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Rev
Sanid Militneurosensorial
Mex 2005; 59(4) Jul.-Ago.:
213-217
Hipoacusia
en diabticos
Artculo de investigacin
RESUMEN
Objetivo. Demostrar la incidencia de hipoacusia neurosensorial de altas frecuencias en pacientes diabticos.
Material y mtodo. Estudio prospectivo en una poblacin de
40 pacientes de uno u otro sexo (20 diabticos y 20 no diabticos,
grupo control). Ambos grupos fueron sometidos a diversos estudios de laboratorio, gabinete y valoracin oftalmolgica.
Resultados. Se demostr que la audiometra tonal de alta frecuencia supera a la audiometra tonal convencional, ya que su sensibilidad permiti determinar en forma temprana cambios audiolgicos mucho antes que los detectara la audiometra tonal convencional que se realiza en forma rutinaria. Sin lugar a duda, la
hiperglucemia produce dao en el sistema auditivo, el cual si bien
no es prevenible ni reversible, podemos lograr la prolongacin en
su aparicin con medicamentos que nos ayuden a mejorar la microcirculacin a ese nivel y con los cuidados generales de odo.
Introduccin
* Otorrinolaringlogo y cirujano de Cabeza y Cuello. ** Adscrito del Servicio de Otorrinolaringologa y Ciruga de Cabeza y Cuello. ***
Oftalmlogo subespecialista en retina. **** Audilogo y foniatra. ***** Enfermera. Servicio de Otorrinolaringologa y Ciruga de Cabeza y Cuello.
Hospital Central Militar, Mxico, D.F.
Correspondencia:
Dra. Alexandra Rodrguez-Morales
Lago Trasimeno No. 39, Int. C-204. Col. Anhuac. C.P. 11320. Del. Miguel Hidalgo. Mxico, D.F.
Recibido: Octubre 19, 2004.
Aceptado: Abril 25, 2005.
REV SANID MILIT MEX 2005; 59(4): 213-217
213
Grado de hipoacusia
Mnima
Media
Moderada
Moderada severa
Severa
Profunda
Material y pacientes
Se realiz un estudio prospectivo, observacional, longitudinal, descriptivo. El universo del estudio fue una poblacin de 40 pacientes (20 diabticos que sern el grupo estudio y 20 no diabticos que sern el grupo control), de uno y
otro sexo, entre los 20 y 55 aos (Figura 1), los cuales fueron referidos al Servicio de Otorrinolaringologa del Hospital Central Militar en el periodo que comprendi del 1/o de
marzo del 2003 al 30 de noviembre del 2003 (por lo que no
existi la seleccin de una muestra).
Ambos grupos fueron sometidos a diversos estudios de
laboratorio (glicemia, examen general de orina, pruebas de
funcin renal, perfil de lpidos), gabinete (audiometra tonal
convencional, audiometra tonal de alta frecuencia) y valoracin oftalmolgica por el gabinete de retina. Los datos se
obtuvieron de fuente primaria, con la ayuda de una hoja de
recoleccin de datos.
Fueron incluidos en el estudio todos los pacientes diabticos y no diabticos sin antecedentes personales o familiares de otopatologas. Se excluyeron del estudio aquellos pacientes diabticos y no diabticos en tratamiento mdico con
medicamentos
ototxicos
por ms de ocho das o que prepdf
elaborado por
medigraphic
sentaron antecedentes personales o familiares de otopatologas o enfermedades sistmicas tipo hipertensin arterial.
10%
60
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Edad
30
20
10
0
Diabticos
Sanos
p valorada: 0.8703
p < 0.05 estadsticamente no significativo
0%
90%
40
15 a 25
55 a 40
40 a 55
55 a 70
70 a 90
Ms de
0%
Resultados
50
Prdida en dB
214
10%
0%
Referente a las pruebas de funcin renal, el nitrgeno ureico srico fue de 23.6 mg/dL y la creatinina srica de 1.34
mg/dL. Con relacin al perfil de lpidos, se present la media de colesterol en 200.45 mg/dL, de triglicridos en 245.3
mg/dL, de HDL en 42.55 mg/dL, y de LDL en 103.18 mg/
dL.
El diagnstico oftalmolgico en la poblacin de estudio
fue variable, presentndose as 14 pacientes (70%) sin caractersticas de retinopata diabtica, dos pacientes (10%)
con retinopata diabtica no proliferativa leve, tres pacientes
(15%) con retinopata diabtica no proliferativa moderada,
y un paciente (5%) con retinopata diabtica proliferativa de
alto riesgo (Figura 6). La p = < 0.05.
