혈액투석을받는만성신부전환자들의전정안반사변화및청각과의관계

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KISEP Otology Korean J Otolaryngol 2000;43: 혈액투석을받는만성신부전환자들의전정안반사변화및청각과의관계 박현민 조정석 박근환 이정구 Changes of Vestibulo-Ocular Reflex and Its Relation with Auditory Functions in Chronic Renal Failure Patients

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KISEP Otology Korean J Otolaryngol 2000;43: 혈액투석을받는만성신부전환자들의전정안반사변화및청각과의관계 박현민 조정석 박근환 이정구 Changes of Vestibulo-Ocular Reflex and Its Relation with Auditory Functions in Chronic Renal Failure Patients Receiving Hemodialysis Hyun Min Park, MD, Chung Seok Cho, MD, Geun Hwan Park, MD and Chung-Ku Rhee, MD Department Otolaryngology-Head and Neck Surgery, College of Medicine, Dankook University, Cheonan, Korea ABSTRACT Background and ObjectivesSensorineural hearing loss and vestibular dysfunction are frequently found in patients receiving hemodialysis with chronic renal failure CRF. However, the responsible etiologic factors, prevalence, relationship between auditory and vestibular dysfunction still remains unclear. The purpose of this study is to assess vestibular dysfunction and to investigate the relation between changes in vestibulo-ocular reflex VOR and auditory dysfunction in CRF patients receiving hemodialysis. Materials and MethodsThirty-five patients 70 ears receiving hemodialysis with chronic renal failure were selected. Pure tone audiometry, monothermal caloric test, and velocity step rotation test were performed to assess the audiovestibular function of the patients. Thirty normal controls were selected for comparison of vestibular function tests. ResultsTwenty-four 34% out of 70 ears had pure tone average PTA of 25 dbhl or more. The average peak velocity of caloric test and the value of slow cumulative eye position SCEP of velocity step test in the patient group were d/sec and degree, respectively. These values were significantly different from those of normal controls whose average peak velocity of caloric test and SCEP values of velocity step test were d/sec and degree, respectively p0.05. The results of caloric test and velocity step test in the patients with PTA of 25 dbhl or more were d/sec and degree, respectively, while those of the patients with PTA of less than 25 dbhl were d/sec and degree, respectively. These two groups showed a statistically significant difference p0.05. Conclusion The patients under hemodialysis with CRF exhibited reduced vestibular function compared to normal control group. (Korean J Otolaryngol 2000;43:937-41) KEY WORDSChronic renal failure Hemodialysis Vestibulo-ocular reflex Hearing loss. 937 Table 1. Age distribution of hemodialysis and control group Age HD group n35 Control group n HDhemodialysis Table 2. Frequency and degree of the hearing loss in HD group (n70) PTA Less than 25 dbhl Number of ears % 25 dbhl or more % 2540 db % 4060 db 4 5.7% 60 db 2 2.9% PTApure tone average HDhemodialysis 938 Korean J Otolaryngol 2000;43:937-41 Table 3. The results of PTA, caloric test and velocity step test according to HD duration HD group n70 3 years n11 3 year n24 Total Control group n30 PTA dbhl Caloric test d/sec ** * SCEP degree ** ** * PTApure tone average HDhemodialysis SCEPslow cumulative eye position *Statistically significant between hemodialysis and control group by student t-test **Statistically significant by ANOVA test Table 4. The result of caloric test and SCEP according to hearing loss level in the patients PTA 25 dbhl n25 PTA 25 dbhl n10 Caloric test d/sec * SCEP degree * PTApure tone average SCEPslow cumulative eye position *statistically significant between normal hearing and hearing loss group by student t-test 939 REFERENCES 1) Quick CA, Fish A, Brown T. The relationship between kidney and cochlea. Laryngoscope 1973;88: ) Alport AD. Hereditary familial congenital hemorrhagic nephritis. Br Med J 1927;1: ) Johnson DW, Mathog RH. Hearing function and chronic renal failure. Ann Oto Rhinolaryngol 1976;85: ) Spencer JT. Hyperlipoproteinemia in the etiology of inner ear disease. Laryngoscope 1973;83: ) Kusakari J, Hara A, Takeyama M, Suzuki S, Igari T. The hearing of the patients treated with hemodialysis: A long term followup study. Auris Nasus Larynx Tokyo 1992;19: ) Rizvi SS, Holms RA. Hearing loss form hemodialysis. Arch Otolaryngol 1980;106: ) Gatland D, Tucker B, Charlstrey S, Keene M, Baker L. Hearing loss in chronic renal failure-hearing threshold changes following hemodialysis. J of Royal Society of Medicine 1991;10: ) Yassin A. Ear, nose and throat manifestations in cases of ranal failure treated by dialysis. Ann Otol Rhinol Laryngol 1966;75: ) Yassin A, Badry A, Fatt-hi A. The role of electrolyte balance on vestibular distrubances in cases of renal failure. J Laryngol 1970; 84: Korean J Otolaryngol 2000;43:937-41 10) Laitakari K. Vestibular disorders in medically managed chronic renal insufficiency. Acta Otolaryngol Suppl 1977;439: ) Hutchinson JC, Klodd DA. Electrophysiologic analysis of auditory, vestibular and brainstem functions in chronic renal failure. Laryngoscope 1982;92: ) Park HM, Kim YH, Rhee CK. Diagnostic value of velocity step rotational test on unilateral peripheral vestibulopathy. Korean J Otolaryngol 1998;41: ) Thomsen J, Bech P, Szpirt W. Otologic symptoms in chronic renal failure. The possible role of aminoglycoside-furosemide interactionl. Arch Otol Rhinol Laryngol 1976;214: ) Yassin A, Bardy A, Fatt-hi A. The relationship between electrolyte balance and cochlear disturbances in cases of renal failure. J Laryngol 1970;84: ) Shaheen FA, Mansuri NA, Sheikh IA, Al-Shaikh AM, Huraib SO, Zazgornik J. Reversible uremic deafness: Is it correlated with the degree of anemia? Ann Otol Rhinol Laryngol 1997;106: ) Bazzi C, Venturini CT, Pagani C, Arrigo G, D Amico G. Hearing loss in short-and long-term hemodialysed patients. Nephrol Dial Transplant 1995;10:
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