Sensorineural Hearing Loss In Infants Research Articles

Infant Cervical Vestibular Evoked Myogenic Potentials: A Scoping Review.

Children diagnosed with hearing loss typically demonstrate increased rates of vestibular loss as compared with their peers, with hearing within normal limits. Decreased vestibular function is linked with delays in gross motor development, acquisition of gross motor skills, and academic challenges. Timely development of sitting and walking gross motor skills aids in the progress of environmental exploratory activities, which have been tied to cognitive, language, and vocabulary development. Considering the time-sensitive development of gross motor skills and cognitive, language, and vocabulary development, identifying vestibular loss in infancy can support early intervention. This scoping review analyzes stimulus, recording, and participant factors relevant to assessing cervical vestibular evoked myogenic potentials (cVEMPs) in the infant population. The scoping literature review was conducted on literature published between 2000 and 2023, focusing on articles assessing cVEMPs in infants. Two authors independently followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines for title and abstract screening, full-text review, data extraction, and quality assessments. Sixteen articles meeting the inclusion criteria were included in the analysis. The existing literature lacks consensus regarding stimulus and recording parameters for measuring infant cVEMPs. In addition, the review reveals a decrease in cVEMP response occurrence rates with the severity of hearing loss, especially in cases of severe to profound hearing loss, compared with mild to moderate sensorineural hearing loss in infants. This scoping review demonstrates the increasing use of cVEMP as a reliable tool for objectively assessing infant vestibular function. The lack of consensus in stimulus and recording parameters emphasizes the need for systematic research to establish an evidence-based protocol for cVEMP measurements in infants. Such a protocol will ensure the reliable measurement of cVEMPs in infants and enhance the effectiveness of cVEMP as part of the infant vestibular test battery. In addition, there is a necessity for a comprehensive large-scale study to evaluate the practicality and feasibility of implementing vestibular screening protocols for infants diagnosed with sensorineural hearing loss in the United States.

Predictors of successful natural sleep MRI for sensorineural hearing loss in infants.

Cochlear implantation (CI) in children with sensorineural hearing loss (SNHL) before 12 months of age (mo) improves language outcomes. MRI is important to assess CI candidacy. Anesthesia before 3 years old may increase risk of neurocognitive delay. Natural sleep MRI (NS-MRI) is an emerging technique to avoid anesthesia in infants, but relies on successful sleep for adequate imaging. Our multidisciplinary team hypothesized the following predictors of successful NS-MRI for CI evaluation: age, distance travelled, comorbidities, primary language, insurance type, HL characteristics, time and duration of MRI. We performed retrospective review of children 0-12mo who attempted NS-MRI. The NS-MRI was successful if imaging was sufficient for definitive clinical management per the managing otolaryngologist. Among 26 patients (29 scans), the median age was 3.2mo (range: 1.2-6.8mo), distance travelled was 16.3 miles (range: 0.9 to 365 miles), 12 (46%) children had medical comorbidities. 8 (31%) had public insurance. 10 (38%) had bilateral HL. 52% (15/29) of scans were successful. Patients with comorbidities had significantly lower odds of successful NS-MRI (OR 0.09; 95% CI 0.01-0.54). Success was not associated with age, distance travelled, insurance type, primary language, HL characteristics, time or duration of MRI on univariable analysis. All 11 children who failed NS-MRI underwent hearing-aid fitting and/or imaging with sedation and CI as clinically indicated before 12mo. NS-MRI was successful in 52% of infants, regardless of age, demographics, HL or MRI characteristics. Unsuccessful NS-MRI did not result in delayed intervention. NS-MRI is an effective consideration for a broad range of infants with SNHL.

