Auditory Brainstem Response in Patients with Tinnitus Associated with Vitamin B12 Deficiency.

Abtract Objective: The auditory brainstem response (ABR) has been reported as normal in patients with vitamin B12 deficiency, but there have also been reported cases of interference in amplitude responses. However, studies investigating the effects of vitamin B12 on auditory response are limited in patients with tinnitus. The aim of this study was to investigate the ABR findings in patients with tinnitus together with vitamin B12 deficiency. MATERIAL AND METHODS: Twenty-eight patients with tinnitus-related vitamin B12 deficiency were included in the study. Their serum vitamin B12 levels were lower than 200 pg/ml. Patients were between 19 and 58 years with a mean age of 36.82 ± 11.19 (ratio: male/female, 6/22). ABR was performed in all patients. Latencies ( I, II, III, IV, V), interpeak latencies (I-III, III-V, I-V) and amplitudes were evaluated. Neurologic and ear physical examinations were evaluated and brain magnetic resonance imaging (MRI) was also performed in all patients. RESULTS: Neurologic,ear-auditory physical examinations and brain MRI findings were normal in all patients. Wave latencies and interpeak latencies were normal in all patients. Six patients (21.42 %) had low amplitude in their ABR. In one of them, the left-sided response showed a mild amplitude decrease in all waves compared to the right-side. Bilateral mild low amplitude was observed in 4 (66.6 %) patients in ABR findings. CONCLUSION: These results support that ABR findings can be influenced in vitamin B12 deficiency patients having tinnitus. More detailed studies are needed in tinnitus associated with vitamin B12 deficient patients. Key words: Auditory brainstem response, Tinnitus, Vitamin B12 deficiency, Neurophysiology, Low amplitude.

Impaired function of the levator ani muscle in the grand multipara and great grand multipara.

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.

Auditory brainstem potentials in children with protein energy malnutrition.

OBJECTIVE: In this study, auditory brainstem potentials (ABPs) were studied in children with protein energy malnutrition (PEM) to determine the effects of PEM on the developing brain in children. METHODS: A total of 31 children, aged 3-36 months with moderate/severe PEM and 25 healthy children, aged 3-48 months were included in the study. Nutritional status of the children was assessed by the Gomez classification. Recordings of ABPs were performed by using Nihon Kohden Neuropack 2 device. RESULTS: Of 31 children, 22 (71%) had severe malnutrition, 9 (29%) had moderate malnutrition. Additionally, 8 (26%) and 9 (29%) children had iron deficiency anemia and hypoalbuminemi, respectively. There were significant differences in the mean latencies of the waves I-V on the right and left ears and in the mean interpeak latencies (IPLs) of the waves III-V and I-V on the right ear between the study and control groups (P<0.05). The mean IPLs of I-V on the left side were found to be longer in the moderate PEM group than those of severe PEM group (P<0.05). There was not any difference between the groups of PEM with low serum albumin and PEM with normal serum albumin. While the mean IPLs of I-III on the right side were found longer in the cases of PEM without iron deficiency anemia, the mean latency of wave I on the left side, and the mean IPLs of III-V on the right side were longer in the children with PEM plus iron deficiency anemia (P<0.05). CONCLUSIONS: Our findings showed that children with moderate/severe PEM had ABPs abnormalities in different degrees, which reflect defects in myelination of auditory brainstem pathways in children with moderate/severe PEM. However, we found contradictory results between abnormalities in ABPs and degree of malnutrition and iron deficiency anemia. We think that more extensive studies should be performed to determine whether or not there was a relationship between these parameters.

Visual evoked potentials in multiple sclerosis before and after two years of interferon therapy.

Magnetic resonance imaging (MRI) is important in the diagnosis of and follow-up for the treatment of multiple sclerosis (MS); evoked potentials may be important if MRI is normal or cannot be performed. We assessed serial visual evoked potentials (VEPs) and cranial MRI in a group of clinically relapsing-remitting multiple sclerosis (N = 15) treated with interferon beta-lb (INFB-1b) and in normal subjects (N = 15). The investigations were done 1 week before INFB-lb therapy, 1 year later (N = 15), and 2 years later (N = 10). VEPs were abnormal in most of the patients; MRIs were abnormal in all patients. We used P100 latency as an electrophysiological index for the progress of illness. There were significant differences in VEPs between the beginning and ending of the interferon treatment. We concluded that VEPs would be a reliable index for following up the progress of MS under interferon therapy.