慢性肾功能不全血液透析患者的高频纯音听阈检测

目的:探讨慢性肾功能不全血液透析患者的高频听阈的变化特点。方法:将慢性肾功能不全行血液 透析的患者(透析组)与正常人(对照组)的高频听阈的变化特点进行比较。结果:透析组与对照组高频听阈的平 均阈值均随年龄的增加而增加,然高频阈值的检出率则随年龄和测听频率的增加而下降;但透析组阈值增加的程 度明显高于对照组。结论:透析组患者的听力损害以高频下降为主,其高频阈值亦较对照组高,差异有统计学意 义。     

Auditory function in young patients with chronic renal failure

Debate on the relationship between renal insufficiency and hearing loss continues mainly due to the advanced age and the possible accelerated presbycusis of the patients that have been studied in surveys. Hearing acuity was studied in 46 children and adolescents suffering from renal insufficiency. Sensorineural hearing loss (mainly high-frequency) of unknown cause was found in 14 patients (30.4%). Hearing loss was not influenced by the various haematological, biochemical and clinical parameters (type of renal disease, blood pressure, history of ototoxic drugs administration). However, hearing loss seemed to be affected by the method of management of the renal insufficiency (more in the haemodialysis group than in the peritoneal dialysis group). There were no significant changes in audiometric findings before and after haemodialysis.     

Organised haematoma of the maxillary sinus in patients with chronic renal failure

Objective: Organised haematoma of the maxillary sinus may be present in chronic renal failure patients, because these patients are at high risk of haemorrhage. Case reports: We present two cases of organised haematoma of the maxillary sinus in patients with chronic renal failure. Conclusion: A diagnosis of organised haematoma of the maxillary sinus should be considered when a patient with a history of chronic renal failure develops unilateral, recurrent epistaxis and nasal obstruction.     

Hearing impairment associated with chronic renal failure

The auditory sensitivity of 67 patients with chronic end-stage renal failure was assessed. In order to determine the incidence of hearing loss and to describe the impairment and possible contributing factors, one group of 39 patients was assessed prior to treatment by hemodialysis. Twelve of these subjects were then followed for 1 year as they are treated by hemodialysis. The reMayning 27 patients, not treated by hemodialysis, were also retested in one year. A second group of 28 patients who had been receiving hemodialysis over periods of 1 1/2, 3, and 6 years was also evaluated. A high incidence of high-frequency impairment was obtained which could not be attributed to age, noise exposure, ototoxicity, or hereditary. An association between this high-frequency impairment and both the renal disease and its treatment was suggested. Clinically significant sensorineural hearing loss did not appear associated with non-genetic kidney disease.     

胆脂瘤型中耳炎并发迷路瘘管38例临床分析

目的分析胆脂瘤型中耳炎并发迷路瘘管的临床特征,总结其诊治经验和体会。方法回顾性分析我科2000年7月至2010年12月收治的38例经手术证实为胆脂瘤型中耳炎并发迷路瘘管患者的临床资料,38例患者均在全麻下行乳突根治术,术中一期清除瘘管处胆脂瘤及肉芽,Ⅰ型、Ⅱ型瘘管取双层颞肌筋膜覆盖封闭瘘口,Ⅲ型瘘管行半规管阻塞术。结果胆脂瘤型中耳炎并发迷路瘘管的发生率为8.2%(38/464),术中发现瘘管全部位于水平半规管,术后所有患者均获干耳,眩晕未再发作,干耳后平均骨导听阈与术前相比无明显差异。结论迷路瘘管的确诊有赖于手术中发现证实;只要术中精细操作并采用合适的方法修补瘘管,一期彻底清除瘘管处病变可以同时有效地保存耳蜗功能;对于病变广泛的Ⅲ型瘘管,半规管阻塞术是一个安全、有效的治疗方法。     

High frequency audiometry and chronic renal failure

High frequency audiometry with pure tones from 9 to 18 kHz was performed in 37 patients with chronic renal failure undergoing conservative medical treatment and in a control group of 96 patients (age range 30 59 years for both groups). It was noted that the high frequency thresholds were significantly higher for the patients with chronic renal disease, and further deterioration of hearing function was observed at the examination performed after 1 year of follow-up. It was concluded that high frequency audiometry is a sensitive method for detecting hearing changes in patients with chronic renal failure and can be used to monitor these patients.     

