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Wang J, Zhao L, Gu X, Xue Y, Wang S, Xiao R, Vandenberghe L, Peng KA, Shu Y, Li H. Efficient delivery of adeno-associated virus (AAV) into inner ear in vivo via trans-stapes route in adult guinea pig. Hum Gene Ther 2022; 33:719-728. [PMID: 35156857 DOI: 10.1089/hum.2021.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adeno-associated virus (AAV) are potent vectors to achieve treatment against hearing loss resulting from genetic defects. However, the effects of delivery routes and the corresponding transduction efficiencies for clinical applications remain elusive. Here, we screened AAV vectors of three serotypes (AAV 8, 9 and Anc80L65) into the inner ears of adult normal guinea pigs through trans-stapes (oval window) and trans-round window delivery routes in vivo. Trans-stapes route is akin to stape surgeries in humans. Then, auditory brainstem response (ABR) measurements were conducted to evaluate postoperative hearing, and inner ear tissues were harvested for transduction efficiency analysis. Results showed that AAV8 targeted partial inner hair cells (IHCs) in cochlear basal turn; AAV9 targeted IHCs in cochlear basal and second turn, also a part of vestibular hair cells (VHCs). In contrast, Anc80L65 contributed to GFP signals of 80%-95% IHCs and 67%-91% outer hair cells (OHCs), as well as 69% VHCs via the trans-round window route, with 15-20 dB ABR thresholds shifts. And, via trans-stapes (oval window) route, there were 71%-90% IHCs and 42%-81% OHCs, along with 64% VHCs demonstrating GFP positive, and the ABR thresholds shifts were within 10 dB. This study revealed AAV could be efficiently delivered into mammalian inner ear cells in vivo via trans-stapes (oval window) route with postoperative hearing preservation, and both delivery routes showed promise of virus-based clinical translation of hearing impairment treatment.
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Affiliation(s)
- Jinghan Wang
- Eye and ENT hospital of Fudan University, Department of Otorhinolaryngology, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Shanghai, China;
| | - Liping Zhao
- ENT institute, Eye & ENT Hospital, Fudan University, Department of Otorhinolaryngology, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
| | - Xi Gu
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
| | - Yuanyuan Xue
- ENT institute, Eye & ENT Hospital, Fudan University, Department of Otorhinolaryngology, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
| | - Shengyi Wang
- ENT institute, Eye & ENT Hospital, Fudan University, Department of Otorhinolaryngology, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
| | - Ru Xiao
- Ocular Genomics Institute, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States.,Grousbeck Gene Therapy Center, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States;
| | - Luk Vandenberghe
- Harvard Medical School, Boston, United States.,Ocular Genomics Institute, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States.,Grousbeck Gene Therapy Center, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States;
| | - Kevin A Peng
- House Ear Institute, 556621, Los Angeles, California, United States;
| | - Yilai Shu
- ENT institute, Eye & ENT Hospital, Fudan University, Department of Otorhinolaryngology, Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
| | - Huawei Li
- Eye and ENT Hospital, Shanghai Medical College, Fudan University, Department of Otolaryngology - Head and Neck Surgery, , Shanghai, China.,Fudan University Institutes of Biomedical Sciences, 262117, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China;
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2
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Zhang C, Frye MD, Riordan J, Sharma A, Manohar S, Salvi R, Sun W, Hu BH. Loss of CX3CR1 augments neutrophil infiltration into cochlear tissues after acoustic overstimulation. J Neurosci Res 2021; 99:2999-3020. [PMID: 34520571 DOI: 10.1002/jnr.24925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
The cochlea, the sensory organ for hearing, has a protected immune environment, segregated from the systemic immune system by the blood-labyrinth barrier. Previous studies have revealed that acute acoustic injury causes the infiltration of circulating leukocytes into the cochlea. However, the molecular mechanisms controlling immune cell trafficking are poorly understood. Here, we report the role of CX3CR1 in regulating the entry of neutrophils into the cochlea after acoustic trauma. We employed B6.129P-Cx3cr1tm1Litt /J mice, a transgenic strain that lacks the gene, Cx3cr1, for coding the fractalkine receptor. Our results demonstrate that lack of Cx3cr1 results in the augmentation of neutrophil infiltration into cochlear tissues after exposure to an intense noise of 120 dB SPL for 1 hr. Neutrophil distribution in the cochlea is site specific, and the infiltration level is positively associated with noise intensity. Moreover, neutrophils are short lived and macrophage phagocytosis plays a role in neutrophil clearance, consistent with typical neutrophil dynamics in inflamed non-cochlear tissues. Importantly, our study reveals the potentiation of noise-induced hearing loss and sensory cell loss in Cx3cr1-/- mice. In wild-type control mice (Cx3cr1+/+ ) exposed to the same noise, we also found neutrophils. However, neutrophils were present primarily inside the microvessels of the cochlea, with only a few in the cochlear tissues. Collectively, our data implicate CX3CR1-mediated signaling in controlling neutrophil migration from the circulation into cochlear tissues and provide a better understanding of the impacts of neutrophils on cochlear responses to acoustic injury.
