Quinine causes isolated outer hair cells to change length

Ototoxic hearing loss from antimalarials: A systematic narrative review

BACKGROUND

Drugs used in curative and prophylactic antimalarial treatment may be ototoxic and lead to permanent hearing loss, but there is no consensus regarding prevalence and permanence of ototoxic hearing loss caused by antimalarials. The purpose of this systematic narrative review was to synthesize current evidence on antimalarial ototoxicity in human populations.

METHOD

Studies published between 2005 and 2018 that reported prevalence of post-treatment hearing loss in individuals treated for malaria were included.

RESULTS

Twenty-two studies including data from 21 countries were included. Primary themes of the included studies were to evaluate drug safety and/or efficacy (n = 13) or ototoxic effects of drugs (n = 9). Hearing data were measured objectively in 9 studies. Five studies focused on quinine (or derivates), 10 focused on artemisinin combination therapies, and 7 considered multiple drug combinations. There is a paucity of evidence that thoroughly reports potentially permanent ototoxic effects of antimalarials.

CONCLUSIONS

Antimalarial drugs may be ototoxic in some cases. More research in human populations is needed to describe ototoxicity of current antimalarials and of future drugs that will be used/developed in response to antimalarial resistance. It is recommended that randomized trials evaluating drug safety objectively measure and report ototoxic hearing loss as an adverse event.

The Ototoxicity of Antimalarial Drugs-A State of the Art Review

This review summarizes current knowledge about the occurrence of hearing and balance disorders after antimalarial drugs treatment. It also examines the clinical applications of antimalarials, their mechanisms behind this ototoxicity and how it can be monitored. It includes studies with larger numbers of patients and those in which auditory function was assessed using audiological tests. Some antimalarials have been repurposed for other conditions like autoimmune disorders, rheumatic diseases, some viral diseases and cancers. While old antimalarial drugs, such as quinoline derivatives, are known to demonstrate ototoxicity, a number of new synthetic antimalarial agents particularly artemisinin derivatives, demonstrate unknown ototoxicity. Adverse audiovestibular effects vary depending on the medication itself, its dose and route of administration, as well as the drug combination, treated disease and individual predispositions of the patient. Dizziness was commonly reported, while vestibular symptoms, hearing loss and tinnitus were observed much less frequently, and most of these symptoms were reversible. As early identification of ototoxic hearing loss is critical to introducing possible alternative treatments with less ototoxic medications, therefore monitoring systems of those drugs ototoxic side effects are much needed.

Quinine in Otology and Neurotology: Ototoxicity and Historic Role in Therapy

OBJECTIVES/HYPOTHESIS

Quinine, a cinchona bark-derived antimalarial alkaloid, is a known ototoxic. Isolated and named in 1820 by the French scientists Pierre-Joseph Pelletier and Joseph-Bienaimé Caventou, it has since been employed in the treatment of different maladies. Quinine was also recommended as a local anesthetic in surgical procedures in the early 20th century. This article aims to identify early ototoxicity reports regarding quinine and to investigate if quinine was previously used in otology as an anesthetic agent or as an actual therapy.

METHOD

Historical review of medical and pharmaceutical literature from the 19th and 20th centuries in databases (PubMed; Web of Science), as well as medical books on ototoxic drugs, quinine, and therapies in otology.

RESULTS

The first identified reference of quinine ototoxicity was from 1824. Quinine also had a therapeutic role in otology and neurotology and was employed for its analgesic properties. It was used in Menière's disease, vertigo, otalgia, purulent otitis media, neuralgia of the plexus tympani, furuncles in the auditory canal, and herpes zoster in the auricle.

CONCLUSION

Quinine was acknowledged as an ototoxic drug in the 19th century. Quinine was used in several otologic disorders, both as an analgesic (for herpes zoster, otalgia) and as a therapeutic agent (Menière's disease, vertigo, purulent otitis media, furuncles in the auditory canal). This research demonstrates that, analogously to gentamicin, quinine was used in Menière's disease specifically due to its ototoxic effects.

