                                 Ru-Tuss
Easprin                                 Rythmol
Ecotrin                                 Salflex
Edecrin                                 Sandimmune [2% or less]
Effexor [2%]                            Sedapap [infrequent]
Elavil                                  Sensorcaine
Eldepryl                                Septra
Emcyt                                   Sinequan [occasional]
Emla cream                              Soma Compound
Empirin with Codiene                    Sporanox [less than 1%]
Endep                                   Stadol [3-9%]
Engerix-B                               Streptomycin Sulfate
Equagesic                               Sulfadiazine
Esgic-plus [infrequent                  Surmontil
Eskalith                                Talacen [rare]
Ethmozine [less than 2%]                Talwin [rare]
Etrafon                                 Tambocor [1% or less than 3%]
Fansidar                                Tavist and Tavist-D
Feidene [1-3%]                          Tegretol
Fioricat with Codeine [infrequent]      Temaril
Flexeril [less than 1%]                 Tenex [3% or less]
Floxin [less than 1%]                   Thera-Besic
Foscavir [1-5%]                         Thiosulfil Forte
Fungijzone                              Ticlid [0.5-1%]
Ganite                                  Timolide
Gantanol                                Timoptic
Gantrisin                               Tobramycin
Garamycin                               Tofranil
Glauctabs                               Tolectin [1-3%]
HIVID [less than 1%]                    Tonocard [0.4-1.5%]
Halcion [rare]                          Toprol XL
Hyperstat                               Toradol [1% or less]
Hytrin [at least 1%]                    Torecan
Ibuprofen [less than 3%] [Advil, etc.}  Trexan
Ilosone                                 Triaminic
Imdur [less than or equal to 5%]        Triavil
Indocin [greater than 1%]               Trilisate [less than 20%]
Intron A [up to 4%]                     Trinalin Repetabs
Kerione [less than 2%]                  Tympagesic Ear Drops
Lariam [among most frequent]            Ursinus
Lasix                                   Vancocin HCI [rare]
Legatrin                                Vantin [less than 1%]
Lncocin [occasional]                    Vascor [up to 6.52%]
Lioresal                                Vaseretic [0.5-2%]
lithane                                 Vasotec [0.5-1%]
Lithium Carbonate                       Vivactil
Lithobid                                Voltqaren [1-3%]
Lithonate                               Wellbutrin
Lodine [greater than 1% less than 3%]   Xanax [6.6%]
Lopressor Ampuis                        Xylocaine [among most common]
Lopressor DCT [1 in 100]                Zestril '0.3-1%]
Lopressor                               Zestoretic [0.3-1%]
Loreico                                 Ziac
Lotensin HCT [0.3-1%]                   Zoleft [1.4%]
Ludiomil [rare]                         Zosyn [less than 1%]
MZM [among most frequent]               Zyloprim [less than 1%]
Magnevist [less than 1%]
Marinol (Dronabinol) [less than 1%]     Risperdal [rare]
Marcaine Hydrochloride
Marcaine Spinal
Maxaquin [less than 1%]

Your physician should always be consulted about questions before any
changes are made in your medication.

The absence of incidence data means there was none given, and/or it is
unknown.

---------------------------------------------------------------------------

7) What is Meniere's Disease?

Meniere's is a very serious disease of the inner ear, resulting in extended
vertigo attacks, major hearing loss, and frequently tinnitus. Here is one
sufferer's (not myself) story:

What are the symptoms?

     In my case it started with a constant fullness in my right ear
     and the constant ringing. I also noticed I wasn't hearing very
     well and I was having some vertigo attacks.

     Originally I had my Allergist treat me. She thought it might just
     be an inner ear infection or a sinus infection. It manifested
     itself in the fall which is one of my worst allergy seasons.

     By Spring she referred me to an ENT.

What tests would a physician do to diagnose it?

     First was a hearing test. This was followed by an MRI to ensure
     there wasn't a tumor to deal with. There was also the physical to
     ensure there was no other underlying cause, including Diabetes.
     Then being referred to a surgeon who specializes in this kind of
     thing. He did further hearing tests and another test which I will
     have to get the name for you. It consists of lights on the wall
     that you follow with your eyes. They also insert warm and cold
     water into each ear (ENG/AU test) to measure the response; a
     short vertigo spell is the result for healthy ears. There is also
     a special set of hearing tests that they do.

Are there any known environmental causes, or is it one of those things that
"just happens" to people?

     One possible cause is Diabetes. Other than that no one that I
     have spoken with knows. It may also be hereditary. Usually
     doesn't show up until later in life 40 and beyond, and can burn
     itself out in 3 - 5 years. Some have it earlier in life (me at
     35) and could have it the rest of our lives.

What are the common treatments? Anti-vertigo drugs? Surgical operations on
the inner ear balance mechanisms?

     The most common treatment for mild episodic Meniere's I guess
     would be to rule out Diabetes and allergies. For the vertigo
     attacks usually the prescription drug Antivert is used or the
     over the counter drug Meclizine. Both tend to relive the vertigo.
     For more chronic cases a low dosage of Valium can help. When
     things get bad enough the next procedure is an Endolymphatic
     Transmastoid Shunt. This helps to keep some of the pressure of
     the inner ear. Changes in diet can help. Removal of sodium,
     caffeine and alcohol can help. Usually a mild diuretic is
     prescribed.

     I know of several folks who keep it under control with allergy
     shots and restricting their sodium intake.

     If it progresses to a point where the patient can no longer
     'live' with it an Eighth Nerve Section can be done. But according
     to my surgeon this is an absolute last resort. It guarantees
     deafness in the ear and some patients report balance problems at
     night. He also claims the risks are high with this procedure
     including partial face paralysis. [Ed. note: new surgical
     techniques access the nerve via the posterior fossa, preserving
     hearing and reducing the risk of facial paralysis. The vestibular
     nerve alone can be sectioned, providing vertigo relief.]

In general, imagine yourself back when you first encountered Meniere's.
What kind of summary info would have been helpful to you?

     Knowing that it can be treated with medication and there is the
     hope that it will burn itself out keeps me going. There does seem
     to be a connection with the tinnitus and the Meniere's. I have
     noticed over the last two years that the tinnitus gets worse and
     my hearing decreases prior to a vertigo episode or series of
     vertigo episodes. 25mg of Meclizine usually has the vertigo under
     control in 20 - 30 minutes for a mild attack. A severe attack can
     leave you completely disoriented such that there is no real up or
     down. An attack this severe usually has bouts of nausea and
     vomiting with it. I find lying down in a quiet dark room helps
     while the medicine kicks in. Anti-nausea drugs can help. In my
     case when I have had a severe episode I usually feel
     'out-of-sorts' for a couple of days.

     If you experience pretty intense tinnitus coupled with vertigo
     and the inability of hold your eyes steady on an object I would
     suggest seeing an ENT who knows about Meniere's. I have found
     that it is not well known or understood.

Meniere's, Tinnitus, & Gentamicin, as explained by Jim Chinnis
<[e-mail]>:

     Originally, streptomycin was tried as a treatment for medically
     intractable Meniere's (before considering surgical approaches).
     As best I can determine, the technique was developed at Tulane
     Univ by Charles Norris in the US and first tested by Dr. John
     Shea Jr. in Memphis, Tennessee, USA. Doctors knew that
     streptomycin could destroy hearing and balance. Early interest
     was in seeing if the vestibular system could be suppressed with
     small doses during space travel in order to reduce motion
     sickness experienced by NASA astronauts.

     Shea and others soon recognized that streptomycin could be used
     in two ways for Meniere's. Either a large dose could be used to
     chemically destroy the neural hair cells of the inner ear (giving
     a result similar to nerve section, but without surgery) or a
     carefully monitored dose could be used so that treatment would
     stop as soon as any hearing or vestibular damage could be
     measured. The latter idea was based on the thought that either
     the vestibular signal could be weakened or even that the cells in
     the vestibular (balance) system in the ear that were misfiring
     and causing vertigo might be selectively destroyed with
     streptomycin. It was also known that aminoglycosides had complex
     activity within the tissues of the inner ear and had a particular
     affinity for tissue believed responsible for the production of
     endolymph. (Overproduction of endolymph or failure of resorption
     is believed to be the principal cause of Meniere's symptoms and
     the symptoms of some other inner ear problems, as well.) Dr. Shea
     was somewhat successful in developing this treatment. It has been
     tried now around the USA, in Italy, Australia, Canada, and
     elsewhere in numerous variations but is not generally known to
     practicing ENTs.

     The newer form of the treatment is to use gentamycin instead of
     streptomycin because it is safer. The drug is administered either
     into the middle ear and allowed to perfuse through the round
     window into the inner ear or given by (systemic) injection.
     Patient goes home same day. Results have been very good as far as
     I can tell. One large unilateral study (people with Meniere's in
     one ear) showed the following results: vertigo gone in over 90%
     of cases, tinnitus GONE in more than 80% of cases. Another large
     study found vertigo gone in 85.5% of cases, improvement of
     hearing of at least 10 db in 26.7%, disappearance of pressure or
     fullness in 78.4%, and the disappearance of tinnitus in 51.6% of
     cases and its significant reduction in another 24.2%.

     Researchers (e.g., T. Sala in Italy) think that the gentamicin
     permanently affects the"vascular stria" and the "dark cells" so
     that less endolymph is produced and causes changes in a number of
     cellular biochemical processes in the inner ear.

     Of major importance to those with Meniere's affecting both ears
     is the finding that the Meniere's may be "cured" by either
     parenteral injections or middle ear applications. Sala cites four
     additional references that report on treatment/cure of bilateral
     Meniere's using streptomycin or gentamicin. He argues for
     gentamicin, due to its greater affinity for tissues believed
     responsible for endolymph production and because of its lower
     toxicity. He argues also that the topical administration of
     gentamicin can be used even when little or no hearing loss is
     present, since the dosing can be stopped before significant
     hearing loss occurs. Because the drug then (allegedly) results in
     reduction of endolymph pressure, no further hearing loss or
     vertigo attacks are expected. Thus gentamicin perfusion therapy
     appears to be a viable treatment at any stage of Meniere's
     unilateral or bilateral, and may preserve hearing and balance if
     used soon enough.

     Sala also argues that treatment with aminoglycosides could be
     expected to be effective against tinnitus or balance disorders
     due to any of a wide variety of causes, not just Meniere's. I
     have not seen any research done on this assertion.

     A finding of major importance is that when the earliest patients
     from about 15 years ago are examined today, the improvements made
     by the streptomycin therapy are still there, suggesting that the
     treatment may be permanent.

     Please note that if you seek this treatment or ask your doctor to
     consider it you will probably have difficulty. S/he will probably
     never have heard of it. I have a list of about six doctors in the
     US who perform the treatment in at least some versions. There is
     obviously Sala in Italy (Venice), and I have a lead to a doctor
     in Australia and Canada.

     This information is just my take on some fairly technical journal
     articles. The opinions are those of medical doctors who wrote the
     journal articles but the words are mine. I am not a medical
     doctor, just a Meniere's patient like many of you.

     References:

     Dickens, John R.E., M.D., and Graham, Sharon S. (Meniere's
     Disease--1983-1989). The American Journal of Otology, Vol. 11,
     Number 1. January 1990.

     Sala, T. (Transtympanic administration of aminoglycosides in
     patients with Meniere's disease). Archives of
     Oto-Rhino-Laryngology, 245:293-296. 1988.

     Pyykko, I., Ishizaki, H., Kaasinen, S., Aalto, H. (Intratympanic
     gentamicin in bilateral Meniere's disease). Otolaryngology--Head
     & Neck Surgery, 110(2):162-167. Feb 1994.

     Shea, J.J. Jr., and Ge, X. (Streptomycin perfusion of the
     labyrinth through the round window plus intravenous
     streptomycin). Otolaryngologic Clinics of North America,
     27(2):317-24. April 1994.

Endolymphatic hydrops (see http://lab9924.wustl.edu/Intro4.htm) is a
condition similar to Meniere's that involves vertigo without hearing loss,
as described by another contributor:

     I have a problem with one ear that is called endolymphatic
     hydrops, which is something like Meniere's without a severe
     hearing loss. Apparently the fluid in the semicircular canals
     responds to changes in body fluid levels - which it isn't
     supposed to do- and sends messages to say you are dizzy. I have
     spontaneous vertigo attacks and motion induced dizziness - all
     lasting only a short time. Well, what does this have to do with
     tinnitus? I also have tinnitus in that ear, which is helped by
     some things I have been taught to do for dizziness. Eating small
     meals several times a day keeps your body fluid levels fairly
     consistent. Also avoid salt. That really makes a difference with
     tinnitus and avoid too much sugar as well. Other things to be
     careful of are fatigue and dehydration. All these things have
     been helpful for me.

---------------------------------------------------------------------------

8) What is hyperacusis?

Hyperacusis is defined as a collapsed tolerance to normal environmental
sounds. It is a rare hearing disorder whereby a person becomes highly
sensitive to noise. Sometimes people think they have hyperacusis because
they are bothered by loud sounds like music, heavy equipment or sirens.
This is not hyperacusis because these sounds are loud to the normal ear.
Individuals with hyperacusis have difficulty tolerating sounds which do not
seem loud to others. The ears lose much of their normal dynamic range, and
everyday noises sound unbearably or painfully loud. Simply stated, it is
like the volume control on your hearing is stuck on HIGH! Hyperacusis can
affect people of all ages and is almost always accompanied by tinnitus, an
ailment that causes sufferers to hear constant ringing, buzzing or static.
Unlike hyperacusis, tinnitus is very common and is associated with many
hearing disorders. Hyperacusis and tinnitus can affect one or both ears.
Recruitment is a similar hearing disorder which is often confused with
hyperacusis. The difference is that an individual with hyperacusis is
highly sensitive to sound but has _no hearing loss_ whereas a person with
recruitment is highly sensitive to sound but also _has hearing loss_. This
is an important difference.

What causes hyperacusis?

Unfortunately, because hyperacusis is so rare, little research has been
done so little is known about it. The onset is usually caused by exposure
to loud noise (either prolonged or a single episode) or a head injury. Some
experts speculate that the cause is damage to the auditory nerves.
Currently, a popular theory is that there has been a breakdown or
dysfunction in the efferent portion of the auditory nerve. Efferent meaning
fibers that originate in the brain which serve to regulate or inhibit
incoming sounds. If the cause would be damage to the auditory nerve then
why does hyperacusis most often show up in patients who have little or no
discernable hearing loss? One possibility is that the efferent fibers of
the auditory nerve are selectively damaged even though the hair cells that
allow us to hear pure tones in an audiometry evaluation remain intact. The
real problem is that no one clearly understands how the brain interprets
sound. Medicine has much to learn about the auditory system before
hyperacusis and many other auditory problems can be fully understood. Other
contributing causes of hyperacusis are thought to be Temporomandibular
Syndrome (TMJ), Williams Syndrome, Bell's Palsy, Meniere's Disease and
Tay-Sachs Disease. Also as many as 40% of all autistic children are
sensitive to noise, however their condition is called hyperacute hearing.
Autistic children currently receive Auditory Integration Therapy (AIT) to
resolve their sound sensitivities. These treatments do not work on
hyperacusis and can actually worsen our condition - particularly the
tinnitus because it is administered at uncomfortably loud sound levels.

What can be done?

Currently all treatments for hyperacusis are experimental. The most
promising treatment comes from Dr. Pawel Jastreboff who have patients with
hyperacusis listen to static (white noise) from ear appliances called
maskers. The theory is that by listening to a specific kind of white noise
at a barely audible volume for a disciplined period of time each day that
the efferent system of the auditory nerve will be retrained through
desensitization to once again tolerate normal environmental sounds. The
treatment has been somewhat successful on a select number of patients but
usually no improvement is seen during the treatment period for at least the
first 3 months. Treatment may take as long as 2 years.

How rare is hyperacusis?

Although there may be as many as 1% of the population who are sound
sensitive, hyperacusis sufferers go well beyond the definition of sound
sensitive and often cannot tolerate their surroundings or even people's
voices. Because the media has not publicized this disorder it is hard to
get a handle on how rare hyperacusis is, however, it may be as little as
one in every 50,000 people. That is extremely rare!

Where can I turn to for help?

Because so little is known about it, doctors either have no idea what is
wrong with us or give us poor advice. Some even subject our ears to tests
which only make our ears worse. A person who comes down with hyperacusis
needs immediate counseling. No one can even imagine what this condition is
like unless they experience it first hand. Running water, rustling
newspaper pages, people talking, slamming doors, kitchen silverware and
driving in a car can all be intolerable particularly without ear
protection. Most hyperacusis patients wear ear protection - either foam ear
plugs or ear muffs when they are in areas which are not sound-friendly.
When ears suddenly become traumatized it is even difficult to sleep because
the sufferer's stress level is so high. To help individuals who are
experience the trauma of hyperacusis, an international support network has
been established called The Hyperacusis Network. See Organizations below
for details.

[The above information was provided courtesy of The Hyperacusis Network.]

---------------------------------------------------------------------------

9) What drugs, vitamins, and herbs are available for treating tinnitus?

   * niacin

     Niacin supplements produce a temporary flushing effect that is
     supposed to pump more oxygen into the inner ear due to vasodilation.
     Take niacin on an empty stomach for best results. You may experience a
     flush ranging from a mild sunburn to wondering about spontaneous skin
     combustion. ;-) You may also experience a "dry mouth" sensation.

     MEGADOSES OF NIACIN CAN DESTROY YOUR LIVER AND KILL YOU. 50mg twice
     per day is a common dose for tinnitus. If you experience the flush,
     then you are getting the maximum benefit. Caution: niacin can provoke
     migraine headache attacks in some people.

     Some people report good results from niacin, other people gain
     nothing. Your mileage may vary. One contributor advocates taking
     niacin in combination with thiamine:

          The 1994 text on Myofascial Pain: Trigger Points said that
          Niacin without Thiamine will do no good for tinnitus. I
          don't recall the reasoning. Nicotinic Acid (a form of
          Niacin) if taken in over 500mg per day should only be done
          so with Dr. approval. I take 100mg per day with a B-complex
          vitamin that already is balanced properly. You want roughly
          two parts niacinamide for each one part thiamine. Most
          vitamins will come balanced in this proportion. To my
          knowledge Nicotinic Acid in large doses like 2-5mg per day
          over a year or so, could lead to liver damage. Niacinamide
          shouldn't have any negative effects nor should thiamine. But
          I suppose if someone swallows a bottle they'd have a side
          effect!

     There is no clinical proof for the effectiveness of niacin in treating
     tinnitus. This is inherently difficult to prove due to a possible
     "placebo effect" arising from the niacin flush sensation rather than
     any therapeutic value of the underlying vasodilation. Additionally,
     any vasodilation that occurs cannot benefit the cochlear hair cells,
     because the blood vessel (vas spralie) that feeds these cells cannot
     expand or contract.

   * lecithin

     The following anecdotal report advocates lecithin in combination with
     niacin [Ed. note: my nutrition book does not cover lecithin, so I
     cannot speculate as to toxicity and side-effects]:

          After reading the tinnitus faq I emailed to my father, he
          replied that he has helped a number of people cure their own
          tinnitus by using Niacin and Lecithin. His theory is that
          the lecithin, being an emulsifier, helps disperse the build
          up of fats in the capillaries, and the niacin helps dilate
          the capillaries to let the lecithin in.

          He had meier's [sic - Meniere's?] syndrome in the 70's, and
          cured it this way. Our neighbor, a police officer, retired
          on disability for the same reason, and Dad practically cured
          him that way.

          I got tinnitus as a result of childhood ear infections, and
          it has done nothing for me, but then, mine is not what I
          would call irritating.

          It does seem that after chelation, the noise is less.

     CAUTION: Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Heath
     Freedom Publications, ISBN 0-9627418-9-2, says that phosphatidyl
     choline is the active ingredient of lecithin, and as a precursor of
     acetylcholine should be avoided by people who are manic-depressive
     because it can deepen the depressive phase.

   * gingko biloba

     Gingko biloba leaves have been used therapeutically by the Chinese for
     centuries for the treatment of asthma and bronchitis. In western
     countries a standardized 50:1 concentrate of 24% gingko
     flavoglycosides is used, either in liquid or capsule form. Gingko has
     been shown to increase circulation throughout the body and the brain.

     The article "Ginkgo biloba", The Lancet, Vol 340, Nov 7, 1992, pp.
     1136-1139, examines numerous studies on the efficacy of ginkgo on
     intermittent claudication (pain while walking), and cerebral
     insufficiency, a wide collection of vascular impairment symptoms
     including tinnitus. Typical dosages range from 120-160mg per day,
     divided equally at meal time.

     Most studies showed that between 30-70% of subjects had reduced
     symptoms over a 6-12 week period. No serious side effects were
     observed, and any minor side effects were not statistically
     significant compared to subjects treated only with placebo.

     Other references on gingko biloba:

     As to tinnitus, Hobbs in reference (1) says:

     For example, in 1986 a study statistically proved the effectiveness of
     treatment with ginkgo extract for tinnitus: the ringing completely
     disappeared in 35% of the patients tested, with a distinct improvement
     in as little as 70 days!(2)

     Similarly, when 350 patients with hearing defects due to old age were
     treated with ginkgo extract, the success rate was 82%. Furthermore, a
     follow-up study of 137 of the original group of elderly patients 5
     years later revealed that 67% still had better hearing(3).

     References

     1.) Ginkgo Elixir of Youth; Christopher Hobbs; Botanica Press, Box
     742, Capitola, CA 95010; 1991; pages 50-51

     2.) Tinnitus-multicenter study. A multicentric study of the ear;
     Meyer, B.; 1980; Ann. Oto-Laryng. (Paris) 103:185-8

     3.) Tebonin-therapy with old hard-of-hearing people. Koeppel, F. W.;
     1980; Therapiewoche 30: 6443-46

     Here's an abstract of a recent paper in Audiology:

          Holgers KM; Axelsson A; Pringle I
          Ginkgo biloba extract for the treatment of tinnitus.
          Department of Audiology, Sahlgren's Hospital, Goteborg,
          Sweden.
          Language: Eng
          Source: Audiology 1994 Mar-Apr;33(2):85-92
          Unique Identifier: 94234927

          Abstract:

          Previous studies have shown contradictory results of Ginkgo
          biloba extract (GBE) treatment of tinnitus. The present
          study was divided into two parts: first an open part,
          without placebo control (n = 80), followed by a double-blind
          placebo-controlled study (n = 20). The patients included in
          the open study were patients who had been referred to the
          Department of Audiology, Sahlgren's Hospital, Goteborg,
          Sweden, due to persistent severe tinnitus. Patients
          reporting a positive effect on tinnitus in the open study
          were included in the double-blind placebo-controlled study
          (20 out of 21 patients participated). 7 patients preferred
          GBE to placebo, 7 placebo to GBE and 6 patients had no
          preference. Statistical group analysis gives no support to
          the hypothesis that GBE has any effect on tinnitus, although
          it is possible that GBE has an effect on some patients due
          to several reasons, e.g. the diverse etiology of tinnitus.
          Since there is no objective method to measure the symptom,
          the search for an effective drug can only be made on an
          individual basis.

     And still another abstract:

          I searched the medline for your using PHYSICIANS ON LINE
          software, from 1988 to present obtained the following:

          Remacle J, Houbion A, Alexandre I, Michiels C

          [Behavior of human endothelial cells in hyperoxia and
          hypoxia: effect of Ginkor Fort]

          Laboratoire de Biochimie Cellulaire, Facultes Universitaires
          N.D. de la Paix, Namur, Belgique.

          Phlebologie 1990 Apr-Jun;43(2):375-86

          Article Number: UI91046351

          ABSTRACT:

          Recent discoveries have shown that venous diseases have a
          multifactorial etiology. One of the factors which is
          definitely involved in this pathologic process is the change
          in the concentration of oxygen. An increase in the
          concentration of oxygen, hyperoxia, or reoxygenation
          following hypoxia, damages the tissues by stepping up the
          production of free radicals. In addition, a reduction in
          oxygen concentration, or hypoxia, is also damaging, probably
          through a reduction in ATP synthesis. From a therapeutic
          standpoint, the veins, and more particularly the
          endothelium, must be protected against the impact on the
          tissue of these changes in oxygen concentration. In this
          study, the effects of Ginkor Fort were tested on cultured
          endothelial cells subjected to varying oxygen pressures. The
          results show that Ginkor Fort can provide good protection of
          endothelial cells against hyperoxia and
          hypoxia-reoxygenation. These beneficial effects are probably
          due to the presence of flavonoids in the **Ginko** biloba
          extract; these flavonoids have an anti-oxidant effect. In
          addition, this substance also protects the cells against
          hypoxia, possibly by increasing the availability of oxygen
          for ATP synthesis. This dual protective effect, which is
          produced by two different mechanisms, may account for the
          wide spectrum of Ginkor Fort in its use in venous diseases.

     Despite the above quotes, one prominent American tinnitus specialist
     says that gingko does no better in rigorous scientific studies than a
     placebo effect of 5%.

   * anti-depressants, tranquilizers, and muscle relaxants

     Many tinnitus sufferers become depressed from having to deal with the
     constant noise. Treating the depression may make the tinnitus seem
     less severe. But beware that certain ototoxic anti-depressants may
     _worsen_ tinnitus. SSRI anti-depressants may temporarily worsen
     tinnitus for the first few weeks, but risk fewer side-effects as
     compared to the older tricyclic drugs.

     Tricyclic anti-depressants, such as Nortriptyline and benzodiazepines,
     such as Alprazolam (Xanax) were used in one study in which some people
     reported improvement.

     Possible reasons:

     (1) Patients just think they feel better (placebo effect).

     (2) Since these drugs are central nervous system depressants, auditory
     responsiveness diminishes.

     (3) Tinnitus is stress-related - i.e. muscle tension in neck & jaw
     restricts blood and lymph flow.

     Alprazolam (Xanax)

     A double-blind study with placebo control showed 76% of the subjects
     benefited with tinnitus reductions of at least 40%, whereas only 5% of
     the placebo subjects had an improvement. Try 0.5mg at bedtime. Can be
     addicting, and may make you feel excessively mellow.

     An abstract of an article describing the Xanax study:

          Use of Alprazolam for Relief of Tinnitus
          A Double-Blind Study
          Robert M. Johnson, PhD; Robert Brummett, PhD; Alexander
          Schleuning, MD
          (Arch Otolaryngol Head Neck Surg. 1993:119:842-845)

          OBJECTIVE: To systematically test the effectiveness of
          alprazolam as a pharmacological agent for patients with
          tinnitus.

          DESIGN: Prospective, placebo-controlled, double-blind study.

          PATIENTS: Forty adult patients with constant tinnitus who
          had experienced their tinnitus for a minimum of 1 year and
          who resided in the Portland, Oreg., metropolitan area.
          Twenty patients were randomly assigned to the experimental
          group and 20 to the control group.

          RESULTS: Seventeen of 20 patients in the experimental
          (alprazolam) group and 19 of the 20 in the placebo (lactose)
          group completed the study. Of the 17 patients receiving
          alprazolam, 13 (76%) had a reduction in the loudness of
          their tinnitus when measurements were made using a tinnitus
          synthesizer and a visual analog scale. Only one of the 19
          who received the placebo showed any improvement in the
          loudness of their tinnitus. No changes were observed in the
          audiometric data or in tinnitus masking levels for either
          group. Individuals differed in the dosages required to
          achieve benefit from the alprazolam, and the side effects
          were minimal for this 12-week study.

          CONCLUSIONS: Alprazolam is a drug that will provide
          therapeutic relief for some patients with tinnitus.
          Regulation of the prescribed dosage of alprazolam is
          important since individuals differ considerably in
          sensitivity to this medication.

          Reprint requests to 3515 SW Veterans Hospital Rd., Portland,
          OR 97201 (Dr. Johnson).

     Here's the Conclusion section of the article:

          CONCLUSION. It appears that alprazolam is beneficial in
          treating some patients with tinnitus. Because long-term use
          of a benzodiazepine is not recommended, it probably should
          be used as an option when the patient cannot benefit from
          tinnitus maskers, hearing aids, or other therapy. Patients
          who elect to continue taking the drug are prescribed it for
          a maximum of 4 months. The dosage is then reduced by 0.25 mg
          every 3 days before it is completely discontinued. Once the
          drug therapy program has been terminated, it is not resumed
          for at least 1 month. For some patients, the tinnitus
          remained at a low level. Also, some patients are able to
          continue the drug at daily dosages of 0.5 mg and 1.0 mg. It
          is important to regulate the prescribed dosage of alprazolam
          since individuals differ considerably with regard to
          sensitivity to this medication.

     Patients in the Portland study reported an average tinnitus loudness
     of 7.5 dB before Xanax treatment, and 2.3 dB after.

