Normal Hearing Function in Children Prenatally Exposed to Zika Virus

THIEME Original Research Normal Hearing Function in Children Prenatally Exposed to Zika Virus Maria Helena Magalhães Barbosa1,2 Cristiane Fregonesi Dutra Garcia3 Maria Clara de Magalhães Barbosa2 Jaqueline Rodrigues Robaina4 Arnaldo Prata-Barbosa2,5 Marco Antonio de Melo Tavares de Lima1 Antonio José Ledo Alves da Cunha5,6 1 Department of Otorhinolaryngology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brazil 2 Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil 3 Department of Phonoaudiology, Universidade Federal do Rio de Janeiro Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brazil 4 Department of Epidemiology, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil 5 Department of Pediatrics, Universidade Federal do Rio de Janeiro Maternidade Escola, Rio de Janeiro, RJ, Brazil 6 Department of Pediatrics, Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil Address for correspondence Maria Helena de Magalhães Barbosa, Master, Department of Otorhinolaryngology, Universidade Federal do Rio de Janeiro Hospital Universitário Clementino Fraga Filho, Rua Prof Rodolpho Paulo Rocco, 255 Ilha do Governador, Rio de Janeiro, RJ, 21941-913, Brazil (e-mail: ). Int Arch Otorhinolaryngol 2020;24(3):299–307. Abstract Keywords ► zika virus ► hearing ► prenatal injuries received April 16, 2019 accepted September 27, 2019 published online December 13, 2019 Introduction The association between prenatal Zika virus infection and hearing alterations in offspring has been the object of some studies, although few have assessed children without microcephaly. However, a current trend to include prenatal Zika virus exposure in the group of risk indicators for hearing loss is noted. Objective To present a series of 27 children prenatally exposed to the Zika virus submitted to multiple hearing assessments over time. Methods A cohort of children born to symptomatic mothers with laboratorial Zika virus infection confirmation during pregnancy was submitted to an otoacoustic emission test, auditory brainstem response test (automated, neurodiagnostic and frequency-specific), audiometry, and imitanciometry over a period of 36 months since birth. The hearing assessment was performed independently of the presence of microcephaly or other apparent signs of congenital Zika syndrome. Results The hearing tests presented predominantly normal results. Some children had signs of middle ear pathology. The only microcephalic child had normal electrophysiological tests, as well as preserved audiometric thresholds, but presented altered motor responses to sound. Conclusion Prenatal exposure to Zika virus does not always determine hearing impairment. This risk seems to be more associated to the severity of the central nervous system damage. Hearing screening and follow-ups of the affected children are important, as well as further research in this area. DOI https://doi.org/ 10.1055/s-0039-3399539. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 299 300 Normal Hearing Function in Children Prenatally Exposed to Zika Virus Introduction The relationship between congenital Zika virus (ZIKV) infection and hearing impairment has been studied, especially after the Latin American epidemic in 2015, with reports of sensorineural hearing loss in affected children with microcephaly.1,2 The occurrence of neurological and ocular alterations and multiple malformations has raised the hypothesis of a possible association of Zika infection with hearing impairments, as demonstrated in other congenital infections.3–5 However, few studies to date have assessed the hearing function of infected children without microcephaly.6,7 On the other hand, ocular findings in non-microcephalic children have been reported.8 The hearing screening of children with risk indicators for hearing loss must be conducted by the otoacoustic emission (OAE) and the auditory brainstem response (ABR) tests.9 Congenital infections such as syphilis, cytomegalovirus, toxoplasmosis, and rubella are hearing loss indicators.10 Based on existing reports, a trend to include children with congenital ZIKV infection in this group is noted.2,11–14 Furthermore, it is recommended that children in the risk group are followed-up by developmental milestone surveillance, hearing abilities, and middle ear conditions. At least one audiological evaluation should be performed between 24 and 30 months of age, due to the risk of progressive or late onset hearing loss.9 Although the incidence of new cases is currently declining, the risk of a new epidemic is constant, as the mosquito vector and favorable climatic conditions for its proliferation are present in many countries, in addition to increasing global mobility of people. Moreover, many infected individuals, notably children affected by congenital Zika syndrome (CZS), exhibit outcomes due to the infection and, therefore, require regular multidisciplinary follow-up. Further studies on the consequences of this infection in the human body are necessary to support screening, management and follow-up recommendations of individuals exposed to the ZIKV. Objective The aim of the present study is to present the results of the hearing assessments of 27 children born to mothers with laboratorial confirmation of ZIKV infection during pregnancy. Methods This is an observational, descriptive and longitudinal study of a cohort of 27 children followed from birth to
36 months. The study was conducted in a public university maternity hospital, where 50% of the patients are high-risk pregnant women referred to the institution and the remaining are normal pregnancies from the surrounding neighborhood. Most of the mother and child study procedures were performed in the maternity hospital, such as information collection, blood sample collection for laboratorial tests, otoacoustic emission (OAE) hearing tests, neurodiagnostic auditory brainstem response (ABR) and frequency-specific ABR (FS-ABR). The automated ABR (a-ABR), imitanciometry and audiometry tests were performed in a quaternary public hospital belonging to International Archives of Otorhinolaryngology Vol. 24 No. 3/2020 Barbosa et al. the same university. Efforts to reduce missing tests in the follow-up phase were made, such as more than one telephone contact, transport reimbursement and more than one option of days to attend the reevaluation visits. All infants born to mothers admitted to the maternity hospital from December 1st 2015 to June 30th 2017 with laboratorial confirmation of ZIKV infection during pregnancy were included. Exclusion criteria comprised refusal to sign the free and clarified consent term (FCCT) and the presence of infant malformations that precluded the performance of the auditory tests. Participants that withdre (...truncated)