AOH :: TINNITUS.FAQ
Frequently Asked Questions on Tinnitus
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Tinnitus Frequently Answered Questions
Last update v1.7, October 8, 1995
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What's New
* What is Masking?: residual inhibition
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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.
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
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?
About the Tinnitus FAQ Maintainer
I took over 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, "The American Tinnitus Association".
In 1993, I got started 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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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. [Ed. note: I've had knee MRIs done, and even with earplugs and
my head outside the bulk of the machine it was very loud.]
* wax/dirt build-up in the ear canal
If you're experiencing tinnitus, this is one of the first things you
should check for. NEVER try digging or suctioning the ear canal yourself
or allow a physician to do it as SERIOUS damage may result. Numerous
over-the-counter chemical washes are available from your drugstore which
will clean the ear canal in a safe and gentle manner.
* acoustic neuromas
Acoustic neuromas are small, 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/~sbroock/index.html , 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. 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.
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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.
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7) What is Meniere's Disease?
Meniere's is a very serious disease of the inner ear, resulting in extended
vertigo attacks, major hearing loss, and frequently tinnitus. Here is one
sufferer's story:
What are the symptoms?
In my case it started with a constant fullness in my right ear and
the constant ringing. I also noticed I wasn't hearing very well and I
was having some vertigo attacks.
Originally I had my Allergist treat me. She thought it might just be
an inner ear infection or a sinus infection. It manifested itself in
the fall which is one of my worst allergy seasons.
By Spring she referred me to an ENT.
What tests would a physician do to diagnose it?
First was a hearing test. This was followed by an MRI to ensure there
wasn't a tumor to deal with. There was also the physical to ensure
there was no other underlying cause, including Diabetes. Then being
referred to a surgeon who specializes in this kind of thing. He did
further hearing tests and another test which I will have to get the
name for you. It consists of lights on the wall that you follow with
your eyes. They also insert warm and cold water into each ear (ENG/AU
test) to measure the response; a short vertigo spell is the result
for healthy ears. There is also a special set of hearing tests that
they do.
Are there any known environmental causes, or is it one of those things that
"just happens" to people?
One possible cause is Diabetes. Other than that no one that I have
spoken with knows. It may also be hereditary. Usually doesn't show up
until later in life 40 and beyond, and can burn itself out in 3 - 5
years. Some have it earlier in life (me at 35) and could have it the
rest of our lives.
What are the common treatments? Anti-vertigo drugs? Surgical operations on the
inner ear balance mechanisms?
The most common treatment for mild episodic Meniere's I guess would
be to rule out Diabetes and allergies. For the vertigo attacks
usually the prescription drug Antivert is used or the over the
counter drug Meclizine . Both tend to relive the vertigo. For more
chronic cases a low dosage of Valium can help. When things get bad
enough the next procedure is an Endolymphatic Transmastoid Shunt.
This helps to keep some of the pressure of the inner ear. Changes in
diet can help. Removal of sodium, caffeine and alcohol can help.
Usually a mild diuretic is prescribed.
I know of several folks who keep it under control with allergy shots
and restricting their sodium intake.
If it progresses to a point where the patient can no longer 'live'
with it an Eighth Nerve Section can be done. But according to my
surgeon this is an absolute last resort. It guarantees deafness in
the ear and some patients report balance problems at night. He also
claims the risks are high with this procedure including partial face
paralysis. [Ed. note: new surgical techniques access the nerve via
the posterior fossa, preserving hearing and reducing the risk of
facial paralysis. The vestibular nerve alone can be sectioned,
providing vertigo relief.]
In general, imagine yourself back when you first encountered Meniere's. What
kind of summary info would have been helpful to you?
Knowing that it can be treated with medication and there is the hope
that it will burn itself out keeps me going. There does seem to be a
connection with the tinnitus and the Meniere's. I have noticed over
the last two years that the tinnitus gets worse and my hearing
decreases prior to a vertigo episode or series of vertigo episodes.
25mg of Meclizine usually has the vertigo under control in 20 - 30
minutes for a mild attack. A severe attack can leave you completely
disoriented such that there is no real up or down. An attack this
severe usually has bouts of nausea and vomiting with it. I find lying
down in a quiet dark room helps while the medicine kicks in.
Anti-nausea drugs can help. In my case when I have had a severe
episode I usually feel 'out-of-sorts' for a couple of days.
If you experience pretty intense tinnitus coupled with vertigo and
the inability of hold your eyes steady on an object I would suggest
seeing an ENT who knows about Meniere's. I have found that it is not
well known or understood.
Meniere's, Tinnitus, & Gentamicin, as explained by Jim Chinnis <
jchinnis@interramp.com >:
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 requires patients with
hyperacusis to 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.
