Protective effects of Salvia miltiorrhiza against cisplatin-induced ototoxicity in guinea pigs

Objective

The aim of the study was to investigate the protective effects of Salvia miltiorrhiza (SM) against cisplatin-induced ototoxicity in guinea pigs.

Methods

Thirty-nine guinea pigs were randomly divided into 3 groups. The first group (control group) received physiologic saline by intraperitoneal (i.p.) injection for 5 days. The second group (cisplatin group) was treated with cisplatin (2 mg/kg per day, i.p. injection) for 5 days. The third group (SM group) was given SM (8 g/kg per day, i.p. injection) for 2 days and then was given SM (8 g/kg per day, i.p. injection) and cisplatin (2 mg/kg per day, i.p. injection) for 5 days. Auditory brain stem response (ABR) and cochlea blood flow measurement were used to evaluate cochlea function. The structures of cochlea were observed by light microscope, scanning electron microscope, transmission electron microscope (TEM), and immunohistochemical examination.

Results

Cisplatin could cause severe acoustic damages including significant elevation of ABR threshold, substantial losses of outer hair cells and inner hair cells, and severe damage on the stria vascularis and spiral ganglion cells (SGCs). Although in SM group, the increased tendency of threshold was milder than that in cisplatin group. The damages in cochlea and stria vascularis were also less severe than those in cisplatin group. The expression of induced nitric oxide synthase in the cochlea and SGC in SM group was lower than that in cisplatin group.

Conclusions

Salvia miltiorrhiza can significantly reduce the cisplatin-induced side effects.     

Comparison of cochlear morphology and apoptosis in mouse models of presbycusis

Objectives

Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea.

Methods

We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE).

Results

ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression.

Conclusion

These data suggest that the C57 mouse could be an excellent animal model for early onset ''sensory'' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.     

Morphological observation of the stria vascularis in midkine and pleiotrophin knockout mice

Objectives

Midkine and Pleiotrophin are low molecular weight basic proteins with closely related structures and serve as growth/differentiation factors. They have been reported to be expressed in the cochlea during the embryonic and perinatal periods. In the present study, we focused on the roles of midkine and pleiotrophin in the stria vascularis and investigated morphological changes using mice deficient in these genes.

Methods

Midkine knockout, pleiotrophin knockout, and double knockout mice were used and compared to wild-type mice. Auditory brain stem responses (ABRs) and cochlear blood flows were measured in each type of mice. Pathological changes in the stria vascularis were examined by light microscopy, including immunohistochemical staining with anti-Kir4.1 antibody, and electron microscopy.

Results

Hearing thresholds examined by ABRs were significantly higher in midkine knockout and pleiotrophin knockout mice than in wild-type mice. Double knockout mice showed higher thresholds compared to midkine knockout and pleiotrophin knockout mice. Blood flow in the lateral walls did not significantly differ and light microscopy examination showed an almost normal appearance of the stria vascularis in these knockout mice. However, the expression of Kir4.1 was weak in the knockout mice and severe vacuolar degeneration was observed by electron microscopy in the intermediate cells of the double knockout mice.

Conclusion

The present study demonstrates that midkine and pleiotrophin play some roles for the morphological maintenance of intermediate cell in the stria vascularis.     

Histopathological morphometric study of cochleosaccular dysplasia in Dalmatian dogs

Objective

To analyze temporal bones of deaf Dalmatian dogs from 5 days after birth to adulthood to better understand the pathogenesis of cochleosaccular dysplasia.

Methods

This is an experimental animal histopathological temporal bone study that included two groups of temporal bones. Group I consisted of 41 temporal bones from deaf Dalmatian dogs and group II of 25 temporal bones from 15 “normal” aged-matched, hearing Black Labradors. Morphometric analysis included: stria vascularis and spiral ligament area measurements, and cell counts of spiral ganglion, Scarpa's ganglion, and hair cells of saccular macula.

Results

The following findings were significantly less in deaf Dalmatian group compared to hearing Labradors: (1) cellular area of the stria vascularis in all cochlear turns; (2) cellular area of spiral ligament in the inferior part of the basal turn; (3) cellular density of spiral ganglion cells within segments III and IV; (4) number of Scarpa's ganglion cells; and (5) density of saccular hair cells types I and II. A borderline negative correlation was found between average density of spiral ganglion cells of segments III and IV and age in group I. Young deaf animals showed some cochlear hair cells, however in adult dogs all hair cells were replaced by supporting cells.

