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Otorinolaringologia 2018 September;68(3):101-7

DOI: 10.23736/S0392-6621.18.02162-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Early vestibulospinal reflex changes in type 2 diabetes mellitus in relation to peripheral neuropathy

Mostafa M. EL-KHOSHT 1, Maha H. ABOU-ELEW 1, Amira M. EL-SHENNAWY 1, Randa F. SALAM 2, Yahya M. MAKKEYAH 3, Ahmad L. ABDELMOHSIN 4

1 Audio-Vestibular Unit, ENT Department, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt; 2 Department of Internal Medicine, Kasr Al Aini Faculty of Medicine, Cairo University, Cairo, Egypt; 3 Department of Internal Medicine and Nephrology, Ain Shams Faculty of Medicine, Ain Shams University, Cairo, Egypt; 4 Audio-Vestibular Unit, Medical Research Division, National Research Centre, Giza, Egypt


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BACKGROUND: Diabetes mellitus (DM) and its complications are rapidly becoming the world’s most significant cause of morbidity and mortality. Most of patients with DM complain of imbalance and/or dizziness. The aim of this study was to assess the cervical vestibular evoked myogenic potential (cVEMP) in diabetic patients as an indicator of the integrity of the vestibulo-spinal reflex (VSR) that plays a pivotal role in balance.
METHODS: Forty adult patients (mean age=49.12±9.03 years) with a confirmed diagnosis of type II DM underwent cVEMP. Results were compared with those of 40 age and gender matched control subjects selected randomly. Patients and controls were not known to have neither peripheral nor central vestibular disorders. The grade of peripheral neuropathy, level of HbA1c and duration of DM were compared with cVEMP results.
RESULTS: Patients had higher cVEMP threshold with longer P13 and N23 wave latencies than controls. Neuropathic patients, those with poorer glycemic control and those with disease duration >5 years had significant higher cVEMP threshold and prolonged wave latencies in both ears than other patients. Severity of neuropathy had the strongest correlation with cVEMP results followed by level of HbA1c and finally the disease duration.
CONCLUSIONS: Diabetic patients have altered VSR in the form of delayed waves and elevated threshold of cVEMP response which is correlated with neuropathic changes found in these patients. DM affects both labrynthine and retro-labrynthine parts of the VSR pathway. Also, diabetic patients have a subclinical vestibular deficit that may appear with progression of diabetic complications.


KEY WORDS: Diabetes mellitus - Diabetic neuropathies - Vestibular evoked myogenic potentials

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