NEWS AND REVIEWS By Susan L. Engel-Arieli, M.D. Below are summaries of articles that appeared in recent medical journals. WHEN IS VERTIGO A SERIOUS FORM OF DIZZINESS? Physicians from the Mayo Clinic recently wrote an article intended to help physicians distinguish between serious vertigo and minor dizziness. The article states that most people with dizziness, a "whirling sensation in the head with a tendency to fall," had one of the following: (a) impaired blood flow to the nervous system, heart, and/or blood vessels; (b) disequilibrium (imbalance when standing or walking) such as that caused by multiple sensory deficits; (c) vertigo such as that caused by Meniere's disease or vestibular neuronitis; (d) other causes. The authors suggest that correctly diagnosing vertigo is important because serious forms of vertigo (a type of dizziness defined as "a disturbance in which the external world seems to revolve around the individual or in which the individual seems to revolve in space") are caused by conditions associated with increased mortality or disability of one month or more. The authors suggest that physicians do the following to determine if a patient has serious vertigo: (a) distinguish vertigo from dizziness; (b) take a detailed history from the patient, asking when dizziness occurs and if there are other ear or neurologic symptoms and patterns); (c) perform a good physical exam, including a neurologic exam and ear exam, a check for nystagmus (abnormal eye movements), and a head- hanging maneuver. These authors also provide their hypotheses on how to predict if vertigo will become serious. See Froehling, D., Silverstein, M., et al., "Does This Dizzy Patient Have a Serious Form of Vertigo?, JAMA, Vol. 271, No. 5, Feb. 2, 1994, pages 385-388. DIZZINESS AND CHILDREN Children can frequently feel and say they are dizzy. The causes can be nearly endless, and in order to make a diagnosis, physicians must take into account the symptoms, age, and test findings of the child. The author of a recent article discusses specific neurologic, postural, and equilibrium tests that can be used by physicians for different age groups of children to try to determine the problem. She also recommends using ENG (electronystagmography) and rotational tests. The author also provides an interesting chart showing symptoms and listing potential tests, exam findings, and likely diagnoses. For example, a 16-month to 5-year-old child with vertigo, no hearing loss, nystagmus, a normal EEG (electroencephalogram), and an equivocal ENG may most likely have benign paroxysmal vertigo. See Eviatar, Lydia, "Dizziness in Children," Otolaryngologic Clinics of North America, Vol. 27, No. 3, June 1994, pages 557-71. REPOSITIONING MANEUVER FOR BPPV Physicians from Ohio State University who studied 27 patients with BPPV pointed out in a recent article that the disease might not be self-limiting or benign. Drs. Robert Baloh and Vincente Honrubia, in a prior article, had reported that 1/3 of people with BPPV might have symptoms for longer than one year. One theory about BPPV is that it is caused by free-floating particles in the semicircular canals of the inner ear. The Ohio State physicians performed a maneuver, which they called particle repositioning, similar to the Semont (liberatory) maneuver and the Brandt- Daroff exercises. The maneuver was combined with gentle shaking of the head. Nineteen of the 27 patients had complete resolution of all symptoms; two had resolution of their vertigo but not of accompanying unsteadiness; four did not have resolution of their symptoms, and two were found to have a problem other than BPPV. See Welling, D.B., and Barnes, D.E., "Particle Repositioning for Benign Paroxysmal