New horizons in holistic, person-centred health promotion for hearing healthcare.

Over the course of a lifetime, the risk of experiencing multiple chronic conditions (multimorbidity) increases, necessitating complex healthcare regimens. Healthcare that manages these requirements in an integrated way has been shown to be more effective than services that address specific diseases individually. One such chronic condition that often accompanies ageing is hearing loss and related symptoms, such as tinnitus. Hearing loss is not only highly prevalent in older adults but is also a leading cause of disability. Accumulating evidence demonstrates an interplay between auditory function and other aspects of health. For example, poorer cardiometabolic health profiles have been shown to increase the risk of hearing loss, which has been attributed to microvascular disruptions and neural degeneration. Additionally, hearing loss itself is associated with significantly increased odds of falling and is a potentially modifiable risk factor for cognitive decline and dementia. Such evidence warrants consideration of new possibilities-a new horizon-for hearing care to develop a holistic, person-centred approach that promotes the overall health and wellbeing of the individual, as well as for audiology to be part of an interdisciplinary healthcare service. To achieve this holistic goal, audiologists and other hearing healthcare professionals should be aware of the range of conditions associated with hearing loss and be ready to make health promoting recommendations and referrals to the appropriate health practitioners. Likewise, healthcare professionals not trained in audiology should be mindful of their patients' hearing status, screening for hearing loss or referring them to a hearing specialist as required.

Evidence of "hidden hearing loss" following noise exposures that produce robust TTS and ABR wave-I amplitude reductions.

In animals, noise exposures that produce robust temporary threshold shifts (TTS) can produce immediate damage to afferent synapses and long-term degeneration of low spontaneous rate auditory nerve fibers. This synaptopathic damage has been shown to correlate with reduced auditory brainstem response (ABR) wave-I amplitudes at suprathreshold levels. The perceptual consequences of this "synaptopathy" remain unknown but have been suggested to include compromised hearing performance in competing background noise. Here, we used a modified startle inhibition paradigm to evaluate whether noise exposures that produce robust TTS and ABR wave-I reduction but not permanent threshold shift (PTS) reduced hearing-in-noise performance. Animals exposed to 109 dB SPL octave band noise showed TTS >30 dB 24-h post noise and modest but persistent ABR wave-I reduction 2 weeks post noise despite full recovery of ABR thresholds. Hearing-in-noise performance was negatively affected by the noise exposure. However, the effect was observed only at the poorest signal to noise ratio and was frequency specific. Although TTS >30 dB 24-h post noise was a predictor of functional deficits, there was no relationship between the degree of ABR wave-I reduction and degree of functional impairment.

Assessment of thermal treatment via irrigation of external ear to reduce cisplatin-induced hearing loss.

Systemic and local changes in body temperature can have a profound effect on traumatic injuries including those to the inner ear. Therefore, we investigated the effects of acutely increasing or decreasing the temperature of the external ear canal on cisplatin-induced hearing loss. The external auditory canals of male guinea pigs were acutely irrigated with warm (44 °C), euthermic (37 °C), or cool (30 °C) water and subsequently injected with cisplatin (12 mg/kg, i.p.). Hearing was assessed by the auditory brainstem response and cochleograms were prepared to determine loss of hair cells. Ear canal irrigation with warm water potentiated cisplatin-induced hearing loss and outer hair cell loss whereas cool ear canal irrigation showed significant protection from cisplatin-induced hearing loss and outer hair cell loss. These results suggest that non-invasive cool water ear canal irrigation may be highly effective clinical procedure for protecting against cisplatin-induced hearing loss.

Application of frequency modulated chirp stimuli for rapid and sensitive ABR measurements in the rat.

Rodents have proven to be a useful model system to screen genes, ototoxic compounds and sound exposure protocols that may play a role in hearing loss. High-throughput screening depends upon a rapid and reliable functional assay for hearing loss. This study describes the use of a frequency modulated (FM) chirp stimulus as an alternative to the click to derive a rapid assessment of auditory brainstem response (ABR) threshold in the rodent. We designed a rising frequency A-chirp based upon the spatial mapping of preferred frequency along the rat basilar membrane to provide a more synchronous and equipotent input across the length of the cochlea. We observed that the ABR wave I and wave IV amplitudes evoked by the A-chirp were significantly greater than the click and that A-chirp minimum response thresholds were lower than the click. Subsequent analyses compared the efficacy of the A-chirp to linear, time-reversed and amplitude-reversed chirps and confirmed that the A-chirp was most effective chirp configuration. These data suggest that the A-chirp may be optimally suited as a single screening broad-frequency stimulus for rapid ABR threshold estimations in the rodent and could serve to complement more detailed frequency-specific physiologic and behavioral estimates of hearing threshold.

Effects of a static magnetic field on audiogenic seizures in black Swiss mice.

Effects of a static magnetic field (SMF) with strong gradient components were studied in black Swiss mice. Exposure to SMF (100-220 mT, 15-40 T/m for 1h) did not affect the threshold for detecting auditory brainstem responses. Serial seizures elevated the hearing threshold at some frequencies, but there was no difference between SMF-exposed and unexposed control mice. EEG changes were recorded during audiogenic seizures. Pretreatment with SMF prolonged seizure latency in response to stimulation with white noise of increasing intensity from 74 to 102 dBA (1 min interval between 2 and 4 dBA increments) without significant effects on seizure severity. Gender-related differences were not statistically significant. Stimulation with 10 min sound steps revealed prolongation of latency and reduction of seizure severity in SMF-exposed, but not unexposed, mice. Pretreatment with phenytoin (5 mg/kg) in combination with SMF had significantly greater effects on seizure latency and severity than either pretreatment alone. These findings indicate that the SMF studied here under different conditions elevated seizure threshold and had anticonvulsant properties in Black Swiss mice and increased the efficacy of a conventional anticonvulsant drug.