1
|
Abstract
BACKGROUND AND AIMS More attention has recently been focused on auditory impairment of young type 1 diabetics. This study aimed to evaluate auditory function of young type 1 diabetics and the correlation between clinical indexes and hearing impairment. METHODS We evaluated the auditory function of 50 type 1 diabetics and 50 healthy subjects. Clinical indexes were measured along with analyzing their relation of auditory function. RESULTS Type 1 diabetic patients demonstrated a deficit with elevated thresholds at right ear and left ear when compared to healthy controls (p <0.01). The elevated auditory threshold was significantly related with HDL-cholesterol, diabetes duration, and systemic blood pressure (p <0.05). Moreover, latencies of right ear (wave III, V and interwave I-V) and left ear (wave III, V and interwave I-III, I-V) in diabetic group significantly increased compared to those in control subjects (p <0.01). Auditory brainstem response was significantly related with GHbA1C and microalbuminuria (p <0.01). Furthermore, distortion product evoked otoacoustic emissions (DPOAE) of diabetes group were statistically significant in right ears at 4.0, 6.0 kHz and in left ears at 4.0, 6.0, 8.0 kHz (p <0.01) compared with those of controls. Diabetic patients demonstrated lower amplitude responses of the right ear than the left ear at 8.0 kHz. Only triglyceride was positively correlated to the hearing impairment defined by DPOAE (p <0.01). There was no significance of transient evoked otoacoustic emissions (TEOAE) between groups. TEOAE was associated with age and GHbA1C (p <0.01). CONCLUSIONS Type 1 diabetics exerted higher auditory threshold, slower auditory conduction time and cochlear impairment. HDL-cholesterol, diabetes duration, systemic blood pressure, microalbuminuria, GHbA1C, triglyceride, and age may affect the auditory function of type 1 diabetics.
Collapse
|
2
|
ALDajani N, ALkurdi A, ALMutair A, ALdraiwesh A, ALMazrou KA. Is type 1 diabetes mellitus a cause for subtle hearing loss in pediatric patients? Eur Arch Otorhinolaryngol 2014; 272:1867-71. [PMID: 24627078 DOI: 10.1007/s00405-014-2994-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 03/01/2014] [Indexed: 11/28/2022]
Abstract
The objective of this study is to investigate the effects of IDDM on the function of the auditory pathway from the cochlea to the auditory cortex in child patients. Totally, 140 ears of 70 children with IDDM and 60 ears of 30 age and gender-matched healthy controls were included in the study. The ages of patients and controls ranged from 4 to 14 years. Audiological assessment including pure-tone audiometry, otoacoustic emission testing (OAE) and auditory brainstem response testing (ABR) has been performed to all participants. There was no significant difference between the patients and controls regarding pure-tone thresholds on audiometry (p > 0.05). The latencies of waves I, III and V on ABR were not significantly different between the patients and controls (p > 0.05). The amplitudes on DPOAE testing obtained from both groups were not significantly different at the frequencies of 2,000 and 4,000 Hz (p > 0.05). However, the DPOAE amplitudes of the patients at 1,000 Hz were significantly lower than those of controls at the same frequency (p = 0.03). There was no difference between the patients who had chronic disease (>5 years) and healthy controls regarding pure-tone audiometry, ABR and DPOAE testing results (p > 0.05). In the light of the findings obtained with pure-tone audiometry, and OAE and ABR testing, it seems that auditory system is spared in children with IDDM at clinical level. Diabetes control and chronicity of the disease do not impact on the auditory system except for a subclinical involvement in the apical portion of the cochlea.
