Differential ototoxicities induced by lead acetate and tetraethyl lead

Lead poisoning disrupts many biological structures and functions, including those of the auditory system. This study examined the ototoxic effects of lead acetate (LA) and tetraethyl lead (TEL) of equal lead content on cochlear function and the ability of alpha-phenyl-tert-butyl-nitrone (PBN) to attenuate such effects. Baseline 1.0 microV cochlear microphonic (CM) and compound action potential (CAP) responses were recorded and animals administered either PBN (100 mg/kg, i.p.) or an equal volume of 0.9% saline, followed by an i.p. injection of LA (50 mg/kg) in an ethanol vehicle, TEL (42.7 mg/kg) in a corn oil vehicle, corn oil or ethanol vehicle alone. Two hours after administration, post-exposure CM and CAP responses were recorded. CAP threshold shifts in the saline-LA group were elevated by 5-10 dB at mid to high frequencies relative to controls (20-24 kHz, P<0.05). Mean CAP threshold shifts in the saline-TEL were significantly greater than those of both control groups at all tested frequencies except 2 kHz (P<0.001). However, threshold shifts in the group receiving PBN prior to TEL were significantly smaller than shifts in the group receiving saline prior to TEL (P<0.01). These data suggest that TEL is more ototoxic than is LA and that free radicals partially mediate TEL-induced CAP disruption.

Fluoride therapy for cochlear otosclerosis? an audiometric and computerized tomography evaluation

The progress of sensorineural hearing loss (SNHL) in patients with cochlear otosclerosis was compared for 19 patients treated with fluoride for 1-5 years and 22 untreated controls. CT scans of eight patients before and after fluoride treatment were evaluated visually. Fluoride therapy arrested the progression of SNHL in the low (250, 500 and 1,000 Hz) (p < 0.001) and high (2 and 4 kHz) (p = 0.008) frequencies. It seemed to be more effective for the higher frequencies in cases with an initial SNHL of < 50 dB. Fluoride administration for 4 years did not seem to be superior to a shorter treatment period (1-2 years). For six patients followed up after discontinuing fluoride therapy there was minimal deterioration in SNHL. There was no clear relationship between the size and site of otospongiotic lesions on CT and the severity of SNHL. Follow-up with CT evaluation did not provide reliable information as to the efficacy of fluoride therapy.

Effects of combinations of sodium salicylate and noise on the auditory threshold

Thirty-nine monaural chinchillas were used to study the interaction between sodium salicylate and various TTS-producing noise paradigms. Five animals were included in each of the following three groups: 1) sodium salicylate (400 mg/kg) plus 2-4 kHz, 95 dB SPL noise band for one hour; 2) sodium salicylate (400 mg/kg) plus 4 kHz CF octave band noise at 80 dB SPL for 96 hours; and 3) sodium salicylate (400 mg/kg) plus 50 impulses having 50 musec A-duration and 158 dB peak SPL, presented at one per minute. The remaining 24 animals served as various controls in groups exposed to sodium salicylate or the noise paradigm alone. Thresholds were estimated before, during, and after exposure using the AER technique and cochleagrams were mapped for each cochlea 30 days after exposure. When sodium salicylate was combined with the various noise conditions, the maximum TTS values obtained from the combination studies were comparable to those obtained from the single agent producing the greatest TTS at a particular frequency. No consistent alteration in either magnitude or time course of posttreatment threshold shift was found following the combination treatments as compared to the individual agents alone. Hazard to the auditory system resulting from a combination of sodium salicylate and noise was concluded to be no greater than the hazard presented by either agent alone. This result is also substantiated in the histological results.

Continuous topical drug delivery using osmotic pump in animal cochlear implant model: Continuous steroid delivery is effective for hearing preservation

CONCLUSIONS

Continuous topical drug delivery using an osmotic pump is an effective supplementary technique for hearing preservation after cochlear implantation, as demonstrated in a guinea pig model.

OBJECTIVE

To evaluate the effect of continuous topical steroid delivery via an osmotic pump in an animal cochlear implant model.

