A four-state kinetic model of the temporary threshold shift after loud sound based on inactivation of hair cell transduction channels

Assessment of occupational noise-related hearing impairment among dental health personnel

Objectives

The purpose of the study was to examine hearing thresholds among dental personnel. The secondary aim was to evaluate sound levels among dental equipment that dental personnel are exposed to.

Methods

Two hundred forty‐four dentists, dental technicians, dental assistants, and dental students participated. Sixty‐two participated as a control group. Audiological thresholds for the test groups were compared to the control group. All participants were from Jordan University Hospital. Participants completed a questionnaire in addition to their audiometric testing. Otoscopy, tympanometry, and pure tone audiometry were included in their assessment. Three‐factor ANOVA and t tests were utilized to assess the statistical differences of hearing thresholds among the groups and between the two ears. Pearson correlation test was used to assess the effect of age, experience, and duration of exposure on the degree of hearing loss in the test groups for both ears.

Results

The authors reported statistically significant differences among hearing thresholds between the control group and others. Left hearing thresholds were noted to be significantly poorer in the left versus right ear at 1000, 2000, 4000, and 8000 Hz in dental assistants. The authors also reported a significant relationship between the degree of hearing impairment among dental assistants and the daily duration of exposure to dental occupational noise, followed by age.

Conclusion

Hearing impairment was higher among dental professionals than the control group and especially among dental assistants and technicians. The authors recommended screening guidelines and adapting hearing protection methods for dental professionals and particularly for dental assistants and technicians.

The Effect of Short-Term Noise Exposure on Audiometric Thresholds, Distortion Product Otoacoustic Emissions, and Electrocochleography

Purpose The purpose of the study was to examine the effect of short-term noise exposure on audiometric thresholds, distortion product otoacoustic emissions (DPOAEs), and electrocochleography (ECochG) as a function of ear and sex. Method Preexposure and postexposure measures of audiometric thresholds, DPOAEs, and ECochG indices were examined. Sixteen male and 16 female adults participated. Participants were exposed to a 2000-Hz narrowband noise presented at 105 dBA for 10 min. Results Following noise exposure, significantly ( p < .0001) larger auditory threshold differences were observed for left ears. Larger auditory threshold differences were also observed for 3000 and 4000 Hz versus 2000 and 6000 Hz. DPOAE absolute amplitude differences increased with decreasing L ₁, L ₂ level ( p < .0001). DPOAE absolute amplitude differences also significantly rose with increasing f₂ frequencies ( p < .0001). Females generally had larger DPOAE absolute amplitude differences than males ( p < .05). Summating potential amplitudes were significantly larger for female left ears following noise exposure ( p = .03). Left-ear summating potential/action potential amplitude ratios and summating potential/action potential area ratios were increased following noise exposure ( p < .05). Conclusions Utilizing a test battery to examine the effects of short-term noise exposure can reveal the functional status of different structures in the cochlea. There appears to be a susceptibility of the left ear to short-term loud noise exposure. Findings with respect to a sex susceptibility to short-term loud noise exposure were not strong, as sex differences were only observed for a subset of the conditions.

Impact of Activities OF NA+,K+-Atpase and CA2+-Atpase in the Cochlear Lateral Wall on Recovery from Noise-Induced Temporary Threshold Shift

The present study was designed to investigate the relationship between the noise-induced temporary threshold shift (TTS) and the specific activities of sodium potassium adenosine triphosphatase (Na+,K+-ATPase) and calcium adenosine triphosphatase (Ca2+-ATPase) in the cochlear lateral wall. The specific activities of these enzymes were quantified by microcolorimetric assay. Changes in auditory brain stem response (ABR) thresholds were compared with the quantitative alterations of the specific activities of Na+,K+-ATPase and Ca2+-ATPase in the cochlear lateral wall of guinea pigs with a noise-induced TTS. In the majority of those noise-exposed ears with complete recovery of ABR thresholds, the specific activities of both enzymes returned to at least 70% of the mean specific activity of the control group. Although other factors may be involved, reversible inactivation of Na+,K+-ATPase and Ca2+-ATPase in the cochlear lateral wall may be one component of the TTS. Our present findings could drive further studies on the molecular basis of noise-induced hearing loss.