Collapse
Affiliation(s)
- Nader ALDajani
- Department of Otorhinolaryngology, King Abdulaziz Medical City, Riyadh, Saudi Arabia,
| | | | | | | | | |
Collapse
|
3
|
Brainstem auditory evoked potentials with the use of acoustic clicks and complex verbal sounds in young adults with learning disabilities. Am J Otolaryngol 2013; 34:646-51. [PMID: 23953938 DOI: 10.1016/j.amjoto.2013.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/29/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE AND BACKGROUND Acoustic signals are transmitted through the external and middle ear mechanically to the cochlea where they are transduced into electrical impulse for further transmission via the auditory nerve. The auditory nerve encodes the acoustic sounds that are conveyed to the auditory brainstem. Multiple brainstem nuclei, the cochlea, the midbrain, the thalamus, and the cortex constitute the central auditory system. In clinical practice, auditory brainstem responses (ABRs) to simple stimuli such as click or tones are widely used. Recently, complex stimuli or complex auditory brain responses (cABRs), such as monosyllabic speech stimuli and music, are being used as a tool to study the brainstem processing of speech sounds. We have used the classic 'click' as well as, for the first time, the artificial successive complex stimuli 'ba', which constitutes the Greek word 'baba' corresponding to the English 'daddy'. PATIENTS AND METHODS Twenty young adults institutionally diagnosed as dyslexic (10 subjects) or light dyslexic (10 subjects) comprised the diseased group. Twenty sex-, age-, education-, hearing sensitivity-, and IQ-matched normal subjects comprised the control group. Measurements included the absolute latencies of waves I through V, the interpeak latencies elicited by the classical acoustic click, the negative peak latencies of A and C waves, as well as the interpeak latencies of A-C elicited by the verbal stimulus 'baba' created on a digital speech synthesizer. RESULTS The absolute peak latencies of waves I, III, and V in response to monoaural rarefaction clicks as well as the interpeak latencies I-III, III-V, and I-V in the dyslexic subjects, although increased in comparison with normal subjects, did not reach the level of a significant difference (p<0.05). However, the absolute peak latencies of the negative wave C and the interpeak latencies of A-C elicited by verbal stimuli were found to be increased in the dyslexic group in comparison with the control group (p=0.0004 and p=0.045, respectively). In the subgroup consisting of 10 patients suffering from 'other learning disabilities' and who were characterized as with 'light' dyslexia according to dyslexia tests, no significant delays were found in peak latencies A and C and interpeak latencies A-C in comparison with the control group. CONCLUSIONS Acoustic representation of a speech sound and, in particular, the disyllabic word 'baba' was found to be abnormal, as low as the auditory brainstem. Because ABRs mature in early life, this can help to identify subjects with acoustically based learning problems and apply early intervention, rehabilitation, and treatment. Further studies and more experience with more patients and pathological conditions such as plasticity of the auditory system, cochlear implants, hearing aids, presbycusis, or acoustic neuropathy are necessary until this type of testing is ready for clinical application.
Collapse
|
4
|
Liu DS, Gao W, Lin WW, Hao YY, Zhong LH, Li W, Inoguchi T, Takayanagi R. Effects of the Chinese Yi-Qi-Bu-Shen Recipe extract on brainstem auditory evoked potential in rats with diabetes. JOURNAL OF ETHNOPHARMACOLOGY 2011; 137:414-420. [PMID: 21669272 DOI: 10.1016/j.jep.2011.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/29/2011] [Accepted: 05/30/2011] [Indexed: 05/30/2023]
Abstract
This study was designed to investigate the effects of the Chinese Yi-Qi-Bu-Shen Recipe (YB) on brain stem auditory evoked potential (BAEP) in diabetic rats and on the protection of the diabetic rat brain's functional lesion. Thirty-three male rats were randomly divided into three groups: the normal control group (NC), the diabetic group (DM), and the diabetic rats treated with YB group (DM+YB). Blood glucose and body weight were measured every three weeks. After six weeks, the serum insulin, blood biochemical indices, superoxide dismutase, malondialdehyde, monoamine neurotransmitters, and BAEP were measured. Compared with the NC group, the waves III, V PLs, and the I-III, I-V IPLs of BAEP in the DM group were significantly delayed (all P<0.05). However, YB-treated diabetic rats maintained a normal brainstem function over the experimental period. Compared with the NC group, the waves I, III, V PL, and waves I-III, III-V and I-V IPLs of BAEP in the DM+YB group were very close (all P>0.05). On the other hand, compared with the DM group, the III, V PLs and the I-III, I-V IPLs of BAEP in the DM+YB group were significantly improved. It was discovered that the central conduction time of rats with diabetes had a close correlation with serum insulin, blood glucose, malondialdehyde, and insulin resistance index. Our results suggest that YB extract has a beneficial effect in preserving the brain's electrophysiological function in diabetic rats, likely through its antihyperglycemic activity, ability to reduce insulin resistance, and antioxidant activity.
