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Table of Contents
ORIGINAL ARTICLE
Year : 2004  |  Volume : 6  |  Issue : 2  |  Page : 71-73

Meningitis in children a risk factor for hearing loss: A prospective study


Security Forces Hospital Riyadh, Saudi Arabia

Date of Web Publication12-Jul-2020

Correspondence Address:
MD, FRCS Siraj M Zakzouk

Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.289586

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  Abstract 


Objective: To identify risk factor for hearing loss in children with meningitis and to determine the incidence of hearing loss in a group of children with confirmed meningitis
Design: This was a prospective study conducted during the year 1999-2000,
Setting: A secondary referral paediatrics hospital in Riyadh. Saudi Arabia.
Patients and Methods: Children admitted to Children’s Solimania Hospital in Riyadh with the diagnosis of suspected meningitis were included in this study. The age range was from 7 days to 7 years. The diagnosis of acute meningitis was confirmed. Thirty eight of the children underwent audiological assessment using auditory brain-stem responses (ABR) and tympanometry.
Results: A total of 74 children with an age range between 7 years were included in the study. Forty two were boys and 32 were girls. There were 38 children with proven bacterial meningitis. Hearing results showed profound sensorineural hearing loss (SNHL) in 5 of them, 4 with conductive hearing loss and one with mixed hearing loss. Four children died and 32 were found with viral meningitis and discharged with no hearing tests performed. The prevalence of (SNHL) was 13%.
Conclusions: Sensorineural hearing loss (SNHL) developed during the early stages of bacterial meningitis. The hearing loss may become permanent. Early diagnosis of and prompt treatment may reduce the overall prevalence of SNHL.

Keywords: Meningitis - sensorineural hearing loss, (SNHL)- A,B,R


How to cite this article:
Al AbduIwahab N, Asiri S, Zakzouk SM. Meningitis in children a risk factor for hearing loss: A prospective study. Saudi J Otorhinolaryngol Head Neck Surg 2004;6:71-3

How to cite this URL:
Al AbduIwahab N, Asiri S, Zakzouk SM. Meningitis in children a risk factor for hearing loss: A prospective study. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2004 [cited 2022 Nov 30];6:71-3. Available from: https://www.sjohns.org/text.asp?2004/6/2/71/289586




  Introduction: Top


Bacterial meningitis is usually responsible for approximately 6 to 8% of all cases of hearing impairment in children [1],[2],[3]. It is also one of the main cause of acquired SNHL cases. Those group of infants and children recovering from bacterial meningitis are at raised risk of hearing loss. Sensorineural hearing impairment occurs in 5-10% of these children and about one quarter of these will have a profound bilateral hearing loss [4], Early referral and detection of SNHL by audiological assessment is obligatory and should be achieved. Meningitis usually produces primarily cochlear damage early in the disease and diagnosis is important to facilitate rehabilitation and to make possible the insertion of a cochlear implant electrode before cochlear ossification developed. The main methods of diagnosing hearing loss include Auditory Brain stem response (ABR) and evoked otoacoustic emission (EOAE).

The aim of this study was to confirm the diagnoses of bacterial meningitis in those children admitted to children hospital, to screen them using ABR and tympanometry, to differentiate cochlear, retro- cohlear and mixed hearing loss and to find the prevalence rate of hearing loss among these children.


  Material and Methods: Top


All children (74) admitted to the peadiatrec hospital (Solimania) with suspicion of meningitis were included. Confirmation of bacteria! meningitis was accomplished by blood culture and CSF examination in 38 children. Medical treatment was started ii screening by ABR and tympanometry using GSI 30 was performed early, while in hospital and 3-6 months after discharge. Otoacoustic emission was not available and therefore not done.

Intravenous antibiotics were given according to hospital policy as follow: Neonates ampicillin and gentamycin; Infants rocephin (ceftrixone) lOOmgm /kg / day for 10-14 days. In addition dexametha- zone was given at a dose of 0.6 mgm/ kg/ day, for 3 days.


  Results: Top


A total of 74 children ranging in age between 7 days to 7 years were included in this study. There were 42 (56.76%) boys and 32 girls (43,24%). Thirty eight children with proven bacterial culture undergone audiological assessment. Tympanometry- showed B type in 4 cases (5.4%), diagnosed as otitis media with effusion (OME). ABR showed delayed waves in these cases indicating conductive deafness. In 5 children (13%) ABR showed profound SNHL bilaterally (3 girls and 2 boys) and one child boy (2.6%) had mixed hearing loss. ABR was not done in 36 infants and children as 4 died and 32 did not stay long enough in the hospital.


  Discussion: Top


Acute bacterial meningitis is a serious childhood disease world wide. It develops rapidly into a severe clinical illness which may end fatally. The prevalence of long lasting neurological disabilities as hearing impairment, convulsion, mental retardation were high despite antimicrobial therapy, prophylaxis and vaccines. Bacterial meningitis continue to be a major cause of morbidity, neurological complications and mortality [5].