Concentration-Response Relationship of Hearing Impairment Caused by Quinine and Salicylate: Pharmacological Similarities but Different Molecular Mechanisms

This review has the purpose to summarize concentration-effect studies made with quinine and to compare the effects on hearing between quinine and salicylate. Quinine and salicylate have roles in experimental hearing research and may induce pronounced and reversible hearing impairment when administered in sizeable doses. The quinine-induced increase in hearing threshold and its recovery can be analysed according to 'the psychophysical power function'. The power function is a special case of the Hill equation when the stimulus (e.g. a drug concentration) is exceedingly small compared with the concentration that would elicit a half-maximum response. Quinine and salicylate induce sensorineural hearing impairment and tinnitus when given in higher dose ranges in man. The drugs influence the presence, magnitude, and quality of audiological responses, such as spontaneous and evoked otoacoustic emissions. Quinine reversibly reduces frequency selectivity and hearing sensitivity, whereas the self-attained most comfortable speech level and the acoustic stapedius reflex are not affected, that is the dynamic range of hearing is reversibly reduced. This observation supports the view that quinine acts on the outer hair cell of the cochlea. Both drugs share a protective effect against the permanent hearing damages caused by gentamicin. This action is interpreted as a request for functioning mechanoelectric transducer (MET) channels to elicit the ill effect of aminoglycosides. Both drugs may interfere with the cochlear amplifier through blocking MET channels and the motor protein prestin. This review finds considerable overlap between type and extent of pharmacological actions of quinine and salicylate, supposedly caused by partly shared mechanisms of action but performed with different molecular mechanisms.

Understanding drug ototoxicity: molecular insights for prevention and clinical management

Ototoxicity is a trait shared by aminoglycoside and macrolide antibiotics, loop diuretics, platinum-based chemotherapeutic agents, some NSAIDs and antimalarial medications. Because their benefits in combating certain life-threatening diseases often outweigh the risks, the use of these ototoxic drugs cannot simply be avoided. In this review, the authors discuss some of the most frequently used ototoxic drugs and what is currently known about the cell and molecular mechanisms underlying their noxious effects. The authors also provide suggestions for the clinical management of ototoxic medications, including ototoxic detection and drug monitoring. Understanding the mechanisms of drug ototoxicity may lead to new strategies for preventing and curing drug-induced hearing loss, as well as developing new pharmacological drugs with less toxic side effects.

Slow motility in hair cells of the frog amphibian papilla: Ca2+-dependent shape changes

We investigated the process of slow motility in non-mammalian auditory hair cells by recording the time course of shape change in hair cells of the frog amphibian papilla. The tall hair cells in the rostral segment of this organ, reported to be the sole recipients of efferent innervation, were found to shorten in response to an increase in the concentration of the intracellular free calcium. These shortenings are composed of two partially-overlapping phases: an initial rapid iso-volumetric contraction, followed by a slower length decrease accompanied with swelling. It is possible to unmask the iso-volumetric contraction by delaying the cell swelling with the help of K+ or Cl- channel inhibitors, quinine or furosemide. Furthermore, it appears that the longitudinal contraction in these cells is Ca2+-calmodulin-dependent: in the presence of W-7, a calmodulin inhibitor, only a slow, swelling phase could be observed. These findings suggest that amphibian rostral AP hair cells resemble their mammalian counterparts in expressing both a Ca2+-calmodulin-dependent contractile structure and an "osmotic" mechanism capable of mediating length change in response to extracellular stimuli. Such a mechanism might be utilized by the efferent neurotransmitters for adaptive modulation of mechano-electrical transduction, sensitivity enhancement, frequency selectivity, and protection against over-stimulation.

Unique responses of auditory cortex networks in vitro to low concentrations of quinine

The anti-malarial drug quinine has several side effects including tinnitus. The aim of the study was to determine if cultured auditory networks growing on microelectrode arrays exhibited unique dynamic states when exposed to quinine. Eight auditory cortex networks (ACN), eight frontal cortex networks (FCN), and five inferior colliculus networks (ICN) were used in this study. Response of ACNs to quinine was biphasic, with an excitatory phase followed by inhibition. FCNs and ICNs revealed only inhibitory responses. The concentrations at which the spike rate was inhibited by 50% (IC50 mean +/- SE) were 42.5 +/- 3.9, 28.7 +/- 4.8 and 23.9 +/- 2.1 microM for ACNs, FCNs, and ICNs, respectively. Quinine increased the regularity and coordination of bursting in all three tissues. The increased burst pattern regularity of ICNs coupled with the excitatory responses seen only in ACNs between 1 and 10 microM show a unique susceptibility of auditory tissues to quinine that may be related to the underlying mechanism that triggers tinnitus-like activity.

