Combined effects of exposure to styrene and ethanol on the auditory function in the rat

Effects of coexposure to noise and mixture of toluene, ethylbenzene, xylene, and styrene (TEXS) on hearing loss in petrochemical workers of southern China

Many harmful factors existing simultaneously with noise are reported to induce hearing impairment, such as organic solvents. However, the existing hearing safety limits and current risk assessment for hearing loss rely on single noise exposure. It is urgent to clarify the combined effect of noise and other harmful factors on hearing loss. Petrochemical workers are always exposed to noise and organic solvents, mainly benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS), while the combined effect of their coexposure on hearing remains unclear. Herein we conducted a cross-sectional survey, measuring pure-tone audiometry of 1496 petrochemical workers in southern China. Participants exposed to BTEXS were 569, 524, 156, 452, and 177 respectively. Individual cumulative noise exposure (CNE) levels and BTEXS exposure were assessed. The average CNE was 93.27 ± 4.92 dB(A)·years, and the concentrations of BTEXS were far below the occupational exposure limits of China. Logistic regression analyses showed that CNE was consistently positively associated with hearing loss (HL) and high-frequency hearing loss (HFHL) but not related to speech-frequency hearing loss (SFHL). Compared with participants in the lowest quartile of CNE, those in the highest quartile showed an OR of 5.229 (95% CI: 3.179, 8.598) for HFHL. Two-pollutant model analysis indicated that TEXS exposure was positively associated with HL (OR 1.679, 95%CI 1.086, 2.597), SFHL (OR 2.440, 95%CI 1.255, 4.744), and HFHL (OR 1.475, 95%CI 1.077, 2.020). However, no interactions were observed between CNE and TEXS coexposure on hearing loss. In our study, covariates including smoking and drinking status, body mass index (BMI), ear protection and personal protective equipment, and use of earphone/headphone were adjusted. In conclusion, coexposure to noise and low-level TEXS could induce more severe damage on hearing function than exposure to each alone, especially SFHL. Therefore, petrochemical workers simultaneously exposed to noise and TEXS, even at low-level, should be included in hearing protection programs.

Acute Alcohol Intake Deteriorates Hearing Thresholds and Speech Perception in Noise

OBJECTIVES

The hearing process involves complex peripheral and central auditory pathways and could be influenced by various situations or medications. To date, there is very little known about the effects of alcohol on the auditory performances. The purpose of the present study was to evaluate how acute alcohol administration affects various aspects of hearing performance in human subjects, from the auditory perceptive threshold to the speech-in-noise task, which is cognitively demanding.

METHODS

A total of 43 healthy volunteers were recruited, and each of the participants received calculated amounts of alcohol according to their body weight and sex with a targeted blood alcohol content level of 0.05% using the Widmark formula. Hearing was tested in alcohol-free conditions (no alcohol intake within the previous 24 h) and acute alcohol conditions. A test battery composed of pure-tone audiometry, speech reception threshold (SRT), word recognition score (WRS), distortion product otoacoustic emission (DPOAE), gaps-in-noise (GIN) test, and Korean matrix sentence test (testing speech perception in noise) was performed in the 2 conditions.

RESULTS

Acute alcohol intake elevated pure-tone hearing thresholds and SRT but did not affect WRS. Both otoacoustic emissions recorded with DPOAE and the temporal resolution measured with the GIN test were not influenced by alcohol intake. The hearing performance in a noisy environment in both easy (-2 dB signal-to-noise ratio [SNR]) and difficult (-8 dB SNR) conditions was decreased by alcohol.

CONCLUSIONS

Acute alcohol elevated auditory perceptive thresholds and affected performance in complex and difficult auditory tasks rather than simple tasks.

Evaluation of potential health effects associated with occupational and environmental exposure to styrene - an update

The potential chronic health risks of occupational and environmental exposure to styrene were evaluated to update health hazard and exposure information developed since the Harvard Center for Risk Analysis risk assessment for styrene was performed in 2002. The updated hazard assessment of styrene's health effects indicates human cancers and ototoxicity remain potential concerns. However, mechanistic research on mouse lung tumors demonstrates these tumors are mouse-specific and of low relevance to human cancer risk. The updated toxicity database supports toxicity reference levels of 20 ppm (equates to 400 mg urinary metabolites mandelic acid + phenylglyoxylic acid/g creatinine) for worker inhalation exposure and 3.7 ppm and 2.5 mg/kg bw/day, respectively, for general population inhalation and oral exposure. No cancer risk value estimates are proposed given the established lack of relevance of mouse lung tumors and inconsistent epidemiology evidence. The updated exposure assessment supports inhalation and ingestion routes as important. The updated risk assessment found estimated risks within acceptable ranges for all age groups of the general population and workers with occupational exposures in non-fiber-reinforced polymer composites industries and fiber-reinforced polymer composites (FRP) workers using closed-mold operations or open-mold operations with respiratory protection. Only FRP workers using open-mold operations not using respiratory protection have risk exceedances for styrene and should be considered for risk management measures. In addition, given the reported interaction of styrene exposure with noise, noise reduction to sustain levels below 85 dB(A) needs be in place.

