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Corazzi V, Fordington S, Brown TH, Donnelly N, Bewick J, Ehsani D, Pelucchi S, Bianchini C, Ciorba A, Borsetto D. Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08527-x. [PMID: 38411671 DOI: 10.1007/s00405-024-08527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To review possible risk factors for permanent delayed-onset, progressive sensorineural hearing loss (SNHL) in the paediatric population to recommend follow-up protocols for early detection. METHODS PRISMA-compliant systematic review was performed, including observational studies on the paediatric population up to 16 years old who have passed the newborn hearing screening programme (NHSP), investigating the development of late-onset, progressive SNHL. Electronic searches were performed through Medline, Embase, Cochrane, and Emcare. RESULTS 37 studies were included. 21 showed an association between late-onset SNHL and congenital cytomegalovirus (cCMV) infection (age at hearing loss diagnosis 0.75 to 204 months, mean 45.6 ± 43.9), while 16 between late-onset SNHL and other congenital or perinatal factors, namely Neonatal Intensive Care Unit (NICU) stay, prematurity, neonatal respiratory failure, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, hypocapnia, hypoxia, alkalosis, seizure activity, congenital diaphragmatic hernia (CDH), inner ear malformation, and gene mutations (age at hearing loss diagnosis 2.5 to 156 months, mean 38.7 ± 40.7). CONCLUSIONS cCMV infection may cause late-onset SNHL, which can be missed on standard NHSP. There is, therefore, evidence to support universal screening programmes to enable detection in even asymptomatic neonates. Ongoing audiological follow-up for all children with cCMV is advisable, to enable timely treatment. In the paediatric population presenting conditions such as NICU stay > 5 days, prematurity ≤ 34 weeks gestation, severe neonatal respiratory failure, mechanical ventilation, ECMO support, and CDH surgery, an audiological follow-up from 3 months of age up to at least 3-4 years of age, and at least annually, should be recommended.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Surina Fordington
- Department of Paediatrics, Cambridge University Hospitals, Hills Road, Cambridge, UK
| | | | - Neil Donnelly
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jessica Bewick
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Diana Ehsani
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy.
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Hillam K, Suarez D, Nielson C, Traxler A, Sommer E, Winslow A, Holley A, Huang E, Hughes M, Firpo MA, Rower J, Park AH. Hearing Following Prolonged and Delayed Ganciclovir Treatment in a Murine Cytomegalovirus Model. Laryngoscope 2024; 134:433-438. [PMID: 37421238 DOI: 10.1002/lary.30860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Compare hearing outcomes utilizing standard, prolonged and delayed ganciclovir (GCV) therapy in a murine model of cytomegalovirus (CMV). METHODS BALB/c mice were inoculated with mouse cytomegalovirus (mCMV) or saline via intracerebral injection on postnatal day 3 (p3). Intraperitoneal GCV or saline was administered at 12 h intervals for the duration of the standard (p3-p17), delayed (p30-p44), or prolonged treatment windows (p3-p31). Auditory thresholds were assessed using distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) testing at 4, 6, and 8 weeks of age. Blood and tissue samples were harvested from mice on p17 and p37 one hour after GCV administration, and their concentrations were assessed via liquid chromatography-mass spectrometry. RESULTS A delayed course of GCV improved ABR but not DPOAE thresholds in mCMV-infected mice. A prolonged course of GCV did not provide better hearing thresholds than those administered standard treatment. The average GCV concentration in all 17-day-old mice tissue was significantly higher than those in older 37-day-old mice. CONCLUSION Delayed GCV treatment provided a hearing benefit on ABR over untreated mCMV infected mice. Prolonged CGV administration showed no benefit compared to a shorter duration GCV treatment. GCV drug concentrations both systemically and in the cochlea are much lower in older mice. These results have potential implications for the clinical management of cCMV infected children. LEVEL OF EVIDENCE NA Laryngoscope, 134:433-438, 2024.
