Professional Documents
Culture Documents
Tinnitus Today
THE JOURNAL OF THE AMERI CAN TINNITUS ASSOCIATION
"To carry on and support research and educationaJ activities relating to the treatment of
tinnitus and other defects or diseases of the ear."
In This Issue:
A Chronicle of
Electrical Stimulation
Ginkgo Biloba and
Animal Research
Fifth International
Tinnitus Seminar
Schedule of Events
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------------------------1-L.- - - - __
Tinnitus T o d ~ y
E<litorial and advertising offices:
American Tinnitus Association,
P.O. Box 5, Portland, OR 97207.
Executive Director & Editor:
Gloria E. Reich, Ph.D.
Associate Editor: Barbara Thbachnick
Editorial Advisor: 1i'udy Drucker, Ph.D.
Advertising sales: ATAAD, P.O. Box 5,
Portland, OR 97207 (800-634-a978)
Tinnitus 'TOday is published quarterly in
March, June, September and December. It
is mailed to members of American Tinnitus
Association and a selected list of tinnitus
sufferers and professionals who treat
tinnitus. Circulation is rotated to 100,000
annually.
The Publisher reserves the right to reject or
edit any manuscript received for publication
and to reject any advertising deemed
unsuitable for Tinnitus 'TOday. Acceptance of
advertising by Tinnitus 7bday does not con-
stitute endorsement of the advertiser, or its
products or services, nor does Tinnitus
Thday make any claims or guarantees as to
the accuracy or validity of the advertiser's
offer. The opinions expressed by contribu-
tors to Tinnitus 7bday are not necessarily
those of the Publisher, editors, staff, or
advertisers. Amerkan Tinnitus Association
is a non-profit human health and welfare
agency under 26 USC 501 (c)(3).
Copyright 1995 by American Tinnitus
Association. No part of this publication may
be reproduced, stored in a retrieval system,
or transmitted in any form, or by any
means, without the prior written perm is
sion of the Publisher. ISSN: 0897-6368
Scientific Advisory Committee
Ronald G. Amedee, M.D., New Orleans, LA
Robert E. Brummett, Ph.D., Portland, OR
Jack D. Clemis, M.D., Chicago, IL
Roben A. Dobie, M.D., San Antonio, TX
John R. Emmett, M.D., Memphis, TN
Chris B. Foster, M.D., San Diego, CA
Barbara Goldstein, Ph.D., New York, NY
Richard L. Goode, M.D., Stanford, CA
John W. House, M.D., Los Angeles, CA
Robert M. Johnson, Ph.D., Portland, OR
William H. Martin, Ph.D., Philadelphia, PA
Gale W. Miller, M.D., Cincinnati, OH
J. Gail Neely, M.D., St. Louis, MO
Jerry Northern, Ph.D., Denver, CO
Robert B. Sandlin, Ph.D., San Diego, CA
Alexander J. Schleuning, II, MD,
Portland, OR
Abraham Shulman, M.D., Brooklyn, .NY
Mansfield Smith, M.D., San Jose, CA
Honorary Board
Senator Mark 0 . Hatfield
Mr. Thny Randall
Legal Counsel
Henry C. Breithaupt
Stoel Rives Boley Jones & Grey,
Portland, OR
Board of Directors
Edmund Grossberg, Chicago, IL
Dan Robert Hocks, Portland, OR
w. F. S. Hopmeier, St. Louis, MO
Philip 0. Morton, Portland, OR, Chmn.
Aaron I. Osherow, St. Louis, MO
Gloria E. Reich, Ph.D., Portland, OR
Timothy S. Sotos, Lenexa, KS
The Journal of the American Tinnitus Association
Volume 20 Number 2
1
June 1995
Tinnitus, ringing in the ears or head noises, is experienced by as
many as 50 million Americans. Medical help is often sought by those
who have it in a severe, stressful, or life-disrupting form.
Contents
4 From the Editor
by Gloria E. Reich
6 Seashell
by James W May
7 A Chronicle of Electrical Stimulation Therapy
by Barbara Thbachnick
13 Ginkgo Biloba and Animal Research
by Pawel f. Jastreboff
14 'Thmporal Bone Organ Donations
15 Road to Recovery - One Year Later
by Stefan P Kruszewski
17 Your Letters to Barbra Streisand
18 Thlking It Out
by Barbara Thbachnick
19 Health Meetings Across the U.s.
by Pat Daggett
20 Is Our Help Wanted?
20 New Tinnitus Support Network Volunteers
20 Our New PSA's
Regular Features
5 Letters to the Editor
16 Questions & Answers
21 Tributes, Sponsors, Special Donors, Professional Associates
Cover artwork: Watercolor painting 'Flowers in the Mountains#
by Janet Louvau Holt. Inquiries to 2768 SW Thlbot Rd., Portland, OR 97201
(503) 227-7000
This painting, donated to ATA, is the logo for the Fifth International
Tinnitus Seminar
Tinnitus 1bday/June 1995 3
From the Editor
by Gloria E. Reich, Ph.D ,
Executive Director
On March 22, 1995, the
National Institute on
Deafness and Other
Communication Disorders
held a tinnitus workshop
-- for defining future direc-
~ ~ ~ = = ~ ~ ~ tions for tinnitus research.
b This was a much sought
after effort to involve the NIDCD specifically in
the field of tinnitus. Your letters to your congres-
sional representatives were extremely helpful,
and I encourage you to keep writing to ensure a
continued push by Congress for tinnitus
research.
