Silvana Griz 2,6, B
More details
Hide details
Electrophysiology, Advanced Electrophysiology and Neuroaudiology Center, Brazil
Audiology, Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Brazil
Audiology, Institute of Physiology and Pathology of Hearing, Poland
Audiology, Department of Heart Failure and Cardiac Rehabilitation, Poland
ENT, Institute of Sensory Organs, Poland
Audiology, Universidade Federal de Pernambuco – UFPE, Brazil
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
Publication date: 2021-03-31
Corresponding author
Milaine Dominici Sanfins   

Electrophysiology, Advanced Electrophysiology and Neuroaudiology Center, Avenida Jacutinga, 220- apto 12,, 04515-030, São Paulo, Brazil
J Hear Sci 2021;11(1):65-71
The Zika virus (ZIKV) was detected in Brazil in 2014. At the end of 2015 microcephaly was the first distinctive sign. By 2016, the first two cases of congenital Zika had been described, with a strong correlation between the virus and microcephaly.

Case report:
A male infant was born at 32 weeks gestation, weight 1,750 grams, cranial perimeter 26 cm. He remained in intensive care for 5 days for neonatal seizures, required oxygen therapy, and had early sepsis. After 11 days in hospital a diagnosis of microcephaly was made. At 12 months, hydrocephalus was identified by computed tomography, with calcification foci in the subcortical region, basal nuclei, cerebellum, and brainstem. These characteristics are typical of congenital zika syndrome (CZS). Audiological tests were done: immittanciometry (tympanometry and acoustic reflex), transient evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), click ABR, and frequency following response (FFR). In patients with ZIKV, radiological findings show distinctive calcifications at the gray–white matter junction and degrees of delayed cortical development. The findings here of no acoustic reflex and a reduction in otoacoustic emissions in both ears is a preliminary indication of outer hair cell involvement that could later lead to communication deficits. ABR responses showed hearing pathway impairment in both ears up to the brainstem, and diminished FFR responses point to possible difficulties in speech perception. The present case study adds to our knowledge of the effect of CZS on the auditory system and strengthens the recommendation that ZIKV be included as an indicator for risk of hearing loss.