Positional Vertigo," Laryngoscope, 104 (8, part 1), Aug. 1994, pages 946-949. VESTIBULAR TRAINING, DRUGS, AND BPPV Physicians in Japan studied 61 patients with BPPV. They were divided into three groups. Group 1 received only a drug called betahistine mesylate, not available in the U.S. Group 2 received only vestibular training, and Group 3 received vestibular training plus betahistine mesylate. Vestibular training (VT) consisted of the patients being asked to do specific exercises three times daily for eight weeks. Improvement rates were higher in Group 3 (both VT and the drug) than in the other groups. The authors question whether the effects of VT can be enhanced by certain drugs and suggest that studies should be done with other medications. See Fujino, A., et al., "Vestibular Training for Benign Paroxysmal Positional Vertigo," Archives of Otolaryngology - Head and Neck Surgery, Vol. 120, 1994, page 497. HISTAMINE AND MENIERE'S Dr. J. Roy Guyther, of Mechanicsville, Maryland, anecdotally writes that intravenous infusions of histamine diphosphate can relieve the severe nausea and dizziness of Meniere's disease and can lengthen the interval between episodes. This idea was not presented as a study but simply as a letter of opinion published recently in a journal. See Guyther, J. Roy, IV Histamine for Meniere's, Cortlandt Forum, May 1994, page 78. INNER EAR HAIR CELL REGENERATION Researchers from the University of Washington in Seattle, Wash., presented some interesting data recently about hair cells in the inner ear. We know that hearing and balance disorders can be caused by loss of hair cells. Studies in birds have shown that their inner ear hair cells can recover after drug or noise damage. Preliminary research in mammals seems to indicate that regeneration may occur in higher animals and perhaps in humans as well. The researchers postulate that stimulation or transplantation of inner ear hair cells in damaged human ears may be possible in the future. See Tsue, T., et al., "Hair Cell Regeneration in the Inner Ear," Otolaryngology - Head and Neck Surgery, 111, 1994, pages 281-301. POTENTIAL MARKERS FOR PERILYMPH FISTULAS The diagnosis of perilymph fistulas (small tears between the inner and middle ears) can be very difficult to diagnose, and this is true even at the operating table. Researchers from the Washington University in St. Louis, Mo., and at the Bowman-Gray School of Medicine in Winston-Salem, N.C., have reported the identification and quantification of 30 proteins in human perilymph fluid from the ear. Two proteins, apo D and apo J, were found to be most prominent. The researchers hope that more studies will help clarify the significance of their findings and that one or more of these proteins may be useful in the diagnosis of perilymph fistulas. See Thalmann, I., Kohut, R., et al., "Protein Profile of Human Perilymph," Otolaryngology - Head and Neck Surgery, Sept. 1994, pages 273-280. Below are summaries of articles appearing in recent consumer publications: BALANCE AND T'AI CHI An article starting on page 71 of the December 1994 issue of Prevention magazine discussed the use of t'ai chi by the Rehabilitation Institute of Chicago for people with balance disorders. Timothy Hain, M.D., of the institute, told a reporter that t'ai chi could be useful for these patients because the movements were natural, helped build muscle strength, had a good repertoire of head/eye motion, were fun, and relaxed the mind. Dr. Hain found that after 22 patients participated in t'ai chi for two months, they had about a 10 percent improvement in balance. See Stocker, Sharon, "Catch Your Balance with T'ai Chi." SPIN DOCTORING An article in Your Health magazine gave an overview of