Pub Date : 2023-05-24DOI: 10.1097/01.hj.0000938620.95430.10
Andy Polhamus
It’s a virus that can spread through even brief physical contact, and can have serious, long-lasting consequences in newborns. There is no vaccine currently available, and experts say that far too few people know that it can happen to their families.www.shutterstock.com.Cytomegalovirus, or CMV, is an extremely common but sometimes devastating infection that occurs in adults and children alike. And although most people will contract CMV and recover without even knowing they’ve had it, congenital CMV is the leading infectious cause of birth defects in the United States. It is also the single most common of any congenital infection. One of the most significant birth defects associated with congenital CMV is hearing loss. With June marking National Cytomegalovirus Awareness Month, The Hearing Journal spoke with experts about screening, treatment, and prevention strategies, as well as new developments in this rapidly changing area of medicine. EPIDEMIOLOGY The CDC says that more than half of adults in the United States will be infected with cytomegalovirus by the time they turn 40. Further, the agency reports, one in every three children will be infected before they reach their fifth birthday. Many people will be infected with the virus without ever knowing it. Infections may be completely asymptomatic or produce influenza-like symptoms so mild that the illness passes without the infected person giving it a second thought. However, the CDC explains, once the virus is inside a person’s body, it stays there for the rest of the person’s life. The virus, which is a type of herpes virus, can be reactivated in a person’s body years after infection, and people may also be reinfected later with another strain. “It’s believed that about 50% to 80% of adults in the United States will have contracted CMV before they’re 40 years of age,” says Angela Shoup, PhD, Executive Director of the Callier Center for Communication Disorders, Professor of Behavioral and Brain Sciences at the University of Texas at Dallas and Professor of Otolaryngology. “There are other prevalence rates, depending on the global location, that range from 45% to 100%. And you can contract it very easily. You can get it from any exposure to bodily fluids.” Some examples, Shoup explained, can include contracting the virus while changing a baby’s diaper, wiping off a pacifier after a toddler drops it, or even a simple kiss. Even symptomatic infections can be hard to identify. People experiencing symptoms of CMV infections generally experience mild, influenza-like symptoms, including fatigue, sore throat, and fever. CMV is most dangerous in those with weakened immune systems and when caught before birth. “Typically, once contracted, CMV will remain dormant for most of your life,” says Shoup. “But the problem we encounter, and are really cognizant of, is when cytomegalovirus is contracted by an adult who’s been immunocompromised. Patients with HIV can have severe sequelae from cytomegalovirus. Anybo
{"title":"Cytomegalovirus: Screening, Treatment, and Prevention Strategies","authors":"Andy Polhamus","doi":"10.1097/01.hj.0000938620.95430.10","DOIUrl":"https://doi.org/10.1097/01.hj.0000938620.95430.10","url":null,"abstract":"It’s a virus that can spread through even brief physical contact, and can have serious, long-lasting consequences in newborns. There is no vaccine currently available, and experts say that far too few people know that it can happen to their families.www.shutterstock.com.Cytomegalovirus, or CMV, is an extremely common but sometimes devastating infection that occurs in adults and children alike. And although most people will contract CMV and recover without even knowing they’ve had it, congenital CMV is the leading infectious cause of birth defects in the United States. It is also the single most common of any congenital infection. One of the most significant birth defects associated with congenital CMV is hearing loss. With June marking National Cytomegalovirus Awareness Month, The Hearing Journal spoke with experts about screening, treatment, and prevention strategies, as well as new developments in this rapidly changing area of medicine. EPIDEMIOLOGY The CDC says that more than half of adults in the United States will be infected with cytomegalovirus by the time they turn 40. Further, the agency reports, one in every three children will be infected before they reach their fifth birthday. Many people will be infected with the virus without ever knowing it. Infections may be completely asymptomatic or produce influenza-like symptoms so mild that the illness passes without the infected person giving it a second thought. However, the CDC explains, once the virus is inside a person’s body, it stays there for the rest of the person’s life. The virus, which is a type of herpes virus, can be reactivated in a person’s body years after infection, and people may also be reinfected later with another strain. “It’s believed that about 50% to 80% of adults in the United States will have contracted CMV before they’re 40 years of age,” says Angela Shoup, PhD, Executive Director of the Callier Center for Communication Disorders, Professor of Behavioral and Brain Sciences at the University of Texas at Dallas and Professor of Otolaryngology. “There are other prevalence rates, depending on the global location, that range from 45% to 100%. And you can contract it very easily. You can get it from