Subclinical neural hearing alterations in school children with type 1 diabetes mellitus

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of Speech Therapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pediatric Endocrinology Unit, University Hospital Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alteraciones neuroauditivas subclínicas en escolares con diabetes mellitus tipo 1" ] ] "textoCompleto" => "IntroductionDiabetes mellitus (DM) is a complex metabolic disorder that affects several organs, including the central auditory nervous system.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Oxidative stress, macro-and microvascular alterations, degeneration of the 8th cranial nerve, and a reduction in the number of nerve fibers have been identified as mechanisms responsible for the dysfunction of the central auditory pathway in patients with DM.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In addition, previous studies have shown that type 1 diabetes mellitus (T1DM) is associated with a high risk of neurocognitive and behavioral deficits due to early cerebrovascular and neurodegenerative changes, impairing the development of school-age children, adolescents, and young adults.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>The effect of these alterations on the auditory pathway can be investigated using electrophysiological tests to analyze the bioelectrical activities of thalamocortical auditory pathways after acoustic stimulation. These tests are objective, have high sensitivity and specificity, provide information on the integrity of the auditory system, and allow early identification of alterations and dysfunctions in the central auditory nervous system.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Among the auditory evoked potentials, brainstem auditory evoked potentials (BAEP) and event-related potentials (P300) assess the neurophysiological integrity of the brainstem and physiological processes of sensory, perceptual, and cognitive performance related to information processing.A recent review study analyzed the temporal development of the P300 cognitive potential, from childhood to adolescence. This review carried out a historical approach showing the findings of the first investigations on the P300 in groups of children and adolescents, which demonstrated that this cognitive potential could be detected in children and seemed to reflect cognitive processes similar to those of adults. Later studies also identified the lack of a precise P300 component in children and adolescents, the presence of differentiated electrophysiological responses to new stimuli, changes in P300 in groups with atypical development, individual differences in this cognitive potential and neural substrates throughout childhood development. The authors point out that changes in brain function have been associated with cognitive development, using this potential to assess the performance of school-aged children, and that, with advancing age, significant reductions in latency and increases in amplitude that persist are observed up to 20 years.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Studies have shown that BAEP in individuals with T1DM results in delays in absolute latencies and interpeak intervals.<a class="elsevierStyleCrossRefs" href="#bib0020">4,7</a> These findings suggest that signal transduction in the auditory pathway may be slow, suggesting the presence of early neural deficits characterized by delayed signal conduction from the brainstem to the midbrain.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>The possible influence of DM on cognitive function has also been investigated by different researchers,<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> who observed prolonged latencies and reduced amplitudes in the P300 in individuals with T1DM in different age demonstrates the importance of this hormone for neurotransmitter functioning, synaptic plasticity, and cognitive function; therefore, relative insulin][deficiency must be considered during the neurological development of children with T1DM.<a class="elsevierStyleCrossRefs" href="#bib0035">7,9</a> Despite clinical evidence, few studies have investigated neural auditory deficits in school children with T1DM. The prevalence and severity of possible hearing disorders are not yet well established, and further studies are needed.<a class="elsevierStyleCrossRefs" href="#bib0055">11–13</a>The investigation of neural integrity in children and adolescents with T1DM can provide subsidies for the detection of functional auditory deficits, including subclinical deficits, allowing the early diagnosis of hearing loss and elaboration of protocols and monitoring of the cochleo-neural auditory function to avoid or minimize the disturbances caused by auditory and cognitive alterations in the development of this population.Therefore, this study aimed to investigate the effects of T1DM on BAEP responses and P300 and the incidence of cognitive complaints in school-age children and adolescents.Materials and methodsStudy populationA total of 101 children and adolescents participated in this study, 50 with T1DM, 25 of whom were male, aged between 7 and 18 years, with a mean age of 11.7 (±3.0) years, accompanied by a public reference service. In addition, 51 volunteers, apparently healthy, 28 males, aged between 8 and 18 years, with a mean age of 11.3 (±2.7) years, were recruited from the Speech Therapy Teaching Clinic at the Universidade do Estado da Bahia.All participants underwent a structured interview prepared by the researchers, containing closed questions about hearing health, clinical and behavioral aspects. Adolescents and the parents of the evaluated children answered the questionnaire. Participants were included if they had a diagnosis of DM1. Participants in the comparison group did not have T1DM. Individuals with other types of diabetes, neurological and psychiatric diseases, risk of hearing problems such as use or previous use of ototoxic drugs and history of hereditary hearing loss were excluded from both groups.Information regarding the clinical metabolic profile of participants with T1DM, such as disease duration and age at diagnosis, was acquired through secondary data obtained from medical records. Metabolic control of participants with T1DM was classified according to the guidelines proposed by the American Diabetes Association.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> All participants included in this study had unaltered otoscopy, normal hearing thresholds (HTL) ≤20 dB,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> obtained by researching hearing thresholds using pure tone audiometry, with frequencies from 0.25 to 8kHz, and analyzed using the audiometer AD229e (Interacoustic®, Middlefart, Denmark), with TDH-39 supra-aural headphones (TDH-39 Thelephonics®). New York, NY, USA). Middle ear integrity was defined by the presence of “type A” tympanometric curves.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Hearing assessmentTo investigate the electrophysiological threshold of hearing, the participants were subjected to a BAEP test to analyze the potentials generated in the auditory nerve (wave I) to the brainstem (waves III and V) and the P300 for evaluation of the cerebral cortex. These potentials were evaluated using Contronic Masble ATC Plus 3AABR equipment (Pelotas, Brazil). To investigate this auditory evoked potential, after cleaning the skin with electrolytic paste, four electrodes were placed on the participant’s head: one active electrode (Fz), one neutral electrode (Fpz), and two reference electrodes (M1/M2). Electrode impedance was considered adequate when it was below 5 kΩ. The stimulus used was a monaural click at an intensity of 80dBHL, with a presentation speed of 17.2 c/s, alternating polarity, and 2000 scans.In the investigation of cognitive function, the bioelectrical responses of the P300 were analyzed, and the electrodes were positioned as follows: active (Cz), ground (Fpz), and reference electrodes (M1 /M2). The stimuli were presented in the form of a single paradigm, with an intensity of 80dB HL, a frequency of 2 KHz used as a rare stimulus, and 1 KHz as a frequent stimulus, with 80% of frequent stimuli and 20% of rare stimuli. The signal was presented to both ears simultaneously, with a stimulus plateau of 20ms and an ascending fall of 5ms, alternating polarity, inter-stimulus interval of 0.8ms, filter from 1 to 20Hz, and window of 1000ms. The P300 wave was considered as the highest peak of positive polarity after the N1-P2-N2 complex and was presented as the sum of rare stimuli.Ethical aspectsThis study was approved by the Research Ethics Committee of the Federal University of Bahia (UFBA) (opinion no. 946, 282). All participants were volunteers in the research, agreeing to sign the Free and Clarified Consent Term or the Free and Clarified Term of Assent when necessary.Statistical analysisSPSS version 22.0 for Windows (Chicago, IL, USA) was used for statistical analysis of the results. The normality of BAEP and P300 responses was assessed using the Kolmogorov-Smirnov test. To compare the latency parameters of BAEP and P300 between the groups, Student’s T or Mann-Whitney U test was used. Quantitative variables were organized using measures of central