Hearing levels in the Cornelia de Lange syndrome. A report of seven cases

Audiological profile of individuals with Cornelia de Lange syndrome: an integrative review

ABSTRACT Purpose: to describe the audiological profile of patients with Cornelia de Lange syndrome (CdLS) in an integrative review of the literature. Methods: after developing the research question, articles were searched in six databases (EMBASE, ISI of Knowledge, LILACS, MEDLINE/PubMed, SciELO, and Scopus) and in sources of information (Google Scholar, OpenGrey, and ProQuest), with the following descriptors: audiology, hearing loss, deafness, hearing disorders, and Cornelia de Lange syndrome. This review was registered in Prospero under number CRD42020191481. National and international studies were considered for analysis, using the PECO acronym. The risk of bias in the studies was analyzed with Joanna Briggs Institute protocols. Then, the studies were described and analyzed. Results: of the 1,080 articles found, 12 met the inclusion criteria. Audiological results showed that individuals with CdLS can have hearing loss - conductive hearing losses were the most frequent impairments, corresponding to 49.20% of individuals with CdLS assessed, followed by sensorineural hearing losses (13.49%). The degrees of hearing loss ranged from mild to profound. Conclusion: individuals presented with CdLS often have hearing loss, mainly due to middle ear changes, with degrees ranging from mild to profound.

Perfil audiológico de indivíduos com síndrome de Cornelia de Lange: revisão integrativa da literatura

RESUMO Objetivo: descrever o perfil audiológico de pacientes com Síndrome de Cornelia de Lange (SCdL), por meio de uma revisão integrativa da literatura. Métodos: após formulação da pergunta, realizou-se uma busca em seis bases de dados (Embase, ISI of Knowledge, Lilacs, Medline/PubMed, Scielo e Scopus), e fontes de informação (Google Acadêmico, OpenGrey e Proquest), com os descritores: audiologia, perda auditiva, surdez, transtornos da audição e Síndrome de Cornelia de Lange. Esta revisão foi cadastrada no Próspero, sob número CRD42020191481. Foram considerados para análise, estudos nacionais e internacionais, utilizando o direcionamento do acrônimo PECO. Para análise do risco de viés dos estudos, utilizou-se os protocolos do Instituto Joanna Briggs. Após isso, os estudos foram descritos e analisados. Resultados: dos 1.080 artigos encontrados, 12 atenderam aos critérios de inclusão. Nos resultados audiológicos, constatou-se que indivíduos com SCdL podem apresentar perda auditiva, sendo que o comprometimento pela perda auditiva condutiva foi o mais frequente, correspondendo a 49,20% dos indivíduos com SCdL avaliados, seguido pela perda auditiva neurossensorial (13,49%). O grau de perda auditiva variou de leve à profundo. Conclusão: indivíduos com SCdL frequentemente apresentam perda auditiva, decorrente principalmente de alterações de orelha média, com graus variando de leve a profundo.

Cornelia de lange manifestations in otolaryngology: A systematic review and meta-analysis

OBJECTIVES

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder. Our goal was to systematically review the literature regarding otolaryngology manifestations of CdLS.

METHODS

We systematically reviewed the PubMed, Embase, CINAHL, Scopus, and Google Scholar databases for original articles of otolaryngology manifestations for patients with CdLS. These articles were analyzed, and pooled prevalence was calculated.

RESULTS

We analyzed 1,310 patients included in 35 case series and 34 case reports. Hearing loss was present for many patients (27 studies), with sensorineural hearing loss affecting 40.3% (95% confidence interval [CI]: 17.3-63.4) and conductive affecting 22.7% (95% CI: 5.7-39.7). Recurrent acute otitis media was the most frequent infectious manifestation, with 56.5% (95% CI: 34.1-78.4) in seven studies, followed by recurrent airway infections with 44.1% (95% CI: 11.0-87.1) in five studies. Forty-nine (49.7%) percent of patients (95% CI: 25.9-73.6) in nine studies had dysphagia, and 76.6% (95% CI: 59.8-93.3) in four studies had some degree of dysphonia. Craniofacial anomalies were reported in 30 studies, with micrognathia (53.1%; 95% CI: 34.1-72.1) and high arched palate (70.6%; 95% CI: 56.5-84.8) commonly reported. Additional physical exam abnormalities reported included those involving: lips (76.8%; 95% CI: 65.3-88.4), dentition (65.1%; 95% CI: 27.2-100), mouth (85.5%; 95% CI: 76.2-93.8), and eyelashes (87.1%; 95% CI: 77.2-96.9). Sleep-disordered breathing or obstructive sleep apnea affected 25.8% (95% CI: 11.4-40.2) of patients (7 studies). Airway anomalies were reported in 11 case reports.

