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Evaluation of cochlear implantation in post-meningitic adults
1Department of Otolaryngology, University Hospital Birmingham, Queen Elizabeth Hospital, Edgbaston, UK.
Abstract:
Meningitis is an important cause of deafness and in some studies has been associated with poorer outcomes in adult patients following cochlear implantation. Of the first 100 adults implanted under the Midland Cochlear Implant Programme, 28 were deafened as a result of meningitis. We compare our experience with these patients with patients with a non-meningitic aetiology. A degree of cochlear ossification was a more common finding in the meningitic group. In six cases (four meningitis, two non-meningitis) ossification was encountered only during surgery, not being apparent on pre-operative radiology. The average scores achieved on auditory tests by the meningitic group were similar to those achieved by non-meningitic patients. At nine months, using only the implant, users were able to identify 54 per cent of common environmental sounds, achieved an average score of 30 words per minute on connected discourse tracking and identified an average of 42 per cent of words correctly in BKB sentences. Poorer outcomes were more commonly associated with cochlear ossification. In patients with cognitive and neurological sequelae, benefits with the implant were not always apparent in the early months, however, with intensive therapy these patients can obtain measurable sustained benefit from their implant.
Insights
Meningitis can cause deafness, but adult cochlear implant outcomes are similar to other causes. Cochlear ossification, more common after meningitis, is linked to poorer results.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Meningitis is a significant cause of deafness.
- Previous studies suggest meningitis-related deafness may lead to poorer outcomes after cochlear implantation in adults.
- The Midland Cochlear Implant Programme evaluated outcomes in patients deafened by meningitis.
Purpose of the Study:
- To compare cochlear implantation outcomes in adult patients deafened by meningitis versus those with non-meningitic causes.
- To investigate the prevalence of cochlear ossification in meningitis patients.
- To assess the impact of cochlear ossification and neurological sequelae on implant outcomes.
Main Methods:
- Retrospective review of the first 100 adult cochlear implant cases at the Midland Cochlear Implant Programme.
- Comparison of auditory test scores between patients with meningitis and non-meningitic aetiologies.
- Analysis of pre-operative and intra-operative findings, including cochlear ossification.
Main Results:
- 28% of patients were deafened by meningitis.
- Cochlear ossification was more frequent in the meningitis group.
- Auditory test scores at nine months were similar between meningitis and non-meningitis groups.
- Poorer outcomes were associated with cochlear ossification.
- Patients with cognitive/neurological sequelae showed delayed but sustained benefits with intensive therapy.
Conclusions:
- Cochlear implantation offers comparable auditory benefits for adults deafened by meningitis versus other causes.
- Cochlear ossification presents a surgical challenge and is linked to reduced outcomes.
- Intensive rehabilitation can lead to significant benefits even in patients with neurological deficits.