home Auditorium 7 Constant noise in one ear. Causes of noise in the right and left ear. Examination of the patency of the auditory tube

Constant noise in one ear. Causes of noise in the right and left ear. Examination of the patency of the auditory tube

Tinnitus (tinnitus) is the sensation by a person of any sounds in the ears or head, not induced by any external source. Tinnitus is a symptom (“1 symptom and 1000 causes”). Diseases that cause tinnitus belong to various areas of medicine. According to various sources, from 10 to 30% of the population suffers from this symptom.

Patients suffering from tinnitus describe various variations of sounds: ringing, buzzing, noise, chirping, knocking, squelching. The noise can be low-frequency (the roar of a turbine) and high-frequency (like the squeak of a mosquito). It may come and go or be continuous, felt on one or both sides. Tinnitus can occur as an isolated symptom or in combination with hearing loss, dizziness, and balance problems. Most often, women over 50 years of age suffer from tinnitus.

Degrees of tinnitus

Depending on how noise is tolerated, there are 4 degrees of noise:

Fairly easy to carry, minor discomfort.
Poorly tolerated in silence, at night. During the day it is almost not annoying.
Feels like it day and night. Sleep is disturbed. Depression, decreased mood.
Intrusive, unbearable noise, depriving sleep. Constantly bothers me, the patient is practically unable to work.

The degree of noise tolerance depends on the personality type. Anxious, suspicious patients focus on these sensations, are unable to distract themselves from them, they perceive this noise as an inevitable potential hearing loss or serious disease brain Negative emotions arising in connection with this further stimulate the pathological focus of perception in the cerebral cortex. Arises vicious circle, the noise in the ears and head seems unbearable and dominates all other sensations. Patients withdraw into themselves and become depressed.

But even in the calmest and most balanced patients, the presence of incessant noise for years leads to neuroses, depression, and psychosis.

Most scientists divide tinnitus into objective(audible not only to the patient himself, but also to those around him) and subjective(felt only by the patient himself).

Objective noise is unlikely to be heard at a distance, but armed with a stethoscope, the doctor can verify that the source of the sound actually exists.

In what cases can objective noise occur?

Objective tinnitus can occur with the following diseases:

Causes of subjective tinnitus

This noise is much more common. It has no source of sound vibrations from the outside. In 80% of cases, tinnitus is a problem for otolaryngologists, as it occurs due to pathology of any part of the ear. However, there are other reasons. Tinnitus is considered as a lesion of some area auditory analyzer: from sound receptors to the cerebral cortex. Contralateral noise occurs: for example, there is noise in the left ear, and the pathology of the auditory analyzer is detected on the right. Quite often the cause of tinnitus cannot be determined.

The most common reasons:

Irritation of the eardrum - presence in the external ear canal foreign body or .
Inflammatory process in the middle ear ().
Inflammation auditory tube ().
Barotrauma.
Presbycusis (senile hearing loss).
Tumor auditory nerve.
Arachnoiditis of the cerebellopontine angle.
Tumors of the posterior cranial fossa.
Toxic effects or by-effect some medicines. These are mainly aminoglycoside antibiotics, salicylates, non-steroidal anti-inflammatory drugs, and diuretics.
Long-term exposure to external noise (working in a noisy industry, frequent and prolonged listening to loud music through headphones)
Degenerative changes in the cervical spine with impaired circulation in the vertebrobasilar system.
Subjective pulsatile tinnitus may occur with increased cardiac output, which occurs in thyrotoxicosis, anemia, pregnancy, physical activity, low blood pressure.
Mental disorders.
Hypertonic disease.
Atherosclerosis of cerebral vessels.

The mechanism of tinnitus is still not entirely clear. It is not clear which part of the auditory analyzer is responsible for the appearance of this pathological sensation and why, with the same diagnosis, it occurs in some people and not in others.

What to do and how to treat tinnitus? Today this is one of the open questions in medicine. The main problem is to identify the real reason the resulting noise is often very difficult. Typically, older people suffer from tinnitus. ENT doctor, not finding it during a routine examination obvious pathology ear, sends them to a neurologist to “treat the blood vessels.” The neurologist also, without particularly insisting on a thorough examination, prescribes conventional vascular therapy, which in most cases does not bring any relief to the patient. Then everyone shrugs: “There are no pills for tinnitus.” A person accepts the fact that he cannot get rid of the ringing and buzzing in his ears, that he is terminally ill, withdraws into himself, and limits communication with others. Against the background of depression, various somatoform disorders arise, which can lead to truly life-threatening complications.

