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Intrathecal Bupivacaine has no selectivity for afferent and efferent pathways, and Intrathecal Fentanyl acts synergistically to enhance the effect of Bupivacaine on the afferent pathway without a measurable effect on sympathetic outflow.
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.
The somatic efferent pathways leave the central nervous system via spinal nerves and innervate various skeletal muscles.
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.