Subject: Tinnitus Frequently Answered Questions v2.3
Supersedes: <medicine/tinnitus-faq-1-826304404@spock.dis.cccd.edu>
Date: 8 Apr 1996 09:00:07 -0700
Summary: Questions and answers regarding tinnitus - ringing ears and other head noises

Posted-By: auto-faq 3.1.1.2
Posting-Frequency: monthly
Version: 2.3



Tinnitus Frequently Answered Questions

Last update v2.3, April 5, 1996

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What's New



   * What organizations can I turn to for more information? French Tinnitus
     Association: "France Acouphnes" is updated to their new address.
   * What causes tinnitus? Arnold Chiari Malformation (ACM) In a *unscientific*
     survey, about 50% of ACM patients reported having ringing ears and about
     30% reported having a whooshing sound. The survey of patients was
     conducted by Darlene Long-Thompson, RN, MHSc. Contributors of ACM
     information are: Bernard Meyer and Darlene Long-Thompson.
   * What other treatments are available for tinnitus? hypnotherapy :
     Hypnotherapy has been reported by Dr. Kevin Hogan, who is a registered
     Clinical Hypnotherapyst, to be showing remarkable results for tinnitis
     sufferers .
   * What online resources are available?
        * http://www.cabotsafety.com/tech/earlog Includes a series of 20
          articles on the study of hearing protection.
        * http://www.dejanews.com/ Archives of alt.support.tinnitus since
          01/01/96. Also does word searches in a.s.t and other newsgroups.
        * http://www.hollys.com/success-dynamics/ Information about Tinnitus
          and treatment of Tinnitus by Hypnosis.
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What Was New In Recent Updates



   * In v2.2 What online resources are available? :
     http://www.sconcept.com/~SammyC/hacusis.html The Hyperacusis Site: An
     online page that has information about hyperacusis and what can be done to
     relieve and/or cope with it.
   * In v2.1- What online resources are available? :
     http://lab9924.wustl.edu/men.htm A clinically orientated web page for
     patients with Meniere's disease.
   * In v2.1- What books can I turn to for more information? and What online
     resources are available? : TINNITUS - NEW HOPE FOR A CURE by Paul Van
     Valkenburgh: An informative and thought provoking book for laymen and
     professional. http://members.aol.com/neurosense/tinnitus.html
   * In v2.0- What drugs, vitamins, and herbs are available for treating
     tinnitus? : "CARBOGEN", a drug that may help those with recent
     (days/weeks) acustic trauma. Courtesy of Dan Segal.
   * In v2.0- What online resources are available? There is a small (_CME)
     change in a URL of a University of Texas paper on the causes and
     treatments of tinnitus:
     gopher://phil.utmb.edu/00/UTMB%20ENT%20Grand%20Rounds/TINNITUS_CME My
     Thanks to Tinnitus FAQ reader, "Thomas Kersebom", who was considerate and
     informed me of the change (the old URL won't work) and what that change
     was .
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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, Lee Leggore, at
nomader@eskimo.com .

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

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About the Tinnitus FAQ Maintainer



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

In 1993, I became involved in computer science at, "Tacoma Community College",
where I previosly earned a diploma in Management. Other than, "Basic First Aid
and CPR", I am WITHOUT medical training. Everything in this FAQ is the
contribution of many, many people, who submitted via private e-mail and
indirectly via public postings to alt.support.tinnitus. While I will always try
to answer questions via private e-mail, you will probably reach people with
better expertise than I by posting publicly to alt.support.tinnitus.

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

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

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

get faq tinnitus.html
get faq tinnitus.txt

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

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

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Topics covered in this FAQ:



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

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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, hyperacusis, recruitment , 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.

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

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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?


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

   * overexposure to loud noises
     
     Repeated exposure to loud noises such as guns, artillery, aircraft, lawn
     mowers, movie theaters, amplified music, heavy construction, etc, can
     cause permanent hearing damage. Some people report auditory fatigue from
     driving automobiles long distances with the windows down. Anybody
     regularly exposed to these conditions should consider wearing ear plugs or
     other hearing protection (see below).
     
     
   * MRI, CAT, and other non-invasive scanning machines
     
     These high-tech machines may take great images, but they are very, very
     LOUD. Do not attempt this type of imaging without wearing approved
     earplugs ; any competent imaging facility should be able to supply the
     earplugs. [Note: Mark Bixby reports that he had knee MRIs done, and even
     with earplugs and his head outside the bulk of the machine it was very
     loud.]
     
     
   * wax/dirt build-up in the ear canal
     
     If you're experiencing tinnitus, this is one of the first things you
     should check for. NEVER try digging or suctioning the ear canal yourself
     or allow a physician to do it as SERIOUS damage may result. Numerous
     over-the-counter chemical washes are available from your drugstore which
     will clean the ear canal in a safe and gentle manner.
     
     
   * acoustic neuromas
     
     Acoustic neuromas are small, slow growing benign tumors that press against
     or invade the auditory nerves. If your tinnitus is only in one ear, you
     should see your physician to rule this one out. An MRI will probably be
     required for a definitive diagnosis, but one contributor's ENT felt that
     an MRI wasn't warranted unless frequent dizziness was present. Acoustic
     neuromas are removable by surgery but involve a risk of hearing loss.
     Doing nothing should be considered an option by elderly patients since
     these tumors grow so slowly.
     
     
   * ototoxic drugs
     
     Many prescription and over-the-counter drugs may cause tinnitus and/or
     hearing loss that may be permanent or may disappear when the dosage is
     reduced or eliminated. Before starting treatment with any prescription
     drug, tinnitus sufferers should always ask their physician and/or
     pharmacist about the potential for ototoxic side effects. See the next
     section for more detail. These drugs include:
     
     salicylate analgesics (higher doses of aspirin)
     naproxen sodium (Naprosyn, Aleve)
     ibuprofen
     many other non-steroidal anti-inflammatories
     aminoglycoside antibiotics
     anti-depressants
     loop-inhibiting diuretics
     quinine/anti-malarials
     oral contraceptives
     chemotherapy
     
     
   * severe ear infections
     
     Many tinnitus cases onset after severe ear infections. But this may also
     be related to the use of ototoxic antibiotics (see above).
     
     
   * high blood cholesterol
     
     High blood cholesterol clogs arteries that supply oxygen to the nerves of
     the inner ear. Reducing your cholesterol level may reduce your tinnitus.
     
     
   * vascular abnormalities
     
     Arteries may press too closely against the inner ear machinery or nerves.
     This is sometimes correctable by delicate surgery.
     
     
   * Temporo-Mandibular Joint (TMJ) syndrome
     
     This jaw disorder may cause tinnitus and is characterized by many
     symptoms, including headaches, earaches, tenderness of the jaw muscles,
     dull facial pain, jaw noises, the jaw locking open, and pain while
     chewing. For a good online document on TMJ, see:
     
     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...
     
     
     
     There is a highly recommended dentist knowledgable about TMJ/tinnitus
     cases who has 30 years of experience and has authored/co-authored several
     papers on the subject:
     
     Doug Morgan, DDS
     308 Foothill Boulevard
     Glendale, CA USA 91214
     +1 818 248-1283
     
     For more information about TMJ, visit the TMJ Foundation (a California
     public nonprofit corporation) WorldWideWeb site at
     http://www.tmjfound.com/ , or contact them at:
     
     TMJ Foundation
     P.O. Box 28275
     San Diego, CA USA 92128-0275
     fax +1 619 592-9107
     
     
   * traumatic head injuries
     
     Some automobile crash victims have reported a sudden onset of tinnitus.
     
     
   * cochlear implant or other skull surgeries
     
     Sometimes poking around inside the skull will accidentally damage the
     hearing system. Tinnitus can result, or even profound deafness caused by
     severe inner ear infections.
     
     
   * stress
     
     Stress is not a direct cause of tinnitus, but it will generally make an
     already existing case worse.
     
     
   * diet and other lifestyle choices
     
     Like stress above, a poor diet can worsen an existing case of tinnitus.
     Alcohol, tobacco, caffeine, quinine/tonic water, high fat, high sodium can
     all make tinnitus worse in some people.
     
     
   * food allergies
     
     Specific foods may trigger tinnitus. Problem foods include red wine,
     grain-based spirits, cheese, and chocolate. One contributor reported
     hearing tones after consuming honey. Another contributor notes that these
     same foods are on the list known to trigger migraine headaches; additional
     migraine foods include soy and anything including soy, MSG, very ripe
     bananas, avocados, and citrus fruits.
     
     
   * foods rich in salicylates
     
     There is a long list of foods that are supposed to be "rich" in
     salicylates. See the Shulman book listed below for details. [Ed. note: I'm
     not listing the foods here since no data is given on exactly how rich the
     foods are, i.e. "13 mangoes = 1000mg aspirin" as a hypothetical example.]
     
     
   * glaumous tumors
     
     These tumors can cause pulsatile tinnitus . They are confirmed with a CAT
     scan or other imaging, and may be surgically removable by a delicate
     procedure.
     
     
   * mercury amalgam tooth fillings
     
     Researchers June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7
     2PT, U.K.) have found a possible connection between mercury tooth fillings
     and tinnitus. They publish a booklet on the subject available for 6
     International Reply Coupons, and they also have a questionnaire that
     interested people can fill out. Their research suggests following a
     vegetarian diet, plus eating 2 raw African green chillies one day,
     followed by 1 chilli the next day for temporary relief.
     
     But a prominent American tinnitus specialist says that no such link has
     been established.
     
     
   * marijuana
     
     Marijuana usage may worsen pre-existing cases of tinnitus.
     
     
   * Lyme Disease
     
     Lyme is a parasitic, tick-borne disease, which in the United States is
     most commonly seen in eastern states. In some cases, tinnitus has been a
     side-effect of Lyme.
     
     Lyme disease deserves special mention partly because it is so difficult to
     diagnose objectively; the commonly available serological tests have very
     high rates of false negatives. In the only study (by McDonald) in the
     literature which used objective measures (histopathology) to confirm test
     results, over 50% of currently infected patients were negative by ELISA
     and/or Western Blot. False positives are infrequent, occurring primarily
     in pts. exposed to other nasties such as syphilis or rocky mountain
     spotted fever. So serologies can be used to confirm but not to rule out
     diagnosis.
     
     The Lyme Urine Antigen Test is a useful supplement test to serologies; it
     tests for current infection, as opposed to a history of exposure. It has
     some problems with low sensitivity; these can be improved by the following
     regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5 take and test
     first-in-the morning urine specimens. The LUAT can be ordered by your MD
     from Immugenex, 1-415-424-1191. Other, better tests (including PCR) are
     under development, expected to be available for clinical use within the
     next few years.
     
     For further online information about Lyme Disease, you may send the
     following command in the body of an e-mail message to listserv@lehigh.edu:
     
     subscribe LymeNet-L yourfirstname yourlastname
     
     A regular newsletter is published here, and patients & physicians may
     exchange their stories.
     
     
   * dental procedures
     
     Certain dental procedures such as difficult tooth extractions and
     ultrasonic cleaning can cause hearing damage via bone conduction of loud
     sounds directly to the ear. Wearing ear plugs will not guard against bone
     conduction.
     
     
   * intracranial hypertension
     
     Intracranial hypertension can cause pulsatile tinnitus . If you can stop
     your tinnitus by slight pressure to the neck on the affected side, that is
     an indication. The definite way to find out is if you get a spinal tap and
     your Opening Pressure is higher than 200.
     
     
   * otosclerosis
     
     Otosclerosis is a bony growth around the footplate of the stapes (one of
     the 3 middle ear bones). This footplate forms the seal that separates the
     middle ear space from the inner ear. When the footplate moves normally,
     the sound vibrations are passed from the middle ear "chain" of bones into
     the fluid of the inner ear. If the footplate is fixated, the vibrations
     cannot pass into the inner ear as well and hence a resulting hearing loss.
     Tinnitus may also be involved. Treatment is by surgery, as one poster to
     alt.support.tinnitus explains:
          
          When should surgery be performed? Well IMHO, it all depends upon
          the amount of loss (or progression of the condition) and the
          amount of difficulty that the patient experiences. If the amount
          of loss caused by the otosclerosis is 40 dB or more, then
          surgery may be an option that you may want to think about. But
          remember that surgeries can be complicated and can always end up
          with no real improvement.
          
          Stapedectomy involves removal of the stapes, along with the
          fixated footplate, and insertion of a prosthetic stapes into the
          window that contains the oval window.
          
          One "nice" thing about people with conductive hearing loss (i.e.
          otosclerosis) is that they are excellent candidates for hearing
          aids. They often do not experience the overwelming loudness that
          people with sensorineural hearing loss often report, and speech
          is not distorted.
          
          If your condition involves a 40 dB loss *DIRECTLY* due to
          otoscelerosis, you may want to thnik about surgery, but if it is
          less than that, you may want to try a hearing aid, and think
          about surgery in the future (if the condition develops further).
     
     
     
     
   * aspartame
     
     Some people allege (quite controversially) that the artificial sugar
     substitute aspartame is linked to tinnitus, vertigo, and many other
     serious problems (I agree). To retrieve further information about the
     allegations against aspartame, send e-mail to freeinfo@servint.com and
     include the lowercase command "info mp" in the body (not the Subject:) of
     the message.
     
     
   * Arnold Chiari Malformation (ACM)
     
     An *unscientific* response of 30 ACM patients revealed that 14 had ringing
     in the ears (significant) and 9 had a whooshing sound in their ears (also
     significant). The survey of patients was conducted by Darlene
     Long-Thompson, RN, MHSc.
     
     Essentially there is (in ACM) extra cerebellum crowding the outlet of the
     brainstem/spinal cord from the skull on its way to the spinal canal. This
     crowding will commonly lead to headaches, neck pain, funny feelings in the
     arms and/or legs, stiffness, and less often will cause difficulties with
     swallowing, or gagging . There are those that believe it can cause
     tinnitus. Often the symptoms are made worse with straining.
     
