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Prior work has provided extensive documentation of threshold sensitivity and sensory hair cell losses after noise exposure. It is now clear, however, that cochlear synaptic loss precedes such losses, at least at low-moderate noise doses, silencing affected neurons. To address questions of whether, and how, cochlear synaptopathy and underlying mechanisms change as noise dose is varied, we assessed cochlear physiologic and histologic consequences of a range of exposures varied in duration from 15 min to 8 h and in level from 85 to 112 dB SPL. Exposures delivered to adult CBA/CaJ mice produced acute elevations in hair cell- and neural-based response thresholds ranging from trivial (∼5 dB) to large (∼50 dB), followed by varying degrees of recovery. Males appeared more noise vulnerable for some conditions of exposure. There was little to no inner hair cell (IHC) loss, but outer hair cell (OHC) loss could be substantial at highest frequencies for highest noise doses. Synapse loss was an early manifestation of noise injury and did not scale directly with either temporary or permanent threshold shift. With increasing noise dose, synapse loss grew to ∼50%, then declined for exposures yielding permanent hair cell injury/loss. All synaptopathic, but no non-synaptopathic exposures produced persistent neural response amplitude declines; those additionally yielding permanent OHC injury/loss also produced persistent reductions in OHC-based responses and exaggerated neural amplitude declines. Findings show that widespread cochlear synaptopathy can be present with and without noise-induced sensory cell loss and that differing patterns of cellular injury influence synaptopathic outcomes.

Age-related hearing loss in humans is characterized by progressive loss of threshold sensitivity, especially at high frequencies. A multivariable regression of histopathological metrics from normal-aging human cochleae (Wu et al., 2020) showed that hair cell loss better predicts the audiometric shifts than either neural loss or strial atrophy, however considerable variability in age-related threshold elevation remained unexplained. Here, we develop and apply an algorithm to quantify stereocilia pathology in high-power confocal images of inner and outer hair cells in normal aging human cochleae, aged 21 - 71 yrs. Microdissected epithelial wholemounts of the cochleae were immunostained for myosin VIIa and espin to show cuticular plates and stereocilia, respectively, and each cochlea was imaged at 10 log-spaced locations along the cochlear spiral. An approach based on Fourier transforms was used to quantify the regularity of each stereocilia bundle, and the outcome was compared to a parallel analysis by a human observer. Results show a significant age-related decline in stereocilia regularity and increase in stereocilia loss and fusion. Stereocilia pathology was especially severe on the outer hair cells and in the basal half of the cochlea, and may represent a key contributor to age-related threshold elevations. For the one case with an associated pre-mortem audiogram, the threshold shifts are better predicted from the pattern of stereocilia damage than from the pattern of hair cell loss alone.

Acquired sensorineural hearing loss is one of the most prevalent chronic diseases, and aging and acoustic overexposure are common contributors. Decades of study in animals and humans have clarified the cellular targets and perceptual consequences of these forms of hearing loss, and preclinical studies have led to the development of therapeutics designed to slow, prevent or reverse them. Here, we review the histopathological changes underlying age-related and noise-induced hearing loss and the functional consequences of these pathologies. Based on these relations, we consider the ambiguities that arise in diagnosing underlying pathology from minimally invasive tests of auditory function, and how those ambiguities present challenges in the design and interpretation of clinical trials.

Cochlear synaptopathy, i.e. the loss of auditory-nerve connections with cochlear hair cells, is seen in aging, noise damage, and other types of acquired sensorineural hearing loss. Because the subset of auditory-nerve fibers with high thresholds and low spontaneous rates (SRs) is disproportionately affected, audiometric thresholds are relatively insensitive to this primary neural degeneration. Although suprathreshold amplitudes of wave I of the auditory brainstem response (ABR) are attenuated in synaptopathic mice, there is not yet a robust diagnostic in humans. The middle-ear muscle reflex (MEMR) might be a sensitive metric (Valero et al., 2016), because low-SR fibers may be important drivers of the MEMR (Liberman and Kiang, 1984; Kobler et al., 1992). Here, to test the hypothesis that narrowband reflex elicitors can identify synaptopathic cochlear regions, we measured reflex growth functions in unanesthetized mice with varying degrees of noise-induced synaptopathy and in unexposed controls. To separate effects of the MEMR from those of the medial olivocochlear reflex, the other sound-evoked cochlear feedback loop, we used a mutant mouse strain with deletion of the acetylcholine receptor required for olivocochlear function. We demonstrate that the MEMR is normal when activated from non-synaptopathic cochlear regions, is greatly weakened in synaptopathic regions, and is a more sensitive indicator of moderate synaptopathy than the suprathreshold amplitude of ABR wave I.

