The role of serotonergic 5-HT1A receptors in central cardiovascular regulation in haemorrhagic shock in rats.

The bleeding and haemorrhage is strictly related with accidents and many medical procedures. In some conditions it leads to hypovolaemia and further to hypovolaemic shock. Under conditions of haemorrhagic shock, heart rate and blood pressure critically collapse. Reversing the sympathoinhibitory phase of hypovolaemia could be crucial for clinical management of injured patients after haemorrhage. Systemic administration of 5-HT1A agonists seams to produce resuscitating effects. The aim of this study was to investigate the participation of central serotonin and, in particular, 5-HT1A receptors in cardiovascular regulation in haemorrhagic shock in rats. Intracerebroventricular (i.c.v.) administration of serotonin (5-HT) increased the heart rate (HR), mean arterial pressure (MAP) and implicated that all haemorrhaged animals survived for the whole observation time (2 hours). Similar, although significantly more minor, effects were achieved after selective 5-HT1A activation. Moreover, the i.c.v. administration of selective 5-HT1A antagonist before i.c.v. 5-HT injection partially inhibited 5-HT induced changes. The results of the present work indicate that 5-HT plays an important role in the reversal of the haemorrhagic shock in rats. These effects are at least partially dependent on activation of 5-HT1A receptors.

Effect of tonsillectomy on the level of exhaled nitric oxide (NO) in patients with recurrent tonsillitis.

BACKGROUND: Increased expression of inducible nitric oxide synthase in inflamed tonsils has been reported. Our preliminary observation was the first to demonstrate that increased exhaled NO level may occur in patients with tonsillitis. OBJECTIVE: To extend the observation scope, the same group of patients was examined for NO exhaled after tonsillectomy. MATERIALS AND METHODS: Exhaled oral NO level was measured with Niox Mino(®) analyzer, six-seven months after tonsillectomy in 27 non-atopic patients who suffered from recurrent tonsillitis and in 35 healthy non-atopic subjects. RESULTS: After tonsillectomy, exhaled NO levels were significantly reduced as compared to the preoperative period values and did not differ significantly from those of the healthy subjects. CONCLUSIONS: The results support a finding of the elevated exhaled NO consequent to NO production in chronically inflamed tonsils, but whether NO plays any role in the pathogenesis of tonsillitis or is merely a by-product of another process, needs to be determined.

Role of leptin, ghrelin, angiotensin II and orexins in 3T3 L1 preadipocyte cells proliferation and oxidative metabolism.

There is now growing evidence that the reactive oxygen species have an influence on proliferation and antioxidative status of various cell types. The aim of the study was to investigate the effects of different concentrations of leptin, ghrelin, angiotensin II and orexins on proliferation, culture medium malondialdehyde (MDA) levels and antioxidative enzymes activities: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in 3T3 L1 preadipocytes cell culture. Cell proliferation was measured using [(3)H]tymidine incorporation. In 3T3-L1 cells leptin caused a significant reduction in proliferation (by 36%) compared to control. Ghrelin increased preadipocyte proliferation, and the effect was stronger in higher dose (by 39%), while proproliferatory effect of angiotensin II was stronger in lower doses (by 47%). All used doses of orexin A significantly increased 3T3 L1 cell proliferation (from 21% to 160%), while orexin B caused a marked reduction (from 35% to 70%) of this proliferation. The effects of both orexins were dose-dependent. Leptin and ghrelin increased activity of SOD, CAT, GSH-Px and decreased level of MDA. Angiotensin II treatment stimulated only SOD and CAT activities. Influence of orexins was different on various enzymes. Orexin A increased MDA levels, while orexin B caused a marked decrease in MDA levels. Our results strongly suggest the effects of appetite affecting hormones such as leptin and ghrelin on proliferation and antioxidative enzyme activities of preadipocyte cell lines. Orexin A was found to be the most efficient proliferative-signalling hormone, while orexin B revealed the most significant inhibitory effect on preadipocytes proliferation.

Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight.

The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome.

Sleep study in patients with overweight and obesity.