Collapse
Affiliation(s)
- De-Shan Liu
- Department of Traditional Chinese Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Ball KK, Harik L, Gandhi GK, Cruz NF, Dienel GA. Reduced gap junctional communication among astrocytes in experimental diabetes: contributions of altered connexin protein levels and oxidative-nitrosative modifications. J Neurosci Res 2011; 89:2052-67. [PMID: 21567444 DOI: 10.1002/jnr.22663] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 02/11/2011] [Accepted: 03/17/2011] [Indexed: 12/11/2022]
Abstract
Experimental diabetes increases production of reactive oxygen-nitrogen species and inhibits astrocytic gap junctional communication in tissue culture and brain slices from streptozotocin (STZ)-diabetic rats by unidentified mechanisms. Relative connexin (Cx) protein levels were assessed by Western blotting using extracts from cultured astrocytes grown in high (25 mmol/liter) or low (5.5 mmol/liter) glucose for 2-3 weeks and STZ-diabetic rat brain. Chemiluminescent signals for diabetic samples were normalized to those of controls on the same blot and same protein load. Growth in high glucose did not alter relative Cx26 level, whereas Cx30 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were reduced by ∼30%, and Cx43 increased ∼1.9-fold. In the inferior colliculus of STZ-diabetic rats, Cx30 and Cx43 levels in three of four rats were half those of controls, whereas GAPDH and actin were unaffected. Diabetes did not affect levels of Cx30, Cx43, or GAPDH in cerebral cortex, but actin level rose 24%. Cx43 was predominantly phosphorylated in control and diabetic samples, so the reduced dye transfer is not due to overall dephosphorylation of Cx43. Astrocytic growth in high glucose reduced the dye-labeled area by 75%, but 10 min of treatment with dithiothreitol restored normal dye transfer. In contrast, nitric oxide donors inhibited dye transfer among astrocytes grown in low glucose by 50-65% within 1 hr. Thus, modifications arising from oxidative-nitrosative stress, not altered connexin levels, may underlie the reduced dye transfer among severely hyperglycemic cultured astrocytes, whereas both oxidative-nitrosative stress and regionally selective down-regulation of connexin protein content may affect gap junctional communication in the brains of STZ-diabetic rats.
Collapse
Affiliation(s)
- Kelly K Ball
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | | | | | | | | |
Collapse
|
6
|
Hyperglycaemia and diabetes impair gap junctional communication among astrocytes. ASN Neuro 2010; 2:e00030. [PMID: 20396375 PMCID: PMC2839462 DOI: 10.1042/an20090048] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 01/03/2010] [Accepted: 01/05/2010] [Indexed: 01/21/2023] Open
Abstract
Sensory and cognitive impairments have been documented in diabetic humans and
animals, but the pathophysiology of diabetes in the central nervous system is
poorly understood. Because a high glucose level disrupts gap junctional
communication in various cell types and astrocytes are extensively coupled by
gap junctions to form large syncytia, the influence of experimental diabetes on
gap junction channel-mediated dye transfer was assessed in astrocytes in tissue
culture and in brain slices from diabetic rats. Astrocytes grown in
15–25 mmol/l glucose had a slow-onset, poorly reversible decrement in
gap junctional communication compared with those grown in 5.5 mmol/l glucose.
Astrocytes in brain slices from adult STZ (streptozotocin)-treated rats at
20–24 weeks after the onset of diabetes also exhibited reduced dye
transfer. In cultured astrocytes grown in high glucose, increased oxidative
stress preceded the decrement in dye transfer by several days, and gap
junctional impairment was prevented, but not rescued, after its manifestation by
compounds that can block or reduce oxidative stress. In sharp contrast with
these findings, chaperone molecules known to facilitate protein folding could
prevent and rescue gap junctional impairment, even in the presence of elevated
glucose level and oxidative stress. Immunostaining of Cx (connexin) 43 and 30,
but not Cx26, was altered by growth in high glucose. Disruption of astrocytic
trafficking of metabolites and signalling molecules may alter interactions among
astrocytes, neurons and endothelial cells and contribute to changes in brain
function in diabetes. Involvement of the microvasculature may contribute to
diabetic complications in the brain, the cardiovascular system and other
organs.
