Cochlear blood flow in noise-damaged ears

The use of hyperbaric oxygen therapy in acute hearing loss: a narrative review

INTRODUCTION

Acute hearing loss can have a major impact on a patient's life. This holds true for both acute acoustic trauma (AAT) and idiopathic sudden sensorineural hearing loss (ISSHL), two devastating conditions for which no highly effective treatment options exist. This narrative review provides the rationale and evidence for HBOT in AAT and ISSHL.

METHODS

Narrative review of all the literature available on HBOT in acute hearing loss, studies were retrieved from systematic searches on PubMed and by cross referencing.

DISCUSSION

First, the etiological mechanisms of acute hearing loss and the mechanism of action of HBOT were discussed. Furthermore, we have provided an overview of 68 studies that clinically investigated the effect of HBOT in the last couple of decades. For future studies, it is recommend to start as early as possible with therapy, preferably within 48 h and to use combination therapy consisting of HBOT and corticosteroids.

IMPLICATIONS FOR PRACTICE

HBOT has been used quite extensively for acute hearing loss in the last couple of decades. Based on the amount of studies showing a positive effect, HBOT should be discussed with patients (shared decision making) as optional therapy in case of AAT and ISSHL.

Physiopathology of the cochlear microcirculation

Normal blood supply to the cochlea is critically important for establishing the endocochlear potential and sustaining production of endolymph. Abnormal cochlear microcirculation has long been considered an etiologic factor in noise-induced hearing loss, age-related hearing loss (presbycusis), sudden hearing loss or vestibular function, and Meniere's disease. Knowledge of the mechanisms underlying the pathophysiology of cochlear microcirculation is of fundamental clinical importance. A better understanding of cochlear blood flow (CoBF) will enable more effective management of hearing disorders resulting from aberrant blood flow. This review focuses on recent discoveries and findings related to the physiopathology of the cochlear microvasculature.

Effect of hypoxia on noise-induced auditory impairment

Chemical asphyxiants have been shown to potentiate noise-induced hearing loss (NIHL) in our previous reports. However, it is still unclear whether hypoxia interacts with noise to potentiate NIHL. This is an important issue, since many people at risk of exposure to noise may also suffer from hypoxia. In the present study, rats were exposed to 14.1-kHz octave-band noise at 105, 110, and 115 dB SPL and hypoxic air (10% O(2) and 18% O(2)) for 4 h. Cochlear compound action potential threshold loss and hair cell loss were determined 4 weeks after the exposure. Though the hypoxia did not cause hearing loss and hair cell loss, the combined exposure to noise and hypoxic air caused more hearing loss and hair cell loss than the noise alone. The NIHL potentiation by hypoxia appeared to increase linearly with the hypoxia level. 10% O(2) exposure significantly potentiated NIHL and 18% O(2) exposure also showed an evident NIHL potentiation. This suggests that people suffering from hypoxia may have increased risk to noise trauma.

R-phenylisopropyladenosine attenuates noise-induced hearing loss in the chinchilla

Reactive oxygen species, which are cytotoxic to living tissues, are thought to be partly responsible for noise-induced hearing loss. In this study R-phenylisopropyladenosine (R-PIA), a stable non-hydrolyzable adenosine analogue which has been found effective in upregulating antioxidant enzyme activity levels, was topologically applied to the round window of the right ears of chinchillas. Physiological saline was applied to the round window of the left ears (control). The animals were then exposed to a 4 kHz octave band noise at 105 dB SPL for 4 h. Inferior colliculus evoked potential thresholds and distortion product otoacoustic emissions (DPOAE) were measured and hair cell damage was documented. The mean threshold shifts immediately after the noise exposure were 70-90 dB at frequencies between 2 and 16 kHz. There were no significant differences in threshold shifts at this point between the R-PIA-treated and control ears. By 4 days after noise exposure, however, the R-PIA-treated ears showed 20-30 dB more recovery than saline-treated ears at frequencies between 4 and 16 kHz. More importantly, threshold measurements made 20 days after noise exposure showed 10-15 dB less permanent threshold shifts in R-PIA-treated ears. The amplitudes of DPOAE also recovered to a greater extent and outer hair cell losses were less severe in the R-PIA-treated ears. The results suggest that administration of R-PIA facilitates the recovery process of the outer hair cell after noise exposure.