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Affiliation(s)
- Celia Zhang
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA.,Department of Audiology, School of Health Sciences, University of the Pacific, San Francisco, CA, USA
| | - Mitchell D Frye
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA
| | - Juliana Riordan
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA
| | - Ashu Sharma
- Department of Oral Biology, School of Dental Medicine, University of Buffalo, The State University of New York, Buffalo, NY, USA
| | | | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA
| | - Wei Sun
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA
| | - Bo Hua Hu
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA
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3
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Swiderski DL, Colesa DJ, Hughes AP, Raphael Y, Pfingst BE. Relationships between Intrascalar Tissue, Neuron Survival, and Cochlear Implant Function. J Assoc Res Otolaryngol 2020; 21:337-352. [PMID: 32691251 DOI: 10.1007/s10162-020-00761-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/12/2020] [Indexed: 12/15/2022] Open
Abstract
Fibrous tissue and/or new bone are often found surrounding a cochlear implant in the cochlear scalae. This new intrascalar tissue could potentially limit cochlear implant function by increasing impedance and altering signaling pathways between the implant and the auditory nerve. In this study, we investigated the relationship between intrascalar tissue and 5 measures of implant function in guinea pigs. Variation in both spiral ganglion neuron (SGN) survival and intrascalar tissue was produced by implanting hearing ears, ears deafened with neomycin, and neomycin-deafened ears treated with a neurotrophin. We found significant effects of SGN density on 4 functional measures but adding intrascalar tissue level to the analysis did not explain more variation in any measure than was explained by SGN density alone. These results suggest that effects of intrascalar tissue on electrical hearing are relatively unimportant in comparison to degeneration of the auditory nerve, although additional studies in human implant recipients are still needed to assess the effects of this tissue on complex hearing tasks like speech perception. The results also suggest that efforts to minimize the trauma that aggravates both tissue development and SGN loss could be beneficial.
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Affiliation(s)
- Donald L Swiderski
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deborah J Colesa
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aaron P Hughes
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yehoash Raphael
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bryan E Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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Honeder C, Zhu C, Gausterer JC, Schöpper H, Ahmadi N, Saidov N, Nieratschker M, Gabor F, Arnoldner C. Sustained-Release Triamcinolone Acetonide Hydrogels Reduce Hearing Threshold Shifts in a Model for Cochlear Implantation with Hearing Preservation. Audiol Neurootol 2019; 24:237-244. [PMID: 31574511 DOI: 10.1159/000501331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In recent years, the preservation of residual hearing has become a major factor in patients undergoing cochlear implantation (CI). In studies attempting to pharmaceutically improve hearing preservation rates, glucocorticoids (GCs) applied perioperatively in many institutions have emerged as a promising treatment regimen. Although dexamethasone is most commonly used and has been applied successfully by various research groups, recently pharmacological properties have been reported to be relatively unsuitable for topical delivery to the inner ear. Consequently other glucocorticoids merit further evaluation. The aim of this study was therefore to evaluate the otoprotective effects of the topical application of a sustained-release triamcinolone acetonide (TAAC) hydrogel in CI with hearing preservation. METHODS Normal-hearing pigmented guinea pigs were randomized into a group receiving a single dose of a 6% TAAC poloxamer 407 hydrogel, a group receiving a 30% TAAC hydrogel and a control group. All hydrogel applications were performed 1 day prior to CI. After a cochleostomy was drilled, a specifically designed silicone electrode was inserted into the scala tympani for 5 mm. Frequency-specific compound action potentials of the auditory nerve (0.5-32 kHz) were measured pre- and directly postoperatively as well as on days 3, 7, 14, 21, and 28. Finally, temporal bones were harvested for histological evaluation. RESULTS Application of the TAAC hydrogels resulted in significantly reduced hearing threshold shifts in low, middle and high frequencies and improved spiral ganglion cell survival in the second turn of the cochlea. Outer hair cell numbers in the basal and second turn of the cochlea were slightly reduced after TAAC application. CONCLUSION In summary, we were able to demonstrate functional benefits of a single preoperative application of a TAAC hydrogel in a guinea pig model for CI, which persisted until the end of the observational period, that is, 28 days after surgery.
