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The Tinnitus Clinic provides expert tinnitus treatment using scientific and evidence-based techniques of tinnitus specialised tinnitus counselling, neurofeedback, and hypnosis. The Tinnitus Recovery Program is located in East Adelaide, South Australia. The Tinnitus Clinic Helping people overcome tinnitus and regain control Experienced clinical guidance using a safe, structured, personalised approach. Even long-standing tinnitus can improve when the brain’s response to the signal is retrained. John Wibrow MSc (Neuroscience) King's College London, MSocSc (Counselling Studies) Adelaide University, BHthSc. Tinnitus Neurocognitive Specialist Helping patients retrain the brain’s response to tinnitus | 30+ Years Clinical Experience Initial Consultation Enquiries (08) 8333 1010 Referrals & email: clinic@eastadelaide.com.au Our evidence-informed integrated tinnitus treatment helps reduce both tinnitus distress and perception. What happens next? STEP 1 Initial Contact • Call 8333 1010 for a brief, no-obligation conversation to discuss your tinnitus concerns. • If appropriate, an initial consultation appointment will be arranged. • Appointment details and required medical information will be sent to you following your call STEP 2 Initial Consultation • Attend your initial consultation at the Tinnitus Clinic where we explore your tinnitus experience in detail. • A comprehensive assessment is undertaken to understand your tinnitus experience. • You will receive a clear explanation of your tinnitus together with practical management strategies. • Together, we discuss further treatment options and next steps as appropriate. STEP 3 Individualised Treatment & Support • Treatment is tailored to your needs and may include cognitive retraining, neurofeedback, hypnosis, sound therapy, or an integrated approach designed to reduce tinnitus distress and perception. • The goal is to reduce tinnitus distress and and perception and improve daily functioning. • You will be supported throughout your recovery including take-home resources and recordings. • Where appropriate, additional assessment can be arranged to support your particular case. Who typically benefits from our approach? Tinnitus that is recent or long-standing Tinnitus-related distress, anxiety, or low mood Difficulty sleeping or concentrating Feeling stuck or discouraged after previous treatments Why people choose our approach With over 30 years of clinical experience, our work focuses on understanding your individual tinnitus experience and providing practical, structured strategies aimed at reducing distress and restoring control. We listen to your narrative with understanding and compassion. We do not sell hearing aids or expensive sound generators. Treatment approaches are safe and grounded in established clinical practice. You will receive complimentary take-home audio scripts, recordings, and supporting resources. Guidance on using simple, affordable tinnitus support apps and devices that are widely commercially available. Where further assessment or support is appropriate, we work collaboratively with your GP, ENT, physical therapist, and local audiology provider. Your treatment progress can also be visually tracked using modern EEG technology together with international tinnitus questionnaires. Many people find that as they understand how tinnitus is generated and maintained in the brain, their distress gradually reduces and the sound becomes far less intrusive. Client Experiences Many people who contact the clinic have already tried other approaches. This is what they say are the key differences. • A structured, calm approach focused on understanding your individual tinnitus experience. • Over 30 years of clinical experience working with distress, attention, and nervous system regulation . • Treatment that complements medical and audiological care rather than replacing it. • Clear explanations and practical strategies designed to restore confidence and control. “I am a different person… I understand my tinnitus so much better now and am rarely affected by it.” — Rebecca K., South Australia “Treatment was most beneficial… tinnitus is no longer an annoyance and no longer affects my life.” — Dr Alan R., Queensland “I now have more control over my tinnitus.” — Richard P., South Australia “I am now in a better place with my tinnitus… would absolutely recommend the program.” — David P., South Australia "I don't think I have ever seen such a well informed, concise information source related to Tinnitus distress anywhere else." — Geoff M., Wellington, NZ Experience - Innovation - Results