Given the prevalence of CMV in the population, would you recommend hearing tests to screen for deafness due to congenital CMV? Are there hospitals which do hearing screens in infancy?

It is now mandated that all newborns in NYS, and about half the states in the US, be screened for deafness. Oddly this law is not funded, so screening is not quite what it should be and although it is usually done at CHONY through a program run by Abby Berg, some months it is only high risk babies and some months in is all babies. There is no funding for recording this info in the babies' chart, so if you are suspicious, you can call her and she can look your patient up in her log.

Our screens are done by oto-acoustic emission tests, which are passive, quick and relatively inexpensive to perform and do not require an observation of a behavioral response to the stimulus. They read electrical activity in a live cochlea. No activity is suspicious for cochlear disease or 8th nerve malfunction, so the most common problems of newborns are pretty well covered, as I understand it. The test has a problem with false positives, which raise anxiety and require retesting. Some centers use automated ABRs which a bit more costly and also a bit more likely to be correct if they find a problem.

The important question you raise is: What about progressive hearing loss after the newborn period? This of course can be from CMV which continues to proliferate in an infected newborn, can cause progressive hearing loss (and other neurologic damage) and can continue to be shed in the urine for two or three years. I do not understand why we see that so infrequently, but at least in my experience it is rare. I do not know of any other centers that routinely test toddlers after the newborn screen.

Obviously if a baby had congenital infection with symptoms and positive titers in the newborn period he would merit sequential testing of hearing (probably every 6 months). and if a baby is found to have hearing loss he should be tested for CMV.

The general rule I would follow would be to remain vigilant for early signs of congenital infection (poor head growth...) and especially for delay in language development, which in CMV may be due to hearing loss or also directly to problems in brain development. We don't need to wait for failure of words to be counted. We should react to late development of initial consonants, failure to use inflected, speech-like babbling, pointing with the index finger, interactive sound play, etc. Any baby with those delays should have an audiometric exam after 6 months of age, and I automatically ask for audiology on any toddler whom I send to Early Intervention for speech or language therapy.

I suppose if we really wanted to focus on the risk from CMV in the first few years the easiest way to look at it would be to culture the urine for persistent CMV, which is a lot easier and cheaper than hearing and developmental testing.

I hope this answers your question. Yours, Harriet McGurk