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Pollick SA, Mansour Y, Pesch MH. Newborn congenital cytomegalovirus screening and hearing outcomes: a systematic review of current literature. Curr Opin Otolaryngol Head Neck Surg 2024; 32:329-338. [PMID: 39146216 DOI: 10.1097/moo.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the very recent literature surrounding hearing outcomes of children with congenital cytomegalovirus (cCMV) detected through systematic screening programs. RECENT FINDINGS There are several different approaches to cCMV screening including forms of targeted vs. universal screening of newborns as well as maternally-derived prenatal testing. However, many studies fail to document hearing-related outcomes both in the newborn period and further into childhood when late-onset sensorineural hearing loss (SNHL) can occur. This systematic review included studies of neonates screened for cCMV reporting hearing outcomes for at least one point in time. Hearing targeted screening appeared the most widely reported for detection of unilateral and bilateral SNHL in those with cCMV. A few studies examined these clinical findings in relation to antiviral treatment. SUMMARY Congenital CMV is an important and common cause of childhood hearing loss. Newborn screening programs may expand opportunities for early diagnosis and treatment of the infection and its sequelae.
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Affiliation(s)
- Sarah A Pollick
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Yusra Mansour
- Henry Ford Health System, Department of Otolaryngology - Head & Neck Surgery, USA
| | - Megan H Pesch
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan
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Forli F, Capobianco S, Berrettini S, Bruschini L, Lorenzoni F, Fiori S, Lazzerini F. Long-term outcomes of congenital cytomegalovirus infection in children early identified by extended hearing-targeted screening. Int J Pediatr Otorhinolaryngol 2024; 184:112070. [PMID: 39191004 DOI: 10.1016/j.ijporl.2024.112070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES Congenital Cytomegalovirus (cCMV) has been associated with hearing, vision, and neurodevelopmental long-term sequelae. Despite the social burden associated with the disease, a universally accepted consensus on screening, diagnostic, therapeutic and follow-up approaches has not been reached. The present observational retrospective study aims at describing long-term sequelae and radiological abnormalities associated with cCMV in children early identified by extended hearing-targeted screening and evaluated by audiological follow-up in a single III Level Audiological Referral Center for at least 2 years. METHODS Audiological neonatal and follow-up data were available for all subjects. Data collection included clinical neonatal and virological assessment at birth. Ophthalmological, neurodevelopmental and neuroradiological follow-up abnormalities compatible with cCMV sequelae were collected by clinical reports. Spearman's rank correlation coefficient (rho-ρ) was used to evaluate possible correlations among the considered parameters. RESULTS 61 newborns were identified by extended hearing-targeted cCMV screening and diagnosed mostly (83.6 %) by PCR viral DNA extraction in urine collected within the 15° day of life. Seventeen babies were born preterm, with a mean gestational age of 33.5 weeks. Sixteen patients (26.2 %) were admitted to an Intensive or sub-Intensive Neonatal Care Unit. At birth, 35 newborns were symptomatic (57.3 %), and 19 of them received antiviral treatment by valganciclovir or ganciclovir. Overall, 20 children (32.7 %) were diagnosed with sensorineural hearing loss (SNHL), among them 17 (85 %) were refer at the newborn hearing screening while 3 (15 %) were Pass. 5/20 children (25 %) presented isolated SNHL, while in 15/20 (75 %) children SNHL was associated to other long-term sequelae. In 5 patients (25 %) a progression of the hearing threshold was observed, with a mean age of progression of 26 months of age. Risk factors for progression were a worse final hearing threshold (Spearman's ρ = 0.434; p = 0.0001) and a worse hearing threshold at birth (Spearman's ρ = 0.298; p = 0.020). Thirteen children were fitted with hearing aids, 8 of whom subsequently underwent cochlear implantation. Concerning long term impairments, 10/61 children (17 %) presented a variety of ophthalmological sequelae, while 16/40 cCMV patients (40 %) were diagnosed with neurodevelopmental abnormalities. Language delays were significantly associated with a worse hearing threshold (ρ = 0.582; p = 0.0001) and with other neurocognitive abnormalities (ρ = 0.677, p = 0.0001). 30 children underwent radiological brain evaluation by Magnetic Resonance Imaging, and 63.3 % of them presented abnormalities compatible with cCMV. Mean viral load at birth did not show significant associations with long-term sequelae. CONCLUSIONS The study highlights the diverse and significant long-term sequelae of cCMV infection detected through early screening. With a significant proportion of cCMV children developing sensorineural hearing loss, ophthalmological and neurodevelopmental issues, the results emphasize the importance of continuous, multidisciplinary follow-up. Early identification and tailored interventions are crucial for improving the long-term health and quality of life of children affected by cCMV.
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Affiliation(s)
- Francesca Forli
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy.
| | - Silvia Capobianco
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Francesca Lorenzoni
- Neonatal Unit and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Lazzerini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
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Howard A, Nishikawa JK, Sánchez PJ. "Minimally symptomatic" congenital cytomegalovirus infection: latest data and emerging concepts. Curr Opin Pediatr 2024; 36:480-488. [PMID: 38747205 DOI: 10.1097/mop.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Universal and targeted screening of newborns for congenital cytomegalovirus (CMV) infection is increasing globally. Questions remain concerning the management of infants who have been identified with congenital CMV infection, especially those with "minimally symptomatic" or clinically inapparent infection. Our objective is to discuss current management of CMV-infected neonates with a focus on less affected infants with or without sensorineural hearing loss (SNHL). RECENT FINDINGS Valganciclovir is being prescribed increasingly in neonates with congenital CMV infection for improvement in hearing outcomes through 2 years of age. Treatment initiated in the first month of age is recommended for clinically apparent disease. A recent study showed hearing improvement at 18-22 months of age when therapy was initiated at age 1-3 months in infants with clinically inapparent CMV infection and isolated SNHL. SUMMARY Antiviral therapy with either ganciclovir or valganciclovir has shown moderate benefit in prevention of hearing deterioration among infants with clinically apparent CMV infection or isolated SNHL. Sustainability of benefit beyond 2 years of age remains unknown. At present, infants with clinically inapparent CMV infection (normal complete evaluation including hearing) should not receive antiviral therapy. All CMV-infected infants require close audiological and neurodevelopmental follow-up.
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Affiliation(s)
- Ashley Howard
- Department of Pediatric Infectious Diseases and Immunology, Connecticut Children's Hospital, Hartford, Connecticut
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut
| | - Javier K Nishikawa
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Perinatal Research, Ohio Perinatal Research Network, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Poletti de Chaurand V, Scandella G, Zicoia M, Arienti F, Fernicola F, Lanteri L, Guglielmi D, Carli A, Vasarri MV, Iozzi L, Cavallero A, Malandrin SMI, Locatelli A, Ventura ML, Sinelli M, Ornaghi S. Useful Clinical Criteria for Identifying Neonates with Congenital Cytomegalovirus Infection at Birth in the Context of an Expanded Targeted Screening Program. Viruses 2024; 16:1138. [PMID: 39066300 PMCID: PMC11281348 DOI: 10.3390/v16071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Cytomegalovirus (CMV) is the leading infectious cause of brain defects and neurological dysfunctions, including sensorineural hearing loss (SNHL). Targeted screening in neonates failing the hearing screen is currently recommended in Italy according to national guidelines. However, SNHL may not be present at birth; also, congenital CMV (cCMV) may manifest with subtle signs other than SNHL. Therefore, the inclusion of additional criteria for cCMV screening appears clinically valuable. Starting January 2021, we have implemented expanded targeted cCMV screening at our center, with testing in case of maternal CMV infection during pregnancy, inadequate antenatal care, maternal HIV infection or immunosuppression, birthweight and/or head circumference < 10th centile, failed hearing screen, and prematurity. During the first three years of use of this program (2021-2023), 940 (12.3%) of 7651 live-born infants were tested. The most common indication was birthweight < 10th centile (n = 633, 67.3%). Eleven neonates were diagnosed as congenitally infected, for a prevalence of 1.17% (95%CI 0.48-1.86) on tested neonates and of 0.14% (95%CI 0.06-0.23) on live-born infants. None of the cCMV-infected newborns had a failed hearing screen as a testing indication. Implementation of an expanded cCMV screening program appears feasible and of clinical value.
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Affiliation(s)
- Valeria Poletti de Chaurand
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Gaia Scandella
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Marianna Zicoia
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Francesca Arienti
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Fernicola
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Laura Lanteri
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Diletta Guglielmi
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Anna Carli
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
| | - Maria Viola Vasarri
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Lucia Iozzi
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Annalisa Cavallero
- Microbiology Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (A.C.); (S.M.I.M.)
| | | | - Anna Locatelli
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Mariateresa Sinelli
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Sara Ornaghi
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
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Corazzi V, Fordington S, Brown TH, Donnelly N, Bewick J, Ehsani D, Pelucchi S, Bianchini C, Ciorba A, Borsetto D. Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:3397-3421. [PMID: 38411671 DOI: 10.1007/s00405-024-08527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To review possible risk factors for permanent delayed-onset, progressive sensorineural hearing loss (SNHL) in the paediatric population to recommend follow-up protocols for early detection. METHODS PRISMA-compliant systematic review was performed, including observational studies on the paediatric population up to 16 years old who have passed the newborn hearing screening programme (NHSP), investigating the development of late-onset, progressive SNHL. Electronic searches were performed through Medline, Embase, Cochrane, and Emcare. RESULTS 37 studies were included. 21 showed an association between late-onset SNHL and congenital cytomegalovirus (cCMV) infection (age at hearing loss diagnosis 0.75 to 204 months, mean 45.6 ± 43.9), while 16 between late-onset SNHL and other congenital or perinatal factors, namely Neonatal Intensive Care Unit (NICU) stay, prematurity, neonatal respiratory failure, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, hypocapnia, hypoxia, alkalosis, seizure activity, congenital diaphragmatic hernia (CDH), inner ear malformation, and gene mutations (age at hearing loss diagnosis 2.5 to 156 months, mean 38.7 ± 40.7). CONCLUSIONS cCMV infection may cause late-onset SNHL, which can be missed on standard NHSP. There is, therefore, evidence to support universal screening programmes to enable detection in even asymptomatic neonates. Ongoing audiological follow-up for all children with cCMV is advisable, to enable timely treatment. In the paediatric population presenting conditions such as NICU stay > 5 days, prematurity ≤ 34 weeks gestation, severe neonatal respiratory failure, mechanical ventilation, ECMO support, and CDH surgery, an audiological follow-up from 3 months of age up to at least 3-4 years of age, and at least annually, should be recommended.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Surina Fordington
- Department of Paediatrics, Cambridge University Hospitals, Hills Road, Cambridge, UK
| | | | - Neil Donnelly
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jessica Bewick
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Diana Ehsani
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy.
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Mackey AR, Persson A, Uhlén I. Pre-school hearing screening is necessary to detect childhood hearing loss after the newborn period: a study exploring risk factors, additional disabilities, and referral pathways. Int J Audiol 2024:1-9. [PMID: 38913507 DOI: 10.1080/14992027.2024.2368571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To explore strategies for detecting childhood hearing loss, aside from newborn hearing screening. DESIGN A retrospective review of medical records on the modes of detection of hearing loss, risk factors for late-onset hearing loss, hearing loss degree, aetiology, additional disabilities, and timelines from referral to intervention. STUDY SAMPLE Children, born 2006 to 2015, enrolled for intervention whose hearing loss was detected up to age 7 years but not from newborn hearing screening (n = 326). RESULTS Universal pre-school hearing screening detected 38% of the cohort at 4-5 years of age. Risk factors for late-onset hearing loss were present in 36% of children, 80% of whom had a reported family history. Sixty-nine percent had mild bilateral or unilateral hearing loss. Children with additional disabilities faced significantly longer delays from referral to intervention. Children self-referred due to parent concern had more severe degree of hearing loss than those referred from screening. CONCLUSION Most children with hearing loss detected after the newborn period do not have any known risk factors for late-onset hearing loss. Pre-school hearing screening is needed for comprehensive detection of hearing loss in early childhood. More work is needed towards improving timely diagnosis and intervention for children with additional disabilities.
