Speech and Language Challenges in Children with Congenital CMV

Speech and Language Challenges in Children with Congenital CMV

Congenital cytomegalovirus (cCMV) is widely recognized as the leading non-genetic cause of sensorineural hearing loss in children. However, its impact on early speech and language development remains poorly understood, especially in children without clinically apparent hearing loss.

A recent multicenter retrospective study published in the International Journal of Pediatric Otorhinolaryngology (Cherches et al., 2026; DOI: 10.1016/j.ijporl.2026.112771) examined speech outcomes in 69 children with confirmed cCMV identified within the first 21 days of life across two large academic health systems in North Carolina.

Nearly half of the cohort (49.3%) had documented speech dysfunction. Most of these cases were categorized under “constitutional speech delay,” a broad term used in this study to aggregate a range of speech delay diagnoses lacking more specific classification. A smaller proportion of children received more specific diagnoses including articulation disorder, apraxia, or dysarthria.

The demographics of the infants in this study reflected patterns seen in prior cCMV literature, which describe disparities in infection rates that disproportionately affect Black infants and infants from lower socioeconomic backgrounds. Compared to 2020 North Carolina Census data, the cohort included a higher proportion of Black children (36.2% vs 12.4%) and a lower proportion of White children (50.7% vs 61.6%). Socioeconomic status was not reported in this study.

One of the most notable findings was that speech dysfunction was not limited to children with hearing loss. While hearing impairment was diagnosed in 43.5% of children within the study’s ten year chart review period, a substantial proportion (24.3%) of children demonstrating speech delays had no documented hearing loss. This pattern suggests that speech and language outcomes in cCMV may not be explained by auditory impairment alone and may reflect broader neurodevelopmental effects of the virus.

Among children with hearing loss, speech dysfunction was highly prevalent, with the highest rates observed in those with symmetric hearing loss, reinforcing the established relationship between auditory access and language development. 73.3% of infants were diagnosed with hearing loss within the first year of life, while 26.7% of diagnoses occurred between ages one and four years, consistent with patterns of late-onset, progressive, or fluctuating hearing loss described in cCMV.

Speech-language pathology involvement was common once hearing loss was identified, with most referred patients attending at least one session and many showing documented improvement. However, the timing of intervention varied widely, with a mean initiation age of 5.52 months, a maximum of 28 months, and a standard deviation of 6.91 months.

Taken together, these findings suggest that speech dysfunction in cCMV is common and not fully explained by hearing loss status. A meaningful subset of children with speech dysfunction had no diagnosed hearing impairment, suggesting that reliance on auditory screening alone may not fully capture the spectrum of early communication impairment. This pattern highlights the potential value of earlier and more routine consideration of speech-language evaluation alongside audiological assessment in children with cCMV, and may reflect broader, incompletely understood effects on neurodevelopment. Overall, this research, representing the largest US-based study of cCMV speech outcomes, adds to a growing body of literature that underscores the need for continued research into the mechanisms linking cCMV to early communication outcomes, including pathways that extend beyond hearing loss alone.