How We Work With Tinnitus The Tinnitus Clinic provides clinical care informed by modern neuroscience research into how tinnitus is generated and maintained in the brain. Our work focuses on helping the brain gradually learn to respond differently to the sound. We use an integrated treatment approach that combines counselling, neurofeedback, and hypnosis. These approaches work together to help regulate attention, reduce distress, and retrain the brain’s response to tinnitus. Our clinical protocols are guided by international tinnitus research frameworks, including the work of the Tinnitus Research Initiative (TRI). Assessment and progress are measured using established tinnitus questionnaires widely used in research and clinical practice. All services are delivered within a careful, ethical, and evidence-informed clinical framework. How the Components Work Together Neurofeedback Hypnosis Tinnitus Retraining Counselling Integrated approaches working together to retrain the brain’s response to tinnitus Each component of treatment targets different aspects of the tinnitus process — attention, stress regulation, brain activity patterns, and auditory perception. Tinnitus is not only an ear signal — it is also a brain process involving attention, prediction, and threat monitoring. How the Treatment Components Work Together The treatment approach combines several complementary methods, each targeting different aspects of how tinnitus is generated and maintained within the brain. Neurofeedback Supporting healthier brain activity patterns Neurofeedback uses EEG monitoring to help the brain learn healthier patterns of activity. By providing real-time feedback about brain states, it allows individuals to gradually improve self-regulation of attention and arousal. Research suggests that improving these brain activity patterns may help reduce tinnitus perception and the distress associated with the sound. How neurofeedback helps to: • support regulation of attention networks • promote calmer brain states • reduce tinnitus perception and distress Tinnitus Counselling Understanding tinnitus and changing the brain’s response For some people, the onset of tinnitus can be distressing or even traumatic. The brain may begin to treat the sound as a threat, which keeps it at the centre of attention. Tinnitus counselling helps people understand how tinnitus works in the brain and develop practical strategies for reducing distress and restoring a sense of control. Counselling focuses on: • understanding the tinnitus process • reducing threat and anxiety responses • developing practical coping strategies Hypnosis Reducing attentional capture and salience Hypnosis is a focused state of attention that allows individuals to engage with thoughts and sensations differently. In clinical settings it can help people develop new ways of responding to tinnitus. Many people find hypnosis helpful for reducing stress, calming the nervous system, and shifting attention away from the tinnitus signal. Hypnosis helps: • reduce stress and hyper-arousal • shift attention away from the sound • support nervous system regulation Learn More About the Neuroscience of Tinnitus A deeper explanation of the brain mechanisms behind tinnitus. Many people find it helpful to understand how tinnitus is generated and maintained in the brain. John Wibrow’s book Rethinking Tinnitus Through Neuroscience explains these ideas in clear, practical language and explores how the brain can learn to respond differently to tinnitus. Download the Free eBook View the Kindle Edition on Amazon Call (08) 8333 1010 for a brief, no-obligation conversation to discuss your tinnitus concerns.

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Local, interstate, and international inquiries are welcomed. Call the clinic now (08) 8333 1010 Free, no-obligation initial conversation to determine whether our approach is suitable for you. Your full consultation will provide: A thorough assessment of your tinnitus and the possible triggers. A detailed explanation of the current understanding of the neurophysiological model of tinnitus and how this relates to the onset and continuation of your tinnitus. Management strategies to help relieve tinnitus perception and distress. A brief overview of our trimodal tinnitus relief and support program. Referalls & email: clinic@eastadelaide.com.au

