Volume 03 Issue 10-2023
13
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
13-17
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 dynamic observation of indicators of objective methods of hearing testing in 36
children with auditory neuropathy. Based on the data obtained, a comparative analysis of the indicators of SAEP and
TEOAE in dynamics was carried out.
KEYWORDS
Auditory neuropathy, otoacoustic emissions, short-latency auditory evoked potentials.
INTRODUCTION
Today, thanks to the widespread introduction into the
practice of audiologists of objective methods for
studying auditory function, a new type of hearing
impairment has been identified - auditory neuropathy
(AN) [1, 2, 3]. According to G. Rance[4] and T. Picton[5],
approximately 10% of children diagnosed as having
sensorineural hearing loss may actually have HF. This
figure reaches 15-20% in children with severe hearing
loss [6].
It is already known that in HF, unlike sensorineural
hearing loss, the outer hair cells are not damaged; the
Research Article
INDICATORS OF OTOACOUSTIC EMISSIONS AND SHORT-LATENCY
EVOKED POTENTIALS IN CHILDREN WITH AUDITORY NEUROPATHY
Submission Date:
October 01, 2023,
Accepted Date:
October 06, 2023,
Published Date:
October 11, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue10-03
G.Khaydarova
Researcher, 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 03 Issue 10-2023
14
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
13-17
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
complexity of diagnosis and the diversity of the clinical
picture of this disorder complicates the choice of
rehabilitation method.
Various symptoms of HF are explained by functional
disorders or pathological changes in the peripheral
part of the auditory analyzer. However, in HF, the main
clinical manifestation is sensorineural hearing loss of
varying degrees with preserved outer hair cell
function. Patients have otoacoustic emissions (OAE)
but no short-latency auditory evoked potentials
(SLEPs).
Studies have examined that in patients with HF,
conventional rehabilitation tactics that help patients
with sensorineural hearing loss are not always
effective [7]. However, most studies studying the
characteristics of HF were carried out on small groups
of patients, and there is inconsistency in the results
obtained by different authors.
AIM OF THE RESEARCH
To study the indicators of SAEP and TEOAE in auditory
neuropathy over time.
PATIENTS AND RESEARCH METHODS
180 children with hearing impairment were examined.
Of these, 36 children with auditory neuropathy (AN)
were selected. This represented 20% of all patients.
Among those examined, 20 were boys (56%), 16 were
girls (44%).
In the majority of patients (29 people), the diagnosis of
HF was established before the age of 5 years. In 5
patients, HF was detected at the age of 1-3 years. In one
patient, HF was diagnosed in adolescence.
As objective methods for assessing hearing, we used
the method of recording otoacoustic emissions (OAE)
and short-latency auditory evoked potentials of the
brain (SAEP). The study was carried out at initial
treatment and over time after 3 months.
The study was carried out using the Neuro-Audio
apparatus. To register the UAE, they used a probe
containing two phones and a microphone. One tone is
continuously transmitted through one telephone, and
a second tone is continuously transmitted through the
other. The microphone provides registration of OAE
and control of the level of test tones. To isolate OAEs,
it is also necessary to reduce the level of input noise as
much as possible. Therefore, the examination was
carried out in a quiet room, and the probe was
hermetically installed in the external auditory canal.
The stimuli were broadband acoustic clicks presented
at a repetition rate of 20
–
50/s. The response signal
picked up by the microphone is amplified with a
bandwidth of 500 to 5000 Hz and sent to the computer
through an analog-to-digital converter.
The source of sound stimuli for recording SAEP was in-
ear telephones with an earmold pre-selected to size.