Effects of nimodipine on quinine ototoxicity

The compound action potential (CAP) in response to a click train stimulus was recorded at the round window of guinea pigs. Administration of quinine hydrochloride (200 mg/kg) significantly elevated the CAP thresholds by 5 to 25 dB (p < .05), and the CAP waveform elicited by the click train stimulus was abnormal. The amplitude of the CAP elicited by the second click was bigger than that elicited by the first click. These changes may be caused by an abnormally broadened N1 response to the first click in the click train. In contrast, CAP waveforms elicited by the second and subsequent clicks appeared normal. After administration of nimodipine (2 mg/kg), the CAP thresholds and waveforms elicited by the click train stimulus were unchanged. Simultaneous administration of both quinine (200 mg/kg) and nimodipine (2 mg/kg) resulted in the same electrophysiological changes as those induced by quinine alone. These results suggest that nimodipine prevents neither the deterioration in the CAP nor the abnormal properties in the response to a click train stimulus.

Quinine affects the response properties of compound action potentials elicited by periodic click trains

The effects of systemically applied quinine on the compound action potential (CAP) were investigated in 5 guinea pigs. A dose of 200 mg/kg body weight of quinine hydrochloride was administered intramuscularly, and CAPs were recorded at the round window before and after administration. The CAP thresholds of the animals were elevated by 5 to 25 dB approximately 30 minutes after administration, and thresholds recovered in some animals during the experimental session. The CAP waveform elicited by the click train stimulus was abnormal after administration of quinine. The amplitude of the CAPs elicited by the second click was larger than that of those elicited by the first click. These changes may be induced by an abnormally broadened N1 response to the first click in the click train following quinine administration. In contrast, the CAP waveforms elicited by the second click and by the following clicks in the click train appeared normal.

Mechanics of the mammalian cochlea

In mammals, environmental sounds stimulate the auditory receptor, the cochlea, via vibrations of the stapes, the innermost of the middle ear ossicles. These vibrations produce displacement waves that travel on the elongated and spirally wound basilar membrane (BM). As they travel, waves grow in amplitude, reaching a maximum and then dying out. The location of maximum BM motion is a function of stimulus frequency, with high-frequency waves being localized to the "base" of the cochlea (near the stapes) and low-frequency waves approaching the "apex" of the cochlea. Thus each cochlear site has a characteristic frequency (CF), to which it responds maximally. BM vibrations produce motion of hair cell stereocilia, which gates stereociliar transduction channels leading to the generation of hair cell receptor potentials and the excitation of afferent auditory nerve fibers. At the base of the cochlea, BM motion exhibits a CF-specific and level-dependent compressive nonlinearity such that responses to low-level, near-CF stimuli are sensitive and sharply frequency-tuned and responses to intense stimuli are insensitive and poorly tuned. The high sensitivity and sharp-frequency tuning, as well as compression and other nonlinearities (two-tone suppression and intermodulation distortion), are highly labile, indicating the presence in normal cochleae of a positive feedback from the organ of Corti, the "cochlear amplifier." This mechanism involves forces generated by the outer hair cells and controlled, directly or indirectly, by their transduction currents. At the apex of the cochlea, nonlinearities appear to be less prominent than at the base, perhaps implying that the cochlear amplifier plays a lesser role in determining apical mechanical responses to sound. Whether at the base or the apex, the properties of BM vibration adequately account for most frequency-specific properties of the responses to sound of auditory nerve fibers.

Quinine-induced alterations of electrically evoked otoacoustic emissions and cochlear potentials in guinea pigs

