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Tinnitus can be perceived in one or both ears or in the head. Tinnitus is the description of a noise inside a personâs head in the absence of auditory stimulation. The noise can be described in many different ways but the most common description of the tinnitus is a pure tone sound. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test and, in some cases, pressure changes from the interior ear.[6] It has also been described as a "whooshing" sound because of acute muscle spasms, as of wind or waves.[7] Tinnitus can be intermittent or it can be continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.[8] Most people with tinnitus have some degree of hearing loss:[9] they are often unable to clearly hear external sounds that occur within the same range of frequencies as their "phantom sounds".[10] This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.[11] The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one's own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one's ear, changes within the canal of one's ear or issues related to blood flow of the neck or face.[12] Tinnitus annoyance is more strongly associated with psychological condition than loudness or frequency range.[17][18][19] Other psychological problems such as depression, anxiety, sleep disturbances and concentration difficulties are common in those with worse tinnitus.[20][21][22] 45% of people with tinnitus have an anxiety disorder at some time in their life.[23] As part of the idea that the central-auditory-system may be implicated into the tinnitus development, serotonin has also been implicated. Indeed, serotonin has been postulated to be involved in plastic changes in the brain. Serotonin re-uptake inhibitors (such as some anti-depressant drugs) have often been used for this reason.[24] However those medications do not benefit in a consistent fashion on non-depressant people.[25] Psychological research has looked at the tinnitus distress reaction (TDR) to account for differences in tinnitus severity.[20] Research has stigmatized people with severe tinnitus by implying they have personality disorders, such as neuroticism, anxiety sensitivity, and catastrophic thinking, which all predispose increased TDR.[26][27][28] These findings suggest that at the initial perception of tinnitus, conditioning links tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.
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