From G.L.Eden@newcastle.ac.ukThu Jun 15 12:14:04 1995 Date: Thu, 15 Jun 1995 14:43:28 +0100 (BST) From: g303 To: " Jason W. King" Subject: Re: Tinnitus On Tue, 13 Jun 1995, Jason W. King wrote: > If you want, send stuff to me and I will put it at hyperreal. thanks... well here it is Tinnitus Frequently Answered Questions Last update v1.4, June 8, 1995 ------------------------------------------------------------------------------ What's New * Hyperacusis: completely revised section. * Treatments: Auditory Integration Training. * Organizations: a Dutch tinnitus committee; new write-up for The Hyperacusis Network. * other cosmetic or administrative tweaks too minor to mention or too obvious to bother If your submission didn't make it into this edition, be patient. I promise to clean out the queue of FAQ submissions before the start of summer. To Do This FAQ is a work in progress. Areas where I know I need more advice are delineated by "*****[]*****", but please feel free to comment on anything. Yes, I know, this FAQ is getting huge. :-) Someday if I ever have enough free time, I'll consider splitting it into multiple postings. ------------------------------------------------------------------------------ About the Tinnitus FAQ Welcome to the Tinnitus FAQ. At the present time, there are many questions about tinnitus, but few definitive answers that apply to all sufferers. If you have any additional insights not covered in this document, please help your fellow tinnitus sufferers by contacting the FAQ Maintainer, Mark Bixby , at markb@cccd.edu . 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 Topics covered: 1) What is tinnitus? 2) What does tinnitus sound like? 3) How is tinnitus diagnosed? 4) What causes tinnitus? 5) How can I avoid getting tinnitus? 6) What are some ototoxic drugs? 7) What is Meniere's Disease? 8) What is hyperacusis? 9) What drugs, vitamins, and herbs are available for treating tinnitus? 10) What other treatments are available for tinnitus? 11) What is masking? 12) What types of ear plugs or other hearing protection are available? 13) What organizations can I turn to for more information? 14) What books can I turn to for more information? 15) What online resources are available? 16) What can I do when all else fails? 17) Where did the medical advice in the FAQ come from? 18) What clinics or physicians can I turn to for real medical advice? 19) Who are the contributors to this FAQ? About the Tinnitus FAQ Maintainer The Tinnitus FAQ Maintainer, Mark Bixby , is just a computer geek with tinnitus and WITHOUT medical training. Everything I have learned about tinnitus has been included in this FAQ, along with the contributions from many, many other people, both submitted explicitly via private e-mail to me and indirectly via public postings to alt.support.tinnitus. While I will always try to answer questions sent to me via private e-mail, you will probably reach people with better expertise than I by posting publicly to alt.support.tinnitus. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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 ------------------------------------------------------------------------------ 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). ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 7) What is Meniere's Disease? Meniere's is a very serious disease of the inner ear, resulting in extended vertigo attacks, major hearing loss, and frequently tinnitus. Here is one sufferer's story: What are the symptoms? In my case it started with a constant fullness in my right ear and the constant ringing. I also noticed I wasn't hearing very well and I was having some vertigo attacks. Originally I had my Allergist treat me. She thought it might just be an inner ear infection or a sinus infection. It manifested itself in the fall which is one of my worst allergy seasons. By Spring she referred me to an ENT. What tests would a physician do to diagnose it? First was a hearing test. This was followed by an MRI to ensure there wasn't a tumor to deal with. There was also the physical to ensure there was no other underlying cause, including Diabetes. Then being referred to a surgeon who specializes in this kind of thing. He did further hearing tests and another test which I will have to get the name for you. It consists of lights on the wall that you follow with your eyes. They also insert warm and cold water into each ear (ENG/AU test) to measure the response; a short vertigo spell is the result for healthy ears. There is also a special set of hearing tests that they do. Are there any known environmental causes, or is it one of those things that "just happens" to people? One possible cause is Diabetes. Other than that no one that I have spoken with knows. It may also be hereditary. Usually doesn't show up until later in life 40 and beyond, and can burn itself out in 3 - 5 years. Some have it earlier in life (me at 35) and could have it the rest of our lives. What are the common treatments? Anti-vertigo drugs? Surgical operations on the inner ear balance mechanisms? The most common treatment for mild episodic Meniere's I guess would be to rule out Diabetes and allergies. For the vertigo attacks usually the prescription drug Antivert is used or the over the counter drug Meclizine . Both tend to relive the vertigo. For more chronic cases a low dosage of Valium can help. When things get bad enough the next procedure is an Endolymphatic Transmastoid Shunt. This helps to keep some of the pressure of the inner ear. Changes in diet can help. Removal of sodium, caffeine and alcohol can help. Usually a mild diuretic is prescribed. I know of several folks who keep it under control with allergy shots and restricting their sodium intake. If it progresses to a point where the patient can no longer 'live' with it an Eighth Nerve Section can be done. But according to my surgeon this is an absolute last resort. It guarantees deafness in the ear and some patients report balance problems at night. He also claims the risks are high with this procedure including partial face paralysis. [Ed. note: new surgical techniques access the nerve via the posterior fossa, preserving hearing and reducing the risk of facial paralysis] In general, imagine yourself back when you first encountered Meniere's. What kind of summary info would have been helpful to you? Knowing that it can be treated with medication and there is the hope that it will burn itself out keeps me going. There does seem to be a connection with the tinnitus and the Meniere's. I have noticed over the last two years that the tinnitus gets worse and my hearing decreases prior to a vertigo episode or series of vertigo episodes. 