Abstract
IntroductionThe association between hearing loss and chronic kidney disease and hemodialysis has been well documented. However, the classification used for the degree of loss may underestimate the actual diagnosis due to specific characteristics related to the most affected auditory frequencies. Furthermore, correlations of hearing loss and hemodialysis time with hearing handicap remain unknown in this population. ObjectiveTo compare the results of Lloyd's and Kaplan's and The Bureau Internacional d’Audiophonologie classifications in chronic kidney disease patients, and to correlate the averages calculated by their formulas with hemodialysis time and the hearing handicap. MethodsThis is an analytical, observational and cross-sectional study with 80 patients on hemodialysis. Tympanometry, speech audiometry, pure tone audiometry and interview of patients with hearing loss through Hearing Handicap Inventory for Adults. Cases were classified according to the degree of loss. The correlations of tone averages with hemodialysis time and the total scores of Hearing Handicap Inventory for Adults and its domains were verified. Results86 ears (53.75%) had hearing loss in at least one of the tonal averages in 48 patients who responded to Hearing Handicap Inventory for Adults. The Bureau Internacional d’Audiophonologie classification identified a greater number of cases (n=52) with some degree of disability compared to Lloyd and Kaplan (n=16). In the group with hemodialysis time of at least 2 years, there was weak but statistically significant correlation of The Bureau Internacional d’Audiophonologie classification average with hemodialysis time (r=0.363). There were moderate correlations of average The Bureau Internacional d’Audiophonologie classification (r=0.510) and tritone 2 (r=0.470) with the total scores of Hearing Handicap Inventory for Adults and with its social domain. ConclusionThe Bureau Internacional d’Audiophonologie classification seems to be more appropriate than Lloyd's and Kaplan's for use in this population; its average showed correlations with hearing loss in patients with hemodialysis time≥2 years and it exhibited moderate levels of correlation with the total score of Hearing Handicap Inventory for Adults and its social domain (r=0.557 and r=0.512).
Highlights
The association between hearing loss and chronic kidney disease and hemodialysis has been well documented
Patients with normal otoscopy underwent tympanometry with an Interacoustics® brand immittanciometer, model at[235] XP, serial number 206331, contralateral TDH39 handset, ipsilateral clinical headset; patients with tympanogram of Jerger type ‘‘A’’ (1970) underwent speech audiometry and Pure Tone Audiometry (PTA) in an audiometric 2 m × 2 m cabin to assess the frequencies of 0.25; 0.5; 1; 2; 4; 6 and 8 kHz with Interacoustics® audiometer, ac[33] model, serial number 185994 with bone vibrator b-71, TDH-39 right and left headphones properly calibrated according to standards ISO 389-1 and ISO 389-3; PTA tests, speech audiometry and imitanciometry tests were performed by the same physician in all cases
Eighty-six ears (53.75%) had hearing loss in at least one of the pure tone averages in 48 patients
Summary
The association between hearing loss and chronic kidney disease and hemodialysis has been well documented. Objective: To compare the results of Lloyd’s and Kaplan’s and The Bureau Internacional d’Audiophonologie classifications in chronic kidney disease patients, and to correlate the averages calculated by their formulas with hemodialysis time and the hearing handicap. The correlations of tone averages with hemodialysis time and the total scores of Hearing Handicap Inventory for Adults and its domains were verified. There were moderate correlations of average The Bureau Internacional d’Audiophonologie classification (r = 0.510) and tritone 2 (r = 0.470) with the total scores of Hearing Handicap Inventory for Adults and with its social domain. There are several classification scales of the degree of hearing loss and their formulas consider different hearing frequencies to calculate the tone average. There is not yet consensus on which scale better fits the pattern of hearing loss occurring in patients with chronic kidney disease (CKD) and hemodialysis (HD). In 2013, 2.5 million patients were on dialysis in the world, and this number is expected to reach 6.5 million in 2030.11 In 2014, the estimated total number of dialysis patients in Brazil was 112,004, with 91.4% being on HD, and 8.6% on peritoneal dialysis.[12]
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