title: Underlying mechanisms of tinnitus: review and clinical implications.
abstract: BACKGROUND
  The study of tinnitus mechanisms has increased tenfold in the last decade. The common denominator for all of these studies is the goal of elucidating the underlying neural mechanisms of tinnitus with the ultimate purpose of finding a cure. While these basic science findings may not be immediately applicable to the clinician who works directly with patients to assist them in managing their reactions to tinnitus, a clear understanding of these findings is needed to develop the most effective procedures for alleviating tinnitus.
  
  
  OBJECTIVE
  The goal of this review is to provide audiologists and other health-care professionals with a basic understanding of the neurophysiological changes in the auditory system likely to be responsible for tinnitus.
  
  
  RESULTS
  It is increasingly clear that tinnitus is a pathology involving neuroplastic changes in central auditory structures that take place when the brain is deprived of its normal input by pathology in the cochlea. Cochlear pathology is not always expressed in the audiogram but may be detected by more sensitive measures. Neural changes can occur at the level of synapses between inner hair cells and the auditory nerve and within multiple levels of the central auditory pathway. Long-term maintenance of tinnitus is likely a function of a complex network of structures involving central auditory and nonauditory systems.
  
  
  CONCLUSIONS
  Patients often have expectations that a treatment exists to cure their tinnitus. They should be made aware that research is increasing to discover such a cure and that their reactions to tinnitus can be mitigated through the use of evidence-based behavioral interventions.
authors.affiliation: VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: James A
authors.initials: JA
authors.lastname: Henry
authors.affiliation: Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Larry E
authors.initials: LE
authors.lastname: Roberts
authors.affiliation: Pharmacology Department, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Caspary
authors.affiliation: VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Theodoroff
authors.affiliation: Center for Hearing and Deafness, University of Buffalo, Buffalo, NY.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Salvi
mesh_terms: D000818:Animals; D001303:Auditory Cortex / Q000503:physiopathology; D001307:Auditory Perception / Q000502:physiology; D015834:Cochlear Diseases / Q000150:complications* / Q000503:physiopathology; D017626:Cochlear Nucleus / Q000503:physiopathology; D003943:Diagnostic Techniques, Neurological; D004195:Disease Models, Animal; D005829:Geniculate Bodies / Q000503:physiopathology; D034381:Hearing Loss / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D012001:Hyperacusis / Q000503:physiopathology; D007245:Inferior Colliculi / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009473:Neuronal Plasticity; D009622:Noise / Q000009:adverse effects; D049268:Positron-Emission Tomography; D014012:Tinnitus / Q000209:etiology* / Q000503:physiopathology*