The correlation between neonatal parameters and late-onset inner ear disorders in congenital cytomegalovirus infection: a 10-year population-based cohort study.

OBJECTIVE: To evaluate the correlation of neonatal parameters with late-onset sensorineural hearing loss (SNHL) and vestibular dysfunction in individuals with congenital cytomegalovirus (cCMV) infection using the National Health Insurance Research Database (NHIRD) in Taiwan. DESIGN: Retrospective cohort study. SETTING: The whole Taiwanese population. PARTICIPANTS: Patients with related diagnostic codes and examinations in their records were regarded as having cCMV infection. Each subject in that group was matched to 10 control individuals with noncongenital CMV infection on the basis of several neonatal parameters, including low gestational age, low birth weight, low Apgar score, maternal history of CMV infection and prolonged cCMV infection. A total of 5893 and 58 930 participants were enrolled in the study and control groups, respectively. MAIN OUTCOME MEASURES: The main outcomes were the development of SNHL and the development of vestibular dysfunction within one year after birth as reflected by diagnostic codes and specific examinations. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (HR) and 95% confidence interval (CI) of each primary outcome between the two groups. RESULTS: Overall, 109 and 397 episodes of SNHL developed in the study group and the control group, respectively, and the study group demonstrated a significantly higher incidence of SNHL (adjusted HR: 2.56; 95% CI: 2.07-3.18). In addition, similar incidence rates of vestibular dysfunction were found in the study group and the control group, with 7 and 90 events, respectively (adjusted HR: 0.77; 95% CI: 0.36-1.67). In subgroup analyses, a higher incidence of SNHL was correlated with lower gestational age (GA) (adjusted HR: 2.09; 95% CI: 1.29-3.39), lower birth weight (BW) (adjusted HR: 2.05; 95% CI: 1.28-3.30) and prolonged cCMV infection (adjusted HR: 3.92; 95% CI: 1.95-7.88). CONCLUSIONS: Low GA, low BW and a long disease course are significantly correlated with late-onset SNHL in cCMV infection.

Effects of Covid-19 on the audio-vestibular system.

PURPOSE: It was aimed to investigate the effects of COVID-19 infection on hearing and the vestibular system. METHODS: Twenty-six patients whose treatment had been completed and who had no previous hearing or balance complaints were included in the study. Patients diagnosed with the disease by PCR were included in the study. Patients with at least one month of illness were included in the study. The hearing of patients was evaluated with transient evoked otoacoustic emissions (TEOAE) and pure-tone audiometry. Bedside tests, the European Evaluation of Vertigo scale (EEV), Video Head Impulse Test (vHIT), Ocular Vestibular Myogenic Evoked Potential (oVEMP), Cervical Vestibular Myogenic Evoked Potential (cVEMP) and Videonystagmography (VNG) tests were applied to evaluate the vestibular system. RESULTS: A statistically significant difference was found between the COVID-19 positive and control groups according to the mean values of the 4000 Hz and 8000 Hz in both the right and left ears (p < 0.05). No statistically significant difference was found in the other frequencies and TEOAE. No statistically significant difference was found between the COVID-19 positive and control groups in terms of their normal or pathological VNG saccade, optokinetic and spontaneous nystagmus values (p > 0.05). The normal and pathological VNG head shake values were found to be significantly different between the COVID-19 positive and control groups (p < 0.05). CONCLUSiON: The high frequencies in audiometry in the COVID-19 positive group were worse than those in the control group. In the vestibular system, especially in oVEMP and cVEMP, asymmetric findings were obtained in comparison to the control group, and a low gain in vHIT was shown. This study shows that the audiovestibular system of people with COVID-19 infection may be affected.

SARS-CoV-2 (COVID-19) and audio-vestibular disorders.

To describe the audio-vestibular disorders related to the newly SARS-CoV-2 infection, including the possible ototoxicity side-effects related to the use of drugs included in the SARS-CoV-2 treatment protocols. A systematic review was performed according to the PRISMA protocol. The Medline and Embase databases were searched from March 1, 2020 to April 9, 2021. Initially the search yielded 400 manuscripts, which were reduced to 15, upon the application of inclusion criteria. Sensorineural hearing loss (SNHL) is the most frequent audio-vestibular symptom described, occurring alone or in association with tinnitus and vertigo. The etiopathogenesis of the inner ear disorders related to COVID-19 infection is still poorly understood. The number of reports of COVID-19 infections associated to audio-vestibular disorders is increasing; even if the quality of the studies available is often insufficient, audio-vestibular disorders should be considered as possible manifestations to be included among the symptoms of this infection.

