The Natural History of Hearing Disorders in Asymptomatic Congenital Cytomegalovirus Infection

Abstract

Background and Aim: Cytomegalovirus (CMV) is the main cause of congenital infection in developed countries leading to deafness but the burden of sensorineural hearing loss (SNHL) in asymptomatic children remains incompletely characterized. Aim of this study was to evaluate the long-term audiological outcome in this group of patients.Methods: Consecutive neonates with congenital CMV infection were followed from 2002 to 2018. Patients were considered asymptomatic if free from any clinical and instrumental impairment at referral and underwent serial clinical exams, audiological evaluations and CMV-PCR determinations.Results: A cohort of 258 children was analyzed and the disease onset was asymptomatic in 125 (48%) infants. Among these, we studied 102 patients with a follow-up longer than 1 year and a median observation period of 2.8 years (range: 1-10.3 years). No patient developed a stable delayed SNHL but only 14 (14%) presented a variable hearing impairment, seven of which bilateral. The unstable SNHL was mild in 12 infants and moderate in two. Patients with fluctuating SNHL had significantly higher urine viral load (p 0.002) and more often positive viremia (p 0.015) than babies with stable normal hearing.Conclusions: CMV infected, asymptomatic neonates have a low risk of transient SNHL later in infancy. Positive viremia and high urine viral load at onset are significant risk factors for delayed fluctuating SNHL. These data are relevant for an appropriate follow up plan of these patients.

Severe fetal intracranial hemorrhage: Congenital Cytomegalovirus infection may play a role? A case report and review of literature

“…The diagnosis of cCMV infection in neonates include real-time PCR of saliva, urine or both, as soon as possible after birth within the first 3 weeks of life. Valganciclovir treatment for 6 months in congenitally infected neonates with moderately to severely symptomatic disease could improve audiological and neurodevelopmental outcomes at 2 years of age [ 6 , 7 ]. Early diagnosis of cCMV is mandatory to start therapy within the first month of life.…”

Diagnosis of Congenital Cytomegalovirus (cCMV) in an Asymptomatic Neonate on Placental Pathology

“…The symptoms of cCMV can range from intrauterine growth retardation (IUGR), central nervous system abnormalities like microcephaly, cortical malformations, ventriculomegaly, periventricular calcifications, SNHL, chorioretinitis, hepatosplenomegaly, transaminitis, directhyperbilirubinemia, and petechiae/thrombocytopenia. Isolated SNHL is classified as a subgroup of asymptomatic infection [10]. Infants with SNHL need hearing screening at frequent intervals as SNHL is the most common sequelae of cCMV and 40% of SNHLs are late onset, i.e., after one month of age.…”

Congenital Cytomegalovirus and Human Immunodeficiency Virus: Effects on Hearing, Speech and Language Development, and Clinical Outcomes in Children

“…However, in a population of 92 asymptomatic cCMV children and 51 controls, Lanzieri et al ( 17 ) found that the risk of developing SNHL after age 5 was not significantly different than the risk for uninfected children to develop SNHL, suggesting this hearing loss is likely to manifest before entering grade school. Similarly, Salomè et al ( 21 ) studied the long-term hearing outcomes for 102 children with asymptomatic CMV. After following up with these families for an average of 3.3 years after birth, the researchers did not find a delayed onset hearing loss for any of the children.…”