A growing consensus in current tinnitus research suggests central nervous changes as the cause of tinnitus. Several animal and human experimental studies were able to show altered tonotopic representations as well as spontaneous activity in the auditory cortex. However, a causal relationship between altered neurophysiological processes and aspects of tinnitus are still missing. Furthermore, it is likely that the importance of diverse processes changes with continuing duration of tinnitus. These open questions complicate the development of effective treatments. Nevertheless, today several neuroscientifically motivated treatments are available, or treatments that can be integrated into a neuroscientific framework. This article gives an overview of current neuroscientific developments in tinnitus research and discusses their implications for the treatment of tinnitus.