METHODS

Twenty-three guinea pigs were used for the study. The animals were divided into three groups: control group (n = 8), simple topical dexamethasone delivery group (sDEXA group, n = 7) and continuous topical dexamethasone delivery group (cDEXA, n = 8). The hearing thresholds of all animals were measured by pre-operative auditory brain stem responses (ABRs) at 2, 8, 16, 24, and 32 kHz. ABRs were re-evaluated after cochlear implantation, and the animals were sacrificed for hematoxylin and eosin staining.

RESULTS

The ABR threshold at 1 week post-operatively was significantly lower in the cDEXA group than in the control and sDEXA groups at most frequencies. Threshold shifts from baseline were statistically smaller in the cDEXA group than in the control and sDEXA groups at all frequencies. Histological analysis revealed decreased numbers of multi-nucleated giant cells and thinner histiocyte layers.

The acute effects of tetrahydrocannabinol on auditory threshold and frequency resolution in human subjects

AIMS

The study was designed to investigate the acute effects of ingested tetrahydrocannabinol (THC) on auditory function.

METHODS

Eight male subjects (aged 22-30 years), who had previous experience of cannabis use, took part in this study. They performed air conduction pure tone audiometry in both ears over 0.5-8 kHz. A simple test of frequency selectivity by detecting a 4-kHz tone under two masking noise conditions was also carried out in one ear. Three test sessions at weekly intervals were carried out, at the start of which they ingested a capsule containing either placebo, or 7.5 or 15 mg of THC. These were administered in a randomized cross-over, double-blind manner. Auditory testing as described above was carried out 2 hours after ingestion. Blood samples were also obtained at this time point and assayed for delta 9- and 11-OH-THC levels.

RESULTS

No significant changes in threshold or frequency resolution were seen with the dosages employed in this study.

CONCLUSIONS

This suggests that THC at the plasma levels attained in this study does not have profound effect on the processing of elementary stimuli by the auditory pathway.

Systemic co-treatment with alpha-melanocyte stimulating hormone delays hearing loss caused by local cisplatin administration in guinea pigs

It has previously been demonstrated that ototoxicity induced by systemic administration of cisplatin is reduced by concomitant administration of melanocortins, like alpha-melanocyte stimulating hormone (alpha-MSH). However, these experiments were hampered by large interanimal variability. Therefore, we re-investigated the effects of systemically administered alpha-MSH during local (intracochlear) administration of cisplatin. Guinea pigs, implanted with a round-window electrode, allowing daily monitoring of the compound action potentials (CAPs), and a mini-osmotic pump, pumping either 0.5 microl/h physiological saline or cisplatin solution (15 microg/ml), were co-treated daily with a subcutaneous bolus injection of either alpha-MSH (75 microg/kg) or physiological saline for 1 week or until the electrocochleogram showed a persistent decrease in CAP amplitude (40 dB threshold shift at 8 kHz). Next, the animals were sacrificed and the cochleas were processed for histology. After 2-3 days, cisplatin alone caused a threshold shift at all frequencies (2-16 kHz). Co-administration with alpha-MSH consistently delayed the criterion threshold shift by 1 day. When the 40 dB criterion had been reached, similar outer hair cell losses in both the cisplatin/alpha-MSH- and cisplatin/saline-treated groups were observed. This experiment confirms that direct administration of cisplatin into the cochlea results in considerably less interanimal variability than systemic administration and that co-treatment with alpha-MSH delays cisplatin ototoxicity. Since cisplatin was delivered directly to the cochlea, the ameliorating effect of alpha-MSH probably involves a cochlear target.