tendency and dispersion, as well as minimum and maximum values and simple and relative frequency. Correlations between BAEP variables and metabolic control were analyzed using the Kruskal–Wallis test.ResultsClinical features and cognitive complaintsData from 50 children and adolescents with T1DM and 51 healthy participants were analyzed. There were no significant differences in terms of age between the groups evaluated. The mean ages of participants were 11.7 (±3.0) and 11.2 (±2.9). In the T1DM group and group without disease, respectively. There were no differences between the participants in terms of gender and education. However, significant differences were observed in relation to cognitive complaints of memory (p=0.002) and attention (p=0.021), with a higher prevalence of symptoms in participants with T1DM than in those without the disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Metabolic characteristicsThe estimated mean blood glucose values for participants with T1DM were 253.19 (±70.9) mg/dL and 79.0 (±8.8) mg/dL for the apparently healthy group. Regarding the metabolic profile of participants with T1DM, the mean age at diagnosis was 8.6 (±2.8) years, with 50% of the sample having the disease diagnosed between 5 and 10 years. The mean duration of T1DM was 4.3 (±2.5) years, and 60% of the participants had the disease for at least 5 years. The mean value of glycated hemoglobin (HbA1c) was 10.0% (±2.4), and 50% of children and adolescents had poor metabolic control (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Hearing assessmentAuditory evoked potentialsThere were differences in BAEP values between the groups with T1DM and the group without disease in both ears. Mean latencies were significantly higher in participants with diabetes when compared to apparently healthy children (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Significant differences were found concerning the metabolic control of participants with T1DM and wave III latencies in the left ear (p=0.006) and in wave V in the right (p=0.026) and left ears (p=0.005), as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The associations between BAEP latencies and metabolic variables, age at diagnosis, and disease duration in participants with T1DM were analyzed, and no relationship was found. There was also no significant relationship between BAEP and P300 findings and memory or attention complaints.In the present study, the mean P300 latency values were similar between the groups with T1DM (323.0±89.1) and in those without the disease (321.2±88.2), with no significant differences between them (p=0.459).DiscussionOur results showed significant differences in the presence of complaints related to attention and memory difficulties in the T1DM group compared with healthy participants. In addition, a recent study concluded that T1DM is associated with auditory disorders that affect activities of daily living and that non-hearing deficits, such as cognitive alterations, can also contribute to the worsening of the performance of activities.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Evidence has shown that T1DM can affect cognitive functions early since the brain of a developing child is more susceptible to metabolic instability due to the greater need for glucose to aid in neuronal growth and differentiation.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Moreover, regarding individuals with T1DM, in addition to the damage related to hyperglycemia, glycemic instability resulting from the regular use of insulin can contribute to neural hearing deficits and decreased attentional activities in children.<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a>In this study, the mean BAEP latency values showed significant differences between waves III and V in the evaluated participants and were higher in individuals with the disease than in apparently healthy individuals. However, these differences between the means do not characterize clinical alterations; therefore, it is not possible to affirm that our findings represent a retrocochlear auditory alteration. However, these higher latencies may suggest a delay in neural transmission, which may indicate the appearance of subclinical changes in the afferent pathway, specifically in the brainstem structures. These findings can be interpreted as signs of neural dysfunction in children and adolescents with T1DM, whose auditory nerves and different brainstem sites may present central auditory alterations. These data allowed us to hypothesize that the prolongation of BAEP latencies may, with the duration of the disease and frequent glycemic alterations, evolve into a retrocochlear clinical finding. These results are in agreement with another study that found subclinical hearing alterations in pediatric patients with a shorter duration of diabetes.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Some studies have associated the reduction in nerve conduction efficiency with demyelination of the auditory nerve and metabolic alterations in diabetes.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Others consider changes in BAEP latencies to be an early indication of diabetic neuropathy, which may be a risk factor for the development of auditory neuropathy.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> The explanation for this hypothesis is that auditory dysfunction appears earlier than changes in peripheral nerves owing to differences in the diameter of the nerve fibers. These differences would justify the theory that auditory symptoms precede peripheral symptoms, as these larger nerves take longer to present alterations, leading to the appearance of peripheral neuropathy later, after auditory neuropathy.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>In the present study, a significant relationship was found between metabolic control and latencies of waves III and V, confirming their involvement at the brainstem level. It was also observed that the increase in absolute latencies was proportional to worsening glycemic control. These findings imply that diabetes can be harmful to the brain, even in the early stages of the disease, probably because the pediatric population with T1DM has not yet acquired the “protective effect” of insulin due to the short treatment time. This confirms the hypothesis that poor metabolic control, found in half of the participants with diabetes in this study, maybe the main cause of neural hearing alterations.Research has also shown that the use of insulin provides a “protective effect” against the harmful metabolic changes and complications of T1DM in the auditory system. Experimental studies have suggested that this possible "protection" occurs due to the use of subcutaneous insulin, which decreases the expression of key antigens in B cells, defending them from destruction by the immune system.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a>In the analysis of P300, no significant difference was observed between the groups with and without T1DM. These results may be associated with the short duration of illness (<5 years) presented by more than 60% of children and adolescents with the disease. A recent study has demonstrated that poor metabolic control may increase the risk of cognitive impairment in children with T1DM.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Several investigators have shown significantly increased P300 latencies in participants with T1DM who have had longer disease duration and an association of poor glycemic control with increased latencies and reduced amplitudes, suggesting dysfunction of the central auditory system.<a class="elsevierStyleCrossRefs" href="#bib0045">9,23,24</a>Although we did not find statistical significance in the P300 complex in the extra-group analysis, self-reported cognitive complaints related to memory and attention difficulties were significantly higher in participants with T1DM than in healthy participants. Thus, we hypothesize that this cognitive potential may not have adequate sensitivity to detect subtle, yet subclinical, changes in the central nervous system.The literature shows that the mechanisms underlying cognitive deficits are complex and multifactorial and can be explained by the direct effects of altered glucose metabolism in the brain, cardiovascular disease, and microvascular dysfunction. Neuroimaging studies in individuals with T1DM have shown that the brain areas responsible for cognitive skills related to memory and attention show a considerable reduction in gray matter mass, with the left hemisphere being the most affected. These cortical regions are responsible for processing, memory, and attention.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>Participants with DM1 were invited to participate in annual auditory monitoring and were instructed on the importance of maintaining adequate metabolic control to prevent the appearance and/or development of alterations in the auditory pathway.A limitation of this study was that specific protocols were not used for neuropsychological assessments related to cognitive functions of memory and attention to validate self-reported cognitive complaints.ConclusionChildren and adolescents with T1DM may have early, albeit subclinical, hearing dysfunction that can affect the retrocochlear structures, possibly due to poor metabolic control.FundingNo funding.Conflicts of interestThe authors declare no conflicts of interests regarding research authorship and/or publishing of this article." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2006654" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1719301" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2006653" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Justificación y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1719302" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Hearing assessment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical aspects" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical features and cognitive complaints" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Metabolic characteristics" ] 2 => array:3 [ "identificador" => "sec0050" "titulo" => "Hearing assessment" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Auditory evoked potentials" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-27" "fechaAceptado" => "2023-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1719301" "palabras" => array:4 [ 0 => "Diabetes mellitus" 1 => "Hearing loss" 2 => "Auditory evoked potential" 3 => "Children" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1719302" "palabras" => array:4 [ 0 => "Diabetes mellitus" 1 => "Hipoacusia" 2 => "Potenciales evocados auditivos" 3 => "Niños" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesEvidence has shown a cause-and-effect relationship between type 1 diabetes mellitus and auditory and cognitive dysfunctions. This study aimed to investigate the effect of type 1 diabetes mellitus (T1DM) on central auditory and cognitive functions in school-age children and adolescents. MethodsThe study sample consisted of 101 children and adolescents, 50 with T1DM, of both sexes, aged between 7 and 18 years. All participants were selected for a structured interview on hearing, behavioral, and cognitive health and assessment of brainstem auditory evoked potentials (BAEP) and event-related potentials (P300). ResultsSignificant differences were observed in memory (p=0.002) and attention (p=0.021) complaints between participants with and without T1DM. In the BAEP responses, there were differences between wave III latencies in the right (p=0.017) and left (p=0.019) ears and in wave V latencies in the left ear (p=0.001) between the evaluated groups. In addition, there was an association between BAEP findings and metabolic control in the T1DM group in the left ear in waves III (p=0.006) and V (p=0.005) and in the right ear in wave V (p=0.026). No differences were observed in the latencies of P300 between the evaluated groups. ConclusionThis study demonstrated the existence of a subclinical finding in the central auditory pathway, offering an increased risk for retrocollear alterations, which may be a consequence of poor metabolic control." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Justificación y objetivosLa evidencia ha demostrado una relación de causa y efecto entre la diabetes mellitus tipo 1 y las disfunciones auditivas y cognitivas. Este estudio tuvo como objetivo investigar el efecto de la diabetes mellitus tipo 1 (DM1) en las funciones cognitivas y auditivas centrales en niños y adolescentes en edad escolar. MétodosLa muestra del estudio estuvo constituida por 101 niños y adolescentes, 50 con DM1, de ambos sexos, con edades entre 7 y 18 años. Todos los participantes fueron seleccionados para una entrevista estructurada sobre la salud auditiva, conductual y cognitiva y la evaluación de los potenciales evocados auditivos del tronco encefálico (BAEP) y los potenciales relacionados con eventos (P300). ResultadosSe observaron diferencias significativas en quejas de memoria (p=0,002) y atención (p=0,021) entre participantes con y sin DM1. En las respuestas BAEP, hubo diferencias entre las latencias de la onda III en el oído derecho (p=0,017) e izquierdo (p=0,019) y en las latencias de la onda V en el oído izquierdo (p=0,001) entre los grupos evaluados. Además, hubo asociación entre los hallazgos de PEATC y el control metabólico en el grupo de DM1 en el oído izquierdo en las ondas III (p=0,006) y V (p=0,005) y en el oído derecho en la onda V (p=0,026). No se observaron diferencias en las latencias de P300 entre los grupos evaluados. ConclusiónEste estudio demostró la existencia de un hallazgo subclínico en la vía auditiva central, ofreciendo un mayor riesgo de alteraciones retrocollar, lo que puede ser consecuencia de un mal control metabólico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Justificación y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "1. Identification: 1.1.Name: _______________________________________________ 1.2. Age: __________________ DN: ___/____/________ 1.3. Gender: () M () F 1.4. Schooling: () kindergarten () Elementary School I () Elementary School II () High school 2. Auditory aspects: 2.1. Do you think the child or teenager listens well? () yes () no 2.2. Have you had multiple episodes of ear infection? () yes () no 2.3. Had diseases such as: () rubella () mumps () measles () meningitis () chicken pox 2.4. Do you feel aural fullness? () no () yes () right ear () left ear 2.5. Does it feature autophony? () no () yes () right ear () left ear 2.6. Does it have tinnitus? () no () yes () right ear () left ear () low pitch () high pitch 2.7. Are you uncomfortable with loud sounds? () yes () no () right ear () left ear 2.8. Do you feel dizzy? () yes () no () Rotary () objective (objects rotate around) () subjective (the patient feels himself turning in relation to the environment) () imbalance () fluctuation () darkening of sight () others 2.9. Do you have pain in the cervical region? () yes () no 2.10. Do you have a habit of using headphones? () yes () no 3. Auditory processing 3.1 Do you have difficulty understanding speech? () yes () no 3.2. Do you have difficulty understanding speech in noise? () Yes () no 3.3. Difficulties understanding television? () yes () no 3.4. Understands people well. () yes () no 3.5. Difficulty talking on the phone? () yes () no 3.6. Having trouble locating the sound? () yes () no 3.7. Are you distracted in a noisy environment? () yes () no 4. Behavioral aspects 4.1. Is it hectic? () yes () no 4.2. Are you hyperactive? () yes () no 4.3 Is it quiet? () yes () no 4.4. Is shy? () yes () no 4.5. Do you tend to isolate yourself? () yes () no 4.6. Do you have memory difficulties? () yes () no 4.7. Do you have trouble staying alert? () yes () no 4.8. Are you easily angered? () yes () no 5. Clinical and laboratory data 5.1. Glycemic rate: _________________ Test _______________date:__________ 5.2. Practice exercises? () yes () no 5.3. Value of Glycated Hemoglobin:_________Date:________Method___________ 5.4. Age of patient at diagnosis of diabetes mellithus (DM):____________________ 5.5. Duration of illness: () 0 to 5 years () 5 to 10 years () 10 to 15 years" "titulo" => "Audiological interview" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0175" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data represented the level of education divided into: ES- elementary School and HS-high school, *values were statistically significant at the level of (p < 0.05)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Characterization \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">T1DM \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Healthy controls \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.542</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25(50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28(54.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25(50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23(45.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schooling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.143</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ES \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48(96.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42(75.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">02(4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">08(15.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Difficulties of memory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.002*</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43(85.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28(56.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22(44.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">08(15.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Difficulties of attention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.021*</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20(40.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10(19.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41(80.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30(60.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332392.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of absolute and relative frequencies of socio-educational aspects and cognitive complaints by sex between T1DM (n=50) and healthy controls (n=51)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0180" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data are represented as mean (SD) for subjects with T1DM." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Metabolic characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age – diagnosis of the disease (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="middle">8.6(±2.8)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11(22.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5−10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25(50.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14(28.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of illness (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="middle">4.3(±2.7)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32(64.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5−10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13(26.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">05(10.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metabolic control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="middle">10.0(±2.5)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">08(16.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17(34.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25(50.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332390.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Metabolic characteristics of the T1DM group (n=50)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0185" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data are represented as mean (SD) for n subjects. * p<0.05 indicated statistical signiﬁcance using the independent samples t-test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Ears \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Waves \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">T1DM (n=50) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Healthy control (n=51) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="6" align="left" valign="middle">Right</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.40(0.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38(0.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.492 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.58(0.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.48(0.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.017* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.42(0.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.22(0.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.066 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I-III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.14(0.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.14(0.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.990 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III-V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.86(0.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.87(0.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.840 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I-V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.01(0.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.02(0.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.874 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="6" align="left" valign="middle">Left</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.37(0.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.35(0.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.439 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.55(0.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.46(0.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.019* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.43(0.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.27(0.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I-III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.15(0.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.12(0.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.320 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III-V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.92(0.31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.86(0.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.282 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I-V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.04(0.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.98(0.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.110 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332389.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Absolute latencies and interpeak latencies obtained with auditory brainstem response, for the two ears, in the different groups." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0190" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data represented as mean (SD)/* p<0.05)/using the Kruskal Wallis test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Ears</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Metabolic control</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">III</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="middle">Right</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.51(0.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.372</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.34(0.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.026*</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.54(0.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.47(0.26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.60(0.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.52(0.17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="middle">Left</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.48(0.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.006*</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.33(0.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">0.005*</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.51(0.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.42(0.26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.56(0.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.54(0.17) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332391.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association between auditory brainstem response and metabolic control in the T1DM (n=50) group." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive dysfunction in diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.J. 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Original article

Subclinical neural hearing alterations in school children with type 1 diabetes mellitus

Alteraciones neuroauditivas subclínicas en escolares con diabetes mellitus tipo 1

Nadja Braitea,

Corresponding author

nbraite@uneb.br

Corresponding author.

, Luciene da Cruz Fernandesb, Mara Renata Rissatto Lagoa, Caio Leônidas Oliveira de Andradea, Crésio Aragão Dantas Alvesc

a Department of Life Science, State University of Bahia, Salvador, Bahia, Brazil

b Department of Speech Therapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil

c Pediatric Endocrinology Unit, University Hospital Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes mellitus &#40;DM&#41; is a complex metabolic disorder that affects several organs&#44; including the central auditory nervous system&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Oxidative stress&#44; macro-and microvascular alterations&#44; degeneration of the 8th cranial nerve&#44; and a reduction in the number of nerve fibers have been identified as mechanisms responsible for the dysfunction of the central auditory pathway in patients with DM&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition&#44; previous studies have shown that type 1 diabetes mellitus &#40;T1DM&#41; is associated with a high risk of neurocognitive and behavioral deficits due to early cerebrovascular and neurodegenerative changes&#44; impairing the development of school-age children&#44; adolescents&#44; and young adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The effect of these alterations on the auditory pathway can be investigated using electrophysiological tests to analyze the bioelectrical activities of thalamocortical auditory pathways after acoustic stimulation&#46; These tests are objective&#44; have high sensitivity and specificity&#44; provide information on the integrity of the auditory system&#44; and allow early identification of alterations and dysfunctions in the central auditory nervous system&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the auditory evoked potentials&#44; brainstem auditory evoked potentials &#40;BAEP&#41; and event-related potentials &#40;P300&#41; assess the neurophysiological integrity of the brainstem and physiological processes of sensory&#44; perceptual&#44; and cognitive performance related to information processing&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A recent review study analyzed the temporal development of the P300 cognitive potential&#44; from childhood to adolescence&#46; This review carried out a historical approach showing the findings of the first investigations on the P300 in groups of children and adolescents&#44; which demonstrated that this cognitive potential could be detected in children and seemed to reflect cognitive processes similar to those of adults&#46; Later