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Diaz-Decaro J, Myers E, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Schmidt E, Natenshon A, Talarico C, Buck PO. A systematic literature review on the humanistic burden of cytomegalovirus. Curr Med Res Opin 2023; 39:739-750. [PMID: 36938652 DOI: 10.1080/03007995.2023.2191477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) infection is typically asymptomatic in healthy individuals; however, certain populations are vulnerable to infection and may develop serious sequelae. CMV infection may also have a broad impact on humanistic outcomes, including patient health status and quality of life (QoL). We conducted a systematic literature review (SLR) to describe the global humanistic burden of CMV and congenital CMV (cCMV) infections across all age groups. METHODS Medline, Embase, and LILACS were searched to identify studies on humanistic outcomes following CMV infection, including health status/QoL and any outcomes in domains such as auditory, cognitive ability, developmental status, intelligence, language, memory, mental health, motor performance, social communication, speech, and vocabulary. The SLR included articles published from 2000-2020 and focused geographically on Australia, Europe, Israel, Japan, Latin America, and North America. RESULTS Sixty-three studies met the inclusion criteria. In general, individuals with symptomatic cCMV infection experience a greater burden of disease and more substantial impact on QoL versus those with asymptomatic cCMV infection. Children with hearing loss due to cCMV infection, both symptomatic and asymptomatic, showed improved auditory outcomes following cochlear implantation. Newborns, infants, and children with cCMV infections had worse cognitive outcomes in psychological development, sequential and simultaneous processing, phonological working memory, and attention control versus age-matched controls without cCMV infection. CMV infection was also associated with cognitive decline in elderly populations. CONCLUSIONS CMV infection can have substantial, lifelong, heterogenous impacts on humanistic outcomes, including health status and QoL, which should be considered when developing and implementing treatment and prevention strategies.
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Affiliation(s)
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Witold Lewandowski
- Certara, Inc., Krakow, Poland
- Certara, Inc., employee at the time of the study
| | | | | | | | - Carla Talarico
- Moderna, Inc., Cambridge, MA, USA
- Moderna, Inc., employee at the time of the study
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2
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Jenks CM, Mithal LB, Hoff SR. Early Identification and Management of Congenital Cytomegalovirus. Otolaryngol Clin North Am 2021; 54:1117-1127. [PMID: 34535282 DOI: 10.1016/j.otc.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital cytomegalovirus (cCMV) is the most common nongenetic cause of sensorineural hearing loss. Despite its prevalence, universal screening for cCMV is not currently performed. Hearing loss caused by cCMV is most often severe to profound, often bilateral, and may be fluctuating or progressive. Infants with hearing loss at birth and confirmed cCMV might benefit from antiviral therapy. Roughly half of hearing loss cases owing to cCMV are delayed in onset, and consequently, these children pass newborn hearing screening. Children with cCMV require close audiologic monitoring, require appropriate management with hearing aids, and should be monitored for cochlear implant candidacy.
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Affiliation(s)
- Carolyn M Jenks
- Department Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street 6th Floor, Baltimore, MD 21287, USA
| | - Leena B Mithal
- Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #20, Chicago, IL 60611, USA
| | - Stephen R Hoff
- Department Otolaryngology-Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Otolaryngology-Head & Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA.
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3
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Courtois C, Blanchard M, Rouillon I, Parodi M, De Lamaze A, Prang I, Couloigner V, Denoyelle F, Loundon N. Outcome for bilateral cochlear implantation in patients with congenital Cytomegalovirus infection. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:337-341. [PMID: 33495071 DOI: 10.1016/j.anorl.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the impact of bilateral cochlear implantation (CI) on perceptual and linguistic development in hearing-impaired children with congenital Cytomegalovirus (CMV) infection. PATIENTS AND METHOD A retrospective study was performed for the period 1991-2016 in a pediatric CI reference center. Closed Set Word (CSW) recognition scores, Categories of Auditory Performance (CAP) and linguistic level on the MT Lenormand scale (MTL) were compared between bilateral (Bi) and unilateral (Uni) groups 12, 24 and 36 months after first CI (CI-1). RESULTS 84 patients with congenital CMV infection who underwent CI were included, in 2 groups: sequential or simultaneous bilateral CI (Bi) (N=20), and unilateral CI (Uni) (N=64). Twelve, 24 and 36 months after CI-1, CSW scores were 35.56%, 64.52% and 82.93% in Uni and 60.3%, 85% (P=0.0084*), and 100% (P=0.00085*) in Bi. CAP scores 12, 24 and 36 months after CI-1 were 2.57, 3.85 and 4.3 in Uni and 3.91 (P=0.0068*), 5.00 (p=0.029*) and 5.50 (P=0.051*) in Bi. MTL linguistic level scores at 12, 24 and 36 months were 0.72, 1.25 and 1.65 in Uni, and 1.72, 3 (P=0.033) and 3.11 (P=0.045) in Bi. These significantly better scores in Bi at 24 and 36 months after CI-1 were also found on analysis of subgroups with no associated neurologic disorder (P=0.046* and P=0.032*), no associated psychiatric pathology (P=0.0055* and P=0.0073*), and no other associated disorder (P=0.0018* and P=0.035*), and for all subgroups together (P=0.0036 and P=0.037). CONCLUSION Bilateral CI is a faster way than unilateral CI for patients with congenital CMV infection to achieve structured fluent oral language. 50% of the series showed cerebral abnormalities on MRI, without difference between groups. This was not in itself predictive of poor progression of oral communication, unless associated with major neurologic disorder. Some children made little or no use of their CI in the medium term.