Noise-induced threshold shift dynamics measured with distortion-product otoacoustic emissions and auditory evoked potentials in chinchillas with inner hair cell deficient cochleas

Chinchillas (n = 6) were treated with carboplatin and, following a 30-day recovery period, were exposed to a 115 dB peak SPL impact noise presented at a rate of l/s for 6 h/day for 10 days. A second group (n = 6) received only the noise treatment. Cubic distortion product otoacoustic emissions (2f1-f2) and auditory evoked potential (AEP) detection thresholds in response to tone bursts were measured before and 30 days after drug treatment and following the first and 10th day of the noise exposure. Thirty days after the final exposure day, permanent changes in AEP detection thresholds and emissions were measured and cochleograms constructed. The drug treatment eliminated over 80% of the inner hair cells (IHC) in the cochlea, leaving the outer hair cell (OHC) population essentially intact prior to the interrupted noise exposure. The drug treatment alone had very little or no effect on AEP detection thresholds and emission metrics. Following the noise exposure, the IHC-deficient animals showed clear 'toughening' effects in the AEP and emission measures which were the same as measured in the group receiving only the noise. After a 30-day post-exposure recovery period. AEP thresholds were elevated about 10 dB at the low frequencies in the drug-noise group whereas emissions returned to near normal despite the massive IHC losses. These results are consistent with the idea that an intact OHC population is required for toughening. However, sound-evoked efferent pathways activated by the few remaining IHCs (approximately 20%) which, in this preparation, are distributed throughout the cochlea, may still contribute significantly to the toughening phenomena.

Otoprotective Effects of Zingerone on Cisplatin-Induced Ototoxicity

Previous studies have described the effects of zingerone (ZO) on cisplatin (CXP)-induced injury to the kidneys, liver, and other organs but not to the cochlea. This study aimed to investigate the effects of ZO on CXP-induced ototoxicity. Eight-week-old Sprague-Dawley rats were used and divided into a control group, a CXP group, and a CXP + ZO group. Rats in the CXP group received 5 mg/kg/day CXP intraperitoneally for five days. Rats in the CXP + ZO group received 5 mg/kg/day CXP intraperitoneally for five days and 50 mg/kg/day ZO intraperitoneally for seven days. Auditory brainstem response thresholds (ABRTs) were measured before (day 0) and after (day 10) drug administration. Cochlear histology was examined using hematoxylin and eosin (H&E) staining and cochlear whole mounts. The expression levels of cytochrome P450 (CYP)1A1, CYP1B1, inducible nitric oxide synthase (iNOS), nuclear factor kappa B (NFκB), tumor necrosis factor alpha (TNFα), and interleukin 6 (IL6) were estimated using quantitative reverse transcription-polymerase chain reaction. The expression levels of heme oxygenase 1 (HO1) and caspase 3 were analyzed via Western blotting. The auditory thresholds at 4, 8, and 16 kHz were attenuated in the CXP + ZO group compared with the CXP group. The mRNA expression levels of CYP1A1, CYP1B1, iNOS, NFκB, TNFα, and IL6 were lower in the CXP + ZO group than in the CXP group. The protein expression levels of HO1 and caspase 3 were lower in the CXP + ZO group than in the CXP group. Cotreatment with ZO exerted otoprotective effects against CXP-induced cochlear injury via antioxidative and anti-inflammatory activities involving CYPs, iNOS, NFκB, and TNFα.

Comparison of distortion-product and transient evoked otoacoustic emissions with ABR threshold shift in chinchillas with ototoxic damage

In this study we compare distortion product otoacoustic emissions (DPOAEs), transient evoked otoacoustic emissions (TEOAEs) and ABR threshold shifts in an animal model (chinchilla) of cochlear hearing loss. Subjects were treated with an aminoglycoside (amikacin) to produce basal cochlear lesions of various degree. DPOAE and TEOAE were measured throughout the treatment period and until hearing thresholds stabilized. ABR thresholds to tone pip stimuli were determined. Cytocochleograms of cochleas were prepared using scanning microscopy. DPOAEs (2f1-f2) were compared to fast Fourier transform (FFT)-analyzed TEOAEs components in the 1-, 2-, and 4-kHz frequency regions. Both types of emission were compared with corresponding ABR thresholds. There was no significant linear correlation between these different measures of cochlear function. Moreover, the amplitudes of DPOAEs reflected smaller regions of cochlear outer hair cell (OHC) damage better than TEOAEs. These results suggest that DPOAEs can be used to more accurately monitor hair cell function at specific hearing locations than TEOAEs.

