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ORIGINAL ARTICLE
Year : 2010  |  Volume : 14  |  Issue : 1  |  Page : 9-11

Type -2 diabetes mellitus and auditory brainstem responses - A hospital based study


Department of Otorhinolaringology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh- 202002, India

Date of Web Publication10-Jan-2011

Correspondence Address:
Rahul Gupta
Department of Otorhinolanngology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh- 202002
India
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Source of Support: None, Conflict of Interest: None


PMID: 21448408

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  Abstract 

Introduction: Diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia. The metabolic dysregulation associated with DM causes secondary patho-physiological changes in multiple organ systems. The brainstem auditory electric responses represent a useful, non invasive and simple procedure to detect both acoustic nerve and CNS damage.
Material & Methods: The study was carried out in the department of ENT, JNMC from 2008 -2010. The study included two groups, (i) diabetic group (n=25) (ii) Control group (n = 25). Diabetic group included patients attending Endocrinology OPD and ward. The equipment used for recording evoked response audiometry is IHS-BERA. Model number TH72312HT. Year of manufacture 2006.
Results: Mean age of control group was 45.7 years. In the study group 13 (52%) were males where as 12 (48%) were females. Mean age of study group was 46.8 years. There is no significant difference between age groups of controls and cases. Significant difference was found in latencies of wave III and interpeak III-V while highly significant difference was found in latencies of wave V and interpeak I-III, I-V between control and study group at 70 dB. Highly significant difference was found in latencies of wave III, V and interpeak I-III and I-V while significant difference was found in interwave III-V between control and study group at 80 dB. Significant difference was found in latencies of wave V and interpeak III-V while highly significant difference was found in wave III and interpeak I-III, I-V between control and study group at 90 dB.
Conclusion: BERA is a simple, non-invasive procedure to detect early impairment of acoustic nerve, and CNS pathways, even in the absence of specific symptoms. This study suggests that if BERA is carried out in diabetic patients; involvement of central neuronal axis can be detected earlier.

Keywords: Type 2 diabetes mellitus, auditory response, auditory neuropathy, hyperglycemia, BERA


How to cite this article:
Gupta R, Aslam M, Hasan S A, Siddiqi S S. Type -2 diabetes mellitus and auditory brainstem responses - A hospital based study. Indian J Endocr Metab 2010;14:9-11

How to cite this URL:
Gupta R, Aslam M, Hasan S A, Siddiqi S S. Type -2 diabetes mellitus and auditory brainstem responses - A hospital based study. Indian J Endocr Metab [serial online] 2010 [cited 2019 Jun 17];14:9-11. Available from: http://www.ijem.in/text.asp?2010/14/1/9/75076


  Introduction Top


Diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of diabetes mellitus exist and are caused by a complex interaction of genetic, environmental factors and life style choices. The two broad categories of DM are designated as type-1 and type-2. Type-2 diabetes is due to predominantly insulin resistance with relative insulin deficiency NIDDM, which is much more common than IDDM was discovered by chance. It is typically gradual in onset and occurs mainly in the middle aged and elderly. The metabolic dysregulation associated with DM causes secondary patho-physiological changes in multiple organ systems. In general the risks of chronic complication increases as a function of the duration of hyperglycemia, they usually become apparent in the second decade of hyperglycemia. Since type-2 DM often has a long asymptomatic period of hyperglycemia, many individuals with type-2 DM have complication at the time of diagnosis.

Neuropathy is the more precocious and frequent late complication of DM. So far most of the clinical and diagnos­tic studies on diabetic neuropathy have concerned only peripheral and autonomic nerve but recently with the refinement of evoked potential techniques detailed explora­tion of sensory pathway in central nervous system has been possible. Also pathological studies by Reske-Nielson and Ludback (1965) and Makishima and Tanaka (1971) have shown involvement of brain parenchyma in patients of long standing DM.

The brainstem auditory electric responses represent a useful, non invasive and simple procedure to detect both acoustic nerve and CNS damage. ABR is a far field recording of the synchronized response of a large number of neurons in the lower portion of auditory pathway. It was first described by Shemer and Femmesser in 1967.A full description of AEP is given by Hyde (1987).

