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Tinnitus, Psychosis, and Suicide-Reply

Mark D. Sullivan, MD, PhD
Arch Intern Med. 1994;154(20):2375. doi:10.1001/archinte.1994.00420200127016.
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Frankenburg and Hegarty make a useful point about the potential association of tinnitus and depression with auditory hallucinations. Depression, when severe or combined with another psychiatric disorder such as schizophrenia, may produce hallucinations and delusions. It is important to note, however, that formed auditory hallucinations are extremely rare in patients with tinnitus. We saw no patients with formed hallucinations among the over 150 depressed patients with tinnitus in our three studies.1-3 Clinically, it is easy to distinguish formless buzzing, hissing, or ringing from intelligible words. Musical hallucinations are associated with otologic, rather than psychiatric, disease.4

Whether depression produces auditory hallucinations seems to be more related to the severity of the depression, rather than the presence of tinnitus. Tinnitus is almost always associated with a high-frequency sensorineural hearing loss. Once established, tinnitus becomes louder, more intrusive, and more disabling in the presence of depression. The usual mode of interaction


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