Melatonin reduces radiation damage in inner ear.

The purpose of this study was to use a murine model to determine if melatonin can protect the inner ear from radiation-induced damage. A total of 81 4-week-old Balb/c mice were randomly divided into five groups: control group; 50 mg/kg melatonin group; 5 mg/kg melatonin+radiotherapy group; 50 mg/kg melatonin+radiotherapy group; radiotherapy group. The radiotherapy groups received 16 Gy irradiation and melatonin was administered by intraperitoneal injection 30 min before radiotherapy. On days 3 and 7 after irradiation the function of outer hair cells was determined by auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) testing, pathological changes of inner ear cells were observed by light microscopy, and the expression of prestin mRNA was determined. ABR thresholds were increased and wave I latencies were extended after radiotherapy; however, the increases were lower in the groups that received melatonin (P < 0.05). DPOAEs showed radiotherapy-induced hearing loss at 8-12 kHz, and hearing loss was greater on day 7 than day 3. However, hearing loss was less in the melatonin groups (P < 0.05). Histopathological examination showed irradiation resulted in breaks and distortion of the cochlear basement membrane, disruption of the stria vascularis, and swelling of outer hair cells. Melatonin reduced these changes. Radiotherapy upregulated prestin mRNA expression. Radiotherapy-induced upregulation of prestin was decreased in the melatonin groups (P < 0.05), and the decrease was greater in the 50 mg/kg melatonin group (P < 0.05). Melatonin protects against radiation-induced cochlear damage by reducing damage to outer hair cells.

Constant Light Dysregulates Cochlear Circadian Clock and Exacerbates Noise-Induced Hearing Loss.

Noise-induced hearing loss is one of the major causes of acquired sensorineural hearing loss in modern society. While people with excessive exposure to noise are frequently the population with a lifestyle of irregular circadian rhythms, the effects of circadian dysregulation on the auditory system are still little known. Here, we disturbed the circadian clock in the cochlea of male CBA/CaJ mice by constant light (LL) or constant dark. LL significantly repressed circadian rhythmicity of circadian clock genes Per1, Per2, Rev-erbα, Bmal1, and Clock in the cochlea, whereas the auditory brainstem response thresholds were unaffected. After exposure to low-intensity (92 dB) noise, mice under LL condition initially showed similar temporary threshold shifts to mice under normal light-dark cycle, and mice under both conditions returned to normal thresholds after 3 weeks. However, LL augmented high-intensity (106 dB) noise-induced permanent threshold shifts, particularly at 32 kHz. The loss of outer hair cells (OHCs) and the reduction of synaptic ribbons were also higher in mice under LL after noise exposure. Additionally, LL enhanced high-intensity noise-induced 4-hydroxynonenal in the OHCs. Our findings convey new insight into the deleterious effect of an irregular biological clock on the auditory system.

Photobiomodulation using low-level 808 nm diode laser rescues cochlear synaptopathy after acoustic overexposure in rat.

A certain degree of noise can cause hearing problems without a permanent change in the hearing threshold, which is called hidden hearing loss and results from partial loss of auditory synapses. Photobiomodulation (PBM) enhances neural growth and connections in the peripheral nervous systems. In this study, we assessed whether PBM could rescue cochlear synaptopathy after acoustic overexposure in rat. PBM was performed for 7 days after noise exposure. The auditory brainstem responses (ABRs) were acquired before and after noise exposure using a tone and a paired-click stimulus. Auditory response to paired click sound with short time interval was performed to evaluate auditory temporal processing ability. In the result, hearing threshold recovered 2 weeks after noise exposure in both groups. Peak wave 1 amplitude of the ABR and ABR recovery threshold did not recover in the noise only group, whereas it fully recovered in the noise + PBM group. The number of synaptic ribbons was significantly different in the control and noise only groups, while there was no difference between the control and noise + PBM group. These results indicate that PBM rescued peak wave 1 amplitude and maintained the auditory temporal processing ability resulting from a loss of synaptic ribbons after acoustic overexposure.