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Affiliation(s)
- C Courtois
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.
| | - M Blanchard
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - I Rouillon
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - M Parodi
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - A De Lamaze
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - I Prang
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - V Couloigner
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - F Denoyelle
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - N Loundon
- Necker - Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
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4
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Corazzi V, Ciorba A, Bianchini C, Rosignoli M, Negossi L, Minazzi F, Borin M, Malagutti N, Stomeo F, Pelucchi S. Outcome of cochlear implantation in children with congenital Cytomegalovirus infection: A retrospective case control study. Int J Pediatr Otorhinolaryngol 2020; 138:110364. [PMID: 33152959 DOI: 10.1016/j.ijporl.2020.110364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To date, cCMV represents the most frequent non-genetic congenital cause of permanent sensorineural hearing loss (SNHL) in childhood and the leading infectious cause of developmental and neurologic disabilities. The aim of this paper is to describe the outcome of cochlear implantation in children affected by severe-to-profound sensorineural hearing loss, due to a symptomatic or asymptomatic cCMV infection, particularly comparing their performance results to that of matched mutated Connexin 26 (Cx26) implanted patients. METHODS Retrospective case control study. The clinical data of symptomatic cCMV and asymptomatic cCMV patients were collected and compared to those of Cx26 patients matched for age and pre-CI (cochlear implant) linguistic category; all subjects were affected by bilateral severe-to-profound SNHL and were treated by CI and speech therapy rehabilitation. The Speech Perception Category, the language stage and the linguistic level scores, at 6 months, 1 year, and 3-4 years after CI of the three groups (symptomatic cCMV, asymptomatic cCMV and Cx26 mutation) were collected and compared. RESULTS Statistical analysis did not show any significant difference in pre-CI perception category and linguistic level among the three groups; the symptomatic cCMV group showed a statistically worse performance of the language stage over time (p = 0.017). CONCLUSIONS Our data support that children affected by cCMV have improved language abilities over time, although the symptomatic cCMV group achieved a lower language stage 3-4 years after CI compared to the asymptomatic cCMV and Cx26 mutation groups. Nonetheless, to date, CI supported by speech therapy can be considered an effective intervention for children affected by cCMV-related severe-to-profound hearing loss.
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Affiliation(s)
- Virginia Corazzi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Andrea Ciorba
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy.