     Untreated, the chronic crowding of the brainstem and spinal cord can lead
     to very serious consequences including paralysis. There are many ways to
     treat Chiari malformations, but all require surgery.
     
     When the diagnosis is suspected the study of choice is an MRI scan. These
     malformations are very difficult to see on CT scans and impossible to see
     on plain x-rays.
     
     If you are intending to have an MRI for another reason, e.g., Acustic
     Neuroma, the MRI technicians should be alerted to the possibility of ACM
     (if you are showing any symptoms listed above) since the "MRIing" will
     have to concentrate on the brain stem/cerebellum area to detect the
     problem.
     
     Most of the preceding (ACM) information provided courtesy of: Bernard H.
     Meyer
     
     Arnold Chiari Malformation involves the herniation of the cerebellum
     and/or brainstem through the foramen magnum. This can cause problems in
     the areas of cerebellar compression and dysfunction, cranial and spinal
     nerve (including trigeminal and acoustic nerve) compression and
     inflammation, CSF blockages and increased intracranial pressure (constant
     or intermittent), and brainstem compression and inflammation. ANY of these
     components can cause symptomology associated with tinnitus...(Think of the
     ringing in the ears or buzzing sound associated with light headedness or
     fainting...many ACM sufferers experience this either due to acoustic nerve
     involvement or to fluid and pressure dynamics).
     
     Because hard data on ACM is difficult to find (and often contradictory) it
     is difficult to find a source that says specifically any one symptom is
     related to ACM...but the symptoms are often categorized as...cerebellar
     syndrome, brainstem deficits, CSF obstruction, and cranial nerve deficits.
     Due to the close proximity of the acoustic nerve to the hindbrain region
     it would be one of the primary cranial nerves involved in the
     compression/inflammation syndrom.[sic]
     
     Two of my references on this are as follows...
     Tinnitus and Neurosurgical Disease
     Journal: Journal of Laryngology & Otology
     Authors:  WA Shucart
                      M. Tenner
     Citation: (4): 166-8
     ISSN0144-2945
     
     Tinnitus from Intracranial Hypertension
     Journal: Neurology
     Authors: KJ Meador
                    TR Swift
     Citation: 34(9): 1258-61
     ISSN 0028-3878
     Preceding (ACM) information provided courtesy of: Darlene Long-Thompson,
     RN, MHSc.

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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.
There are "tough" ears, and there are "weak" ears; what may be safe or
dangerous for one individual may not be the same for you. If you ever
experience temporary ringing after a sound exposure, YOU ARE AT A SEVERE RISK
FOR TINNITUS AND/OR HEARING LOSS .

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

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6) What are some ototoxic drugs?


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

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

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

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

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

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

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

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

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

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


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

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

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



7) What is Meniere's Disease?


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

What are the symptoms?
     
     In my case it started with a constant fullness in my right ear and
     the constant ringing. I also noticed I wasn't hearing very well and I
     was having some vertigo attacks.
     
     Originally I had my Allergist treat me. She thought it might just be
     an inner ear infection or a sinus infection. It manifested itself in
     the fall which is one of my worst allergy seasons.
     
     By Spring she referred me to an ENT.

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

Are there any known environmental causes, or is it one of those things that
"just happens" to people?
     
     One possible cause is Diabetes. Other than that no one that I have
     spoken with knows. It may also be hereditary. Usually doesn't show up
     until later in life 40 and beyond, and can burn itself out in 3 - 5
     years. Some have it earlier in life (me at 35) and could have it the
     rest of our lives.

What are the common treatments? Anti-vertigo drugs? Surgical operations on the
inner ear balance mechanisms?
     
     The most common treatment for mild episodic Meniere's I guess would
     be to rule out Diabetes and allergies. For the vertigo attacks
     usually the prescription drug Antivert is used or the over the
     counter drug Meclizine . Both tend to relive the vertigo. For more
     chronic cases a low dosage of Valium can help. When things get bad
     enough the next procedure is an Endolymphatic Transmastoid Shunt.
     This helps to keep some of the pressure of the inner ear. Changes in
     diet can help. Removal of sodium, caffeine and alcohol can help.
     Usually a mild diuretic is prescribed.
     
     I know of several folks who keep it under control with allergy shots
     and restricting their sodium intake.
     
     If it progresses to a point where the patient can no longer 'live'
     with it an Eighth Nerve Section can be done. But according to my
     surgeon this is an absolute last resort. It guarantees deafness in
     the ear and some patients report balance problems at night. He also
     claims the risks are high with this procedure including partial face
     paralysis. [Ed. note: new surgical techniques access the nerve via
     the posterior fossa, preserving hearing and reducing the risk of
     facial paralysis. The vestibular nerve alone can be sectioned,
     providing vertigo relief.]

In general, imagine yourself back when you first encountered Meniere's. What
kind of summary info would have been helpful to you?
     
     Knowing that it can be treated with medication and there is the hope
     that it will burn itself out keeps me going. There does seem to be a
     connection with the tinnitus and the Meniere's. I have noticed over
     the last two years that the tinnitus gets worse and my hearing
     decreases prior to a vertigo episode or series of vertigo episodes.
     25mg of Meclizine usually has the vertigo under control in 20 - 30
     minutes for a mild attack. A severe attack can leave you completely
     disoriented such that there is no real up or down. An attack this
     severe usually has bouts of nausea and vomiting with it. I find lying
     down in a quiet dark room helps while the medicine kicks in.
     Anti-nausea drugs can help. In my case when I have had a severe
     episode I usually feel 'out-of-sorts' for a couple of days.
     
     If you experience pretty intense tinnitus coupled with vertigo and
     the inability of hold your eyes steady on an object I would suggest
     seeing an ENT who knows about Meniere's. I have found that it is not
     well known or understood.

Meniere's, Tinnitus, &AMP; Gentamicin, as explained by Jim Chinnis &LT;
jchinnis@interramp.com &GT;:
     
     Originally, streptomycin was tried as a treatment for medically
     intractable Meniere's (before considering surgical approaches). As
     best I can determine, the technique was developed at Tulane Univ by
     Charles Norris in the US and first tested by Dr. John Shea Jr. in
     Memphis, Tennessee, USA. Doctors knew that streptomycin could destroy
     hearing and balance. Early interest was in seeing if the vestibular
     system could be suppressed with small doses during space travel in
     order to reduce motion sickness experienced by NASA astronauts.
     
     Shea and others soon recognized that streptomycin could be used in
     two ways for Meniere's. Either a large dose could be used to
     chemically destroy the neural hair cells of the inner ear (giving a
     result similar to nerve section, but without surgery) or a carefully
     monitored dose could be used so that treatment would stop as soon as
     any hearing or vestibular damage could be measured. The latter idea
     was based on the thought that either the vestibular signal could be
     weakened or even that the cells in the vestibular (balance) system in
     the ear that were misfiring and causing vertigo might be selectively
     destroyed with streptomycin. It was also known that aminoglycosides
     had complex activity within the tissues of the inner ear and had a
     particular affinity for tissue believed responsible for the
     production of endolymph. (Overproduction of endolymph or failure of
     resorption is believed to be the principal cause of Meniere's
     symptoms and the symptoms of some other inner ear problems, as well.)
     Dr. Shea was somewhat successful in developing this treatment. It has
     been tried now around the USA, in Italy, Australia, Canada, and
     elsewhere in numerous variations but is not generally known to
     practicing ENTs.
     
     The newer form of the treatment is to use gentamycin instead of
     streptomycin because it is safer. The drug is administered either
     into the middle ear and allowed to perfuse through the round window
     into the inner ear or given by (systemic) injection. Patient goes
     home same day. Results have been very good as far as I can tell. One
     large unilateral study (people with Meniere's in one ear) showed the
     following results: vertigo gone in over 90% of cases, tinnitus GONE
     in more than 80% of cases. Another large study found vertigo gone in
     85.5% of cases, improvement of hearing of at least 10 db in 26.7%,
     disappearance of pressure or fullness in 78.4%, and the disappearance
     of tinnitus in 51.6% of cases and its significant reduction in
     another 24.2%.
     
     Researchers (e.g., T. Sala in Italy) think that the gentamicin
     permanently affects the"vascular stria" and the "dark cells" so that
     less endolymph is produced and causes changes in a number of cellular
     biochemical processes in the inner ear.
     
     Of major importance to those with Meniere's affecting both ears is
     the finding that the Meniere's may be "cured" by either parenteral
     injections or middle ear applications. Sala cites four additional
     references that report on treatment/cure of bilateral Meniere's using
     streptomycin or gentamicin. He argues for gentamicin, due to its
     greater affinity for tissues believed responsible for endolymph
     production and because of its lower toxicity. He argues also that the
     topical administration of gentamicin can be used even when little or
     no hearing loss is present, since the dosing can be stopped before
     significant hearing loss occurs. Because the drug then (allegedly)
     results in reduction of endolymph pressure, no further hearing loss
     or vertigo attacks are expected. Thus gentamicin perfusion therapy
     appears to be a viable treatment at any stage of Meniere's unilateral
     or bilateral, and may preserve hearing and balance if used soon
     enough.
     
     Sala also argues that treatment with aminoglycosides could be
     expected to be effective against tinnitus or balance disorders due to
     any of a wide variety of causes, not just Meniere's. I have not seen
     any research done on this assertion.
     
     A finding of major importance is that when the earliest patients from
     about 15 years ago are examined today, the improvements made by the
     streptomycin therapy are still there, suggesting that the treatment
     may be permanent.
     
     Please note that if you seek this treatment or ask your doctor to
     consider it you will probably have difficulty. S/he will probably
     never have heard of it. I have a list of about six doctors in the US
     who perform the treatment in at least some versions. There is
     obviously Sala in Italy (Venice), and I have a lead to a doctor in
     Australia and Canada.
     
     This information is just my take on some fairly technical journal
     articles. The opinions are those of medical doctors who wrote the
     journal articles but the words are mine. I am not a medical doctor,
     just a Meniere's patient like many of you.
     
     References:
     
     Dickens, John R.E., M.D., and Graham, Sharon S. (Meniere's
     Disease--1983-1989). The American Journal of Otology, Vol. 11, Number
     1. January 1990.
     
     Sala, T. (Transtympanic administration of aminoglycosides in patients
     with Meniere's disease). Archives of Oto-Rhino-Laryngology,
     245:293-296. 1988.
     
     Pyykko, I., Ishizaki, H., Kaasinen, S., Aalto, H. (Intratympanic
     gentamicin in bilateral Meniere's disease). Otolaryngology--Head &
     Neck Surgery, 110(2):162-167. Feb 1994.
     
     Shea, J.J. Jr., and Ge, X. (Streptomycin perfusion of the labyrinth
     through the round window plus intravenous streptomycin).
     Otolaryngologic Clinics of North America, 27(2):317-24. April 1994.
     
     

Endolymphatic hydrops (see http://lab9924.wustl.edu/Intro4.htm) is a condition
similar to Meniere's that involves vertigo without hearing loss, as described
by another contributor:
     
     I have a problem with one ear that is called endolymphatic hydrops,
     which is something like Meniere's without a severe hearing loss.
     Apparently the fluid in the semicircular canals responds to changes
     in body fluid levels - which it isn't supposed to do- and sends
     messages to say you are dizzy. I have spontaneous vertigo attacks and
     motion induced dizziness - all lasting only a short time. Well, what
     does this have to do with tinnitus? I also have tinnitus in that ear,
     which is helped by some things I have been taught to do for
     dizziness. Eating small meals several times a day keeps your body
     fluid levels fairly consistent. Also avoid salt. That really makes a
     difference with tinnitus and avoid too much sugar as well. Other
     things to be careful of are fatigue and dehydration. All these things
     have been helpful for me.

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



8) What is hyperacusis?


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

What causes hyperacusis?

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

What can be done?

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

How rare is hyperacusis?

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

Where can I turn to for help?

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

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

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



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


   * niacin
     
     Niacin supplements produce a temporary flushing effect that is supposed to
     pump more oxygen into the inner ear due to vasodilation. Take niacin on an
     empty stomach for best results. You may experience a flush ranging from a
     mild sunburn to wondering about spontaneous skin combustion. ;-) You may
     also experience a "dry mouth" sensation.
     
     MEGADOSES OF NIACIN CAN DESTROY YOUR LIVER AND KILL YOU. 50mg twice per
     day is a common dose for tinnitus. If you experience the flush, then you
     are getting the maximum benefit. Caution: niacin can provoke migraine
     headache attacks in some people.
     
     Some people report good results from niacin, other people gain nothing.
     Your mileage may vary. One contributor advocates taking niacin in
     combination with thiamine:
          
          The 1994 text on Myofascial Pain: Trigger Points said that
          Niacin without Thiamine will do no good for tinnitus. I don't
          recall the reasoning. Nicotinic Acid (a form of Niacin) if taken
          in over 500mg per day should only be done so with Dr. approval.
          I take 100mg per day with a B-complex vitamin that already is
          balanced properly. You want roughly two parts niacinamide for
          each one part thiamine. Most vitamins will come balanced in this
          proportion. To my knowledge Nicotinic Acid in large doses like
          2-5mg per day over a year or so, could lead to liver damage.
          Niacinamide shouldn't have any negative effects nor should
          thiamine. But I suppose if someone swallows a bottle they'd have
          a side effect!
     
     
     
     There is no clinical proof for the effectiveness of niacin in treating
     tinnitus. This is inherently difficult to prove due to a possible "placebo
     effect" arising from the niacin flush sensation rather than any
     therapeutic value of the underlying vasodilation. Additionally, any
     vasodilation that occurs cannot benefit the cochlear hair cells, because
     the blood vessel (vas spralie) that feeds these cells cannot expand or
     contract.
     