Effects of very high-frequency sound and ultrasound on humans. Part II: A double-blind randomized provocation study of inaudible 20-kHz ultrasound.

Some people have reported symptoms such as nausea, dizziness, and headaches that they attribute to ultrasound (US) emitted by devices in public places. The primary aim of the present study was to investigate whether inaudible US can provoke adverse symptoms compared to a sham presentation, under double-blind conditions. A second aim was to investigate whether the expectation of US being present could provoke adverse symptoms (a nocebo response). The US stimulus was a 20 kHz tone presented continuously for 20 min set to at least 15 dB below the participants' detection threshold, giving a typical sound pressure level (SPL) of 84 dB. No evidence that US provoked symptoms was found, but there was evidence of small nocebo effects. A case study on an individual with high self-reported sensitivity to US gave similar results. The present study did not reproduce the severe symptoms reported previously by some members of the public; this may be due to the SPL or duration of the stimulus, or strength of the nocebo stimulus. These findings cannot be used to predict outcomes from exposures to sounds that are audible to the individual in question, or to sounds with higher SPLs, longer durations, or different frequency content.

Effects of very high-frequency sound and ultrasound on humans. Part I: Adverse symptoms after exposure to audible very-high frequency sound.

Various adverse symptoms resulting from exposure to very high-frequency sound (VHFS) and ultrasound (US) have previously been reported. This study aimed to establish whether these symptoms are experienced under controlled laboratory conditions and are specific to VHFS/US. To do this, participants were exposed to VHFS/US (at frequencies between 13.5 and 20 kHz and sound pressure levels between 82 and 92 dB) and to a 1 kHz reference stimulus, both at 25 dB above their hearing threshold. The VHFS/US and reference stimuli were presented 4 times, each time for 3 min, during which participants performed a sustained attention task, rated their symptom severity, and had their galvanic skin response (GSR) measured to assess their level of anxiety. Prior to exposure, participants were assigned either to a symptomatic or an asymptomatic group, based on their prior history of symptoms that they attributed to VHFS/US. In both groups, overall discomfort ratings were higher in the VHFS/US condition than the reference condition. In the symptomatic group only, difficulty concentrating and annoyance were also rated higher in the VHFS/US than the reference condition. No difference between the two stimulus conditions was seen in performance on the attention task or on average GSRs for either group.

Age-corrected hearing loss after chemoradiation in cervical cancer patients.

OBJECTIVE: This study aimed to evaluate subjective and objective hearing loss in cervical cancer patients after chemoradiation with cisplatin (mono). PATIENTS AND METHODS: A total of 51 cervical cancer patients with indication for chemoradiation were included. Pure tone and impedance audiometry were performed before and after chemoradiation. Hearing loss was scaled according to ASHA criteria. Subjective hearing was assessed with the Oldenburger Sentence Test. To consider age-dependent changes, hearing loss was corrected for age and the time interval between measurements. RESULTS: Median age at diagnosis was 46 years, 46% were active/former smokers (n = 24), 28 (54%) patients were never-smokers. Median total weekly cisplatin dose was 70 ± 14.2 mg. Cumulative doses of cisplatin during chemoradiation ranged between 115.2 and 400 mg cisplatin (mean 336.1 mg, median 342 ± 52.7 mg). The median interval between last chemotherapy and second audiometry was 320 ± 538 days (35-2262 days). Changes in hearing threshold ≥20 dB were experienced by 32/52 patients (62%) following chemoradiation, 55% of them for frequencies ≥6000 Hz. No statistically significant hearing loss remained after chemoradiation upon correction for age and time interval. Patients >40 years had a higher risk of hearing loss than younger patients. Objective data on hearing function did not correlate with subjective hearing loss and did not impair daily activity in any patient. CONCLUSION: Chemoradiation with cumulative cisplatin doses up to 400 mg did not lead to significant impairment of objective or subjective hearing. For cervical cancer patients undergoing chemoradiation, standard audiometry is not indicated.

Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing : Retrospective analysis of 29 medulloblastoma patients.

PURPOSE: To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (Dmean), and total cisplatin dose. MATERIAL AND METHODS: In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. RESULTS: Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though Dmean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m2, with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. CONCLUSION: The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when Dmean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies.

Low Iron Diet Increases Susceptibility to Noise-Induced Hearing Loss in Young Rats.

We evaluated the role of iron deficiency (ID) without anemia on hearing function and cochlear pathophysiology of young rats before and after noise exposure. We used rats at developmental stages as an animal model to induce ID without anemia by dietary iron restriction. We have established this dietary restriction model in the rat that should enable us to study the effects of iron deficiency in the absence of severe anemia on hearing and ribbon synapses. Hearing function was measured on Postnatal Day (PND) 21 after induction of ID using auditory brainstem response (ABR). Then, the young rats were exposed to loud noise on PND 21. After noise exposure, hearing function was again measured. We observed the morphology of ribbon synapses, hair cells and spiral ganglion cells (SGCs), and assessed the expression of myosin VIIa, vesicular glutamate transporter 3 and prestin in the cochlea. ID without anemia did not elevate ABR threshold shifts, but reduced ABR wave I peak amplitude of young rats. At 70, 80, and 90 dB SPL, amplitudes of wave I (3.11 ± 0.96 µV, 3.52 ± 1.31 µV, and 4.37 ± 1.08 µV, respectively) in pups from the ID group were decreased compared to the control (5.92 ± 1.67 µV, 6.53 ± 1.70 µV, and 6.90 ± 1.76 µV, respectively) (p < 0.05). Moreover, ID without anemia did not impair the morphology hair cells and SGCs, but decreased the number of ribbon synapses. Before noise exposure, the mean number of ribbon synapses per inner hair cell (IHC) was significantly lower in the ID group (8.44 ± 1.21) compared to that seen in the control (13.08 ± 1.36) (p < 0.05). In addition, the numbers of ribbon synapses per IHC of young rats in the control (ID group) were 6.61 ± 1.59, 3.07 ± 0.83, 5.85 ± 1.63 and 12.25 ± 1.97 (3.75 ± 1.45, 2.03 ± 1.08, 3.81 ± 1.70 and 4.01 ± 1.65) at 1, 4, 7 and 14 days after noise exposure, respectively. Moreover, ABR thresholds at 4 and 8 kHz in young rats from the ID group were significantly elevated at 7 and 14 days after noise exposure compared to control (p < 0.05). The average number of young rat SGCs from the ID group were significantly decreased in the basal turn of the cochlea compared to the control (p < 0.05). Therefore, ID without anemia delayed the recovery from noise-induced hearing loss and ribbon synapses damage, increased SGCs loss, and upregulated prestin after noise exposure. Thus, the cochleae in rat pups with ID without anemia were potentially susceptible to loud noise exposure, and this deficit may be attributed to the reduction of ribbon synapses and SGCs.

Short-term Peripheral Auditory Effects of Cranial Irradiation: A Mouse Model.

