Hearing handicap in patients with chronic kidney disease: a study of the different classifications of the degree of hearing loss

Abstract Introduction: The association between hearing loss and chronic kidney disease and hemodialysis has been well documented. However, the classification used for the degree of loss may underestimate the actual diagnosis due to specific characteristics related to the most affected auditory frequencies. Furthermore, correlations of hearing loss and hemodialysis time with hearing handicap remain unknown in this population. Objective: To compare the results of Lloyd's and Kaplan's and The Bureau Internacional d'Audiophonologie classifications in chronic kidney disease patients, and to correlate the averages calculated by their formulas with hemodialysis time and the hearing handicap. Methods: This is an analytical, observational and cross-sectional study with 80 patients on hemodialysis. Tympanometry, speech audiometry, pure tone audiometry and interview of patients with hearing loss through Hearing Handicap Inventory for Adults. Cases were classified according to the degree of loss. The correlations of tone averages with hemodialysis time and the total scores of Hearing Handicap Inventory for Adults and its domains were verified. Results: 86 ears (53.75%) had hearing loss in at least one of the tonal averages in 48 patients who responded to Hearing Handicap Inventory for Adults. The Bureau Internacional d'Audiophonologie classification identified a greater number of cases (n = 52) with some degree of disability compared to Lloyd and Kaplan (n = 16). In the group with hemodialysis time of at least 2 years, there was weak but statistically significant correlation of The Bureau Internacional d'Audiophonologie classification average with hemodialysis time (r = 0.363). There were moderate correlations of average The Bureau Internacional d'Audiophonologie classification (r = 0.510) and tritone 2 (r = 0.470) with the total scores of Hearing Handicap Inventory for Adults and with its social domain. Conclusion: The Bureau Internacional d'Audiophonologie classification seems to be more appropriate than Lloyd's and Kaplan's for use in this population; its average showed correlations with hearing loss in patients with hemodialysis time ≥ 2 years and it exhibited moderate levels of correlation with the total score of Hearing Handicap Inventory for Adults and its social domain (r = 0.557 and r = 0.512).

摘要 引言：听力损失与慢性肾脏病（chronic kidney disease）及血液透析（hemodialysis）之间的关联已有充分文献证实。然而，由于与受影响最为显著的听觉频率相关的特异性特征，现有听力损失程度分级分类方法可能会低估实际诊断结果。此外，该人群中听力损失、血液透析时长与听力障碍三者间的相关性仍未明确。研究目的：比较劳埃德-卡普兰（Lloyd's and Kaplan's）分类法与国际听力学局（Bureau Internacional d'Audiophonologie）分类法在慢性肾脏病患者中的应用效果，并分析二者公式计算的听阈平均值与血液透析时长及听力障碍程度的相关性。研究方法：本研究为分析性观察横断面研究，纳入80名血液透析患者。采用鼓室图测试（tympanometry）、言语测听（speech audiometry）、纯音测听（pure tone audiometry），以及成人听力障碍量表（Hearing Handicap Inventory for Adults）对存在听力损失的患者进行访谈。根据听力损失程度对病例进行分级。验证了纯音听阈平均值与血液透析时长、成人听力障碍量表总分及其各维度得分的相关性。研究结果：在完成成人听力障碍量表调查的48名患者中，共86耳（53.75%）在至少一项纯音听阈平均值检测中存在听力损失。与劳埃德-卡普兰分类法（n=16）相比，国际听力学局分类法识别出的存在不同程度听力障碍的病例数更多（n=52）。在血液透析时长≥2年的亚组中，国际听力学局分类法的听阈平均值与血液透析时长呈弱但具有统计学意义的相关性（r=0.363）。国际听力学局分类法听阈平均值（r=0.510）与2号三音调（tritone 2）检测结果（r=0.470），均与成人听力障碍量表总分及其社会维度得分呈中等程度相关。研究结论：相较于劳埃德-卡普兰分类法，国际听力学局分类法似乎更适用于该患者人群；其听阈平均值在血液透析时长≥2年的患者中与听力损失存在相关性，且与成人听力障碍量表总分及其社会维度得分呈中等程度相关（r=0.557和r=0.512）。