     
   * lecithin
     
     The following anecdotal report advocates lecithin in combination with
     niacin [Ed. note: my nutrition book does not cover lecithin, so I cannot
     speculate as to toxicity and side-effects]:
          
          After reading the tinnitus faq I emailed to my father, he
          replied that he has helped a number of people cure their own
          tinnitus by using Niacin and Lecithin. His theory is that the
          lecithin, being an emulsifier, helps disperse the build up of
          fats in the capillaries, and the niacin helps dilate the
          capillaries to let the lecithin in.
          
          He had meier's [sic - Meniere's ?] syndrome in the 70's, and
          cured it this way. Our neighbor, a police officer, retired on
          disability for the same reason, and Dad practically cured him
          that way.
          
          I got tinnitus as a result of childhood ear infections, and it
          has done nothing for me, but then, mine is not what I would call
          irritating.
          
          It does seem that after chelation, the noise is less.
     
     CAUTION: Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Heath Freedom
     Publications, ISBN 0-9627418-9-2, says that phosphatidyl choline is the
     active ingredient of lecithin, and as a precursor of acetylcholine should
     be avoided by people who are manic-depressive because it can deepen the
     depressive phase.
     
     
   * gingko biloba
     
     Gingko biloba leaves have been used therapeutically by the Chinese for
     centuries for the treatment of asthma and bronchitis. In western countries
     a standardized 50:1 concentrate of 24% gingko flavoglycosides is used,
     either in liquid or capsule form. Gingko has been shown to increase
     circulation throughout the body and the brain.
     
     The article "Ginkgo biloba", The Lancet, Vol 340, Nov 7, 1992, pp.
     1136-1139, examines numerous studies on the efficacy of ginkgo on
     intermittent claudication (pain while walking), and cerebral
     insufficiency, a wide collection of vascular impairment symptoms including
     tinnitus. Typical dosages range from 120-160mg per day, divided equally at
     meal time.
     
     Most studies showed that between 30-70% of subjects had reduced symptoms
     over a 6-12 week period. No serious side effects were observed, and any
     minor side effects were not statistically significant compared to subjects
     treated only with placebo.
     
     Other references on gingko biloba:
     
     As to tinnitus, Hobbs in reference (1) says:
     
     For example, in 1986 a study statistically proved the effectiveness of
     treatment with ginkgo extract for tinnitus: the ringing completely
     disappeared in 35% of the patients tested, with a distinct improvement in
     as little as 70 days!(2)
     
     Similarly, when 350 patients with hearing defects due to old age were
     treated with ginkgo extract, the success rate was 82%. Furthermore, a
     follow-up study of 137 of the original group of elderly patients 5 years
     later revealed that 67% still had better hearing(3).
     
     References
     
     1.) Ginkgo Elixir of Youth; Christopher Hobbs; Botanica Press, Box 742,
     Capitola, CA 95010; 1991; pages 50-51
     
     2.) Tinnitus-multicenter study. A multicentric study of the ear; Meyer,
     B.; 1980; Ann. Oto-Laryng. (Paris) 103:185-8
     
     3.) Tebonin-therapy with old hard-of-hearing people. Koeppel, F. W.; 1980;
     Therapiewoche 30: 6443-46
     
     Here's an abstract of a recent paper in Audiology:
          
          Holgers KM; Axelsson A; Pringle I
          Ginkgo biloba extract for the treatment of tinnitus.
          Department of Audiology, Sahlgren's Hospital, Goteborg, Sweden.
          Language: Eng
          Source: Audiology 1994 Mar-Apr;33(2):85-92
          Unique Identifier: 94234927
          
          
          Abstract:
          
          Previous studies have shown contradictory results of Ginkgo
          biloba extract (GBE) treatment of tinnitus. The present study
          was divided into two parts: first an open part, without placebo
          control (n = 80), followed by a double-blind placebo-controlled
          study (n = 20). The patients included in the open study were
          patients who had been referred to the Department of Audiology,
          Sahlgren's Hospital, Goteborg, Sweden, due to persistent severe
          tinnitus. Patients reporting a positive effect on tinnitus in
          the open study were included in the double-blind
          placebo-controlled study (20 out of 21 patients participated). 7
          patients preferred GBE to placebo, 7 placebo to GBE and 6
          patients had no preference. Statistical group analysis gives no
          support to the hypothesis that GBE has any effect on tinnitus,
          although it is possible that GBE has an effect on some patients
          due to several reasons, e.g. the diverse etiology of tinnitus.
          Since there is no objective method to measure the symptom, the
          search for an effective drug can only be made on an individual
          basis.
     
     And still another abstract:
          
          I searched the medline for your using PHYSICIANS ON LINE
          software, from 1988 to present obtained the following:
          
          Remacle J, Houbion A, Alexandre I, Michiels C
          
          [Behavior of human endothelial cells in hyperoxia and hypoxia:
          effect of Ginkor Fort]
          
          Laboratoire de Biochimie Cellulaire, Facultes Universitaires
          N.D. de la Paix, Namur, Belgique.
          
          Phlebologie 1990 Apr-Jun;43(2):375-86
          
          Article Number: UI91046351
          
          ABSTRACT:
          
          Recent discoveries have shown that venous diseases have a
          multifactorial etiology. One of the factors which is definitely
          involved in this pathologic process is the change in the
          concentration of oxygen. An increase in the concentration of
          oxygen, hyperoxia, or reoxygenation following hypoxia, damages
          the tissues by stepping up the production of free radicals. In
          addition, a reduction in oxygen concentration, or hypoxia, is
          also damaging, probably through a reduction in ATP synthesis.
          From a therapeutic standpoint, the veins, and more particularly
          the endothelium, must be protected against the impact on the
          tissue of these changes in oxygen concentration. In this study,
          the effects of Ginkor Fort were tested on cultured endothelial
          cells subjected to varying oxygen pressures. The results show
          that Ginkor Fort can provide good protection of endothelial
          cells against hyperoxia and hypoxia-reoxygenation. These
          beneficial effects are probably due to the presence of
          flavonoids in the **Ginko** biloba extract; these flavonoids
          have an anti-oxidant effect. In addition, this substance also
          protects the cells against hypoxia, possibly by increasing the
          availability of oxygen for ATP synthesis. This dual protective
          effect, which is produced by two different mechanisms, may
          account for the wide spectrum of Ginkor Fort in its use in
          venous diseases.
     
     
     
     Despite the above quotes, one prominent American tinnitus specialist says
     that gingko does no better in rigorous scientific studies than a placebo
     effect of 5%.
     
     
   * anti-depressants , tranquilizers, and muscle relaxants
     
     Many tinnitus sufferers become depressed from having to deal with the
     constant noise. Treating the depression may make the tinnitus seem less
     severe. But beware that certain ototoxic anti-depressants may _worsen_
     tinnitus. SSRI anti-depressants may temporarily worsen tinnitus for the
     first few weeks, but risk fewer side-effects as compared to the older
     tricyclic drugs.
     
     Tricyclic anti-depressants, such as Nortriptyline and benzodiazepines,
     such as Alprazolam (Xanax) were used in one study in which some people
     reported improvement.
     
     Possible reasons:
     
     (1) Patients just think they feel better (placebo effect).
     
     (2) Since these drugs are central nervous system depressants, auditory
     responsiveness diminishes.
     
     (3) Tinnitus is stress-related - i.e. muscle tension in neck & jaw
     restricts blood and lymph flow.
     
     Alprazolam (Xanax)
     
     A double-blind study with placebo control showed 76% of the subjects
     benefited with tinnitus reductions of at least 40%, whereas only 5% of the
     placebo subjects had an improvement. Try 0.5mg at bedtime. Can be
     addicting, and may make you feel excessively mellow.
     
     An abstract of an article describing the Xanax study:
          
          Use of Alprazolam for Relief of Tinnitus
          A Double-Blind Study
          Robert M. Johnson, PhD; Robert Brummett, PhD; Alexander
          Schleuning, MD
          (Arch Otolaryngol Head Neck Surg. 1993:119:842-845)
          
          OBJECTIVE: To systematically test the effectiveness of
          alprazolam as a pharmacological agent for patients with
          tinnitus.
          
          DESIGN: Prospective, placebo-controlled, double-blind study.
          
          PATIENTS: Forty adult patients with constant tinnitus who had
          experienced their tinnitus for a minimum of 1 year and who
          resided in the Portland, Oreg., metropolitan area. Twenty
          patients were randomly assigned to the experimental group and 20
          to the control group.
          
          RESULTS: Seventeen of 20 patients in the experimental
          (alprazolam) group and 19 of the 20 in the placebo (lactose)
          group completed the study. Of the 17 patients receiving
          alprazolam, 13 (76%) had a reduction in the loudness of their
          tinnitus when measurements were made using a tinnitus
          synthesizer and a visual analog scale. Only one of the 19 who
          received the placebo showed any improvement in the loudness of
          their tinnitus. No changes were observed in the audiometric data
          or in tinnitus masking levels for either group. Individuals
          differed in the dosages required to achieve benefit from the
          alprazolam, and the side effects were minimal for this 12-week
          study.
          
          CONCLUSIONS: Alprazolam is a drug that will provide therapeutic
          relief for some patients with tinnitus. Regulation of the
          prescribed dosage of alprazolam is important since individuals
          differ considerably in sensitivity to this medication.
          
          Reprint requests to 3515 SW Veterans Hospital Rd., Portland, OR
          97201 (Dr. Johnson).
     
     Here's the Conclusion section of the article:
          
          CONCLUSION. It appears that alprazolam is beneficial in treating
          some patients with tinnitus. Because long-term use of a
          benzodiazepine is not recommended, it probably should be used as
          an option when the patient cannot benefit from tinnitus maskers,
          hearing aids, or other therapy. Patients who elect to continue
          taking the drug are prescribed it for a maximum of 4 months. The
          dosage is then reduced by 0.25 mg every 3 days before it is
          completely discontinued. Once the drug therapy program has been
          terminated, it is not resumed for at least 1 month. For some
          patients, the tinnitus remained at a low level. Also, some
          patients are able to continue the drug at daily dosages of 0.5
          mg and 1.0 mg. It is important to regulate the prescribed dosage
          of alprazolam since individuals differ considerably with regard
          to sensitivity to this medication.
     
     Patients in the Portland study reported an average tinnitus loudness of
     7.5 dB before Xanax treatment, and 2.3 dB after.
     
     Klonopin
     
     Same class of drug as Xanax, but somewhat less effective and less
     addictive. Klonopin has not been tested for tinnitus reduction in rigorous
     scientific studies.
     
     A word of warning:
     
     Big-time antidepressants like the tricyclics and Prozac cannot be expected
     to have an effect if the tinnitus sufferer does not suffer from an
     affective disorder originating in brain chemistry. Minor tranquilizers may
     help. But people should beware of trusting their friendly local
     internist/GP to prescribe drugs of this type. Current knowledge of
     psychopharmacology is essential. GP prescriptions of these drugs have
     messed up more facets of people's lives than just their hearing.
     
     
   * anti-convulsants
     
     Carbamazepine (Tegretol, a dangerous drug!), phenytoin (Dilantin),
     primidone (Mysoline), valproic acid (Depakene) have all shown some
     effectiveness in reducing tinnitus. But there is no standard dosage for
     tinnitus applications, and some of these drugs may cause dangerous
     side-effects that require careful monitoring via blood chemistry and other
     tests. Anti-convulsants have not been studied in rigorous scientific tests
     for reduction of tinnitus.
     
     
   * intravenous lidocaine
     
     An initial injection of lidocaine followed by an IV drip may provide
     temporary relief to some sufferers. In one study, relief of up to 30
     minutes after IV disconnection was reported by 23 out of 26 patients.
     
     
   * tocainide hydrochloride
     
     This is an oral relative of lidocaine thought to act in a similar manner.
     Tocainide can have serious side-effects.
     
     
   * histamine
     
     On p.32 of Conn's Current Therapy, 1994, W.B. Saunders Co., MDs Jack C.
     Clemis and Sally McDonald write "The authors' choice for pharmacotherapy
     is histamine. In a study awaiting publication, nearly 70% of patients
     treated with histamine achieved complete or partial resolution of their
     symptoms."
     
     Anyone with more information about this Therapy, the study to be
     published, MDs Jack C. Clemis and Sally McDonald, and/or anyone else using
     this Therapy please contact me at: nomader@eskimo.com I have as to date no
     other information than that is in the above paragraph.
     
     
   * anti-histamine
     
     [Ed. note: Yes, I realize this is in contradiction with the above
     paragraph.] The theory is that the mild sedative effect eases anxiety, and
     that mucous reduction allows the inner ear to dry out, thus relieving
     cochlear pressure.
     
     
   * meclizine
     
     This is an over-the-counter (USA) anti-vertigo drug. While it is obviously
     relevant to the severe vertigo that comes with Meniere's, there was one
     anecdotal report submitted to this FAQ by a tinnitus sufferer who did not
     _have_ vertigo but took meclizine to successfully reduce his tinnitus.
     
     
   * DMSO
     
     The following appeared in a recent article in Alternatives regarding
     tinnitus:
          
          "Ask your doctor to review the following article, Annals of the
          New York Academy of Sciences 75:243:468:74. 'In this study,15
          patients were suffering from tinnitus. Every four days 2
          milliliters of a medicated DMSO solution containing
          anti-inflammatory and vasodilatory compounds were applied
          locally to the external auditory canals of their ears. They were
          also given an intramuscular injection of DMSO at the same time.
          
          'After one month, 9 of the 15 patients had a total cessation of
          the tinnitus and it didn't return during the one year
          observation period. It was diminished in two others and in the
          remaining four it became only an occasional problem instead of
          permanent (cold temperatures seemed to be the main factor
          causing it to return).
          
          'In addition, all of the five patients that were suffering from
          vertigo noted significant improvement...'
     
