Amiga Plus 1995 #2/Amiga Plus CD - 1995 - No. 2.iso/internet/faq/englisch/tinnitus

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Posted-By: auto-faq 3.1.1.2
Archive-name: medicine/tinnitus-faq
Posting-Frequency: monthly
Last-modified: 3 Mar 1995
Version: 1.2



Tinnitus Frequently Answered Questions

Last update v1.2, March 3, 1995

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What's New



   * Meniere's Disease:
        * a similar condition called endolymphatic hydrops
   * Drugs:
        * additional details for betahistine hydrochloride (Serc)
        * a caution about dealing with Interlab
        * a "French connection" for hydergine
        * CERI's Smart Drug Sources listing free if you mention the Tinnitus
          FAQ
   * Organizations:
        * British Tinnitus Association new telephone number
        * many new United States organizations
             * NIH/National Institute of Deafness and Other Communication
               Disorders (NIDCD)
             * National Organization for Rare Disorders (NORD)
             * Meniere Crouzon Syndrome Support Network
             * The E.A.R. Foundation
             * Vestibular Disorders Association
             * The Hyperacusis Network
   * Online resources:
        * Center for Hearing and Balance at Johns Hopkins University
        * Boys Town National Research Hospital
        * Vestibular Disorders Association
   * Clinics:
        * University of Maryland Tinnitus Center
   * other cosmetic or administrative tweaks too minor to mention or too
     obvious to bother

To Do

This FAQ is a work in progress. Areas where I know I need more advice are
delineated by "*****[]*****", but please feel free to comment on anything.

Yes, I know, this FAQ is getting huge. :-) High on the "to do" list is
splitting it into multiple Usenet postings.

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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, Mark Bixby , at
[e-mail] .

In addition to being posted monthly to the Usenet newsgroups
alt.support.tinnitus, news.answers, and many others, 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

Topics covered:

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?



About the Tinnitus FAQ Maintainer



The Tinnitus FAQ Maintainer, Mark Bixby , is just a computer geek with tinnitus
and WITHOUT medical training. Everything I have learned about tinnitus has been
included in this FAQ, along with the contributions from many, many other
people, both submitted explicitly via private e-mail to me and indirectly via
public postings to alt.support.tinnitus. While I will always try to answer
questions sent to me via private e-mail, you will probably reach people with
better expertise than I by posting publicly to alt.support.tinnitus.

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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, hearing hypersensitivity , and balance problems may or may not be
present in conjunction with tinnitus.

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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.

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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


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4) What causes tinnitus?


   * 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. [Ed. note: I've had knee MRIs done, and even with earplugs and
     my 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 tumors that press against 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.


   * 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. See the next section for more detail. These drugs
     include:

     salicylate analgesics (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:

     gopher://gopher.uiuc.edu/00/UI/CSF/health/heainfo/diseases/misc/tmj

     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...


   * 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.


   * 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 rests on top of a membrane (oval
     window) 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).



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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. 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.

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6) What are some ototoxic drugs?


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--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.

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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 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]

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.

Endolymphatic hydrops 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.

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8) What is hyperacusis?


Hyperacusis is an extreme sensitivity to sound, where even small sounds are
perceived as painfully strong. Usually occurs in combination with tinnitus. May
also be a side effect of certain ear/skull surgeries.

Information describing hyperacusis can be found in the ATA pamphlet
"Hyperacusis - A life-altering supersensitivity to sound". Available by writing
or phoning them at the place listed in this FAQ.

Hyperacusis is like tinnitus in that severity and ways it exhibits itself
varies. Severity can be as low and a mild annoyance to normal sounds to the
point where maximal ear protection cannot stop the sound of something like a
mini computer disk drive whine from causing great pain. It differs from
recruitment, where only loud sounds are uncomfortable, in that *all* sounds are
uncomfortable. Apparently the ear's volume regulation system from efferent
nerve fibers lose control and the ear's "volume knob" is broken on maximum.
There is some overlap between hyperacusis and tinnitus. Some tinnitus sufferers
have some hyperacusic symptoms. Further damage might take them toward full
blown hyperacusis. Hyperacusis is caused almost always by loud sound, usually
music. Usually no hearing loss occurs in the hyperacusic person.

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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.

     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!


   * 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.


   * 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.

     (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.



     Klonopin

     Same class of drug as Xanax, but somewhat less effective and less
     addictive.

     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), 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 serious side-effects that require careful
     monitoring via blood chemistry and other tests.


