Cochlear function in patients with chronic kidney disease

Samantha Marlanie Govender,Cyril Devdas Govender,Glenda Matthews

doi:10.7196/sajcd.243

Abstract

To evaluate cochlear functioning in patients (18-45 years old) with varying stages of chronic kidney disease (CKD). Using purposive sampling, 50 participants, 10 in each of the 5 stages of CKD, were selected and underwent pure tone audiometric testing and distortion product otoacoustic emissions (DPOAEs).Significant differences (p < 0.05) were found between pure tone audiometry and DPOAEs in detecting early cochlear dysfunction in the high-frequency range in stages 3 (6,000/5,000 Hz; p = 0.00), 4 (6,000/5,000 Hz; p < 0.03) and 5 (4,000/3,333 Hz; p < 0.01, 8,000/6,667 Hz: p < 0.05) with DPOAEs being more sensitive in identifying early cochlear dysfunction. Patients in stages 1 and 2 presented with normal puretone thresholds and DPOAEs, suggesting that cochlear functioning in these patients was normal. Early cochlear dysfunction, thereby indicating a subclinical hearing loss, was identified in stages 3, 4 and 5 by DPOAE testing. In addition, blood test results, drug intake and concomitant conditions were recorded and analysed which suggested a relationship between reduced cochlear functioning and increased electrolyte levels, treatment regimens and concomitant conditions.Participants in the later stages of CKD presented with early cochlear dysfunction, presenting with subclinical hearing loss. It was postulated that this subclinical hearing loss resulted from a combination of electrolytic, urea and creatinine imbalances, together with concomitant medical conditions and ototoxic drug intake. It was concluded that audiological monitoring be included in the management of patients with CKD and that DPOAEs be introduced as part of the test battery to monitor cochlear function in patients with varying degrees of CKD.

Highlights

It is plausible to assume that any physiological disruption to the fluids within the cochlea caused by chronic kidney disease (CKD), together with the intake of ototoxic medication and the interaction of concomitant conditions, can impact on cochlear functioning, resulting in abnormal distortion product otoacoustic emissions (DPOAEs) as well as abnormal audiometric thresholds
A significant difference was seen at the high-frequency range of 4 000 Hz (p
When the blood test results in group 5 were statistically analysed; it became apparent that the K+, urea and creatinine levels were relatively higher and outside of the normative range when compared with participants in the earlier stages of CKD

Summary

Objective

To evaluate cochlear functioning in patients (18 - 45 years old) with varying stages of chronic kidney disease (CKD). It is postulated by the researchers that a similar decline occurs in auditory functioning, which could occur as a result of one or a combination of factors, including the disease itself, concomitant conditions such as hypertension/high blood pressure (HBP) and diabetes, as well as intake of ototoxic medication These conditions are more likely to impact on cochlear functioning; the literature indicates that cochlear alterations have been observed in patients with diabetes, HBP and CKD (Fukushima, Paparella, Schachern & Harada, 2005; Sobh et al, 1999). It is plausible to assume that any physiological disruption to the fluids within the cochlea caused by CKD, together with the intake of ototoxic medication and the interaction of concomitant conditions, can impact on cochlear functioning, resulting in abnormal DPOAEs as well as abnormal audiometric thresholds.

Participants

Study design

Ethical considerations

Results

Discussion