Furosemide ototoxicity: Clinical and experimental aspects

Rybak, Leonard P.

doi:10.1288/00005537-198509010-00001

Cited by 85 publications

(56 citation statements)

References 67 publications

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“…A main finding here is that furosemide, when applied chronically to the round window of the gerbil cochlea, can significantly increase the proliferation of fibrocytes in the spiral ligament. Furosemide is a selective inhibitor of NKCC1 and, when administrated systemically, promotes ultrastructural changes in the stria vascularis and a reversible decrease in the EP (Forge 1976;Sewell 1984;Rybak 1985). In this study, chronic furosemide treatment for one week decreased EP to about 30 mV lower than that found in the normal control cochlea.…”

Section: Effects Of Chronic Furosemide Treatmentmentioning

confidence: 48%

“…Recovery after acute systemic treatment with furosemide takes only a few minutes or hours (Forge 1976;Sewell 1984;Rybak 1985;Ikeda et al 1997). However, EP and CAP measures in our lab showed little recovery 6-24 h after chronic treatment (data not shown).…”

Section: Ep Recovery After Furosemide Treatment and Fibrocyte Prolifementioning

confidence: 99%

“…) cotransporter (NKCC1) and decreases the EP (Forge 1976;Rybak 1985;Ikeda et al 1997). We have developed a young-gerbil model of presbyacusis by using an osmotic pump to deliver furosemide chronically to one cochlea (Schmiedt et al 1999(Schmiedt et al , 2002Schmiedt and Lang 2001).…”

Section: Introductionmentioning

confidence: 99%

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Effects of Chronic Furosemide Treatment and Age on Cell Division in the Adult Gerbil Inner Ear

Lang

Schulte

Schmiedt

2003

JARO - Journal of the Association for Research in Otolaryngolog

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Atrophy of the stria vascularis and spiral ligament and an associated decrease in the endocochlear potential (EP) are significant factors in age-related hearing loss (presbyacusis). To model this EP decrease, furosemide was delivered into the round-window niche of young adult gerbils by osmotic pump for seven days, chronically reducing the EP by 30-40 mV. Compound action potential (CAP) thresholds were correspondingly reduced by 30-40 dB SPL at high frequencies. Two weeks after withdrawal of furosemide, the treated ears showed an EP recovery of up to 20-30 mV along with a similar recovery of CAP thresholds. The influence of cell division on furosemide-induced and age-related decline of the EP was examined using a mitotic tracer, bromodeoxyuridine (BrdU). Cell proliferation was examined in three groups: young control, furosemide-treated, and aged cochleas. Sections immunostained for BrdU were bleached with H 2 O 2 to eliminate ambiguities with melanin pigment in the inner ear. Cell types positively labeled for BrdU in all three groups included Schwann cells in Rosenthal's canal; glial cells in the osseous spiral lamina; fibrocytes in the limbus, sacculus, and spiral ligament (SL); epithelial cells in Reissner's and round-window membranes; intermediate cells in the stria vascularis; and vascular endothelial cells. Quantitative analysis showed that the mean number of BrdU-positive (BrdU+) intermediate cells in the stria did not differ significantly among the three groups. In contrast, there was a significant increase of BrdU + fibrocytes in the SL of furosemidetreated animals as compared to the young control group. Moreover, there was a significant decrease in labeled fibrocytes in the aged versus the young ears, particularly among the type II and type IV subtypes. The results suggest that the increased fibrocyte turnover in the SL after furosemide treatment may be related to the recovery of EP and CAP thresholds, supporting the hypothesis that fibrocyte proliferation may be essential for maintaining the EP and cochlear function in normal and damaged cochleas. Moreover, the decreased turnover of SL fibrocytes with age may be a contributing factor underlying the lateral wall pathology and consequent EP loss that often accompanies presbyacusis.