If you carefully examine the patient and identify the most probable cause ear noise, the chances of successful treatment are much higher.

What examinations are advisable for a patient with tinnitus?

In addition to the usual examination and otoscopy, the following can help in diagnosis:

Audiometry.
Pneumootoscopy.
X-ray of the temporomandibular joint.
Are common, biochemical tests blood, coagulogram.
Dopplerography of the vessels of the head and neck.
CT or MRI of the brain.
Angiography.
Examination of specialists: otoneurologist, therapist, neurologist, psychotherapist, endocrinologist.

Treatment for tinnitus

The approach to treating tinnitus depends on the underlying disease:

Medicines used for tinnitus

As already mentioned, there is no single medication that specifically suppresses tinnitus. However, there are a number of drugs that significantly reduce the severity of noise if used taking into account the predominance of one or another mechanism.

Anticonvulsants. They give good effect with muscle noise (convulsive contractions of the muscles of the middle ear, the tensor tympani muscle, the levator muscle soft sky). Drugs such as finlepsin, phenytoin, lamotrigine are used. The dosage is selected by an otoneurologist.

Sedatives. Psychotropic anti-anxiety medications are prescribed by a psychotherapist to patients whose tinnitus is most likely related to the disorder. nervous system, as well as those patients who have this symptom led to secondary neuroses.
Drugs that improve cerebral blood flow. Prescribed to patients with labyrinthine and central types of noise. Drugs used:
1. Betahistine is the most effective drug for vestibulopathies, Meniere's disease.
2. Nimodipine.
3. Pentoxifylline.
4. Cinnarizine.
5. Gingko biloba.
Agents that improve venous outflow– Troxevasin, Detralex.
Nootropic and neuroprotective agents– piracetam, trimetazidine, mexidol.
Zinc preparations. It was noticed that in people with zinc deficiency in the body, the administration of this mineral significantly reduced tinnitus.
Antihistamines– preferably with psychotropic activity, such as promethazine and hydroxyzine.
To improve exchange processes, appointed biostimulants and vitamins.

Achieving noise control, masking

However, everything known methods can give in best case scenario temporary relief, not complete cure. Currently, the term “noise control” is increasingly used, which is understood as facilitating noise tolerance, distraction, turning noise into one of the surrounding sounds, which significantly improves the quality of life.

The noise masking method has become widespread. The essence of the method is that listening to extraneous (masking) noise makes internal noise invisible and reduces its significance. To mask your own noise, sources with recordings of the sounds of birds singing, flowing water, and low monotonous music are used. Indifferent noise such as a radio on non-working waves or a switched-on fan is used. The idea is that the masking noise should be similar in frequency range to its own noise and should not be louder than it.

In persons with hearing aid will also act as a noise masker, so hearing aids are recommended for patients with tinnitus and hearing loss.

Video: tinnitus, Dr. Sperling

One can only sympathize with people who suffer from tinnitus; they can never rest in complete silence. Some patients call this condition torture, and indeed, extraneous noise greatly depresses the psyche. Doctors call this condition tinnitus. This symptom is not a separate disease, it just indicates some kind of problem in the body. Sometimes there is a noise in the left ear, it resembles a grinding or squeaking sound. This condition may be a sign of serious illness.

Causes

Constant noise in the left ear most often indicates diseases of the auditory organs. Such a symptom may indicate various dysfunctions of the conduction system of the ear and a special hearing center, which is located in the brain. Reason constant noise May be sulfur plug. This happens especially often after swimming in ponds.

Noise in the head may be the first symptom of illness vascular system and hearts. This condition occurs in a number of pathologies:

For vascular stenosis.
At coronary disease hearts.
For atherosclerosis.

Constant ringing in the ear is considered a pathological condition. This may be a consequence of inflammatory and systemic diseases. The cause of ringing in the left side of the head can also be oncological pathologies.

The most common cause of ringing in the left ear is otitis media. This disease occurs with characteristic symptoms:

Arises strong pain, while the pain intensifies even with a slight touch to the auricle.
The hearing organ is red, swollen and hot to the touch.
Severe itching is felt in the middle of the ear canal.
There is discharge of pus. If damaged eardrum, then the pus may be mixed with blood.