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Affiliation(s)
- Allison R Mackey
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Persson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Inger Uhlén
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
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Gana N, Huluță I, Cătănescu MȘ, Apostol LM, Nedelea FM, Sima RM, Botezatu R, Panaitescu AM, Gică N. Congenital Cytomegalovirus-Related Hearing Loss. Audiol Res 2024; 14:507-517. [PMID: 38920964 PMCID: PMC11200402 DOI: 10.3390/audiolres14030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital hearing loss is a significant global health concern that affects millions of newborns and infants worldwide, posing substantial challenges for affected individuals, their families, and healthcare systems. This condition, present at birth, can stem from genetic factors, in utero exposures, infections, or complications during pregnancy or childbirth. The spectrum of congenital hearing loss ranges from mild to profound, impacting the development of speech, language, and cognitive skills, thereby influencing educational achievements, social integration, and future employment opportunities. Early detection and intervention strategies, such as newborn hearing screenings, genetic counseling, and the use of hearing aids or cochlear implants, are crucial for mitigating these impacts. This review article aims to explore the diagnostic approaches and management strategies for congenital cytomegalovirus-related hearing loss, emphasizing the importance of interdisciplinary care and the potential for technological advances to improve outcomes for affected individuals.
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Affiliation(s)
- Nicoleta Gana
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
| | - Iulia Huluță
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mihai-Ștefan Cătănescu
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
| | - Livia-Mihaela Apostol
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Florina Mihaela Nedelea
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Romina-Marina Sima
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
| | - Radu Botezatu
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anca Maria Panaitescu
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Nicolae Gică
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (N.G.); (I.H.); (M.-Ș.C.); (R.-M.S.); (R.B.); (A.M.P.); (N.G.)
- Gynecology Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Speck I, Gundlach E, Schmidt S, Spyckermann N, Lesinski-Schiedat A, Rauch AK, Aschendorff A, Thangavelu K, Reimann K, Arndt S. Auditory capacity of the better-hearing ear in asymmetric hearing loss. Eur Arch Otorhinolaryngol 2024; 281:2303-2312. [PMID: 38006462 PMCID: PMC11024001 DOI: 10.1007/s00405-023-08342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Our aim was to investigate the course of the hearing capacity of the better-hearing ear in single-sided deafness (SSD) and asymmetric hearing loss (AHL) over time, in a multicenter study. METHODS We included 2086 pure-tone audiograms from 323 patients with SSD and AHL from four hospitals and 156 private practice otorhinolaryngologists. We collected: age, gender, etiology, duration of deafness, treatment with CI, number and monosyllabic speech recognition, numerical rating scale (NRS) of tinnitus intensity, and the tinnitus questionnaire according to Goebel and Hiller. We compared the pure tone audiogram of the better-hearing ear in patients with SSD with age- and gender-controlled hearing thresholds from ISO 7029:2017. RESULTS First, individuals with SSD showed a significantly higher hearing threshold from 0.125 to 8 kHz in the better-hearing ear compared to the ISO 7029:2017. The duration of deafness of the poorer-hearing ear showed no relationship with the hearing threshold of the better-hearing ear. The hearing threshold was significantly higher in typically bilaterally presenting etiologies (chronic otitis media, otosclerosis, and congenital hearing loss), except for Menière's disease. Second, subjects that developed AHL did so in 5.19 ± 5.91 years and showed significant reduction in monosyllabic word and number recognition. CONCLUSIONS Individuals with SSD show significantly poorer hearing in the better-hearing ear than individuals with NH from the ISO 7029:2017. In clinical practice, we should, therefore, inform our SSD patients that their disease is accompanied by a reduced hearing capacity on the contralateral side, especially in certain etiologies.
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Affiliation(s)
- Iva Speck
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79110, Freiburg, Germany.
| | - Elisabeth Gundlach
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79110, Freiburg, Germany
| | - Sandra Schmidt
- Department of Oto-Rhino-Laryngology, Central Army Hospital Koblenz, Ruebenacher Str. 170, 56072, Koblenz, Germany
| | - Nadine Spyckermann
- Department of Oto-Rhino-Laryngology, Central Army Hospital Koblenz, Ruebenacher Str. 170, 56072, Koblenz, Germany
| | - Anke Lesinski-Schiedat
- Department of Otorhinolaryngology, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ann-Kathrin Rauch
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79110, Freiburg, Germany
| | - Antje Aschendorff
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79110, Freiburg, Germany
| | - Kruthika Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Katrin Reimann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Susan Arndt
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79110, Freiburg, Germany
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Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI). THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100892. [PMID: 38590940 PMCID: PMC10999471 DOI: 10.1016/j.lanepe.2024.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) infection carries a significant burden with a 0.64% global prevalence and a 17-20% chance of serious long-term effects in children. Since the last guidelines, our understanding, particularly regarding primary maternal infections, has improved. A cCMV guidelines group was convened under the patronage of the European Society of Clinical Virology in April 2023 to refine these insights. The quality and validity of selected studies were assessed for potential biases and the GRADE framework was employed to evaluate quality of evidence across key domains. The resulting recommendations address managing cCMV, spanning prevention to postnatal care. Emphasizing early and accurate maternal diagnosis through serological tests enhances risk management and prevention strategies, including using valaciclovir to prevent vertical transmission. The guidelines also strive to refine personalized postnatal care based on risk assessments, ensuring targeted interventions for affected families.
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Affiliation(s)
- Marianne Leruez-Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Christos Chatzakis
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
- Second Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniele Lilleri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniel Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - Ana Alarcon
- Department of Neonatology, Hospital Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal, Fetal and Neonatal Medicine), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Nicolas Bourgon
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ina Foulon
- Department of Otorhinolaryngology and Head & Neck Surgery, Vrije Universiteit Brussels, University Hospital UZ Brussel, Brussels Health Campus. De Poolster, Rehabilitation Centre, Brussels, Belgium
| | - Jacques Fourgeaud
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Anna Gonce
- BCNatal: Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - Christine E. Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Paul Klapper
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - André Krom
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Paulo Paixao
- CHRC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisbon, Portugal
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - George Sourvinos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, Crete, 71003, Greece
| | - Pamela Vallely
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - Yves Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ann Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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10
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Iwamoto L, Liu CA. Late Onset Hearing Loss in Very Low Birth Weight Infants. RESEARCH SQUARE 2024:rs.3.rs-4249951. [PMID: 38746457 PMCID: PMC11092861 DOI: 10.21203/rs.3.rs-4249951/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Objective To determine the incidence of late onset hearing loss and associated risk factors in very low birth weight (VLBW) infants. Study Design Retrospective study (2003-2015) of post-discharge hearing outcomes and risk factors in the VLBW infant population, before and after the institution of a standardized follow-up program. Results Late onset hearing loss increased from 2.9 per 100 VLBW infants to 7.8 per 100 after instituting a monitoring protocol. The follow-up compliance rate nearly doubled. Both infants with late-onset sensorineural hearing loss and those with a conductive component were identified. The rate of conductive loss detection increased seven-fold. Conclusion The institution of a standardized hearing follow-up program significantly increased the detection of late onset hearing loss in VLBW infants. A significant proportion of those with late onset hearing loss had a conductive component. Without identification and treatment, even conductive losses may negatively impact speech and language development.
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Affiliation(s)
- Lynn Iwamoto
- University of Hawaii John A Burns School of Medicine
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11
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Merav L, Ofek Shlomai N, Oiknine-Djian E, Caplan O, Livneh A, Sido T, Peri A, Shtoyer A, Amir E, Ben Meir K, Daitch Y, Rivkin M, Kripper E, Fogel I, Horowitz H, Greenberger S, Cohen M, Geal-Dor M, Gordon O, Averbuch D, Ergaz-Shaltiel Z, Eventov Friedman S, Wolf DG, Yassour M. Implementation of pooled saliva tests for universal screening of cCMV infection. Nat Med 2024; 30:1111-1117. [PMID: 38459181 PMCID: PMC11031397 DOI: 10.1038/s41591-024-02873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.
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Affiliation(s)
- Lior Merav
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Livneh
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Sido
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Peri
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aviad Shtoyer
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eden Amir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Kerem Ben Meir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Yutti Daitch
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Kripper
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Fogel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Horowitz
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sraya Greenberger
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Miriam Geal-Dor
- Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
| | - Oren Gordon
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel.
| | - Moran Yassour
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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12
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Alissa R, Maraqa N, Williams PD, Hipp JA, Nath S, Torres NS, Lee T, Matoq A, Rathore M. Prevalence of asymptomatic cytomegalovirus (CMV) infection in newborns in northeast Florida. FRONTIERS IN EPIDEMIOLOGY 2024; 3:1270374. [PMID: 38455916 PMCID: PMC10910985 DOI: 10.3389/fepid.2023.1270374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024]
Abstract
Background Congenital cytomegalovirus (CMV) infection is the leading cause of hearing loss and neurocognitive delay among children. Affected infants may be asymptomatic at birth and even pass their universal hearing screen. Early identification of CMV-infected infants will allow earlier detection, evaluation and management. The prevalence of congenital CMV infection in the developed world varies geographically from 0.6% to 0.7% of all deliveries and certain regions are at higher risk. The prevalence of congenital CMV is unknown for our region. Aim The purpose of this study was to determine the prevalence of CMV infection among the neonatal population at an urban, tertiary hospital in northeast Florida which serves a large population of patients with low socioeconomic status to assess if universal screening program for congenital asymptomatic CMV infection can be determined. Methods The study was submitted and approved by our Institutional Review Board. We tested the urine for CMV infection in 100 asymptomatic newborns (>32 weeks gestational age and >1,750 g weight at the time of delivery) delivered between June 2016 and July 2017. Results Urine CMV was tested on 100 infants. One infant had a positive urine NAAT for CMV, making the prevalence of congenital CMV infection among asymptomatic newborns in our hospitals' population 1%. Conclusion CMV prevalence in our setting of an urban, tertiary hospital is relatively consistent with the national average of all congenital CMV infections. A policy of universal screening for congenital CMV may be necessary.