The participants, invited by the NIDCD, are
mostly active in basic hearing research. The
meeting was called to order by Dr. Ralph F.
Naunton, Director of the Division of Human
Communication. Participants and guests were
welcomed by NIDCD Director, Dr. James B.
Snow, Jr. In attendance were Drs. Alfred Nuttall,
Richard Bobbin, Pamela Burch-Sims, Donald
Godfrey, Charles Liberman, Mary Florentine,
Joseph Santos-Sacchi, Richard Schmeidt, Donota
Oertel, Rinaldo Canalis, and Pawel Jastreboff.
Other NIDCD representatives were Drs. Judith
Cooper, Larry Shetland, Jay Moskowitz, Amy
Donahue, Kenneth Gruber, and Mr. W. David
Kerr. Guest observers included myself, my hus-
band Ted Reich, Dr. Margaret Jastreboff, Dr.
Erleen Elkins, and Mr. and Mrs. Patrick O'Meara
(ATA members).
The morning session was devoted to an
overview of current knowledge and of problems
specific to performing tinnitus research.
Participants spoke about their recent laboratory
work on tinnitus or a related field and how that
work might provide an insight into the pathologi-
cal mechanism producing tinnitus. A discussion
followed about the need for increased tinnitus
research, both basic and clinical.
Research approaches were created that could
be presented to NIH staff, Congress, potential
researchers, and to individuals and foundations
interested in funding research. A final summary
report is available from the NIDCD. Contact
Kenneth A. Gruber, Ph.D., Health Scientist
Administrator, Division of Communication
4 Tinnitus Thday/ June 1995
Sciences and Disorders, NIDCD/ DHC, Executive
Plaza South, Room 400C, Bethesda, MD 20892,
or telephone (301 )402-3458.
There have been quite a few changes at ATA!
Thomas Wissbaum, C.P.A. resigned from the
ATA board after 15 years of service. Tbm has
been more than helpful in providing accounting
services at no cost to ATA. His dedication is
greatly appreciated and we thank him for
serving such a long time.
New to the ATA medical advisory committee
is researcher William H. Martin, Ph.D.,
Director of Audiology and Auditory Research at
the Garfield Auditory Research Laboratory of
Temple University Medical School, Philadelphia,
PA. We appreciate Billy's new commitment to
work on our behalf.
At our national office we have both lost
and gained staff. Those who are no longer with
us are:
+ Lisa Cochran, our mail and volunteer
coordinator for the last two years.
+ Marina Czapszys, our client services
representative for more than four years.
+ Brent Mower, our development director for
nearly two years.
+ Priscilla Reed, our front office secretary for
the last year.
Thanks to all of these wonderful people for
the time and devotion they gave to ATA.
New on the scene are:
+ Robin Jennings, who will be handling the
ATA mail and working with our volunteers.
+ Evelyn Peasley, who will be helping with
data processing and general office procedures.
+ Corky Stewart, who is helping with the Fifth
International Tinnitus Seminar and other
special projects.
+ Anne Young, who is helping on a temporary
basis witl1 general secretarial duties.
Please welcome these new voices when you
call. We're very glad to have them working
with us.
This issue contains an insert about the Fifth
International Tinnitus Seminar. We thought you'd
like to know a bit more about the meeting itself
even though you might not be able to attend.
Remember that the proceedings of this meeting
will be published in book form and will be avail-
able from ATA. We'll let you know details about
ordering the book in a future issue.
Letters to the Editor
The opinions expressed are strictly those of the letter
writers and do not reflect an opinion or endorse-
ment by ATA.
E
ach time I find myself feeling completely
hopeless, along comes my Tinnitus 'Ibday
and the feeling of aloneness goes away.
I lost most of my hearing in December 1992, and
the terrifying noise began a few weeks later.
Having tried everything known to man, I have
finally decided to try to handle this on my own.
By keeping a journal, I am able to identify the
days when the tinnitus is worse. For me it seems
to occur after exposure to noise. Being an extro-
vert, it has been extremely difficult to avoid
crowds, but I know it is the only way I can han-
dle the situation.
Phyllis Flesher, Shreveport LA
I
n 1993, I began to experience rapidly pro-
gressing hearing loss in both ears and period-
ic mild tinnitus, coincidental with the failure
of my liver which had been under assault by
hepatitis C. After my total loss of hearing, which
coincided with my liver transplant, I experi-
enced tinnitus to varying degrees of severity. I
attempted to correlate my tinnitus with a num-
ber of variables, e.g. blood pressure, stress, eat-
ing, talking, and medications. (As a transplant
patient, I take 12 different medications, many of
which are included on the list of suspected tinni-
tus causes.) Talking had the most significant
effect on the variability of my tinnitus.
Six months after my liver transplant, I under-
went surgery for a cochlear implant in my right
ear. When the device was "turned on," my tinni-
tus immediately disappeared. I hear remarkably
well with my implant. I think I'm in the top tier
of those benefitting from this incredible technol-
ogy. I have since found that if I talk on the
phone for an hour or more without turning on
my Spectra 22 Speech Processor, the tinnitus
starts coming back. It can get pretty bad if I talk
for a couple ofhours.
