i 
 
Hearing Function in Children with Chronic Renal Dysfunction  
 
Student: Jennifer Lau 
 
Submitted to the 
Discipline of Speech Pathology and Audiology 
School of Human and Community Development 
Faculty of Humanities 
University of the Witwatersrand 
in fulfilment of the requirements for the 
Degree of Master of Audiology 
 
July 2012 
 
 
 
 
 
 
 
ii 
 
Declaration 
I, Jennifer Lau, hereby declare that this submission is my own original work and that the 
assistance which I have received is detailed in the Acknowledgements of this report. To the 
best of my knowledge and belief, it contains no material which has been accepted for the 
award of any other degree or diploma at any other university or other institute of higher 
learning, except where due acknowledgement has been made in the text. I am responsible for 
the study and conclusions reached. 
 
________________        _______________ 
JENNIFER LAU        Date 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
iii 
 
Acknowledgements 
I would like to express my sincerest gratitude to the following people: 
 Professor Katijah Khoza-Shangase, my supervisor, for her encouragement, advice and 
assistance throughout the supervision of my research. 
 The participants with chronic renal disorder and their caregivers, who so willingly 
gave of their time to expand my knowledge. 
 The Chief Executive Officer, Medical Superintendent and Heads of Department for 
both the Renal Department and Speech and Hearing Department at Charlotte Maxeke 
Johannesburg Academic Hospital, for granting me the opportunity to conduct this 
research. 
 Dr. Levy, for his time and knowledge that he shared with me regarding renal disorders 
as well as the advice that he gave me regarding the research. I would also like to thank 
all the other doctors, nurses and administrative staff from the Renal Department, who 
so willingly helped me during the data collection phase of the study. 
 The Head of Department as well as my fellow friends and colleagues from the Speech 
and Hearing Department, for their continual support, friendship, encouragement and 
assistance during my academic endeavours. 
 The Ear, Nose and Throat Specialists at Charlotte Maxeke Johannesburg Academic 
Hospital, for their support and encouragement.   
 Professor Peter Fridjhon, Dr. Michael Greyling, and Dr. Charles Chimedza, 
statisticians from the University of the Witwatersrand, for all their valuable time, 
knowledge and guidance regarding data analysis of the study. Their input and 
guidance is much appreciated. 
 Mr. Herman Tesner, for his most timeous input, guidance and support with regards to 
the final check and editing of the research report. 
 All hospital speech and hearing therapists and university staff who provided 
audiological input and emotional encouragement during this study.  
 My family, for their unconditional love and support in the realization of my dreams, 
and standing by me through thick and thin. 
 My friends, for their encouragement, interest and patience in the carrying out of my 
research study. 
 
May God Bless You Always! 
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Abstract 
The primary aim of the research was to describe hearing function in a group of 
children with chronic renal dysfunction receiving treatment in an academic hospital in 
Johannesburg, South Africa.  Specific objectives in the study were to determine the 
prevalence of hearing loss in paediatric patients with chronic renal dysfunction; to 
describe the type, degree and configuration of the hearing loss; and to establish if 
there was a relationship between the presenting hearing loss and the severity of renal 
dysfunction, the different treatment regimens, duration of renal dysfunction, and the 
duration of treatment.  
 
One hundred children between the ages five -18 years participated in the study and 
comprised 65 males and 35 females.  The mean age of the participants was 11.68 
years.  
 
A cross-sectional, descriptive, quantitative research design was employed.  All 
participants underwent a case history interview and a full audiological examination 
which included an otoscopic examination, immittance testing (tympanometry and 
ipsilateral acoustic reflex testing), pure tone audiometry including extended high 
frequency testing up to 16 kilohertz as well as diagnostic distortion product 
otoacoustic emission testing.  A record review was also done.  
 
Both descriptive and inferential statistics were used to analyse the collected data.  
Inferential statistics included parametric measures using multiple regression measures 
as well as non parametric measures using the Kruskal-Wallis statistical analysis. 
 
Results revealed that there was a high prevalence of hearing loss in children with 
chronic renal dysfunction.  Results from the extended high frequency pure tone 
testing as well as the diagnostic distortion product testing revealed that the most 
common hearing loss was a low and high to ultrahigh frequency mild sensorineural 
hearing loss.  The study showed that there was no relationship between the severity of 
hearing loss and the severity of renal dysfunction, or the duration of renal dysfunction 
and the duration of treatment.  However, the study showed that there was a 
relationship between the severity of hearing loss and certain treatments, that is, 
v 
 
haemodialysis and the use of ototoxic medication such as loop diuretics, tuberculosis 
medication, and antimalarial medication.  
 
As the potential to miss hearing loss in this population is high, the research 
highlighted the importance of extended high frequency audiometry as well as 
diagnostic distortion product otoacoustic emission testing for the use of ototoxic 
monitoring in patients with chronic renal dysfunction. The research also highlighted 
the need for further research in this area as well as the need for educating medical 
personnel and caregivers working with children with chronic renal disease. 
 
Key words: chronic renal dysfunction; hearing loss; distortion product; otoacoustic 
emissions; extended high frequency audiometry. 
 