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Affiliation(s)
- Rana Alissa
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Nizar Maraqa
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Patty D. Williams
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Jennifer A. Hipp
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Sfurti Nath
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Nicole S. Torres
- Department of Pediatrics, University of Miami Health System, Miami, FL, United States
| | - Tiffany Lee
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Amr Matoq
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Mobeen Rathore
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, FL, United States
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13
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De Cuyper E, Acke F, Keymeulen A, De Leenheer E, Van Hoecke H, Padalko E, Boudewyns A, Gilles A, Muylle M, Kuhweide R, Royackers L, Desloovere C, Verstreken M, Schatteman I, Dhooge I. Risk Factors for Natural Hearing Evolution in Newborns With Congenital Cytomegalovirus Infection. JAMA Otolaryngol Head Neck Surg 2024; 150:30-38. [PMID: 37917050 PMCID: PMC10623298 DOI: 10.1001/jamaoto.2023.3507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/10/2023] [Indexed: 11/03/2023]
Abstract
Importance Congenital cytomegalovirus (cCMV) is the major cause of congenital nonhereditary sensorineural hearing loss in children. Currently, criteria to identify infants at increased risk for unfavorable hearing outcome are lacking. Objective To identify risk factors associated with cCMV-related hearing improvement, hearing deterioration, and late-onset hearing loss. Design, Setting, and Participants This multicenter cohort study included patients from 6 secondary and tertiary hospitals enrolled in the Flemish CMV registry (Belgium). Newborns with untreated cCMV infection with at least 4-year audiological follow-up were included. Patients who presented with other possible causes of sensorineural hearing loss were excluded. Data were collected for 15 years (January 1, 2007, to February 7, 2022) and analyzed from September 26, 2022, to January 16, 2023. Main Outcomes and Measures Primary outcome was hearing evolution (per-ear analysis; described as stable hearing, improvement, or deterioration). The association of gestational characteristics, clinical findings, timing of seroconversion, viral load, and hearing status at birth with hearing evolution was investigated using effect sizes (Cramer V, odds ratio [OR], or Hedges g). Results Of the 387 children, 205 of 385 with nonmissing data were male (53.2%), 113 (29.2%) had a symptomatic infection, and 274 (70.8%) had an asymptomatic infection. Every child was 4 years or older at final hearing evaluation. A total of 701 of 774 ears (90%) showed stable hearing (normal hearing or stable hearing loss since birth) over time. Late-onset hearing loss (normal hearing at birth followed by hearing loss) was present in 43 of 683 ears (6.3%). Among children with hearing loss present at birth, 24 of 34 ears (70.6%) had hearing deterioration, and 6 of 91 ears (6.6%) had hearing improvement. Prematurity was associated with a higher chance of hearing improvement (OR, 12.80; 95% CI, 2.03-80.68). Late-onset hearing loss was more prevalent in a first trimester infection (OR, 10.10; 95% CI, 2.90-34.48). None of the 104 ears of children with a third trimester seroconversion developed late-onset hearing loss. Conclusions and Relevance Findings of this cohort study support that ongoing audiological follow-up for untreated children with congenital hearing loss is important, as the majority of patients had hearing deterioration. The timing of seroconversion was associated with the risk of developing late-onset hearing loss. These insights can aid in parental counseling, patient stratification, and follow-up. Future research should focus on the effect of treatment, the influence of determined risk factors, and the study of eventual new risk factors in patients at high risk to develop hearing loss.
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Affiliation(s)
- Elise De Cuyper
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Frederic Acke
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Keymeulen
- Department of Neonatal Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Elizaveta Padalko
- Laboratory of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - An Boudewyns
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Annick Gilles
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Marie Muylle
- Department of Ear, Nose and Throat, Sint Jan Hospital, Bruges, Belgium
| | - Rudolf Kuhweide
- Department of Ear, Nose and Throat, Sint Jan Hospital, Bruges, Belgium
| | - Liesbeth Royackers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals of Leuven, Belgium
| | - Christian Desloovere
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals of Leuven, Belgium
| | - Margriet Verstreken
- Department of Ear, Nose and Throat, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - Isabelle Schatteman
- Department of Ear, Nose and Throat, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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14
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Dhondt C, Maes L, Van Acker E, Martens S, Vanaudenaerde S, Rombaut L, De Cuyper E, Van Hoecke H, De Leenheer E, Dhooge I. Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection. Ear Hear 2023; 44:1354-1366. [PMID: 37122081 DOI: 10.1097/aud.0000000000001377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV), the leading nongenetic cause of pediatric sensorineural hearing loss, can also affect vestibular function. Literature findings suggest clinical presentation of vestibular loss in cCMV to be as variable as the hearing loss. Still, probably due to the considerable additional burden it entails for both patients and diagnostic centers, longitudinal vestibular follow-up in cCMV is not well-established in clinical practice. Therefore, this study aims to propose an evidence-based vestibular follow-up program with proper balance between its feasibility and sensitivity. DESIGN In this longitudinal cohort study, 185 cCMV-patients (mean age 3.2 years, SD 1.6 years, range 0.5-6.7 years) were included. Vestibular follow-up data were obtained through lateral video head impulse test (vHIT) and cervical vestibular evoked myogenic potential (cVEMP) evaluations around the ages of 6 months, 1 year, and 2 years. Around 3 and 4.5 years of age, data from vertical vHIT and ocular vestibular evoked myogenic potentials (oVEMP) were also collected. RESULTS At birth, 55.1% (102/185) of patients were asymptomatic and 44.9% (83/185) were symptomatic. The mean duration of follow-up for all patients was 20.8 (SD 16.3) months (mean number of follow-up assessments: 3.2, SD 1.5). Vestibular loss occurred at some point during follow-up in 16.8% (31/185) of all patients. Six percent (10/164) of patients with normal vestibular function at first assessment developed delayed-onset vestibular loss; 80.0% (8/10) of these within the first 2 years of life. Vestibular deterioration was reported both in patients who had been treated with postnatal antiviral therapy and untreated patients. At final evaluation, both the semicircular and the otolith system were impaired in the majority of vestibular-impaired ears (29/36, 80.6%). Dysfunctions limited to the semicircular system or the otolith system were reported in 4 (4/36, 11.1%) and 3 (3/36, 8.3%) ears, respectively. The occurrence of vestibular loss was highest in patients with first trimester seroconversion (16/59, 27.1%) or with an unknown timing of seroconversion (13/71, 18.3%), patients with sensorineural hearing loss (16/31, 51.6%), and patients with periventricular cysts on magnetic resonance imaging (MRI) (7/11, 63.6%). CONCLUSIONS Longitudinal vestibular follow-up, most intensively during the first 2 years of life, is recommended in cCMV-patients with vestibular risk factors (first trimester or unknown timing of seroconversion; sensorineural hearing loss; periventricular cysts on MRI). If those risk factors can be ruled out, a single evaluation early in life (around 6 months of age) might be sufficient. Both semicircular and otolith system evaluation should be part of the follow-up program, as partial losses were reported.
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Affiliation(s)
- Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Emmely Van Acker
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Elise De Cuyper
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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15
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Singh S, Maheshwari A, Boppana S. CMV-induced Hearing Loss. NEWBORN (CLARKSVILLE, MD.) 2023; 2:249-262. [PMID: 38348106 PMCID: PMC10860330 DOI: 10.5005/jp-journals-11002-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common fetal viral infection and contributes to about 25% of childhood hearing loss by the age of 4 years. It is the leading nongenetic cause of sensorineural hearing loss (SNHL). Infants born to seroimmune mothers are not completely protected from SNHL, although the severity of their hearing loss may be milder than that seen in those whose mothers had a primary infection. Both direct cytopathic effects and localized inflammatory responses contribute to the pathogenesis of cytomegalovirus (CMV)-induced hearing loss. Hearing loss may be delayed onset, progressive or fluctuating in nature, and therefore, a significant proportion will be missed by universal newborn hearing screening (NHS) and warrants close monitoring of hearing function at least until 5-6 years of age. A multidisciplinary approach is required for the management of hearing loss. These children may need assistive hearing devices or cochlear implantation depending on the severity of their hearing loss. In addition, early intervention services such as speech or occupational therapy could help better communication, language, and social skill outcomes. Preventive measures to decrease intrauterine CMV transmission that have been evaluated include personal protective measures, passive immunoprophylaxis and valacyclovir treatment during pregnancy in mothers with primary CMV infection. Several vaccine candidates are currently in testing and one candidate vaccine in phase 3 trials. Until a CMV vaccine becomes available, behavioral and educational interventions may be the most effective strategy to prevent maternal CMV infection.
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Affiliation(s)
- Srijan Singh
- Department of Neonatology, Kailash Hospital, Noida, Uttar Pradesh, India
- Global Newborn Society (https://www.globalnewbornsociety.org/), Clarksville, Maryland, United States of America
| | - Akhil Maheshwari
- Global Newborn Society (https://www.globalnewbornsociety.org/), Clarksville, Maryland, United States of America
- Department of Pediatrics, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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16
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Kocharyan A, Schaefer AM, Smith RJH, Hansen MR. Is Genetic Testing Indicated in a Pediatric Patient with Unilateral Hearing Loss or Single-Sided Deafness? Laryngoscope 2023; 133:2042-2043. [PMID: 37203861 PMCID: PMC10875683 DOI: 10.1002/lary.30715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
| | - Amanda M Schaefer
- Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
- Molecular Otolaryngology and Renal Research Laboratories, Department of Otolaryngology-Head and Neck Surgery, Roy J. and Lucille A. Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
- Molecular Otolaryngology and Renal Research Laboratories, Department of Otolaryngology-Head and Neck Surgery, Roy J. and Lucille A. Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
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17
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Lanzieri TM, Hall MAK, Rau A, McBride H, Watson D, Rheaume C, Demmler-Harrison G. Parental Perspectives on Communication from Health Care Providers following a Newborn Diagnosis of Congenital Cytomegalovirus Infection: A Secondary Analysis of a Qualitative Study. Int J Neonatal Screen 2023; 9:49. [PMID: 37754775 PMCID: PMC10531899 DOI: 10.3390/ijns9030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
The study objective was to identify communication messages that parents of children diagnosed with congenital cytomegalovirus (cCMV) infection reported as essential and helpful. We performed a secondary analysis of focus groups and interviews conducted with 41 parents of children with cCMV who had enrolled in a long-term follow-up cCMV study at an academic medical center. Three groups of parents who had children with cCMV participated in the study: parents with children symptomatic at birth, parents with children asymptomatic at birth who later developed sensorineural hearing loss, and parents with children asymptomatic at birth who remained asymptomatic into adulthood. Using a health marketing approach, we identified six general themes from the focus group sessions: initial diagnosis, likely health outcome(s), comfort and coping, symptom watch, resources, and prevention. Receiving the initial diagnosis was shocking for many parents, and they wanted to know how their child would or could be affected. They valued access to the information, follow-up visits for early detection of hearing loss and other developmental delays, and support from other parents. Parents wished to obtain this information from their pediatrician but felt that experts offered more up-to-date knowledge about prognosis, monitoring, and treatment. With more U.S. states implementing cCMV screening strategies which would lead to more infant diagnoses, it will be necessary for providers to meet parents' expectations and communication needs.
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Affiliation(s)
- Tatiana M. Lanzieri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-34, Atlanta, GA 30333, USA
| | - Mary Ann K. Hall
- Division of Hospital Medicine, Emory University School of Medicine, 101 Woodruff Cir, Atlanta, GA 30322, USA
| | - Ashrita Rau
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-34, Atlanta, GA 30333, USA
| | - Holly McBride
- Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St., Houston, TX 77030, USA
| | - Danie Watson
- Kirby Marketing Solutions, 3808 Villas Del Sol Ct, Tampa, FL 33609, USA
| | - Carol Rheaume
- Kirby Marketing Solutions, 3808 Villas Del Sol Ct, Tampa, FL 33609, USA
| | - Gail Demmler-Harrison
- Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St., Houston, TX 77030, USA
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18
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Del Valle Penella A, Miller J, Rochat R, Demmler-Harrison G. Utility of Dried Blood Spots for the Diagnosis of Congenital Cytomegaloviruses within the First 21 Days of Life in a Single Center. Int J Neonatal Screen 2023; 9:44. [PMID: 37606481 PMCID: PMC10443379 DOI: 10.3390/ijns9030044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
In this retrospective study, we aimed to evaluate the performance of dried-blood-spot (DBS) testing as a diagnostic method for the congenital cytomegalovirus (cCMV). We reviewed the medical records and DBS test results of 89 patients who had also undergone diagnostic cCMV testing within the first 21 days of life. The DBS test had a sensitivity of 83.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 73%. Patients with a true-positive DBS had a higher median level of CMV in blood according to PCR than those with a false-negative result. Additionally, all patients with cCMV and hearing loss had a positive DBS test, with higher median viremia levels observed in those with hearing loss compared to those without a CMV PCR blood test. These results suggest that DBS-based testing is useful in the diagnosis of cCMV, and its performance may be related to levels of CMV viremia. DBS testing accurately identified those patients with congenital/early onset hearing loss and those at risk of developing late-onset hearing loss.
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Affiliation(s)
| | | | | | - Gail Demmler-Harrison
- Department of Pediatrics, Division of Infectious Disease, Baylor College of Medicine, Houston, TX 77030, USA; (A.D.V.P.); (J.M.); (R.R.)
