Conflict of interest

is the final product of different factors that are harmful to hearing during an individual's lifetime, such that its prevention is hindered by the limits in controlling these factors from childhood onward. Avoiding hearing loss caused by the use of ototoxic drugs is a challenge, since they cannot always be substituted by non-cochleotoxic medication due to the greater efficacy of the former in treating serious diseases, such as cancer. Maintaining good auditory acuity in chronic kidney patients is essential, since hearing loss becomes one more disorder for patients who depend on care and need good communication. Hearing loss related to CKD leads to restricted participation, as well as social and emotional impacts; however, the physio-

Some cell factors characterize the basal turn of the cochlea as a risk zone, justifying selective hearing loss at high frequencies in NIHL, presbycusis, ototoxic hearing loss, and CKD. The lower number of ciliated cells and their greater susceptibility in the basal turn make it a risk

Furthermore, the acoustic reflex is efficient in protecting at frequencies below 2 kHz, leaving high frequencies under unfavorable conditions [52]. This reflex is defined as the contraction of middle ear muscles induced by intense acoustic stimulation. The tensor tympani muscle pulls the malleus (hammer) away from the eardrum and the stapedius muscle exerts force behind the stirrup, causing greater stiffness in the system and reducing sound transmission, primarily at low frequencies, that is, below 1 kHz. Thus, changes in middle-ear impedance, due to the

Studying hearing loss using a new model based on oxidative stress leads to new perspectives on how to prevent this disorder. Several factors display important limitations with respect to preventing auditory damage. However, when oxidative stress is present, understanding how it occurs and devising therapies to minimize it is a new prevention strategy that could be applied to workers exposed to intense noise, individuals with a family history of presbycusis, patients using ototoxic drugs and chronic kidney patients. Adjuvant antioxidant therapies represent a new method to help prevent hearing loss. This model serves as a potential alternative to treat the forms of hearing loss under study, and should be assessed more thoroughly for

NIHL, presbycusis, ototoxic hearing loss, and hearing loss associated with CKD may seem disconnected and quite different from one another, but oxidative stress emerges as a paradigm that helps reassess the reasoning behind these losses and better understand the environment of

It is hoped that this new paradigm for the different hearing losses will result in a different approach to the physiological changes that affect the auditory system in the form of high-frequency hearing

the cochlea when exposed to harmful intrinsic and extrinsic factors.

aforementioned contractions, have little or no effect on frequencies above 2 kHz [53].

pathology of CKD causes progressive and irreversible cochlear damage.

zone under aggressor conditions (noise, aging, ototoxic, CKD).

these and other hearing disorders.

5. Conclusions

106 An Excursus into Hearing Loss

There is no conflict of interest.
