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Introduction to Ototoxins and Hearing Conservation

Jaime Westbrook, AuD, CCC-A, IF-AAA

• What is noise induced hearing loss?

• What is temporary threshold shift?

• What is permanent threshold shift?

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Introduction
Protect your hearing* by avoiding:
• Noise
• How does noise damage hearing?
• Ototoxins
*Genetics play and important role in age-related hearing loss.

• You have had this class work already, but can direct non-
audiologists interested in the topic to http://www.caohc.org/ for
lectures about the anatomy and physiology of hearing.
Organ of Corti

Yost (2007) Fig. 7.3

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High risk factors for HL:

• Age • Smoking.
• Gender and genetic factors. • Heat.
• Race and amount of • Vibrations.
pigmentation. • Solvents.
• Medical conditions. • Noise.
• High cholesterol.
• Hypertension.
• Medications (Antibiotics,
• Hyperlipedemia.
Analgesics, etc.)
• Diabetes. • Nutritional deficiencies.

Basic strategy for hearing conservation

Healthy
diet

Ototoxic Anti-
substance oxidents
exposure Hearing
control
conservation

Hazardous
noise Exercise
exposure
control

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Effect of noise on the auditory system

• Outer ear: Ear drum rupture due to noise blast.

• Middle ear: Ossicular dislocation due to noise blast.

• Inner ear: How does the noise affect the cochlea and the hair
cells?

• Auditory nerve: What do you think?

• Central auditory system: What do you think?

Effect of noise on inner ear

• Effect on stereocilia:
• Swelling.
• Fuse.
• Distorted shape.
• Decreased stiffness.

• Effect on cell body:

• Increased intracellular calcium.
• Decreased stiffness of OHCs.

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Noise induced hearing loss

• Buckling of pillar bodies.
• Distortion of hair cells.
• Edema in the strial vascularis.
• Vasoconstrictions in the spiral ligament.
• Afferent neurons might be affected too.
• Metabolic exhaustion.
• Ischemia.
• Elevated potassium level.
• Generation of free oxygen radicals.

Noise trauma (125 – 130 dB)

• Mechanical damage to reticular lamina.

• Disruption of endolymphatic compartment.

• Mechanical damage to hair cells.

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Effect of noise on auditory nerve

• Excessive release of neurotransmitters.

• Swelling and possible loss of nerve terminals.

• Neural degeneration.

Effect of noise on the central auditory system

• Tonotopic reorganization and neural hyperactivity to

compensate the reduced output from the cochlea.

Race and amount of pigmentation

• Melanin may be compensating for the inactivation of
dehydrogenase resulting from noise exposure.

• Melanin amount in the cochlea is related to the melanin

amount in the iris.

• Fair eyed (blue, hazel, green, or gray) workers may be more

susceptible to NIHL than dark eyed workers (black or brown)
workers. Same is true for white vs. dark skin workers.

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Effect of hazardous noise on hearing function

• Reduced audibility:
• Hearing loss.
• Poor signal to noise ratios in noisy environments.

• Tinnitus.

• Diplacusis: when the same tone presented to both ears but the
pitch is perceived defiantly in each ear.

• Hyperacusis: annoyance or discomfort associated with sounds that

are considered normal.

• Distortion.

NITS vs. TTS vs. PTS vs. CTS

• Noise induced threshold shift: Regardless recovery.

• Temporary threshold shift: Full recovery.

• Permanent threshold shift: No recovery.

• Compound threshold shift: Partial recovery.

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Non-auditory effects of noise

• Job productivity.
• Reduce communication ability.
• Reduce worker concentration.
• Worker fatigue.

• Annoyance: aggression behavior, stress, etc.

• Accidents: hearing loss or overprotection might reduce the ability

of the worker to hear instructions or warnings, etc.

• Sleep disturbances.

• Increase blood pressure and heart rate.

Ototoxins and noise interactions

• Ototoxins:
• Asphyxiants: e.g. carbon monoxide.
• Drugs:
• Some chemotherapy agents.
• Some antibiotics (Aminoglycocides).
• Aspirin.
• Opioid.
• Metals: e.g. mercury, manganese, lead, germanium, etc.
• Solvents: e.g. ethylbenzene, styrene, toluene.
• Chemicals: hydrogen cyanide, diesel fuel, other types of fuel.