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Affiliation(s)
- Katrina Hillam
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Daniel Suarez
- Department of Otolaryngology, State University of New York Downstate Medical Center, Stony Brook, New York, U.S.A
| | - Christopher Nielson
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Abigail Traxler
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Elizabeth Sommer
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Anna Winslow
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Anna Holley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Emily Huang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Maura Hughes
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Matthew A Firpo
- Department of Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Rower
- University of Utah Center for Human Toxicology and Department of Pharmacology and Toxicology, Salt Lake City, Utah, U.S.A
| | - Albert H Park
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Shi X, Liu X, Sun Y. The Pathogenesis of Cytomegalovirus and Other Viruses Associated with Hearing Loss: Recent Updates. Viruses 2023; 15:1385. [PMID: 37376684 DOI: 10.3390/v15061385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Virus infection is one of the most common etiologies of hearing loss. Hearing loss associated with viral infection can be unilateral or bilateral, mild or severe, sudden or progressive, and permanent or recoverable. Many viruses cause hearing loss in adults and children; however, the pathogenesis of hearing loss caused by viral infection is not fully understood. This review describes cytomegalovirus, the most common virus causing hearing loss, and other reported hearing loss-related viruses. We hope to provide a detailed description of pathogenic characteristics and research progress on pathology, hearing phenotypes, possible associated mechanisms, treatment, and prevention measures. This review aims to provide diagnostic and treatment assistance to clinical workers.
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Affiliation(s)
- Xinyu Shi
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaozhou Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Tapasak B, Cronkite DA, Hustedt-Mai AR, Morlet TM, Parkes WJ, Maul TM, Pritchett CV. Hearing outcomes in children with Congenital Cytomegalovirus: A multi-center, single-enterprise experience. Int J Pediatr Otorhinolaryngol 2022; 163:111376. [PMID: 36370539 DOI: 10.1016/j.ijporl.2022.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/29/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common cause of non-genetic sensorineural hearing loss (SNHL) in the United States; yet screening for congenital CMV (cCMV) remains controversial. CMV related SNHL can be present at birth, or develop in a delayed manner, and it is a consistent feature in children with either symptomatic or asymptomatic disease. A retrospective chart review was performed to determine the characteristics of patients diagnosed with cCMV and SNHL. METHODS The electronic database warehouse of the Nemours Children's Health System (NCHS) was queried from 01/01/2004 to 10/05/2019. ICD 9 (771.1) and ICD 10 (B25.9, P35.1) diagnostic codes were used to identify patients throughout the system with a diagnosis of cCMV infection. Patient demographics including gender, race/ethnicity, age of diagnosis, results of newborn hearing screening (NBHS), detection and progression of hearing loss, presence of antiviral therapy, and frequency of monitoring were collected, and descriptive statistics performed. RESULTS Of the 170 patients confirmed to have cCMV, 153 (90%) were symptomatic and 17 (10%) were asymptomatic. CNS involvement (63.5%), radiographic evidence of disease present (69.4%), and SNHL (50.6%) were the most common manifestations of the disease. Of these 170 patients, 83 (48.8%) were determined to have SNHL eligible for evaluation. For these patients with SNHL, the average time of hearing monitoring was 50.6 months. At the time of initial reported detection 63 of 83 (76%) had bilateral hearing loss and 20 (24%) had unilateral loss. Over the study period 3 (15%) progressed from unilateral to bilateral involvement, and 32 (47%) had a deterioration in hearing, with severe to profound SNHL in at least one ear identified at the last visit in 53 (64%) patients. Newborn hearing testing results were available for 69 (83%) of those with hearing loss and 26 patients passed initial testing. However, of the 26 patients who passed, 22 (85%) eventually developed SNHL by their last visit. Within our cohort, females with cCMV were significantly more likely to have SNHL than males with cCMV (62.3% versus 37.6%; p < 0.01). CONCLUSION In the absence of targeted or universal cCMV screening, the majority of children identified with this condition present symptomatically. Approximately one half of children with symptomatic cCMV failed NBHS at birth while at least 25% develop SNHL later in life. Children with cCMV are at high risk of delayed onset loss and such children, particularly females, should be monitored closely.
