Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF
  • Original Article
  • Open access
  • Published:

The relationship between auditory brainstem response, nerve conduction studies, and metabolic risk factors in type II diabetes mellitus

Egyptian Rheumatology and Rehabilitation volume 43, pages 163–171 (2016)Cite this article

Abstract

Background

Few studies have reported a correlation between auditory brainstem response (ABR) findings and nerve conduction studies (NCSs). The correlation between ABR findings and the metabolic profile of these patients is not well documented in previous studies. The present study was designed to investigate the impact of the disturbed metabolic profile (hyperglyceridemia and hyperlipidemia) in diabetic patients on the peripheral nervous system as well as the auditory brainstem response.

Aim

The present study aimed to detect the effect of diabetic control on the presence of abnormal ABR and/or peripheral nerve affection in Egyptian diabetic patients.

Patients and methods

The study was conducted on two groups: the diabetic group (n=68) and the control group, which was matched for age, sex, blood pressure, and BMI (n=60). All participants were subjected to clinical assessment, basic audiologic assessment, brainstem auditory evoked potential, NCS, and metabolic profile [serum level of glycated hemoglobin (HbA1c%) and lipid profile].

Results

There was a significant increase in absolute wave latencies of ABR and interpeak latencies (IPLs) in the diabetic group compared with the control group. Twenty-six (38.2%) patients had abnormal ABR values. IPLs (I–III and III–V) were significantly negatively correlated with sensory conduction velocity of the sural, median, and ulnar nerves as well as F-wave latency of the posterior tibial, median, and ulnar nerves (P=0.01 and 0.001, respectively). Moreover, IPL III–V and sural sensory conduction velocity were significantly correlated with HbA1c% and total cholesterol, as well as triglyceride serum levels.

Conclusion

Brainstem dysfunction and ABR changes are common in patients with type II diabetes mellitus. These changes are significantly correlatedto NCS parameters on one hand and serum HbA1c% and lipid profile (total cholesterol and triglycerides) on the other hand.

References

  1. Giniş Z, Öztürk G, Sırmalı R, Yalçındag A, Dülgeroglu Y, Delibası T, et al. The role of HbA1c as a screening and diagnostic test for diabetes mellitus in Ankara. Turk J Med Sci 2012; 42(Suppl 2):1430–1436.

    Google Scholar 

  2. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for2013 and projections for 2035. Diabetes Res Clin Pract 2014; 103:137–149.

    Google Scholar 

  3. Maia CA, Campos CA. Diabetes mellitus as etiological factor of hearing loss. Braz J Otorhinolaryngol 2005; 71:208–214.

    PubMed  Google Scholar 

  4. Jali MV, Kambar S, Jali SM, Gowda S. Familial early onset of type-2 diabetes mellitus and its complications. N Am J Med Sci 2009; 1:377–380.

    PubMed  PubMed Central  Google Scholar 

  5. Biessels GJ, Cristino NA, Rutten GJ, Hamers FP, Erkelens DW, Gispen WH. Neurophysiological changes in the central and peripheral nervous system of streptozotocin-diabetic rats. Course of development and effects of insulin treatment. Brain 1999; 122(Pt 4):757–768.

    PubMed  Google Scholar 

  6. Irkeç C, Nazliel B, Yetkin I, Koçer B. Facial nerve conduction in diabetic neuropathy. Acta Neurol Belg 2001; 101:177–179.

    PubMed  Google Scholar 

  7. Kazem SS, Behzad D. Role of blink reflex in diagnosis of subclinical cranial neuropathy in diabetic mellitus type II. Am J Phys Med Rehabil. 2006; 85:449–452.

    PubMed  Google Scholar 

  8. Durmus C, Yetiser S, Durmus O. Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing. Int J Audiol 2004; 43:29–33.

    PubMed  Google Scholar 

  9. Uzun N, Uluduz D, Mikla S, Aydin A. Evaluation of asymptomatic central neuropathy in type I diabetes mellitus. Electromyogr Clin Neurophysiol 2006; 46:131–137.

