After genetic causes, congenital cytomegalovirus infection is the leading cause of congenital and early childhood hearing loss. This article in HNO summarises the 2025 German AWMF S2k guideline on CMV in pregnancy and in newborns and children.
The key recommendation for ENT and audiology teams: if newborn hearing screening is abnormal on the first and the follow-up test, CMV DNA PCR on urine (the gold standard) or saliva should be done immediately — preferably before the baby leaves the maternity or paediatric unit, and no later than the second to third week of life. That timing matters because congenital infection can only be confirmed from early samples, and antiviral treatment can be offered within the first 30 days, including for babies whose only sign is hearing loss. Treatment may lessen, stabilise or prevent progression of the loss. Long-term follow-up is needed because CMV-related hearing loss can progress or appear late.
Where CMV testing is not yet part of the referral pathway after a failed screen, adding it is a low-cost change.
- When a newborn fails the hearing screen twice, arrange urine or saliva CMV PCR straight away.
- Aim to test within the first two to three weeks of life; later samples cannot confirm congenital infection.
- Refer CMV-positive infants promptly so antiviral treatment can be considered within 30 days.
- Keep children with congenital CMV under long-term audiological follow-up for progression or late-onset loss.
- Agree the pathway jointly between maternity, neonatal, ENT and audiology teams.
Why it matters
Missing the first three weeks closes the window for both diagnosis and treatment.
Don't overread it
This is a national consensus (S2k) guideline; the treatment benefit for isolated hearing loss rests on limited evidence.
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