(899) Vestibular Dysfunction in Congenital Cytomegalovirus: Associations with Motor Delay and Autism Spectrum Disorder

Introduction: Congenital cytomegalovirus (cCMV) is a leading cause of sensorineural hearing loss (SNHL) and developmental delay, yet the specific contribution of vestibular dysfunction to these outcomes is often confounded by hearing status. This study investigates the prevalence of vestibular dysfunction in patients with cCMV to characterize its prevalence in patients with co-occurring autism spectrum disorder (ASD) and its relationship with motor delay.

Methods: We performed a retrospective case-control study of 27 cCMV patients from 2014 to 2025 at the University of Michigan. Strict exclusion criteria removed confounders including genetic SNHL, meningitis, trauma, or cerebral palsy. Multivariable Firth penalized logistic regression was used to analyze risk factors for motor delay (adjusting for gestational age) and the association between ASD status and vestibular dysfunction (adjusting for SNHL severity).

Results: Vestibular function was not a significant predictor of motor delay (p > 0.05). Although bilateral vestibular loss showed a higher adjusted odds ratio (aOR=6.44), this association did not reach statistical significance (95% CI: 0.36 - 743.84; p = 0.21), likely reflecting sample size limitations. Vestibular dysfunction was more prevalent in patients with ASD (66% vs 26%) and remained significantly associated after controlling for SNHL (aOR=12.78; p = 0.041). Additionally, severe-to-profound SNHL was strongly associated with vestibular dysfunction (aOR=39.88; p = 0.009).

Conclusions: Our findings suggest that SNHL severity is a strong predictor of vestibular loss in cCMV. Furthermore, the data suggest that patients with cCMV are predisposed to the co-occurrence of autism and vestibular dysfunction independently of hearing status. While a statistically significant association between vestibular severity and motor delay was not detected in this cohort, the trend suggests that larger, multi-site studies are warranted to further elucidate this relationship.