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Updated: May 12, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Reversible audiometric threshold changes in children with uncomplicated malaria
George O Adjei1, Bamenla Q Goka, Emmanuel Kitcher
1Centre for Tropical Clinical Pharmacology and Therapeutics, College of Health Sciences, University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana.
Insights
Malaria infection in children temporarily causes elevated hearing thresholds. Hearing returned to normal within nine months, suggesting malaria, not antimalarial drugs, is the primary cause.
Area of Science:
- Malariology
- Pediatrics
- Audiology
Background:
- Plasmodium falciparum malaria and some antimalarial drugs are linked to adult hearing loss.
- Limited data exists on malaria's impact on hearing in children.
- Evidence on artemisinin combination therapies (ACTs) and hearing is inconclusive.
Purpose of the Study:
- To investigate the effects of malaria and its treatment on hearing thresholds in children.
- To compare the ototoxic potential of different antimalarial treatments in pediatric malaria patients.
Main Methods:
- Audiometry was performed on children with uncomplicated malaria treated with artesunate-amodiaquine, artemether-lumefantrine, or amodiaquine.
- Hearing tests were repeated at intervals up to 9 months post-treatment.
- Results were compared to a control group of healthy children from the same region.
Main Results:
- Children with acute malaria showed significantly elevated hearing thresholds compared to controls.
- Hearing threshold elevations persisted for up to 28 days.
- No significant hearing differences were observed between treated children and controls after 9 months.
- Artemisinin combination therapies (ACTs) showed comparable hearing thresholds, lower than amodiaquine alone during acute illness.
Conclusions:
- Malaria infection itself is likely responsible for temporary hearing threshold elevations in children.
- These findings have implications for child development in high-transmission areas and for assessing new antimalarial drug safety.
- Further research is needed to understand the long-term effects and potential ototoxicity of antimalarial treatments.
Abstract:
Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs) with hearing is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (n = 37), artemether-lumefantrine (n = 35), or amodiaquine (n = 8) in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared with those of a control group of children (n = 57) from the same area. Findings. During the acute stage, hearing threshold levels of treated children were significantly elevated compared with controls (P < 0.001). The threshold elevations persisted up to 28 days, but no differences in hearing thresholds were evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels during the acute illness, a finding that has implications for learning and development in areas of intense transmission, as well as for evaluating potential ototoxicity of new antimalarial drugs.
