Otoneurological findings in psycho-organic syndrome caused by industrial solvent exposure

Audiological Tests Used in the Evaluation of the Effects of Solvents on the Human Auditory System: A Mixed Methods Review

This study aimed to scope the literature, identify knowledge gaps, appraise results, and synthesize the evidence on the audiological evaluation of workers exposed to solvents. We searched Medline, PubMed, Embase, CINAHL, and NIOSHTIC-2 up to March 22, 2021. Using Covidence, two authors independently assessed study eligibility, risk of bias, and extracted data. National Institute of Health Quality Assessment Tools was used in the quality evaluation of included studies; the Downs and Black checklist was used to assess the risk of bias. Of 454 located references, 37 were included. Twenty-five tests were studied: two tests to measure hearing thresholds, one test to measure word recognition in quiet, six electroacoustic procedures, four electrophysiological tests, and twelve behavioral tests to assess auditory processing skills. Two studies used the Amsterdam Inventory for Auditory Disability and Handicap. The quality of individual studies was mostly considered moderate, but the overall quality of evidence was considered low. The discrepancies between studies and differences in the methodologies/outcomes prevent recommending a specific test battery to assess the auditory effects of occupational solvents. Decisions on audiological tests for patients with a history of solvent exposures require the integration of the most current research evidence with clinical expertise and stakeholder perspectives.

Balance system assessment in workers exposed to organic solvent mixture

OBJECTIVE

The aim of this study was to assess the balance and vestibular systems in healthy workers exposed to low concentrations of organic solvent mixtures.

METHODS

The study groups comprised 60 workers exposed to mixture of organic solvents and 110 reference workers. All subjects performed static posturography and electronystagmography (ENG).

RESULTS

In posturography, abnormal reaction time was more frequent and statistically longer in solvent-exposed group. Also, worse results of movement coordination parameters were observed in this group. The ENG square waves and abnormal optokinetic results were more common in exposed group. Mean caloric response was shorter in the exposed group. Negative relationship was found between time of caloric response and cumulative toluene concentration.

CONCLUSIONS

Balance abnormalities in solvent-exposed workers indicated subclinical damage, mainly of central part of vestibular system and body-movement coordination. It would not be reasonable to exclude the vestibular hyporeactivity.

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.

Neurotoxic effect of occupational exposure to mixed organic solvents in Korea: Posturographic study

BACKGROUND

This study used static posturography to investigate the neurotoxic effects on workers exposed to mixed organic solvents at low concentrations under the levels of the threshold limit values (TLV).

METHODS

Forty-one workers from four plants exposed to mixed solvents and 90 non-exposed referents were examined. The lifetime cumulative biological exposure (CE) was estimated according to subject's occupational history and biological monitoring results. Static posturography and questionnaire were the basis of data collection.

RESULTS

The mean exposure index of mixed organic solvents of four plants was 0.47 (SD: 0.33, range: 0.08-1.39). The exposed group showed a larger sway area and length under the eye open condition than did the non-exposed group. In a multiple linear regression, a significant positive association was demonstrated between postural sway area and CE.

CONCLUSIONS

This study results suggest that the exposure to organic solvents under TLV levels may cause disturbance in postural stability.

Auditory neuropathy in a patient exposed to xylene: case report

OBJECTIVE

To report the case of an adult patient who developed auditory complaints following xylene exposure, and to review the literature on the effects of solvent exposure on hearing.

CASE REPORT

The patient presented with a gradual deterioration in his ability to hear in difficult acoustic environments and also to hear complex sounds such as music, over a 40-year period. His symptoms began following exposure to the solvent xylene, and in the absence of any other risk factor. Our audiological investigations revealed normal otoacoustic emissions with absent auditory brainstem responses and absent acoustic reflexes in both ears, consistent with a diagnosis of bilateral auditory neuropathy. Central test results were also abnormal, indicating possible involvement of the central auditory pathway.

CONCLUSIONS

To our knowledge, this is the first report of retrocochlear hearing loss following xylene exposure. The test results may provide some insight into the effect of xylene as an isolated agent on the human auditory pathway.

Assessment of central auditory processing in a group of workers exposed to solvents

CONCLUSION

Despite having normal hearing thresholds and speech recognition thresholds, results for central auditory tests were abnormal in a group of workers exposed to solvents. Workers exposed to solvents may have difficulties in everyday listening situations that are not related to a decrement in hearing thresholds. A central auditory processing disorder may underlie these difficulties.

OBJECTIVE

To study central auditory processing abilities in a group of workers occupationally exposed to a mix of organic solvents.