Acute bacterial meningitis classically presents with fever, headache, meningism. and signs of cerebral dysfunction. In very young and neonates, fever, refusal to feed and irritability are the most common symptoms. The most important aspect of laboratory investigations are CSF microscopic and culture evaluation. Blood culture and agglutination tests will show the main agents e g. H. influenza etc.Cerebrospinal fluid culture and blood cultures were positive in 75.5% and 6.6% of cases reported by Al-Mazrou et al ,2003, [6]. They also reported that hearing impairment was detected in 5 out of 208 cases. Zakzouk and Elsayed, 1992, [2], reported high incidence of SNHL of 29.4% among 68 children with septic meningitis. The same authors, 1996,[3] reported that meningitis is the main cause of acquired SNHL. Hearing impairment (H.I.), when profound and bilateral, is devastating to the development of speech, particularly in very young children when its presence may go undetected [7]. Partial or unilateral hearing impairment in children of all ages likewise may go undetected as the child unknowingly compensates and vital stimulation may be missed, particularly in the early years at school [8].

In a meta analysis by Baraff et al. 1993, [9], the incidencc of deafness in children surviving bacterial meningitis was reported to be 10.5%. In another study by Richardson et al, 1997,[10], the incidence was 2.4%. In developing countries e.g. India, the incidence was 28.1% [11]. In our study the incidence was 13%.

Meningitis caused by H. infuenzae type b is now rare due to the compulsory vaccination; most of the cases seen now were due to meningococcus species.

Steroids have been shown to reduce significantly the incidence of deafness in some studies [12]. and in others the incidence is higher [10]. It was also reported by Fortnum [13] that 10% of the patients had fluctuating hearing loss caused by reversible cochlear dysfunction, this may progress to permanent deafness if the meningitis had not been treated.


  Conclusions: Top


The incidence of bilateral SNHL among survivors of bacterial meningitis is high in our study 13%. And always occurred in the early stage of the disease..

Pediatricians should always refer post meningitis patients for hearing assessment even if the child or parents had no complaints.



 
  References Top

1.
Das V. K. Actioloogy of bilateral sensorineural deafness in children. Scand Audiol 1989; (Suppl. 30): 43-56.  Back to cited text no. 1
    
2.
Zakzouk SM. SI Sayed Y. Bactcrial meningitis and hearing impairment: A prospective study. Ann Saudi Med 1992;12:480-483.  Back to cited text no. 2
    
3.
SI Sayed Y. Zakzouk SM. Prevalence and aetiology of childhood sensorineural hearing loss in Riyadh. Ann Saudi Med 1996; 16: 262-265.  Back to cited text no. 3
    
4.
Fortaum I I and . Davis A. Hearing impairment in children after bactcrial meningitis: incidence and resource implications. British J Audiol 1993;27: 43-52.  Back to cited text no. 4
    
5.
Tunkel AR, Scheld WM. Acute Meningitis; Mandell, Douglas and Bcnncttis Principle and Practice of Infectious Diseases. 4th ed New York (NY): Churchill Livingstone; pp. 831-865,1995.  Back to cited text no. 5
    
6.
Al Mazrou Yagob Y, Musa Elgeili K., Abdalla Mohamcd M, Al Jeffri Mohamed H. Al Najjar Sami H, Mohamed Omer M.. Disease burden and case management of bacterial meningitis among children under 5 years of age in Saudi Arabia. Saudi Med J 20; 24 (12): 1300-1307  Back to cited text no. 6
    
7.
Fortnum H M., hull D. Is hearing assessed after bacterial meningitis?. Arch Dis Child 1992; 67: 111-2.  Back to cited text no. 7
    
8.
Brookhouscr PE. Auslander MC, .Mcskan ME. The pattern and stability of postmcningitis hearing loss in children. Laryngoscope 1988: 98: 940-8.  Back to cited text no. 8
    
9.
Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: meta-analysis. Pediatr Infect Dis J. 1993; 12: 289-294.  Back to cited text no. 9
    
10.
Richardson M P, A Reid, M J Tarlow, P T Rudd. Hearing loss during bactcrial meningitis. Arch Dis Childhood. 1997;76:134-138.  Back to cited text no. 10
    
11.
Cherian B. Singh T, Chacko B, Abraham A. Sensorineural hearing loss following acute bacterial meningitis in non-neonatcs. Indian J Pediatr. 2002 Nov; 69 (11): 951-5.  Back to cited text no. 11
    
12.
Kama GY. Ozen H, Secmeer G, Ceyhan M, Ecevit Z, Belgin E. Beneficial effects of dcxamethasonc in children with pneumococcal meningitis. Pediatr Infect Dis J. 1995; 14: 490-4.  Back to cited text no. 12
    
13.
Fortnum H M. hearing impairment after bacterial Meningitis: a review. Arch Dis Childhood. 1992; 67: 1128-1133.  Back to cited text no. 13
    




 

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