DEPARTMENT OF OTORHINOLARYNGOLOGY

OTOTOXICITY
THE ADVERSE EFFECTS OR ILLEFFECTS OFDRUGS AND CHEMICALS IN THE INNER EAR PRODUCING DISTURBANCE OF HEARINGMECHANISM AND FUNCTIONING OF VESTIBULAR LABRYNTH

MODERN MEDICINES INTRODUCTION OFMORE AND MORE SYNTHETIC DRUGS

INNER EAR HIGHLY VULNERABLE TO DRUG TOXICITY

CORDINAL SYMPTOMS DEAFNESS TINNITUS VERTIGO

DEAFNESS

SENSORY NEURAL TYPE TEMPORARY TRANSIENT PERMANENT

DELAYED FOR SOMETIME AFTER THE USAGE OF THE DRUGS

PATHWAYS 1-BLOOD STREAM-ABSORPTION ANTIBIOTICS PARNTRAL ORAL TOPICAL 2-DIRECT ACESS TO THE INNER EAR 3-INTRATHECALLY BY WAY OF CSF AND PERILYMPH 4-PERMEATION OF DRUGS PERMEATE THROUGH THE ROUND WINDOW OR ANNULAR LIGAMENT OF OVAL WINDOW AND REACH THE PERILYMPH AND REACH THE ORGAN OF CORTI-SCALA VESTIBULI-THROUGH REISNERS MEMBRANE

CONTD
5 SLOW ELIMINATION OF DRUGS FROM THE ORGAN OF CORTI AND RESORPTION IN THE STRIAE VASCULARIS ANTIBIOTICS-AMINOGLYCOSIDES ELIMINATED FROM THE ORGAN OF CORTI THROUGH THE STRIAE VASCULARIS IN SOME CASES DAMAGED STRIAE VASCULARIS-NO RESORPTION AND ACCUMILATION- HIGHL CONCENTRATION OF DRUGS IN THE ORGAN OF CORTI

PLACENTAL BARRIER
DEVELOPING FOETUS CONGENITAL DEAFNESS-STREPTOMYCIN

PATHOGENESIS
1.VASOCONSTRICTION IN THE INNER EAR THEREBY PROMOTE

THE DEGENERATION OF THE EPETHELIAL STRUCTURES IN THE INNER EAR

2.DIRECTLY ON THE HAIR CELLS-DEGENERATION OF HAIR CELLS Eg-STREPTOMYCIN 3.INHIBITION OF PROTEIN SYNTHESIS

ANTIBIOTICS INHIBITS THE PROTEIN SYNTHESIS OF BACTERIA AND IN THE SAME WAY PROTEIN SYNTHESIS OF CELLS ARE AFFECTED

HISTO PATHOLOGY

ELECTRON MICROSCOPIC STUDIES

DEGENERATION OF HAIR CELLS IN GENERAL FOR ALL CHEMICALS AND TOXIC DRUGS

-OUTER HAIRCELLS-AFFECTED FIRST IN THE BASAL TURN

OF COCHLEA-LESION PROGRESSES GRADUALLYTO THE APEX OF THE COCHLEA

-INNER HAIR CELLS FOLLOWS-STARTS FROM THE APEX OF THE COCHLEA AND PROGRESSES TO THE BASE
-NEURAL CHANGES

NEURAL CELLS ARE AFFECTED NEXT TO COCHLEAR CELLS

CONTD-

EARLIEST CHANGES ARE SEEN IN SUPRA NUCLEAR CYTOPLASM OF THE OUTER HAIR CELLS MULTIVESSICULATED BODIES LYSOSOMES,MYLENE FIGURES OCCUR IN THE OUTER HAIRCELLS ----CYTOPLASM LOOSE ITS ARCHITEXTURE AND BECOMES PALE---NUCLEAR CHROMATIN BECOMES CLUMPED THE SAME CHANGES OCCUR IN THE INNER HAIR CELLS THE ORGAN OF CORTI BECOMES COLLAPSD
DEGENERATION STARTS SPIRAL GANGLION AUDITORY NERVE CELLS

DRUGS

AMINOGLYCOSIDES
STREPTOMYCIN DEHYDROSTREPTOMYCIN TOBRAMYCIN GENTAMYCIN

NEOMYCIN
NITILMYCIN

AMICACIN
KANAMYCIN OVER COCHLEA THAN VEST

CISPLATN 50mg > 100 > 150> 225 > CARBOPLATIN BRAIN TUMORS

SALYCYLATES ASPRIN 20 TO 50 mg-NO THRESHOLD EVEN BELOW 20 mg REVERSIBLE !