“…However, damage to cochlear hair cells is also associated with a secondary degeneration of SG cells (e.g., Kellerhals et al, 1967;Spoendlin, 1975;Webster and Webster, 1981;Zimmermann et al, 1995), which is attenuated markedly in chonically deafened animals by growth factor treatment (Miller et al, 1997;Kanzaki et al, 2002). The evidence supporting a direct component to aminoglycoside toxicity in ganglion cells includes human temporal bone cases with SG cell loss and sparing of hair cells (Hinojosa and Lerner, 1987;Zimmermann et al, 1995;Sone et al, 1998) and the time course of histological changes after intoxication in animal studies (Bichler et al, 1983;Sera et al, 1987;Harada et al, 1991;Dodson, 1997), particularly after systemic Km treatment (Webster and Webster, 1981). Hence, it seems prudent to regard biochemical responses of inner ear ganglion cells to KM treatment as a reflection of both rapid direct and prolonged indirect mechanisms of action (e.g., deafferentation).…”