studies also identified the lack of a precise P300 component in children and adolescents&#44; the presence of differentiated electrophysiological responses to new stimuli&#44; changes in P300 in groups with atypical development&#44; individual differences in this cognitive potential and neural substrates throughout childhood development&#46; The authors point out that changes in brain function have been associated with cognitive development&#44; using this potential to assess the performance of school-aged children&#44; and that&#44; with advancing age&#44; significant reductions in latency and increases in amplitude that persist are observed up to 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Studies have shown that BAEP in individuals with T1DM results in delays in absolute latencies and interpeak intervals&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7</span></a> These findings suggest that signal transduction in the auditory pathway may be slow&#44; suggesting the presence of early neural deficits characterized by delayed signal conduction from the brainstem to the midbrain&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The possible influence of DM on cognitive function has also been investigated by different researchers&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> who observed prolonged latencies and reduced amplitudes in the P300 in individuals with T1DM in different age demonstrates the importance of this hormone for neurotransmitter functioning&#44; synaptic plasticity&#44; and cognitive function&#59; therefore&#44; relative insulin&#93;&#91;deficiency must be considered during the neurological development of children with T1DM&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a> Despite clinical evidence&#44; few studies have investigated neural auditory deficits in school children with T1DM&#46; The prevalence and severity of possible hearing disorders are not yet well established&#44; and further studies are needed&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The investigation of neural integrity in children and adolescents with T1DM can provide subsidies for the detection of functional auditory deficits&#44; including subclinical deficits&#44; allowing the early diagnosis of hearing loss and elaboration of protocols and monitoring of the cochleo-neural auditory function to avoid or minimize the disturbances caused by auditory and cognitive alterations in the development of this population&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore&#44; this study aimed to investigate the effects of T1DM on BAEP responses and P300 and the incidence of cognitive complaints in school-age children and adolescents&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 101 children and adolescents participated in this study&#44; 50 with T1DM&#44; 25 of whom were male&#44; aged between 7 and 18 years&#44; with a mean age of 11&#46;7 &#40;&#177;3&#46;0&#41; years&#44; accompanied by a public reference service&#46; In addition&#44; 51 volunteers&#44; apparently healthy&#44; 28 males&#44; aged between 8 and 18 years&#44; with a mean age of 11&#46;3 &#40;&#177;2&#46;7&#41; years&#44; were recruited from the Speech Therapy Teaching Clinic at the Universidade do Estado da Bahia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All participants underwent a structured interview prepared by the researchers&#44; containing closed questions about hearing health&#44; clinical and behavioral aspects&#46; Adolescents and the parents of the evaluated children answered the questionnaire&#46; Participants were included if they had a diagnosis of DM1&#46; Participants in the comparison group did not have T1DM&#46; Individuals with other types of diabetes&#44; neurological and psychiatric diseases&#44; risk of hearing problems such as use or previous use of ototoxic drugs and history of hereditary hearing loss were excluded from both groups&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Information regarding the clinical metabolic profile of participants with T1DM&#44; such as disease duration and age at diagnosis&#44; was acquired through secondary data obtained from medical records&#46; Metabolic control of participants with T1DM was classified according to the guidelines proposed by the American Diabetes Association&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> All participants included in this study had unaltered otoscopy&#44; normal hearing thresholds &#40;HTL&#41; &#8804;20 dB&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> obtained by researching hearing thresholds using pure tone audiometry&#44; with frequencies from 0&#46;25 to 8<span class="elsevierStyleHsp" style=""></span>kHz&#44; and analyzed using the audiometer AD229e &#40;Interacoustic&#174;&#44; Middlefart&#44; Denmark&#41;&#44; with TDH-39 supra-aural headphones &#40;TDH-39 Thelephonics&#174;&#41;&#46; New York&#44; NY&#44; USA&#41;&#46; Middle ear integrity was defined by the presence of &#8220;type A&#8221; tympanometric curves&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Hearing assessment</span><p id="par0060" class="elsevierStylePara elsevierViewall">To investigate the electrophysiological threshold of hearing&#44; the participants were subjected to a BAEP test to analyze the potentials generated in the auditory nerve &#40;wave I&#41; to the brainstem &#40;waves III and V&#41; and the P300 for evaluation of the cerebral cortex&#46; These potentials were evaluated using Contronic Masble ATC Plus 3AABR equipment &#40;Pelotas&#44; Brazil&#41;&#46; To investigate this auditory evoked potential&#44; after cleaning the skin with electrolytic paste&#44; four electrodes were placed on the participant&#8217;s head&#58; one active electrode &#40;Fz&#41;&#44; one neutral electrode &#40;Fpz&#41;&#44; and two reference electrodes &#40;M1&#47;M2&#41;&#46; Electrode impedance was considered adequate when it was below 5 k&#937;&#46; The stimulus used was a monaural click at an intensity of 80<span class="elsevierStyleHsp" style=""></span>dBHL&#44; with a presentation speed of 17&#46;2 c&#47;s&#44; alternating polarity&#44; and 2000 scans&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the investigation of cognitive function&#44; the bioelectrical responses of the P300 were analyzed&#44; and the electrodes were positioned as follows&#58; active &#40;Cz&#41;&#44; ground &#40;Fpz&#41;&#44; and reference electrodes &#40;M1 &#47;M2&#41;&#46; The stimuli were presented in the form of a single paradigm&#44; with an intensity of 80<span class="elsevierStyleHsp" style=""></span>dB HL&#44; a frequency of 2 KHz used as a rare stimulus&#44; and 1 KHz as a frequent stimulus&#44; with 80&#37; of frequent stimuli and 20&#37; of rare stimuli&#46; The signal was presented to both ears simultaneously&#44; with a stimulus plateau of 20<span class="elsevierStyleHsp" style=""></span>ms and an ascending fall of 5<span class="elsevierStyleHsp" style=""></span>ms&#44; alternating polarity&#44; inter-stimulus interval of 0&#46;8<span class="elsevierStyleHsp" style=""></span>ms&#44; filter from 1 to 20<span class="elsevierStyleHsp" style=""></span>Hz&#44; and window of 1000<span class="elsevierStyleHsp" style=""></span>ms&#46; The P300 wave was considered as the highest peak of positive polarity after the N1-P2-N2 complex and was presented as the sum of rare stimuli&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical aspects</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study was approved by the Research Ethics Committee of the Federal University of Bahia &#40;UFBA&#41; &#40;opinion no&#46; 946&#44; 282&#41;&#46; All participants were volunteers in the research&#44; agreeing to sign the Free and Clarified Consent Term or the Free and Clarified Term of Assent when necessary&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">SPSS version 22&#46;0 for Windows &#40;Chicago&#44; IL&#44; USA&#41; was used for statistical analysis of the results&#46; The normality of BAEP and P300 responses was assessed using the Kolmogorov-Smirnov test&#46; To compare the latency parameters of BAEP and P300 between the groups&#44; Student&#8217;s T or Mann-Whitney <span class="elsevierStyleItalic">U</span> test was used&#46; Quantitative variables were organized using measures of central tendency and dispersion&#44; as well as minimum and maximum values &#8203;&#8203;and simple and relative frequency&#46; Correlations between BAEP variables and metabolic control were analyzed using the Kruskal&#8211;Wallis test&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Clinical features and cognitive complaints</span><p id="par0080" class="elsevierStylePara elsevierViewall">Data from 50 children and adolescents with T1DM and 51 healthy participants were analyzed&#46; There were no significant differences in terms of age between the groups evaluated&#46; The mean ages of participants were 11&#46;7 &#40;&#177;3&#46;0&#41; and 11&#46;2 &#40;&#177;2&#46;9&#41;&#46; In the T1DM group and group without disease&#44; respectively&#46; There were no differences between the participants in terms of gender and education&#46; However&#44; significant differences were observed in relation to cognitive complaints of memory &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and attention &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41;&#44; with a higher prevalence of symptoms in participants with T1DM than in those without the disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Metabolic characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">The estimated mean blood glucose values &#8203;&#8203;for participants with T1DM were 253&#46;19 &#40;&#177;70&#46;9&#41; mg&#47;dL and 79&#46;0 &#40;&#177;8&#46;8&#41; mg&#47;dL for the apparently healthy group&#46; Regarding the metabolic profile of participants with T1DM&#44; the mean age at diagnosis was 8&#46;6 &#40;&#177;2&#46;8&#41; years&#44; with 50&#37; of the sample having the disease diagnosed between 5 and 10 years&#46; The mean duration of T1DM was 4&#46;3 &#40;&#177;2&#46;5&#41; years&#44; and 60&#37; of the participants had the disease for at least 5 years&#46; The mean value of glycated hemoglobin &#40;HbA1c&#41; was 10&#46;0&#37; &#40;&#177;2&#46;4&#41;&#44; and 50&#37; of children and adolescents had poor metabolic control &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Hearing assessment</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Auditory evoked potentials</span><p id="par0090" class="elsevierStylePara elsevierViewall">There were differences in BAEP values between the groups with T1DM and the group without disease in both ears&#46; Mean latencies were significantly higher in participants with diabetes when compared to apparently healthy children &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Significant differences were found concerning the metabolic control of participants with T1DM and wave III latencies in the left ear &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and in wave V in the right &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41; and left ears &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The associations between BAEP latencies and metabolic variables&#44; age at diagnosis&#44; and disease duration in participants with T1DM were analyzed&#44; and no relationship was found&#46; There was also no significant relationship between BAEP and P300 findings and memory or attention complaints&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study&#44; the mean P300 latency values &#8203;&#8203;were similar between the groups with T1DM &#40;323&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;1&#41; and in those without the disease &#40;321&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88&#46;2&#41;&#44; with no significant differences between them &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;459&#41;&#46;</p></span></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Our results showed significant differences in the presence of complaints related to attention and memory difficulties in the T1DM group compared with healthy participants&#46; In addition&#44; a recent study concluded that T1DM is associated with auditory disorders that affect activities of daily living and that non-hearing deficits&#44; such as cognitive alterations&#44; can also contribute to the worsening of the performance of activities&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Evidence has shown that T1DM can affect cognitive functions early since the brain of a developing child is more susceptible to metabolic instability due to the greater need for glucose to aid in neuronal growth and differentiation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Moreover&#44; regarding individuals with T1DM&#44; in addition to the damage related to hyperglycemia&#44; glycemic instability resulting from the regular use of insulin can contribute to neural hearing deficits and decreased attentional activities in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; the mean BAEP latency values &#8203;&#8203;showed significant differences between waves III and V in the evaluated participants and were higher in individuals with the disease than in apparently healthy individuals&#46; However&#44; these differences between the means do not characterize clinical alterations&#59; therefore&#44; it is not possible to affirm that our findings represent a retrocochlear auditory alteration&#46; However&#44; these higher latencies may suggest a delay in neural transmission&#44; which may indicate the appearance of subclinical changes in the afferent pathway&#44; specifically in the brainstem structures&#46; These findings can be interpreted as signs of neural dysfunction in children and adolescents with T1DM&#44; whose auditory nerves and different brainstem sites may present central auditory alterations&#46; These data allowed us to hypothesize that the prolongation of BAEP latencies may&#44; with the duration of the disease and frequent glycemic alterations&#44; evolve into a retrocochlear clinical finding&#46; These results are in agreement with another study that found subclinical hearing alterations in pediatric patients with a shorter duration of diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Some studies have associated the reduction in nerve conduction efficiency with demyelination of the auditory nerve and metabolic alterations in diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Others consider changes in BAEP latencies to be an early indication of diabetic neuropathy&#44; which may be a risk factor for the development of auditory neuropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The explanation for this hypothesis is that auditory dysfunction appears earlier than changes in peripheral nerves owing to differences in the diameter of the nerve fibers&#46; These differences would justify the theory that auditory symptoms precede peripheral symptoms&#44; as these larger nerves take longer to present alterations&#44; leading to the appearance of peripheral neuropathy later&#44; after auditory neuropathy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In the present study&#44; a significant relationship was found between metabolic control and latencies of waves III and V&#44; confirming their involvement at the brainstem level&#46; It was also observed that the increase in absolute latencies was proportional to worsening glycemic control&#46; These findings imply that diabetes can be harmful to the brain&#44; even in the early stages of the disease&#44; probably because the pediatric population with T1DM has not yet acquired the &#8220;protective effect&#8221; of insulin due to the short treatment time&#46; This confirms the hypothesis that poor metabolic control&#44; found in half of the participants with diabetes in this study&#44; maybe the main cause of neural hearing alterations&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Research has also shown that the use of insulin provides a &#8220;protective effect&#8221; against the harmful metabolic changes and complications of T1DM in the auditory system&#46; Experimental studies have suggested that this possible &#34;protection&#34; occurs due to the use of subcutaneous insulin&#44; which decreases the expression of key antigens in B cells&#44; defending them from destruction by the immune system&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In the analysis of P300&#44; no significant difference was observed between the groups with and without T1DM&#46; These results may be associated with the short duration of illness &#40;&#60;5 years&#41; presented by more than 60&#37; of children and adolescents with the disease&#46; A recent study has demonstrated that poor metabolic control may increase the risk of cognitive impairment in children with T1DM&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Several investigators have shown significantly increased P300 latencies in participants with T1DM who have had longer disease duration and an association of poor glycemic control with increased latencies and reduced amplitudes&#44; suggesting dysfunction of the central auditory system&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;23&#44;24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Although we did not find statistical significance in the P300 complex in the extra-group analysis&#44; self-reported cognitive complaints related to memory and attention difficulties were significantly higher in participants with T1DM than in healthy participants&#46; Thus&#44; we hypothesize that this cognitive potential may not have adequate sensitivity to detect subtle&#44; yet subclinical&#44; changes in the central nervous system&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The literature shows that the mechanisms underlying cognitive deficits are complex and multifactorial and can be explained by the direct effects of altered glucose metabolism in the brain&#44; cardiovascular disease&#44; and microvascular dysfunction&#46; Neuroimaging studies in individuals with T1DM have shown that the brain areas responsible for cognitive skills related to memory and attention show a considerable reduction in gray matter mass&#44; with the left hemisphere being the most affected&#46; These cortical regions are responsible for processing&#44; memory&#44; and attention&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Participants with DM1 were invited to participate in annual auditory monitoring and were instructed on the importance of maintaining adequate metabolic control to prevent the appearance