Additive effects of antiepileptic drugs and pentylenetetrazole on hearing

The long-term effect of three of the most widely used antiepileptic drugs at relevant doses on the hearing decline that accompanies pentylenetetrazole (PTZ)-induced experimental epilepsy was investigated here, and compared with the effect of vinpocetine (VPC), which is a drug with antiepileptic potential. For this purpose, cortical activity (monitored by the EEG) and auditory sensitivity, as indicated by brainstem auditory evoked potential (BAEP) threshold at 4 and 8 kHz tone frequencies, were determined in guinea pigs daily injected for 28 days with vehicle (control), 20 mg/kg carbamazepine (CBZ), 6 mg/kg phenytoin (PHT), 30 mg/kg valproate (VPA) or 2 mg/kg vinpocetine (VPC) before and after the administration of PTZ at a convulsing dose (100 mg/kg). Results show that all the antiepileptic drugs tested were more or less effective in preventing PTZ-induced seizures. The long-term treatment with VPC decreased the auditory threshold, whereas the long-term treatment with CBZ, PHT or VPA increased the auditory threshold to a similar extent as the convulsing agent, PTZ. The combined effects of the antiepileptic drugs and PTZ on auditory threshold were additive. Therefore, only VPC prevented the increase in the auditory threshold induced by PTZ. It is concluded that the hearing loss produced by the long-term treatment with the most commonly used antiepileptic drugs could be aggravated by the illness. The prevention exerted by VPC on the hearing decline that accompanies experimental epilepsy, along with its capacity to control seizures at low doses in this and other animal models of epilepsy, would make VPC a valid candidate for the treatment of epilepsy.

Reflex modification and the detection of toxicant-induced auditory dysfunction

There are numerous environmental chemicals that adversely impact sensory functioning in exposed populations. Test methods are needed that can rapidly and efficiently assess the potential of chemicals to induce sensory toxicity. Reflex modification of the startle response is a technique that provides rapid, objective and quantitative assessments of sensorimotor function. This procedure has been shown to be sensitive to a variety of neurotoxic compounds. Reflex modification can also provide independent estimates of chemical-induced alterations in both sensory and motor function. Future efforts should focus on expanding the use of this procedure in both the identification and characterization of neurotoxic chemicals.

Effects of the ovarian and contraceptive cycles on absolute thresholds, auditory fatigue and recovery from temporary threshold shifts at 4 and 6 kHz

Absolute thresholds at 4 and 6 kHz were tested in three sessions before and after 20 min of exposure to 105 dB(A) pink noise in 12 young normal-cycling females, 11 young females on oral contraceptives and 8 young men. Women on contraceptives showed lower resting thresholds, larger temporary threshold shift (TTS) and higher recovery rates than normal-cycling females. The analysis of resting thresholds, auditory fatigue and recovery from auditory fatigue did not evidence any sex-linked difference. Significant differences linked to the phases of the menstrual cycle and of the contraceptive cycle were observed during recovery from auditory fatigue at 4 kHz and in resting thresholds at 6 kHz. Application of Kendall's coefficient of concordance confirmed these results. Absolute thresholds were highest at menstruation and lowest in the postovulatory phase in normal-cycling females and in women on oral contraceptives, during the days of pill ingestion. Oral contraception is probably a more important factor of change in hearing performance than the phases of the menstrual cycle.

Dichotic listening failure in dysphoric neuropsychiatric patients who endorse multiple seizure-like symptoms

In the present investigation, the dichotic word listening performance of a sample of 25 dysphoric neuropsychiatric patients who endorsed multiple partial seizure-like symptoms was compared with that of matched samples of normal controls and patients with mood disorders who did not endorse multiple seizure-like symptoms. Eighty percent of the patients who endorsed multiple episodic phenomena failed the dichotic listening task, compared with 8% of normal controls and 28% of patients with typical mood disorders. After treatment with carbamazepine, a subsample of polysymptomatic patients manifested significantly fewer seizure-like symptoms. This clinical improvement was typically associated with markedly improved dichotic listening performance in most cases. The results are consistent with our previous hypothesis that "subclinical" electrophysiological dysfunction may severely disrupt the normal transmission and processing of auditory information. Because it is sensitive to this type of presumed cerebral dysfunction and relatively specific, impaired dichotic listening performance is likely to be a useful clinical marker for this complex neuropsychiatric syndrome.