any exposure to bodily fluids.” Some examples, Shoup explained, can include contracting the virus while changing a baby’s diaper, wiping off a pacifier after a toddler drops it, or even a simple kiss. Even symptomatic infections can be hard to identify. People experiencing symptoms of CMV infections generally experience mild, influenza-like symptoms, including fatigue, sore throat, and fever. CMV is most dangerous in those with weakened immune systems and when caught before birth. “Typically, once contracted, CMV will remain dormant for most of your life,” says Shoup. “But the problem we encounter, and are really cognizant of, is when cytomegalovirus is contracted by an adult who’s been immunocompromised. Patients with HIV can have severe sequelae from cytomegalovirus. Anybo","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.1097/01.hj.0000938632.49580.f5
Harvey B. Abrams
The American psychologist and architect of Maslow’s Hierarchy of Needs, Abraham Maslow, is credited with the expression, “If all you have is a hammer, everything looks like a nail.” 1 We can extend Maslow’s observation to: “If all you have is a set of headphones, everything looks like a pair of ears.” As hearing care specialists, we are often so focused on the ears that we neglect the other pair of sensory organs staring right at us—the eyes. Indeed, the same demographic that experiences age-related hearing impairment (presbycusis), is likely to also experience age-related vision impairment (presbyopia). This coexistence of hearing and visual impairments is known as dual-sensory impairment, or DSI. Most of us are aware of the growing literature that supports a relationship between hearing loss and other health conditions, such as depression, falls, cognitive impairment, and dementia. Age-related vision impairment has been associated with an increased risk of experiencing some of these same disorders. 2Figure 1: Trajectories of cognition scores by the presence of any sensory impairment in the 2015 China Health and Retirement Longitudinal Study. Source: Rong, H., Lai, X., Jing, R., Wang, X., Fang, H., Mahmoudi, E. (2020). Association of sensory impairments with cognitive decline and depression among older adults in China. JAMA Network Open, 3(9):e2014186. https://doi.org/10.1001/jamanetworkopen.2020.14186HOW COMMON IS DSI? What we know about the prevalence of DSI largely depends on the measures used to identify it. Some prevalence data are based on objective measures such as audiometry or the Snellen chart, while others rely on self-reported or functional measures of hearing and vision impairment. One study conducted in the United States using objective measures 3 estimated the prevalence of DSI in older adults at 3% increasing to 12% among those 85 years of age and older. WHAT ARE THE CONSEQUENCES OF DSI? DSI has been associated with increased risks of dementia, depression, social anxiety, falls, and death. Given that either hearing or vision impairment increases the risks of many of the same disorders, it shouldn’t come as a surprise that DSI, compared with a single sensory impairment, may further increase the risks associated with these conditions. For example, investigators in South Korea followed over 6,500 individuals with DSI as part of a longitudinal study on cognitive aging and dementia. 4 At baseline, DSI was positively associated with dementia prevalence compared with those with normal sensory function. Over the six-year follow-up period, DSI was associated with higher odds of dementia incidence than hearing or visual impairment alone. In a similar study conducted in the United States, researchers followed over 7,500 Medicare beneficiaries who self-reported vision or hearing impairment. 5 Data collected after seven years indicated that those with DSI were at greater risk for developing dementia than those with hearing or vision impairmen
与单独的视力或听力障碍相比，DSI似乎与更大的全因死亡率相关。AGES-Reykjavik研究10涉及4900多名冰岛人，他们参加了一项大型流行病学研究，他们在2002年至2006年期间接受了听力检查，并在2009年之前对他们的死亡率进行了前瞻性随访。结果表明，听力损失或视力受损的人比没有听力或视力受损的人死于心血管疾病的风险更高;患有DSI的人比那些只有听力或视力障碍的人有更高的死亡率。同样，Tan等人11对听力损失和DSI与死亡率之间关系的研究进行了系统回顾。研究人员分析了符合纳入标准的27项研究的结果(14项回顾性研究和13项前瞻性研究设计，共1,213,756名参与者)。他们的分析显示，与那些听力和视力正常的人相比，DSI的参与者有明显更高的风险(即风险比;HR)的全因死亡率(HR = 1.40, 95% CI = 1.30 - 1.51)，特别是心血管死亡率(HR = 1.86, 95% CI = 1.31 - 2.65)。将多感觉障碍的后果扩展到其他模式(嗅觉和味觉，除了视觉和听觉)，Liljas和同事发现，在英国老龄化纵向研究(2016年5月至2017年6月)的6147个样本中，随着感觉障碍的数量增加，生活质量下降，抑郁症增加。毫不奇怪，那些报告有三到四种感觉障碍的人经历了最差的生活质量。dsi对听力保健专业人员的影响是什么?您的老年患者可能患有多种慢性疾病，因此请考虑以下问题:更新您的摄入表格，包括与听力和视力障碍相关的合并症。询问你的病人最近一次检查眼睛或更新眼镜处方是什么时候。检查你的病人是否有视力障碍。让你的老年病人大声朗读一些东西(例如，从你的病人教育手册或助听器使用手册中的一个样本)。与你所在社区的视力保健专家发展和建立关系。继续了解与听力、视力和双感官损伤相关的慢性疾病，包括认知障碍、抑郁、焦虑和跌倒。
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Pub Date : 2023-05-24DOI: 10.1097/01.hj.0000938616.47591.bf
Jan Blustein, Barbara E. Weinstein, Joshua Chodosh