and&#47;or development of alterations in the auditory pathway&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A limitation of this study was that specific protocols were not used for neuropsychological assessments related to cognitive functions of memory and attention to validate self-reported cognitive complaints&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Children and adolescents with T1DM may have early&#44; albeit subclinical&#44; hearing dysfunction that can affect the retrocochlear structures&#44; possibly due to poor metabolic control&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">No funding&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests regarding research authorship and&#47;or publishing of this article&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evidence has shown a cause-and-effect relationship between type 1 diabetes mellitus and auditory and cognitive dysfunctions&#46; This study aimed to investigate the effect of type 1 diabetes mellitus &#40;T1DM&#41; on central auditory and cognitive functions in school-age children and adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The study sample consisted of 101 children and adolescents&#44; 50 with T1DM&#44; of both sexes&#44; aged between 7 and 18 years&#46; All participants were selected for a structured interview on hearing&#44; behavioral&#44; and cognitive health and assessment of brainstem auditory evoked potentials &#40;BAEP&#41; and event-related potentials &#40;P300&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Significant differences were observed in memory &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and attention &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; complaints between participants with and without T1DM&#46; In the BAEP responses&#44; there were differences between wave III latencies in the right &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; and left &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#41; ears and in wave V latencies in the left ear &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; between the evaluated groups&#46; In addition&#44; there was an association between BAEP findings and metabolic control in the T1DM group in the left ear in waves III &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and V &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; and in the right ear in wave V &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; No differences were observed in the latencies of P300 between the evaluated groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">This study demonstrated the existence of a subclinical finding in the central auditory pathway&#44; offering an increased risk for retrocollear alterations&#44; which may be a consequence of poor metabolic control&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Justificaci&#243;n y objetivos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La evidencia ha demostrado una relaci&#243;n de causa y efecto entre la diabetes mellitus tipo 1 y las disfunciones auditivas y cognitivas&#46; Este estudio tuvo como objetivo investigar el efecto de la diabetes mellitus tipo 1 &#40;DM1&#41; en las funciones cognitivas y auditivas centrales en ni&#241;os y adolescentes en edad escolar&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La muestra del estudio estuvo constituida por 101 ni&#241;os y adolescentes&#44; 50 con DM1&#44; de ambos sexos&#44; con edades entre 7 y 18 a&#241;os&#46; Todos los participantes fueron seleccionados para una entrevista estructurada sobre la salud auditiva&#44; conductual y cognitiva y la evaluaci&#243;n de los potenciales evocados auditivos del tronco encef&#225;lico &#40;BAEP&#41; y los potenciales relacionados con eventos &#40;P300&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se observaron diferencias significativas en quejas de memoria &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; y atenci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41; entre participantes con y sin DM1&#46; En las respuestas BAEP&#44; hubo diferencias entre las latencias de la onda III en el o&#237;do derecho &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; e izquierdo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; y en las latencias de la onda V en el o&#237;do izquierdo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; entre los grupos evaluados&#46; Adem&#225;s&#44; hubo asociaci&#243;n entre los hallazgos de PEATC y el control metab&#243;lico en el grupo de DM1 en el o&#237;do izquierdo en las ondas III &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; y V &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y en el o&#237;do derecho en la onda V &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#46; No se observaron diferencias en las latencias de P300 entre los grupos evaluados&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Este estudio demostr&#243; la existencia de un hallazgo subcl&#237;nico en la v&#237;a auditiva central&#44; ofreciendo un mayor riesgo de alteraciones retrocollar&#44; lo que puede ser consecuencia de un mal control metab&#243;lico&#46;</p></span>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">1&#46; Identification&#58;</span></p> <p id="par0185" class="elsevierStylePara elsevierViewall">1&#46;1&#46;Name&#58; &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;</p> <p id="par0190" class="elsevierStylePara elsevierViewall">1&#46;2&#46; Age&#58; &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95; DN&#58; &#95;&#95;&#95;&#47;&#95;&#95;&#95;&#95;&#47;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;</p> <p id="par0195" class="elsevierStylePara elsevierViewall">1&#46;3&#46; Gender&#58; &#40;&#41; M &#40;&#41; F</p> <p id="par0200" class="elsevierStylePara elsevierViewall">1&#46;4&#46; Schooling&#58; &#40;&#41; kindergarten &#40;&#41; Elementary School I</p> <p id="par0205" class="elsevierStylePara elsevierViewall">&#40;&#41; Elementary School II &#40;&#41; High school</p> <p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">2&#46; Auditory aspects&#58;</span></p> <p id="par0215" class="elsevierStylePara elsevierViewall">2&#46;1&#46; Do you think the child or teenager listens well&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0220" class="elsevierStylePara elsevierViewall">2&#46;2&#46; Have you had multiple episodes of ear infection&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0225" class="elsevierStylePara elsevierViewall">2&#46;3&#46; Had diseases such as&#58; &#40;&#41; rubella &#40;&#41; mumps &#40;&#41; measles &#40;&#41; meningitis &#40;&#41; chicken pox</p> <p id="par0230" class="elsevierStylePara elsevierViewall">2&#46;4&#46; Do you feel aural fullness&#63; &#40;&#41; no &#40;&#41; yes &#40;&#41; right ear &#40;&#41; left ear</p> <p id="par0235" class="elsevierStylePara elsevierViewall">2&#46;5&#46; Does it feature autophony&#63; &#40;&#41; no &#40;&#41; yes &#40;&#41; right ear &#40;&#41; left ear</p> <p id="par0240" class="elsevierStylePara elsevierViewall">2&#46;6&#46; Does it have tinnitus&#63; &#40;&#41; no &#40;&#41; yes &#40;&#41; right ear &#40;&#41; left ear &#40;&#41; low pitch &#40;&#41; high pitch</p> <p id="par0245" class="elsevierStylePara elsevierViewall">2&#46;7&#46; Are you uncomfortable with loud sounds&#63; &#40;&#41; yes &#40;&#41; no &#40;&#41; right ear &#40;&#41; left ear</p> <p id="par0250" class="elsevierStylePara elsevierViewall">2&#46;8&#46; Do you feel dizzy&#63; &#40;&#41; yes &#40;&#41; no &#40;&#41; Rotary &#40;&#41; objective &#40;objects rotate around&#41; &#40;&#41; subjective &#40;the patient feels himself turning in relation to the environment&#41; &#40;&#41; imbalance &#40;&#41; fluctuation &#40;&#41; darkening of sight &#40;&#41; others</p> <p id="par0255" class="elsevierStylePara elsevierViewall">2&#46;9&#46; Do you have pain in the cervical region&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0260" class="elsevierStylePara elsevierViewall">2&#46;10&#46; Do you have a habit of using headphones&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">3&#46; Auditory processing</span></p> <p id="par0270" class="elsevierStylePara elsevierViewall">3&#46;1 Do you have difficulty understanding speech&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0275" class="elsevierStylePara elsevierViewall">3&#46;2&#46; Do you have difficulty understanding speech in noise&#63; &#40;&#41; Yes &#40;&#41; no</p> <p id="par0280" class="elsevierStylePara elsevierViewall">3&#46;3&#46; Difficulties understanding television&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0285" class="elsevierStylePara elsevierViewall">3&#46;4&#46; Understands people well&#46; &#40;&#41; yes &#40;&#41; no</p> <p id="par0290" class="elsevierStylePara elsevierViewall">3&#46;5&#46; Difficulty talking on the phone&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0295" class="elsevierStylePara elsevierViewall">3&#46;6&#46; Having trouble locating the sound&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0300" class="elsevierStylePara elsevierViewall">3&#46;7&#46; Are you distracted in a noisy environment&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">4&#46; Behavioral aspects</span></p> <p id="par0310" class="elsevierStylePara elsevierViewall">4&#46;1&#46; Is it