The clinical features and prognosis of mumps-associated hearing loss: a retrospective, multi-institutional investigation in Japan

Clinical practice guidelines for the diagnosis and management of acute sensorineural hearing loss

OBJECTIVE

Acute sensorineural hearing loss represents a spectrum of conditions characterized by sudden onset hearing loss. The "Clinical Practice Guidelines for the Diagnosis and Management of Acute Sensorineural Hearing Loss" were issued as the first clinical practice guidelines in Japan outlining the standard diagnosis and treatment. The purpose of this article is to strengthen the guidelines by adding the scientific evidence including a systematic review of the latest publications, and to widely introduce the current treatment options based on the scientific evidence.

METHODS

The clinical practice guidelines were completed by 1) retrospective data analysis (using nationwide survey data), 2) systematic literature review, and 3) selected clinical questions (CQs). Additional systematic review of each disease was performed to strengthen the scientific evidence of the diagnosis and treatment in the guidelines.

RESULTS

Based on the nationwide survey results and the systematic literature review summary, the standard diagnosis flowchart and treatment options, including the CQs and recommendations, were determined.

CONCLUSION

The guidelines present a summary of the standard approaches for the diagnosis and treatment of acute sensorineural hearing loss. We hope that these guidelines will be used in medical practice and that they will initiate further research.

Clinical characteristics and prognosis of sudden sensorineural hearing loss in single-sided deafness patients

Background

Sudden sensorineural hearing loss (SSNHL) in patients with single-sided deafness (SSD) is rare. The prognosis of the sole serviceable hearing ear is very important for these patients. However, the clinical characteristics and prognosis of SSNHL in SSD patients are not well-documented.

Objective

This study aimed to investigate the clinical features and treatment outcomes of SSNHL in SSD patients.

Methods

Clinical data of 36 SSD patients and 116 non-SSD patients with unilateral SSNHL from January 2013 to December 2022 were retrospectively investigated. The clinical characteristics of the SSD patients were analyzed. All SSD patients were treated with intratympanic steroids plus intravenous steroids. Pure-tone average (PTA) and word recognition score (WRS) before and after treatment were recorded. The hearing recovery of SSNHL in SSD patients in comparison with non-SSD patients was explored. Auditory outcomes in SSD patients with different etiologies were also compared.

Results

Initial hearing threshold showed no significant differences between the SSD group and the non-SSD group (66.41 ± 24.64 dB HL vs. 69.21 ± 31.48 dB HL, p = 0.625). The SSD group had a higher post-treatment hearing threshold (median (interquartile range, IQR) 53.13(36.56) dB HL) than the non-SSD group (median 32.50(47.5) dB HL, p < 0.01). Hearing gains (median 8.75(13.00) dB) and the rate of significant recovery (13.89%) were lower in the SSD group than in the non-SSD group (median 23.75(34.69) dB, 45.69%). The etiology of SSD was classified as SSNHL, special types of infection, chronic otitis media, and unknown causes. SSNHL accounted for the maximum proportion (38.9%) of causes of SSD in the SSD group. Hearing gains were lower in the SSNHL-SSD group than in other causes of the SSD group. A binary logistic regression analysis demonstrated that SSD serves as an indicator of unfavorable hearing recovery outcomes (OR = 5.264, p < 0.01).

Conclusion

The prognosis of SSNHL in SSD patients is unsatisfactory. SSNHL accounts for the maximum proportion of causes of SSD in this group of patients. For SSD patients caused by SSNHL, less hearing improvement after treatment was expected when SSNHL occurred in the contralateral ear in comparison with SSD patients with other causes.

Etiology, Severity, Audiogram Type, and Device Usage in Patients with Unilateral Moderate to Profound Sensorineural Hearing Loss in Japan

BACKGROUND

Few studies have reported on the etiology, severity, or device usage of unilateral sensorineural hearing loss (UHL) compared to bilateral hearing loss. Therefore, this study investigated the characteristics of UHL in adults and children.

METHODS

We performed a survey using questionnaires for secondary and tertiary otolaryngology institutions.

