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Is CMV PCR of inner ear fluid during cochlear implantation a way to diagnose CMV-related hearing loss?

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Abstract

To evaluate the diagnostic performance of cytomegalovirus (CMV) polymerase chain reaction (PCR) on inner ear fluid collected during cochlear implantation and to assess its interest in current practice. This monocentric prospective study included consecutive children presenting with severe to profound sensorineural hearing loss (SNHL) who were candidates for unilateral and/or bilateral cochlear implantation. The etiology of the SNHL was determined before cochlear implantation when possible. During the surgery, drop-like samples of inner ear fluid and blood were collected. CMV PCR was then performed on both samples. Between January 2017 and September 2021, 113 children with severe to profound SNHL underwent cochlear implantation with inner ear fluid collection. Among these children, 77 of them presented with a known cause of SNHL (68%) and 36 of them had an unknown cause of SNHL at the time of surgery (32%). Sensitivity and specificity of the CMV PCR on inner ear fluid were 60% (95% CI: [49–71]) and 98% (95% CI: [96–100]), respectively. Positive and negative predictive values were 90% (95% CI: [83–97]) and 92% (95% CI: [86–98]), respectively. A sensitivity analysis according to age at cochlear implantation showed a decrease with age.

Conclusion: Sampling of inner ear fluid during cochlear implant surgery is an interesting, simple and safe way to diagnose CMV-related hearing loss, especially when the diagnosis of congenital infection can no longer be confirmed. However, the sensitivity decreases with age.

Trial registration: NCT04724265

What is Known:

• Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children. In the absence of systematic screening at birth, many cCMV infections go undetected and are often undiagnosed despite the development of sensorineural sequelae. 

• Nearly 40% of indications for cochlear implantation are of unknown etiology.

What is New:

• Performing CMV PCR on inner ear fluid at the time of cochlear implantation is a safe way with high diagnostic performance (PPV = 90%, NPV = 92%) to detect a CMV-related hearing loss.

• This sample may be interesting in cases of unknown cause of hearing loss in order to identify undiagnosed cCMV infections.

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Abbreviations

cCMV:

Congenital cytomegalovirus

CMV:

Cytomegalovirus

CT:

Computerized tomography

cVEMP:

Cervical vestibular evoked myogenic potential

MRI:

Magnetic resonance imaging

PCR:

Polymerase chain reaction

SNHL:

Sensorineural hearing loss

vHIT:

Video head impulse test

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France

    Emilien Chebib, Charlotte Benoit, Nathalie Noël Petroff, Thierry Van Den Abbeele, Audrey Maudoux & Natacha Teissier

  2. AP–HP Université Paris-Saclay, Hôpital Paul-Brousse, Department of Virology, INSERM U1193, 94804, Villejuif, France

    Christelle Vauloup-Fellous

  3. Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France

    Christelle Vauloup-Fellous & Natacha Teissier

  4. Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France

    Audrey Maudoux

  5. Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut de L’Audition, Institut Pasteur, Université de Paris, INSERM-UMRS1120, 63 rue de Charenton, F-75012, Paris, France

    Audrey Maudoux

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  1. Emilien Chebib
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Contributions

Dr. Chebib conceptualized and designed the study, drafted the initial manuscript, designed the data collection instruments, collected data, analyzed and interpreted data, carried out the initial analyses, and reviewed and revised the manuscript. Prof. Teissier and Dr. Vauloup-Fellous conceptualized and designed the study, collected data, analyzed and interpreted data, carried out the initial analyses, and reviewed and revised the manuscript. Prof. Van Den Abbeele, Dr. Benoit, Dr. Noël Petroff, and Dr. Maudoux collected data, analyzed and interpreted data, reviewed, and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Emilien Chebib.

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Ethics approval

The investigation was approved by our Institutional Human Experimentation Committee (Comité de Protection des Personnes CPP Ile de France; 191072).

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Informed consent was obtained from all patients included in the study as well as from their legal guardians.

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The authors have no relevant financial of non-financial interests to disclose.

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Communicated by Peter de Winter

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Chebib, E., Vauloup-Fellous, C., Benoit, C. et al. Is CMV PCR of inner ear fluid during cochlear implantation a way to diagnose CMV-related hearing loss?. Eur J Pediatr 182, 375–383 (2023). https://doi.org/10.1007/s00431-022-04691-6

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