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 masker trying to sleep or relax, as it is within these quiet environments that the tinnitus is at its most noticeable. They commonly take the form of CD or MP3 recordings, or bedside noise generators. When used in conjunction with a sound pillow (which contains small embedded speakers) they can mask a person's tinnitus sounds without disturbing his/her partner. These masker devices use soothing natural sounds such as ocean surf, rainfall or synthetic sounds such as white noise, pink noise, or brown noise to help the auditory system become less sensitive to tinnitus and promote relaxation by reducing the contrast between