Occupational Styrene Exposure on Auditory Function Among Adults: A Systematic Review of Selected Workers

A review study was conducted to examine the adverse effects of styrene, styrene mixtures, or styrene and/or styrene mixtures and noise on the auditory system in humans employed in occupational settings. The search included peer-reviewed articles published in English language involving human volunteers spanning a 25-year period (1990–2015). Studies included peer review journals, case–control studies, and case reports. Animal studies were excluded. An initial search identified 40 studies. After screening for inclusion, 13 studies were retrieved for full journal detail examination and review. As a whole, the results range from no to mild associations between styrene exposure and auditory dysfunction, noting relatively small sample sizes. However, four studies investigating styrene with other organic solvent mixtures and noise suggested combined exposures to both styrene organic solvent mixtures may be more ototoxic than exposure to noise alone. There is little literature examining the effect of styrene on auditory functioning in humans. Nonetheless, findings suggest public health professionals and policy makers should be made aware of the future research needs pertaining to hearing impairment and ototoxicity from styrene. It is recommended that chronic styrene-exposed individuals be routinely evaluated with a comprehensive audiological test battery to detect early signs of auditory dysfunction.

Self-reported hearing performance in workers exposed to solvents

OBJECTIVE: To compare hearing performance relating to the peripheral and central auditory system between solvent-exposed and non-exposed workers. METHODS: Forty-eight workers exposed to a mixture of solvents and 48 non-exposed control subjects of matched age, gender and educational level were selected to participate in the study. The evaluation procedures included: pure-tone audiometry (500 - 8,000 Hz), to investigate the peripheral auditory system; the Random Gap Detection test, to assess the central auditory system; and the Amsterdam Inventory for Auditory Disability and Handicap, to investigate subjects' self-reported hearing performance in daily-life activities. A Student t test and analyses of covariance (ANCOVA) were computed to determine possible significant differences between solvent-exposed and non-exposed subjects for the hearing level, Random Gap Detection test and Amsterdam Inventory for Auditory Disability and Handicap. Pearson correlations among the three measures were also calculated. RESULTS: Solvent-exposed subjects exhibited significantly poorer hearing thresholds for the right ear than non-exposed subjects. Also, solvent-exposed subjects exhibited poorer results for the Random Gap Detection test and self-reported poorer listening performance than non-exposed subjects. Results of the Amsterdam Inventory for Auditory Disability and Handicap were significantly correlated with the binaural average of subject pure-tone thresholds and Random Gap Detection test performance. CONCLUSIONS: Solvent exposure is associated with poorer hearing performance in daily life activities that relate to the function of the peripheral and central auditory system.

A weight of evidence approach for the assessment of the ototoxic potential of industrial chemicals

There is accumulating epidemiological evidence that exposure to some solvents, metals, asphyxiants and other substances in humans is associated with an increased risk of acquiring hearing loss. Furthermore, simultaneous and successive exposure to certain chemicals along with noise can increase the susceptibility to noise-induced hearing loss. There are no regulations that require hearing monitoring of workers who are employed at locations in which occupational exposure to potentially ototoxic chemicals occurs in the absence of noise exposure. This project was undertaken to develop a toxicological database allowing the identification of possible ototoxic substances present in the work environment alone or in combination with noise exposure. Critical toxicological data were compiled for chemical substances included in the Quebec occupational health regulation. The data were evaluated only for noise exposure levels that can be encountered in the workplace and for realistic exposure concentrations up to the short-term exposure limit or ceiling value (CV) or 5 times the 8-h time-weighted average occupational exposure limit (TWA OEL) for human data and up to 100 times the 8-h TWA OEL or CV for animal studies. In total, 224 studies (in 150 articles of which 44 evaluated the combined exposure to noise and a chemical) covering 29 substances were evaluated using a weight of evidence approach. For the majority of cases where potential ototoxicity was previously proposed, there is a paucity of toxicological data in the primary literature. Human and animal studies indicate that lead, styrene, toluene and trichloroethylene are ototoxic and ethyl benzene, n-hexane and p-xylene are possibly ototoxic at concentrations that are relevant to the occupational setting. Carbon monoxide appears to exacerbate noise-induced hearing dysfunction. Toluene interacts with noise to induce more severe hearing losses than the noise alone.