Recently I have started experiencing a mild
to medium severity of tinnitus in the left ear
only, even when the speech processor is turned
on. It is annoying but doesn't interfere with liv-
ing my life which I am now able to do with gusto
since the liver transplant. Although it is not pre-
scribed solely for that purpose (alleviating tinni-
tus), I understand from my otolaryngologist that
others have also benefitted as I have from a
cochlear implant.
Ronnald E. McElvogue, La Porte, TX
(Editors Note: See "A Chronicle of Electrical
Stimulation Therapy" in this issue)
I
have been taking rutalin for the past six
months and found that it helped me concen-
trate. I'd had no noticeable side effects
except for some muscle soreness in my neck
from a previous injury. About two months ago I
noticed some intermittent ringing in my ears
that gradually became louder and more constant.
My internist said it was probably nasal conges-
tion and prescribed spray. AnENT did a hearing
exam and told me I had a hearing loss and tinni-
tus. When I asked about the fullness in my ears,
he said I was just thinking too much about them.
I cried for two days and then sought another
opinion. Another ENT suggested that I take
niacin and have TMJ ruled out. I next asked a
psychopharmacologist if there was any correla-
tion between Ritalin and tinnitus. He said there
was and suggested that I try another medication.
I then went to a chiropractor/nutritionist who
suggested a correlation between my stiff neck
and tinnitus. I went to a TMJ dentist who told
me that the sensation of fullness in the ears is a
TMJ symptom, but he didn't know a great deal
about tinnitus and suggested we do some
research. In a medical book, I read about the
sterno- cleido- mastoideus muscle and asked him
where it was. He said, "That muscle is the one
that runs from your shoulder up to behind your
ear." The light went on- That was the muscle
that had been sore for months!
I began massage therapy and a regime of vit-
amins. The ringing went away after the first
hour of massage and only comes back intermit-
tently and much more quietly. I have also cut
out some stress-causing activities, am eating
more sensibly, take Motrin for muscle inflamma-
tion, and have stopped taking Ritalin.
Clearly the MD's do not have all of the
answers. I urge people to do their own research
and treat themselves as if they were puzzles.
Doctors may only provide one piece of that
puzzle.
Daphne Suzanne Crocker-White PhD,
San Mateo CA
Tinnitus Today/ June 1995 5
Letters to the Editor (continued)
I
h.ave suffered very severely from tinnitus
smce 1988. Throughout this period I have
done everything I know of- experimented
with relaxation therapy, self-hypnosis, exercise,
sma1l doses of herbs and vitamins, megadoses of
herbs and vitamins, Xanax, various types of anti-
depressants, and on and on. I had grown to
accept the intensity of the ringing, but when the
pulsating began a few years ago and continued
to get worse, I simply could not deal with it.
Desperately seeking help, I experimented with
the antidepressant Effexor which made me very
nauseated at first. But I noticed that the pulsat-
ing went away for at least 85% of the time.
I now take one-half of a 37.5 mg tablet at bed-
time and have been doing so for two months.
I felt it my moral obligation to pass this good
fortune on.
Kerry Jensen, Price, UT
I
have been given a renewal gift oflifet It has
to do with my tinnitus and my attempt at
suicide when I could no longer stand the
Seashell
We shall see
if this is a sound
that comes and goes.
We shall see
what no one else knows;
the echoes in the ears
resound my deepest fears
when no one else is near;
no one hears what I hear.
by James W May
6 Tinnitus Today/ June 1995
affliction. I am now 62 and have had tinnitus
since my army days in 1954 but it was hardly
noticeable until December 1992 when I had
three pieces of hardened wax removed from my
right ear. I began suddenly suffering from severe
loud noises in both ears. Last summer, the tinni-
tus went into a remission that only lasted until
September. It then worsened to the earlier
degree. I could not sleep, was prescribed Xanax
and Valium but nothing helped. On November
8th, I took an overdose of four medications and
alcohol but lived to tell my tale! I was taken by
ambulance to our nearest hospital and was
given new medication - Paxil (20mg) and
Stelezine ( 4mg) which I take each night at bed-
time with the addition of Lorezapam (1 mg) and
Doxepin (lOOmg) that I had been taking. The
noises have decreased almost 90% and I feel
like a human being again. I know now that
there is a silver lining up there. Thank you for
all your help.
Ed Rosenberg, Rochester, NY
I CORRECTION
Th the ''Drugs and Tinnitus Relief' article
from the March 1995 Tinnitus Tbday:
On page 12, protriptyline should be listed
as an antidepressant rather than as an
antianxiety agent.
Also, fluoxetine, sertraline, and
bupropion are antidepressants, but not of the
tricyclic variety.
From Volta's Battery to Cochlear Implants
A Chronicle of Electrical Stimulation Therapy
by Barbara Th.bachnick,
Client Services Manager
The medical use of electricity has a surpris-
ing - and a surprisingly long - history. The
first historical mention of it, albeit static elec-
tricity, pre-dat es the American Revolut ion. In
1801, barely one year after the invention of the
battery (the first device to harness and generate
a continuous electric current), a German scien-
tist tenaciously placed electrodes from the bat-
tery into the canals of tinnitus-affected ears to
observe the effects. For the following 100 years,
researchers regularly conducted electrical stimu-
lation (ES) experiments and published
articles that advocated its use as a tinnitus treat-
ment. By the end of the 19th century, ES was
the therapy of choice for dozens of physical ills.
In 1901, this "Golden Age of Medical
Electricity" came curiously to a full stop and
remained stopped for more than half a century.