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Section: Effects Of Chronic Furosemide Treatmentmentioning

confidence: 48%

Section: Ep Recovery After Furosemide Treatment and Fibrocyte Prolifementioning

confidence: 99%

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Effects of Chronic Furosemide Treatment and Age on Cell Division in the Adult Gerbil Inner Ear

Lang

Schulte

Schmiedt

2003

JARO - Journal of the Association for Research in Otolaryngolog

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“…26 Alteration in endolymph electrolyte composition combined with the inhibition of cell proliferation 27 may contribute to permanent structural changes within the inner ear of the developing neonate after loop diuretic exposure. Over the past two decades, there have been conflicting reports regarding the association between furosemide and SNHL in high-risk neonates.…”

Section: Discussionmentioning

confidence: 99%

Extremely low birth weight infants are at high risk for auditory neuropathy

et al. 2007

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Auditory neuropathy (AN) is a condition in which transmission of sound to the brain is abnormal. This is reflected as an electrophysiologic profile of normal otoacoustic emissions (OAE), with abnormal auditory brainstem evoked responses (ABR). Functionally speech perception is impaired and management strategies remain controversial. AN can be missed if high-risk newborns are screened for hearing loss with only OAE testing. The rate of sensorineural hearing loss (SNHL) in high-risk nursery infants is 10 times greater compared with normal term newborns. Therefore, we hypothesize that infants from the neonatal intensive care unit (NICU) are at significantly higher risk for AN than normal term infants.Objective: The objective of this study is to establish a prevalence rate and characterize risk factors for NICU graduates who demonstrate the AN electrophysiologic profile.Study Design: This retrospective study examined infants admitted to the NICU at Kapi'olani Medical Center for Women and Children in Honolulu, HI from 1999 through 2003. Infants were screened with automated ABR. Diagnostic testing and OAE were performed before discharge if the ABR was abnormal. Hospital courses of 24 AN, 71 SNHL and 95 gestational age (GA)-matched control infants with normal hearing were reviewed.Result: With a SNHL prevalence of 16.7/1000, the rate for AN was 5.6/1000 NICU infants. Compared to infants with SNHL, infants with AN were significantly younger (GA 28.3±4.8 AN vs 32.9±5.2 weeks SNHL, P<0.0001) and smaller (BW 1318±894 AN vs 1968±1006 g SNHL).Nearly two-thirds of the AN infants were ELBW and had significantly longer hospital stays compared to SNHL infants of the same birth weight group. Exposure to furosemide, aminoglycosides, vancomycin or dexamethasone was associated with increased AN but not SNHL. Peak bilirubin level correlated with SNHL but not AN.Conclusion: Low birth weight NICU infants are at significant risk for AN. ELBW infants are at significantly higher risk for both AN and SNHL.Infants admitted to the NICU should be routinely screened by automated ABR and if abnormal, further evaluation should be started before hospital discharge. Early identification of AN will result in better understanding of this disorder and lead to the development of appropriate intervention strategies.

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“…Transient hearing loss may occur in patients receiving rapid intravenous bolus injection-so injection at a rate > 4 mg/minute is not advisable. Permanent sensorineuronal hearing loss may occur at doses equivalent to furosemide 1000 mg per day [13].…”

Section: Loop Diureticsmentioning

confidence: 99%

The use of diuretics in acute heart failure: Evidence based therapy?

Vazir¹,

Cowie²

2013

WJCD

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The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is firmly established in clinical practice, and endorsed in clinical guidelines. Loop diuretics are typically the first line diuretic strategy for the treatment of acute heart failure. For patients with considerable fluid retention, there is some evidence that initial treatment with continuous infusion or boluses of high dose loop diuretic is superior to an initial lower dose strategy. In patients who are diuretic resistant, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. Intravenous low-dose dopamine has also been used to assist diuresis and preserve renal function in such circumstances, but trials are underway to confirm the clinical value of this agent. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence base is not secure, and its place in clinical practice is yet to be established.

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Furosemide ototoxicity: Clinical and experimental aspects

Cited by 85 publications

References 67 publications

Effects of Chronic Furosemide Treatment and Age on Cell Division in the Adult Gerbil Inner Ear

Effects of Chronic Furosemide Treatment and Age on Cell Division in the Adult Gerbil Inner Ear

Extremely low birth weight infants are at high risk for auditory neuropathy

The use of diuretics in acute heart failure: Evidence based therapy?

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