Ganciclovir Treatment in Symptomatic Congenital CMV Infection at Siriraj Hospital: 11 Year-Review (2008 to 2019)

Background: Congenital cytomegalovirus (CMV) infection is the most common non-genetic cause of permanent sensorineural hearing loss in infants and children. A 6-month course of intravenous ganciclovir or valganciclovir is recommended for treatment of patients with moderate to severe symptomatic congenital CMV disease. Hearing status improvement has been reported in those that received treatment within the first month of life. In Thailand, there has been no data of antiviral treatment in symptomatic congenital CMV patients. Objective: To determine the incidence of symptomatic congenital CMV infection in the past 11 years and to evaluate the hearing, neurological, and developmental outcomes of the antiviral treatment and factors associated with hearing outcomes. Materials and Methods: A retrospective observational study was performed at Siriraj Hospital, between January 2008 and December 2019. The medical records of the patients diagnosed of symptomatic congenital CMV infection (ICD10-P351) were reviewed. Results: The incidence of symptomatic congenital CMV infection was 0 to 1.01 case per 1,000 livebirths. Of the 52 patients, 18 received 6-week course of ganciclovir and five continued with oral valganciclovir for three to six months. Developmental delayed was found in 69.2% (36). No difference in hearing outcomes at 6 and 12 months of age between the patients who did or did not receive treatment. Among 24 (46.1%) children who underwent hearing test at two to three years of age, the birth characteristics, as well as antiviral treatment (attributable risk 0.007, 95% CI –0.4 to 0.4, p=0.973), had no difference in hearing outcome. Long-term disability was diagnosed in the lower proportion among the patients receiving antiviral treatment (attributable risk –0.3, 95% CI –0.5 to –0.1, p=0.030). Conclusion: Symptomatic congenital CMV infection resulted in poor hearing and developmental outcomes. Antiviral treatment reduced risk of disability but did not improve hearing outcomes. The results underscore the need for early diagnosis and initiation of antiviral treatment in infants with symptomatic congenital CMV. Keywords: Congenital infection; CMV; Hearing loss; Ganciclovir; Valganciclovir; Disability

Factors associated with increased odds of sensorineural hearing loss in infants exposed to the Zika virus during pregnancy.

The Zika virus (ZIKV) infection in pregnant women has been associated with an increased risk of birth defects. We aimed to estimate the prevalence of sensorineural hearing loss (SNHL) in infants exposed to the ZIKV during their gestation and evaluate the factors associated with its increased odds. A cross-sectional study was performed from July 2016 to June 2019 in a Western state of Mexico and data from 61 infants that presented with laboratory-positive (RT-qPCR) evidence of in utero exposure to ZIKV were analyzed. Brain stem auditory evoked potentials were used. Hearing loss was documented in 6 (9.8%) of infants. The prevalence of SNHL in children with microcephaly was 75.0%, as compared to 5.3% in those without anomalies (odds ratio, OR = 14.31, 95% CI = 2.54 - 19.12). Half of children with SNHL had no physical manifestations of gestational ZIKV exposure. Hearing loss was a frequent event in ZIKV-exposed children, particularly among those with microcephaly. Our results highlight the relevance of systematic hearing screening.

Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis.

Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis. A retrospective review was performed among infants (age <365 days) with bacterial meningitis (n = 115). Independent and consensus blinded review of brain MRIs (n = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL. The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0-338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose (P = .04, .02) and high CSF protein (P = .04, .03). Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.

Evaluating the success of a newly introduced Feed and Wrap protocol in magnetic resonance imaging scanning of the temporal bone for the evaluation of congenital sensorineural hearing loss

