Berbatov was left out of the squad for the Barclays Premier League clash, with head coach Juande Ramos accusing the striker of having a negative effect on the dressing room and being distracted.

Sunderland took full advantage and led through Kieran Richardson's powerful drive before Jermaine Jenas equalised.

However, Cisse - signed on loan from Marseille this week - headed in with seven minutes to go to inflict consecutive defeats for Spurs.

Ramos is clearly concerned with the how Berbatov affects morale in his squad, but another problem he faces is the lack of strikers available.

A year ago Spurs had the four strikers they thought would fire them into the Champions League places - only Darren Bent is left after Jermain Defoe and Robbie Keane left and Berbatov made it clear he wanted to join them through the exit door.

"I have not selected him as I do not think that he is focused enough and I do not feel that he will be good for the dressing room and the team effort," said Ramos.

"It doesn't matter how good a player is, if he is not in the right frame of mind, then he will not perform well. The only thing I concern myself with is picking the best team to try and win the game.

"I shall talk to the player tomorrow, he is our player and we shall work with him at training."

Middlesbrough were the beneficiaries of Berbatov's absence last week - he was a substitute at the Riverside - and Spurs missed his spark against the Black Cats.

Bent was prolific in pre-season but has struggled in his first two matches of the season and he barely had sight of goal in a dull first half.

David Bentley, playing as one of the attacking midfielders in a 4-2-3-1 formation, had the first effort at goal but his 25-yard drive went well wide.

El-Hadji Diouf tried his luck from a similar distance for Sunderland but Jonathan Woodgate headed the shot away for a corner. At the other end, Woodgate got his head on a Bentley corner but could not direct his header on target.

Attempting to make something happen, Gareth Bale earned a booking in the 26th minute for a dive as he tried to convince Mike Dean into awarding a penalty when Danny Collins challenged him in the area.

Roy Keane had Andy Reid and Steed Malbranque, both former Spurs players, in Sunderland's starting XI and both received warm receptions from the home fans.

It was Malbranque who came closest to opening the scoring in the first 45 minutes. The Frenchman struck the foot of the post six minutes before the interval with a low drive from long distance, with Woodgate clearing the rebound.

Bale had a clear opening three minutes after the restart when he met Bentley's corner but his header went over Craig Gordon's crossbar.

Danny Collins also went close with his head for Sunderland when Reid found him with a free-kick.

Heurelho Gomes was then forced into a save when Daryl Murphy met Diouf's far-post cross with a volley.

The visiting fans were not made to wait long for the opener, with Richardson cracking his powerful half-volley perfectly into the side-netting of the goal.

Ledley King had failed to clear and then Richardson won a tussle with Jermaine Jenas 25 yards from goal before unleashing his finish. Spurs fans were still protesting for a handball as Richardson whipped off his shirt and ran towards the Sunderland fans.

Woodgate should have equalised when Gordon could only parry Bentley's free-kick - but the finish from the six-yard box went wide. Gordon also saved when Bent ran through and lashed at the near post.

Bentley had a shot tipped over by Gordon before the equaliser came with 17 minutes remaining. Luka Modric burst into the penalty area and after his shot was saved, Jenas tapped into the empty net.

Then an unmarked Cisse got on the end of Daryl Murphy's cross to score the winner and compound Spurs' problems.