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19
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Rodriguez AK, Tjiattas-Saleski L. A Case Report on Congenital Cytomegalovirus. Cureus 2023; 15:e42792. [PMID: 37664302 PMCID: PMC10469921 DOI: 10.7759/cureus.42792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Cytomegalovirus (CMV) is the most common congenital infection worldwide and in the United States. The majority of healthy adults who acquire CMV infections have few symptoms and no long-term consequences, though this is not the case for certain groups, including neonates infected in utero. This infection can lead to permanent sequelae, including death. Despite this, congenital cytomegalovirus (cCMV) is not well known among women of childbearing age. Women are more informed about neural tube defects, fetal alcohol syndrome, Down syndrome, and toxoplasmosis than they are about cCMV, although these pose less threat to the newborn. This is a case of a newborn presenting with petechiae, thrombocytopenia, and direct hyperbilirubinemia due to cCMV infection. The initial diagnosis was congenital sepsis, not cCMV. This case report highlights the importance of including a TORCH (toxoplasmosis, others, such as syphilis, rubella, CMV, and herpes) panel when considering abnormal neonatal findings. Diagnosing cCMV is critical, especially because untreated infection can cause permanent sequelae, including death.
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Affiliation(s)
- Arley K Rodriguez
- Obstetrics and Gynecology, Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, USA
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20
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Aldè M, Binda S, Primache V, Pellegrinelli L, Pariani E, Pregliasco F, Di Berardino F, Cantarella G, Ambrosetti U. Congenital Cytomegalovirus and Hearing Loss: The State of the Art. J Clin Med 2023; 12:4465. [PMID: 37445500 DOI: 10.3390/jcm12134465] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In developed countries, congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, representing the leading non-genetic cause of sensorineural hearing loss (HL). Diagnosis of cCMV infection can be performed by detection of CMV DNA in urine or saliva within 2-3 weeks after birth, or later in dried blood samples on the Guthrie card. Currently, there are many controversies regarding the preventive, diagnostic, and therapeutic approaches to cCMV infection. HL secondary to cCMV is highly variable in onset, side, degree, audiometric configuration, and threshold changes over time. Therefore, it is of paramount importance to perform a long and thorough audiological follow-up in children with cCMV infection to ensure early identification and prompt treatment of progressive and/or late-onset HL. Early cochlear implantation appears to be a valid solution not only for children with bilateral profound HL, but also for those with single-sided deafness, improving localization ability and understanding speech in noisy environments. Moreover, the decision to apply a unilateral cochlear implant in children with cCMV is strengthened by the non-negligible possibility of hearing deterioration of the contralateral ear over time.
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Affiliation(s)
- Mirko Aldè
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Valeria Primache
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Fabrizio Pregliasco
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Federica Di Berardino
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Umberto Ambrosetti
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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21
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Palma S, Forli F, Rossi C, Filice R, D'adamo C, Roversi MF, Monzani D, Lorenzoni F, Botti C, Berrettini S, Bruschini L, Berardi A, Genovese E, Canelli R. The Audiological Follow-Up of Children with Symptomatic Congenital Cytomegalovirus Infection: An Experience in Two Italian Centers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1136. [PMID: 37508638 PMCID: PMC10378266 DOI: 10.3390/children10071136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection is the leading cause of non-hereditary sensorineural hearing loss in children. While about 10% of children reportedly display symptoms at birth, 85-90% of cCMV infection cases are asymptomatic. However, 10-15% of these asymptomatic infants may later develop hearing, visual, or neurodevelopmental impairments. This study aimed to evaluate the impact of cCMV infection on newborns' hearing function with a particular emphasis on progressive and late-onset cases. METHODS This study is a retrospective chart analysis with longitudinal character and was conducted in two Italian centers: Center 1 (from 1 November 2007 to 31 December 2021) and Center 2 (from 1 January 2012 to 31 December 2021). Data collected included newborn hearing screening results, characterization of hearing loss (unilateral/bilateral, degree of impairment), and audiological follow-up. RESULTS The cohort consisted of 103 children (42% males, 58% females). In total, 28 children presented with hearing impairment; 71.4% (20 out of 28) of the cases of hearing loss were severe/profound, with 35.7% of the cases due to unilateral hearing loss. Out of twenty-eight, six experienced progression of hearing loss and four had late-onset hearing loss. CONCLUSIONS In the absence of universal cCMV screening, hearing screening at birth for cCMV remains a critical factor for early diagnosis. A significant percentage of children affected by cCMV with normal audiological evaluations at birth is easily lost to follow-up. Close collaboration between neonatologists, pediatricians, and audiological services is fundamental to ensure timely diagnosis and treatment of cCMV-related hearing loss.
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Affiliation(s)
- Silvia Palma
- Audiology, Primary Care Department, AUSL of Modena, 41100 Modena, Italy
| | - Francesca Forli
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria, 56121 Pisa, Italy
| | - Cecilia Rossi
- Department of Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Riccardo Filice
- Department of Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Concetta D'adamo
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Maria Federica Roversi
- Department of Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Daniele Monzani
- ENT, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Borgo Roma Hospital, 37100 Verona, Italy
| | - Francesca Lorenzoni
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, 56124 Pisa, Italy
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy
| | - Stefano Berrettini
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria, 56121 Pisa, Italy
| | - Luca Bruschini
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria, 56121 Pisa, Italy
| | - Alberto Berardi
- Department of Neonatal Intensive Care Unit, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Elisabetta Genovese
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria of Modena, 41125 Modena, Italy
| | - Rachele Canelli
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria, 56121 Pisa, Italy
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22
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Zhang Y, Egashira T, Egashira M, Ogiwara S, Tomino H, Shichijo A, Mizukami T, Ogata T, Moriuchi H, Takayanagi T. Expanded targeted screening for congenital cytomegalovirus infection. Congenit Anom (Kyoto) 2023; 63:79-82. [PMID: 36946004 DOI: 10.1111/cga.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 02/26/2023] [Indexed: 03/23/2023]
Abstract
An early diagnosis and intervention for congenital cytomegalovirus infection can reduce long-term disability; however, the introduction of universal neonatal screening has been controversial worldwide. The present study clarified the outcome of a targeted screening protocol for detecting congenital cytomegalovirus infection based on suggestive perinatal conditions. In addition, the positive rate was compared to those from the reported studies and the validity of the targeted screening criteria was discussed. A total of 2121 newborn infants were admitted to our hospital between October 2018 and October 2021. Cytomegalovirus DNA was examined by the isothermal nucleic acid amplification method for urine samples from newborns with any of the following: microcephaly, abnormal ultrasound findings in the brain and visceral organs, repeated failure in neonatal hearing screening, suspicious maternal cytomegalovirus infection during pregnancy, and other abnormal findings suggestive of congenital cytomegalovirus infection. Among 2121 newborns, 102 (4.8%) were subject to the urine cytomegalovirus DNA test based on the abovementioned criteria. Of them, three were cytomegalovirus DNA-positive. According to the protocol, the cytomegalovirus DNA-positive rates were 0.14% among the total enrollment of 2121 newborns and 2.9% (3/102) among the targeted newborns. This protocol may overlook congenital cytomegalovirus infection that is asymptomatic or exhibits inapparent clinical manifestations only at birth; however, it is feasible and helps lead to the diagnosis of congenital cytomegalovirus infection that may otherwise be overlooked.
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MESH Headings
- Humans
- Infant, Newborn
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- Cytomegalovirus/physiology
- Cytomegalovirus Infections/diagnosis
- Cytomegalovirus Infections/pathology
- Cytomegalovirus Infections/urine
- Cytomegalovirus Infections/virology
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/urine
- Infant, Newborn, Diseases/virology
- Neonatal Screening
- Female
- Pregnancy
- DNA, Viral/genetics
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Affiliation(s)
- Yumeng Zhang
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
- Department of Pediatrics, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomoko Egashira
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Masakazu Egashira
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Shun Ogiwara
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Hiroyuki Tomino
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Akinori Shichijo
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Tomoko Mizukami
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
| | - Tsutomu Ogata
- Department of Pediatrics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshimitsu Takayanagi
- Department of Pediatrics, National Hospital Organization Saga National Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan
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23
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Kettler M, Shoup A, Moats S, Steuerwald W, Jones S, Stiell SC, Chappetto J. American Academy of Audiology Position Statement on Early Identification of Cytomegalovirus in Newborns. J Am Acad Audiol 2023. [PMID: 36972678 DOI: 10.1055/s-0043-1768036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The American Academy of Audiology recommends early identification of congenital cytomegalovirus (cCMV) through screening to allow for appropriate early diagnosis, intervention, and monitoring for congenital, progressive, and delayed-onset hearing loss in infants with cCMV.Early identification of cCMV is a valuable component in the diagnostic evaluation of infants with sensorineural hearing loss. The Academy recognizes the important role audiologists serve as clinical care providers and educators and advocates for early identification and audiological management of infants with cCMV.
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Affiliation(s)
- Maggie Kettler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Shoup
- Callier Center for Communication Disorders, The University of Texas at Dallas, Dallas, Texas
| | - Shelley Moats
- Norton Children's Medical Group, Louisville, Kentucky
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24
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Hoki C, White M, Pesch MH, Melvin AJ, Park AH. A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection. Int J Neonatal Screen 2023; 9:ijns9020017. [PMID: 37092511 PMCID: PMC10123618 DOI: 10.3390/ijns9020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) continues to be a major public health care issue due to its high prevalence throughout the world. However, there is a paucity of studies evaluating how providers manage this infection. This study surveyed North American Pediatric Infectious Disease (PID) physicians to elicit their approach towards the evaluation and treatment of this condition. Thirty-two PID physicians responded to this survey. Institutional testing and screening for cCMV were infrequently reported. The respondents in general agreed upon most laboratory and diagnostic testing except for neuroimaging. For those tests, there was a disparity in indications for head ultrasound versus brain MRI imaging. Most (68.8%) agreed with the clinical practice of starting valganciclovir in an infant less than 1 month of age with one sign or symptom of disease, and 62.5% would do so for an infant with isolated sensorineural hearing loss. However, only 28.1% would treat cCMV-infected infants older than 1 month of age. In conclusion, few healthcare institutions represented by PID physicians in this cohort had a cCMV screening or testing initiative, yet most respondents would test at a much higher level based on their clinical practice. While there is general consensus in evaluation and treatment of these children, there are disparities in practices regarding neuroimaging and indications for antiviral treatment with respect to age and severity of disease. There is a great need for an evidence based policy statement to standardize cCMV workup and treatment.
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Affiliation(s)
- Chieko Hoki
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Michelle White
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ann J Melvin
- Pediatric Infectious Disease, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - Albert H Park
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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25
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Phillips VL, Xu J, Park A, Gantt S, Dedhia K. The cost-effectiveness of targeted screening for congenital cytomegalovirus in newborns compared to clinical diagnosis in the US. Int J Pediatr Otorhinolaryngol 2023; 166:111450. [PMID: 36773448 DOI: 10.1016/j.ijporl.2023.111450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) is the leading environmental cause of hearing loss (HL) among children, affecting four in one thousand newborns. cCMV testing in the US is currently based on clinical diagnosis which does not consistently identify cCMV cases and precludes early intervention to prevent and reduce the severity of HL. We estimated the cost-effectiveness of targeted newborn screening and cCMV testing among newborns compared to clinical diagnosis. METHODS We use a decision-analytic model to estimate the costs of preventing HL progression, of additional cases of severe HL, of identifying a case of HL one year earlier, and of identifying an additional case of cCMV, through targeted screening and cCMV testing for infants failing two newborn hearing screens with follow-up to age five. We also estimate the costs of nationwide implementation of a newborn screening and testing program. Model pathways were based on best practices for screening, testing, and treatment. Probabilities were drawn from the published literature; costs were estimated based on Medicare reimbursement rates. Probabilistic and scenario analyses were conducted to determine the robustness of results. RESULTS Targeted testing and cCMV screening, compared to standard of care, cost an additional $2.96 (±2.26) per infant screened and identified 0.00038 (±0.00022) cases of HL, 3.8 in 10000 children, at a cost of $8197 (±4217) per case of HL identified. Implementing targeted screening for all children in the US was estimated to cost $193,229. CONCLUSIONS Although cases numbers are small, our model shows that targeted newborn screening and cCMV testing reduced cases of HL progression. Adoption of newborn targeted screening as standard of care should be considered given it may prevent disability at very low cost.
