15th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 13-15, 2016 • San Diego, CA
3/14/2016 | 2:00 PM - 2:30 PM | Topical Session 2 | Royal Palm 1/2 | 1 - EHDI Program Enhancement
Sensorineural Hearing Loss in Children with Asymptomatic Congenital Cytomegalovirus Infection Identified through Newborn Screening Followed for up to 18 Years - The Houston Congenital Cytomegalovirus Longitudinal Study
Newborns with asymptomatic cCMV identified through hospital-based screening (positive CMV urine culture within 3 days of life) during 1982-1992 were evaluated using auditory brainstem response, behavioral audiometry, and tympanometry. Sensorineural hearing loss (SNHL) was defined as ?25dB threshold in any frequency, and characterized as progressive or fluctuating-progressive (overall deterioration with intermittent improvement) based on changes ?20dB in any frequency, or ?10dB in the 4-pure-tone-average of 0.5, 1, 2, and 4 kHz, or across any 2 or 3 frequencies in consecutive exams, without middle ear disorder.
Of 92 children with asymptomatic cCMV, 82 (89%) were last evaluated at age 9-18 years, of which, 20 (24%) children had SNHL. Nine (45%) children had congenital SNHL, 1 bilaterally and 8 unilaterally; 5 were first evaluated ?3 months and 4 between 4-10 months. Of 8 children who initially had congenital SNHL unilaterally, 5 (63%) developed delayed-onset SNHL in the normal hearing ear, diagnosed at age 6 months in 1 child and between 4-10 years in 4 (80%). Eleven children with initial normal hearing had delayed-onset SNHL, 3 bilaterally and 8 unilaterally; 1 (9%) diagnosed at age 1 year, 4 (36%) between 5-8 years, 5 (45%) between 9-14 years, and 1 (9%) at 17 years. SNHL was progressive in 10 children and fluctuating-progressive in 2. Progression to SNHL >90dB in the worse ear was observed in 9 children. At last evaluation, 2 (2%) of 92 children with asymptomatic cCMV had bilateral SNHL between 40-70dB and 2 (2%) at >70dB.
Asymptomatic cCMV is associated with congenital and delayed-onset SNHL that may manifest and progress throughout adolescence. Ongoing long-term audiological follow-up is needed to provide timely interventions and better understanding on the burden of CMV-related SNHL.
- Describe the proportion of children with asymptomatic congenital CMV infection who are diagnosed with SNHL shortly after birth
- Describe the proportion of children with asymptomatic congenital CMV infection who are diagnosed with SNHL after a time span of 18 years
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Presenters/Authors
Winnie Chung
(Primary Presenter), Centers for Disease Control & Prevention, wchung@cdc.gov;
Winnie Chung, Au.D, a Health Scientist with CDC, is the subject matter expert with the Early Hearing Detection & Intervention (EHDI) team. Winnie Chung has been an audiology provider in various clinical setting from 1990 to 2009. She began her involvement in EHDI in 2001 providing outpatient hearing screening and diagnostic for newborns at Kaiser Permanente San Francisco and Oakland. From 2004 to 2009, besides coordinating Rhode Island state newborn hearing screening program, she also provided audiological services in the tertiary neonatal intensive care unit and managed the audiology outpatient clinic at Woman & Infants' Hospital. She joined CDC as a health scientist in April of 2009 providing technical assistance to state EHDI programs and investigating public health related issues for the CDC-EHDI team.
ASHA DISCLOSURE:
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No relevant financial relationship exist.
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No relevant nonfinancial relationship exist.
Tatiana Lanzieri
(Author), CDC, uyk4@cdc.gov;
Dr. Tatiana Lanzieri, MD, MPH is a subject matter expert on congenital cytomegalovirus in the Herpesvirus Team in the Epidemiology Branch of the Division of Viral Diseases at the U.S. Centers for Disease Control and Prevention (CDC). She has been involved in epidemiologic and mathematical modeling studies of congenital and perinatal CMV infection.
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Gail Demmler
(Author), Baylor School of Medicine, gdemmler@bcm.edu;
Dr. Gail Demmler-Harrison, MD, is a pediatric infectious diseases specialist, clinical virologist, and the Principal Investigator for the Houston Congenital Cytomegalovirus (CMV) Longitudinal Study. Dr Demmler is a Professor of Pediatrics at Baylor College of Medicine and Attending Physician at Texas Children's Hospital, Houston, Texas and she has studied the biology, epidemiology, diagnosis, clinical manifestations, long term effects, treatment, and prevention of CMV infections for over 30 years at these institutions. She is also author of numerous scientific publications, book chapters, and an on-line website and blog on CMV.
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Marily Flores
(Author), Baylor School of Medicine, marilyf@bcm.edu;
Marily Flores is an epidemiologist with the Houston Congenital CMV Longitudinal Study.
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Chantal Caviness
(Author), Baylor School of Medicine, ACCavine@texaschildrens.org;
Dr. Chantal Caviness is a pediatrician and holds a PhD in Epidemiology. She is an Associate Research Director for the section of pediatric emergency medicine and guides clinical research methodology within the section. She directs the clinical research and evidence-based medicine teaching initiatives within the section. She is a Co-Investigator for the National Children’s Study, which is the largest pediatric cohort study to be conducted within the United States. She is a Co-Investigator in an Emergency Medical Services for Children (EMSC)-funded project for pediatric asthma management in the emergency department.
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Scott Grosse
(Author), Centers for Disease Control and Prevention, SGrosse@cdc.gov;
Scott Grosse is a health economist with the National Center on Birth Defects and Developmental Disabilities.
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Stephanie Bialek
(Author), Centers for Disease Control and Prevention, SBialek@cdc.gov;
Stephanie Bialek is the team lead for the Herpes Virus Team in the National Center for Immunization and Respiratory Diseases.
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