Conclusion

General pattern of cochleosaccular dysplasia is variable, even when only one etiology, the genetic one, is involved. The gradual degeneration of inner ear elements in the cochleosaccular degeneration might indicate that early intervention might be crucial to stop the progression of cochleosaccular dysplasia.     

Effect of Ginkgo biloba extract on endotoxin-induced labyrinthitis

Objective

There are no reports on the therapeutic effect of Ginkgo biloba extract (GBE) on otitis media-induced labyrinthitis. The present study examined whether GBE can protect against cochlear damage induced by intratympanic instillation of lipopolysaccharide (LPS)-induced labyrinthitis.

Materials and methods

Experiments were performed in 20 healthy young male guinea pigs. The control group (n = 10) received an intratympanic instillation of LPS (20 μl, 3 mg/ml). The experimental group (n = 10) received intratympanic instillation of LPS immediately after instillation of GBE (10 mg/kg) and then experimental groups received GBE (100 mg/kg) by intraperitoneal injection every day for 3 days. Instillation of LPS or LPS immediately after GBE was done in the right ear; the untreated left ear was considered normal. Physiological and morphological changes were evaluated.

Results

Statistical analysis of treatment of GBE revealed significantly less hearing loss than LPS group (p < 0.05). The ratio of the value of cochlear blood flow (CBF) compared to untreated left side was significantly higher in the GBE treated group than in the LPS-treated group (p < 0.05). This result indicated the recovery of CBF in GBE treated group compared to LPS treated group. In the LPS group, scanning electron microscopy revealed hair cell damage with edema. Missing stereocilia in the third layer of the outer hair cell was revealed. However, both the inner hair cells and the outer hair cells had normal appearance in the GBE group. LPS group showed that cochlear Evans blue extravasation was increased strongly in the stria vascularis, spiral limbus, and in the spiral ligament compared with the GBE treated group.

Conclusion

GBE significantly minimizes cochlear damage against LPS-induced otitis media with labyrinthitis in a guinea pig model. GBE has potential as an adjunctive therapy to antibiotics in the treatment of acute otitis media with complicated labyrinthitis.     

川芎嗪对庆大霉素耳中毒耳蜗外毛细胞和血管纹的保护作用

目的：探讨在庆大霉素（gentamycin，GM）耳中毒情况下，川芎嗪（tetramethylpyrazine，TMP）对豚鼠耳蜗外毛细胞和血管纹边缘细胞的保护作用。方法：12只豚鼠随机分为GM组、联合用药组、TMP组及对照组，用药十天后处死，采用透射电镜观察耳蜗外毛细胞及血管纹边缘细胞超微结构，扫描电镜观察血管纹边缘细胞表面形态。结果：透射和扫描电镜显示，联合用药组外毛细胞及血管纹边缘细胞超微及表面结构破坏不均明显轻于庆大霉素组，特别是其中的线粒体结构破坏与数目减少更显著轻于庆大霉素组。结论：川芎嗪具有保护庆大霉素耳中毒耳蜗外毛细胞和血管纹结构的作用，从而拮抗庆大霉素耳毒性。     

Presbycusis: a human temporal bone study of individuals with flat audiometric patterns of hearing loss using a new method to quantify stria vascularis volume

