Posted-By: auto-faq 3.1.1.2 Archive-name: medicine/tinnitus-faq Posting-Frequency: monthly

Posted-By: auto-faq 3.1.1.2 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 ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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? ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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 ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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). 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. 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. 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. 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?]***** ------------------------------------------------------------------------------ 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]***** ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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]***** ------------------------------------------------------------------------------ 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)