Neural damage in the guinea pig cochlea after noise exposure. A light microscopic study

The use of neurotrophin therapy in the inner ear to augment cochlear implantation outcomes

Severe to profound deafness is most often secondary to a loss of or injury to cochlear mechanosensory cells, and there is often an associated loss of the peripheral auditory neural structures, specifically the spiral ganglion neurons and peripheral auditory fibers. Cochlear implantation is currently our best hearing rehabilitation strategy for severe to profound deafness. These implants work by directly electrically stimulating the remnant auditory neural structures within the deafened cochlea. When administered to the deafened cochlea in animal models, neurotrophins, specifically brain derived neurotrophic factor and neurotrophin-3, have been shown to dramatically improve spiral ganglion neuron survival and stimulate peripheral auditory fiber regrowth. In animal models, neurotrophins administered in combination with cochlear implantation has resulted in significant improvements in the electrophysiological and psychophysical measures of outcome. While further research must be done before these therapies can be applied clinically, neurotrophin therapies for the inner ear show great promise in enhancing CI outcomes and the treatment of hearing loss.

Supporting cell characteristics in long-deafened aged mouse ears

Significant sensory hair cell loss leads to irreversible hearing and balance deficits in humans and other mammals. Future therapeutic strategies to repair damaged mammalian auditory epithelium may involve inserting stem cells into the damaged epithelium, inducing non-sensory cells remaining in the epithelium to transdifferentiate into replacement hair cells via gene therapy, or applying growth factors. Little is currently known regarding the status and characteristics of the non-sensory cells that remain in the deafened auditory epithelium, yet this information is integral to the development of therapeutic treatments. A single high-dose injection of the aminoglycoside kanamycin coupled with a single injection of the loop diuretic furosemide was used to kill hair cells in adult mice, and the mice were examined 1 year after the drug insult. Outer hair cells are lost throughout the entire length of the cochlea and less than a third of the inner hair cells remain in the apical turn. Over 20% and 55% of apical organ of Corti support cells and spiral ganglion cells are lost, respectively. We examined the expression of several known support cell markers to investigate for possible support cell dedifferentiation in the damaged ears. The support cell markers investigated included the microtubule protein acetylated tubulin, the transcription factor Sox2, and the Notch signaling ligand Jagged1. Non-sensory epithelial cells remaining in the organ of Corti retain acetylated tubulin, Sox2 and Jagged1 expression, even when the epithelium has a monolayer-like appearance. These results suggest a lack of marked SC dedifferentiation in these aged and badly damaged ears.

Neurotrophic factors and neural prostheses: potential clinical applications based upon findings in the auditory system

Spiral ganglion neurons (SGNs) are the target cells of the cochlear implant, a neural prosthesis designed to provide important auditory cues to severely or profoundly deaf patients. The ongoing degeneration of SGNs that occurs following a sensorineural hearing loss is, therefore, considered a limiting factor in cochlear implant efficacy. We review neurobiological techniques aimed at preventing SGN degeneration using exogenous delivery of neurotrophic factors. Application of these proteins prevents SGN degeneration and can enhance neurite outgrowth. Furthermore, chronic electrical stimulation of SGNs increases neurotrophic factor-induced survival and is correlated with functional benefits. The application of neurotrophic factors has the potential to enhance the benefits that patients can derive from cochlear implants; moreover, these techniques may be relevant for use with neural prostheses in other neurological conditions.

Clinical application of neurotrophic factors: the potential for primary auditory neuron protection

Sensorineural hearing loss, as a result of damage to or destruction of the sensory epithelia within the cochlea, is a common cause of deafness. The subsequent degeneration of the neural elements within the inner ear may impinge upon the efficacy of the cochlear implant. Experimental studies have demonstrated that neurotrophic factors can prevent this degeneration in animal models of deafness, and can even provide functional benefits. Neurotrophic factor therapy may therefore provide similar protective effects in humans, resulting in improved speech perception outcomes among cochlear implant patients. There are, however, numerous issues pertaining to delivery techniques and treatment regimes that need to be addressed prior to any clinical application. This review considers these issues in view of the potential therapeutic application of neurotrophic factors within the auditory system.