OBJECTIVE: The purpose of this study was to determine the prevalence of stria vascularis atrophy in individuals with presbycusis and flat audiometric patterns of hearing loss. Individuals with presbycusis have historically been categorized by the shape of their audiograms, and flat audiometric thresholds have been reported to be associated with atrophy of the stria vascularis. Stria vascularis volume was not measured in these studies. STUDY DESIGN: Retrospective case review. METHODS: Archival human temporal bones from individuals with presbycusis were selected on the basis of strict audiometric criteria for flat audiometric thresholds. Six temporal bones that met these criteria were identified and compared with 10 temporal bones in individuals with normal hearing. A unique quantitative method was developed to measure the stria vascularis volume in these temporal bones. The hair cell and spiral ganglion cell populations also were quantitatively evaluated. RESULTS: Only one of the six individuals with presbycusis and flat audiometric thresholds had significant atrophy of the stria vascularis. This individual with stria vascularis atrophy also had reduced inner hair cell, outer hair cell, and ganglion cell populations. Three of the individuals with presbycusis had spiral ganglion cell loss, three individuals had inner hair cell loss, and all six individuals had outer hair cell loss. CONCLUSIONS: The results of this investigation suggest that individuals with presbycusis and flat audiometric patterns of hearing loss infrequently have stria vascularis atrophy. Outer hair cell loss alone or in combination with inner hair cell or ganglion cell loss may be the cause of flat audiometric thresholds in individuals with presbycusis.     

Effects of type 2 diabetes mellitus on cochlear structure in humans

OBJECTIVE: To evaluate the effects of type 2 diabetes mellitus on cochlear elements in humans. DESIGN: Comparative study of the histopathologic characteristics of human temporal bones. SETTING: Otopathology laboratory in a tertiary academic medical center. PATIENTS: Temporal bones from 18 patients with type 2 diabetes mellitus were divided into 2 groups according to the method of management of diabetes: insulin in 11 patients (mean age, 51.9 years; age range, 44-65 years) and oral hypoglycemic agents in 7 patients (mean age, 54.4 years; age range, 45-64 years). The diabetic groups and 26 age-matched controls (mean age, 52.9 years) were examined using light microscopy, and the cochlear changes were compared between groups. MAIN OUTCOME MEASURES: Morphometric measurements of vessel wall thickness in the basilar membrane and stria vascularis were made in all turns of the cochlea at the midmodiolar level. Area measurements of the stria vascularis were made in all turns of the cochlea at the midmodiolar level. Cochlear reconstructions and standard cytocochleograms were prepared using an oil immersion objective. The number of spiral ganglion cells was determined for each segment of the cochlea. Comparisons were made in each segment between diabetic and control groups. RESULTS: In the insulin group, walls of the vessels of the basilar membrane and stria vascularis in all turns were significantly thicker than those of controls. Walls of the vessels of the stria vascularis in the basal turn were also significantly thicker in the oral hypoglycemic group than in controls. Atrophy of the stria vascularis in most turns of the insulin group and the lower middle turn of the oral hypoglycemic group was significantly greater than in the controls. Loss of cochlear outer hair cells was significantly greater in the lower and upper basal turns in both diabetic groups. No significant difference was found in the number of spiral ganglion cells or inner hair cells between groups. CONCLUSION: This study demonstrates that cochlear microangiopathy and degeneration of the stria vascularis and cochlear outer hair cells are found in patients with type 2 diabetes mellitus.     

Quantitative analysis of cochlear active mechanisms in tinnitus subjects with normal hearing sensitivity: Time-frequency analysis of transient evoked otoacoustic emissions and contralateral suppression

Objective

The aim of this study was to analyze the fine structure of transient evoked otoacoustic emissions (TEOAEs) and contralateral suppression effects in tinnitus subjects with normal hearing in order to assess whether a minor cochlear or efferent dysfunction, possibly limited in narrow cochlear regions, might play a role in tinnitus.

Methods

TEOAEs were recorded, both in the absence and in the presence of contralateral acoustic stimulation, in 23 tinnitus patients with normal hearing sensitivity and in 31 non-tinnitus control subjects. The broad-band TEOAE recordings were analyzed by using an innovative algorithm and separated into a set of 33 narrow-band frequency components, that represent the different cochlear contributions to the whole TEOAE response. In each frequency component, three different parameters were analyzed and compared between tinnitus and non-tinnitus subjects, i.e., reproducibility, latency, and the suppression effects induced by contralateral acoustic stimulation.

Results

Significantly lower reproducibility was observed in the frequency components of the tinnitus subjects compared to the controls, whereas no significant differences in latency and in suppression effects were observed between tinnitus and non-tinnitus ears.

