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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1999  |  Volume : 10  |  Issue : 2  |  Page : 144-147
Value of Otoacoustic Emission in Monitoring Hearing Acuity in Chronic Renal Failure Patients


1 Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Assiut University, Egypt
2 Department of Otolaryngology, Audiology Unit, Faculty of Medicine, Assiut University, Egypt

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   Abstract 

To evaluate hearing acuity in chronic renal failure (CRF), we studied 48 patients of age less than 40 year as well as 15 years age and sex matched healthy subjects as controls by using the conventional pure-tone audiometry and evoked otoacoustic emission (TEOAE). Twenty-two of the study patients were treated conservatively and 26 patients by regular hemodialysis (HD). The dialyzed patients were further classified according to the duration of HD into 14 patients dialyzed for <1 year and 12 patients dialyzed for >1-year. TEOAE was applied only for patients proved to have normal pure tone thresholds. Sensorineural hearing loss was more in CRF patients treated conservatively than in those treated by dialysis (22.7%) and 15.3%, respectively), but the difference was not statistically significant. TEOAE was more sensitive than pure-tone audiometry in detecting sensorineural hearing loss in these patients (27.2% Vs 19.2%, respectively) and in the whole reproducibility of the test. However there were no significant statistical differences in the CRF subgroups and the controls. Furthermore, there was no correlation between TEOAE parameters and serum urea and creatinine. In conclusion, hearing acuity was found to be impaired in chronic renal failure patients whether treated conservatively or hemodialyzed. The transient evoked otoacoustic emission is more sensitive than the conventional pure-tone audiometry for evaluation of hearing acuity in this setting. Although the parameters of TEOAE seem to be better in hemodialyzed than in conservatively treated patients, but it did not reach statistical significance.

Keywords: Hearing loss, Otoacoustic emission, Renal Failure.

How to cite this article:
Sobh MA, El Koussi MM, Bakr MS. Value of Otoacoustic Emission in Monitoring Hearing Acuity in Chronic Renal Failure Patients. Saudi J Kidney Dis Transpl 1999;10:144-7

How to cite this URL:
Sobh MA, El Koussi MM, Bakr MS. Value of Otoacoustic Emission in Monitoring Hearing Acuity in Chronic Renal Failure Patients. Saudi J Kidney Dis Transpl [serial online] 1999 [cited 2019 May 19];10:144-7. Available from: http://www.sjkdt.org/text.asp?1999/10/2/144/37219

   Introduction Top


Since Alport [1] reported the classic genetic syndrome linking hearing deficit and renal failure, there has been a steadily growing interest in the erring function of patients with kidney disease. Unfortunately, debate on such relationship continues either because of the possible effect of advanced age on the results in the studied patient[2] or treat­ment with hemodialysis on hearing threshold. [3] Some studies have reported either deterio­ration or improvement in hearing acuity in patients with renal failure irrespective of modality of therapy. [3]

We evaluate in this study the hearing acuity in chronic renal failure (CRF) patient sand the sensitivity of detecting methods of sensorineural hearing loss (SNHL) as well as the effect.


   Subjects and Methods Top


Sixty-three subjects wee enrolled in this study in the renal dialysis unit of Assiut University Hospital, Egypt, during the period from March to December 1997. They were classified into 3 groups. Group I included 15 healthy subjects as a control group. Group II included 22 patients with CRF on conservative treatment. Group III included 26 patients with CRF on regular hemo­dialysis (HD) who were further classified according to the duration of HD into tow subgroups; IIIb included 12 for >1 year, [Table - 1].

Patients with history of otological diseases, ear trauma, noise exposure, diabetes mellitus or receiving ototoxic drugs were excluded.

Only subjects with normal middle ear function as confirmed by tympanometric measurement were selected. We evaluated hearing loss by using the conventional pure­tone audiometry and evoked otoacoustic emission (TEOAE). TEOAE was applied only for patients proved to have normal pure tone threshold. TEOAEs were measured using computerized ILO88 analyzer (oto­dynamic Ltd.). [4] The schedule for patients on HD was 4-6 hours three times weekly using cuprophane dialyzers. In these patients evaluation of hearing acuity was performed before starting dialysis sessions.


   Statistical Analysis Top


The laboratory values are reported as mean ± standard deviation. Student's (t) test, Spearman's rank correlation coefficient and Fisher's exact test are applied in comparing groups. P value is set at <0.05.


