RESUMO
Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures. Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis. These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.
Assuntos
Infecções por Citomegalovirus/complicações , Doenças do Recém-Nascido/diagnóstico , Toxoplasmose Congênita/complicações , Audiometria , Cegueira/diagnóstico , Cegueira/etiologia , Pré-Escolar , Coriorretinite/diagnóstico , Coriorretinite/etiologia , Infecções por Citomegalovirus/diagnóstico , Surdez/diagnóstico , Surdez/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Oftalmoscopia , Toxoplasmose Congênita/diagnósticoRESUMO
More than 6000 children born annually in this country have hearing loss resulting from congenital cytomegalovirus (CMV) infection, the leading nonhereditary congenital cause of hearing loss in children. This exemplary congenital symptomatic CMV case focuses on the results of longitudinal audiologic, educational, medical, psychological, and visual evaluations and intervention. Decreased ocular motor control and visual acuity were observed as was bilateral deterioration of hearing from 3 days though 9 years of age. Treatment with dexamethasone and histamine resulted in almost complete reversal of the most recent progression of hearing loss in the left ear.
Assuntos
Citomegalovirus/isolamento & purificação , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/virologia , Equipe de Assistência ao Paciente , Administração Oral , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Audiometria de Tons Puros , Criança , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Deficiências do Desenvolvimento/diagnóstico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Avaliação Educacional , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Estudos Longitudinais , Contagem de PlaquetasRESUMO
Hearing sensitivity was assessed in 20 children who were diagnosed as having symptomatic neonatal herpes simplex virus (HSV) infection. The subjects were seen as part of an interdisciplinary project that included audiological, medical, visual, and developmental assessments. Audiologic procedures consisted of behavioral and/or auditory brain stem tests and immittance audiometry. Eighteen children were found to have normal hearing and 2 were documented as having sensorineural hearing impairments. Similarities in the manner in which HSV and congenital cytomegalovirus affect the auditory mechanism are discussed.
Assuntos
Surdez/congênito , Herpes Simples/congênito , Audiometria de Resposta Evocada , Tronco Encefálico/fisiopatologia , Criança , Pré-Escolar , Surdez/fisiopatologia , Feminino , Seguimentos , Herpes Simples/fisiopatologia , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
Hearing impairment and otologic problems have been reported to be prevalent among individuals with Down syndrome. This study was designed to determine whether children with Down syndrome have a higher prevalence of auditory abnormalities than do children with other forms of mental retardation. Hearing, impedance, and otoscopic examinations were performed on 30 children with Down syndrome and 30 children without Down syndrome matched for CA and IQ. Results indicated that the children with Down syndrome had a significantly higher prevalence of hearing impairment and otologic disorders.
Assuntos
Síndrome de Down/complicações , Otopatias/complicações , Transtornos da Audição/complicações , Testes de Impedância Acústica , Adolescente , Cerume/fisiologia , Criança , Pré-Escolar , Humanos , Deficiência Intelectual/complicações , Otite Média com Derrame/complicações , Membrana Timpânica/patologiaRESUMO
The relationship between hearing disorder and performance on intelligence tests among 28 children and young adults with Down syndrome was investigated. Intellectual and audiological assessments were obtained and evaluated in a multiple regression analysis. Performance on intelligence tests by individuals with abnormal tympanograms was inferior to that of individuals with normal tympanograms. Hearing sensitivity measures were uncorrelated. Findings suggest the need for an awareness of the potential impact of middle ear disorder when assessing intellectual functioning and the importance of otological care for infants and young children with Down syndrome.
Assuntos
Síndrome de Down/complicações , Transtornos da Audição/complicações , Inteligência , Testes de Impedância Acústica , Adolescente , Fatores Etários , Cognição , Síndrome de Down/psicologia , Feminino , Transtornos da Audição/psicologia , Humanos , MasculinoRESUMO
Audiological assessment of 86 children with congenital cytomegalovirus infection revealed progressive hearing loss in four of 12 subjects with sensorineural hearing impairments. Case descriptions are presented documenting the progression of the hearing loss. In view of the findings, children with congenital cytomegalovirus should be monitored closely to insure detection of possible delayed or progressive hearing impairment and delivery of appropriate habilitative services.
Assuntos
Infecções por Citomegalovirus/congênito , Surdez/etiologia , Perda Auditiva Neurossensorial/etiologia , Limiar Auditivo , Pré-Escolar , Infecções por Citomegalovirus/complicações , Feminino , Humanos , Lactente , Masculino , Fatores de TempoRESUMO
OBJECTIVE: To determine the prevalence and temporal changes of sensorineural hearing loss (SNHL) among children with clinically inapparent (asymptomatic) congenital cytomegalovirus (CMV) infection identified from a cohort of newborn infants screened for congenital CMV infection. METHODS: The study population consisted of 307 children with documented asymptomatic congenital CMV infection, 76 uninfected siblings of children with asymptomatic congenital CMV infection, and 201 children whose neonatal screen for congenital CMV infection showed negative results. Audiologic evaluations were completed for all children to determine their hearing status. RESULTS: SNHL occurred only in children with congenital CMV infection. Of the children with asymptomatic congenital CMV infection, 22 (7.2%; 95% confidence interval, 4.5% to 10.6%) had SNHL. Among the children with hearing loss, further deterioration of hearing occurred in 50.0%, with the median age at first progression at 18 months (range, 2 to 70 months). Delayed-onset SNHL was observed in 18.2% of the children, with the median age of detection at 27 months (range, 25 to 62 months). Fluctuating SNHL was documented in 22.7% of the children with hearing loss. CONCLUSIONS: Asymptomatic congenital CMV infection is likely a leading cause of SNHL in young children. The continued deterioration of hearing and delayed onset of SNHL in these children emphasizes the need for continued monitoring of their hearing status.
Assuntos
Infecções por Citomegalovirus/congênito , Perda Auditiva Neurossensorial/etiologia , Idade de Início , Audiometria , Criança , Pré-Escolar , Infecções por Citomegalovirus/complicações , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Recém-Nascido , MasculinoRESUMO
The Developmental Profile was completed on 32 prospectively followed children with symptomatic congenital cytomegalovirus infection (mean age 6 7/12 years; 78% white, 59% male). The distribution of intelligence and general developmental scores was bimodal; one group had severe deficits (mean IQ 28.8), the other had relatively less severe intellectual sequelae (mean IQ 91.6). Correlation analysis (Pearson r) showed that three variables--microcephaly, neurologic abnormalities, and chorioretinitis--when apparent during the first year of life, were all significantly associated with low intelligence. No correlation was found between IQ and severity of neonatal reticuloendothelial disease or hearing loss. Multiple regression analysis showed that age at testing, chorioretinitis, and neurologic sequelae accounted for 63% of the IQ variance in our sample. We conclude that children with symptomatic congenital cytomegalovirus infection have a greater range of intellectual outcomes than has been previously reported, and that certain early clinical manifestations may be useful in anticipating special needs.