Otorhinolaryngological findings and hearing in HIV-positive and HIV-negative children in a developing country

Abstract

The otorhinolaryngological (ORL) manifestations of Human Immunodeficiency virus (HIV) are common, but remain poorly characterized among children of Sub-Saharan Africa, where 90% of new pediatric infections occur. Our objective was to compare ORL findings and hearing in HIV-positive and -negative children of Luanda, Angola, using a comparative study of 78 outpatients from the HIV polyclinic and of 78 age- and sex-matched controls in a pediatric hospital with interview, general and ORL examination, brainstem auditory evoked potentials, and at age >5 years pure tone open-air audiometry. ORL pathology emerged in 92% of HIV-positive and 78% (p = 0.02) of control children. HIV-associated ORL findings comprised dental caries (56 vs. 32%; p = 0.0009), cervical lymphadenopathy >1 cm (45 vs. 10%; p < 0.0001), facial skin lesions (32 vs. 5.1%; p < 0.0001), chronic suppurative otitis media (26 vs. 3.8%; p = 0.0002), dry tympanic membrane perforations (9 vs. 1%; p = 0.03), tonsils of Mallampati score 0-1 (87 vs. 64%; p = 0.0009), and bilateral hearing loss of >25 dB (13 vs. 1%; p = 0.009). Other HIV-associated characteristics included ear pain (44 vs. 27%; p = 0.006), earlier otorrhea episodes (34 vs. 17%; p = 0.004), tuberculosis (29 vs. 2.6%; p < 0.0001), and pneumonia (22 vs. 2.6%; p = 0.0003). ORL pathology appeared usual in both HIV-positive and -negative children. However, the overall high frequency and severity of the findings among the HIV-positive children require regular inclusion of the ORL area in these children's clinical evaluation.

Comparison of auditory brainstem response in HIV-1 exposed and unexposed newborns and correlation with the maternal viral load and CD4+ cell counts

“…Although 6.4% HIV-exposed newborns had mild hearing loss as compared to 2.5% in the non-exposed group, this difference was not significant, however, the mild sensorineural hearing loss has been reported to interfere with language, education and psychosocial development of a child later in life [24, 33]. Sensorineural hearing loss distorts auditory signals as it leaves the cochlea to be processed at higher auditory center thereby incapacitating the development of communication ability of the affected individual.…”

“…The aetiology of hearing loss in the newborn include mitochondrial abnormalities, genetic or congenital malformations, neurologic disorders or damage secondary to congenital infections such as cytomegalovirus (CMV), toxoplasmosis, rubella[26–30]. Others are intrauterine exposure to ototoxic medications [26–30] and HIV infection [19, 31–33]. …”

Middle Ear Function in Human Immunodeficiency Virus (HIV)-Infected South African Children

“…Two PHIV children in the current study had present otorrhea whereas no HIV-uninfected child presented with otorrhea. Statistics were not completed given the small numbers, though other researchers have shown that HIV-infected children in Africa have significantly more present or past episodes of otorrhea [7] and significantly more episodes of recurrent otorrhea [12].…”

“…The World Health Organization (WHO) reports the prevalence of chronic suppurative otitis media (CSOM) ranging from <1% to 7.8% [1]. Human immunodeficiency virus-infected (HIVinfected) children who are immunocompromised are at higher risk for this opportunistic infection [2][3][4][5][6][7][8]. Further, greater immunosuppression in HIV-infected children is associated with both a higher rate of otitis media and greater severity of otitis media [6] and more symptomatic HIV-infected children are at higher risk for recurrent episodes of otitis media [2,5].…”

Chronic Pediatric Pain in Low and Middle Income Countries

“…In Haiti, 37% pediatric patients with Tungiasis wounds reported pain. Chronic ear pain was prevalent in 44% of patients with HIV infection in Angola [43]. Twenty percent of pediatric patients with cerebral malaria in Mali reported headaches [44].…”