Physiology and phenomenology of tinnitus: Implications for treatment

We examine a contrast in understanding tinnitus and how this impacts on treatment approaches. First, a physiological account of tinnitus is described based on disinhibition and cortical remapping following injury at the receptor level, the analog for tinnitus being the 'phantom limb pain' phenomenon. Secondly, an experimental model of tinnitus is reviewed that relies on inference from 'conditioning' animal behaviour. Arising from this, a role for conditioning in people distressed by tinnitus has been proposed, based on the unfounded premise that, for humans, tinnitus is a 'neutral stimulus', the distress being due to association with other stressful events. We critique this because we believe it influences approaches to tinnitus treatment. Finally, the phenomenology of tinnitus in the human case is analysed, with its nature illuminated via a series of distinctions with hearing impairment. Tinnitus can be 'intrinsically' stressful for some people. Understanding this emphasizes the need to involve concepts and treatment in the area of clinical psychology. A flexible coalition between clinical audiologists and clinical psychologists is proposed as fruitful for tinnitus and related rehabilitation.