| | - Chiara Bianchini
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Monica Rosignoli
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Laura Negossi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Federica Minazzi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Michela Borin
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Nicola Malagutti
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Francesco Stomeo
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Stefano Pelucchi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
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Löfkvist U, Anmyr L, Henricson C, Karltorp E. Executive Functions, Pragmatic Skills, and Mental Health in Children With Congenital Cytomegalovirus (CMV) Infection With Cochlear Implants: A Pilot Study. Front Psychol 2020; 10:2808. [PMID: 31998167 PMCID: PMC6965306 DOI: 10.3389/fpsyg.2019.02808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common cause of progressive hearing impairment. In our previous study around 90% of children with a cCMV infection and CI had severely damaged balance functions (Karltorp et al., 2014). Around 20% had vision impairment, 15% were diagnosed with Autism-Spectrum-Disorder, and 20% with ADHD. One clinical observation was that children with cCMV infection had problems with executive functioning (EF), while controls with a genetic cause of deafness (Connexin 26 mutations; Cx26) did not have similar difficulties. A follow-up study was therefore initiated with the main objective to examine EF and pragmatic skills in relation to mental health in children with a cCMV infection and to draw a comparison with matched controls with Cx26 mutations (age, sex, hearing, non-verbal cognitive ability, vocabulary, and socioeconomic status level). Ten children with a cCMV infection and CI (4.8–12:9 years) and seven children with CI (4:8–12:8 years) participated in the study, which had a multidisciplinary approach. Executive functioning was assessed both with formal tests targeting working memory and attention, parent and teacher questionnaires, and a systematic observation by a blinded psychologist during one test situation. Pragmatics and mental health were investigated with parent and teacher reports. In addition, the early language outcome was considered in non-parametric correlation analyses examining the possible relationships between later EF skills, pragmatics, and mental health. Children with cCMV had a statistically significant worse pragmatic outcome and phonological working memory than controls despite their groups having similar non-verbal cognitive ability and vocabulary. However, there were no statistical differences between the groups regarding their EF skills in everyday settings and mental health. There were associations between early language outcomes and later EF skills and pragmatics in the whole sample. Conclusion: Children with a cCMV infection are at risk of developing learning difficulties in school due to difficulties with phonological working memory and pragmatic skills in social interactions.
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Affiliation(s)
- Ulrika Löfkvist
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
| | - Lena Anmyr
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Henricson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Eva Karltorp
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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Fletcher KT, Horrell EMW, Ayugi J, Irungu C, Muthoka M, Creel LM, Lester C, Bush ML. The Natural History and Rehabilitative Outcomes of Hearing Loss in Congenital Cytomegalovirus: A Systematic Review. Otol Neurotol 2019; 39:854-864. [PMID: 29912824 DOI: 10.1097/mao.0000000000001861] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the literature regarding the natural history and rehabilitative outcomes of sensorineural hearing loss from congenital cytomegalovirus infections. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA A systematic search was performed in PubMed, PsychINFO, CINAHL, and Web of Science to identify peer-reviewed research. Eligible studies were those containing original peer-reviewed research in English addressing either the natural history or rehabilitative outcomes of sensorineural hearing loss (SNHL) in congenital cytomegalovirus (cCMV). STUDY APPRAISAL AND SYNTHESIS METHODS Two investigators independently reviewed all articles and extracted data. Bias was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa Assessment Scale. RESULTS Thirty-six articles were reviewed. Universal screening identifies 0.2 to 1% of newborns with cCMV infection. SNHL ranged from 8 to 32% of infants and was more prevalent in symptomatic versus asymptomatic cases. Nine to 68% of hearing loss occurs in a late or delayed fashion. In 7 to 71% of cases hearing loss is progressive. Cochlear implantation (CI) is a viable option for patients with cCMV associated hearing loss and leads to improvements in hearing and language. There is limited literature comparing rehabilitation outcomes in cCMV and non-cCMV CI recipients. CONCLUSION Late onset and progressive hearing loss is seen in children who develop hearing loss from cCMV. Frequent audiologic follow-up is necessary considering the natural history of cCMV hearing loss. Universal screening should be pursued due to the number of asymptomatic children, at birth, who develop late onset/delayed hearing loss. CI is an effective means of improving speech and language in this population.
