THIEME
Original Research
Long-term Effects of Unilateral and Bilateral Otitis
Media and Myringotomy on Long-Latency Verbal
and Non-Verbal Auditory-Evoked Potentials
Milaine Dominici Sanfins1
Caroline Donadon1
Maria Francisca Colella-Santos1
Letícia Reis Borges1
1 Human Development Department, Faculdade de Ciências Médicas,
Universidade Estadual de Campinas, Campinas, Brazil
2 Department of Teleaudiology and Hearing Screening, World Hearing
Center, Institute of Physiology and Pathology of Hearing, Warsaw/
Kajetany, Poland
3 Department of Heart Failure and Cardiac Rehabilitation, Warsaw, Poland
4 Department of Science and Development, Institute of Sensory
Organs, Warsaw, Poland
Piotr H. Skarzynski2,3,4
Address for correspondence Milaine Dominici Sanfins, MDS,
Departamento de Desenvolvimento Humano, Faculdade de Ciências
Médicas, Universidade Estadual de Campinas, Campinas, Avenida
Jacutinga, 220 - apto 12, Indianópolis, São Paulo, 04515-030, SP, Brazil
(e-mail: msanfi
[email protected]).
Int Arch Otorhinolaryngol 2020;24(4):e413–e422.
Abstract
Keywords
► hearing
► otitis media
► electrophysiology
► long-latency
auditory-evoked
potential
► children
Introduction Otitis media (OM) is considered one of the most common reasons
patients seek medical care in childhood. The fluctuating nature of hearing loss in cases
of OM leads to irregular sound stimulation of the central auditory nervous system.
Objectives To analyze the long-latency auditory-evoked potential (LLAEP) by verbal
and nonverbal sounds in children with a history of OM in the first six years of life.
Methods A total of 106 schoolchildren participated in the study, 55 females and 51
males, aged between 8 and 16 years, who were divided into 3 groups: the control group
(CG), the bilateral experimental group (BEG), and the unilateral experimental group
(UEG). All children underwent a complete audiological evaluation (audiometry,
logoaudiometry and immitance testing) and an electrophysiological evaluation (LLAEP
with toneburst stimulus – LLAEP-TB, and LLAEP with speech stimulus – LLAEP-S).
Results Both study groups (BEG and UEG) presented a statistically lower performance
(p < 0.005) when compared with the CG regarding all of the electrophysiological tests with
the prolongation of the latency values and decrease in the amplitude values: LLAEP-TB (BEG:
latency - N1, P2, N2 [females] and P300, amplitude - N1 and P2), LLAEP-S (BEG: latency - P2
and N2 [females], amplitude - P2 /UEG: latency - P2 and P300, amplitude: N1 and P2).
Conclusion Children who had suffered secretory OM in the first six years of life and
who had undergone myringotomy for the placement of a ventilation tube, either
unilaterally or bilaterally, presented worse performance in their electrophysiological
responses to verbal and nonverbal LLAEPs.
Introduction
For the development of speech and language, a sound and
active listening system is of fundamental importance. The
central auditory nervous system (CANS) can be harmed by
received
February 14, 2019
accepted
July 8, 2019
DOI https://doi.org/
10.1055/s-0039-1697006.
ISSN 1809-9777.
several occurrences, including otitis media (OM), which
originates from an inflammation in the middle ear and is
often associated with accumulation of fluid, either infected
or uninfected. Otitis media has a multifactorial pathology,
including factors such as infection of the nasal cavities, the
Copyright © 2020 by Thieme Revinter
Publicações Ltda, Rio de Janeiro, Brazil
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Long-Term Effects of Unilateral and Bilateral Otitis Media
Sanfins et al.
sinus cavities, or the rhinopharynx, which are propagated to
the middle ear through the Eustachian tube.1
Otitis media is considered one of the most common reasons
patients seek medical care in childhood.2 Approximately 50%
of 1-year-olds have had at least one OM episode, and at least 2/
3 of all children have had an episode of OM with effusion (OME)
in the first 5 years of life, an affliction that can result in
conductive hearing loss of up to 40 dB.3,4 Most hearing loss
from OM is conductive and temporary. The fluctuating nature
of hearing loss in cases of OM leads to irregular sound
stimulation of the CANS, and this can distort sound perception.
Due to contralateral ear involvement, the majority of OM
occurrences are bilateral. Although unilateral OM suggests
there might be a better overall hearing performance, this is
questionable because of CANS effects: it appears that the
hearing gap between the ears, either in the unilateral or
bilateral asymmetric conditions, leads to a more effective
participation of the less compromised ear in capturing sound
information. As a result, the performance of the altered ear
gradually declines, impairing auditory activities that require
binaural hearing.5
Knowing that OM causes deleterious effects to the individual, it is important that the treatment be very well established.
In short-term cases, one can try a conservative approach, such
as insufflation of the Eustachian tube together with decongestant medication. However, in cases of recurrent or long-term
OM, this type of treatment is generally not effective.6,7 Thus,
myringotomy with the placement of a ventilation tube (MVT)
appears to be a good alternative,8 since it provides an alternative way of aerating the middle ear.
The relationship between OM and adverse effects on oral
language development and learning has been well documented.9–11 Children with OM hear verbal and non-verbal
sounds in a reduced or distorted way, which leads to a loss of
auditory cues such as speech formants. These difficulties may
remain throughout the school years and adult life, and are
especially acute in difficult listening environments. Therefore, an evaluation of the possible effectiveness of myringotomy, combined with a study of how auditory information is
processed by the CANS, is recommended. In this context,
auditory-evoked potentials (AEPs) are an extremely useful
tool to study auditory perception and its abnormalities.12
Long-latency AEPs (LLAEPs) are thought to represent a
range of cognitive processes that includes the update of the
working memory and the transfer of information to consciousness.13,14 Long-latency AEPs enable the observation of
the neurophysiological substrate of processes that occur in
the cortex related to cognition – such as memory, attention,
the sequential processing of auditory information, decision
making, and auditory discrimination. Eliciting LLAEPs with
verbal stimuli provides additional information about the
biological processes involved in speech processing, especially
since it can provide information that is complementary to
that obtained by standard behavioral evaluations (cognitive,
auditory, or linguistic).15,16 There have been few studies that
have aimed at identifying impairment in central auditory
function due to OM in children. The aim of the present study
was to analyze LLAEP responses evoked by verbal and
nonverbal sounds in children with a history of OM (...truncated)
