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. 1997 Feb;76(2):134–138. doi: 10.1136/adc.76.2.134

Hearing loss during bacterial meningitis

M Richardson 1, A Reid 1, M Tarlow 1, P Rudd 1
PMCID: PMC1717058  PMID: 9068303

Abstract

Accepted 20 August 1996


OBJECTIVE—To determine the natural history and pathogenesis of hearing loss in children with acute bacterial meningitis.
DESIGN—Multicentre prospective study.
SETTING—21 hospitals in the south and west of England and South Wales.
SUBJECTS—124 children between the ages of 4 weeks and 16 years with newly diagnosed bacterial meningitis.
METHODS—Children underwent repeated audiological assessment with the first tests being performed within six hours of diagnosis. By using a combination of oto-acoustic emissions, auditory brainstem responses, and tympanometry the differences between cochlear, neural, and conductive defects were distinguished.
RESULTS—Ninety two children (74%) had meningococcal and 18 (15%) had pneumococcal meningitis. All cases of hearing loss were apparent at the time of the first assessment. Three children (2.4%, 95% confidence interval (CI) 0.5 to 6.9%) had permanent sensorineural hearing loss. Thirteen children (10.5%) had reversible hearing loss of whom nine had an impairment that resolved within 48 hours of diagnosis. It is believed that this `fleeting' hearing loss has not been reported previously. The cochlea was identified as the site of the lesion in both the permanent sensorineural and reversible impairments. Hearing loss was more common in children who had been ill for more than 24 hours (relative risk 2.72; 95% CI 0.93 to 7.98).
CONCLUSIONS—Sensorineural hearing loss developed during the earliest stages of meningitis. Permanent deafness was rare but 10% of the patients had a rapidly reversible cochlear dysfunction. This may have progressed to permanent deafness if the patients had not been treated promptly.



