Riga Maria, Korres George, Chouridis Pantelis, Naxakis Stephanos, Danielides Vasilios
Democritus University of Thrace, University Hospital of Evros, ENT Department, Dragana University Campus, 68100, Alexandroupolis, Greece.
Central Manchester University Hospitals, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
Int J Pediatr Otorhinolaryngol. 2018 Dec;115:156-164. doi: 10.1016/j.ijporl.2018.10.005. Epub 2018 Oct 4.
Congenital cytomegalovirus (CMV) infection is one of the most important risk factors for delayed onset and progressive hearing loss in children. However, the relevant literature is limited, heterogeneous and currently insufficient to provide guidance toward the effective monitoring of hearing acuity in these children.
The aim of this study was to provide a systematic review focused on types of hearing loss that may escape diagnosis through universal neonatal hearing screening and/or present significant changes during childhood, such as progressive, fluctuating and late-onset hearing loss.
A review of the present literature was conducted via the PubMed database of the US National Library of Medicine (www.pubmed.org) and Scopus database (www.scopus.com) with the search terms "late-onset hearing loss cytomegalovirus", "progressive hearing loss cytomegalovirus" and "fluctuating hearing loss cytomegalovirus".
Prospective or retrospective clinical studies were included if they presented a detailed audiological assessment, for a follow-up period of >2years.
The prevalence and time of diagnosis of progressive, fluctuating and late-onset hearing loss were considered as primary outcomes. Results were recorded separately for symptomatic and asymptomatic children, when possible.
This analysis refers to a population of 181 children with CMV-induced hearing loss, who were diagnosed among 1089 with congenital CMV infection. The prevalence of CMV-induced hearing loss was significantly higher among symptomatic children (p < 0.0001), who were also significantly more likely to develop bilateral hearing loss (p = 0.001). There was not sufficient information on the prevalence, laterality, degree and time of diagnosis of progressive, fluctuating and late-onset hearing loss that could constitute the basis toward the report of specific follow-up guidelines.
Further studies are needed in order to understand and quantify the potential effects of congenital CMV infection in the inner ear and hearing acuity. The results presented in the relative studies should be very carefully evaluated and compared to each other, since they correspond to substantially different cohorts, study designs, and result elaboration. Infants with congenital CMV infection should be closely monitored, regarding their hearing acuity at least during their preschool years, although substantial changes in hearing thresholds have been reported as late as the 16th year of age. Parental counseling is of outmost importance in order to minimize the numbers of children lost to follow-up.
先天性巨细胞病毒（CMV）感染是儿童迟发性和进行性听力损失的最重要危险因素之一。然而，相关文献有限、存在异质性，目前不足以指导对这些儿童的听力敏锐度进行有效监测。
本研究的目的是进行一项系统综述，重点关注可能通过新生儿听力普遍筛查漏诊和/或在儿童期出现显著变化的听力损失类型，如进行性、波动性和迟发性听力损失。
通过美国国立医学图书馆的PubMed数据库（www.pubmed.org）和Scopus数据库（www.scopus.com）对现有文献进行综述，检索词为“迟发性听力损失 巨细胞病毒”、“进行性听力损失 巨细胞病毒”和“波动性听力损失 巨细胞病毒”。
纳入前瞻性或回顾性临床研究，这些研究需提供详细的听力学评估，随访期超过2年。
将进行性、波动性和迟发性听力损失的患病率及诊断时间作为主要结果。如有可能，分别记录有症状和无症状儿童的结果。
该分析涉及181例CMV感染所致听力损失儿童，这些儿童是在1089例先天性CMV感染患儿中确诊的。有症状儿童中CMV感染所致听力损失的患病率显著更高（p<0.0001），他们发生双侧听力损失的可能性也显著更高（p=0.001）。关于进行性、波动性和迟发性听力损失的患病率、患侧性、程度及诊断时间，没有足够信息可作为报告特定随访指南的依据。
需要进一步研究以了解和量化先天性CMV感染对内耳和听力敏锐度的潜在影响。相关研究中的结果应非常仔细地评估并相互比较，因为它们对应着截然不同的队列、研究设计和结果阐述。先天性CMV感染的婴儿应密切监测听力敏锐度，至少在学龄前阶段，尽管有报道称听力阈值在16岁时仍有显著变化。为尽量减少失访儿童数量，家长咨询至关重要。