Reasons and further treatment otitis media are somewhat different. The disease can occur when exposed to pathogenic microorganisms in the ear, which often occurs when chronic diseases ENT organs. Otitis media may be caused by exposure to dirty water into the ear canal, when swimming in open water. Often this problem occurs after careless ear cleaning. If the hearing organs are cleaned cotton swabs or other sharp objects, there is a high risk of injury to the skin, where infection subsequently occurs.

The cause of noise in the left ear may be otosclerosis. This pathology is considered chronic, it is characterized by the proliferation bone tissue in the middle ear area. Initially, otosclerosis develops in one organ of hearing, then gradually the disease spreads to the other side.

Representatives of the fair sex and children are most susceptible to this disease. Otosclerosis must be treated as soon as possible, since this disease leads to complete deafness.

A doctor can find out the cause of obsessive noise in the ear, after full examination patient.

What else could be causing the noise?

If ringing in the left ear is accompanied by severe dizziness, then a tumor of the auditory nerve may be suspected. This disease is called neuroma. With this disease, there may be no obvious symptoms until the tumor becomes impressive in size and puts pressure on the surrounding tissues. In the absence of proper treatment, a person faces hearing loss, impaired coordination of movements and regular tingling in the face.

Extraneous tinnitus is not always associated only with the hearing organs. The cause of this pathological phenomenon may be migraine, problems with teeth or throat. The appearance of ringing and humming in the hearing organs can be associated with severe stress.

The reason may lie in the sudden change atmospheric pressure. This phenomenon is often observed in weakened people who are sensitive to weather changes. Ringing can occur after listening to loud music on headphones or after attending noisy events.

Some people associate the appearance of tinnitus with omens. Some of them say that there will be news, others that the weather will soon change.

Noise classification

In order to make a correct diagnosis in the future, it is necessary to have an idea of the nature of the noise and its intensity:

Stage 1 – a person’s performance is not impaired, they even get used to it.
Stage 2 – pronounced ringing in the head, it is especially intense in evening time and at night.
Stage 3 – the whistle is heard constantly. It prevents a person from working and resting. There may be neurological disorders.
Stage 4 – the noise is heard almost constantly, the person is distracted by it. Performance is severely impaired.

The doctor determines the degree of tinnitus, according to which further treatment of the patient is determined.

ENT doctors distinguish several types of tinnitus. Extraneous sounds can be heard not only by the patient, but also by others. If the whistle in the head is heard only by the patient, diagnosing the disease becomes difficult. Determining the cause of such a pathological phenomenon is very problematic.

What symptoms should you be wary of?

If your left ear rings frequently and this is accompanied by a lack of coordination, then you should urgently see a doctor. The following conditions should also be the reason for going to the hospital:

Purulent or bloody issues from the auditory canal.
Symptoms of intoxication.
Heat.
Severe ear pain.
Dizziness, vomiting, loss of coordination of movements.
Migraine.
Swelling of the ear.

It is imperative to see a doctor if there is prolonged noise in the hearing organs or its character has changed somewhat.

You should not endure ringing and whistling in your ears for long. How formerly a doctor examines the patient and prescribes treatment, the better the further prognosis.

Diagnostics

There are many causes of noise in the ear area, which creates certain difficulties in making a diagnosis. Most often, the cause of regular tinnitus is determined only after a full examination with the involvement of a number of specialists.

Initially, the person should see a therapist who will conduct initial examination and prescribe a series of tests. After this, the patient is referred to an otolaryngologist and other specialists. For staging correct diagnosis The following doctors may be involved:

Audiologist.
Neuropathologist.
Surgeon.
Psychiatrist.
Cardiologist.

The patient undergoes detailed blood tests. According to the doctor's indications, an x-ray may be prescribed, CT scan and audiometry. If there are complaints about ringing during migraine attacks, then an examination is carried out by a neurologist.

How to get rid

Some types of tinnitus are fairly easy to treat. If the ringing and whistling are caused by wax, it will be removed in the doctor's office. This procedure takes no more than 15 minutes. Uncomplicated otitis media also responds well to therapy; you can get rid of this disease in a week. If the inflammation proceeds with the formation of pus, then treatment will take longer. In this case it is prescribed antibacterial drugs And antiseptic solutions for treating the ear cavity.

