Synergistic interactions of noise and other ototraumatic agents

The following is a review of the literature on interaction of noise and other agents, both ototraumatic and nonototraumatic. A short description of the anatomical effects of exposure to intense sound previews the interaction literature. The effects of exposure to combinations of continuous and impulse noise are discussed. This is followed by a review of data on interactions of noise and ototoxic drugs and noise and whole-body vibration, including discussion of putative mechanisms of synergism. In addition, preliminary results of noise-cisplatinum interaction are presented which suggest that if cisplatinum is presented during noise exposure in dose schedules simulating human chemotherapy schedules, hearing threshold shifts and histological damage is much greater than that caused by either agent in isolation. The clinical relevance of the interactions is discussed, along with potential synergistic interactions not yet investigated.