     
     
     
   * vinpocetine and vincamine
     
     The following is an anecdotal report concerning vinpocetine, a drug that
     is NOT registered in the United States. A search of the Physician's Desk
     Reference and several CDROM databases turned up nothing on the drug or its
     manufacturer. Be skeptical, but also remember that some of today's wonder
     drugs were once new and unregistered. A prominent American tinnitus
     researcher (Dr. Jack Vernon) says, "Vinpocetine shows high promise ."
     Judge for yourselves:
          
          I started taking vinpocetine (a nootropic drug available
          mail-order from Europe) a couple months ago, and my tinnitus
          (due to listening to a walkman for the entire eighties) is now
          almost gone. Occasionally the tinnitus will re-occur, but I
          think that's due to what I happen to be eating (or not eating)
          that day, as the FAQ states.
          
          In short, vinpocetine cured what I thought was incurable, and
          made me a whole-lot happier -- especially since I'm in the music
          industry and depend on my ears.
          
          From what I understand, vinpocetine repairs damaged nerve cells,
          among other things. There are no side effects -- you don't
          notice anything while taking it except that you may remember
          things better, and your tinnitus may improve.
          
          "VINPOCETINE: A side effect free synthetic derivative of
          vincamine. Vinpocetine is three to four times as potent as
          vincamine at improving cerebral circulation and overall is OVER
          TWICE as potent as vincamine in humans. Vinpocetine has wide
          ranging effects and can be used to improve memory, treat stroke,
          menopausal symptoms, macular degeneration, impaired hearing and
          tinnitus. The usual oral starting dose is 1-2 tablets three
          times daily, to be followed by a maintenance dose of 1 tablet
          three times daily for a longer period of time. Vinpocetine has
          not been reported to interact with other drugs and may be used
          in combination." -- 'Recommended Dosages' sheet from Interlab.
          
          You can order vinpocetine by sending a letter to Interlab asking
          for an order form. Currently, vinpocetine is US$26 for 100
          tablets. For Canadians, you can only order a three month
          personal supply at a time. For Americans, you may need a
          doctor's prescription, and can only order a three month personal
          supply at a time. Call your government's "Customs" agency, or
          "Food and Drug" administration to be sure.
          
          Interlab
          BCM box 5890
          London
          WC1N 3XX
          England
     
     A different contributor has this interjection to make about Interlab:
          
          Interlab is not a reputable source. They are a "black"
          organization that has shipped bogus drugs, and they routinely
          ignore complaints. They use greeting cards to ship drugs into
          the US (which is very reliable) and people either love their
          service or hate it, depending on whether or not they have had a
          problem that Interlab will not remedy.
     
     How did you find out about vinpocetine? Did you explicitly try it for
     tinnitus, or was it for some other condition and the tinnitus cure was an
     unexpected side-effect? Did a doctor recommend it to you?
          
          I read about it in a document regarding drugs that the FDA won't
          approve because they don't consider the problem the drug cures
          important enough (such as tinnitus.) It was on the net somewhere
          -- I don't have it.
          
          I got it specifically for tinnitus. A doctor didn't recommend it
          -- I "prescribed" it to myself. I have a degree is psychology,
          so I'm not completely in the dark as to its effects.
     
     The literature from the manufacturer almost has that "too good to be true"
     ring to it. Have you ever seen any other literature on this drug that
     didn't come from the manufacturer?
          
          Nothing really substantial, except personal reports from people
          who say it works with them.
     
     Do you have any info regarding undesirable side-effects or toxicity
     levels?
          
          Non-toxic at any level, no side-effects . It's available OTC
          (Over The Counter) in Europe and South America. It is not
          available in North America because drug laws stipulate that a
          drug has to cure an existing condition before it can be
          approved. I guess tinnitus isn't a real problem to them. The
          only way we can find out if it really works is if several people
          try it and report back. I doubt tinnitus is something that
          placebo response can overcome, and I'm sure that if other
          peoples tinnitus was as annoying as mine, they'll jump at the
          chance to try vinpocetine.
     
     Another FAQ contributor reports:
          
          In a quick review of the medline literature I did not find any
          papers dealing with vinpocetine and tinnitus, but did find some
          with information I will share....I found some information in the
          merck index as well as in two articles on vinpocetine-side
          effects in the Journal of the American Geriatics Society ..JAGS
          35:425(1987); 37:515(1989).....
          
          VINPOCETINE
          ethyl apovincaminate
          3,16-eburnamenine-14-carboxylic acid ethyl ester
          registered drug names...cavinton,ceractin,eusenium,finacilen
          
          mode of action...cerebral vasodilator used to treat cerebral
          dysfunction resulting from reduced blood flow....in addition has
          other complex metabolic actions..."In humans, the effect on
          cerebral blood flow is not certain, with some investigators
          reporting no change, while others report an increase". It has
          been reported that vinpocetine can be used safely to treat
          patients with "chronic cerebral dysfunction of vascular origin".
          The drug is not without some side effects but these.. "were mild
          and not considered to be of a serious nature". These papers also
          discussed the concentration of drug administered to groups of
          patients in controlled studies...There was mention made in the
          1989 paper that vinpocetine was under investigation in the US
          assessing its value in patients with multi-infarct dementia...
          
          The information that vinpocetine helps some people that have
          tinnitus is at the moment anecdotal...as one with tinnitus, I
          certainly would approach self treatment very conservatively....I
          take niacin for my hypercholesteremia and haven't noticed any
          change in the ringing...I would be willing to take lecithin and
          ginko but I don't think I will attempt vinpocetine until I am
          sure of its efficacy....most of the people with tinnitus do not
          have cerebral dysfunction!... I can also appreciate trying
          anything to reduce the discomfort of tinnitus...please be
          cautious when it comes to the use of drugs...as we know even
          niacin in excess is potentially harmful....
     
     Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Health Freedom
     Publications, ISBN 0-9627418-9-2, has this to say about vinpocetine and
     vincamine:
          
          "Vinpocetine is a powerful memory enhancer. It facilitates
          cerebral metabolism by improving cerebral microcirculation
          (blood flow), stepping up brain cell ATP production (ATP is the
          cellular energy molecule), and increasing utilization of glucose
          and oxygen.
          
          ...
          
          Vinpocetine is often used for the treatment of cerebral
          circulatory disorders such as memory problems, acute stroke,
          aphasia (loss of the power of expression), apraxia (inability to
          coordinate movements), motor disorders, dizziness and other
          cerebro-vestibular (inner-ear) problems, and headache.
          Vinpocetine is also used to treat acute or chronic
          ophthalmological diseases of various origin, with visual acuity
          improving in 70% of the subjects.
          
          Vinpocetine also is used in the treatment of sensorineural
          hearing impairment.
          
          ...
          
          Vinpocetine is a derivative of vincamine, which is an extract of
          the periwinkle. Although they have many similar effects
          vinpocetine has more benefits and fewer adverse effects than
          vincamine.
          
          Precautions: Adverse effects are rare, but include hypotension,
          dry mouth, weakness, and tachycardia [Ed. note: this is
          excessively rapid heartbeat, which can be FATAL . I do not
          consider that to be "very safe"]. Vinpocetine has no drug
          interactions, no toxicity, and is generally very safe.
          
          ...
          
          Vincamine is an extract of the periwinkle. It is a vasodilator
          and increases blood flow to the brain and improves the brain's
          use of oxygen.
          
          Vincamine has been used to treat a remarkable variety of
          conditions related to insufficient blood flow to the brain,
          including vertigo and Meniere's syndrome , difficulty in
          sleeping, mood changes, depression, hearing problems, high blood
          pressure and lack of blood flow to the eyes. Vincamine has also
          been used for improving memory defects and inability to
          concentrate. Vincamine has extremely low toxicity and is very
          inexpensive.
          
          ...
          
          Precautions: Rarely causes gastrointestinal distress, which
          disappears when usage is stopped. Vincamine has not been proven
          to be safe for pregnant women or children."
     
     Like vinpocetine, vincamine is not directly available in the United
     States. For a list of mail-order suppliers of these and other "smart
     drugs", send US$2.00 to the address below and request the Smart Drug
     Sources List:
     
     Cognition Enhancement Research Institute
     P.O. Box 4029
     Menlo Park, CA 94026-4029
     USA
     
     Smart Drugs & Nutrients is also available from CERI:
          
          It is now 5 years since SD&N was published and it is getting
          hard to find in many bookstores in many areas of the country.
          For those who can't find it locally, they can get it from CERI
          for $12.95 plus $3 for Priority Mail shipping. If they mention
          the Tinnitus FAQ, we will include the Smart Drug Sources listing
          for free.
     
     
     
     
   * hydergine
     
     Another "smart drug", for which Dean & Morgethaler say:
          
          "Hydergine is reported to increase mental abilities, prevent
          damage to brain cells from insufficient oxygen (hypoxia), and
          may even be able to reverse existing damage to brain cells [Ed.
          note: Call me skeptical].
          
          Hydergine is an extract of ergot, a fungus that grows on rye.
          Midwives in Europe traditionally used ergot with birthing
          mothers to lower their blood pressure. Researchers at the
          pharmaceutical giant Sandoz analyzed ergot in the late 1940s,
          looking for blood-pressure medications. Of the thousands of
          compounds that researchers found in ergot, three were combined
          and tested for their anti-hypertensive properties. When studies
          with elderly people uncovered cognition-enhancing effects,
          Sandoz began spending a great deal of research money on
          Hydergine. It is now one of the most popular treatments for all
          forms of senility in the U.S., and is used to treat a plethora
          of problems elsewhere in the world.
          
          Hydergine probably has several modes of action for its
          cognitive-enhancement properties. Its wide variety of reported
          effects include the following:
          
             * 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
          headache. Overall, Hydergine does not produce any serious side
          effects. It is nontoxic even at very large doses and it is
          contraindicated only for individuals who have chronic or acute
          psychosis, or who are allergic to it. Overdosage of Hydergine
          may, paradoxically, cause an amnesic effect."
     
     Hydergine is available in the United States with a doctor's prescription.
     It is also available from overseas sources, as one contributor explains:
          
          Hydergine is widely used in France, and it is cheap there. One
          person told me that you can get 5 mg Hydergine tablets there for
          less than the price of 1 mg in the US. If contacts can be made
          directly with French pharmacists sympathetic to the use of the
          higher European dosages in the US, mail-order access might be
          arrangeable for US tinnitus people.
     
     Hydergine has not been proven in rigorous scientific tests to be effective
     for tinnitus reduction.
     
     
   * sodium fluoride
     
     May be helpful when the tinnitus is due to cochlear otosclerosis.
     
     
   * vasodilators
     
     Vasodilators like niacin , gingko biloba , and prescription drugs for
     hypertension increase blood flow inside the skull, raising the oxygen
     available for good nerve health. But note that vasodilation cannot benefit
     the cochlear hair cells, as the blood vessel (vas spralie) which feeds
     these cells cannot expand or contract. Furthermore, vasodilation may not
     always be helpful, as explains one FAQ contributor:
          
          A few years ago, physicians started treating some forms of
          stroke, especially TIA's, with vasodilators. The theory was
          that, with dilation, more blood could flow to the starved areas.
          A later study showed that, in many cases, the vasodilators made
          the condition worse. The reason was that dilation increased flow
          to non-damaged areas and robbed damaged areas of even more
          blood.
          
          By extrapolation, one could conclude that tinnitus related to
          vascular damage could be made worse with vasodilators. I have no
          data to back this extrapolation up, but it does seem reasonable.
     
     
     
     
   * zinc
     
     The cochlea has the body's greatest concentration of zinc. Supplements of
     90-150 mg per day may be beneficial in some cases. BUT BEWARE: high levels
     of zinc interfere with the body's absorption of copper, leading to anemia.
     Several studies have identified the 150mg dosage as leading to toxicity
     problems. Zinc therapy when prescribed by physicians is often accompanied
     by frequent blood tests to monitor copper levels. Zinc has not been
     formally tested for the treatment of tinnitus.
     
     
   * diuretics
     
     Diuretics may be prescribed when Meniere's Disease is present. One
     contributor reported tinnitus relief from Dyazide. But be aware that some
     diuretics are ototoxic and can worsen or even cause tinnitus.
     
     
   * homeopathic remedies
     
     One contributor reports tinnitus relief from homeopathic cell salts:
          
          I am a big believer in homeopathic cell salts. They have help me
          tremendously in coping with the high input-output life of a
          drummer. I perform approximately 12-15 hours a week, full blast,
          which could take its toll (I'm 42) if I wasn't taking care of
          myself.
          
          For tinnitus, Kali Phos and Mag Phos for the nerves, Kali Mur
          for any swelling in the inner ear. If I take the remedy before
          retiring for the night, the symptoms are greatly relieved by
          morning, and always within 48 hours.
          
          These are generic names. There are several manufacturers,
          notably Scheussler's Cell Salts (the guy who invented them back
          in 1905), and Boiron out of France; Standard Homeopathy here in
          the U.S.; all of which are usually available in most health and
          nutrition stores.
          
          You cannot overdose on homeopathic remedies, they are very cheap
          ($5 for 150 doses), and extremely effective, especially on acute
          conditions.
     
     
   * betahistine hydrochloride (SERC)
     
     The symptoms of Meniere's Disease can be ameliorated somewhat by
     betahistine hydrochloride. It is sold, but alas, not in the United States,
     under a host of names. It should NOT be taken by anyone pregnant or
     lactating, by children, anyone with an adrenal tumor (pheochromocytoma),
     bronchial asthma, or peptic ulcers. Possible side effects are nausea,
     gastric distress, headache, rash.
     
     It is not always effective, but if it is, relief is provided for 6 to 12
     hours on the standard dosage of 24-48 mg per day. It is believed to reduce
     pressure in the inner ear, and perhaps improve the blood flow to the small
     blood vessels there.
     
     Betahistine hydrochloride is sold in Canada under the trade name "SERC",
     and is distributed by Solvay Kingswood, Inc, Scarborough, Ontario, M1B 3L6
     for Unimed, Inc.
     