Organic solvents and hearing loss: The challenge for audiology

Organic solvents have been reported to adversely affect human health, including hearing health. Animal models have demonstrated that solvents may induce auditory damage, especially to the outer hair cells. Research on workers exposed to solvents has suggested that these chemicals may also induce auditory damage through effects on the central auditory pathways. Studies conducted with both animals and humans demonstrate that the hearing frequencies affected by solvent exposure are different to those affected by noise, and that solvents may interact synergistically with noise. The present article aims to review the contemporary literature of solvent-induced hearing loss, and consider the implications of solvent-induced auditory damage for clinical audiologists. Possible audiological tests that may be used when auditory damage due to solvent exposure is suspected are discussed.

Relation between outer hair cell loss and hearing loss in rats exposed to styrene

The relationship between outer hair cell (OHC) loss and cochlear sensitivity is still unclear, because in many animal models there exist surviving but dysfunctional OHCs and also injured/dead inner hair cells (IHC). Styrene is an ototoxic agent, which targets and destroys OHCs starting from the third row to the second and first rows depending on the exposure level. The remaining cells may be less affected. In this experiment, rats were exposed to styrene by gavage at different doses (200-800 mg/kg/day) for varying periods (5 days/week for 3-12 weeks). An interesting finding was that the cochlear sensitivity was not affected in a few rats with all OHCs in the third row being destroyed by styrene. A further loss of OHCs was usually accompanied with a linear input/output (I/O) function of cochlear compound action potentials (CAP), indicating the loss of cochlear amplification. However, normal CAP amplitudes at the highest stimulation level of 90 dB SPL were often observed when all OHCs were destroyed, indicating normal function of the remaining IHCs. The OHC-loss/hearing-loss relation appeared to be a sigmoid-type function. Initially, styrene-induced OHC losses (<33%) did not result in a significant threshold shift. Then CAP threshold shift increased dramatically with OHC loss from 33% to 66%. Then, CAP threshold changed less with OHC loss. The data suggest a tri-modal relationship between OHC loss and cochlear amplification. That is, under the condition that all surviving OHCs are ideally functioning, the cochlear amplifier is not affected until 33% of OHCs are absent, then the gain of the amplifier decreases proportionally with the OHC loss, and at last the amplifier may fail completely when more than 67% of OHCs are lost.

Ototoxicity of organic solvents - from scientific evidence to health policy

The scientific workshop, organized under the 6th European Framework Programme, the Marie Curie Host Fellowship for the Transfer of Knowledge "NoiseHear" Project, by the Nofer Institute of Occupational Medicine (Łódź, Poland, 15-16 November 2006), gathered world specialists in noise, chemicals, and ototoxicity, including hearing researchers, toxicologists, otolaryngologists, audiologists and occupational health physicians.The workshop examined the evidence and the links between isolated exposure to organic solvents, combined exposure to noise and solvents, and effects on the auditory system. Its main purpose was to review the key scientific evidence to gather the necessary knowledge for developing adequate occupational health policies. This paper summarizes the workshop sessions and subsequent discussions.

