Evaluation of Auditory Impairment and Peripheral Neuropathy in Type 1 Diabetes Mellitus

Thirumeni, T (2020) Evaluation of Auditory Impairment and Peripheral Neuropathy in Type 1 Diabetes Mellitus. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Type 1 Diabetes Mellitus (T1DM) is a heterogeneous disorder. It is characterized by destruction of pancreatic beta cells, leading to absolute insulin deficiency. The majority of cases are attributed to autoimmune destruction of beta cells (Type 1a), while a small minority of cases result from an idiopathic destruction or failure of beta cells (Type 1b). There are numerous complications caused by Diabetes Mellitus to the body. This study mainly focuses on peripheral neuropathy and auditory impairment. AIM OF THE STUDY: To evaluate auditory impairment and peripheral neuropathy in patients with Type 1 Diabetes mellitus. OBJECTIVES: 1. To evaluate auditory impairment in Type I diabetic patients, by conducting Audiogram and to compare the mean hearing thresholds between Type I Diabetic patients and control group. 2. To evaluate peripheral neuropathy in Type I Diabetic patients by performing sensory nerve conduction study and to compare the mean conduction velocity and amplitude of sural nerve conduction between Type I Diabetic patients and control group. 3. To analyze the association of auditory impairment and peripheral neuropathy in Type 1 Diabetic patients with the duration of the disease. MATERIALS & METHODS: This study was conducted in Department of physiology and ENT OPD, Govt. Kilpauk Medical College, Chennai. STUDY DESIGN: Comparative cross sectional study. STUDY PARTICIPANTS: Total sample size – 120. Group 1 – Non Diabetic control group (60), Group 2 – Type I Diabetic patients (60). Group 2 Patients were further divided into three subgroups, based on the duration of Type I Diabetes, as Group 2 a (≤ 5 years), 2b (6-10 years) and 2c (11-15 years) with 20 subjects under each group. Period of Study: 12 months. Place of study: Nerve conduction studies were conducted at Dept. of Physiology, Kilpauk Medical College, Chennai. Pure Tone Audiometry was done in the ENT Department. Ethical issues: Ethical committee approval was obtained from the Institutional Ethical committee of Govt. Kilpauk Medical College. Inclusion Criteria: 1. Patients who were diagnosed to have T1DM with duration ≤ 5 years, 6-10 years and 11-15 years and age and sex matched non diabetic controls were included. 2. Male and female subjects of age group 18 – 40 years were included. 3. Patients who have consented to participate in the study. 4. Patients with controlled Type I Diabetes mellitus. Exclusion Criteria: Individuals with Type 2 diabetes mellitus, Hypertension, history of working in noisy environments,middle ear disease (ruled out by screening otoscopy), already diagnosed with severe to profound sensory neural hearing loss, neurologic or psychiatric disorders, Meniere disease, history of taking drugs causing hearing loss and neuropathy (NSAIDS, Gentamicin, Streptomycin, Neomycin, Amiodarone, Metronidazole, Isoniazid, Disulfiram), history of alcoholism, smoking, traumatic neuropathy and uncontrolled type I diabetes mellitus were excluded from the study. Screening Procedures: Patients who qualified under the inclusion criteria were enrolled in the study. Their blood glucose levels, blood pressure, height and weight were recorded. Otoscopic examination in was done at ENT OPD. Kilpauk Medical College, Chennai. Brief history was taken and general clinical examination was done. Consent: Written consent was obtained from controls and patients after explaining the procedure and its significance in their vernacular language. Equipment details: The Pure Tone Audiometry (PTA) was done in the ENT Department using ALPS Advanced Digital Audiometer ADS 2100. Sensory sural nerve conduction studies were carried out in a standardized and computerized Nerve conduction testing equipment (Medicaid, computerized Physiolab, Neuroperfect plus) in the research laboratory of Department of Physiology, Govt. Kilpauk Medical College. RESULTS: In this study the total sample size was 120, who were divided into two groups. Group 1 was the Non Diabetic control group with 60 participants and Group 2 consisted of 60 Type I Diabetic patients. Parameters like Age(in years), Gender(male/female), Height(cm), Weight(kg), Body Mass Index (BMI) and Fasting Blood Glucose levels(mg/dL) and duration of diabetes (for Type 1 DM patients) were noted for both groups. Pearson’s Chi–Square test was conducted between Group 1 and Group 2 to compare the age and gender distribution between the two groups and they were found to be similar. T- test was done to compare the Height (Table 5.a), (Table 5.b Weight) and BMI (Table 5.c) of the participants in Group 1 and Group 2. There was no significant difference in any of these parameters. Pure Tone Audiometry (PTA) was performed for both groups and the mean hearing threshold for various frequencies (250 Hz,500Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz) for both ears were compared between Group 1 and Group 2 using T- Test. In the right ear (Table 5.d). and left ear (Table 5.j), there was no significant difference between the two groups