vestibular disorders and discussed the similarity of symptoms among different vestibular disorders and the difficulty doctors have in making a correct diagnosis. The article says that of those patients eligible for vestibular rehabilitation (and who are treated by it) 85 percent improve and 30 percent recover completely. See Vaughan, Don, "Spin Doctoring," Your Health, Nov. 15, 1994, pages 49-54. HEAD SPINNING TOO In a Woman's Day article ("Your Health," Jan. 10, 1995, page 36), Marianne Legato, M.D., presents an overview of some of the causes of vertigo and also briefly discusses treatment modes such as vestibular rehabilitation. She points out some non-vestibular causes of head spinning such as overexertion, dehydration, certain medicines, and mentions potential solutions for these problems. WHO SAYS EARS ARE NOT ATTRACTIVE? Andrew Rooney, the author of "The Ears Don't Have It," on page 22 of the January/February 1995 issue of The Saturday Evening Post, has fun with ears. Although this article is probably of no scientific or medical interest, some parts are thought- provoking as well as amusing. For instance, the author says that "ears were poorly placed in relationship to our necessity to wear clothing that is often pulled on over the head, too. . . . The head itself can be forced through even quite a small aperture, but the ears invariably get caught. . . . If the human body is ever done over, no part of it needs redesign more than the ears." PUTTING AN END TO DIZZINESS An article on pages 4 and 5 of The Johns Hopkins Medical Letter for November 1994 presents an overview of dizziness. The authors state that dizziness is the most common complaint of people over 75 and that dizziness produces as much disability as such problems as arthritis, heart diseases, and high blood pressure. They review what maintains balance, what can go wrong, when to see your doctor, and how vestibular disorders are treated. Additionally, they provide useful information about what causes orthostatic hypotension (a drop in blood pressure, which produces dizziness sometimes when people stand up) and how to prevent yourself from falling. MENIERE'S DISEASE Early in her article, "Meniere's Disease - A Balancing Act" (Harvard Health Letter, Vol. 20, No. 1, Nov. 1994, pages 3-5), Leah Garnett notes that there is no known cure for Meniere's disease, although there are treatments. We know that the attacks of vertigo, fluctuating hearing loss, and/or tinnitus can vary in severity and duration from episode to episode and from one person to another. Studies have shown that remissions can occur in two-thirds of the people with this disease and usually occur within eight years after onset. Interestingly, the author also points out that Meniere's disease may be caused by a virus, and at least one Harvard professor suspects that the disease may be a variant of viral labyrinthitis, an inner ear infection. Author's Note: Please note that neither Dr. Engel-Arieli or VEDA can recommend any particular treatment for any particular disorder or be responsible for an individual's reaction to a particular treatment. These reviews are not intended as a substitute for professional health care by your own physician. Please do not begin treatment without first checking with your physician. OCCUPATIONAL THERAPY By Doreit S. Bialer, M.A., O.T.R./L., and Joy Brett, M.S., O.T.R. (Ms. Bialer is the director of occupational therapy at Long Island Pediatric and Adult Therapy Center in Great Neck, N.Y. Ms. Brett is the coordinator of the occupational therapy department at that same clinic.) The vestibular system is located in the inner ear and is responsible for detecting changes in the position of the head. This sophisticated