OBJECTIVES: Assess postcranial irradiation: (1) short-term threshold shift, (2) short-term peripheral auditory histopathology, and (3) the mouse as an experimental model. METHODS: Adult mice were exposed to single-dose radiation of 10 to 60 Gy. Pre- and post-irradiation (baseline, 2-8 days) audiometric brainstem response data were recorded with analysis of cochlear ultrastructure. RESULTS: Significant threshold shift occurred at all test frequencies in mice exposed to ≥20 Gy at 4 to 6 days post-irradiation. Ultrastructurally in Rosenthal's canal and the spiral lamina, neuronal density and extracellular matrix decreased dramatically. There was overall preservation of hair cells, stria vascularis, and vasculature. No difference within Gy group was noted in the frequency or severity of pathology along the length of the cochlea. CONCLUSIONS: The initial impact of radiation in the first week post-exposure focuses on spiral ganglion cell bodies and peripheral projections, resulting in significant threshold shift for irradiation dosages≥20 Gy. This study demonstrates that the mouse is a viable model for study of short-term peripheral auditory effects using single-dose cranial irradiation. Additionally, with access to a precise animal irradiator, the mouse may be used as an experimental model for a fractionated irradiation dosage of 10 Gy, simulating stereotactic therapeutic cranial irradiation.

The relevance of dosimetry in animal models of cochlear irradiation.

OBJECTIVE: To compare dose measurements of three different irradiation setups for an animal model of unilateral cochlear irradiation using radiochromic films positioned at the cochlear plane. A method of dosimetry is proposed. METHODS: Radiation field simulation was performed to locate the cochlear plane for irradiation experiments using CT scan images. Fifteen film pieces were irradiated at the cochlear plane with 3 different irradiation field sizes. A 12-mm diameter field (n = 5), 5.7 mm diameter field (n = 5), and a 6.5 × 7.2 mm field (n = 5). After obtaining an ideal irradiation field size, 15 film pieces were used to compare dosimetry between tissue substitute materials (PVC n = 5 and PVC + Teflon, 5 each) and real tissue (frozen animal, n = 5). Auditory brainstem responses at 3 frequencies (8, 16, 20, and 25 kHz) were performed on 7 guinea pigs after a cycle of fractionated unilateral irradiation. RESULTS: Dosimetry in real tissue demonstrated an asymmetric dose distribution at the cochlear plane and ultimately a lower dose deposition (30%) when compared with tissue substitute materials. Auditory brainstem responses of ears subjected to radiotherapy demonstrated progressive hearing loss in long-term assessment. CONCLUSION: Asymmetric dose deposition at the cochlear plane highlights the need of comprehensive real tissue dosimetry in animal studies of cochlear irradiation. To avoid misleading discrepancies in dose-deposition between different studies using the same animal model, appropriate planning and confirmatory dosimetry systems are highly desirable.

Neonato afecto del síndrome del ácido valproico fetal / Newborn with fetal valproic acid syndrom

Introducción. El síndrome del ácido valproico fetal consiste en alteraciones congénitas que aparecen en el feto expuesto a tratamiento gestacional con ácido valproico. El ácido valproico, el antiepiléptico más teratogénico, es utilizado ampliamente en gestantes afectas de epilepsia. Las estrategias de prevención, sospecha y detección precoz de este síndrome son de vital importancia, ya que el inicio precoz del estudio y tratamiento permite ofrecer una mejoría en la calidad de vida del paciente. Caso clínico. Se presenta el caso clínico de un recién nacido afecto del síndrome del ácido valproico fetal. En el paciente destacaba una facies peculiar con microtia bilateral. Al alta fue seguido por Otorrinolaringología, para la realización de pruebas audiológicas y colocación de audífonos, y por Cirugía, para realizar la reconstrucción de los pabellones auriculares. Comentarios. El estudio en los casos de microtia consiste en la realización de pruebas de imagen (Tomografía computeritzada craneal), para comprobar el grado de afectación del oído medio e interno, y pruebas audiológicas para conocer el umbral auditivo del paciente, hipoacusia moderada de transmisión en la mayoría de los casos. El tratamiento persigue una estimulación precoz del oído para favorecer el lenguaje mediante la colocación de audífonos de transmisión ósea. El tratamiento quirúrgico se realiza a partir de los 10 años de vida, y consiste en la reconstrucción de un pabellón auricular en tres dimensiones a partir de cartílago costal(AU)

