Saudi Journal of Kidney Diseases and Transplantation

: 1999  |  Volume : 10  |  Issue : 2  |  Page : 144--147

Value of Otoacoustic Emission in Monitoring Hearing Acuity in Chronic Renal Failure Patients

Mohammad A Sobh1, Mohsen M.H El Koussi1, Muhammad S Bakr2,  
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

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


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.

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;10:144-147

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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 2021 Oct 27 ];10:144-147
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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

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

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 [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.


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