Collapse
Key Words
- 4-PBA, 4-phenylbutyric acid
- 6-NBDG, 6-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxyglucose
- Cx, connexin
- DCF, 2′,7′-dichlorodihydrofluorescein
- DIC, differential interference contrast
- DMEM, Dulbecco's modified Eagle's medium
- ER, endoplasmic reticulum
- FBS, fetal bovine serum
- LYCH, Lucifer Yellow CH
- LYVS, Lucifer Yellow VS
- MnTBAP, manganese(III) tetrakis (4-benzoic acid) porphyrin chloride
- NA, numerical aperture
- NOS, nitric oxide synthase
- PKC, protein kinase C
- RNS, reactive nitrogen species
- ROS, reactive oxygen species
- STZ, streptozotocin
- TMAO, trimethylamine N-oxide dihydrate
- TUDCA, tauroursodeoxycholic acid
- aCSF, artificial cerebrospinal fluid
- astrocyte
- carboxy-DCF-DA, carboxy DCF diacetate
- connexin (Cx)
- dBcAMP, dibutyryl cAMP
- diabetes
- gap junction
- hyperglycaemia
- l-NAME, l-Nω-nitro-l-arginine methyl ester
- streptozotocin
Collapse
|
7
|
Durmus C, Yetiser S, Durmus O. Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing. Int J Audiol 2009; 43:29-33. [PMID: 14974625 DOI: 10.1080/14992020400050005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy. metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group (p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I-III, III-V and I-V was not significant (p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies (p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients.
Collapse
Affiliation(s)
- Coskun Durmus
- Department of ORL & HNS, Gulhane Medical School, Etlik, Ankara, Turkey
| | | | | |
Collapse
|
8
|
Yitmen I, Oflazoglu B, Işak B, Ciprut A, Akdaş F, Tanridag T, Us O. Brainstem auditory evoked potentials and middle latency auditory evoked potentials in patients with impaired glucose tolerance. Diabet Med 2008; 25:805-10. [PMID: 18644067 DOI: 10.1111/j.1464-5491.2008.02469.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aim was to investigate the effects of impaired glucose tolerance (IGT) on the central nervous system via brainstem auditory evoked potentials (BAEPs) and middle latency auditory evoked potentials (MLAEPs), and on the peripheral nervous system via nerve conduction studies (NCS). METHODS Thirty patients with IGT and 20 control subjects underwent NCS, BAEPs and MLAEPs. RESULTS Tibial distal motor latencies were significantly prolonged in the IGT group; no differences in other parameters, including BAEPs and MLAEPs, were observed between the IGT and control subjects. CONCLUSION Brainstem involvement may not be seen in IGT patients as in DM. The was no obvious electrophysiological finding indicating peripheral nervous system disfunction in our patients.
Collapse
Affiliation(s)
- I Yitmen
- Departments of Neurology and Audiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
9
|
Pessin ABB, Martins RHG, de Paula Pimenta W, Simões ACP, Marsiglia A, Amaral AV. Auditory Evaluation in Patients with Type 1 Diabetes. Ann Otol Rhinol Laryngol 2008; 117:366-70. [DOI: 10.1177/000348940811700507] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes. Methods: Group 1 consisted of 40 patients with type 1 diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests). Results: Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group 1 and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group 1 ears. All patients of group 2 presented normal audiograms and ABR tests. Conclusions: In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group 1 who had normal audiometric thresholds.
Collapse
|
10
|
Lisowska G, Namysłowski G, Morawski K, Strojek K. Early Identification of Hearing Impairment in Patients With Type 1 Diabetes Mellitus. Otol Neurotol 2001; 22:316-20. [PMID: 11347633 DOI: 10.1097/00129492-200105000-00008] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the cochlear micromechanics and central auditory function in patients with type I diabetes mellitus and to identify the site of possible dysfunction. METHODS Cochlear activity was evaluated by recording distortion product otoacoustic emissions (DPOAEs). DPOAEs were performed using an ILO 92 Otodynamics Analyser. Functional changes in the retrocochlear auditory pathway were evaluated by auditory brainstem responses (ABRs). DPOAEs and ABRs were measured in 42 normally hearing patients with type 1 diabetes mellitus aged 21 to 42 years, and 33 age- and sex-matched nondiabetic control subjects. RESULTS Both of the groups (diabetic and control) had normal and undifferentiated results in tonal and impedance audiometry. ABR peripheral transmission time (wave I) and central transmission time (interpeak latencies I-V) were significantly delayed in the diabetic compared with normal subjects, and the mean amplitudes of various DPOAEs were significantly reduced in the diabetic patients compared with the control subjects. CONCLUSIONS Combined use of different procedures for monitoring central and peripheral portions of the auditory pathway in diabetic patients showed alterations in cochlear micromechanics and the retrocochlear auditory pathway. Hearing impairment in diabetic patients is usually mild and subclinical, and can be detected early by accurate and objective audiometric methods.