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation and daytime somnolence. Obesity is one of the most important risk factor for the development of OSAS. The exact mechanisms responsible for the relationship between obesity and OSAS are still unclear. The fat deposits in the pharynx region as well as the reduction in the lung volume have been considered as factors that might be responsible for the increase of the upper airway collapsibility. The aim of our study was to evaluate the correlation between the Body Mass Index (BMI) and sleep study parameters in overweight and obese patients suffering from breathing disturbances during sleep. We studied a group of 106 consecutive obese or overweight patients with a primary complaint of snoring or other breathing disturbances during sleep. In all cases, BMI and sleep studies (PolyMESAM) were examined. We evaluated relationship between the BMI and sleep study parameters such as Respiratory Disturbance Index (RDI), Apnea Index (AI), Desaturation Index (DI) and Average of Lowest Saturation (LSAT). The results showed the lack of significant statistical correlations between BMI and all the sleep parameters studied in the overweight patients and the statistical positive correlation between the BMI and RDI in the obese cases. We conclude that BMI determination may be considered as a simple, yet important predictor, of the OSAS in the group of obese patients.

The nasal airway evaluation in morbid obesity.

The aim of the present study was to evaluate objectively the nasal patency in the obese patients. A total of 18 morbidly obese patients were recruited for the study. All of them were surgically treated because of morbid obesity using Bilo-Pancreatic Diversion (BPD) or Laparoscopic Gastric Banding (LGB) methods. The patients were free of nasal abnormalities, such as septum deviation, polyps, nasal concha hypertrophy and paranasal sinus diseases. This group comprised 10 men and 8 women aged from 17 to 54. The mean Body Mass Index (BMI) was 51.6 kg/m(2), ranged from 34.7 to 61.8 kg/m(2). In all of the patients the nasal patency was examined by active anterior rhinomanometry according International Standardization Rhinomanometric Committee using air pressure 75, 100 and 150 dPa. The results were compared to the healthy control group. The correlation between BMI and nasal airflow pressure was also examined. We found that inspiration values for 75, 100 and 150 dPa as well as the expiration values for 100 and 150 dPa in standard method and expiration values for 100 and 150 dPa in Broms method using anterior rhinomanometry in morbidly obese patients were statistically significant higher in comparison with the healthy controls. No statistical significant correlation between BMI of obese patients and the airflow pressure values was found. We conclude that in the morbid obesity the nasal patency is reduced as compared to the healthy controls.

Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d. with cefuroxime 500 mg b.i.d. in the treatment of chronic and acute exacerbation of chronic sinusitis in adults.

The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125 mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.

Photodynamic therapy of premalignant lesions and local recurrence of laryngeal and hypopharyngeal cancers.

The main advantage of photodynamic therapy (PDT) in laryngology seems to be its non-invasiveness and the possibility of using it despite previous application of conventional methods. In the study, we gave PDT to two separate groups of patients, i.e. five patients with advanced tumour (four of them with local recurrence (squamous cell carcinoma) after surgery and radiotherapy and one with a primary hypopharyngeal tumour) and five patients with leucoplakia. In the first group delta-aminolaevulinic acid (ALA) was administered orally (dose 3 g), while in the second, an ointment containing 10% ALA was applied locally. In both groups prior to irradiation, the tissue level of protoporphyrin IX was verified using an adapted Xillix Life instrument. All treated lesions were irradiated with an argon-pumped dye laser (dose range 100-250 J/cm2, wavelength 635 nm). In the first group, partial response was obtained. In these advanced cases, diminution of cancerous ulcerations was observed. In the leucoplakia group, complete response was achieved in four out of five treated patients. On the basis of our preliminary results, PDT may be useful in eradicating premalignant lesions of the oral cavity and in the palliation of advanced lesions of the oropharynx and larynx.

A comparative study of cefaclor vs. amoxicillin/clavulanate in tonsillopharyngitis.

BACKGROUND: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents. MATERIAL AND METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics. RESULTS: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups. CONCLUSIONS: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

[The analysis of the relationship between integrated grade of the gray and other karyometric parameters in the precancerous lesions and laryngeal cancer]. / Charakterystyka zaleznosci szarosci zintegrowanej jadra komórkowego od innych parametrów kariometrycznych w stanach przedrakowych i raku krtani.

