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ABR disturbances in children with insulin dependent diabetes mellitus
International Journal of Pediatric Otorhinolaryngology 44 (1998) 1 – 4
ABR disturbances in children with insulin dependent diabetes mellitus Grazyna Niedzielska 1,*, Emilia Katska Department of Paediatric Otolaryngology, Phoniatry and Audiology, Medical Academy, Lublin, Poland Received 16 July 1997; received in revised form 8 January 1998; accepted 11 January 1998
Abstract A number of papers present the research on hearing disturbances in the course of diabetes mellitus. Some authors report the damage of inner ear cells, whereas others maintain that it is located in the retrocochlear part of the hearing pathway. The objective of the paper was to find the location of the auditory pathway disturbances in children suffering from diabetes mellitus. The analysis concerns 37 insulin treated children aged 6 – 18 years. The following audiometric methods were applied: pure-tone audiometry, impedance audiometry as well as auditory brainstem response (ABR). We observed conduction disturbances within the stem in ABR, in the children without hearing loss in pure-tone audiometry. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Diabetes mellitus; Hearing tests; ABR
The main reason for the occurrence of degenerative changes in patients with insulin dependent diabetes mellitus is the insufficiency of insulin with secondary hyperglycaemia in the insulin dependent tissues. The excess of glucose supply results in excess glycoproteins production, mainly in the basement layer of the vessels, the excessive production of sorbitol and the increase of glucolysic haemoglobin concentration. Simultaneously the hypercoagulability of blood is * Corresponding author. 1 Present address: Grazyna Niedzielska, ul. Kozmiana 34, 20-429 Lublin, Poland.
developed and it depends on the increased aggregation of platelets and blood viscosity, as well as on the excessive production of prostaglandins and thromboxanes. The fibrinogen level is increased and the fibrinolytic activity of plasma is decreased. These disorders result in hypoxia [1,2]. As the publications point out diabetes mellitus causes senso-neurinal hearing loss [3]. The aim of the study was to evaluate the hearing organ in children with insulin dependent diabetes and to localize the disorders. The paper presents the preliminary results of the investigations which will be carried on.
0165-5876/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S0165-5876(98)00017-2
2
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
Fig. 1. Disorders in ABR in the diabetes course.
1. Material and methods The clinical analysis included 37 children (74 ears) at 6–18 years of age. The patients were treated with humanised insulin Eli Lilly and Novo-Nordisk twice a day. The group was divided into two subgroups differentiated by the duration of diabetes treatment. Group I included 16 children up to 3 years of diabetes treatment; group II included 21 patients whose treated lasted more than 3 years. Audiological tests included pure-tone audiometry, impedance audiometry with stapedial reflex and the auditory brainstem responses (90 dB nHL, 30 impulses per second, click 125 ms halfwave square). During the tests all the children were in the clinical and biochemical balance period.
2. Results The audiometric tests showed the hearing level at 10–15 dB in all the patients. The tympanometric test defined the regular condition of the middle ear (tympanogram of A type) and the presence of the stapedial reflex. These tests were performed after videootoscopy. In hearing potentials from the brain stem we observed elongation of the latency of wave I in four ears, of wave III in 54 ears and of wave V in
70 ears. Moreover, we noticed (Fig. 1). also elongation of interval I–III in nine ears, III–V in seven ears and I–V in 23 ears. The latence time mean values for wave I is 2.0, for wave III, 4.4 and for wave V, 6.4. As follows from the studies the interval of waves I and III is 2.3, III and V is 2.0, I and V is 4.3. The results of our investigations were compared statistically. Latence times for waves I, III and V compared to the norm values were statistically significant; pB 0.001. Intervals I–III and I–V were also statistically significant; pB 0.001. However, the values for interval III–V were higher than the norm but statistically insignificant. The analysis of the results depending on the disease treatment duration showed that the pathological changes concerned more frequently the children of group I (Figs. 2 and 3). It should be assumed that the reasons for this phenomenon are the variations of glucose level in blood as well as haemoglobin HbA-1c concentration increase in the first stage of diabetes treatment. The laboratory tests in the children with changes in ABR records showed that their diabetes was of unstable character. HbA-1c level oscillated from 5.8 to 11.2% (standard up to 6%), and fructosamine level from 304 to 620 mm/l (standard up to 280 mm/l). The increased values of haemoglobin HbA-1c and fructosamine levels concerned about 68% of the children from group
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
3
Fig. 2. Graphical presentation: A, normal waves; B, waves in the course of diabetes mellitus.