Some historians attribute the ES hiatus to the
medical charlatans of the time who, trying to
take advantage of a no-longer-innocent
populace, promised miracles they couldn't
deliver. For the next 59 years, therapeut ic use of
electricity for tinnitus relief was at a standstill.
Interest in ES therapy eventually was renewed
in the midst of astonishing advances in
electrical science, and quite by accident.
Note: The types of electrical current and the place-
ment of electrodes are primary variants in the body
of published articles on ES, and are therefore given
emphasis in this article. Other factors (electrical
frequencies, amperes, voltage, type of electrode,
duration of stimulation, modulations, wave lengths,
tinnitus etiology, specific patient variations - and
all of their combinations) are addressed in the
referenced articles.
A Brief History:
17 45 - In Ho11and, the electrical capacitor was
invented. It was the first machine to store and
release a charge of electrostatic energy (static
electricity).
1768 - Georg Daniel Wibel reported successful
treat ment of tinnitus with electticity.
1800 - Alessandro Volta invented the direct
current (DC) battery, a stack of thin metal plates
separated by brine-soaked pasteboard, with two
extending wire electrodes (a negative cathode
and a positive anode) of different metals. After
placing the two probes from the battery into his
own ear canals to see what would happen, Vol ta
received a shock to his head and heard a loud
"disagreeable" noise.
1801 - In Berlin, Grapengiesser began exten-
sive experiments with Volta's battery in an
attempt to cure deafness, but was careful to note
the changes that occurred with his patients'
tinnitus. He found that ES from the positive zinc
pole was more effective than from the negative
silver pole in the occasional and short-lived
suppression of tinnitus. He also noted that some
patients who didn't have tinnitus before ES, had
it afterwards.
1842 -de Lamballe combined DC with needles
(he called it "acupuncture"): one needle through
the tympanic membrane touching the promon-
tory and another in the wall of the Eustachian
tube. He claimed good results in treating
tinnitus.
1855 - Duchenne de Boulogne claimed that he
cured tinnitus in eight out of 10 patients using
electrodes inserted in ears half-filled with water,
using Faraday's new induction coil that pro-
duced alternating electric current (AC).
1868 -In Germany, Rudolf Brenner returned
to the use of direct current because of patients'
"unbearable reactions" to alternating current
stimulation. He recommended that an individu-
alized approach toES therapy was most effica-
cious because patient reactions varied so widely.
1901 - In Vienna, Urbantschitsch advocated
both direct and alternating currents with slow
current variations for tinnitus treatment.
The value of this early research information
may seem more historical than medical - in
most cases, no data exist to authenticate or
explain it. But when trends of the present echo
those of the past, and today's studies find confir-
mation in the outcomes of ancient experiments,
the relevance emerges.
Tinnitus Thday/ June 1995 7
Electrical Stimulation Therapy (continued)
In 1960, American researchers Hatton,
Erulkar, and Rosenberg were observing DC
electrical stimulation as part of a vestibular
functioning test. Coincidentally, they noticed
that tinnitus intensity was lessened in 15 out of
33 cases. Their research showed more:
+ Only the anodal (positive) current
suppressed tinnitus.
+ Suppression meant complete elimination of
the tinnitus.
+ The majority of patients who responded had
severe hearing loss.
+ Only one of the 15 responders had
presbycusis (hearing loss as a result of
aging) compared to 10 of the 18 non-
responders.
+ When electrodes were placed on the
zygomatic arches (cheek bones) of patients
with "bilateral tinnitus" or noises in both
ears, tinnitus was suppressed by the anodal
(positive) electrode and exacerbated by the
cathodal (negative) electrode.
+ When patients first noticed the beginning of
tinnitus reduction, electrical intensity
needed only to be increased by 1/1000 of an
amp or less to achieve complete
suppression.
+ Tinnitus suppression lasted only as long as
the electrical stimulation occurred.
Because the relief was short-lived and often
at the expense of healthy tissue, Hatton did not
see ES as a viable tinnitus therapy. (It was
known at that time that tissue damage resulted
from direct current stimulation.) Nevertheless,
the research of Hatton and his colleagues
piqued the interest of the worldwide science
community and more studies were attempted.
In 1979, the French research team of
Chouard, Meyer, and Maridat studied 64 unilat-
eral and bilateral tinnitus patients using a
variety of electrical currents (direct, alternating
or "sinusoidal," biphasic pulses, etc.), electrode
sites (inner ear, behind the ear lobe, cathode on
the affected then unaffected side, etc.), and
electrode types. Patients were able to control the
increasing voltage until they experienced a "pins
and needles" sensation. From that point, stimu-
lation lasted approximately 20 minutes. If specif-
ic configurations of sites and currents didn't
work, others were tried. Placebo stimulation was
tried in 12 cases but failed each time, presum-
8 Tinnitus Thday/June 1995
ably because patients knew - by the absense of
tingling - that they were not receiving ES.
In this study, 30 ofthe 64 patients had
tinnitus suppression that lasted from a few days
to a few weeks, with no complaints of worsened
tinnitus or aggravated vertigo during or after
treatment. Researchers noted that positive
results were most often obtained with biphasic
pulses and that electrode site was not critical to
success.
Further studies were conducted in France
that same year by Portmann, Cazals,
Negrevergne, and Aran. When 15 tinnitus
patients had "trains" of negative DC pulses
applied to their cochleas via needle electrodes
that rested on either the round window or
promontory of their affected ears, all experi-
enced auditory sensations such as ringing,
tapping, or a worsening of their tinnitus. When
the polarity of the electricity was changed to
positive, 80% experienced tinnitus suppression.
