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On the central projection of SGN axons, electron microscopy analysis showed with repeated exposure to loud noise (100 dB SPL, 3 h per day over 3 days) marked elongation of the nodes of Ranvier and a moderate retraction of the paranodes was observed together with a reduced number of lamellar wraps and decreased myelin thickness (Tagoe et al., 2014)

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Nevertheless, available evidence strongly supports reconsidering the traditional six-month behavioral therapy requirement before medication initiation