     Klonopin

     Same class of drug as Xanax, but somewhat less effective and less
     addictive. Klonopin has not been tested for tinnitus reduction in
     rigorous scientific studies.

     A word of warning:

     Big-time antidepressants like the tricyclics and Prozac cannot be
     expected to have an effect if the tinnitus sufferer does not suffer
     from an affective disorder originating in brain chemistry. Minor
     tranquilizers may help. But people should beware of trusting their
     friendly local internist/GP to prescribe drugs of this type. Current
     knowledge of psychopharmacology is essential. GP prescriptions of
     these drugs have messed up more facets of people's lives than just
     their hearing.

   * anti-convulsants

     Carbamazepine (Tegretol, a dangerous drug!), phenytoin (Dilantin),
     primidone (Mysoline), valproic acid (Depakene) have all shown some
     effectiveness in reducing tinnitus. But there is no standard dosage
     for tinnitus applications, and some of these drugs may cause dangerous
     side-effects that require careful monitoring via blood chemistry and
     other tests. Anti-convulsants have not been studied in rigorous
     scientific tests for reduction of tinnitus.

   * intravenous lidocaine

     An initial injection of lidocaine followed by an IV drip may provide
     temporary relief to some sufferers. In one study, relief of up to 30
     minutes after IV disconnection was reported by 23 out of 26 patients.

   * tocainide hydrochloride

     This is an oral relative of lidocaine thought to act in a similar
     manner. Tocainide can have serious side-effects.

   * histamine

     On p.32 of Conn's Current Therapy, 1994, W.B. Saunders Co., MDs Jack
     C. Clemis and Sally McDonald write "The authors' choice for
     pharmacotherapy is histamine. In a study awaiting publication, nearly
     70% of patients treated with histamine achieved complete or partial
     resolution of their symptoms."

     Anyone with more information about this Therapy, the study to be
     published, MDs Jack C. Clemis and Sally McDonald, and/or anyone else
     using this Therapy please contact me at: [e-mail] I have as
     to date no other information than that is in the above paragraph.

   * anti-histamine

     [Ed. note: Yes, I realize this is in contradiction with the above
     paragraph.] The theory is that the mild sedative effect eases anxiety,
     and that mucous reduction allows the inner ear to dry out, thus
     relieving cochlear pressure.

   * meclizine

     This is an over-the-counter (USA) anti-vertigo drug. While it is
     obviously relevant to the severe vertigo that comes with Meniere's,
     there was one anecdotal report submitted to this FAQ by a tinnitus
     sufferer who did not _have_ vertigo but took meclizine to successfully
     reduce his tinnitus.

   * DMSO

     The following appeared in a recent article in Alternatives regarding
     tinnitus:

          "Ask your doctor to review the following article, Annals of
          the New York Academy of Sciences 75:243:468:74. 'In this
          study,15 patients were suffering from tinnitus. Every four
          days 2 milliliters of a medicated DMSO solution containing
          anti-inflammatory and vasodilatory compounds were applied
          locally to the external auditory canals of their ears. They
          were also given an intramuscular injection of DMSO at the
          same time.

          'After one month, 9 of the 15 patients had a total cessation
          of the tinnitus and it didn't return during the one year
          observation period. It was diminished in two others and in
          the remaining four it became only an occasional problem
          instead of permanent (cold temperatures seemed to be the
          main factor causing it to return).

          'In addition, all of the five patients that were suffering
          from vertigo noted significant improvement...'

   * vinpocetine and vincamine

     The following is an anecdotal report concerning vinpocetine, a drug
     that is NOT registered in the United States. A search of the
     Physician's Desk Reference and several CDROM databases turned up
     nothing on the drug or its manufacturer. Be skeptical, but also
     remember that some of today's wonder drugs were once new and
     unregistered. A prominent American tinnitus researcher (Dr. Jack
     Vernon) says, "Vinpocetine shows high promise." Judge for yourselves:

          I started taking vinpocetine (a nootropic drug available
          mail-order from Europe) a couple months ago, and my tinnitus
          (due to listening to a walkman for the entire eighties) is
          now almost gone. Occasionally the tinnitus will re-occur,
          but I think that's due to what I happen to be eating (or not
          eating) that day, as the FAQ states.

          In short, vinpocetine cured what I thought was incurable,
          and made me a whole-lot happier -- especially since I'm in
          the music industry and depend on my ears.

          From what I understand, vinpocetine repairs damaged nerve
          cells, among other things. There are no side effects -- you
          don't notice anything while taking it except that you may
          remember things better, and your tinnitus may improve.

          "VINPOCETINE: A side effect free synthetic derivative of
          vincamine. Vinpocetine is three to four times as potent as
          vincamine at improving cerebral circulation and overall is
          OVER TWICE as potent as vincamine in humans. Vinpocetine has
          wide ranging effects and can be used to improve memory,
          treat stroke, menopausal symptoms, macular degeneration,
          impaired hearing and tinnitus. The usual oral starting dose
          is 1-2 tablets three times daily, to be followed by a
          maintenance dose of 1 tablet three times daily for a longer
          period of time. Vinpocetine has not been reported to
          interact with other drugs and may be used in combination."
          -- 'Recommended Dosages' sheet from Interlab.

          You can order vinpocetine by sending a letter to Interlab
          asking for an order form. Currently, vinpocetine is US$26
          for 100 tablets. For Canadians, you can only order a three
          month personal supply at a time. For Americans, you may need
          a doctor's prescription, and can only order a three month
          personal supply at a time. Call your government's "Customs"
          agency, or "Food and Drug" administration to be sure.

          Interlab
          BCM box 5890
          London
          WC1N 3XX
          England

     A different contributor has this interjection to make about Interlab:

          Interlab is not a reputable source. They are a "black"
          organization that has shipped bogus drugs, and they
          routinely ignore complaints. They use greeting cards to ship
          drugs into the US (which is very reliable) and people either
          love their service or hate it, depending on whether or not
          they have had a problem that Interlab will not remedy.

     How did you find out about vinpocetine? Did you explicitly try it for
     tinnitus, or was it for some other condition and the tinnitus cure was
     an unexpected side-effect? Did a doctor recommend it to you?

          I read about it in a document regarding drugs that the FDA
          won't approve because they don't consider the problem the
          drug cures important enough (such as tinnitus.) It was on
          the net somewhere -- I don't have it.

          I got it specifically for tinnitus. A doctor didn't
          recommend it -- I "prescribed" it to myself. I have a degree
          is psychology, so I'm not completely in the dark as to its
          effects.

     The literature from the manufacturer almost has that "too good to be
     true" ring to it. Have you ever seen any other literature on this drug
     that didn't come from the manufacturer?

          Nothing really substantial, except personal reports from
          people who say it works with them.

     Do you have any info regarding undesirable side-effects or toxicity
     levels?

          Non-toxic at any level, no side-effects. It's available OTC
          (Over The Counter) in Europe and South America. It is not
          available in North America because drug laws stipulate that
          a drug has to cure an existing condition before it can be
          approved. I guess tinnitus isn't a real problem to them. The
          only way we can find out if it really works is if several
          people try it and report back. I doubt tinnitus is something
          that placebo response can overcome, and I'm sure that if
          other peoples tinnitus was as annoying as mine, they'll jump
          at the chance to try vinpocetine.

     Another FAQ contributor reports:

          In a quick review of the medline literature I did not find
          any papers dealing with vinpocetine and tinnitus, but did
          find some with information I will share....I found some
          information in the merck index as well as in two articles on
          vinpocetine-side effects in the Journal of the American
          Geriatics Society ..JAGS 35:425(1987); 37:515(1989).....

          VINPOCETINE
          ethyl apovincaminate
          3,16-eburnamenine-14-carboxylic acid ethyl ester
          registered drug names...cavinton,ceractin,eusenium,finacilen

          mode of action...cerebral vasodilator used to treat cerebral
          dysfunction resulting from reduced blood flow....in addition
          has other complex metabolic actions..."In humans, the effect
          on cerebral blood flow is not certain, with some
          investigators reporting no change, while others report an
          increase". It has been reported that vinpocetine can be used
          safely to treat patients with "chronic cerebral dysfunction
          of vascular origin". The drug is not without some side
          effects but these.. "were mild and not considered to be of a
          serious nature". These papers also discussed the
          concentration of drug administered to groups of patients in
          controlled studies...There was mention made in the 1989
          paper that vinpocetine was under investigation in the US
          assessing its value in patients with multi-infarct
          dementia...

          The information that vinpocetine helps some people that have
          tinnitus is at the moment anecdotal...as one with tinnitus,
          I certainly would approach self treatment very
          conservatively....I take niacin for my hypercholesteremia
          and haven't noticed any change in the ringing...I would be
          willing to take lecithin and ginko but I don't think I will
          attempt vinpocetine until I am sure of its efficacy....most
          of the people with tinnitus do not have cerebral
          dysfunction!... I can also appreciate trying anything to
          reduce the discomfort of tinnitus...please be cautious when
          it comes to the use of drugs...as we know even niacin in
          excess is potentially harmful....

     Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Health Freedom
     Publications, ISBN 0-9627418-9-2, has this to say about vinpocetine
     and vincamine:

          "Vinpocetine is a powerful memory enhancer. It facilitates
          cerebral metabolism by improving cerebral microcirculation
          (blood flow), stepping up brain cell ATP production (ATP is
          the cellular energy molecule), and increasing utilization of
          glucose and oxygen.

          ...

          Vinpocetine is often used for the treatment of cerebral
          circulatory disorders such as memory problems, acute stroke,
          aphasia (loss of the power of expression), apraxia
          (inability to coordinate movements), motor disorders,
          dizziness and other cerebro-vestibular (inner-ear) problems,
          and headache. Vinpocetine is also used to treat acute or
          chronic ophthalmological diseases of various origin, with
          visual acuity improving in 70% of the subjects.

          Vinpocetine also is used in the treatment of sensorineural
          hearing impairment.

          ...

          Vinpocetine is a derivative of vincamine, which is an
          extract of the periwinkle. Although they have many similar
          effects vinpocetine has more benefits and fewer adverse
          effects than vincamine.

          Precautions: Adverse effects are rare, but include
          hypotension, dry mouth, weakness, and tachycardia [Ed. note:
          this is excessively rapid heartbeat, which can be FATAL. I
          do not consider that to be "very safe"]. Vinpocetine has no
          drug interactions, no toxicity, and is generally very safe.

          ...

          Vincamine is an extract of the periwinkle. It is a
          vasodilator and increases blood flow to the brain and
          improves the brain's use of oxygen.

          Vincamine has been used to treat a remarkable variety of
          conditions related to insufficient blood flow to the brain,
          including vertigo and Meniere's syndrome, difficulty in
          sleeping, mood changes, depression, hearing problems, high
          blood pressure and lack of blood flow to the eyes. Vincamine
          has also been used for improving memory defects and
          inability to concentrate. Vincamine has extremely low
          toxicity and is very inexpensive.

          ...

          Precautions: Rarely causes gastrointestinal distress, which
          disappears when usage is stopped. Vincamine has not been
          proven to be safe for pregnant women or children."

     Like vinpocetine, vincamine is not directly available in the United
     States. For a list of mail-order suppliers of these and other "smart
     drugs", send US$2.00 to the address below and request the Smart Drug
     Sources List:

     Cognition Enhancement Research Institute
     P.O. Box 4029
     Menlo Park, CA 94026-4029
     USA

     Smart Drugs & Nutrients is also available from CERI:

          It is now 5 years since SD&N was published and it is getting
          hard to find in many bookstores in many areas of the
          country. For those who can't find it locally, they can get
          it from CERI for $12.95 plus $3 for Priority Mail shipping.
          If they mention the Tinnitus FAQ, we will include the Smart
          Drug Sources listing for free.

   * hydergine

     Another "smart drug", for which Dean & Morgethaler say:

          "Hydergine is reported to increase mental abilities, prevent
          damage to brain cells from insufficient oxygen (hypoxia),
          and may even be able to reverse existing damage to brain
          cells [Ed. note: Call me skeptical].

          Hydergine is an extract of ergot, a fungus that grows on
          rye. Midwives in Europe traditionally used ergot with
          birthing mothers to lower their blood pressure. Researchers
          at the pharmaceutical giant Sandoz analyzed ergot in the
          late 1940s, looking for blood-pressure medications. Of the
          thousands of compounds that researchers found in ergot,
          three were combined and tested for their anti-hypertensive
          properties. When studies with elderly people uncovered
          cognition-enhancing effects, Sandoz began spending a great
          deal of research money on Hydergine. It is now one of the
          most popular treatments for all forms of senility in the
          U.S., and is used to treat a plethora of problems elsewhere
          in the world.

          Hydergine probably has several modes of action for its
          cognitive-enhancement properties. Its wide variety of
          reported effects include the following:

             o Increases blood supply and oxygen to the brain.
             o Enhances brain cell metabolism.
             o Protects the brain from free-radical damage during
               decreased or increased oxygen supply.
             o Speeds the elimination of age pigment (lipofuscin) in
               the brain.
             o Inhibits free-radical activity.
             o Increases intelligence, memory, learning, and recall.
             o Normalizes systolic blood pressure.
             o Lower abnormally high cholesterol levels in some cases.
             o Reduces symptoms of tiredness.
             o Reduces symptoms of dizziness and tinnitus (ringing in
               the ears).

          ...

          Precautions: If too large a dose is used when first taking
          Hydergine, it may cause slight nausea, gastric disturbance,
          or headache. Overall, Hydergine does not produce any serious
          side effects. It is nontoxic even at very large doses and it
          is contraindicated only for individuals who have chronic or
          acute psychosis, or who are allergic to it. Overdosage of
          Hydergine may, paradoxically, cause an amnesic effect."

     Hydergine is available in the United States with a doctor's
     prescription. It is also available from overseas sources, as one
     contributor explains:

          Hydergine is widely used in France, and it is cheap there.
          One person told me that you can get 5 mg Hydergine tablets
          there for less than the price of 1 mg in the US. If contacts
          can be made directly with French pharmacists sympathetic to
          the use of the higher European dosages in the US, mail-order
          access might be arrangeable for US tinnitus people.

     Hydergine has not been proven in rigorous scientific tests to be
     effective for tinnitus reduction.

   * sodium fluoride

     May be helpful when the tinnitus is due to cochlear otosclerosis.