Vestibular, Gaze, and Balance Disorders in Asymptomatic Congenital Cytomegalovirus Infection.

BACKGROUND AND OBJECTIVES: Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss and developmental disabilities. Because there are limited data from studies of vestibular involvement in select groups of children with cCMV, the true frequency of vestibular disorders in cCMV is likely underestimated. Our objective for this study is to determine the prevalence of vestibular, gaze, and balance disorders in a cohort of children with asymptomatic cCMV. METHODS: Comprehensive vestibular, gaze, and balance assessments were performed in 40 children with asymptomatic cCMV. The function of semicircular canals of the inner ear and vestibulo-visual tract were assessed by measuring vestibulo-ocular reflex in a computer-driven motorized rotary chair; inner ear saccular function was assessed by using cervical vestibular evoked myogenic potential; gaze stability during head movement was assessed by using clinical dynamic visual acuity, and balance was assessed by using the sensory organization test and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Test results for each variable were compared with those of a control group without cCMV and/or compared to age-matched normative published data. RESULTS: Vestibular disorders were evident in 45% of the cohort on the basis of rotary chair and cervical vestibular evoked myogenic potential testing, suggesting abnormalities in semicircular canals, the utricle and saccule of the inner ear, and vestibulo-visual tracts. Additionally, 46% of the cohort had difficulties maintaining gaze during head movement, and one-third to one-half of the cohort had difficulties maintaining balance. CONCLUSIONS: Vestibular, gaze, and balance disorders are highly prevalent in children with asymptomatic cCMV. Systematic screening for vestibular disorders will be used to determine the full clinical impact for the development of effective interventions.

Does coronavirus affect the audio-vestibular system? A rapid systematic review.

Objective: This rapid systematic review investigated audio-vestibular symptoms associated with coronavirus.Design: The protocol for the rapid review was registered in the International Prospective Register of Systematic Reviews and the review methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the National Institute of Heath quality assessment tools.Study sample: After rejecting more than 2300 records, there were five case reports and two cross-sectional studies that met the inclusion criteria.Results: No records of audio-vestibular symptoms were reported with the earlier types of coronavirus (i.e. severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]). Reports of hearing loss, tinnitus, and vertigo have rarely been reported in individuals who tested positive for the SARS-CoV-2.Conclusion: Reports of audio-vestibular symptoms in confirmed COVID-19 cases are few, with mostly minor symptoms, and the studies are of poor quality. Emphasis over time is likely to shift from life-threatening concerns to longer-term health-related consequences such as audio-vestibular dysfunction. High-quality studies are needed to investigate the acute effects of COVID-19, as well as for understanding long-term risks, on the audio-vestibular system. Review registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020184932).

Paciente con clínica neurológica como única manifestación de infección por SARS-CoV-2 / Report of a patient with neurological symptoms as the sole manifestation of SARS-CoV-2 infection

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Audiovestibular consequences of congenital cytomegalovirus infection.

Congenital cytomegalovirus (CMV) infection is the second most frequent cause of mental retardation and sensorineural hearing loss, after genetic factors. Recently, pediatric forensic and fetopathological studies have led to progress in understanding the pathophysiological mechanisms underlying the various neurosensory sequelae. Thanks to the identification of certain prognostic factors of hearing loss, therapeutic protocols based on antiviral molecules are now proposed for target populations. This treatment has shown efficacy in limiting hearing threshold deterioration and even, in some cases, seems to provide partial recovery of hearing in symptomatic congenitally infected CMV neonates. However, optimal treatment duration and administration modalities are not clearly defined. This article reviews recent data concerning audiovestibular sequelae and their management in children congenitally infected by CMV.

Stapediovestibular ankylosis in an HIV/HCV-copositive patient.

