1 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Otolaryngol Head Neck Surg. 2018 Apr;158(4):736-744. doi: 10.1177/0194599818758247. Epub 2018 Mar 20.
Objectives To compare hearing trajectories among children with symptomatic and asymptomatic congenital cytomegalovirus infection through age 18 years and to identify brain abnormalities associated with sensorineural hearing loss (SNHL) in asymptomatic case patients. Study Design Longitudinal prospective cohort study. Setting Tertiary medical center. Subjects and Methods The study included 96 case patients (4 symptomatic and 92 asymptomatic) identified through hospital-based newborn cytomegalovirus screening from 1982 to 1992 and 72 symptomatic case patients identified through referrals from 1993 to 2005. We used growth curve modeling to analyze hearing thresholds (0.5-8 kHz) by ear with increasing age and Cox regression to determine abnormal findings on head computed tomography scan associated with SNHL (hearing threshold ≥25 dB in any audiometric frequency) among asymptomatic case patients. Results Fifty-six (74%) symptomatic and 20 (22%) asymptomatic case patients had SNHL: congenital/early-onset SNHL was diagnosed in 78 (51%) and 10 (5%) ears, respectively, and delayed-onset SNHL in 25 (17%) and 20 (11%) ears; 49 (32%) and 154 (84%) ears had normal hearing. In affected ears, all frequency-specific hearing thresholds worsened with age. Congenital/early-onset SNHL was significantly worse (severe-profound range, >70 dB) than delayed-onset SNHL (mild-moderate range, 26-55 db). Frequency-specific hearing thresholds were significantly different between symptomatic and asymptomatic case patients at 0.5 to 1 kHz but not at higher frequencies (2-8 kHz). Among asymptomatic case patients, white matter lucency was significantly associated with SNHL by age 5 years (hazard ratio, 4.4; 95% CI, 1.3-15.6). Conclusion Congenital/early-onset SNHL frequently resulted in severe to profound loss in symptomatic and asymptomatic case patients. White matter lucency in asymptomatic case patients was significantly associated with SNHL by age 5 years.
目的 通过比较 18 岁以下有症状和无症状先天性巨细胞病毒感染儿童的听力轨迹，以及识别无症状病例患者中与感音神经性听力损失（SNHL）相关的脑异常。
研究设计 纵向前瞻性队列研究。
地点 三级医疗中心。
研究对象和方法 本研究纳入了 1982 年至 1992 年通过医院新生儿巨细胞病毒筛查发现的 96 例病例患者（4 例有症状和 92 例无症状）和 1993 年至 2005 年通过转诊发现的 72 例有症状病例患者。我们使用生长曲线模型分析了随年龄增长的双耳听力阈值（0.5-8 kHz），并使用 Cox 回归确定了无症状病例患者中与 SNHL 相关的头 CT 扫描异常发现（任何听力学频率的听力阈值≥25 dB）。
结果 56 例（74%）有症状和 20 例（22%）无症状病例患者有 SNHL：分别在 78 例（51%）和 10 例（5%）耳中诊断为先天性/早发性 SNHL，25 例（17%）和 20 例（11%）耳中诊断为迟发性 SNHL；49 例（32%）和 154 例（84%）耳中听力正常。在受影响的耳朵中，所有频率特异性听力阈值随年龄增长而恶化。先天性/早发性 SNHL 明显比迟发性 SNHL 更严重（严重-重度范围，>70 dB）（轻度-中度范围，26-55 dB）。在 0.5 至 1 kHz 时，症状和无症状病例患者的频率特异性听力阈值有显著差异，但在较高频率（2-8 kHz）时无差异。在无症状病例患者中，在 5 岁时，脑白质透亮与 SNHL 显著相关（危险比，4.4；95%置信区间，1.3-15.6）。
结论 先天性/早发性 SNHL 常导致有症状和无症状病例患者出现严重至重度听力损失。无症状病例患者在 5 岁时脑白质透亮与 SNHL 显著相关。