At present this evoked potential has become a routine part of the standard audio logical test battery. It is recorded by placing active electrodes positioned at vertex and reference electrode at the mastoid or earlobe. A stimulus is generated by using 100 microseconds rectangular pulse or click. The recording is in the form of waves having peaks and troughs. There are seven waves traditionally designated with roman numerals from I to VII. Wave I and II represent activity in cochlear nerve, wave III in cochlear nucleus, wave IV in superior olivary complex, wave V which is biggest and most consistent represent activity in nuclei of lateral lemniscus while wave VI and VII in the inferior colhculus. In this way whole of the auditory pathway can be studied. The amplitude of peaks are variable with in subjects while the latencies of peaks are stable and are well documented.

In detecting evidence of central neuropathy in DM, Coshum Durmus et al (2004), Toth et al(2001), Virtamemi J et al(1993) found evidence of central auditory pathway involvements.

A very distinct advantage of using ABR as a diagnostic modality that it is resistant to the effect of sleep, sedation and anesthesia. It is suitable for children and for adult who are not able to co-operate.


  Aims and Objectives Top


The present study was carried at finding out central auditory pathway involvement in diabetes mellitus by BERA.


  Materials and Methods Top


The study was carried out in the department of ENT, JNMC from 2008 -2010. The study included two groups, (i) diabetic group (n=25) (ii) Control group (n=25). Diabetic group included patients attending Endocrinology OPD and ward.

Inclusion criteria: Age group-30 years and above. Duration of disease- DM (Type II for five years duration). Patients having other micro vascular or macro vascular complications were preferred.

Exclusion criteria: Patient who gave history of ear disease, exposure to prolonged loud noise, intake of ototoxic drug, stroke, head injury or family history of deafness were not included. Patient taking any medication which might be expected to interfere with the functioning of central nervous system. (Methyldopa, reserpine, phenytoin, Antipsychotic, antidepressants) were excluded from the study.

The controls were matched for age and sex with the study group. Their blood sugars both random and post prandial were in the normal range.

The equipment used for recording evoked response audiometry is IHS-BERA. Model number TH72312HT Year of manufacture 2006.


  Results Top


In the control group 17 (68%) were males where as 8 (32%) were females. Mean age of control group was 45.7 years. In the study group 13 (52%) were males where as 12 (48%) were females. Mean age of study group was 46.8 years. There is no significant difference between age groups of controls and cases.[Table 1]
Table 1: Comparison of Absolute Latencies and Interpeak Latencies in control and in patients With Diabetes Mellitus at 70, 80 and 90 dB.

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Significant difference was found in latencies of wave III and interpeak III-V while highly significant difference was found in latencies of wave V and interpeak I-III, I-V between control and study groupat70dB.

Highly significant difference was found in latencies of wave III, V and interpeak I-III and I-V while significant difference was found in interwave III-V between control and study group at 80 dB.

Significant difference was found in latencies of wave V and interpeak III-V while highly significant difference was found in wave III and interpeak I-III, I-V between control and studygroupat90dB.

The duration of DM was 5-10 years in 13 (52%) patients and among these patients BERA was delayed in 7 (53.84%) subjects. 12 (48%) patients had history of diabetes for > 10 years and among these patients, BERA was delayed in (91.66%) subjects.

In the study group 13/25 cases had neuropathy, 1/25 cases had nephropathy and 2/25 cases had retinopathy in the study group

Among 25 patients, 13 (52%) patients had peripheral neuropathy and the BERA was delayed in 12(92.3%) patients. While the incidence of delayed BERA was 50% in patients without peripheral neuropathy.


  Discussion Top


Both the study group and control group were tested 2-3 times, so as to confirm the reproducibility of the results. Intensity 70-90 dB were presented to evoke good quality ABRs.

The recordings were tabulated and statistical analysis of the data was done by applying "unpaired student's t-test" to the data. A p-value of less than 0.05 and less than < 0.001 was considered as significant and highly significant respectively.

The maximum number of cases i.e., 11 (44%) were from 41-50years age group. The mean age of study group was 46.8years and mean age of controls was 45.5years.