Noise-induced hearing loss (NIHL) is known to have significant consequences for temporal, spectral, and spatial resolution. However, much remains to be discovered about their underlying pathophysiology. This report extends the recent development of a nonhuman primate model of NIHL to explore its consequences for hearing in noisy environments, and its correlations with the underlying cochlear pathology. Ten macaques (seven with normal-hearing, three with NIHL) were used in studies of masked tone detection in which the temporal or spatial properties of the masker were varied to assess metrics of temporal and spatial processing. Normal-hearing (NH) macaques showed lower tone detection thresholds for sinusoidally amplitude modulated (SAM) broadband noise maskers relative to unmodulated maskers (modulation masking release, MMR). Tone detection thresholds were lowest at low noise modulation frequencies, and increased as modulation frequency increased, until they matched threshold in unmodulated noise. NH macaques also showed lower tone detection thresholds for spatially separated tone and noise relative to co-localized tone and noise (spatial release from masking, SRM). Noise exposure caused permanent threshold shifts that were verified behaviorally and audiologically. In hearing-impaired (HI) macaques, MMR was reduced at tone frequencies above that of the noise exposure. HI macaques also showed degraded SRM, with no SRM observed across all tested tone frequencies. Deficits in MMR correlated with audiometric threshold changes, outer hair cell loss, and synapse loss, while the differences in SRM did not correlate with audiometric changes, or any measure of cochlear pathophysiology. This difference in anatomical-behavioral correlations suggests that while many behavioral deficits may arise from cochlear pathology, only some are predictable from the frequency place of damage in the cochlea.

Neonatal thiamine deficiency can cause auditory neuropathy in humans. To probe the underlying cochlear pathology, mice were maintained on a thiamine-free or low-thiamine diet during fetal development or early postnatal life. At postnatal ages from 18 days to 22 wks, cochlear function was tested and cochlear histopathology analyzed by plastic sections and cochlear epithelial whole-mounts immunostained for neuronal and synaptic markers. Although none of the thiamine-deprivation protocols resulted in any loss of hair cells or any obvious abnormalities in the non-sensory structures of the cochlear duct, all the experimental groups showed significant anomalies in the afferent or efferent innervation. Afferent synaptic counts in the inner and outer hair cell areas were reduced, as was the efferent innervation density in both the outer and inner hair cell areas. As expected for primary neural degeneration, the thresholds for distortion product otoacoustic emissions were not affected, and as expected for subtotal hair cell de-afferentation, the suprathreshold amplitudes of auditory brainstem responses were more affected than the response thresholds. We conclude that the auditory neuropathy from thiamine deprivation could be produced by loss of inner hair cell synapses.

Cochlear neuropathy, i.e. the loss of auditory nerve fibers (ANFs) without loss of hair cells, may cause hearing deficits without affecting threshold sensitivity, particularly if the subset of ANFs with high thresholds and low spontaneous rates (SRs) is preferentially lost, as appears to be the case in both aging and noise-damaged cochleas. Because low-SR fibers may also be important drivers of the medial olivocochlear reflex (MOCR) and middle-ear muscle reflex (MEMR), these reflexes might be sensitive metrics of cochlear neuropathy. To test this hypothesis, we measured reflex strength and reflex threshold in mice with noise-induced neuropathy, as documented by confocal analysis of immunostained cochlear whole-mounts. To assay the MOCR, we measured contra-noise modulation of ipsilateral distortion-product otoacoustic emissions (DPOAEs) before and after the administration of curare to block the MEMR or curare + strychnine to also block the MOCR. The modulation of DPOAEs was 1) dominated by the MEMR in anesthetized mice, with a smaller contribution from the MOCR, and 2) significantly attenuated in neuropathic mice, but only when the MEMR was intact. We then measured MEMR growth functions by monitoring contra-noise induced changes in the wideband reflectance of chirps presented to the ipsilateral ear. We found 1) that the changes in wideband reflectance were mediated by the MEMR alone, and 2) that MEMR threshold was elevated and its maximum amplitude was attenuated in neuropathic mice. These data suggest that the MEMR may be valuable in the early detection of cochlear neuropathy.

