From all methods of the treatment of tinnitus, medical, masking, surgery, electrical stimulation and psychological, we believe a reliable medical treatment would be preferable because it is easy to apply. An immense variety of drugs have been used for the treatment of tinnitus (Vernon, 1977). The most reliable drugs so far on tinnitus are intravenous procaine and lidocaine (Bárány, 1935; Lewy, 1937; Melding et al., 1978; Martin and Colman, 1980; Israel et al., 1982). The fact that these drugs cannot be given orally because of the poor biological availability after oral administration, is a great disadvantage. In view of the important pharmaco-therapeutic role of lidocaine as an anti-arrhythmic drug, considerable research has been devoted to drugs with comparable anti-arrhythmic properties but permitting oral administration. This work produced tocainide (Smith, 1981), which showed a certain degree of effect on tinnitus as well (Emmett and Shea, 1980; Cathcart, 1982). Before starting a randomized double-blind controlled trial to assess the effect on tinnitus of tocainide, we studied the effect of several doses of tocainide HCl on tinnitus in order to select an appropriate dosage. Nineteen patients with obstructive tinnitus of various aetiologies were admitted to the study. There were 10 women and nine men. Their mean age was 54 years (range 22–67 years). Tocainide was administered in five different doses in a single-blind controlled trial. To be able to judge the effect under steady conditions, each dose was given for four days, as shown in Table I. On the fourth day of each period the patients had to record the degree of impediment caused by the tinitus on a six-point scale (Table II). They were also asked to report all sideeffects.

Medical treatment offers the best hope, we believe, of the various treatment methods available for the management of tinnitus.

One of the most frustrating clinical problems for both otolaryngologist and patient is having to deal with the symptom of tinnitus. From the patient's point of view, frustration stems from the fact that this often unrelenting symptom can lead to a total disruption of a productive lifestyle, and in a number of instances, proves to be a tragically fatal symptom as the patients turn to suicide as a final solution. The otolaryngologist has been frustrated because until recently he has had little more than sympathy to offer the patient. This has led to a helpless feeling between both parties.

A randomized controlled study using benzodiazepines to treat patients with chronic subjective tinnitus was performed to determine if these drugs could suppress intractable tinnitus. Trials with the antihistames meclizine, chlorpheniramine, and dexchlorpheniramine were used as the controls in the evaluation of diazepam, flurazepam, carbamazepine, oxazepam, and clonazepam. Of all the benzodiazepines studied, only oxazepam and clonazepam were significantly more effective than antihistamines in suppressing chronic tinnitus, but these two drugs alleviated the symptom in 52 per cent and 69 per cent of the individuals treated respectively. Oxazepam 30 milligrams daily or clonazepam 0.5 milligrams three times daily provides substantial control of chronic tinnitus.

There have been five recent studies of drug treatment in tinnitus in the UK using Class I anti-arrhythmic preparations. We present a new double-blind study of tocainide hydrochloride in severe, unmaskable tinnitus. No significant response is noted in any of the controlled trials to the active ingredient, and more work is needed on diagnostic criteria to see if those who do respond constitute a separate group. There was a surprisingly low incidence of placebo response and the importance of the side effects produced by the drugs in this group is stressed. The finding that three patients with profound hearing losses have had some continued benefit leads to the cautious conclusion that drug responders may be have a central component to their tinnitus.

Eight patients with bilateral Menière's disease are reported in whom intramuscular Streptomycin Sulfate (ISS) dosage was titrated in an attempt to alleviate disabling vertigo and hearing loss.

It appears possible to eliminate the vertiginous episodes, preserve or improve hearing, avoid ataxia and oscillopsia, and lessen tinnitus in most of these individuals.

At the present time, we consider this treatment regimen our first choice of therapy in people with bilateral active Menière's disease or in patients whose only hearing ear is actively fluctuating and in whom associated disabling vertigo is present.

The effect on tinnitus in 110 patients undergoing translabyrinthine vestibular nerve section is presented. The effect on tinnitus of vestibular and cochlear nerve section (VCNS) together and vestibular nerve section (VNS) alone was studied. The number of patients improved with VCNS (61 per cent) was slightly better than with VNS alone (49 per cent). VNS alone worsened tinnitus more often than VCNS. Age, side involved, sex, etiology of vertigo, severity of tinnitus, interference with sleep and activities, slope of the pre-operative audiogram, and magnitude of the hearing loss had no value in predicting the change in tinnitus following either VNS or VCNS.

The effect on tinnitus in 110 patients undergoing translabyrinthine vestibular nerve section is presented. The effect on tinnitus of vestibular and cochlear nerve section (VCNS) together and vestibular nerve section (VNS) alone was studied. The number of patients improved with VCNS (61 per cent) was slightly better than with VNS alone (49 per cent). VNS alone worsened tinnitus more often than VCNS. Age, side involved, sex, etiology of vertigo, severity of tinnitus, interference with sleep and activities, slope of the pre-operative audiogram, and magnitude of the hearing loss had no value in predicting the change in tinnitus following either VNS or VCNS.

This study attempts to correlate the relationship between clinical otosclerosis, tinnitus, and stapedectomy surgery. One hundred and thirty-five patients who recently underwent stapedectomy surgery were evaluated to determine the effects upon tinnitus and to determine if there was an association between tinnitus and the pre-operative cochlear reserve, the degree of footplate pathology, and/or the post-operative hearing result.

Diminished cochlear reserve and the post-operative audiometric result had no relationship to the tinnitus symptom. A beneficial effect on tinnitus occurred in 25 per cent of the patients requiring drilling of the stapes footplate.

One hundred and seventy-two patients with Menière's disease (including tinnitus) who underwent endolymphatic system (ELS) surgery for vertigo and/or hearing loss, were evaluated to determine whether ELS surgery had an incidental effect on tinnitus. Tinnitus was eliminated in 34 patients (19.9 per cent), reduced in 64 patients (37.2 per cent), unchanged in 39 patients (22.6 per cent), and worse in 35 patients (20.3 per cent). No significant correlation existed between surgical results for hearing and an improvement in tinnitus. A successful elimination of vertigo, however, was associated with better results for tinnitus relief. Tinnitus is not considered to be an indication for ELS surgery.

Otologic surgeons have long searched for a predictable surgical procedure for the control of tinnitus, but without success. Yet periodically, surgical procedures employed primarily for other purposes serendipitously produce relief of associated tinnitus. An effort will be made to study this aspect of tinnitus. The recent literature on the subject will be surveyed briefly. The effect upon tinnitus in 332 patients by the use of various neurotologic surgical procedures, performed primarily for other purposes, will be presented and discussed.