system has many connections in the nervous system that influence muscle tone, coordinate sensory processing, maintain posture and balance, and help the eyes to fixate and gaze on objects in the environment. The vestibular system also works in conjunction with the cerebellum to help individuals develop a sense of where their bodies are in space, which allows them to move freely in the environment without relying on vision. Vestibular dysfunction can be disabling since the patient may experience nausea, spinning, dizziness, disorientation, and lack of balance. These symptoms may lead to difficulties at work, at home, or in participating in community functions. Our goal is to help clients return to work, become independent in daily life tasks, and continue as active members of their communities. When a patient is referred to an occupational therapist by a physician, the therapist evaluates specific movements or components of activities that elicit negative vestibular responses such as nausea, dizziness, and imbalance. People with vestibular dysfunction also often experience vision difficulties and trouble with proprioception (body-in-space awareness). Through rehabilitation and exercise, we help people learn to counter the negative effects of the vestibular system and to achieve diminished or extinguished symptoms. Patients who undergo vestibular therapy may find themselves involved in a home exercise program that reinforces therapy. Exercises performed in the clinic and at home involve moving the head and eyes quickly, doing balance exercises with eyes closed and eyes open, simulating daily activities with which the client is having trouble, training for mobility, and working on postural endurance. Each program is individually designed to address the systems (visual, proprioceptive, and vestibular) that need to be strengthened in order to overcome conflicting messages from a dysfunctional vestibular system. The therapist designs the home program, challenges the vestibular system in the clinic, and adjusts the program as the patient improves. Patients who faithfully perform their home exercises generally experience marked physical improvement and a return to a higher quality of life. The rehabilitative program at our center on Long Island lasts from three to nine months and includes frequent reevaluation to assess each patient's functional gains. We have had many success stories with our vestibular rehabilitation program. SUPPORT GROUPS Dr. Jeffrey Harris, chief of the department of otolaryngology at the University of California - San Diego, spoke to the Sacramento, Calif., Meniere's group on "Dizziness, Its Cause and Its Cure" in December. In January, the group held an open discussion. Neil Shepard, Ph.D., director of the vestibular testing center at The University of Michigan, in Ann Arbor, spoke recently to the Royal Oak, Mich., support group on the use of vestibular rehabilitation therapy in Meniere's disease. Michael Politzer, O.D., a vision specialist, spoke in November to the Middle Tennessee group in Nashville. The group's fall newsletter mentioned possible meeting topics including responses to treatment, aids for survival at home, safety, filling the void when you lose your career, dating/social life, finding a doctor, needs of spouses, humor, hearing loss, fears, depression, surgery, diet, legal problems, and others. Dr. Cindy Kish, an otolaryngologist with an interest in vestibular rehabilitation, spoke recently to the newly formed support group in Fort Wayne, Ind. Her topic was "Diagnosis and Management of Dizziness and Balance Disorders." In February, a physician will speak to the group on biofeedback and relaxation techniques. Heather Whitestone, Miss