Calvet G, Aguiar R, Melo A, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis, 2016; 16: 653–60.
Oliveira, Melo A, Malinger G, Ximenes R, Szejnfeld P, Alves Sampaio S, et al. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol, 2016; 47: 6–7.
Brito C. Zika virus: a new chapter in the history of medicine. Acta Med Port, 2015; 28: 679–80.
Araújo Td, Ximenes R, Miranda-Filho D, Souza W, Montarroyos U, Melo A, et al. Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case–control study. Lancet Infect Dis. 2018; 18: 328–36.
Stirnemann J, Villar J, Salomon LJ, et al. International estimated fetal weight standards of the INTERGROWTH-21st Project. Ultrasound Obstet Gynecol, 2017; 49(4): 478–86.
Melo A, Aguiar R, Amorim M, Arruda M, Melo F, Ribeiro S, et al. Congenital zika virus infection: beyond neonatal microcephaly. JAMA Neurol, 2016; 73: 1407–16.
Soares de Oliveira-Szejnfeld P, Levine D, Melo A, et al. Congenital brain anormalities and zika virus: what the radiologist can expect to see prenatally and postnatally. Radiology, 2016; 281: 203–18.
Leal M, Muniz L, Ferreir aT, et al. Hearing loss in infants with microcephaly and evidence of congenital zika virus infection: Brazil, November 2015–May 2016. MMWR Morb Mortal Wkly Rep, 2016; 65(34): 917–9.
Ventura C, Maia M, Travassos S, et al. Risk factors associated with the ophthalmoscopic findings identified in infants with presumed zika virus congenital infection. JAMA Ophthalmol, 2016; 134: 912–8.
Pessoa A, Van der Linden V, Yeargin-Allsopp M, Carvalho M, Ribeiro E, Van Naarden Braun K, et al. Motor abnormalities and epilepsy in infants and children with evidence of congenital zika virus infection. Pediatrics, 2018; 141: S167–S179.
Duffy M, Chen T, Hancock W, Powers A, Kool J, Lanciotti R, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med, 2009; 360: 2536–43.
Lessler J, Chaisson L, Kucirka L, Bi Q, Grantz K, Salje H. Assessing the global threat from Zika virus. Science, 2016; 353.
Pereira JP, Maykin MM, Vasconcelos Z, Avvad-Portari E, Zin AA, Tsui I, et al. The role of amniocentesis in the diagnosis of congenital Zika syndrome. Clin Infect Dis, 2019; 69(4): 713–6.
Musso D, Roche C, Nhan T, Robin E, Teissier A, Cao‐Lormeau V. Detection of Zika vírus in saliva. J Clin Virol, 2015; 68: 53–5.
Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol, 1970; 92(4): 311–24.
Jasper HH. The ten–twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol, 1958; 10: 371–75.
Gorga MP, Reiland JK, Beauchaine KA, Worthington DW, Jesteadt W. Auditory brainstem responses from graduates of an intensive care nursery: normal patterns of response. J Speech Hear Res, 1987; 30(3): 311–8.
Gorga MP, Kaminski JR, Beauchaine KL, Jesteadt W, Neely ST. Auditory brainstem responses from children three months to three years of age: normal patterns of response II. J Speech Hear Res, 1989; 32: 281–8.
Sanfins MD, Borges LR, Ubiali T, Donadon C, Hein TAD, Hatzopoulos S, et al. Speech-evoked brainstem response in normal adolescent and children speakers of Brazilian Portuguese. Int J Pediatr Otorhinolaryngol, 2016 Nov; 90: 12–9.
Johnson KL, Nicol T, Zecker SG, Kraus N. Developmental plasticity in the human auditory brainstem. J Neurosci, 2008; 28(15): 4000–7.
Ahadi M, Pourbakht A, Jafari AH, Jalaie S. Effects of stimulus presentation mode and subcortical laterality in speech-evoked auditory brainstem responses. Intl J Audiol, 2014; 53(4): 243–9.
Rana B, Barman A. Correlation between speech-evoked auditory brainstem responses and transient evoked otoacoustic emissions. J Laryngol Otol, 2011; 125(9): 911–6.
Wagner R, Torgesen J, Rashotte C. Development of readingrelated phonological processing abilities: new evidence of bidirectional casuality from a latent variable longitudinal study. Devel Psychol, 1994; 30(1): 73–87.
Karawani H, Banai K. Speech-evoked brainstem responses in Arabic and Hebrew speakers. Intl J Audiol, 2010; 49(11): 844–9.
Song JH, Nicol T, Kraus N. Test–retest reliability of the speechevoked auditory brainstem response. Clin Neurophysiol, 2011; 122(2): 346–55.
Russo N, Nicol T, Musacchia G, Kraus N. Brainstem responses to speech syllables. Clin Neurophysiol, 2004; 115: 2021–30.
American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics, 2007; 120: 898–921.
Scharf R, Scharf G, Stroustrup A. Developmental milestones. Pediatr Rev, 2016; 37: 25–37.
Council on Children with Disabilities. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics, 2006; 118: 405–20.
Russell K, Oliver S, Lewis L, et al. Update: interim guidance for the evaluation and management of infants with possible congenital Zika virus infection—United States, August 2016. MMWR Morb Mortal Wkly Rep, 2016; 65: 870–8.
Simmons F. Perceptual theories of middle ear muscle function. Ann Otol Rhinol Laryngol, 1964; 73: 724–39.
Wormald P, Rogers C, Gatehouse S. Speech discrimination in patients with Bell’s palsy and a paralysed stapedius muscle. Clin Otolaryngol Allied Sci, 1995; 20: 59–62.
Leite RFP, Santos MSA, Ribeiro EM, Pessoa ALS, Lewis DR, Giacheti CM, et al. Hearing screening in children with congenital zika virus syndrome in Fortaleza, Ceará, Brazil, 2016. Epidemiol Serv Saúde, 2018 Nov 8; 27(4): e2017553.
Leal MC, Muniz LF, Caldas Neto SS, Van der Linden V, Ramos RCF. Sensorineural hearing loss in a case of congenital Zika virus. Braz J Otorhinolaryngol, 2016 Jun-Aug; 86(4): 513–5.
Khan K, Khan W. Congenital toxoplasmosis: An overview of the neurological and ocular manifestations. Parasitol Int, 2018; 67: 715–21.
Sanfins MD, Garcia MV, Biaggio EPV, Skarzynski PH. The frequency-following response: evaluations in different age groups. In: Hatzopoulos S, Ciorba A, Skarzynski PH. Human Auditory System: Basic features and updates on audiological diagnosis and therapy. Croatia: IntechOpen; 2019. doi: 10.5772/intechopen.85076.
Banai K, Amitay S. The effects of stimulus variability on the perceptual learning of speech and non-speech stimuli. PLoS One, 2015; 10(2): e0118465.
Anderson S, Parbery-Clark A, White-Schwoch T, Kraus N. Development of subcortical speech representation in human infants. J Acoust Soc Am, 2015; 137: 3346–55.
Sanfins MD, Skarzynski PH, Colella-Santos MF. Speech-evoked brainstem response. In: Hatzopoulos S, editor. Advances in Clinical Audiology. Croatia: IntechOpen; 2017. doi: 10.5772/66206.
Kuo D, Houtrow A, Arango P, Kuhlthau K, Simmons J, Neff J. Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J, 2012; 16: 297–305.
Journals System - logo
Scroll to top