   * vasodilators

     Vasodilators like niacin, gingko biloba, and prescription drugs for
     hypertension increase blood flow inside the skull, raising the oxygen
     available for good nerve health. But note that vasodilation cannot
     benefit the cochlear hair cells, as the blood vessel (vas spralie)
     which feeds these cells cannot expand or contract. Furthermore,
     vasodilation may not always be helpful, as explains one FAQ
     contributor:

          A few years ago, physicians started treating some forms of
          stroke, especially TIA's, with vasodilators. The theory was
          that, with dilation, more blood could flow to the starved
          areas. A later study showed that, in many cases, the
          vasodilators made the condition worse. The reason was that
          dilation increased flow to non-damaged areas and robbed
          damaged areas of even more blood.

          By extrapolation, one could conclude that tinnitus related
          to vascular damage could be made worse with vasodilators. I
          have no data to back this extrapolation up, but it does seem
          reasonable.

   * zinc

     The cochlea has the body's greatest concentration of zinc. Supplements
     of 90-150 mg per day may be beneficial in some cases. BUT BEWARE: high
     levels of zinc interfere with the body's absorption of copper, leading
     to anemia. Several studies have identified the 150mg dosage as leading
     to toxicity problems. Zinc therapy when prescribed by physicians is
     often accompanied by frequent blood tests to monitor copper levels.
     Zinc has not been formally tested for the treatment of tinnitus.

   * diuretics

     Diuretics may be prescribed when Meniere's Disease is present. One
     contributor reported tinnitus relief from Dyazide. But be aware that
     some diuretics are ototoxic and can worsen or even cause tinnitus.

   * homeopathic remedies

     One contributor reports tinnitus relief from homeopathic cell salts:

          I am a big believer in homeopathic cell salts. They have
          help me tremendously in coping with the high input-output
          life of a drummer. I perform approximately 12-15 hours a
          week, full blast, which could take its toll (I'm 42) if I
          wasn't taking care of myself.

          For tinnitus, Kali Phos and Mag Phos for the nerves, Kali
          Mur for any swelling in the inner ear. If I take the remedy
          before retiring for the night, the symptoms are greatly
          relieved by morning, and always within 48 hours.

          These are generic names. There are several manufacturers,
          notably Scheussler's Cell Salts (the guy who invented them
          back in 1905), and Boiron out of France; Standard Homeopathy
          here in the U.S.; all of which are usually available in most
          health and nutrition stores.

          You cannot overdose on homeopathic remedies, they are very
          cheap ($5 for 150 doses), and extremely effective,
          especially on acute conditions.

   * betahistine hydrochloride (SERC)

     The symptoms of Meniere's Disease can be ameliorated somewhat by
     betahistine hydrochloride. It is sold, but alas, not in the United
     States, under a host of names. It should NOT be taken by anyone
     pregnant or lactating, by children, anyone with an adrenal tumor
     (pheochromocytoma), bronchial asthma, or peptic ulcers. Possible side
     effects are nausea, gastric distress, headache, rash.

     It is not always effective, but if it is, relief is provided for 6 to
     12 hours on the standard dosage of 24-48 mg per day. It is believed to
     reduce pressure in the inner ear, and perhaps improve the blood flow
     to the small blood vessels there.

     Betahistine hydrochloride is sold in Canada under the trade name
     "SERC", and is distributed by Solvay Kingswood, Inc, Scarborough,
     Ontario, M1B 3L6 for Unimed, Inc.

     Here is one sufferer's SERC experience:

          I have suffered from Meniere's disease for 21 years. I've
          had endolymphatic sac and 8th vestibular nerve surgeries on
          my left ear during the last 5 years. Starting in September
          '95, my right ear, which previously had been fine, began
          ringing loudly. The hearing in the right ear declined
          dramatically. My doctor tried a course of steroids to no
          effect. It looked like I was going to be deaf within a year.

          A friend of mine found your tinnitus FAQ file and mailed it
          to me. I reviewed its contents with my doctor. He referred
          me to another doctor who is more familiar with homeopathic
          and other alternative treatments. This doctor encouraged me
          to try SERC, which is not available in the US. I got an
          appointment with a Canadian doctor in Windsor, Ontario. I
          started using SERC (one 4mg pill three times per day) on
          April 20, 1995. Seven days later, nothing had improved so I
          increased the dosage to two 4mg pills three times per day
          (as the doctor said I could). Two days later the right ear
          ringing stopped completely and hasn't returned!!! I stayed
          on that dosage for a month. I've now cut back to 2mg three
          times a day and the ringing has not returned as of 7/30/95.
          There were no side effects from the SERC at any of the
          dosages I've tried.

          I have my life back. My left ear works pretty well with a
          hearing aid. My right ear has full normal hearing. I have no
          side effects from the SERC. (By the way, SERC is cheap. 100
          4mg pills cost me about $18.)

          I'm happy to share my story with anyone. My name is Ken
          Cornell. Phone is: 313-878-0809. E-mail: [e-mail]

          Please add this to your FAQ and keep up your good work. Your
          efforts have saved my hearing. All my friends, family, work
          associates and I thank you VERY much.

   * magnesium

          Magnesium Prevents Hearing Loss:

          Three hundred young healthy male military recruits
          undergoing two months of basic training were studied. The
          trainees were repeatedly exposed to high levels of impulse
          noises. Each recruit received daily either 167 mg of
          magnesium (as magnesium aspartate) or a placebo (sodium
          aspartate). Permanent hearing loss was significantly more
          frequent and more severe in the placebo group than in the
          magnesium group-

     Attias J, Weisz G, Almog S, Shahar A, WienerM, et al. Oral magnesium
     intake reduces permanent hearing loss induced by noise exposure. Am J
     Otolaryngol 1994;15:26-32.

          COMMENT: Hearing loss is a common problem, particularly
          among older individuals. Although there are many causes,
          repeated exposure to excessive noise is one key factor. Many
          people do not realize how much noise pollution we are
          subjected to on a daily basis, from the steady hum of home
          appliances to the roar of trucks and autos. People who live
          in large cities face a constant bombardment with potentially
          damaging noise. Studies in animals have shown that noise
          exposure causes magnesium to be lost from the body. Perhaps
          supplementing with a little magnesium might prevent all of
          that noise from damaging your hearing.

     Nutrition and Healing, November 1994, p.8

   * caroverine

     Some research on caroverine is being done in Austria:

          Dr. Doris Maria DEINK c/o
          Universitiftsklinik flir Hals-Nasen-Ohrenkrankheiten
          Vorstand: Univ.Prof.Dr. KEhrenberger
          Allgemeines Krankenhaus der Stadt Wien
          1090 Wien, Wahringer Gurtel 18-20
          Telephone: [phone]

          September 9, 1994

          Dear Mr. Berger,

          Referring to your letter of August 1994, 1 am writing to
          give you some informations, about our tinnitus treatment
          with Caroverine. As you already know, the treatment with
          Caroverine is indicated in cases of cochlearsynaptic
          tinnitus. Therefore, a thorough ENT and audiological
          examination is necessary before therapy to rule out other
          tinnitus causes. If necessary, the diagnostic measurements
          should also comprise brainstem audiometry. As far as I know,
          Caroverine is not available as a registered drug in the
          United States. Therefore, I do not know any collegue who
          uses this substance in tinnitus treatment. Caroverine is a
          commercially available drug in Austria (Spasmium-R),
          Switzerland and Japan. In Austria, Spasmium-R has been used
          as a spasmolytic drug for nearly 30 years. I am enclosing
          some information about Spasmium-R. Caroverine is a
          Quinoxaline - derivative. It is produced by
          DONAU-PHARMAZIE-CEHASOL Ges.m.b.H., A-1230 VIENNA, AUSTRIA.
          You can get further informations about the availability of
          Spasmium-R from: PHAFAG AG, Im Bretscha 29,FL-9494, SCHAAN,
          LIECHTENSTEIN FAX [phone].

          For tinnitus treatment, Caroverine is applied as slow
          intravenous infusion (2 ml per minute). The dosage of
          Caroverine differs from patient to patient and depends on
          the tinnitus reduction achieved in the individual patient.
          When the tinnitus is reduced, the infusion is stopped. At
          maximum, 160mg Caroverine (4 ampules) are given in 100ml
          physiologic saline solution. Until now, we have not observed
          any severe side-effects. In some patients, a slight
          transient headache or dizziness occured. I hope that our
          informations will help you a little.

          With best wishes for you,
          Yours sincerely,
          Dr. Doris-Maria Denk, MD

          Dr. Doris Maria Denk
          Allgemaines Krankenhaus der Stadt Wien
          HALS-, NASEN- UND OHRENKLINIK
          DER UNIVERSITAT WIEN
          Vorstand: Prof. Dr. K. Ehrenberger
          A-1090 Wien Lazarettgasse 14
          tel. [phone]
          FAX [phone]

          Jan.23, 1993

          The symptom tinnitus may be due to various causes.
          Therefore, an exact audiological examination is absolutely
          necessary. The tinnitus therapy with transmitter antagonists
          can influence a special form of tinnitus - the so called
          cochlear synaptic tinnitus. It is caused by functional
          disturbances in the synapse between the inner hair cells and
          the afferent dendrites of the auditory nerve. By intravenous
          application of transmitter antagonists (e.g. GDEE,
          Caroverine) the synaptic function can be improved and the
          tinnitus reduced.

          All other forms of tinnitus cannot be reduced by transmitter
          antagonists. The substances we use for therapy of cochlear
          synaptic tinnitus are GDEE (Glutamic acid diethyl ester) and
          Caroverine. GDEE is not a registered drug and is only
          available upon special request by the clinic. The substance
          is produced by "FLUKA Biochemie, Industriegasse 25, CH-9479
          BUCHS, Switzerland). GDEE has to be lyophilised in order to
          be effectful. Now we are mainly using Caroverine. This
          substance is a registered drug in Austria (SpasmiumR) and
          known for its spasmolytic effect. At the Annual Meeting of
          the American Academy of Otolaryngology Head and Neck Surgery
          in Washington in September 1992 I reported about our
          results. Now we are preparing a publication. I am enclosing
          some information about our therapy (including papers about
          the theoretical basis).

          In your case the tinnitus etiology seems to be noise. If in
          addition to the mechanical damage of the inner ear a
          functional disturbance is present, there is a chance to
          influence the tinnitus. If you like to come to Vienna for
          therapy, please contact me to fix a date. I would propose a
          date at the beginning of March. If I can be of any further
          assistance, please let me know.

          Yours sincerely,
          Doris-Maria Denk, MD.

          Head and Neck Surgery
          Therapy of Cochlear Synaptic Tinnitus
          DORIS MARIA DENK MD (presenters, R. BRIX PHD, D. FELIX PHD,
          and K EHRENBERGER MD, Vienna, Austria

          Tinnitus occurs in about 60% of inner ear diseases. A
          tinnitus model that explains the pathophysiology of a
          certain type of cochlear tinnitus, the so called cochlear
          synaptic tinnitus, is presented. Cochlear synaptic tinnitus
          is caused by functional disturbances of the synapse between
          inner hair cells and afferent dendrites of the auditory
          nerve. This may be the case in sudden hearing loss, hearing
          loss in the elderly ("presbycusis") or noise-induced hearing
          loss. The cochlear synapse has the following
          characteristics: (1) glutamate is supposed to be the
          transmitter substance, and (2) on the subsynaptic membrane,
          two different receptor types work as a dual receptor system:
          NMDA (N-methyl-D-aspartate) and non-NMDA-receptors
          (Quisqualate, Kainate). This dual receptor system is
          responsible for a typical pattern of depolarization, which
          can be shown in microiontophoretic animal experiments. Under
          pathological conditions, spontaneous receptor-dependent
          depolarization patterns mimic sound-induced patterns, which
          are perceived as tinnitus. On the basis of these
          considerations, we use the specific Quisqualate antagonist
          glutamic acid diethyl ester (GDEE) for therapy of cochlear
          synaptic tinnitus to normalize the synaptic function. We
          have treated 130 patients by intravenous application of
          GDEE. In 77.2% of the patients, tinnitus was reduced by more
          than 50% in absolute values of sound intensity. The
          indications, diagnostic and therapeutic procedures, as well
          as methods of subjective and objective evaluation of the
          therapeutic effect, will be discussed.

          CAROVERINE
          Countries Where Available and Release Dates: Austria (1970);
          Sp. synonyms: v TP 20 1 - I
          Brand Names und Manufacturers:
          Base: Espasmofibra-Faes (Spain), Spasmiurn-Donau Pharmazie
          (Austria)
          Hydrochloride: Espasmofibra-Faes (Spain), Spasmium-Donau
          Pharmazie (Austria)
          Drug Action: Spasmolytic.
          Indications/Usage: Intestinal spasm; biliary spasm.
          How Supplied: 20 mg capsules; 40 mg ampules; 40 mg
          suppositories
          Dosage: 40 mg up to 3 times daily.
          Precautions/Warnings: Hyperthyroidism; cardiac
          insufficiency; muscular weakness in the elderly and
          disabled.
          Contraindications: Glaucoma; prostate hypertrophy; duodenal
          obstruction.
          Interactions: Phenothiazines; anticholinergics;
          antihistamines; tricyclic antidepressants; digoxin.
          Adverse Effects: Dry mouth; blurred vision; urinary
          retention; tachycardia.
          US Treatments: Cicyclomine, L-hyoscyamine and propanthelin
          are US anticholinergic drugs with similar pharmocologic
          properties

   * carbogen

          From: [e-mail] (Paul.Govaerts)
          To: [e-mail]

          Dear Mr Segal

          ....The problem of acoustic trauma is completely different
          from a large vestibular aqueduct or even a sudden deafness.
          In acoustic trauma there is both physical lesion of the
          hairs of the hair cells and biochemical lesion of the
          auditory neurons because of toxicity of the excitatory
          neurotransmittor that is involved. (Ref Prof Pujol,
          Montpellier, France). The tinnitus and vertigo and I guess
          also the hearing loss result from these lesions. It has been
          shown that these cells may have a good potential for
          recuperation and possibly also for regeneration (ref Van De
          Water, Bronx, NY and Lefebvre, Liege, Belgium). By
          administering vaso-active drugs and carbogen inhalation, a
          massive peripheral vaso-dilation is triggered, bringing huge
          amounts of oxygen and nutrients to these damaged cells.
          Although one has not been able to demonstrate superior
          effect of vasoactive drugs to placebo, carbogen has never
          been really studied. And I have several cases with sudden
          deafness (including after acoust or baro-trauma) who were
          not responding to vasoactive drugs and who responded
          spectacularly to carbogen, even when given several weeks
          after the injury. Unfortunately this treatment has no
          success when given too late, since there is no more
          potential for regeneration....