ObjectivesMagnetic resonance imaging (MRI) of the temporal bones, specifically of the cochlea and retro-cochlear pathway, is an important investigation in the diagnostic workup and management of congenital hearing loss. However, obtaining a diagnostic quality MRI scan depends upon the need for the infant to remain still for the duration of the scan. The Feed and Wrap (F + W) technique is a method that has been used successfully in infants for scans of other parts of the body, but has not been properly studied in MRI scans performed for hearing loss.The primary aim was to evaluate the diagnostic success rate of a newly introduced Feed and Wrap MRI scanning protocol used for assessment of sensorineural hearing loss in infants at Western Australia's Tertiary Paediatric hospital over the last three years. The secondary aims were to discuss the advantages and disadvantages of this technique and to review the available published literature on this technique and compare it to our case series. MethodsAll F + W MRI scans performed for the investigation of congenital hearing loss between 2016 and 2019 at the King Edward Memorial Hospital for Women and Perth Children's Hospital were retrospectively reviewed. The primary outcome was the diagnostic utility of the MRI scan with a diagnostic scan defined as the ability to diagnose or exclude radiological causes of sensorineural hearing loss. Results53 MRI scans of the temporal bone and brain were identified. 86.8% of scans were diagnostic. The mean age of infants who underwent diagnostic scans was 6.8 weeks old compared to 10.9 weeks (p = 0.01) for those who had non-diagnostic scans. The optimal age cut off for F + W technique was ≤10 weeks. The odds of failure are 16.7 (95%CI 6.5–42.8, p = 0.003) times higher above the cut of age of 10 weeks compared to ≤10 weeks. ConclusionThe F + W technique is a viable method for obtaining diagnostic quality MRI scans of the inner ear structures in infants with hearing loss, with a greater likelihood of success when applied in younger infants.

Virus-induced cochlear inflammation in newborn mice alters auditory function

Although human cytomegalovirus (HCMV) is a known cause of sensorineural hearing loss in infants with congenital HCMV (cCMV) infections, mechanisms that contribute to sensorineural hearing loss (SNHL) in infants with cCMV infection are not well defined. Using a murine model of CMV infection during auditory development, we have shown that peripheral infection of newborn mice with murine CMV (MCMV) results in focal infection of the cochlea and virus-induced cochlear inflammation. Approximately 50%-60% of infected mice exhibited increased auditory brainstem response (ABR) thresholds across a range of sound frequencies. Histological analyses of the cochlea in MCMV-infected mice with elevated ABR thresholds revealed preservation of hair cell (HC) number and morphology in the organ of Corti. In contrast, the number of spiral ganglion neurons (SGN), synapses, and neurites connecting the cochlear HC and SGN nerve terminals were decreased. Decreasing cochlear inflammation by corticosteroid treatment of MCMV-infected mice resulted in preservation of SGN and improved auditory function. These findings show that virus-induced cochlear inflammation during early auditory development, rather than direct virus-mediated damage, could contribute to histopathology in the cochlea and altered auditory function without significant loss of HCs in the sensory epithelium.

Normal neonatal hearing screening did not preclude sensorineural hearing loss in two-year-old very preterm infants.

Very preterm infants are at risk of neonatal hearing loss. However, it is unknown whether infants with a normal neonatal hearing screening result risk sensorineural hearing loss (SNHL) at a later age. This cohort study was conducted at the Erasmus Medical University Center Rotterdam, the Netherlands, on 77 very preterm infants born between October 2005 and September 2008. All infants underwent auditory brainstem response audiometry during neonatal hearing screening and at two years of corrected age. The frequency of SNHL in infants with a normal neonatal hearing screening was analysed and the risk factors associated with newly diagnosed SNHL in these infants were examined. We found that 3.9% (3/77) of the very preterm infants showed permanent hearing loss during their neonatal hearing screening. In addition, a relatively high prevalence of newly diagnosed SNHL (4.3%) was found in three of the 70 infants followed up at the age of two. The total prevalence rate of permanent hearing loss in the cohort was approximately 8%. A normal outcome of neonatal hearing screening did not guarantee normal hearing at two years of age in this very preterm cohort and paediatricians should be alert to the possibility of late-onset SNHL.

Risk of sensorineural hearing loss in infants with abnormal head size

The purpose was to determine the risk of sensorineural hearing loss (SNHL) in young infants with abnormal head sizes in a developing country. A matched case-control study of two (hospital-based and community-based) cohorts of term infants who failed a two-stage hearing screening test with transient-evoked otoacoustic emissions and automated auditory brainstem response in Lagos, Nigeria. Abnormal head size (microcephaly or macrocephaly) was determined with World Health Organisation's growth standards for head circumference. The adjusted odds ratios for the risk of SNHL in microcephalic and macrocephalic infants were established through unconditional and conditional logistic regression analyses. Some 194 cases and 970 matched controls drawn from 8,872 term singletons 3 months or younger were studied. The median age of enrolment was 1 day in the hospital-based cohort and 17 days in the community-based cohort. Microcephalic infants in both cohorts were significantly at risk of SNHL while no significant risk was found among macrocephalic infants regardless of birth setting. Microcephalic infants should be routinely screened for potential hearing loss particularly where universal newborn hearing screening is not immediately practicable. Etiological investigation of abnormal head size in this and similar population is warranted. Routine screening and maternal immunization for congenital infections should also be considered.

