Comparative Effects of Valganciclovir and Ganciclovir on the Congenital Cytomegalovirus Infection and Hearing Loss: A Randomized Controlled Trial

Background: Cytomegalovirus (CMV) is a highly specific herpes virus spreading only from person to person. Valganciclovir (VGCV) and ganciclovir (GCV) are effective in the treatment of neonatal congenital CMV infection. Objectives: This study aimed to compare the curative effects of VGCV and GCV among neonates with CMV infection and evaluate their effects on hearing. Methods: A total of 48 neonates with congenital CMV infection admitted to Huaian Maternal and Child Health Care Hospital, China, were selected from January 2016 to December 2019 and randomly divided into two equal groups of intervention and group (n = 24 each). While the control group received intravenous injection of GCV, the intervention group received oral VGCV. After a 6-week course of treatment, polymerase chain reaction (PCR) was applied to detect the CMV load in both urine and blood. We used the ELISA method to detect the serum CMV-IgM expression level before and after treatment. Moreover, we compared the positive rates of CMV-DNA and CMV-IgM, hyperbilirubinemia, retinitis, hepatosplenomegaly, thrombocytopenia, neutropenia, as well as the results of hearing screening and brainstem auditory evoked potentials (BAEP). Results: Before treatment, there was no statistical difference in blood/urine CMV-DNA expression level and positive expression rates of blood/urine CMV-DNA and CMV-IgM between the groups (P > 0.05). After treatment, blood/urine CMV-DNA expression and the positive expression rates of blood/urine CMV-DNA and CMV-IgM significantly decreased in both groups compared to before treatment (P < 0.05), but there was no statistical significance between the two groups (P > 0.05). Before treatment, there was no significant difference in hearing abnormality rates between the control (50%) and intervention (62.5%) groups (P > 0.05). After treatment, both the control (20.83%) and intervention (29.17%) groups had significantly decreased hearing abnormality rates, and the difference was statistically significant compared with before treatment (P < 0.05), but the difference between the two groups was not statistically significant (P > 0.05). After treatment, the results of comparing BAEP showed that both groups had no statistically significant differences in the number of neonates with normal hearing, mild hearing loss, moderate to severe hearing loss, severe hearing loss, and extremely severe hearing loss (P > 0.05). Before treatment, both groups had no statistically significant differences in the number of neonates with hyperbilirubinemia, retinitis, hepatosplenomegaly, thrombocytopenia, and neutropenia (P > 0.05). After treatment, while the number of neonates with hyperbilirubinemia, retinitis, hepatosplenomegaly, and thrombocytopenia decreased, neutropenia cases increased, and the difference before and after treatment was statistically significant (P < 0.05); however, the difference between the two groups was not statistically significant (P > 0.05). Conclusions: VGCV is similar to GCV in the treatment of neonatal congenital CMV infection, but the oral route of administration of VGCV is more acceptable among neonates.

Co-occurring Hearing Loss and Cognitive Decline in Older Adults: A Dual Group-Based Trajectory Modeling Approach

Hearing loss and cognitive impairments are both highly prevalent neurological complications for older adults. While there is growing evidence to suggest that these two conditions are interrelated, little research has been conducted that directly examines the progression and developmental trajectories of these complications contemporaneously. The aim of the study is to identify the distinct trajectory profiles for hearing loss and cognitive function in an older population over a 10-year period. Through dual trajectory modeling, the interrelationship, co-occurring movements, and overlaps between these two complications were examined. We also investigated the influence of hearing aid ownership on cognitive function trajectories. We utilized longitudinal data from 1,445 participants in the Blue Mountains Hearing Study (aged 55+ years) involving repeated measures from a population-based survey with audiometric hearing assessments. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). The group-based trajectory modeling (GBTM) identified three trajectory profiles for both hearing loss and cognitive function in two older age groups (55–69 years and 70+ years). The outputs from the dual trajectories models showed the conditional probability for “no hearing loss” trajectories to be around 90% more likely to have “high-normal” cognitive function, demonstrating co-occurring overlap. In contrast, for “moderate to severe hearing loss” trajectories, the conditional probability drops to 65% and 79% for the 55–69 age group and 70+ age group respectively. There was also an increasing probability for “cognitive decline” conditional on the severity of hearing loss with 6.7%, 7.5%, and 8.7% for no hearing loss, mild hearing loss, and moderate to severe hearing loss trajectory groups. While we did not find any statistically significant difference in the influence of hearing aid use in the cognitive function trajectories, there was a consistent greater representation of non-hearing aid users in the trajectories with poorer cognitive function. This study found GBTM to identify trajectories that were in agreement with our current understanding of hearing loss and cognitive impairment in older adults. This study also adds to the existing evidence-base as dual trajectories demonstrated co-occurrence in developmental changes in these two common neurological complications for the older population.

Novel Homozygous Mutation in PDZD7 Gene in a Family with Nonsyndromic Sensorineural Hearing Loss

Hearing loss is the most common sensory neural disorder in human, and according to WHO estimation, 5.5% (466 million) people worldwide have disabling hearing loss. In this study, a Chinese family with prelingual sensorineural hearing loss was investigated. The affected individuals showed moderately-severe hearing loss at all frequencies. Using target genome enrichment and high-throughput sequencing, a homozygous mutation c.2372delC, p.S791Ffs*17 was identified in PDZD7. The deletion mutation lies in exon 15 of PDZD7 and resultes in a frame shift followed by an early stop codon. Our study expand the mutation spectrum of PDZD7 and strengthens the clinical importance of this gene in patients with moderately-severe hearing loss.