Calcium channel blockade reduces noise-induced vascular permeability in cochlear stria vascularis

Exposure to noise results in multiple perturbations of cochlear microcirculation, including increases in vascular permeability. There is evidence that these events are mediated, in part, by calcium channels. The current study examined the effects of calcium channel blockade on the diameter and permeability of cochlear vessels during noise exposure. Subjects were exposed to either noise alone or noise after verapamil pretreatment. Vessels of the cochlear stria vascularis were imaged using intravital microscopy. Animals exposed to noise showed decreases in diameter and increased permeability above baseline levels. Animals pretreated with the calcium channel blocker verapamil and exposed to noise demonstrated increases in vessel diameter and no changes in permeability. These data indicate that calcium channel blockade reduces noise-induced microvascular permeability. Treatment strategies designed to protect from increases in vascular permeability due to noise exposure may reduce temporary threshold shifts.

The influence of loud sound on red blood cell velocity and blood vessel diameter in the cochlea

Using intravital microscopy, we observed both decreases in red blood cell velocity and possible vasoconstriction in stria vascularis capillaries of the rat cochlea in response to loud sound (Quirk et al., 1991). However, our observation of vasoconstriction was subject to error in measurements from the two dimensional images obtained with our silicon intensified (SIT) camera due to the influence of focus causing image blur. The purpose of the current study was to apply an extended focus microscopy technique to obtain quantitative assessment of vessel diameter changes (Avinash et al., 1992), as well as to extend these studies to the guinea pig model. Broad-band sound stimulation at intensities of 84 dB SPL and 110 dB SPL were used. The results show that loud sound induces a sequence of changes in cochlear blood flow. Stimulation with 110 dB SPL resulted in a mean increase (maximum = 27%) in red blood cell velocity for the first 20 min of exposure followed by a gradual decrease below baseline (minimum = -12%) prior to termination of the signal. This velocity decrease and subsequent recovery were associated with significant changes in vessel diameters of selected and measured capillaries. In contrast, the 84 dB SPL stimulus caused an increase in red blood cell velocity (maximum = 20%) and vessel diameter (mean = 7.5) during the stimulation period. No recovery was observed during the 10 min observation period following sound. Several possible mechanisms responsible for these changes are discussed.

Noise-induced changes in red blood cell velocity in lateral wall vessels of the rat cochlea

The effects of loud sound on the microvasculature of the cochlea are not well characterized or understood. Morphological changes in the stria vascularis and changes in blood flow are known to occur during or following sound stimulation, however, the effects on cochlear blood flow appear to be complex. Studies have shown that noise exposure may produce increases in blood flow, decreases in blood flow, or no measureable change in blood flow. These inconsistent results probably reflect the various noise exposure parameters, the animal model used, and could be a function of the specific procedures utilized to assess blood flow changes. The purpose of the current study was to investigate the effects of one specific class of sound exposure (high intensity noise) on red blood cell velocity in the capillaries of the second turn of the rat cochlea using intravital microscopy. This class of sound exposure was selected in order to attempt a confirmation of previous findings of increased blood flow (Perlman and Kimura, 1962) using the quantitative technique of red blood cell velocity measurement. Following determination of pre-exposure red blood cell velocities in capillaries of the rat cochlea second turn, animals were exposed to 133 dB or 110 dB broad-band noise for ten minutes. The red blood cell velocity was recorded continuously during the exposure. Exposure to both sound intensities disrupted stable and orderly baseline flow patterns and resulted in overall intensity-dependent increases in red blood cell velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Strial circulation impairment due to acoustic trauma

Blood circulation in the cochlear lateral wall after exposure to a non-physiological level of sound (120-125 dB SPL, 3 h) was investigated immunohistologically. Kanamycin (KM), which was expected to function as a tracer of blood flow, was administered to guinea pigs 5 min to 21 h after sound termination. At 5-30 min, KM was scarce in the capillaries of the stria vascularis (CSVs), whereas abundant KM was present in the spiral ligament vessels. These findings differed markedly from those in non-sound-exposed animals. After the initial period, KM gradually did enter into the CSVs, but its pattern of existence there differed from the normal pattern. These observations suggest that acoustic trauma causes blood stagnation in the strial capillaries, leading to strial dysfunction.

Cochlear blood flow: measurement techniques

The measurement of inner ear blood flow and other microvascular variables is subject to unique technical problems which are compounded by methodological limitations. As a result, the interpretation of experimental results is often difficult. This report discusses the most important methods currently available for cochlear blood circulation measurements and the technical problems associated with their use. The use of a combination of measurements to resolve problems of interpretation is stressed. An extensive review of the pertinent literature is provided in relation to each method.