(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."
* anti-histamine
[Ed. note: Yes, I realize this is in contradiction with the above
paragraph.] The theory is that the mild sedative effect eases anxiety, and
that mucous reduction allows the inner ear to dry out, thus relieving
cochlear pressure.
* meclizine
This is an over-the-counter (USA) anti-vertigo drug. While it is obviously
relevant to the severe vertigo that comes with Meniere's, there was one
anecdotal report submitted to this FAQ by a tinnitus sufferer who did not
_have_ vertigo but took meclizine to successfully reduce his tinnitus.
* DMSO
The following appeared in a recent article in Alternatives regarding
tinnitus:
"Ask your doctor to review the following article, Annals of the
New York Academy of Sciences 75:243:468:74. 'In this study,15
patients were suffering from tinnitus. Every four days 2
milliliters of a medicated DMSO solution containing
anti-inflammatory and vasodilatory compounds were applied
locally to the external auditory canals of their ears. They were
also given an intramuscular injection of DMSO at the same time.
'After one month, 9 of the 15 patients had a total cessation of
the tinnitus and it didn't return during the one year
observation period. It was diminished in two others and in the
remaining four it became only an occasional problem instead of
permanent (cold temperatures seemed to be the main factor
causing it to return).
'In addition, all of the five patients that were suffering from
vertigo noted significant improvement...'
CAUTION: DMSO was recently implicated in the mysterious case of the
"fume-emitting body" from Riverside, California. A terminal cancer patient
was brought by paramedics to an emergency room, where toxic fumes from the
patient incapacitated and in certain cases seriously injured the attending
physicians. Investigation has revealed that the patient used DMSO (to
relieve pain and inflammation?), and that due to several unusual
coincidences, the DMSO was metabolized into a toxic substance used in
chemical warfare.
* vinpocetine and vincamine
The following is an anecdotal report concerning vinpocetine, a drug that
is NOT registered in the United States. A search of the Physician's Desk
Reference and several CDROM databases turned up nothing on the drug or its
manufacturer. Be skeptical, but also remember that some of today's wonder
drugs were once new and unregistered. A prominent American tinnitus
researcher 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
ehadache. Overall, Hydergine does not produce any serious side
effects. It is nontoxic even at very large doses and it is
contraindicated only for individuals who have chronic or acute
psychosis, or who are allergic to it. Overdosage of Hydergine
may, paradoxically, cause an amnesic effect."
Hydergine is available in the United States with a doctor's prescription.
It is also available from overseas sources, as one contributor explains:
Hydergine is widely used in France, and it is cheap there. One
person told me that you can get 5 mg Hydergine tablets there for
less than the price of 1 mg in the US. If contacts can be made
directly with French pharmacists sympathetic to the use of the
higher European dosages in the US, mail-order access might be
arrangeable for US tinnitus people.
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@ix.netcom.com
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
------------------------------------------------------------------------------
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 Eight 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.
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.
------------------------------------------------------------------------------
11) What is masking?
Masking is the technique of producing external "white noise" sounds that will
mask the tinnitus and make it less distracting. Masking machines come in both
in-the-ear and portable models that produce sounds ranging from random white
noise to waterfalls to surf, etc. Frequencies used are generally within a 1 khz
- 12 khz band. Hearing aids can also function as maskers by amplifying external
sounds. Many people find that tuning a regular FM radio to an empty frequency
and listening to the static beneficial. Another popular method is to run an
electric fan. If you have an audio CD player, consider putting on a nature
sounds (ocean, jungle, whales, etc) CD in autorepeat mode before going to bed.
In a study of masking, 16% of patients reported relief with a hearing aid
alone, 21% reported relief from a tinnitus masker alone, and 63% reported
relief from a combination hearing aid / tinnitus masker. In the latter case it
was important to properly adjust the hearing aid before attempting masking.
Residual Inhibition
Masking can also produce a phenomenon called, "residual inhibition". The effect
residual inhibition has is to cause the tinnitus sound to partially or
completely disappear for a few mins. to a few hours, weeks, months or even for
life. I was tested for residual inhibition by G. Gordon Gibson at the, Tacoma
Tinnitus Clinic", in Tacoma, Wa. in 1985. Mr. Gibson revelled in his
experiences with tinnitus patients referred to him by ENTs, that some had
complete remission for awhile and then would just need to listen to the "white
noise" for a short while to make the tinnitus go away again. One person, he
said, "Went into complete remission". I was also tested for ri at the
University of Washingtons' Tinnitus Clinic in 1986, but I was not to be so
fortunate as others at either place I tried.
The important thing is to have a "Tinnitus Clinic" test your ears for your
specific tinnitus sound, so the right white noise can be matched up to it. You
can get a Professionl Referrals list of your area from American Tinnitus
Association .
