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| Cheryl McGinnis,
MBA, Executive Director of the American Tinnitus
Association. |
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Introduction and History:
The American Tinnitus Association (ATA) assists
healthcare providers in serving patients who
have, or are learning to cope with, tinnitus. An
estimated 40-50 million people in the United
States experience tinnitus, 10-12 million of
these individuals have sought help for their
tinnitus and 2.5 million people report their
tinnitus is debilitating (AAA, 2001).
Hearing healthcare services in general, and
audiologic services in particular, are in demand
as these patients seek answers and relief from
the ringing, hissing, roaring, or other sounds
that are perceived, but cannot be attributed to
an external sound source.
Charles Unice, MD, and Jack Vernon, PhD, founded
the American Tinnitus Association (ATA) in 1971
for the purpose of providing financial support
for tinnitus research. During the early years,
the University of Oregon Medical School (now
known as the Oregon Health Sciences University)
sponsored ATA as an affiliate nonprofit
association. Advisors to the ATA were
scientists, academicians, clinicians,
businessmen, and public officials. Volunteers
completed all activities of the association
until 1979 when a small full-time staff was
hired and the ATA was incorporated as a 501
(c)(3) organization. Robert Hocks, a Portland
businessman, was the first Board of Directors
Chairman and Gloria Reich, PhD, was the first
Executive Director.
The ATA currently has a 13 member Board of
Directors and a 22 member Scientific Advisory
Committee (SAC). The Board of Directors is
responsible for the governance issues of the
association including setting policies. The
Scientific Advisory Committee members are
physicians, audiologists, and other researchers
who review research grant applications and
advise the Board and staff on scientific
matters.
ATA?s research grant program funds tinnitus
research projects at the nation?s top
institutions. Many ATA funded projects have gone
on to receive support from the National
Institutes of Health. Please visit our Web site
(www.ata.org)
for a listing of research projects funded. To
date, ATA?s support for tinnitus research
exceeds $1.3 million. Our goal is to fund
$500,000 in research projects for each of the
next three years. Musicians including Styx and
Barbara Streisand, as well as others, have
donated money for tinnitus research.
Importantly, funding research was not (and is
not) the only function of the ATA. People with
tinnitus and tinnitus treatment specialists
requested many things of the ATA. Callers asked
for information about the condition and for
techniques that would provide relief. In 1978,
ATA initiated workshops, regional meetings, and
seminars for professionals and patients to learn
about tinnitus.
Public Service Announcements (PSAs) to raise
public awareness featured such celebrities as
Lou Ferrigno (actor in Incredible Hulk TV
series), William Christopher (actor in
M*A*S*H series), Tony Randall (actor in
Odd Couple series), and Al Unser (auto
racing driver).
Tinnitus Diagnosis and Management:
The diagnosis and management of tinnitus has
become highly specialized. The long wait to
obtain appointments in tinnitus clinics across
the U.S. gives testimony to the need for this
focused, specialized care. A person troubled by
tinnitus will usually seek services from a
family physician, an ENT, or an audiologist.
This is where appropriate diagnosis must begin.
ATA staff encourage tinnitus patients to seek
diagnosis and treatment from physicians and
audiologists. A multidisciplinary team approach
is recommended (AAA, 2001). Interestingly,
hearing loss is a co-existing condition for 90%
of individuals who have tinnitus.
The most common cause of tinnitus is exposure to
excessively loud noise ? either a single intense
event (acoustic trauma), or long-term noise
exposure. Other causes of tinnitus might
include; physical trauma to the head or neck,
acoustic trauma, conditions such as
hypertension, acoustic neuroma, ear infection,
impacted cerumen, ototoxic drugs, thyroid
disease, vascular disorders, TMJ disorder,
nutritional deficiency, aneurysm, multiple
sclerosis, and many others. Prescription and
over-the-counter drugs can exacerbate tinnitus.
In some cases, tinnitus will lessen or
completely disappear when the offending drug is
discontinued.
The physician?s role in tinnitus diagnosis and
treatment is typically to rule out, counsel or
treat physical or medical causes of tinnitus. In
some cases, successful treatment of a medical
condition can relieve tinnitus. Most patients
who seek medical help for their tinnitus learn
there is no serious medical problem causing
their condition. This knowledge is sometimes
enough to allow some patients to adapt to their
tinnitus. Other people, however, experience
tinnitus as disruptive and stress inducing, and
need help learning how to cope with and manage
the sounds.
The audiologist?s role is multifaceted and
relates to comprehensive testing (including;
diagnostic audiometric evaluations, loudness
discomfort levels, tinnitus pitch and loudness
matching, minimal masking level, questionnaire
administration and interpretation), hearing
protection, hearing aids, tinnitus maskers,
assistive listening devices, tinnitus management
therapies, counseling and tinnitus support group
participation and facilitation.
Sometimes referral to a professional counselor
or other specialists experienced in managing
tinnitus patients, is particularly beneficial
when stress, depression or obsession with
tinnitus is noted by the audiologist or the
physician.
Tinnitus Treatment Strategies:
Among the vast treatments for tinnitus, the
most common treatments include:
*Hearing aids are often used to help 'cover-up'
tinnitus by increasing the sounds of the
environment. Multiple memory (multiple program)
hearing aids are sometimes useful as they
provide alternative sounds to listen to,
depending on the tinnitus and the acoustic
environment.