Time course of nerve-fiber regeneration in the noise-damaged mammalian cochlea

The time course of events which are essential for nerve-fiber regeneration in the mammalian cochlea was determined using a group of chinchillas that had been exposed for 3.5 hr to an octave band of noise with a center frequency of 4 kHz and a sound pressure level of 108 dB. The animals recovered from 40 min (0 days) to 100 days at which times their inner ears were fixed and the organs of Corti prepared for phase-contrast and bright-field microscopy as plastic-embedded flat preparations. Selected areas identified in the flat preparations were semi-thick and thin sectioned at radial or tangential angles for examination by bright-field and transmission electron microscopy. The following time-ordered events appeared critical for nerve-fiber regeneration: (1) The area of the basilar membrane in which regeneration had a possibility of occurring showed signs of severe injury. Outer hair cells degenerated first followed by outer pillars, inner pillars, inner hair cells and other supporting cells; (2) Myelinated nerve fibers in the osseous spiral lamina became fragmented, starting at the distal ends of the fibers. This degeneration gradually extended back to Rosenthal's canal; (3) Fibrous processes, originating from Schwann-like cells in the osseous spiral lamina, extended laterally on the basilar membrane; (4) Schwann cells lined up medial to the habenulae perforata in the areas of severest damage, apparently ready to migrate through the habenulae onto the basilar membrane; (5) Schwann-cell nuclei appeared on the basilar membrane beneath the developing layer of squamous epithelium which was in the process of replacing the degenerated portion of the organ of Corti; (6) Regenerated nerve fibers with thin myelin sheaths or a simple investment of Schwann cell cytoplasm appeared in areas of total loss of the organ of Corti; and (7) The myelin sheaths on the regenerated nerve fibers gradually became thicker.

Regenerated nerve fibers in the noise-damaged chinchilla cochlea are not efferent

Nerve-fiber regeneration in the chinchilla cochlea following a traumatic noise exposure was systematically described by Bohne and Harding (1992). However, their study did not determine the origin of the regenerated nerve fibers (RNFs). In the present study, 23 chinchillas were exposed for 12 h to a 0.5 kHz octave band of noise at 120 dB SPL. After a 3-month or 1-year recovery period, their right cochleas were incubated to demonstrate acetylcholinesterase (AChE) activity and then briefly counterstained with Neutral Red or OsO4. Their left cochleas were fixed with OsO4 and dissected using a combined organ of Corti (OC)/modiolus technique that preserved both structures for high-resolution microscopy. All cochleas were prepared as plastic-embedded flat preparations. Damage was located in the basal two-thirds of the cochlea and generally consisted of multiple lesions in the OC, often involving total degeneration of one or more OC segments (i.e., OC wipeouts). The OC wipeouts were separated from one another by areas which contained some identifiable cells of the OC (i.e., OC remnants). Most RNFs were found in OC wipeouts adjacent to OC remnants. In those animals (83%) with significant OC damage, 13 (100%) 3-month-recovery chinchillas had 1-96 RNFs while 6 (86%) 1-year-recovery chinchillas had 7-62 RNFs. In the AChE-stained cochleas, none of the RNFs were AChE-positive, but normal AChE-positive fibers were found in the undamaged apical turn. A variable number of surviving spiral ganglion cells was present in those regions of Rosenthal's canal that had originally innervated the missing hair cells in the OC wipeouts and remnants. It is concluded that RNFs are not part of the efferent cochlear system and therefore, most likely belong to the afferent system.

Neuronal sprouting and synapse formation in response to injury in the mouse organ of Corti in culture

The effect of mechanical injury on induction of regenerative phenomena within the neurosensory epithelium was investigated in cultures of neonatal mouse cochlea. The oldest examined culture in which new neuronal growth followed insult, was injured at 13 days in vitro and fixed 24 h later. By far, the most vigorous regenerative reaction was observed in a 3-day culture 4 h post-injury. The reaction included sprouting of nerve fibers injured directly, synapse formation between the surviving hair cells and sprouting neuronal growth cones, wrapping of growing nerve fibers by extending processes of hair cell cytoplasm, and collateral sprouting of synaptically-engaged nerve endings and of nerve fibers in passage.

Cochlear damage following interrupted exposure to high-frequency noise

Four groups of chinchillas were exposed to an octave band of noise with a center frequency of 4 kHz and a sound pressure level of 80 or 86 dB SPL on interrupted schedules with 18, 42 or 162 h of rest between successive 6-h exposures. Damage in these ears was compared to that in ears receiving continuous exposures which were equal in total energy. The same pattern of cell loss was found in ears damaged by continuous and interrupted exposures. However, both the incidence and average size of the lesion in the basal turn were reduced in all ears receiving interrupted exposures. Eighteen hours of rest between successive 6-h, high-frequency noise exposures was found to provide significant protection from damage for the basal turn of the chinchilla cochlea.