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Affiliation(s)
- Brandon Tapasak
- University of Central Florida College of Medicine, Orlando, FL, USA.
| | - David Alex Cronkite
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), Los Angeles, California, USA
| | - Alexandra R Hustedt-Mai
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - Thierry M Morlet
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - William J Parkes
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Timothy M Maul
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pediatric Otolaryngology, Nemours Children's Hospital, Orlando, FL, USA
| | - Cedric V Pritchett
- University of Central Florida College of Medicine, Orlando, FL, USA; Division of Pediatric Otolaryngology, Nemours Children's Hospital, Orlando, FL, USA
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Cushing SL, Purcell PL, Papaiaonnou V, Neghandi J, Daien M, Blaser SI, Ertl-Wagner B, Wagner M, Sheng M, James AL, Bitnun A, Papsin BC, Gordon KA. Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences. Laryngoscope 2022; 132 Suppl 11:S1-S24. [PMID: 35302239 DOI: 10.1002/lary.30108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. METHODS In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. RESULTS All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. CONCLUSIONS cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia L Purcell
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vicky Papaiaonnou
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Neghandi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maya Daien
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics (Infectious Diseases), University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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Keymeulen A, De Leenheer E, Casaer A, Cossey V, Herregods N, Laroche S, Mahieu L, Van Mol C, Vanhaesebrouck S, Walle CV, Smets K. Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection? Eur J Pediatr 2022; 181:911-920. [PMID: 34636957 DOI: 10.1007/s00431-021-04273-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Whether or not cranial ultrasound (crUS) and cerebral magnetic resonance imaging (MRI) have both a place in the assessment of children with congenital cytomegalovirus infection (cCMV) remains a topic of discussion between research groups. Literature suggests that MRI is indicated only in children with abnormal crUS.In Flanders, Belgium, combined crUS and MRI was performed on 639 children with cCMV, referred for diagnostic assessment. Cranial US was classified as abnormal in the presence of striatal vasculopathy, calcifications, cysts, cystic germinolysis, and/or ventriculomegaly. MRI findings were classified as abnormal in the presence of gyration disorders, cerebellar abnormalities, ventriculomegaly, cysts, or pathologic white matter lesions.One in five children (93/480) with normal crUS showed abnormal findings on MRI. Of them, 85 (91.4%) were classified as symptomatic. In 37 of those 93 children (39.8%), classification as severely symptomatic was made based on MRI lesions alone. MRI and crUS proved to be complementary in the assessment of CNS involvement in children with cCMV. Long-term studies are needed to evaluate the importance of this finding with respect to outcome and benefit of therapy in this particular subgroup of patients with cCMV infection.Conclusion: Our findings support an enhanced role of MRI in the diagnosis of CNS involvement in children with cCMV infection. The ideal assessment should include both imaging techniques, as the strengths of each test compensate for the other's weaknesses. What is Known: • Congenital CMV infection involves the central nervous system with direct injury to and possible disruption of brain development. • Experts suggest that MRI is indicated only in children with abnormal crUS. What is New: • In almost 20% of our children with a normal cranial ultrasound, abnormalities were detected on MRI. • Our results suggest that performing both MRI and cranial US is important to obtain a complete assessment of central nervous system involvement in children with cCMV.