in the mean hearing threshold at the frequency of 250 Hz. There was a high significant difference between Group1 and Group 2 in all the other frequencies in both ears. That is, at the frequencies of 500Hz (Table 5.e), 1000 Hz (Table 5.f), 2000 Hz (Table 5.g) 4000Hz (Table 5.h) and 8000 Hz (Table 5.i) in the right ear and at 500Hz (Table 5.k), 1000 Hz (Table 5.l), 2000 Hz (Table 5.m), 4000Hz (Table 5.n) and 8000 Hz (Table 5.o) in the left ear. The mean hearing threshold was significantly increased in both ears between 500Hz to 8000 Hz frequencies in Type 1 Diabetic patients (group 2) when compared to controls (Group 1). Sural sensory nerve conduction study was done for both groups and the conduction velocity (m/s) and amplitude (μV) values of both the legs were compared using T- Test. All the four parameters, i.e., right sural nerve conduction velocity, right sural nerve amplitude, left sural nerve conduction velocity and left sural nerve amplitude, were found to have high significant difference between Group 1 and Group 2. The amplitude and velocity of conduction was significantly decreased in Type 1 Diabetic patients (Group 2) when compared to controls (Group 1). Reciever Operating Characterictic (ROC) curves (Table 6.Fig 19) were plotted for sural sensory nerve conduction values. The associated criterion was calculated as ≤ 16.78 for left sural nerve amplitude, ≤ 16.92 for right sural nerve amplitude, ≤ 49.55 for left sural nerve conduction velocity, and ≤ 50.12 for right sural nerve conduction velocity. Youden Index was also calculated for all the four parameters. Pair wise comparison of ROC curves (Table 8) was also done. To analyze the association of auditory impairment and peripheral neuropathy in Type 1 diabetic patients with the duration of the disease, Group 2 was further divided into three subgroups based on the duration of Type 1 Diabetes, as Group 2 a (≤ 5 years), 2b (6-10 years) and 2c (11-15 years) with 20 subjects under each subgroup. ANOVA test was done to compare various parameters among the three subgroups - 2a, 2b and 2c. There was no significant difference in height, weight and BMI among the three subgroups. The Pure Tone Audiometry (PTA) results were compared among the three subgroups using ANOVA Test. In the right ear and left ear, there was no significant difference between the three subgroups in the mean hearing threshold at the frequency of 250 Hz. There was significant difference in the right ear hearing threshold at frequency of 500 Hz among the three subgroups with a significance value of 0.021. There was a high significant difference in mean hearing threshold among the three subgroups in all the other frequencies in both ears. That is, at the frequencies of 1000 Hz, 2000 Hz, 4000Hz and 8000 Hz in the right ear and at 500Hz, 1000 Hz, 2000 Hz, 4000Hz and 8000 Hz in the left ear. The increase in mean hearing threshold in 500- 8000 Hz frequencies was highly significant in the group 2c (11-15 years) when compared to 2 a (≤ 5 years) and 2b (6-10 years). The sural sensory nerve conduction test results were compared among the three subgroups using ANOVA Test. All the four parameters, i.e., right sural nerve conduction velocity (Table 9.q), right sural nerve amplitude (Table 9.r), left sural nerve conduction velocity (Table 9.s) and left sural nerve amplitude (Table 9.t), were found to have high significant difference among the three subgroups - 2 a (≤ 5 years), 2b (6-10 years) and 2c (11-15 years). The decrease in mean conduction velocity and amplitude of sural nerve was highly significant in the group 2c (11-15 years) when compared to 2 a (≤ 5 years) and 2b (6-10 years) CONCLUSION: It can be concluded from the present study that, significant changes are observed in Pure Tone Audiometry and Sural sensory nerve conduction studies in Type 1 diabetic Patients when compared to age and sex matched controls. There is a significant increase in mean hearing threshold and decrease in sural nerve conduction velocity and amplitude in Type 1 Diabetic patients and these changes are related to the duration of the disease. Thus, this study suggests that Pure Tone Audiometry and Nerve Conduction Studies are highly sensitive, reliable and non invasive methods that can help in early detection of changes in the auditory pathway and peripheral sensory nerves in Type 1 Diabetic patients. Hence these tests are recommended as screening tests for early assessment of neuropathy in Type 1 diabetic patients. These investigations can aid in timely detection and suitable management of disease complications and therefore decrease the morbidity of the disease. LIMITATIONS OF THE STUDY: The present study was conducted on a small sample size and hence advanced study on a larger group of individuals is necessary to authenticate the present findings.

Item Type: Thesis (Masters)
Additional Information: 201715151
Uncontrolled Keywords: Type 1 Diabetes Mellitus(T1DM), Pure Tone Audiometry (PTA), Nerve Conduction Studies (NCS), Sural nerve.
Subjects: MEDICAL > Physiology
Depositing User: Subramani R
Date Deposited: 30 Jan 2021 16:50
Last Modified: 01 Mar 2021 03:18
URI: http://repository-tnmgrmu.ac.in/id/eprint/13489

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