hectic&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0315" class="elsevierStylePara elsevierViewall">4&#46;2&#46; Are you hyperactive&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0320" class="elsevierStylePara elsevierViewall">4&#46;3 Is it quiet&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0325" class="elsevierStylePara elsevierViewall">4&#46;4&#46; Is shy&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0330" class="elsevierStylePara elsevierViewall">4&#46;5&#46; Do you tend to isolate yourself&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0335" class="elsevierStylePara elsevierViewall">4&#46;6&#46; Do you have memory difficulties&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0340" class="elsevierStylePara elsevierViewall">4&#46;7&#46; Do you have trouble staying alert&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0345" class="elsevierStylePara elsevierViewall">4&#46;8&#46; Are you easily angered&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">5&#46; Clinical and laboratory data</span></p> <p id="par0355" class="elsevierStylePara elsevierViewall">5&#46;1&#46; Glycemic rate&#58; &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95; Test &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;date&#58;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;</p> <p id="par0360" class="elsevierStylePara elsevierViewall">5&#46;2&#46; Practice exercises&#63; &#40;&#41; yes &#40;&#41; no</p> <p id="par0365" class="elsevierStylePara elsevierViewall">5&#46;3&#46; Value of Glycated Hemoglobin&#58;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;Date&#58;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;Method&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;</p> <p id="par0370" class="elsevierStylePara elsevierViewall">5&#46;4&#46; Age of patient at diagnosis of diabetes mellithus &#40;DM&#41;&#58;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;</p> <p id="par0375" class="elsevierStylePara elsevierViewall">5&#46;5&#46; Duration of illness&#58; &#40;&#41; 0 to 5 years &#40;&#41; 5 to 10 years &#40;&#41; 10 to 15 years</p>"
            "titulo" => "Audiological interview"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Data represented the level of education divided into&#58; ES- elementary School and HS-high school&#44; &#42;values were statistically significant at the level of &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#46;05&#41;&#46;</p>"
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                  \t\t\t\t" scope="col">Characterization&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">T1DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&#40;54&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&#40;45&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Schooling&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="middle">0&#46;143</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ES&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#40;75&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">02&#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">08&#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#40;56&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#40;44&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">08&#40;15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Difficulties of attention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">0&#46;021&#42;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#40;19&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#40;80&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3332392.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of absolute and relative frequencies of socio-educational aspects and cognitive complaints by sex between T1DM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; and healthy controls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0180"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Data are represented as mean &#40;SD&#41; for subjects with T1DM&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Metabolic characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#8211; diagnosis of the disease &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="middle">8&#46;6&#40;&#177;2&#46;8&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8722;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duration of illness &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="middle">4&#46;3&#40;&#177;2&#46;7&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#40;64&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8722;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#40;26&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">05&#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metabolic control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="middle">10&#46;0&#40;&#177;2&#46;5&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">08&#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#40;34&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3332390.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Metabolic characteristics of the T1DM group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0185"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Data are represented as mean &#40;SD&#41; for n subjects&#46; &#42; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 indicated statistical signi&#64257;cance using the independent samples <span class="elsevierStyleItalic">t</span>-test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Ears&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Waves&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">T1DM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Healthy control &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="6" align="left" valign="middle">Right</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;40&#40;0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38&#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;492&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;58&#40;0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;48&#40;0&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;017&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;42&#40;0&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;22&#40;0&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I-III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;14&#40;0&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;14&#40;0&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;86&#40;0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;87&#40;0&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;840&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;01&#40;0&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;02&#40;0&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;874&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="6" align="left" valign="middle">Left</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;37&#40;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;35&#40;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;55&#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;46&#40;0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;019&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;43&#40;0&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;27&#40;0&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I-III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;15&#40;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;12&#40;0&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;92&#40;0&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;86&#40;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;04&#40;0&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;98&#40;0&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Absolute latencies and interpeak latencies obtained with auditory brainstem response&#44; for the two ears&#44; in the different groups&#46;</p>"
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        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Data represented as mean &#40;SD&#41;&#47;&#42; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#47;using the Kruskal Wallis test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Ears</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Metabolic control</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">III</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="middle">Right</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;51&#40;0&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">0&#46;372</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;34&#40;0&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">0&#46;026&#42;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;54&#40;0&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;47&#40;0&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;60&#40;0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;52&#40;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="middle">Left</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;48&#40;0&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 00016519
Original language: English

DOI:10.1016/j.otorri.2023.04.002

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