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Sensorineural Hearing Loss in Children with Congenital CMV Infections

Sensorineural hearing loss is common and variable in children with either asymptomatic or symptomatic congenital CMV infections.

Estimates vary on the incidence of sensorineural hearing loss (SNHL) in infants with asymptomatic or symptomatic congenital cytomegalovirus (CMV) infections. In this large prospective study, investigators evaluated SNHL incidence among 14,021 infants born at one Brussels, Belgium, hospital while a screening program was in place (between June 1996 and November 2006) for detection of congenitally infected neonates. Pregnant women underwent serologic testing during pregnancy. Urine samples were collected from infants during the first week of life; infants diagnosed with congenital CMV infections underwent audiologic testing at birth, 6 months, 1 year, and annually thereafter.

Of 74 newborns (0.53%) diagnosed with congenital CMV infections, only 4 (5.4%) were symptomatic. Twenty-two percent of infected infants developed SNHL (ranging from mild to profound); only one had symptomatic infection. Three infants (5%) developed SNHL after age 6 months (1 infant also contracted bacterial meningitis). Among 44 infants who underwent multiple hearing tests, 16% exhibited fluctuating hearing thresholds, 11% had progressive hearing loss, and 18% showed improving hearing thresholds. SNHL developed in 4 of 26 neonates (15%) born to mothers with primary infections, and most hearing losses were severe. One infant whose mother had a recurrent CMV infection developed severe and bilateral loss. SNHL developed in 8 of 20 neonates (40%) born to mothers whose times of infection were unknown.

Comment: All newborns with CMV infections — not just those with symptomatic infections — should be monitored for hearing loss (JW Pediatr Adolesc Med May 28 2008). These data do not help predict which infants will develop SNHL or the severity and timing of hearing loss; however, serial audiologic testing for all CMV-positive infants is important, regardless of maternal antibody status. The frequency and duration of audiologic testing are also difficult to determine, given the reported fluctuating hearing status. The schedule of audiologic testing used in this study — at birth, 6 months, 1 year, and annually thereafter — seems reasonable.

— Robin Drucker, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 20, 2008

Citation(s):

Foulon I et al. A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr 2008 Jul; 153:84.

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