Volume 04 Issue 01-2024
37
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
01
P
AGES
:
37-41
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The article presents the results of the examination of children with auditory neuropathy. comparative indicators of
otoacoustic emission and short-latency auditory evoked potentials are given. In children with AN, there were
violations of the transmission of acoustic signals to the central auditory system, as well as violations of the maturation
of the auditory pathways and centers.
KEYWORDS
Auditory neuropathy, hearing loss.
INTRODUCTION
Auditory neuropathy (AN) - retrocochlear lesion,
classroom neuropathy is a symptom complex
characterized by the normal functioning of the inner
ear and impaired processing of sound information in
the deeper parts of the auditory system. According to
world statistics, about 1 out of 10 children with chronic
hearing loss suffer from this type of hearing system
lesion. [1, 2, 3].
It is already known that with AN, unlike sensorineural
hearing loss, the outer hair cells are not damaged, the
complexity of diagnosis and the variety of the clinical
Research Article
AUDIOLOGICAL INDICATORS IN AUDITORY NEUROPATHY
Submission Date:
January 06, 2024,
Accepted Date:
January 11, 2024,
Published Date:
January 16, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue01-07
G. Khaydarova
Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 01-2024
38
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
01
P
AGES
:
37-41
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
picture of this disorder complicates the choice of a
rehabilitation method [4].
Various symptoms of AN are explained by functional
disorders or pathological changes in the peripheral
part of the auditory analyzer. Nevertheless, with AN,
the main clinical manifestation is sensorineural hearing
loss of varying degrees with the preserved function of
the outer hair cells. Patients have otoacoustic emission
(OAE), but there are no short-latency auditory evoked
potentials (SAEPs).
In studies, it has been studied that in patients with AN,
the usual methods of rehabilitation tactics that help
patients with sensorineural hearing loss are not always
effective [5,6]. However, most studies on the study of
the features of AN were performed on small groups of
patients, there is a contradiction in the results obtained
by different authors.
The purpose of the study:
to study the indicators of
OAE and SAEPs in auditory neuropathy in dynamics.
METHOD
180 children with hearing impairments were examined.
36 children with auditory neuropathy were selected
from them. This was 20% of all patients. Among the
surveyed 20 were boys (56%), 16 were girls (44%).
The majority of patients (29 people) were diagnosed
with AN before the age of 5 years. In 5 patients, AN was
detected at the age of 1-3 years. In one patient, AN was
detected in adolescence.
The method of registration of otoacoustic emission
and short-latency auditory evoked potentials of the
brain were used as objective methods for assessing
hearing. The study was carried out at the initial
treatment and in dynamics after 3 months.
The study was carried out on the Neuro-Audio device.
To register the OAE, a probe was used, in which two
phones and a microphone are located. One tone is
continuously fed through one phone, and a second
tone is continuously fed through another. The
microphone provides OAE registration and control of
the level of test tones. To highlight the OAE, it is also
necessary to minimize the level of input noise.
Therefore, the examination was carried out in a quiet
room, and the probe is hermetically installed in the
external auditory canal.
The stimuli were broadband acoustic clicks presented
with a repetition rate of 20-50/s. The response signal
emitted by the microphone is amplified at a bandwidth
from 500 to 5000 Hz and sent to the computer via an
analog-to-digital converter.
The source of sound stimuli for the registration of
SAEPs were in-ear phones with a pre-sized earbud. Cup
silver chloride electrodes were used to register brain
responses. The electrodes were fixed on the area at
the border of the scalp (reference electrode) and in the
Volume 04 Issue 01-2024
39
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
01
P
AGES
:
37-41
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
area of the mastoid processes on the right and left
(active electrodes). In studies, the interelectrode
resistance did not exceed 5 ohms, which was achieved
by pretreatment of the patient's skin and the use of
special conductive gels. Various types of stimuli were
used during the VSWP - an acoustic click with a duration
of 100 ms, tonal signals with a frequency of 1000, 4000,
2000 and 500 Hz.
RESULTS AND DISCUSSION
The analysis of the results showed that all the patients
with AN examined by us had an operation on the right
and left ear during the initial examination. The
exception was one patient in whom the OAE was
registered only on one ear.
Acoustic reflex was not registered in 55% of children
with AN. In 29% of children, acoustic reflex was
registered at frequencies of 500 Hz and 1000 Hz. The
threshold for registering the reflex in these cases was
120 dB.
We obtained the following results when registering
SAEPs: in 95% of children, SAEPs was not registered
during primary and repeated examinations. In 2 (5%)
children, a VSWP was registered for sound stimuli with
a level of 95-103 dB.
AN refers to sound perception disorders and differs
from the rest of the hearing pathology in the topic of
damage to the structures of the inner ear and auditory
nerve [7]. With AN, the outer hair cells are preserved,
thanks to which the TEOAEs and DPOAEs are
registered. The presence of OAE in the absence SAEPs
of or registration of SAEPs only for maximum incentive
levels is a generally recognized feature specific to AN.
However, the data obtained by us indicate that in some
patients with AN, OAEs may disappear over time.
According to our data, this was observed in 22% of
patients. Similar cases were reported in the J.Attias
study [8] (tab 1). Table 1 shows the results of a dynamic
OAE study in children with HF 3 months after the initial
examination.
Table 1
Comparative analysis of the UAE registration results in patients
with auditory neuropathy (N=36)
the OAE was registered
at the initial examination
the OAE was registered after 3
months
Percentage quantity
92%
76%
Volume 04 Issue 01-2024
40
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
01
P
AGES
:
37-41
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Significant changes in patients with AN were also
detected during the registration of SAEPs. In 95% of
patients with auditory neuropathy, SAEPs was not
recorded during stimulation of both the right and left
ear. Only in 2 out of 36 patients, SAEPs was registered
for sound stimuli with a level of 95-103 dB.
Repeated examination of patients with auditory
neuropathy did not reveal any changes in the SAEPs.
Dynamic observation was carried out in order to
analyze the variability of the indicators of registration
of SAEPs and OAE in children with AN (tab 2).
Table 2
Dynamics of changes in the indicators of registration of VSWP and SVOAE during repeated
examinations
Number of
children
Frequency of occurrence (%)
Increase in
thresholds
Decrease in
thresholds
Stability of
thresholds
SAEPs
OAE
SAEPs
OAE
SAEPs
OAE
36
-
-
-
-
100
100
The data obtained indicates that a single study of
auditory function in children is not enough and requires
dynamic observation.
Based on the above, the electrophysiological criteria
for the diagnosis of hearing loss are quite definite and
do not allow for discrepancies. At the same time, the
results of instrumental studies of patients with
auditory neuropathy are not always unambiguous and
require a deep understanding of the complexity of the
mechanisms of sound perception.
Timely identification of the features of the nature of
pathology in the sound perception system is of great
clinical importance due to the difference in the tactics
of treatment and rehabilitation of such patients. This,
in turn, makes it possible to carry out a full-fledged
rehabilitation of such patients.
Volume 04 Issue 01-2024
41
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
01
P
AGES
:
37-41
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
CONCLUSION
The features of auditory function in patients with
auditory neuropathy indicate differences in the
mechanisms underlying the disorders of auditory
function in these groups of patients. Differences in the
structure of risk factors in patients with AN from the
rest of the hearing pathology indicate the etiological
heterogeneity of these forms. This gives grounds for
their separation into independent nosological units.
The results obtained showed that children with AN, on
the one hand, have violations of the transmission of
acoustic signals to the central auditory system, on the
other - violations of the maturation of the auditory
pathways and centers.
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