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Affiliation(s)
- Clemens Honeder
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Chengjing Zhu
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Julia Clara Gausterer
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
| | - Hanna Schöpper
- Department of Pathobiology, Institute of Anatomy, Histology and Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Navid Ahmadi
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Nodir Saidov
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Michael Nieratschker
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Franz Gabor
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria,
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
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Glucocorticoid for Hearing Preservation After Cochlear Implantation: A Systemic Review and Meta-analysis of Animal Studies. Otol Neurotol 2019; 40:1178-1185. [DOI: 10.1097/mao.0000000000002383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Ren Y, Landegger LD, Stankovic KM. Gene Therapy for Human Sensorineural Hearing Loss. Front Cell Neurosci 2019; 13:323. [PMID: 31379508 PMCID: PMC6660246 DOI: 10.3389/fncel.2019.00323] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/01/2019] [Indexed: 12/22/2022] Open
Abstract
Hearing loss is the most common sensory impairment in humans and currently disables 466 million people across the world. Congenital deafness affects at least 1 in 500 newborns, and over 50% are hereditary in nature. To date, existing pharmacologic therapies for genetic and acquired etiologies of deafness are severely limited. With the advent of modern sequencing technologies, there is a vast compendium of growing genetic alterations that underlie human hearing loss, which can be targeted by therapeutics such as gene therapy. Recently, there has been tremendous progress in the development of gene therapy vectors to treat sensorineural hearing loss (SNHL) in animal models in vivo. Nevertheless, significant hurdles remain before such technologies can be translated toward clinical use. These include addressing the blood-labyrinth barrier, engineering more specific and effective delivery vehicles, improving surgical access, and validating novel targets. In this review, we both highlight recent progress and outline challenges associated with in vivo gene therapy for human SNHL.
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Affiliation(s)
- Yin Ren
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States
| | - Lukas D. Landegger
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States
- Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Konstantina M. Stankovic
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States
- Harvard Program in Therapeutic Science, Harvard University, Boston, MA, United States
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7
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Chen Y, Gu J, Liu J, Tong L, Shi F, Wang X, Wang X, Yu D, Wu H. Dexamethasone-loaded injectable silk-polyethylene glycol hydrogel alleviates cisplatin-induced ototoxicity. Int J Nanomedicine 2019; 14:4211-4227. [PMID: 31239676 PMCID: PMC6559256 DOI: 10.2147/ijn.s195336] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Cisplatin is an extensively used anti-neoplastic agent for the treatment of various solid tumors. However, a high incidence of severe ototoxicity is accompanied by its use in the clinic. Currently, no drugs or therapeutic strategies have been approved for the treatment of cisplatin-induced ototoxicity by the FDA. Purpose: The purpose of this study was to investigate the otoprotective effects of dexamethasone (DEX)-loaded silk-polyethylene hydrogel (DEX-SILK) following round window membrane administration in the cisplatin-induced ototoxicity mouse model. Methods: The morphology, gelation kinetics, viscosity and secondary structure of the DEX-SILK hydrogel were analyzed. DEX concentration in the perilymph was tested at different time points following hydrogel injection on the RWM niche. Cultured cells (HEI-OC1), organ of Corti explants (C57/BL6, P0-2), and cisplatin-induced hearing loss mice model (C57/BL6) were used as in vitro and in vivo models for investigating the otoprotective effects of DEX-SILK hydrogel against cisplatin. Results: Encapsulation of DEX with a loading of 8% (w/v) did not significantly change the silk gelation time, and DEX was evenly distributed in the Silk-PEG hydrogel as visualized by scanning electron microscopy (SEM). The concentration of Silk majorly influenced DEX distribution, morphological characteristics, viscosity, and gelation time. The optimized DEX-SILK hydrogel (8% w/v loading, 15% silk concentration, 10 μl) was administered directly onto the RWM of the guinea pigs. The DEX concentration in the perilymph was maintained above 1 μg/ml for at least 21 days for the DEX-SILK, while it was maintained for less than 6 h in the control sample of free DEX. DEX-SILK (5-60 ng/ml) exhibited significant protective effects against cisplatin-induced cellular ototoxicity and notably reduced the production of reactive oxygen species (ROS). Eventually, pretreatment with DEX-SILK effectively preserved outer hair cells in the cultured organ of Corti explants and demonstrated significant hearing protection at 4, 8, and 16 kHz in the cisplatin-induced hearing loss mice as compared to the effects noted following pretreatment with DEX. Conclusion: These results demonstrated the clinical value of DEX-SILK for the therapy of cisplatin-induced ototoxicity.
