Article 13928 of misc.health.alternative:
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From: markb@spock.dis.cccd.edu (Mark Bixby)
Newsgroups: alt.support.tinnitus,alt.rock-n-roll.hard,misc.health.alternative,rec.audio.misc,rec.audio.pro,rec.music.makers,rec.music.misc,sci.med,sci.med.dentistry,sci.med.nutrition
Subject: Tinnitus Frequently Answered Questions v0.7
Supersedes: <tinnitus-faq-1-780783307@spock.dis.cccd.edu>
Followup-To: alt.support.tinnitus
Date: 28 Sep 1994 13:23:17 -0700
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Summary: Questions and answers regarding tinnitus - ringing ears and other head noises
Keywords: faq tinnitus ear ringing
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Posted-By: auto-faq 3.1.1.2
Archive-name: tinnitus-faq
Posting-Frequency: periodically
Last-modified: 28 Sep 1994
Version: 0.7



Tinnitus Frequently Answered Questions

Last update v0.7, September 28, 1994

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What's New


The only change to the previous v0.6 version of this FAQ was format conversion
to WorldWideWeb hypertext. There is no new information content.

I am once again accepting new contributions. Especially appreciated would be
URLs that I could use as pointers to detailed external information.

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

This is a draft copy of the Tinnitus FAQ. It 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 periodically 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).

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

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

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

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7) What is Meniere's Disease?

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

What are the symptoms?
     
     In my case it started with a constant fullness in my right ear and
     the constant ringing. I also noticed I wasn't hearing very well and I
     was having some vertigo attacks.
     
     Originally I had my Allergist treat me. She thought it might just be
     an inner ear infection or a sinus infection. It manifested itself in
     the fall which is one of my worst allergy seasons.
     
     By Spring she referred me to an ENT.

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

Are there any known environmental causes, or is it one of those things that
"just happens" to people?
     
     One possible cause is Diabetes. Other than that no one that I have
     spoken with knows. It may also be hereditary. Usually doesn't show up
     until later in life 40 and beyond, and can burn itself out in 3 - 5
     years. Some have it earlier in life (me at 35) and could have it the
     rest of our lives.

What are the common treatments? Anti-vertigo drugs? Surgical operations on the
inner ear balance mechanisms?
     
     The most common treatment for mild episodic Meniere's I guess would
     be to rule out Diabetes and allergies. For the vertigo attacks
     usually the prescription drug Antivert is used or the over the
     counter drug Meclizine . Both tend to relive the vertigo. For more
     chronic cases a low dosage of Valium can help. When things get bad
     enough the next procedure is an Endolymphatic Transmastoid Shunt.
     This helps to keep some of the pressure of the inner ear. Changes in
     diet can help. Removal of sodium, caffeine and alcohol can help.
     Usually a mild diuretic is prescribed.
     
     I know of several folks who keep it under control with allergy shots
     and restricting their sodium intake.
     
     If it progresses to a point where the patient can no longer 'live'
     with it an Eighth Nerve Section can be done. But according to my
     surgeon this is an absolute last resort. It guarantees deafness in
     the ear and some patients report balance problems at night. He also
     claims the risks are high with this procedure including partial face
     paralysis.

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...'
     
     
   * 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]*****

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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                         Internet: markb@cccd.edu
Coast Community College District   1370 Adams Avenue
District Information Services      Costa Mesa, CA, USA  92626
Technical Support                  (714) 432-5064
"You can tune a file system, but you can't tune a fish." - tunefs(1M)