It is important to be supported during your tinnitus journey. Recovery is possible with the right support and help. CRISIS CARE CONTACTS The Tinnitus Clinic is not a helpline or crisis centre. If you are in crisis with your tinnitus, you must seek appropriate emergency care immediately. Please contact your healthcare professional and/or the emergency department of your local hospital for assistance. If you are experiencing thoughts of self-harm or suicide, please contact Lifeline (13 11 14) or call 000 immediately. The contacts below are provided as additional support: The following information is provided for general guidance and is not intended as a replacement for professional assessment and treatment. Please contact your healthcare provider in the first instance. 1. Maintain a rich sound environment. This helps to stimulate the auditory pathways and retrain your brain to defocus away from the tinnitus. \if you have significant hearing loss, consider the fitment of hearing aid(as) as appropriate. 2. Use ear protection when sound exposure is likely to cause hearing damage (e.g. loud concerts, occupational noise, movie theatre, prolonged dental work, etc). Ear protection should be selected depending on the situation (e.g. Musician’s ear plugs for concerts and movie theatre; ear muffs for industrial situations; noise cancelling headphones for long haul flights). 3. Avoid very quiet environments or blocking your ears or using ear plugs in normal sound level situations. This is particularly relevant in the early stages of tinnitus. Once you have habituated to your tinnitus and hardly ever notice it and are no longer distressed by your tinnitus, you will be able to enjoy very quiet situations again. 4. Do not be overly concerned about temporary spikes in your tinnitus which can occur from time-to-time as a result of reactive tinnitus to certain triggers such as car cabin noise when on a long trip, certain foods and drinks, medications, stress, dental treatment, neck and jaw problems, neuralgia, etc. For most people, the peak intensity eases over time. 5. Discuss your medications with your GP and/or treating specialist. Some medications or combinations of medications have been reported to trigger or exacerbate tinnitus or can cause damage to your hearing - ototoxic (e.g. Aspirin and certain antibiotics). 6. Remember that tinnitus perception is strongly correlated to your degree of stress and anxiety about tinnitus. Fear of tinnitus will enhance your attention to the tinnitus and contribute to distress and anxiety and this will increase your perception of tinnitus. As a consequence, what is a small tinnitus signal can be perceived as overwhelmingly loud as your auditory neural pathways amplify the internal sound. 7. Utilise any technique that reduces your anxiety levels such as relaxation, meditation, mindfulness, hypnosis, neurofeedback, yoga, tai chi, etc. It is important that you receive reassurance, understanding and support from a suitably qualified tinnitus counsellor. 8. The use of appropriately prescribed medication in the early stages of tinnitus is understandable and acceptable. If medication is of the benzodiazapine family, then possible addition and withdrawal is a consideration. Short-term and infrequent use is best. Slow withdrawal is important to minimise the chances of tinnitus spikes. 9. Remember that invariably tinnitus improves over time and in many people they become completely unaware of their tinnitus for most of the time. For some people, being aware of head or ear-sounds is a normal phenomenon. The most realistic goal is therefore to only be aware of your tinnitus when you listen for it or in very quiet situations. 10. Tinnitus perception and intensity invariably eases over time. However, if you become extremely distressed or affected by your tinnitus it is important to talk to someone about it. If you are in an emergency, or at immediate risk of harm to yourself or others, please contact emergency services on 13 11 14 and talk to someone now. GENERAL MANAGEMENT TECHNIQUES

The Tinnitus Clinic is staffed by professionally master-qualified practitioners with extensive experience in tinnitus management. We do not sell hearing aids or profit from anything other than our professional services. We have no fiduciary interest in external sources. MSc (King's), MSSc, BHSc. John Wibrow is a graduate of the University of South Australia with degrees in electronic engineering and health science. He also holds post graduate qualifications in management and social science and is a Masters-qualified counsellor with a particular interest in the neuroscience of tinnitus. John also has a Masters in Applied Neuroscience from King's College London and is a full member of the Applied Neuroscience Society of Australasia (ANSA) and the International Society for Neurofeedback & Research (ISNR). John is also a professional registered clinical