Current Issues in the Treatment of Deep Sensoneural Hearing Loss and Deafness in Kyrgyzstan

This article presents the main issues of the relevance of the spread of severe hearing loss and deafness in Kyrgyzstan, leading to permanent disability of patients, especially children. Despite significant technological progress and constant improvement of digital sound processing for cochlear implantation and hearing aids, in Kyrgyzstan, for a number of reasons, there are significant difficulties for their widespread implementation due to the lack of necessary government programs and appropriate funding.

Speech Recognition In Hearing Aids: Used For Assessing CI Candidacy In Tonal Language Population

Objective: CI (cochlear implantation) candidacy is somewhat controversial in severe hearing loss among tonal mandarin-speaking patients. To assess the relationship between pure tone audiometry (PTA) and speech recognition score (SRS), with and without hearing aid amplification, among patients who did not meet the NIH criteria of CI candidacy in tonal language mandarian-speaking countries, especially those with severe hearing loss (70 dB HL < 4FPTA(0.5, 1, 2, 4 KHz) ≤ 90 dB HL) Materials and Methods: A total of 414 patients with sensorineural hearing loss with 774 ears were reviewed retrospectively in a tertiary referral center. The Mandarin Monosyllable Recognition Test (MMRT) was used to evaluate the SRS of these ears. Results: 31% (10/32) of the 32 ears with severe hearing loss, 70-90 dB HL, still showed poor speech recognition (SRS<30%) after hearing aid amplification, while 71% (46/65) of the 65 ears with profound hearing loss, > 90 dB HL, showed poor speech recognition with hearing aid amplification. Conclusions: The speech audiometry with Mandarin Monosyllable Recognition Test (MMRT) helped identify those patients whose 4FPTA< 90 dB HL fell outside the CI candidacy criteria of NIH in tonal language mandarin-speaking countries but showed significantly poor (SRS< 30%) speech recognition performance.

Severe sudden sensorineural hearing loss related to risk of stroke and atherosclerosis

The cause of idiopathic sudden sensorineural hearing loss (idiopathic SSNHL)—diagnosed after excluding other causes of hearing loss, such as SSNHL associated with vestibular schwannoma (VS)—is unknown. The presumed pathogenesis of idiopathic SSNHL includes circulatory disorders (e.g., cochlear infarction). We tested the hypothesis that patients with SSNHL who are at high stroke risk will have a lower rate of VS compared to those with low stroke risk. The rationale is that the primary cause of SSNHL in patients with high stroke risk might be a circulatory disturbance. We conducted a retrospective study in six hospitals. Our sampling of SSNHL patients included those diagnosed with idiopathic SSNHL and VS-associated SSNHL. SSNHL patients who had a head MRI were stratified by severity of hearing loss and evaluated for differences in the detection rate of VS between the high-scoring CHADS2 (CHADS2-H-), an index of stroke risk, and low-scoring CHADS2 (CHADS2-L-) groups. We identified 916 patients who met the inclusion criteria. For severe hearing loss, the CHADS2-H group had a significantly lower rate of VS than the CHADS2-L group (OR 0 [95% CI 0.00–0.612]; P = 0.007). These results indirectly support the hypothesis that a primary cause of severe idiopathic SSNHL in those at high risk of stroke might be a circulatory disorder.

Audiometric Characteristics of Presbycusis: A Hospital-Based Study

Background: Presbycusis is related to degenerative changes of aging resulting from deficient cochlear microcirculation. It is characterized by bilateral, symmetrical, sensorineural hearing loss (SNHL) in which recruitment and speech discrimination is affected in the absence of noise exposure. The objective of this study was to analyze the pure tone audiogram characteristics in Presbycusis. Methods: This descriptive study recruited n=192 cases of presbycusis of both genders, aged 50 to 80 years with convenience sampling technique. The study was conducted at Yusra General Hospital and the National Institute of Rehabilitation Medicine, Islamabad from1st July 2017 to 30th September 2017. Pure tone audiometry was used to collect audiometric data. SPSS-24 was used for data analysis. Chi-square and Pearson’s correlation were used to determine association between variables with p < 0.05 taken as significant. Results: Pure tone audiometry revealed 58 (30.2%) right and 65 (33.9%) left ears with high frequency gently sloping audiogram, while the second commonest configuration being high frequency steeply sloping curve in 51(26.6%) right and 52(27.1%) left ears. There was a significant correlation between the configuration of the audiogram and age with p=0.000, while no significant correlation with gender (p=0.71). The majority,77 (40.10%) right and 71(36.98%) of left ears had moderately severe hearing loss, while severe hearing loss was second commonest with 60(31.25%) right and 70(36.46%) left ears affected. The severity of hearing loss had a significant (P=0.000) positive correlation with age but no significant relationship with gender. Conclusion: High frequency gently sloping audiogram was the commonest configuration followed by high frequency steeply sloping curve. Moderately severe hearing loss was most commonly seen followed by severe hearing loss.