There is plenty of evidence that it is not just the hearing brain that is involved with tinnitus. There are other parts of the brain called the amygdala (our emotional computer) and the hippocampus (related to memory storage) that seem to be linked to chronic and bothersome tinnitus.
The amygdala is our emotional computer while memories are dealt with in the hippocampus. Both regions have been shown to be connected to the auditory system in our brain. It is believe that with tinnitus people can learn negative responses to the percept and over time encode it into something related to negative emotions. All these regions cause a feedback loop that can make tinnitus feel worse or louder for some people.
For some this circuit can be more active than others which may be why some can experience tinnitus and feel a lot of distress, while someone else with constant tinnitus may learn to ignore it. More research has to be done on this topic.
However, as most people who have worked with tinnitus sufferers know, it is not just about the sound the person hears, but also their response to it and how much they feel it affects their life and has “always” affected their life. A treatment approach that provides feelings of control and also addresses the uncertainty can be helpful because we are addressing these other brain regions.
There are two goals for tinnitus sufferers: addressing the reaction to and perception of tinnitus (Jastreboff, 2000). The reaction consists of issues like anxiety, depression and insomnia, whereas the perception is how loud or noticeable the sound is to the person. It is important for tinnitus sufferers to regain a sense of control while working to manage or reduce their tinnitus.