421 - Late-Onset Hearing Loss and Antiviral Therapy for Congenital Cytomegalovirus Infection

Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensorineural hearing loss (SNHL) in children. While SNHL is often present at birth, as many as 20% of infants with congenital CMV infection may develop late-onset hearing loss beyond the neonatal period. Antiviral therapy improves hearing outcomes, but its effect on the occurrence of late-onset SNHL is not fully known.

Objective:

To describe the prevalence of SNHL at birth and late SNHL in infants with congenital CMV infection and assess the impact of antiviral treatment on late-onset SNHL

Design/Methods: From 2013 to present, infants with congenital CMV infection referred to the NEO-ID Clinic at Nationwide Children’s Hospital (NCH), Columbus, OH underwent complete evaluation including hearing testing. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Infants with SNHL at birth or who developed late-onset SNHL were identified and compared with respect to receipt of antiviral therapy in the neonatal period.

Results: During the 9-year study period, 186 infants had congenital CMV infection. 72% (133/186) had symptomatic congenital CMV infection, while 28% (53/186) had clinically inapparent infection (normal physical examination, growth parameters, normal evaluation). Overall, 32% (n=60) had SNHL at birth or on follow-up audiologic evaluation with the majority (92%, 55/60) having symptomatic infection. Of the 60 infants with SNHL, 32% (n=19) had late-onset SNHL in one (n=12) or both (n=7) ears at a median age of 24 months (range, 1 month – 80 months). Of the 112 infants who received antiviral therapy starting in the first month of age, 12 (11%) developed late-onset SNHL in one (n=8) or both (n=4) ears; all 12 had symptomatic congenital CMV infection. 4 received cochlear implants in one or both ears. Of the 74 infants who did not receive any antiviral therapy, 7 (9%) developed late-onset SNHL (4, unilateral [2, symptomatic]; 3, bilateral [2, symptomatic]) and 1 received cochlear implant. There was no difference in the occurrence of late-onset SNHL in treated (11%) vs. untreated (9%) infants with congenital CMV infection (p=0.08).

Conclusion(s):

In this small cohort of mostly symptomatic infants with congenital CMV infection, antiviral treatment did not reduce the occurrence of late-onset SNHL. Further study on the impact of early antiviral therapy on severity of the SNHL is ongoing.