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Affiliation(s)
- Victoria L Phillips
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Albert Park
- University of Utah, Department of Pediatric Otolaryngology, Salt Lake City, UT, USA
| | - Soren Gantt
- Departments of Microbiology, Infectiology & Immunology and Pediatrics, University of Montreal, Research Centre of the Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, USA
| | - Kavita Dedhia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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26
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Liao EN, Stephans J, Taketa E, Mohamad NI, Kaur Khalsa I, Naugle K, Chan DK. Factors associated with congenital cytomegalovirus infection detected by dried blood spot testing in children with hearing loss. Int J Pediatr Otorhinolaryngol 2023; 165:111446. [PMID: 36657329 DOI: 10.1016/j.ijporl.2023.111446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/11/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) infection in infants leads to an increased risk of developing sensorineural hearing loss (SNHL), even if they are asymptomatic at birth. There are currently no national guidelines for universal screening for CMV, placing children with cCMV at a high risk for unidentified and untreated HL, which in turn places them at greater risk for lasting impacts on quality of life and cognitive and behavioral abilities. We sought to describe the sociodemographic and hearing loss characteristics of children with HL due to cCMV. DESIGN We performed a retrospective cohort study of patients 0-18 years of age who completed CMV dried blood spot (DBS) testing in our HL clinic before April 1, 2022. Home ZIP codes were entered into the Healthy Places Index (HPI) database to quantify the health of the community in which the patient lived. Severity of HL was determined by pure tone averages (PTA) of hearing thresholds for frequencies of 500Hz, 1000Hz, 2000Hz, and 4000Hz. Progression was defined as those who referred on newborn hearing screen and then had a >15 dB increase in PTA, and those who passed newborn hearing screen and were found to have HL later in life. Logistic regression was used to compare variables. RESULTS Of 365 children who received a CMV DBS test, 15 (4%) had a positive test, indicating the presence of cCMV infection, and 350 (96%) had a negative test. 192 (53%) were male, 212 (58%) were URM, 202 (55%) had public insurance, the median number of ICD-10 codes was 2 (range 0-53), and the median HPI percentile score was 71.2 (range: 3.4-99.9). Although CMV DBS testing was ordered for those with suspicion of SNHL, ultimately diagnostic testing found 333 (91%) with SNHL, 4 (1%) with CHL, 13 (4%) with mixed HL, 9 (3%) with auditory neuropathy spectrum disorder, and 5 (4%) with unspecified HL, and 11 (3%) without HL. Of the 353 patients with HL, 126 (36%) had unilateral, 156 (44%) had symmetric bilateral, and 71 (20%) had asymmetric bilateral HL; 183 (52%) had progressive and 138 (39%) had stable HL. In children with SNHL (n = 333), we tested the association of socio-demographic and audiologic factors with cCMV. Those with asymmetric bilateral SNHL (OR 5.19, 95% CI 1.81-14.90) or profound SNHL (>90 dB) in either ear (OR 13.91, 95% CI 3.82-50.67) had higher odds of having cCMV. Those with symmetric bilateral SNHL had lower odds of a positive CMV DBS test result (OR 0.17, 95% CI 0.02-0.76). All sociodemographic variables, medical comorbidities, and other audiologic variables were not associated with CMV DBS test results. CONCLUSION Congenital CMV infection is associated with asymmetric bilateral and profound SNHL. More research is warranted to determine best practices for universal screening for cCMV to identify these children.
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Affiliation(s)
- Elizabeth N Liao
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jihyun Stephans
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Emily Taketa
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Noura I Mohamad
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Inderpreet Kaur Khalsa
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kendyl Naugle
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Congenital Cytomegalovirus Infection and Hearing Outcomes in Twins: A Systematic Review of Reported Cases. Otol Neurotol 2023; 44:e53-e62. [PMID: 36538753 DOI: 10.1097/mao.0000000000003776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus infection is the leading nonhereditary cause of pediatric sensorineural hearing loss. This systematic review evaluated infection concordance and comparative hearing abilities in twins/multiple births to model infection patterns. DATABASES REVIEWED PubMed, Embase, Web of Science, and Google Scholar. METHODS Studies that reported hearing outcomes of congenital cytomegalovirus infection in at least one multiple birth were eligible. Concordant infections (both twins) and discordant infections (single twin) were included. Multiple reviewers performed data extraction and quality assessment. Analyses involved relative risk of infection concordance by zygosity and chorionicity and odds of hearing loss by infection concordance. Hearing outcomes were compared between siblings. RESULTS Of 247 studies screened, 31 were included (74.2% high quality). The review captured 40 eligible multiple births. Among infected patients, 42.9% (95% confidence interval, 31.2-55.2%) demonstrated hearing loss. All uninfected twins had normal hearing. Most infections were concordant, and infected patients experienced 4.11 (1.18-14.36) times greater odds of hearing loss if their twin was also infected ( p = .02). Yet siblings' hearing outcomes diverged in over 40% of concordant cases. If either twin is infected, infection risk in the second twin is 3.25 (1.83-5.79) times greater in monozygotic than dizygotic twins and 2.50 (1.61-3.88) times greater in monochorionic than dichorionic twins (both p < .001). We describe a case from our practice. CONCLUSION Congenital cytomegalovirus infection patterns and hearing outcomes can vary widely even within a shared fetal and postnatal environment. Suspected infection in a twin indicates that both should receive testing and continued monitoring for late-onset sequelae.
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Chenge S, Ngure H, Kanoi BN, Sferruzzi-Perri AN, Kobia FM. Infectious and environmental placental insults: from underlying biological pathways to diagnostics and treatments. Pathog Dis 2023; 81:ftad024. [PMID: 37727973 DOI: 10.1093/femspd/ftad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
Because the placenta is bathed in maternal blood, it is exposed to infectious agents and chemicals that may be present in the mother's circulation. Such exposures, which do not necessarily equate with transmission to the fetus, may primarily cause placental injury, thereby impairing placental function. Recent research has improved our understanding of the mechanisms by which some infectious agents are transmitted to the fetus, as well as the mechanisms underlying their impact on fetal outcomes. However, less is known about the impact of placental infection on placental structure and function, or the mechanisms underlying infection-driven placental pathogenesis. Moreover, recent studies indicate that noninfectious environmental agents accumulate in the placenta, but their impacts on placental function and fetal outcomes are unknown. Critically, diagnosing placental insults during pregnancy is very difficult and currently, this is possible only through postpartum placental examination. Here, with emphasis on humans, we discuss what is known about the impact of infectious and chemical agents on placental physiology and function, particularly in the absence of maternal-fetal transmission, and highlight knowledge gaps with potential implications for diagnosis and intervention against placental pathologies.
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Affiliation(s)
- Samuel Chenge
- Department of Medical Microbiology and Laboratory Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, off Thika road, P. O. Box 62000-00200 Nairobi, Kenya
| | - Harrison Ngure
- Directorate of Research and Innovation, Mount Kenya University, General Kago road, P.O. Box 342-01000, Thika, Kenya
| | - Bernard N Kanoi
- Directorate of Research and Innovation, Mount Kenya University, General Kago road, P.O. Box 342-01000, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, General Kago road, P.O. Box 342-01000, Thika, Kenya
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Francis M Kobia
- Directorate of Research and Innovation, Mount Kenya University, General Kago road, P.O. Box 342-01000, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, General Kago road, P.O. Box 342-01000, Thika, Kenya
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Fitzpatrick EM, Nassrallah F, Gaboury I, Whittingham J, Vos B, Coyle D, Durieux-Smith A, Pigeon M, Olds J. Trajectory of hearing loss in children with unilateral hearing loss. Front Pediatr 2023; 11:1149477. [PMID: 37114003 PMCID: PMC10126436 DOI: 10.3389/fped.2023.1149477] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction The aim of this study was to quantify the amount of deterioration in hearing and to document the trajectory of hearing loss in early identified children with unilateral hearing loss (UHL). We also examined whether clinical characteristics were associated with the likelihood of having progressive hearing loss. Methods As part of the Mild and Unilateral Hearing Loss Study, we followed a population-based cohort of 177 children diagnosed with UHL from 2003 to 2018. We applied linear mixed models to examine hearing trends over time including the average amount of change in hearing. Logistic regression models were used to examine the relationship between age and severity at diagnosis, etiology, and the likelihood of progressive loss and amount of deterioration in hearing. Results The median age of the children at diagnosis was 4.1 months (IQR 2.1, 53.9) and follow-up time was 58.9 months (35.6, 92.0). Average hearing loss in the impaired ear was 58.8 dB HL (SD 28.5). Over the 16-year period, 47.5% (84/177) of children showed deterioration in hearing in one or both ears from their initial diagnostic assessment to most recent assessment including 21 (11.9%) who developed bilateral hearing loss. Average deterioration in the impaired ear ranged from 27 to 31 dB with little variation across frequencies. Deterioration resulted in a change in category of severity for 67.5% (52/77) of the children. Analysis for children who were followed for at least 8 years showed that most lost a significant amount of hearing rapidly in the first 4 years, with the decrease stabilizing and showing a plateau in the last 4 years. Age and severity at diagnosis were not significantly associated with progressive/stable loss after adjusting for time since diagnosis. Etiologic factors (ENT external/middle ear anomalies, inner ear anomalies, syndromic hearing loss, hereditary/genetic) were found to be positively associated with stable hearing loss. Conclusion Almost half of children with UHL are at risk for deterioration in hearing in one or both ears. Most deterioration occurs within the first 4 years following diagnosis. Most children did not experience sudden "large" drops in hearing but more gradual decrease over time. These results suggest that careful monitoring of UHL especially in the early years is important to ensure optimal benefit from early hearing loss detection.
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Affiliation(s)
- Elizabeth M. Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, ON, Canada
- Correspondence: Elizabeth M. Fitzpatrick
| | - Flora Nassrallah
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, ON, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - JoAnne Whittingham
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, ON, Canada
- Audiology Clinic, CHEO, Ottawa, ON, Canada
| | - Bénédicte Vos
- School of Public Health, Université libre de Bruxelles (ULB), Brussells, Belgium
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrée Durieux-Smith
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, ON, Canada
| | | | - Janet Olds
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, ON, Canada
- Audiology Clinic, CHEO, Ottawa, ON, Canada
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Novelli M, Natale F, Di Norcia A, Boiani A, Temofonte S, Calandriello F, Zitarelli C, Caravale B. Early neurodevelopmental outcomes in children with asymptomatic congenital CMV infection. Ital J Pediatr 2022; 48:203. [PMID: 36572905 PMCID: PMC9793498 DOI: 10.1186/s13052-022-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/23/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Approximately 85-90% of congenital cytomegalovirus infections (cCMV) are asymptomatic. Few studies have investigated early and long-term neurodevelopmental outcomes in children with asymptomatic cCMV (acCMV), and the data is contradictory. In the present study, we did investigate the effect of cCMV asymptomatic infection on neurological outcomes and in cognitive, language and motor development at 6 months of age. METHODS Fifty-six children with cCMV asymptomatic infection were followed for 6 months, as part of a long-term surveillance program, examining their neurological and developmental outcomes. Neurological examination and Bayley-III Scales were performed. RESULTS Clinical evaluation revealed that early neurological outcomes were essentially normal, with minor neurological deficits (i.e., tone abnormalities) in a subgroup of patients. Bayley-III scores were substantially in the normal range, with 14% showing a score less than 85 (-1SD) in the Motor Scale. Children's neurological and neurodevelopmental outcomes at 6 months of age did not differ according to the trimester of infection. CONCLUSIONS Some infants with cCMV asymptomatic infection may present minor neurological abnormalities in early stages of life. It seems useful to monitor this population for early and late neurodevelopmental sequelae.
