Nonsyndromic deafness

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Nonsyndromic deafness
Other namesNon-syndromic genetic deafness
Treatmentvancomycin

Nonsyndromic deafness is hearing loss that is not associated with other signs and symptoms. In contrast, syndromic deafness involves hearing loss that occurs with abnormalities in other parts of the body. Nonsyndromic deafness constitutes 75% of all hearing loss cases, and an estimated 100 genes are thought to be linked to this condition. About 80% are linked to autosomal recessive inheritance, 15% to autosomal dominant inheritance, 1-3% through the X chromosome, and 0.5-1% are associated with mitochondrial inheritance. [1] [2]

Contents

Genetic changes are related to the following types of nonsyndromic deafness:

Each type is numbered in the order in which it was described. For example, DFNA1 was the first described autosomal dominant type of nonsyndromic deafness. Mitochondrial nonsyndromic deafness involves changes to the small amount of DNA found in mitochondria, the energy-producing centers within cells. [3]

Most forms of nonsyndromic deafness are associated with permanent hearing loss caused by damage to structures in the inner ear. The inner ear consists of three parts: a snail-shaped structure called the cochlea that helps process sound, nerves that send information from the cochlea to the brain, and structures involved with balance. Loss of hearing caused by changes in the inner ear is called sensorineural deafness. Hearing loss that results from changes in the middle ear is called conductive hearing loss. The middle ear contains three tiny bones that help transfer sound from the eardrum to the inner ear. Some forms of nonsyndromic deafness involve changes in both the inner ear and the middle ear; this combination is called mixed hearing loss.

The severity of hearing loss varies and can change over time. It can affect one ear (unilateral) or both ears (bilateral). Degrees of hearing loss range from mild (difficulty understanding soft speech) to profound (inability to hear even very loud noises). The loss may be stable, or it may progress as a person gets older. Particular types of nonsyndromic deafness often show distinctive patterns of hearing loss. For example, the loss may be more pronounced at high, middle, or low tones.

Classification

Nonsyndromic deafness can occur at any age. Hearing loss that is present before a child learns to speak is classified as prelingual or congenital. Hearing loss that occurs after the development of speech is classified as postlingual.

Genetics

Nonsyndromic deafness can have different patterns of inheritance. Between 75% and 80% of cases are inherited in an autosomal recessive pattern, which means two copies of the gene in each cell are altered. Usually, each parent of an individual with autosomal recessive deafness is a carrier of one copy of the altered gene. These carriers do not have hearing loss.

Another 20% to 25% of nonsyndromic deafness cases are autosomal dominant, which means one copy of the altered gene in each cell is sufficient to result in hearing loss. People with autosomal dominant deafness most often inherit an altered copy of the gene from a parent who has hearing loss.

Between 1% and 2% of cases show an X-linked pattern of inheritance, which means the mutated gene responsible for the condition is located on the X chromosome. Males with X-linked nonsyndromic deafness tend to develop more severe hearing loss earlier in life than females who inherit a copy of the same gene mutation. Fathers will not pass X-linked traits to their sons since they do not pass on the X chromosome to their male offspring.

Mitochondrial nonsyndromic deafness, which results from changes to the DNA in mitochondria, occurs in fewer than 1% of cases in the United States. The altered mitochondrial DNA is passed from a mother to her sons and daughters. This type of deafness is not inherited from fathers.

Late onset progressive deafness is the most common neurological disability of the elderly. Although hearing loss of greater than 25 decibels is present in only 1% of young adults between the ages of 18 and 24 years of age, this increases to 10% in persons between 55 and 64 years of age and approximately 50% in octogenarians.

The relative contribution of heredity to age-related hearing impairment is not known, however the majority of inherited late-onset deafness is autosomal dominant and non-syndromic (Van Camp et al., 1997). Over forty genes associated with autosomal dominant non-syndromic hearing loss have been localized and of these fifteen have been cloned.

