Cytomegalovirus Affects More Than Hearing

A mom gives her thirsty toddler a drink from her water bottle, and then takes a few sips herself. She doesn’t give the act a second thought. But she risks contracting cytomegalovirus (CMV)—a virus common in people of all ages, usually causing no symptoms. She will likely have no ill effects, but if she’s pregnant, CMV can pass through the placenta to the unborn child, causing congenital CMV.

As communication sciences and disorders (CSD) professionals, we are most likely familiar with congenital CMV as the leading cause of nongenetic hearing loss in infants. What we may not fully understand, however, is that congenital CMV can also cause other serious complications that will require speech-language treatment and the expertise of physical and occupational therapists and neurologists.

Transmission and symptoms

More than half of people 40 and older, and a third of children 5 and younger have had a CMV infection in their lives, and most don’t even know it (see sources). CMV is passed through direct, prolonged contact with bodily fluids (blood, urine, saliva), so pregnant women who have or work with young children are most at risk of contracting CMV through the children’s blood, saliva, and urine. For those who have never had a CMV infection and thus lack the antibodies to fight the infection, the risk of transmission to their unborn baby is greater.

One in 200 children are born in the U.S. with CMV each year, a prevalence that exceeds that of spina bifida, fetal alcohol syndrome, and Down syndrome. About one in five babies with congenital CMV infection will have long-term health problems (see sources).

Audiologists and SLPs are aware of the effects of CMV on hearing, but there is a significant knowledge gap among SLPs about its overall impact on a child's development. Only 26% of SLPs were somewhat familiar with CMV in a recent American Journal of Audiology study by physician Kavita Dedhia and colleagues in medicine and audiology.

Not all families know that their child was exposed to CMV in utero, and symptoms may not be present at birth. The National CMV Foundation lists congenital CMV signs and symptoms, which include including prematurity, thrombocytopenia (low blood platelet levels), low birth weight, jaundice, an enlarged liver and spleen, microcephaly (small head), and feeding difficulties (see sources). Calcifications of the brain are common in babies born with CMV, as are seizures and hydrocephaly.

Children with congenital CMV can have a wide spectrum of long-term effects, including delayed language acquisition and speech development (with or without hearing loss), motor impairment, sensory issues, vision loss, cerebral palsy, learning and/or mental disabilities, and death.

More education

A more thorough understanding of the overall impact of CMV on the brain —as well as understanding that congenital CMV-related difficulties may not surface until two or more years after birth—will help audiologists and SLPs make more informed clinical decisions and foster interprofessional relationships for the benefit of patients. Proper identification and a definitive diagnosis can help families have a better understanding of what challenges may lie ahead and what professionals should be involved in their child’s ongoing care. 

Audiologists and SLPs who note the following signs in young patients may want to consider speaking with the child’s caregivers about suspected CMV:

• Feeding difficulties/failure to thrive
• Sensory issues
• Progressive hearing loss or late-onset hearing loss
• Microcephaly
• Vision loss

Children who have been diagnosed with CMV should be evaluated by an audiologist and followed by a neurologist. Supporting children with CMV requires interprofessional collaboration that may include audiologists, SLPs, occupational therapists, physical therapists, infectious disease specialists, neurologists, ophthalmologists, dieticians, and more. SLPs may need to consider alternative and augmentative communication devices, co-treatments with occupational and physical therapists, and consultation with dietitians.

The key is knowing that CMV affects fall along a spectrum, and children with congenital CMV may have different types of challenges at different levels of severity.

The Centers for Disease Control and Prevention and the National CMV Foundation offer extensive information about CMV.

Increasing knowledge will allow audiologists and SLPs to better serve their clients, and to take appropriate preventive measures for themselves.

Sydney Bassard, MSP, CCC-SLP (she/her/hers), owns The Listening SLP, a private practice that focuses on facilitating functional communication outcomes for children and adults. [email protected]

Lisa Eickel, MS, CCC-SLP (she/her/hers), whose 4-year-old son was born with congenital CMV, has worked with birth through elementary school children in several practice settings. She is a Community Alliance Chair for the National CMV Foundation and a 1-3-6 Family Educator for Virginia’s Center for Family Involvement. [email protected]