    CAS  PubMed  Google Scholar 

  10. Aminoff M. Electrodiagnosis in Clinical Neurology. In: Daube JR, editor. 4th ed. Philadelphia, PA: Churchill Livingstone; 1999. 421–435, 451–479.

    Google Scholar 

  11. De España R, Biurrun O, Lorente J, Traserra J. Hearing and diabetes. ORL J Otorhinolaryngol Relat Spec 1995; 57:325–327.

    PubMed  Google Scholar 

  12. Ravecca F, Berrettini S, Bruschini L, Segnini G, Sellari-Franceschini S. Progressive sensorineural hearing loss: metabolic, hormonal and vascular etiology. Acta Otorhinolaryngol Ital 1998; 18(Suppl 59):42–50.

    CAS  PubMed  Google Scholar 

  13. Dalton DS, Cruickshanks KJ, Klein R, Klein BE, Wiley TL. Association of NIDDM and hearing loss. Diabetes Care 1998; 21:1540–1544.

    CAS  PubMed  Google Scholar 

  14. Obrebowski A, Pruszewicz A, Gawlinski M, Swidziński P. Electrophysiological hearing examination in children and teenagers with insulin-dependent diabetes mellitus. Otolaryngol Pol 1999; 53:595–598.

    CAS  PubMed  Google Scholar 

  15. Gupta S, Baweja P, Mittal S, Kumar A, Singh KD, Sharma R. Brainstem auditory evoked potential abnormalities in type 2 diabetes mellitus. N Am J Med Sci 2013; 5:60–65.

    PubMed  PubMed Central  Google Scholar 

  16. Pan CH, Chen TJ, Chen SS. Brainstem auditory evoked potentials in diabetes mellitus. Zhonghua Yi Xue Za Zhi (Taipei) 1992; 49:244–252.

    CAS  Google Scholar 

  17. Dolu H, Ulas UH, Bolu E, Ozkardes A, Odabasi Z, Ozata M, Vural O. Evaluation of central neuropathy in type II diabetes mellitus by multimodal evoked potentials. Acta Neurol Belg 2003; 103:206–211.

    PubMed  Google Scholar 

  18. Tóth F, Várkonyi TT, Rovó L, Lengyel C, Légrády P, Jóri J, et al. Investigation of auditory brainstem function in diabetic patients. Int Tinnitus J 2003; 9:84–86.

    PubMed  Google Scholar 

  19. Díaz deLeón-Morales LV, Jáuregui-Renaud K, Garay-Sevilla ME, Hernández-Prado J, Malacara-Hernández JM. Auditory impairment in patients with type 2 diabetes mellitus. Arch Med Res 2005; 36:507–510.

    Google Scholar 

  20. Baweja P, Gupta S, Mittal S, Kumar A, Singh KD, Sharma R. Changes in brainstem auditory evoked potentials among North Indian females with Type 2 diabetes mellitus. Indian J Endocrinol Metab 2013; 17;1018–1023

    PubMed  PubMed Central  Google Scholar 

  21. Chrisholm DJ. The Diabetes Control and Complications Trial (DCCT). A milestone in diabetes management. Med J Aust 1993; 159:721–723.

    CAS  PubMed  Google Scholar 

  22. Azad N, Emanuele NV, Abraira C, Henderson WG, Colwell J, Levin SR, et al. The effects of intensive glycemic control on neuropathy in the VA cooperative study on type II diabetes mellitus (VA CSDM). J Diabetes Complications 1999; 13:307–313.

    CAS  PubMed  Google Scholar 

  23. Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes 2009; 58:1634–1640.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Seidl R, Birnbacher R, Hauser E, Bernert G, Freilinger M, Schober E. Brainstem auditory evoked potentials and visually evoked potentials in young patients with IDDM. Diabetes Care 1996; 19:1220–1224.