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Affiliation(s)
- Kyle T Fletcher
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center
| | | | - John Ayugi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Catherine Irungu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Maria Muthoka
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Liza M Creel
- Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences
| | - Cathy Lester
- Cabinet for Health and Family Services Commission for Children with Special Health Care Needs, Louisville, Kentucky
| | - Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center
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7
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Kraaijenga V, Van Houwelingen F, Van der Horst S, Visscher J, Huisman J, Hollman E, Stegeman I, Smit A. Cochlear implant performance in children deafened by congenital cytomegalovirus-A systematic review. Clin Otolaryngol 2018; 43:1283-1295. [DOI: 10.1111/coa.13142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- V.J.C. Kraaijenga
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - F. Van Houwelingen
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - S.F. Van der Horst
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - J. Visscher
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - J.M.L. Huisman
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - E.J. Hollman
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - I. Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
| | - A.L. Smit
- Department of Otorhinolaryngology, Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- University Utrecht; Domplein 29; 3512 JE Utrecht The Netherlands
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Long-term Outcomes of Cochlear Implantation in Children With Congenital Cytomegalovirus Infection. Otol Neurotol 2018; 38:e190-e194. [PMID: 28604578 DOI: 10.1097/mao.0000000000001483] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of the developmental delay often observed in children with congenital cytomegalovirus (CMV) infection on the improvement of language understanding after cochlear implantation (CI). STUDY DESIGN Retrospective chart review. PATIENTS Sixteen children with severe and/or profound hearing loss due to congenital CMV infection (CMV group) and 107 congenitally deaf children (168 ears) without CMV infection as the cause of deafness (non-CMV group). Mean age at which patients underwent CI was 2.9 years in both groups. The mean follow-up period was 7.8 versus 8.2 years, respectively. INTERVENTIONS/MAIN OUTCOME MEASURES The Enjoji Scale of Infant Analytical Development was used to evaluate/compare pre- and postoperative hearing level, word recognition score, speech discrimination score, and language production and perception skills. The Picture Vocabulary Test-Revised was used to assess vocabulary understanding skill. Correlation between the final vocabulary understanding skill assessment and several factors was also examined. RESULTS Improvement in hearing thresholds (mean: 106.0 dB) was greater after the first CI, (27-45 dB; mean: 33.8 dB) compared with hearing aid (48-74 dB; mean: 63.1 dB). Similarly, language perception and production were better in the CMV group. However, in the long term, differences between good and poor cases became prominent, especially in children with motor or cognitive delay and brain abnormalities who performed poorly in the CMV group. CONCLUSION Long-term language perception and production after CI were overall satisfactory in congenital CMV-deafened children. CI was effective, particularly in the absence of CMV-induced disorders. However, this effectiveness was limited in those with motor or cognitive delay.
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Hoey AW, Pai I, Driver S, Connor S, Wraige E, Jiang D. Management and outcomes of cochlear implantation in patients with congenital cytomegalovirus (cCMV)-related deafness. Cochlear Implants Int 2017; 18:216-225. [DOI: 10.1080/14670100.2017.1315510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew Wesley Hoey
- Department of Paediatric Otolaryngology, Evelina London Children's Hospital, London, UK
| | - Irumee Pai
- Department of Paediatric Otolaryngology, Evelina London Children's Hospital, London, UK
| | - Sandra Driver
- Department of Paediatric Otolaryngology, Evelina London Children's Hospital, London, UK
| | - Steve Connor
- Department of Head and Neck Imaging, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Elizabeth Wraige
- Children's Neurosciences Centre, Newcomen Centre at St Thomas, London, UK
| | - Dan Jiang
- Department of Paediatric Otolaryngology, Evelina London Children's Hospital, London, UK
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10
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Lyutenski S, Götz F, Giourgas A, Majdani O, Bültmann E, Lanfermann H, Lenarz T, Giesemann AM. Does severity of cerebral MRI lesions in congenital CMV infection correlates with the outcome of cochlear implantation? Eur Arch Otorhinolaryngol 2016; 274:1397-1403. [DOI: 10.1007/s00405-016-4408-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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11
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Audiovestibular consequences of congenital cytomegalovirus infection. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:413-418. [PMID: 27067701 DOI: 10.1016/j.anorl.2016.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the second most frequent cause of mental retardation and sensorineural hearing loss, after genetic factors. Recently, pediatric forensic and fetopathological studies have led to progress in understanding the pathophysiological mechanisms underlying the various neurosensory sequelae. Thanks to the identification of certain prognostic factors of hearing loss, therapeutic protocols based on antiviral molecules are now proposed for target populations. This treatment has shown efficacy in limiting hearing threshold deterioration and even, in some cases, seems to provide partial recovery of hearing in symptomatic congenitally infected CMV neonates. However, optimal treatment duration and administration modalities are not clearly defined. This article reviews recent data concerning audiovestibular sequelae and their management in children congenitally infected by CMV.
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Laccourreye L, Ettienne V, Prang I, Couloigner V, Garabedian EN, Loundon N. Speech perception, production and intelligibility in French-speaking children with profound hearing loss and early cochlear implantation after congenital cytomegalovirus infection. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:317-20. [DOI: 10.1016/j.anorl.2015.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L Laccourreye
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.
| | - V Ettienne
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - I Prang
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - V Couloigner
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - E-N Garabedian
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - N Loundon
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
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13
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Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:696281. [PMID: 26236732 PMCID: PMC4506828 DOI: 10.1155/2015/696281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Abstract
Background. Specific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders. Methods. The present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests. Results. Between January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0). Conclusions. Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent.