We’ve all had these conversations. A family member asks us, “What’s all this talk about hearing loss and dementia?” A patient comes to our clinic and says, “I heard if I get a hearing aid, I will not get dementia.” Perhaps they’ve seen a headline claiming that “hearing loss is a major risk factor for dementia” in The Washington Post1 or heard an interview on National Public Radio’s Weekend Edition Sunday explaining that hearing loss “actually affect(s) the brain’s structural integrity.” 2 Other major news outlets have run similar stories 3,4, leading many to wonder: has hearing loss already damaged my brain? Am I destined to develop dementia?www.shutterstock.com.We recently wrote an article that critiqued these media reports. Our article was published in a geriatrics journal. Given the favorable reader response we have chosen to share our thoughts with our community of hearing health care professionals. The primary point we wish to convey is that messages like “hearing loss is a risk factor for dementia” need to be changed. Not only is such messaging confusing, but such messages are also prone to stigmatize and worry people with hearing loss. We should add as well that most scientists agree that the evidence to date is unsettled. CONFUSION ABOUT RISK The message that hearing loss is “the largest potentially modifiable risk factor for dementia” comes from an epidemiologic analysis that appeared in The Lancet in 2017 and 2020. 5 The reports were primarily based on studies in which people with various degrees of hearing loss (but without cognitive impairment at the start of the study) were followed over several years. In each of the studies, people with greater hearing loss at the outset were more likely to perform poorly on cognitive tests over time. Their cognitive dysfunction was severe enough to be labeled “dementia” more often than the dysfunction found in people who did not have hearing loss at the outset. Based on the studies reviewed, a set of distinguished epidemiologists declared that hearing loss is a leading “risk factor” for dementia. But “risk” and “risk factor” have special meanings in epidemiology. Unlike in everyday English (where “risk” suggests a cause of something bad) epidemiologic risk is only about co-occurrence, or correlation. But as we all probably learned during our undergraduate or graduate studies, correlation is not causation. In other words, saying that hearing loss is a risk factor for dementia does not mean that hearing loss causes dementia. SCIENTIFIC UNCERTAINTY ABOUT THE UNDERLYING CAUSE It is important to realize that after many years of research there is very little known about the causes of Alzheimer’s disease (AD) and AD-related dementias (AD/ADRD). Given our general ignorance, it is not surprising that we lack a scientific understanding about whether and how hearing loss might be involved. Four possible explanations have been advanced. 6 The first points to the social isolation that accompanies hearing loss,
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Pub Date : 2023-05-24DOI: 10.1097/01.hj.0000938628.78258.4a
Ben Sebothoma, Katijah Khoza-Shangase
Low- and middle-income countries (LMICs) continue to experience the highest incidence of hearing loss. 1 With the incidence of hearing loss projected to reach approximately 2.5 billion globally in the next couple of decades 2, LMICs may bear the highest burden of this proportion. Within the South African context, various risk factors, which form part of the quadruple burden of diseases such as the human immunodeficiency virus (HIV) 3,4, diabetes 5, tuberculosis (TB) 6, and hypertension 7 increase the risk of hearing loss, with COVID-19 having potentially added to this challenge. 8 Ntlhakana et al. 9 found that the combined effects of risk factors increase the risk of hearing loss in South African mine workers, with Khoza-Shangase 10 comprehensively discussing these risk factors for this important sector of the South African economy while arguing for their contextualization.www.shutterstock.com. Golden Rules, audiologists, cochlear implants, hearing aids, OTC.Despite the ever-increasing prevalence of hearing loss in LMICs, such as South Africa, established hearing protocols such as hearing screening do not seem to have improved access to ear and hearing health care to a wider population in these regions. Prevalence of hearing loss remains underreported, thus negatively influencing governmental obligation to provide equitable resources and focus to hearing health care programs. 11 Extreme shortages of ear and hearing health practitioners 12–14, and limited healthcare institutions that provide hearing healthcare services, with preventive ear and hearing care measures taking a back seat 13,15, exacerbate the rapid increase of hearing loss in LMICs. Given that approximately 80% of the South African population, for example, access health through the government funded public health sector, patients who experience ear and hearing related symptoms may not have sufficient access to services due to contextual realities including financial challenges such as transportation money to access health care centres, as well as the general population’s limited awareness of the existence of hearing health care practitioners as a profession. 16,17 The shortage of hearing health practitioners seen through capacity versus demand challenges and the general lack of resources form part of the dilapidated health care system, which lacks the capabilities to deal with most health problems. 18 The strained health care system, at the expense of quality of life, tends to prioritize life-threatening conditions, which hearing loss does not fall under. It is therefore not surprising that some preventive audiological programs such as the hearing conservation programs (HCPs) do not seem to yield positive outcomes of zero ear harm due to excessive noise in mines 19, while early hearing detection and intervention (EHDI) and ototoxicity monitoring programs remain at infancy and developmental stages. 20–22 TELEAUDIOLOGY Teleaudiology emerged as a promising vehicle to deliver hearing heal
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