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Related to efferent pathway: afferent pathway
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They include direct electrical stimuli, mechanical stimuli brought about by the deflection of cilia, and chemical stimuli produced by iontophoresis with acetylcholine, a neurotransmitter present in the cochlear efferent pathway.
Indeed, antimuscarinic agents, which are currently the gold standard treatment, may also exert some of their beneficial effects through afferent as well as efferent pathways.
Therefore, an excess of feedback could generate tinnitus via a complex interaction between afferent and efferent pathways, a circumstance that is not specific to otospongiosis.