A behavioral measure of the cochlear changes underlying temporary threshold shifts

It is well documented that exposure to recreational noise may result in a temporary threshold shift (TTS) due to cochlear dysfunction. A forward-masking paradigm was used to estimate the relative contribution of inner hair cell (IHC) and outer hair cell (OHC) dysfunction to TTS. Eighteen normal-hearing adults completed a test battery before, immediately after, and one week after attending a loud music venue. Personal dosimeters recorded mean equivalent exposure levels of 99.0 dB A. Shortly after exposure, there was an average TTS of 10.8 dB at 4 kHz, and an average reduction in the estimated gain provided by the OHCs of 11.5 dB. Gain reduction correlated significantly with TTS. The results suggest that OHC dysfunction can account almost entirely for the raised thresholds. For the test battery conducted a week after exposure, all measures showed recovery to pre-exposure values.

Long term effects of BAPTA in scala media on cochlear function

BAPTA was iontophoresed or allowed to diffuse into the scala media of the first turn of the guinea pig cochlea via pipettes inserted through the round window and basilar membrane. Cochlear action potential (CAP) thresholds for basal turn frequencies were elevated, scala media cochlear microphonic in response to a 207Hz tone were drastically reduced and the distortion products 2f1-f2 and f2-f2 in response to primaries set at 18 and 21.6kHz were eliminated or severely reduced. The animals were recovered and the above measurements repeated between 24 and 240h after the application of BAPTA. In all animals thresholds for basal turn frequencies remained elevated, and the distortion components were severely reduced. The endolymphatic potential (EP), measured through the basilar membrane on recovery, was not significantly different from the values measured before BAPTA was applied. If the effect of BAPTA, in lowering endolymphatic Ca(2+) concentration, is restricted to the destruction of tip links, as has been shown in many other preparations, then these results suggest that this effect has permanent consequences, either because the tip links failed to regenerate or because their destruction precipitated the degeneration of OHCs. These results may have a bearing on the mechanisms behind permanent threshold shift.

Contextual modulation of cochlear hearing desensitization depends on the type of loud sound trauma

In ears in which cochlear efferent pathways were cut and with testing done under anaesthetic conditions that preclude middle ear muscle activity (so as to examine the "intrinsic" effects of loud sound on the cochlea without any confounding effect of efferent pathways to the auditory periphery), atraumatic background white noise (WN) increases cochlear hearing loss (temporary threshold shifts, TTSs) induced by a traumatic pure tone but reduces TTSs caused by traumatic 5-kHz wide narrow band (NB) sound. The short-duration moderately intense traumata used in these studies most likely cause TTSs by affecting cochlear mechanics and these WN modulatory effects, exerted directly on the cochlea's intrinsic susceptibility to TTSs, are not predicted by any current description of cochlear mechanics. Here it is demonstrated that background WN reduces trauma-induced TTSs with even a relatively small increase in trauma bandwidth beyond that of a pure tone, discounting the alternative that contextual modulatory effects transition systematically along a continuum as trauma bandwidth increases from a pure tone to a broader bandwidth (albeit 2 kHz-wide NB) trauma. These results have implications for cochlear mechanics as the TTSs due to the traumatic sound of this study are most likely due to changes in cochlear mechanics but are not easily explained by what is currently known of cochlear mechanics.

Underwater temporary threshold shift in pinnipeds: effects of noise level and duration

Behavioral psychophysical techniques were used to evaluate the residual effects of underwater noise on the hearing sensitivity of three pinnipeds: a California sea lion (Zalophus californianus), a harbor seal (Phoca vitulina), and a northern elephant seal (Mirounga angustirostris). Temporary threshold shift (TTS), defined as the difference between auditory thresholds obtained before and after noise exposure, was assessed. The subjects were exposed to octave-band noise centered at 2500 Hz at two sound pressure levels: 80 and 95 dB SL (re: auditory threshold at 2500 Hz). Noise exposure durations were 22, 25, and 50 min. Threshold shifts were assessed at 2500 and 3530 Hz. Mean threshold shifts ranged from 2.9-12.2 dB. Full recovery of auditory sensitivity occurred within 24 h of noise exposure. Control sequences, comprising sham noise exposures, did not result in significant mean threshold shifts for any subject. Threshold shift magnitudes increased with increasing noise sound exposure level (SEL) for two of the three subjects. The results underscore the importance of including sound exposure metrics (incorporating sound pressure level and exposure duration) in order to fully assess the effects of noise on marine mammal hearing.