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Selected References

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  1. Baraff L. J., Lee S. I., Schriger D. L. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J. 1993 May;12(5):389–394. doi: 10.1097/00006454-199305000-00008. [DOI] [PubMed] [Google Scholar]
  2. Bhatt S. M., Cabellos C., Nadol J. B., Jr, Halpin C., Lauretano A., Xu W. Z., Tuomanen E. The impact of dexamethasone on hearing loss in experimental pneumococcal meningitis. Pediatr Infect Dis J. 1995 Feb;14(2):93–96. doi: 10.1097/00006454-199502000-00002. [DOI] [PubMed] [Google Scholar]
  3. Bhatt S. M., Lauretano A., Cabellos C., Halpin C., Levine R. A., Xu W. Z., Nadol J. B., Jr, Tuomanen E. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis. 1993 Mar;167(3):675–683. doi: 10.1093/infdis/167.3.675. [DOI] [PubMed] [Google Scholar]
  4. Dodge P. R., Davis H., Feigin R. D., Holmes S. J., Kaplan S. L., Jubelirer D. P., Stechenberg B. W., Hirsh S. K. Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med. 1984 Oct 4;311(14):869–874. doi: 10.1056/NEJM198410043111401. [DOI] [PubMed] [Google Scholar]
  5. Fortnum H. M. Hearing impairment after bacterial meningitis: a review. Arch Dis Child. 1992 Sep;67(9):1128–1133. doi: 10.1136/adc.67.9.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Guiscafré H., Benitez-Díaz L., Martínez M. C., Muñoz O. Reversible hearing loss after meningitis. Prospective assessment using auditory evoked responses. Ann Otol Rhinol Laryngol. 1984 May-Jun;93(3 Pt 1):229–232. doi: 10.1177/000348948409300308. [DOI] [PubMed] [Google Scholar]
  7. Guo Y., Wu Y., Chen W., Lin J. Endotoxic damage to the stria vascularis: the pathogenesis of sensorineural hearing loss secondary to otitis media? J Laryngol Otol. 1994 Apr;108(4):310–313. doi: 10.1017/s0022215100126623. [DOI] [PubMed] [Google Scholar]
  8. Huang M., Dulon D., Schacht J. Outer hair cells as potential targets of inflammatory mediators. Ann Otol Rhinol Laryngol Suppl. 1990 Jun;148:35–38. doi: 10.1177/00034894900990s610. [DOI] [PubMed] [Google Scholar]
  9. Jiang Z. D., Liu X. Y., Wu Y. Y., Zheng M. S., Liu H. C. Long-term impairments of brain and auditory functions of children recovered from purulent meningitis. Dev Med Child Neurol. 1990 Jun;32(6):473–480. doi: 10.1111/j.1469-8749.1990.tb16972.x. [DOI] [PubMed] [Google Scholar]
  10. Kanra G. Y., Ozen H., Seçmeer G., Ceyhan M., Ecevit Z., Belgin E. Beneficial effects of dexamethasone in children with pneumococcal meningitis. Pediatr Infect Dis J. 1995 Jun;14(6):490–494. doi: 10.1097/00006454-199506000-00005. [DOI] [PubMed] [Google Scholar]
  11. Kaplan S. L., Catlin F. I., Weaver T., Feigin R. D. Onset of hearing loss in children with bacterial meningitis. Pediatrics. 1984 May;73(5):575–578. [PubMed] [Google Scholar]
  12. Kaplan S. L., Smith E. O., Wills C., Feigin R. D. Association between preadmission oral antibiotic therapy and cerebrospinal fluid findings and sequelae caused by Haemophilus influenzae type b meningitis. Pediatr Infect Dis. 1986 Nov-Dec;5(6):626–632. doi: 10.1097/00006454-198611000-00005. [DOI] [PubMed] [Google Scholar]
  13. Kemp D. T. Stimulated acoustic emissions from within the human auditory system. J Acoust Soc Am. 1978 Nov;64(5):1386–1391. doi: 10.1121/1.382104. [DOI] [PubMed] [Google Scholar]
  14. Kilpi T., Anttila M., Kallio M. J., Peltola H. Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis. Pediatr Infect Dis J. 1993 Mar;12(3):184–188. doi: 10.1097/00006454-199303000-00002. [DOI] [PubMed] [Google Scholar]
  15. Kotagal S., Rosenberg C., Rudd D., Dunkle L. M., Horenstein S. Auditory evoked potentials in bacterial meningitis. Arch Neurol. 1981 Nov;38(11):693–695. doi: 10.1001/archneur.1981.00510110053007. [DOI] [PubMed] [Google Scholar]
  16. Lebel M. H., Freij B. J., Syrogiannopoulos G. A., Chrane D. F., Hoyt M. J., Stewart S. M., Kennard B. D., Olsen K. D., McCracken G. H., Jr Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. N Engl J Med. 1988 Oct 13;319(15):964–971. doi: 10.1056/NEJM198810133191502. [DOI] [PubMed] [Google Scholar]
  17. Michel O., Brusis T. Hearing loss as a sequel of lumbar puncture. Ann Otol Rhinol Laryngol. 1992 May;101(5):390–394. doi: 10.1177/000348949210100503. [DOI] [PubMed] [Google Scholar]
  18. Moxon E. R., Smith A. L., Averill D. R., Smith D. H. Haemophilus influenzae meningitis in infant rats after intranasal inoculation. J Infect Dis. 1974 Feb;129(2):154–162. doi: 10.1093/infdis/129.2.154. [DOI] [PubMed] [Google Scholar]
  19. Nadol J. B., Jr Hearing loss as a sequela of meningitis. Laryngoscope. 1978 May;88(5):739–755. doi: 10.1002/lary.1978.88.5.739. [DOI] [PubMed] [Google Scholar]
  20. Orchik D. J., Dunn J. W., McNutt L. Tympanometry as a predictor of middle ear effusion. Arch Otolaryngol. 1978 Jan;104(1):4–6. doi: 10.1001/archotol.1978.00790010008002. [DOI] [PubMed] [Google Scholar]
  21. Ozdamar O., Kraus N., Stein L. Auditory brainstem responses in infants recovering from bacterial meningitis. Audiologic evaluation. Arch Otolaryngol. 1983 Jan;109(1):13–18. doi: 10.1001/archotol.1983.00800150017003. [DOI] [PubMed] [Google Scholar]
  22. Palva T. Cochlear aqueduct in infants. Acta Otolaryngol. 1970 Aug;70(2):83–94. doi: 10.3109/00016487009181863. [DOI] [PubMed] [Google Scholar]
  23. Probst R., Lonsbury-Martin B. L., Martin G. K. A review of otoacoustic emissions. J Acoust Soc Am. 1991 May;89(5):2027–2067. doi: 10.1121/1.400897. [DOI] [PubMed] [Google Scholar]
  24. Radetsky M. Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J. 1992 Sep;11(9):694–701. doi: 10.1097/00006454-199209000-00002. [DOI] [PubMed] [Google Scholar]
  25. Richardson M. P., Williamson T. J., Lenton S. W., Tarlow M. J., Rudd P. T. Otoacoustic emissions as a screening test for hearing impairment in children. Arch Dis Child. 1995 Apr;72(4):294–297. doi: 10.1136/adc.72.4.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Salwén K. M., Vikerfors T., Olcén P. Increased incidence of childhood bacterial meningitis. A 25-year study in a defined population in Sweden. Scand J Infect Dis. 1987;19(1):1–11. doi: 10.3109/00365548709032371. [DOI] [PubMed] [Google Scholar]
  27. Tarlow M. J., Comis S. D., Osborne M. P. Endotoxin induced damage to the cochlea in guinea pigs. Arch Dis Child. 1991 Feb;66(2):181–184. doi: 10.1136/adc.66.2.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Vienny H., Despland P. A., Lütschg J., Deonna T., Dutoit-Marco M. L., Gander C. Early diagnosis and evolution of deafness in childhood bacterial meningitis: a study using brainstem auditory evoked potentials. Pediatrics. 1984 May;73(5):579–586. [PubMed] [Google Scholar]
  29. Wald E. R., Kaplan S. L., Mason E. O., Jr, Sabo D., Ross L., Arditi M., Wiedermann B. L., Barson W., Kim K. S., Yogov R. Dexamethasone therapy for children with bacterial meningitis. Meningitis Study Group. Pediatrics. 1995 Jan;95(1):21–28. [PubMed] [Google Scholar]
  30. Wenner W. J., Jr Diagnostic delays with bacterial meningitis. JAMA. 1995 Feb 22;273(8):621–622. [PubMed] [Google Scholar]
  31. Yager J. Y., Johnston B., Seshia S. S. Coma scales in pediatric practice. Am J Dis Child. 1990 Oct;144(10):1088–1091. doi: 10.1001/archpedi.1990.02150340032019. [DOI] [PubMed] [Google Scholar]

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