counsellor and is a clinical member of the Psychotherapists and Counselling Federation of Australia (PACFA). He is also registered with the Australian Register of Counsellors and Psychotherapists (ARCAP). He has a strong interest in tinnitus trauma and the psychological impact of tinnitus on people with this condition and their families. John has a deep personal understanding of tinnitus having had the condition since 1994. He was instrumental in obtaining government funding for the establishment of the first Government-funded tinnitus clinic in Australia. John was also co-founder of the Tinnitus Advisory Group (TAG) and was its President for eight years. John also co-authored the video “Tinnitus - Let’s Be Positive” and has written a book "Rethinking Tinntus - A Neuroscience Perspective". He is is currently writing another book called “Recovery From Tinnitus Distress”. John is co-founder of the Tinnitus Clinic and utilises a combination of techniques such as person-centred counselling, trauma counselling, neurofeedback, and behavioural therapy techniques, BA, MA. Marta Lohyn is a psychologist who specialises in the use of clinical hypnosis for a range of difficulties. She has been working clinically with adults and children for 30 years and has found hypnosis to be an invaluable tool in assisting clients to deal with problems like anxiety, depression, sleep problems and chronic pain. Marta joined the Executive Committee of the South Australian Society of Hypnosis as treasurer in 2009 and in 2010 was invited to undertake the role of Director of Studies. In this role she developed and coordinated the training course, also taking a significant part in the teaching program. Marta has also conducted training for the Australian Society of Hypnosis (ASH) and is co-director of Hypnosis Today, which offers training in hypnosis to registered health professionals. Marta is co-founder of the Tinnitus Clinic and has become involved in the tinnitus area through her collaboration with John. As well as her considerable experience as a psychologist and counsellor, with hypnosis Marta offers tinnitus clients a very relaxing and powerful tool to reduce their perception of tinnitus and manage their distress and discomfort more effectively. Marta is also a full member of the the Applied Neuroscience Society of Australasia (ANSA).

The Neuroscience of Tinnitus Emerging neuroscientific research describes tinnitus as dysregulation across three primary brain networks: the salience network (SN), the default mode network (DMN), and the central executive network (CEN) (De Ridder et al., 2014, 2022). First described by Menon (2011) as the triple network model (TNM), functional connectivity (FC) across these brain regions plays a distinct role in certain psychopathology: the SN is responsible for enhancing the salience of sensory input (Uddin, 2016); the DMN governs self-referential thought, which influences cognitive and emotional processing (Buckner et al., 2008); and the CEN regulates priority cognitive functions that influence attention and executive decisions (Seeley et al., 2007). Recent neuroimaging studies consistently show abnormal FC within TNM regions among tinnitus sufferers. For example, Chen et al. (2018) investigated how tinnitus perception and distress correlates with altered FC within the TNM using functional magnetic resonance imaging (fMRI) and seed-based correlation analysis. Fifty chronic tinnitus participants were compared with fifty controls, matched for age and gender, and hyperactivity was observed between the SN and DMN in tinnitus participants which positively correlated with tinnitus handicap inventory (THI) scores, a validated measure of tinnitus impact (Newman et al., 1998). In contrast, hypoactivity was observed between the DMN-CEN in tinnitus participants which correlated with heightened emotional response and attentional focus on tinnitus. Zhou et al. (2022) also demonstrated that tinnitus is linked to disruptions in FC within the TNM. In a fMRI and seed-based functional connectivity analysis, forty-five chronic tinnitus participants and forty-five healthy controls were matched for demographic variables such as age and gender. Distress levels were measured using the tinnitus handicap inventory (THI) and tinnitus functional index (TFI) to assess tinnitus impact on emotional and functional domains. Elevated SN-DMN connectivity and reduced DMN-CEN connectivity were observed in tinnitus participants, which positively correlated with levels of tinnitus distress and perception. De Ridder et al. (2022) posits that increased SN-DMN connectivity aligns with a neurological predisposition