Vascular diseases and oncological pathologies are more difficult to treat. To reduce extraneous noise in the head, the doctor may prescribe the following medications:

Medicine for activating blood circulation – Cinnarizine.
Drugs that affect the nervous system - these include sedatives, nootropics and antidepressants.
Cholesterol lowering drugs.
Medicines for the treatment of hypertension.
Iron-containing preparations.
Hormonal medications if the noise is caused by problems with the thyroid gland.

Physiotherapeutic procedures may be prescribed - electrophoresis, pneumomassage and acoustic massage. In some cases, eliminate whistling in the ears conservative methods If it fails, then they resort to surgical intervention.

If it is not possible to accurately determine the cause of the pathological phenomenon, the doctor simply prescribes treatment that will help reduce the noise level. In turn, a person should try to get used to the ringing and whistling and not notice it. If the patient constantly concentrates on the ringing in his head, this will lead to stress and depression.

If the noise in your head is caused by hearing problems, your doctor may recommend using a hearing aid.

Complications

If a person is constantly bothered by tinnitus, the quality of life noticeably deteriorates. Tinnitus prevents a person from working and resting normally; the patient constantly hears an obsessive hum that exhausts him mentally. This pathological phenomenon often causes stressful situations And increased anxiety. In particularly severe cases, a person may face prolonged depression, the treatment of which will take a lot of time.

Often ringing in the head is a striking symptom serious illness, which progresses and leads to complications. The sooner a person consults a doctor and finds out the cause of the constant noise, the better the future prognosis.

If tinnitus occurs due to otitis media, the infection can quickly spread to healthy tissue and lead to a series pathological conditions. Consequence purulent otitis may become meningitis. In this case, the patient faces not only total loss hearing, but also disability.

If the noise is accompanied by other symptoms, you should see a doctor as soon as possible. Otherwise, the disease will start and it will be problematic to cure it.

Traditional methods of treatment

Methods to help get rid of extraneous sounds in your ears at home traditional medicine. Decoctions and infusions are used for treatment medicinal herbs that need to be taken several times a day:

Two tablespoons of lemon balm are poured into 0.5 liters of boiling water, infused under the lid and filtered. You need to take this infusion one glass, 2 times a day.
Boil dry or fresh dill in a liter of water; you need to take 3-4 tablespoons of chopped herbs. Leave the decoction for an hour, then strain and drink 3 times a day, ½ cup. Treatment is continued until extraneous sounds in the ears decrease or disappear.
Can also help special massage. You need to press down with your fingers active points located near the earlobes and behind the ear.
Several viburnum berries are ground with honey, the mixture is wrapped in a bandage and placed in the ear overnight. Treatment must be continued for 4-5 days.
Cut out the center of the onion with a knife and fill it with cumin seeds. Bake the root vegetable in the oven, cool and squeeze out the juice. The resulting composition is dripped into the problematic ear 3-4 times a day.
A teaspoon alcohol tincture propolis mixed with a tablespoon vegetable oil. The resulting mixture is slightly heated to steam bath. Moisten gauze turundas in the mixture and place them in the ear canals.
2 tablespoons of rowan berries are poured into 0.5 liters of boiling water, brought to a boil and infused. After this time, filter the mixture and drink 2 tablespoons before each meal.

Application of any folk recipes should be agreed with your doctor. If you are allergic to herbs, it is better to refuse such treatment.

The reasons for the appearance of extraneous sounds in the left ear are quite different. This phenomenon can be provoked by diseases of the hearing organs, heart disease and neurological pathologies. If a noise in the head constantly haunts a person, it is necessary to consult a doctor who will determine the cause and prescribe treatment.

Often the body gives signals that are difficult to ignore. Various reasons for concern may be discomfort states, which are not separate diseases. They serve as a sign of certain problems in the body. For example, a hum in the ear, the causes of which are not related to external noise. What is this symptom and why does it occur?

How does it manifest itself?

Unexplained noises in the head that are not audible to others can manifest themselves in different ways. Some hear a thin squeak, others hear a ringing. Sometimes it is rustling and rustling, sometimes it is buzzing or whistling. Sometimes patients complain of regular clicks, while others simply have a buzzing in their ears. Although, it is worth noting that some pathologies are accompanied by tinnitus, which can be heard by those standing nearby. All these sounds have certain causes.