 
 
 
 
 
 
 
 
 
 
 
 
vi 
 
Table of Contents 
 
          Pages 
Acknowledgements         iii 
Abstract          iv-v 
List of Tables          viii-ix 
List of Figures         x 
List of Appendices         xi 
Introduction          1-22 
Methodology          23-40 
Aims          23 
Research Design         24 
Participants         24-25 
 Research instrumentation       26-27 
 Ethical considerations        27-28 
Research procedure        28-30 
 Audiological testing        30-37 
 Validity and reliability       37 
Analysis of data        37-40 
Results          41-74 
Description of participants       41-42 
 Data analysis in terms of case history     43-46 
Description of hearing function      47-56 
 Prevalence of hearing loss       56-57 
Type, degree and configuration of hearing loss     57-61 
Relationship between hearing loss and severity of     61-63 
chronic renal disease 
Relationship between hearing loss and the different treatment regimens 64-66 
Relationship between hearing loss and the duration of renal dysfunction 66-67 
Relationship between hearing loss and the duration of treatment for  68-70 
renal dysfunction 
Additional results obtained of the study     70-74 
Discussion of results         75-82 
Conclusion, limitations and recommendations     83-88 
vii 
 
References          89-97 
Appendices          98-113 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
viii 
 
List of tables 
 
         Pages 
Table 1: Stages of Chronic Kidney Disease     2 
Table 2: Prevalence Figures of Hearing Loss for Sub-Saharan Africa  12 
Table 3: Published Studies on the Effect of Haemodialysis on    16-17 
 Hearing Function 
Table 4: Results of Loop Diuretic Effects on Hearing Function in   20-21 
 Animal Studies 
Table 5: Interpretation of Tympanometry Results     32 
Table 6: Classification of Hearing Loss      34-35 
Table 7: Mean Pure Tone Audiometry Results, Standard Deviations   51 
 and Median Results for the Right and Left Ear (in dB HL)   
Table 8: Pure Tone Audiometry Results for the Right and Left Ear  52-53 
Table 9: Mean DPOAE Results and Standard Deviations for the Right   54-55 
 and Left Ear  
Table 10: Type and degree of hearing loss between ears    60-70 
Table 11: Parametric analysis showing the relationship between severity of  62 
 hearing loss and stage of chronic renal dysfunction 
Table 12: Non-parametric statistical analysis showing the relationship   63
 between degree of hearing loss and severity of chronic renal  
 dysfunction 
Table 13: Parametric Statistical Analysis of the independency of variable   64 
 severity of hearing loss and treatment methods 
Table 14: Non-Parametric Statistical Analysis of the relationship between  65 
 degree of hearing loss and different ototoxic medications 
Table 15: Parametric logistic regression statistical analysis of the relationship  66 
 between degree of hearing loss and the duration of chronic renal  
 dysfunction 
Table 16: Non-parametric Kruskal-Wallis statistical analysis of the relationship  67 
 between degree of hearing loss and the duration of chronic renal  
 dysfunction 
 
ix 
 
Table 17: Parametric logistic regression statistical analysis of the relationship  68 
 between degree of hearing loss and the duration of treatment for  
 chronic renal dysfunction 
Table 18: Non-parametric Kruskal-Wallis statistical analysis of the relationship  69 
 between degree of hearing loss and duration of treatment for chronic  
 renal dysfunction 
Table 19: Parametric multiple regression statistical analysis of the relationship  70 
 between degree of hearing loss, duration of renal dysfunction and  
 duration of treatment 
 
 
 
 
x 
 
List of figures 
 
          Page 
Figure 1: Gender distribution of participants with chronic renal dysfunction  41 
Figure 1: Distribution of stages of chronic kidney disease    42 
Figure 2: Number of participants with a family history of kidney disease  43 
Figure 3: Treatment regimens for participants with chronic renal disorder 44 
Figure 4: Medications used by the participants      45 
Figure 5: Otoscopic examination for each participant     47 
Figure 6: Tympanometry results for each participant     48 
Figure 7: Ipsilateral acoustic reflexes for the right and left ear    49 
Figure 8: Mean pure tone audiometry results for the right and left ear   50 
 for each frequency (in dBHL)        
Figure 9: Mean DPOAE results for the right and left ear for each frequency 54 
Figure 10: DPOAE responses for the right and left ear     56 
Figure 11: Prevalence of hearing loss in a sample of paediatric participants  57
 with chronic kidney disease  
Figure 12: Types of hearing loss        58 
Figure 13: Degree of hearing loss        59 
Figure 14: Perceived hearing loss by the participants and their caregivers   71 
Figure 15: Perceived onset of hearing loss       72 
Figure 16: Perceived symmetry of hearing loss      73 
Figure 17: Other related ear symptoms      74 
 
 
 
 
 
 
 
 
 
 
xi 
 
 
List of appendices 
 
         Page 
Appendix A: Participant information sheet for parents/legal guardians  98-99 
Appendix B: Participant information sheet for paediatric patients  100-101 
Appendix C: Consent form for parent/legal guardian of the participants in  102 
 the study 
Appendix D: Assent form for the participants in the study   103 
Appendix E: Hospital information sheet      104-105 
Appendix F: Case history questionnaire for parents/legal guardians of   106 
 paediatric patients with renal dysfunction  
 (Biographical Information) 
Appendix G: Case history questionnaire for parents/legal guardians of   107 
 paediatric patients with renal dysfunction 
 (Renal and Hearing Information) 
Appendix H: Letter of permission for the study from the chief executive  108 
 officer of Charlotte Maxeke Johannesburg Academic Hospital 
Appendix I: Letter of permission for the study from the head of the   109 
 paediatric renal department of Charlotte Maxeke  
 Johannesburg Academic Hospital 
Appendix J: Letter of permission for the study from the head of the speech  110 
 and hearing department of Charlotte Maxeke  
 Johannesburg Academic Hospital 
Appendix K: Letter of permission for the study from Human Research Ethical  111 
Committee 
Appendix L: Certificate of calibration for the GSI Tympstar tympanometer 112 
Appendix M: Certificate of calibration for the Audera distortion product  113 
 otoacoustic emission meter