Clinical Predictors for Hearing Loss in Children With Bacterial Meningitis

Baylor College of Medicine, Houston, Texas, United States
Archives of Otolaryngology - Head and Neck Surgery (Impact Factor: 2.33). 10/2006; 132(9):941-5. DOI: 10.1001/archotol.132.9.941
Source: PubMed


To identify clinical risk factors that predict a higher incidence of hearing loss in children with bacterial meningitis, to determine the overall incidence of hearing loss in a large group of children proven by culture findings to have bacterial meningitis, and to compare clinical characteristics among patients with Streptococcus pneumoniae meningitis and Neisseria meningitidis meningitis.
Retrospective review
Tertiary pediatric hospital.
A total of 171 children identified with bacterial meningitis who met inclusion criteria over a consecutive 10-year period.
Presence of sensorineural hearing loss.
Of 134 patients who underwent audiologic testing during their initial hospitalization, 41 (30.6%) were found to have at least a unilateral mild sensorineural hearing loss. The incidence of hearing loss was greater in patients with S pneumoniae meningitis than in patients with N meningitidis meningitis (35.9% and 23.9%, respectively). Length of hospitalization, development of seizures, elevated cerebrospinal fluid protein, and decreased cerebrospinal fluid glucose were significant predictors for hearing loss in children with bacterial meningitis. These factors were not found to be as strong a predictor for hearing loss in patients with N meningitidis meningitis. Stability of hearing was demonstrated with limited follow-up audiometry.
Sensorineural hearing loss is a common sequela in children with bacterial meningitis. Identification of hearing loss in children with bacterial meningitis and early rehabilitation will lessen the long-term educational and social difficulties these children may experience.

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    • "All participants fulfilled the following criteria: age of six months or older at the time of admission and confirmed diagnosis of bacterial meningitis. Bacterial meningitis was defined according to the World Health Organization (WHO) workbook recommendations based on laboratory findings, symptoms, or signs [8]. Those excluded from the study included all subjects with a confirmed diagnosis of tuberculosis and those on current treatment for tuberculosis; those with a prior history of hearing loss; those using ototoxic antibiotics as part of treatment; those with chronic medical conditions (diabetes, renal, cardiac diseases); those on treatment for malaria. "
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    ABSTRACT: Background This study aimed to examine hearing function in a group of children aged between the ages of six months and twelve years admitted with bacterial meningitis so as to determine the prevalence and degree of sensorineural hearing loss in them. This prospective study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital, KNH. Methods The study involved 83 children (49 males and 34 females) between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14 months (range from 5 to 120 months). They were sequentially recruited and at discharge following treatment, underwent age-appropriate hearing testing to evaluate presence and degree of hearing loss which was analyzed. The study was limited by the absence of otoacoustic emission and auditory brainstem responses testing by excluding the significant numbers of children below six months of age admitted with bacterial meningitis. Results Thirty six of the 83 children (44.4%) were found to have at least a unilateral mild sensorineural hearing loss during initial audiologic testing. Of the children with hearing loss, 22 (26.5%) had mild or moderate sensorineural hearing loss and 14 (16.9%) had severe or profound sensorineural hearing loss. Conclusions Sensorineural hearing loss was shown to be highly prevalent in children treated for bacterial meningitis. There is therefore a need for objective hearing assessment in infants and young children following bacterial meningitis and further studies involving larger population sizes.
    Full-text · Article · May 2013 · International Journal of Otolaryngology
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    • "Regardless, such an atypical skin eruption, chronologically associated with cerebral vasculitis, has not been described in a child with pneumococcal meningitis to date. However, a low CSF glucose level, which was profoundly low (2 mg/dL) in our patient, is an established significant risk factor for hearing loss after pneumococcal meningitis [8,9]. "
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    ABSTRACT: Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses. We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis. Atypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.
    Full-text · Article · Aug 2011 · Journal of Medical Case Reports
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    • "According to previous reports, hearing impairment of any type is expected to develop in 5.6% to 30.6% of patients with bacterial meningitis, while severe, profound or bilateral hearing loss is expected to occur in 1.0 to 5.1% of patients [10,14,18-21]. These findings are in agreement with the current study as 23 out of 2,235 children (1.0%), developed severe hearing loss. "
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    ABSTRACT: Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae. A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model. The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3). A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.
    Full-text · Article · Aug 2011 · BMC Infectious Diseases
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