25mg of Meclizine usually has the vertigo under control in 20 - 30 minutes for a mild attack. A severe attack can leave you completely disoriented such that there is no real up or down. An attack this severe usually has bouts of nausea and vomiting with it. I find lying down in a quiet dark room helps while the medicine kicks in. Anti-nausea drugs can help. In my case when I have had a severe episode I usually feel 'out-of-sorts' for a couple of days. If you experience pretty intense tinnitus coupled with vertigo and the inability of hold your eyes steady on an object I would suggest seeing an ENT who knows about Meniere's. I have found that it is not well known or understood. Endolymphatic hydrops is a condition similar to Meniere's that involves vertigo without hearing loss, as described by another contributor: I have a problem with one ear that is called endolymphatic hydrops, which is something like Meniere's without a severe hearing loss. Apparently the fluid in the semicircular canals responds to changes in body fluid levels - which it isn't supposed to do- and sends messages to say you are dizzy. I have spontaneous vertigo attacks and motion induced dizziness - all lasting only a short time. Well, what does this have to do with tinnitus? I also have tinnitus in that ear, which is helped by some things I have been taught to do for dizziness. Eating small meals several times a day keeps your body fluid levels fairly consistent. Also avoid salt. That really makes a difference with tinnitus and avoid too much sugar as well. Other things to be careful of are fatigue and dehydration. All these things have been helpful for me. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 10) What other treatments are available for tinnitus? * surgery For tinnitus caused by acoustic neuromas , vascular abnormalities , and TMJ syndrome. But note above in the Causes section that tinnitus, hyperacusis , or even profound deafness can _result_ from ear/skull surgery. * maintain a healthy diet & lifestyle This means no tobacco, no alcohol, no caffeine, low fat, low sodium. This may not cure your tinnitus, but there are other well-proven health benefits. Other less obvious foods like quinine/tonic water should also be avoided. * biofeedback Useful as a stress reduction tool, biofeedback may help some people. *****[comments from someone who's been there?]***** * accupuncture May provide temporary relief to some people. One contributor reports significant relief that enabled him to avoid the heavy-duty anti-depressants that his Western physician had prescribed. * stress reduction Many people say their tinnitus is more active when they're tired and stressed out. Get a good night's sleep and avoid unnecessary stress. * hearing aids Some people with severe tinnitus may benefit from hearing aids that bring normal speech sounds above the background tinnitus sounds. In addition to amplification, hearing aids may be useful as maskers when they also introduce white noise into the sound stream. * cranial sacral therapy There is anecdotal evidence of help for tinnitus through cranial sacral therapy by osteopaths and chiropractors. * electrical stimulation Various electrode placements with various voltages & frequencies may provide some relief. External, ear canal, transtympanic, middle ear, and cochlear electrodes have all been tried. Side effects may include pain, and alterations to sense of taste & smell. 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 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. 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. ------------------------------------------------------------------------------ 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. 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 testimonial 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 Slecthorended 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 video made exclusively for H.E.A.R., "Can't Hear You Knocking" c1990 Flynner Films, 17 minute VHS, featuring Ray Charles, Pete Townshend, Lars Ulrich and other music industry professionals spotlight the dangers and effects of hearing loss. Send $39.95 plus S&H, $5 US/$10 Over seas to: (above address). All donations are tax-deductible. (even smaller print): "CHYK" 55 minute VH-S. The Cinema Guild, NY. Don't ask me why they first say the video is 17 minutes, then at the bottom they say it's 55 minutes. NIH/National Institute of Deafness and Other Communication Disorders (NIDCD) 9000 Rockville Pike Bethesda, MD 20892 +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. ------------------------------------------------------------------------------ 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. Mark Bixby markb@cccd.edu (FAQ Maintainer) Richard Alpert alpert@cs.bu.edu Barbara Bixby markb@cccd.edu Julie Bixby markb@cccd.edu Karl F. Bloss blosskf@ttown.apci.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 Erik Christensen erchrist@char.vnet.net Michael Claes claes@bbt.com Michael L. Connolly connolly@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 Kevin Hogan KJXT98A@prodigy.com 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 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 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 -- Mark Bixby E-mail: markb@cccd.edu Coast Community College Dist. Web: http://www.cccd.edu/~markb/ District Information Services 1370 Adams Ave., Costa Mesa, CA, USA 92626-5429 Technical Support +1 714 432-5865 x7064 "You can tune a file system, but you can't tune a fish." - tunefs(1M) greg The Official WARP Web Site 3 0 3 http://www.ncl.ac.uk/~n264671/wap-indx.html