178例先天性巨细胞病毒感染患儿听力评估及随访

Hearing Evaluation and Follow-up Study of 178 Children with Congenital Cytomegalovirus Infection

目的探讨先天性巨细胞病毒(congenital cytomegalovirus,cCMV)感染患儿听力损失特点。方法对178例诊断为先天性巨细胞病毒感染的患儿,采用自动听性脑干反应(AABR)行新生儿听力筛查,未通过者42天复筛,并于3、6、9、12、18、24、30及36月龄时进行随访,随访过程中AABR听力筛查未通过的患儿进行听力诊断,包括专科检查、畸变产物耳声发射(DPOAE)、声导抗、听性脑干反应(ABR)检测。结果178例cCMV感染患儿中诊断感音神经性听力损失(SNHL)16例(8.99%,16/178),症状型感染患儿的听力损失检出率(28.57%,8/28)明显高于无症状感染患儿(5.33%,8/150);单侧9例,双侧7例,其中中重度及以上听力损失者分别为66.67%(6/9)和57.14%(4/7);先天性SNHL 5例(31.25%,5/16),迟发性SNHL11例(68.75%,11/16),其中中重度及以上听力损失7例;波动性SNHL2例(其中1例随访过程中听力恢复正常),渐进性SNHL5例,其余9例在随访期间表现为平稳性SNHL。结论cCMV感染患儿SNHL发生率较高,且多表现为中重度及以上程度听力损失,症状型感染患儿的听力损失更明显;迟发性SNHL所占比例较大,听力损失初始时间多在婴幼儿早期,应密切随访,及早发现并干预。

Objective To investigate the characteristics of hearing loss in children with congenital cytomegalovirus(cCMV)infection.Methods A total of 178 children with congenital cytomegalovirus infection were screened by automatic auditory brainstem response(AABR).Those who failed to pass the screening were re-screened for 42 days.Audiological follow-up was conducted at the age of 3,6,9,12,18,24,30 and 36 months.The hearing diagnosis was made for the children who failed the AABR hearing screening,including physical examination by specialists and distortion product otoacoustic emission(DPOAE),acoustic immittance and auditory brainstem response(ABR)were measured.Results Among 178 children with cCMV infection,16 cases(8.99%,16/178)were diagnosed with sensorineural hearing loss(SNHL).The detection rate of hearing loss in children with symptomatic infection(28.57%,8/28)was significantly higher than that in children with asymptomatic infection(5.33%,8/150).There were 9 cases of unilateral and 7 cases of bilateral hearing loss,of which the proportion of moderate and severe hearing loss was 66.67%(6/9)and 57.14%(4/7)respectively.There were 11 cases of delayed SNHL(68.75%,11/16),including 7 cases of moderate and severe hearing loss.2 cases of fluctuating SNHL,including 1 case of normal hearing,5 cases of progressive SNHL,and the rest showed stable SNHL during follow-up.Conclusion The incidence of SNHL in children with cCMV infection is high,and most of them are moderate to severe degree or above,and the hearing loss of children with symptomatic infection is more obvious.The proportion of delayed SNHL is larger than that of congenital SNHL,and the initial time of hearing loss is mostly in the early stage of infants.It is suggested to further close follow-up,and early detection and intervention should be carried out.