to engage in self-referential and distressful thoughts about tinnitus, whereas reduced DMN-CEN connectivity is associated with weakened cognitive regulation, contributing to difficulty in shifting attention away from the tinnitus. In a study using resting-state electroencephalography (rs-EEG), Xiong et al. (2023), specifically found enhanced connectivity between the SN’s anterior insula (AI) and auditory cortex, as well as between the DMN’s parahippocampal cortex (PHC) and posterior cingulate cortex (PCC). These patterns were more pronounced in moderate-to-severe tinnitus cases and were associated with higher levels of distress and attentional focus on tinnitus, as reflected by elevated THI and TFI scores. A consistent finding in tinnitus participants therefore appears to be SN-DMN and SN-CEN hyperactivity and DMN-CEN hypoactivity as depicted in Figure 1. Figure 1. Triple network model (TNM) of tinnitus showing dysregulation parameters. Non-invasive neuromodulation techniques that target these dysfunctional pathways are therefore of particular interest. Laundry et al. (2020) and Trevis et al. (2018) demonstrated that cognitive therapy (CT), including CBT, helps individuals reframe negative perceptions and reduce emotional distress associated with tinnitus. However, we must turn to related applications of CT to gain insights on its effect on TNM pathways. Yoshino et al. (2018) used resting-state fMRI (rs-fMRI) to show that chronic pain subjects who underwent cognitive therapy (CT) exhibited improved DMN-CEN regulation, which is particularly relevant given the parallels between the emotional responses to chronic pain and chronic tinnitus (De Ridder et al., 2022; Johansson et al., 2024). Comparable findings have been observed in disorders such as obsessive-compulsive disorder (OCD) (Fan et al., 2017) and major depressive disorder (MDD) (Pinto et al., 2014), which, like tinnitus, are characterised by disruptions in emotional and attentional brain networks (Cyr et al., 2020; Teng et al., 2022, 2024). Zimmerman et al. (2019) found that mindfulness based cognitive therapy (MBCT) increased DMN-CEN connectivity and regulation which positively correlated with a reduction in distress in tinnitus subjects. Bauer et al. (2017) used fMRI to demonstrate that CT increased DMN-CEN connectivity which correlated with reduced emotional reactivity and reduced tinnitus distress. Cognitive therapies therefore appear to have a specific role in modulating the DMN-CEN pathway which may explain why, as a monomodal therapy it is helpful in reducing tinnitus distress but not so for tinnitus perception which is more strongly associated with the SN pathways. However, the inclusion of CT in a multimodal approach clearly holds promise. Neurofeedback, a technique that trains individuals to regulate brainwave activity via real-time monitoring of EEG signals, has been successfully used to treat post-traumatic stress disorder (PTSD) (Vlachou et al., 2022) and attention deficit hyperactivity disorder (ADHD) (Reiter et al., 2016), two conditions which display hyperactivity in SN-DMN functional connections; a phenomenon also found in tinnitus sufferers (Abdallah et al., 2019; Sidlauskaite et al., 2016). When considered within the context of the triple network model, neurofeedback has been found to be a promising tool for modulating key brain networks implicated in tinnitus (Barrenechea, 2022). For example, Guntensperger et al. (2017, 2019), demonstrated that neurofeedback can modulate key regions of the DMN, such as the posterior cingulate cortex (PCC) which correlated with reduction in tinnitus-related distress. Similarly, Kleinjung et al. (2023) and Jensen et al. (2023) demonstrated that neurofeedback can downregulate hyperactivity of the SN-DMN and SN-CEN by neuromodulating the anterior insular (AI) and anterior cingulate cortex (ACC) regions involved in the perceptual salience and attentional focus on tinnitus. One challenge with neurofeedback research, however, is the variability across studies on the optimal training protocol (Rogala et al., 2016). Notwithstanding, a protocol developed by Crocetti et al. (2011) aimed at reducing delta and beta waves and increasing alpha activity, resulted in significant reductions in tinnitus perception, as evidenced by improved THI scores. This alpha/delta/beta training protocol has been refined by Jensen et al. (2020, 2023) and incorporated into the study design of this proposal. While speculative, neurofeedback potentially contributes to downregulating SN-DMN hyperactivity and therefore stands as a complementary component of a multimodal treatment approach to