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Affiliation(s)
- Yuming Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300) , Shanghai 200011, People's Republic of China
| | - Jiayi Gu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300) , Shanghai 200011, People's Republic of China
| | - Jian Liu
- National Engineering Laboratory for Modern Silk, Soochow University , Suzhou 215123, People's Republic of China
| | - Ling Tong
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
| | - Fuxin Shi
- Department of Otology and Laryngology, Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Decibel Therapeutics , Boston, MA, 02215, USA
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, Soochow University , Suzhou 215123, People's Republic of China
| | - Xueling Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300) , Shanghai 200011, People's Republic of China
| | - Dehong Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300) , Shanghai 200011, People's Republic of China
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Ear Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300) , Shanghai 200011, People's Republic of China
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8
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Honeder C, Ahmadi N, Kramer AM, Zhu C, Saidov N, Arnoldner C. Cochlear Implantation in the Guinea Pig. J Vis Exp 2018. [PMID: 29985368 PMCID: PMC6101746 DOI: 10.3791/56829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cochlear implants are highly efficient devices that can restore hearing in subjects with profound hearing loss. Due to improved speech perception outcomes, candidacy criteria have been expanded over the last few decades. This includes patients with substantial residual hearing that benefit from electrical and acoustical stimulation of the same ear, which makes hearing preservation during cochlear implantation an important issue. Electrode impedances and the related issue of energy consumption is another major research field, as progress in this area could pave the way for fully implantable auditory prostheses. To address these issues in a systematic way, adequate animal models are essential. Therefore, the goal of this protocol is to provide an animal model of cochlear implantation, which can be used to address various research questions. Due to its large tympanic bulla, which allows easy surgical access to the inner ear, as well as its hearing range which is relatively similar to the hearing range of humans, the guinea pig is a commonly used species in auditory research. Cochlear implantation in the guinea pig is performed via a retroauricular approach. Through the bullostomy a cochleostomy is drilled and the cochlear implant electrode is inserted into the scala tympani. This electrode can then be used for electrical stimulation, determination of electrode impedances and the measurement of compound action potentials of the auditory nerve. In addition to these applications, cochlear implant electrodes can also be used as drug delivery devices, if a topical delivery of pharmaceutical agents to the cells or fluids of the inner ear is intended.
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Affiliation(s)
- Clemens Honeder
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna;
| | - Navid Ahmadi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna
| | | | - Chengjing Zhu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna
| | - Nodir Saidov
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna
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Abstract
Drug delivery to the inner ear is an ideal method to treat a wide variety of otologic conditions. A broad range of potential applications is just beginning to be explored. New approaches combine principles of inner ear pharmacokinetics with emerging technologies of drug delivery including novel delivery systems, drug-device combinations, and new categories of drugs. Strategies include cell-specific targeting, manipulation of gene expression, local activation following systemic delivery, and use of stem cells, viral vectors, and gene editing systems. Translation of these therapies to the clinic remains challenging given the potential risks of intracochlear and intralabyrinthine trauma, our limited understanding of the etiologies of particular inner ear disorders, and paucity of accurate diagnostic tools at the cellular level. This review provides an overview of future methods, delivery systems, disease targets, and clinical considerations required for translation to clinical medicine.
