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Learning Theory and Subjective Hearing Problems in Tinnitus Patients

M any peripheral and central mechanisms likely contribute to the origin of tinnitus, including discordant hair cell damage, dorsal cochlear nucleus hyperactivity, tonotopic map reorganization, cochlear synaptopathy, increased spontaneous neuronal firing, increased neuronal synchrony, and failure of inhibitory pathways.1-4 Nevertheless, the trigger for tinnitus is usually some type of damage to the cochlea.5 However, “cochlear pathology is not always expressed in the audiogram.”2 A normal audiogram can be obtained even when there is up to 30 percent diffuse loss of outer hair cells.6,7 In such cases, an individual may be able to detect faint tones and repeat monosyllabic words in a quiet sound booth. Understanding complex real-world speech, however, requires greater cochlear specificity than that required by a simple hearing test; as a result, communication often fails. The prevalence of tinnitus among veterans is over twice as high as that among non-veterans (11.7% vs. 5.4%).8 In a review of over 2,500 consecutive audiology referrals at the Atlanta VA Medical Center, 26 percent were for the primary complaint of tinnitus, and nearly half of these (45%) had normal or near-normal hearing through 8,000 Hz.9 Learning theory concepts of working memory and cognitive load may help explain the hearing complaints of tinnitus patients with normal or near-normal hearing.