Mutations in the ACTG1 , CABP2 , CDH23 , CLDN14 , COCH , COL11A2 , DFNA5 , ESPN , EYA4 , GJB2 , GJB6 , KCNQ4 , MYO15A , MYO6 , MYO7A , OTOF , PCDH15 , POU3F4 , SLC26A4 , STRC , TECTA , TMC1 , TMIE , TMPRSS3 , USH1C , and WFS1 genes cause nonsyndromic deafness, with weaker evidence currently implicating genes CCDC50 , DIAPH1 , DSPP , ESRRB , GJB3 , GRHL2 , GRXCR1 , HGF , LHFPL5 , LOXHD1 , LRTOMT , MARVELD2 , MIR96 , MYH14 , MYH9 , MYO1A , MYO3A , OTOA , PJVK , POU4F3 , PRPS1 , PTPRQ , RDX , SERPINB6 , SIX1 , SLC17A8 , TPRN , TRIOBP , SLC26A5 , and WHRN .

The causes of nonsyndromic deafness can be complex. Researchers have identified more than 30 genes that, when mutated, may cause nonsyndromic deafness; however, some of these genes have not been fully characterized. Many genes related to deafness are involved in the development and function of the inner ear. Gene mutations interfere with critical steps in processing sound, resulting in hearing loss. Different mutations in the same gene can cause different types of hearing loss, and some genes are associated with both syndromic and nonsyndromic deafness. In many families, the gene(s) involved have yet to be identified.

Deafness can also result from environmental factors or a combination of genetic and environmental factors, including certain medications, peri-natal infections (infections occurring before or after birth), and exposure to loud noise over an extended period.

Types include:

OMIM GeneType
124900 DIAPH1 DFNA1
600101 KCNQ4 DFNA2A
612644 GJB3 DFNA2B
601544 GJB2 DFNA3A
612643 GJB6 DFNA3B
600652 MYH14 DFNA4
600994 DFNA5 DFNA5
601543 TECTA DFNA8/12
601369 COCH DFNA9
601316 EYA4 DFNA10
601317 MYO7A DFNA11, neurosensory
601868 COL11A2 DFNA13
602459 POU4F3 DFNA15
603622 MYH9 DFNA17
604717 ACTG1 DFNA20/26
606346 MYO6 DFNA22
605192 SIX1 DFNA23
605583 SLC17A8 DFNA25
608641 GRHL2 DFNA28
606705 TMC1 DFNA36
605594 DSPP DFNA36, with dentinogenesis
607453 CCDC50 DFNA44
607841 MYO1A DFNA48
613074 MIR96 DFNA50
220290 GJB2 DFNB1A
612645 GJB6 DFNB1B
600060 MYO7A DFNB2, neurosensory (see also Usher syndrome)
600316 MYO15A DFNB3
600971 TMIE DFNB6
600974 TMC1 DFNB7
601072 TMPRSS3 DFNB8, childhood onset
601071 OTOF DFNB9
601386 CDH23 DFNB12
603720 STRC DFNB16
602092 USH1C DFNB18
603629 TECTA DFNB21
607039 OTOA DFNB22
609533 PCDH15 DFNB23
611022 RDX DFNB24
613285 GRXCR1 DFNB25
609823 TRIOBP DFNB28
614035 CLDN14 DFNB29
607101 MYO3A DFNB30
607084 WHRN DFNB31
608565 ESRRB DFNB35
609006 ESPN DFNB36
607821 MYO6 DFNB37
608265 HGF DFNB39
610153 MARVELD2 DFNB49
609706 COL11A2 DFNB53
610220 PJVK DFNB59
611451 LRTOMT DFNB63
610265 LHFPL5 DFNB67
613079 LOXHD1 DFNB77
613307 TPRN DFNB79
613391 PTPRQ DFNB84
613453 SERPINB6 DFNB91
614899 CABP2 DFNB93
304500 PRPS1 DFNX1
304400 POU3F4 DFNX2
580000 MT-RNR1, COX1 [4] deafness, aminoglycoside-induced
500008 (several mtDNA) DFN, sensorineural, mt