CONCLUSION

This is the first comprehensive evaluation of otolaryngologic manifestations in the CdLS literature. Most reported hearing loss and craniofacial anomalies. Sleep disorders occurred in a minority of patients, whereas airway disorders were primarily reported in case reports. These conditions should be further examined given their potential life-threatening implications.

LEVEL OF EVIDENCE

3a Laryngoscope, 130:E122-E133, 2020.

Otitis media with effusion and hearing loss in children with Cornelia de Lange syndrome

The development of children who have syndromes with mental retardation and/or language delay can be worsened by sensorineural or conductive hearing loss (HL). Given the existing scarcity of data, we investigated the prevalence of otitis media with effusion and/or HL in 50 children with Cornelia de Lange syndrome (CdLS) aged 1-18 years, and its impact on the children's performance. The children underwent otological and audiological examinations in order to ascertain the relative frequencies of otitis media with effusion and/or hearing impairment; their demographic and clinical data were obtained by questionnaires and from information in their medical charts. Otitis media with effusion was diagnosed in 94%, and its prevalence was similar in all age groups; HL was detected in 40 children (80%). Conductive HL due to middle ear effusion was the main cause of hearing impairment alone (60%) or in combination with sensorineural deficit (20%). HL had a negative impact on performance regardless of the type. A history of routine audiological and/or otological assessments was reported by a minority of parents. Our findings indicate that otitis media with effusion and/or HL is an important feature of children with CdLS and may negatively affect their performance. Careful follow-up throughout childhood is necessary to detect and treat any hearing loss in children with CdLS in order to minimize its impact on performance.

Temporal bone CT findings in Cornelia de Lange syndrome

BACKGROUND AND PURPOSE

Cornelia de Lange syndrome is a rare developmental malformation syndrome with a high prevalence of hearing impairment. The purposes of this study were to describe the characteristic temporal bone CT findings in patients with Cornelia de Lange syndrome and to correlate audiometric data with radiologic findings in these patients.

MATERIALS AND METHODS

Ten children (6 girls and 4 boys; mean age, 42.0 months) who were clinically diagnosed with Cornelia de Lange syndrome (classic, n = 5; mild form, n = 5) were enrolled. Temporal bone CT was prospectively performed, and 32 aspects of each temporal bone CT were analyzed, 21 by direct measurement and 11 by visual inspection. Twenty age-matched children (n = 20 ears) with normal temporal bone CT scans served as a control group. Audiologic tests were also performed on all patients.

RESULTS

Characteristic temporal bone CT findings of Cornelia de Lange syndrome were external auditory canal stenosis, soft-tissue opacification of the hypoplastic tympanomastoid cavity, dysmorphic ossicle, hypoplastic cochlea, and dysplastic vestibule, all of which were more prevalent in patients with the classic form of the disease than in those with the mild form. Children who had more severe structural abnormalities on temporal bone CT had worse hearing levels compared with those without structural abnormalities.

CONCLUSION

Temporal bone CT scans in Cornelia de Lange syndrome could document combined structural abnormalities of the external, middle, and inner ear, which were one of the characteristic clinical manifestations; CT abnormalities were well correlated with the audiometric data.

Temporal bone pathology in Cornelia de Lange syndrome

OBJECTIVE

This study aimed to demonstrate the temporal bone histopathology of Cornelia de Lange syndrome.

STUDY DESIGN

Histopathologic examination of an infant with this syndrome.

SETTING

This study was performed at the temporal bone laboratory. Fukushima Medical University, Fukushima.

RESULTS

The authors describe interesting temporal bone findings of this syndrome: anomalies of the middle and inner ear and the facial nerves.

CONCLUSIONS

This is the second case report describing the histologic findings of the temporal bone in Cornelia de Lange syndrome in the English literature.

