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 Table of Contents  
ORIGINAL ARTICLE
Year : 2011  |  Volume : 17  |  Issue : 3  |  Page : 109-112

A study on hearing evaluation in patients of chronic renal failure


1 Departments of ENT and Head and Neck Surgery, Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
2 Department of Medicine, Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
3 Department of Pediatrics, Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
4 Department of Community Medicine, Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India

Date of Web Publication26-Dec-2011

Correspondence Address:
Ravinder Sharma
46 Saketkunj, Saket, Meerut 250003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.91189

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  Abstract 

Aims and Objective: The aim of the study was to evaluate hearing threshold and the severity of hearing loss at different frequencies (250Hz, 500Hz, 1000Hz, 2000Hz, 3000Hz, 4000Hz, 6000Hz, and 8000Hz) in patients of chronic renal failure (CRF), and to analyze the role of duration of disease on hearing threshold in patients of CRF. Materials and Methods: Fifty two patients of CRF were evaluated in Nephrology unit and ENT OPD. Cases with middle ear involvement were not included in the study. Pure tone audiometry was done in all cases to establish hearing threshold at different frequencies. Cases with hearing loss were classified according to the severity of hearing loss. In patients with sensorineural hearing loss, mean hearing threshold was calculated. Cases were classified in two groups on the basis of duration of disease (less than two years and more than two years) and the mean hearing thresholds were calculated. The significant differences between the mean hearing thresholds of these two groups were assessed using student's t test for unequal samples. Results : A total of 52 patients (28 males and 24 females) were included in the study. Majority of the patients were in 21 to 40 year age group (mean age 36.84 years). Of the 104 ears, 76 ears (73.07%) had sensorineural hearing loss and 28 ears (26.93%) had normal hearing. Majority of the ears with hearing loss had mild (44.73%) or moderate (42.11%) sensorineural hearing loss. Mean hearing threshold was higher at low frequencies and high frequencies with a relative sparing of mid frequencies. Comparison of the mean hearing threshold in patients of Group I (duration of disease less than two years - 42 ears) and Group II (duration of disease more than two years - 34 ears) showed a statistically significant difference (P<0.05) in mean hearing threshold at 250 Hz. Conclusion: Hearing loss is present in majority of the patients of CRF. Most of the cases have mild to moderate sensorineural hearing loss. Hearing threshold worsens at low frequency (250 Hz) as the duration of disease increases.

Keywords: Chronic renal failure, Deafness, Sensorineural hearing loss


How to cite this article:
Sharma R, Gaur S, Gautam P, Tiwari R, Narain A, Lalchandani T. A study on hearing evaluation in patients of chronic renal failure. Indian J Otol 2011;17:109-12

How to cite this URL:
Sharma R, Gaur S, Gautam P, Tiwari R, Narain A, Lalchandani T. A study on hearing evaluation in patients of chronic renal failure. Indian J Otol [serial online] 2011 [cited 2019 May 20];17:109-12. Available from: http://www.indianjotol.org/text.asp?2011/17/3/109/91189


  Introduction Top


Chronic renal failure is characterized by gradually progressive loss of renal function. It result from a variety of causes; however, the basic defect is gradually progressive destruction of nephrons which leads to a progressive reduction in glomerular filtration rate leading to increase in blood urea and creatinine, accumulation of toxins, electrolyte imbalance, metabolic acidosis, and disturbance in calcium metabolism. These patients are prone to develop hematological complications, bleeding diathesis, deranged calcium metabolism, neuropathy, and hearing loss.

To evaluate the hearing in patients of chronic renal failure, this study was conducted on 52 patients of chronic renal failure attending nephrology unit in a tertiary care centre from January 2009 to December 2009. The results of the findings are presented with the review of literature.


  Materials and Methods Top


The patients included in the study were cases of CRF attending nephrology unit at a tertiary care center from January 2009 to December 2009. The criterion for diagnosis of CRF was decrease in kidney glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m 2 for three or more months. The aim of the study was to:

  1. To evaluate the hearing at different frequencies in patients of chronic renal failure
  2. To study the correlation between hearing loss and duration of chronic renal failure.


A total of 52 patients were included in the study group (28 male and 24 female). These cases were evaluated in nephrology unit and ENT OPD. Cases with past history of hearing loss, ear discharge, diabetes, and hypertension were not included in the study. Thereafter, all patients were subjected to basic tests of renal function Hb, Hct, blood urea, serum creatinine, and blood urea nitrogen). On the basis of the findings of biochemical investigations, GFR was calculated. All these patients were then subjected to clinical evaluation and pure tone audiometry (ALPS advanced digital audiometer AD2000) at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz in a sound treated room. The findings on audiometry were noted and patients were classified according to WHO classification for pure tone audiogram. In 38 patients with hearing loss, mean hearing threshold was calculated at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz to evaluate the severity and pattern of hearing loss in chronic renal failure.