Recent animal work has suggested that cochlear synapses are more vulnerable than hair cells in both noise-induced and age-related hearing loss. This synaptopathy is invisible in conventional histopathological analysis, because cochlear nerve cell bodies in the spiral ganglion survive for years, and synaptic analysis requires special immunostaining or serial-section electron microscopy. Here, we show that the same quadruple-immunostaining protocols that allow synaptic counts, hair cell counts, neuronal counts and differentiation of afferent and efferent fibers in mouse can be applied to human temporal bones, when harvested within 9 hrs post-mortem and prepared as dissected whole mounts of the sensory epithelium and osseous spiral lamina. Quantitative analysis of five “normal” ears, aged 54 to 89 yrs, without any history of otologic disease, suggests that cochlear synaptopathy and the degeneration of cochlear nerve peripheral axons, despite a near-normal hair cell population, may be an important component of human presbycusis. Although primary cochlear nerve degeneration is not expected to affect audiometric thresholds, it may be key to problems with hearing in noise that are characteristic of declining hearing abilities in the aging ear.

Two mouse models, the Coch G88E/G88E or “knock-in” and the Coch −/− or “knock-out” ( Coch null), have been developed to study the human late-onset, progressive, sensorineural hearing loss and vestibular dysfunction known as DFNA9. This disorder results from missense and in-frame deletion mutations in COCH ( co agulation factor C h omology), encoding cochlin, the most abundantly detected protein in the inner ear. We have performed hearing and vestibular analyses by auditory brainstem response (ABR) and vestibular evoked potential (VsEP) testing of the Coch −/− and Coch G88E/G88E mouse models. Both Coch −/− and Coch G88E/G88E mice show substantially elevated ABRs at 21 months of age, but only at the highest frequency tested for the former and all frequencies for the latter. At 21 months, 9 of 11 Coch −/− mice and 4 of 8 Coch G88E/G88E mice have absent ABRs. Interestingly Coch −/+ mice do not show hearing deficits, in contrast to Coch G88E/+ , which demonstrate elevated ABR thresholds similar to homozyotes. These results corroborate the DFNA9 autosomal dominant mode of inheritance, in addition to the observation that haploinsufficiency of Coch does not result in impaired hearing. Vestibular evoked potential (VsEP) thresholds were analyzed using a two factor ANOVA (Age X Genotype). Elevated VsEP thresholds are detected in Coch −/− mice at 13 and 21 months, the two ages tested, and as early as seven months in the Coch G88E/G88E mice. These results indicate that in both mouse models, vestibular function is compromised before cochlear function. Analysis and comparison of hearing and vestibular function in these two DFNA9 mouse models, where deficits occur at such an advanced age, provide insight into the pathology of DFNA9 and age-related hearing loss and vestibular dysfunction as well as an opportunity to investigate potential interventional therapies.

Summary At the presynaptic active zone, Ca 2+ influx triggers fusion of synaptic vesicles. It is not well understood how Ca 2+ channel clustering and synaptic vesicle docking are organized. Here, we studied structure and function of hair cell ribbon synapses following genetic disruption of the presynaptic scaffold protein Bassoon. Mutant synapses—mostly lacking the ribbon—showed a reduction in membrane-proximal vesicles, with ribbonless synapses affected more than ribbon-occupied synapses. Ca 2+ channels were also fewer at mutant synapses and appeared in abnormally shaped clusters. Ribbon absence reduced Ca 2+ channel numbers at mutant and wild-type synapses. Fast and sustained exocytosis was reduced, notwithstanding normal coupling of the remaining Ca 2+ channels to exocytosis. In vitro recordings revealed a slight impairment of vesicle replenishment. Mechanistic modeling of the in vivo data independently supported morphological and functional in vitro findings. We conclude that Bassoon and the ribbon (1) create a large number of release sites by organizing Ca 2+ channels and vesicles, and (2) promote vesicle replenishment.

