High prevalence of hearing
loss and ear disease in HIV-infected Peruvian children
C.K. Chao1,2,3, A.H. Messner3, J.A. Czechowicz3, L. Kolevic4, M. Larragan5, J. Alarcon6, S. Montano7, J.R. Zunt2
1Fogarty International Research and Training Program, Bethesda, United States, 2University of Washington, Seattle, United States, 3Stanford University School of Medicine, Stanford, United States, 4Instituto Nacional de Salud del Nino, Lima, Peru, 5Hospital Nacional Arzobispo Loayza, Lima, Peru, 6Universidad Nacional Mayor de San Marcos, Lima, Peru, 7Naval Medical Research Center Detachment, Lima, Peru
Background: HIV infection has been
associated with hearing loss in adults and children, but risk factors and
etiologies are not well defined. The objective of this study was to determine the
prevalence of and risk factors for hearing loss and other ear diseases in
HIV-infected children in Peru.
Methods: Cross-sectional study of
HIV-infected children ages 4 through 17 receiving care at two public hospitals
in Lima, Peru: Hospital Nacional Arzobispo Loayza and Instituto Nacional de
Salud del Nino. Study examination
included pure-tone audiometry, tympanometry and otoscopy. Historical and
socioeconomic information was obtained through parental survey and chart
review. Data were analyzed using SPSS.
Results: One hundred HIV-infected
Peruvian children were examined. Average age was 9.5 years; 53 (53%) were
female; 86 (86%) were receiving HAART therapy (average duration 4.2 years).
Hearing loss was identified through abnormal audiometry in 35 (35%) children:
30 (30%) had conductive hearing loss; 1 (1%) had sensorineural loss; and 4 (4%)
had mixed conductive and sensorineural loss. Tympanic membrane (TM) pathology
was seen on tympanometry in 56 (56%) children and 10 (10%) children had TM
perforations. Abnormal tympanometry was correlated with history of pneumonia (p
= 0.004) and three or more ear infections in the past year (p = 0.029), but not
with CD4 count or HAART therapy.
Conclusions: This is the largest
assessment of ear disease in HIV-infected children to date. We found a high
prevalence of conductive and mixed hearing loss, abnormal tympanometry and TM
perforations - significantly higher than rates reported in HIV-uninfected
children in Peru and elsewhere. The mechanism of HIV-associated hearing
impairment is not clearly defined, but the association with recurrent ear
infections highlights the importance of screening HIV-infected children for ear
infections and treating infections appropriately when detected.
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