Departments of Pediatrics,
Physical Therapy.
Pediatrics. 2021 Feb;147(2). doi: 10.1542/peds.2019-3945. Epub 2021 Jan 8.
Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss and developmental disabilities. Because there are limited data from studies of vestibular involvement in select groups of children with cCMV, the true frequency of vestibular disorders in cCMV is likely underestimated. Our objective for this study is to determine the prevalence of vestibular, gaze, and balance disorders in a cohort of children with asymptomatic cCMV.
Comprehensive vestibular, gaze, and balance assessments were performed in 40 children with asymptomatic cCMV. The function of semicircular canals of the inner ear and vestibulo-visual tract were assessed by measuring vestibulo-ocular reflex in a computer-driven motorized rotary chair; inner ear saccular function was assessed by using cervical vestibular evoked myogenic potential; gaze stability during head movement was assessed by using clinical dynamic visual acuity, and balance was assessed by using the sensory organization test and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Test results for each variable were compared with those of a control group without cCMV and/or compared to age-matched normative published data.
Vestibular disorders were evident in 45% of the cohort on the basis of rotary chair and cervical vestibular evoked myogenic potential testing, suggesting abnormalities in semicircular canals, the utricle and saccule of the inner ear, and vestibulo-visual tracts. Additionally, 46% of the cohort had difficulties maintaining gaze during head movement, and one-third to one-half of the cohort had difficulties maintaining balance.
Vestibular, gaze, and balance disorders are highly prevalent in children with asymptomatic cCMV. Systematic screening for vestibular disorders will be used to determine the full clinical impact for the development of effective interventions.
先天性巨细胞病毒（cCMV）是导致感音神经性听力损失和发育障碍的主要非遗传原因。由于对选择性 cCMV 患儿的前庭受累的研究数据有限，因此 cCMV 患者前庭障碍的真实频率可能被低估。本研究的目的是确定无症状 cCMV 患儿队列中前庭、眼动和平衡障碍的患病率。
对 40 例无症状 cCMV 患儿进行了全面的前庭、眼动和平衡评估。通过在计算机驱动的电动转椅上测量前庭眼反射来评估内耳半规管和前庭视觉通道的功能；通过使用颈源性前庭诱发肌源性电位评估内耳球囊功能；通过临床动态视力评估头部运动期间的眼球稳定性，通过感觉组织测试和布鲁因克斯-奥塞尔斯基运动能力测试第二版评估平衡。将每个变量的测试结果与无 cCMV 和/或与年龄匹配的发表正常数据的对照组进行比较。
根据转椅和颈源性前庭诱发肌源性电位测试，45%的队列存在前庭障碍，表明半规管、内耳的耳石器和囊以及前庭视觉通道存在异常。此外，46%的队列在头部运动期间存在注视困难，三分之一到一半的队列存在平衡困难。
无症状 cCMV 患儿中存在高度的前庭、眼动和平衡障碍。系统的前庭障碍筛查将用于确定有效的干预措施的全面临床影响。