Quinine is a well-known ototoxic drug which may affect portions of the auditory system with different biochemical effects, causing reversible hearing loss and tinnitus. Recent investigations indicate that quinine at high concentrations can act directly on cochlear outer hair cells to affect their motility and the mechanical response of the basilar membrane. This study aimed to investigate the effect of quinine on the electromotility of outer hair cells in vivo by means of measuring the electrically evoked otoacoustic emissions (EEOAEs), and the relationship between EEOAE and hearing sensitivity alterations in guinea pigs. Quinine was infused into the scala tympani with concentrations between 0.05 and 5 mM. An alternating current (35 microA RMS) swept from 400 Hz to 40 kHz was applied to the round window to evoke the EEOAE. The compound action potential (CAP), cochlear microphonic (CM) and summating potential (SP) were also measured. Results show that quinine affects the EEOAE in a dose-dependent manner and that its effects are reversible. Two aspects of the EEOAE were affected by quinine, depending on concentration: (1) the 'fine structure' only for concentrations below 0.1 mM and (2) the overall amplitude and the 'fine structure' for concentrations above 0.1 mM. At 5 mM the fine structure was completely absent and the mean amplitude of the EEOAE greatly decreased. Multiple component analysis shows the short delay component of the EEOAE is related to the mean value of the amplitude spectrum while the long delay component is related to the fine structure. The alterations of the EEOAE are roughly comparable to that of the cochlear potentials. A 'threshold concentration' for quinine's effects was found at 25 microM. CAP was significantly affected at 25 microM while EEOAE, CM and SP were not. Enhancement of the EEOAE amplitude was noticed in five out of 20 animals in the current study. The enhancement appears only related to the EEOAE mean level or short delay component. The results suggest that quinine can affect in vivo electromotility of outer hair cells at low concentration and therefore change the cochlear amplifier performance via an effect on electro-mechanical transduction. Its effects on the cochlear spiral ganglion neurons and/or their presynaptic process are also suggested, and these are speculated to be the primary sites for quinine's effects on the auditory system.

Changes in 2f1 - f2 acoustic distortion products in humans during quinine-induced cochlear dysfunction

Quinine is a suitable model substance for the study of otoacoustic emissions (OAEs) as it reversibly affects the outer hair cells, thus reducing sensitivity, frequency-selectivity and various forms of OAEs. The aim of this experiment was to study quinine-induced changes in the input/output (I/O) function of 2f1 - f2 distortion product OAE (DPOAE; f2/f1 = 1.22; 750-6,000 Hz). Six volunteers with normal hearing (26-39 years old) were intravenously infused to achieve pseudostable quinine plasma concentrations (approximately12 microM) inducing an average pure-tone threshold (PTT; 750-6,000 Hz) shift of 18 dB (5-30 dB) (frequency-independent and reversible). The mean quinine-induced DPOAE shift increased continuously with decreasing equal-level primary tones, e.g. from 1.0 dB at 70 dB sound pressure level (SPL) (n = 42) to 10.5 dB (n = 22) at 40 dB SPL (pooled data, no frequency dependence). According to recruitment, the mean slope of the DPOAE I/O function (at 30-60 dB SPL) increased from 0.86 to 1.35 dB/dB. The lack of correlation between shifts in DPOAE and PTT is in stark contrast to the excellent correlation reported between shifts in transient evoked OAE detection threshold and its corresponding psychoacoustic threshold. The highly vulnerable spontaneous OAEs, in combination with the less vulnerable DPOAEs, fit into a recently proposed taxonomic classification for OAEs.

Nonlinear electroelastic model for the composite outer hair cell wall

A nonlinear electroelastic model for the composite wall of the cochlear outer hair cell is proposed. The cell wall is modeled as a two-layer shell with elastic connections between the layers: an active layer corresponds to the plasma membrane and a passive layer corresponds to a combination of the cytoskeleton and the subsurface cisternae. As a basis of the constitutive relations, a thermodynamic potential for such a composite wall is developed. Expressions for the components of the active force are obtained in terms of the active strains and the elastic properties of the passive and active layers. An application to the electrical stimulation of the cell under the conditions of the microchamber experiment is given. As a result, active strains, active forces, and mechanical energy stored in each of the two layers are presented as functions of the wall (membrane) potential.

The effect of quinine on outer hair cell shape, compliance and force

Quinine intoxication causes a well-described syndrome that includes tinnitus, sensorineural hearing loss and vertigo. The pathophysiology of quinine's effects on hearing is unknown, but may include a peripheral component. The cochlear outer hair cell is known to be motile and to contribute force to amplify the vibration pattern of the organ of Corti. The outer hair cell is also a target of diseases involving tinnitus and sensorineural hearing loss, including salicylate intoxication. These effects may be mediated through changes either in motile force or in mechanical properties. Quinine's effects on outer hair cell motility and mechanical properties have therefore been examined in vitro. Quinine at 5.0 mM substantially decreased active force generation in isolated guinea pig cochlear outer hair cells. Isolated cells also elongated and dilated in diameter when exposed to 5.0 mM quinine. No consistent changes in mechanical properties were observed. 1.0 mM quinine was ineffective in either force reduction or elongation. Trifluoperazine, a calmodulin inhibitor, and ML-9, a blocker of myosin light chain kinases, were ineffective in blocking quinine-induced force reduction or elongation. Deferoxamine, a hydroxyl free radical scavenger, also failed to block either the force decrease or the elongation.