Audiologic profile of infants at risk: Experience of a Western Sicily tertiary care centre

ObjectiveTo identify the incidence of sensorineural hearing loss (SNHL) on infant at risk and to classify the degree and type of hearing loss describing the main causes associated in Western Sicily. To compare single TEOAE and combined TEOAE/ABR techniques studying the referral rate, the false-positive and false-negative rates through concordance test (κ coefficient), sensitivity (TPR) and specificity (TNR) for each protocol. MethodsFrom January 2010 to June 2011, 412 infants at risk, ranging from 4 to 20 weeks of life, transferred to Audiology Department of Palermo from the births centers of Western Sicily, underwent to audiological assessment with TEOAE, tympanometry and ABR. The following risk factors were studied: family history of SNHL, consanguinity, low birth weight, prematurity, cranio-facial abnormality and syndromes associated to SNHL, respiratory distress, intensive care in excess of 5 days (NICU), pregnant maternal diseases, perinatal sepsis or meningitis, hyperbilirubinemia, ototoxic drugs administration. ResultsForty-seven infants (11.41%) were diagnosed with SNHL; median corrected age at final audiological diagnosis was 12 weeks. SNHL resulted moderate in 44.68%, severe in 10.64% and profound in 21 cases with a significant difference in family history and NICU infants (p<0.0001). As the number of coexisting risk factors increases, the percentage value of SNHL in infants (χ2=12.31, p=0.01, r2=0.98) and the degree of hearing loss (χ2=13.40, p=0.0095, r=0.92) also increase. The study of single TEOAE and combined TEOAE/ABR showed a statistical difference (χ2=14.89, p<0.001) with a low concordance value (κ=0.87) confirming the importance of combined techniques for NICU group (κ=0.86) where four cases (0.97%) of auditory neuropathy were diagnosed. ConclusionThis study demonstrates the necessity to implement a neonatal hearing screening program in Western Sicily because of the high percentage of SNHL in infants at risk. Family history of HL is an independent significant risk factor for SNHL easily diagnosed through single TEOAE technique. Combined TEOAE/ABR is the gold standard for NICU babies which are at risk for auditory neuropathy. Coexisting risk factors are an additional risk factor for HL.

Is lenticulostriated vasculopathy a sign of central nervous system insult in infants with congenital CMV infection?

BackgroundIn previous studies, lenticulostriated vasculopathy (LSV) was detected in 0.4–5.8% of neonates who had undergone brain ultrasound studies during the neonatal period. Most infants were referred from neonatal intensive care...

Risk factors associated with hearing loss in infants: An analysis of 5282 referred neonates

