Tinnitus Frequently Answered Questions

Archive-name: medicine/tinnitus-faq
Posting-Frequency: monthly
Last-modified: 8 Nov 1994
Version: 1.0



Tinnitus Frequently Answered Questions

Last update v1.0, November 8, 1994

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What's New


This document is now an official Usenet FAQ, posted monthly to the
various
*.answers newsgroups. The last version to be widely posted was 0.7;
there was
a
0.8 proto-official FAQ version available from my site that did not
contain any
new medical information. The only new medical information in this 1.0
version
is an important caution about DMSO.

I am once again accepting new submissions to be included in this
document. I
hope to be able to process the existing backlog and issue version 1.1
sometime
in December 1994.

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.

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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 the document, please help
your
fellow tinnitus sufferers by contacting the FAQ Maintainer, Mark Bixby
, at
markb@cccd.edu.

In addition to being posted monthly to Usenet, 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

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?

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1) What is tinnitus?

Tinnitus can be described as "ringing" ears and other head noises that
are
perceived in the absence of any external noise source. It is estimated
that 1
out of every 5 people experience some degree of tinnitus.

Tinnitus is classified into two forms: objective and subjective.
Objective
tinnitus, the rarer form, consists of head noises audible to other
people in
addition to the sufferer. The noises are usually caused by vascular
anomalies
,
repetitive muscle contractions, or inner ear structural defects.
Subjective
tinnitus is much less understood, with the causes being many and open
to
debate. Anything from the ear canal to the brain may be involved.

Hearing loss, hearing hypersensitivity , and balance problems may or
may not
be
present in conjunction with tinnitus.

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2) What does tinnitus sound like?

Many sufferers in the online community report that their tinnitus
sounds like
the high-pitched background squeal emitted by some computer monitors
or
television sets. Others report noises like hissing steam, rushing
water,
chirping crickets, bells, breaking glass, or even chainsaws. Some
report that
their tinnitus temporarily spikes in volume with sudden head motions
during
aerobic exercise, or with each footfall while jogging.

Objective tinnitus sufferers may hear a rhythmic rushing noise caused
by their
own pulse. This form is known as pulsatile tinnitus.

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3) How is tinnitus diagnosed?

The following flowchart from the Cecil Textbook of Medicine, 1992
(19th ed.),
W.B. Saunders, shows the logic for diagnosing the common causes of
tinnitus:

ear exam--->(audible sounds)-+-->sync w/respiration--->patent
eustachian tube
   |                         |
   |                         +-->sync w/pulse--->aneurysm, vascular
tumor,
   v                         |                   vascular
malformation,
(no audible sounds)          |                   venous hum
   |                         |
   |                         +-->continuous--->venous hum, acoustic
emissions
   v
neurological exam-->(normal)-->audiogram
   |                             |
   |                             +-->normal--->idiopathic tinnitus
   |                             |
   |                             +-->conductive hearing loss
   v                             |             |
(brain stem signs)               |             v
   |                             |     impacted cerumen, chronic
   |                             |     otitis, otosclerosis
   v                             |
multiple sclerosis,              +-->sensorineural hearing loss
tumor, ischemic                                  |
infarction                                       v
                                             BAER test
                                                 |
                                                 v
                                       +---------+--------------+
                                       |                        |
                                       v                        v
                                    abnormal (neural)      normal
cochlear
                                       |                        |
                                       v                        v
                                    acoustic neuroma       noise
damage
                                    other tumors           ototoxic
drugs
                                    vascular compression
labyrinthitis
                                                           Meniere's
Disease
                                                           perilymph
fistula
                                                           presbycusis


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4) What causes tinnitus?

   * 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 tumors that press against 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.


   * 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. See the next section for more detail.
These drugs include:

     salicylate analgesics (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


   * 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.


   * 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.


   * 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.

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5) How can I avoid getting tinnitus?

Avoid the causes listed above. Really. The number one cause of
tinnitus is exposure to excessively loud noise. Either avoid these
noisy situations, or wear hearing protection as described below. Rock
concerts, movie theaters, nightclubs, construction sites, guns, power
tools, stereo headphones and musical instruments are just some of the
things that can be hazardous to your ears. Damage can result from
either a single exposure or cumulative trauma. If you ever experience
temporary ringing after a sound exposure, YOU ARE AT A SEVERE RISK FOR
TINNITUS AND/OR HEARING LOSS .

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

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6) What are some ototoxic drugs?

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--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).


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

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

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

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7) What is Meniere's Disease?

Meniere's is a very serious disease of the inner ear, resulting in
extended vertigo attacks, major hearing loss, and frequently tinnitus.
Here is one sufferer's story:

What are the symptoms?

     In my case it started with a constant fullness in my right ear
and the constant ringing. I also noticed I wasn't hearing very well
and I was having some vertigo attacks.

     Originally I had my Allergist treat me. She thought it might just
be an inner ear infection or a sinus infection. It manifested itself
in the fall which is one of my worst allergy seasons.

     By Spring she referred me to an ENT.

What tests would a physician do to diagnose it?

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

Are there any known environmental causes, or is it one of those things
that "just happens" to people?

     One possible cause is Diabetes. Other than that no one that I
have spoken with knows. It may also be hereditary. Usually doesn't
show up until later in life 40 and beyond, and can burn itself out in
3 - 5 years. Some have it earlier in life (me at 35) and could have it
the rest of our lives.