Dose-response relationships for furosemide ototoxicity in rat

Furosemide is an ototoxic loop diuretic which is highly bound to serum albumin. Previous studies have shown that rats deficient in albumin are more susceptible to furosemide ototoxicity than are rats with normal serum albumin concentrations. The present study was designed to compare the dose-response relationships for furosemide ototoxicity in rats with normal serum albumin concentration to rats without albumin in their serum. Young adult rats 50-80 days of age from each group were anesthetized with Rompun, and the endocochlear potential (EP) and compound action potential (CAP) thresholds were measured before and after furosemide injection. Afer a stable EP and CAP threshold were measured, each animal was injected with a single dose of furosemide through a cannula in the jugular vein. Rats with normal serum albumin had very little change in the EP or CAP threshold until the dose of furosemide was 40 mg/kg or greater. The dose-response curves for EP reduction and CAP threshold elevation then rose steeply to reach a maximum at 50 mg/kg. Albumin-deficient rats were much more sensitive to the effects of furosemide. The dose-response curves for both EP and CAP were shifted to the left. The doses resulting in half-maximal effects in the albumin-deficient rats were about half that found in the normal rats. These findings support the hypothesis that the access of furosemide to its site of ototoxic action in the cochlea depends on the quantity of unbound furosemide in the serum.

Outer hair cell activity is not required for the generation of the forward masking curve

Forward masking of the auditory brainstem response (ABR) was achieved by increasing the time interval from 0 to 12 ms between the masker offset and the probe onset. The forward masking response demonstrated a near linear function with an approximate 3.0-dB increase in masking threshold for every millisecond interval increase in the control guinea pig. The slope of the masking curve at selected frequencies together with the quantification of hair cell loss through the analysis of cochlear surface morphology was studied before and after chemical insult. The intracochlear infusion of sodium salicylate caused an approximately 45-dB threshold shift of the ABR whereas the slope of the forward masking curve was not significantly different from the control values at the tested frequencies (1, 4, and 8 kHz). Systemic kanamycin administration (400 mg/kg body weight for 9 consecutive days) caused a permanent ABR threshold shift of 43-63 dB at 1, 4, and 8 kHz. The slope of the forward masking curve was not significantly different at 1 kHz despite significant outer hair cell loss. The slope of the forward masking curve at 4 and 8 kHz showed significant reductions at the time intervals between 0 and 4 ms. Analysis of the kanamycin-treated cochleae revealed not only significant outer hair cell loss throughout the cochlea but significant inner hair cell and inner pillar cell loss in the basal end of the cochlea. The results suggest that the outer hair cells are not needed for maintaining a normal forward masking curve, whereas the slope of the forward masking curve is sensitive to alterations induced to either the inner hair cells or the inner pillar cells.

Cochlear administration of adenosine triphosphate facilitates recovery from acoustic trauma (temporary threshold shift)

BACKGROUND

Adenosine triphosphate (ATP) has often been used in the treatment of acoustic trauma although evidence supporting its clinical use was lacking. The aim of this study was to evaluate the chronic effects of ATP on acoustic trauma in guinea pigs.

METHODS

We infused ATP into the perilymph of the guinea pig cochlea concurrently with intense noise exposure to investigate the effect of ATP on the process of recovery after acoustic trauma. We assessed auditory brainstem response (ABR) thresholds to evaluate cochlear function.

RESULTS

After noise exposure (120 dB SPL, 5 h), ABR thresholds showed an increase of approximately 50 dB SPL that returned to normal after 14 days. Cochlear function in ATP-treated ears recovered more quickly than in control ears. The effect of ATP was inhibited by the administration of the ATP receptor antagonist: pyridoxal- phosphate-6-azophenyl-2',4'-disulfonic acid.

CONCLUSION

These results suggest that ATP mitigates the effects of noise trauma through the ATP receptor.