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Affiliation(s)
- Annelies Keymeulen
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Els De Leenheer
- Ear-Nose-Throat Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alexandra Casaer
- Neonatology Department, AZ Sint Jan Bruges, Rudderhove 10, 8000, Bruges, Belgium
| | - Veerle Cossey
- Neonatology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Nele Herregods
- Radiology Department, Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sabine Laroche
- Neonatology Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Ludo Mahieu
- Neonatology Department, Antwerp University, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Christine Van Mol
- Neonatology Department, GZA Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Sophie Vanhaesebrouck
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Caroline Vande Walle
- Radiology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Koenraad Smets
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Tissera KA, Williams A, Perry J, Kawai K, Kenna M, Mankarious LA. Hearing Stability in Patients With Unilateral Hearing Loss Due to Congenital CMV. Otolaryngol Head Neck Surg 2022; 167:739-744. [PMID: 35133894 DOI: 10.1177/01945998221076439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence and severity of progressive hearing loss in both ears in a population of longitudinally-tracked patients with unilateral hearing loss due to congenital cytomegalovirus (cCMV). By determining the natural history of unilateral hearing loss due to cCMV infection, we aim to facilitate therapeutic recommendations. STUDY DESIGN Retrospective chart review. SETTING Two tertiary care hospitals. METHODS Pure-tone averages (PTAs) based on yearly audiograms were calculated for each patient for both ears, and changes were assessed using a linear mixed-effects model. RESULTS A total of 32 patients with cCMV with congenital, unilateral hearing loss were enrolled. Of these, 4 (12.5%) had progressive losses ≥10 dB by PTA in the initially normal-hearing ear. For the hearing-impaired side, the mean (SD) PTA at initial presentation was 67.9 (29.2) dB. Eight patients initially in this cohort had profound hearing impairment, and of the other 24 patients, 17 (70.8%) had hearing loss progression. Hearing levels stabilized in the initially normal-hearing and hearing-impaired ear when patients were approximately 10 and 2 years old, respectively. CONCLUSION In 32 patients with unilateral hearing loss related to cCMV, 4 (12.5%) exhibited a shift in hearing levels in the normal-hearing ear that progressively stabilized by age 10 years. For ears with congenital hearing loss, progressive stabilization of hearing occurred by age 2 years.
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Affiliation(s)
- Kristin A Tissera
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alisha Williams
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Julia Perry
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Leila A Mankarious
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Auditory neuropathy spectrum disorder (ANSD) is a specific auditory disorder caused by dysfunction of periphery part of the auditory system, in which the function of the outer hair cells is preserved, but the afferent input at the cochlear level suffers due to the pathology of the inner hair cells, neurons of the spiral ganglion and/or the auditory nerve, as well as synaptic contact between them. As a result, a specific condition is formed, in which a patient's otoacoustic emissions and/or cochlear microphonics are present, auditory brainstem responses are abnormal or absent, the discrepancy between the hearing level and the electrophysiological data, poor speech perception which may not correlate with the hearing thresholds. ANSD is a multifactorial disease. One of the main risk factors is perinatal pathology and, in particular, prematurity. The possible factors associated with prematurity that provoke the onset of the disease, features of the pathogenesis, clinical and audiological peculiarities of ANSD in premature infants, contemporary approaches to the habilitation of such patients are discussed in the article. The necessity of an individual, patient-oriented approach to the treatment of premature infants with ANSD is substantiated; such an approach should be based both on the genesis of the disorder, taking into account possible points of lesion in the auditory system, and the developmental peculiarities of a premature baby considering the presence of concomitant diseases associated with prematurity. In the article attention is focused on the main directions of habilitation work with such children, including a multidisciplinary approach, regular careful monitoring of the auditory, speech and language skills, intensive psychological and speech therapist support, the choice of an adequate way of intervention and its improvement as necessary.
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Affiliation(s)
- I V Savenko
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - E S Garbaruk
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - M Yu Boboshko
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
- Mechnikov North-West State Medical University, St. Petersburg, Russia
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9
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Otsuka KS, Nielson C, Firpo MA, Park AH, Beaudin AE. Early Life Inflammation and the Developing Hematopoietic and Immune Systems: The Cochlea as a Sensitive Indicator of Disruption. Cells 2021; 10:cells10123596. [PMID: 34944105 PMCID: PMC8700005 DOI: 10.3390/cells10123596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
Emerging evidence indicates that perinatal infection and inflammation can influence the developing immune system and may ultimately affect long-term health and disease outcomes in offspring by perturbing tissue and immune homeostasis. We posit that perinatal inflammation influences immune outcomes in offspring by perturbing (1) the development and function of fetal-derived immune cells that regulate tissue development and homeostasis, and (2) the establishment and function of developing hematopoietic stem cells (HSCs) that continually generate immune cells across the lifespan. To disentangle the complexities of these interlinked systems, we propose the cochlea as an ideal model tissue to investigate how perinatal infection affects immune, tissue, and stem cell development. The cochlea contains complex tissue architecture and a rich immune milieu that is established during early life. A wide range of congenital infections cause cochlea dysfunction and sensorineural hearing loss (SNHL), likely attributable to early life inflammation. Furthermore, we show that both immune cells and bone marrow hematopoietic progenitors can be simultaneously analyzed within neonatal cochlear samples. Future work investigating the pathogenesis of SNHL in the context of congenital infection will therefore provide critical information on how perinatal inflammation drives disease susceptibility in offspring.
