TO THE EDITOR: We read with interes...

TO THE EDITOR: We read with interest the article, (1) "Diagnostic Approach to Tinnitus," through Drs. Crummer and Hassan in the January 1 2004 issue of American Family Physician. It carefully and clearly currented the problem of tinnitus and can be a valuable source of information for family physicians and their patients. The authors (1) propos their algorithm for a diagnostic approach to patients with tinnitus. We would like to instant our experience in treating patients with this condition.

In the department of Otolaryngology at the Medical University in Gdansk, Poland, as in in the greatest degree centers that manage patients with tinnitus, common of the most important proper states of diagnostics is history data. (2) Patients classify in a graphic way the pitch and loudnes of tinnitus using a visual analog scale (see accompanying figure). Our patients receive questionnaires that assess to what extent troublesome their tinnitus is and its influence forward their daily activity and ability to function. We compare terminates of the visual analog scale and the questionnaires before and after treatment, which helps to objectively assess the therapy accrues (3)

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Perhaps the algorithm instanted in the article (1) will issue in the addition of about new elements of objective diagnostics of tinnitus, like as positron emission tomography (PET) or single photon emission comput tomography. (4-6) individual study (4) using PET in 10 patients with tinnitus set increased metabolic activity of the predominant auditory cortex. Although the patients complained of bilateral tinnitus, the brain metabolic activity was higher upon the left side. (4) Another meditation (6) investigated four patients with continuous unilateral tinnitus, which could be altered by means of clenching their jaws. Using fondling the results showed that when the tinnitus was increased in this way the brain metabolic activity was increased upon the opposite side. (6) The contemplation (6) also found that the hippocampus was activated in these patients on the contrary not in the control make submissives Hippocampus activation could offer an explanation for the adverse psychologic forces that patients with tinnitus repeatedly experience. The new methods enable physicians to visualize what previously solitary had been heard and felt

WALDEMAR NAROZNY, MD PHD

JERZY KUCZKOWSKI, MD PHD

BOGUSLAW MIKASZEWSKI, MD PHD

Medical University of Gdansk Department of Otolaryngology ul

Debinki 7 Gdansk, POLAND 80-211

REFERENCES

(1) Crummer RW Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004; 69:120-6

(2) Tyler R Babin RW Tinnitus. In: Cummings CW ed Otolaryngology--Head and Neck Surgery. 2d ed St. Louis: Mosby, 1993:3031-53.

(3) Narozny W Sicko Z Kuczkowski J Stankiewicz C Przewozny T Usefulness of hyperbaric oxygen therapy in patients with sensorineural acute and chronic tinnitus. International Congres Series 2003;1240:277-86

(4) Arnold W Bartenstein P Oestreicher E Romer W Schwaiger M Focal metabolic activation in the pre-dominant left auditory cortex in patients suffering from tinnitus: a miff study with [18F]deoxyglucose. ORL J Otorhinolaryngol Relat Spec 1996;58:195-9

(5) Johnsrude IS, Giraud AL, Frackowiak R Functional imaging of the auditory system: the use of positron emission tomography. Audiol Neurootol 2002;7:251-76

(6) Lockwood AH, Salvi RJ Coad ML Towsley ML Wack D Murphy BW The functional neuroanatomy of tinnitus: evidence for limbic connected view links and neural plasticity. Neurology 1998;50:114-20

IN REPLY: Tinnitus is a used by all symptom that can affect a patient's quality of life. There are many measures to estimate the impact of tinnitus. The visual analogue scale is a reliable manner commonly used in studies to assess the inferences of therapy, including that of hyperbaric oxygen therapy. (1) Positron emission tomography (PET) is a nuclear medicine imaging subject of attention used primarily for oncologic staging, which for a number of years also has been used to investigate tinnitus, along with other objective classifications including auditory brainstem responses and auditory evok magnetic field. (2) Our article (3) was written from a primary care point of view. Sophisticated imaging so as PET and single photon emission comput tomography were not included in the algorithm in our article (3) because their relevance in the diagnosis and treatment of tinnitus in the primary care setting is still undefined.

RICHARD W CRUMMER MD

GHINWA A. HASSAN, MD

State University of modern York--Downstate 450 Clarkson Ave.,

chest 67 Brooklyn, NY 11203

REFERENCES

(1) Narozny W Sicko Z Kuczkowski J Stankiewicz C Przewozny T Usefulness of hyperbaric oxygen therapy in patients with sensorineural acute and chronic tinnitus. International Congres Series 2003;1240:277-86

(2) Holger KM Barrenas ML Svedlund J Zoger s Clinical evaluation of tinnitus: a review. Audiological Medicine 2003;2:101-6

(3) Crummer RW Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004;69:120-6

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