   Results Top


[Table - 2] shows the patients with SNHL as detected by pure-tone audiometry and TEOAE. There were 22.7% and 15.3% of patients with hearing loss in group (II) and (III), respectively, detected by pure-tone audiometry. TEOAE detected more patients with hearing loss than pure-tone audiometry in these patients; 27.2% and 19.2% for both the response and the whole reproducibility of the right ear versus 31.8% and 23.1% for the left ear, respectively. There is no statistically significant difference in the percentages of patients with SNHL on comparing between the two groups. There was no correlation between the levels of serum urea and creatinine and TEOAE parameter.


   Discussion Top


Patients with CRF exhibit varying degrees of sensorineural hearing loss (SNHK).[5],[6],[7],[8],[9],[10] The percentages of SNHL in our patients were 22.7% and 15.3% in the CRF and the hemodialyzed groups, respectively, as detected by pure-tone audiometry test. TEOAE raised the percentages of detection of SNHL indicating that it is a better technique than the conventional pure-tone audiometry for evaluation of hearing acuity.

The frequency of sensorineural hearing loss in our patients was comparable to that reported y some authors, [2],[9],[11],[12],[13],[14] though higher percentage of SNHL was reported by others. [7],[8],[15],[16],[17] This discrepancy may be due to age of patients, duration of CRF and HD, or magnitude of hearing impairment. In our stud, we selected patients who were relatively young (aged less than 40 years) to avoid the possibility of effect of early presbycusis on the results. Also, we excluded any factor that could contribute to the genesis of hearing impairment other than CRF and/or HD. The difference between our results and those of others may also be related to the method of assessment of hearing acuity. We used TEOAE, which is a more sensitive technique than the conven­tional pure-tone audiometry used in other studies.[7],[8],[15],[16],[17] There was a marginal increment in response and whole reproducibility of group III compared with group II; how­ever, this did not reach statistical significance.

Electrolyte disturbances, in particular sodium, water imbalance an elevated serum urea level, have all been implicated as potential factors that could participate in deteriorating hearing acuity in chronic renal failure. [7],[14],[17],[18],[19] Hemodialysis has a beneficial effect on these risk factors. However, some authors have negated the deleterious effects of some or all of these factors.[2],[3],[14]

The results of our study demonstrate marginally worse, though statistically not significant, effect of increased duration of dialysis on hearing acuity. Episodes of hypotension, hypoxia, prolonged alkalosis and accumulation of contaminants from dialysate water have been incriminated as having a direct deleterious effect on the organ of Corti in long-term HD patients.[20] The debate on the effect of regular HD on hearing acuity continues. Some have reported that regular HD treatment does not seem to affect hearing acuity for at least the first five years of treatment.[21],[22],[23],[24]However, others have reported an adverse effect of HD on hearing acuity.[2],[9],[12]

In conclusion, hearing acuity was found to be impaired in CRF patients whether conservatively treated or hemodialyzed. The transient evoked otoacoustic emission is more sensitive than the conventional puretone audiometry for evaluation of hearing acuity in this setting. Hemodialysis may not have a deleterious effect on hearing impairment in CRF patients.

