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 tinnitus sounds and background sound. More advanced software based tinnitus maskers can use a combination of natural and synthetic sounds or a filtered noise generator tailored to mask the specific frequencies at which the tinnitus signal is experienced. Some sufferers require masking at all times. These people may employ wearable hearing aids which amplify ambient sound, generate low level wide band sounds such as white noise, or combination devices that mix both functions into one device. A standard hearing aid may be used for tinnitus masking; the tuning and amplification characteristics are different than when one is used in compensation