ORIGINAL RESEARCH
Evaluation of Efferent Auditory System in Patients with Multiple Sclerosis Using Electrophysiological Methods
Efferent İşitsel Sistemin Multipl Sklerozlu Hastalarda Elektrofizyolojik Yöntemlerle Değerlendirilmesi
Received Date : 29 Jun 2024
Accepted Date : 17 Jul 2024
Available Online : 13 Aug 2024
Mitat Selçuk BOZHÖYÜKa, Sevgi KUTLUb, Emre OCAKc, Zerin ÖZAYDIN AKSUNd,
Suna TOKGÖZ YILMAZb, Canan YÜCESANd, İrfan YORULMAZc
aBitlis Tatvan Devlet Hastanesi, Kulak Burun Boğaz Hastalıkları Kliniği, Bitlis, Türkiye
bAnkara Üniversitesi Sağlık Bilimleri Fakültesi, Odyoloji Bölümü, Ankara, Türkiye
cAnkara Üniversitesi Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları AD, Ankara, Türkiye
dAnkara Üniversitesi Tıp Fakültesi, Nöroloji AD, Ankara, Türkiye
Doi: 10.24179/kbbbbc.2024-104608 - Makale Dili: TR
Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2024;32(3):118-27.
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: This study aims to evaluate auditory efferent system
by medial olivocochlear (MOC) reflex on patients with multiple sclerosis (MS).
Material and Methods: 53 participants with normal hearing (30 MS patients
and 23 control group) was involved in the study. MS patients divided in two
groups as “patients without definable brainstem lesion (Group 1, n=15)” and “patients
with definable brainstem lesion (Group 2, n=15)” by cranial magnetic resonance
imaging. All participants had pure tone audiometry, acoustic reflex test,
transient evoked otoacoustic emission (TEOAE) amplitude measurements [with
80 ±4 dB peak equivalent sound pressure level (peSPL) click stimulus]. MOC
pathway evaluated with contralateral suppresion measurement is made by 65 dB
peSPL linear click stimulus with 50 dB SPL white noise on contralateral ear. Results:
TEOAE signal to noise-ration (SNR) amplitudes on right ear on 2,000 and
2,800 Hz are found to be higher on control group than Group 2 (p<0.05). In the
left ear, SNR amplitudes with 4,000 Hz in Group 1 and control group is higher
than Group 2 (p<0.05). In terms of MOC reflex positivity ratio; there is no statistically
meaningful difference (p>0.05). Mean suppresion in the control group’s
left ears found to be higher than Group 2 left ears (p<0.05). Conclusion: Our results
demonstrated TEOAE SNR amplitude reduction in MS patients with brainstem
involvement. Even though no MOC reflex positivity ratio difference was
found between groups, control groups suppression level on the left side found to
be superior to Group 2. In MS patients, because of brainstem involvement;
TEAOE SNR amplitudes and suppresion levels may decrease.
Keywords: Efferent auditory innervation; contralateral acoustic stimulus; multiple sclerosis; olivocochlear bundle; otoacoustic emission
ÖZET
Amaç: Bu çalışmada, multipl skleroz (MS) hastalarında işitsel efferent
sistemin mediyal olivokoklear (MOK) refleks ile değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya 30’u MS hastası ve 23’ü kontrol grubu
olmak üzere işitmeleri normal olan 53 katılımcı dâhil edildi. MS hastaları kraniyal
manyetik rezonans görüntülemesi bulgularına göre “saptanabilir beyin sapı
lezyonu olmayanlar (Grup 1, n=15)” ve “saptanabilir beyin sapı lezyonu olanlar
(Grup 2, n=15)” olarak iki gruba ayrıldı. Tüm katılımcılara; saf ses odyometrisi,
akustik refleks testi ve transient evoked otoakustik emisyon (TEOAE) amplitüt ölçümü
[80±4 dB peak equivalent sound pressure level (peSPL) klik uyaran kullanılarak]
yapıldı. MOK refleksi, kontralateral akustik uyaran sonrası TEOAE’de
supresyon düzeyi ölçülerek değerlendirildi. Kontralateral supresyon ölçümü 65
dB peSPL lineer klik uyaran ve kontralateral kulaktan 50 dB SPL beyaz gürültü
kullanılarak 260 klik uyaran yanıtı averajlanarak yapıldı. Bulgular: Sağ kulakta
TEOAE sinyal gürültü oranı [signal to noise-ration (SNR)] amplitütleri 2.000 ve
2.800 Hz’de kontrol grubunda Grup 2’den daha yüksek saptanmıştır (p<0,05).
Sol kulakta ise Grup 1 ve kontrol grubunun 4.000 Hz’de elde edilen SNR amplitütleri
Grup 2’den daha yüksek bulunmuştur (p<0,05). Gruplar arasında MOK
refleksi pozitiflik oranları açısından istatistiksel olarak anlamlı bir fark saptanmamıştır
(p>0,05). Sol kulaktaki ortalama supresyon miktarı kontrol grubunda
Grup 2’den daha yüksek bulunmuştur (p<0,05). Sonuç: Beyin sapı tutulumu olan
MS hastalarında TEOAE SNR amplitütlerinde azalma görülmüştür. Gruplar arasında
MOK refleksi pozitiflik oranı açısından anlamlı bir fark saptanmasa da kontrol
grubunun sol taraftaki supresyon seviyesi, Grup 2 hastalardan daha yüksek
saptanmıştır. MS hastalarında beyin sapı tutulumu nedeniyle TEOAE SNR amplitütlerinde
ve supresyon seviyesinde azalma olabilmektedir.
Anahtar Kelimeler: Efferent işitsel inervasyon; kontralateral akustik uyarı; multipl skleroz; olivokoklear yolak; otoakustik emisyon
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