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Affiliation(s)
- Maria Novelli
- grid.7841.aDepartment of Human Neuroscience, Polyclinic Umberto I Hospital, Sapienza University, Via Dei Sabelli 108, 00185 Rome, Italy
| | - Fabio Natale
- grid.7841.aDepartment of Maternal and Child Sciences and Urology, Polyclinic Umberto I Hospital, Sapienza University, Rome, Italy
| | - Anna Di Norcia
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Arianna Boiani
- grid.7841.aDepartment of Human Neuroscience, Polyclinic Umberto I Hospital, Sapienza University, Via Dei Sabelli 108, 00185 Rome, Italy
| | - Sara Temofonte
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Francesca Calandriello
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy ,Centro NE.SVI, Rome, Italy
| | - Cristina Zitarelli
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Barbara Caravale
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Tapasak B, Cronkite DA, Hustedt-Mai AR, Morlet TM, Parkes WJ, Maul TM, Pritchett CV. Hearing outcomes in children with Congenital Cytomegalovirus: A multi-center, single-enterprise experience. Int J Pediatr Otorhinolaryngol 2022; 163:111376. [PMID: 36370539 DOI: 10.1016/j.ijporl.2022.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/29/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common cause of non-genetic sensorineural hearing loss (SNHL) in the United States; yet screening for congenital CMV (cCMV) remains controversial. CMV related SNHL can be present at birth, or develop in a delayed manner, and it is a consistent feature in children with either symptomatic or asymptomatic disease. A retrospective chart review was performed to determine the characteristics of patients diagnosed with cCMV and SNHL. METHODS The electronic database warehouse of the Nemours Children's Health System (NCHS) was queried from 01/01/2004 to 10/05/2019. ICD 9 (771.1) and ICD 10 (B25.9, P35.1) diagnostic codes were used to identify patients throughout the system with a diagnosis of cCMV infection. Patient demographics including gender, race/ethnicity, age of diagnosis, results of newborn hearing screening (NBHS), detection and progression of hearing loss, presence of antiviral therapy, and frequency of monitoring were collected, and descriptive statistics performed. RESULTS Of the 170 patients confirmed to have cCMV, 153 (90%) were symptomatic and 17 (10%) were asymptomatic. CNS involvement (63.5%), radiographic evidence of disease present (69.4%), and SNHL (50.6%) were the most common manifestations of the disease. Of these 170 patients, 83 (48.8%) were determined to have SNHL eligible for evaluation. For these patients with SNHL, the average time of hearing monitoring was 50.6 months. At the time of initial reported detection 63 of 83 (76%) had bilateral hearing loss and 20 (24%) had unilateral loss. Over the study period 3 (15%) progressed from unilateral to bilateral involvement, and 32 (47%) had a deterioration in hearing, with severe to profound SNHL in at least one ear identified at the last visit in 53 (64%) patients. Newborn hearing testing results were available for 69 (83%) of those with hearing loss and 26 patients passed initial testing. However, of the 26 patients who passed, 22 (85%) eventually developed SNHL by their last visit. Within our cohort, females with cCMV were significantly more likely to have SNHL than males with cCMV (62.3% versus 37.6%; p < 0.01). CONCLUSION In the absence of targeted or universal cCMV screening, the majority of children identified with this condition present symptomatically. Approximately one half of children with symptomatic cCMV failed NBHS at birth while at least 25% develop SNHL later in life. Children with cCMV are at high risk of delayed onset loss and such children, particularly females, should be monitored closely.
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Affiliation(s)
- Brandon Tapasak
- University of Central Florida College of Medicine, Orlando, FL, USA.
| | - David Alex Cronkite
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), Los Angeles, California, USA
| | - Alexandra R Hustedt-Mai
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - Thierry M Morlet
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - William J Parkes
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Timothy M Maul
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pediatric Otolaryngology, Nemours Children's Hospital, Orlando, FL, USA
| | - Cedric V Pritchett
- University of Central Florida College of Medicine, Orlando, FL, USA; Division of Pediatric Otolaryngology, Nemours Children's Hospital, Orlando, FL, USA
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Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation. Braz J Otorhinolaryngol 2022; 89:159-189. [PMID: 36529647 PMCID: PMC9874360 DOI: 10.1016/j.bjorl.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss. CONCLUSIONS Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Muacevic A, Adler JR. A Review of Sensorineural Hearing Loss in Congenital Cytomegalovirus Infection. Cureus 2022; 14:e30703. [PMID: 36439580 PMCID: PMC9693817 DOI: 10.7759/cureus.30703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
The intrauterine transmission of the TORCH group (toxoplasmosis, rubella cytomegalovirus (CMV), herpes simplex, and HIV) produces severe complications in the fetus, leading to major life challenges for the newborns. CMV is considered one of the leading causes of congenital hearing loss in babies born to infected mothers. The majority of the cases are asymptomatic but a certain proportion show symptoms, which may not be present until later. The human cytomegalovirus (HCMV) infection can also be transferred to the baby postnatally through breastfeeding. Mothers facing primary infection from the CMV have a greater tendency to transmit the infection to the fetus, whereas secondary infection due to reactivation of the virus in females who were affected before pregnancy, delivers asymptomatic babies in most cases. Vertical transmission of HCMV, that is via the placenta from infected mother to fetus, is one of the leading causes of congenital sensorineural hearing loss (SNHL) and neurodevelopmental complications in newborns. It accounts for up to 10% of SNHL cases in newborns, of both unilateral and bilateral types. Antiviral therapy is helpful in such cases if administered within the first month of life, and for hearing impairment, cochlear implants have been used to treat children who develop profound hearing loss. The child can present with hearing loss at birth or it may be late in onset and of progressive type. Suspected children should be evaluated regularly for the early detection of hearing loss and to provide the appropriate treatment.
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Jin Y, Liu X, Chen S, Xiang J, Peng Z, Sun Y. Analysis of the Results of Cytomegalovirus Testing Combined with Genetic Testing in Children with Congenital Hearing Loss. J Clin Med 2022; 11:jcm11185335. [PMID: 36142981 PMCID: PMC9504080 DOI: 10.3390/jcm11185335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022] Open
Abstract
To improve the etiological diagnosis of congenital hearing loss by combining whole-exome sequencing (WES) with cytomegalovirus (CMV) testing and to explore the potential benefits of adding CMV screening to newborn hearing screening, 80 children under 2 years of age with bilateral sensorineural hearing loss were recruited. Peripheral venous blood was extracted from the children for WES analysis. Saliva after mouthwash and the first urine in the morning were collected and used as samples to quantify CMV DNA copy number in urine and saliva by qPCR; among the 80 children with congenital deafness, 59 (74%) were found to have genetic variants that may cause congenital deafness, including 44 with GJB2 or SLC26A4 gene variant, 1 with STRC gene variant, and 14 with other genetic variants. A total of 12 children carried deafness gene variants associated with a syndrome; CMV test results showed that in two children, the CMV DNA copy number in saliva was >1000/mL, which indicates that they were CMV-positive, and their genetic test results were negative. A neonatal CMV test combined with genetic screening can improve the etiological diagnosis rate of congenital deafness, and the direct evidence of neonatal CMV infection deserves further verification.
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Affiliation(s)
- Yuan Jin
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaozhou Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sen Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiale Xiang
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhiyu Peng
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence:
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Dhondt C, Maes L, Martens S, Vanaudenaerde S, Rombaut L, Sucaet M, Keymeulen A, Van Hoecke H, De Leenheer E, Dhooge I. Predicting Early Vestibular and Motor Function in Congenital Cytomegalovirus Infection. Laryngoscope 2022. [PMID: 36054219 DOI: 10.1002/lary.30375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV) can affect vestibular function, which is an important cornerstone for early motor development. This study aims to identify risk factors for early vestibular dysfunction with severe repercussions on the motor outcome. METHODS This prospective cohort study included 169 cCMV-patients with complete vestibular assessment (lateral video Head Impulse Test and cervical Vestibular Evoked Myogenic Potentials) before the age of 18 months (mean 8.9, standard deviation 3.27 months). Motor results using the Alberta Infant Motor Scale were collected in 152 of these patients. Logistic and linear regression models were applied to identify risk factors for the vestibular and motor outcomes, respectively. RESULTS The odds of developing early vestibular dysfunction were 6 times higher in patients presenting with hearing loss at birth compared to those born with normal hearing (p = .002). Within the latter group, significant predictors for vestibular dysfunction were (delayed-onset) hearing impairment at the time of vestibular testing (p = .003) and the presence of periventricular cysts on magnetic resonance imaging (p = .005). Remarkably, none of the patients infected during the third trimester of pregnancy (n = 14) developed early vestibular dysfunction. On average, vestibular-impaired patients had a z-score on the Alberta Infant Motor Scale that was 1.17 points lower than patients without vestibular deficit (p < .001). CONCLUSION Early vestibular loss can have a significant adverse effect on motor development. Hearing and cranial imaging findings could facilitate the widespread implementation of a (targeted) vestibular assessment approach in the cCMV-population. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Marieke Sucaet
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Annelies Keymeulen
- Neonatal Intensive Care Department, Ghent University Hospital, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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36
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杨 军, 金 玉, 陈 建, 张 青, 段 茂. [To address on the refined and individualized comprehensive evaluation of inner ear function]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:651-658;664. [PMID: 36036063 PMCID: PMC10127629 DOI: 10.13201/j.issn.2096-7993.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Auditory and vestibular function detection technology is the premise and key to the diagnosis and management for inner ear diseases. Concurrent damage to the auditory and vestibular system occurs in many inner ear diseases. The general points and issues on hearing and vestibular function tests, as well as the clinical significance of refined and individualized comprehensive evaluation of inner ear function are described in this paper.
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Affiliation(s)
- 军 杨
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 玉莲 金
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 建勇 陈
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 青 张
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 茂利 段
- 瑞典斯德哥尔摩卡罗林斯卡大学医院创伤与修复医学耳鼻咽喉病区Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- 瑞典斯德哥尔摩卡罗林斯卡医学院临床科学干预及技术系耳鼻咽喉头颈外科Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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Childhood Hearing Health and Early Language Exposure: A Culturally Sensitive Approach. Adv Pediatr 2022; 69:23-39. [PMID: 35985712 DOI: 10.1016/j.yapd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Implementation of the universal newborn hearing screening has changed the landscape for children born deaf or hard of hearing, and with this, pediatricians must be knowledgeable about the screening and referral process, state protocols, and how to support patients and their families in their unique journeys. Early access to language-spoken, signed, both-forms the foundation for successful outcomes for the development of fluent language. For children using spoken language, early access to sound is critical and can often be achieved with the assistance of hearing devices, even in the newborn period. For all language modalities, state-funded Deaf mentor programs allow families to have meaningful exposure to the Deaf community. The authors come from different professions in the health care and education fields, including General Pediatrics, Otolaryngology Head and Neck Surgery, and the state Department of Education, and use different languages, including spoken and American Sign Language.
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Abstract
Over a century of research has focused on improving our understanding of congenital cytomegalovirus (cCMV), yet it remains the most common congenital infection in the United States, affecting 3 to 6 per 1000 live born infants each year. Pregnancies affected by cCMV are at a heightened risk of spontaneous abortion and intrauterine fetal demise. Neonates born with cCMV are also at substantial risk for long-term neurodevelopmental sequelae and disability, including sensorineural hearing loss, even those born without clinically apparent disease. Considerable progress has been made in recent years in study of the epidemiology and transmission of cCMV, developing better diagnostic strategies, implementing newborn screening programs, improving therapeutics, and launching vaccine trials. In this article, we review recent developments in the understanding of the virology and immunobiology of cytomegalovirus. We further discuss how this knowledge informs our understanding of the pathophysiology of cCMV and directs strategies aimed at improving outcomes and quality of life for congenitally infected children. We also provide an update on the epidemiology of cCMV in the United States, evolving scientific understanding of maternal-fetal transmission, enhanced screening approaches, and recognition of neonatal and long-term sequelae. Finally, we review the current landscape of pediatric cCMV research and provide recommendations for novel and high-priority areas for future investigation.