Cochlear hair cells use SK2 currents to shape responses to cholinergic efferent feedback from the brain. Using SK2-/- mice, we demonstrate that, in addition to their previously defined role in modulating hair cell membrane potentials, SK2 channels are necessary for long-term survival of olivocochlear fibers and synapses. Loss of the SK2 gene also results in loss of electrically driven olivocochlear effects in vivo, and down regulation of ryanodine receptors involved in calcium-induced calcium release, the main inducer of nAChR evoked SK2 activity. Generation of double-null mice lacking both the α10 nAChR gene, loss of which results in hypertrophied olivocochlear terminals, and the SK2 gene, recapitulates the SK2-/- synaptic phenotype and gene expression, and also leads to down regulation of α9 nAChR gene expression. The data suggest a hierarchy of activity necessary to maintain early olivocochlear synapses at their targets, with SK2 serving an epistatic, upstream, role to the nAChRs. Fil: Murthy, Vidya. Tufts University; Estados Unidos Fil: Maison, Stéphane F.. Massachusetts Eye and Ear Infirmary; Estados Unidos. Harvard Medical School; Estados Unidos Fil: Taranda, Julian. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Tufts University; Estados Unidos Fil: Haque, Nadeem. University of Notre Dame; Estados Unidos Fil: Bond, Chris T.. Oregon Health Sciences University; Estados Unidos Fil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina Fil: Adelman, John P.. Oregon Health Sciences University; Estados Unidos Fil: Liberman, M. Charles. Massachusetts Eye and Ear Infirmary; Estados Unidos. Harvard Medical School; Estados Unidos Fil: Vetter, Douglas E.. Tufts University; Estados Unidos

The phenomenon of 'conditioning', whereby prior exposure to moderate-level non-traumatic sound reduces the permanent injury to subsequent high-level sound exposures, is suggestive of protective effects mediated by stress-induced gene expression in other systems. To test the role of stress pathways in acoustic injury, this study investigated the effect of mild physical restraint, a classic non-acoustic elicitor of stress, on vulnerability to subsequent noise-induced hearing loss. CBA/CaJ mice were divided into groups (control, restraint-only, restraint pre-trauma, and trauma-only), and cochlear sensitivity was assessed via compound action potentials and distortion product otoacoustic emissions. Results showed that two 12-h epochs of mild physical restraint significantly reduced permanent threshold shifts from a subsequent acoustic overexposure, as long as the treatment-trauma interval was short (2 h). Concurrent measures of circulating glucocorticoids showed that the period of protection coincided with the period of elevated corticosterone. Results are consistent with the idea that cochlear protective effects may be mediated by stress pathways and that glucocorticoid levels may be an important upstream regulator of these effects.

129/SvEv is an inbred mouse strain popular for use in genetic knockout studies. Here, we compare normal auditory function and vulnerability to acoustic injury in wild-type mice of the 129/SvEv vs. CBA/CaJ strains. Compound action potentials (CAPs) and distortion product otoacoustic emissions (DPOAEs) showed slightly higher thresholds for 129/SvEv re CBA/CaJ, especially at frequencies >20 kHz. Middle-ear motion (i.e. umbo velocity) was similar in the two strains; although frequencies >20 kHz could not be evaluated. Permanent threshold shift (PTS) and hair cell losses, measured 1 week after high-intensity exposure to an 8-16 kHz noise band, were smaller in129/SvEv at all exposure levels and durations from 97 dB SPLx2 h to 106 dB SPLx8 h. Furthermore, PTS growth with increasing exposure energy was slower in 129/SvEv (

Histological analysis of cochleas from 100 albino guinea pigs (Hartley strain) obtained from Charles River Laboratories revealed an apparently congenital anomaly in 24% of animals, with roughly equal prevalence in males and females. In affected animals, 15-50% of the first-row outer hair cells (OHCs) showed distinctly abnormal orientation of the W-shaped stereociliary array. These abnormal hair bundles could be rotated by up to 180 degrees from the normal quasi-radial orientation. Second- and third-row OHCs appeared normal in all cases. Cochlear sensitivity was assayed in a subset of animals via compound action potentials (CAPs): CAP thresholds in affected animals were, on average, elevated by 5-10 dB with respect to normal controls. If the contributions of individual OHCs to cochlear 'amplification' add linearly, and if the total OHC contribution corresponds to approximately 45 dB of 'gain', a quantitative correlation of the degree of stereociliary rotation and the degree of threshold shift in these ears suggests that first-row OHCs make a larger contribution to the cochlear amplifier than either of the other OHC rows.

The olivocochlear bundle was sectioned at the floor of the fourth ventricle in a series of cats. From three to thirty weeks post-operatively, recordings were made from single auditory-nerve fibers. Tuning curves, spontaneous discharge rates, and rate-level functions for tones at the characteristic frequency were measured and compared to normal data. Light- and electron-microscopic analysis of the cochleas suggested the lesions were complete, for both classes of cochlear efferents, in three cases. Electrophysiological data from these cases showed normal thresholds, tuning curves and rate-level functions; however, the distributions of spontaneous activity suggested significant decreases in average rates in the de-efferented cases.