Introduction. The fetal valproic acid syndrome consists of congenital abnormalities occurring in the fetus exposed to gestational treatment with valproic acid; this drug is the most teratogenic antiepileptical treatment that is used in pregnant women suffering from epilepsy. Strategies for prevention and early diagnosis of this syndrome are key since early evaluation and treatment can improve significantly the quality of life of these patients. Case report. We report the case of a newborn affected by fetal valproic syndrome, who presented with an abnormal facies with severe microtia bilaterally. The patient was subsequently followed by otorhinolaryngology for audiology evaluation and placement of hearing aids, followed by reconstructive surgery of the earlobes. Comments. The diagnostic evaluation of microtia involves neuroimaging for assessing the degree of involvement of the middle and inner ear, and audiology evaluation, which shows moderate conductive hearing loss in most cases. Treatment aims to stimulating early hearing to promote language through the placement of bone transmission hearing aids. Surgical treatment is usually not recommended until 10 years of age, and it includes 3-dimensional ear reconstruction using rib cartilage(AU)

Effects of Bluetooth device electromagnetic field on hearing: pilot study.

BACKGROUND: The Bluetooth wireless headset has been promoted as a 'hands-free' device with a low emission of electromagnetic radiation. OBJECTIVE: To evaluate potential changes in hearing function as a consequence of using Bluetooth devices, by assessing changes in pure tone audiography and distortion production otoacoustic emissions. DESIGN: Prospective study. MATERIALS AND METHODS: Thirty adult volunteers were exposed to a Bluetooth headset device (1) on 'standby' setting for 6 hours and (2) at full power for 10 minutes. Post-exposure hearing was evaluated using pure tone audiography and distortion production otoacoustic emission testing. RESULTS: There were no statistically significant changes in hearing, as measured above, following either exposure type. CONCLUSION: Exposure to the electromagnetic field emitted by a Bluetooth headset, as described above, did not decrease hearing thresholds or alter distortion product otoacoustic emissions.

Repetitive transcranial magnetic stimulation: hearing safety considerations.

BACKGROUND: The guidelines for use of repetitive transcranial magnetic stimulation (rTMS) advise frequent updating of rTMS safety guidelines and recommendations. Although rTMS can produce sound of more than 120 dB C, which is sufficient to induce hearing loss, the effect of rTMS noise on the hearing of both patients and rTMS practitioners is understudied. OBJECTIVE: This study investigated the effects of rTMS noise on subjects' hearing using otoacoustic emissions evoked by clicks (transiently evoked otoacoustic emissions, TEOAEs), which is an objective and sensitive method of cochlear exploration. METHODS: Hearing thresholds and TEOAEs were recorded in 24 normal-hearing healthy subjects before and after a real or sham rTMS session (a single 20-minute session applied to the superior temporal gyrus with 1200 pulses at 100% of the individual motor threshold). RESULTS: No significant difference in hearing thresholds was observed between subjects exposed to real or sham rTMS. However, the difference in TEOAE amplitude between pre- and post-rTMS sessions increased significantly with rTMS noise for those subjects the least protected by earplugs, showing a post-rTMS slight decrease of TEOAE amplitude for high rTMS intensities and hence minor hearing function alteration. However, this correlation was no longer found 1 hour after the rTMS session. CONCLUSIONS: These findings suggest that, even when rTMS is used within normal safety limits and with good hearing protection, rTMS noise can transiently disturb hearing mechanisms in normal-hearing healthy subjects. This transient effect of rTMS on hearing may be an important consideration for Institutional Review Boards when rTMS is used at higher stimulation intensities.

Low-frequency therapeutic ultrasound with varied duty cycle: effects on the ischemic brain and the inner ear.