The latency of wave I was found to be equal in the diabetics and controls. This suggests that the eight nerve transmission till the level of cochlear nucleus was not altered in the diabetics. The latency of wave III was delayed by 0.39 msec, 0.42 msec and 0.42 msec at 70, 80 and 90 dB respec­tively in diabetic group as compared to control group. The delay was found to be highly significant on statistical analysis. The latency of wave V was delayed by 0.48 msec, 0.47 msec and 0.50 msec at 70, 80 and 90 dB respectively in diabetic group as compared to control group. The delay was found to be highly significant on statistical analysis.

The interpeak latency I-III, III - V and I-V was delayed in the diabetic group. This suggests delayed transmission of the auditory stimulus in the auditory pathway of diabetics at the level of brainstem and midbrain. The delay in the latency of wave III and V in the diabetics indicate neuropathy at brainstem and midbrain level in the auditory pathway.

Fidele et al in 1984 found the latencies (ms) of ABR waves were significantly impaired in diabetic subjects as compared with normal. Peripheral transmission time (Wave I) and central transmission time (Wave I-V) were also significantly delayed in diabetic subjects.

Kunen et al in 1989 evaluated hearing threshold of 30 diabetic patients and 30 healthy controls by using puretone audiometry. They found that diabetics had a poorer hearing threshold than the non-diabetics. All age group with diabetes showed a significant high frequency hearing loss as compared to the control population.

Sharma et al in (2000) found the incidence of delayed wave latencies in diabetics was 64%, 72% and 84% at 2 KHz, 4 KHz and 6 KHz respectively, suggesting that if brainstem evoked response audiometry is conducted at higher fre­quency like 6 KHz in diabetic patients, and the involvement of central neural axis can be detected earlier.

Diabetes for more than 10 years duration was present in 12 (48%) patients, among these BERA was delayed in 11 (91.66%) cases. So longer duration of diabetes is a definite risk factor for development of central neuropathy. Diabetics with peripheral neuropathy (n= 13) had more incidence of delayed BERA (n=12) tracings. So we concluded that diabetic subjects could suffer not only from peripheral and autonomic neuropathy but also from central neuropathy. The CNS involvement can be related to duration of diabetes and peripheral neuropathy.

Bayazit Y et al in 2000 also concluded the likelihood of encountering a diabetic complication increases as the ABR results become abnormal.


  Conclusions Top


BERA is a simple, non-invasive procedure to detect early impairment of acoustic nerve, and CNS pathways, even m the absence of specific symptoms. This study suggests that if BERA is carried out in diabetic patients; involvement of central neuronal axis can be detected earlier. So we strongly recommend that BERA should be done in all patients with diabetic mellitus. [7]

 
  References Top

1.Bayazit Y, Yilmaz M, Kepekgi Y, Mumbuc. 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 (l-2):29-32.  Back to cited text no. 1
    
2.Durmus C, Yetiser S, Durmus O. Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing. International J of Audiology2004;43(l);29-33.  Back to cited text no. 2
    
3.Fidele D, Martin A, Cardone C et al. Impaired auditory Brain Stem Evoked response in diabetes mellitus. Diabetes 1984;33:1805-1089.  Back to cited text no. 3
    
4.Kunen M, Thomas K, Bhanu T S. Hearing thresholds in patients with diabetes mellitus. Journal of Laryngology and Otology Rhinology 1989;80:218-288.  Back to cited text no. 4
    
5.Sharma R, Gupta SC, Tyagi I et al. Brain Stem Evoked Responses in patients with Diabetes Mellitus. Indian J of Otolaryngology and Head and Neck Surgery 2000;52(3); 221-229.  Back to cited text no. 5
    
6.Toth et al, Brainstem auditory evoked potential examinations in diabetic patients, ScandinavianAudiology2001;30;156-159.  Back to cited text no. 6
    
7.Virtanierni J, Laakso M, Nuutinen J., Karjalainens. Quoted by Booth JB. Scott Brown's Otolaryngology: 6th edition, Vol. 3, Butterworths, London; pp 95:1997.  Back to cited text no. 7
    



 
 
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   Abstract
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   Aims and Objectives
   Materials and Me...
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