Objective The aim of our study was to evaluate the frequency of risk factors and their influence on – the distribution and manifestation of – hearing loss in infants. The study was conducted at the Department of Laryngology in the Upper Silesian Center for Child Health in Katowice (Poland), as part of the Polish National Universal Neonatal Hearing Screening, conducted from 2003 to 2009. Materials and methods The selected population included every newborn that twice tested positive on the transient evoked otoacoustic emission (TEOAE) screening test, as well as all neonates with one or more risk factors as defined by the Joint Committee of Infant Hearing in 2000 (JCIH). The following procedures were used with each neonate: otolaryngological examination (with otoscopy), tympanometry, automated otoacoustic emission (AOAE), and auditory brainstem response (ABR). A total of 5282 infants were examined. Subjects were categorized into two groups: the first group consisted of 2986 (56.53%) neonates with risk factors of hearing loss, while the second group included 2296 (43.47%) neonates without any known risk factors, but who twice tested positive on the TEOAE screening. Results Among all infants examined (5282), sensorineural hearing loss (SNHL) was identified in 240 cases (4.54%), and conductive hearing loss (CHL) in 40 cases (0.76%), while normal hearing (NH) appeared in 5002 cases (94.70%). In the first group, SNHL was identified in 128 neonates (4.29%), and CHL in 28 (0.94%), while NH appeared in 2830 (94.78%). The largest percentage of SNHL (15.52%) appeared in children with identified or suspected syndromes associated with hearing loss. The next highest frequency of SNHL was comprised of children subjected to mechanical ventilation for a period in excess of 5 days (11.45%). Only a small percentage (2.86%) of SNHL appeared to be due to the use of ototoxic medications, despite the fact that this factor is the most prevalent (33.13%) of all analyzed risk factors of hearing impairment. After ototoxic medications, the frequencies of risk factors are as follows: premature birth (16.21%); low birth weight (12.04%); intensive care in excess of 7 days (10.64%). Furthermore, as the number of coexisting risk factors increases, the probability of SNHL in infants is seen to also increase. For children with one to four coexisting risk factors, the probability of SNHL ranges from 3.15% to 5.56%; for five or more risk factors the probability nearly doubles. Conclusion Our results indicate that syndromes associated with hearing loss and mechanical ventilation for more than 5 days were statistically significant risk factors in the occurrence of hearing loss. The most common risk factors are ototoxic medications, premature birth, low birth weight, and intensive care in excess of 7 days. As the number of risk factors an infant is exposed to grows, the probability of hearing impairment increases. The large percentage of children with sensorineural hearing loss in the absence of any known risk factors demonstrates the necessity of hearing examinations in all neonates.

Reply to the correspondence letter: “Congenital CMV: are we treating too many?”

Dear Editor, I read with interest the comments of LI Gonzalez-Granado regarding the criteria for selecting infants suffering from symptomatic congenital cytomegalovirus (CMV) infection for antiviral treatment. In our case series of infants [1], we chose to treat only infants with clinical or ultrasound findings related to central nervous system (CNS) involvement: microcephaly, choioretinitis, sensorineural hearing loss (SNHL) or brain ultrasound findings. Of the 23 infants included in the study, 19 had more than one site of CMV damage. Two out of the four infants had only one site SNHL. In the other two patients, ultrasound findings included brain calcification. The issue of lenticulostriated vasculopathy (LSV) as a sign of CNS involvement is still unclear; however, in our study, LSV was detected on brain ultrasound in only four infants. All four also had other signs of congenital CMV infection: chorioretinitis in two, moderate and severe SNHL in three, and microcephaly in one. We feel, as do others [4,5], that LSV in infants with congenital CMV is a sign of CNS involvement. We recently completed a study dealing with this issue. Based on our data, we conclude that LSV is a good predictor for SNHL in infants with congenital CMV.Most data about of the incidence of LSV were taken from hospital records of infants hospitalized in neonatal intensive care units due to either prematurity or serious medical problems [2,3]. Therefore we cannot say at this point that “LSV is a normal finding on brain ultrasound during the neonatal period” .W e agree that most infants with LSV do not suffer from congenital infection but those who have had a congenital infection such as CMV, findings of LSV is probably a subtle sign of CNS involvement.

Risk factors for sensorineural hearing loss in NICU infants compared to normal hearing NICU controls

