The enigma of tinnitus. (Editorial).Tinnitus Tinnitus Definition Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head. is a common complaint that can cause both the patient who suffers with it and the otologist otologist (ōtol´  jist),n a doctor who specializes in conditions and diseases of the ear. great frustration. Although much is already known about the etiology, pathogenesis, and treatment of this condition, many physicians are unaware of the available knowledge. (1-3) The lead article in this month's EAR, NOSE & THROAT JOURNAL by Drs. Yoneoka, Fujii, and Nakada clearly describes a type of tinnitus that is caused by a lesion of the temporal lobe. In addition to reminding our readers that a brain lesion can be the cause of tinnitus, they have demonstrated that the etiology of tinnitus can often be determined if a timely and thorough examination is made. Certainly, magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. of not only the cerebellopontine angle but also the entire brain--with or without gadolinium--is part of the examination of patients with tinnitus. This is a test that is often overlooked by physicians not interested in this condition. The authors' confirmation of the functionality of the cortical region involved represents technology near the cutting edge. Brain mapping and single-photon emission computed tomography (SPECT SPECT single-photon emission computed tomography. SPECT abbr. single photon emission computed tomography SPECT, n See single photon emission computer tomography. ) are used by some for this purpose. The use of positron emission tomography positron emission tomography: see PET scan. positron emission tomography (PET) Imaging technique used in diagnosis and biomedical research. (PET), which is available in most centers, would likely shed much light on the etiology of tinnitus in many patients. Unfortunately, the third-party payers have arbitrarily decided not to provide reimbursement for PET studies done for tinnitus. The routine use of advanced testing such as electrically evoked brainstem audiometry and other methods yet to be developed will eventually provide us with an understanding of the mechanisms involved in all types of tinnitus. Availability of these new tests is on the horizon, but until we have them, we must use the tools at hand to investigate all patients with tinnitus as thoroughly as possible. References (1.) Pulee JL, Hodell SF, Anthony PF, Tinnitus: Diagnosis and treatment. Ann Otol Rhinol Laryngol 1978;87:821-33. (2.) Pulee JL, Treatment of tinnitus. ORL ORL Oto-Rhino Laryngologie (France) ORL Orlando Executive Airport (Airport Code) ORL Optical Return Loss ORL Journal for Oto-Rhino-Laryngology and its related specialties and Allergy Digest 1979;41:15-26. (3.) Pulee JL, Cochlear nerve section for intractable tinnitus. ENT ENT ears, nose, and throat (otorhinolaryngology). ENT abbr. ear, nose, and throat ENT ear, nose and throat. ENT Ears, nose & throat; formally, otorhinolaryngology J 1995;74:468,470-6. JACK L. PULEC, MD Editor-in-Chief EAR, NOSE & THROAT JOURNAL |
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