Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection,☆☆,

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Abstract

Objective: To determine the prevalence and temporal changes of sensorineural hearing loss (SNHL) among children with clinically inapparent (asymptomatic) congenital cytomegalovirus (CMV) infection identified from a cohort of newborn infants screened for congenital CMV infection.

Methods: The study population consisted of 307 children with documented asymptomatic congenital CMV infection, 76 uninfected siblings of children with asymptomatic congenital CMV infection, and 201 children whose neonatal screen for congenital CMV infection showed negative results. Audiologic evaluations were completed for all children to determine their hearing status.

Results: SNHL occurred only in children with congenital CMV infection. Of the children with asymptomatic congenital CMV infection, 22 (7.2%; 95% confidence interval, 4.5% to 10.6%) had SNHL. Among the children with hearing loss, further deterioration of hearing occurred in 50.0%, with the median age at first progression at 18 months (range, 2 to 70 months). Delayed-onset SNHL was observed in 18.2% of the children, with the median age of detection at 27 months (range, 25 to 62 months). Fluctuating SNHL was documented in 22.7% of the children with hearing loss.

Conclusions: Asymptomatic congenital CMV infection is likely a leading cause of SNHL in young children. The continued deterioration of hearing and delayed onset of SNHL in these children emphasizes the need for continued monitoring of their hearing status. (J Pediatr 1997;130:624-30)

Section snippets

Study population

The study population consisted of children born between 1980 and December 1995, who were identified by newborn screening for congenital CMV infection at two hospitals in Birmingham, Ala. 14, 15 Congenital CMV infection was identified by isolation of virus in urine or saliva in the first or second week of life. 16, 17, 18 These children were assessed and their medical records were systematically reviewed by study personnel to determine whether any of the following symptoms were observed in the

RESULTS

There were 584 children in the study population who had audiologic evaluations to assess SNHL. The children were divided into three groups: 307 children with congenital CMV infection, 76 uninfected siblings of children with asymptomatic congenital infection, and 201 randomly selected control children. Characteristics for each group of children are shown in Table I. The CMV-negative group was more likely to be black, have Medicaid or no insurance, and receive prenatal care at the health

DISCUSSION

Our study found a prevalence of SNHL of 7.2% (95% CI, 4.5% to 10.6%) for children with asymptomatic congenital CMV infection. Approximately half of the children with SNHL had bilateral hearing loss. The severity of loss ranged from mild high-frequency loss to profound loss, with further deterioration of hearing occurring in 50% of the children with SNHL. Late-onset hearing loss occurred in about 20% of the children with SNHL. Neither the siblings nor the children whose test results were

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    Supported in part by a research grant (5 P01 HD 10699) from the National Institute of Child Health and Human Development, a research grant (5 R01 DC 02139) from the National Institute on Deafness and Other Communication Disorders, and a research grant (5 M01 RR 00032) from the General Clinical Research Center, National Institutes of Health, the Deafness Research Foundation, and the Civitan International Research Center.

    ☆☆

    Reprint requests: Karen B. Fowler, DrPH, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave. South, Suite 752, Birmingham, AL 35233.

    0022-3476/97/$5.00 + 0 9/21/78377

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