Tinnitus that develops gradually with age and is managed through directive counseling and the use of amplification devices, is different from tinnitus that exhibits pain or hyperacusis, aural fullness, tonic tensor tympani syndrome (TTTS), headaches or migraines, and insomnia. These latter conditions have also been associ- ated with sudden sensorineural hearing loss (UHF-SSHL), high-level noise-induced hearing loss, and acoustic shock (Noise Health. 2013;15:117). Although the mechanisms are not well understood, it has been suggested that disruption in the homeostasis of the tonic firing rate due to ear damage results in central gain enhancements and network maladap- tation. These occur at different levels within the auditory sys- tem, and also in regions outside of the auditory pathways (Front Neuro. 2014;5:206). Furthermore, patients with hy- peracusis complain of headaches (76%) or earaches (10%) in response to sound (hyperacusisresearch.org).