The authors assessed morphometrically the parameters describing nuclei of the normal epithelium (superficial and basal layers), precancerous lesions (dysplasia and keratosis) and laryngeal cancer in the postoperative samples of 12 patients treated in the II Laryngology Clinic Silesian Medical Academy in Zabrze. Then the relationship between the integrated grade of grey (the index of changes in DNA structure) and the others kariometric parameters was evaluated. The value of the integrated grade of grey was the smallest in the superficial layers nuclei and the biggest in the laryngeal cancer one. The evaluation of the relationship was made by using the Spearman Rang Test. The integrated grade of grey was correlated with others quantitative nuclear measurements, though the correlation power was differ in the individual morphometrical stages.

[Middle ear adenoma: a case report]. / Przypadek gruczolaka ucha srodkowego.

Middle ear adenoma (MEA) is a rare neoplasm with benign clinical behavior. The immunohistochemical and ultrastructural studies revealed the mixed, bidirectional mucinous and neuroendocrine character. These tumors have been known by many different names, reflecting the controversies relating to their histogenesis and differentiation. The term middle ear adenoma was proposed by Hyams and Michaels in 1976 and since this time over 100 cases were described in the literature. The most often symptoms of the MEA are the unilateral hearing loss and the tinnitus. MEA should be treated by surgery and very attentive postoperative follow-up. The prognosis of these tumors are good. The histological structure of middle ear adenoma, as well as symptomatology, treatment and clinical behavior are discussed on the basis of the literature. A case of histologically confirmed middle ear adenoma in a 34 year old women is presented.

[Deafness, as a complication of Pseudomonas aeruginosa septicemia in a 9-year old boy with acute lymphoblastic leukemia]. / Gluchota, jako powiklanie posocznicy wywolanej paleczka ropy blekitnej u 9-letniego chlopca chorujacego na ostra bialaczka limfoblastyczna.

We described natural history of Pseudomonas aeruginosa septicemia in 9 year old boy, who was treated for acute lymphoblastic leukemia (ALL). After 14 day treatment of ALL the following signs and symptoms occurred: fever, earache with otorhoea, deafness, bilateral peripheral paralysis of n. VII, erythema, pneumonia, paralytic ileus. After 4 weeks of antimicrobial and supportive therapy, in the 10th week of chemotherapy, he achieved haematological remission. During continuation therapy, two-stage bilateral myringoplasty was performed. At present the maintenance therapy is continued, and in the future hearing aid and cochlear implant, will be applied.

Early identification of hearing impairment in patients with type 1 diabetes mellitus.

OBJECTIVE: The aim of this study was to evaluate the cochlear micromechanics and central auditory function in patients with type I diabetes mellitus and to identify the site of possible dysfunction. METHODS: Cochlear activity was evaluated by recording distortion product otoacoustic emissions (DPOAEs). DPOAEs were performed using an ILO 92 Otodynamics Analyser. Functional changes in the retrocochlear auditory pathway were evaluated by auditory brainstem responses (ABRs). DPOAEs and ABRs were measured in 42 normally hearing patients with type 1 diabetes mellitus aged 21 to 42 years, and 33 age- and sex-matched nondiabetic control subjects. RESULTS: Both of the groups (diabetic and control) had normal and undifferentiated results in tonal and impedance audiometry. ABR peripheral transmission time (wave I) and central transmission time (interpeak latencies I-V) were significantly delayed in the diabetic compared with normal subjects, and the mean amplitudes of various DPOAEs were significantly reduced in the diabetic patients compared with the control subjects. CONCLUSIONS: Combined use of different procedures for monitoring central and peripheral portions of the auditory pathway in diabetic patients showed alterations in cochlear micromechanics and the retrocochlear auditory pathway. Hearing impairment in diabetic patients is usually mild and subclinical, and can be detected early by accurate and objective audiometric methods.

[Monitoring of neurophysiologic modalities during surgery for cerebellopontine angle tumors. Personal experiments]. / Monitorowanie neurofizjologicznych modalnosci w trakcie zabiegów operacyjnych guzów kata mostowo-mózdzkowego. Doswiadczenia wlasne.

