Brain imaging shows that chronic tinnitus involves networks far beyond just the auditory cortex.

Some of the strongest tinnitus-related brain changes occur in regions of the default mode network.

The default mode network helps construct self-awareness, identity, and autobiographical narrative.

Neuropsychological therapies may help reshape how the brain integrates tinnitus into the self.

A patient sits across from me and says: "I hear a loud ringing sound."

Two years later, the same patient says: "I'm a tinnitus sufferer."

The condition may be no different, but the brain's relationship to it has changed. What began as a perception has become part of a person's identity. Brain imaging suggests this transformation involves networks far beyond the auditory cortex, reshaping our understanding of chronic tinnitus and how it should be treated.

The Brain That Builds a Self

To understand what goes wrong in chronic tinnitus, it helps to understand what the brain is doing when it has downtime.

When you're not focused on a task — not reading, not driving, not solving a problem — your brain doesn't go quiet. It activates a network of regions devoted to inner narrative: reviewing memories, imagining futures, and evaluating yourself.

The part of our brain that does this is called the default mode network (DMN). It's the neural home of the self, the system that asks: Who am I, what has happened to me, and what does it mean?

What makes this relevant to tinnitus is where the strongest brain abnormalities in chronic tinnitus patients actually appear. It's not in the auditory cortex, as most people would expect. The most........

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