Diagnosis

The diagnosis of nonsyndromic deafness involves a comprehensive assessment to determine the cause of hearing loss in an individual without associated syndromic features. Key steps in the diagnosis may include:

In some cases, other methods may be conducted, including imaging techniques such as CT or MRI, to examine the structures of the inner ear and identify any abnormalities in the cochlea or auditory nerve. Screening blood tests for metabolic conditions or infections that could contribute to hearing loss may also be recommended. [9] [10]

Treatment

Treatment is supportive and consists of management of- manifestations. Use of hearing aids and/or cochlear implant, suitable educational programs can be offered. Periodic surveillance is also important. [11]

Epidemiology

About 1 in 1,000 children in the United States is born with profound deafness. By age 9, about 3 in 1,000 children have hearing loss that affects the activities of daily living. More than half of these cases are caused by genetic factors. Most cases of genetic deafness (70% to 80%) are nonsyndromic; the remaining cases are caused by specific genetic syndromes. In adults, the chance of developing hearing loss increases with age; hearing loss affects half of all people older than 80 years.

Related Research Articles

<span class="mw-page-title-main">Genetic disorder</span> Health problem caused by one or more abnormalities in the genome

A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders are the most common, the term is mostly used when discussing disorders with a single genetic cause, either in a gene or chromosome. The mutation responsible can occur spontaneously before embryonic development, or it can be inherited from two parents who are carriers of a faulty gene or from a parent with the disorder. When the genetic disorder is inherited from one or both parents, it is also classified as a hereditary disease. Some disorders are caused by a mutation on the X chromosome and have X-linked inheritance. Very few disorders are inherited on the Y chromosome or mitochondrial DNA.

<span class="mw-page-title-main">Wolfram syndrome</span> Human disease

Wolfram syndrome, also called DIDMOAD, is a rare autosomal-recessive genetic disorder that causes childhood-onset diabetes mellitus, optic atrophy, and deafness as well as various other possible disorders including neurodegeneration.

<span class="mw-page-title-main">Waardenburg syndrome</span> Genetic condition involving hearing loss and depigmentation

Waardenburg syndrome is a group of rare genetic conditions characterised by at least some degree of congenital hearing loss and pigmentation deficiencies, which can include bright blue eyes, a white forelock or patches of light skin. These basic features constitute type 2 of the condition; in type 1, there is also a wider gap between the inner corners of the eyes called telecanthus, or dystopia canthorum. In type 3, which is rare, the arms and hands are also malformed, with permanent finger contractures or fused fingers, while in type 4, the person also has Hirschsprung's disease. There also exist at least two types that can result in central nervous system (CNS) symptoms such as developmental delay and muscle tone abnormalities.

<span class="mw-page-title-main">Alport syndrome</span> Medical condition

Alport syndrome is a genetic disorder affecting around 1 in 5,000-10,000 children, characterized by glomerulonephritis, end-stage kidney disease, and hearing loss. Alport syndrome can also affect the eyes, though the changes do not usually affect vision, except when changes to the lens occur in later life. Blood in urine is universal. Proteinuria is a feature as kidney disease progresses.

<span class="mw-page-title-main">Usher syndrome</span> Recessive genetic disorder causing deafblindness

Usher syndrome, also known as Hallgren syndrome, Usher–Hallgren syndrome, retinitis pigmentosa–dysacusis syndrome or dystrophia retinae dysacusis syndrome, is a rare genetic disorder caused by a mutation in any one of at least 11 genes resulting in a combination of hearing loss and visual impairment. It is a major cause of deafblindness and is at present incurable.

<span class="mw-page-title-main">Pendred syndrome</span> Medical condition

Pendred syndrome is a genetic disorder leading to congenital bilateral sensorineural hearing loss and goitre with euthyroid or mild hypothyroidism. There is no specific treatment, other than supportive measures for the hearing loss and thyroid hormone supplementation in case of hypothyroidism. It is named after Vaughan Pendred (1869–1946), the British doctor who first described the condition in an Irish family living in Durham in 1896. It accounts for 7.5% to 15% of all cases of congenital deafness.

