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In some embodiments, the otoprotectant is a compound of Formula (V) having the structure of Formula (Va): In some embodiments, the otoprotectant is a compound of Formula (VI): wherein: X is a pharmaceutically acceptable counterion

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Finally, dihydrolipoamide dehydrogenase activity in the glycine cleavage system (L protein) and in the -ketoacid dehydrogenase complexes (protein E3) catalyzes the conversion of the dihydrolipoyl moiety (reduced form) to the lipoyl moiety (oxidized form)

Finally, if there is excess skin, it may be gently trimmed away by using very thin incisions that are hidden in a natural skin crease and behind the ear for a smoother, toned look