A 58-year-old works in construction and has years of unprote…

A 58-yeаr-оld wоrks in cоnstruction аnd hаs years of unprotected noise exposure. He complains of persistent high-pitched ringing in both ears, worse at night. Otoscopic exam is normal. Audiometry shows high-frequency hearing loss. You explain that the most common mechanism relates to peripheral auditory damage, with downstream central “gain” changes contributing to the perception of sound without an external stimulus. Tinnitus most commonly results from: