Rita Malesci, Serena Salomè, Giovanni Freda, Nicola Serra, Giuseppe Manna, Valeria Del Vecchio, Chiara Quatrano, Letizia Capasso, Francesco Raimondi, Anna Rita Fetoni
Audiology Section "Federico II", Department of Neuroscience, Reproductive Sciences and Dentistry Department, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
Sci Rep. 2025 May 6;15(1):15740. doi: 10.1038/s41598-025-98150-5.
This study aims to evaluate long-term vestibular function and hearing outcomes in a cohort of children with congenital cytomegalovirus infection (cCMV) using a comprehensive battery of vestibular and hearing tests, and possible relationships between vestibular and cochlear damage and relevant clinical presentation variables of cytomegalovirus (CMV) infection. A prospective cohort study was carried out from June 2016 to December 2023 and included 40 children affected by cCMV. Our sample was composed by 35% males and 65% females, with age at first vestibular assessment ranging from 3 to 8 years old, and 30% (12) were symptomatic at birth. All patients received their diagnosis during the neonatal period, with none diagnosed retrospectively through dried blood spots. The median follow-up period was 5.3 years (ranging from 4.6 to 6.0). Comparing children with and without symptoms related to CMV, the presence of hearing loss (50% vs. 0.0%, p = 0.0002), psychomotor delay (25% vs. 0.0%, p = 0.024) and vestibular dysfunction (VD) (66.7% vs. 17.9%, p = 0.0075) were significantly increased in symptomatic patients. The VD was confirmed with a reduced gain of the lateral semicircular canals (LSCC) at the video head impulse test (vHIT) (58.3% vs. 17.9%, p = 0.021), and with the absence of response at cervical vestibular evoked myogenic potentials (cVEMPs) (54.5% vs. 3.7%, p = 0.0009). Comparing children with and without VD, we found a significant presence of reduced LSCC gain during the vHIT (93.3% vs. 0.0%, p < 0.0001), of an exclusive alteration in cVEMPs (61.5% vs. 0.0%, p < 0.0001), of hearing loss (46.2% vs. 0.0%, p = 0.0004), of patients with symptoms related to cCMV at birth (61.5% vs. 14.8%, p = 0.0075), of pathological neuroimaging at onset (61.5% vs. 7.4%, p = 0.0006), presence of antiviral therapy (61.5% vs. 11.1%, p = 0.0017) and positive viremia at onset (100% vs. 63%, p = 0.018). Finally, about time of maternal CMV infection the first trimester was associated to children with VD, while the third trimester to children without VD. cCMV infection can involve the entire inner ear: vestibular function seems to be more affected than cochlear function. Therefore, vestibular evaluation should be included in the audiological work up and follow-up in children with cCMV.
本研究旨在通过一系列全面的前庭和听力测试，评估先天性巨细胞病毒感染（cCMV）儿童队列的长期前庭功能和听力结果，以及前庭和耳蜗损伤与巨细胞病毒（CMV）感染相关临床表现变量之间的可能关系。2016年6月至2023年12月进行了一项前瞻性队列研究，纳入了40名受cCMV影响的儿童。我们的样本中男性占35%，女性占65%，首次前庭评估时的年龄在3至8岁之间，30%（12名）在出生时出现症状。所有患者均在新生儿期确诊，无通过干血斑进行回顾性诊断的情况。中位随访期为5.3年（范围为4.6至6.0年）。比较有和无CMV相关症状的儿童，有症状患者中听力损失（50%对0.0%，p = 0.0002）、精神运动发育迟缓（25%对0.0%，p = 0.024）和前庭功能障碍（VD）（66.7%对17.9%，p = 0.0075）的发生率显著增加。在视频头脉冲试验（vHIT）中，外侧半规管（LSCC）增益降低证实了VD（58.3%对17.9%，p = 0.021），并且在颈前庭诱发肌源性电位（cVEMPs）中无反应也证实了VD（54.5%对3.7%，p = 0.0009）。比较有和无VD的儿童，我们发现vHIT期间LSCC增益降低的情况显著存在（93.3%对0.0%，p < 0.0001）、cVEMPs仅有改变的情况显著存在（61.5%对0.0%，p < 0.0001）、听力损失的情况显著存在（46.2%对0.0%，p = 0.0004）、出生时有cCMV相关症状的患者情况显著存在（61.5%对14.8%，p = 0.0075）、发病时病理神经影像学检查的情况显著存在（61.5%对7.4%，p = 0.0006）、抗病毒治疗的情况显著存在（61.5%对11.1%，p = 0.0017）以及发病时病毒血症阳性的情况显著存在（100%对63%，p = 0.018）。最后，关于母亲CMV感染时间，孕早期与有VD的儿童相关，而孕晚期与无VD的儿童相关。cCMV感染可累及整个内耳：前庭功能似乎比耳蜗功能受影响更大。因此，前庭评估应纳入cCMV儿童的听力检查和随访中。