          Yours,

          Paul Govaerts, MD, MS.

     This information is courtesy of Dan Segal ([e-mail]).

---------------------------------------------------------------------------

10) What other treatments are available for tinnitus?

   * surgery

     For tinnitus caused by acoustic neuromas, vascular abnormalities, and
     TMJ syndrome. But note above in the Causes section that tinnitus,
     hyperacusis, or even profound deafness can _result_ from ear/skull
     surgery.

   * maintain a healthy diet & lifestyle

     This means no tobacco, no alcohol, no caffeine, low fat, low sodium.
     This may not cure your tinnitus, but there are other well-proven
     health benefits. Other less obvious foods like quinine/tonic water
     should also be avoided. If your dietary intake isn't sufficiently
     diverse, consider supplements:

          My research work during the past ten years has been on
          health and nutrition, and I can see that use of some dietary
          supplements would be a rational approach to ameliorating
          tinnitus. More than half of our population is at least
          slightly deficient in all of the B vitamins, magnesium,
          zinc, and perhaps copper and iron. Since folate, vitamin B6,
          vitamin B12 are critical for tissue repair and organ
          regeneration, it would be a very good idea to consider
          supplementing the daily diet with these. In addition, our
          diets are deficient in essential elements, including
          calcium, magnesium and zinc. Calcium is necessary for the
          action of about 500 enzymes, while magnesium is required by
          about 400 enzymes. All of these are interlinked in a system
          that is active 24 hours a day. Just supplementing the diet
          with one will not be completely effective if others are
          lacking. I think that the first step for anyone who wants to
          be really healthy, with ability to efficiently repair tissue
          and organ damage, should examine the diet critically to find
          deficiencies, then make sure that all of the essential
          elements and vitamins are present in greater than minimal
          amounts. Supplements make very good sense if approached this
          way.

   * biofeedback

     Useful as a stress reduction tool, biofeedback may help some people.

     *****[comments from someone who's been there?]*****

   * accupuncture

     May provide temporary relief to some people. One contributor reports
     significant relief that enabled him to avoid the heavy-duty
     anti-depressants that his Western physician had prescribed.

   * stress reduction

     Many people say their tinnitus is more active when they're tired and
     stressed out. Get a good night's sleep and avoid unnecessary stress.

   * hearing aids

     Some people with severe tinnitus may benefit from hearing aids that
     bring normal speech sounds above the background tinnitus sounds. In
     addition to amplification, hearing aids may be useful as maskers when
     they also introduce white noise into the sound stream.

   * cranial sacral therapy

     There is anecdotal evidence of help for tinnitus through cranial
     sacral therapy by osteopaths and chiropractors.

   * electrical stimulation

     Various electrode placements with various voltages & frequencies may
     provide some relief. External, ear canal, transtympanic, middle ear,
     and cochlear electrodes have all been tried. Side effects may include
     pain, and alterations to sense of taste & smell. In one study of
     electrical stimulation on the round window, 3 out of 5 patients
     experienced some relief when frequencies of 40 Hz or less were
     applied.

   * surgically severing the auditory nerves

     An Eighth Nerve section is the treatment of last resort. You will be
     totally deaf. But beware - if your tinnitus originates somewhere
     inside the brain, you will be totally deaf AND still have tinnitus. A
     prominent American tinnitus specialist says this surgery should never
     be done for tinnitus, since he knows of patients whose tinnitus
     INCREASED to suicidal levels afterward.

   * hyperbaric oxygen therapy

     This treatment is supposed to be beneficial when the tinnitus is
     thought to be due to a lack of oxygen for the hearing mechanism. It
     may be more effective for recent onset cases rather than long-term
     ones. [Ed. note: this treatment is not without risk; at one such
     center in my community that treats Alzheimer's patients, the door
     seals on the chamber failed, resulting in an explosive decompression
     that injured several patients.] One poster to alt.support.tinnitus has
     this to say about the therapy:

          Following is a summary (my own words) of an article which
          recently appeared in the "MAINZER ALLGEMEINE ZEITUNG"
          describing a new method treating T with pure oxygen under
          high air pressure (hyperbaric oxygen treatment - in short
          "HBO" treatment).

          PLEASE NOTE: I cannot in any way guarantee the validity of
          the information given in that article. The same is true for
          my interpretation of the article's information and my
          summarzing it (I tried to be as close as I could). Using
          this info is at the reader's own risk.

          SUMMARY starts:

          A doctor's practice in Duesseldorf (no further details
          mentioned) uses a submarine-like tube (6 meters in length)
          which is a similar device as used for treating divers who
          have suffered a diving accident or patients with carbon
          monoxide poisoning or having had a "hearing infarct" (could
          not find the right English word !). Such "Oxygen Therapy
          Centers", mostly stationary ones, do exist at various other
          locations in Germany, mainly hospitals.

          Twelve tinnitus patients can be accomodated in Duesseldorf
          at the same time. Treatment is comparable to a dive to 15
          meters depth of water while breathing pure oxygen.
          Consequently, treatment starts with air pressure in the tube
          being raised slowly within 20 minutes. Pure oxygen is
          supplied to each patient via oxygen mask. Treatment lasts
          for two hours. Depressurization at the end lasts somewhat
          longer than 20 minutes. An experienced professional diver is
          accompanying the patients during treatment to assist them if
          they have problems due to climbing or falling air pressure.
          Newspapers and headphones are provided to help avoid boredom
          during the two hours treatment.

          Ten consecutive treatments are offered, one each day. Cost:
          300 DMarks (about just below $ 200.-) per treatment.

          HBO treatment is offered to patients who often have been
          suffering from tinnitus for years with no other traditional
          treatments having helped (like infusions, blood circulation
          improving medicine, etc). -- Health insurance normally does
          not cover the HBO treatments. They may consider taking part
          of the bill, however, in specific cases, e.g. if classical
          tinnitus treatment methods have been used unsuccessful.

          Traditional medicine has not found a general treatment
          method for tinnitus so far. The theory behind the new HBO
          treatment is based on the assumption that tinnitus is caused
          mainly by oxygen supply shortage in the inner ear organs.
          Studies at Munich Technical University have shown that pure
          oxygen treatment under high air pressure can increase oxygen
          saturation in the inner ear up to 500 %. In the USA and in
          the former Soviet Union this method reportedly has been used
          extremely successfully for many years. Alone in Moscow are
          about 40 pressure chambers in use. (No further details for
          either country).

          Cure from tinnitus through the new therapy cannot be
          guaranteed, according to the doctors. The article closes
          with a statement of one doctor: "I can hardly *promise*
          anything."

          SUMMARY end !

          So much for the article. I hope I could understandably relay
          what it said. No information has been supplied in the
          article about success rates or the like. -- I hope this
          information is of some help. If some co-sufferer has tried
          the HBO treatment his comments would certainly be very
          welcome.

   * feedback therapy

     A poster to alt.support tinnitus reports about a therapy involving
     listening to a series of electronically-produced tinnitus noises:

          This may be old news to some readers, but perhaps many
          others might be interested. A very interesting paper by L.
          P. Ince, et al appeared in the journal Health Psychology in
          1987, "A matching-to-sample feedback technique for training
          self-control of tinnitus." Here's a summary:

          Ince and his colleagues worked with 30 individuals suffering
          from tinnitus, and used a "matching-to-sample" feedback
          procedure. Each subject's tinnitus sounds were reproduced
          electronically and played into either one ear (for those
          with single-side T) or both ears. The sound was then reduced
          by 5 dB during each session. The subject was asked to
          "think" their tinnitus sounds down to match the signal that
          was supplied. No instructions were provided as to how to do
          this...each subject just tried the best he or she could.
          Each trial lasted 60 seconds, with 30 second rests between
          trials. If the tinnitus was brought down to the lower level
          during any one trial, the subject was then supplied with the
          electronically-produced sound that was lowered by an
          additional 5 dB, otherwise the same signal was provided. A
          total of 15 trials were run each session (so, less than one
          half hour overall for the session). Subjects went through 3
          to 12 of these sessions.

          Almost all of the 30 subjects experienced a reduction in
          their tinnitus. One subject completely eliminated the
          tinnitus in 3 sessions. By the end of the experiment, eight
          subjects eliminated the tinnitus. One subject who had had
          tinnitus for 30 years reduced the level from 40 to 10 dB.

          The subjects' tinnitus at the start varied greatly in
          quality and loudness and had varied greatly in the duration
          since onset.

          This experiment showed that many people could be trained to
          "not hear" their tinnitus. This was not just a case of the
          subjects' being less bothered by the sounds, but actually
          reducing the sound levels. This was shown by playing random
          sound levels for the subjects who indicated when the sound
          level matched their tinnitus.

          I wrote Dr. Ince in 1991. He replied that he was not a
          tinnitus specialist and had ceased his studies. However, he
          was very willing to aid professionals who wished to try to
          replicate his results. He also informed me that it is not
          possible to reproduce his study with standard household
          electronic equipment (such as tapes), and only trained
          audiologists should try to do such a study.

          Dr. Ince's study reminded me of an interesting question I
          once heard asked about tinnitus: Why doesn't *everyone* hear
          wild noises? The blood going through the inner ear creates
          vibrations that are FAR greater than even fairly loud sounds
          outside the ear. Perhaps we all have trained our brains to
          ignore such sounds.

     A prominent American tinnitus specialist says that Ince's work was a
     "misleading dead end".

   * Auditory Integration Training (AIT)

     Auditory Integration Training (AIT) was originally developed by a
     French doctor named Alfred Tomatis. Another French doctor who was
     seeking a cure for his tinnitus (the crickets he kept hearing
     everywhere he went) received Dr. Tomatis's training. Dr. Guy Berard
     was so fascinated by the cure that he studied it and modified the
     treatment. The original Tomatis auditory training is still available
     today. It involves many hours of listening therapy, sometimes on the
     magnitude of hundreds of hours of therapy. (See sound therapy, below.)

     Dr. Berard's auditory training method is ten total hours of treatment.
     The treatment involves listening to music that has been altered such
     that the high frequencies and low frequencies are randomly shifted in
     and out. The sessions are 30 minutes in length given twice a day
     (treatments separated by four hours) for 10 days. Some practictioners
     opt to run the program in two consecutive weekday blocks while others
     run the program through the weekend. The music ranges from Gordon
     Lightfoot to reggae. It sounds distorted.

     The Berard method of AIT is described in Dr. Guy Berard's book,
     _Hearing Equals Behavior_. The method was brought to the United States
     in the early nineties by Annabel and Peter Stehli whose daughter
     recovered from autism after receiving AIT in France. Their daughter's
     story is documented in Annabel's book, _The Sound of a Miracle_.
     Because of the Stehli's affiliation with autism, AIT is used heavily
     by persons with autism and hyperacusis although Dr. Berard has used
     AIT mostly for learning disabilities, tinnitus, and depression.

     There are two different devices that are capable of delivering Berard
     AIT: the audiokinetron, which was developed by Dr. Berard, and the BGC
     which is designed and manufactured in the United States. Research has
     not shown any difference in results according to which machine
     delivers the AIT.

     The preparation for AIT usually involves an audiogram to look for
     hypersensitive hearing. A normal audiogram should be nearly flat (all
     frequencies heard equally well) but sometimes a person may have an
     audiogram that resembles a mountain range. If a person shows extreme
     sensitivity to particular frequencies, then filters may be used during
     AIT to eliminate those frequencies from the training. However there is
     some feeling that by filtering out certain frequencies the
     randomization of AIT is reduced and perhaps the effectiveness is
     reduced.

     There is no scientifically proven theory explaining why AIT works. It
     may be that the stimulation of the middle ear acts and physical
     therapy for the ear. Since each frequency stimulates a different area
     of the cochlea, it may be that the broad range of frequencies evens
     out the cochlear response to sound.

     Once a person has undergone AIT, they should not listen to music
     through headphones as it may undo the training. Other factors that
     have been known to reverse the benefits of AIT have been high fevers
     (meningitis), general anesthesia, exposure to loud sounds, and
     headphone use for music. Listening to voices (story tapes or language
     tapes) is acceptable.

     AIT treatments do not work on those with hyperacusis and can actually
     worsen the condition - particularly the tinnitus, because it is
     administered at uncomfortably loud sound levels.

     For further information on AIT:

        o Hearing Equals Behavior, by Dr. Guy Berard (translated by Simone
          Monnier-Clay & Catherine Dodge), 192 pages, 1993, paperback
          US$17.95, ISBN 0-87983-600-8, Keats Publishing Inc., New Canaan,
          CT USA, [phone].
        o The Sound of a Miracle by Annabel Stehli
        o Dancing in the Rain, edited by Annabel Stehli. This is a
          collection of stories written about children with special needs
          who have undergone AIT.

     AIT organizations:

     The Georgiana Organization
     P.O. Box 2607
     Westport, CT 06880 USA
     [phone]

     A packet on AIT as well as a list of AIT practitioners trained by the
     Georgiana Organization.

     Autism Research Institute
     4182 Adams Ave.
     San Diego, CA USA

     A packet on AIT which includes research papers published by Steve
     Edelson, Ph.D.

     Society for Auditory Integration Training
     Center for the Study of Autism
     Boardwalk Plaza, Suite 230
     9725 SW Beaverton-Hillsdale Hwy
     Beaverton, OR 97005 USA
     [phone]

     SAIT (Society for Auditory Integration Training) is dedicated to the
     enhancement of the quality of life for individuals with special needs
     through auditory integration training. The purpose or goal of SAIT is
     to establish policies, minimum training and equipment standards and
     guidelines for _all_ AIT practitioners, and to promote a professional
     image. SAIT's objectives are: Promote professional and ethical
     standards for AIT; Set procedural standards; Promote networking and
     sharing of information; Advise and evaluate research on the efficacy
     of AIT.

     SAIT does not promote any single method of AIT (Berard, BGC, or
     other). They will provide you objective information about many issues
     concerning Auditory Integration Training (research, age
     recommendations, after-care, etc.) and answer frequently asked
     questions. They maintain a list of persons trained in _both_ the
     Berard and BGC methods of AIT.

     The SAIT Newsletter is published quarterly and is full of information
     on AIT. Associate membership ($30) is open to anyone interested in
     AIT. Professional memberships (reserved for practitioners who had
     passed the examination for SAIT certification and who had the
     appropriate educational backgrounds) have been temporarily suspended
     pending FDA approval of the Audiokinetron and other AIT devices.
     Currently a Practitioner membership is open to practitioners who have
     been trained by an "approved" instructor. No certification of these
     members will take place.