Relative ototoxicity of 21 aromatic solvents

Some aromatic solvents (e.g. toluene, p-xylene, styrene, and ethylbenzene) show, in the rat, striking ototoxicity characterized by an irreversible hearing loss, as measured by behavioural or electrophysiological methods, associated with damage to outer hair cells in the cochlea of the exposed animals. To broaden the range of aromatic solvents studied concerning their potential ototoxicity and to compare their ototoxicity quantitatively, 21 aromatic solvents were administered orally by gastric intubation to Sprague-Dawley rats for 5 days/week for a 2-week period. The dose used was 8.47 mmol kg(-1) body weight day(-1). The possible ototoxicity of the aromatic solvents was evaluated by morphological investigation of the cochlea. Whole-mount surface preparations of the organ of Corti were made to quantify the number of missing hair cells (cytocochleogram). Among the 21 solvents studied, eight (toluene, p-xylene, ethylbenzene, n-propylbenzene, styrene, alpha-methylstyrene, trans-beta-methylstyrene, and allylbenzene) caused histological lesions of the organ of Corti. They differed widely in their potency. The least ototoxic solvents caused outer hair cell (OHC) loss in the middle turn of the organ of Corti. The OHC loss was slight in the first row, and greater in the second and third rows. The most ototoxic solvents caused high losses in the three rows of the outer hair cells along the entire length of the basilar membrane. There were also occasional inner hair cell (ICH) losses in the most affected animals. Although no measurements were made of the chemical concentrations reached in the blood or the brain, tentative ranking of an increasing ototoxicity of the eight aromatic solvents could be proposed on the basis of the histological losses observed-alpha-methylstyrene<trans-beta-methylstyrene=toluene< or =p-xylene<n-propylbenzene<styrene=ethylbenzene<allylbenzene. There was no relationship between the degree of ototoxicity and the lipophilic properties of the ototoxic agents as expressed by the octanol/water partition coefficients. However, it seemed that some structural constraint was essential to induce ototoxicity. It seems there must be a single side-chain on the aromatic ring for ototoxicity, except with p-xylene. The other aromatic solvents with two side-chains were not ototoxic. When the saturated side-chain was branched (isopropylbenzene, isobutylbenzene, sec-butylbenzene, tert-butylbenzene), no ototoxicity was observed. The ototoxic potency increased when the length of the saturated side-chain extended from one carbon atom to two carbon atoms. Beyond that point, the ototoxic effect decreased with n-propylbenzene and disappeared with n-butylbenzene. Moreover, unsaturation of the side-chain of allylbenzene increased the ototoxicity of n-propylbenzene substantially. Branching of the unsaturated chain (alpha-methylstyrene and trans-beta-methylstyrene) decreased the ototoxicity of styrene.

On membrane motor activity and chloride flux in the outer hair cell: lessons learned from the environmental toxin tributyltin

The outer hair cell (OHC) underlies mammalian cochlea amplification, and its lateral membrane motor, prestin, which drives the cell's mechanical activity, is modulated by intracellular chloride ions. We have previously described a native nonselective conductance (G(metL)) that influences OHC motor activity via Cl flux across the lateral membrane. Here we further investigate this conductance and use the environmental toxin tributyltin (TBT) to better understand Cl-prestin interactions. Capitalizing on measures of prestin-derived nonlinear capacitance to gauge Cl flux across the lateral membrane, we show that the Cl ionophore TBT, which affects neither the motor nor G(metL) directly, is capable of augmenting the native flux of Cl in OHCs. These observations were confirmed using the chloride-sensitive dye MQAE. Furthermore, the compound's potent ability, at nanomolar concentrations, to equilibrate intra- and extracellular Cl concentrations is shown to surpass the effectiveness of G(metL) in promoting Cl flux, and secure a quantitative analysis of Cl-prestin interactions in intact OHCs. Using malate as an anion replacement, we quantify chloride effects on the nonlinear charge density and operating voltage range of prestin. Our data additionally suggest that ototoxic effects of organotins can derive from their disruption of OHC Cl homeostasis, ultimately interfering with anionic modulation of the mammalian cochlear amplifier. Notably, this observation identifies a new environmental threat for marine mammals by TBT, which is known to accumulate in the food chain.

Effects of alcohol and noise on temporary threshold shift in Guinea pigs

The purpose of this study was to investigate the effects of concomitant exposure to noise and alcohol on the auditory thresholds. Twenty-four guinea pigs were equally divided into three groups: the acute intoxication group, the chronic intoxication group and the control group. Animals in the acute group received single intraperitoneal injections of ethanol (2 g/kg). In the chronic group, alcohol was administered via drinking water (10%, v/v) over a 60-day period. All animals were exposed to a white noise at the intensity of 105 dB A for 30 min. Auditory brainstem response (ABR) thresholds and distortion product otoacoustic emission (DPOAE) levels were measured before, immediately after noise exposure and also 1, 2, and 7 days following exposure. The results showed: first, acute alcohol injection caused a significant, temporary elevation of ABR threshold (4.8 dB in average), while chronic alcohol treatment did not change auditory threshold significantly. Second, noise exposure induced a mean threshold shift of 15.4- 19.7 dB. ABR threshold returned to normal 2 days after exposure. Both acute and chronic alcohol treatment did not alter the magnitude and time course of recovery of the temporary threshold shift (TTS). Third, the mean DPOAE amplitudes decreased at most frequencies following acute injection of alcohol. However, the differences did not reach statistical significance. Fourth, the mean DPOAE levels dropped 3.4-9.6 dB in all groups after noise exposure and returned to normal 1 day to 2 days after noise. There were no significant differences in the amount of DPOAE suppression after noise between the three groups. In summary, we have found that acute and chronic treatment of alcohol in combination with noise did not significantly exacerbate TTS or decrease DPOAE amplitudes relative to noise exposure alone.

