Congenital cytomegalovirus (cCMV) is the primary cause of non-genetic infantile sensorineural hearing loss (SNHL).  The global prevalence is 0.64%, with a 17-20% risk of persistent sequelae in affected children. Patients with cCMV require sophisticated and multidisciplinary management, which includes clinical, laboratory, and instrumental examinations from infancy to school age. In recent years, significant progress has been made in preventing infection-related complications, including the effectiveness of antiviral treatments given during pregnancy to stop vertical transmission, the relationship between the stage of pregnancy and symptom severity, and advanced research into a cytomegalovirus vaccine. These developments have led to updates and adaptations of existing guidelines to better suit new circumstances and management needs. This aims to facilitate early infection diagnosis, implement therapeutic and rehabilitative strategies, and ensure proper monitoring of children’s development during their early years. Management of hearing loss caused by cCMV primarily emphasizes early detection and timely intervention. Newborn hearing screening programs, such as those using transient evoked otoacoustic emissions (TEAOE), alongside targeted cCMV testing in high-risk groups, play a crucial role in identifying children at risk. For infants diagnosed with hearing loss, early treatments—including hearing aids, cochlear implants, and speech therapy—can enhance outcomes and promote the development of language and communication skills.

The author aims to highlight the challenges and recommendations regarding this topic in Italy, with a focus on early rehabilitation and audiological follow-up.

Background: Unilateral Hearing loss in children has been widely underestimated in the past, but is currently matter of attention as its diagnosis is made earlier due to universal newborn hearing screening and to stricter follow-up of children at risk. A significant challenge in this area is the reduction in auditory attention, which contributes not only to difficulties in cognitive and linguistic development but also to a diminished quality of life. Children with unilateral hearing loss (UHL) often face challenges in selective auditory attention, especially in environments with multiple speakers, compared to their peers with normal hearing.

Management options for UHL in children include traditional hearing aids (HA), bone-conduction devices, contralateral routing of signal (CROS) systems, and Remote Microphone Hearing Assistance Technology (RMHAT) systems. However, there is currently no consensus regarding which levels of UHL necessitate amplification. Additionally, studies provide conflicting evidence on the benefits of restoring normal signal perception through hearing aids in children with UHL.

This prospective study aims to evaluate auditory attention and hearing quality in children with UHL by comparing outcomes between a group using hearing aids and those not using any amplification devices.

Description: Twenty-four children, including 12 hearing aids users and 12 without any hearing rehabilitation, underwent audiological evaluation including speech audiometry in both quiet and noise, auditory attention tests, and the parent-reported version of the Speech, Spatial, and Quality of Hearing Questionnaire.

Conclusions: We assessed that children with unilateral hearing impairment exhibit significant challenges in auditory attention, which may result in substantial difficulties in real-world communication, especially in comprehending speech. In contrast, peers who have used hearing aids for at least one year demonstrate notable improvements, as the restoration of binaural hearing enhances their performance in auditory attention tests and parent-reported outcomes on the SSQ questionnaire.