America 1995, spoke to the members of the St. Louis, Mo., group in January. Ms. Whitestone, 21, lost her hearing when she was 1, and is the first Miss America with a profound disability. "I really believe that the most handicapped person in the whole world is a negative thinker," she is quoted as saying in a news release. STORIES SOUGHT The Vestibular Disorders Association is seeking vestibular success stories for a sequel to its book, Stories and Strategies. The idea is to collect and publish a wide variety of short first-person accounts about living with inner-ear disorders. In Stories, the authors spoke in their own voices about what happened to them and what they did about it. This time, VEDA would especially like to hear from people who have become symptom-free or nearly so. If you have a success story to tell, please send it to us. If you know others who have gotten well, please ask them to write to VEDA, P.O. Box 4467, Portland, OR 97208-4467. HANK YOU We thank all of the following for their contributions to VEDA through Dec. 20, 1994: Friends ($500 to $999): Steven Smith, Michigan; Kellie and Clifford DeLine, Colorado; Larry Kreicher, Connecticut; Alliance Capital Management, New York. Associates ($100 to $499): Harland Hoghren, California; A.H. Duvall, Florida; Richard H. Krause, Oregon; Elizabeth Eastman, George Viscomi M.D., Michigan; Henry Chaffee, Florida; Bess Pitt, Texas; Elena McClain, California; Dr. David Kessler, Indiana; Deanne Bonnar, Massachusetts; Mr. & Mrs. Domenick Celentano, New Jersey; Marsha Mayers, New York; Kenneth Brookler M.D., New York; Naomi Lederer, New York; Stephen and Ruth Hendel, New York; Steven Millen M.D., Wisconsin; Lillian Dorcas, Alaska; Mary Ann Watson, Oregon; Carol Kanter, New York; Martin Gizzi M.D., New Jersey; McCain Charitable Trust, Florida. Contributors ($10 to $99): ALABAMA: Lewis Ellenburg, Sarah Davis. ALASKA: Donald Abel, Marilyn Schoder, David Beal M.D., Monica Weyhe, Shirley Jacobson, Susan Rodriguez. ARIZONA: Norma Raya, Fred Lucas, Linda Goeglein, Norma Raya, Roberta Merrill, Harriet Schultz, Fred Guilford, Mary Haertel, Charles Isaacs, Jerry Eastridge. ARKANSAS: Richard Brothers, Henry Terrill, Wilbur Martin. CALIFORNIA: Susan Garry, Lillian Kuhn, Debby Zurzolo, Robert Ulmer, George Peters, James Garvie, Lisa Walker, Karolyn Zebarth, Helmut Zoike, Ann Ulrich, Julie Yamamoto, Jean McClure, Gary & Diane Hahnert, Peggy Van Patten, A.C. Steele, Joann Caouette, Richardine Freeman, Peter Willey, C.J. Ziady, Jon Crawford, Adeline Amaro, Jane Gauthier, Vivian Gatzert, Margaret Weilhart, Mary Shores, Virginia Bodenburg, Gene Marple, Lee Beckom, Lee Law, Thomas Chester, Larry Strom, Myron Roth, Ronald Roberto, Louise Fowle, Misa Stroker, Beverly Kluger, Stuart Lasher, Laura Kerhin, Lee Law, Jacqueline Cursi, Judy Novell, B. Christa Vragel, Shari Parriott, Mario Persico, Wendee Vivenzi, Roseanne Brown, Cynthia Polecritti, Susan McDonald, Carol Springer, Richard Rykoff, Sally Smith, Julia Leonard, Beverly Reynolds, Dr. & Mrs. Walter Hunt, Sally Smith, Violet Ohmert, Alice Werbel, John Fitzgerald, Josephine Tarver, Mary Lou Wood, Arturita Tolentino, John Pino, Jana Fouladpour, Meg Flaherty, Shirley Rapkin, Jean Houchens, Chris Blanchard, Fred Meinzen, Irving Abrams, Carolyn Zebarth, John Carlson, Evelyn Graybill, Stan Waliszek, Shane Gregory, Dolores Frye. COLORADO: Dorothy Fresenborg, Lois Jensen, Janice Gilland, Lois Jensen, Jeanne Sanders, Lydia Coulter, James Turre, Mr. & Mrs. Robert Weber, Lois & Richard Burke, Marilyn Girouard, Kim Saltus Johnston, Mary Ann Neumann, John & Joan Cook, Mr. & Mrs. Dana Switzer, Patty Haybach. CONNECTICUT: Dawn Danis, Denis Bonito, Marie Miller, Charles Hamlin M.D., Terry Kelly, Lawrence