Collapse
Affiliation(s)
- G Lisowska
- Second ENT Department, Silesian Medical Academy, Zabrze, Poland
| | | | | | | |
Collapse
|
11
|
Bayazit Y, Yilmaz M, Kepekçi Y, Mumbuç S, Kanlikama M. Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus. J Neurol Sci 2000; 181:29-32. [PMID: 11099708 DOI: 10.1016/s0022-510x(00)00400-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of the study was to assess whether a relationship exists between the auditory brain stem response (ABR) results and diabetes mellitus with and without complications. In the clinical and audiometry laboratory settings, diabetic patients with and without complications (retinopathy and/or nephropathy) were examined using ABR testing, and the results were interpreted for their applicability in clinical practice. Fifty-nine patients with diabetic retinopathy or nephropathy (study group) and 20 diabetic patients without any known diabetic complication (control group) were assessed with audiometry and ABR testing. ABR revealed that the absolute latencies and interwave intervals of the waves I through V were prolonged significantly in the study group when compared to the control group. The amplitudes of waves I through V were diminished in the study group when compared to the control group, but a statistical significance was present only for wave V amplitude. Quantitative (wave I to wave V amplitude ratio) and qualitative analyses of the ABR waves showed abnormal waveforms in the study and control groups by 55.2 and 27.6%, respectively. There is a brain stem neuropathy in diabetes mellitus which can be assessed with ABR testing. The likelihood of encountering a diabetic complication increases as the ABR results become abnormal.
Collapse
Affiliation(s)
- Y Bayazit
- Department of Ear Nose Throat, Faculty of Medicine, Gaziantep University, Kolejtepe, Gaziantep, Turkey.
| | | | | | | | | |
Collapse
|
12
|
Sharma R, Gupta SC, Tyagi I, Kumar S, Mukherjee K. Brain stem evoked responses in patients with diabetes mellitus. Indian J Otolaryngol Head Neck Surg 2000; 52:223-9. [PMID: 23119681 PMCID: PMC3451087 DOI: 10.1007/bf03006189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diabetes mellitus is a systeihic disorder which targets multiple organs. The neurological involvement is not only in the form of peripheral neuropathy, but may also lead to central neuropathy. To evaluate the presence of central neuropathy auditory brain stem evoked responses were recorded from 25 normal hearing diabetic subjects aged 28 years to 49 years (Mean age 44.28 years) at 2KHz, 4KHz, & 4KHz, frequencies. The results obtained were compared with those obtained from 10 subjects with normal hearing of matched age and sex. In diabetic subjects, abnormal wave latencies were correlated with blood glucose level, duration of illness and peripheral neuropathy.The absolute latencies and inter peak latencies were significantly impaired (P<.001) in diabetic subjects as compared to control subjects at 2, 4, & 6KHz frequencies. The incidence of delayed wave latencies was 64%, 72%. & 84% at 2KHz, 4KHz, & 6KMz respectively suggesting that if brain stem evoked response audiometry is conducted at higher frequency like 6KBz in diabetic patients, the involvement of central neural axis can be detected earlier. This study is the first to demonstrate that brain stem evoked response audiometry is a useful non-invasive test for earlier detection of damage in central neural axis in patients of diabetes mellitus. There is no relationship between the delayed wave latencies and the blood glucose level, however there exists a significant relationship between the delayed wave latencies and the duration of disease & peripheral neuropathy.