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Skarżyńska MB, Skarżyński PH, Król B, Kozieł M, Osińska K, Gos E, Skarżyński H. Preservation of Hearing Following Cochlear Implantation Using Different Steroid Therapy Regimens: A Prospective Clinical Study. Med Sci Monit 2018; 24:2437-2445. [PMID: 29680860 PMCID: PMC5933206 DOI: 10.12659/msm.906210] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background A prospective clinical study was conducted to assess different regimens of steroid therapy and preservation of hearing following cochlear implantation. Material/Methods Study participants were ≥18 years-of-age, with a cochlear duct length ≥27.1 mm measured by computed tomography (CT), with hearing sound levels in the range of 10–120 decibels (dB) and sound frequencies of 125–250 hertz (Hz); sound levels of 35–120 dB and frequencies of 500–1,000 Hz; sound levels of 75–120 dB and frequencies of 2,000–8,000 Hz. Study exclusion criteria included diseases with contraindications for steroid therapy or medications that increased the effects of steroids. Patients had cochlear implantation and were divided into three treatment groups: intravenous (IV) steroid therapy (standard steroid therapy): combined oral and IV steroid therapy (prolonged steroid therapy); and a control group (cochlear implantation without steroid therapy). Hearing preservation was established by pure tone audiometry based on the pre-operative and postoperative average hearing thresholds according to the formula developed by the HEARRING Network. Results There were 36 patients included in the study. In all cases, the cochlear implant electrode was inserted via the round window approach with a straight electrode length of 28 mm. Patients with combined oral and IV steroid therapy (prolonged steroid therapy) had better results when compared with patients with intravenous (IV) steroid therapy (standard steroid therapy) and the control group. Conclusions Prolonged steroid therapy using combined oral and IV steroids stabilized hearing thresholds and preserved hearing in adult patients following cochlear implantation.
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Affiliation(s)
- Magdalena Beata Skarżyńska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Poland
| | - Piotr Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland.,Centre of Hearing and Speech Medincus, Kajetany, Poland.,Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Król
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland
| | - Magdalena Kozieł
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland
| | - Kamila Osińska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland
| | - Elżbieta Gos
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland
| | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,World Hearing Center, Kajetany, Poland
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11
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Zhong LL, Zhang Y, Liang XJ, Hou K, Han JW, Wang FY, Hao QQ, Jiang QQ, Yu N, Guo WW, Yang SM. Inner ear structure of miniature pigs measured by multi-planar reconstruction techniques. Am J Transl Res 2018; 10:709-717. [PMID: 29636861 PMCID: PMC5883112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/21/2017] [Indexed: 06/08/2023]
Abstract
To study the structures of the scala vestibuli and tympani of miniature pigs in order to evaluate the feasibility of using miniature pigs as the animal model for cochlear implant. The temporal bones of three miniature pigs with normal hearing were scanned by micro-CT. With the aid of the Mimics software, we reconstructed the 3D structure of inner ear basing on the serial images of the miniature pig, and obtained dimensions of the scala vestibuli and tympani with multi-planar reconstruction (MPR) technique. The constructed slicing images displayed the fine structures of the cochlea. The results of our study showed that the cross-sectional areas of the scala tympani were greatest at 2.67 ± 0.90 mm2 when the circumferential length from the starting point of basal turn of the cochlea reached to 1.16 mm. The scala vestibuli has a largest width and height at the starting point of basal turn. The width and the height were 2.65 ± 0.45 mm and 2.43 ± 0.2 mm respectively. The largest width and height of the scala tympani were 2.17 ± 0.30 mm and 1.83 ± 0.42 mm. The result of our study suggests that the cochlea of miniature pigs is highly consistent with human's. Miniature pigs may be used as a new model for cochlear implant. MPR technique may be used as a new approach to obtain further information of patient's cochlea in surgeons which is helpful to select suitable cochlear implant devices and surgery approach.