Temporal bone and brain stem histopathological findings in Cornelia de Lange syndrome

The temporal bone and the brain stem of an infant with Cornelia de Lange syndrome, aged 9 months, were studied histopathologically. Abnormalities in the inner ear included short cochlea, dilated vestibule, and mesenchyme-filled perilymphatic spaces of the vestibule and semicircular canals. The inner and outer hair cells were normal. Many spiral ganglion cells, which normally would be located in the canal of Rosenthal, were seen in the internal auditory meatus. Some of the vestibular ganglion cells intruded into the facial nerve. The facial nerve formed a loose curve and the geniculum was difficult to recognize. The middle ear was filled with mesenchyme, and there was marked dehiscence of the facial canal. The brain stem, particularly the pons, was smaller than normal, while the fourth ventricle was dilated. The microscopic observation of the pons revealed weak staining with Luxol Fast Blue and decreased number of oligodendroglia. These findings suggested the malformation of the myelin of transverse fibers.

Auditory brainstem responses in children with Cornelia de Lange syndrome

Auditory brainstem evoked responses (ABRs) were recorded in 10 Japanese infants and children with Cornelia de Lange syndrome to determine the level of the lesion causing their poor response to sound. Behavioral audiometry showed severe threshold elevation compared to an age-matched control group. ABR thresholds, peak latencies of wave I and IV and the peak interval latency of waves I-V were measured. ABR abnormalities of 4 types: no ABRs following 85 dB clicks in both ears (4 cases), no ABRs in one ear but normal ABR in the other (2 cases), mild wave V threshold elevation of ABR with a markedly prolonged wave V (2 cases) and normal ABR pattern in the one side and abnormal ABR pattern in the opposite side suggesting brainstem immaturity for age (2 cases). Our results demonstrate a high prevalence of peripheral sensorineural hearing loss in Cornelia de Lange syndrome, but brainstem immaturity was not ruled out in 2 cases.

Hearing impairment in two boys with Cornelia de Lange syndrome

We analyzed brainstem auditory evoked potentials in 2 boys with Cornelia de Lange syndrome. One patient showed no responses with 100 dB hearing level (HL) stimuli. The other showed a normal latency of wave I, a normal I-V interpeak latency with 80 dB HL stimuli, and an elevated threshold of wave V (40 dB HL). It is likely that these abnormal findings reflect the presence of sensorineural hearing impairment.

Clinical variability within Brachmann-de Lange syndrome: a proposed classification system

Seven patients, including two sibs, with the Brachmann-de Lange syndrome (BDLS) are presented as representative of the different types of BDLS in a proposed classification system. Type I ("classic") patients have the characteristic facial and skeletal changes of BDLS using the criteria in the diagnostic index of Preus and Rex. Type I is distinguished from the other subtypes by prenatal growth deficiency (< 2.5 S.D. below mean for gestation) becoming more severe postnatally (< 3.5 S.D. below the mean), moderate to profound psychomotor retardation, and major malformations which result in severe disability or death. Type II ("mild") BDLS patients have similar facial and minor skeletal abnormalities to those seen in type I; however, these changes may develop with time or may be partially expressed. Patients with type II BDLS are distinguished from those with other types by mild to borderline psychomotor retardation, less severe pre- and postnatal growth deficiency, and the absence of (or loss severe) major malformations. Behavioral problems can be a significant clinical problem in type II BDLS. Type III ("phenocopies") BDLS includes patients who have phenotypic manifestations of BDLS which are causally related to chromosomal aneuploidies or teratogenic exposures.

Survey of speech and language skills with prognostic indicators in 116 patients with Cornelia de Lange syndrome

Speech and language evaluations of 116 patients, ages 2 months to 29 years, with Cornelia de Lange syndrome (CdLS), also known as Brachmann-de Lange syndrome, were conducted to survey speech and language skills and to ascertain the prognostic value of related variables. These patients were evaluated at conferences of the CdLS Foundation. The data from these evaluations were then analyzed using the database program of Paradox 3.5. The findings indicated that 53% of the children who were 4 years or older combined 2 or more words into sentences and 33% had no words or only 1-2 words. Four percent were judged to have language skills within normal to low-normal limits. Children who were not talking at all or who were severely delayed in language skills had at least one of the following characteristics: birth weight under 5 lbs.; a reported diagnosis of moderate-to-severe hearing impairment; upper limb malformations; poor abilities to relate socially; and/or severe motor delays, e.g., they did not sit up until after age 25 months or did not walk until after 35 months.