RESULTS

We included 15,981 patients (1549 children and 14,432 adults) from 196 institutions with otolaryngology residency programs and 2844 patients (336 children and 2508 adults) from 27 institutions with board members of the Japan Audiology Society. The latter submitted audiological data. Among children, most diagnoses were made at age 0. Approximately half of them had profound hearing loss, and 37 children (2.2%) used hearing devices. Among adults, the number of cases increased with age, but decreased when people reached their 80s and 90s. More than half of them had moderate hearing loss. Sudden sensorineural hearing loss was the most common cause of UHL of all ages; 4.4% of UHL patients used hearing devices, and most of the device users (98.6%) selected a conventional hearing aid.

CONCLUSIONS

Hearing aid use is limited in children and adults with UHL in Japan. There could be many candidates with UHL for intervention such as a cochlear implant.

The Pathogenesis of Cytomegalovirus and Other Viruses Associated with Hearing Loss: Recent Updates

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.

The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone

BACKGROUND

Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors.

METHODOLOGY AND PRINCIPAL FINDINGS

EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss.

CONCLUSIONS AND SIGNIFICANCE

This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.

Epidemiological features and sociodemographic factors associated with mumps in mainland China from 2004 to 2018

BACKGROUND

Mumps is an acute infectious disease that spreads widely around the world. The aim of this study was to investigate the epidemiological features and sociodemographic factors associated with mumps in mainland China from 2004 to 2018.

METHODS

Incidence data for mumps during the period 2004-2018 were collected from the Public Health Sciences Data Center of China. Joinpoint regression analysis was performed to explore the trends of mumps. Space-time clustering analysis was conducted to spatial and temporal aggregation areas of mumps. A generalized linear model was used to explore sociodemographic factors associated with the incidence of mumps.

RESULTS

Average annual incidence of mumps was 21.44/100,000 in mainland China. It was increased dramatically during 2004-2012 (APC = 7.51, 95%CI: 2.28 to 13.00). After 2012, it remained stable, however, significantly increased in intermediately developed regions from 2015 to 2018 (APC = 25.84, 95%CI: 3.59 to 52.86). The first-level spatial and temporal aggregation areas were distributed in Xinjiang, Gansu, Qinghai, Ningxia and Shaanxi, Tibet, Sichuan, Yunnan, Chongqing, Guizhou, Guangxi, with gathering times from Jan 1, 2006 to Dec 31, 2012 (RR = 1.87, P < 0.001). The percentage of the population aged 0-14 years, number of health workers per capital, and number of passengers were found to be positively associated with the incidence of mumps.

CONCLUSIONS

Overall, after 2012, the incidence of mumps in mainland China remained stable. High-risk periods, clusters of regions and sociodemographic factors for mumps were identified, which will help the government develop disease- and location-specific interventive measures. This article is protected by copyright. All rights reserved.

An Economic Analysis of Mumps Vaccination in Fiji: Static Model Simulation of Routine Measles-Mumps-Rubella (MMR) Vaccination Instead of Current Measles-Rubella (MR) Vaccination

Mumps remains endemic in Fiji, with 7802 cases reported between 2016 and 2018. The introduction of mumps vaccination has been discouraged due to perceptions of mumps as a self-limited disease and the perceived high cost of mumps vaccines. We estimated the benefits and costs of introducing a mumps vaccination program in Fiji. First, we estimated the burden of mumps and mumps-related complications in Fiji based on the reported cases in the Fiji National Notifiable Disease Surveillance System between 2016 and 2018. We then developed a static simulation model with stable mumps herd immunity after routine measles–mumps–rubella (MMR) vaccination. Finally, we compared the estimated economic burden of mumps with current MR vaccination and the assumptive burden of the stable-state simulation model after routine MMR vaccination. The benefit–cost ratios (BCRs) were 2.65 from the taxpayer view and 3.00 from the societal view. A probabilistic sensitivity analysis indicated that the 1st and 99th percentiles of BCRs were 1.4 and 5.2 from the taxpayer’s perspective and 1.5 and 6.1 from the societal perspective. From both the taxpayer and societal perspectives, the probability of BCRs greater than 1.0 was 100%. A routine MMR program has value for money from both the taxpayer and societal perspectives. MMR vaccination should be urgently introduced in Fiji.