MATERIALS AND METHODS

Ten workers exposed to a mix of organic solvents and 10 matched non-exposed workers were studied. The test battery comprised pure-tone audiometry, tympanometry, acoustic reflex measurement, acoustic reflex decay, dichotic digit, pitch pattern sequence, masking level difference, filtered speech, random gap detection and hearing-in-noise tests.

RESULTS

All the workers presented normal hearing thresholds and no signs of middle ear abnormalities. Workers exposed to solvents had lower results in comparison with the control group and previously reported normative data, in the majority of the tests.

Combined effects of noise and mixed solvents exposure on the hearing function among workers in the aviation industry

This study aims to evaluate the effect of occupational exposure to noise and organic solvents on hearing loss in the aviation industry. The study population comprised 542 male workers, who worked in avionics jobs in Kimhae, Korea, who kept records of work environment evaluations and medical examinations. The Cumulative Exposure Index (CEI) was constructed to assess the lifetime cumulative exposure of the workers, and pure tone audiometry (PTA) data of the workers from their biannual medical surveillance was used to assess hearing loss. The prevalence of hearing loss found in the group exposed to noise and mixed solvents simultaneously (54.9%) was higher than those in the other groups (6.0% in the unexposed, 17.1% in the noise-only, and 27.8 % in the exposed to only a solvents mixture). The relative risks, adjusted for age, were estimated to be 4.3 (95 % CI 1.7-10.8) for the noise-only group, 8.1 (95% CI 2.0-32.5) for the noise and solvents group, and 2.6 (95 % CI 0.6-10.3) for the solvents-mixture group. These suggest that chronic exposure to mixed solvents had a toxic effect on the auditory system. This raises the issue of whether hearing conservation regulations should be applied to all workers exposed to solvents.

Hearing loss from combined exposures among petroleum refinery workers

Workers from a refinery (n = 438) were interviewed, had their hearing tested and had their exposures to noise and solvents assessed. Measurements suggested that most exposures to noise and solvents were within exposure limits recommended by international agencies; however, the prevalence for hearing loss within the exposed groups ranged from 42 to 50%, significantly exceeding the 15-30% prevalence observed for unexposed groups. The adjusted odds ratio estimates for hearing loss were 2.4 times greater for groups from aromatics and paraffins (95% CI 1.0-5.7), 3 times greater for the maintenance group (95% CI 1.3-6.9) and 1.8 times greater for the group from shipping (95% CI 0.6-4.9), when compared to unexposed workers from the warehouse and health clinic. The results of acoustic reflex decay tests suggest a retrocochlear or central auditory pathway involvement in the losses observed in certain job categories. These findings indicate that factors in addition to noise ought to be considered when investigating and preventing occupational hearing loss.

Postural sway frequency analysis in workers exposed to n-hexane, xylene, and toluene: assessment of subclinical cerebellar dysfunction

To clarify the effects of organic solvents on the postural balance system, 29 male sandal, shoe, and leather factory workers exposed to n-hexane, xylene, and toluene (solvent workers) were examined by computerized static posturography with sway frequency analysis. Concentrations of metabolites of solvents in urine samples taken from the workers in the morning before work ranged from 0.41 to 3.06 (mean, 1.20) mg/g creatinine (Cn) for 2,5-hexanedione, from 0.10 to 0.43 (mean, 0.19) g/g Cn for methylhippuric acid, and from 0.05 to 2.53 (mean, 0.37) g/g Cn for hippuric acid; estimated concentrations of n-hexane in workplace air ranged from 13 to 100 (mean, 40) ppm. Control subjects were 22 healthy males without exposure to solvents. With eyes open, postural sway with a frequency of 2-4 Hz in solvent workers was significantly larger than that in controls in the anteroposterior direction. With eyes closed, sway with a frequency of 0-1 Hz was significantly larger in solvent workers in the mediolateral and anteroposterior directions. Results of multiple regression analysis showed that with eyes open the 1- to 2-Hz and 2- to 4-Hz sways were related positively to 2,5-hexanedione and inversely with methylhippuric acid. The pattern of changes suggests that the vestibulocerebellar and spinocerebellar afferent systems are asymptomatically affected by n-hexane; the effect of n-hexane on the vestibulocerebellar system is possibly inhibited by xylene.