Electron microscopical studies of the effect of time lapse on outer hair cells in acoustically exposed rabbits

After acoustic exposure of a pure tone of 2 kHz, 100 dB for 2 hours, the outer hair cells of the rabbits were observed by electron microscope. The infranuclear region of the cells in the lower half of the second turn were observed in this experiment. In this region, small vesicles, free ribosomes and coated vesicles decreased or increased in number, and the cytoplasmic matrix became lower or higher in electron density after acoustic exposure. Immediately after exposure the percentage of normal cells was 25% and increased to 60% within a period of one month. The effect of time lapse on the damaged cells' recovery is discussed.

Hereditary deafness in the cat. An electron microscopic study of the spiral ganglion

The spiral ganglion from white cats with hereditary deafness has been studied with the transmission electron microscope, and comparisons made with hearing animals at different ages. Ganglion cell loss occurs secondary to destruction of the organ of Corti, but only after the lapse of several months. Prior to neuronal loss, the type I ganglion cells lose their myelin sheaths and concurrently develop an increased content of neurofilaments. Type I neurons transform into type II through an intermediate type III stage. This process of neurofilamentous degeneration occurs slowly, and phagocytosis is therefore an inconspicuous feature.

Ultrastructural changes of the nerve elements following disruption of the organ of Corti. II. Nerve elements outside the organ of Corti

Various stages of changes in the nerve fibers, spiral ganglion cells, and satellite cells from the guinea pig cochlea 3 to 137 days after perilymphatic perfusion with streptomycin solution (2 and 20%) were observed electron microscopically. Initially, the axoplasms of the cochlear nerve fibers became swollen or pyknotic. Then, the axons disappeared and myelin lamellae disrupted. The Schwann cells shrank and degenerated, though their basement membranes survived for a time. Regeneration of the cochlear nerve fibers began with extension of axonal sprouts into the tube of the basement membrane and surviving Schwann cells, which still contained myelin debris. Only one of the axonal sprouts matured for myelination. These regenerating cochlear nerve fibers were found in the osseous spiral lamina, modiolus and internal auditory meatus, but these fibers atrophied and disappeared afterward. Retrograde degeneration occurred in the olivo-cochlear bundle. Some of the efferent myelinated fibers also showed temporary regeneration.

Degeneration patterns in human ears exposed to noise

Various forms of sensorineural degeneration patterns related to noise exposure are illustrated in six pairs of temporal bones selected from a group of 33 male patients with histories of noise exposure. For the entire group the commonest form of lesion, associated with a 4-kHz dip in the audiogram, was a relatively diffuse degeneration in the second quadrant of the basal turn, in the 9-13 mm area. An advanced form of this lesion had a wide gap of more or less complete sensorineural degeneration affecting the entire second quadrant and displaying various degrees of extension toward the apex and base. The pattern associated with an "abrupt high-tone loss," with more or less complete hair cell and nerve degeneration in both the second and first quadrants and extending to the basal end of the cochlea, was rare. In one case this pattern appeared to have evolved from the first type of lesion as the remaining nerve fibers in the first quadrant had degenerated. The protective effect of the acoustic shadow of the head for the right ear, in shooting from the right shoulder, is demonstrated for the higher frequencies. Two almost identical cases of sharply-circumscribed single areas of degeneration in the first quadrant and one case with two such areas represent the third type of lesion. In one of these cases there was a history of firearm usage. It is postulated that this type of lesion is caused by impulse noise. In most of the material the degeneration pattern differed markedly from the diffuse degeneration seen with presbycusis. Degeneration patterns with knife-sharp transitions between completely degenerated and apparently undamaged areas appear to be characteristic of noise-induced injuries.

Microcirculation in the labyrinth

The inner ear is unique in the number and variety of specialized microvascular networks that furnish blood to its parts. Four distinct capillary networks arranged in parallel supply the structures of the outer wall, and four others those of the spiral lamina. Most of the capillaries are surrounded by pericapillary spaces favoring filtration and reabsorption of fluid. In the guinea pig those of the spiral prominence and outer sulcus show a special pericapillary tissue. The strial capillaries are larger in diameter and are closely invested by strial cells. The blood within them has a higher hematocrit and flows more slowly than elsewhere in the labyrinth. The arcades of the tympanic lip and basilar membrane receive occasional innervation by fine unmyelinated nerve fibers. A possible role of prostaglandins in controlling the tone of the cochlear microvasculature is suggested. Although it appears unlikely that vascular lesions within the labyrinth could be responsible for the hydrops of Menière's syndrome, devascularization and atrophy of the endolymphatic sac might be contributory factors.