The purpose of intraoperative monitoring of many modalities is to save some structures of the nervous system being at risk of damaging during surgical procedures. In cerebellopontine angle (cpa) tumour cases these nervous system structures can include cranial nerves (trigeminal, facial, cochlear, accessory), motor and sensory tracts localised within brainstem, and other. Continuous registration of somatosensory and auditory evoked potentials as well as electromyography of masseter muscle, orbicular muscle of eye and trapezius muscle during procedure is the method of brainstem, cochlear tract and cranial nerves status evaluation. Direct stimulation of cranial nerves within posterior fossa using bipolar electrode is the method of facial, trigeminal and accessory nerves localisation, especially in patients with large tumours. In Department of Neurosurgery Silesian University School of Medicine for intraoperative monitoring of many modalities in cpa lesion cases Nocolet Viking IV D unit with special IOM software is employed. Authors presented own experience in such method and effect in treatment of group of 15 patients operated with electrophysiological intraoperative monitoring.

[A case of tongue neoplasm in a 15-year old patient treated with immunosuppressants for renal insufficiency]. / Przypadek raka jezyka u 25-letniego pacjenta poddanego leczeniu immunosupresyjnemu z powodu niewydolnosci nerek.

The case of lingual cancer in the 25-years old man treated in 2nd ENT Department Silesian Medical Academy in Zabrze was presented in this paper. The patient has been treated from 1989 due to chronic pyelonephritis finished with the renal insufficiency. In 1991 the renal graft was performed and in 1993 graftectomy due to its rejection. In 1991-1993 the long-term immunosuppression was taking including medicines like Cyclosporin, Imuran, Azatioprin and Encorton. The aim of this study was to consider the influence of immunosuppression therapy on lingual cancer appearance in our patient.

Assessment of the medial olivocochlear efferent system in children. pure tone 1.0 kHz and 2.0 kHz suppressive effects on transient evoked otoacoustic emission.

The role of medial efferent system in regulating outer hair cell function has been studied by many investigators. Usually narrow band noise or white noise as contralateral stimulation (CS) suppressors have been used and changes in OAE amplitudes estimated. Thirty children aged 6-15 years (mean 12.5 +/- 4.7), without any changes in tonal and impedance audiometry and with negative history regarding otiatric diseases were examined. Transient evoked otoacoustic emissions (TEOAE) were recorded using ILO 92 Otodynamics Analyser. CS was performed using 1.0 kHz and 2.0 kHz continuous pure tones of 30 dB SL or 50 dB SL. Effects of CS on TEOAE evoked by click of 80, 70 and 60 dB SPL were investigated. TEOAE analysis included assessment of TEOAE amplitude of half octave frequency bandwidth (HOFBW-1.0; HOFBW-1.5; HOFBW-2.0; HOFBW-3.0 and HOFBW-4.0 kHz) and 0.8 kHz frequency bandwidth (0.8-FBW) amplitudes centred at 1.0; 2.0; 3.0; 4.0 and 5.0 kHz. TEOAE amplitude recorded for stimuli 80, 70 and 60 dB SPL without CS decreased: mean values respectively 6.1 +/- 4.2; 5.4 +/- 4.5 and 3.3 dB SPL +/- 4.3. CS effect on TEOAE was observed for all CS options, however, larger suppressive effect was recorded on TEOAE elicited by 70 dB SPL stimulus using 1 kHz/50 dB SL tone as a suppressor and on TEOAE elicited by 60 dB SPL stimulus using 2 kHz/50 dB SL tone as a suppressor. HOFBW and 0.8-FBW analyses showed the association between the frequency/intensity of the suppressors and decreasing of amplitudes of adequate frequency bands. It is concluded that the described method of investigating of the medial olivocochlear efferent system seems to be sensitive and confirms frequency-dependent suppressive effect on OAE.

Latencies of the 2f1-f2 distortion product otoacoustic emissions measured using a phase-gradient method in young people, in the elderly and in people exposed to noise.