Effects of quinine on the excitability and voltage-dependent currents of isolated spiral ganglion neurons in culture

This work examined how quinine, a drug that induces both hearing loss and tinnitus, interfered with the excitability of spiral ganglion (SG) neurons in cultures. The membrane potential changes and the modification of the action-potential waveform induced by quinine were studied in SG neurons under current clamp. The effects of the drug on voltage-dependent currents in SG neurons were also investigated by the voltage-clamp method. Quinine did not appreciably affect either resting membrane potentials or input resistance at rest. However, action potentials fired by SG neurons were significantly broadened by the presence of quinine. With higher concentrations of quinine (>20 microM), the amplitude of action potentials was also reduced. Voltage-clamp results demonstrated that quinine primarily blocked the whole cell potassium currents (IK) in a voltage-dependent manner. Up to 100 microM of quinine did not appreciably block IK evoked by a test pulse to -35 mV. In contrast, IK was significantly reduced with more positive test pulses, e.g., the concentration needed to obtain 50% inhibition (IC50) was 8 microM for a test pulse to 65 mV. At higher concentrations (>20 microM), quinine also reduced the size of sodium currents (INa) in a use-dependent manner, while leaving calcium currents (ICa) relatively unaffected. Compared with the potency of quinine's effects on other targets in the inner ear, the relatively low IC50 and the voltage-dependent nature of quinine inhibition on IK suggested that its modulation of the waveform and threshold of action potentials of SG neurons probably was primarily responsible for its ototoxic effects. From the point of view of how neural signaling process is affected by the drug, quinine-induced tinnitus may be explained by its broadening of action potentials while the drug's inhibition on INa may result in hearing loss by making the conversion from excitatory postsynaptic potentials to the generation of action potentials more difficult.

Mechanical responses of the mammalian cochlea

Recent findings in auditory research have significantly changed our views of the processes involved in hearing. Novel techniques and new approaches to investigate the mammalian cochlea have expanded our knowledge about the mechanical events occurring at physiologically relevant stimulus intensities. Experiments performed in the apical, low-frequency regions demonstrate that although there is a change in the mechanical responses along the cochlea, the fundamental characteristics are similar across the frequency range. The mechanical responses to sound stimulation exhibit tuning properties comparable to those measured intracellularly or from nerve fibres. Non-linearities in the mechanical responses have now clearly been observed at all cochlear locations. The mechanics of the cochlea are vulnerable, and dramatic changes are seen especially when the sensory hair cells are affected, for example, following acoustic overstimulation or exposure to ototoxic compounds such as furosemide. The results suggest that there is a sharply tuned and vulnerable response related to the hair cells, superimposed on a more robust, broadly tuned response. Studies of the micromechanical behaviour down to the cellular level have demonstrated significant differences radially across the hearing organ and have provided new information on the important mechanical interactions with the tectorial membrane. There is now ample evidence of reverse transduction in the auditory periphery, i.e. the cochlea does not only receive and detect mechanical stimuli but can itself produce mechanical motion. Hence, it has been shown that electrical stimulation elicits motion within the cochlea very similar to that evoked by sound. In addition, the presence of acoustically-evoked displacements of the hearing organ have now been demonstrated by several laboratories.

Effects of quinine on neural activity in cat primary auditory cortex

The effect of systemically applied quinine on single-unit firing activity in primary auditory cortex was investigated in seven cats. A dose of 100 or 200 mg/kg of quinine hydrochloride was administered intramuscularly and recordings from the same units were performed prior to application and continuously up to on average 5.5 h after administration. All animals showed 10-40 dB of threshold shift about 30 min after administration and some animals showed recovery during the course of the investigation. Significant increases were found in spontaneous firing rates for low-firing-rate units (initial firing rate < 1 spike/s). For high-firing-rate units (initial firing rate > 1 spike/s) no significant changes were observed. There were no significant changes in modal and mean interspike interval. The time-to-rebound peak in the autocorrelation function for spontaneous firings was not altered significantly. The rate of burst occurrence showed no significant change. The best modulation frequency in response to stimulation with periodic click trains decreased after administration, but the limiting rate did not change. Peak cross-correlation coefficients for the spontaneous firings of simultaneously recorded cells showed a significant increase and the correlogram's central peak was significantly narrower after quinine application. Dose effects were only present for cross-correlation results and temporal modulation transfer functions. The results for both spontaneous firing rate, peak width in the cross-correlogram and click stimulation were similar to those observed in salicylate-treated cats (Ochi and Eggermont, 1996). The other findings were different from those observed after salicylate. It is obvious that the effects of quinine on the auditory system are not the same as those of salicylate. The increased synchronization of the spontaneous firings across different neurons observed after application of both drugs may be related to tinnitus.