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Arndt S, Prosse S, Laszig R, Wesarg T, Aschendorff A, Hassepass F. Cochlear implantation in children with single-sided deafness: does aetiology and duration of deafness matter? Audiol Neurootol 2015; 20 Suppl 1:21-30. [PMID: 25999052 DOI: 10.1159/000380744] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
For adult patients with single-sided deafness (SSD), treatment with a cochlear implant (CI) is well established as an acceptable and beneficial hearing rehabilitation method administered routinely in clinical practice. In contrast, for children with SSD, CI has been applied less often to date, with the rationale to decide either on a case-by-case basis or under the realm of clinical research. The aim of our clinical study was to evaluate the longitudinal benefits of CI for a group of children diagnosed with SSD and to compare their outcomes with respect to patient characteristics. Evaluating a pool of paediatric SSD patients presenting for possible CI surgery revealed that the primary aetiology of deafness was congenital cochlear nerve deficiency. A subgroup of children meeting the CI candidacy criteria for the affected ear (the majority with acquired hearing loss) were enrolled in the study. Preliminary group results suggest substantial improvements in speech comprehension in noise and in the ability to localise sound, which was demonstrated through objective and subjective assessments after CI treatment for the group, with results varying from patient to patient. Our study shows a trend towards superior outcomes for children with acquired hearing loss and a shorter duration of hearing loss compared to congenitally deafened children who had a longer duration of SSD. This indicates an interactive influence of the age at onset, aetiology and duration of deafness upon the restoration of binaural integration and the overall benefits of sound stimulation to two ears after CI treatment. Continued longitudinal investigation of these children and further studies in larger groups may provide more guidance on the optimal timing of treatment for paediatric patients with acquired and congenital SSD.
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Affiliation(s)
- Susan Arndt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Freiburg, Freiburg, Germany
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Affiliation(s)
- James F Bale
- Departments of Pediatrics and Neurology, The University of Utah School of Medicine, Salt Lake City, UT, USA.
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Kadambari S, Luck S, Davis A, Williams EJ, Berrington J, Griffiths PD, Sharland M. Clinically targeted screening for congenital CMV - potential for integration into the National Hearing Screening Programme. Acta Paediatr 2013; 102:928-33. [PMID: 23927434 DOI: 10.1111/apa.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/09/2013] [Accepted: 06/25/2013] [Indexed: 12/01/2022]
Abstract
UNLABELLED Screening for a condition should only be undertaken if certain strict criteria are met. Congenital CMV (cCMV) is a leading cause of sensorineuronal hearing loss (SNHL) and meets many of these criteria, but is not currently screened for in the UK. Ganciclovir reduces CMV-induced progressive SNHL if treatment is begun in the first month of life. The Newborn Hearing Screening Programme (NHSP) has been shown to identify SNHL at the earliest possible age. The potential of integrating screening for cCMV into the NHSP is discussed to consolidate the link between screening, early diagnosis and management. CONCLUSION The early diagnosis and treatment of cCMV may prevent a small proportion of late SNHL. In the absence of any screening programme, we provide evidence that clinically targeted screening through the NHSP is a potential option in the UK, enhancing the diagnostic pathway and enabling appropriate early treatment to reduce long-term morbidity.