All effects stopped when the hour-long electrical
stimulations ended. (This therapy was ineffectu-
al for patients with "central tinnitus" or head
noises.) The researchers noted that in an earlier
animal study by Aran (1977), guinea pigs
developed cochlear lesions when low amperage
negative DC stimulation was applied for several
hours.
Between 1979 and 1985, ES studies were
conducted in Belgium by Gersdorff, Thibert, and
Robillard. In one study where bursts of AC were
applied to the skin of 39 patients, 26% had slight
improvement and 20% had prolonged
disappearance of their tinnitus.
In 1981, Aran noted that when a platinum
electrode was surgically implanted in the round
window and positive DC stimulation was
delivered to it, complete tinnitus suppression
was produced in 60% of his patients. Positive
DC stimulation to the promontory produced
suppression for 43%. In all cases, tinnitus
suppression occurred in the stimulated ear only
and lasted only as long as the ES occurred. He
theorized that round window stimulation more
effectively directed the current to the cochlea
and the eighth nerve than did stimulation to the
promontory or external ear. Because DC
electricity destroys cochlear hair cells, its use,
he cautioned, should be limited to the ears of
deaf or nearly deaf patients.
Electrical Stimulation Therapy (continued)
In 1985, Shulman introduced the Audimax
Theraband, an AC electrical stimulation headset
with external electrodes that rest on the mastoid
bones. Reported results were exce11ent: 13 out of
21 patients who wore the device for up to two
weeks had tinnitus suppression. Seven ofthe 13
had complete relief. (These results, however,
have not been replicated.) Shulman stressed the
importance of selecting patients who have
maskable and peripheral (in the ears) tinnitus,
and who have an absence of active ear disease
or vestibular asymmetry to increase the
chances of success with this
treatment.
A newer Theraband model was
tested in 1987 by researchers
Thedinger, Karlsen, and Schack in
Kansas City. Because the Thera band
delivers inaudible and undetectable
electric current, 30 tinnitus patients
were involved in a double-blind,
crossover placebo study (in which
patients received both the actual
and the placebo treatments
alternatingly, and neither the patient
nor the physician knew which
treatment was being administered- or
when). During the two-week study, five of
the 30 patients reported relief using the
Theraband device. Interestingly, two of the five
had tinnitus relief during actual stimulation and
three of the five had tinnitus relief during the
placebo treatment but not during ES treatment.
Side effects of headache, dizziness, and
worsened tinnitus were experienced
temporarily. The researchers admitted that
Shulman's patients wore the devices longer, and
consequently conducted an additional test on
six of the original 30. (The two patients who had
previously responded to the ES declined further
treatment stating that the improvement was too
mild to warrant wearing the uncomfortable
device.) None of the six who received 25
additional hours of Thera band ES reported any
relief.
In 1987, Portmann commented on his nine
years of ES research: "Despite good results, we
are still very disappointed because it is difficult
to give the patient continuous help. Th achieve
suppression of tinnitus, you have to give
positive direct current. .. but the structure of the
ear is such that [with DC] there is destruction of
the hair cells. If we give AC, results are very
poor.'' In some patients, DC implants were tried
but eventually abandoned. As with addictive
drugs, patients found that they needed more
and more intensity of the potentially damaging
current to relieve the tinnitus. As a whole,
scientists moved away from DC research and
began innovative explorations of AC for tinnitus
relief.
Kuk, 'TYler, Rustad, Harker, and lYe-Murray
tested AC stimulation on the tympanic
membranes of 10 patients with maskable
tinnitus in a 1989 study. The
researchers used a variety of
electrical wave forms (square,
\ triangle, and sinusoidal) to learn
~ l which, if any, was most effective.
Their findings: Five of the 10
patients tested experienced up to
four hours of tinnitus relief following
10 minutes of ES. Also, square and
triangle waves were found to be the
most effective.
In 1991, researchers Okusa,
Shiraishi, Kubo, and Matsunaga
studied the effects of promontory
stimulation on the ears of 52
patients (54 ears) whose tinnitus
did not previously respond to drug
therapy. The electrical current
intensity was kept low to avoid cochlear
damage. Okusa and his colleagues found that
bursts of alternating biphasic square waves
produced tinnitus reduction in 65% of the cases,
or 35 ears. Tinnitus that accompanied idiopathic
(of unknown cause) sudden deafness or
Meniere's disease, or that resulted from
ototoxicity or labrynthitis, responded to this
treatment with post-stimulation suppression
lasting from 30 seconds to one week. No relief
was experienced by patients whose tinnitus
resulted from acoustic neuromas.
Cochlear Implants
The leap from Volta's battery-induced
"disagreeable" noise to the purposeful and
permanent implantation of electrodes into the
human cochlea for sound enhancement took
more than 150 years. Pioneering work, first
done in France in 1957 and then in the 1960's
by William House in the United States, offered
profoundly or totally deaf patients a restoration
' finnitus Thday/ June 1995 9
Electrical Stin1ulation Therapy <continued)
Implanted Receiver/
Stimulator
Microphone (outline)
behind ear
Cord to Speech Processor - - - - - ~
Cross-section of the ear with Nucleus 22 Channel Cochlear
Implant System.
of some usable sounds with an AC single-
channel implant.