     Here is one sufferer's SERC experience:
          
          I have suffered from Meniere's disease for 21 years. I've had
          endolymphatic sac and 8th vestibular nerve surgeries on my left
          ear during the last 5 years. Starting in September '95, my right
          ear, which previously had been fine, began ringing loudly. The
          hearing in the right ear declined dramatically. My doctor tried
          a course of steroids to no effect. It looked like I was going to
          be deaf within a year.
          
          A friend of mine found your tinnitus FAQ file and mailed it to
          me. I reviewed its contents with my doctor. He referred me to
          another doctor who is more familiar with homeopathic and other
          alternative treatments. This doctor encouraged me to try SERC,
          which is not available in the US. I got an appointment with a
          Canadian doctor in Windsor, Ontario. I started using SERC (one
          4mg pill three times per day) on April 20, 1995. Seven days
          later, nothing had improved so I increased the dosage to two 4mg
          pills three times per day (as the doctor said I could). Two days
          later the right ear ringing stopped completely and hasn't
          returned!!! I stayed on that dosage for a month. I've now cut
          back to 2mg three times a day and the ringing has not returned
          as of 7/30/95. There were no side effects from the SERC at any
          of the dosages I've tried.
          
          I have my life back. My left ear works pretty well with a
          hearing aid. My right ear has full normal hearing. I have no
          side effects from the SERC. (By the way, SERC is cheap. 100 4mg
          pills cost me about $18.)
          
          I'm happy to share my story with anyone. My name is Ken Cornell.
          Phone is: 313-878-0809. E-mail: cordley@ismi.net
          
          Please add this to your FAQ and keep up your good work. Your
          efforts have saved my hearing. All my friends, family, work
          associates and I thank you VERY much.
     
     
     
     
   * magnesium
     
     
          
          Magnesium Prevents Hearing Loss:
          
          Three hundred young healthy male military recruits undergoing
          two months of basic training were studied. The trainees were
          repeatedly exposed to high levels of impulse noises. Each
          recruit received daily either 167 mg of magnesium (as magnesium
          aspartate) or a placebo (sodium aspartate). Permanent hearing
          loss was significantly more frequent and more severe in the
          placebo group than in the magnesium group-
     
     Attias J, Weisz G, Almog S, Shahar A, WienerM, et al. Oral magnesium
     intake reduces permanent hearing loss induced by noise exposure. Am J
     Otolaryngol 1994;15:26-32.
     
     
          
          COMMENT: Hearing loss is a common problem, particularly among
          older individuals. Although there are many causes, repeated
          exposure to excessive noise is one key factor. Many people do
          not realize how much noise pollution we are subjected to on a
          daily basis, from the steady hum of home appliances to the roar
          of trucks and autos. People who live in large cities face a
          constant bombardment with potentially damaging noise. Studies in
          animals have shown that noise exposure causes magnesium to be
          lost from the body. Perhaps supplementing with a little
          magnesium might prevent all of that noise from damaging your
          hearing.
     
     
     
     Nutrition and Healing, November 1994, p.8
     
     
   * caroverine
     
     Some research on caroverine is being done in Austria:
          
          Dr. Doris Maria DEINK c/o
          Universitiftsklinik flir Hals-Nasen-Ohrenkrankheiten
          Vorstand: Univ.Prof.Dr. KEhrenberger
          Allgemeines Krankenhaus der Stadt Wien
          1090 Wien, Wahringer Gurtel 18-20
          Telephone: 011-43-1-426355
          
          
          September 9, 1994
          
          Dear Mr. Berger,
          
          Referring to your letter of August 1994, 1 am writing to give
          you some informations, about our tinnitus treatment with
          Caroverine. As you already know, the treatment with Caroverine
          is indicated in cases of cochlearsynaptic tinnitus. Therefore, a
          thorough ENT and audiological examination is necessary before
          therapy to rule out other tinnitus causes. If necessary, the
          diagnostic measurements should also comprise brainstem
          audiometry. As far as I know, Caroverine is not available as a
          registered drug in the United States. Therefore, I do not know
          any collegue who uses this substance in tinnitus treatment.
          Caroverine is a commercially available drug in Austria
          (Spasmium-R), Switzerland and Japan. In Austria, Spasmium-R has
          been used as a spasmolytic drug for nearly 30 years. I am
          enclosing some information about Spasmium-R. Caroverine is a
          Quinoxaline - derivative. It is produced by
          DONAU-PHARMAZIE-CEHASOL Ges.m.b.H., A-1230 VIENNA, AUSTRIA. You
          can get further informations about the availability of
          Spasmium-R from: PHAFAG AG, Im Bretscha 29,FL-9494, SCHAAN,
          LIECHTENSTEIN FAX 05/075/232 19 93.
          
          For tinnitus treatment, Caroverine is applied as slow
          intravenous infusion (2 ml per minute). The dosage of Caroverine
          differs from patient to patient and depends on the tinnitus
          reduction achieved in the individual patient. When the tinnitus
          is reduced, the infusion is stopped. At maximum, 160mg
          Caroverine (4 ampules) are given in 100ml physiologic saline
          solution. Until now, we have not observed any severe
          side-effects. In some patients, a slight transient headache or
          dizziness occured. I hope that our informations will help you a
          little.
          
          With best wishes for you,
          Yours sincerely,
          Dr. Doris-Maria Denk, MD
          
          Dr. Doris Maria Denk
          Allgemaines Krankenhaus der Stadt Wien
          HALS-, NASEN- UND OHRENKLINIK
          DER UNIVERSITAT WIEN
          Vorstand: Prof. Dr. K. Ehrenberger
          A-1090 Wien Lazarettgasse 14
          tel. 40400/3305
          FAX 43/222/4021722
          
          
          Jan.23, 1993
          
          The symptom tinnitus may be due to various causes. Therefore, an
          exact audiological examination is absolutely necessary. The
          tinnitus therapy with transmitter antagonists can influence a
          special form of tinnitus - the so called cochlear synaptic
          tinnitus. It is caused by functional disturbances in the synapse
          between the inner hair cells and the afferent dendrites of the
          auditory nerve. By intravenous application of transmitter
          antagonists (e.g. GDEE, Caroverine) the synaptic function can be
          improved and the tinnitus reduced.
          
          All other forms of tinnitus cannot be reduced by transmitter
          antagonists. The substances we use for therapy of cochlear
          synaptic tinnitus are GDEE (Glutamic acid diethyl ester) and
          Caroverine. GDEE is not a registered drug and is only available
          upon special request by the clinic. The substance is produced by
          "FLUKA Biochemie, Industriegasse 25, CH-9479 BUCHS,
          Switzerland). GDEE has to be lyophilised in order to be
          effectful. Now we are mainly using Caroverine. This substance is
          a registered drug in Austria (SpasmiumR) and known for its
          spasmolytic effect. At the Annual Meeting of the American
          Academy of Otolaryngology Head and Neck Surgery in Washington in
          September 1992 I reported about our results. Now we are
          preparing a publication. I am enclosing some information about
          our therapy (including papers about the theoretical basis).
          
          In your case the tinnitus etiology seems to be noise. If in
          addition to the mechanical damage of the inner ear a functional
          disturbance is present, there is a chance to influence the
          tinnitus. If you like to come to Vienna for therapy, please
          contact me to fix a date. I would propose a date at the
          beginning of March. If I can be of any further assistance,
          please let me know.
          
          Yours sincerely,
          Doris-Maria Denk, MD.
          
          
          Head and Neck Surgery
          Therapy of Cochlear Synaptic Tinnitus
          DORIS MARIA DENK MD (presenters, R. BRIX PHD, D. FELIX PHD, and
          K EHRENBERGER MD, Vienna, Austria
          
          
          Tinnitus occurs in about 60% of inner ear diseases. A tinnitus
          model that explains the pathophysiology of a certain type of
          cochlear tinnitus, the so called cochlear synaptic tinnitus, is
          presented. Cochlear synaptic tinnitus is caused by functional
          disturbances of the synapse between inner hair cells and
          afferent dendrites of the auditory nerve. This may be the case
          in sudden hearing loss, hearing loss in the elderly
          ("presbycusis") or noise-induced hearing loss. The cochlear
          synapse has the following characteristics: (1) glutamate is
          supposed to be the transmitter substance, and (2) on the
          subsynaptic membrane, two different receptor types work as a
          dual receptor system: NMDA (N-methyl-D-aspartate) and
          non-NMDA-receptors (Quisqualate, Kainate). This dual receptor
          system is responsible for a typical pattern of depolarization,
          which can be shown in microiontophoretic animal experiments.
          Under pathological conditions, spontaneous receptor-dependent
          depolarization patterns mimic sound-induced patterns, which are
          perceived as tinnitus. On the basis of these considerations, we
          use the specific Quisqualate antagonist glutamic acid diethyl
          ester (GDEE) for therapy of cochlear synaptic tinnitus to
          normalize the synaptic function. We have treated 130 patients by
          intravenous application of GDEE. In 77.2% of the patients,
          tinnitus was reduced by more than 50% in absolute values of
          sound intensity. The indications, diagnostic and therapeutic
          procedures, as well as methods of subjective and objective
          evaluation of the therapeutic effect, will be discussed.
          
          CAROVERINE
          Countries Where Available and Release Dates: Austria (1970);
          Sp. synonyms: v TP 20 1 - I
          Brand Names und Manufacturers:
          Base: Espasmofibra-Faes (Spain), Spasmiurn-Donau Pharmazie
          (Austria)
          Hydrochloride: Espasmofibra-Faes (Spain), Spasmium-Donau
          Pharmazie (Austria)
          Drug Action: Spasmolytic.
          Indications/Usage: Intestinal spasm; biliary spasm.
          How Supplied: 20 mg capsules; 40 mg ampules; 40 mg suppositories
          Dosage: 40 mg up to 3 times daily.
          Precautions/Warnings: Hyperthyroidism; cardiac insufficiency;
          muscular weakness in the elderly and disabled.
          Contraindications: Glaucoma; prostate hypertrophy; duodenal
          obstruction.
          Interactions: Phenothiazines; anticholinergics; antihistamines;
          tricyclic antidepressants; digoxin.
          Adverse Effects: Dry mouth; blurred vision; urinary retention;
          tachycardia.
          US Treatments: Cicyclomine, L-hyoscyamine and propanthelin are
          US anticholinergic drugs with similar pharmocologic properties
          
     
     
     
     
   * carbogen
     
     
          
          From: govaerts@uia.ua.ac.be (Paul.Govaerts)
          To: Sigeroo@aol.com
          
          Dear Mr Segal
          
          ....The problem of acoustic trauma is completely different from
          a large vestibular aqueduct or even a sudden deafness. In
          acoustic trauma there is both physical lesion of the hairs of
          the hair cells and biochemical lesion of the auditory neurons
          because of toxicity of the excitatory neurotransmittor that is
          involved. (Ref Prof Pujol, Montpellier, France). The tinnitus
          and vertigo and I guess also the hearing loss result from these
          lesions. It has been shown that these cells may have a good
          potential for recuperation and possibly also for regeneration
          (ref Van De Water, Bronx, NY and Lefebvre, Liege, Belgium). By
          administering vaso-active drugs and carbogen inhalation, a
          massive peripheral vaso-dilation is triggered, bringing huge
          amounts of oxygen and nutrients to these damaged cells. Although
          one has not been able to demonstrate superior effect of
          vasoactive drugs to placebo, carbogen has never been really
          studied. And I have several cases with sudden deafness
          (including after acoust or baro-trauma) who were not responding
          to vasoactive drugs and who responded spectacularly to carbogen,
          even when given several weeks after the injury. Unfortunately
          this treatment has no success when given too late, since there
          is no more potential for regeneration....
          
          Yours,
          
          Paul Govaerts, MD, MS.
     
     This information is courtesy of Dan Segal (sigeroo@aol.com).
     
     

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



10) What other treatments are available for tinnitus?


   * surgery
     
     For tinnitus caused by acoustic neuromas , vascular abnormalities , and
     TMJ syndrome. But note above in the Causes section that tinnitus,
     hyperacusis , or even profound deafness can _result_ from ear/skull
     surgery.
     
     
   * maintain a healthy diet & lifestyle
     
     This means no tobacco, no alcohol, no caffeine, low fat, low sodium. This
     may not cure your tinnitus, but there are other well-proven health
     benefits. Other less obvious foods like quinine/tonic water should also be
     avoided. If your dietary intake isn't sufficiently diverse, consider
     supplements:
          
          My research work during the past ten years has been on health
          and nutrition, and I can see that use of some dietary
          supplements would be a rational approach to ameliorating
          tinnitus. More than half of our population is at least slightly
          deficient in all of the B vitamins, magnesium, zinc, and perhaps
          copper and iron. Since folate, vitamin B6, vitamin B12 are
          critical for tissue repair and organ regeneration, it would be a
          very good idea to consider supplementing the daily diet with
          these. In addition, our diets are deficient in essential
          elements, including calcium, magnesium and zinc. Calcium is
          necessary for the action of about 500 enzymes, while magnesium
          is required by about 400 enzymes. All of these are interlinked
          in a system that is active 24 hours a day. Just supplementing
          the diet with one will not be completely effective if others are
          lacking. I think that the first step for anyone who wants to be
          really healthy, with ability to efficiently repair tissue and
          organ damage, should examine the diet critically to find
          deficiencies, then make sure that all of the essential elements
          and vitamins are present in greater than minimal amounts.
          Supplements make very good sense if approached this way.
     
     
     
     
   * biofeedback
     
     Useful as a stress reduction tool, biofeedback may help some people.
     
     *****[comments from someone who's been there?]*****
     
     
   * accupuncture
     
     May provide temporary relief to some people. One contributor reports
     significant relief that enabled him to avoid the heavy-duty
     anti-depressants that his Western physician had prescribed.
     
     
   * stress reduction
     
     Many people say their tinnitus is more active when they're tired and
     stressed out. Get a good night's sleep and avoid unnecessary stress.
     