     The recent FDA investigation of AIT has interrupted SAIT's efforts to
     certify practitioners and to insure the ethical and professional
     practice of AIT. Once the Audiokinetron and other AIT devices receive
     FDA approval, SAIT will recommence its original mission. Currently
     SAIT's first priority is to provide practitioners and families with
     information about the current status and pressing issues of AIT. The
     newsletter will focus on research, legal advice and other noteworthy
     news. A supplemental paper on a related topic will also be distributed
     on a quarterly basis to its members; such topics will include sensory
     integration, visual training, and hearing anomalies.

   * sound therapy

     Sound therapy originates from the work of Dr. Alfred Tomatis. The
     following is quoted from a flyer entitled "Tinnitus, Vertigo, and
     Sound Therapy", published by Sound Therapy Australia, P.O. Box E237,
     St. James, N.S.W. 2000 (this organization sells books and cassette
     tapes for this therapy):

          How can Sound Therapy help?

          The middle ear contains two tiny muscles, tensor tympani and
          stapedius, which play an active role in the functioning of
          the ear. Lack of tone in these muscles means that the ear
          loses its ability to recognise certain frequencies of sound,
          so these sounds never reach the inner ear. The ear's ability
          to adjust and balance the fluid pressure in the inner
          chambers is also impeded if the stapedius muscle is not
          fully functional.

          The electronic ear used in the recording of Sound Therapy
          challenges the ear with constantly alternating sounds of
          high and low tone. At the same time, low frequency sounds
          are progressively removed from the music so the ear is
          introduced to higher and higher frequencies. The result is a
          complete rehabilitation of the ear, improving the tone and
          responsiveness of the middle ear muscles. Once the ear is
          able to recognise and admit high frequency sounds to the
          inner ear, this creates the opportunity for the sensory
          cells in the inner ear to be stimulated and restored to
          their upright, receptive position.

          ...

          Meniere's vertigo

          Dr. Tomatis has proposed that Menieres vertigo which
          produces attacks of dizziness is also due to an anomaly in
          the tension of the stirrup muscle. This muscle may be
          subject to involuntary twitches, like any other muscle in
          the body. Such twitching would radically alter the fluid
          pressure in the inner ear chambers, thus causing havoc with
          the balance mechanism. The re-toning of the stirrup muscle
          achieved by Sound Therapy frequently resolves this
          condition.

          Does it really work?

          ...

          The length of time it takes to achieve results varies from
          twenty four hours to fourteen months. Usually more severe
          cases take longer, so it is advisable to persist with the
          therapy for at least six months.

          ...

          The initial results of a listener survey conducted by Sound
          Therapy Australia [Ed. note: not exactly unbiased] indicate
          that 96% of tinnitus sufferers who perservered with the
          listening felt they benefited from the therapy. Of these,
          20% said the tinnitus stopped completely, and 36%
          experienced a reduction in the sound. The other 44%
          experienced other benefits such as improved sleep and
          reduced stress, which made the tinnitus easier to bear.

   * hypnotherapy

     Hypnotherapy has been reported by Dr. Kevin Hogan, who is a registered
     Clinical Hypnotherapyst, to be showing remarkable results for tinnitis
     sufferers .

     Dr. Hogan says, (in reguards to a April 95 release of a study by
     Mason, J, Rogerson, D, Derbyshire Royal Infirmary, UK., which stated,
     in part: ...."therapy for their tinnitus....68% showed some benefit
     for their tinnitus ...32% showed no evidence of improvement for their
     tinnitus"....) ..."This confirms previous research in the use of
     hypnotherapy to reduce the volume and distress of tinnitus. The best
     controlled study I have on hand shows 74% efficacy"....

---------------------------------------------------------------------------

11) What is masking?

Masking is the technique of producing external "white noise" sounds that
will mask the tinnitus and make it less distracting. Masking machines come
in both in-the-ear and portable models that produce sounds ranging from
random white noise to waterfalls to surf, etc. Frequencies used are
generally within a 1 khz - 12 khz band. Hearing aids can also function as
maskers by amplifying external sounds. Many people find that tuning a
regular FM radio to an empty frequency and listening to the static
beneficial. Another popular method is to run an electric fan. If you have
an audio CD player, consider putting on a nature sounds (ocean, jungle,
whales, etc) CD in autorepeat mode before going to bed.

In a study of masking, 16% of patients reported relief with a hearing aid
alone, 21% reported relief from a tinnitus masker alone, and 63% reported
relief from a combination hearing aid / tinnitus masker. In the latter case
it was important to properly adjust the hearing aid before attempting
masking.

Residual Inhibition

Masking can also produce a phenomenon called, "residual inhibition". The
effect residual inhibition has is to cause the tinnitus sound to partially
or completely disappear for a few mins. to a few hours, weeks, months or
even for life. I was tested for residual inhibition by G. Gordon Gibson at
the, Tacoma Tinnitus Clinic", in Tacoma, Wa. in 1985. Mr. Gibson revelled
in his experiences with tinnitus patients referred to him by ENTs, that
some had complete remission for awhile and then would just need to listen
to the "white noise" for a short while to make the tinnitus go away again.
One person, he said, "Went into complete remission". I was also tested for
ri at the University of Washingtons' Tinnitus Clinic in 1986, but I was not
to be so fortunate as others at either place I tried.

The important thing is to have a "Tinnitus Clinic" test your ears for your
specific tinnitus sound, so the right "white noise" can be matched up to
it. You can get a Professionl Referrals list of your area from American
Tinnitus Association.

In a Sept. 1986 American Tinnitus Association Newsletter, "Colin Kemp", an
engineer working in Austrailia who markets a unit called, "The Tinnitus
Inhibitor" says, "At our Tinnitus Clinic, we call this phenomenon Residual
Inhibition and routinely test all patients for it. Residual inhibition
comes in many forms, But in one form or another we find it in nearly 89% of
patients".

The following is an excerpt from: "Oregon Tinnitus Data Archive 95-01"

Residual inhibition was tested in each ear separately if patient had
tinnitus that was bilateral or "in the head". Results shown here are for
each patient's best trial (maximum residual inhibition effect).

Residual Inhibition - Type

   Type of RI              N       (%)
   -------------------------------------
    No RI                  173    (11.9)
    Partial RI only        476    (32.8)
    Complete RI only        34     (2.3)
    CRI +  PRI*            768    (52.9)
                           ---     ----
    Total                 1451*   (99.9)

* Omits patients who were not tested for RI, primarily because a minimum
masking level could not be obtained.

End of excerpt.

Some masking machine vendors:

Ambient Shapes, Inc.
P.O. Box 5069
Hickory, NC 28603
USA
[phone]
[phone]

Product #1550, the Marsona Tinnitus Masker. An external masker with over
3000 settings. US$249.

The Sharper Image
650 Davis Street
San Francisco, CA 94111
USA
[phone]

Product #SI420, Portable Sound Soother, US$120, and product #SI430, Digital
Sound Soother XS, US$170 (same as previous product but includes an AM/FM
radio). Both products feature alarm clocks and three classes of sound:
White Noise, Seaside, and Countryside. You get primary sounds such as waves
and crickets, plus random auxilary sounds such as fog horns, buoy bells,
doves, owls, etc. Both the primary and auxilary sounds have independently
adjustable volume. [Ed. note: my mother is a satisfied PSS user.]

*****[insert masker models, prices, manufacturers, phone numbers here]*****

---------------------------------------------------------------------------

12) What types of earplugs or other hearing protection are available?

Wearing ear plugs protects your ears from new damage as well as allowing
them to rest without external stimuli. Noise attenuation may vary by
frequency, so if you're a musician you may want to shop around for ear
protection with fairly flat frequency response. Hearing protection devices
are assigned Noise Reduction Ratings (NRRs) by their manufacturers under
laboratory conditions and may not reflect Real World performance. Most
plugs average around 20dB of noise reduction. Maximal noise reduction
(about 50dB NRR) can be achieved by wearing canal plugs in combination with
muffs, but *some* noise will still be perceived via bone conduction of the
skull in extremely loud situations. The following classes of hearing
protection devices are available:

   * moldable ear canal plugs

     Moldable ear plugs come in foam, silicone, and wax and fit into the
     ear canal itself. Because they are moldable, a tight fit is always
     obtained. These are the best hearing protection devices available
     today, with NRRs ranging from 15-33dB. Cheap, available in drugstores,
     and reusable.

   * custom ear plugs

     These plugs are made from impressions taken of the customer's ear
     canal. NRRs range from 27-29dB, with the cost typically US$30-70. You
     generally order these through a hearing specialist who will take the
     impressions.

   * filtered musician's ear plugs

     A variation on custom plugs that offer even sound attenuation across a
     broad spectrum of frequencies. NRRs range from 15-20dB, and cost
     ranges from US$50-150. A contributor offers this review for one
     popular brand:

          Now for my 2 cents worth. I am an acoustic engineer working
          for the British Broadcasting Corporation (BBC). Although my
          main job is designing studios, I also act as a consultant on
          noise at work legislation. In that capacity I work on the
          safety of people listening professionally on earphones and
          loudspeakers, and also musicians in the several orchestras
          which the BBC maintains. So I am interested in such items as
          musicians earplugs.

          We intend to conduct, in the near future, a trial of the
          filtered musicians' earplugs that you refer to, and I can
          therefore fill out a bit of information on these. The ones
          we intend to use are type ER15 from Etymotic Research. These
          have an attenuation of 15dB, largely independent of
          frequency. (As far as I can find out, these are the only
          plugs claiming "flat attenuation" for which independent lab
          reports of attenuation are available. Of course you must
          have such a report if you're going to use the plugs for
          industrial safety purposes.)

          Etymotic Research (they like to pronounce the "o" long, as
          in rose, by the way, and print it with a line over the top,
          but I think they're fighting a losing battle on this one)
          also make a non-individually moulded "constant attenuation"
          plug, the ER20. However a close examination of its
          attenuation vs. frequency characteristic shows that it is
          really not all that different from more ordinary plugs.
          Despite this, some musicians report finding it useful. Its
          overwhelming advantage is that it comes at about 10UKP per
          pair!

          I can confirm the address you give for Etymotic Research.
          They are probably the best people to approach for details of
          suppliers in the American continent, as they will be up to
          date with changes.

          In the UK, the distributor is:

          MBS Medical Ltd
          129 Southdown Road
          Harpenden
          Herts. AL5 1PU
          England
          [phone] voice
          [phone] fax
          This is a fairly recent change of supplier.
          Cost in the UK - about 120UKP per pair.

          The main distributor for Europe is in Holland:
          Elcea BV
          PO box 230
          5100 AE Dongen
          The Netherlands
          [phone]

          A large scale research programme on the use of flat
          attenuation earplugs with the Dutch Philharmonic Orchestra
          has recently been carried out by Dr Van Hees of Amsterdam
          University. I believe the findings will be made public soon,
          and I will post you if they are relevant.

          I have had a pair of these ER15 plugs moulded for myself, to
          see what it's like both having the moulds made and wearing
          them. The ears must first be checked for wax, which must be
          dissolved out in the usual way if excessive. Soft putty-like
          material is then put in the ears to make the mould. This is
          slightly uncomfortable, but certainly not painful. The
          moulds are then sent away to have the plugs made. For
          Europe, the plug manufacture is done by Elcea in Holland,
          who have a special apparatus for determining when the hole
          is the correct diameter. The filters are small flat devices
          which clip on to the outside of the plugs. The plugs are
          reasonably comfortable in use, although my own ear canals
          are very narrow and most earplugs don't fit me well. To give
          the flattest attenuation characteristic, the plugs go
          somewhat deeper into the ear than an ordinary hearing-aid
          earpiece.

          Early reports indicate that although their attenuation is
          less than that of other plugs, it is still too much for some
          musicians. It is possible that a lower attenuation plug will
          be available in future.

          Although my own work with musicians mainly involves symphony
          orchestras, musicians who work on stage in shows and rock
          concerts are probably at higher risk, due to high levels of
          sound from "foldback" loudspeakers. Listening using small
          in-ear earphones (which may possibly be individually
          moulded) can reduce the required foldback sound level, as
          the earphones keep out a lot of the external sound.

          Systems:

          Etymotic Research make high quality (but expensive)
          earphones which may be used for this purpose - type ER4.

          A well known system of this type, usually using a radio link
          to the performer, is The Radio Station. Manufacturer:

          Garwood Communications
          Ltd 8A Hassop Rd
          Cricklewood
          London NW2 6RX
          England
          [phone] voice
          [phone] fax

          No doubt I have gone on about some of my pet subjects at
          excessive length, but I hope you may find something useful
          here. I must, of course, say that my views are entirely my
          own and must not be quoted as the BBC's.

   * ear muffs

     These over the ear devices are more comfortable than canal plugs, and
     have NRRs that range from 23-29dB. But they are very bulky and
     obviously can't be worn discretely.

   * active sportsman's ear muffs

     These are active (possibly amplifying), powered devices that pass
     normal levels of sound, but will attenuate extremely loud impulse-type
     noises similar to gunshots, etc. They are typically sold through gun
     catalogs and sporting goods stores, and when used in combination with
     plugs can achieve near-maximal NRRs of about 50dB.

     Note that amplified muffs actually have a negative NRR, which is one
     indication that the NRR doesn't tell the whole story for "impulse"
     noise such as gunshots. These muffs detect impulse noise and turn off
     the amplification in time to keep that noise from reaching the ear
     through the electronics. See below for a first-hand account of active
     muff performance:

          Date: 16 Apr 1992 8:36 EDT
          Subject: Re: electronic muffs

          Having just purchased a set of Peltor Tactical 7-S active
          muffs from Dillon Precision, I'll add my two cents to the
          conversation.

          The T7-S's are stereo electronic muffs with a microphone on
          the front of each ear cup. They seem to be pretty sturdy in
          construction. One cup contains a circuit board covered with
          surface-mount parts and some trim pots. The other contains a
          nine-volt battery accessible from an outside door (there may
          also be a small circuit board in there, too). Each contains
          a small speaker, and the two are connected via a cable that
          crosses through the headband. There is a single gain control
          that is switched to provide the on/off function.
          Side-to-side balance is adjustable by one of the trim pots.
          A small concern I have is that the foam mic covers may come
          to harm while being jostled around in my range bag.

