In the course of our clinical experience with tinnitus, the concepts of sub-clinical tinnitus; non-auditory tinnitus have developed. This has been an outgrowth of the critical emphasis placed upon the clinical history; and the attempt to objectivize the subjective tinnitus using auditory brainstem response recording (ABR). These concepts developed from observations and its correlation with the results of the neurotologic evaluation of our cases. These concepts are separate but can overlap.

Hallucinations are a well known aspect of chronic alcoholism. Visual hallucinations are much more common than auditory hallucinations, and both occur as part of the syndrome of sudden withdrawal following prolonged, heavy imbibition of alcoholic beverages, approximately the equivalent of one pint of ethanol per day for forty days. During the first 24–36 hours of alcohol withdrawal, acute visual and auditory hallucinations and grand mal seizures may occur prior to the disorientation and autonomic changes of delirium tremens, which need not follow invariably. Thus, some study of the patients in this stage is possible. The characteristic of the hallucinational content is its concreteness. The visual hallucination is of figures, faces and objects which the patient describes in concrete detail. The auditory hallucinations are of voices which the patient can describe, and quote what they are saying to him or to each other. Often the faces and voices are not familiar to the patient, and they may seem benign, although they are more commonly threatening. These hallucinations are distinctly different from those seen in schizophrenic patients. During the acute phase, the auditory hallucinations are localized as coming from the next room, or from the street, and not as being inside the head or in the ears.