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153 Noise can damage cochlear tissues through a variety of mechanisms that are also factors in age-related hearing loss, such as increased inflammation and free radical production, disordered calcium metabolism in the inner ear, altered cell signaling, and programmed cell death, all of which have been implicated in hair cell and auditory neuron damage

Upon exposure to heavy metals, PCs are synthesized in the cytosol to chelate free metal ion and to prevent the generation of hydroxyl radicals [4, 5, 6] (Figure 1)

Self-assembling nanocarriers made of biocompatible, biodegradable, and amphiphilic copolymers, these polymeric vesicles can be natural or synthetic [292, 293]

MATERIALS AND METHODS Study Design This study was a single-site, double-blind study carried out at Leiden University Medical Center (LUMC) and is summarized in the Consolidated Standards of Reporting Trials (CONSORT) flow diagram (Figure 1)

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