To study the effect of duration of disease on hearing threshold all patients of chronic renal failure were divided into two groups - with duration of disease less than two years (21 cases) and more than two years (17). The mean hearing thresholds at different frequencies were compared in both the groups. The significant differences between the hearing thresholds of these two groups were assessed using student's t test for unequal samples.


  Results Top


The characteristics of the study group are as shown in [Table 1]. Of the 52 patients, 28 (53.84%) were males and 24 (46.16%) were females. A total of 71.15% (37/52) of the patients were in 21 to 40 year age group. The mean age group was 36.84 years with a standard deviation of 10.80.
Table 1: Age and sex distribution of patients of chronic renal failure in the study group (number of patients 52)


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On the basis of history, deafness was present in 36.53% of the patients followed by vertigo in 23.07% of cases and tinnitus in 19.23% of cases [Table 2].
Table 2: Details of ear symptoms in patients of chronic renal failure (number of patients 52)


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Of the 104 ears, 76 ears (73.07%) had sensorineural hearing loss and 28 ears (26.93%) had normal hearing on pure tone audiogram. [Table 3] shows severity of hearing loss in 76 ears with sensorineural hearing loss. Majority of the ears had mild (44.73%) or moderate hearing loss (42.11%).
Table 3: Severity of hearing loss in patients of chronic renal failure (38 patients, 76 ears)


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The mean hearing threshold in 76 ears with sensorineural hearing loss at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz is as shown in [Figure 1]. The mean hearing threshold was higher at 250 Hz, 500 Hz, 6000 Hz, and 8000 Hz as compared to mean hearing threshold at 1000, 2000, 3000, and 4000 Hz.
Figure 1: Showing mean hearing threshold at different frequencies in patients of chronic renal failure

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The number of ears with duration of CRF less than two years was 42 (55.26%), while number of ears with duration of chronic renal failure more than two years was 34 (44.73%). The mean hearing thresholds at different frequencies is as shown in [Table 4]. There was a significant difference (P<0.05) in mean hearing threshold at 250 Hz in two groups. For rest of the frequencies, the difference in mean hearing threshold was non-significant.
Table 4: Relation in hearing threshold and duration of chronic renal failure


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  Discussion Top


Chronic renal failure is characterized by gradually progressive loss of renal function. It is a major cause of morbidity and mortality, particularly in later stages of disease. Approximately one million nephrons are present in each kidney, each contributing to the total GFR. Regardless of the etiology of renal injury, there is gradually progressive destruction of nephrons in patients of chronic renal failure. The kidney has an innate ability to maintain GFR by hyperfiltration and compensatory hypertrophy of the remaining healthy nephrons. The adaptive changes in nephron lead to maladaptive consequences i.e. increase in glomerular filteration causing glomerular injury. Abnormal glomerular permeability further leads to proteinuria. When the renal reserve exhausts, it leads to an increase in plasma level of urea and creatinine. [1] Possible cause of uremic manifestations in chronic renal failure is due to accumulation of toxins due to impairment of renal function. As a result the blood becomes too acidic, bones starts loosing calcium, and nerves starts degenerating leading to sensorineural hearing loss.

Deafness in chronic renal failure

Sensorineural hearing loss in patients of chronic renal failure is relatively higher in comparison to the general population. Quite a good number of studies show that patients of chronic renal failure have sensorineural hearing loss. [2],[3],[4] In the present study, 73.07% of the ears had sensorineural hearing loss and 26.93% of the ears had normal hearing. Almost similar results were reported by Bazzi et al, [5] (sensorineural hearing loss in 77%), Kusakari et al, [6] (60% of the patients had hearing loss) and Charachon [7] (sensorineural hearing loss in 75% cases) in patients of chronic renal failure. Kusakari [6] also reported that 36% of the patients had vestibular dysfunction and 26% had a combination of hearing and vestibular dysfunction. Vestibular dysfunction was not evaluated in the present study.

Majority of the patients in the present study had mild to moderate sensorineural hearing loss. A total of 44.73% of the ears had mild sensorineural hearing loss, while 42.11% of the ears had moderate sensorineural hearing loss. Ozturan [8] reported moderate to severe hearing loss in 46% of patients of chronic renal failure.

Only a few studies are available showing the mean hearing threshold at all frequency levels. The mean hearing threshold varied from 29.40 dBHL at 1000 Hz to 38.35 dBHL at 8000 Hz. The mean hearing threshold at low frequencies (250 Hz and 500 Hz) and at higher frequencies (4000 Hz, 6000 Hz, and 8000 Hz) was relatively more as compared to that mid frequencies (1000 Hz and 2000 Hz) suggesting the predilection for high and low frequencies involvement in patients of chronic renal failure. Gatland et al, [9] reported incidence of deafness as 41% in low frequencies, 15% in mid frequencies, and 53% in higher frequencies. However, Johnson et al, [10] and Antonelli et al, [3] reported only high frequency hearing loss in patients of chronic renal failure. Ozturan [8] reported a notch at 6 Khz in patients of chronic renal failure. Stavroulaki et al, [11] found hearing loss in 55.5% of the children with CRF, with hearing mainly affected at higher frequencies (12 Hz).

