الفهرس 
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Abstract
As DN occurs up to 50% of patients with DM, the main objectives of the current study were to evaluate the function of the vestibular end organs and the vestibular nerve in patients with type 2 DM with polyneuropathy and compare results to those of the patients without polyneuropathy. Results of both patient categories was compared with those that had been obtained from healthy control subjects.
The comparative study started at June 2020 and finished within 12 months. It was carried out on: The Study Group: 30 type 2 diabetes mellitus patients with and 30 patients without polyneuropathy. The Control Group: 30 healthy non-diabetic individuals.
The results of the study revealed:
The comparison between 3 groups as regarding PTA thresholds was significant at all frequencies. Both DM and DPN groups had significantly higher audiometric thresholds than the control group at each frequency. Moreover, DPN had significantly higher audiometric thresholds than the DM group at each frequency.
As regarding speech discrimination, averaged speech discrimination score between the two ears was significantly worse in each of DM and DPN group than in the control group. Moreover, the speech discrimination was significantly worse in the DPN group than in the DM group.
The comparison between 3 groups as regarding ABR wave (I, III& V) latencies and inter-wave latencies (I-III, I-V, III-V) showed significant difference among the groups as regards the absolute and inter-wave latencies.
The comparison between three groups as regarding the c-VEMP parameters revealed marked abnormalities in the DPN group in the form of prolonged latencies, and reduced amplitude.
As regarding o-VEMP the comparison between three groups, DPN showed the longest latencies, smallest amplitude, and the largest AR
Occulomotor testing was normal in three groups. None of the patients had gaze evoked nystagmus. They had normal saccadic velocity, latency and accuracy. Smooth pursuit testing demonstrated normal gain to both sides. Optokinetic nystagmus had normal slow phase velocity and symmetrical between the two sides.
In the DM group, 2 patients (6.7%) had right posterior canal BPPV, and 1 patient (3.3%) had right horizontal canal BPPV. In the DPN group, 6 patients (20%) had posterior canal BPPV (4 in right ear and 2 in left ear), and 5 patient (16.6%) had horizontal canal BPPV (3 in right ear and 2 in left ear). There was statistically significant prevalence of BPPV in the DPN group compared to the control and DM group.
For caloric test, 2 patients (6.7%) of DM group had right canal weakness and 4 patients (13.3%) in the DPN had canal weakness (3 in right ear and 1 in left ear). There was statistically significant prevalence of caloric weakness in the DPN group compared to DM group.
13(43.3%) patients in DM group and 20 (66.7%) patients in DPN group were complaining from dizziness and comparison between three groups was significant.
The comparison between 3 groups in studying motor and sensory nerve conduction in upper limb (UL) and lower limb (LL). Abnormal nerve conduction study in the DPN group was mild in 13(43.3%) patients, moderate in 15(50%) patients and marked in 2(6.7%). The amplitude was significantly lower in the DPN patients compared to either the control group or the DM patients.
The effect of disease duration was studied on the whole diabetic patients (DM and DPN).
As disease duration increased the hearing thresholds increased. No significant effect of disease duration was found in the audiometric frequencies 1000 Hz and below. While audiometric hearing thresholds at 2000 Hz and higher frequencies increased significantly as the disease duration increased. For the c-VEMP, there was no effect of disease duration on P1 and N1 latencies while P1-N1 amplitude decreased significantly as the disease duration increases. For the o-VEMP, disease duration had a significant effect on the latency and amplitude whereas the N1 and P1 latency increased and the amplitude decreased as diseased duration increased.
The c- and o- VEMP parameters in the DPN patients having different degrees of polyneuropathy. The only significant difference between DPN having mild degree and those having moderate or marked degree was in the amplitude of the c-VEMP response whereas the P1-N1 amplitude was larger in the DPN patients having mild degree compared to those having moderate or marked degree. Otherwise, no significant difference was found as regards the other parameters among DPN patients having different degree of polyneuropathy.
No significant effect of disease duration was found on the nerve conduction study in the DPN group.