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 significantly bothered by it. However, some of the problems caused by tinnitus include annoyance, anxiety, panic, and loss of sleep and/or concentration. The distress of tinnitus is strongly associated with various psychological factors; loudness, duration and other characteristics of the tinnitus are secondary. TRT may offer real although moderate improvement in tinnitus suffering for adults with moderate-to-severe tinnitus, in the absence of hyperacusis, significant hearing loss and/or depression. Not everyone is a good candidate for TRT. Factors associated with suitability for TRT and predisposing for favorable outcome are: lower loudness of tinnitus, higher pitch of tinnitus, shorter duration of tinnitus