Prevalence and nature of hearing loss in a cohort of children with sickle cell disease

Association between hearing impairment, school performance and cognitive function in children and adolescents with sickle cell disease

OBJECTIVE

To investigate the association among hearing impairment, school performance, and cognitive function in children and adolescents with sickle cell disease.

METHODS

Thirty-one participants with sickle cell disease (SCD) and 31 healthy participants in the control-comparison group (CG), both aged 8-17 years underwent auditory system evaluation (pure tone audiometry and acoustic reflex), were screened for the risks of (central) auditory processing disorder and dysfunction of cognitive function using the Scale of Auditory Behaviors (SAB) and the Mini-Mental State Examination (MMSE), respectively, and were interviewed to obtain clinical data and data on school performance.

RESULTS

In the SCD group, eight (25.8%) participants presented with sensorineural hearing loss (SNHL). The group with SCD and SNHL presented a higher occurrence of poor school performance than the group of participants with SCD without SNHL (p= 0.016). The MMSE score for aspects related to attention and calculation in the SCD group with SNHL was lower than in the SCD group without SNHL (p= 0.016). In the SAB, the SCD group with SNHL presented a lower score than the SCD group without SNHL in aspects related to academic performance and attention.

CONCLUSION

Hearing impairment in children and adolescents with SCD, specifically SNHL, is associated with poor school performance and enhances the risk of cognitive impairment in terms of attention and calculation.

Neurologic and Cognitive Outcomes in Sickle Cell Disease from Infancy through Adolescence

Children with sickle cell disease (SCD) are at risk for neurologic and cognitive complications beginning in early childhood. Current treatment for SCD focuses on primary prevention of complications, such as hydroxyurea for prevention of pain and acute chest syndrome, and chronic transfusion therapy for children who are at high risk for strokes. In this article, the prevalence, pathophysiology, and available interventions to prevent and treat neurologic and cognitive complications of SCD will be reviewed.

Functional Connectivity Decreases with Metabolic Stress in Sickle Cell Disease

OBJECTIVE

Children with sickle cell disease (SCD) experience cognitive deficits even when unaffected by stroke. Using functional connectivity magnetic resonance imaging (MRI) as a potential biomarker of cognitive function, we tested our hypothesis that children with SCD would have decreased functional connectivity, and that children experiencing the greatest metabolic stress, indicated by elevated oxygen extraction fraction, would have the lowest connectivity.

METHODS

We prospectively obtained brain MRIs and cognitive testing in healthy controls and children with SCD.

RESULTS

We analyzed data from 60 participants (20 controls and 40 with sickle cell disease). There was no difference in global cognition or cognitive subdomains between cohorts. However, we found decreased functional connectivity within the sensory-motor, lateral sensory-motor, auditory, salience, and subcortical networks in participants with SCD compared with controls. Further, as white matter oxygen extraction fraction increased, connectivity within the visual (p = 0.008, parameter estimate = -0.760 [95% CI = -1.297, -0.224]), default mode (p = 0.012, parameter estimate = -0.417 [95% CI = -0.731, -0.104]), and cingulo-opercular (p = 0.009, parameter estimate = -0.883 [95% CI = -1.517, -0.250]) networks decreased.

INTERPRETATION

We conclude that there is diminished functional connectivity within these anatomically contiguous networks in children with SCD compared with controls, even when differences are not seen with cognitive testing. Increased white matter oxygen extraction fraction was associated with decreased connectivity in select networks. These data suggest that elevated oxygen extraction fraction and disrupted functional connectivity are potentially presymptomatic neuroimaging biomarkers for cognitive decline in SCD. ANN NEUROL 2020;88:995-1008.

Prevalence of Sensorineural Hearing Loss in Pediatric Patients with Sickle Cell Disease: A Meta-analysis

OBJECTIVES

To determine the prevalence of Sensorineural Hearing Loss (SNHL) attributable to Sickle Cell Disease (SCD) in the global pediatric population and to identify factors contributing to its severity.

STUDY DESIGN

Meta-analysis.

METHODS

We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations under 18 years of age with excluding studies analyzing patients on iron chelation therapy, adults, or those without objective audiological analysis.

RESULTS

We identified 138 initial studies with 17 selected for analysis after applying the exclusion criteria. A total of 1,282 SCD patients and 553 controls were included in the meta-analysis. There was a statistically significant increase in the prevalence of SNHL in children with SCD compared to the general population with a cumulative risk ratio of 3.33.

CONCLUSION

This is the first systematic investigation of the relationship between SCD and SNHL in pediatric patients across the globe. The increased prevalence of SNHL in the pediatric SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of SCD patients to reduce the social and developmental morbidity of hearing loss at a young age. PROSPERO Registration #: CRD42019132601. Laryngoscope, 131:1147-1156, 2021.

The emergence and prevalence of hearing loss in children with homozygous sickle cell disease

OBJECTIVES

Many children with sickle cell disease (SCD) experience the effect of cochlear insult due to hemolytic anemia and vaso-occlusion that accompanies the disease. As a result, hearing sensitivity eventually decreases. The purpose of this study was to investigate the emergence of hearing loss and the prevalence of such in children with homozygous SCD.

METHODS

A large pediatric database was utilized to gather audiometric outcomes in children with homozygous SCD. Children were identified by primary diagnosis ICD codes. Demographic and audiometric data was drawn to determine presence, type, degree, and laterality of hearing loss. Hearing loss was defined as an elevated audiometric threshold >15 dB HL for pure tone air conduction audiometry or >20 dB HL minimal response level for sound-field testing.

RESULTS

One hundred and twenty-eight children were identified. The prevalence of hearing loss ranged from 28.8% to 50.8% depending on the calculation method (i.e., individual vs. ear specific prevalence and any elevated threshold vs. a three-frequency pure tone average). Conductive hearing loss and bilateral loss were most prevalent. The degree of hearing loss ranged from slight to profound. The mean age of identification of sensorineural hearing loss was 9.6 years.

CONCLUSION

The prevalence of hearing loss in children with homozygous SCD is higher than in normal children. Regular hearing assessments of children with SCD is warranted and should be advocated in early infancy and as part of their ongoing care.