PP701 - Cytomegalovirus (CMV) Public Education and Outcomes of CMV-Deafened Cochlear Implant Users

Abstract:
Congenital Cytomegalovirus (cCMV) is the leading environmental cause of childhood hearing loss. Although cCMV has a very high prevalence rate, most people have never heard of it. A cochlear implant (CI) is a successful treatment option for children with a severe to profound hearing loss. However, due to the limited research on CI outcomes in children with cCMV, it has been unclear how to counsel parents about appropriate expectations of CIs in children with cCMV. This study aimed to increase awareness of cCMV among daycare workers and parents of young children and to investigate outcomes of CI users with cCMV.

Summary:

Introduction
Congenital Cytomegalovirus (cCMV) is the leading environmental cause of childhood hearing loss. Healthy adults and children who are infected with CMV are often asymptomatic or have very mild symptoms; however, it can have a detrimental impact on a fetus infected in utero. Long term effects of cCMV include sensorineural hearing loss, vision loss, motor impairment, cognitive impairment, and sometimes death of the fetus. CMV affects 1/200 births in the U.S. Despite its high prevalence, only 15% of women and 64% of healthcare workers have heard of it (Wizman et al., 2016). A cochlear implant (CI) has been proven to be a successful treatment option for children with a severe to profound hearing loss. However, due to the limited research on CI outcomes in children with cCMV, it has been unclear how to counsel parents about appropriate expectations of CIs in children with cCMV. The purpose of this study was two-fold: to increase awareness of CMV among daycare workers and parents of young children and to investigate outcomes of cochlear implant users with cCMV.

Methods
For the CMV awareness project, we visited local daycares during the child pick-up time to conduct an in-person CMV educational session. Parents, caregivers, and childcare workers attended individual, 5 to 10-minute informational sessions about cCMV. We also created and dispersed a variety of educational materials for cCMV prevention and its relationship to hearing loss. At the end of the session, parents were then asked to complete a brief questionnaire including questions about CMV awareness prior to the session, cCMV and hearing loss, and their behavior moving forward.

For the second project, a systematic literature review was conducted using the initial keywords “cochlear implants” and “cytomegalovirus” in PubMed and Scopus. For the inclusion criteria, studies should use a retrospective or experimental design and report outcomes for CI children with cCMV using language, cognitive, academic, or audiological outcomes measures.

Results
So far, about 30 parents and 12 daycare workers have attended the CMV educational sessions. About 30% of the participants had heard of cCMV before. However, only 16.7% participants knew beforehand that cCMV could cause hearing loss. About 80% of participants reported that they would change their behavior moving forward with the information provided during the session. For the systematic review, only 17 studies met the inclusion criteria for the CI outcomes in children with cCMV. Unlike more consistently successful CI outcomes in children with genetic etiologies such as GJB2, CI outcomes varied greatly in children with cCMV.

Discussion
This study aimed to increase awareness of CMV and investigate the outcomes of CI users with cCMV. Most participants indicated that the information provided would change their behavior in the future. Although the literature is limited in number and control groups, this review demonstrated that pediatric CI users with a history of cCMV benefit from CIs, even if they have additional disabilities. We hope that this study encourages audiologists to be actively involved in public awareness and counseling with cCMV.