Otoneurological study in workers exposed to styrene in the fiberglass industry

Twenty workers exposed to styrene and acetone in small fiberglass factories were monitored for 8 h using passive dosimeters. Urine samples were collected at the end of the workshift and before the start of work on the next morning. The 8-h time-weighted average exposure values for styrene and acetone ranged from 14 to 416 mg/m3 and from 70 to 277 mg/m3, respectively. The sum of styrene metabolites, mandelic acid and phenylglyoxylic acid (MA + PGA), in the next-morning urine samples ranged from 81 to 943 mg/g creatinine. Different test sensitivity was identified in the otoneurological battery: it was low for audiometric tests and ABR, and relatively high for vestibular tests. The vestibular system seems partially sensitive to the toxic effects of styrene in the absence of clinical signs and symptoms. The actual exposure levels for styrene cannot be considered devoid of functional subclinical consequences.

Auditory and vestibular functions after single or combined exposure to toluene: a review

Toluene is a widely used organic solvent, heavily employed in many manufacturing industries. Recently, evidence has begun to accumulate on the deleterious effect of toluene exposure has on the auditory and vestibular systems. Although little published information exists regarding these effects, the reported findings indicate a need for further investigation. The results of such investigations may dramatically affect occupational hearing conservation practices and legislation. Both human and animal studies will be summarized in discussing the effects of toluene alone or in combination with noise or other chemicals. Gaps in scientific knowledge are highlighted to assist future research.

An investigation of the association between exposure to styrene and hearing loss

The importance of the association between advancing age and hearing loss is well recognized. Further, prolonged significant noise exposures are also known to result in permanent hearing loss. However, little is known of the contribution of industrial chemical exposures to hearing loss. Information available, from both animal and human studies, raises the possibility that certain aromatic hydrocarbons are ototoxic. The purpose of this study was to assess whether occupational styrene exposure causes hearing loss in a group of workers in the fiber-reinforced plastics manufacturing industry. The hearing acuity of 299 subjects was determined, using pure-tone screening audiometry, at the beginning of a single workshift and again at the end of the shift. On the same day, the personal, time-weighted average exposures of each subject to both styrene and noise were measured. In addition, information on the following factors was obtained from each participant: previous work history, including exposures to noise and chemicals; use of personal protective equipment for noise or solvents; personal and family history of hearing problems; and smoking history. Current exposures together with work histories were used to construct lifetime noise and styrene exposure indices. No conclusive evidence was found for a chronic styrene-induced effect on hearing acuity, when both noise and styrene lifetime exposures were taken into account. As expected, age and noise exposures were highly important variables, both positively associated with hearing loss. In addition, the detrimental effect of noise exposure on hearing acuity was found to be strengthened with increased age. Noise and styrene exposures were highly correlated, clearly illustrating the importance of considering all associated variables in analysis of such data. No evidence was found for a relationship between smoking, recreational noise, solvent exposures, and hearing loss.

Auditory degeneration after exposure to toluene in two genotypes of mice

Two inbred strains of mice, CBA/Ca (with a moderate hearing loss starting late in life) and C57BL/6J (with an early onset of spontaneous auditory degeneration), were exposed to toluene by inhalation (1000 ppm, 12 h/day, 7 days) at either 1 or 6 months of age. Thresholds of auditory brainstem response (ABR) were measured 3-5 days after exposure and assessed repeatedly up to the age of 16 months (C57) or 23 months (CBA). Both strains of mice exposed to toluene at 1 month of age showed a mild loss of sensitivity at a high frequency (31.5 kHz) shortly after exposure. With increasing age, toluene exposure had little effect on the aging process of the auditory system in CBA mice but accelerated age-related hearing loss in C57 mice. The results indicate that toluene exposure can aggravate auditory deterioration only in mice with a strong genetic predisposition to spontaneously precocious age-related hearing loss.

Otoneurologic disturbances caused by solvent pollution

Subjects exposed to industrial solvents may experience vertigo and nausea. Solvents are usually volatile hydrocarbon compounds, which are important parts of everyday life in a modern society. They may also cause neurastenia, personality changes, and reduced intellectual capacity. The syndrome that may develop was formerly named psycho-organic syndrome (POS), but in modern terminology it is called chronic toxic encephalopathy (CTE). The syndrome develops slowly, and during the first years no pathological findings will be found using various test batteries. Somewhat later, when the syndrome still might be reversible, psychometric, auditory, and otoneurologic testing may well unveil disturbances within the posterior fossa structures. Animal experiments suggest one site of effect for solvents to be within the cerebellum and brainstem regions with close relationship to the gamma-amino-butyric acid (GABA) transmission. In the otoneurologic test battery, visual suppression and smooth pursuit are of extreme value, as are some auditory tests such as discrimination of interrupted speech and cortical response audiometry using frequency glides as stimuli. Dynamic posturography and magnetic resonance imaging (MRI) have recently proved valuable in the diagnosis. Research is needed concerning the most efficient test battery for early detection of solvent-induced lesions. During further research it is important to unveil other toxic agents, like heavy metals and alcohol, and their damage to the central nervous system and to make comparisons between these substances and the lesions caused by hydrocarbon solvents.

