VOLUME 4, NO.

2, JULY, 1979
THE AMERI CAN TINNITUS ASSOCIATION

Seminar- Honored
Guest
Dr. Jack Vernon, Director of the
Kresge Hearing Research Laboratory,
University of Oregon Health Sciences
Center, was the Guest of Honor at
the Firs t International Tinnitus
Seminar held in New York City on
June 8, 9, 1979.
The seminar, under the direction
of Dr. Abraham Shulman of Downstate
Medical Center, provided an opportunity
for the exchange of research efforts .
Over 250 invited professionals from
the field of hearing were attracted.
Dr. Vernon was cited for his many
contributions in the area of tinnitus,
and for generating interest among
professionals world wide in the
problem of subjective idiopathic
tinnitus.
His contributions include the
development of the tinnitus masking
program, the training of personnel
throughout the United States involved
in the treatment of tinnitus and
providing the impetus for much of the
electronic equipment used in the
evaluation and treatment of tinnitus
patients.
Our congratulations to Jack on being
the recipient of this honor.
RESEARCH
Drug Treatment
for Tinnitus
by Jeffrey M.D.
Dr. Israel is a Resident in Otolaryngology at the University of Oregon Health Sciences
Center. The following study represents the first of this type of investigation into
treatment measures. Other studies are being considered.
Currently work is being carried on at the Kresge Hearing Research Laboratory (research
facility in the Department of Otolaryngology) involving the use of intravenous Lidocaine
and oral anticonvulsants in the treatment of tinnitus.
Our study group differs from others reported in that we are using people from our
Tinnitus Clinic population who have otherwise been unable to be helped by use of the
Tinnitus Masker or hearing aid.
Our pilot study incorporating Lidocaine has proven to be quite successful in that we
have been able to alleviate and/or eliminate tinnitus for brief periods of time in 9 of
11 patients. The tinnitus has been evaluated both subjectively by the patient and
objectively by the Tinnitus Synthesizer giving confirmation to the fact that the tinnitus
has been diminished.
As soon as we find how and why Lidocaine works selectively on the inner ear apparatus
or centrally to help control tinnitus, we will be closer to finding the answer for a
rational cure. Further work with oral anticonvulsants and cardiac antiarrythmiacs is
being pursued and evaluated for longer term control of tinnitus.
DIAGNOSTIC TOOL
Measurement
Of
YE'AH, DOC,
-rHOSe:: PROPS
Dl P s-roP AAY