Klein, Grace Longo, Cynthia Goldberg, Gary Cherhoniak, Rita Tryon, Dorothy Coughlin, Jill Durall, Nancy Howie, Gerald Labriola M.D., Mary Dargan, Nicholas Sinisi, Wes Loker, Susan Tupper, Elaine Brodeur. DELAWARE: Ted Zink, W. Roberts Richmond, George Moore, Bernadine Lunski. DISTRICT OF COLUMBIA: Herbert Franklin, Brad Peipmeier. FLORIDA: Sarah Gross, Susan Cohen, Edna Saint-Thomas, Christie Johnson, Connie Campbell, Josephine Natale, Jo Yoakum, Lillian Archer, Mary Panagotacos, Jennie Bond, Clifton Duty, Allen De Graw, Louise Darby, Susan Kellett, Carl MacKenzie, Henry Getzoff, Donna Bendell, Beatrice Barr, Dorothy Bering, Lisa Jerigan, Elmer Swanson, Marjorie Braxton, Reba Weber, Mary Follett Wright, Marilyn Krumholz, Dorothy Robinson, Roberta Bastie, Gilda Gutlove, Julianne Bennett, Karen Stevens, Claire Baggerly, John Vandigriff, Rigoberto Gonzalez. GEORGIA: Harriet Leslie, Gaye Cronin, Olga Conley, Margaret Tandel, Peggy Tiller, Mary Sumner, Mary Castiglione, James French, Donn Chrisman, Louise Williams. HAWAII: Robert Schwarzhaupt, Tamar Weber. IDAHO: Tim Foster, Shirley Caldwell. ILLINOIS: Edward Twohill, Mary Coniglio, Teresa Campana, Jim Gonzalez, Mildred Eychaner, Vera Richards, Mildred Wood, Delores Clay, Chester Moculeski, Darleen Runge, Timothy Ives, Jesse Irick, Donald Fawcett, S.L. Nielsen, Dwight Elliott, Joseph Pompei, Natalie Lamb, Frieda Volpel, Dorothy Knudsen, Eleanor Bergren, Arlene Stielow. INDIANA: James Young, G.K. Bhagavan, R.C. Cinert, Cecilia Weber, Carol Fitzgerald. IOWA: Evelyn Dunn, Lloyd Shelangoski, Johanna Dippold, Joann Banghart, Jeff Jeambeg & LuAnn Vondracek. KANSAS: John Voss, Barbara Edwards, John Peterson, Barbara Cosner, Dr. & Mrs. David Travis. KENTUCKY: N.F. Northern. LOUISIANA: Mary Jo Griffin, Lorraine Vallon, Doris Branton, Wallace Rubin M.D., Sidney Sandoz Jr. MAINE: Don DeDoes, Susan Dunlap RPT, Mary Dyer. MARYLAND: Martha Kline, Cleo Jerrell, Charles Tull, Elizabeth Garmatz, Celia Weinstein, Mary Zamary R.N., Mary Personette, Lavern Riggs, Mildred Maddox, Jean & John Erskine. MASSACHUSETTS: Edward Flaherty, Margo Blake, Nancy Friedrichs, Ronald Mehlhorn, John & Anne Kendrick, Betty Commerford, Marilyn Steele, Virginia Strauss, Joan Chaplick, Michele Moran, Cynthia Jacques, Kathy Longo, Ruth Norr, Ann Charlesworth, Mukesh Thakkar, William Brackman, Angie Walsh, Elizabeth Quirk, Frances Clohecy, Sr. Murielle Bourgeois, Jane Raymond, Paul Pitman, Eunice Good, Claudia Broghamer, Mary Slack, Norma Lipson, Benjamin Miller, Jill Pinnola, Frederica Cushman, Paul Harrigan. MICHIGAN: Beverly Lynch, Stuart Doneson, Steven Flaggman, Doreen Wise-Friedenberg, Gary Potter, Larry French, Sara Essex, Dorothy Schmidt, Signe Pekkarinen, Ron O'Brien, Patricia Lacasse, Jeanne Srock, Diane Hillman, Betty Saputo, Caryl Kerber, Reinard Nanzig, Colleen Stanczak, Peggy Kilgus, June Evans, Steven Eisenberg, Mary Jo Regan, Peg Turney, J.D. Bulone, Mary & Tom Rogers, Lois Jensen, Verna Chambers, Beverly Lynch, Stephen Fisher, Michaela Begg. MINNESOTA: Deborah Wingert, Alice Fingerson, Mary Spinler, Linda Fort, Angela Kaiser, Charles Bobertz. MISSISSIPPI: William Stokes. MISSOURI: Floyd Chapman, Olive Duffy, Kathleen Black, Adrianna Avellino. MONTANA: Ed Kahoe, Sherry Marsillo, Carl Swanson. NEBRASKA: Paul Kreuscher. NEVADA: Winnie Crump, Joe Mochnick, Betty Hensley, Lon Hurst, Susan Schwartz. NEW HAMPSHIRE: Dudley Weider M.D., Norma Moore, Ruth Edwards. NEW JERSEY: Jennifer Schutte, Susan Pepe, Amy Klein, Walter Lyon, Joseph & Sylvia Nichols, Fran DeGregorio, Margaret Fiori, Susan Marx, Bob Hackney, Anita Drescher, Barbara Feigen, Jill Spasser, Anne Moore, Cathy Sogorka, Ron Jablonski, Christina Cohon, Marie Wehling, Margaret Vishnupad, Jeffrey