Frequency specificity of distortion-product otoacoustic emissions produced by high-level tones despite inefficient cochlear electromechanical feedback

Distortion product otoacoustic emissions (DPOAEs) are thought to stem from the outer hair cells (OHCs) around the normally narrow place tuned to the primary tone stimuli. They are thus said to be frequency-specific: their local absence should accurately pinpoint local OHC damage. Yet the influence of impaired tuning on DPOAE frequency specificity is poorly documented. Mice with local damage to OHCs were examined. Their DPOAEs were frequency-specific in that audiometric notches were accurately tracked. The same cochleae were further impaired by ischemia or furosemide injection inducing strial dysfunction with flat loss of sensitivity and tuning, while the preexisting pattern of damaged OHCs remained unaltered. Despite the loss of cochlear activity, DPOAEs produced by high-level (> or =70 dB SPL) primaries remained large in about the same interval where they had been initially normal, i.e., that with nondamaged OHCs, albeit with a slight frequency shift, of -1.1 kHz on average. Thus, the ability of DPOAEs to map structurally intact OHCs cannot be a mere consequence of cochlear tuning as it largely persists in its absence. The key element for this correct mapping is likely part of intact OHC structures (e.g., stereocilia bundles) and must have some tuning of its own.

Influence of hearing sensitivity on mechano-electric transduction

This study examined the relation between the extent of permanent hearing loss and the change in a third-order polynomial transducer function (PTF) representing mechano-electric transduction (MET). Mongolian gerbils were exposed to noise for 1 to 128 h. A control group received no exposure. The cochlear microphonic (CM) was recorded from a round-window electrode and stapes velocity was recorded with a laser Doppler vibrometer in response to Gaussian noise. A nonlinear systems identification procedure provided the frequency-domain coefficients of the PTF and their associated coherence functions. In the control group, the PTF in the high frequencies was dominated by linear and cubic terms. In noise-exposed animals, the magnitude of these terms decreased with increasing threshold, suggesting a progressive decrease in the receptor currents through basal hair cells. Moreover, the linear coherence increased and the cubic coherence decreased, indicating that MET in the cochlear base became linear. In the low frequencies, noise exposure altered the group delay of the CM, demonstrating a redistribution of hair-cell currents. The low-frequency PTF was characterized by an increase in the contribution in the quadratic term. With increasing threshold, the slope of the PTF decreased and the saturation for positive CM was eliminated.

Physiopathological significance of distortion-product otoacoustic emissions at 2f1-f2 produced by high- versus low-level stimuli

Distortion product otoacoustic emissions emitted by the cochlea at 2f1-f2 in response to pairs of pure tones at f1 and f2 (DPOAE) form a class of otoacoustic emissions and as such, are viewed as a reliable tool for screening outer hair cell (OHC) dysfunctions on a pass/fail basis. However, the persistence of residual DPOAEs from impaired cochleae at high stimulus levels has suggested that above 60-70 dB SPL, instead of reflecting "active" cochlear motion, DPOAEs might represent another "passive" modality: they would thus become unsuitable for analyzing cochlear function. The present work reports the consequences on high- vs low-level DPOAEs of three types of cochlear impairments involving OHCs: progressive OHC degeneration of genetic origin in CD1 mice, complete cochlear ischemia in gerbils, and furosemide injection vs ischemia-reperfusion in gerbils. An alternative to the "active-passive" model was used wherein regardless of stimulus level, cubic DPOAEs are produced by N (probably OHC-borne) nonlinear elements driven by input I and modulated by a function F3 of their operating point o; thus, DPOAE proportional to NI3F3(o). When OHCs degenerated, thereby implying a decrease of N, DPOAE levels also decreased regardless of the stimulus level up to 80 dB SPL, in line with the previous formula but at variance with the prediction of the active-passive concept. Instead of affecting N, the other two experiments impaired the efficiency of the cochlear feedback loop as a result of its electrical drive being decreased by strial dysfunction. As it is well accepted that the impaired basilar-membrane motion, although greatly reduced at low levels, tends to catch up with a normal one at higher levels, it was assumed the same was true with I so that DPOAE levels had to be, and indeed were little affected at high levels while plummeting at low levels, without any need for invoking two modalities for DPOAE generation. Finally, comparisons of furosemide vs ischemia effects revealed additional influences on DPOAEs, possibly accounted for by function F3(o). These results lead to the proposal that although high-level DPOAEs are expected to be poor audiometric indicators, they seem well adapted to assessing the functional integrity of nonlinear elements in OHCs, i.e., presumably their mechanoelectrical transduction channels.

