Additions Required

As regards the introductory sentences “Chronic tinnitus is a commonly occurring symptom of the auditory system” and “Tinnitus is a very frequent symptom of impaired auditory processing” (1), I wish to note that tinnitus can be an independent pathology, fundamentally different from short episodes. In addition to the phenomenological diversity, we see difference of manifold causes, pathophysiology, chronification, effects, and disease related disability. In addition to acute and chronic course, a so-called subjective tinnitus can be differentiated on the basis of pathophysiology in the inner ear and/or the central nervous system from objective tinnitus, if sound is heard in proximity to the ear (2).

The term comorbidity is often used without reflection. Feinstein defined comorbidity as „any distinct additional clinical entity“ that existed beforehand or occurs during the course of an illness (3). It should be differentiated from signs and symptoms of a disease—for example, if retrocochlear disturbances present with the symptom tinnitus—and also from sequelae, if anxiety, depression, insomnia, adaptation disorder develop, among others. In this scenario treating the underlying disease is priority, whereas in comorbidities, several treatment approaches are rational and appropriate. One should also consider structural or functional couplings, where no time differences are seen as opposed to causal effects.

Regarding treatment: If tinnitus cannot be relieved, the alleviation of intolerable suffering into tolerable suffering is the aim. For individuals it is gratifying if substantial relief up to freedom from symptoms can be achieved by means of physiotherapeutic, osteopathic measures in craniomandibular dysfunctions, neck-back anomalies, dysbalances, tendinitis and tenosynovitis, or trigger points with possible interactions. Accordingly, in addition to controlled studies, reviews, and meta-analyses, individual cases that are not captured in epidemiological cross sectional studies are important.