Chronic toxic encephalopathy investigated using dynamic posturography

Seven male patients previously exposed to industrial solvents and diagnosed with chronic toxic encephalopathy (aged 38 to 69 years; mean age, 56 years) were investigated by dynamic posturography and compared with healthy, age-matched male control patients. Dynamic posturography comprises two phases: a sensory organization (SO) phase, in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed, and a movement coordination (MC) phase, in which the platform makes active movements. In SO testing, the patient group showed significantly impaired equilibrium performance compared with the control group in most test conditions. The MC test revealed no differences between groups. A relationship was found between the equilibrium score resulting from SO testing with stable support and visual surround and the sway area of the confidence ellipse elicited 3 years previously by static posturography with eyes open. We conclude that patients with chronic toxic encephalopathy have impaired equilibrium, as demonstrated by dynamic posturography testing.

Abstinent chronic alcoholics investigated by dynamic posturography, ocular smooth pursuit and visual suppression

Eleven male chronic alcoholic volunteers aged 44-65 years (mean 57 years) were investigated by dynamic posturography, ocular smooth pursuit and visual suppression of the vestibulo-ocular reflex (VOR). Their drinking time ranged from 8-30 years (mean 20 years) and they had been abstinent for the last 1-20 years (mean 7 years). Ocular smooth pursuit showed abnormalities in 8/11. Abnormalities were found in 5/11 in the visual suppression of the VOR. The results of dynamic posturography tests were compared to an age-matched reference material. Dynamic posturography (EquiTest) comprises a sensory organization (SO) part in which the support surface and visual surround are either stable or referenced to the patient's sway, with eyes open or closed. In the SO part the chronic alcoholics had lower equilibrium scores in all test conditions, and the differences were significant in 4 tests out of 6. In a movement coordination part the platform makes active movements, the latencies to which were significantly prolonged in the 2 larger of the 3 translational amplitudes. Adaptation to repeated tilting of the platform was estimated to be pathological in 4/10, compared to none of the controls. The abnormal pattern found in dynamic posturography correlates well with the pathology in ocular smooth pursuit and visual suppression tests, suggested to be due to alcohol induced cerebellar lesions. It is concluded that dynamic posturography is a valuable test for assessing dysequilibrium in chronic alcoholics, even abstinent.

Vestibular-oculomotor, opto-oculomotor and visual function in the rat after long-term inhalation exposure to toluene

Pigmented rats were exposed to toluene (1000 ppm, 21 h/day) for 6 or 11 weeks. The function of the vestibulo- and opto-oculomotor systems was tested one month after the end of the exposure by recording of nystagmus, induced by vestibular or optokinetic stimuli. The eye movements were recorded by a magnetic search coil technique. The optokinetic gain in the exposed animals was reduced compared to a control group. There was also a slight reduction in gain during sinusoidal oscillatory vestibular stimulation. No effect of the toluene exposure on the gain or duration of nystagmus during acceleratory or deceleratory rotatory stimulation was demonstrated, nor was there any change in the duration of the optokinetic after-nystagmus. The function of the visual system was tested 2 to 5 days after exposure by recording the electroretinogram and the visual evoked response. The conduction velocity in peripheral nerve was also measured. No effect of the toluene exposure on these variables was seen. The results indicate that long-term inhalation of toluene causes a long-lasting, possibly permanent, lesion within the vestibulo-cerebellum. They gave no evidence that such exposure affects peripheral vestibular or visual function.

The effect of toluene on the vestibulo- and opto-oculomotor system in rats, pretreated with GABAergic drugs

Toluene, an aromatic solvent, prolongs the duration of nystagmus induced by a rotatory acceleration or by an optokinetic stimulation in the pigmented rat. Baclofen, an agonist of GABAB receptors, and 4,5,6,7-tetrahydroisoxazolo[5,4-c]-pyridin-3-ol (THIP), an agonist of GABAA receptors are able to block this toluene effect on the vestibular system. On the contrary diazepam, which by itself causes an evident reduction of the duration of acceleratory nystagmus, is not able to block the toluene effect. The results indicate that the toluene effect is related to GABA transmission and that the solvent interacts by a rather receptor specific mechanism of action.