In a Sept. 1986 American Tinnitus Association Newsletter, "Colin Kemp", an
engineer working in Austrailia who markets a unit called, "The Tinnitus
Inhibitor" says, "At our Tinnitus Clinic, we call this phenomenon Residual
Inhibition and routinely test all patients for it. Residual inhibition comes in
many forms, But in one form or another we find it in nearly 89% of patients".
The following is an excerpt from: Oregon Tinnitus Data Archive 95-01
Residual inhibition was tested in each ear separately if patient had tinnitus
that was bilateral or "in the head". Results shown here are for each patient's
best trial (maximum residual inhibition effect).
Residual Inhibition - Type
Type of RI N (%)
-------------------------------------
No RI 173 (11.9)
Partial RI only 476 (32.8)
Complete RI only 34 (2.3)
CRI + PRI* 768 (52.9)
--- ----
Total 1451* (99.9)
* Omits patients who were not tested for RI, primarily because a minimum
masking level could not be obtained.
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-Acouphenes
117 rue Cuvier
69006 Lyon, France
[Dues and services presently unknown.]
Germany
DTL (Deutsche Tinnitus Liga)
Postfach 349
D-42353 Wuppertal
Germany
Phone: ++49-(0)202-464584
This organization consisting of tinnitus sufferers and some supporting medical
professionals is one of the biggest ones. Members get lots of information about
medicines, new therapies and the sites which offer them and and and...
Furthermore you'll get the DTL newspaper named "Tinnitus Forum" four times a
year. The DTL also organizes member meetings and workshops. Detailed info about
the DTL activities and membership (min. 60.- DM per year) can be obtained by
writing to the address written above.
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
professional referrals list by geographic region that lists ENTs, audiologists,
dentists, psychiatrists, and psychologists that are all well-educated about
tinnitus. If you're searching for a knowledgable medical professional, you
might want to start here. US $25 per year, check, VISA, MasterCard. A brief
history of the ATA and their relationship to the neighboring OHRC and OHSU as
provided by the Oregon Hearing Research Center:
A doctor by the name of Charles Unice, from California, wanted to
know what was being done about tinnitus (he was a sufferer), so he
contacted the National Institutes of Health, who referred him to our
laboratory. The Kresge Hearing Research Laboratory (us, in 1978 or
so) was the only place in the United States doing research on
tinnitus funded by the NIH at that time. Unice decided to found an
American Tinnitus Association. Its purpose would be the dissemination
of information about tinnitus, and if possible, to provide money for
research on tinnitus problems.
The American Tinnitus Association was started here in Portland, in
order to be close to the research taking place. There were some
interested citizens in Portland who were willing to help get it
started. It was started under the "umbrella" of the University of
Oregon Medical School (now called the Oregon Health Sciences
University). It was started in Oregon, as opposed to Dr. Unice's home
state of California, because of simpler tax laws here. Eventually,
the ATA became an independent organization from the Medical School
and is now doing quite well. They have offices in the downtown area
of Portland, OR.
In 1985, the Kresge Hearing Research Laboratory became the Oregon
Hearing Research Center. We are the research division of the
Otolaryngology-Head & Neck Surgery Dept. of the Oregon Health
Sciences University. We're located in the west hills of Portland,
above downtown.
Dr. Vernon writes a column for the ATA in their "Tinnitus Today"
publication. Members of the OHRC are often asked to review grant
applications for ATA, as are other researchers in the area of
tinnitus across the country. OHRC staff are also consulted for
information regarding brochures and literature ATA develops. They
refer calls and letters when they cannot provide the answers.
Other than that, we do not have any official ties to ATA. We are not
receiving funding from them at this time (I say at this time because
it is possible we could apply for grant applications in the future),
and they receive no funding from the OHSU nor the OHRC. Their funding
comes from contributions from their members and combined charitable
campaigns.
The OHSU Biomedical Information and Communications Center (BICC) has
taken on as one of their missions to provide internet access to
health providers in the state of Oregon. The ATA, as an organization
who provides health information to the public, was given internet
access by the OHSU. This does not mean that they are a part of OHSU.
H.E.A.R. (Hearing Education and Awareness for Rockers)
P.O. Box 460847
San Francisco, CA 94146
USA
+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.
------------------------------------------------------------------------------
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
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.
------------------------------------------------------------------------------
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@ix.netcom.com
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@prl.philips.nl
Steve Gotthardt steveg@up.edu
Doug Gwyn gwyn@arl.mil
Jamie Hanrahan jeh@cmkrnl.com
George Harvey gwh@panpacific.reno.nv.us
Kevin Hogan KJXT98A@prodigy.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
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
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
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