Ototoxicity of Divalent Metals

Excess exposure to both essential and non-essential heavy metals can lead to a variety of adverse clinical conditions which selectively affect a variety of organs and cells in the body. The diverse, but highly specific nature of the symptoms produced by each metal indicates that they can interact with a restricted population of cellular targets ultimately resulting in unique clinical manifestations. The symptoms, which can be reversible or irreversible, often present with different patterns and outcomes depending on the net accumulated dose of any given metal. There are some common pathological conditions that result from excess exposure to heavy metals which unfortunately have not received widespread recognition and thus, have not been extensively investigated. For example, chronic exposure to several heavy metals such as Co, Mn, Cd, Pb, and Hg has the potential to affect hearing in humans and experimental animals based on previous studies including case reports and ex vivo studies. Understanding exactly how these metals induce hearing deficits is complicated by the fact that the inner ear is an extremely complex system that composed of a diverse collection of sensory, neural, and supporting cells which must act in synchrony to produce a neurophysiological signal terminating in the central auditory system. This review will focus on the anatomical, cellular, and functional changes that occur in the cochlea, the sensory organ for hearing, due to excessive exposure to manganese, cadmium, cobalt, lead, and mercury.