Sir: Dr. Smith raises an interesting and excellent point. As part of BT's annual physical, I obtained audiometry data that supported bilateral sensorineural hearing loss (again, he is a lifelong road construction worker exposed to jackhammers, bulldozers, etc.). As far as hypomania is concerned, I have seen him in follow-up for other incidental items during the interim (sniffles), and he appears to be quite even-keeled. I appreciate Dr. Smith's comments, for they raise an excellent point to consider when evaluating such patients.