ASSESSMENT OF COCHLEAR FUNCTION IN MALNOURISHED INFANTS

Abstract

The World Health Organization defines malnutrition as "the cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions. PEM is almost always accompanied by deficiencies of other nutrients. For this reason, the term severe childhood malnutrition, which more accurately describes the condition, is preferred. Hearing loss is a common problem that can occur at any age and makes verbal communication difficult. Hearing impairment refers to complete or partial loss of the ability to hear from one or both ears. The degree of impairment can be mild, moderate, severe or profound. Total hearing loss refers to the complete loss of ability to hear from one or both ears. Malnourished children are more prone to developing Suppurative otitis media, in addition to the impairment of physical growth and of cognitive and other physiologic functions, together with immune response changes. (Siddartha et al., 2010). This case control study aimed to detect hearing impairment in malnourished infant using TEOAE & ABR. Our study was conducted on 50 children who suffered from PEM during infancy. They were recruited from the outpatient clinic, Children’s Hospital, Faculty of medicine, Ain Shams University. Their ages ranged from 6 - 24 months. They were compared to 50 age and sex matched children clinically healthy children who served as controls. All patients and controls were subjected to the following: 1- Full history taking stressing on dietetic history and socioeconomic status, thorough clinical and anthropometric examination. 2- Complete blood count. 3- Audological examination using: Tympanometry, ABR and TEOAE. ¬¬¬¬¬Exclusion criteria: other possible causes of hearing loss in this age: 1- Family history of congenital hearing loss. 2- Prematurity. 3- Low birth weight. 4- Admission in NICU on antibiotic. 5- Hyperbilirubenemia. 6- History of infection that may cause hearing loss (CMV, Measles, Rubella, Toxo plasmosis.). Regarding anthropometric measurements of Protein energy malnutrition patients are significantly lower compared to their values in controls, as we evaluated weight, weight % for age and weight Z –score with a mean value in patients group (7.72±1.9), (59.5±9.7) and (.09±0.99) respectively, and in controls (11.35±2.26), (97.8±10.8)and (0.04±1) respectively. Height, , height %for age and height Z –score mean values in patients group were (67.7±8.13), (82.7±7.6) and (0.022±.87) respectively and in controls (78.32±7.44), (101±2.36) and (.29±10.8) respectively. Weight % for height and weight % for height Z – score were assessed with a mean value in patients (77.9±.13.2) and (-0.14±0.14) respectively, and in controls (92.7±7.22) and (1.1±0.7) respectively. we used left mid upper arm circumference as an index of malnutrition as it reflects muscle mass and it was significantly lower in the PEM patients with a mean value 11.8cm±0.31compared to its value in controls was 12.9±0.33cm and it was statistically significant P=0.00. Also Triceps skin fold thickness, It was statistically lower in patients (10mm±0.06) compared to controls (12mm±0.06) due to loss of subcutaneous fat. Skin fold thickness is statistically significant correlated with malnutrition P=0.00 We reported Weaning malpractice in the form of delayed weaning at mean age of 7 months and unbalanced weaning is noticed among pt more than among controls and this may explain common age of our study. Anemia is a complementary sign for PEM and in our work we detected that 72% of Protein energy malnutrition patients were anemic compared to controls with a mean hemoglobin level 10.2 mg/dl.and 12.24 mg /dl respectively and also hemoglobin level was lower in patients than in controls. Hemoglobin level was negatively correlated to hearing impairment. Signs of hypovitaminosis and Zinc deficiency also detected as a part of malnutrition and it may share in choclear disfunction.