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Can an Audiogram Diagnose Congenital Cytomegalovirus in the Older Child? Is Early CMV Testing Necessary?

Abstract Summary

OBJECTIVE: A considerable proportion of cCMV-infected children will present with late-onset sensorineural hearing loss (SNHL). If these children are not diagnosed early and cannot procure DBS CMV PCR testing, an alternative approach is needed for diagnosis. We hypothesize that the hearing phenotype of the cCMV-infected child with isolated SNHL may differ from other causes of SNHL. METHODS: Hearing outcomes (auditory brainstem response -ABR and behavioral) were collected from SNHL patients between 2005-2022 at Primary Children’s Hospital and categorized into 4 different groups: cCMV with isolated SNHL, Connexin 26 mutation, enlarged vestibular aqueduct (EVA) and Idiopathic. We collected a minimum of three hearing test scores for each patient. Outcome measures included hearing thresholds for the better and worse ear at 500 Hz, 1k Hz, 2k Hz, 4k Hz, hearing score average (2k and 4k Hz) and the difference between the better and worse ear at these various parameters over time. Tukey honestly significant difference (HSD) and one-way ANOVA tests were performed to assess the difference of hearing outcomes mentioned above. RESULTS: A total of 76 patients were evaluated. These included 23 patients cCMV with isolated SNHL, 13 with a connexin 26 mutation, 24 with EVA and, and 16 with idiopathic SNHL. Of the various analyses performed, the hearing score average difference between the better and worse hearing ears over time demonstrated the most characteristic phenotype when comparing cCMV group to the other cohorts. A model in which the cCMV and other SNHL groups were smoothed over time showed a robust statistically significant difference. CONCLUSION: Our study suggests the hearing phenotype of the cCMV infected child with isolated SNHL is different from the other causes of SNHL.

Learning Objectives

• Understand the current challenges in diagnosing a congenital cytomegalovirus (cCMV) infection in the “older” child with late onset sensorineural hearing loss (SNHL).
• Appreciate whether there is a characteristic hearing phenotype amongst the different causes of pediatric SNHL.
• Entertain a feasible alternative approach to diagnose cCMV in the “older” child with late onset SNHL.

Presentation

3440589_16086ShiLiang.pdf

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