Collapse
Affiliation(s)
- R Sharma
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, 226014 Lucknow, India
| | | | | | | | | |
Collapse
|
13
|
Affiliation(s)
- P D Fowler
- Department of Diabetes, Endocrinology and Nutrition, Queen's Medical Centre, Nottingham, UK
| | | |
Collapse
|
14
|
Karamitsos DG, Kounis NG, Zavras GM, Kitrou MP, Goudevenos JA, Papadaki PJ, Koutsojannis CM. Brainstem auditory evoked potentials in patients with ischemic heart disease. Laryngoscope 1996; 106:54-7. [PMID: 8544628 DOI: 10.1097/00005537-199601000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors of this study used the method of increased stimulus rate on brainstem auditory evoked potentials (BAEPs) in 30 patients with ischemic heart disease (IHD) and in an equal number of healthy age-matched control subjects. The BAEPs were recorded using 100- to 3000-Hz alternating polarity clicks at a rate of 22.6 per second. Measurements included the absolute latencies of waves I through V, the interpeak latencies I-III, III-V, and I-V, and the peak amplitudes of peaks I, III, and V. The measured absolute latencies and interpeak latencies were found to be significantly increased, and the peak amplitudes were found to be diminished. The audiometric tests revealed no significant hearing loss in IHD patients. This study is the first to demonstrate prolongation of BAEPs in IHD patients. BAEP recording may become an additional noninvasive tool for detecting IHD patients with impaired microcirculation.
Collapse
|
15
|
Virtaniemi J, Kuusisto J, Karjalainen L, Karjalainen S, Laakso M. Improvement of metabolic control does not normalize auditory brainstem latencies in subjects with insulin-dependent diabetes mellitus. Am J Otolaryngol 1995; 16:172-6. [PMID: 7661312 DOI: 10.1016/0196-0709(95)90097-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION In our previous study (Am J Otolaryngol 14:413-418, 1993), we reported that prolonged auditory brainstem response latencies are associated with microvascular complications and the duration of diabetes in patients with insulin-dependent diabetes mellitus (IDDM). To investigate whether short-term improvement in metabolic control also affects ABR-responses, we compared ABR-latencies in subjects with IDDM before and after intensified insulin and diet therapy. MATERIALS AND METHODS Auditory brainstem latencies were measured in 13 subjects with IDDM (mean age: 25 years) before and after intensified insulin and diet therapy. The acoustic stimulus was a half sine wave with a duration of 0.250 millisecond and a frequency of 2,000 Hz. The stimulus was presented monaurally with fixed polarity through shielded headphones TDH-39 at repetition rate of 10 Hz and at 90 dB hearing level. All subjects had normal hearing ability. Glycated hemoglobin A1C (GHbA1C), blood glucose immediately before ABR-measurements, and mean blood glucose during 24 hours before auditory studies were measured before and after intensified therapy. RESULTS During intensified insulin therapy, GHbA1C improved significantly (P < .05) in study subjects. However, no changes were observed in ABR-latencies. We also studied those 10 patients whose blood glucose improved during intensified insulin therapy. Although blood glucose was significantly lower (P < .01) after intensified insulin therapy compared with that at baseline, no changes were observed between ABR-latencies at baseline and follow-up. CONCLUSION ABR-latencies were not affected by improvement in metabolic control in patients with IDDM. Our finding suggests that delayed ABR-latencies found in patients with IDDM are not caused by poor metabolic control of diabetes but rather by other mechanisms, for example, microvascular complications.
Collapse
Affiliation(s)
- J Virtaniemi
- Department of Otolaryngology, University of Kuopio, Finland
| | | | | | | | | |
Collapse
|
16
|
Stenninger E, Leissner L, Aman J. Brainstem auditory evoked potentials during hypoglycaemia in insulin-dependent diabetic children. Acta Paediatr 1994; 83:1291-5. [PMID: 7734873 DOI: 10.1111/j.1651-2227.1994.tb13019.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Brainstem auditory evoked potentials (BAEP) were studied in 10 type 1 diabetic children during normoglycaemia (5.5 +/- 0.4 mmol/l), hypoglycaemia and in the post-hypoglycaemic state. In addition, BAEP during normoglycaemia in diabetic children were compared with those of an age-, weight- and sex-matched group of healthy control children. No significant differences were observed between all latencies of the diabetic children compared with those of the healthy children during normoglycaemia. During induction of hypoglycaemia a minor (p < 0.05) prolongation of the inter-peak latency I-V at a blood glucose concentration of 4.1 +/- 0.5 mmol/l was observed. This prolongation was not aggravated at glucose nadir (1.7 +/- 0.3 mmol/l). In conclusion, and in contrast with previous findings in non-diabetic children and in adults with type 1 diabetes, no changes in BAEP were demonstrated during short-term severe hypoglycaemia in diabetic children and only minor transient changes were seen during the initial phase of a standardized induction of hypoglycaemia.