Cochlear implants, however, are certifiably
imperfect: The perception of distorted environ-
mental sounds and garbled voices as an aid to
lip reading is a realistic post-implantation out-
come, although some patients fare better.
(People deaf from birth vs. later-deafened indi-
viduals typically do not reap as great a benefit
from hearing sound without a previous frame of
reference.) But the technology is ingenious: A
small microphone is worn behind the ear (in the
Nucleus implant) like a hearing aid. Sounds
picked up by the microphone are sent via a thin
cord to an externally worn speech processor -
about the size of a pocket calculator - that
amplifies, filters, and digitizes the sound into
coded signals. The signals are sent via the same
cord to a disk-shaped transmitting coil held in
place magnetically on the side of the head by a
receiver/stimulator that has been surgically
10 Tinnjtus 1bday/ June 1995
Transmitting Coil
Directional Microphone
Cable (cord) to Speech
Processor
imbedded just below the skin and behind the
ear. Attached to the internal receiver/stimulator
is an array of electrodes that passes through the
middle ear (leaving the ear drum intact), and is
threaded through the round window and into
the cochlea. The remaining nerve fibers deep in
the cochlea are stimulated to send information
to the brain that is interpreted as sound.
Surgical implantation of the cochlear device
destroys hair cells and all residual hearing a
patient might have in the implanted ear. Its use,
consequently, has been carefully limited to the
deaf or near-deaf.
In 1976, a cochlear implant patient first
reported its positive effect on her tinnitus, and
Electrical Stimulation Therapy (continued)
research took a new turn. By 1984, John House
had studied 64 deaf tinnitus patients who had
received the House Single Channel cochlear
implant and evaluated their tinnitus improve-
ment. Thirty-four of the 64 had experienced a
decrease in the number of tinnitus sounds
heard, diminished loudness and frequency of
currents, and frequencies and reported the
results in their 1993 extracochlear (outside of
the cochlea) implant research. When electrodes
were implanted onto the extracochlear tissue of
the deaf ears of three patients with previously
intractable tinnitus, relief was obtained and
sustained for more than three years. The lowest
occurance, and a
change in pitch. For
some, the tinnitus
remained suppressed
for periods of time
with the device
turned off. Some
experienced a sup-
pression of tinnitus
in the non-implanted
ear as welL Those
whose previous use
of hearing aids had
helped their tinnitus
were often the ones
who experienced
successful tinnitus
suppression with
implants. After one
year, patients subjec-
tively evaluated their
own status: All who
..---------------'--="'------==--.. possible frequency
of stimulation (20
'JYmpanic Membrane
(Ear Drum)
Promontory
Round Window
Hz) from the
implant gave the
~ ~ i i l l l i j best suppression, but
' at no time was
Implant Electrode
Array
tinnitus suppression
achieved without
evoking a sensation
of hearing other
sound. Researchers
speculate that lower
frequencies could
elicit better results.
Work is currently in
progress in Sweden
and England on
implants specifically
designed for tinnitus
Nu-c-le_u_s -22- Ch_a_n_n-el_C_o_c_ hl_ea_r_I_m_p_la_n_t - el- ec_tr_od _e_a_rr _a_y_fi-ed- th-ro-u-gh- ro-u-nd _. suppression.
window into cochlea. Because cochlear
had had relief initially, still experienced relief.
Al1 who had not been helped initially, remained
unhelped. For five of the 64 original implantees,
the tinnitus worsened.
The implantation effect of the new Nucleus
22 Channel cochlear implant was evaluated in
1991 by Ward, Tonkin, Berlin, David, Rigby,
Nuss, Palmer, and Follent. Of 149 implantees
with tinnitus, 98 had post-operative reduction of
their tinnitus, six reported tinnitus increase, and
two reported tinnitus onset after the surgery.
In 1993, Dauman, 'JYler, and Aran closely
studied two tinnitus patients who had received
multi-channeled cochlear implants. The
researchers learned that stimulating selected
electrodes with varying pulses of current affect-
ed the different sounds of tinnitus (e.g., elec-
trode 4 with a pulse rate of 250 Hz was best for
cricket noise, electrode 20 was best for ocean
noises, etc.).
Hazell, Jastreboff, Meerton, and Conway
applied complex variations ofband widths,
implant users often
note a reduction in stress as they rejoin the
hearing world, a question is still unanswered: Is
the reduced stress level the causative factor in
tinnitus reduction? Other questions remain: Is
post-implantation tinnitus suppression a result
of masking by newly heard ambient sounds or is
the electrical stimulation causing true suppres-
sion? Are the long-term effects of AC stimula-
tion known? Considering the invasive nature of
the therapy and its formidable expense (about
$35,000), can the tinnitus patients who would
most likely benefit from it be pre-selected? Can
this technology cross the deafbarrier to benefit
the mi11ions of tinnitus sufferers who hear? Can
the transient tinnitus suppression produced by
other types of ES- internal and external -be
sustained for weeks or months without causing
tissue damage and hearing loss? The answers
today are unknown. But history, in its persis-
tence, reminds us that answers are always
around the corner.