Noise classification

Doctors divide murmurs into several types:

Most noise is audible only to the patient. In this case, the hum in the ear, the causes of which will be discussed later, cannot be heard by a stranger or recorded by equipment. However, if such a symptom appears, you should immediately consult a doctor. The fact is that a seemingly harmless problem may turn out to be a sign of a serious pathology.

Humming in the ears: causes

These disorders may be a consequence different problems. Most often, the reason why there is a buzzing in the ears is as follows:

Middle ear defect. It can appear when bone tissue is damaged or internal elements ear after otitis media or eardrum injury.
Defect inner ear developed as a result of a cold, taking antibiotics, loud sounds, the appearance of a tumor in the area of the auditory nerve, high blood pressure, atherosclerosis.
Entry of a foreign body or liquid into the ear canal. Most often, children suffer for this reason.
Meniere's disease.
Formation of sulfur plug.
Aneurysm formation, malformation.
Acoustic neuroma.
Narrowing carotid artery or jugular vein.
Osteochondrosis.
Traumatic brain injury.
Overwork and stress.
Kidney diseases.
Diabetes.
Loss of perception of high tones, which is a particular manifestation of aging. The medical name is presbycusis.

Meniere's disease

Some causes of noise in the head require additional decoding. For example, the above list includes Meniere's disease. This is a disease caused by an increase in the amount of endolymph (fluid) in the cavity of the inner ear. The fluid puts pressure on the cells that regulate spatial orientation body and maintaining balance. The disease is rare because it is diagnosed in a small percentage of the population. However, in medical practice False diagnosis of Meniere's disease based on recurrent dizziness has occurred.

The causes of the disease are poorly understood. Most often, tinnitus and dizziness in Meniere's syndrome occur as a result vascular diseases, injuries, inflammatory processes or infections. In addition to noise and dizziness, the patient suffers from a balance disorder, which makes it difficult not only to walk and stand, but even to sit. The patient sweats profusely and feels nauseous. The disease is accompanied frequent vomiting, pale skin, low blood pressure.

A complete cure for this disease is impossible. But doctors are trying to reduce the frequency of manifestations and stop the symptoms. For this purpose it is prescribed special diet, taking diuretics, taking antihistamines and sedatives.

Acoustic neuroma

Folk remedies

Treatment for tinnitus folk remedies most often relieves the symptom, but the underlying disease still requires treatment. However, many resort to traditional methods to get the opportunity to take a break from the constantly accompanying noise. The following remedies are most often recommended:

Onions with cumin. To do this, a large onion stuffed with cumin seeds is baked in the oven. Then squeeze out the juice and drop 2 drops into each ear several times a day. After a while, the noise disappears, but treatment continues for another 2 days.
Dill. Not only small leaves are used, but also the stem and the rosette with seeds. The plant is crushed, poured with boiling water, infused for an hour and drunk half a glass before meals. The course of treatment is 8 weeks. Both fresh and dried dill are suitable.

"Earplugs" made of viburnum. Ripe berries are brought to a boil and cooled. Then the liquid is drained and kneaded into a paste (it will not be homogeneous due to the skin and seeds). The gruel is mixed with the same amount of honey and spread on cheesecloth. Next, the gauze is tied into a knot, which is placed in the ear overnight. The procedure is repeated until the noise disappears.
“Earplugs” made from potatoes with honey. In this case raw potatoes rubbed on a medium grater, a little juice is squeezed out of it, the resulting gruel is mixed with honey and spread on cheesecloth. Next, as in the recipe with viburnum.
Beet. 100 gr. Finely grated beets are poured into a glass of water and placed on the stove in an enamel bowl. A spoonful of honey is added to the beets. All this must be boiled for about 15 minutes. Then a cotton swab is dipped into the beet mass and placed in the ear. This remedy works especially well for complications of colds.