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Affiliation(s)
- Kelly S. Otsuka
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA;
| | - Christopher Nielson
- Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (C.N.); (A.H.P.)
| | - Matthew A. Firpo
- Department of Surgery, University of Utah, Salt Lake City, UT 84112, USA;
| | - Albert H. Park
- Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (C.N.); (A.H.P.)
| | - Anna E. Beaudin
- Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
- Correspondence:
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Shi K, Purser JS, Germiller JA, Rampton JW, Firpo MA, Park AH. Gadolinium-based contrast agent for Magnetic Resonance Imaging as a predictor of postmeningitic hearing loss in children. Int J Pediatr Otorhinolaryngol 2021; 150:110936. [PMID: 34700237 DOI: 10.1016/j.ijporl.2021.110936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/14/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if Gadolinium-based enhanced Magnetic Resonance Imaging (GdMRI) can be used to predict sensorineural hearing loss (SNHL) in pediatric patients diagnosed with bacterial meningitis. STUDY Design: Retrospective chart review. SETTING Primary Children's Hospital, Salt Lake City, Utah. SUBJECTS and Methods: We studied forty-two pediatric patients diagnosed with bacterial meningitis who underwent brain GdMRI during their index hospital admission and for whom ear specific audiometric data were available (August 2008-July 2018). A pediatric neuroradiologist, blinded to both disease and audiometric data, rated cochlear enhancement of each GdMRI (0-3; none to markedly enhanced). RESULTS Ear specific MRI scores were statistically significantly related to ear specific hearing outcomes (p < 0.01). SNHL occurred in 19 out of 82 ears (12 out of 42 patients; 2 ears were excluded due to pre-existing SNHL in one ear and inability to read the GdMRI on the other ear). Ten of 19 ears (53%) that developed SNHL showed mild/moderate/marked enhancement (MRI score of 1, 2, or 3 respectively). Fifty-three of the 63 unaffected ears (84%) showed no enhancement (MRI score of 0). Ten of 13 (77%) ears that developed severe to profound SNHL showed mild/moderate/marked enhancement. GdMRI was 58% sensitive and 84% specific in predicting which ears would develop SNHL. GdMRI was 77% sensitive and 84% specific in identifying severe to profound SNHL. CONCLUSION Our study demonstrates that GdMRI is a promising tool for predicting specifically severe-profound hearing loss in pediatric patients following bacterial meningitis infection.
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Affiliation(s)
- Kevin Shi
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy S Purser
- Texas A&M University Health and Science Center, Bryan, TX, USA
| | - John A Germiller
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - John W Rampton
- Pediatric Radiology, Intermountain Medical Group, Salt Lake City, UT, USA
| | - Matthew A Firpo
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Albert H Park
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
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Lanzieri TM, Caviness AC, Blum P, Demmler-Harrison G. Progressive, Long-Term Hearing Loss in Congenital CMV Disease After Ganciclovir Therapy. J Pediatric Infect Dis Soc 2021; 11:16-23. [PMID: 34718680 PMCID: PMC9590555 DOI: 10.1093/jpids/piab095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Long-term hearing outcomes among children with symptomatic congenital cytomegalovirus (CMV) disease who received 6-week ganciclovir therapy early in life are unknown. METHODS Longitudinal study of 76 children with symptomatic congenital CMV disease, born 1983-2005, who were categorized into three groups: group A treated with ganciclovir; group B untreated who had microcephaly, chorioretinitis, or sensorineural hearing loss (SNHL; ≥25 dB) diagnosed in the first month of life (congenital); and group C untreated who did not meet criteria for group B. RESULTS Patients in groups A (n = 17), B (n = 27), and C (n = 32) were followed to median age of 13, 11, and 13 years, respectively. In group A, patients received ganciclovir for median of 40 (range, 11-63) days; 7 (41%) had grade 3 or 4 neutropenia. Congenital SNHL was diagnosed in 11 (65%) patients in group A, 15 (56%) in group B, and none in group C. Early-onset SNHL was diagnosed between ages ≥1-12 months in an additional 4 (24%), 6 (22%), and 8 (25%) patients in groups A, B, and C, respectively. By the end of follow-up, 12 (71%), 16 (59%), and 7 (22%) of patients in groups A, B, and C, respectively, had severe (>70 dB) SNHL in the better-hearing ear. CONCLUSIONS In this study, most patients with symptomatic congenital CMV disease and congenital or early-onset SNHL eventually developed hearing loss severe enough to have been potential candidates for cochlear implantation, with or without 6-week ganciclovir therapy. Understanding long-term hearing outcomes of patients treated with 6-month oral valganciclovir (current standard of care) is needed.