Ototoxicity of vancomycin: an experimental study in guinea pigs

Vancomycin (V)-a polypeptide antibiotic-is the drug of choice in severe infections with multiresistant staphylococcus spp. Due to the multimorbidity of the patients receiving V, the interactions with known ototoxic agents and the lack of an audiometric documentation, earlier clinical reports of V-associated hearing loss must be carefully interpreted. To elucidate this topic, a controlled animal study considering nonspecific effects was performed. 40 albino guinea pigs with positive Preyer's reflex and normal hearing were used. The hearing function was controlled by means of brainstem auditory evoked potentials before and after intraperitoneal administration of V (75, 150, 300 mg/kg b.w. for 11-17 days), gentamicin (60 mg/kg b.w. for 26 days), neomycin (100 mg/kg b.w. for 17 days) and sodium chloride solution. The cochleas were dissected for hair cell counting by the surface preparation technique. Additionally, the serum concentrations of V were measured. As a result there was no significant difference in hearing loss between the controls and the animals treated with 75 and 150 mg V; toxic doses of 300 mg V led to a certain threshold elevation after click stimuli, but not after trapezoid stimuli of 1, 4 and 8 kHz. On the other hand, the aminoglycosides as a positive control caused an obvious hearing loss after click and trapezoid stimuli, which was correlated to the amount of outer hair cell loss. Renal damage could be excluded by histological examination of the kidneys and estimation of creatinine in serum. Therefore, treatment with moderate doses of V comparable to clinical conditions does not exhibit a specific ototoxicity as compared to the aminoglycosides.(ABSTRACT TRUNCATED AT 250 WORDS)

Intratympanic gentamicin treatment in Meniere's disease: Patients' experiences and outcomes

Objective: The aim of this study was to assess the experiences and outcomes of patients receiving intratympanic gentamicin treatment for Ménière's disease in Norfolk, UK.

Design: This study was based on a retrospective questionnaire survey and a review of patients' medical records.

Setting: Two district hospitals.

Participants: All 29 patients treated between 1999 and 2001, with a minimum follow up of two years post-treatment, were included in the study. Twenty-three patients completed the questionnaires (79 per cent response rate).

Main outcome measures: Glasgow benefit inventory (GBI) and vertigo symptom scale (VSS) scores, plus change in hearing thresholds.

Results: The mean GBI total score was +36, indicating substantial improvement in patients' overall quality of life following gentamicin treatment. The VSS scores demonstrated low levels of vertigo or unsteadiness in treated patients. Three patients suffered deterioration in their hearing thresholds following a single injection of gentamicin. However, 96 per cent of responders stated that they would be willing to have such treatment again, if necessary.

Conclusion: Intratympanic gentamicin treatment ought to be offered to Ménière's patients suffering from disabling vertigo, with the proviso that they be made aware of the possibility of hearing deterioration.

[Infusion therapy in sudden deafness. Reducing the risk of pruritus after hydroxyethyl starch and maintaining therapeutic success--a prospective randomized study]

A Prospective Randomized Study: The aim of the study was to demonstrate the effectiveness of two different treatment schemes with hydroxyethyl starch (HES) and the incidence of pruritus as a side effect in a population of patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Under these circumstances we found a significant hearing improvement with infusions of 500 ml 10% HES 200/0.5 compared to saline infusions in a previous double-blind placebo-controlled study. Two groups are compared in a prospective randomized study. Group 1 was treated with infusions of 250 ml 10% HES 200/0.5 and group 2 with 500 ml of the same substance (n = 200). No difference in hearing improvement was detected between the two groups. The results were significantly better than with saline infusions. Eleven percent of the patients in group 1 developed pruritus and 38% in group 2. The incidence of pruritus correlated with the cumulative dosage of HES given. A correlation between allergic disposition and pruritus could not be found. Therefore, we suggest infusions with 250 ml 10% HES 200/0.5 per day for patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Indications for a long lasting HES-therapy should be restrictive. The effectiveness of HES has not been yet demonstrated in patients with lower hemoglobin and hematocrit values.

