High Prevalence of Hearing Impairment in HIV‐Infected Peruvian Children

Abstract

Objectives To measure the prevalence and to identify risk factors of hearing impairment in human immunodeficiency virus-infected children living in Peru. Study design Cross-sectional observational study. Setting Two public hospitals and 1 nonprofit center in Lima, Peru, between August 2009 and April 2010. Subjects A total of 139 HIV-infected children, ages 4 to 19 years. Methods Hearing impairment and otologic health were assessed with pure tone audiometry, tympanometry, and otoscopy. The primary outcome was hearing loss, defined as average threshold >25dB for 0.5, 1, 2, and 4 kHz, in one or both ears. Historical and socioeconomic information was obtained through parental survey and medical chart review. Statistical analysis included univariate analysis and multivariate logistic regression. Results Fifty-four (38.8%) of 139 children had hearing impairment. On multivariate analysis, risk factors included: tympanic membrane perforation (odds ratio [OR] 7.08; 95% confidence interval [CI], 1.65-30.5; P = .01), abnormal tympanometry (OR 2.71; 95% CI, 1.09-6.75; P = .03), cerebral infection (OR 11.6; 95% CI, 1.06-126; P = .05), seizures (OR 5.20; 95% CI, 1.21-22.4; P = .03), and CD4 cell count <500 cells/mm3 (OR 3.53; 95% CI, 1.18-10.5; P = .02). Conclusions The prevalence of hearing impairment in HIV-infected children in Lima, Peru was 38.8%. Middle ear disease, prior cerebral infection, and low CD4 cell count were significantly associated with hearing impairment. The high prevalence of hearing impairment emphasizes the need for periodic hearing assessment in the routine clinical care of HIV-infected children.

Middle Ear Function in Human Immunodeficiency Virus (HIV)-Infected South African Children

“…This rate is higher than the rate in the current study which presented only 8 children (13.1%) with flat tympanograms. This difference is most likely a result of the health of the HIV-infected children in Chao et al [3]. In that study, 40 (29.8%) HIV-infected children had a most recent CD4 count ≤500 cells/mm 3 and 59 (44.4%) HIV-infected children had a most recent HIV viral load >400 copies/mL.…”

“…This difference is most likely a result of the health of the HIV-infected children in Chao et al [3]. In that study, 40 (29.8%) HIV-infected children had a most recent CD4 count ≤500 cells/mm 3 and 59 (44.4%) HIV-infected children had a most recent HIV viral load >400 copies/mL. Two PHIV children in the current study had present otorrhea whereas no HIV-uninfected child presented with otorrhea.…”

“…This is one of the few studies to incorporate quantitative tympanometry data to evaluate middle ear function in PHIV children. Although other researchers [3,11] have reported types of tympanograms for children, specific data were not reported. For example, Chao et al [3] used tympanometry to evaluate middle ear pathologies in HIV-infected children, using a classification of: Type A (normal), Type B (flat), or Type C (negative middle ear pressure) and found 38.1% with flat tympanograms either unilaterally or bilaterally.…”

“…Adherence to HAART maintains virological suppression but these initial data suggest that HAART may not be ototoxic to the middle ear. Because the mean age of the children in Chao et al [3] was just under 10 years, these children were on HAART for just over 4 years. As a result, they started treatment later than the present study cohort.…”

“…The World Health Organization (WHO) reports the prevalence of chronic suppurative otitis media (CSOM) ranging from <1% to 7.8% [1]. Human immunodeficiency virus-infected (HIVinfected) children who are immunocompromised are at higher risk for this opportunistic infection [2][3][4][5][6][7][8]. Further, greater immunosuppression in HIV-infected children is associated with both a higher rate of otitis media and greater severity of otitis media [6] and more symptomatic HIV-infected children are at higher risk for recurrent episodes of otitis media [2,5].…”