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Affiliation(s)
- S Kadambari
- Paediatric Infectious Diseases Research Group; Jenner Wing; St George's University of London; London; UK
| | - S Luck
- Centre for Virology; University College London Medical School and Royal Free Hospital; London; UK
| | - A Davis
- Public Health England; London; UK
| | - EJ Williams
- Newcastle Neonatal Service; Royal Victoria Infirmary; Newcastle-upon-Tyne; UK
| | - J Berrington
- Newcastle Neonatal Service; Royal Victoria Infirmary; Newcastle-upon-Tyne; UK
| | - PD Griffiths
- Centre for Virology; University College London Medical School and Royal Free Hospital; London; UK
| | - M Sharland
- Paediatric Infectious Diseases Research Group; Jenner Wing; St George's University of London; London; UK
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Hart CK, Wiley S, Choo DI, Eby C, Tucker L, Schapiro M, Meinzen-Derr J. Developmental disabilities and intracranial abnormalities in children with symptomatic cytomegalovirus and cochlear implants. ISRN OTOLARYNGOLOGY 2012; 2012:502746. [PMID: 23762614 PMCID: PMC3671708 DOI: 10.5402/2012/502746] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/26/2012] [Indexed: 06/02/2023]
Abstract
Objective. To examine the association of intracranial radiographic abnormalities and developmental measures with outcomes in children with congenital symptomatic cytomegalovirus (CMV) and cochlear implants (CI). Design/Methods. It was a retrospective review of 15 children implanted from 2004 to 2010. Preimplant nonverbal intelligence quotient/developmental quotient (IQ/DQ) and head circumference (HC) were obtained. Computed tomography and magnetic resonance imaging of the brain and post-CI audiometry and language assessments were reviewed. Results. Eleven children (73%) had cognitive delay. Most had >1 developmental disability. Median IQ/DQ was 65 (23-90). All had imaging abnormalities. Most imaging abnormalities were in parietal (60%) and temporal (60%) lobes. Children with HC < 5th percentile had poorer median post-CI PTA (38 dB versus 27 dB, P = 0.02). Periventricular calcifications were associated with lower receptive (r b = -0.75, P = 0.03) and expressive (r b = -0.84, P = 0.008) language. Because IQ/DQ was associated with periventricular calcifications (r b = -0.53, P = 0.04) and small HC (r b = -0.73, P = 0.002), their relationships with language appear partially driven by IQ/DQ. Conclusions. The location of brain abnormalities appears to correlate with worse outcomes after CI. These findings may allow for more accurate counseling of parents regarding anticipated postimplantation performance.
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Affiliation(s)
- Catherine K. Hart
- Division of Pediatric Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Daniel I. Choo
- Division of Pediatric Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christine Eby
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Laura Tucker
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Mark Schapiro
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Black J, Hickson L, Black B. Defining and evaluating success in paediatric cochlear implantation--an exploratory study. Int J Pediatr Otorhinolaryngol 2012; 76:1317-26. [PMID: 22743078 DOI: 10.1016/j.ijporl.2012.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/28/2012] [Accepted: 05/29/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This work is a preliminary study that sought to investigate and develop a method for defining and evaluating "success" in paediatric cochlear implantation (PCI) and to apply a process by which a clinical team could optimally achieve this aim. METHODS A pilot group of 25 profoundly deaf children who received a unilateral cochlear implant from 1995 to 2008 was used to develop the process. The cases displayed features that are commonly encountered in PCI. Individual case records were examined retrospectively for adverse factors that might impact on the implantation outcome with particular reference to the probability and severity of impact of each factor. Case prognosis was then rated on a 1-4 basis (1: excellent, 2: good, 3: fair, 4: poor). The subsequent outcomes were assessed using standardised speech (GFW, DEAP), language (PLS-4; CELF) and vocabulary (PPVT; EVT) assessments. Auditory performance outcomes were assessed using a new Categories of Auditory Performance Index (CAPI) that incorporated criteria, testing and scoring aspects. Family issues were also evaluated. Case outcomes were rated 1-4 as above and the prognoses and outcomes were then compared. RESULTS Accurate prognostication was seen in 14 cases, 5 had better outcomes than expected and 6 obtained poorer results. "Success", where the outcome equalled or exceeded the prognosis, occurred in 19 (76%) of cases. The successful group contained some "limited gains" cases where the results were nonetheless in line with expectations and parental satisfaction. The detrimental effect of delayed implantation was evident; Connexin 26 (GJB2) mutation had little influence. Poor general medical condition and adverse family situations commonly produced poorer outcomes. CONCLUSIONS Success in PCI is achieved when the outcome matches or exceeds the pre-operative expectations of the well-counselled family, without adverse side effects. The assessments achieved a good success rate, but further research is required to clearly identify potential problems and a skilled team is needed to evaluate their risk to the PCI outcome. Unforseen events may also intervene. Currently, differing outcome evaluation techniques impede comparison of studies, particularly in the speech and hearing domains. Rationalisation of these is recommended to facilitate future research.
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Affiliation(s)
- Jane Black
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane 4072, Australia.
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Abstract
Human cytomegalovirus, a human herpesvirus, remains a major cause of neurological disorders as a consequence of infections acquired in utero or postnatally. This article summarizes current information regarding the epidemiology, clinical manifestations, treatment, and prevention of this ubiquitous human infection.