What are the common treatments? Anti-vertigo drugs? Surgical
operations on the inner ear balance mechanisms?

     The most common treatment for mild episodic Meniere's I guess
would be to rule out Diabetes and allergies. For the vertigo attacks
usually the prescription drug Antivert is used or the over the counter
drug Meclizine . Both tend to relive the vertigo. For more chronic
cases a low dosage of Valium can help. When things get bad enough the
next procedure is an Endolymphatic Transmastoid Shunt. This helps to
keep some of the pressure of the inner ear. Changes in diet can help.
Removal of sodium, caffeine and alcohol can help. Usually a mild
diuretic is prescribed.

     I know of several folks who keep it under control with allergy
shots and restricting their sodium intake.

     If it progresses to a point where the patient can no longer
'live' with it an Eighth Nerve Section can be done. But according to
my surgeon this is an absolute last resort. It guarantees deafness in
the ear and some patients report balance problems at night. He also
claims the risks are high with this procedure including partial face
paralysis.

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.

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8) What is hyperacusis?

Hyperacusis is an extreme sensitivity to sound, where even small
sounds are perceived as painfully strong. Usually occurs in
combination with tinnitus. May also be a side effect of certain
ear/skull surgeries.

Information describing hyperacusis can be found in the ATA pamphlet
"Hyperacusis - A life-altering supersensitivity to sound". Available
by writing or phoning them at the place listed in this FAQ.

Hyperacusis is like tinnitus in that severity and ways it exhibits
itself varies. Severity can be as low and a mild annoyance to normal
sounds to the point where maximal ear protection cannot stop the sound
of something like a mini computer disk drive whine from causing great
pain. It differs from recruitment, where only loud sounds are
uncomfortable, in that *all* sounds are uncomfortable. Apparently the
ear's volume regulation system from efferent nerve fibers lose control
and the ear's "volume knob" is broken on maximum. There is some
overlap between hyperacusis and tinnitus. Some tinnitus sufferers have
some hyperacusic symptoms. Further damage might take them toward full
blown hyperacusis. Hyperacusis is caused almost always by loud sound,
usually music. Usually no hearing loss occurs in the hyperacusic
person.

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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.

     Some people report good results from niacin, other people gain
nothing. Your mileage may vary.


   * 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.


   * 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.

     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.

     Klonopin

     Same class of drug as Xanax, but somewhat less effective and less
     addictive.

     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), 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 serious side-effects
that require careful monitoring via blood chemistry and other tests.


   * intravenous lidocaine

     An initial injection of lidocaine followed by an IV drip may
provide temporary relief to some sufferers.


   * tocainide hydrochloride

     This is an oral relative of lidocaine thought to act in a similar
manner.


   * 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. 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

     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


   * 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.


   * 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.


   * 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.


   * 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.

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

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.


   * surgically severing the auditory nerves

     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.

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

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.
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. Some masking machine vendors:

Ambient Shapes, Inc.

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. 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.


   * 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

*****[product #, price, manufacturer, phone number, NRRs?]*****

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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

[Dues and services presently unknown.]

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 professional referrals by region. US $25 per year, check,
VISA, MasterCard.

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.

*****[Other orgs & countries needed, especially European]*****

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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.

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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.

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-------

16) What can I do when all else fails?

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.

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

With only one small exception, 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.

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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

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

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19) Who are the contributors to this FAQ?


Unless otherwise requested, all contributors will be credited here.

Mark Bixby              markb@cccd.edu (FAQ Maintainer)

Barbara Bixby           markb@cccd.edu Julie Bixby
markb@cccd.edu Karl F. Bloss           blosskf@ttown.apci.com Pete
Brooks             Peter_Brooks@sj.hp.com W. Keith Brummet
wkb@cblph.att.com David Charlap           david@porsche.visix.com Erik
Christensen        erchrist@char.vnet.net Michael Claes
claes@bbt.com Michael L. Connolly     connolly@netcom.com Scott Dayman
scott@ida.jpl.nasa.gov Bob Dubin, DC           drdubin@aol.com Steve
Gotthardt         steveg@up.edu Doug Gwyn               gwyn@arl.mil
Norman F. Johnson       njohnson@nosc.mil Douglas R. Jones
djones@iex.com Laurie Kramer           kramerl@gdb.org Richard
Landesman       rlandesm@moose.uvm.edu Colleen Lynch
clynch@random.ucs.mun.ca Rob McCaleb             rmccaleb@hrf.org Paul
Murphy             pmurphy@carbon.denver.colorado.edu John Setel
O'Donnell    jod@equator.com Mark A. Pitcher
sols7520@mach1.wlu.ca Dallas Roark            roark@kuhub.cc.ukans.edu
Mark Sharp              mvsharp@tenet.edu Chandra Shekhar
chandy@sophia.inria.fr Jeff Slavitz            jslavitz@netcom.com
Lori Snidow             lnsnidow@ufcc.ufl.edu Kurt Strain
kurts@sr.hp.com Jack Trainor            jdt@well.sf.ca.us Allen Watson
allen_watson@quickmail.apple.com Mike Watterson
watterson@stsci.edu Steve Zimmerman         stevezim@crl.com -- Mark
Bixby                         E-mail: markb@cccd.edu Coast Community
College District   Web: http://www.cccd.edu/~markb/ District
Information Services      1370 Adams Ave., Costa Mesa, CA, USA  92626
Technical Support                  +1 714 432-5064 "You can tune a
file system, but you can't tune a fish." - tunefs(1M)