Levin, Lisa Wagner, Tunie Missry, Celestine Moran, Rita Gavasci, Mary Nallin, Robert Bergeman, Jerome Grever, Frank Dolcemascolo, Alexander Hochheiser, Joel F. Lehrer M.D., Martin Warshaw, Vera Sumutka. NEW MEXICO: Milward Pinckney. NEW YORK: Marissa Panigrosso, Robert Benson, Mary Anne Casola, Helen Vega, Nancy Mesh, Audrey Mecteau, Frank Mascolo Jr., Naomi Utevsky, Carol Iannello, Jerry Wolkoff, Donald Witt, Sam Weissman, Clelia Cannarella, Carole Mitchel, William Crawford, Mary Braverman, Nancy Mahler, Lewis French, Maria Lyons, Sandy Hyman, Sheila Rabinowitz, Rita Demers, Doreit Bialer OTR/L, Ellen Bondy, Bernice Heller, Rose Benderly Ph.D., Margaret Venezia, Dorothy Launer, Barbara Galgano, Thomas Curtin, Gail Higgins, George Holzmann, Howard Ordemann, Kathryn Waluk PT, Margaret Naughton, Connie Dimaggio, Pearl Schnur, Suzanne Brennan, Dr. Maryanne Geskie, Joyce Sica, Michael Chatoff, Ernest Puce, Sylvia Heim, Carmela Cottone, C.L.Saypol, Shirley Weiss, Helen Goldberg, David Critelli, James Troutt, Norman Griner, Armando Girillo, Patty Busa, Libby Nelson, George Mahoney, Fanny Acuna, Malinda Myers, Lucille Wassmansdorf, Yakov Michael, Richard Tripp, Margaret Gillin, Margaret Arena, Jane Schlick, Barbara Freeman, Gloria Balzano, Linda Meaney, Sandra Wiesel, Sandord Levine, John Miele, Susan Drucker, Paul Neumann, Mary McCarthy, Frances Wagner. NORTH CAROLINA: Gloria Herritage, Charles George, Nate Sanson, Dorothy Langston, Nancy Dobbs, Richard McCallum, Leo Farr, Donna Hodges, Kathy Nelson, Ingeborg Bush, Sylvia Searcy, Marilyn Johnson, Robert Kirkpatrick, Anne Freeze. NORTH DAKOTA: Patti Miedema, Patricia Christiansen. OHIO: Lillian Sherwin, Robert Clark, Lillian Sherwin, George Tyler, Janet Kadunc, Nancy Helmick, Michael Schaeffer, William Reynolds, Kenneth Mauk, Lisa Billings, Robert Roberts Sr., Reta Bisesi, Kathleen Kins, Bernice Mills, Mario Dentino, Monica Kandrac, Elizabeth Fesler, Rita Batcho, Steve Reasoner, Miriam Faud RN, Frank Gaal, Raymond Juskiw, Mary Binion, Dorothy S. Rice, Nancy Roberts, Stephen Mosher, Suzanne Forsgren. OKLAHOMA: Jean Tanner. OREGON: Barbara Goetze, Charlotte Shupert, Susie Eckerson, Carol Whitman, Betsy Mercer, Bernd Crasemann, Elizabeth Shane, Martha Torson, Bertha Nelson, Velma Nicholson, Margaret Hogg, Leo Ferroni, Pat Waalkes, Kenneth Starr, June O. Underwood, Scott Moreland, Elizabeth Anne Korn, Wendell Cook, Marge Dillon, Bette Richards, Colleen Decker, Dorothea Radel, Charlotte Shupert, Shirley DeJong, Norma McKain, Debbie Goldberg, Norma McKain, John Chester M.D., Ted Norton, Karolyn Eiseman, Lisa Haven. PENNSYLVANIA: Lorraine Wescott, Jim & Barbara Nagel, Susie Goodman, Marilyn Albert, Deborah Simon, Rosanne Bostock, Dorothy Clark, Haarryette Radcliffe, Joan Palladino, Muriel Jackson, Robert Slater M.D., Mary Ann Heidenwag, Jessie Permar, Edwin Allison, Martha Leslie, Nancy Persinger, Don Leisey, Gretchen Cochran, Dorothy Yarnell, Angela Newman, Ruben Pottash M.D. PUERTO RICO: Gaspar Leon, Patria Echevarria. RHODE ISLAND: Patty Alperin, Deborah Smith, Harriet Reed, Margaret LeBlanc. SOUTH CAROLINA: Frances Ross, Dr. Suzanne Cormier, Harry McDowell, Bruce Stapleton, Kay Hanson. SOUTH DAKOTA: Karl Bachmayer, Joanne Carson, Alice Wrage, Dolores Shanks. TENNESSEE: Joanne Jones, Anita Nix, Debbie Pigna, Robert Bryant, Bill Nunnelly, Richard Godwin, Mr. & Mrs. Robert Jarratt, Rosa Serra, Meredith Leslie, Mary Timmons, Janet Clark. TEXAS: Elizabeth Faye Hicks, Sybil Johnson, Edna Davidson, Theresa Holden, Mr. & Mrs. Earl Landis, Rufus Burnett, Babatunde Akomolafe, Raymond Hickey, Gale Robertson, Jennie Davis, Betty Wharton, May Pickett, Carol Irwin, Joe Stanley, Sandra Jones, Melissa Pickett, Hope Higinbotham, Mary