I. No correlation was found between the duration of the disease and disorders appearance in the auditory responses from the brain stem. Many authors have studied the disorders of hearing organ in the course of diabetes mellitus, however so far it has not been defined if the disorders are localised in cochlea, nerve, hearing pathway or in cortical centres areas [3]. Rust and co-workers in their experimental studies on animals observed significant loss of outer hearing cells in rats with diabetes mellitus. They suggest the outer hearing cells loss is related to
hyperglycemia and a genetic predisposition for glucose intolerance [4]. Van-den-Ouweland I.M. et al., observed the decrease in mitochondrial enzyme activities of the respiratory chain. According to them, the pathogenetic factor responsible for diabetes mellitus combined with sensorineural hearing loss is a mutation in mitochondrial DNA [5]. Grosse-Aldenhovel and Gallenkamp think that the degenerative changes in the hearing organ concern the retrocochlear part [1]. The results of our tests confirm the above assumption.
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
4
Fig. 3. ABR recordings depending on the treatment duration.
3. Conclusions 1. In the course of diabetes mellitus conduction disturbances within the stem are confirmed by electrophysiological methods even when no hearing loss is found in the pure-tone audiometry. 2. The latency elongation of wave I latency was confirmed in 93% tested ears and of wave III in 54 ears, i.e. 73%. 3. The elongated latence times of the waves under consideration as well as intervals I – III and I –V were statistically significant.
[2] [3]
[4]
[5]
References [1] H.B. Grosse-Aldenhovel, U. Gallenkamp, C.A. Sulem-
.
ana, Juvenile onset diabetes mellitus, central diabetes insipidus and optic atrophy (Wolfram syndrome), neurological findings and prognostic implications, Neuropediatrics 22 (2) (1991) 103. H. Ludwiczak, A. Symonides-Ławecka, Cukrzyca u dzieci i jej leczenie, PZWL, Warszawa, 1981. A. Pruszewicz, B. Kulczyn´ski, A. Kruk-Zagajewska, M. Walczak, D. Mrozikiewicz, Pro´ba lokalizacji uszkodzen´ narzadu słuchu w cukrzycy u dzieci. Materiały naukowe VII Dni Otolaryngologii Dzieciecej 5-7.06, Poznan´, 1987, p. 376. K.R. Rust, J. Prazma, R.J. Triana, O.E. Michaelis, H. Pillsbury, Inner ear dammage secondary to diabetes mellitus, II: changes in aging SHR/W-cp rats, Arch. Otolaryngol. Head Neck Surg. 118 (4) (1992) 397. J.M. Van-den-Ouweland, H.H. Lemkes, W. Ruitenbeek, L.A. Sandkuijl, Mutation in mitochondrial tRNA (Leu) (UUR) gene in a large pedigree with maternally transmitted type II: diabetes mellitus and deafness, Nat. Genet. 1 (5) (1992) 368.
ABR disturbances in children with insulin dependent diabetes mellitus Grazyna Niedzielska 1,*, Emilia Katska Department of Paediatric Otolaryngology, Phoniatry and Audiology, Medical Academy, Lublin, Poland Received 16 July 1997; received in revised form 8 January 1998; accepted 11 January 1998
Abstract A number of papers present the research on hearing disturbances in the course of diabetes mellitus. Some authors report the damage of inner ear cells, whereas others maintain that it is located in the retrocochlear part of the hearing pathway. The objective of the paper was to find the location of the auditory pathway disturbances in children suffering from diabetes mellitus. The analysis concerns 37 insulin treated children aged 6 – 18 years. The following audiometric methods were applied: pure-tone audiometry, impedance audiometry as well as auditory brainstem response (ABR). We observed conduction disturbances within the stem in ABR, in the children without hearing loss in pure-tone audiometry. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Diabetes mellitus; Hearing tests; ABR
The main reason for the occurrence of degenerative changes in patients with insulin dependent diabetes mellitus is the insufficiency of insulin with secondary hyperglycaemia in the insulin dependent tissues. The excess of glucose supply results in excess glycoproteins production, mainly in the basement layer of the vessels, the excessive production of sorbitol and the increase of glucolysic haemoglobin concentration. Simultaneously the hypercoagulability of blood is * Corresponding author. 1 Present address: Grazyna Niedzielska, ul. Kozmiana 34, 20-429 Lublin, Poland.
developed and it depends on the increased aggregation of platelets and blood viscosity, as well as on the excessive production of prostaglandins and thromboxanes. The fibrinogen level is increased and the fibrinolytic activity of plasma is decreased. These disorders result in hypoxia [1,2]. As the publications point out diabetes mellitus causes senso-neurinal hearing loss [3]. The aim of the study was to evaluate the hearing organ in children with insulin dependent diabetes and to localize the disorders. The paper presents the preliminary results of the investigations which will be carried on.
0165-5876/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S0165-5876(98)00017-2
2
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
Fig. 1. Disorders in ABR in the diabetes course.
1. Material and methods The clinical analysis included 37 children (74 ears) at 6–18 years of age. The patients were treated with humanised insulin Eli Lilly and Novo-Nordisk twice a day. The group was divided into two subgroups differentiated by the duration of diabetes treatment. Group I included 16 children up to 3 years of diabetes treatment; group II included 21 patients whose treated lasted more than 3 years. Audiological tests included pure-tone audiometry, impedance audiometry with stapedial reflex and the auditory brainstem responses (90 dB nHL, 30 impulses per second, click 125 ms halfwave square). During the tests all the children were in the clinical and biochemical balance period.
