Audiological evaluation in children with suspected congenital zika virus infection

Abstract

Introduction: between 2014 and 2018, the zika virus, whose reports of previous cases in humans were sporadic, caused extensive outbreaks in America, which resulted in an increase in the prevalence of congenital defects associated with perinatal infection by this virus, mainly microcephaly and alterations of the central nervous system. Hearing loss is one of the birth defects described as part of congenital zika syndrome. Costa Rica, a country with areas of high density of the transmitting vector, did not escape this reality, being today an endemic country of the virus. Objective: to define the ideal audiological evaluation that children with congenital zika virus infection should have, according to the evidence in the literature. Methodology: a qualitative review study of the literature was carried out, based on a bibliographic search carried out between June 2019 and June 2020 in the Redalyc, Pubmed, and Scielo databases, using as descriptors the words Hearing loss AND zika, congenital zika OR zika Virus; Articles published from 2016 to 2020, in Spanish, English and Portuguese languages ​​were selected. Two independent reviewers performed article selection, data extraction, and quality assessment. Studies containing auditory evaluation of patients with congenital or acquired zika virus infection were included; and / or hypotheses or evidence about the pathophysiology of hearing impairment associated with the zika virus; and / or recommendations were included on the detection and follow-up of patients with hearing impairment due to the zika virus. Forty-one articles were included in the review. Evaluation algorithms were proposed in children born to mothers with exposure to the zika virus during the prenatal stage or suspected congenital infection. Results: the main manifestation of hearing impairment associated with congenital zika is sensorineural hearing loss; the case series published in this regard vary considerably in terms of prevalence and largely depend on the diagnostic method used and the follow-up. Hearing loss in these cases can be derived from lesions in the auditory pathway at both the cortical and cochlear levels; several are the proposed mechanisms of action. Hearing impairment can be progressive and late-onset and the impairment can be moderate to severe. A similarity has been found in the clinical manifestations of the zika virus with those of the TORCH group, which establishes a similarity in the configuration of hearing loss and its possible retrocochlear and late-onset effects. A detection and monitoring algorithm is proposed for this population. Conclusions: The audiological evaluation of children of mothers affected by VZ during pregnancy should be timely, continuous, and interdisciplinary during at least the first two years of life.