Hyaluronan applied to lesioned round window membrane is free from cochlear ototoxicity

Hyaluronan (HYA) in 1% solution was instilled into the round window (RW) niche of rats (n = 6) prior to perforating the round window membrane (RWM). Cochlear functioning and structure were then monitored by recording auditory brainstem responses (ABRs) at 2-31.5 kHz and by scanning electron microscopy. Perforation of the RWM alone (n = 6) resulted in immediate loss of ABR thresholds between 6 and 31.5 kHz in 2 of 6 animals. Similar results were obtained after instilling HYA into the RW niche and subsequent RWM perforation (n = 6). After 2 months, ABR thresholds were recorded at all frequencies in the HYA-treated animals, whereas in 2 of the controls no ABR thresholds could be elicited at 20 and 31.5 kHz. However, in both treatment groups the mean ABR thresholds and mean latencies for wave II at the ABR threshold returned to the pre-surgical (normal) range after 2 months. With respect to the cochlear morphology the results in both treatment groups were also alike including minor structural changes in hair cell stereociliae but no loss of hair cells. It is concluded that HYA, when instilled into the middle ear with the inner ear opened, is free from cochlear otoxicity.

Assessing ototoxicity due to chronic lead and cadmium intake with and without noise exposure in the mature mouse

Exposure to heavy metals may lead to hearing impairment. However, experimental studies have not explored this issue with and without noise exposure in mature animals with environmentally relevant doses. The aim of this study was to investigate ototoxicity produced by lead (Pb) and cadmium (Cd) and noise, singly and in combination, in the adult CBA/CaJ mouse. Metals were delivered via drinking water (0.03 mM, 1 mM, and 3 mM Pb; or 30, 100, and 300 μM Cd) for 12 weeks, resulting in environmentally- and occupationally relevant mean (± standard deviations) blood levels of Pb (2.89 ± 0.44, 38.5 ± 4.9, and 60.1 ± 6.6 μg/dl, respectively) and Cd (1.3 ± 0.23, 6.37 ± 0.87, 27.2 ± 4.1 μg/L, respectively). Metal treatment was also combined with a noise exposure consisting of a 105 dB broadband (2-20 kHz) stimulus for 2 hr or a sham exposure. Auditory performance was determined by comparing auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) at baseline and after 11 weeks of metal treatment. Metal-exposed animals did not develop significant auditory deficits and did not exhibit morphological damage to cochlear hair cells. In contrast, noise-exposed animals, including those exposed to combinations of metals and noise, demonstrated significant hair cell loss, reduced DPOAE amplitudes, and ABR threshold shifts of 42.2 ± 13 dB at 32 kHz (105 dB noise alone). No significant potentiation or synergistic effects were found in groups exposed to multiple agents. This study establishes a highly reproducible adult mouse model that may be used to evaluate a variety of environmental exposure mixtures.

[Use of the round window micro cath for inner ear therapy - results of a placebo-controlled, prospective study on chronic tinnitus]

BACKGROUND

The local therapy of inner ear diseases provides a means of directly applying pharmacological substances and delivering electrical stimulation to inner ear structures. Problems relating to dosage, systemic effects and the blood-cochlear barrier are thus avoided, which is not the case with systemic therapy. The preferred access point is the membrane of the round window.

PATIENTS AND METHODS

An appropriately shaped catheter (DURECT Corporation, Cupertino, CA, USA), whose double-lumen passage system permits the variation of concentration and flow, is inserted into the round window niche. In a prospective, placebo-controlled clinical study, this application system was tested in 20 patients with chronic tinnitus. Following implantation the substances lidocaine, glutamate, glutamic acid and caroverine were applied via an attached external micropump.

RESULTS

The values for tinnitus loudness, level of irritation caused by the tinnitus and subjective effectiveness of the therapy - measured by means of the visual analog scale (VAS) - showed no significant change, although the most marked improvement was indicated for caroverine.

CONCLUSIONS

These results indicate that a positive effect was observable only in a proportion of the patients. Continuous therapy of tinnitus and inner ear diseases will only be possible once a totally implantable microdosage system has been developed.