title: Protein energy malnutrition associates with different types of hearing impairments in toddlers: Anemia increases cochlear dysfunction.
abstract: OBJECTIVE
  This work aimed to highlight a challenging asymptomatic problem which is early detection of hearing impairment in toddlers with protein energy malnutrition (PEM) as a neuro-cognitive effect of PEM on developing brain in relation to hemoglobin level.
  
  
  METHODS
  100 toddlers, aged 6-24 months, fifty with moderate/severe PEM and fifty healthy children, were included in study. Both TEOAEs and ABR testing were used to assess auditory function.
  
  
  RESULTS
  Study reported an association between malnutrition and hearing impairment, 26% of cases had conductive deafness secondary to otitis media with effusion using tympanometry; 84.6% showed type B and 15.4% type C which may suggest developing or resolving otitis media. Their ABR showed 46% mild and 53% moderate impairment. 32% of PEM cases had sensory neural hearing loss and with type (A) tympanometry. Those were assessed using ABR; 58% had mild, 34% moderate and 8% profound impairment. 10% of PEM cases had mixed hearing loss with 50% type B and 50% type C tympanometry and their ABR showed moderate to profound impairment. TEOAEs latencies at different frequencies correlate negatively with hemoglobin level.
  
  
  CONCLUSIONS
  Toddlers with moderate/severe PEM had hearing impairments of different types and degrees. Neuro-physiological methods could be early and safe detectors of auditory disorders especially in high-risk toddlers. Anemia increases risk for auditory dysfunction.
authors.affiliation: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Terez2003@hotmail.com.
authors.forename: Terez Boshra
authors.initials: TB
authors.lastname: Kamel
authors.affiliation: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Tharwat_deraz@hotmail.com.
authors.forename: Tharwat Ezzat
authors.initials: TE
authors.lastname: Deraz
authors.affiliation: Audiology Unit, Otolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Rashahamdi74@gmail.com.
authors.forename: Rasha H
authors.initials: RH
authors.lastname: Elkabarity
authors.affiliation: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Rashakamal@gmail.com.
authors.forename: Rasha K
authors.initials: RK
authors.lastname: Ahmed
mesh_terms: D000158:Acoustic Impedance Tests; D000740:Anemia / Q000453:epidemiology*; D016022:Case-Control Studies; D002675:Child, Preschool; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D006314:Hearing Loss, Conductive / Q000453:epidemiology* / Q000503:physiopathology; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000503:physiopathology; D010034:Otitis Media with Effusion / Q000453:epidemiology* / Q000503:physiopathology; D017084:Otoacoustic Emissions, Spontaneous; D011502:Protein-Energy Malnutrition / Q000453:epidemiology*
keywords: Anemia; Auditory brainstem evoked responses (ABR); Hearing loss; Infants; Otoacoustic emissions (OAEs); Protein energy malnutrition (PEM)