Conclusions

The analysis of the fine structure of TEOAEs revealed that the tinnitus subjects involved in this study might, possibly, have a minor dysfunction of the cochlear active mechanisms that resulted in frequency components with lower reproducibility. Conversely, the analysis of suppression effects in the narrow-band frequency components of TEOAE indicated that the subjects involved showed no relevant damage to the efferent regulatory mechanisms that control the cochlear activity, neither through the cochlea as a whole, nor in limited cochlear regions.     

Pathologic correlations of otologic symptoms in acute lymphocytic leukemia

Objectives

To assess the clinicopathologic correlations of otologic complaints in patients with acute lymphocytic leukemia.

Design

Otologic complaints and histologic findings were evaluated in 25 temporal bones of 13 acute lymphocytic leukemia patients.

Results

Nine patients had a history of otologic complaints, including hearing loss, otalgia, otorrhea, and vertigo in 5, 3, 3, and 2 patients, respectively. Hemorrhage was most commonly observed in the middle ear (6 patients, 9 temporal bones) and was also observed in cochlea (4 patients, 4 temporal bones), and vestibule (6 patients, 6 temporal bones). Leukemic infiltration was observed in the petrous apex (13 patients, 24 temporal bones), middle ear (7 patients, 14 temporal bones), cochlea (3 patients, 4 temporal bones), vestibule (3 patients, 4 temporal bones), and internal auditory canal (5 patients, 8 temporal bones). Inflammatory changes were observed in the cochlea (5 patients, 8 temporal bones) and vestibule (5 patients, 8 temporal bones). Middle ear effusion containing floating tumor cells was observed in 4 temporal bones of 3 patients. Irreversible histopathologic changes of the middle ear, such as the destruction of the ossicles, perforation of the tympanic membrane, and granulation tissues were observed in 5 temporal bones of 4 patients.

Conclusions

Ear involvement is common in acute lymphocytic leukemia patients. With prolonged survival due to the progress of treatment, the diagnosis and treatment of nonhematopoietic system symptoms, such as ear problems due to acute lymphocytic leukemia, have become more important.     

A comparison of the proliferative capacity and ultrastructure of proliferative cells from the cochleae of newborn rats of different ages

Objective

Recent reports have shown that multipotent stem cells/progenitor cells that are capable of proliferation and regeneration are present in mammalian cochleae. However, progenitor cells have not been isolated from the adult cochlea. We examined the proliferative potential of cells derived from neonatal rats of various ages. The determination of the differences between the proliferative cells from rats of different ages may provide clues to the mechanisms controlling the destiny of these cells.

Methods

Proliferative cells were isolated from the cochleae of 1-, 7-, and 14-day-old rats, and the proliferative capacity and ultrastructure of the cells from each age group were assessed using flow cytometry and transmission electron microscopy, respectively.

Results

During the first two postnatal weeks, the number of proliferative cells gradually fell to zero. This decrease occurred in parallel with the impairment of the proliferative capacity of the cells and the accumulation of proliferative cells in G0/G1. In addition, some of the cells exited the cell cycle by means of gradual maturity and apoptosis.

Conclusions

Our study suggests that cochlear proliferative cells are remnants of the progenitor cells that originally gave rise to the sensory epithelium. The disappearance of the cochlear proliferative cells in adult mammalian cochleae may result from their differentiation and/or apoptosis.     

内皮素在噪声性内耳损伤过程中的作用

目的研究噪声性内耳损伤过程中耳蜗微循环的病理变化以及内皮素(endothelin，ET)在这一病理过程中的作用及意义。方法30只大鼠按电脑产生随机数字法分为5组：对照组、噪声暴露(115dB白噪声每天8h)1、4、8和15d组。分别用扫描电镜观察毛细胞的形态，血管纹铺片观察耳蜗微循环的状态，放射免疫方法检测血浆ET含量，免疫组化染色观察ET-1、ETA、ETB的分布。结果噪声4、8、15d组出现了血管纹明显缺血，外毛细胞形态异常。血浆ET于4d组出现暂时性升高。ET-1于耳蜗组织中有广泛的阳性表达，噪声暴露前后差异无统计学意义；ETA主要分布于血管纹中间细胞与微血管壁周围的细胞，对照组与1d组表达呈弱阳性( )，噪声4、8、15d组表达呈强阳性( )。ETB主要分布于血管纹毛细血管内皮细胞，其变化趋势与ETA相似。结论噪声性内耳损伤过程中出现了明显的耳蜗微循环障碍，同时大鼠耳蜗组织的ET系统活性增高，二者在时间上有明显的一致性。推测噪声所致的耳蜗微循环障碍过程中ET起了重要的介导作用。     