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Affiliation(s)
- Tatiana M Lanzieri
- Corresponding Author: Tatiana M. Lanzieri, MD, MPH, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop A-34, Atlanta, GA 30333, USA. E-mail:
| | | | - Peggy Blum
- Texas Children’s Hospital, Houston, Texas, USA
| | - Gail Demmler-Harrison
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Texas Children’s Hospital, Houston, Texas, USA
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Wu PH, Lee CY, Huang JY, Yang SF, Shih CP. The correlation between neonatal parameters and late-onset inner ear disorders in congenital cytomegalovirus infection: a 10-year population-based cohort study. Clin Otolaryngol 2021; 47:107-114. [PMID: 34547825 DOI: 10.1111/coa.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/08/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the correlation of neonatal parameters with late-onset sensorineural hearing loss (SNHL) and vestibular dysfunction in individuals with congenital cytomegalovirus (cCMV) infection using the National Health Insurance Research Database (NHIRD) in Taiwan. DESIGN Retrospective cohort study. SETTING The whole Taiwanese population. PARTICIPANTS Patients with related diagnostic codes and examinations in their records were regarded as having cCMV infection. Each subject in that group was matched to 10 control individuals with noncongenital CMV infection on the basis of several neonatal parameters, including low gestational age, low birth weight, low Apgar score, maternal history of CMV infection and prolonged cCMV infection. A total of 5893 and 58 930 participants were enrolled in the study and control groups, respectively. MAIN OUTCOME MEASURES The main outcomes were the development of SNHL and the development of vestibular dysfunction within one year after birth as reflected by diagnostic codes and specific examinations. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (HR) and 95% confidence interval (CI) of each primary outcome between the two groups. RESULTS Overall, 109 and 397 episodes of SNHL developed in the study group and the control group, respectively, and the study group demonstrated a significantly higher incidence of SNHL (adjusted HR: 2.56; 95% CI: 2.07-3.18). In addition, similar incidence rates of vestibular dysfunction were found in the study group and the control group, with 7 and 90 events, respectively (adjusted HR: 0.77; 95% CI: 0.36-1.67). In subgroup analyses, a higher incidence of SNHL was correlated with lower gestational age (GA) (adjusted HR: 2.09; 95% CI: 1.29-3.39), lower birth weight (BW) (adjusted HR: 2.05; 95% CI: 1.28-3.30) and prolonged cCMV infection (adjusted HR: 3.92; 95% CI: 1.95-7.88). CONCLUSIONS Low GA, low BW and a long disease course are significantly correlated with late-onset SNHL in cCMV infection.
