Hearing Loss With Congenital Cytomegalovirus Infection

摘要

Congenital cytomegalovirus (cCMV) infection is the most common fetal viral infection and is the leading cause of nonhereditary sensorineural hearing loss (SNHL) in the developed world. This prospective study aimed to determine the incidence of SNHL in 157 children with proven cCMV infection, along with searching for risk determinants for developing hearing loss and proposing recommendations for screening and follow-up with the newborn. A total of 173 children with a cCMV infection managed in the ear, nose, and throat department of the Universitair Ziekenhuis Brussel were included in the study, selected using virological screening in all live-born infants within 5 days after birth. Standard prenatal care included screening for cytomegalovirus antibodies at the first prenatal consultation and at birth, which allowed healthcare providers to determine the type of maternal cytomegalovirus infection for each congenitally infected child. All congenitally infected neonates were examined at birth by a pediatrician and tested for SNHL until birth. Normal hearing at birth with hearing loss recorded at a follow-up was diagnosed as late-onset hearing loss. Children with an SNHL at birth but worsening of their hearing threshold during later visits were diagnosed with progressive hearing loss. Overall, 157 children were enrolled in the study. Of this cohort, 9 children (5.7%) were diagnosed with symptomatic infections, whereas 146 (93%) were asymptomatic. A primary cytomegalovirus infection during the first trimester of pregnancy resulted in severe to profound hearing loss in 5 (29.4%) of 17 children. Of 3 children who developed hearing loss after an infection in the second trimester of pregnancy, 1 child developed a severe unilateral hearing loss after bacterial meningitis. Two children had unilateral mild or moderate SNHL, with the mother of the latter having an infection at similar to 15 weeks gestation. One child developed mixed hearing loss at the age of 19 years after a third trimester infection. The findings of the study spark discussion points, such as the idea that, despite high incidences of hearing loss, not all children need hearing rehabilitation. Also, implementing neonatal screening for cCMV infection will result in many diagnoses for children with asymptomatic infections. Another point was that the true burden of late-onset hearing loss has long been overestimated, as it was a problem for only 2.5% of children in this study without important risk factors for hearing loss. Increased screening should be performed for children born after a maternal primary infection in the first trimester of pregnancy, children with a symptomatic infection, and children with abnormalities revealed on brain ultrasounds or magnetic resonance imaging (MRI), as they are at higher risk for developing SNHL and late-onset hearing loss. The results indicate that prevalence of SNHL in children with cCMV infection in the population is 12.7%. Children with a symptomatic infection, abnormal brain ultrasound or MRI examination results, or a maternal primary infection in the first trimester of pregnancy have higher risks for developing late-onset SNHL. Audiological follow-up on the basis of these risk indicators is wise, and preventative measures to avoid cytomegalovirus infection during pregnancy should be implemented before conception, because primary infections in the first trimester of pregnancy had the highest risk for SNHL.