Tinnitus Thday/ June 1995 11
Electrical Stimulation Therapy <continued)
Resources
.House Ear Clinic, 2100 W 3rd St., l st floor,
Los Angeles, CA 90057, (21 3) 483-5706
Cochlear Corporation, (Nucleus 22-Channel Implant),
61 Inverness Dr. E., #200, Englewood, CO 80112. Cochlear
Implant Information Hotline (800) 458-4999, V /TDD
(303) 790-9010
Advanced Bionics (Clarion Implant), 12740 San Fernando
Rd., Sylmar, CA 91342, (800) 678-2575, TT (800) 678-3575
References
Aran, J-M., and J-P. Erre. 1987. Effects of Electrical Currents
Applied to the Cochlea. Proceedings III Intl. Tinnitus Sem.
400-409.
Aran, J-M., andY. Cazals. 1981. Electrical Suppression of
Tinnitus. Ciba. Found. Sym. 85:217-231.
Aran, J-M. 1981. Electrical Stimulation ofthe Auditory
System and Tinnitus Control. f. Laryngol. Otol. (Supp).
4:153-161.
Balkany, T., and H. Bantli. 1987. Workshop:Direct Electrical
Stimulation of the Inner Ear for the Relief of Tinnitus.
Am. J. Otol. 8:207-212.
Berliner, K.., and F. Cunningham. 1987. Tinnitus
Suppression in Cochlear Implantation. Tinnitus 118-130.
Chouard, C.H., B. Meyer, and D. Maridat. 1981.
Transcutaneous Electrotherapy for Severe Tinnitus. Acta.
Otol. (Stockh). 91:415-422.
Cohen, N., and M. Gordon. 1994. Cochlear Implants: Basics,
History, and Future Possibilities. S.H.H.H.J. Jan/Feb 8-10.
Dauman, R., R. '!yler, and J-M. Aran. 1993. Intracochlear
Electrical Tinnitus Reduction. Acta. Otolaryngol. (Stockh).
113:291-295.
Feldmann, H. 1987. Electrical Stimulation in Suppressing of
Tinnitus - Historical Remarks. Proceedings III Intl. Tinnitus
Sem. 394-399.
Feldmann, H. 1984. Suppression of Tinnitus by Electrical
Stimulation: A Contribution to the History of Medicine.
f. Laryngol. Otol. (Supp). 9:123-124.
Gersdor.ff, M., and T. Robillard. 1987. Our Clinical
Experience of Electrical Stimulation in Treatment of
Tinnitus. Proceedings III Intl. Tinnitus Sem. 459-460.
Hazell, J., L. Meerton, and R. Ryan. 1989. Electrical
Tinnitus Suppression. Hear. J. 42(11):26-33.
Hazell, J., P. Jastreboff, L. Meerton, and M. Conway. 1993.
Electrical Tinnitus Suppression: Frequency Dependence of
Effects. Audiology 32:68-77.
House, J . 1984. Effects of Electrical Stimulation on
Tinnitus. f. Laryngol. Otol. (Supp). 9: 139-140.
Kitahara, M. 1988. Combined Treatment for Tinnitus.
Tinnitus Pathophysiology and Mngmt. Ch 9:107-117.
Kitajima, K., M. Kitahara, and K. Uchida. 1987.
Transcutaneous Suppression of Tinnitus with High
Frequency Carrier Waves. Proceedings III Intl. Tinnitus Sem.
435-438.
12 Tinnitus 1bday/June 1995
Kuk, F., R. 'fYier, N. Rustad, L. Harker, and N. 'lYe-Murray.
1989. Alternating Current at the Eardrum for Tinnitus
Reduction. J. Speech Hear. Res. 32:393-400.
Okusa, M., 1'. Shiraishi, A. Thmaki, T. Kubo, and
T. Matsunaga. l 991. Attempts to Suppress Tinnitus by
Electrical Promontory Stimulation. Proceedings Fourth Intl.
Tinnitus Sem. 409-411.
Portmann, M., Y. Cazals, M. Negrevergne, and J .M. Aran.
1979. Temporary Tinnitus Suppression in Man Through
Electrical Stimulation of the Cochlea. Acta. Otoltlryngol.
(Stockh). 87:294-299.
Shulman, A. 1989. Electrical Stimulation for Tinnitus
Treatment/Control. Hear. Instr. 40(6):18-19.
Thedinger, B., E. Karlsen, and S. Schack. 1987. 'Treatment
of Tinnitus with Electrical Stimulation: An Evaluation of
the Audimax Theraband. Laryngoscope 97(1):33-37.
Vernon, J. 1985. A Review of Attempts to Use Electrical
Stimulation to Produce Suppression of Tinnitus. ATA
Newsletter 10(1 ): 1-3.
Vernon, J. 1987. Use of Electricity to Suppress Tinnitus.
Seminars in Hearing 8(1 ):29-48.
Ward, N., J. Thnkin, C. Berlin, S. David Jr., P. Rigby,
D. Nuss, A. Palmer, and S. Follent. 1991. The Effect of
Promontory and External Ear Canal Electrical Stimulation
of Tinnitus. Proceedings Fourth Intl. Tinnitus Sem. 413-415.
International Hearing Aid
Conference III
An international conference on hearing aids
titled "New Directions for Clinical Practice" will
be held at the University oflowa, June 15-18,
1995. The guest of honor is Dr. Brian C.J. Moore
from Cambridge University, England. Dr. Moore,
an expert on auditory perception with a strong
background in applied research, will present
new information on the perceptual conse-
quences of cochlear hearing loss and the practi-
cal and theoretical application this has on
hearing aid design and use.
Presentations will include current perspec-
tives on fitting modern non-linear hearing aids
and information on the new wave of subjective
scales that are emerging from the FDA mandate.
