Metabolic Acidosis. Ciba Foundation Symposium 87

centering around this complex problem. After reading this book, the overriding message is very clear. Simply stated, tinnitus is a much easier problem to describe than to diagnose or treat. The book describes very little convincing work as to the origin of tinnitus except that it is most likely central in the region of the cochlear nucleus. Several panel discussions are presented in which people describe their experiences on an anecdotal basis. On the whole, there has been very little convincing work to support the use of medical or surgical therapy for tinnitus, and the most successful work to date seems to center around biofeedback, attempting to convince the patient that the problem is less severe than he perceives it. Individuals who read this symposium might get a feeling as to what present directions are being pursued in finding a cure for tinnitus, but little in the way of concrete information. Certainly there seems to be no impending breakthrough. In a discussion at the end of one of the chapters, Victor Goodhill was quoted as having said in 1950, "Any management which is based upon the single panacea for the treatment of a symptom, and not a disease, will result in failure." This certainly seems to be the key problem with the results reported at this symposium. The exception is objective tinnitus when a specific lesion is found and surgically removed. Unfortunately, this situation only occurs in approximately 20 percent of reported cases. Perhaps the next symposium in several years will provide more insight into the nature of this important problem.