Collapse
Affiliation(s)
- E Stenninger
- Department of Paediatrics, Orebro Medical Centre Hospital, Sweden
| | | | | |
Collapse
|
17
|
Virtaniemi J, Laakso M, Nuutinen J, Karjalainen S, Vartiainen E. Hearing thresholds in insulin-dependent diabetic patients. J Laryngol Otol 1994; 108:837-41. [PMID: 7989828 DOI: 10.1017/s0022215100128270] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hearing thresholds were studied in 53 patients with insulin-dependent diabetes mellitus (IDDM) and 42 randomly selected non-diabetic control subjects, aged between 20 and 40 years. The hearing level tended to be worse in diabetic patients than in control subjects, but the differences were statistically significant only at frequencies of 6,000 and 8,000 Hz. Microvascular complications (retinopathy and nephropathy), and the duration of diabetes were associated with the elevated hearing thresholds. In contrast, poor metabolic control (high fasting blood glucose and glycated haemoglobin A1c) was not associated with increased hearing thresholds. The changes caused by diabetic neuropathy appeared simultaneously with microvascular complications and a long duration of the diabetes, and thus a causative role of diabetic neuropathy in the pathogenesis of elevated hearing thresholds remained unsolved. It was concluded that elevated sensorineural hearing thresholds at the frequencies of 6,000 and 8,000 Hz in patients with IDDM are probably caused by the long duration of diabetes and the microvascular complications associated with it.
Collapse
Affiliation(s)
- J Virtaniemi
- Department of Otolaryngology, University of Kuopio, Finland
| | | | | | | | | |
Collapse
|
18
|
Impulse activity of neurons of the sensorimotor cortex of rabbits with experimental diabetes mellitus. Bull Exp Biol Med 1994. [DOI: 10.1007/bf02444287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Virtaniemi J, Laakso M, Kärjä J, Nuutinen J, Karjalainen S. Auditory brainstem latencies in type I (insulin-dependent) diabetic patients. Am J Otolaryngol 1993; 14:413-8. [PMID: 8285312 DOI: 10.1016/0196-0709(93)90116-o] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION This study was undertaken to compare auditory brainstem response latencies in insulin-dependent diabetics, and to compare these findings with metabolic control, microangiopathy, neuropathy, and the duration of diabetes. METHODS Auditory brainstem latencies were studied in 53 type I diabetic patients and 42 randomly selected nondiabetic control subjects, aged between 20 and 40 years. Three different stimulus repetition rates (10, 30, and 50 Hz) were used. All subjects had normal hearing ability. RESULTS Wave V latencies were longer in diabetic patients when compared with those of control subjects at all repetition rates. At repetition rates of 10 and 50 Hz, diabetic patients had a prolonged I-V interwave latency, and at a repetition rate of 50 Hz, diabetics had a longer III-V interwave latency than control subjects. These findings indicate a central disturbance in the auditory pathway. Microvascular complications (retinopathy, nephropathy) and the duration of diabetes were associated with the prolongation of auditory brainstem latencies. In contrast, poor metabolic control (high fasting blood glucose and glycated hemoglobin A1c) at the time of the present study was only marginally associated with prolonged auditory brainstem latencies. The changes in auditory brainstem latencies associated with diabetic neuropathy (measured with five cardiac autonomic nervous function tests) appeared simultaneously with microvascular complications and in patients with diabetes of long duration, and thus a causative role of diabetic neuropathy in the pathogenesis of prolonged auditory brainstem latencies remains unsolved. CONCLUSION Delayed auditory brainstem latencies in type I diabetic patients are probably caused by the long duration of diabetes and the microvascular complications associated with it.
Collapse
Affiliation(s)
- J Virtaniemi
- Department of Otolaryngology, University of Kuopio, Finland
| | | | | | | | | |
Collapse
|