<span class="mw-page-title-main">Collagen, type XI, alpha 2</span> Protein found in humans

Collagen alpha-2(XI) chain is a protein that in humans is encoded by the COL11A2 gene.

<span class="mw-page-title-main">Branchio-oto-renal syndrome</span> Medical condition

Branchio-oto-renal syndrome (BOR) is an autosomal dominant genetic disorder involving the kidneys, ears, and neck. It is also known as Melnick-Fraser syndrome.

<span class="mw-page-title-main">GJB2</span> Protein-coding gene in the species Homo sapiens

Gap junction beta-2 protein (GJB2), also known as connexin 26 (Cx26) — is a protein that in humans is encoded by the GJB2 gene.

<span class="mw-page-title-main">MT-RNR1</span> SSU rRNA of the mitochondrial ribosome

Mitochondrially encoded 12S ribosomal RNA is the SSU rRNA of the mitochondrial ribosome. In humans, 12S is encoded by the MT-RNR1 gene and is 959 nucleotides long. MT-RNR1 is one of the 37 genes contained in animal mitochondria genomes. Their 2 rRNA, 22 tRNA and 13 mRNA genes are very useful in phylogenetic studies, in particular the 12S and 16S rRNAs. The 12S rRNA is the mitochondrial homologue of the prokaryotic 16S and eukaryotic nuclear 18S ribosomal RNAs. Mutations in the MT-RNR1 gene may be associated with hearing loss. The rRNA gene also encodes a peptide MOTS-c, also known as Mitochondrial-derived peptide MOTS-c or Mitochondrial open reading frame of the 12S rRNA-c.

<span class="mw-page-title-main">USH1C</span>

Harmonin is a protein that in humans is encoded by the USH1C gene. It is expressed in sensory cells of the inner ear and retina, where it plays a role in hearing, balance, and vision. Mutations at the USH1C locus cause Usher syndrome type 1c and nonsyndromic sensorineural deafness.

<span class="mw-page-title-main">GJB6</span> Protein-coding gene in the species Homo sapiens

Gap junction beta-6 protein (GJB6), also known as connexin 30 (Cx30) — is a protein that in humans is encoded by the GJB6 gene. Connexin 30 (Cx30) is one of several gap junction proteins expressed in the inner ear. Mutations in gap junction genes have been found to lead to both syndromic and nonsyndromic deafness. Mutations in this gene are associated with Clouston syndrome.

<span class="mw-page-title-main">TECTA</span> Protein-coding gene in the species Homo sapiens

Alpha-tectorin is a protein that in humans is encoded by the TECTA gene.

<span class="mw-page-title-main">Otoferlin</span> Protein-coding gene in the species Homo sapiens

Otoferlin is a protein that in humans is encoded by the OTOF gene. It is involved in vesicle membrane fusion, and mutations in the OTOF gene are associated with a genetic form of deafness.

<span class="mw-page-title-main">TMC1</span> Protein-coding gene in the species Homo sapiens

Transmembrane channel-like protein 1 is a protein that in humans is encoded by the TMC1 gene. TMC1 contains six transmembrane domains with both the C and N termini on the endoplasmic side of the membrane, as well as a large loop between domains 4 and 5. This topology is similar to that of transient receptor potential channels (TRPs), a family of proteins involved in the perception of senses such as temperature, taste, pressure, and vision. TMC1 has been located in the post-natal mouse cochlea, and knockouts for TMC1 and TMC2 result in both auditory and vestibular deficits indicating TMC1 is a molecular part of auditory transduction.

<span class="mw-page-title-main">STRC</span> Protein-coding gene in the species Homo sapiens

Stereocilin is a protein that in humans is encoded by the STRC gene.

<span class="mw-page-title-main">Björnstad syndrome</span> Medical condition

Björnstad syndrome is an autosomal recessive congenital condition involving pili torti, sensorineural deafness, and hair abnormalities. It was first characterized in 1965, in Oslo, by prof. Roar Theodor Bjørnstad after he observed an association between pili torti and hearing loss. The condition is extremely rare, with less than 50 cases documented in medical literature worldwide.

