Comparative study of brainstem evoked response audiometry in diabetic patients and non-diabetic subjects to assess the involvement of central auditory pathway

<p><strong>Background: </strong>Diabetes mellitus (DM) which is prevalent in world is associated with sensorineural hearing loss. Brainstem evoked response audiometry (BERA) is a simple, non-invasive procedure to detect early impairment of acoustic nerve and auditory pathway. The present study is under taken to evaluate the impact of DM on BERA parameters. Aim of the study was to compare the BERA of diabetic patients to those of age and gender matched controls to assess the involvement of central auditory pathway.</p><p><strong>Methods</strong>: A cross sectional study was conducted on 35 diabetic patients, aged 35 to 55 years, who were on treatment for at least 2 years, and 35 age and sex matched control participants, were subjected for BERA at 70,80 and 90 dB. The waveforms, absolute latency of wave I, wave III, wave V and interwave/ inter peak latency of I-III, III-V and I-V were analyzed with respect to both groups.</p><p><strong>Results</strong>: The absolute latency of wave III and wave V, interpeak/ interwave latency of I-III, interpeak/ interwave latency of I-V, III-V and absolute latency of wave V were highly significant at corresponding tested stimuli in the diabetic group compared to the control group.</p><p><strong>Conclusions</strong>: Early involvement of central auditory pathway in diabetic patients, can be detected with fair accuracy with auditory evoked potential studies; if done on a regular basis warrants meticulous glycemic control and prevents further damage.</p>

Role of Brainstem Evoked Response Audiometry in Evaluating Sensorineural Hearing Loss in Diabetic Patients

Introduction Diabetes has become a global epidemic. Hearing loss has been long associated with diabetes. Brainstem Evoked Response Audiometry (BERA) is an objective, non-invasive, electro diagnostic test that not only evaluates the functional integrity of the subcortical auditory pathway but also provides topo-diagnosis of hearing loss. This study aims to identify the role BERA in detecting hearing loss early in diabetic patients.Materials and Methods In this study a total of 210 patients were taken and subjected to blood glucose levels followed by PTA were divided into two groups. Group I (n=105) consisted of diabetic patients with sensorineural hearing loss (SNHL) and Group II (n=105) had age and sex matched non-diabetics with SNHL. All the patients were evaluated with BERA.Results All the patients were subjected to Brain Stem Evoked Response Audiometry (BERA). Absolute latency of Wave I, III, V, I-III, III-V and I-V were assessed for both the ears. In both ear Absolute latency were significantly higher in diabetics as compared to non-diabetic patientsConclusion The findings of present study showed that the severity of hearing loss was significantly higher in diabetic patients as compared to non-diabetic controls. Level of glycemic control showed a possible link with severity of hearing loss.

Effect of Stimulus Rates in Chirp and Click Evoked Auditory Brainstem Response in Adults with Normal Hearing Sensitivity

Introduction The effects of increasing stimulus repetition rate on the ABR using click stimuli have been investigated in normal and hearing impaired subjects with neurologic abnormality but there is limited study on the effect of stimulus repetition rate on ABR using chirp stimuli. The present study aims to compare the chirp evoked auditory brainstem responses with reference to changes in latency of peaks, interaural latency differences and interwave latency intervals as a function of rate and compare those responses with the click evoked auditory brainstem responses, in normal hearing subjects. Materials and Methods Total 30 normally hearing adults were considered for this study. All participants were screened for normal hearing sensitivity upto 8 kHz in pure tone audiometry for middle ear pathology and central auditory processing disorder. Four parameters of ABR were considered to assess in this study including absolute latency, interwave latency intervals, latency-rate function and interaural latency. ABR was done based on the protocol of this study. Results Results revealed that there was a significant difference in the absolute latency and interwave intervals when the stimulus repetition rate was increased. Conclusion The latencies of wave III and V increases and waveform morphology changed as the stimulus repetition rate increased above 20/sec. The absolute latency of wave III and V was found to be shorter than clicks and can be used especially in newborn hearing evaluation assuming in shorter time window.

TONEBURST-EVOKED ABR: NORMS AND GENDER DIFFERENCES

Background: The ABR procedure has become a powerful non-invasive technique to assess the integrity of the auditory processing system particularly in infants and difficult-to-test subjects. The inability of click stimulus in frequency selectivity the tone burst makes it possible to obtain relatively narrow frequency range responses, particularly at lower frequencies. However, the click-evoked ABR does not provide frequency-specific information of the auditory system. The lack of normative data and the potential usefulness of the toneburst-evoked ABR, the present study aimed to establish gender-specific norms for the same at the octave frequencies. Methods: Twenty normal hearing subjects within the age range 18 to 25 years were examined followed by tympanometry, puretone audiometry and toneburst ABR for 500Hz, 1000Hz, 2000Hz and 8000Hz in each ear. Results: Wave-V was identified till 20 dBnHL for all tested frequencies with a decrease in mean absolute latency of waves with increase in frequency. Mean absolute latency of each wave was shorter in female than male for the tested frequencies. The difference in mean of puretone and TB-ABR thresholds ranged between 8-11.25 dBnHL for different frequencies. Conclusion: TB-ABR can be reliably used as an excellent tool to achieve frequency-specific information for difficult-to-test population.

Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study (Preprint)

BACKGROUND Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. OBJECTIVE We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. METHODS A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. RESULTS In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. CONCLUSIONS Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants

Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time (p = 0.287), percentage of effective nerve blocks (p = 0.634), anesthetic block duration (p = 0.895), or pain level during puncture (p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals.

Assessment protocols for forward masking in Frequency-Following Response

ABSTRACT Purpose: to investigate forward masking by comparing latencies values of positive and negative peaks in frequency-following responses (FFR) recordings, in normally hearing young adults. Methods: from a database, 20 FFR recordings were selected, 10 being from men, and 10 from women, aged 18 to 25 years, with normal hearing. They were qualitatively analyzed by two experienced researchers and also analyzed, according to two different protocols of recording identification: (i) predominance of positive peaks - PV, A, PW, PX, PY, PZ, and O waves; and (ii) predominance of negative peaks - V, A, C, D, E, F, and O waves. The Shapiro-Wilk normality test, the Wilcoxon test, and the Student’s t-test were conducted, by adopting the significance level of p<0.05. Results: the comparative analysis of latency peak values did not reveal any significant difference between the studied protocols. However, the standard deviation was higher for absolute latency values as compared to negative peaks, suggesting an inverted pattern of what was expected. Conclusion: forward masking was identified in both proposals and the protocol of predominant positive peaks was less variable.

Effect of severity of hypertension on brain stem auditory evoked potentials

Background: Hypertension is one of the most important public health problems among worldwide. Central nervous system dysfunctions are common in these patients due to micro-infarctions caused by arteriolar spasm of cerebral blood vessels. This will lead to hypoperfusion, subcortical white matter demyelination, and cognitive decline. The Brainstem auditory evoked potentials (BAEP) are far field subcortical electrical potentials which provide an objective electrophysiological method for assessing the auditory pathway from auditory nerve to the brainstem. Aim and objective of the study was to assess the effect of increasing severity of hypertension on the brainstem auditory pathway, among the patients of essential hypertension.Methods: A total of 75 subjects of age group 30 to 60 years were included in the study. Among them 25 were healthy age and sex matched controls (Group I), 25 were stage 1 hypertensives (Group IIa) and 25 were stage 2 hypertensives (Group IIb) as per JNC 7 criteria. The absolute latencies I, III, V and interpeak latencies (IPL) I-III, III-V, I-V were recorded by using Neuroperfect EMG 2000 system with installed BAER and data were statistically analyzed using Student unpaired t test.Results: All the hypertensive (Group IIa and IIb) patients were found to have significantly prolonged absolute latency of wave III, V and IPL III-V, I-V as compared to that of normal healthy controls. The wave V latency was prolonged as the severity of hypertension increased. Intergroup comparison among hypertensive patients (Group IIa and IIb) revealed a significant prolongation of absolute latency of Wave III, V and IPL III-V, I-V.Conclusions: The results show that there exists a sensory deficit along with synaptic delay across the auditory pathway in the hypertensive patients and the sensory deficit progresses with the severity of the disease.

Auditory brainstem response in gerbils submitted to ischemia and sepsis

Introduction: An ischemic stroke is a clinical condition that affects thousands of people worldwide. As a result of this injury, neuronal death can be observed, and in the natural course of recovery, the individual may develop sepsis. Sepsis is a systemic inflammatory response that can lead the patient to death. To assess the clinical condition of a patient with this condition, the Auditory Brainstem Response (ABR) can be useful, since it is not an invasive procedure, it is a fast technique and it can be done at the bedside. Purpose: To assess auditory brainstem response (ABR) latency values in gerbils subjected to ischemia and sepsis. Methods: ABR values were collected from 72 adult male gerbils, which were divided into six groups: control, sepsis, ischemia, sham, ischemia with sepsis, and sham with sepsis. For the induction of sepsis, lipopolysaccharide (LPS) was applied intraperitoneally in gerbils. The animals were anesthetized with a ketamine/xylazine combination before collection; their ABR were collected before any procedure (base collection), after ischemia, and 24 hours after the application of LPS. The absolute latency of wave IV was evaluated, and the values were compared between groups. Results: There were significant differences in the groups submitted to sepsis in the latency value of wave IV in relation with the other groups. Conclusion: ABR was sensitive to sepsis with the increase in latency of wave IV during the development of the disease in the experimental model used.

Auditory Brainstem Response: reference-values for age

PURPOSE: To study the absolute latencies of waves I , III and V and interpeak I-III , III-V and I-V of Auditory brainstem responses obtained in preterm newborns in relation to post-conceptual age, term newborns and six months of age infants, establishing reference values for each age group. METHODS: Retrospective study realized through the analysis of tests performed on 80 infants divided into four groups, being the group one composed per newborns assessed between 35 and 36 weeks post-conceptual age; group two by newborns assessed between 37 and 38 weeks; group three with newborns reviewed between 39 to 40 weeks; and group four with infants evaluated with six months. RESULTS: The wave I absolute latency in the group one was 1.81 ms, decreasing to 1.79 ms in groups two and three, and to 1.70 ms in group four. The wave III latency in group one was 4.74 ms, decreasing to 4.62 ms in group two, to 4.56 ms in the group three and to 4.37 ms in the group four. The wave V latency in group one was 7.14 ms, in the group two it was 7.05 ms, in the group three 6.90 ms; and in the group four it was 6.50 ms. Interpeak latencies were also decreased in all groups. CONCLUSION: The latencies studied decreased with the increasing age and were similar values with the international literature.