*Specialized tinnitus maskers which produce
low-level sound to reduce or eliminate the
perception of tinnitus. Masking can cause
'residual inhibition,' the reduction or
elimination of tinnitus that continues for a
short time after the masker is removed.
*Combined hearing aid/tinnitus maskers, in one
unit. These units allow the patient to select
which circuit to listen to, either the masker or
the traditional hearing aid circuit.
*Tinnitus retraining therapy (often referred to
as TRT) involves directive counseling to
de-mystify tinnitus. Tinnitus retraining therapy
also uses maskers to help a person learn to be
less aware of, or to habituate to, the sounds of
their tinnitus.
*Biofeedback is essentially a method of
relaxation, sought as a stress-reduction
technique to help control heart rate, blood
pressure, breathing, and muscle tension.
* Drugs can help ease stress, depression, and
sleep difficulties. Many of these drugs are
available by prescription only, and most have
met with minimal, although highly variable
success.
*Counseling services can assist with stress,
depression or anxiety that may accompany
tinnitus. Cognitive therapy helps patients alter
the way they react to tinnitus by identifying
and eliminating negative thought and behavior
patterns.
*Alternative treatments sought include
naturopathy, hypnosis, massage therapy, and
acupuncture.
Professional advice is beneficial to best match
the patient with an appropriate treatment
strategy. Referring patients to the ATA will
further enhance the services provided directly.
For people seeking tinnitus information, often
the local healthcare professionals are the best
first step. Secondarily, ATA can provide
additional patient support though our education,
advocacy, research and support services.
ATA Services and Resources:
The American Tinnitus Association?s many
programs are organized under the acronym
E.A.R.S.?Education, Advocacy, Research, and
Support.
The education program includes 'Hear For a
Lifetime,' which teaches 1st through
3rd grade students how to avoid
tinnitus. Additionally, we offer outreach
programs to doctors, audiologists, and hearing
aid specialists regarding tinnitus and treatment
as part of our education program.
Our two most visible and popular means of
providing information are through our quarterly
journal, Tinnitus Today, which is
sent to all ATA members, and the ATA Web site
www.ata.org.
ATA offers books, videos, audiotapes,
informational brochures, and posters. Our
bibliography service includes over 4,000 article
titles related to tinnitus. ATA?s six
educational brochures answer the most common
questions about tinnitus and are available in
English and in Spanish.
Brochures are sold for 25? each to members and
$1.00 each to non-members. Information covered
is described by the titles:
Coping with the Stress of Tinnitus; Information about Tinnitus;
Noise and Its Effects on Hearing and
Tinnitus;
If You Have Tinnitus: the First Steps to
Take;
Tinnitus Treatments: What?s New, What Works;
and
Understanding Tinnitus: Advice for Family
and Friends.
ATA sponsors several public forums around the
U.S. annually. Our public forums feature panels
of audiologists, physicians, and researchers
with expertise in tinnitus. Equal time is given
for attendees to ask questions of the experts.
Our advocacy department researches public policy
issues, supports hearing conservation
activities, and provides resources for people
needing specific assistance on such things as
pursuing insurance claims. Our national media
campaign aims to raise awareness, generate
support for research, and educate people on ways
to prevent tinnitus.
The support program includes self-help groups,
help network volunteers, and provider
listings?all resources to help people cope with
tinnitus. Self-help groups meet regularly to
share coping strategies, offer a supportive
environment, and emphasize positive change. ATA
has a network of 50 self-help groups. Group
leaders receive information and organizational
support from the ATA. Frequently, leaders
schedule guest speakers ? audiologists,
biofeedback specialists, medical doctors,
psychologists, and others who actively treat
tinnitus patients.
Help Network Volunteers are friendly telephone,
e-mail, and letter contacts that listen and
respond to callers needing understanding,
comfort, and information. In this way, support
and comfort is given while engaging in a healthy
dialogue about ways to successfully manage
tinnitus.
Our Tinnitus Provider Listing includes the names
and contact information of physicians,
audiologists, and other healthcare providers who
have an active interest in treating tinnitus.
The listed professionals self-report their
specialties and services and are listed by
region for distribution to interested patients.
Tinnitus is often as frustrating for the
clinician to treat as it is for the patient to
resolve. The ATA is a resource available to
tinnitus patients and healthcare professionals.
We invite you to become involved in the ATA as a
member yourself.
You can contact us by calling (800) 634-8978,
writing to us at PO Box 5, Portland, OR 97207,
or e-mailing
tinnitus@ata.org.
Recommended Resources and References:
AAA (2001). American Academy of Audiology
Position Statement on 'Audiologic Guidelines for
the Diagnosis and Management of Tinnitus
Patients.' Audiology Today, Vol 13, No 2,
March/April 2001.
Tyler, R. S., (Ed.). (2000). Tinnitus
Handbook. San Diego, CA: Singular Thomson
Learning.
Vernon, J. A. & Tabachnick Sanders, B. (2001).
Tinnitus questions and answers. Needham
Heights, MA: Allyn & Bacon.
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