Sonothrombolysis is a promising modality for acute stroke treatment. In vitro data suggest a duty cycle dependence of sonothrombolytic efficacy of low-frequency applications. The aim of our study was to examine its impact on safety issues in a rat model of middle cerebral artery occlusion. Rats were exposed to transcranial 60-kHz ultrasound with varied duty cycles. To determine effects on the inner ear, the acoustic threshold was determined in additional healthy animals (acoustic evoked potentials). A short duty cycle (20%) resulted in significant adverse effects (ischemic volume, hemorrhage, functional outcome), which was not observed in longer duty cycle (80%). Continuous-wave insonation produced high rates of mortality and subarachnoid hemorrhage. Hearing was impaired independent of duty cycle. In conclusion, cerebral side effects may be efficiently reduced by modulation of pulsed parameters, which is in line with data on an improved efficacy with longer duty cycle. However, side effects on the auditory system were found to be independent of parameter settings.

Absence of short-term effects of UMTS exposure on the human auditory system.

The aim of this study, which was performed in the framework of the European project EMFnEAR, was to investigate the potential effects of Universal Mobile Telecommunications System (UMTS, also known as 3G) exposure at a high specific absorption rate (SAR) on the human auditory system. Participants were healthy young adults with no hearing or ear disorders. Auditory function was assessed immediately before and after exposure to radiofrequency (RF) radiation, and only the exposed ear was tested. Tests for the assessment of auditory function were hearing threshold level (HTL), distortion product otoacoustic emissions (DPOAE), contralateral suppression of transiently evoked otoacoustic emission (CAS effect on TEOAE), and auditory evoked potentials (AEP). The exposure consisted of speech at a typical conversational level delivered via an earphone to one ear, plus genuine or sham RF-radiation exposure obtained by an exposure system based on a patch antenna and controlled by software. Results from 73 participants did not show any consistent pattern of effects on the auditory system after a 20-min UMTS exposure at 1947 MHz at a maximum SAR over 1 g of 1.75 W/kg at a position equivalent to the cochlea. Analysis entailed a double-blind comparison of genuine and sham exposure. It is concluded that short-term UMTS exposure at this relatively high SAR does not cause measurable immediate effects on the human auditory system.

Prospective study of sensorineural hearing loss following radiotherapy for nasopharyngeal carcinoma.

OBJECTIVES: To investigate the severity and incidence of sensorineural hearing loss in patients with nasopharyngeal carcinoma treated with radiotherapy. METHODS: Forty-two patients with nasopharyngeal carcinoma were treated with conventional radiotherapy. Audiological testing was performed to compare patients' hearing before and at varying stages after radiotherapy. RESULTS: At one month post-radiation, a significant hearing threshold increase was seen only for high frequencies. At 12, 24 and 60 months post-radiation, significant threshold increases were observed at speech frequencies (4.0 and 8.0 kHz), compared with pre-radiation data. The mean values of wave I, III and V latencies and of the I-V interpeak latency intervals were not significantly altered at one month post-radiation, but were significantly prolonged at 12, 24 and 60 months post-radiation, compared with pre-radiation data. CONCLUSION: In patients with nasopharyngeal carcinoma treated with radiotherapy, the severity and incidence of radiation-induced sensorineural hearing loss increased with time, especially at high frequencies. This hearing impairment may be due to changes in the cochlea and/or the retrocochlear auditory pathway.

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas.