Deleterious effects of an environmental noise on sleep and contribution of its physical components in a rat model

Sleep disturbances induced by environmental noise (EN) exposure are now well admitted. However, many contradictory conclusions and discrepancies have been reported, resulting from uncontrolled human factors or the use of artificial noises (pure tone). Thus, the development of an animal model appears to be a useful strategy for determining whether EN is deleterious to sleep. The aims of this study were: (i) to confirm the effects of noise on sleep in a rat model; and (ii) to determine the most deleterious physical component of noise regarding sleep structure. For this purpose, rats were exposed during 24 h either to EN or to artificial broad-band noises [either continuous broad-band noise (CBBN) or intermittent broad-band noise (IBBN)]. All the noises decrease both slow wave sleep (SWS) and paradoxical sleep (PS) amounts during the first hours of exposure. However, CBBN acts indirectly on PS through a reduction of SWS bout duration, whereas IBBN and EN disturb directly and more strongly both SWS and PS. Finally, EN fragments SWS and decreases PS amount during the dark period, whereas IBBN only fragments PS. These results demonstrate the validity and suitability of a rodent model for studying the effects of noise on sleep and definitively show that sleep is disturbed by EN exposure. Two physical factors seem to be implicated: the intermittency and the frequency spectrum of the noise events, which both induce long-lasting sleep disturbances. An additive effect of frequency spectrum to intermittency tends to abolish all possible adaptations to EN exposure. Since sleep is involved in cognitive processes, such disturbances could lead to cognitive deficits.

Ototoxic effects of occupational exposure to styrene and co-exposure to styrene and noise

Ototoxicity of styrene and the synergistic action of styrene and noise have been shown in rats. The respective data in humans are scarce and equivocal. This study evaluated the effects of occupational exposure to styrene and combined exposures to styrene and noise on hearing. The study group, comprised of 290-yacht yard and plastic factory workers, was exposed to a mixture of organic solvents, having styrene as its main compound. The reference group, totaling 223 subjects, included (1) white-collar workers, exposed neither to solvents nor noise and (2) metal factory workers, exposed exclusively to noise. All subjects were assessed by means of a detailed questionnaire and underwent otorhinolaryngological and audiometric examinations. Multiple logistic regression analysis revealed almost a 4-fold (or 3.9; 95% CI = 2.4-6.2) increase in the odds of developing hearing loss related to styrene exposure. The factors adjusted for were: age, gender, current occupational exposure to noise, and exposure to noise in the past. In cases of the combined exposures to styrene and noise, the odds ratios were two to three times higher than the respective values for styrene-only and noise-only exposed subjects. The mean hearing thresholds--adjusted for age, gender, and exposure to noise--were significantly higher in the solvent-exposed group than in the unexposed reference group at all frequencies tested. A positive linear relationship existed between an averaged working life exposure to styrene concentration and a hearing threshold at the frequencies of 6 and 8 kHz. This study provides the epidemiological evidence that occupational exposure to styrene is related to an increased risk of hearing loss. Combined exposures to noise and styrene seem to be more ototoxic than exposure to noise alone.

Audiometric findings in workers exposed to low levels of styrene and noise

Audiometry and exposure measurements were conducted on workers from fiberglass and metal products manufacturing plants and a mail distribution terminal (N = 313). Workers exposed to noise and styrene had significantly worse pure-tone thresholds at 2, 3, 4, and 6 kHz when compared with noise-exposed or nonexposed workers. Age, noise exposure, and urinary mandelic acid (a biologic marker for styrene) were the variables that met the significance level criterion in the multiple logistic regression. The odds ratios for hearing loss were 1.19 for each increment of 1 year of age (95% confidence interval [CI], 1.11-1.28), 1.18 for every decibel >85 dB(A) of noise exposure (95% CI, 1.01-1.34), and 2.44 for each millimole of mandelic acid per gram of creatinine in urine (95% CI, 1.01-5.89). Our findings suggest that exposure to styrene even below recommended values had a toxic effect on the auditory system.