Objectives To evaluate independent etiologic factors associated with sensorineural hearing loss in infants who have been admitted to the neonatal intensive care unit compared to normal hearing controls. Method Between 2004 and 2009, 3366 infants were admitted to the neonatal intensive care unit of Sophia Children's Hospital, of which 3316 were screened with AABR. A total of 103 infants were referred for auditory brainstem response analysis after failure on neonatal hearing screening. We included all infants diagnosed with sensorineural hearing loss. Each patient was matched with two normal hearing controls from the neonatal intensive care unit of the same gender and postconceptional age. The following risk factors were studied: birth weight, dysmorphic features, APGAR scores (at 1, 5 and 10 min), respiratory distress (IRDS), CMV infection, sepsis, meningitis, cerebral bleeding, cerebral infarction, hyperbilirubinemia requiring phototherapy, peak total bilirubin level, furosemide, dexamethason, vancomycin, gentamycin and tobramycin administration. Results Fifty-eight infants were diagnosed with sensorineural hearing loss: 26 girls and 32 boys. The incidence of dysmorphic features ( P = 0.000), low APGAR score (1 min) ( P = 0.01), sepsis ( P = 0.003), meningitis ( P = 0.013), cerebral bleeding ( P = 0.016) and cerebral infarction ( P = 0.000) were significantly increased in infants with sensorineural hearing loss compared to normal hearing controls ( n = 116). Conclusion Dysmorphic features, low APGAR scores at 1 min, sepsis, meningitis, cerebral bleeding and cerebral infarction are associated with sensorineural hearing loss independent of neonatal intensive care unit admittance.

Sensorineural hearing loss in infants with neonatal jaundice in Lagos: a community-based study

To establish the incidence and predictors of sensorineural hearing loss (SNHL) in infants with neonatal jaundice (NNJ) in an inner-city setting with predominantly non-hospital births. A community-based study in Lagos, Nigeria in which infants with SNHL attending well-child clinics for routine immunisation were detected by two-stage universal hearing screening with transient evoked oto-acoustic emissions and automated auditory brainstem response from July 2005 to December 2006. Predictors of SNHL among infants with a history of NNJ were determined with multivariate logistic regression based on adjusted odds ratio (OR) at 95% confidence intervals (CI). Of the 3676 infants enrolled, 52.4% were not born in hospital and 71 (2.1%) were confirmed to have SNHL. Fourteen (6.0%) of the 234 infants with NNJ had SNHL. Bilateral hearing loss was moderate (41-70 dB) in three (21.4%), severe (71-90 dB) in eight (57.1%) and profound (>90 dB) in two (14.3%) infants. One infant (7.1%) had unilateral SNHL. Six (42.9%) of the infants with SNHL had a profile suggestive of auditory neuropathy/dyssynchrony. Christianity (OR 0.15, CI 0.03-0.93), multiparity (OR 7.33, CI 1.17-45.99), low social class (OR 6.04, CI 1.33-27.48), infant's age (OR 10.17, CI 1.91-54.05), multiple gestations (OR 10.55, CI 1.98-56.11) and exchange blood transfusion (OR 7.74, CI 1.66-36.2) were predictive of SNHL. This model has a sensitivity of 85.7%, a specificity of 83.6%, a negative predictive value of 98.9% but a positive predictive value of only 25.0% for identifying SNHL among infants with severe NNJ. SNHL is prevalent among infants with NNJ and community-orientated early detection to curtail the associated long-term developmental consequences is feasible in resource-poor settings where facilities for clinical monitoring are limited. Hearing evaluation of infants treated for severe NNJ should be incorporated into the management and follow-up of these patients.

Risk Factors Associated with Sensorineural Hearing Loss in Infants at the Neonatal Intensive Care Unit: 15-Year Experience at the National Institute of Perinatology (Mexico City)

Infants from neonatal intensive care units (NICU) are at high risk for sensorineural hearing loss (SNHL); however, risk factors may change from NICU to NICU and from country to country. Our objective was to describe the main causes associated with SNHL in infants from a tertiary level NICU in Mexico City and to show the associated audiometric profiles. We performed a comparison of follow-up of infants from NICU with SNHL and a control group with the same history but with normal hearing. Infants were examined at birth by brainstem auditory evoked potentials (BAEP) and followed by audiometric tests. Hearing loss was associated with clinical variables. SNHL group had 146 children and the control group had 272 children. Mean weight at birth in the SNHL group was 1530+/-581 g and in the control group, 1723+/-805 g (p<0.01). Days spent at the NICU and under mechanical ventilation were higher in the SNHL group (p<0.001). In addition, serum bilirubin levels were higher in the SNHL group than in the control group (p<0.001). Blood exchange, intraventricular hemorrhage, and neonatal meningitis comprised the main SNHL-associated variables. Use of prenatal steroids and pulmonary surfactant demonstrates protection against SNHL. Audiometric profiles disclosed mainly severe SNHL. Low birth weight, longer stay in NICU and under mechanical ventilation, higher serum bilirubin levels, prevalence of blood exchange, intraventricular hemorrhage, and meningitis in high-risk newborns were the main risk factors associated with SNHL and merit hearing screening and early intervention in high-risk infants.