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Affiliation(s)
- Pei-Hsuan Wu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Ping Shih
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Affiliation(s)
- Gail J Demmler-Harrison
- Department of Pediatrics, Baylor College of Medicine and Infectious Diseases Service, Texas Children's Hospital, Houston, Texas
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Walsh H, Zuwala J, Hunter J, Oh Y. Congenital Cytomegalovirus and Human Immunodeficiency Virus: Effects on Hearing, Speech and Language Development, and Clinical Outcomes in Children. Front Pediatr 2021; 9:771192. [PMID: 34976894 PMCID: PMC8716614 DOI: 10.3389/fped.2021.771192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Prenatal infections can have adverse effects on an infant's hearing, speech, and language development. Congenital cytomegalovirus (CMV) and human immunodeficiency virus (HIV) are two such infections that may lead to these complications, especially when left untreated. CMV is commonly associated with sensorineural hearing loss in children, and it can also be associated with anatomical abnormalities in the central nervous system responsible for speech, language, and intellectual acquisition. In terms of speech, language, and hearing, HIV is most associated with conductive and/or sensorineural hearing loss and expressive language deficits. Children born with these infections may benefit from cochlear implantation for severe to profound sensorineural hearing losses and/or speech therapy for speech/language deficits. CMV and HIV simultaneously present in infants has not been thoroughly studied, but one may hypothesize these speech, language, and hearing deficits to be present with potentially higher severity. Early identification of the infection in combination with early intervention strategies yields better results for these children than no identification or intervention. The purpose of this review was to investigate how congenital CMV and/or HIV may affect hearing, speech, and language development in children, and the importance of early identification for these populations.
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Affiliation(s)
- Hannah Walsh
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jillian Zuwala
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jessica Hunter
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Yonghee Oh
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
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Haller T, Shoup A, Park A. Should hearing targeted screening for congenital cytomegalovirus infection Be implemented? Int J Pediatr Otorhinolaryngol 2020; 134:110055. [PMID: 32361556 PMCID: PMC7293539 DOI: 10.1016/j.ijporl.2020.110055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022]
Abstract
Since 2013, after Utah became the first state to implement hearing targeted early CMV screening, a national debate has been percolating about whether this approach should be introduced nationally. Currently Utah, Iowa, Connecticut, and New York have passed legislation mandating early CMV screening, and over 100 birth hospitals across the United States have voluntarily implemented early CMV screening programs as part of their standard of care. We reviewed the evidence related to this approach and used the Wilson and Jungner (1968) criteria to evaluate this method of screening. Based on these criteria, there is substantial rationale and evidence to support a hearing targeted approach to screen for congenital CMV. Given this evidence, we currently recommend that infants who fail newborn hearing screen should undergo CMV screening.
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Affiliation(s)
- Travis Haller
- Division of Otolaryngology- Head and Neck Surgery, University of Utah
| | - Angela Shoup
- Division of Communicative and Vestibular Disorders, Department of Otolaryngology University of Texas Southwestern Medical Center at Dallas
| | - Albert Park
- Division of Otolaryngology- Head and Neck Surgery, University of Utah
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16
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Abstract
BACKGROUND Sensorineural hearing loss (SNHL) is well described in children with congenital cytomegalovirus (CMV) infection, but limited data are available on middle ear effusion (MEE) occurrence in this population. We assessed the prevalence of MEE and the degree of transient hearing change associated with MEE among children with congenital CMV infection. METHODS Children with congenital CMV infection enrolled in a longitudinal study received hearing and tympanometric testing during scheduled follow-up visits annually up to 6 years of age. We used a generalized linear mixed-effect logistic regression model to compare the odds of MEE, defined as type B tympanogram (normal ear canal volume with little tympanic membrane movement) among patients categorized as symptomatic or asymptomatic based on the presence of congenital CMV-associated signs in the newborn period. RESULTS Forty-four (61%) of 72 symptomatic and 24 (28%) of 87 asymptomatic patients had ≥1 visit with MEE. After controlling for the number of visits, symptomatic patients had significantly higher odds of MEE (odds ratio: 2.09; 95% confidence interval: 1.39-3.14) than asymptomatic patients. Transient hearing decrease associated with a type B tympanogram ranged from 10 to 40 dB, as measured by audiometric air-bone gap in 11 patients. CONCLUSIONS Among children with congenital CMV, MEE can result in transient hearing decrease, which can reduce the efficacy of a hearing aid in those with SNHL. It is warranted that children with congenital CMV infection and SNHL receive routine audiologic and tympanometric testing to better manage hearing aid amplification levels.
