Abstract
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.
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