Abstract：
BACKGROUND: This prospective cohort study aims to investigate the hearing dynamics and the changes in the central auditory pathways in infants with congenital cytomegalovirus (cCMV) infection.
METHODS: cCMV-infected neonates aged ≤3 weeks old were recruited and underwent clinical and laboratory tests to detect viremia and symptomatic infection, hearing examinations at three and six months of age, and radiological imaging of brain auditory pathways using diffusion tensor imaging.
RESULTS: From 26 eligible infants (52 ears), we detected symptomatic infection in nine (34.6%), viremia in 14 (14/25; 56.0%) and sensorineural hearing loss (SNHL) in 14 infants (53.8%). We observed 40 ears (76.9%) with unstable hearing thresholds, 17 (42.5%) of which fluctuated. Hearing fluctuation and progressivity were more common in symptomatic infection (66.7% vs. 14.7%, p<0.001; and 38.9% vs. 2.9%, p=0.002; respectively). A substantial proportion of ears had reduced fractional anisotropy (FA) in the medial geniculate body (59.1%), superior olivary nucleus (45.5%), trapezoid body (40.9%), auditory radiation (36.4%) and inferior colliculus (31.8%). Symptomatic infection was associated with an increased FA in the medial geniculate body (mean difference, MD: 0.12; 95% Confidence Intervals, 95%CI: 0.03, 0.22) and viremia in the inferior colliculus (MD: 0.09; 95%CI: 0.02, 0.16). An FA in the inferior colliculus of ≥0.404 had a sensitivity and specificity of 68.8% and 83.3% in predicting viremia (area under the curve 0.823; 95%CI: 0.633, 1.000, p=0.022).
CONCLUSIONS: SNHL along with its fluctuation and progression are common in cCMV-infected infants. cCMV infection may induce structural changes in the central auditory pathway.
METHODS: cCMV-infected neonates aged ≤3 weeks old were recruited and underwent clinical and laboratory tests to detect viremia and symptomatic infection, hearing examinations at three and six months of age, and radiological imaging of brain auditory pathways using diffusion tensor imaging.
RESULTS: From 26 eligible infants (52 ears), we detected symptomatic infection in nine (34.6%), viremia in 14 (14/25; 56.0%) and sensorineural hearing loss (SNHL) in 14 infants (53.8%). We observed 40 ears (76.9%) with unstable hearing thresholds, 17 (42.5%) of which fluctuated. Hearing fluctuation and progressivity were more common in symptomatic infection (66.7% vs. 14.7%, p<0.001; and 38.9% vs. 2.9%, p=0.002; respectively). A substantial proportion of ears had reduced fractional anisotropy (FA) in the medial geniculate body (59.1%), superior olivary nucleus (45.5%), trapezoid body (40.9%), auditory radiation (36.4%) and inferior colliculus (31.8%). Symptomatic infection was associated with an increased FA in the medial geniculate body (mean difference, MD: 0.12; 95% Confidence Intervals, 95%CI: 0.03, 0.22) and viremia in the inferior colliculus (MD: 0.09; 95%CI: 0.02, 0.16). An FA in the inferior colliculus of ≥0.404 had a sensitivity and specificity of 68.8% and 83.3% in predicting viremia (area under the curve 0.823; 95%CI: 0.633, 1.000, p=0.022).
CONCLUSIONS: SNHL along with its fluctuation and progression are common in cCMV-infected infants. cCMV infection may induce structural changes in the central auditory pathway.
摘要：
背景：这项前瞻性队列研究旨在调查先天性巨细胞病毒（cCMV）感染婴儿的听力动力学和中枢听觉通路的变化。
方法：招募≤3周龄的cCMV感染新生儿，并进行临床和实验室检查，以检测病毒血症和症状性感染。三、六个月大的听力检查，和使用扩散张量成像的脑听觉通路的放射学成像。
结果：来自26名合格婴儿（52耳），我们发现有症状的感染有9例(34.6%)，14例（14/25；56.0％）的病毒血症和14例婴儿（53.8％）的感觉神经性听力损失（SNHL）。我们观察到40只耳朵（76.9％）的听力阈值不稳定，17（42.5%），其中波动。听力波动和进展性在有症状的感染中更为常见(66.7%vs.14.7%,p<0.001；38.9%vs.2.9%,p=0.002；分别）。相当比例的耳朵在内侧膝状体中具有降低的分数各向异性（FA）（59.1％），上橄榄核（45.5%），梯形体（40.9%），听觉辐射(36.4%)和下丘(31.8%)。症状性感染与内侧膝状体的FA增加相关(平均差，MD：0.12；95%置信区间，95CI：0.03，0.22）和下丘病毒血症（MD：0.09；95CI：0.02，0.16）。下丘FA≥0.404在预测病毒血症方面的敏感性和特异性分别为68.8%和83.3%(曲线下面积0.823;95CI:0.633,1.000,p=0.022)。
结论：SNHL及其波动和进展在cCMV感染的婴儿中很常见。cCMV感染可引起中枢听觉通路的结构改变。
方法：招募≤3周龄的cCMV感染新生儿，并进行临床和实验室检查，以检测病毒血症和症状性感染。三、六个月大的听力检查，和使用扩散张量成像的脑听觉通路的放射学成像。
结果：来自26名合格婴儿（52耳），我们发现有症状的感染有9例(34.6%)，14例（14/25；56.0％）的病毒血症和14例婴儿（53.8％）的感觉神经性听力损失（SNHL）。我们观察到40只耳朵（76.9％）的听力阈值不稳定，17（42.5%），其中波动。听力波动和进展性在有症状的感染中更为常见(66.7%vs.14.7%,p<0.001；38.9%vs.2.9%,p=0.002；分别）。相当比例的耳朵在内侧膝状体中具有降低的分数各向异性（FA）（59.1％），上橄榄核（45.5%），梯形体（40.9%），听觉辐射(36.4%)和下丘(31.8%)。症状性感染与内侧膝状体的FA增加相关(平均差，MD：0.12；95%置信区间，95CI：0.03，0.22）和下丘病毒血症（MD：0.09；95CI：0.02，0.16）。下丘FA≥0.404在预测病毒血症方面的敏感性和特异性分别为68.8%和83.3%(曲线下面积0.823;95CI:0.633,1.000,p=0.022)。
结论：SNHL及其波动和进展在cCMV感染的婴儿中很常见。cCMV感染可引起中枢听觉通路的结构改变。
