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 metrics. Tinnitus activities treatment (TAT) is a clinical adaptation of TRT that focuses on four areas: thoughts and emotions, hearing and communication, sleep, and concentration. Progressive tinnitus management (PTM) is a 5-step structured clinical protocol for management of tinnitus which may include tinnitus retraining therapy. The five steps are: The U.S. Department of Veterans Affairs (VA) now employs PTM to help patients self-manage their tinnitus. Cognitive behavior therapy (CBT), the counselling part of TRT, as a generalized type of psychological and behavioral counselling, has also been used by itself in the management of tinnitus. If tinnitus is associated with hearing