Distortion product otoacoustic emissions (DPOAE) are generally accepted as a good tool for investigating the micromechanics of the cochlea. The 2f1-f2 DPOAE latencies provide significant data regarding travelling waves. In this study the 2f1-f2 DPOAE latencies were measured using a phase-gradient method, with a swept-f2 procedure, for three groups: Group I comprised 60 healthy young people, aged 17-32 years; Group II comprised elderly patients, aged 56-72 years, with presbyacusis; and Group III consisted of 74 miners, aged 19-35 years, who had been exposed to noise for 2-15 years. Measurements were performed for frequencies between 1.0 and 6.0 kHz. In all groups the latencies were fitted using a non-linear regression model. The aim of the study was to compare the latency and amplitude of 2f1-f2 DPOAE in different inner ear pathologies. The highest DPOAE amplitudes were recorded in Group I and in miners with 2-4 years noise exposure (Group IIIa), and the latencies showed a similar pattern. The lowest DPOAE amplitudes were recorded in the elderly and in miners with 8-15 years noise exposure (Group IIIc), but in contrast the longest latencies were measured in miners and the shortest in the elderly. The latency analysis significantly reinforces opinions on the micromechanics of the cochlea, mostly in terms of the cochlear functioning as a filter and amplifier and with regard to the elasticity of the basilar membrane.

Contralateral suppression of TEOAE in diabetic children. Effects of 1.0 kHz and 2.0 kHz pure tone stimulation--preliminary study.

The medial efferent system and its regulating outer hair cell function have not been previously studied in diabetic children. In this study, the group comprised 32 diabetic children, aged 6.0-16.0 years, with diabetes lasting 2.0-9.0 years, with normal tonal and impedance audiometry. A control group consisted of 30 healthy children with similar age and sex distribution. Contralateral stimulation (CS) was performed using 1.0 and 2.0 kHz pure tones on the level of 30 and 50 dB SL. Effects of CS on transient evoked otoacoustic emissions (TEOAE) elicited by click of a level equal to 70 and 60 dB SPL were investigated. Analysis included assessment of TEOAE amplitude and 0.8 kHz frequency bandwidth (0.8-FBW) amplitudes (signal/noise) centred at 1.0; 2.0; 3.0; 4.0; 5.0 kHz. TEOAE-RA recorded for stimulus 80, 70 and 60 dB SPL without CS were decreasing: average values respectively 7.3, 4.7 and 3.9 dB SPL. In the group of diabetic children TEOAE amplitudes, recorded for different click levels without CS, were similar to these recorded in healthy children. It suggested that normal function of the cochlea was preserved, mostly outer hair cells. However, the obtained effects of CS, in comparison with healthy children, were weaker and not so regular. Statistical analysis revealed that the reduction of TEOAE amplitudes for adequate 0.8-FBW in the control group was significantly higher, for both 1.0 kHz and 2.0 kHz CPTs of 30 dB SL and 50dB SL, in comparison with diabetic children. It is concluded that the suppressive effect on OAE in diabetic children is rather weak and seems to be associated with pathological changes in medial olivo-cochlear myelinated fibres.

Cochlear dysfunction and diabetic microangiopathy.

The aim of this study was to evaluate the cochlear micromechanics in type 1 diabetic patients and to compare these findings with diabetic microvascular complications (retinopathy and nephropathy). Cochlear activity was evaluated by recording 2f1-f2 DPOAE. DPOAEs were performed using an ILO92 Otodynamics Ltd Analyser. DPOAEs were measured in 42 normally hearing IDDM patients aged between 21 and 42 years, and 33 age-and sex-matched non-diabetic control subjects. IDDM patients were divided into two groups: 17 patients without microangiopathy and 25 with microangiopathy. Microangiopathy was evaluated with ophthalmoscopy and 24-hour albumin excretion rate into urine. Both groups (diabetic and control) had normal and undifferentiated results in tonal and impedance audiometry. The mean amplitudes of various DPOAEs were significantly reduced in the diabetic groups (with and without microangiopathy) compared with control subjects. No correlation was found between diabetic microvascular complications and DPOAE amplitudes reduction. Our results indicate the existence of an alteration in cochlear micromechanics in diabetic patients with microangiopathy as well as in patients without microangiopathy. The lack of significant correlation between the degree of microvascular complications in the retina or kidneys and DPOAEs amplitude reduction suggest that the impaired functional properties of the outer hair cells are probably caused by early metabolic complications in diabetes (among other things non-enzymatic glycation related to hyperactivity of free oxygen radicals) and not directly by diabetic microangiopathy.