RINGINS ..
by Fred Hughes
Mr . Fred Hughes is a Portland, 2
Ore.Jon Hearing Aid Dispenser and
developer of the first tinnitus -
synthesizer, which was intro-
duced at the l 978 Amer ican
Academy of Optha l mo logy and
Oto laryn(JO logy meetings .
It has been barely three years since the first
Tinnitus Clinic was held at the University of
Oregon Health Sciences Center. As 1 ate as two
years ago, we were virtually struggling with
only four different masker instruments to meet
the needs of our patients. Indeed, that was true
even a year ago. Today, 4 manufacturers have
brought into the market place nearly 29 different
models, some of them combined with the latest
in basic hearing aid technology.
This significant increase in available
instrumentation has resulted from information
related to the various parameters, or character-
istics, of tinnitus gleaned from careful measure-
ments of each patient.
Bearing in mind the tremendous costs of
research and development, it is only logical to
assume that further improvement in prosthetic
instrumentation will come about only as we
acquire a deeper understanding of their disease.
To this end, two manufacturers , the Vicon
Instrument Company in Colorado Springs and
Norwest Acoustics in Portland, Oregon, have
developed and are now producing tinnitus diagnostic
instruments which are destined to help hearing
specialists acquire more valuable information.
Another manufacturer, Starkey Laboratories in
Minneapolis, plans to have their instrument
available early in 1980.
These diagnostic tools, in their various
formats, consist of combinations of tone and noise
generators which provide calibrated outputs that
can be channelled either individually or together
into one or both headphones . Small digital
"windows" make it possible to re:ad these parameters
with a great deal of accuracy. This feature has
proven quite valuable to the diagnostician, since
often minute changes in loudness, in particular,
will have significant effects on the efficiency of
whatever wearable masker will be selected.
As more experience is gained in the treatment
of tinnitus, there is no doubt that the level of
sophistication of these diagnostic tools will in-
crease. As an example, the measurement of sound
pressure levels in the ear canal will aid in the
DIAGNOSTIC TOOL continued
assessment of actual levels of masking required
to provide for what has become known as the
"efficiency of masking." In addition, a spectral
analys is of masking signals will help in
establishing proper bandwidths that will also
contribute to greater efficiency. Patient
operated controls may, according to one
manufacturer, reduce the amount of inhibition
that is claimed exists when the examiner operates
the controls and the patient relates what is
happening i n the matching process. Scores of
other systems will undoubtedly come about, all as
a result of efforts by manufacturers, clinicians
and dispensers to provide the relief which the
tinnitus patient often so desperately needs.
Por specifications of Tinnitus Synthesizers
please contact the following .
NORWEST ACCOUSTICS, 4511 SE Hawthorne Blvd, No. 16A
Portland, Oregon 97215
The VICON I NSTRUMENT CO., P.O. Box 1676, Colorado
Spring, Colorado 80901
STARKEY LABORATORIES, I nc., P.O. Box 9457, Minneapolis,
Minnesota 55440
FINANCIAL SUPPORT
by Gloria Reich
l1r's . Reich is the Administrator for the American
Tinnitus Association.
Response to our recent national newspaper and
television publi city has been nothing short of
overwhelming. An article in the Parade magazine
alone generated well over 20,000 letters, all of
which have been answered. To relieve the deluge
of letters, hundreds of hours, 18 volunteers,
and the help of a computer was enlisted. Only
half of the costs of that effort was recovered
from donations; the balance had to be borrowed
from earmarked funds.
Many of the people who write to us join ATA,
thus, financially supporting our programs
including the dissemination of information.
However, not all of the people (45 ,000) on the
ATA mailing list contribute. We continue to
send information to these people in the hope
of helping them find relief for their tinnitus.
ATA is a private organization without
governmental support of any kind; we depend
entirely upon your support. Although we operate
largely with volunteer labor, the maintenance of
an office and the utilization of modern data
processing methods for accurate membership
records are necessary expenses .
The bottoN line is that we need your support.
FINANCIAL support. We cannot continue to do our
work without it. If you haven't made a contri-
bution to ATA this year, will you please make
one now? If you've already sent us a gift, we
thank you. Can you contribute again? Your gifts
are tax deductible, of course.
Last month,articlesabout tinnitus appeared
in the Newsweek and U.S. News & World Report
magazines, so once again we have hundreds of
inquiry letters. With the helpful support of
each of these tinnitus sufferers will
be assured of an early reply. And, with your
donation, the American Tinnitus Association will
continue the dispersion of available tinnitus
information.
PERSONAL
OBSERVATION
by Raymond E. Poseh
of Las Vegas , Nevada
When I decided to purchase a Tinnitus Masker, I
wasn't just sure as to what I could expect in the
way of r elief from the constant annoyi ng and
sometimes frustrat ing ear noises I have had for
the past 15 years. Was this Masker another high-
priced toy which wouldn't help me, or could I
expect a miracle and get quick and lasting relief.
After much soul searching, I decided to give
it a try for 30 days as any help it could give
would be an improvement over my present tinnitus
probl em. If it didn't help me I lost nothing
more than a month ' s rental on the Masker plus
having the satisfaction of knowing I at least
tried.
After being fitted and issued my Masker,
realized it would take a "breaking in" period
