Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Shears, Annalie; Fidler, Katy; Luck, Suzanne; Walter, Simone

doi:10.1097/01.hj.0000752304.01935.cb

Cited by 2 publications

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“…Moreover, although Figure 6 only covers vestibular follow-up, diagnosis of vestibular dysfunction should obviously urge to refer for functional (e.g., motor, visual acuity) assessment to evaluate the impact on the child's daily function and discuss the need for therapy. Although we aimed to take the feasibility of our follow-up proposal into account, the result might still not be possible for many centers (Shears et al 2021). In that case, it is important to keep in mind that a single vestibular evaluation already entails a critical difference for a child's developmental outcome and that the described risk factors can guide in the implementation of a targeted approach (Dhondt et al 2022).…”

Section: Evidence-based Vestibular Follow-up Proposalmentioning

confidence: 99%

“…On the one hand, this might be due the unfamiliarity with and the underestimation of the pivotal role of the vestibular system in various domains of development; early gross motor development being the most evident (Rine et al 2000; Braswell & Rine 2006; Franco & Panhoca 2008; De Kegel et al 2012; Lacroix et al 2020; Singh et al 2021). On the other hand, hesitancy might be related to feasibility issues from both diagnostic centers and patients and their families, as the burden of longitudinal follow-up should not be underestimated (Korndewal et al 2018; Vandrevala et al 2020; Shears et al 2021). More specifically, this would be an addition to an already established wide-ranging cCMV follow-up program, generally involving neurodevelopmental, ophthalmologic, and auditory evaluation until primary school age (Luck et al 2017).…”

Section: Introductionmentioning

confidence: 99%

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Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection

et al. 2023

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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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Section: Evidence-based Vestibular Follow-up Proposalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection

et al. 2023

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“…However, routine vestibular assessment is currently not part of the recommended follow-up of infants with cCMV in the UK. A recent survey of paediatricians and audiovestibular physicians identified several barriers around vestibular assessment of children with cCMV in the UK, such as lack of time in clinic and insufficient training 12. Vestibular dysfunction is therefore likely to be underdiagnosed in this population, even though vestibular physiotherapy exercises may improve motor outcomes for affected children 13…”

Section: Introductionmentioning

confidence: 99%

Vestibular and balance dysfunction in children with congenital CMV: a systematic review

Shears

Yan

Mortimer

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThis systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities.DesignMEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.PatientsChildren with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture).InterventionStudies of vestibular function and/or balance assessments.Main outcome measuresVestibular function and balance.Results1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%–60%), than asymptomatic cCMV (0%–12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months.ConclusionsVestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case–controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions.PROSPERO registrationCRD42019131656.

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Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Cited by 2 publications

References 0 publications

Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection

Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection

Vestibular and balance dysfunction in children with congenital CMV: a systematic review

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