tinnitus. Hypnosis, a therapeutic technique that induces a state of focused attention and heightened suggestibility, has been shown to modulate brain networks associated with tinnitus perception and distress (Laundry et al., 2017). In neuroimaging studies, hypnosis demonstrated enhanced cognitive control by modulating the dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC) of the DMN-CEN pathway, which is implicated in rumination, a feature also in tinnitus (Oakley & Halligan, 2013; Hammond, 2019). In a neuroimaging study by Deeley et al. (2012), reduced DMN activity, measured by fMRI, correlated with the depth of the hypnotic state compared to the alert state. Similar findings were reported by McGeown et al. (2009), who used fMRI to demonstrate that hypnotic induction significantly decreased brain activity in the prefrontal cortex (PFC) of the DMN compared with the no-hypnosis state. An fMRI study by Jiang et al. (2017) observed down-regulation of the DMN-CEN pathway in tinnitus sufferers which was countered by a hypnotic state and which also decreased hyperactivity between the SN and CEN, leading to greater emotional regulation of sensory input from the SN and a reduced state of arousal. A review by Bralic (2023) of neuroimaging evidence for clinical hypnosis and its relation to the triple network model (TNM) of psychopathology, concluded that hypnosis downregulates attentional and emotional neural pathways by modulating hypoactivity at both a DMN-CEN, and SN-CEN level, which demonstrates a complementary contribution within a multimodal treatment approach. In consideration of the triple network model (TNM) of tinnitus, it is evident from neuroimaging research, that cognitive therapy, neurofeedback, and hypnosis have a synergistic and complementary therapeutic neuromodulating effect on different functional connections of the TMN as depicted in Figure 2. Figure 2. Trimodal tinnitus treatment model showing areas of main influence from cognitive therapy, neurofeedback, and hypnosis. References

Change your brain states and lower your tinnitus distress and perception through the use of specialised hypnosis recordings. Reduce tinnitus distress Reduce tinnitus perception Restore balance Change your brain states and lower your tinnitus distress and perception through the use of specialised hypnosis recordings. Hypnosis Recordings Website * Unique hypnosis recordings specific for people with tinnitus. * Developed by specialists in tinnitus management and recovery. * Based on many hours of clinical practice and client feedback. * Can be used anytime and anywhere to suit your personalised requirements. * Download to your electronic device for your convenience and ease of use. Reduce tinnitus distress Reduce tinnitus perception Restore balance

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Hypnosis forms one component of our specialised tinnitus recovery program. Hypnosis for the Treatment of Tinnitus Hypnosis is a highly focused state of attention during which we can perceive and experience things differently. In our daily life we often experience this highly focused and somewhat detached state, for example, when we are day dreaming or absorbed in a book, or the computer, or watching TV or a film. But when hypnosis is used in the clinical setting, it can help us to make changes we want to achieve by building skills and strengthening inner resources to overcome particular difficulties and problems. So the contemporary understanding of hypnosis is that it is a natural ability we all have (to a greater or smaller extent as we are all different) that we can use in a clinical setting to make desired changes. With the development of knowledge in the field of neuro-science, we now know that when we are in this highly focused state of attention, our brains process information differently although knowledge about what happens in the brain during hypnosis is still in its infancy. But what we do know is that when we are focused in this way, we can be especially responsive to new ideas and possibilities that can help us make desired changes. That is, when we are in hypnosis, we are more receptive to suggestions. Most importantly, however, there are studies which show that hypnosis can be effective in the treatment and management of tinnitus; whilst research into hypnosis and tinnitus is not extensive, it is encouraging and consistent with feedback received to date from our tinnitus clients. Hypnosis can help people with tinnitus become less distressed about the tinnitus and more positive and skilled at managing it. It can sometimes also help with reducing the experience of the tinnitus.