     
   * hearing aids
     
     Some people with severe tinnitus may benefit from hearing aids that bring
     normal speech sounds above the background tinnitus sounds. In addition to
     amplification, hearing aids may be useful as maskers when they also
     introduce white noise into the sound stream.
     
     
   * cranial sacral therapy
     
     There is anecdotal evidence of help for tinnitus through cranial sacral
     therapy by osteopaths and chiropractors.
     
     
   * electrical stimulation
     
     Various electrode placements with various voltages & frequencies may
     provide some relief. External, ear canal, transtympanic, middle ear, and
     cochlear electrodes have all been tried. Side effects may include pain,
     and alterations to sense of taste & smell. In one study of electrical
     stimulation on the round window, 3 out of 5 patients experienced some
     relief when frequencies of 40 Hz or less were applied.
     
     
   * surgically severing the auditory nerves
     
     An Eighth Nerve section is the treatment of last resort. You will be
     totally deaf. But beware - if your tinnitus originates somewhere inside
     the brain, you will be totally deaf AND still have tinnitus. A prominent
     American tinnitus specialist says this surgery should never be done for
     tinnitus, since he knows of patients whose tinnitus INCREASED to suicidal
     levels afterward.
     
     
   * hyperbaric oxygen therapy
     
     This treatment is supposed to be beneficial when the tinnitus is thought
     to be due to a lack of oxygen for the hearing mechanism. It may be more
     effective for recent onset cases rather than long-term ones. [Ed. note:
     this treatment is not without risk; at one such center in my community
     that treats Alzheimer's patients, the door seals on the chamber failed,
     resulting in an explosive decompression that injured several patients.]
     One poster to alt.support.tinnitus has this to say about the therapy:
          
          Following is a summary (my own words) of an article which
          recently appeared in the "MAINZER ALLGEMEINE ZEITUNG" describing
          a new method treating T with pure oxygen under high air pressure
          (hyperbaric oxygen treatment - in short "HBO" treatment).
          
          PLEASE NOTE: I cannot in any way guarantee the validity of the
          information given in that article. The same is true for my
          interpretation of the article's information and my summarzing it
          (I tried to be as close as I could). Using this info is at the
          reader's own risk.
          
          SUMMARY starts:
          
          A doctor's practice in Duesseldorf (no further details
          mentioned) uses a submarine-like tube (6 meters in length) which
          is a similar device as used for treating divers who have
          suffered a diving accident or patients with carbon monoxide
          poisoning or having had a "hearing infarct" (could not find the
          right English word !). Such "Oxygen Therapy Centers", mostly
          stationary ones, do exist at various other locations in Germany,
          mainly hospitals.
          
          Twelve tinnitus patients can be accomodated in Duesseldorf at
          the same time. Treatment is comparable to a dive to 15 meters
          depth of water while breathing pure oxygen. Consequently,
          treatment starts with air pressure in the tube being raised
          slowly within 20 minutes. Pure oxygen is supplied to each
          patient via oxygen mask. Treatment lasts for two hours.
          Depressurization at the end lasts somewhat longer than 20
          minutes. An experienced professional diver is accompanying the
          patients during treatment to assist them if they have problems
          due to climbing or falling air pressure. Newspapers and
          headphones are provided to help avoid boredom during the two
          hours treatment.
          
          Ten consecutive treatments are offered, one each day. Cost: 300
          DMarks (about just below $ 200.-) per treatment.
          
          HBO treatment is offered to patients who often have been
          suffering from tinnitus for years with no other traditional
          treatments having helped (like infusions, blood circulation
          improving medicine, etc). -- Health insurance normally does not
          cover the HBO treatments. They may consider taking part of the
          bill, however, in specific cases, e.g. if classical tinnitus
          treatment methods have been used unsuccessful.
          
          Traditional medicine has not found a general treatment method
          for tinnitus so far. The theory behind the new HBO treatment is
          based on the assumption that tinnitus is caused mainly by oxygen
          supply shortage in the inner ear organs. Studies at Munich
          Technical University have shown that pure oxygen treatment under
          high air pressure can increase oxygen saturation in the inner
          ear up to 500 %. In the USA and in the former Soviet Union this
          method reportedly has been used extremely successfully for many
          years. Alone in Moscow are about 40 pressure chambers in use.
          (No further details for either country).
          
          Cure from tinnitus through the new therapy cannot be guaranteed,
          according to the doctors. The article closes with a statement of
          one doctor: "I can hardly *promise* anything."
          
          SUMMARY end !
          
          So much for the article. I hope I could understandably relay
          what it said. No information has been supplied in the article
          about success rates or the like. -- I hope this information is
          of some help. If some co-sufferer has tried the HBO treatment
          his comments would certainly be very welcome.
     
     
   * feedback therapy
     
     A poster to alt.support tinnitus reports about a therapy involving
     listening to a series of electronically-produced tinnitus noises:
          
          This may be old news to some readers, but perhaps many others
          might be interested. A very interesting paper by L. P. Ince, et
          al appeared in the journal Health Psychology in 1987, "A
          matching-to-sample feedback technique for training self-control
          of tinnitus." Here's a summary:
          
          Ince and his colleagues worked with 30 individuals suffering
          from tinnitus, and used a "matching-to-sample" feedback
          procedure. Each subject's tinnitus sounds were reproduced
          electronically and played into either one ear (for those with
          single-side T) or both ears. The sound was then reduced by 5 dB
          during each session. The subject was asked to "think" their
          tinnitus sounds down to match the signal that was supplied. No
          instructions were provided as to how to do this...each subject
          just tried the best he or she could. Each trial lasted 60
          seconds, with 30 second rests between trials. If the tinnitus
          was brought down to the lower level during any one trial, the
          subject was then supplied with the electronically-produced sound
          that was lowered by an additional 5 dB, otherwise the same
          signal was provided. A total of 15 trials were run each session
          (so, less than one half hour overall for the session). Subjects
          went through 3 to 12 of these sessions.
          
          Almost all of the 30 subjects experienced a reduction in their
          tinnitus. One subject completely eliminated the tinnitus in 3
          sessions. By the end of the experiment, eight subjects
          eliminated the tinnitus. One subject who had had tinnitus for 30
          years reduced the level from 40 to 10 dB.
          
          The subjects' tinnitus at the start varied greatly in quality
          and loudness and had varied greatly in the duration since onset.
          
          This experiment showed that many people could be trained to "not
          hear" their tinnitus. This was not just a case of the subjects'
          being less bothered by the sounds, but actually reducing the
          sound levels. This was shown by playing random sound levels for
          the subjects who indicated when the sound level matched their
          tinnitus.
          
          I wrote Dr. Ince in 1991. He replied that he was not a tinnitus
          specialist and had ceased his studies. However, he was very
          willing to aid professionals who wished to try to replicate his
          results. He also informed me that it is not possible to
          reproduce his study with standard household electronic equipment
          (such as tapes), and only trained audiologists should try to do
          such a study.
          
          Dr. Ince's study reminded me of an interesting question I once
          heard asked about tinnitus: Why doesn't *everyone* hear wild
          noises? The blood going through the inner ear creates vibrations
          that are FAR greater than even fairly loud sounds outside the
          ear. Perhaps we all have trained our brains to ignore such
          sounds.
     
     A prominent American tinnitus specialist says that Ince's work was a
     "misleading dead end".
     
     
   * Auditory Integration Training (AIT)
     
     Auditory Integration Training (AIT) was originally developed by a French
     doctor named Alfred Tomatis. Another French doctor who was seeking a cure
     for his tinnitus (the crickets he kept hearing everywhere he went)
     received Dr. Tomatis's training. Dr. Guy Berard was so fascinated by the
     cure that he studied it and modified the treatment. The original Tomatis
     auditory training is still available today. It involves many hours of
     listening therapy, sometimes on the magnitude of hundreds of hours of
     therapy. (See sound therapy, below.)
     
     Dr. Berard's auditory training method is ten total hours of treatment. The
     treatment involves listening to music that has been altered such that the
     high frequencies and low frequencies are randomly shifted in and out. The
     sessions are 30 minutes in length given twice a day (treatments separated
     by four hours) for 10 days. Some practictioners opt to run the program in
     two consecutive weekday blocks while others run the program through the
     weekend. The music ranges from Gordon Lightfoot to reggae. It sounds
     distorted.
     
     The Berard method of AIT is described in Dr. Guy Berard's book, _Hearing
     Equals Behavior_. The method was brought to the United States in the early
     nineties by Annabel and Peter Stehli whose daughter recovered from autism
     after receiving AIT in France. Their daughter's story is documented in
     Annabel's book, _The Sound of a Miracle_. Because of the Stehli's
     affiliation with autism, AIT is used heavily by persons with autism and
     hyperacusis although Dr. Berard has used AIT mostly for learning
     disabilities, tinnitus, and depression.
     
     There are two different devices that are capable of delivering Berard AIT:
     the audiokinetron, which was developed by Dr. Berard, and the BGC which is
     designed and manufactured in the United States. Research has not shown any
     difference in results according to which machine delivers the AIT.
     
     The preparation for AIT usually involves an audiogram to look for
     hypersensitive hearing. A normal audiogram should be nearly flat (all
     frequencies heard equally well) but sometimes a person may have an
     audiogram that resembles a mountain range. If a person shows extreme
     sensitivity to particular frequencies, then filters may be used during AIT
     to eliminate those frequencies from the training. However there is some
     feeling that by filtering out certain frequencies the randomization of AIT
     is reduced and perhaps the effectiveness is reduced.
     
     There is no scientifically proven theory explaining why AIT works. It may
     be that the stimulation of the middle ear acts and physical therapy for
     the ear. Since each frequency stimulates a different area of the cochlea,
     it may be that the broad range of frequencies evens out the cochlear
     response to sound.
     
     Once a person has undergone AIT, they should not listen to music through
     headphones as it may undo the training. Other factors that have been known
     to reverse the benefits of AIT have been high fevers (meningitis), general
     anesthesia, exposure to loud sounds, and headphone use for music.
     Listening to voices (story tapes or language tapes) is acceptable.
     
     AIT treatments do not work on those with hyperacusis and can actually
     worsen the condition - particularly the tinnitus, because it is
     administered at uncomfortably loud sound levels.
     
     For further information on AIT:
     
        * Hearing Equals Behavior, by Dr. Guy Berard (translated by Simone
          Monnier-Clay & Catherine Dodge), 192 pages, 1993, paperback US$17.95,
          ISBN 0-87983-600-8, Keats Publishing Inc., New Canaan, CT USA, +1 800
          858-7014.
        * The Sound of a Miracle by Annabel Stehli
        * Dancing in the Rain, edited by Annabel Stehli. This is a collection
          of stories written about children with special needs who have
          undergone AIT.
     
     AIT organizations:
     
     The Georgiana Organization
     P.O. Box 2607
     Westport, CT 06880 USA
     +1 203 454-3788
     
     A packet on AIT as well as a list of AIT practitioners trained by the
     Georgiana Organization.
     
     Autism Research Institute
     4182 Adams Ave.
     San Diego, CA USA
     
     A packet on AIT which includes research papers published by Steve Edelson,
     Ph.D.
     
     Society for Auditory Integration Training
     Center for the Study of Autism
     Boardwalk Plaza, Suite 230
     9725 SW Beaverton-Hillsdale Hwy
     Beaverton, OR 97005 USA
     +1 503 643-4121
     
     SAIT (Society for Auditory Integration Training) is dedicated to the
     enhancement of the quality of life for individuals with special needs
     through auditory integration training. The purpose or goal of SAIT is to
     establish policies, minimum training and equipment standards and
     guidelines for _all_ AIT practitioners, and to promote a professional
     image. SAIT's objectives are: Promote professional and ethical standards
     for AIT; Set procedural standards; Promote networking and sharing of
     information; Advise and evaluate research on the efficacy of AIT.
     
     SAIT does not promote any single method of AIT (Berard, BGC, or other).
     They will provide you objective information about many issues concerning
     Auditory Integration Training (research, age recommendations, after-care,
     etc.) and answer frequently asked questions. They maintain a list of
     persons trained in _both_ the Berard and BGC methods of AIT.
     
     The SAIT Newsletter is published quarterly and is full of information on
     AIT. Associate membership ($30) is open to anyone interested in AIT.
     Professional memberships (reserved for practitioners who had passed the
     examination for SAIT certification and who had the appropriate educational
     backgrounds) have been temporarily suspended pending FDA approval of the
     Audiokinetron and other AIT devices. Currently a Practitioner membership
     is open to practitioners who have been trained by an "approved"
     instructor. No certification of these members will take place.
     
     The recent FDA investigation of AIT has interrupted SAIT's efforts to
     certify practitioners and to insure the ethical and professional practice
     of AIT. Once the Audiokinetron and other AIT devices receive FDA approval,
     SAIT will recommence its original mission. Currently SAIT's first priority
     is to provide practitioners and families with information about the
     current status and pressing issues of AIT. The newsletter will focus on
     research, legal advice and other noteworthy news. A supplemental paper on
     a related topic will also be distributed on a quarterly basis to its
     members; such topics will include sensory integration, visual training,
     and hearing anomalies.
     
     
   * sound therapy
     
     Sound therapy originates from the work of Dr. Alfred Tomatis. The
     following is quoted from a flyer entitled "Tinnitus, Vertigo, and Sound
     Therapy", published by Sound Therapy Australia, P.O. Box E237, St. James,
     N.S.W. 2000 (this organization sells books and cassette tapes for this
     therapy):
          
          How can Sound Therapy help?
          
          The middle ear contains two tiny muscles, tensor tympani and
          stapedius, which play an active role in the functioning of the
          ear. Lack of tone in these muscles means that the ear loses its
          ability to recognise certain frequencies of sound, so these
          sounds never reach the inner ear. The ear's ability to adjust
          and balance the fluid pressure in the inner chambers is also
          impeded if the stapedius muscle is not fully functional.
          