Transient otoacoustic emissions in children with chronic renal failure

This study was conducted on 34 children with chronic renal failure: 27 on regular haemodialysis and seven on conservative treatment. Twenty normal healthy children served as controls. They were subjected to clinical examination including otoscopic examination, basic audiological assessment and transient otoacoustic emission testing (TOAE). Four patients had a conductive hearing loss and five had a bilateral moderately severe high frequency sensory neural hearing loss. TOAE testing was carried out for the rest whose ears displayed normal hearing. No response (fail) was obtained in 8% of them but in none of the controls and a partial pass response in 38% versus 10% of controls (P < 0.001). Cochlear dysfunction was significant only at low frequency levels. The mean overall echo-level and reproducibility were significantly lower in patients than in controls. The same holds true for the subgroup of patients on haemodialysis but not for those on conservative treatment. The overall echo-levels did not correlate with serum urea, creatinine, sodium or potassium.     

Olfactory function in chronic renal failure

BACKGROUND: Patients with chronic renal failure (CRF) show a high prevalence of poor nutritional state so that dietary treatment becomes a significant part of the therapeutic regimen. Because smell plays an important role in nutrition, this study aimed to investigate olfactory function in CRF patients. METHODS: A total of 64 CRF patients were investigated. Forty-nine of them were treated with hemodialysis, 15 CRF patients were not dialysis dependent. For comparison we examined 15 healthy subjects. Olfactory function was assessed for odor discrimination, odor identification, and butanol odor thresholds. RESULTS: Olfactory loss was found in 56% of the patients, with 3 functional anosmics and 33 hyposmics. CRF had specific effects on individual tests of olfactory function. Elevated odor thresholds werefound in 11% of patients, 38% of patients had reduced odor discrimination, and 48% of patients exhibited deficits in odor identification. Results of psychological tests (Mini-Mental State Examination and Trail-Making Test) correlated with results from odor identification (p < 0.01) and discrimination (p < 0.01) but not with odor thresholds. CONCLUSIONS: The ability to discriminate and identify odors was found severely impaired whereas odor thresholds were similar to what is seen in the general population. Consequently, CRF patients should be counseled with regard to the possibility of reduced chemosensory functions.     

Hyperparathyroidism due to chronic renal failure. Analysis of 32 operated patients

We report our study of 32 patients diagnosed as hyperparathyroidism due to chronic renal failure (27 secondary forms and 5 tertiary ones), between June 1990 and 2003, that were sent from Nefrology Department for to surgical intervention. The following parameters have been analysed: Age, sex, clinical symptoms, kind of surgery performed, postoperative complications and anatomopathologic result (AP). On 64 nerves exposed, there were no recurrent nerve palsies. 12 patients suffered a symptomatic hypocalcemia (37,5%) although only one was permanent. The control of calcium, phosporus and calcitriol is essential to try to avoid a hyperplasia of the parathyroid glands.     

Cochlear function of guinea pigs with experimental chronic renal failure.

This study aimed to evaluate electrophysiologically the cochlear function of guinea pigs that underwent a five-sixths nephrectomy and, additionally, to explore the synergistic action between chronic renal failure (CRF) and noise. Cochlear potentials were recorded at 1, 2, and 3 months postoperatively. Slight changes in compound action potential and cochlear microphonics were seen at 1 month postoperative, while moderate and profound changes were seen at 2 and 3 months. Endocochlear potential showed no significant reduction. The results indicate that CRF may be an etiologic factor for cochlear dysfunction and that the hair cells seem likely to be a main site of the lesion. One-month-postoperative animals were exposed to a broadband noise. In contrast to control animals, the test animals demonstrated no recovery from the decrease in compound action potential and cochlear microphonics that occurred immediately after noise exposure. This suggests a synergistic interaction between CRF and noise.     

Hearing evaluation in chronic renal failure children

Chronic renal failure (CRF) causes a lot of systemic side-effects, among them: neurological and otological complications. In present study hearing evaluation was made in young patients, using distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABR). THE AIM OF STUDY: (1) objective assessment of hearing organ activity in CRF children, (2) localization of hearing organ part involved in CRF, (3) establishing best parameters of ipsilateral stimulation in DPOAEs for clinical use. MATERIALS AND METHODS: Hearing acuity was assessed in 22 CRF children ranging in age from 9 to 17 years and 18 healthy children ranging in age from 10 to 18 years. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of hearing condition included: (1) DPOAEs using DP-gram format. Two simultaneous pure-tone signals (primaries) were presented to the ear at two different frequencies (f1 and f2, where f2 > f1) and the 2f1-f2 were analyzed. Five pairs of non equal level and L2 were used L1 and L2: panel A1: L1 = 65 and L2 = 60 dB SPL, panel A2: L1 = 63 and L2 = 55 dB SPL, panel A3: L1 = 59 and L2 = 45 dB SPL, panel A4: L1 = 55 and L2 = 35 dB SPL, panel A5: L1 = 51 and L2 = 25 dB SPL; (2) ABR investigation using click stimulus, at 90 dB nHL level. Wave I, III, V latencies and intervals I-III, III-V, I-V were evaluated. Our results reviled significantly lower mean DPOAEs amplitudes in CRF children when compare to healthy children, at all frequencies measured. No differences in ABR evaluation were observed. Most optimal DPOAEs parameters in clinical use seem to be panel A1, A2 and A3 of level L1 and L2.     