Unique Tropism and Entry Mechanism of Mumps Virus

Mumps virus (MuV) is an important human pathogen that causes parotitis, orchitis, oophoritis, meningitis, encephalitis, and sensorineural hearing loss. Although mumps is a vaccine-preventable disease, sporadic outbreaks have occurred worldwide, even in highly vaccinated populations. MuV not only causes systemic infection but also has a unique tropism to glandular tissues and the central nervous system. In general, tropism can be defined by multiple factors in the viral life cycle, including its entry, interaction with host factors, and host-cell immune responses. Although the underlying mechanisms of MuV tropism remain to be fully understood, recent studies on virus-host interactions have provided insights into viral pathogenesis. This review was aimed at summarizing the entry process of MuV by focusing on the glycan receptors, particularly the recently identified receptors with a trisaccharide core motif, and their interactions with the viral attachment proteins. Here, we describe the receptor structures, their distribution in the human body, and the recently identified host factors for MuV and analyze their relationship with MuV tropism.

Mumps-Related Disease Burden in Japan: Analysis of JMDC Health Insurance Reimbursement Data for 2005-2017

Background

Mumps vaccination coverage is low in Japan, partly because of its voluntary nature. Although pediatric cases of mumps virus infection are captured by the National Epidemiological Surveillance of Infectious Diseases program under the Infectious Disease Law, there are currently no data regarding the occurrence of mumps and its complications in adults.

Methods

We investigated the annual incidence rates of mumps and its complications based on health insurance reimbursement data for 5,209,660 individuals aged 0–64 years for 2005–2017, obtained from JMDC Inc., to estimate the mumps-related disease burden during this period.

Results

There were three mumps outbreaks (2006, 2010, and 2016) during 2005–2017. The annual incidence of mumps was highest in individuals aged 0–5 years (808–3,792 per 100,000 persons), followed by those aged 6–15 years (658–2,141 per 100,000 persons). The incidence of mumps was higher in females than in males (male/female ratio, 0.90). Among mumps-related complications, the overall incidence (per 1,000 mumps cases) was highest for orchitis (6.6), followed by meningitis (5.8), deafness (1.3), pancreatitis (0.5), and encephalitis (0.3). No cases of oophoritis were noted. The overall incidence of mumps-related complications was 2.5 times higher in males than in females.

Conclusions

This study revealed the disease burden due to mumps and its complications in Japan during 2005–2017. These data suggest the need for mumps-prevention measures in adolescents and adults, as well as in children.

Close the gap for routine mumps vaccination in Japan

Mumps is a vaccine-preventable disease. Because the mumps vaccine can cause aseptic meningitis in rare cases, this vaccine is not routine in Japan. This has led to low vaccine coverage and severe disease burden in Japan. The present review summarizes mumps epidemiology and vaccination and discusses effective future strategies to mitigate the current disease burden of mumps in Japan. Although a recent study reported that mumps vaccine coverage rates are improving in Japan, current coverage rates are far below the optimal rate to suppress the ongoing epidemic, which has caused an average annual financial loss of 85 billion JPY between 2000 and 2016. Recent reports have demonstrated a much lower incidence of vaccine-induced aseptic meningitis in newly developed vaccines, especially when administered at 1 year of age. Cost-effectiveness studies suggest that routinization of the currently distributed domestic vaccine would be highly cost-effective. In addition, questionnaire surveillance data suggest that the majority of the Japanese population accepts the nominal risk of the vaccine when the proper information is provided. Finally, there are some successful programs in Japan that have attained high vaccine coverage rates with financial support from local governments. Taken together, these data suggest that the mumps vaccine should be immediately included in routine vaccines in Japan.

[Common clinical causes and audiological manifestations of unilateral hearing loss in children]

Objective:To analyze the common clinical causes and audiological manifestations of unilateral hearing loss in children, and to provide a basis for early prevention and intervention. Method:A retrospective analysis of 20 cases of children diagnosed with unilateral hearing loss was conducted. The medical history was collected, followed by audiological and imaging examinations. Result:The audiological performance of 20 children with unilateral hearing loss: 1 case of conductive deafness, whose hearing curve was flat and showed moderate hearing loss. There were 19 cases of sensorineural deafness, of which 1 case was moderate deafness, 16 cases were severe deafness, and 2 cases were extremely severe deafness. The imaging results showed that there were 1 case with transverse fracture of the temporal bone, 1 case with congenital cholesteatoma, 9 cases with dysplasia of the cochlear nerve, and 4 cases with malformation of the inner ear. The history of the two children was collected and there were clear congenital cytomegalovirus infection and mumps virus infection. The causes of the remaining 3 cases were unknown. Conclusion:Unilateral hearing loss in children is a common clinical diseasewith complex and diverse causes. Carefully analysis should be made to find out the causes and symptomatic treatment to provide a basis for early prevention and intervention of children's hearing.