          I had originally thought (from where, I don't know) that the
          circuit amplified sound according to the gain control, and
          shut off completely noises above 85dB. In fact, the unit
          never actually shuts down, or if it does the switching is so
          quick and quiet that it gets lost in the muffled sounds
          coming through the muff's cups. There is constant
          compression, so that soft sounds are boosted, and loud
          sounds are limited to 85dB or less. The effect is strange at
          first, because you don't think there's much muffling being
          done, but believe me, you can find out real quick that the
          things work very well indeed.

          I used the muffs at an outdoor .22 silhouette match, then
          later in the day at a large indoor range where we were
          shooting .45 ACP and light .44 mag loads. At the match, they
          worked great. I could hear the spotters, the range officer,
          and all the others. I really didn't have a problem with
          distractions as another poster stated. The only "problem" I
          had was that at high gain I could easily hear the road noise
          of cars and trucks passing by about a quarter-mile away. The
          muffs seem to preserve directional information, since I
          don't remember having any problems locating sounds (like the
          CLANK when a ram fell over 100 yards away).

          The indoor range seemed a little different. Gunshots sounded
          a bit more veiled, whereas outdoors they just sounded lower
          in intensity. Voices were still easy to hear, but also
          sounded funny, so it was probably the echo in the large
          room. For grins, I tried the T7-S's at the indoor range
          without turning the active circuitry on, and swapped back
          and forth between them and some Silencio Magnum CDS-80
          passive muffs (rated at -29dB -- my previous regular muffs).
          In an inactive state, the TS-7's were at least as effective
          as the Silencios. Further, the sound of the shots was
          perceived as being about an octave lower through the
          inactive T7-S's than through the Silencios. This was much
          more pleasant over the long run. In fact, my buddy, who was
          also wearing CDS-80's, said that his ears were starting to
          hurt by the end of our indoor range time. Mine were fine.
          (BTW, said buddy tried the T7-S's for a few minutes at each
          place -- he's ordering his today.)

          I tried sitting in a very quiet room with the muffs turned
          way up. I could hear my dog breathing in another room, and
          ripples on the surface of a small, nearby aquarium sounded
          like a set of river rapids. I could hear my own breathing
          quite clearly, and the cloth of my shirt rustling as it rose
          and fell. At really high gain, there was some whitish noise
          that was either the residual noise of the amplifiers, or the
          movement of air in the room.

          The muffs are very comfortable. I wore them most of the day
          with no problem. The ear seals are soft yet firm, and are
          probably more comfortable than the Magnum CDS-80's. The
          seals and inner foam pads are easily removable and
          replaceable. The rather sparse instruction manual suggests
          replacing them once or twice a year for hygienic reasons.

          All in all, I really like these muffs. It would be difficult
          to go back to passive protection after being able to hear
          "normally" while shooting. Dillon currently has the T7-S's
          on sale for $129.95. Regular price is $170. I have no
          connection with Dillon or Peltor save being a satisfied
          customer.

     And an addendum to the above account:

          Date: 5 Jul 1994 13:39 EDT
          Subject: Re: muffs review

          The battery should be a nine-volt alkaline, and it will
          probably last 10-30 hours (depending on gain setting used)
          before you'll notice a drop in volume. I have used the muffs
          while mowing (with a gasoline-powered mower), and with noisy
          power tools (like a circular saw), and they really help.
          Your ears do get a bit warm and sweaty on a hot day,
          however. Finally, I have seen pictures of new(?) Peltor
          muffs on which the foam mic covers were replaced by hard
          plastic grids. These might be an improvement.

Some hearing protection vendors:

Westone Labs
P.O. Box 15100
Colorado Springs, CO 80935
USA
[phone] URL- http://www.earmold.com/

Sells custom plugs.

Dillon Precision Products
7442 E. Butherus Drive
Scottsdale, AZ 85260-2415
USA
[phone] for Catalog requests
[phone] for Sales

Praised on rec.guns have been the "Max" earplugs and Peltor Ultimate 10
muffs. Dillon's "stealth" catalog, The Blue Press is available at no charge

Etymotic Research
61 Martin Lane
Elk Grove, IL 60007
USA
[phone] voice
[phone] fax

Sells musician's earplugs offering about 15dB of flat attenuation.

*****[product #, price, manufacturer, phone number, NRRs?]*****

---------------------------------------------------------------------------

13) What organizations can I turn to for more information?

The following organizations all support tinnitus/hearing research and
provide information for tinnitus sufferers. Frequently they are the sole
force behind tinnitus research in their home countries. Joining one of
these organizations in the best thing that you can do so that research
towards a cure will be funded.

Canada

Tinnitus Association of Canada
23 Ellis Park Road
Toronto, ON Canada
M6S 2V4

Co-ordinator: Mrs. Elizabeth Eayrs. A newsletter is available for an $8.00
annual subscription fee.

France

French Tinnitus Association
France AcouphΦnes
La Varizelle
F 69510 THURINS
phone and telefax 78817312
The association publishes a magazine called "TINNITUSSIMO"

[Dues and services presently unknown.]

Germany

DTL (Deutsche Tinnitus Liga)
Postfach 349
D-42353 Wuppertal
Germany
Phone: ++49-(0)202-464584

This organization consisting of tinnitus sufferers and some supporting
medical professionals is one of the biggest ones. Members get lots of
information about medicines, new therapies and the sites which offer them
and and and...

Furthermore you'll get the DTL newspaper named "Tinnitus Forum" four times
a year. The DTL also organizes member meetings and workshops. Detailed info
about the DTL activities and membership (min. 60.- DM per year) can be
obtained by writing to the address written above.

The Netherlands

Landelijk Bureau van de Nederlandse Vereniging Voor Slecthorenden
ter attentie van de Commissie Tinnitus
Postbus 9505
3506 GM Utrecht
The Netherlands
Phone: [phone]
Fax: [phone]

The Dutch Tinnitus Committee operates under the auspices of the Dutch
Society for the Hard-of-Hearing (N.V.V.S.), and has the following goals:

   * To gather information about this disorder, and to use this information
     to educate the tinnitus patient personally and by regional meetings,
     organized by the local N.V.V.S.-department.
   * To support the tinnitus patient and try and teach him to accept his
     disorder via a network of contactmen spread throughout the country.
   * To help these contactmen give advice to others, and to inform them
     about the latest developments in the field of Tinnitus.
   * To organize local self-help and discussion groups, and to bring
     tinnitus patients into contact with fellow sufferers.
   * To maintain ties with sister organizations in and outside the country,
     and to issue the gathered information to those who are interested in
     it.

Spain

ASOCIACION DE PERSONAS AFECTADAS POR TINITUS(Ac·fenos)
Apartado de Correos n║57
08320 EL MASNOU(Barcelona) Espa±a

Offers support and information. Membership is: 2500 pesetas per year.

United Kingdom

British Tinnitus Association
14/18 West Bar Green
Sheffield S1 2DA
Phone: [phone]

To join the BTA, the subs are 5 pounds sterling UK - 8 pounds sterling
overseas members. The quarterly magazine "Quiet" is inclusive.

They have a number of aims, outlined in the magazine:

   * To obtain greater funding of the Med. Res. Council to extend current
     tinnitus research
   * To lobby for the creation of more tinnitus-only clinics in the UK
   * To promote greater acceptance of tinnitus as a handicap in the
     granting of employment, disability and other welfare benefits
   * To obtain free and universal availability of ear-worn tinnitus maskers
     to sufferers capable of finding relief from them
   * To obtain a higher priority place for tinnitus in individual hospital
     budgets
   * To improve the training of GPs to include greater emphasis on tinnitus
     management
   * To promote stricter control of noise in the workplace
   * To aim for maximum sound levels in discotheques
   * To have health education programmes to warn of the dangers of
     excessive noise, and to have the equipment manufacturers to endorse
     the warnings

United States

American Tinnitus Association
P.O. Box 5
Portland, OR 97207-0005
USA
[phone]

Funds research, does lobbying, provides information, educates the public,
has a national self-help network, and a professional referrals list by
geographic region that lists ENTs, audiologists, dentists, psychiatrists,
and psychologists that are all well-educated about tinnitus. If you're
searching for knowledgable medical professional tinnitus information, you
might want to start here. US $25 per year, outside US $35/year
(professionals $35 and $50 respectively) check, VISA, MasterCard
(membership will entitle you to a year's subscription of ATA's quarterly
journal, "Tinnitus Today").

A brief history of the ATA and their relationship to the neighboring OHRC
and OHSU as provided by the Oregon Hearing Research Center:

     A doctor by the name of Charles Unice, from California, wanted to
     know what was being done about tinnitus (he was a sufferer), so
     he contacted the National Institutes of Health, who referred him
     to our laboratory. The Kresge Hearing Research Laboratory (US, in
     1978 or so) was the only place in the United States doing
     research on tinnitus funded by the NIH at that time. Unice
     decided to found an American Tinnitus Association. Its purpose
     would be the dissemination of information about tinnitus, and if
     possible, to provide money for research on tinnitus problems.

     The American Tinnitus Association was started here in Portland,
     in order to be close to the research taking place. There were
     some interested citizens in Portland who were willing to help get
     it started. It was started under the "umbrella" of the University
     of Oregon Medical School (now called the Oregon Health Sciences
     University). It was started in Oregon, as opposed to Dr. Unice's
     home state of California, because of simpler tax laws here.
     Eventually, the ATA became an independent organization from the
     Medical School and is now doing quite well. They have offices in
     the downtown area of Portland, OR.

     In 1985, the Kresge Hearing Research Laboratory became the Oregon
     Hearing Research Center. We are the research division of the
     Otolaryngology-Head & Neck Surgery Dept. of the Oregon Health
     Sciences University. We're located in the west hills of Portland,
     above downtown.

     Dr. Vernon writes a column for the ATA in their "Tinnitus Today"
     publication. Members of the OHRC are often asked to review grant
     applications for ATA, as are other researchers in the area of
     tinnitus across the country. OHRC staff are also consulted for
     information regarding brochures and literature ATA develops. They
     refer calls and letters when they cannot provide the answers.

     Other than that, OHRC does not have any official ties to ATA. We
     are not receiving funding from them at this time (I say at this
     time because it is possible we could apply for grant applications
     in the future), and they receive no funding from the OHSU nor the
     OHRC. Their funding comes from contributions from their members
     and combined charitable campaigns.

     The OHSU Biomedical Information and Communications Center (BICC)
     has taken on as one of their missions to provide internet access
     to health providers in the state of Oregon. The ATA, as an
     organization who provides health information to the public, was
     given internet access by the OHSU. This does not mean that they
     are a part of OHSU.

H.E.A.R. (Hearing Education and Awareness for Rockers)
P.O. Box 460847
San Francisco, CA 94146
USA
[phone]

This is the H.E.A.R. ad from Bass Player Magazine:

CHANGE THE COURSE OF MUSIC HISTORY

Hearing loss has altered many careers in the music industry. H.E.A.R. can
help you save your hearing. A non-profit organization founded by musicians
and physicians for musicians and other music professionals, H.E.A.R. offers
information about hearing loss, testing, and hearing protection. For an
information packet, send $10.00 to: H.E.A.R. P.O. Box 460847 San Francisco,
CA 94146 or call the H.E.A.R. 24-hour hotline at [phone].

(small print at bottom):
Musicians speak out about hearing loss. A promotional video made
exclusively for H.E.A.R., "Can't Hear You Knocking" c1990 Flynner Films, 17
minute VHS, featuring Ray Charles, Pete Townshend, Lars Ulrich and other
music industry professionals spotlight the dangers and effects of hearing
loss. Send $39.95 plus S&H, $5 US/$10 Over seas to: (above address). All
donations are tax-deductible.

(even smaller print):
"CHYK" 57 minute VHS. The Cinema Guild, NY.
"Can't Hear You Knocking" full length 57 minute video documentary is
available through the Cinema Guild of New York, 1697 Broadway Ste. 506 New
York, NY 10019, office: 212-246-5522 fax: [phone]. (Flynner Films,
Stockholm, Sweden).

NIH/National Institute of Deafness and Other Communication Disorders
(NIDCD)
9000 Rockville Pike
Bethesda, MD 20892
[phone]
[phone] (TDD/TT for the hearing impaired)

[Services presently unknown]

National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
[phone]
[phone] (TDD for the hearing impaired)

[Dues and services presently unknown]

Meniere Crouzon Syndrome Support Network
2375 Valentine Dr., #9
Prescott, AZ 96303

[Dues and services presently unknown]

The E.A.R. Foundation
ATTN: Meniere's Network
2000 Church Street
Nashville, TN 37236
[phone] (Voice & TDD)

[Dues and services presently unknown]

Vestibular Disorders Association
PO Box 4467
Portland, OR 97208-4467
[phone] answering machine
[phone] FAX
E-Mail: [e-mail]
Web: http://www.teleport.com/~veda

Memberships are US$15 per year. VEDA has about 6,000 members worldwide;
about 2,500 of them are part of a pen-pal network that shares information
individually. We maintain a list of local support groups (about 100 of
these now in North America), a list of physicians and clinics interested in
these disorders, and a list of physical therapists who do vestibular rehab.
We also have a large collection of documents, booklets, and videotapes on
these topics, and we publish a quarterly newsletter.

The Hyperacusis Network
444 Edgewood Drive
Green Bay, WI 54302-4873
[phone]
[phone] FAX

The Hyperacusis Network consists of individuals who have a common goal - to
share information and support each other knowing fully well that our
condition at this time is misunderstood and not curable. No one knows more
about our condition than we do. As a network, we work at ways to improve
our condition and educate the medical community about hyperacusis. There is
no membership fee to receive the quarterly network news letter _although
donations are greatly appreciated to help defray costs of paper, printer,
postage, photocopy repairs and long distance phone calls._ Our staff
consists of Dan Malcore as editor. Our supporting editors are people from
all over the world, like yourself, who write into the network. Most have
hyperacusis (sound sensitive), recruitment (sound sensitive with hearing
loss), tinnitus (ringing in the ears), vertigo (dizziness) or Meniere's
disease (combination of auditory problems). Some are from the medical
community who seek to learn and understand. We applaud this since E.N.T.s
(Ear, Nose and Throat) doctors are renown for misdiagnosing our condition,
giving poor advice or subjecting our ears to tests which make our ears
worse. Some in the network are parents of autistic children who seek to
understand why their precious children cover their ears and run from noise.
Autistic children have hyperacute hearing which is somewhat different that
hyperacusis yet our reactions to sounds are nearly the same. We network
with organizations throughout the world like the American Tinnitus
Association, Canadian Tinnitus Association, National Institute on Deafness
and Communications Disorders (NIDCD), Autism Research Institute and H.E.A.R
(Hearing Education & Awareness for Rockers) just to name a few. Many
doctors, audiologists, and health organizations around the world
continually refer people to our network.