Assessment of hearing organ ability in high-frequency auditory in patients suffering from chronic renal failure treated by haemodialysis and human recombinant erythropoietin (rhPEO)

The problem of hearing loss occurrence in the course of chronic renal failure (CRF) was investigated in numerous research studies, attempting to explain both the etiological factors and treatment possibilities. According to various authors, the percentage of hearing loss occurrence in patients suffering from CRF differs between 20% and 80%. The idea of this paper is based on an observation that if peripheral blood parameters such; haemoglobin, amount of red blood cells improve when influenced by rhEPO, then tissue oxidation improvement connected with it causes also better metabolism of cilliar's cells, what helps to improve hearing. The purpose of this study has been to assess the influence of treatment with human recombinant erythropoietin obtained through genetic recombination and by haemodialysis upon the condition of the hearing organ in patients with CRF (as a result of both a single procedure and long-term treatment). 65 haemodialysed patients with chronic renal failure were enrolled in this study. 31 of them (with haematocrit value below 28%) were treated with rhEPO for 4 months (3 times a week, 4000 units). The remaining 34 patients (with haematocrit values of above 28%) were not treated with rhEPO. Impairment of hearing was found in 87.1% of the CRF patients examined, while the hearing loss in high frequency range (9-18 kHz) was significantly more pronounced than those observed in the conventional range. In 70% of the patients the hearing loss was the cochlear type. Thus, combining haemodialysis with recombinant human erythropoietin in treatment of CRF patients results in significant improvement of hearing, correlated with positive results in fighting anaemia. The improved hearing found is, most surely, related to better oxygen supply of ciliated cells of internal ear, resulting from improved oxygen supply in peripheral blood and tissues of the body, and may also be related to the centric activity of erythropoietin, as the presence of receptors for EPO was found in the central nervous system (CNS) neurocytes, and it was also proven that EPO is produced in CNS, probably in astrocytes.     

Ear, nose and throat manifestations in pediatric chronic renal failure patients undergoing peritoneal dialysis

Ear, Nose and Throat manifestations have been frequently observed in patients with chronic renal failure. Many factors viz. ototoxic drugs, associated conditions of renal failure such as electrolyte imbalance, alteration in blood urea etc. have been implicated for these manifestations. The present study has been conducted to evaluate ear, nose and throat manifestations in thirty pediatric patients (age group 4-16 year) of chronic renal failure undergoing peritoneal dialysis. Probable patho-physiology and treatment of ENT manifestations has been discussed. The remarkable findings in all these cases were the high blood urea level. Most of these manifestations were markedly improved by correction of the renal functions and ideal therapeutic measures.     

Hearing status in patients with pronounced chronic kidney insufficiency

Hearing function was assessed in 63 patients with pronounced chronic renal failure (40 males, 23 females aged 20-52 years). Chronic renal failure resulted from chronic glomerulonephritis in 34 patients (16, 10 and 8 cases of nephrotic, hypertensive and mixed form, respectively), chronic pyelonephritis in 29 patients. The acoustic function was evaluated using acumetric methods, tonal threshold and suprathreshold audiometry, ultrasound sensitivity test, speech audiometry. Hearing disorders detected in patients with chronic renal failure were moderate and were characterized as neurosensory hypoacusis. The defects concerned high frequency perception. Hearing thresholds were high in all the examinees.     

Labyrinthine fistula: a complication of chronic suppurative otitis media

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.     

Perforation of the nasal septum in patients with renal failure

Spontaneous perforation of the nasal septum was observed in 8 out of 104 patients (74 on maintenance hemodialysis; 30 after cadaveric renal transplantation). All patients showed a round or oval defect of the non-osseous septum, which was accompanied by marked atrophic rhinitis. Epistaxis was common in uremic patients in general and was also present in 5 patients with septal perforation, but otherwise the defect was hardly associated with any symptoms. Various factors may play a role in the pathogenesis of this lesion; local trauma from nasal catheters postoperatively; impaired mucosa cell proliferation; disturbed innervation of the vessels in the nasal septum due to polyneuropathy of the autonomous nervous system; ischemia secondary to arteriolar narrowing.