The genetic basis of auditory neuropathy spectrum disorder (ANSD)

Objective

Auditory neuropathy is a hearing disorder where outer hair cell function within the cochlea is normal, but inner hair cell and/or the auditory nerve function is disrupted. It is a heterogeneous disorder which can have either congenital or acquired causes. Furthermore, the aetiology of auditory neuropathy is vast, which may include prematurity, hyperbilirubinaemia, anoxia, hypoxia, congenital brain anomalies, ototoxic drug exposure, and genetic factors. It is estimated that approximately 40% of cases have an underlying genetic basis, which can be inherited in both syndromic and non syndromic conditions. This review paper provides an overview of the genetic conditions associated with auditory neuropathy spectrum disorders (ANSDs) and highlights some of the defective genes that have been found to be linked to the pathological auditory changes.

Method

Literature search was conducted using a number of resources including textbooks, professional journals and the relevant websites.

Results

The largest proportion of auditory neuropathy spectrum disorders (ANSDs) is due to genetic factors which can be syndromic, non-syndromic or mitochondrial related. The inheritance pattern can include all the four main types of inheritances such as autosomal dominant, autosomal recessive, X-linked and mitochondrial.

Conclusion

This paper has provided an overview of mutation with some of the genes and/or loci discovered to be the cause for auditory neuropathy spectrum disorders (ANSDs). It has been noted that different gene mutations may trigger different pathological changes in patients with this disorder. These discoveries have provided us with vital information as to the sites of pathology in auditory neuropathy spectrum disorders (ANSDs), and the results highlight the heterogeneity of the disorder.     

Evaluation of tinnitus patients with normal hearing sensitivity using TEOAEs and TEN test

Objectives

This study was designed to investigate the possibility of underlying cochlear damage whether outer hair cells (OHCs) or inner hair cells (IHCs) in tinnitus suffering patients with normal hearing sensitivity, using transient evoked otoacoustic emission (TEOAEs) and threshold equalizing noise (TEN) test, if any.

Methods

Twenty patients suffering from unilateral tinnitus with normal hearing sensitivity participated in this study. Their other ear acted as control ears. They were subjected to full history taking, otoscopy, basic audiologic evaluation, TEOAEs and TEN test.

Results

TEOAEs were abnormal in 85% of the tinnitus ears compared to 20% in control ears; this difference was statistically significant. The abnormal TEOAEs frequency bands in the tinnitus ears were statistically significant above 2000 Hz when compared to the control ears and were more common for the 4000 and 5000 Hz. This suggests that OHCs dysfunction may be important in the generation of tinnitus. TEN test demonstrated dead regions in the cochlea in 15% of the tinnitus ears only. This might be attributed to increased resistance of IHCs to damage compared to OHCs vulnerability. The affected frequency location was at 500 Hz in 5%, 3000 and 4000 Hz in 10% of tinnitus ears.

Conclusion

This work has shown a higher prevalence of OAE abnormalities in tinnitus patients with normal hearing in contrast to TEN test denoting the more vulnerability of OHCs to damage.     

Cochlear implant in the carotid canal. Case report and literature review

Background

Numerous complications have been described following cochlear implantation. Most of them are post-operative and benign, but some are intra-operative and can be more difficult to manage.

Methods

Case report of a pediatric case of misplaced cochlear electrode in the carotid canal and literature review.

Results and conclusions

Post-operative CT-scan allowed the diagnosis. The misplaced cochlear implant in the carotid canal was successfully removed and a successful re-implantation followed immediately. Anatomy of the interval between the cochlea and the carotid canal is reviewed, together with information regarding the neural telemetry response.In each case, specific anatomical landmarks must be identified to perform the cochleostomy in the right position. If not, or if surgery proves itself difficult, the surgeon should intra-operatively control the position of the electrode.     

Cochlea and other spiral forms in nature and art

Background

The original appearance of the cochlea and the specific shape of a spiral are interesting for both the scientists and artists. Yet, a correlation between the cochlea and the spiral forms in nature and art has been very rarely mentioned.