To the best of the author's knowledge, no case of a patient with stapediovestibular ankylosis who was also coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been previously described in the literature. This report describes the case of a 36-year-old woman who was diagnosed with all three conditions. The clinical diagnosis of stapes fixation was based on otoscopic, audiometric, tympanometric, and surgical findings. Stapedectomy was performed, and perilymph and serum samples were obtained and tested for anti-HIV and anti-HCV antibodies. While the titers of anti-HCV antibodies in the serum and perilymph were of similar magnitude, there were almost 16 times more anti-HIV antibodies in the serum than in the perilymph. This case offered a unique opportunity to study the titers of anti-HIV/HCV antibodies in both the blood serum and perilymph. Data relating to these titers may provide new insights into the mechanisms of stapediovestibular ankylosis and inner ear immunology.

Hallazgos otoneurológicos en pacientes portadores de VIH y neurosífilis / Otoneurological findings in HIV and neurosyphilis coinfected patients

Introducción: El virus de la inmunodeficiencia humana (VIH) y el Treponema pallidum comparten mecanismos de transmisión y tienen la potencialidad de cambiar el curso de la otra enfermedad. Entre el 1% y 13% de los pacientes infectados con VIH presentan serología positiva para sífilis o desarrollan la enfermedad durante la evolución. Ambas pueden causar un variado número de alteraciones cocleovestibulares. Objetivo: Describir los hallazgos otoneurológicos en pacientes infectados con VIH y con presentación de neurosífilis durante la evolución de su enfermedad. Material y método: Estudio transversal observacional en 10 pacientes VIH positivos con episodios de neurosífilis de la Unidad de Infectología del Hospital Sótero del Río. Se realizó consulta otorrinolaringológica y examen funcional del octavo par con video-óculo-nistagmografía. Resultados: Sesenta por ciento de los pacientes infectados con VIH y neurosífilis presentó síntomas cocleovestibulares, de los cuales todos presentaron alteraciones audiométricas, 50%% de la muestra, además, presentó alteraciones vestibulares de características periféricas. El síntoma más frecuente fue la hipoacusia (50%%). La alteración audiométrica más frecuente fue la hipoacusia sensorioneural bilateral asimétrica. No se observó predominancia de algún tipo de alteración vestibular. Ningún paciente presentó alteraciones centrales. Conclusión: La evaluación otorrinolaringológica debiera considerarse como de rutina para disminuir la discapacidad generada por patología otoneurológica en estos pacientes.

Introduction: The human immunodeficiency virus (HIV) and Treponema pallidum share transmission mechanisms and have the potentiality of changing one another courses. Between 1 and 13%% of HIV infected patients present positive serology for syphilis or develop this disease during the evolution of the HIV. Both can cause a wide range of cochleovestibular manifestations. Aim: To describe otoneurological findings in HIV patients with episodes of neurosyphilis during the course of the disease. Material and method: Observational transversal study with 10 HIVpositive patients with episodes of neurosyphilis registered in the Infectology Unit of Sótero del Río Hospital. They went under otolaryngologic consult and functional testing of vestibulochoclear nerve with videonystagmography. Results: 60%% of evaluated patients had cochleovestibular symptoms, all of them with audiometric alterations. 50% of the sample also showed vestibular abnormalities (peripheral disorders). The commonest symptom was hearing loss (50%%). The most frequent audiometric alteration was asymmetric bilateral neurosensorial hearing loss. We did not observe any kind of vestibular variation predominance. No patient presented central vestibular disease. Conclusions: The otolaryngologic evaluation should be considered as a routine exam to diminish the disability generated in these patients because of the acquired otoneurological disease.

Systematic review of vestibular disorders related to human immunodeficiency virus and acquired immunodeficiency syndrome.

INTRODUCTION: Disorders of the auditory and vestibular system are often associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome. However, the extent and nature of these vestibular manifestations are unclear. OBJECTIVE: To systematically review the current peer-reviewed literature on vestibular manifestations and pathology related to human immunodeficiency virus and acquired immunodeficiency syndrome. METHOD: Systematic review of peer-reviewed articles related to vestibular findings in individuals with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Several electronic databases were searched. RESULTS: We identified 442 records, reduced to 210 after excluding duplicates and reviews. These were reviewed for relevance to the scope of the study. DISCUSSION: We identified only 13 reports investigating vestibular functioning and pathology in individuals affected by human immunodeficiency virus and acquired immunodeficiency syndrome. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Peripheral vestibular involvement may affect up to 50 per cent of patients, and central vestibular involvement may be even more prevalent. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto- and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance. CONCLUSION: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome should routinely be monitored for vestibular involvement, to minimise functional limitations of quality of life.