          The electronic ear used in the recording of Sound Therapy
          challenges the ear with constantly alternating sounds of high
          and low tone. At the same time, low frequency sounds are
          progressively removed from the music so the ear is introduced to
          higher and higher frequencies. The result is a complete
          rehabilitation of the ear, improving the tone and responsiveness
          of the middle ear muscles. Once the ear is able to recognise and
          admit high frequency sounds to the inner ear, this creates the
          opportunity for the sensory cells in the inner ear to be
          stimulated and restored to their upright, receptive position.
          
          ...
          
          Meniere's vertigo
          
          Dr. Tomatis has proposed that Menieres vertigo which produces
          attacks of dizziness is also due to an anomaly in the tension of
          the stirrup muscle. This muscle may be subject to involuntary
          twitches, like any other muscle in the body. Such twitching
          would radically alter the fluid pressure in the inner ear
          chambers, thus causing havoc with the balance mechanism. The
          re-toning of the stirrup muscle achieved by Sound Therapy
          frequently resolves this condition.
          
          Does it really work?
          
          ...
          
          The length of time it takes to achieve results varies from
          twenty four hours to fourteen months. Usually more severe cases
          take longer, so it is advisable to persist with the therapy for
          at least six months.
          
          ...
          
          The initial results of a listener survey conducted by Sound
          Therapy Australia [Ed. note: not exactly unbiased] indicate that
          96% of tinnitus sufferers who perservered with the listening
          felt they benefited from the therapy. Of these, 20% said the
          tinnitus stopped completely, and 36% experienced a reduction in
          the sound. The other 44% experienced other benefits such as
          improved sleep and reduced stress, which made the tinnitus
          easier to bear.
     
     
   * hypnotherapy
     
     Hypnotherapy has been reported by Dr. Kevin Hogan, who is a registered
     Clinical Hypnotherapyst, to be showing remarkable results for tinnitis
     sufferers .
     
     Dr. Hogan says, (in reguards to a April 95 release of a study by Mason, J,
     Rogerson, D, Derbyshire Royal Infirmary, UK., which stated, in part:
     ...."therapy for their tinnitus....68% showed some benefit for their
     tinnitus ...32% showed no evidence of improvement for their tinnitus"....)
     ..."This confirms previous research in the use of hypnotherapy to reduce
     the volume and distress of tinnitus. The best controlled study I have on
     hand shows 74% efficacy"....
     
     

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



11) What is masking?


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

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

Residual Inhibition

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

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

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

The following is an excerpt from: Oregon Tinnitus Data Archive&nbsp;95-01

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

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


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

End of excerpt.

Some masking machine vendors:

Ambient Shapes, Inc.
P.O. Box 5069
Hickory, NC 28603
USA
+1 800 438 2244
+1 704 324 5222

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
+1 800 344 4444

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

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

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



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


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

   * moldable ear canal plugs
     
     Moldable ear plugs come in foam, silicone, and wax and fit into the ear
     canal itself. Because they are moldable, a tight fit is always obtained.
     These are the best hearing protection devices available today, with NRRs
     ranging from 15-33dB. Cheap, available in drugstores, and reusable.
     
     
   * custom ear plugs
     
     These plugs are made from impressions taken of the customer's ear canal.
     NRRs range from 27-29dB, with the cost typically US$30-70. You generally
     order these through a hearing specialist who will take the impressions.
     
     
   * filtered musician's ear plugs
     
     A variation on custom plugs that offer even sound attenuation across a
     broad spectrum of frequencies. NRRs range from 15-20dB, and cost ranges
     from US$50-150. A contributor offers this review for one popular brand:
          
          Now for my 2 cents worth. I am an acoustic engineer working for
          the British Broadcasting Corporation (BBC). Although my main job
          is designing studios, I also act as a consultant on noise at
          work legislation. In that capacity I work on the safety of
          people listening professionally on earphones and loudspeakers,
          and also musicians in the several orchestras which the BBC
          maintains. So I am interested in such items as musicians
          earplugs.
          
          We intend to conduct, in the near future, a trial of the
          filtered musicians' earplugs that you refer to, and I can
          therefore fill out a bit of information on these. The ones we
          intend to use are type ER15 from Etymotic Research. These have
          an attenuation of 15dB, largely independent of frequency. (As
          far as I can find out, these are the only plugs claiming "flat
          attenuation" for which independent lab reports of attenuation
          are available. Of course you must have such a report if you're
          going to use the plugs for industrial safety purposes.)
          
          Etymotic Research (they like to pronounce the "o" long, as in
          rose, by the way, and print it with a line over the top, but I
          think they're fighting a losing battle on this one) also make a
          non-individually moulded "constant attenuation" plug, the ER20.
          However a close examination of its attenuation vs. frequency
          characteristic shows that it is really not all that different
          from more ordinary plugs. Despite this, some musicians report
          finding it useful. Its overwhelming advantage is that it comes
          at about 10UKP per pair!
          
          I can confirm the address you give for Etymotic Research. They
          are probably the best people to approach for details of
          suppliers in the American continent, as they will be up to date
          with changes.
          
          In the UK, the distributor is:
          
          MBS Medical Ltd
          129 Southdown Road
          Harpenden
          Herts. AL5 1PU
          England
          +44 (0)1582 767007 voice
          +44 (0)1582 767214 fax
          This is a fairly recent change of supplier.
          Cost in the UK - about 120UKP per pair.
          
          
          The main distributor for Europe is in Holland:
          Elcea BV
          PO box 230
          5100 AE Dongen
          The Netherlands
          +31 (0) 1623-18480
          
          
          A large scale research programme on the use of flat attenuation
          earplugs with the Dutch Philharmonic Orchestra has recently been
          carried out by Dr Van Hees of Amsterdam University. I believe
          the findings will be made public soon, and I will post you if
          they are relevant.
          
          I have had a pair of these ER15 plugs moulded for myself, to see
          what it's like both having the moulds made and wearing them. The
          ears must first be checked for wax, which must be dissolved out
          in the usual way if excessive. Soft putty-like material is then
          put in the ears to make the mould. This is slightly
          uncomfortable, but certainly not painful. The moulds are then
          sent away to have the plugs made. For Europe, the plug
          manufacture is done by Elcea in Holland, who have a special
          apparatus for determining when the hole is the correct diameter.
          The filters are small flat devices which clip on to the outside
          of the plugs. The plugs are reasonably comfortable in use,
          although my own ear canals are very narrow and most earplugs
          don't fit me well. To give the flattest attenuation
          characteristic, the plugs go somewhat deeper into the ear than
          an ordinary hearing-aid earpiece.
          
          Early reports indicate that although their attenuation is less
          than that of other plugs, it is still too much for some
          musicians. It is possible that a lower attenuation plug will be
          available in future.
          
          Although my own work with musicians mainly involves symphony
          orchestras, musicians who work on stage in shows and rock
          concerts are probably at higher risk, due to high levels of
          sound from "foldback" loudspeakers. Listening using small in-ear
          earphones (which may possibly be individually moulded) can
          reduce the required foldback sound level, as the earphones keep
          out a lot of the external sound.
          
          Systems:
          
          Etymotic Research make high quality (but expensive) earphones
          which may be used for this purpose - type ER4.
          
          A well known system of this type, usually using a radio link to
          the performer, is The Radio Station. Manufacturer:
          
          Garwood Communications
          Ltd 8A Hassop Rd
          Cricklewood
          London NW2 6RX
          England
          +44 (0) 181 452 4635 voice
          +44 (0) 181 452 6974 fax
          
          
          No doubt I have gone on about some of my pet subjects at
          excessive length, but I hope you may find something useful here.
          I must, of course, say that my views are entirely my own and
          must not be quoted as the BBC's.
     
     
   * ear muffs
     
     These over the ear devices are more comfortable than canal plugs, and have
     NRRs that range from 23-29dB. But they are very bulky and obviously can't
     be worn discretely.
     
     
   * active sportsman's ear muffs
     
     These are active (possibly amplifying), powered devices that pass normal
     levels of sound, but will attenuate extremely loud impulse-type noises
     similar to gunshots, etc. They are typically sold through gun catalogs and
     sporting goods stores, and when used in combination with plugs can achieve
     near-maximal NRRs of about 50dB.
     
     Note that amplified muffs actually have a negative NRR, which is one
     indication that the NRR doesn't tell the whole story for "impulse" noise
     such as gunshots. These muffs detect impulse noise and turn off the
     amplification in time to keep that noise from reaching the ear through the
     electronics. See below for a first-hand account of active muff
     performance:
          
          Date: 16 Apr 1992 8:36 EDT
          Subject: Re: electronic muffs
          
          Having just purchased a set of Peltor Tactical 7-S active muffs
          from Dillon Precision, I'll add my two cents to the
          conversation.
          
          The T7-S's are stereo electronic muffs with a microphone on the
          front of each ear cup. They seem to be pretty sturdy in
          construction. One cup contains a circuit board covered with
          surface-mount parts and some trim pots. The other contains a
          nine-volt battery accessible from an outside door (there may
          also be a small circuit board in there, too). Each contains a
          small speaker, and the two are connected via a cable that
          crosses through the headband. There is a single gain control
          that is switched to provide the on/off function. Side-to-side
          balance is adjustable by one of the trim pots. A small concern I
          have is that the foam mic covers may come to harm while being
          jostled around in my range bag.
          
          I had originally thought (from where, I don't know) that the
          circuit amplified sound according to the gain control, and shut
          off completely noises above 85dB. In fact, the unit never
          actually shuts down, or if it does the switching is so quick and
          quiet that it gets lost in the muffled sounds coming through the
          muff's cups. There is constant compression, so that soft sounds
          are boosted, and loud sounds are limited to 85dB or less. The
          effect is strange at first, because you don't think there's much
          muffling being done, but believe me, you can find out real quick
          that the things work very well indeed.
          
          I used the muffs at an outdoor .22 silhouette match, then later
          in the day at a large indoor range where we were shooting .45
          ACP and light .44 mag loads. At the match, they worked great. I
          could hear the spotters, the range officer, and all the others.
          I really didn't have a problem with distractions as another
          poster stated. The only "problem" I had was that at high gain I
          could easily hear the road noise of cars and trucks passing by
          about a quarter-mile away. The muffs seem to preserve
          directional information, since I don't remember having any
          problems locating sounds (like the CLANK when a ram fell over
          100 yards away).
          
          The indoor range seemed a little different. Gunshots sounded a
          bit more veiled, whereas outdoors they just sounded lower in
          intensity. Voices were still easy to hear, but also sounded
          funny, so it was probably the echo in the large room. For grins,
          I tried the T7-S's at the indoor range without turning the
          active circuitry on, and swapped back and forth between them and
          some Silencio Magnum CDS-80 passive muffs (rated at -29dB -- my
          previous regular muffs). In an inactive state, the TS-7's were
          at least as effective as the Silencios. Further, the sound of
          the shots was perceived as being about an octave lower through
          the inactive T7-S's than through the Silencios. This was much
          more pleasant over the long run. In fact, my buddy, who was also
          wearing CDS-80's, said that his ears were starting to hurt by
          the end of our indoor range time. Mine were fine. (BTW, said
          buddy tried the T7-S's for a few minutes at each place -- he's
          ordering his today.)
          
          I tried sitting in a very quiet room with the muffs turned way
          up. I could hear my dog breathing in another room, and ripples
          on the surface of a small, nearby aquarium sounded like a set of
          river rapids. I could hear my own breathing quite clearly, and
          the cloth of my shirt rustling as it rose and fell. At really
          high gain, there was some whitish noise that was either the
          residual noise of the amplifiers, or the movement of air in the
          room.
          
          The muffs are very comfortable. I wore them most of the day with
          no problem. The ear seals are soft yet firm, and are probably
          more comfortable than the Magnum CDS-80's. The seals and inner
          foam pads are easily removable and replaceable. The rather
          sparse instruction manual suggests replacing them once or twice
          a year for hygienic reasons.
          
          All in all, I really like these muffs. It would be difficult to
          go back to passive protection after being able to hear
          "normally" while shooting. Dillon currently has the T7-S's on
          sale for $129.95. Regular price is $170. I have no connection
          with Dillon or Peltor save being a satisfied customer.
     
     And an addendum to the above account:
          
          Date: 5 Jul 1994 13:39 EDT
          Subject: Re: muffs review
          
          The battery should be a nine-volt alkaline, and it will probably
          last 10-30 hours (depending on gain setting used) before you'll
          notice a drop in volume. I have used the muffs while mowing
          (with a gasoline-powered mower), and with noisy power tools
          (like a circular saw), and they really help. Your ears do get a
          bit warm and sweaty on a hot day, however. Finally, I have seen
          pictures of new(?) Peltor muffs on which the foam mic covers
          were replaced by hard plastic grids. These might be an
          improvement.
     
      Some hearing protection vendors:

Westone Labs
P.O. Box 15100
Colorado Springs, CO 80935
USA
+1 800 525 5071

Sells custom plugs.

Dillon Precision Products
7442 E. Butherus Drive
Scottsdale, AZ 85260-2415
USA
+1 800 762 3845 for Catalog requests
+1 800 223 4570 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
+1 708 228 0006 voice
+1 708 228 6836 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 Acouphnes
La Varizelle
F 69510 THURINS
phone and telefax 78817312
The association publishes a magazine called "TINNITUSSIMO"

[Dues and services presently unknown.]