Rethinking Tinnitus A Brain-Based Framework for Understanding and Adaptation This ebook offers a clear, neuroscience-informed framework for understanding tinnitus as a perceptual and regulatory process. Drawing on contemporary research in predictive processing, attention, and large-scale brain networks, it explains why tinnitus can persist — and how the nervous system can adapt over time. This book is not a treatment manual or a promise of a cure. It is an explanatory guide designed to reduce fear, restore perspective, and support adaptation. Who this ebook is for People living with tinnitus who want a calm, science-based understanding of what is happening in the brain — without alarmist explanations or false promises. Clinicians and health professionals seeking a contemporary framework for tinnitus-related distress that integrates neuroscience, psychology, and lived experience. Practitioners working with anxiety, hypervigilance, or trauma responses, where tinnitus has become persistent or intrusive. Readers interested in modern neuroscience, including predictive processing, neuroplasticity, and how perception is shaped by attention, meaning, and context. What you'll learn Why tinnitus can persist even when there is no ongoing damage to the ears or auditory system How attention, salience, and threat-detection networks influence tinnitus perception and distress The role of prediction, uncertainty, and neuroplasticity in maintaining — and reducing — tinnitus intrusion Why tinnitus distress and tinnitus loudness are not the same thing, and why this distinction matters How modern neuroscience reframes habituation as a process of regulation and reclassification, not suppression Why some approaches reduce distress even when the sound itself does not disappear Download the free ebook below Educational information only — not a substitute for medical or psychological care. Copyright © John Wibrow 2026 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the prior written permission of the author, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law. First name* Last name* Email* Organisation name (if applicable) Phone (optional) “I have read and agree to the copyright statement and conditions of use.” * Email me the download link Use of your information The information collected through this form is used solely to provide access to this ebook and to understand its readership. Your details will not be shared with third parties and will not be used for marketing or promotional communications. No spam - No marketing - Just the ebook

Welcome to the Tinnitus Clinic, a specialist provider of professional tinnitus treatment services aimed at reducing your perception of tinnitus and associated distress. The tinnitus Clinic receives and welcomes referrals from medical specialists. Please email your referral to jwibrow@chariot.net.au and clinic@eastadelaide.com.au attention Director, John Wibrow. Correspondence to PO Box 493 Marden SA 5070. We invite you to explore this section for information on our services, which we hope will provide you with confidence that your client will receive evidence-informed clinical care aimed at being therapeutically beneficial We now know that tinnitus is not a disease of the auditory system alone. It has already been postulated by Jastreboff more than 20 years ago that the difficulty to ignore tinnitus, the annoyance of tinnitus, the anxiety that tinnitus becomes worse, the irritability and the concentration difficulties are related to functional changes in non-auditory brain systems. Neuroimaging studies in tinnitus patients have helped to identify the involved networks in detail. Thus altered activity in the central auditory pathways is not sufficient for tinnitus perception. This explains that many patients with hearing loss (and consequent increased activity in the central auditory pathways) do not perceive tinnitus. Only when the auditory activity is connected to activity in the “attentional network” the tinnitus is consciously perceived. If this activity is further accompanied by activation in a “distress network” the patient perceives tinnitus distress. Imaging studies have also demonstrated that the hippocampal area, which plays an important role for memory, is involved in chronic tinnitus. This finding indicates that there may be a “tinnitus memory”, which perpetuates tinnitus perception. Whether the tinnitus signal is perceived as important and whether the attention focus is kept on the tinnitus, depends on activation of the salience network. A high salience of the tinnitus signal in turn may increase the perceived loudness of tinnitus by causing increased amplification of the signal in auditory pathways. This principally useful mechanism of the brain to amplify important information results in case of tinnitus in a vicious circle that contributes to the perpetuation of tinnitus. Noteably it is important that the different brain networks involved in tinnitus may differ from patient to patient, depending on the specific clinical characteristics. Thus for example in people that are distressed by their tinnitus, the brain activity that is relevant for tinnitus perception is connected to increased activity in the distress network. Moreover earlier findings that the brain activation patterns changes with increasing tinnitus duration have been confirmed. This indicates the importance to differentiate between different forms of tinnitus. Many individuals with tinnitus have abnormal oscillatory brain activity. In our clinical practice, we use techniques that aim to support healthier brain-state regulation (for example neurofeedback, relaxation, hypnosis, and counselling approaches). Our clinical experience suggests that these approaches may help reduce tinnitus intensity and related distress for many clients, as reflected in changes on standard questionnaires such as the Tinnitus Handicap Questionnaire (THQ) and Tinnitus Functional Index (TFI). However, outcomes vary between individuals, and formal research is ongoing