Desenvolvimento de fala e linguagem em crianças com perda auditiva por infecção congênita: revisão de literatura e experiência clínica de um serviço de saúde auditiva

Abstract

Introduc/on: Hearing is essen9al for the development of speech and language, beginning in the gesta+onal phase and con+nuing to develop throughout life. Hearing loss can nega9vely impact language and academic performance. Congenital infec9ons from the TORCHS group (toxoplasmosis, rubella, cytomegalovirus (CMV), herpes simplex, syphilis, Zika virus, and HIV) are significant causes of childhood hearing loss, preventable through specific measures, vaccines, and treatments. Interna9onal and na9onal commi`ees recommend audiological monitoring and early interven9ons for children with congenital infec9on. Objec/ve: To analyze the language and speech development in children with hearing loss due to congenital infec9on at a Hearing Health Center. Materials and Methods: The thesis was divided into two parts: a retrospec9ve review of medical records of children seen between 2019 and 2021 and a prospec9ve cross-sec9onal study with phoniatric evalua9ons. The research was conducted at a Hearing Health Center, following approved ethical standards. In Part 1, clinical and audiological data of children up to 6 years old were analyzed to iden9fy risk factors for sensorineural hearing loss (SNHL). In Part 2, children with congenital TORCHS infec9ons were evaluated for speech and language development using observa9onal tests adapted from phoniatric evalua9on and the Denver II instrument. The analysis iden9fied associa9ons between variables and SNHL. Results: Part 1 of the thesis analyzed 531 children, of which 52.8% had some degree of hearing loss. Among these, sensorineural hearing loss (SNHL) was prevalent in 31.1% of the children. Descrip9ve analysis of clinical variables and the associa9on with the occurrence of SNHL considered factors such as age at the first consulta9on, type of referral, result of neonatal hearing screening (NHS), and clinical reports from parents. The average age of children with SNHL was 13.2 months, while children without hearing loss had an average of 17.5 months. The associa9on between age at the first consulta9on and SNHL was significant (p < 0.001). Most children referred directly from maternity wards had a higher occurrence of SNHL (41.3%) compared to those referred by the health network (24.8%), and most children with SNHL failed the NHS (78.2%). Regarding risk factors, children who suffered neonatal asphyxia, used ototoxic medica9ons (gentamicin), or had congenital infec9ons like CMV showed a significant associa9on with SNHL. Premature and/or low birth weight children had a higher prevalence of SNHL. Part 2 of the thesis evaluated 55 children with congenital TORCHS infec9on, of which 30.9% had SNHL and 10.9% had conduc9ve hearing loss. The analyses focused on speech and language development, as well as other milestones of child development. Most children with SNHL showed significant delays in expressive (43.6%) and recep9ve language (34.5%) in observa9onal tests. There was an associa9on between observa9onal tests and the occurrence of SNHL, with a higher incidence of SNHL in children with "delays" in all five tests. Most congenital infec9ons were associated with "ques9onable" results in the Denver II areas, especially CMV and HIV, which had the highest percentages of ques9onable results. Addi9onally, children with "ques9onable" results in the four Denver II areas had a higher occurrence of SNHL. Children with mul9ple risk factors showed a higher occurrence of SNHL. The use of ototoxic medica9ons and neonatal asphyxia were significantly associated with SNHL (p < 0.05). Discussion: The results from Part 1 highlight the importance of neonatal hearing screening, early diagnosis, and con9nuous monitoring of children with congenital infec9ons and other risk factors for hearing loss. The analysis of risk factors and results from child development tests emphasizes the need for integrated and mul9disciplinary approaches to ensure proper development. Conclusion: This study contributes to understanding the implica9ons of congenital infec9ons on auditory and language development, and highligh9ng the importance of early diagnosis and interven9on