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Affiliation(s)
- Ling-Ling Zhong
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
- Department of Otolayngology, Head & Neck Surgery, The Tianjin Children’s HospitalTianjin 300074, P. R. China
| | - Yan Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Jilin UniversityChangchun 130021, Jilin, P. R. China
| | - Xiao-Jie Liang
- Department of Otolaryngeal-Head Neck Surgery, The Army General Hospita of PLABeijing 100700, P. R. China
| | - Kun Hou
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Jia-Wei Han
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Fang-Yuan Wang
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Qing-Qing Hao
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Qing-Qing Jiang
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Ning Yu
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Wei-Wei Guo
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
| | - Shi-Ming Yang
- Department of Otolayngology, Head & Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General HospitalBeijing 100853, P. R. China
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12
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Pharmacokinetic principles in the inner ear: Influence of drug properties on intratympanic applications. Hear Res 2018; 368:28-40. [PMID: 29551306 DOI: 10.1016/j.heares.2018.03.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/06/2018] [Accepted: 03/02/2018] [Indexed: 01/12/2023]
Abstract
Local drug delivery to the ear has gained wide clinical acceptance, with the choice of drug and application protocol in humans largely empirically-derived. Here, we review the pharmacokinetics underlying local therapy of the ear using the drugs commonly used in clinical practice as examples. Based on molecular properties and perilymph measurements interpreted through computer simulations we now better understand the principles underlying entry and distribution of these and other drugs in the ear. From our analysis, we have determined that dexamethasone-phosphate, a pro-drug widely-used clinically, has molecular and pharmacokinetic properties that make it ill-suited for use as a local therapy for hearing disorders. This polar form of dexamethasone, used as a more soluble agent in intravenous preparations, passes less readily through lipid membranes, such as those of the epithelia restricting entry at the round window membrane and stapes. Once within the inner ear, dexamethasone-phosphate is cleaved to the active form, dexamethasone, which is less polar, passes more readily through lipid membranes of the blood-perilymph barrier and is rapidly eliminated from perilymph without distributing to apical cochlear regions. Dexamethasone-phosphate therefore provides only a brief exposure of the basal regions of the cochlea to active drug. Other steroids, such as triamcinolone-acetonide, exhibit pharmacokinetic properties more appropriate to the ear and merit more detailed consideration.
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Perilymph pharmacokinetics of marker applied through a cochlear implant in guinea pigs. PLoS One 2017; 12:e0183374. [PMID: 28817653 PMCID: PMC5560723 DOI: 10.1371/journal.pone.0183374] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/02/2017] [Indexed: 11/26/2022] Open
Abstract
Patients undergoing cochlear implantation could benefit from a simultaneous application of drugs into the ear, helping preserve residual low-frequency hearing and afferent nerve fiber populations. One way to apply drugs is to incorporate a cannula into the implant, through which drug solution is driven. For such an approach, perilymph concentrations achieved and the distribution in the ear over time have not previously been documented. We used FITC-labeled dextran as a marker, delivering it into perilymph of guinea pigs at 10 or 100 nL/min though a cannula incorporated into a cochlear implant with the outlet in the mid basal turn. After injections of varying duration (2 hours, 1 day or 7 days) perilymph was collected from the cochlear apex using a sequential sampling technique, allowing dextran levels and gradients along scala tympani to be quantified. Data were interpreted quantitatively using computer simulations of the experiments. For injections of 2 hours duration, dextran levels were critically influenced by the presence or absence of fluid leakage at the cochleostomy site. When the cochleostomy was fluid-tight, substantially higher perilymph levels were achieved at the injection site, with concentration declining along scala tympani towards the apex. Contrary to expectations, large dextran gradients along scala tympani persisted after 24 hours of sustained injection and were still present in some animals after 7 days injection. Functional changes associated with implantation and dextran delivery, and the histological state of the implant and cannula were also documented. The persistent longitudinal gradients of dextan along the ear were not readily explained by computer simulations of the experiments based on prior pharmacokinetic data. One explanation is that inner ear pharmacokinetics are altered in the period after cochlear implantation, possibly by a permeabilization of the blood-labyrinth barrier as part of the immune response to the implant.
