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I read with interest the article by Araújo et al1 titled “Intratympanic Dexamethasone Injections as a Treatment for Severe, Disabling Tinnitus,” which was published in the February 2005 issue of the ARCHIVES. The authors are certainly right to state that severe disabling tinnitus is an intense symptom and can produce high annoyance levels. They point out that it is mainly the affective component that “alters the patient’s routine and makes him or her unable to perform daily tasks efficiently.”1 That the paradoxical memory for severe tinnitus may have to do with the affective side of the symptom, as hypothesized by Shulman et al2 and further corroborated by neuroimaging studies of an involvement of hippocampal structures,3 may make possible a “final common pathway for the sensorial and affective components of SDT [severe disabling tinnitus],”as discussed by the authors.1 Lockwood et al4 have suggested that there may be a crossover between the auditory system and the limbic system in patients with severe tinnitus.
I note that Araújo et al1 included patients with chronic tinnitus in their study (only 4% had tinnitus for less than 1 year). It is a pity that they did not try to catch the affective component of the chronic symptom of complex tinnitus by evaluating the affective state of their patients. In a recent prospective study5 performed on 50 patients with acute tinnitus, my colleagues and I found that patients with psychological disturbances and sleeping difficulties on first presentation shortly after the onset of tinnitus have a higher risk of developing tinnitus-related distress. Rather than expecting dexamethasone therapy to alleviate tinnitus-related distress, physicians should try to evaluate psychological methods to reduce anxiety and depression in patients with severe tinnitus. Furthermore, studying the psychological states of Araújo and colleagues’ patients may have shown specific differences of patients who responded to the specific and the control treatment and who did not, and, thus, contributed more insight into the phenomenon of the “placebolike” improvement. My coworkers and I intend to investigate early psychotherapeutic interventions and other treatment modalities in patients who present with tinnitus and who are anxious and dissatisfied with their life as well as those who have insomnia that they attribute to tinnitus.
Correspondence: Dr Langenbach, Department of Psychosomatics and Psychotherapy, St Marien-Hospital Bonn, Robert-Koch Strasse 1, 53115 Bonn-Venusberg, Germany (firstname.lastname@example.org).
Langenbach M. Psychological Factors in Severe Disabling Tinnitus. Arch Otolaryngol Head Neck Surg. 2005;131(9):829. doi:10.1001/archotol.131.9.829-a
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