Chronic renal disease has been documented as a cause for various systemic disorders with various degree of manifestations.one such consequence is ear and neck manifestations. 1 To discuss these manifestations let’s review with this case report. We are discussing about a 79-year-old gentleman who had gone to multiple hospitals and reviewed with an otorhinolaryngologist for tinnitus, fullness in ear with postural dizziness. He was evaluated further and found to have bilateral moderate sensorineural hearing loss with vestibular hypofunction and chronic kidney disease.
In chronic renal disease, there is the accumulation of various metabolic waste products in the body tissue and circulatory system. Toxic influence of nitric compounds, electrolyte imbalance, immunological alteration, and local chemical reactions, especially due to ammonia leads to various otorhinolaryngological manifestations, namely epistaxis, vertigo, sore throat, candida infection, hearing loss, dry mouth, and sialadenitis .2 Due to irreversible loss of endogenous renal function, patients have to depend permanently upon renal function replacement therapy such as dialysis or renal transplantation.
FIGURE 1- CKD RELATED ENT MANIFESTATIONS 3
The literature have shown that based on auditory brainstem audiometry findings, the main site of the lesion is cochlear and to some extent, retro cochlear. The kidney and stria vascularis of the cochlea share physiologic, ultrastructural, and antigenic similarities that could explain the link between chronic kidney disease (CKD) and hearing impairment.4
Here is a elderly patient 79 year old with long standing hypertension, had shown to multiple doctors on the account of dizziness and positional vertigo which was troubling him for over 1 month. Patient upon investigating further had chronic kidney disease. Patient was found to bilateral sensorineural deafness which was reported to be common among patients with chronic renal disease due to damage to sensorineural components of the ear5.
FIGURE – 2- AUDIOGRAM SHOWING SENSORINEURAL DEAFNESS
Among otorhinolaryngological complications, dysfunction of the audiovestibular system is one of the most common problems in Chronic kidney disease. 6,7
FIGURE 3 – POSITIONAL TEST HEAD POSITION – ROLL RIGHT
FIGURE 4 – POSITIONAL TEST HEAD POSITION – ROLL LEFT
In our patient we could observe him to have unilateral vestibular hypofunction on left side as inferenced from the above shown investigations. Despite optical management patients symptoms didn’t get relieved. During the further follow up patient exhibited uraemic symptoms and further derangement of renal parameters and required maintenance dialysis. Post maintenance dialysis patient’s general condition improved leading to reduced symptoms of tinnitus and vertigo.
The aetiology of these complications in patients may be due to structural and functional similarities between the kidney and the inner ear. 8 The disturbances in water and electrolyte homeostasis can affect the endolymphatic fluid, which may induce endolymphatic hydrops. 9 Also some drugs used in the treatment of patients with chronic kidney diseases such as loop diuretics are known for their ototoxicity. 10
The quality of life of such a patient can be reduced by hearing loss. People with hearing loss, tinnitus experience communication issues in daily life, which negatively affects their cognitive and psychosocial functioning. Patients with hearing loss also have to be ruled out for chronic kidney diseases as decreased renal function has also been linked to poor quality of life, hospitalization and cognitive dysfunction.
Dr. C. Chaitra PG 1st Year, DNrB Nephrology Kauvery Hospital Chennai