    CAS  PubMed  Google Scholar 

  25. Talebi M, Moosavi M, Mohamadzade NA, Mogadam R. Study on brainstem auditory evoked potentials in diabetes mellitus. Neurosciences (Riyadh) 2008; 13:370–373.

    Google Scholar 

  26. Andersen H, Stålberg E, Falck B. F-wave latency, the most sensitive nerve conduction parameter in patients with diabetes mellitus. Muscle Nerve 1997; 20:1296–1302.

    CAS  PubMed  Google Scholar 

  27. Albers JW, Herman WH, Pop-Busui R, Feldman EL, Martin CL, Cleary PA, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. Diabetes Care 2010; 33:1090–1096.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Huang CR, Lu CH, Chang HW, Tsai NW, Chang WN. Brainstem auditory evoked potentials study in patients with diabetes mellitus. Acta Neurol Taiwan 2010; 19:33–40.

    PubMed  Google Scholar 

  29. Al-Azzawi LM, Mirza KB. The usefulness of the brainstem auditory evoked potential in the early diagnosis of cranial nerve neuropathy associated with diabetes mellitus. Electromyogr Clin Neurophysiol 2004; 44:387–394.

    CAS  PubMed  Google Scholar 

  30. Kurita A, Mochio S, Isogai Y. Changes in auditory P300 event-related potentials and brainstem evoked potentials in diabetes mellitus. Acta Neurol Scand 1995; 92:319–323.

    CAS  PubMed  Google Scholar 

  31. Goldsher M, Pratt H, Hassan A, Shenhav R, Eliachar I, Kanter Y. Auditory brainstem evoked potentialsininsulin-dependent diabetics with and without peripheral neuropathy. Acta Otolaryngol 1986; 102:204–208.

    CAS  PubMed  Google Scholar 

  32. Siddiqi SS, Gupta R, Aslam M, Hasan SA, Khan SA. Type-2 diabetes mellitus and auditory brainstem response. Indian J Endocrinol Metab 2013; 17:1073–1077.

    PubMed  PubMed Central  Google Scholar 

  33. Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008; 120:1–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Feldman EL. Diabetic neuropathy. Curr Drug Targets 2008; 9:1–2.

    CAS  PubMed  Google Scholar 

  35. Martini A, Comacchio F, Fedele D, Crepaldi G, Sala O. Auditory brainstem evoked responses in the clinical evaluation and follow-up of insulin-dependent diabetic subjects. Acta Otolaryngol 1987; 103:620–627.

    CAS  PubMed  Google Scholar 

  36. Ottaviani F, Dozio N, Neglia CB, Riccio S, Scavini M. Absence of otoacoustic emissions in insulin-dependent diabetic patients: is there evidence for diabetic cochleopathy? J Diabetes Complications 2002; 16:338–343.

    PubMed  Google Scholar 

  37. Lasagni A, Giordano P, Lacilla M, Raviolo A, Trento M, Camussi E, et al. Cochlear, auditory brainstem responses in type 1 diabetes: relationship with metabolic variables and diabetic complications. Diabet Med 2015; doi: 10.1111/dme.13039. [Epub ahead of print]. PMID: 26605750

  38. Várkonyi TT, Börcsök E, Tóth F, Fülöp Z, Takács R, Rovó L, et al. Severity of autonomic and sensory neuropathy and the impairment of visual- and auditory-evoked potentials in type 1 diabetes: is there a relationship? Diabetes Care 2006; 29:2325–2326.

    PubMed  Google Scholar 

  39. Huang CC, Chen TW, Weng MC, Lee CL, Tseng HC, Huang MH. Effect of glycemic control on electrophysiologic changes of diabetic neuropathy in type 2 diabetic patients. Kaohsiung J Med Sci, 2005; 21:15–21

    CAS  PubMed  Google Scholar 

  40. Abo-Elfetoh NM, Mohamed ES, Tag LM, El-Baz MA, Ez Eldeen ME. Auditory dysfunction in patients with type 2 diabetes mellitus with poor versus good glycemic control. Egypt J Otolaryngol 2015; 31:162–169.