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Defining the Hook Region Anatomy of the Guinea Pig Cochlea for Modeling of Inner Ear Surgery. Otol Neurotol 2017; 38:e179-e187. [DOI: 10.1097/mao.0000000000001446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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15
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Mamelle E, Kechai NE, Granger B, Sterkers O, Bochot A, Agnely F, Ferrary E, Nguyen Y. Effect of a liposomal hyaluronic acid gel loaded with dexamethasone in a guinea pig model after manual or motorized cochlear implantation. Eur Arch Otorhinolaryngol 2016; 274:729-736. [PMID: 27714498 DOI: 10.1007/s00405-016-4331-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/30/2016] [Indexed: 11/26/2022]
Abstract
Goals of cochlear implantation have shifted from complete insertion of the cochlear electrode array towards low traumatic insertion with minimally invasive techniques. The aim of this study was first to evaluate, in a guinea pig model of cochlear implantation, the effect of a motorized insertion technique on hearing preservation. The second goal was to study a new gel formulation containing dexamethasone phosphate loaded in liposomes (DEX-P). Guinea pigs had a unilateral cochlear implantation with either a manual technique (n = 12), or a motorized technique (n = 15), with a 0.4 mm diameter and 4 mm long array trough a cochleostomy. At the end of the procedure, hyaluronic acid gel containing drug-free liposomes, or liposomes loaded with DEX-P, was injected into the bulla. Auditory brainstem responses thresholds were recorded before surgery and day 2 and 7 after surgery. All the animals had increased auditory brainstem responses thresholds after the cochlear implantation. Implanted animals with the motorized insertion tool experienced a partial hearing recovery at day 7 but not in those implanted with the manual insertion procedure (p < 0.001). In the manually implanted animals, a partial recovery was observed when DEX-P contained in liposomal gel was locally administrated (p < 0.0001). Finally, no additive effect with the motorized insertion was noticed. The deleterious effect of manual insertion, during cochlear implantation, can be prevented with local DEX-P administration in the bulla at day 7. The use of a motorized tool performed more atraumatic electrode array insertion for postoperative hearing.
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Affiliation(s)
- Elisabeth Mamelle
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France.
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France.
| | - Naila El Kechai
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Benjamin Granger
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
- Department of Public Health, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Olivier Sterkers
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
| | - Amélie Bochot
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Florence Agnely
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Evelyne Ferrary
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
| | - Yann Nguyen
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
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16
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Honeder C, Zhu C, Schöpper H, Gausterer JC, Walter M, Landegger LD, Saidov N, Riss D, Plasenzotti R, Gabor F, Arnoldner C. Effects of sustained release dexamethasone hydrogels in hearing preservation cochlear implantation. Hear Res 2016; 341:43-49. [PMID: 27519654 DOI: 10.1016/j.heares.2016.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/28/2016] [Accepted: 08/08/2016] [Indexed: 01/12/2023]
Abstract
It has been shown that glucocorticoids reduce the hearing threshold shifts associated with cochlear implantation. Previous studies evaluated the administration of glucocorticoids immediately before surgery or the repeated pre- or perioperative systemic application of glucocorticoids. The aim of this study was to evaluate the effects of a sustained release dexamethasone hydrogel in hearing preservation cochlear implantation. To address this issue, a guinea pig model of cochlear implantation was used. 30 normal hearing pigmented guinea pigs were randomized into a group receiving a single dose of a dexamethasone/poloxamer407 hydrogel one day prior to surgery, a second group receiving the hydrogel seven days prior to surgery and a control group. A silicone cochlear implant electrode designed for the use in guinea pigs was inserted to a depth of 5 mm through a cochleostomy. Compound action potentials of the auditory nerve (frequency range 0.5-32 kHz) were measured preoperatively, directly postoperatively and on postoperative days 3, 7, 14, 21 and 28. Following the last audiometry, temporal bones were harvested and histologically evaluated. Dexamethasone hydrogel application one day prior to surgery resulted in significantly reduced hearing threshold shifts at low, middle and high frequencies measured at postoperative day 28 (p < 0.05). Application of the hydrogel seven days prior to surgery did not show such an effect. Dexamethasone application one day prior to surgery resulted in increased outer hair cell counts in the cochlear apex and in reduced spiral ganglion cell counts in the basal and middle turn of the cochlea, a finding that was associated with a higher rate of electrode translocation in this group. In this study, we were able to demonstrate functional benefits of a single preoperative intratympanic application of a sustained release dexamethasone hydrogel in a guinea pig model of cochlear implantation.
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Affiliation(s)
- Clemens Honeder
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Chengjing Zhu
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Hanna Schöpper
- Department of Pathobiology, Institute of Anatomy, Histology and Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Julia Clara Gausterer
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
| | - Manuel Walter
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | | | - Nodir Saidov
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Roberto Plasenzotti
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Franz Gabor
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
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17
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Bas E, Bohorquez J, Goncalves S, Perez E, Dinh CT, Garnham C, Hessler R, Eshraghi AA, Van De Water TR. Electrode array-eluted dexamethasone protects against electrode insertion trauma induced hearing and hair cell losses, damage to neural elements, increases in impedance and fibrosis: A dose response study. Hear Res 2016; 337:12-24. [DOI: 10.1016/j.heares.2016.02.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/30/2015] [Accepted: 02/11/2016] [Indexed: 12/13/2022]
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