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Sensorineural hearing loss (SNHL) affects the inner ear compartment and can be caused by different factors. Usually, the lack, death, or malfunction of sensory cells deputed to transduction of mechanic-into-electric signals leads to SNHL. To date, the therapeutic option for patients impaired by severe or profound SNHL is the cochlear implant (CI), a high-tech electronic device replacing the entire cochlear function. Piezoelectric materials have catalyzed attention to stimulate the auditory neurons by simply mimicking the function of the cochlear sensory epithelium. In this study, the authors investigated lithium niobate (LiNbO 3 ) as a potential candidate material for next generation CIs. LiNbO 3 nanoparticles resulted otocompatible with inner ear cells in vitro, had a pronounced immunomodulatory activity, enhanced human beta-defensin in epithelial cells, and showed direct antibacterial activity against P. aeruginosa. Moreover, LiNbO 3 nanoparticles were incorporated into poly(vinylidene fluoride-trifluoro ethylene) fibers via electrospinning, which enhanced the piezoelectric response. Finally, the resulting fibrous composite structures support human neural-like cell growth in vitro, thus showing promising features to be used in new inner ear devices.

A cochlear implant (CI) is an electronic device that enables hearing recovery in patients with severe to profound hearing loss. Although CIs are a successful treatment for profound hearing impairment, their effectivity may be improved by reducing damages associated with insertion of electrodes in the cochlea, thus preserving residual hearing ability. Inner ear trauma leads to inflammatory reactions altering cochlear homeostasis and reducing post-operative audiological performances and electroacoustic stimulation. Strategies to preserve residual hearing ability led to the development of medicated devices to minimize CI-induced cochlear injury. Dexamethasone-eluting electrodes recently showed positive outcomes. In previous studies by our research group, intratympanic release of dexamethasone for 14 days was able to preserve residual hearing from CI insertion trauma in a Guinea pig model. Long-term effects of dexamethasone-eluting electrodes were therefore evaluated in the same animal model. Seven Guinea pigs were bilaterally implanted with medicated rods and four were implanted with non-eluting ones. Hearing threshold audiograms were acquired prior to implantation and up to 60 days by recording compound action potentials. For each sample, we examined the amount of bone and fibrous connective tissue grown within the scala tympani in the basal turn of the cochlea, the cochleostomy healing, the neuronal density, and the correlation between electrophysiological parameters and histological results. Detection of tumor necrosis factor alpha, interleukin-6, and foreign body giant cells showed that long-term electrode implantation was not associated with an ongoing inflammation. Growth of bone and fibrous connective tissue around rods induced by CI was reduced in the scala tympani by dexamethasone release. For cochleostomy sealing, dexamethasone-treated animals showed less bone tissue growth than negative. Dexamethasone did not affect cell density in the spiral ganglion. Overall, these results support the use of dexamethasone as anti-inflammatory additive for eluting electrodes able to protect the cochlea from CI insertion trauma.

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The biocompatibility and the antioxidant activity of barium titanate (BaTiO3) and lithium niobate (LiNbO3) were investigated on a neuronal cell line, the PC12, to explore the possibility of using piezoelectric nanoparticles in the treatment of inner ear diseases, avoiding damage to neurons, the most delicate and sensitive human cells. The cytocompatibility of the compounds was verified by analysing cell viability, cell morphology, apoptotic markers, oxidative stress and neurite outgrowth. The results showed that BaTiO3 and LiNbO3 nanoparticles do not affect the viability, morphological features, cytochrome c distribution and production of reactive oxygen species (ROS) by PC12 cells, and stimulate neurite branching. These data suggest the biocompatibility of BaTiO3 and LiNbO3 nanoparticles, and that they could be suitable candidates to improve the efficiency of new implantable hearing devices without damaging the neuronal cells.

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