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Affiliation(s)
- Winnie Chung
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tatiana M. Lanzieri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peggy Blum
- Texas Children’s Hospital, Houston, Texas
| | - Gail Demmler-Harrison
- Texas Children’s Hospital, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Torrecillas V, Allen CM, Greene T, Park A, Chung W, Lanzieri TM, Demmler-Harrison G. Should You Follow the Better-Hearing Ear for Congenital Cytomegalovirus Infection and Isolated Sensorineural Hearing Loss? Otolaryngol Head Neck Surg 2020; 162:114-120. [PMID: 31593522 PMCID: PMC7274837 DOI: 10.1177/0194599819880348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the progression of sensorineural hearing loss (SNHL) in the better- and poorer-hearing ears in children with asymptomatic congenital cytomegalovirus (CMV) infection with isolated SNHL. STUDY DESIGN Longitudinal prospective cohort study. SETTING Tertiary medical center. SUBJECTS AND METHODS We analyzed hearing thresholds of the better- and poorer-hearing ears of 16 CMV-infected patients with isolated congenital/early-onset or delayed-onset SNHL identified through hospital-based CMV screening of >30,000 newborns from 1982 to 1992. RESULTS By 12 months of age, 4 of 7 patients with congenital/early-onset SNHL developed worsening thresholds in the poorer-hearing ear, and 1 had an improvement in the better-hearing ear. By 18 years of age, all 7 patients had worsening thresholds in the poorer-hearing ear and 3 patients had worsening thresholds in the better-hearing ear. Hearing loss first worsened at a mean age of 2 and 6 years in the poorer- and better-hearing ears, respectively. Nine patients were diagnosed with delayed-onset SNHL (mean age of 9 years vs 12 years for the poorer- and better-hearing ears), 6 of whom had worsening thresholds in the poorer-hearing ear and 1 in both ears. CONCLUSION In most children with congenital CMV infection and isolated SNHL, the poorer-hearing ear worsened earlier and more precipitously than the better-hearing ear. This study suggests that monitoring individual hearing thresholds in both ears is important for appropriate interventions and future evaluation of efficacy of antiviral treatment.
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Affiliation(s)
- Vanessa Torrecillas
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Chelsea M. Allen
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Albert Park
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Winnie Chung
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tatiana M. Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Purcell PL, Edwards TC, Wisneski M, Chan DK, Ou H, Horn DL, Skirko JR, Sie KCY. Unilateral Hearing Loss in Youth: Development of Candidate Items for a Condition-Specific Validated Instrument. Otolaryngol Head Neck Surg 2018; 159:1043-1050. [PMID: 30149769 DOI: 10.1177/0194599818797092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study interviewed youth with unilateral hearing, utilizing their responses to generate candidate items for a condition-specific patient-reported instrument. STUDY DESIGN Mixed methods, cross-sectional. SETTING Tertiary care children's hospital. PARTICIPANTS AND METHODS Youth with unilateral hearing loss and normal hearing in the contralateral ear were identified and recruited for participation through query of an audiometric database and through hearing loss clinics. Interviews with the youth were qualitatively analyzed to identify common themes and generate items related to functional impact. A multi-institutional expert panel reviewed items with prespecified item selection criteria. Participants rated items for impact on daily life. For preliminary criterion validity assessment, statistical analyses explored correlations between functional scores and type and severity of hearing loss. RESULTS Thirty-nine youth aged 9 to 18 years with unilateral hearing loss participated; 31% used a hearing device. Fifteen youth participated in interviews; thematic analysis, item crafting, and expert panel item review resulted in 41 items. Twenty-six youth responded to the items, reporting low functional scores in the domains of sound localization, ear positioning, and noise environment. They reported better levels of function in carrying out group conversations, focusing on schoolwork, and feeling safe during activities. Multivariate linear regression found that youth scored 0.4 points (or approximately 8%) lower on the functional impact scale with every 20-dB HL increase in pure tone average in the abnormal ear. CONCLUSION Youth with unilateral hearing loss report functional impact, particularly related to sound localization, ear positioning, and noise environment; therefore, they may benefit from a condition-specific functional assessment instrument.
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Affiliation(s)
- Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Todd C Edwards
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meghan Wisneski
- Department of Pediatric Audiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Dylan K Chan
- Division of Pediatric Otolaryngology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Henry Ou
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Horn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan R Skirko
- Division of Pediatric Otolaryngology, Primary Children's Hospital/University of Utah, Salt Lake City, Utah, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
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