Dystrophin expression in the hair cells of the cochlea

Dystrophin is normally expressed in a number of tissues including muscle, brain and the outer plexiform layer of the retina. In Duchenne and Becker muscular dystrophy abnormal or deficient dystrophin expression leads to muscle degeneration and has been implicated in mental retardation and a form of night blindness. We have examined the expression of dystrophin immunoreactivity in cochlear tissues of normal guinea-pig and mouse, and whether expression is perturbed in the cochlea of the dystrophic MDX mouse. A single band of approximately 427 kDa, corresponding to a full-length isoform of dystrophin was detected in guinea-pig and normal mouse but was absent from the MDX mouse. Cochleae from guinea-pig, normal and MDX mouse also showed a second dystrophin isoform of 116 kDa molecular weight with the C-terminal specific antibody. Immunostained guinea pig cochlear half turns were examined by laser scanning confocal microscopy. Dystrophin was localized in both inner and outer hair cells with staining patterns which were qualitatively similar with both antibodies. In the outer hair cells labelling of the lateral wall was especially distinctive. The synaptic region of both hair cell types was also strongly labelled.

Magnitude changes in transient evoked otoacoustic emissions and high-level 2f1-f2 distortion products in man during quinine administration

Quinine reversibly affects the outer hair cells (OHC). It is therefore an ideal drug for studying OHC-related phenomena, such as transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs). Pure-tone thresholds (PTTs), 1,000-4,000 Hz, TEOAEs, and DPOAEs were measured monaurally in 5 normal-hearing volunteers during quinine administration. DPOAE was evoked at 75 dB SPL (f2/f1 = 1.22) and analysed at 2f1-f2 with f2 at 6 frequencies (700-4,000 Hz), while TEOAE was obtained at 79 dB SPLp and analysed at the f2 frequencies (1/3 octave). The PTT-shift was flat, 10 dB, whereas the TEOAE-power and the global mean of the DPOAEs decreased 4.5 dB and 1.4 dB, respectively. No correlation was found between the intra-individual emission shifts. It is concluded that TEOAE is more sensitive than high-level DPOAE for identifying minor cochlear hearing losses. Support is given to the hypothesis that different sources are involved in generating DPOAEs at different evoking levels.

Effects of quinine on the mechanical frequency response of the cupula in the fish lateral line

Quinine induces changes in the motion of the cupula in the lateral line canal of the African knife-fish in response to sinusoidal water movements. Two different phases in the action of quinine on the cupular frequency response can be discerned. In the first phase the best frequency, i.e., the frequency at which the cupular vibratory displacement is maximal in response to constant-amplitude sinusoidal canal fluid displacement, shifts toward higher frequencies. During this phase, lasting about 70-100 min, the best frequency increases by a factor between 1.3 and 1.5. In the second phase, during roughly the following 90 min, the best frequency decreases gradually to a value 0.3-0.5 times that observed before the application of quinine.

Evidence for calcium-binding proteins and calcium-dependent regulatory proteins in sensory cells of the organ of Corti

Calcium is thought to play a major signaling role in outer hair cells to control metabolism, cytoskeletal integrity, cell shape and cell excitability. For this to happen, in resting cells the concentration of free calcium ions must be maintained at low levels so that focal increases can trigger specific events. In this paper, the localization of calcium, calcium-binding and calcium-dependent regulatory proteins in sensory cells from the guinea pig inner ear was demonstrated using immunocytochemical and histochemical techniques. We found the calcium buffer and/or calcium sensor proteins calmodulin, calbindin and calsequestrin predominantly in sensory cells and that when present, these proteins can be enriched in the outer hair cells. Calmodulin is found in the stereocilia, in the cuticular plate and in the cytoplasm and calbindin is found only in the cuticular plate and cytoplasm of both the inner and outer hair cells. The staining for these proteins in the outer hair cells is homogeneous, with no apparent compartmentalization along the lateral wall. Calsequestrin, thought to store and release calcium from membrane bound intracellular storage sites is found only in the cytoplasm of outer hair cells. There, it has a more punctuate staining pattern than does calmodulin or calbindin suggesting that it may be present in calciosomes rather than soluble in the cytoplasm. We did not detect caldesmon and S-100. Using the potassium pyroantimonate technique, we found precipitates containing calcium ions distributed throughout the cytoplasm of outer hair cells, with no evidence that the subsurface cisterns along the lateral wall act as calcium storage sites. Thus, calcium in resting cells is found in the cytoplasm along with calbindin and calmodulin and appears to have a punctate distribution consistent with a co-localization with calsequestrin. The implications of this distribution with respect to the slow shortening and elongation seen in outer hair cells are discussed.