El resultado de la ATC de acuerdo con el nmero de pacientes diabticos fue de: 18 (90%) sin hipoacusia y dos
(10%) con hipoacusia media (Figura 7). Con respecto a la
ATAF, del total de 20 pacientes, cuatro (20%) sin hipoacu-
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a a
Mnima
Media
Moderada
Moderada severa
Severa
Prdida en Hz
12.5
9,000 a 10,000
10,000 a 12,500
12,500 a 16,000
16,000 a 20,000
Ms de 20,000
10.0
Aos
Grado de hipoacusia
15.0
7.5
5.0
60
2.5
50
Edades
40
30
20
10
0
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0.0
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Hombres
Mujeres
p valorada: 0.3023
p < 0.05 estadsticamente no significativo
5%
15%
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Mujeres
p = 0.5545
p < 0.05 estadsticamente no significativo
media para los hombres fue de 10.7 aos y para las mujeres
de ocho aos (Figura 5).
Una vez obtenidos los resultados de los estudios de laboratorio, se present la media de glicemia de 177.8 mg/dL.
En cuanto al examen general de orina, dos pacientes femeninos (10%) presentaron infeccin urinaria reportada como
bacteriuria (+ + + +) y una paciente (5%) present glucosuria (+ + +).
REV SANID MILIT MEX 2005; 59(4): 213-217
70%
1
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bido a que existen numerosos factores que lo pueden complicar, como lo son la exposicin al ruido, drogas y otros
medicamentos como causas ms comunes productoras de
dao al odo interno sin que el paciente lo perciba.
Las alteraciones presentadas, mas no esperadas, fueron
15% de los pacientes con hipoacusia mnima, 10% con hipoacusia media y 5% con hipoacusia moderada; se pudo ver
influida por exposicin al ruido, que es una de las causas
ms comunes de alteracin de las altas frecuencias.1,3-5
Referente al grupo estudio, los pacientes diabticos presentaron p = < 0.05, en cuanto a la edad y al tiempo transcurrido de diagnstico de la enfermedad. La glicemia se
encontraba en estos pacientes ligeramente aumentada: 177.8
mg/dL, para un valor normal de hasta 125 mg/dL.
Se encontr una ligera alteracin del nitrgeno ureico srico, representado por una media de 23.6, siendo el valor normal
de referencia en este estudio de hasta 17 mg/dL; por su parte, la
creatinina srica se situ en el lmite superior normal, lo cual
revela un dao renal, el cual se espera sea encontrado en pacientes diabticos de larga evolucin6,7 y que adems pone en
evidencia el pobre control diabtico que el paciente ha presentado, lo que le ha producido alteracin renal.
Por otra parte, en las pruebas de perfil de lpidos slo se
encontr alteracin de los triglicridos y la media fue de
245.3 mg/dL, tomando como valor de referencia normal
hasta 200 mg/dL, lo que traduce el dao metablico mltiple que sufren estos pacientes y las alteraciones en las diferentes sustancias calorgenas, como fue mencionado anteriormente en la introduccin.1,8,9
Los hallazgos oftalmolgicos de los daos producidos por
la hiperglucemia obtenidos en el estudio son los esperados;
pese a eso no se lograron correlacionar con los aos de evolucin ni con la HNAF, presentada por los pacientes diabticos. Es por lo anterior mencionado que no se logra cumplir
con uno de los objetivos secundarios, que fue el de establecer una clasificacin que relacionara el grado de retinopata
diabtica con la prdida de la audicin.
Los resultados de la ATC comparndolos con los obtenidos
en la ATAF, demuestran claramente que sta ltima es mucho
ms sensible en el diagnstico de esta patologa10-13 y no slo
eso, sino que muestra que los pacientes diabticos s presentan
cambios audiomtricos en altas frecuencias como lo han mencionado varios autores.14-18 La ATC slo mostr alteracin en
10% de los pacientes, presentando como sanos o no hipoacsicos a 90% de los pacientes.19-22 La ATAF mostr alteracin en
85% de los pacientes y se diagnostic sin alteracin o sanos a
15%. Lo anterior demuestra, sin lugar a duda, que existe una
alteracin evidente en los pacientes diabticos, la cual es fcilmente medible;23-28 sin embargo, no se puede descartar que existan otros factores que aumenten esta incidencia, como lo es el
ruido, explicado anteriormente.
30%
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por
medigraphic
pdf elaborado
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Conclusiones
La DM es una enfermedad crnica endocrina muy frecuente y con alto grado de morbimortalidad.
216
9. Kraft JR. Hyperinsulemia: a merging history with idiopathic tinnitus, vertigo and hearing loss. Int Tinnitus J 1998; 4(2): 127-30.
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11. Erdem T, Ozturan O, Miman MC, et al. Exploration of the early
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