Sudden total bilateral deafness due to asymptomatic mumps infection

A review of bilateral sudden sensorineural hearing loss in pediatric patients

OBJECTIVE

Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition.

METHODS

PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected.

RESULTS

Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n = 3), meningitis (n = 13), mumps (n = 5), ototoxin exposure (n = 13), and enlarged vestibular aqueduct (n = 9). Tinnitus (n = 30) was the most reported concurrent symptom, followed by vertigo (n = 21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing.

CONCLUSIONS

This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.

Pediatric Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied.

A mumps model with seasonality in China

BACKGROUND

Mumps, an infectious viral disease, classically manifested by inflammation of salivary glands and is best known as a common childhood viral disease with no specific treatment. Although it can be protected by vaccine, there are more than 100,000 reported mumps cases according to the Chinese Center for Disease Control and Prevention. However, the factors and mechanisms behind the persistence and prevalence of mumps have not been well understood.

METHODS

A mumps model with seasonal fluctuation is formulated and investigated. We evaluate the basic reproduction number ℛ0 and analyze the dynamical behavior of the model. We also use the model to simulate the monthly data of mumps cases and carry out some sensitivity analysis of ℛ0 in terms of various model parameters.

RESULTS

It is shown that there exists only disease-free solution which is globally asymptotically stable if ℛ0 < 1, and there exists a positive periodic solution if ℛ0 > 1. ℛ0 is a threshold parameter, and its magnitude determines the extinction or persistence of the disease.

CONCLUSION

Our analysis shows that vaccination rate and invalid vaccination rate play important roles in the spread of mumps. Hence, Our study suggests to increase the vaccine coverage and make two doses of MMR (Measles, mumps and rubella vaccine) vaccine freely available in China.

Preserved Otoacoustic Emissions in Postparotitis Profound Unilateral Hearing Loss: A Case Report

We report a case of a profound unilateral sensorineural hearing loss following epidemic parotitis, with good response of otoacoustic emissions. The patient was a 12-year-old girl who had developed a unilateral hearing impairment 2 weeks after the onset of mumps. Pure tone audiometry confirmed a profound left sensorineural hearing loss. The affected ear showed an absence of auditory brain stem responses, whereas transient evoked otoacoustic emissions and distortion product otoacoustic emissions were preserved. Epidemic parotitis virus is likely responsible for an impairment of inner hair cells, primary afferent fibers or their synapses, or a combination of these areas, and it does not seem to have a specific tropism for cochlear outer hair cells. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.

Molecular biology, pathogenesis and pathology of mumps virus

Mumps is caused by the mumps virus (MuV), a member of the Paramyxoviridae family of enveloped, non-segmented, negative-sense RNA viruses. Mumps is characterized by painful inflammatory symptoms, such as parotitis and orchitis. The virus is highly neurotropic, with laboratory evidence of central nervous system (CNS) infection in approximately half of cases. Symptomatic CNS infection occurs less frequently; nonetheless, prior to the introduction of routine vaccination, MuV was a leading cause of aseptic meningitis and viral encephalitis in many developed countries. Despite being one of the oldest recognized diseases, with a worldwide distribution, surprisingly little attention has been given to its study. Cases of aseptic meningitis associated with some vaccine strains and a global resurgence of cases, including in highly vaccinated populations, has renewed interest in the virus, particularly in its pathogenesis and the need for development of clinically relevant models of disease. In this review we summarize the current state of knowledge on the virus, its pathogenesis and its clinical and pathological outcomes.

Bilateral sudden sensorineural hearing loss: review

Introduction:

Unilateral and bilateral sudden sensorineural hearing loss represent different disease entities. The unilateral condition is more common and predominantly idiopathic, and up to 65 per cent of patients spontaneously recover hearing. Conversely, the bilateral condition is rare, mostly associated with serious systemic conditions, and has a higher prevalence of morbidity and mortality.

Methods:

A literature search using the PubMed database was conducted using the MeSH terms ‘sudden’, ‘bilateral’ and ‘sensorineural hearing loss’.

Results:

One hundred and three reported cases of bilateral sudden sensorineural hearing loss were identified. The condition is most often associated with toxic, autoimmune, neoplastic and vascular conditions. A younger age of onset, with a bimodal age distribution, was seen for bilateral sudden sensorineural hearing loss, compared with the unilateral condition. Patients with the bilateral condition had more profound hearing loss, with poorer recovery and a 35 per cent mortality rate. Vestibular symptoms were also less common than in the unilateral condition.

Conclusion:

The presentation of bilateral sudden onset sensorineural hearing loss is a medical emergency requiring thorough and urgent investigation to exclude life-threatening and reversible conditions.

Mumps

Mumps is a common childhood infection caused by the mumps virus. The hallmark of infection is swelling of the parotid gland. Aseptic meningitis and encephalitis are common complications of mumps together with orchitis and oophoritis, which can arise in adult men and women, respectively; other complications include deafness and pancreatitis. Clinical diagnosis can be based on the classic parotid swelling; however, this feature is not present in all cases of mumps and can also occur in various other disorders. Laboratory diagnosis is based on isolation of virus, detection of viral nucleic acid, or serological confirmation (generally presence of IgM mumps antibodies). Mumps is vaccine-preventable, and one dose of mumps vaccine is about 80% effective against the disease. Routine vaccination has proven highly effective in reducing the incidence of mumps, and is presently used by most developed countries; however, there have been outbreaks of disease in vaccinated populations. In 2005, a large epidemic peaked in the UK, and in 2006 the American midwest had several outbreaks. In both countries, the largest proportion of cases was in young adults. In the UK, susceptible cohorts too old to have been vaccinated and too young to have been exposed to natural infections were the primary cause of the mumps epidemic. In the USA, effectiveness and uptake in combination appear not to have been sufficient to obtain herd immunity for mumps in populations such as college students.

Causation of permanent unilateral and mild bilateral hearing loss in children

Children with permanent unilateral or mild bilateral hearing loss have been a focus of concern by audiologists, educators, and physicians for at least 2 decades. These children are known to be at risk for psychoeducational difficulties. However, despite this concern, little has been learned about the causative factors of these hearing losses and how those factors might be contributing to child development. This review of known causes of permanent unilateral and mild bilateral hearing loss in children is meant to draw attention to the importance of the search for etiologic factors. That is, the identification of the hearing loss should not signal the end of the diagnostic process but, rather, the beginning of a search for causation. With the combined efforts of audiologists, otolaryngologists, pediatricians, geneticists, and other medical professionals, we may enhance our understanding of the primary causes of unilateral and mild bilateral hearing loss and, perhaps, create links between causative factors and psychosocial and psychoeducational outcomes.

3D-FLAIR magnetic resonance imaging in the evaluation of mumps deafness

A 6-year-old boy suffered acute profound right side deafness after his classmates had mumps. Although his salivary glands were not swollen, he had high levels of anti-mumps IgM and IgG antibodies. The three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) procedure applied to magnetic resonance imaging (MRI) showed high signals in the right cochlea and vestibule. This indicated hemorrhage or a high concentration of protein in the right inner ear. This is the first case demonstrating a high 3D-FLAIR MRI signal of the inner ear in a patient with mumps deafness. Our findings suggest that 3D-FLAIR MRI may help to identify and define labyrinthitis in mumps deafness.

Mumps-Induced Corneal Endotheliitis

OBJECTIVE

To report two cases of corneal endotheliitis following mumps parotitis.

METHODS

Observational case reports of two patients presenting with sudden unilateral diminution of vision while they were in the resolution phase of mumps parotitis.

RESULTS

Central corneal edema with no associated epithelial involvement or iridocyclitis was confirmed on slit-lamp biomicroscopy. Specular microscopy confirmed an increased corneal thickness with corneal endothelial abnormalities. The diagnosis of mumps virus infection was established through detection of IgM antibody in serum samples of the patients using enzyme-linked immunosorbent assay (ELISA). The routine investigations for other systemic diseases were negative.

CONCLUSIONS

Corneal endotheliitis as a sequela to mumps is a new reported association. Timely treatment with topical steroids led to resolution of the disease with full visual recovery without any residual symptoms or signs.

Nongenetic causes of hearing loss

Nongenetic as well as genetic etiologies must be explored in the child with identified hearing loss. Graduates of the neonatal intensive care unit are at increased risk for developing hearing loss due to hypoxia, hyperbilirubinemia, very low birth weight, and ototoxic medications. Although meningitis has decreased in frequency, it is still a risk factor for hearing loss. Cytomegalovirus remains the most common congenital infection and a relatively common etiology of hearing loss, which can be progressive. Preventable causes of hearing loss include those caused by head trauma, noise, and ototoxic medications. Identification of the etiology of hearing loss can facilitate the development of a treatment and management plan.

Mumps meningoencephalitis effect on hearing

Sensorineural hearing loss is an important complication of mumps. Audiologic tests of 26 children with mumps meningoencephalitis, 25 uncomplicated mumps cases and 20 control cases were performed, and hearing level thresholds at speech and high frequencies were determined. The mean hearing level thresholds in the mumps meningoencephalitis group were higher than those of mumps cases at frequencies from 6,000 to 18,000 Hz in the right ear and at 250 and from 4,000 to 18,000 Hz in the left ear (P < 0.05). Mumps meningoencephalitis cases had higher mean hearing thresholds than did control groups at all frequencies other than 125 and 250 Hz in the right ear and 10,000 Hz in the left ear. The mean hearing thresholds of mumps cases were higher than those of control group at frequencies of 1,000 and 4,000 Hz in the right ear and 1,000 and 10,000 Hz in the left ear (P < 0.05). These results show that mumps meningoencephalitis causes a higher risk of hearing loss than does mumps.

Prognostic factors of sudden hearing loss in children

OBJECTIVE

Sudden hearing loss in children under 15 years old is rare and its pathophysiology remains unclear. The aim of this retrospective study was to define prognostic factors of sudden hearing loss in children under 15 years old.

METHODS

Among the patients referred to our institution during the period 1990-1999 for sudden hearing loss, 12 children were considered eligible for this study (mean age=9.5 years old). Patients were divided into three groups according to hearing recovery and seven putative prognostic factors were analyzed.

RESULTS

Total hearing recovery (group I: 90-100%) occurred in 28.5% of cases, partial hearing recovery (group II: 11-89%) occurred in 28.5% of cases and absence of recovery (group III: 0-10%) was reported in 43% of cases. Factors such as age, sex, and bilaterality of hearing loss were not correlated with hearing recovery.

CONCLUSIONS

Initial severe hearing loss, associated vertigo and 'downward' audiometric curve were three negative prognostic factors of hearing recovery. Tinnitus has only been reported in children with partial or total hearing recovery.