Engler. VERMONT: R. DeWitt Mallary Jr., Karen Towslee, Cindy Bryant. VIRGINIA: Susan Mottershead, Howard Olson, Sava Alvis, Anthony Denice, Charles Brooks, Raymond Bowman, Sharon Brendel, Sherry Williams, Charles Olson, Charlotte Flinkow, Mary Horan, Craig Slingluff, Jeanne Webb, Debbie Mayer, Abdul Ghafoor, Louis Mauro, Carrington Dunlap, Amy Hillsman, Donna Mayer, Dianne Cahill, Debbie Noble, Elizabeth Garay. WASHINGTON: Marvin Carmichael, Pam Roy, Anne Kunkel, Martha Waldman, Linda Peterson, Sharon Covey, Steve Rees, Annemarie Warren, Karen Wescom, Art Edburg, Alan Langman M.D., Alice Alden, Helen Clark, Maria Rosa Martins, Nyla Jensen, R. Kevin Klise, Ielene Edmonson, Cheryl Bucher, Lois Latorra, Betty Donnerberg, The Williams Family, Joyce Brigham, Phillip Friend, Dorothy Sturdivant, Sue Parks, Richard White, Mary Oliver, Hildegard McNeil. WEST VIRGINIA: Sarah Horton, Jerry King, Susan Scott. WISCONSIN: Beverly Sterbin, Sandra Carlson, Eugene Schmidt, Aletta Vandervelde, Joyce Buss, Elaine Fouts, Tom Lenz. WYOMING: Jane Camenzind. AUSTRALIA: Michael O'Brien, Kathy Stoddart, Anita Newman. CANADA: Philip Sherlock, Liz Leedham, Arlene Steel, Perry Bender, Shirley Read. SINGAPORE: Kay Ehrhart. DISCLAIMER The information in this newsletter is not intended as a substitute for professional health care. VEDA does not advocate any particular course of treatment for any particular disorder. The opinions expressed in articles in On the Level are those of the authors and not necessarily those of On the Level, or the VEDA medical and scientific advisors, or the VEDA board of directors. NEWS BRIEFS NEW ADVISOR Susan J. Herdman, Ph.D., P.T., of the University of Miami School of Medicine, has joined VEDA's group of distinguished medical and scientific advisors. Dr. Herdman, author of Contemporary Perspectives in Rehabilitation, has published widely on vestibular rehabilitation and related topics. VISION THERAPY VEDA would be interested in hearing from anyone who knows of practitioners who recommend eye exercises as a treatment for dizziness or of any scientific studies of the use of eye exercises to treat dizziness. Please send information to VEDA, PO Box 4467, Portland, OR 97208-4467. BONE BANK If you experience an ear problem such as deafness, dizziness, or infection, the scientific study of your inner ears could help in the search for causes and treatments of hearing and balance disorders. According to a news release, the National Temporal Bone Hearing and Balance Pathology Resource Registry (The Registry) seeks people willing to bequeath their temporal bones to medical research. The inner ear is inaccessible for study during life. Only when the temporal bones are removed after death can the inner ear be studied. To find out more about becoming a donor, call The Registry at (800) 822- 1327 and ask for a free copy of the brochure, "That Others May Hear." It answers the most commonly asked questions about temporal bone donation. TINNITUS SEMINAR The American Tinnitus Association (ATA) will be host for the Fifth International Tinnitus Seminar in Portland, Ore. The meeting, to be held July 12-15 at the Marriott Hotel, will be open to the public. Scientific sessions will address causes of tinnitus, its mechanisms, assessment, etiology, drug therapies, alternative treatments, psychological aspects, animal research models, objective measurement, instrumentation, and clinical evaluation. ATA is seeking research papers from scientists for possible inclusion in seminar sessions or as poster presentations, a news release said. For registration and paper submissions, write to the American Tinnitus Association, P.O. Box 5, Portland, OR 97207-0005, or call (503) 248-9985, or fax (503) 248-0024.