Pragmatic issues related to the new programma-
ble hearing aids will also be addressed. For
further information, contact Regina Tisor
(319) 356-2471 or FAX (319) 353-6739.
Ginkgo Biloba and
Animal Research for Tinnitus
by Pawel J. Jastrebofj; Ph.D., Sc.D.,
Professor and Director, University of Maryland
Tinnitus & Hyperacusis Center
The search for a drug that can effectively
suppress tinnitus, without creating significant
negative side effects, continues. Among the
many substances that have been tried, an
extract from a Chinese tree, ginkgo biloba, has
attracted some attention. It is possible to pur-
chase various ginkgo extracts on the market
with widely different compositions.
The best controlled extract is produced in
France and Germany under governmental con-
trol and can be purchased only as a prescription
drug in those countries. It is called EGb 761 and
is sold in the United States under the label
Ginkgold. There are a number of reports
describing the effect of this drug on tinnitus
patients, with results varying from no effect
whatsoever, to mild improvement in general
well-being, to "taking the edge off tinnit us" and
even partial attenuation of tinnitus.
Ed. note: A few ATA members have called or writ-
ten to say that Ginkgo had worsened their tinnitus.
EGb 761 attracted our attention for the fol-
lowing reasons. The drug has no reported nega-
tive side effects so it can be used safely. If we
were looking for a drug capable of strongly sup-
pressing or eliminating tinnitus, EGB 761 would
not be of particular interest.
However, the drug can potentially offer sub-
stantial benefit when combined with our treat-
ment approach, aimed at inducing and
facilitating tinnitus habituation, that is, reaching
the state where the patient is not aware of the
presence of tinnitus the majority of the time.
This is achieved by retraining the auditory path-
ways in the brain with the help oflow level,
broad-band noise, generated by behind-the-ear
devices. The approach is based on a neurophysi-
ological model of tinnitus. According to the
model, even a partial suppression oftinnitus
while undergoing treatment with broad-band
noise generators should speed up the treatment
process and further improve our results.
Although we are observing a significant
improvement in over 80% of our patients, the
process takes 12 to 18 months and requires us to
spend a large amount of time with each patient.
Finding a drug that can even partially attenuate
tinnitus should shorten the patient's treatment
and allow us to treat more patients. The results
from previous experimental work on animals
performed with EGb 761 at NIH were encourag-
ing and showed that EGb 761 suppresses the
metabolic activity within the auditory pathways.
Since there is a general agreement that tinnitus
is associated with enhancement of the metabolic
activity, there is a chance that ginkgo, by
decreasing this activity, might attenuate tinni-
tus. Other reports have shown that EGb 761
enhances calcium homeostasis. Since we have
postulated that disturbances in calcium home-
ostasis might be involved in the emergence of
tinnitus, EGb 761, by enhancing calcium home-
ostasis, might perhaps attenuate tinnitus.
Our animal model of tinnitus, in which we
temporarily induce tinnitus in rats using salicy-
late, allows us to evaluate not only the presence
or absence of tinnitus in rats, but to measure its
loudness as well. As such, the model is well-suit-
ed for finding out whether a drug has the capa-
bility of attenuating salicylate-induced tinnitus
in animals. We performed experiments on
eleven groups of rats, each group consisting of
six animals treated with different doses of EGb
761, as well as control groups with saline, or
saline and ginkgo only. The results showed a
dose-dependent attenuation of salicylate-
induced tinnitus by EGb 761. Notably, EGb 761
alone was without any effect on animal behav-
ior, indicating that our results were not contami-
nated by nonspecific effects of the drug.
Although the mechanisms of tinnitus sup-
pression by EGb 761 are unknown
1
these results
are encouraging to such an extent that we are
considering performing a clinical double-blind
study with this drug on our patients.
Tinnitus Thday/ June 1995 13
Temporal Bone Organ Donations
The NIDCD's Thmporal Bone Registry, estab-
lished in 1992 to advance research on hearing
and balance disorders, encourages people with
tinnitus and other ear disease to become tempo-
ral bone donors.
They write: The temporal bone is the part of
the skull that contains the structures of hearing and
balance - the middle and inner ear (including the
cochlea, ossicles, ear drum, semicircular canals,
and parts of the cranial and vestibular nerves).
Because of its inaccessible location inside the tem-
poral bone, the inner ear can only be studied after
death when the temporal bones are removed and
processed for microscopic study.
Knowledge gained from the study of temporal
bones about how certain disorders, like tinnitus,
affect the ear will ultimately improve the evaluation
and treatment of hearing and balance disorders for
"COPING WITH TINNITUS"
e STIU:SS MANAGEME.NT &. TREATMENT
e TINNITUS MANAGEMENT IS OFTEN
COMPLICATED BY ANXIETY AND STRESS
e NOW A UNIQUE CASSETIE PROGRAM IS
AVAILABLE DESIGNED TO PROVIDE DAILY
REINFORCEMENT AND SUPPORT FROM THE
STIU:SS OF TINNITUS WITHOUT COMPLEX
INSTRUMENTATION&.. VALUABLE OffiCE TIME
The program consists of one cassette tape of Metronome
Conditioned Relaxation and two additional tapes of unique
masking sounds which have demonstrated substantial benefit
\ whenever the patient feels the
need of additional relief. These
9
9 5 recordings can be used to induce
$ 5 er