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Jonas NE, Ahmed J, Grainger J, Jephson CG, Wyatt ME, Hartley BE, Saunders D, Cochrane LA. MRI brain abnormalities in cochlear implant candidates: how common and how important are they? Int J Pediatr Otorhinolaryngol 2012; 76:927-9. [PMID: 22498141 DOI: 10.1016/j.ijporl.2012.02.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 02/22/2012] [Accepted: 02/26/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the incidence of abnormal findings on brain MRI in paediatric cochlear implantation candidates. METHODS Retrospective review of brain MRI scans of cochlear implant patients between 2000 and 2009 who underwent MRI brain as part of their pre-operative work-up. RESULTS MRI scans of 162 patients were reviewed (76 female patients and 86 male patients). The mean age at time of MRI scan was 3 years 8 months. Abnormalities were detected/ reported in 49 patients (30%). The total number of abnormalities detected was 51 (two patients had two separate abnormalities each). Of the abnormalities 82% could be related to known pre-existing conditions. 18% of the abnormalities were incidental/unexpected. Incidental/unexpected abnormalities were found in 9 patients (6%). Four of the patients with incidental abnormalities required referral and further investigations (2.5%). The most common abnormality detected was white matter changes (70%). All the white matter changes were related to pre-existing known medical conditions. CONCLUSION At our institution abnormalities detected by pre-operative brain MRI scans on cochlear implant candidates are common (30%). The majority of abnormalities are related to known pre-existing medical conditions. Incidental findings are rare (4%) and approximately half of them required further investigation or referral.
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Affiliation(s)
- N E Jonas
- Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom.
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21
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Matsui T, Ogawa H, Yamada N, Baba Y, Suzuki Y, Nomoto M, Suzutani T, Inoue N, Omori K. Outcome of cochlear implantation in children with congenital cytomegalovirus infection or GJB2 mutation. Acta Otolaryngol 2012; 132:597-602. [PMID: 22364789 DOI: 10.3109/00016489.2011.653445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Outcomes following cochlear implantation in children with congenital cytomegalovirus (CMV) infection were almost equivalent to those of children with GJB2 mutation-related sensorineural hearing loss (SNHL). Although our patients with developmental disorder showed poor auditory performance and speech and language skills after cochlear implantation, SNHL with developmental disorder should not be a contraindication for the procedure. OBJECTIVE Congenital CMV infection accounts for approximately 20% of all cases of neonatal hearing loss, while the GJB2 mutation accounts for 30-50% of all cases of profound nonsyndromic hearing loss. Here, outcomes for auditory behavior and speech and language skills were compared in children with congenital CMV infection or GJB2 mutation who received cochlear implantation for profound SNHL. METHODS Five children with asymptomatic congenital CMV infection and seven children with GJB2 mutation-related SNHL, with and without developmental disorder, underwent cochlear implantation. Hearing level and speech and language development were evaluated post-implantation using IT-MAIS, MUSS, and S-S method. RESULTS The IT-MAIS and MUSS scores of the congenital CMV infection group and the GJB2 mutation group continued to increase for 4 years after implantation. The S-S method score in both groups gradually increased, although the scores for children with mental retardation were low.
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Affiliation(s)
- Takamichi Matsui
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
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22
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Weiss JP, Bernal B, Balkany TJ, Altman N, Jethanamest D, Andersson E. fMRI evaluation of cochlear implant candidacy in diffuse cortical cytomegalovirus disease. Laryngoscope 2012; 122:2064-6. [PMID: 22645045 DOI: 10.1002/lary.23243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/27/2011] [Accepted: 01/19/2012] [Indexed: 11/10/2022]
Abstract
Congenital cytomegalovirus infection is the most frequent nongenetic cause of pediatric hearing loss in the United States, affecting approximately 8,000 children each year. Due in part to variable cytomegalic involvement of the auditory cortex, cochlear implantation outcomes have varied widely. Functional magnetic resonance imaging (fMRI) has the potential to assist in determining candidacy for cochlear implantation through the detection of intact auditory pathways including the cortex. We report a case of a 21-month-old girl with cytomegalovirus-related deafness and diffuse white matter involvement in which fMRI was a determining factor for cochlear implantation and side selection.