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Affiliation(s)
- Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark R Schleiss
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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Pesch MH, Danziger P, Ross LF, Antommaria AHM. An Ethical Analysis of Newborn Congenital Cytomegalovirus Screening. Pediatrics 2022; 149:188128. [PMID: 35641472 DOI: 10.1542/peds.2021-055368] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) affects approximately 1 in every 200 US infants and can be associated with long-term neurodevelopmental sequelae, including sensorineural hearing loss, cerebral palsy, and intellectual disability. As cCMV is infrequently diagnosed based on clinical suspicion alone, newborn cCMV screening programs have been gaining traction, especially hearing-targeted programs which only test infants who fail their newborn hearing screen. cCMV screening programs raise unique ethical dilemmas of both under- and over-diagnosis of cCMV. In this Ethics Rounds, we present a case in which the parents of a child with symptomatic cCMV that was not recognized until 4 years of age urge the birth hospital to implement a cCMV screening program. We then ask a parent-clinician, a medical ethicist and pediatrician, and a primary care pediatrician to comment on how they would advise the hospital administration and consider the ethical and clinical implications of a cCMV screening program. The commentaries herein arrive at differing conclusions about cCMV screening. The first highlights the developmental advantages of early cCMV detection, supporting a broad approach to treatment beyond antiviral medication alone. The second explores cCMV screening from the perspective of newborn screening as a public health program, noting shortcomings in available testing platforms, and raising concerns about overdiagnosis and overtreatment. The final commentary challenges the risks of undue parental anxiety and vulnerable child syndrome as a barrier to screening, instead considering cCMV screening as a controlled opportunity to understand and support the experiences of affected children and their families.
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Affiliation(s)
- Megan H Pesch
- University of Michigan and CS Mott Children's Hospital, Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Ann Arbor, Michigan
| | - Phoebe Danziger
- Munson Healthcare Otsego Memorial Hospital, Gaylord, Michigan
| | - Lainie Friedman Ross
- Department of Pediatrics.,MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois
| | - Armand H Matheny Antommaria
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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Fourgeaud J, Boithias C, Walter-Nicolet E, Kermorvant E, Couderc S, Parat S, Pol C, Mousset C, Bussières L, Guilleminot T, Ville Y, Nkam L, Grimaldi L, Parodi M, Leruez-Ville M. Performance of Targeted Congenital Cytomegalovirus Screening in Newborns Failing Universal Hearing Screening: A Multicenter Study. Pediatr Infect Dis J 2022; 41:478-481. [PMID: 35093998 DOI: 10.1097/inf.0000000000003474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most frequent cause of congenital infection and ≈20% of all infected neonates present or will develop sensorineural hearing loss. Targeted congenital CMV (cCMV) screening in newborns who failed universal newborn hearing screening has been proposed as a strategy to identify neonates with both hearing loss and cCMV infection who could benefit from antiviral treatment implemented within the first month of life. OBJECTIVES To evaluate the feasibility and performance of cCMV targeted screening in a French setting. METHODS Neonates were recruited in 5 maternity centers in greater Paris. A saliva sample for CMV polymerase chain reaction (PCR) testing was collected in neonates who failed newborn hearing screening. Outcomes including CMV PCR result and confirmation of hearing loss by an otorhinolaryngologist specialist were documented. RESULTS Two-hundred thirty-six newborns were included and a saliva sample was collected in 98% (231/236) of them. The result of CMV PCR was available at a median of 9 days (7-10 days) of life and in 96% of cases within the first month of life. Two neonates were infected with CMV. The result of the otorhinolaryngologist assessment was available in 75% (178/236) of cases at a median of 16 days (9-26 days). Hearing loss was confirmed in 2.8% (5/178). The 2 infected neonates had hearing loss confirmed at 5 and 8 days of life and were treated with valganciclovir at days 9 and 16, respectively. CONCLUSIONS The result of this study confirms that targeted cCMV screening is feasible in these French settings.
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Affiliation(s)
- Jacques Fourgeaud
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Claire Boithias
- AP-HP, Hospital Bicêtre, Neonatal Intensive Care Unit, Le Kremlin-Bicêtre, France
| | - Elisabeth Walter-Nicolet
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center; and Medicine and Neonatal Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elsa Kermorvant
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Université de Paris, Paris, France
| | - Sophie Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - Sophie Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - Christine Pol
- AP-HP, Hospital Bicêtre, Otology Department, Le Kremlin-Bicêtre, France
| | - Carole Mousset
- Hospital Saint Joseph, Otology Department, Paris, France
| | - Laurence Bussières
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Clinical Research Unit
| | - Tiffany Guilleminot
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Yves Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Maternity
| | - Lionelle Nkam
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Lamiae Grimaldi
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Marine Parodi
- AP-HP, Hospital Necker-E.M, Otology Department, Paris, France
| | - Marianne Leruez-Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
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Puhakka L, Lappalainen M, Lönnqvist T, Nieminen T, Boppana S, Saxen H, Niemensivu R. Hearing outcome in congenitally CMV infected children in Finland - Results from follow-up after three years age. Int J Pediatr Otorhinolaryngol 2022; 156:111099. [PMID: 35276528 DOI: 10.1016/j.ijporl.2022.111099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cytomegalovirus (CMV) is the most common congenital infection affecting about 0.6% of all newborns in developed countries. Vertical transmission to fetus can take place either after maternal primary or non-primary CMV infection during pregnancy. It is the most common infectious agent for sensorineural hearing loss (SNHL) in young children. The hearing loss after congenital CMV (cCMV) may be present at birth, or may develop after months or even years. In this study, we evaluated hearing outcome at 3-4 years of age in children (n 32) with cCMV identified in universal saliva CMV-PCR-based screening. METHODS Study population consisted of mainly asymptomatic children (median age 3.1 years) with cCMV identified in newborn CMV screening. The type of maternal CMV infection (primary or non-primary) was determined by analyzing CMV antibodies (IgM, IgG and IgG avidity) from preserved maternal serum samples drawn in the end of first trimester of pregnancy. Hearing was evaluated with pure tone audiometry (PTA), or transient-evoked otoacoustic emission (TEOAE) and sound field audiometry (SF). RESULTS Unilateral hearing loss occurred in 5/32 (16%) of the children with cCMV. None of the subjects in our cohort had bilateral hearing loss. Hearing loss occurred in 3/15 (20%) of children who were born to mothers with non-primary CMV infection during pregnancy, and in 2/10 (20%) of children whose mother had had a primary CMV infection during the 2-3 trimester. None of the additional 6 children, whose mother had primary infection in the first trimester, had hearing loss by age of 3-4 years. Two children with normal hearing at 1 years age had developed unilateral hearing loss by the age of three. CONCLUSIONS Unilateral hearing loss was relatively common among the mainly asymptomatic children with cCMV identified in screening. Long-term follow up of children with cCMV is essential to identify the children with late-onset hearing loss.
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Affiliation(s)
- Laura Puhakka
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suresh Boppana
- Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harri Saxen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Cushing SL, Purcell PL, Papaiaonnou V, Neghandi J, Daien M, Blaser SI, Ertl-Wagner B, Wagner M, Sheng M, James AL, Bitnun A, Papsin BC, Gordon KA. Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences. Laryngoscope 2022; 132 Suppl 11:S1-S24. [PMID: 35302239 DOI: 10.1002/lary.30108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. METHODS In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. RESULTS All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. CONCLUSIONS cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia L Purcell
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vicky Papaiaonnou
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Neghandi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maya Daien
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics (Infectious Diseases), University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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Yassine BB, Hulkower R, Dollard S, Cahill E, Lanzieri T. A Legal Mapping Assessment of Cytomegalovirus-Related Laws in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E624-E629. [PMID: 34225306 DOI: 10.1097/phh.0000000000001401] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Congenital cytomegalovirus (CMV) infection is the leading infectious cause of birth defects in the United States, affecting approximately 1 out of 200 newborns. Increasing awareness of congenital CMV infection among policy makers and the public is critical for advancing the evidence base for prevention and intervention strategies, including behavioral interventions for pregnant women, newborn screening to enable timely interventions, and garnering support for vaccine development. OBJECTIVE To understand the current landscape of CMV-related statutes and regulations, we conducted a 50-state legal epidemiology study of laws expressly referencing "cytomegalovirus." EVIDENCE REVIEW Our search yielded 101 statutes and regulations from 35 jurisdictions (34 states and District of Columbia). We systematically reviewed and coded the texts for themes. FINDINGS Laws addressed 3 main themes: (1) CMV awareness and education; (2) testing and reporting; and (3) the provision of services. CONCLUSIONS AND RELEVANCE State-level CMV laws have been enacted to increase CMV awareness and to implement CMV testing for infants at a higher risk for infection, such as those who do not pass newborn hearing screening. This study provides a complete legal assessment of existing ways law is used to address CMV infection in the United States.
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Affiliation(s)
- Brianne B Yassine
- Center for State, Tribal, Local, and Territorial Support (Drs Yassine and Hulkower), Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (Drs Dollard and Lanzieri), and Division of Human Development and Disability, National Center for Birth Defects and Developmental Disabilities (Mr Cahill), Centers for Disease Control and Prevention, Atlanta, Georgia
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Liddle K, Beswick R, Fitzgibbons EJ, Driscoll C. Aetiology of permanent childhood hearing loss at a population level. J Paediatr Child Health 2022; 58:440-447. [PMID: 34546616 DOI: 10.1111/jpc.15738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate and describe results of aetiological investigations offered to a population level cohort of babies who had confirmed permanent hearing loss after they either (i) failed universal neonatal hearing screening or (ii) passed newborn screening but were detected with a permanent hearing loss in early childhood. METHODS Descriptive analysis of results of investigations offered to neonates and young children in whom permanent hearing loss was detected as part of a statewide newborn hearing screening programme. A total of 306 285 newborns were screened between 2013 and 2017. The failed screening results were confirmed by a diagnostic audiological assessment battery. Medical evaluation for the identification of the cause of the hearing loss was performed by a paediatrician or otolaryngologist, investigations were ordered using a stepwise approach, and aetiology was assigned using a coding scheme. RESULTS Permanent hearing loss was confirmed in 967 children (0.3%). Data were available for 873. An aetiological factor was identified or presumed in 61.3% of cases. Genetic causes were present in 26.8% and structural causes were present in 24.9% of cases. Congenital cytomegalovirus was present in 4.4%. CONCLUSIONS Use of a coding scheme is feasible at a population level and allows collation of data from multiple sites and will allow outcome mapping and service planning.
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Affiliation(s)
- Karen Liddle
- Child Development Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Beswick
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - E Jane Fitzgibbons
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Carlie Driscoll
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Tissera KA, Williams A, Perry J, Kawai K, Kenna M, Mankarious LA. Hearing Stability in Patients With Unilateral Hearing Loss Due to Congenital CMV. Otolaryngol Head Neck Surg 2022; 167:739-744. [PMID: 35133894 DOI: 10.1177/01945998221076439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence and severity of progressive hearing loss in both ears in a population of longitudinally-tracked patients with unilateral hearing loss due to congenital cytomegalovirus (cCMV). By determining the natural history of unilateral hearing loss due to cCMV infection, we aim to facilitate therapeutic recommendations. STUDY DESIGN Retrospective chart review. SETTING Two tertiary care hospitals. METHODS Pure-tone averages (PTAs) based on yearly audiograms were calculated for each patient for both ears, and changes were assessed using a linear mixed-effects model. RESULTS A total of 32 patients with cCMV with congenital, unilateral hearing loss were enrolled. Of these, 4 (12.5%) had progressive losses ≥10 dB by PTA in the initially normal-hearing ear. For the hearing-impaired side, the mean (SD) PTA at initial presentation was 67.9 (29.2) dB. Eight patients initially in this cohort had profound hearing impairment, and of the other 24 patients, 17 (70.8%) had hearing loss progression. Hearing levels stabilized in the initially normal-hearing and hearing-impaired ear when patients were approximately 10 and 2 years old, respectively. CONCLUSION In 32 patients with unilateral hearing loss related to cCMV, 4 (12.5%) exhibited a shift in hearing levels in the normal-hearing ear that progressively stabilized by age 10 years. For ears with congenital hearing loss, progressive stabilization of hearing occurred by age 2 years.
