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How they tinkle, tinkle, tinkle, In the icy air of night! While the stars that oversprinkle All the heavens, seem to twinkle With a crystalline delight; Keeping time, time, time, In a sort of Runic rhyme, To the tintinnabulation that so musically wells From the bells, bells, bells, bells, Bells, bells, bells— From the jingling and the tinkling of the bells. —Excerpt from "The Bells" by Edgar Allan Poe The opening stanza of Edgar Allan Poe's poem "The Bells" describes the "crystalline delight" of happy sleigh bells. From there, he describes increasingly discordant and then utterly overwhelming pealing, jangling, ghastly moaning of the bells, bells, bells, bells, bells. If you live with tinnitus, you know exactly how this feels. The term tinnitus, pronounced either as TIN-nuh- tus or tin-NIGHT-us, comes from the Latin word tinnire, which means "to ring or tinkle." This word root gives us the wonderful onomatopoeia, tintinnabulation: ringing of bells. And, of course, it refers to the sensation often described as "ringing in the ears." This sounds fairly benign, but for many people, tinnitus is a potentially disabling problem that clangs and bangs and smashes away at their quality of life. But what is tinnitus? How common is it? And above all, what can be done about it? Is there any way to cut through the noise to arrive at some solid answers? WHAT IS TINNITUS? The most common forms of tinnitus are a form of aural mirage: the perception of a stimulus that isn't actually present. It has many presentations. It has been described as nonverbal ringing, buzzing, hissing, or clicking. Other sources add blowing, whining, roaring, rumbling, and whooshing. It may be one-sided or bilateral, or it may change back and forth. The exact sound or pitch may vary from one person to another and from 72 m a s s a g e & b o d y wo r k j u l y/a u g u s t 2 0 2 3 critical thinking | PATHOLOGY PERSPECTIVES day to day—even moment to moment, depending on external issues like stress, how much sleep the person has had, whether they have sinus or ear congestion, the ambient air pressure, and several other factors. Sometimes tinnitus is the result of acoustic trauma, a severe ear infection, or a head injury. It is often described as a symptom of some other problem—high blood pressure, for instance, or a rare kind of tumor that might impact the acoustic nerve. In fact, up to 200 medical conditions list tinnitus as a possible symptom, and several hundred medications list it as a possible side effect. But tinnitus also occurs as a freestanding disorder, often accompanied by some level of age-related hearing loss, but not necessarily tied to any underlying pathology. In rare cases, it can be an indicator of a potentially dangerous issue, like a cerebral aneurysm or a brain tumor. Tinnitus is rarely a life-threatening problem, but it can certainly threaten a person's quality of life. Tinnitus is extremely common, affecting 10–15 percent of the US population: between 30 million and 50 million Americans. Of those, more than half describe their condition as chronic and burdensome. Many of these are people who served in Tinnitus and Massage Therapy "The Tintinnabulation That So Musically Wells" By Ruth Werner

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