Doctors doubt that treating tinnitus with folk remedies is effective. They recommend combining treatment of the underlying disease with elimination of the symptom (ringing in the ears). This is the only way to get rid of the problem or significantly reduce it.

anonymously

From time to time, even more systematically, a noise occurs (especially at night) above the left ear (precisely above, slightly above and behind). Of course, I am old (77), but I am quite active and a working pensioner. I attribute this to a three-year head injury, with which I broke the windshield of a Lada Priori, which flew into me and my great-granddaughter at a pedestrian crossing. Would like to see paid and free neurologists. Diagnoses are different (violation cerebral circulation in the cervical spine, and pinched auditory nerve) the prescriptions and medications are also very different and the courses of treatment were completed almost simultaneously. But the result is equally zero. Maybe: well, all of them are examined? After all, my hearing is still normal, although a free neurologist warned about its possible decrease. Or maybe there are some exercises that I just believe in, because... helped me out more than once?

Hello! There are many reasons for tinnitus: otosclerosis, cervical osteochondrosis, atherosclerosis of neck vessels, hypertonic disease, obstruction of venous outflow from the cranial cavity. In any case, courses of vascular therapy are indicated for you, try wearing a Shants collar splint (head holder), sleeping on an orthopedic pillow with a bolster under the neck, doing exercises to stretch the neck muscles and rehabilitation exercises for dizziness and loss of balance (see my personal website).

Consultation with a neurologist on the topic “Noise in the left ear” is given for informational purposes only. Based on the results of the consultation received, please consult a doctor, including to identify possible contraindications.

About the consultant

Details

Neurologist, candidate medical sciences, medical experience: more than 17 years.
Author of more than 50 publications and scientific works, active participant conferences, seminars and congresses of neurologists in Russia.

Sphere of professional interests:
-diagnosis, treatment and prevention neurological diseases(vegetative-vascular dystonia, discirculatory encephalopathy, consequences of strokes, arterial and venous disorders, memory impairment, attention, neurotic disorders and asthenic conditions, panic attacks, osteochondrosis, vertebrogenic radiculopathies, chronic pain syndrome).
- Patients with complaints of migraines, headaches, dizziness, tinnitus, numbness and weakness of the limbs, disorders of the autonomic nervous system, depressive and anxiety states, panic attacks, acute and chronic pain in the back and herniated discs.
- Functional diagnostics nervous system: electroencephalogram (EEG), ultrasound Dopplerography of the carotid and vertebral arteries (USDG), transcranial Dopplerography (TCD), rheoencephalography (REG), echo-encephalography (ECHO-EG).
- Anti-stress back mesotherapy.
- Shock wave therapy.
- Hirudotherapy.
- Mistletoe therapy.

Every person experiences noise that occurs in both ears or only in one ear. With age, the likelihood of symptoms appearing increases several times. This is due to thinning and disruption vascular walls, against the background of which the blood supply to the brain deteriorates. The noise in the right ear without pain may be clicking or pulsating, as well as quite loud or almost inaudible.

Types of noise in the right ear

Experts distinguish two types of sounds that can occur in the ear, depending on the severity and nature:

In addition, types of sounds such as hissing, buzzing or whistling may occur in the right ear. They have a rather complex structure and are a sign of psychiatric diseases. Most often, noise of this kind acts as the main symptom. Patients can hear music and voices.

Causes

There are many reasons for noise in the right ear without pain. If the symptom arose against the background of otitis, then accompanying symptom there will be a feeling of congestion.

But noise in the ear canal can also be caused by long-term use medicines certain groups. This is due to their toxic effects on the body. More often side effect appears when taking antibiotics.

This is how experts highlight following reasons the occurrence of sounds of various types in the right ear:

Inflammation localized in the middle, inner or outer ear.
Diseases thyroid gland when hormone synthesis is disrupted.
Availability various types neoplasms in the ear canal, middle ear area or inflammation of the area cervical region spine.
Drastic changes blood pressure.
Sulfur plug.
Head or ear injuries.
Reduced serotonin levels.
The aging process of the body.

Based on research, it has been found that people suffering from various hearing impairments are susceptible to tinnitus.

The appearance of various sounds in the right ear without pain can be influenced not only by age, but also by a person’s profession. The symptom occurs when safety precautions are not followed in factories and factories, where workers should wear protective headphones or earplugs.

When to see a doctor

In some cases, tinnitus that is not accompanied painful sensations, does not require special treatment. When it is triggered by a change in blood pressure, all that is required is to normalize it. Often a person only needs good sleep and rest.

You should contact a specialist to find out the cause in cases where noise in the right ear is periodic and is accompanied by the following symptoms: