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We thank Dr Langenbach for his interest in our article and for giving us the opportunity to further discuss our results. Of the 31 patients who were included in our analysis, only 2 (1 man and 1 woman) had psychiatric symptoms (depression and anxiety), and they were being followed up by the Department of Psychiatry at our hospital. They did not report any change in their tinnitus after intratympanic injections of either dexamethasone or saline solution. None of the other participants (n=29) had any psychiatric complaints. All patients included in the study had otologic diagnoses that are commonly associated with tinnitus (see Table 2 and Table 3 in our article). Five patients had otosclerosis and 4 had Ménière’s disease (endolymphatic hydrops), which are major cochlear histopathologic diagnoses in patients with tinnitus.1,2
At the present time, we believe that tinnitus originates in the cochlea in the great majority of patients. Of 500 cases of tinnitus collected from our otology clinic over a period of 6 months, 81% demonstrated mild symptoms that hardly bothered the patients, 18% demonstrated easily controllable symptoms, and only 1% demonstrated severe disabling tinnitus (SDT).3
Shulman et al4 presented evidence for the development of a paradoxical memory for SDT in the area of the medial temporal lobe system and postulated a common final pathway for the sensory and affective components of the symptom. This theory, we believe, explains the degree of annoyance caused by SDT from a neuroscientific standpoint. By pioneering the study of SDT using neuroscientific thinking, Shulman and colleagues certainly changed the way most people previously thought about SDT.
In summary, we believe that while mental disease can definitely increase the problems experienced by patients with SDT, it does not cause the condition and, indeed, is absent in most patients with SDT. However, when mental disturbances are present in patients with SDT, they must be identified and treated.
Correspondence: Dr Oliveira, Department of Otolaryngology, Brasília University Medical School, SHIS QL 22, Conjunto 4, Casa 9, Brasília DF 71650-245, Brazil (firstname.lastname@example.org).
Araújo MFS, Oliveira CA, Bahmad FM. Psychological Factors in Severe Disabling Tinnitus—Reply. Arch Otolaryngol Head Neck Surg. 2005;131(9):829–830. doi:10.1001/archotol.131.9.829-b
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