Programa de triagem auditiva neonatal: associação entre perda auditiva e fatores de risco

Hearing loss in newborns. To verify the prevalence of auditory alterations in newborns of Hospital São Paulo (hospital), observing if there are any correlations with the following variables: birth weight, gestational age, relation weight/gestational age and risk factors for hearing loss. A retrospective analysis of the hospital records of 1696 newborns; 648 records of preterm infants and 1048 records of infants born at term. All of the infants had been submitted to an auditory evaluation consisting of: Transient Otoacoustic Emissions, investigation of the cochleal-palpebral reflexes and acoustic imittance tests, identifying the type and level of hearing loss. Sensorineural hearing loss was identified in .82% of the infants who were born at term and in 3.1% of the preterm infants -- with a statistically significant difference. Conductive hearing loss was the most frequent type of hearing loss in both groups, occurring in 14.6% of the term infants and in 16.3% of the preterm infants. Alteration of the central auditory system was considered as a possible diagnosis for 5.8% of the preterm infants and for 3.3% of the term infants. For the group of infants who were born at term, a significant correlation was observed between failure in the hearing screening test and the presence of risk factors such as family history and presence of a syndrome -- the child who presented a syndrome had 37 times more chances of failing in the hearing screening test and seven times more chances of failing in the right ear when there was a family history for hearing loss. The lower the gestational age (< 30 weeks) and birth weight (< 1500 g), the higher the chances of failing in the hearing screening test (3 times more). Hearing loss had a higher occurrence in preterm infants who remained in the ICU. Gestational age and birth weight were important variables related to the possibility of failure in the hearing screening test. A correlation was observed between the presence of a syndrome and sensorineural hearing loss in infants who were born at term.

Sensorineural Hearing Loss in Infants with Mild Symptoms of Congenital Cytomegalovirus Infection

Sensorineural Hearing Loss in Infants with Mild Symptoms of Congenital Cytomegalovirus Infection

Sensorineural hearing loss in children.

A variety of pathologic conditions cause sensorineural hearing loss in infants and children. Modern imaging techniques such as high-resolution computed tomography (CT) and magnetic resonance (MR) imaging have made it possible to identify a specific cause of pediatric hearing loss in many cases. A classification system has been developed that groups these abnormalities into three anatomic locations along the cochlear nerve: the labyrinth, the internal auditory canal, and the brain stem and cerebrum. Unenhanced high-resolution CT remains the imaging modality of choice in evaluating most cases of pediatric sensorineural hearing loss. In general, CT is the preferred modality in cases of trauma and nonacute congenital otic capsular dysplasias, whereas contrast material-enhanced MR imaging is preferred in cases of inflammatory and neoplastic disorders. Documented acute hearing loss in an older child or adolescent should also be studied with contrast-enhanced MR imaging. Reliable radiologic evaluation requires accurate clinical information as well as knowledge of normal inner ear anatomy and abnormal imaging findings.

Late-Onset Hearing Loss

The findings of Hendricks-Munoz and Walton concerning the incidence of sensorineural hearing loss in infants with persistent pulmonary hypertension (persistent fetal circulation) substantiate our findings that, in some cases, the loss appears to be of delayed onset and progressive. We would, however, like to point out that delayed-onset sensorineural loss is not limited to infants with persistent pulmonary hypertension, because four of the 11 infants we reported did not have persistent pulmonary hypertension. Therefore, serial audiologic evaluations should also be done for any infant with significant respiratory failure requiring prolonged mechanical ventilation with resultant chronic lung disease.