Acar Mehtap, Aycan Zehra, Acar Baran, Ertan Ulker, Peltek Havva Nur, Karasen Riza Murat
Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkey.
J Pediatr Endocrinol Metab. 2012;25(5-6):503-8. doi: 10.1515/jpem-2012-0062.
The aim of this study was to perform audiological evaluation of children with type 1 diabetes mellitus (DM).
One hundred DM patients (200 ears) were included in the study. Pure-tone audiometry at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz; immittance measures including tympanometry and acoustic reflex testing; transient evoked otoacoustic emission (TEOAE); and auditory brainstem response (ABR) testing were performed in the patients. The results were statistically compared with metabolic control of DM, positive and negative autoantibodies, duration of DM, and present concomitant Hashimoto and celiac diseases.
The proportion with a result of 'fail' for the TEOAE test in the DM patients was not statistically significant among all groups (p > 0.05). The autoantibodies, blood glucose level, and present concomitant Hashimoto and celiac diseases were not associated with prolonged ABR latencies. However, ABR peripheral transmission time (wave I) was significantly delayed with the increasing duration of DM (p < 0.05).
Pediatric patients with type 1 DM do not frequently present with cochleovestibular symptoms, but show higher audiometric thresholds and the absence of or reduction in TEOAE amplitudes. In ABR testing, the increase in the peripheral transmission time (wave I) is more suggestive of retrocochlear alterations in pediatric cases of type 1 DM compared with conventional audiometric tests (e.g., pure-tone audiometry and OAEs), which may indicate possible initial auditory neuropathy. Further longitudinal investigations on a wide range of control and pediatric subjects with DM will be necessary to confirm the present data and to detect initial auditory neuropathy.
本研究旨在对1型糖尿病（DM）患儿进行听力学评估。
本研究纳入了100例DM患者（200只耳）。对患者进行了0.25、0.5、1、2、4和8kHz频率的纯音听力测定；包括鼓室导抗图和声反射测试在内的声导抗测量；瞬态诱发耳声发射（TEOAE）；以及听觉脑干反应（ABR）测试。将结果与DM的代谢控制、自身抗体阳性和阴性、DM病程以及目前合并的桥本氏病和乳糜泻进行统计学比较。
DM患者中TEOAE测试结果为“失败”的比例在所有组中无统计学意义（p>0.05）。自身抗体、血糖水平以及目前合并的桥本氏病和乳糜泻与ABR潜伏期延长无关。然而，随着DM病程的延长，ABR外周传导时间（波I）显著延迟（p<0.05）。
1型DM患儿不常出现耳蜗前庭症状，但表现出较高的听力阈值以及TEOAE振幅缺失或降低。在ABR测试中，与传统听力测试（如纯音听力测定和耳声发射）相比，1型DM患儿外周传导时间（波I）增加更提示蜗后改变，这可能表明可能存在早期听觉神经病变。需要对大量对照和DM患儿进行进一步的纵向研究，以证实目前的数据并检测早期听觉神经病变。
