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Auditory Impairments in HIV-Infected Children

Maro, Isaac I.; Fellows, Abigail M.; Clavier, Odile H.; Gui, Jiang; Rieke, Catherine C.; Wilbur, Jed C.; Chambers, Robert D.; Jastrzembski, Benjamin G.; Mascari, John E.; Bakari, Muhammad; Matee, Mecky; Musiek, Frank E.; Waddell, Richard D.; von Reyn, C. Fordham; Palumbo, Paul E.; Moshi, Ndeserua; Buckey, Jay C.

doi: 10.1097/AUD.0000000000000276
Research Articles

Objectives: In a cross-sectional study of human immunodeficiency virus (HIV)-infected adults, the authors showed lower distortion product otoacoustic emissions (DPOAEs) in HIV+ individuals compared with controls as well as findings consistent with a central auditory processing deficit in HIV+ adults on antiretroviral therapy. The authors hypothesized that HIV+ children would also have a higher prevalence of abnormal central and peripheral hearing test results compared with HIV− controls.

Design: Pure-tone thresholds, DPOAEs, and tympanometry were performed on 244 subjects (131 HIV+ and 113 HIV− subjects). Thirty-five of the HIV+, and 3 of the HIV− subjects had a history of tuberculosis treatment. Gap detection results were available for 18 HIV− and 44 HIV+ children. Auditory brainstem response results were available for 72 HIV− and 72 HIV+ children. Data from ears with abnormal tympanograms were excluded.

Results: HIV+ subjects were significantly more likely to have abnormal tympanograms, histories of ear drainage, tuberculosis, or dizziness. All audiometric results were compared between groups using a two-way ANOVA with HIV status and ear drainage history as grouping variables. Mean audiometric thresholds, gap detection thresholds, and auditory brainstem response latencies did not differ between groups, although the HIV+ group had a higher proportion of individuals with a hearing loss >25 dB HL in the better ear. The HIV+ group had reduced DPOAE levels (p < 0.05) at multiple frequencies compared with HIV− subjects. No relationships were found between treatment regimens or delay in starting treatment and audiological parameters.

Conclusions: As expected, children with HIV+ were more likely to have a history of ear drainage, and to have abnormal tympanograms. Similar to the adult findings, the HIV+ group did not show significantly reduced audiometric thresholds, but did have significantly lower DPOAE magnitudes. These data suggest that (1) HIV+ children often have middle ear damage which complicates understanding the direct effects of HIV on the hearing system, and (2) even when corrected for confounders DPOAEs were lower in the HIV+ group. Previous studies suggest ototoxicity from antiretroviral drugs is an unlikely cause of the reduced DPOAE magnitudes. Other possibilities include effects on efferent pathways connecting to outer hair cells or a direct effect of HIV on the cochlea.

In this cross-sectional study, an audiological assessment was performed on a cohort of HIV+ and HIV- children in Tanzania. Compared to HIV- subjects, HIV+ children were more likely to report a history of dizziness and ear drainage. Audiometric thresholds, gap detection thresholds and auditory brainstem latencies were not significantly different between the groups. Even when adjusted for tympanometry status and history of ear drainage, DPOAE levels were significantly lower in the HIV+ group. Previous studies suggest ototoxicity from drugs is unlikely. Other possibilities include effects on cochlear efferent innervation or a direct effect of the HIV virus on the cochlea.

1DarDar Health Study, Dar es Salaam, Tanzania; 2Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, USA; 3Creare, LLC, Hanover, New Hampshire, USA; 4Harvard Medical School, Boston, Massachusetts, USA; 5Muhimbili University of Health and Allied Sciences, Department of Otolaryngology, Dar es Salaam, Tanzania; and 6University of Arizona, Department of Speech, Language, and Hearing Sciences, Tucson, Arizona, USA.

Received May 26, 2015; accepted December 17, 2015.

The authors have no conflicts of interest to disclose.

Address for correspondence: Jay C. Buckey, Professor of Medicine, The Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA. E-mail:

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