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Affiliation(s)
- Kristin A Tissera
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alisha Williams
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Julia Perry
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Leila A Mankarious
- Department of Otology and Laryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Otsuka KS, Nielson C, Firpo MA, Park AH, Beaudin AE. Early Life Inflammation and the Developing Hematopoietic and Immune Systems: The Cochlea as a Sensitive Indicator of Disruption. Cells 2021; 10:cells10123596. [PMID: 34944105 PMCID: PMC8700005 DOI: 10.3390/cells10123596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
Emerging evidence indicates that perinatal infection and inflammation can influence the developing immune system and may ultimately affect long-term health and disease outcomes in offspring by perturbing tissue and immune homeostasis. We posit that perinatal inflammation influences immune outcomes in offspring by perturbing (1) the development and function of fetal-derived immune cells that regulate tissue development and homeostasis, and (2) the establishment and function of developing hematopoietic stem cells (HSCs) that continually generate immune cells across the lifespan. To disentangle the complexities of these interlinked systems, we propose the cochlea as an ideal model tissue to investigate how perinatal infection affects immune, tissue, and stem cell development. The cochlea contains complex tissue architecture and a rich immune milieu that is established during early life. A wide range of congenital infections cause cochlea dysfunction and sensorineural hearing loss (SNHL), likely attributable to early life inflammation. Furthermore, we show that both immune cells and bone marrow hematopoietic progenitors can be simultaneously analyzed within neonatal cochlear samples. Future work investigating the pathogenesis of SNHL in the context of congenital infection will therefore provide critical information on how perinatal inflammation drives disease susceptibility in offspring.
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Affiliation(s)
- Kelly S. Otsuka
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA;
| | - Christopher Nielson
- Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (C.N.); (A.H.P.)
| | - Matthew A. Firpo
- Department of Surgery, University of Utah, Salt Lake City, UT 84112, USA;
| | - Albert H. Park
- Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (C.N.); (A.H.P.)
| | - Anna E. Beaudin
- Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
- Correspondence:
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Kasuga M, Yoshimura H, Shinagawa J, Nishio SY, Takumi Y, Usami SI. Frequency and natural course of congenital cytomegalovirus-associated hearing loss in children. Acta Otolaryngol 2021; 141:1038-1043. [PMID: 34825622 DOI: 10.1080/00016489.2021.2000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Congenital cytomegalovirus-associated hearing loss (cCMV-associated HL) is a common cause of congenital or early-onset deafness. Although cCMV infection has been reported to lead to various types of HL, the natural course of cCMV-associated HL over a long period is not yet known. OBJECTIVES To investigate the clinical phenotype of cCMV-associated HL in the largest study to date. METHODS Thirty-one CMV-positive children, diagnosed by examining CMV DNA extracted from their dried umbilical cords retrospectively, were divided into unilateral and bilateral HL groups, and their hearing ability was evaluated using pure-tone audiometry and auditory steady-state response over time. RESULTS Thirteen patients (41.9%) had unilateral HL and 18 (58.1%) had bilateral HL. In most cases of unilateral cCMV-associated HL, the ear with better hearing maintained a normal hearing threshold. Notably, in most cases of both unilateral and bilateral HL, the ear with worse hearing ultimately showed severe to profound HL. CONCLUSION Our findings revealed that the natural course of cCMV-associated HL was different between the cases of unilateral and bilateral HL, as well as between the ears with better or worse hearing in all cases. These findings indicate that accurate diagnosis could enable proper follow-up and management of cCMV-associated HL in children.
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Affiliation(s)
- Mariko Kasuga
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidekane Yoshimura
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Shinagawa
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ya Nishio
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yutaka Takumi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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Vos B, Noll D, Whittingham J, Pigeon M, Bagatto M, Fitzpatrick EM. Cytomegalovirus-A Risk Factor for Childhood Hearing Loss: A Systematic Review. Ear Hear 2021; 42:1447-1461. [PMID: 33928914 DOI: 10.1097/aud.0000000000001055] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Permanent hearing loss is an important public health issue in children with consequences for language, social, and academic functioning. Early hearing detection, intervention, and monitoring are important in mitigating the impact of permanent childhood hearing loss. Congenital cytomegalovirus (CMV) infection is a leading cause of hearing loss. The purpose of this review was to synthesize the evidence on the association between CMV infection and permanent childhood hearing loss. DESIGN We performed a systematic review and examined scientific literature from the following databases: MEDLINE, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, and CINAHL. The primary outcome was permanent bilateral or unilateral hearing loss with congenital onset or onset during childhood (birth to 18 years). The secondary outcome was progressive hearing loss. We included studies reporting data on CMV infection. Randomized controlled trials, quasi-experimental studies, nonrandomized comparative and noncomparative studies, and case series were considered. Data were extracted and the quality of individual studies was assessed with the Qualitative Assessment Tool for Quantitative Studies (McMaster University). The quality and strength of the evidence were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A narrative synthesis was completed. RESULTS Sixty-five articles were included in the review. Prevalence of hearing loss at birth was over 33% among symptomatic CMV-infected newborns and less than 15% in asymptomatic infections. This difference in prevalence was maintained during childhood with more than 40% prevalence reported for symptomatic and less than 30% for asymptomatic CMV. Late-onset and progressive hearing loss appear to be characteristic of congenital CMV infections. Definitions of hearing loss, degree of loss, and reporting of laterality varied across studies. All degrees and both bilateral and unilateral loss were reported, regardless of symptomatic and asymptomatic status at birth, and no conclusions about the characteristics of hearing loss could be drawn. Various patterns of hearing loss were reported including stable, progressive, and fluctuating, and improvement in hearing (sometimes to normal hearing) was documented. These changes were reported in children with symptomatic/asymptomatic congenital CMV infection, presenting with congenital/early onset/late-onset hearing loss and in children treated and untreated with antiviral medication. CONCLUSIONS Symptomatic and asymptomatic congenital CMV infection should be considered a risk factor for hearing loss at birth and during childhood and for progressive hearing loss. Therefore, CMV should be included as a risk factor in screening and surveillance programs and be taken into account in clinical follow-up of children with hearing loss.
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Affiliation(s)
- Bénédicte Vos
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,CHEO Research Institute, Ottawa, ON, Canada.,School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Dorie Noll
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,CHEO Research Institute, Ottawa, ON, Canada
| | | | | | - Marlene Bagatto
- School of Communication Sciences and Disorders and the National Centre for Audiology, Western University, London, ON, Canada
| | - Elizabeth M Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,CHEO Research Institute, Ottawa, ON, Canada
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Shi K, Purser JS, Germiller JA, Rampton JW, Firpo MA, Park AH. Gadolinium-based contrast agent for Magnetic Resonance Imaging as a predictor of postmeningitic hearing loss in children. Int J Pediatr Otorhinolaryngol 2021; 150:110936. [PMID: 34700237 DOI: 10.1016/j.ijporl.2021.110936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/14/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if Gadolinium-based enhanced Magnetic Resonance Imaging (GdMRI) can be used to predict sensorineural hearing loss (SNHL) in pediatric patients diagnosed with bacterial meningitis. STUDY Design: Retrospective chart review. SETTING Primary Children's Hospital, Salt Lake City, Utah. SUBJECTS and Methods: We studied forty-two pediatric patients diagnosed with bacterial meningitis who underwent brain GdMRI during their index hospital admission and for whom ear specific audiometric data were available (August 2008-July 2018). A pediatric neuroradiologist, blinded to both disease and audiometric data, rated cochlear enhancement of each GdMRI (0-3; none to markedly enhanced). RESULTS Ear specific MRI scores were statistically significantly related to ear specific hearing outcomes (p < 0.01). SNHL occurred in 19 out of 82 ears (12 out of 42 patients; 2 ears were excluded due to pre-existing SNHL in one ear and inability to read the GdMRI on the other ear). Ten of 19 ears (53%) that developed SNHL showed mild/moderate/marked enhancement (MRI score of 1, 2, or 3 respectively). Fifty-three of the 63 unaffected ears (84%) showed no enhancement (MRI score of 0). Ten of 13 (77%) ears that developed severe to profound SNHL showed mild/moderate/marked enhancement. GdMRI was 58% sensitive and 84% specific in predicting which ears would develop SNHL. GdMRI was 77% sensitive and 84% specific in identifying severe to profound SNHL. CONCLUSION Our study demonstrates that GdMRI is a promising tool for predicting specifically severe-profound hearing loss in pediatric patients following bacterial meningitis infection.
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Affiliation(s)
- Kevin Shi
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy S Purser
- Texas A&M University Health and Science Center, Bryan, TX, USA
| | - John A Germiller
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - John W Rampton
- Pediatric Radiology, Intermountain Medical Group, Salt Lake City, UT, USA
| | - Matthew A Firpo
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Albert H Park
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
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Lanzieri TM, Caviness AC, Blum P, Demmler-Harrison G. Progressive, Long-Term Hearing Loss in Congenital CMV Disease After Ganciclovir Therapy. J Pediatric Infect Dis Soc 2021; 11:16-23. [PMID: 34718680 PMCID: PMC9590555 DOI: 10.1093/jpids/piab095] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Long-term hearing outcomes among children with symptomatic congenital cytomegalovirus (CMV) disease who received 6-week ganciclovir therapy early in life are unknown. METHODS Longitudinal study of 76 children with symptomatic congenital CMV disease, born 1983-2005, who were categorized into three groups: group A treated with ganciclovir; group B untreated who had microcephaly, chorioretinitis, or sensorineural hearing loss (SNHL; ≥25 dB) diagnosed in the first month of life (congenital); and group C untreated who did not meet criteria for group B. RESULTS Patients in groups A (n = 17), B (n = 27), and C (n = 32) were followed to median age of 13, 11, and 13 years, respectively. In group A, patients received ganciclovir for median of 40 (range, 11-63) days; 7 (41%) had grade 3 or 4 neutropenia. Congenital SNHL was diagnosed in 11 (65%) patients in group A, 15 (56%) in group B, and none in group C. Early-onset SNHL was diagnosed between ages ≥1-12 months in an additional 4 (24%), 6 (22%), and 8 (25%) patients in groups A, B, and C, respectively. By the end of follow-up, 12 (71%), 16 (59%), and 7 (22%) of patients in groups A, B, and C, respectively, had severe (>70 dB) SNHL in the better-hearing ear. CONCLUSIONS In this study, most patients with symptomatic congenital CMV disease and congenital or early-onset SNHL eventually developed hearing loss severe enough to have been potential candidates for cochlear implantation, with or without 6-week ganciclovir therapy. Understanding long-term hearing outcomes of patients treated with 6-month oral valganciclovir (current standard of care) is needed.
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Affiliation(s)
- Tatiana M Lanzieri
- Corresponding Author: Tatiana M. Lanzieri, MD, MPH, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop A-34, Atlanta, GA 30333, USA. E-mail:
| | | | - Peggy Blum
- Texas Children’s Hospital, Houston, Texas, USA
| | - Gail Demmler-Harrison
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Texas Children’s Hospital, Houston, Texas, USA
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