The effects of quinine on the cochlear mechanics in the isolated temporal bone preparation

Quinine is known to induce a reversible hearing loss and to evoke motile responses of isolated outer hair cells. To study the effect of quinine, mechanical tuning curves of the Hensen's cells were measured in the isolated cochlea preparation in response to acoustical stimuli applied to the ear before and after application of the drug. It was shown that 0.5-4 mM quinine increased the vibration amplitude at the peak of the mechanical resonance curves and increased the sharpness of tuning. The time course of the event depended on whether the scala media was opened or not. The results show that quinine alters the micromechanical tuning of the organ of Corti.

Hearing impairment related to plasma quinine concentration in healthy volunteers

1. Hearing impairment was investigated in six healthy volunteers who received oral doses of 5, 10 and 15 mg kg-1 quinine single-blind and in random order. 2. The plasma concentration of quinine was followed for 48 h and the time course was fitted by a linear one compartment pharmacokinetic model. 3. Hearing thresholds were measured by pure tone audiometry. There was a delay between impairment in hearing and change in plasma quinine concentration. Thus the method of effect compartment modelling was applied. 4. The effect on hearing (L), measured as a shift in hearing threshold (dB), was used to estimate the rate constant for elimination of drug from the assumed effect compartment (ke0) and two parameters specifying the effect model (gamma and k). The effect model applied was L = 10 (log k + gamma x log Ce) where Ce is the calculated drug concentration in the effect compartment. This model is a logarithmic transform of a power expression equivalent to the Hill equation at the lower end of the effect range. In all experiments where there was a clear effect on hearing, convergence on a set of parameter estimates occurred, but inter- and intraindividual variability was large. The mean value of ke0 was 3.32 +/- 5.93 h-1 s.d., for gamma it was 1.73 +/- 1.14 s.d. and for k it was 0.59 +/- 0.66 s.d.

Ultrastructural changes in the outer hair cells of the guinea pig cochlea after exposure to quinine

The outer hair cells have been shown to have motile properties which are likely to participate in the cochlear performance. Quinine is known to induce hearing loss as well as contraction of skeletal muscles. Isolated outer hair cells and isolated cochleae from guinea pigs have been exposed to quinine, which was also injected into living guinea pigs. When a physiological response was registered, the cells and cochleae were fixed and examined by transmission electron microscopy. In the isolated cells the formation of a central microtubule core occurred and in the cochleae a swelling of the subsurface cisternae in the outer hair cells was observed. The results are discussed in the context of a proposed effect of quinine on the contractile processes of the outer hair cells.

The effect of quinine on psychoacoustic tuning curves, stapedius reflexes and evoked otoacoustic emissions in healthy volunteers

Quinine causes reversible hearing loss, closely related to the quinine plasma concentration. The effects of quinine on psychoacoustic tuning curves, stapedius reflex thresholds and evoked otoacoustic emissions were studied in healthy volunteers. The tuning curves became shallower, whereas reflex thresholds were unaffected. The shift in the emission thresholds paralleled that of the pure-tone thresholds. There were also qualitative changes in the emissions: 1) the exponent of the stimulus-response function changed from 0.34 to 0.56; 2) decay time shortened; 3) the power spectrum shifted towards lower frequencies. The results are discussed in relation to various aspects of cochlear performance and are suggested to depend on an outer hair cell dysfunction.

Audiometry as a possible indicator of quinine plasma concentration during treatment of malaria

The spread of chloroquine-resistant malaria has led to a resurgence of quinine in clinical use. One of the well-known side effects of quinine, reversible hearing loss, is closely related to the plasma concentration. We suggest that this hearing effect could be used as an aid in therapy control when quinine drug assay is not available.