Magnitudes and phases of human distortion-product otoacoustic emissions at 2f(1)-f(2) against f(2)/f(1): effects of an audiometric notch

The influence of the frequency ratio f(2)/f(1) of two pure-tone stimuli on the distortion-product otoacoustic emissions (DPOAEs) at 2f(1)-f(2) was assessed in 14 hearing-impaired human ears exhibiting a narrow audiometric notch at 4 kHz, whereas 11 normally hearing ears served as controls. A fixed-f(2) paradigm was used, with f(2) values varying from 2 to 8 kHz in 1-kHz steps. The intensities of the two stimuli were either 60 or 70 dB SPL. The magnitudes and phases of DPOAEs were extracted so that the bandpass filter-like profile of DPOAE magnitude against f(2)/f(1) (f(2)/f(1) magnitude function) could be characterized by the presence and position of its maximum, and DPOAE group delays were derived from the phase gradient of the DPOAE when f(1) varied. The main difference between normal and impaired ears occurred at 4 kHz in that, in contrast with normal ears, nine impaired ears out of 14 did not present any peak in their f(2)/f(1) magnitude function, while the remaining five ears only differed from normal ones by a slightly shifted maximum toward larger f(2)/f(1)s. Group delays were significantly shortened in all impaired ears, with a tendency to be shorter in the subset of ears with flat DPOAE magnitude profiles with f(2)/f(1). No clear effect of notch depth was observed, and with the chosen stimulus characteristics, no abnormal DPOAE result was observed whenever f(2) fell outside the audiometric notch. It is concluded that DPOAE group delays apparently provide useful objective clues of cochlear dysfunction, more sensitive than DPOAE magnitudes inasmuch as many of them remained near the normal range. Although a majority of f(2)/f(1) magnitude functions were clearly flattened when f(2) was impaired, this feature was less systematic.

Origin of cubic difference tones generated by high-intensity stimuli: effect of ischemia and auditory fatigue on the gerbil cochlea

Cubic difference tone (CDT) otoacoustic emissions are thought to arise from the feedback loop allowing outer hair cells to enhance the sensitivity and tuning of the organ of Corti. The existence of residual CDTs during complete cochlear ischemia is therefore disturbing. That stimulus intensities must exceed 50-60 dB SPL for residual CDTs to be recorded and for level notches to be present in CDT growth functions is often cited as evidence for a two-component, "active/passive" model: one component, the residual one, would originate from a passive, hardly vulnerable mechanism and thus be unsuitable for hearing screening purposes. This model was probed in gerbil ears after complete interruption of the cochlear blood flow. Cochlear potentials and CDTs were controlled simultaneously through continuous monitoring of CDT level and phase for 50 and 60 dB SPL stimuli and group-delay measurements. After a clear initial decay, CDT levels elicited at 60 dB SPL plateaued for several minutes at about 20 dB below initial level, and when early level notches were observed, CDT phase changes remained minor. The CDT group delays decreased by less than 30%. Later CDT level notches were associated with sharp phase reversals but the similarity between CDT characteristics before and after a notch was hardly consistent with a two-component interpretation. When mild sound overexposure (pure tone, 90-95 dB SPL, 15-30 min) had been performed prior to ischemia, little or no ischemic CDT came from the frequency bands where auditory fatigue had been detected (within 1 kHz), irrespective of the stimulus intensity. It suggests that instead of being passive, residual ischemic CDTs were vulnerable and produced according to a near-normal tonotopy by the same mechanisms that were sensitive to auditory fatigue. All the results lined up with a simple feedback model of cochlear function assuming a single CDT source related to mechano-electrical transduction in outer hair cells. More parsimonious than a two-component model, it posits that although early stages of ischemia dramatically impair the overall performance of the cochlea, the nonlinear mechanical stages responsible for the existence of CDTs keep working albeit at higher intensities.

Exponential onset and recovery of temporary threshold shift after loud sound: evidence for long-term inactivation of mechano-electrical transduction channels

The onset and recovery of temporary threshold shift (TTS) in one human subject (the author) has been studied during and after pure-tone overstimulation lasting between minutes and days. Under the conditions of these experiments the time courses appeared reproducible, and thresholds always recovered to normal within 3 days. The onset and recovery followed a multiple-exponential time course, with the time constants for the onset being 6.5 and 800 min, and the recovery time constants being 30, 240 and 800 min. The observed time courses were consistent with data previously reported in humans, and with the view that the threshold elevation was due to an inactivation and reactivation of the stretch-activated channels at the apex of the outer hair cells of the cochlea. The time constants of the multi-exponential onset and recovery do not appear to depend on the duration of the overstimulation, but the exponential coefficients do. A simple kinetic model of the onset and recovery is described (for more detail see Patuzzi (1998)). It is suggested that the rapid recovery in the first 5 min after exposure is due to a short-lived disruption of the synapses between the inner hair cells and the primary afferent neurones. Intermittent exposures were found to produce much less TTS than continuous tones, and this reduction was found to be inconsistent with the Equal Energy Hypothesis, in that the TTS produced by intermittent tones was much less than predicted using the Equal Energy model, and the recovery time course was also different from that expected from a shorter exposure to a continuous tone of equal energy.