 Additive effects vs. synergistic effects.

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Complete the following table

Substance Allowable dose Exposure methods Impact on health

Carbon monoxide

Lead

Mercury

Germanium

Styrene

Toluene

n-Hexane

Xylene

Details in chapter 1 in your book.

High risk occupations

• National Institute of Occupational Safety and Health
(NIOSH) (1998):

• Agriculture.
• Mining.
• Construction.
• Manufacturing.
• Utilities.
• Transportation.
• Military.
• Call centers.

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Construction
Require noise emission
labels for tools and
machines
At source
Require construction
companies to use tools
that have safe noise
emissions
Controlling
construction noise Ensure boundary noise
exposure At point of reception limits are not exceeded
at site

Ensure maintenance of
tools and equipment
At work site
and effective hearing
conservation programs

• Some construction machines can be very loud:

• Powered nailer  128 dB A.

Military:
• Some firearms noise  150 – 180 dB SPL.
• NIHL can still happen even with protection.

Manufacturing:
• ~30 to 40% of industrial workers are exposed to
hazardous noise.

Mining:
• ~75% of mining workers are exposed to hazardous noise.

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Other professions at high risk

• Health care professions:

• Some orthopedic surgical instruments include saws, drills, and

hammers can exceed 100 dB A.
• E.g. knee replacement.

• Dentist equipment.

• Workers at large kitchens.

• Professional disc jockeys (e.g. at night clubs).

Recreational NIHL

• Personal music devices.

• Night clubs.

• Concerts.

• Inhale products (e.g. glues) for its euphoric effect.

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Need for hearing conservation

• 7 to 21% of disabling HL is NIHL.

• More in developing countries.

• US statistics (2008)
• Tinnitus is the first most prevalent work-related illness.
• Hearing loss is the second most prevalent work-related illness.

Effects of untreated hearing loss on patient

• Emotional

• Social

• Physical

• Cognitive

• Behavioral

• Professional

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Effects of untreated hearing loss on

significant other, friends and family

• Relationship problems • Misunderstanding

• Stressful communication • Perceived changes in

temperament
• Fatigue
• Increasing voice - harshness
• Individual without HL might feel
rejected/neglected by SO with HL
because of recovery time

The Cognitive Effort of listening

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Effects of untreated hearing loss on Society

• Limited contribution to society.

• Less likely to volunteer.

• Less likely to spend money at theaters, movies, or

restaurants.

• In the USA: Untreated hearing loss impact exceeds $100

billion dollars.

Hearing conservation programs

Chapter (2) Noise monitoring .
Chapter (3) Noise control.
Chapter (4) Monitoring of auditory sensitivity.
Chapter (5) Detailed audiological evaluations if needed.
Use of hearing protection devices when noise control measures are in
Chapter (6)
sufficient.
Chapter (7) Education and training of workers and managers.
Assessment of effectiveness of the hearing conservation measures and
Chapter (8)
correction of any deficiencies.
Chapter (9) Hearing conservation programs for musicians.
Chapter (10) Hearing conservation programs in non-occupational settings.
Chapter (11) Compensation for occupational NIHL patients.
Support workers who have to continue working in noisy environment (e.g.
Chapter (12)
mining).
Chapter (13) Hearing conservation programs in educational settings.

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Measure noise
Chapter (2)
Musicians
Chapter (9)
If control is not enough
Control noise Provide worker
Use protection devices compensation
Chapter (3)
Chapter (6) Chapter (11)
Hearing conservation
Provide comprehensive
Monitor hearing function audiological Support and treat HL
Chapter (4) assessment Chapter (12)
Chapter (5)
Non-occupational
settings Educate and train Provide vocational
Chapter (10) workers rehabilitation
Chapter (7) Chapter (12)

Assess effectiveness of Future trends

Educational settings hearing conservation Correct any deficiencies
Chapter (13) Chapter (8) Chapter (14)
Chapter (8)

Questions?

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