OBJECT: Due to technological advances in neuroradiology in recent years, incidental diagnoses of vestibular schwannomas (VSs) have increased. The aim of this study was to evaluate the hearing function after treatment with Gamma Knife surgery (GKS) for VSs in patients adequately selected with "good" or "useful" hearing before treatment and to assess the possible predictive factors for hearing function preservation. METHODS: Of all patients treated in the authors' hospital between 2001 and 2007, they retrospectively studied 50 patients with a unilateral VS in whom there was serviceable hearing (Gardner-Robertson [GR] Class I or II). Additional inclusion criteria were: no Type 2 neurofibromatosis, no previous treatment, and at least 6 months' follow-up of neuroradiological and audiological data. The median patient age was 54 years (range 24-78 years). The median tumor volume was 0.73 ml (range 0.03-6.6 ml), and the median radiation dose to the tumor margin was 13 Gy (range 12-16 Gy) with an isodose of 50%. RESULTS: Patient age, tumor volume, and presenting symptoms were found to correlate with hearing function. At a median of 36 months after radiosurgery, tumor growth control was 96% and no patient required any other additional treatment. Serviceable hearing was preserved in 34 patients (68%): 21 (62%) with GR Class I hearing and 13 (38%) with GR Class II hearing. The remaining 16 patients had poor hearing function:15 with GR Class III and 1 with GR Class IV hearing function. In 19 (58%) of 33 patients with GR Class I function before GKS the same class was maintained posttreatment; 29 (88%) maintained functional hearing (GR Class I or II). In all patients with an intracanalicular lesion, functional hearing was maintained. Significant prognostic factors for maintaining serviceable hearing were GR Class I function before treatment, symptoms at presentation, patient age younger than 54 years, and Koos Stage T1 disease. CONCLUSIONS: The results of the study show that the probability of preserving functional hearing in patients undergoing GKS treatment for unilateral VSs is very high. Patients with GR Class I, age younger than 54 years, with presenting symptoms other than hearing loss, and a Koos Stage T1 tumor have better prognosis. The prescribed dose of 13 Gy appears to represent an excellent compromise between controlling the disease and preserving auditory function.

Generalized model of the microwave auditory effect.

A generalized theoretical model for evaluating the amplitudes of the sound waves generated in a spherical head model, which is irradiated by microwave pulses, is developed. The thermoelastic equation of motion is solved for a spherically symmetric heating pattern of arbitrary form. For previously treated heating patterns that are peaked at the sphere centre, the results reduce to those presented before. The generalized model is applied to the case in which the microwave absorption is concentrated near the sphere surface. It is found that, for equal average specific absorption rates, the sound intensity generated by a surface localized heating pattern is comparable to that generated by a heating pattern that is peaked at the centre. The dependence of the induced sound pressure on the shape of the microwave pulse is explored. Another theoretical extension, to the case of repeated pulses, is developed and applied to the interpretation of existing experimental data on the dependence of the human hearing effect threshold on the pulse repetition frequency.

The Effect of CO(2) and KTP laser on the cat saccule and utricle.

OBJECTIVES/HYPOTHESIS: To assess the potential carbon dioxide (CO(2)) and potassium-titanyl-phosphate (KTP) laser-related trauma to the saccule and utricle in a cat model. STUDY DESIGN: Basic science experiment utilizing cat model. METHODS: Twelve adult male cats were divided into two groups-CO(2) and KTP-to assess the potential saccule and/or utricle trauma with direct discharge of laser energy into the vestibule after the stapes was removed. Both groups were subdivided to assess the effects with acute sacrifice and three-month survival. Bone conduction auditory brain-stem response thresholds were used to monitor auditory function. Clinical observation was used to monitor vestibular function. The temporal bones were harvested, processed, and stained with hematoxylin and eosin (H&E) in all animals with the uninvolved side serving as the control. RESULTS: None of the animals demonstrated changes in bone conduction auditory brain-stem responses. None of the animals in the survival group demonstrated clinical vestibular dysfunction. Saccular and utricular wall rupture was observed in all animals sacrificed acutely. None of the saccular and utricular wall ruptures were of a size and location that could be attributed to laser trauma, and none of the saccular and utricular wall ruptures were associated with neuroepithelial trauma. CONCLUSIONS: There is no evidence of a difference between the CO(2) and KTP laser in potential laser-related trauma. Using bone-conducting auditory brain-stem response threshold and clinical monitoring of vestibular function, there was no evidence of clinical auditory or vestibular dysfunction. The histologic evidence of saccular and utricular wall rupture is more consistent with stapes extraction trauma than laser-related trauma.