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Sensorineural hearing loss following acute bacterial meningitis in non-neonates
1Department of Pediatrics, Christian Medical College, Ludhiana, Punjab, India.
Insights
Sensorineural hearing loss (SNHL) affects over 28% of children with acute bacterial meningitis (ABM). High cerebrospinal fluid neutrophil counts indicate increased SNHL risk, necessitating early audiological screening with brainstem evoked response audiometry (BERA).
Area of Science:
- Pediatrics
- Neurology
- Audiology
Background:
- Sensorineural hearing loss (SNHL) is a significant complication of acute bacterial meningitis (ABM) in children.
- Early identification and intervention are crucial for managing SNHL in pediatric patients.
Purpose of the Study:
- To determine the incidence of SNHL in non-neonatal children following ABM.
- To investigate the correlation between SNHL and various clinical and laboratory factors.
Main Methods:
- Prospective study of children aged 1 month to 12 years with ABM.
- Analysis of cerebrospinal fluid (CSF) parameters and clinical data.
- Brainstem evoked response audiometry (BERA) performed at discharge.
Main Results:
- SNHL occurred in 28.1% of children, with 21.9% having bilateral and 6.2% unilateral loss.
- Higher protein content and neutrophil percentage in the second CSF sample were associated with SNHL.
- A neutrophil percentage of 80% or more in the second CSF sample predicted over 50% probability of SNHL.
Conclusions:
- The incidence of SNHL following ABM in children is substantial.
- Elevated CSF neutrophils in follow-up samples are a strong predictor of SNHL.
- Routine BERA screening is recommended for all children with meningitis to enable early intervention.
Objective:
Sensorineural hearing loss (SNHL) is an important sequelae of acute bacterial meningitis (ABM) in children. This study was undertaken to determine the incidence of SNHL following meningitis in non-neonates and its correlation with various factors.
Methods:
Children between the ages of 1 month and 12 years with ABM admitted in a teaching hospital over a period of 18 months were enrolled. Detailed history was taken, clinical examination performed and cerebrospinal fluid analyzed at commencement of therapy, 48 hours later and at the end of treatment. On discharge brainstem evoked response audiometry (BERA) was recorded. Data were analyzed using appropriate statistical tests.
Results:
Out of 32 children enrolled, 9 (28.1%) developed SNHL, bilateral in 21.9% and unilateral in 6.2%. Among hearing impaired subjects, 11.2% had mild while 44.4% each had moderate and profound hearing loss. Age, presence of vomiting, altered sensorium seizures and aminoglycoside usage were not significantly different in those with and without SNHL, but the total duration of fever was (p<0.05). There was significantly higher protein content and neutrophils in the second CSF sample of those with SNHL.
Conclusion:
There is a greater than 50% probability of the child developing SNHL if neutrophil percentage in the second CSF is 80% or more. Since the overall risk of SNHL is significant in children with meningitis, it is recommended that BERA be recorded in all, so that early intervention may be possible.