Otoneurological findings in human immunodeficiency virus positive patients.

OBJECTIVE: To investigate vestibular function in human immunodeficiency virus positive subjects. METHODS: We studied vestibular function in 60 human immunodeficiency virus positive subjects reporting dizziness. All three Center for Disease Control and Prevention categories of human immunodeficiency virus infection were represented in the study group (30 patients in class A, 20 in class B and 10 in class C). Subjects had had no previous history of acute vertigo. All subjects underwent: neurotological screening for spontaneous, positional and positioning nystagmus, using head-shaking and head-thrust (Halmagyi) tests; audiometrical examination; and electronystagmography with bithermal stimulation (Freyss' method). The results of the 30 class A subjects were compared with those of 30 human immunodeficiency virus negative patients reporting dizziness. RESULTS: Abnormal otoneurological findings increased progressively from the A to C categories, particularly regarding increased central damage (3.3 per cent of class A, 35 per cent of class B and 100 per cent of class C subjects). In contrast, the incidence of peripheral vestibular disorders remained almost the same, comparing the three categories (33.3 per cent in class A and 50 per cent in classes B and C subjects). Moreover, a higher number of human immunodeficiency virus positive subjects showed abnormal otoneurological findings, compared with the dizzy, human immunodeficiency virus negative subjects. CONCLUSIONS: In our opinion, a vestibular disorder may occur in human immunodeficiency virus positive patients as a result of direct viral damage, even in the early phase of infection. Central vestibular damage may be established later on, and may be linked to different causes (e.g. superinfections, vascular causes and drug toxicity).

Audiovestibular sequelae of congenital cytomegalovirus infection in 3 children presumably representing 3 symptomatically different types of delayed endolymphatic hydrops.

Three cases of congenital cytomegalovirus (CMV) infection with long-term audiovestibular sequelae are presented. Case 1 had no hearing in one ear and severe progressive hearing loss in the other ear; he showed vestibular symptoms at the age of 4.5 years. Case 2 had severe but stationary hearing loss in one ear and showed hearing impairment symptoms in the other ear at 9-13 years of age. Case 3 did not have hearing impairment symptoms, or vestibular symptoms, but was found to have severe progressive hearing loss from the age of 15 months onwards, which led to profound deafness at the age of 2 years and vestibular areflexia at or before the age of 4 years. These cases may represent 3 symptomatically different types of delayed endolabyrinthine hydrops. Type 1 (ipsilateral hydrops) incorporates vestibular symptoms only because of a lack of hearing in the offending labyrinth. Type 2 (contralateral hydrops) incorporates hearing impairment symptoms only because of a lack of vestibular function on both sides and type 3 does not incorporate hearing impairment symptoms or vestibular symptoms (other than those relating to a complete lack of function). Given the present findings, those described by Weiss and Ronis (Trans. Pa. Acad. Opthalmol. Otolaryngol., 30 (1977) 52-54) in one case and other reported findings relating to histopathological or imaging methods in somewhat similar cases, it seems appropriate to include congenital CMV infection in the differential diagnosis of delayed endolymphatic hydrops.

Ultrastructural findings in the vestibular end-organs of AIDS cases.

Neurotologic manifestations are apparent in human immunodeficiency virus (HIV) infection, but are poorly understood. Symptoms related to the vestibular system include episodes of vertigo, imbalance, ataxia, and nausea. Although patients present more often with hearing impairment, vestibular complaints are described and electrophysiologic studies indicate vestibular dysfunction in HIV-infected patients. Whether the disease involvement includes the central, or the peripheral nervous system has not been established. Ultrastructural analysis of vestibular end-organs obtained from HIV autopsy cases revealed pathologic changes in the labyrinth wall, the epithelial lining, and the receptor maculae and cristae. Cytologic changes in hair cells included inclusion bodies, viral-like particles, and hair bundle malformations. Epithelial lining cells, supporting cells, and connective tissue cells had inclusions and viral-like particles. These findings are consistent with those of a previous cochlear study demonstrating intracellular viral-like particles with the morphologic characteristics of HIV. Further cytologic evaluation of decalcified temporal bones and immunohistochemical analysis of freshly harvested HIV-infected temporal bones may provide further insight into the pathogenesis of viral-induced hearing loss and vestibular impairment.