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[Hearing disorders in children less than 16 months of age after bacterial meningitis with reference to cerebrospinal
B Wilken1, J van Wees, F K Tegtmeyer
1Klinik für Pdiatrie, Medizinische Universität zu Lübeck.
Insights
Bacterial meningitis can cause hearing loss in infants. Early hearing screening and dexamethasone treatment may reduce the risk of permanent hearing impairment, especially when elastase levels are high.
Area of Science:
- Pediatrics
- Neurology
- Otolaryngology
Context:
- Acute bacterial meningitis is a known cause of hearing impairment.
- The incidence and risk factors for hearing loss in very young children (<1.5 years) following meningitis are not well understood.
- Inflammation is implicated in meningitis-related hearing deficits.
Purpose:
- To investigate the incidence of hearing loss in infants treated for meningitis.
- To correlate laboratory findings, specifically cerebrospinal fluid elastase levels, with hearing impairment development.
- To evaluate the effect of dexamethasone on hearing outcomes.
Summary:
- Brainstem auditory evoked potentials were assessed in 25 infants (<1.5 years) treated for meningitis.
- Nine children showed abnormal potentials; 7 had transient conductive hearing loss, and 2 developed permanent sensorineural hearing loss.
- A significant correlation between high cerebrospinal fluid elastase and hearing loss was observed, which was reduced by dexamethasone treatment.
Impact:
- Hearing loss is a significant sequela of bacterial meningitis in infants.
- Cerebrospinal fluid elastase levels may serve as a biomarker for predicting hearing impairment.
- Routine hearing screening and consideration of dexamethasone therapy are recommended for infants with meningitis.
Abstract:
Hearing impairment as a sequela of acute bacterial meningitis is a well known complication. Dexamethasone therapy in addition to antibiotics is beneficial in the reduction of deafness, implicating that inflammation may be one reason for hearing impairment. The risk of hearing impairment in different types of bacterial meningitis is well studied. In very young children < 1.5 years of life the incidence of hearing loss and the possible correlation of laboratory data with the development of deafness is yet unknown. We therefore examined the brainstem auditory evoked potentials in 25 children between the first month and the 16th month of life who we treated for meningitis during 3 years in our hospital. 11 children were treated with dexamethasone. In 9 children we found abnormal brainstem auditory evoked potentials, which we controlled every 3 months. 7 children had transient conductive hearing impairment with good recovery during the first year after the disease. In 2 cases we found permanent bilateral sensorineural hearing loss. There was a significant relationship between hearing loss and elastase in cerebrospinal fluid. Dexamethasone reduced this relationship. A screening of hearing should be performed as routine control in all patients with acute meningitis. The association of high elastase in cerebrospinal fluid and later hearing impairment indicates a pathophysiological relation between activation of granulocytes and hearing loss.