    Google Scholar 

  41. Greene DA, Lattimer SA, Sima AAF. Are disturbance of sorbitol, phosphoinositide, and Na+/K+-ATPase regulation involved in pathogenesis of diabetic neuropathy? Diabetes 1988; 37:688–693.

    CAS  PubMed  Google Scholar 

  42. Peppa M, Vlassara H. Advanced glycation end products and diabetic complications: a general overview. Hormones (Athens) 2005; 4:28–37.

    Google Scholar 

  43. Said G. Diabetic neuropathy - a review. Nat Clin Pract Neurol 2007; 3:331–340.

    PubMed  Google Scholar 

  44. Namysłowski G, Trybalska G, Scierski W, Mrówka-Kata K, Bilinska-Pietraszek E, Kawecki D. Hearing evaluation in patients suffering from hypercholesterolemia. Otolaryngol Pol 2003; 57:725–730.

    PubMed  Google Scholar 

  45. Ben-David Y, Pratt H, Landman L, Fradis M, Podoshin L, Yeshurun D. A comparison of auditory brain stem evoked potentials in hyperlipidemics and normolipemic subjects. Laryngoscope 1986; 96:186–189.

    CAS  PubMed  Google Scholar 

  46. Jorgenson MB, Buch NH. Studies on the inner ear function and cranial nerves in diabetics. Arch Otolaryngol 1961; 74:373–381.

    Google Scholar 

  47. Chapman T, Mcqueen Baxter A, Smith TL, Raynor E, Yoon SM, et al. Noninsulin - dependent diabetic micro angiopathy in the inner ear. J Laryngol Otol 1999; 113:13–18.

    Google Scholar 

  48. Ferroni P, Basili S, Falco A, Davì G. Oxidant stress and platelet activation in hypercholesterolemia. Antioxid Redox Signal 2004; 6:747–756.

    CAS  PubMed  Google Scholar 

  49. Kempler P, Tesfaye S, Chaturvedi N, Stevens LK, Webb DJ, Eaton S, et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabet Med 2002; 19:900–909.

    CAS  PubMed  Google Scholar 

  50. Tesfaye S, ChaturvediN, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med 2005; 352:341–350.

    CAS  PubMed  Google Scholar 

  51. Meyer C, Milat F, McGrath BP, Cameron J, Kotsopoulos D, Teede HJ. Vascular dysfunction and autonomic neuropathy in type 2 diabetes. Diabet Med 2004; 21:746–751.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut University, 71516, Assiut, Egypt

    Noha M. Abo-Elfetoh MD

  2. Audiology Unit, Department of ENT, Assiut University Hospital, Assiut University, Assiut, Egypt

    Enass S. Mohamed

  3. Department of Clinical Pathology, Assiut University Hospital, Assiut University, Assiut, Egypt

    Lubna M. Tag

  4. Department of Physical Medicine, Rheumatology and Rehabilitation, Assiut University Hospital, Assiut University, Assiut, Egypt

    Rania M. Gamal, Abeer M. Gandour & Mohamed R. Abd EL Razek

  5. Department of Medical Biochemistry, Assiut University Hospital, Assiut University, Assiut, Egypt

    Mona A. El-Baz

  6. Department of Internal Medicine, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt

    Manal E. Ez Eldeen

Authors
  1. Noha M. Abo-Elfetoh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enass S. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lubna M. Tag
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rania M. Gamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abeer M. Gandour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamed R. Abd EL Razek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mona A. El-Baz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Manal E. Ez Eldeen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noha M. Abo-Elfetoh MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abo-Elfetoh, N.M., Mohamed, E.S., Tag, L.M. et al. The relationship between auditory brainstem response, nerve conduction studies, and metabolic risk factors in type II diabetes mellitus. Egypt Rheumatol Rehabil 43, 163–171 (2016). https://doi.org/10.4103/1110-161X.192253

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.192253

Keywords