Outcomes of cochlear implantations for mumps deafness: A report of four pediatric cases

Mumps virus occasionally causes bilateral hearing loss. We report 4 cases of bilateral mumps deafness in whom cochlear implantations (CI) were performed. The age at the onset of hearing loss was 1-9 years. CI surgery was performed within 6 months from the onset of hearing loss in 3 cases and after 9 years in the other case, showing good speech perception in the early intervention cases and a poor outcome after later implantation. Early CI surgery is highly recommended in sudden onset deafness by mumps in childhood.

Side-related differences in sudden sensorineural hearing loss in children

OBJECTIVE

Most studies on sudden sensorineural hearing loss (SSNHL) do not differentiate the outcomes within varied affected ears in children. The present study was designed to determine the clinical differences between unilateral and bilateral SSNHL in children.

METHODS

The clinical data, from a total of 101 pediatric patients with SSNHL, was retrospectively analyzed from January 2003 to December 2016. The main outcome measures included basic characteristics, etiology, clinical symptoms and treatment courses.

RESULTS

When the bilateral group (n = 28) was compared to the unilateral group (n = 73), neither gender nor onset of SSNHL was significantly different (p > 0.05 each); However, bilateral SSNHL tended to occur in younger ages (8.1 ± 4.0 yrs), with higher percentages of suspected etiologies (50%) and proportion of profound deafness (55.4%, p < 0.05 each). The short-term recovery rate was superior in the unilateral cases over the bilateral cases (37.0% vs. 12.5%, p < 0.05). Milder initial hearing threshold, early onset of treatment (5.6 ± 4.8 days) with unilateral involvement and an older age (11.3 ± 3.0 yrs) in bilaterally affected cases were associated with a better prognosis in this cohort. In addition, the unilateral group showed comparable outcomes, when sub-analyzed by comparison to that in either left- (n = 42) or right-sided (n = 31) SSNHL.

CONCLUSION

Although bilateral and unilateral pediatric SSNHL could cause partial to complete cochlear lesion, they may be relevant to distinct backgrounds. Our data also provides valuable information about demographics and outcomes of SSNHL in children.

Mumps presenting with unilateral, synchronous parotid and submandibular gland swelling

A previously healthy 22-year-old woman presented with acute, unilateral facial and neck swelling, associated with fever and malaise. She was initially treated with intravenous antibiotics; however, CT imaging showed unilateral, synchronous swelling and inflammation of the parotid and submandibular glands, and a PCR swab from the parotid duct was positive for mumps. She was fully immunised and had no contact in the preceding period with anyone diagnosed with mumps. She responded to supportive management and her symptoms resolved over the course of her admission. Unilateral, synchronous swelling and severe inflammation of both the parotid and submandibular glands in mumps is a very unusual presentation, and not one previously reported in the literature.

Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan

OBJECTIVE

Although elevated anti-mumps IgM antibody levels were reported in 5.7%-7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.

METHODS

This is a retrospective multi-institutional study involving patients diagnosed with SSNHL who exhibited the anti-mumps IgM antibody. We compared the positive rate of anti-mumps IgM antibody and the annual average number of mumps cases per sentinel in Hokkaido between the patients in the present study and patients previously evaluated.

RESULTS

Overall, 100 patients with SSNHL were enrolled. One case (1.0%) was positive for anti-mumps IgM antibody. Of the 69 patients evaluated in the previous study, 5 cases (7.2%) were positive for anti-mumps IgM antibody. The positive rate of the anti-mumps IgM antibody in the present cases was significantly lower than that previously reported (p=0.042). The annual average number of mumps cases per sentinel in Hokkaido of the present and previous surveillance period was 34.47 and 42.77, respectively; no significant difference was seen in these data (p=0.4519).

CONCLUSION

The present study revealed that 1.0% of SSNHL was positive for the anti-mumps IgM antibody using the new EIA-IgM measurement kit. After the introduction of the new EIA-IgM measurement kit, anti-mumps IgM antibody positive rate with SSNHL significantly decreased, indicating that the proportion of asymptomatic mumps among etiology of SSNHL may be lower than those previously reported.