Many have found our quarterly newsletters to be an essential tool in
helping themselves and their families understand hyperacusis. For those who
want to become current, all back issues are available for a fee of
US$35.00. If you choose to join the network you can request the 14-page
supplement which explains hyperacusis in great detail.

*****[Other orgs & amp; countries needed]*****

---------------------------------------------------------------------------

14) What books can I turn to for more information?

Tinnitus: Diagnosis/Treatment
Abraham Shulman, M.D.
Lea & Febiger, 1991
ISBN 0-8121-1121-4

This is a several hundred page medical book covering all aspects of
tinnitus. It was used to confirm most of the medical statements in this
document, and is highly recommended.

Hallam, Richard. Tinnitus: Living with the ringing in your ears. Thorsons,
HarperCollins Publishers, 77-85 Fulham Palace Road, Hammersmith, London W6
8JB. A straightforward introduction to the nature of tinnitus distress and
what can be done about it.

Proceedings of the 1st International Tinnitus Seminar. The Journal of
Laryngology and Otology, Supplement 4, 1979.

Proceedings of the 2nd International Tinnitus Seminar. The Journal of
Laryngology and Otology, Supplement 9, 1984.

Proceedings of the 3rd International Tinnitus Seminar. Published by
Karlsruhe, Germany. 1987.

Proceedings of the 4th International Tinnitus Seminar. Published in France
(in English).

Tinnitus: Pathophysiology and Management. Edited by Masaaki Kitahara.
Igaku-Shoin, Tokyo, Japan.

Tinnitus. Ciba Foundation Symposium 85. 1981. Pitman Publishers, Lonson.

Tinnitus: Facts, Theories and Treatments. Dennis McFadden (ed.) Working
Group 89. National Research Council. National Academy Press, Washington,
DC, 1982.

Hazell, Jonathan. Tinnitus. Churchill-Livingstone, London, ISBN
#0-443-02156-2, 1987.

Vernon, Jack A. and Moller, A.R. Mechanisms of Tinnitus. Allyn & Bacon,
Needham Heights, MA. ISBN #0-205-14083-1, 1994.

TINNITUS - NEW HOPE FOR A CURE
by Paul Van Valkenburgh
Published by the author
Box 3611
Seal Beach, Ca 90740
ISBN 0-9617425-2-6
TO ORDER: Send $15.00 (ppd. in USA) to:
TINNITUS-N, Box 3611, Seal Beach, CA 90740
Home Page URL: http://members.aol.com/neurosense/tinnitus.html

An in-depth probe into the problem of tinnitus, which is informative and
thought provoking for the layman and professional.

---------------------------------------------------------------------------

15) What online resources are available?

On the Internet, the Usenet newsgroup alt.support.tinnitus is the primary
discussion forum. Several other peripheral newsgroups exist where people at
risk for tinnitus may be found, as well as for various health disciplines
relevant to the treatment of tinnitus. See the Newsgroups: header of this
FAQ for details. (Be advised that this newsgroup has had obscene posting
and you may be quite repulsed by them! Please! Do not respond to them!)

People without direct access to Usenet newsgroups can still post messages
by e-mailing them to one of the many post-only e-mail->Usenet gateways such
as [e-mail]. When asking questions via this
method, make sure your message text asks people to respond via e-mail,
since these gateways will not allow you to read replies that are posted
back to Usenet.

Some additional resources:

http://www.prima.ruhr.de/projekte/tinnitus
     A German language Web page about tinnitus.
gopher://phil.utmb.edu/00/UTMB%20ENT%20Grand%20Rounds/TINNITUS_CME
     A University of Texas paper on the causes and treatments of tinnitus.
http://www.bme.jhu.edu/labs/chb
     The Center for Hearing and Balance at Johns Hopkins University. The
     Center includes researchers, teachers, clinicians, and others in the
     Hopkins medical community. The goal of the Center is to perform basic
     and clinical research, train young basic and clinical investigators,
     and disseminate research results and relevant information to the
     medical community and the general public. Research is centered on
     auditory (hearing) and vestibular (balance) function in normal
     subjects and in patients with hearing and balance disorders, and on
     rehabilitation.
http://www.boystown.org/hhirr/tinnitis.html
     This is a link to the Boys Town National Research Hospital's page on
     Tinnitus (despite the spelling in the URL). [It's not incredibly
     informative, but the page above it has lots of good hearing
     information.]
http://www.teleport.com/~veda
     The Vestibular Disorders Association (VEDA) is a nonprofit
     organization that exists to provide information and support to people
     with inner ear disorders such as labyrinthitis, BPPV, and Meniere's
     disease.
http://www.ohsu.edu/ohrc/
     The Oregon Hearing Research Center web server is a truly must-see
     server, with plenty of local OHRC information as well as pointers to
     other online information.
http://www.aro.org/showcase/aro/
     The Association for Research in Otolaryngology has hardcore research
     abstracts on many things, including cochlear hair cell regeneration.
http://kuni.nidcd.nih.gov/
     Learn about the basic research being done at NIDCD on cochlear hair
     cells.
http://lab9924.wustl.edu/home.htm
     More basic research being done at the Cochlear Fluids Research
     Laboratory. A good intro to inner ear anatomy is available.
http://lab9924.wustl.edu/men.htm
     A clinically orientated web page for patients with Meniere's disease
http.//www.hearnet.com/index.html
     HEARNET: Rock&Rollers advice to Rock&Rollers et. al. about the harmful
     effects of loud music.
http://members.aol.com/neurosense/tinnitus.html
     About a book called: TINNITUS - NEW HOPE FOR A CURE by Paul Van
     Valkenburgh
http://www.visi.com/~minuet/hearing/hyperacusis/index.html
     The Hyperacusis Site: An online page that has information about
     hyperacusis and what can be done to relieve and/or cope with it.
http://www.cabotsafety.com/tech/earlog
     Includes a series of 20 articles on the study of hearing protection
http://www.dejanews.com/ Archives
     of alt.support.tinnitus since 01/01/96. Also does word searches in
     a.s.t and other newsgroups.
http://www.hollys.com/success-dynamics/
     Information about Tinnitus and the treatment of Tinnitus by Hypnosis.
http://www.teleport.com/~ata
     Home Page Site for the "American Tinnitus Association".
http://www.ucl.ac.uk/~rmjg101/tinnitus1.html
     "Tinnitus Retraining Therapy"- ..."tinnitus management in our clinics
     is a result of retraining and relearning....
http://www.ohsu.edu/ohrc-otda/
     Oregon Tinnitus Data Archive- A reference source for those desiring
     quantitative information about clinically-significant tinnitus.
http://www.cdc.gov/niosh/noise2a.html
     NIOSH- Occupational Noise and Hearing Conservation page. Provides a
     basis for a recommended standard to reduce permanent noise damage.
http://www.visi.com/~minuet/hearing/
     Hearing Exchange Online. Web pointers to just about everything you
     wanted to know about hearing.

---------------------------------------------------------------------------

16) What can I do when all else fails?

Here is one sufferer's advice:

     What caused my tinnitus? Everyone asks that question.

     For some of us, there was an illness, injury, or incident that
     seems directly related to the onset of tinnitus. I'm not sure how
     valuable being able to answer this question is, but at least it
     seems to be answered.

     For others, the onset is sudden, but for no obvious reason. For
     these people, it may be frustrating not knowing "why" but I'm not
     sure of the value of dwelling on this question.

     For others like myself, the onset was gradual, over the years.
     Then, about a year ago, the pace of the onset increased to where
     I am now aware 100% of the time that it's there. If I'm active, I
     don't notice it. But if there's a lull in my mental or physical
     activity or if I think about it, it's there.

     The point I want to make with this post is: Just as "Sh-t
     Happens", I'm afraid "Tinnitus Happens", too. And we're the
     victims, albeit to widely varying degrees.

     Unless it can provide a path towards treatment (and only your
     doctor can determine this), I don't think it is useful to dwell
     heavily on the "why".

     In my case, I fired shotguns with no ear protection when I was a
     kid & I listened to some too-loud music a few times. But that's
     all irrelevant now.

     I've got tinnitus. At present, there's no known treatment for me.
     So, here's what I'm doing about it:

        * I accept that I have tinnitus and I've dispensed with "why".
        * I recognize that it is my problem, not the problem of my
          friends, family, & business associates. I don't complain
          about it to anyone.
        * If, because of my tinnitus, I need to ask someone to repeat
          themselves, I simply ask. No apologies, no explanations.
        * I will monitor my need to ask for repeats. If I have an
          underlying hearing loss, I may need a hearing aid. As
          unattractive to me as getting a hearing aid may be, it is my
          responsibility to have my hearing evaluated & take
          appropriate measures. It is not the responsibility of the
          people around me to act as hearing aids.
        * I will attempt the various herbal remedies, giving them
          enough time to see if they're effective. However, for my own
          sanity, I will accept my present condition as the "zero base
          line". If a remedy helps, that's a "plus". If it doesn't, I
          remain at the baseline. In other words, failure to be helped
          by a possible treatment is not a negative. I will not allow
          disappointment or despair at a treatment failure to get me
          down.
        * Whatever the seriousness of my tinnitus, I will remember
          that others have it much worse & still others have just been
          diagnosed. These are the people who need my support and
          encouragement. I will offer it when I meet them and by
          posting to this newsgroup. I realize that by helping others,
          I am also helping me.

     Comments always welcome.

---------------------------------------------------------------------------

17) Where did the medical advice in this FAQ come from?

With few exceptions, none of the contributors to this FAQ are physicians.
Contributor advice that cannot be confirmed in tinnitus books written by
M.D.s has been labelled anecdotal. Use any of this information, anecdotal
or not, strictly at your own risk.

---------------------------------------------------------------------------

18) What clinics or physicians can I turn to for real medical advice?

The following clinics or physicians all specialize in the treatment of
tinnitus and related disorders.

United States

House Ear Institute
2100 W. 3rd St.
Los Angeles, CA 90057
USA
[phone] voice
[phone] TDD

The Tinnitus Clinic
Oregon Hearing Research Center
Oregon Health Sciences University
3181 SW Sam Jackson Park Road
Portland, OR 97201
[phone]

Dr. Jack Vernon has been involved in tinnitus research and treatment since
1978. The OHRC Tinnitus Clinic sees patients from all over the world. Our
main emphasis here at the OHRC is on tinnitus masking. The technique of
masking was developed here. We have also done some drug studies for
tinnitus relief, the Xanax study being one of them. Be sure to visit the
OHRC web server at http://www.ohsu.edu/~ohrc/ohrc.html.

University of Maryland Tinnitus Center
419 W. Redwood Center
Baltimore, MD 21201
[phone]

Unfortunately, the waiting list for an appointment (which is very
comprehensive and I believe takes 2 days) is currently about 1.5 years.

*****[more references needed]*****

---------------------------------------------------------------------------

19) Who are the contributors to this FAQ?

Unless otherwise requested, all contributors will be credited here.

Lee Leggore                     [e-mail] (FAQ Maintainer)

Richard Alpert                  [e-mail]
Barbara Bixby                   [e-mail]
Julie Bixby                     [e-mail]
Mark Bixby                      [e-mail]
Karl F. Bloss                   [e-mail]
Paul Braunbehrens               [e-mail]
Sabra Broock                    [e-mail]
Pete Brooks                     [e-mail]
W. Keith Brummet                [e-mail]
Angelo Campanella               [e-mail]
David Charlap                   [e-mail]
Jim Chinnis                     [e-mail]
Erik Christensen                [e-mail]
Michael Claes                   [e-mail]
Michael L. Connolly             [e-mail]
Ken Cornell                     [e-mail]
Thomas A. Creedon               [e-mail]
Scott Dayman                    [e-mail]
Bob Dubin, DC                   [e-mail]
Scott Dunbar                    [e-mail]
Steven Wm. Fowkes               [e-mail]
Louis Goossens                  [e-mail]
Steve Gotthardt                 [e-mail]
Doug Gwyn                       [e-mail]
Jamie Hanrahan                  [e-mail]
George Harvey                   [e-mail]
Dr. Kevin Hogan                 [e-mail]
Kuni H. Iwasa                   [e-mail]
Jean Jasinski                   [e-mail]
Norman F. Johnson               [e-mail]
Douglas R. Jones                [e-mail]
Martin Kaiser                   [e-mail]
Patrick Koehne                  [e-mail]
Sacha Krakowiak                 [e-mail]
Laurie Kramer                   [e-mail]
Richard Landesman               [e-mail]
Jill Lilly                      [e-mail]
Darlene Long-Thompson, Rn       [e-mail]
Colleen Lynch                   [e-mail]
Allan MacDonald                 [e-mail]
Boyd Martin                     [e-mail]
Betty Martini                   [e-mail]
Andy Matthiesen                 [e-mail]
Rob McCaleb                     [e-mail]
Kevin McEvoy                    [e-mail]
Bernard H. Meyer                102630.1451@compuserve
Paul Murphy                     [e-mail]
Daniel A. Norton                [e-mail]
John Setel O'Donnell            [e-mail]
Louise M. Peelle                [e-mail]
Susan PF                        [e-mail]
Mark A. Pitcher                 [e-mail]
David Powner                    [e-mail]
Derek L. Rintel                 N/A
Dallas Roark                    [e-mail]
E. C. Roberts                   [e-mail]
Joe Schall                      [e-mail]
Dan Segal                       [e-mail]
Mark Sharp                      [e-mail]
Chandra Shekhar                 [e-mail]
Jeff Sirianni                   [e-mail]
Jeff Slavitz                    [e-mail]
Lori Snidow                     [e-mail]
Kurt Strain                     [e-mail]
Manfred Thuering                [e-mail]
Jack Trainor                    [e-mail]
Jerry Underwood                 [e-mail]
Dr. Jack Vernon                 [e-mail]
Peter Wanner                    [e-mail]
Allen Watson                    [e-mail]
Mike Watterson                  [e-mail]
Alan Wendt                      [e-mail]
Tony Wolf                       [e-mail]
Steve Zimmerman                 [e-mail]
--
Mark Bixby                      E-mail: [e-mail]
Coast Community College Dist.   Web: http://www.cccd.edu/~markb/
District Information Services   1370 Adams Ave, Costa Mesa, CA, USA 92626-5429
Technical Support               [phone]
"You can tune a file system, but you can't tune a fish." - tunefs(1M)