Tinnitus to the inner ear can cause tinnitus, other apparent causes (e.g., temporomandibular joint dysfunction) are difficult to explain. It may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become over-excited. The basis of this theory is that many with tinnitus also have hearing loss. Three reviews of 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which in turn result in a great variety of symptoms demanding specifically adapted therapies. Even when tinnitus is the primary complaint, audiological evaluation is usually preceded by
Tinnitus retraining therapy large proportion of dropouts; reported 'success' ratios may not take these subjects into account. There are few available studies, but most show that tinnitus naturally declines over time (years) in a large proportion of subjects surveyed, without any treatment. The annoyance of tinnitus also tends to decline over time. In at least some, tinnitus spontaneously disappears. A Cochrane review found only one sufficiently rigorous study of TRT and noted that while the study suggested benefit in the treatment of tinnitus, the study quality was not good enough to draw firm conclusions. A separate Cochrane review of sound therapy (though they