Germany


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

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

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


The Netherlands
Landelijk Bureau van de Nederlandse Vereniging Voor Slecthorenden
ter attentie van de Commissie Tinnitus
Postbus 9505
3506 GM Utrecht
The Netherlands
Phone: +31 30 617616
Fax: +31 30 616689

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


United Kingdom


British Tinnitus Association
14/18 West Bar Green
Sheffield S1 2DA
Phone: (0114) 279 6600

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
+1 503 248 9985

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

A brief history of the ATA and their relationship to the neighboring OHRC and
OHSU as provided by the Oregon Hearing Research Center:
     
     A doctor by the name of Charles Unice, from California, wanted to
     know what was being done about tinnitus (he was a sufferer), so he
     contacted the National Institutes of Health, who referred him to our
     laboratory. The Kresge Hearing Research Laboratory (US, in 1978 or
     so) was the only place in the United States doing research on
     tinnitus funded by the NIH at that time. Unice decided to found an
     American Tinnitus Association. Its purpose would be the dissemination
     of information about tinnitus, and if possible, to provide money for
     research on tinnitus problems.
     
     The American Tinnitus Association was started here in Portland, in
     order to be close to the research taking place. There were some
     interested citizens in Portland who were willing to help get it
     started. It was started under the "umbrella" of the University of
     Oregon Medical School (now called the Oregon Health Sciences
     University). It was started in Oregon, as opposed to Dr. Unice's home
     state of California, because of simpler tax laws here. Eventually,
     the ATA became an independent organization from the Medical School
     and is now doing quite well. They have offices in the downtown area
     of Portland, OR.
     
     In 1985, the Kresge Hearing Research Laboratory became the Oregon
     Hearing Research Center. We are the research division of the
     Otolaryngology-Head & Neck Surgery Dept. of the Oregon Health
     Sciences University. We're located in the west hills of Portland,
     above downtown.
     
     Dr. Vernon writes a column for the ATA in their "Tinnitus Today"
     publication. Members of the OHRC are often asked to review grant
     applications for ATA, as are other researchers in the area of
     tinnitus across the country. OHRC staff are also consulted for
     information regarding brochures and literature ATA develops. They
     refer calls and letters when they cannot provide the answers.
     
     Other than that, OHRC does not have any official ties to ATA. We are
     not receiving funding from them at this time (I say at this time
     because it is possible we could apply for grant applications in the
     future), and they receive no funding from the OHSU nor the OHRC.
     Their funding comes from contributions from their members and
     combined charitable campaigns.
     
     The OHSU Biomedical Information and Communications Center (BICC) has
     taken on as one of their missions to provide internet access to
     health providers in the state of Oregon. The ATA, as an organization
     who provides health information to the public, was given internet
     access by the OHSU. This does not mean that they are a part of OHSU.



H.E.A.R. (Hearing Education and Awareness for Rockers)
P.O. Box 460847
San Francisco, CA 94146
USA
+1 415 773 9590

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 (415) 773-9590.

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

(even smaller print):
"CHYK" 57 minute VHS. The Cinema Guild, NY.
"Can't Hear You Knocking" full length 57 minute video documentary is available
through the Cinema Guild of New York, 1697 Broadway Ste. 506 New York, NY
10019, office: 212-246-5522 fax: 212-246-5525. (Flynner Films, Stockholm,
Sweden).

NIH/National Institute of Deafness and Other Communication Disorders (NIDCD)
9000 Rockville Pike
Bethesda, MD 20892
+1 301 496-7243
+1 301 402-0252 (TDD/TT for the hearing impaired)


[Services presently unknown]

National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
+1 203 746-6518
+1 203 746-6927 (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
+1 615 329-7807 (Voice & TDD)


[Dues and services presently unknown]

Vestibular Disorders Association
PO Box 4467
Portland, OR 97208-4467
+1 503 229-7705 answering machine
+1 503 229-8064 FAX
E-Mail: veda@teleport.com
Web: http://www.teleport.com/~veda

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

The Hyperacusis Network
444 Edgewood Drive
Green Bay, WI 54302-4873
+1 414 468-4663
+1 414 432-3321 FAX


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

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

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

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



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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



15) What online resources are available?


On the Internet, the Usenet newsgroup alt.support.tinnitus is the primary
discussion forum. Several other peripheral newsgroups exist where people at
risk for tinnitus may be found, as well as for various health disciplines
relevant to the treatment of tinnitus. See the Newsgroups: header of this FAQ
for details.

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
alt-support-tinnitus@cs.utexas.edu . 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_CME
     A University of Texas paper on the causes and treatments of tinnitus.
http://www.bme.jhu.edu/labs/chb
     The Center for Hearing and Balance at Johns Hopkins University. The Center
     includes researchers, teachers, clinicians, and others in the Hopkins
     medical community. The goal of the Center is to perform basic and clinical
     research, train young basic and clinical investigators, and disseminate
     research results and relevant information to the medical community and the
     general public. Research is centered on auditory (hearing) and vestibular
     (balance) function in normal subjects and in patients with hearing and
     balance disorders, and on rehabilitation.
http://www.boystown.org/hhirr/tinnitis.html
     This is a link to the Boys Town National Research Hospital's page on
     Tinnitus (despite the spelling in the URL). [It's not incredibly
     informative, but the page above it has lots of good hearing information.]
http://www.teleport.com/~veda
     The Vestibular Disorders Association (VEDA) is a nonprofit organization
     that exists to provide information and support to people with inner ear
     disorders such as labyrinthitis, BPPV, and Meniere's disease.
http://www.ohsu.edu/~ohrc/ohrc.html
     The Oregon Hearing Research Center web server is a truly must-see server,
     with plenty of local OHRC information as well as pointers to other online
     information.
http://www.aro.org/showcase/aro/
     The Association for Research in Otolaryngology has hardcore research
     abstracts on many things, including cochlear hair cell regeneration.
http://kuni.nidcd.nih.gov/
     Learn about the basic research being done at NIDCD on cochlear hair cells.
http://lab9924.wustl.edu/home.htm
     More basic research being done at the Cochlear Fluids Research Laboratory.
     A good intro to inner ear anatomy is available.
http://lab9924.wustl.edu/men.htm
     A clinically orientated web page for patients with Meniere's disease
http.//www.hearnet.com/index.html
     Rock&Rollers advice to Rock&Rollers et. al. about the harmful effects of
     loud music.
http://members.aol.com/neurosense/tinnitus.html
     About a book called: TINNITUS - NEW HOPE FOR A CURE by Paul Van
     Valkenburgh
http://www.sconcept.com/~SammyC/hacusis.html
     The Hyperacusis Site: An online page that has information about
     hyperacusis and what can be done to relieve and/or cope with it.
http://www.cabotsafety.com/tech/earlog
     Includes a series of 20 articles on the study of hearing protection
http://www.dejanews.com/ Archives
     of alt.support.tinnitus since 01/01/96. Also does word searches in a.s.t
     and other newsgroups.
http://www.hollys.com/success-dynamics/
     Information about Tinnitus and the treatment of Tinnitus by Hypnosis.


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



16) What can I do when all else fails?


Here is one sufferer's advice:
     
     What caused my tinnitus? Everyone asks that question.
     
     For some of us, there was an illness, injury, or incident that seems
     directly related to the onset of tinnitus. I'm not sure how valuable
     being able to answer this question is, but at least it seems to be
     answered.
     
     For others, the onset is sudden, but for no obvious reason. For these
     people, it may be frustrating not knowing "why" but I'm not sure of
     the value of dwelling on this question.
     
     For others like myself, the onset was gradual, over the years. Then,
     about a year ago, the pace of the onset increased to where I am now
     aware 100% of the time that it's there. If I'm active, I don't notice
     it. But if there's a lull in my mental or physical activity or if I
     think about it, it's there.
     
     The point I want to make with this post is: Just as "Sh-t Happens",
     I'm afraid "Tinnitus Happens", too. And we're the victims, albeit to
     widely varying degrees.
     
     Unless it can provide a path towards treatment (and only your doctor
     can determine this), I don't think it is useful to dwell heavily on
     the "why".
     
     In my case, I fired shotguns with no ear protection when I was a kid
     & I listened to some too-loud music a few times. But that's all
     irrelevant now.
     
     I've got tinnitus. At present, there's no known treatment for me. So,
     here's what I'm doing about it:
     
        * I accept that I have tinnitus and I've dispensed with "why".
          
          
        * I recognize that it is my problem, not the problem of my
          friends, family, & business associates. I don't complain about
          it to anyone.
          
          
        * If, because of my tinnitus, I need to ask someone to repeat
          themselves, I simply ask. No apologies, no explanations.
          
          
        * I will monitor my need to ask for repeats. If I have an
          underlying hearing loss, I may need a hearing aid. As
          unattractive to me as getting a hearing aid may be, it is my
          responsibility to have my hearing evaluated & take appropriate
          measures. It is not the responsibility of the people around me
          to act as hearing aids.
          
          
        * I will attempt the various herbal remedies, giving them enough
          time to see if they're effective. However, for my own sanity, I
          will accept my present condition as the "zero base line". If a
          remedy helps, that's a "plus". If it doesn't, I remain at the
          baseline. In other words, failure to be helped by a possible
          treatment is not a negative. I will not allow disappointment or
          despair at a treatment failure to get me down.
          
          
        * Whatever the seriousness of my tinnitus, I will remember that
          others have it much worse & still others have just been
          diagnosed. These are the people who need my support and
          encouragement. I will offer it when I meet them and by posting
          to this newsgroup. I realize that by helping others, I am also
          helping me.
     
     Comments always welcome.



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



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


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

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



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


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


United States


House Ear Institute
2100 W. 3rd St.
Los Angeles, CA 90057
USA
+1 213 483-9930 voice
+1 213 483-5706 TDD

The Tinnitus Clinic
Oregon Hearing Research Center
Oregon Health Sciences University
3181 SW Sam Jackson Park Road
Portland, OR 97201
+1 503 494-7954

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

University of Maryland Tinnitus Center
419 W. Redwood Center
Baltimore, MD 21201
+1 410 328-6866

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

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

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



19) Who are the contributors to this FAQ?


Unless otherwise requested, all contributors will be credited here.


Lee Leggore                     nomader@eskimo.com (FAQ Maintainer)

Richard Alpert                  alpert@cs.bu.edu
Barbara Bixby                   markb@cccd.edu
Julie Bixby                     markb@cccd.edu
Mark Bixby                      markb@cccd.edu
Karl F. Bloss                   blosskf@ttown.apci.com
Paul Braunbehrens               Bakalite@bakalite.com
Sabra Broock                    sbroock@tmjfound.com
Pete Brooks                     Peter_Brooks@sj.hp.com
W. Keith Brummet                wkb@cblph.att.com
Angelo Campanella               acampane@postbox.acs.ohio-state.edu
David Charlap                   david@porsche.visix.com
Jim Chinnis                     jchinnis@interramp.com
Erik Christensen                erchrist@char.vnet.net
Michael Claes                   claes@bbt.com
Michael L. Connolly             connolly@netcom.com
Ken Cornell                     cordley@ismi.net
Thomas A. Creedon               creedont@ohsu.edu
Scott Dayman                    scott@ida.jpl.nasa.gov
Bob Dubin, DC                   drdubin@aol.com
Scott Dunbar                    dunbar@abacus.colorado.edu
Steven Wm. Fowkes               fowkes@ceri.win.net
Louis Goossens                  goossens@natlab.research.philips.com
Steve Gotthardt                 steveg@up.edu
Doug Gwyn                       gwyn@arl.mil
Jamie Hanrahan                  jeh@cmkrnl.com
George Harvey                   gwh@panpacific.reno.nv.us
Dr. Kevin Hogan                 meta@ix.netcom.com
Kuni H. Iwasa                   kiwasa@helix.nih.gov
Jean Jasinski                   jean@swttools.fc.hp.com
Norman F. Johnson               njohnson@nosc.mil
Douglas R. Jones                djones@iex.com
Martin Kaiser                   makaiser@alma.student.uni-kl.de
Patrick Koehne                  koehne@oslo.informatik.uni-dortmund.de
Sacha Krakowiak                 Sacha.Krakowiak@imag.fr
Laurie Kramer                   laurie@gdb.org
Richard Landesman               rlandesm@moose.uvm.edu
Jill Lilly                      lillyj@ohsu.edu
Darlene Long-Thompson, Rn       darlene@special-hearts.org
Colleen Lynch                   clynch@random.ucs.mun.ca
Allan MacDonald                 almacdon@fox.nstn.ca
Boyd Martin                     boydroid@netcom.com
Betty Martini                   betty@pd.org
Andy Matthiesen                 AndyMatt@ix.netcom.com
Rob McCaleb                     rmccaleb@hrf.org
Kevin McEvoy                    mcevoy_k_t@bt-web.bt.co.uk
Bernard H. Meyer                102630.1451@compuserve
Paul Murphy                     pmurphy@carbon.denver.colorado.edu
Daniel A. Norton                danorton@chsw.win.net
John Setel O'Donnell            jod@equator.com
Louise M. Peelle                lpeelle@umich.edu
Susan PF                        susanPF@aol.com
Mark A. Pitcher                 sols7520@mach1.wlu.ca
David Powner                    dave@filtermx.demon.co.uk
Derek L. Rintel                 N/A
Dallas Roark                    roark@kuhub.cc.ukans.edu
E. C. Roberts                   ecr@tomlinson.com
Joe Schall                      jschall@moose.uvm.edu
Dan Segal                       Sigeroo@aol.com
Mark Sharp                      mvsharp@tenet.edu
Chandra Shekhar                 chandy@sophia.inria.fr
Jeff Sirianni                   sirianni@uts.cc.utexas.edu
Jeff Slavitz                    jslavitz@netcom.com
Lori Snidow                     lnsnidow@ufcc.ufl.edu
Kurt Strain                     kurts@sr.hp.com
Manfred Thuering                manfred@mpi.unibe.ch
Jack Trainor                    jdt@well.sf.ca.us
Jerry Underwood                 veda@teleport.com
Dr. Jack Vernon                 vernonj@ohsu.edu
Peter Wanner                    wanner@pewa.rhein-main.de
Allen Watson                    allen_watson@quickmail.apple.com
Mike Watterson                  watterson@stsci.edu
Alan Wendt                      alan@ezlink.com
Tony Wolf                       tony@howl.demon.co.uk
Steve Zimmerman                 stevezim@crl.com