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Affiliation(s)
- Joshua P Weiss
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
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Yamazaki H, Yamamoto R, Moroto S, Yamazaki T, Fujiwara K, Nakai M, Ito J, Naito Y. Cochlear implantation in children with congenital cytomegalovirus infection accompanied by psycho-neurological disorders. Acta Otolaryngol 2012; 132:420-7. [PMID: 22443855 DOI: 10.3109/00016489.2011.653442] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Cochlear implantation was effective for deaf children with congenital cytomegalovirus (CMV) infection, but their cochlear implant (CI) outcomes were often impaired, depending on the types of CMV-associated psycho-neurological disorders. Evaluation of cognitive development and autistic tendency of implantees might be useful to predict their CI outcomes. OBJECTIVES To reveal the influence of CMV-associated psycho-neurological disorders on CI outcomes. METHODS This was a retrospective evaluation of 11 implantees with congenital CMV infection (CMV-CIs) and 14 implantees with autosomal recessive hearing loss (genetic-CIs). RESULTS Nine of 11 CMV-CIs suffered from psycho-neurological disorders; one from attention deficit hyperactivity disorder, two from pervasive developmental disorder, and six from mental retardation. Aided hearing thresholds with CIs in the two groups did not differ, but two autistic and two mentally retarded CMV-CIs showed significantly low scores in speech discrimination tests. Language-Social (L-S) developmental quotients (DQs) evaluated by the Kyoto Scale of Psychological development were improved after the implantation in both groups, but the postoperative increase of L-S DQs was significantly smaller in the CMV-CIs than that of genetic-CIs. Interestingly, the postoperative L-S and Cognitive-Adaptive (C-A) DQs showed statistically significant correlation in all cases except for two autistic CMV-CIs whose L-S DQs were much lower than those expected from their C-A DQs.
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Japan
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Viccaro M, Filipo R, Bosco E, Nicastri M, Mancini P. Long-Term Follow-Up of Implanted Children with Cytomegalovirus-Related Deafness. ACTA ACUST UNITED AC 2012; 17:395-9. [DOI: 10.1159/000341160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/11/2012] [Indexed: 11/19/2022]
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Shin JJ, Keamy DG, Steinberg EA. Medical and surgical interventions for hearing loss associated with congenital cytomegalovirus: a systematic review. Otolaryngol Head Neck Surg 2011; 144:662-75. [PMID: 21493333 DOI: 10.1177/0194599811399241] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hearing loss associated with congenital cytomegalovirus (CMV) infection occurs in 0.2 to 0.6 per 1000 neonates. OBJECTIVE The primary goal of this systemic review was to test the following null hypotheses: (1) antiviral therapy has no impact on congenital CMV-related sensorineural hearing loss and (2) surgical therapy has no impact on congenital CMV-related sensorineural hearing loss. DATA SOURCES Computerized searches of MEDLINE and EMBASE databases through September 2010 were performed, supplemented with manual searches and inquiries to topic experts. REVIEW METHODS Studies were included based on review of 387 studies according to criteria developed a priori. Data extraction was performed by independent reviewers and focused on relevant audiologic measurements, study designs, and potential confounders. RESULTS Criterion-meeting studies (n = 19) included a total of 446 participants. The largest randomized controlled trial (RCT) suggested a significant protective effect of intravenous ganciclovir against deterioration of hearing in neonates with central nervous system manifestations of CMV infection. It also, however, suggested a 3-fold increase in neutropenia. The second RCT suggested that there may be no significant benefit of intravenous ganciclovir for normal-hearing infants with asymptomatic congenital CMV. Additional prospective and retrospective data evaluated the impact of oral therapy and cochlear implantation in affected patients. CONCLUSION Although results are mixed, the highest level of evidence suggests that antiviral therapy confers a protective benefit on neonates with hearing loss and symptomatic CMV. Cochlear implantation can result in advancement of speech and language skills, but there are mixed results compared with non–CMV-infected patients.
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Affiliation(s)
- Jennifer J Shin
- Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
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Dollard SC, Schleiss MR, Grosse SD. Public health and laboratory considerations regarding newborn screening for congenital cytomegalovirus. J Inherit Metab Dis 2010; 33:S249-54. [PMID: 20532822 DOI: 10.1007/s10545-010-9125-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the most common infection in newborns worldwide and causes hearing loss and other neurological disability in 15-20% of infected infants. Only about half of the hearing loss resulting from congenital CMV infection is currently detected by universal newborn hearing screening because of late-onset hearing loss. Thus, much of the hearing loss and the majority of other CMV-associated disabilities remain undetected for years after birth and are never connected to CMV infection. Congenital CMV may be appropriate to include in national newborn screening (NBS) programs because it is more common than other disorders tested for by NBS programs and is a major cause of disability. Significant obstacles to the implementation of screening for congenital CMV include the lack of a standardized, high-throughput screening test and a protocol for follow-up of CMV-infected children. Nonetheless, screening newborns for congenital CMV infection merits further consideration.
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Affiliation(s)
- Sheila C Dollard
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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