   * intravenous lidocaine

     An initial injection of lidocaine followed by an IV drip may provide
     temporary relief to some sufferers.


   * tocainide hydrochloride

     This is an oral relative of lidocaine thought to act in a similar manner.


   * 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."


   * 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...'

     CAUTION: DMSO was recently implicated in the mysterious case of the
     "fume-emitting body" from Riverside, California. A terminal cancer patient
     was brought by paramedics to an emergency room, where toxic fumes from the
     patient incapacitated and in certain cases seriously injured the attending
     physicians. Investigation has revealed that the patient used DMSO (to
     relieve pain and inflammation?), and that due to several unusual
     coincidences, the DMSO was metabolized into a toxic substance used in
     chemical warfare.


   * 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. 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:

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




   * 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.


   * 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.


   * 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.

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



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.


   * 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.


   * surgically severing the auditory nerves

     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.


   * 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.



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



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. 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. 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. 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.


   * 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]

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-Acouphenes
117 rue Cuvier
69006 Lyon, France

[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.


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
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 a knowledgable medical professional, you
might want to start here. US $25 per year, check, VISA, MasterCard. 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, we do 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 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" 55 minute VH-S. The Cinema Guild, NY.

Don't ask me why they first say the video is 17 minutes, then at the bottom
they say it's 55 minutes.

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
[phone]
[phone] FAX


It consists of abourt 350 members from all across the US and Canada, and is run
by Dan Malcore. Dan publishes a no-charge quarterly newsletter featuring news,
tips, and member letters. Of course donations are welcome. Most of the members
got Hyperacusis (defined as intolerance to "normal" sound levels causing
extreme discomfort or pain in the ears) from loud music, especially rock music.
Some members got hyperacusis from ototoxic drugs like antibiotics, or from auto
accidents, air bags exploding, jaw disfunction, other loud traumatic sounds, or
other accidents in general. Only a very few have gotten close to cured, and
most all doctors are either ignorant of the disease or very ill-informed
regarding hyperacusis. So there is obviously a need to share information among
those who have the condition. Hyperacusis is almost always accompanied by
tinnitus to one degree or another, as well as speech discrimination, sometimes
vertigo, ear pressure and pain, jaw pain, and psychological problems in dealing
with the need to avoid everyday sounds in the environment (espec. extremely
high, loud or extremely low frequency sounds which cause the most pain) as well
as other problems involved in job/career, family and other relationships. The
Hyperacusis Network welcomes all interested persons as members at no charge.

*****[Other orgs & 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.

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



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.

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://ls10-www.informatik.uni-dortmund.de/~koehne/tinnitus/welcome.html
     A German language Web page about tinnitus.
gopher://phil.utmb.edu/00/UTMB%20ENT%20Grand%20Rounds/TINNITUS
     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.


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



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.



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


With only one small exception, 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.

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]*****

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19) Who are the contributors to this FAQ?


Unless otherwise requested, all contributors will be credited here.

Mark Bixby              [e-mail] (FAQ Maintainer)

Richard Alpert          [e-mail]
Barbara Bixby           [e-mail]
Julie Bixby             [e-mail]
Karl F. Bloss           [e-mail]
Pete Brooks             [e-mail]
W. Keith Brummet        [e-mail]
Angelo Campanella       [e-mail]
David Charlap           [e-mail]
Erik Christensen        [e-mail]
Michael Claes           [e-mail]
Michael L. Connolly     [e-mail]
Scott Dayman            [e-mail]
Bob Dubin, DC           [e-mail]
Scott Dunbar            [e-mail]
Steven Wm. Fowkes       [e-mail]
Steve Gotthardt         [e-mail]
Doug Gwyn               [e-mail]
Jamie Hanrahan          [e-mail]
Kevin Hogan             [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]
Colleen Lynch           [e-mail]
Allan MacDonald         [e-mail]
Boyd Martin             [e-mail]
Andy Matthiesen         [e-mail]
Rob McCaleb             [e-mail]
Kevin McEvoy            [e-mail]
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]
Dallas Roark            [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]
Jack Trainor            [e-mail]
Jerry Underwood         [e-mail]
Peter Wanner            [e-mail]
Allen Watson            [e-mail]
Mike Watterson          [e-mail]
Alan Wendt              [e-mail]
Steve Zimmerman         [e-mail]
--
Mark Bixby                      E-mail: [e-mail]
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"You can tune a file system, but you can't tune a fish." - tunefs(1M)