before I accepted it. I had to get used to that
"thing" hanging on my ear; but, more important,
I needed time to adjust to an altogether different
sound. On occasion, I felt I was substituting
one sound for another; but within a week I
realized that, given a choice, the Masker's sound
(which resembles a running brook or wind in a
tree) was much more easily acceptable than my ear
noises.
I quickly learned to adjust my Masker to the
same decibel level as my ear noises. At ti mes, I
feel more comfortable with it adjusted at a
higher level and at other times I find a lower
level more compatible .
By the end of the third week, I had become
totally adjusted to my Masker. I now, for the
most part, forget I am wearing it and because it
does such an excellent job I would be lost
without it .
I do not mean to imply that it is a miracle
gadget that will permanently eliminate all your
problems. You must accept it for what it is -- a
masker which will mask the sometimes devastating
problem of ear noises for a much more pleasing
and acceptable
In my opinion, a person who intends to
purchase a Tinnitus Masker should above all be
opti mi stic that it will help you and, last but not
least, be very patient. Like everythi ng else in
life, it takes getting used to, but wi thin a
month the results will be as close to a miracle
as i s possible.
MaskePG
My most dire and horrible fears
are veplaced by a set of tin ears .
Por the white sound that ' s present
is to me most pleasant,
j'or which The Founder deser'Ves lo"tJ..d cheers .
by Thomas B. Wal sh
Forestville, Cal ifornia
TYMPANOMETRY
by Jeffrey Brown, M. S.
Mr . Brown i s a doct oral aandidat e i n the
Depar tment of Mediaal Ps ychology, U. O.H. S. C.,
and as sists in t he Tinnitus Clini a admi nis tering
tympanometr y tests to all patients.
One of the tests given to the patients visiting
the Tinnitus Clinic at the Kresge Hearing Research
Laboratory is known as Acoustic Impedence
Audiometry, or because of what it is designed to
measure, Tampanometry . The purpose of this test
is to measure the flexibility of the eardrum and
the ossicular chain.
The ossicular chain, a tiny chain of bones
inside the middle ear, is the path nearly all the
sound we hear takes when it travels from the
eardrum to reach the nerves of the inner ear.
Tympanometry is able to determine i f any problems
exist with these tiny bones in a patient with
tinnitus. But beyond that, it is able to tell us
if the eardrum or the ossicular chain are involved
in the production of a patient's tinnitus.
Because everyone who suffers from tinnitus is
different and so is their tinnitus, and because
research has not yet pinpointed a si ngle disorder
which is the cause of all tinnitus, tympanometry
is presently being used here as a research and a
clinical examination tool in the Tinnitus Clinic .
The principles of tympanometry may be
explained very briefly; the eardrum absorbs sound
and transmits the resulting vibrations to the
ossicular chain and from there to the inner ear.
The eardrum is able to absorb and transmit the
maximum amount of sound when the air pressure in
the middle ear is exactly equal to that in the
external ear canal. When there is a difference
in the air pressures between the middle ear and
the external ear canal , such as may be created
during a head cold, descending a mountain or in a
pressurized airplane, sounds seem dull and distant
and the ears feel full. When the pressure across
the eardrum is equalized by yawning or blowing
the nose to open up the eustachian tube, the
sensation disappears.
In tympanometry, an airtight plug is sealed
into the external ear canal and the pressure in
the canal is slowly changed to create a pressure
difference across the eardrum. This causes the
eardrum to become fixated and less able to
transmit sound than when the pressure is equal.
If the sound of tinnitus persists in a patient
when the eardrum and ossicular chain are fixated
in this way it indicates that the source of their
tinnitus is not at these two locations and we must
look to the inner ear for the source of the sounds
from which they suffer. This is the case in the
majority of the patients we see here.
Another aspect of tympanometry is that it
pro vi des a measure of the amount of sound the
eardrum absorbs at different pressures . The
maximum sound absorbance and therefore hearing
ability occurs when the middle ear pressure equals
the outer ear pressure. The amount of sound
absorbed is much less at positive and negative
pressure differences. The measure of the sound
absorbance through the pressure range appears like
this in a normal ear.
c
Ill

DC
0
Ill

4
c
z
;)
0
Ill
-200 0 +200
Changes in the shape of this curve may indi-
cate problems with the eardrum or ossicular
chain. For instance, a tall peaked curve indicates
a loose or disarticulated system, a short flat
curve is often seen in patients with otosclerosis,
a common disorder in elderly persons.
Of course each type of problem will affect
hearing in some way. Because tinnitus is so
often found with almost every hearing pathology,
it is hoped that future research will allow us to
establ i sh meaningful patterns which correspond
to different types of tinnitus. In summary,
tympanometry is a research tool as well as a
clinical tool and provides valuable information
which can be used in the treatment and research
of t i nnitus.
If you are receiving more than one copy of the NEWSLETTER
or if we haue your name or address incorrectly listed, please let
us know. THANK YOU.
Published by the
AMERICAN TI NNITUS
ASSOCIATION
P.O. Box 5
Por tland, Oregon 97207
The American Tinnitus Association
Post Office Box 5
NonProfit Organ.
A private, non-profit organization af
filiated with the University o( Oregon
Health Sciences Center Fourzdation.
Robert W. Hocks . . . National Chairman
Gloria E. Reich . . . ... Administrator
Herlene D. Benson . . .. . ... . Editor
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