Silver chloride cup electrodes were used to record
Volume 03 Issue 10-2023
15
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
13-17
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
brain responses. Electrodes were fixed to the area at
the border of the scalp (reference electrode) and in the
area of the mastoid processes on the right and left
(active electrodes). During the studies, the
interelectrode resistance did not exceed 5 kOhm,
which was achieved by pre-treatment of the patient's
skin and the use of special conductive gels. When
conducting SAEP, various types of stimuli were used -
an acoustic click lasting 100 ms, tones with a frequency
of 1000, 4000, 2000 and 500 Hz
RESULTS AND DISCUSSION
Analysis of the results showed that in all patients with
HF we examined during the initial examination, OAE
was registered in the right and left ear. The exception
was one patient in whom OAE was recorded in only
one ear.
The acoustic reflex was not recorded in 55% of children
with HF. In 29% of children, the acoustic reflex was
recorded at frequencies of 500 Hz and 1000 Hz. The
reflex registration threshold in these cases was 120 dB.
When registering SAEP, we obtained the following
results: in 95% of children, SAEP was not registered
during the initial and repeated examinations. In 2 (5%)
children, SAEP was recorded to sound stimuli at a level
of 95-103 dB nHL.
HF refers to disorders of sound perception and differs
from other hearing pathologies in terms of damage to
the structures of the inner ear and auditory nerve [3,7].
In HF, the outer hair cells are preserved, which is why
OAE and OAEPI are recorded. The presence of OAE in
the absence of SAEP or recording of SAEP only at
maximum stimulus levels is a generally accepted sign
specific to CH.
However, our data indicate that in some patients with
HF, TEOAE may disappear over time. According to our
data, this was observed in 22% of patients. Similar cases
were reported in the study by J. Attias [8] (Table 1).
Table 1 shows the results of a dynamic study of OAE in
children with heart failure 3 months after the initial
examination.
Table 1
Comparative analysis of the results of registration of UAE in patients
with auditory neuropathy (N=36)
OAE was recorded during the initial
examination
OAE was registered after 3 months
Quantity in percentage
92%
76%
Volume 03 Issue 10-2023
16
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
13-17
SJIF
I
MPACT
FACTOR
(2021:
5.
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(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Significant changes in patients with HF were also
detected when registering SAEP. In 95% of patients
with auditory neuropathy, SAEP were not recorded
during stimulation of either the right or left ear. In only
2 out of 36 patients, SAEP were recorded to sound
stimuli at a level of 95-103 dB nHL.
Repeated examination of patients with auditory
neuropathy did not reveal any changes in SAEP.
Dynamic observation was carried out to analyze the
variability of the registration parameters of SAEP and
TEOAE in children with HF (Table 2).
Table 2
Dynamics of changes in the registration indicators of
SAEP
and TEOAE
during repeated examinations
Number
of children
Frequency of occurrence (%)
Raising
thresholds
Lowering
thresholds
Threshold stability
SAEP
OAE
SAEP
OAE
SAEP
OAE
36
-
-
-
-
100
100
The data obtained indicate that a single study of
auditory function in children is not enough and requires
dynamic observation.
Based on the above, electrophysiological criteria for
diagnosing hearing loss are quite specific and do not
allow for discrepancies. At the same time, the results
of instrumental studies of patients with auditory
neuropathy are not always clear and require a deep
understanding of the complexity of the mechanisms of
sound perception.
Timely identification of the peculiarities of the nature
of the pathology in the sound perception system is of
great clinical importance due to the difference in
treatment tactics and rehabilitation of such patients.
This, in turn, makes it possible to carry out full
rehabilitation of such patients.
CONCLUSION
Features of auditory function in patients with auditory
neuropathy (AN) indicate differences in the
mechanisms underlying hearing impairment in these
Volume 03 Issue 10-2023
17
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
13-17
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
groups of patients. Differences in the structure of risk
factors in patients with AN from other hearing
pathologies indicate the etiological heterogeneity of
these forms. This gives grounds for their isolation into
independent nosological units.
The results obtained showed that children with AN, on
the one hand, have disturbances in the transmission of
acoustic signals to the central auditory system, and, on
the other hand, there are disturbances in the
maturation of the auditory pathways and centers.
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