<span class="mw-page-title-main">Mohr–Tranebjærg syndrome</span> Medical condition

Mohr–Tranebjærg syndrome (MTS) is a rare X-linked recessive syndrome also known as deafness–dystonia syndrome and caused by mutation in the TIMM8A gene. It is characterized by clinical manifestations commencing with early childhood onset hearing loss, followed by adolescent onset progressive dystonia or ataxia, visual impairment from early adulthood onwards and dementia from the 4th decade onwards. The severity of the symptoms may vary, but they progress usually to severe deafness and dystonia and sometimes are accompanied by cortical deterioration of vision and mental deterioration.

<span class="mw-page-title-main">Arts syndrome</span> Medical condition

Arts syndrome is a rare metabolic disorder that causes serious neurological problems in males due to a malfunction of the PRPP synthetase 1 enzyme. Arts Syndrome is part of a spectrum of PRPS-1 related disorders with reduced activity of the enzyme that includes Charcot–Marie–Tooth disease and X-linked non-syndromic sensorineural deafness.

Causes of hearing loss include ageing, genetics, perinatal problems, loud sounds, and diseases. For some kinds of hearing loss the cause may be classified as of unknown cause.

References

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  2. Kalatzis, V (1998-09-01). "The fundamental and medical impacts of recent progress in research on hereditary hearing loss". Human Molecular Genetics. 7 (10): 1589–1597. doi: 10.1093/hmg/7.10.1589 . ISSN   1460-2083. PMID   9735380.
  3. Reference, Genetics Home. "nonsyndromic hearing loss". Genetics Home Reference. Retrieved 14 April 2017.
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  6. Funamura, Jamie L. (2017). "Evaluation and management of nonsyndromic congenital hearing loss". Current Opinion in Otolaryngology & Head & Neck Surgery. 25 (5): 385–389. doi:10.1097/moo.0000000000000398. ISSN   1068-9508. PMID   28682819. S2CID   11889662.
  7. Sloan-Heggen, Christina M.; Bierer, Amanda O.; Shearer, A. Eliot; Kolbe, Diana L.; Nishimura, Carla J.; Frees, Kathy L.; Ephraim, Sean S.; Shibata, Seiji B.; Booth, Kevin T.; Campbell, Colleen A.; Ranum, Paul T.; Weaver, Amy E.; Black-Ziegelbein, E. Ann; Wang, Donghong; Azaiez, Hela (2016-03-11). "Comprehensive genetic testing in the clinical evaluation of 1119 patients with hearing loss". Human Genetics. 135 (4): 441–450. doi: 10.1007/s00439-016-1648-8 . ISSN   0340-6717. PMC   4796320 . PMID   26969326.
  8. Vona, Barbara; Doll, Julia; Hofrichter, Michaela A. H.; Haaf, Thomas (2020-08-01). "Non-syndromic hearing loss: clinical and diagnostic challenges". Medizinische Genetik. 32 (2): 117–129. doi:10.1515/medgen-2020-2022. ISSN   1863-5490. S2CID   222005315.
  9. Sommen, Manou; van Camp, Guy; Boudewyns, An (2013). "Genetic and clinical diagnosis in non-syndromic hearing loss". Hearing, Balance and Communication. 11 (3): 138–145. doi:10.3109/21695717.2013.812380. ISSN   2169-5717. S2CID   73090556.
  10. Hone, S.W.; Smith, R.J.H. (2003). "Genetic screening for hearing loss". Clinical Otolaryngology and Allied Sciences. 28 (4): 285–290. doi:10.1046/j.1365-2273.2003.00700.x. ISSN   0307-7772. PMID   12871240.
  11. Smith, Richard JH; Jones, Mary-Kayt N. (1993). "Nonsyndromic Hearing Loss and Deafness, DFNB1". GeneReviews. University of Washington, Seattle. PMID   20301449.

Further reading