A variety of causes like electrolyte imbalance, [12] high blood pressure, [9] use of ototoxic medication, [9] vitamin D deficiency, [12] and inhibition of Na + K + activated ATPase enzyme [13] (important for maintaining cationic gradients in cochlea) have been suggested for sensorineural hearing loss in patients of chronic renal failure.

Correlation in hearing loss with duration of treatment

There was no statistically significant difference in hearing threshold at all frequencies (except at 250 Hz) in patients with duration of illness less than two years and patients with duration of illness more than two years suggesting deafness as an early phenomena in chronic renal failure and it do not progresses further with the duration of disease. There was a statistically significant difference in hearing threshold at 250 Hz suggesting deterioration of hearing at low frequency as the duration of disease increases. This is a significant finding and needs to be studied further in studies with large number of patients. Henrich et al, [14] showed found that 75% of patients showed no deterioration of hearing during a four-year time of follow-up.


  Conclusion Top


Hearing loss is present in majority of the patients of chronic renal failure. Most of the cases have mild to moderate hearing loss. There is a significant association between hearing threshold at 250 Hz with the duration of disease suggesting that hearing threshold worsens at low frequency (250 Hz) as the duration of disease increases. For the rest of the frequencies, there is no significant correlation between hearing loss and the duration of disease.

 
  References Top

1.Chonchol M, Spiegel DM. The patients with Chronic Kidney disease. Manual of Nephrology. 7 th ed. Philadelphia: Lippencott, Williams and Wilkins; 2009. p. 185-8.  Back to cited text no. 1
    
2.Mancini ML, Dello Strologo L, Bianchi PM, Tieri L, Rizzoni G. Sensorineural hearing loss in patients reaching chronic renal failure in childhood. Pediatr Nephrol 1996;10:38-40.  Back to cited text no. 2
    
3.Antonelli AR, Bonfiolii F, Garrubba V, Ghisellini M, Lamoretti MP, Nicolai P, et al. Audiological findings in elderly patient with chronic renal failure. Acta Otolaryngologica 1991;476 (Suppl):54-68.  Back to cited text no. 3
    
4.Kligerman AB, Solangi KB, Ventry IM, Goodman AI, Wesely SA. Hearing impairment associated with Chronic renal failure. Laryngoscope: 1981;91:583-92.  Back to cited text no. 4
    
5.Bazzi C, Venturini C, Pagani C, Arrigo G, D'Amico G. Hearing loss in short and long term haemodialyzed patients. Nephrol Dial Transpl 1995;10:1865-8.  Back to cited text no. 5
    
6.Kusakari J, Kobayashi T, Rokugo M, Arakawa E, Ohyama K, Kawamoto K, et al. The inner ear dysfunction in hemodialysis patients. Tohoku J Exp Med 1981;135:359-69.   Back to cited text no. 6
    
7.Charachon R, Moreno-Ribes V, Cordinnier D. Deafness due to renal failure. Clinicopathological study. Ann Otolaryngol Chir Cervicofac 1978;95:179-203.  Back to cited text no. 7
    
8.Ozturan O, Lam S. The effect of hemodialysis on hearing using pure tone audiometry and distortion - product otoacoustic emissions. ORL J Otorhinolaryngol 1998;60:306-13.  Back to cited text no. 8
    
9.Gatland D, Tucker B, Chalstrey S, Keene M, Baker L. Hearing loss in chronic renal failure - threshold changes following hemodialysis. J R Soc Med 1991;84:587-9.   Back to cited text no. 9
    
10.Johnson DW, Wathen RL, Mathog RH. Effect of hemodialysis on hearing threshold. ORL J Otorhinolaryngol 1976;38:129-39.  Back to cited text no. 10
    
11.Stavroulaki P, Nikolopoulos TP, Psarommatis I, Apostolopoulos N. Hearing evaluation with distortion product otoacoustic emissions in young patients undergoing hemodialysis. Clin Otolaryngol 2001;26:235-42.   Back to cited text no. 11
    
12.Brookes GB. Vitamin D deficiency and deafness 1984 update. Am J Otol 1985;6:102-7.   Back to cited text no. 12
    
13.Alder D, Fiehn W, Rirz E. Inhibition of Na + K + stimulated ATPase in cochlea of the guinea pig. A potential cause of disturbed inner ear function in terminal renal failure. Acta Otolaryngol 1980;90:55-60.  Back to cited text no. 13
    
14.Henrich W, Thompson P, Bergstrom L, Lum GM. Effect of dialysis on hearing acuity. Nephron 1977;18:348-51.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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