2. Results The audiometric tests showed the hearing level at 10–15 dB in all the patients. The tympanometric test defined the regular condition of the middle ear (tympanogram of A type) and the presence of the stapedial reflex. These tests were performed after videootoscopy. In hearing potentials from the brain stem we observed elongation of the latency of wave I in four ears, of wave III in 54 ears and of wave V in
70 ears. Moreover, we noticed (Fig. 1). also elongation of interval I–III in nine ears, III–V in seven ears and I–V in 23 ears. The latence time mean values for wave I is 2.0, for wave III, 4.4 and for wave V, 6.4. As follows from the studies the interval of waves I and III is 2.3, III and V is 2.0, I and V is 4.3. The results of our investigations were compared statistically. Latence times for waves I, III and V compared to the norm values were statistically significant; pB 0.001. Intervals I–III and I–V were also statistically significant; pB 0.001. However, the values for interval III–V were higher than the norm but statistically insignificant. The analysis of the results depending on the disease treatment duration showed that the pathological changes concerned more frequently the children of group I (Figs. 2 and 3). It should be assumed that the reasons for this phenomenon are the variations of glucose level in blood as well as haemoglobin HbA-1c concentration increase in the first stage of diabetes treatment. The laboratory tests in the children with changes in ABR records showed that their diabetes was of unstable character. HbA-1c level oscillated from 5.8 to 11.2% (standard up to 6%), and fructosamine level from 304 to 620 mm/l (standard up to 280 mm/l). The increased values of haemoglobin HbA-1c and fructosamine levels concerned about 68% of the children from group
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
3
Fig. 2. Graphical presentation: A, normal waves; B, waves in the course of diabetes mellitus.
I. No correlation was found between the duration of the disease and disorders appearance in the auditory responses from the brain stem. Many authors have studied the disorders of hearing organ in the course of diabetes mellitus, however so far it has not been defined if the disorders are localised in cochlea, nerve, hearing pathway or in cortical centres areas [3]. Rust and co-workers in their experimental studies on animals observed significant loss of outer hearing cells in rats with diabetes mellitus. They suggest the outer hearing cells loss is related to
hyperglycemia and a genetic predisposition for glucose intolerance [4]. Van-den-Ouweland I.M. et al., observed the decrease in mitochondrial enzyme activities of the respiratory chain. According to them, the pathogenetic factor responsible for diabetes mellitus combined with sensorineural hearing loss is a mutation in mitochondrial DNA [5]. Grosse-Aldenhovel and Gallenkamp think that the degenerative changes in the hearing organ concern the retrocochlear part [1]. The results of our tests confirm the above assumption.
G. Niedzielska, E. Katska / Int. J. Pediatr. Otorhinolaryngol. 44 (1998) 1–4
4
Fig. 3. ABR recordings depending on the treatment duration.
3. Conclusions 1. In the course of diabetes mellitus conduction disturbances within the stem are confirmed by electrophysiological methods even when no hearing loss is found in the pure-tone audiometry. 2. The latency elongation of wave I latency was confirmed in 93% tested ears and of wave III in 54 ears, i.e. 73%. 3. The elongated latence times of the waves under consideration as well as intervals I – III and I –V were statistically significant.
[2] [3]
[4]
[5]
References [1] H.B. Grosse-Aldenhovel, U. Gallenkamp, C.A. Sulem-
.
ana, Juvenile onset diabetes mellitus, central diabetes insipidus and optic atrophy (Wolfram syndrome), neurological findings and prognostic implications, Neuropediatrics 22 (2) (1991) 103. H. Ludwiczak, A. Symonides-Ławecka, Cukrzyca u dzieci i jej leczenie, PZWL, Warszawa, 1981. A. Pruszewicz, B. Kulczyn´ski, A. Kruk-Zagajewska, M. Walczak, D. Mrozikiewicz, Pro´ba lokalizacji uszkodzen´ narzadu słuchu w cukrzycy u dzieci. Materiały naukowe VII Dni Otolaryngologii Dzieciecej 5-7.06, Poznan´, 1987, p. 376. K.R. Rust, J. Prazma, R.J. Triana, O.E. Michaelis, H. Pillsbury, Inner ear dammage secondary to diabetes mellitus, II: changes in aging SHR/W-cp rats, Arch. Otolaryngol. Head Neck Surg. 118 (4) (1992) 397. J.M. Van-den-Ouweland, H.H. Lemkes, W. Ruitenbeek, L.A. Sandkuijl, Mutation in mitochondrial tRNA (Leu) (UUR) gene in a large pedigree with maternally transmitted type II: diabetes mellitus and deafness, Nat. Genet. 1 (5) (1992) 368.