 
   References Top

1.Alport AC. Hereditary familial congenital hemorrhagic nephritis. Br Med J 1927;504­-6.  Back to cited text no. 1    
2.Nekolopoulos TP, Kandiloros DC, Segas JV, et al. auditory function in young patients with chronic renal failure. Clin Otolaryngol 1997;22(3):222-5.  Back to cited text no. 2    
3.Johnson DW, wathen RL, Mathog RH. Effects of hemodialysis on hearing threshold. ORL J Otorhinolaryngol Relt Spec 1976;38:129-39.  Back to cited text no. 3    
4.Kemp D. Development in cochlear mechanics and techniques fo rnnon invasive evaluation. Adv Audiol 1988;(5):27-45.  Back to cited text no. 4    
5.Beaney GP. Otolaryngeal problems arising during the management of severe renal failure. J Laryngol Otol 1964;78:507-15.  Back to cited text no. 5  [PUBMED]  
6.Yassin A, Safwat F, Fatti-Hi. A ear, nose and throat manifestations in cases of renal failue treated by dialysis. Hemodialysis and peritoneal dialysis. Ann Otol Rhinol Laryngol 1966;75:192-201.  Back to cited text no. 6    
7.Yassin A, Badry A, Fatt-Hi A. The relationship between electrolyte balance an cochlear disturbances in cases of renal failure. J Laryngol Otol 1970;84:429-35.  Back to cited text no. 7  [PUBMED]  
8.Bergstrom L, Jenkins P Sando I, English GM. Hearing loss in renal disease: clinical and pathological studies. Ann Otol Rhinol Laryngol 1973;82:555-76.  Back to cited text no. 8    
9.Oda M, Preciado MC, Quick CA, Paparella MM. Labyrinthine pathology of chronic renal failure patients treated with hemodialysis and kidney transplantation. Laryngoscope 1974;84:1480-506.  Back to cited text no. 9    
10.Mitshke H, Schmidt P, Zazgornic J, Kopsa H, Pils P. Effect of renal transplantation on uremic deafness: a long-term study. Autiology 1977;16:530-4.  Back to cited text no. 10    
11.Quick CA. Hearing loss in patients with dialysis and renal transplants. Ann Otol Rhinol Laryngol 1976;85:776-90.  Back to cited text no. 11  [PUBMED]  
12.Kligerman AB, Solangi KB, Ventry IM, Goodmn AI. Wesely SA. Hearing impairment associated with chronic renal failure. Laryngoscope 1981;91:583-92.  Back to cited text no. 12    
13.Mancini MI, Dello-Strologo L, Bianchi PM, Tiery L, Rizzoni G. Sensorieneural hearing loss in patients reaching chronic renal failure in childhood. Pediatr Nephrol 1996;10(1):38-40.  Back to cited text no. 13    
14.Makulska I, Zwolinska D, Orendarz FK, Pospiech L. Effect of metabolic disorders on hering loss in children with chronic renal failure. Nephrol Dial Transplant 1997;12(9):93 (abstract)  Back to cited text no. 14    
15.Arnold W. Inner ear and renal disease. Ann Otol Rhinol Laryngol Suppl 1984;112:119-24.  Back to cited text no. 15  [PUBMED]  
16.Charachon R, Moreno-Ribes V, Cordennir D. Deafness due to renal failure. Ann Otolaryngol Chir Cervicofac 1978;95:179-203.  Back to cited text no. 16    
17.Bazzi C, Venturini CT, Pagani C, Arrigo G. D'Amico G. Hearing loss in short-and long Heamodialysed patients. Nephrol Dial Transplant 1995;10:1865-8.  Back to cited text no. 17    
18.Wigand ME, Meents O, Hennemann H, Heidland A. Cochleo-vestibular Disturbances in uremia in relation t electrolyte metabolism and the glomerular filtration rate. Schweiz Med Wochenschr 1972;102:477-82.  Back to cited text no. 18  [PUBMED]  
19.Urquiza R, Morell M. Effects of experimental renal insufficiency on the osmotic pressure and the biochemical composition of perilymph. Acta Otolaryngol Stoch 1986;102:234-8.  Back to cited text no. 19    
20.Eggar U, Blumberg A, Marti Hr. Acid-base balance and oxygen affinity of hemoglobin in patients in maintenance dialysis. Clin Nephrol 1972;1:70-5.  Back to cited text no. 20    
21.Henrich WL, Thompson P, Bergstrom LV, Lum GM. Effect of dialysis on hering acuity. Nephron 1977;18:348-51.  Back to cited text no. 21  [PUBMED]  
22.Kusakari J, Hara A, takeyama M, Suzuki S. Igari T. the hearing of the patients treated with hemodialysis: a long-term follow up study. Auris Nasus Larynx 1992:;19:105-13.  Back to cited text no. 22    
23.Mirahmadi MK, Vaziri ND. Hearing loss in end-stage renal disease-effect of dialysis. J Dial 1980;4:159-65.  Back to cited text no. 23  [PUBMED]  
24.Rizvi SS, Holmes RA. Hearing loss form hemidialyssi. Arch Otolaryngol 1980;106:751­-6.  Back to cited text no. 24  [PUBMED]  

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Correspondence Address:
Mohsen M.H El Koussi
Department of Internal Medicine, Nephrology Unit, Assiut University, Assiut
Egypt
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PMID: 18212422

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    Abstract
    Introduction
    Subjects and Methods
    Statistical Analysis
    Results
    Discussion
    References
    Article Tables
 

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