Aim

The aim of this study was to investigate the possible correlation between the cochlea and the other spiral objects in nature, as well as the artistic presentation of the spiral forms.

Methods

We explored data related to many natural objects and examined 13 625 artworks created by 2049 artists. We also dissected 2 human cochleas and prepared histologic slices of a rat cochlea.

Results

The cochlea is a spiral, cone-shaped osseous structure that resembles certain other spiral forms in nature. It was noticed that parts of some plants are arranged in a spiral manner, often according to Fibonacci numbers. Certain animals, their parts, or their products also represent various types of spirals. Many of them, including the cochlea, belong to the logarithmic type. Nature created spiral forms in the living world to pack a larger number of structures in a limited space and also to improve their function. Because the cochlea and other spiral forms have a certain aesthetic value, many artists presented them in their works of art.

Conclusions

There is a mathematical and geometric correlation between the cochlea and natural spiral objects, and the same functional reason for their formation. The artists' imagery added a new aspect to those domains. Obviously, the creativity of nature and Homo sapiens has no limits—like the infinite distal part of the spiral.     

Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: A meta-analysis

Objective

A meta-analysis was performed to explore the role of peri-operative bupivacaine infiltration in the relief of pain in adenotonsillectomy.

Methods

Data from Medline, EMBase, Springer and the Cochrane Collaboration database were searched. Reference lists from identified publications were scanned. RevMan 5.0 software was used for statistical analysis.

Results

7 random controlled tests (a total of 286 cases) were included. Pain intensity was evaluated by VAS score or Cheops score. The pain of group bupivacaine (Group B) was less severe than group placebo (Group P). Analgesic requirement of Group B was less than Group P. Nevertheless the difference of complication between bupivacaine and placebo had no statistical difference.

Conclusion

Bupivacaine infiltration is a safe and effective method for relief of pediatric post-adenotonsillectomy pain.     

Scanning electron microscopy of the normal human cochlea

Preservation of the fine structures of the human cochlea has been achieved by perfusing the cochlea with fixative shortly after death. Following the dissection of the temporal bone the surface of the organ of Corti and stria vascularis has been examined in the scanning electron microscope. The surfaces of the inner and outer hair cells can be seen and the stereocilia projecting from their surfaces closely examined. The number and length of the stereocilia of the outer hair cells changes linearly with distance along the cochlear duct. The surface of the stria vascularis is similar to that seen in other animals.     

Subjective tinnitus and hearing problems in adolescents

Objectives

We investigated the hearing problems and tinnitus frequencies in adolescents at three public primary and two high schools.

Methods

This study was carried out at three public primary and two high schools. 428 Turkish school children (244 girls, 184 boys) were asked to voluntarily answer a set of questionnaires in their classrooms at the beginning of the training program. There were 250 students (105 male, 145 female) in Primary School and 178 (79 male, 99 female) students in High School. We used questionnaire to evaluate subjective tinnitus and hearing problems. Walkman usage, listening loud and noisy music, intra-familial physical trauma, concentration difficulty in class and school success were also evaluated.

Results

In age-related groups (Group 1 = 11-13 years; Group 2 = 13-15 years; Group 3 = 16-18 years), hearing loss was present in 32.1% of Group 1, 19% of Group 2 and 28.3% of Group 3. Listening loud and noisy music was reported in 81.8% of Group 1, 95.4% of Group 2 and 87% of Group 3. Tinnitus was present 36.8% in Group 2, 33.5% in Group 1 and 31.5% in Group 3. Tinnitus after listening loud music was present in 42.7% of Group 2, 36.1% of Group 3 and 25.6% of Group 1. Among all students with tinnitus, 19.5% considered their school success as very good, 41.1% as good and 39.4% as bad. In students, using Walkman, tinnitus was seen both in the right and left ears.

Conclusion

Tinnitus may be seen in adolescents at primary and high schools. Listening loud and noisy music and Walkman usage may cause an increase in the frequency of tinnitus manifestation. Adolescents should be educated about the hazardous effects of loud music. Education should include families, teachers, students, and whole community. These issues should be taken into public health policy of the countries.