Objective. This study aimed to examine hearing function in children admitted with bacterial meningitis to determine the risk factors for sensorineural hearing loss. Setting. The study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital. Subjects and Methods. The study involved 83 children between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14. On discharge they underwent hearing testing to evaluate for presence and degree of hearing loss. Results. Thirty six of the 83 children (44.4%) were found to have at least a unilateral mild sensorineural hearing loss during initial audiologic testing. Of the children with hearing loss, 22 (26.5%) had mild or moderate sensorineural hearing loss and 14 (16.9%) had severe or profound sensorineural hearing loss. Significant determinants identified for hearing loss included coma score below eight, seizures, cranial nerve neuropathy, positive CSF culture, and fever above 38.7 degrees Celsius. Conclusions. Sensorineural hearing loss was found to be highly prevalent in children treated for bacterial meningitis. There is need to educate healthcare providers on aggressive management of coma, fever, and seizures due to their poor prognostic value on hearing. 1. Introduction Deafness is one of the commonest serious complications of bacterial meningitis in childhood. In developed countries, approximately 10% of survivors of bacterial meningitis are left with permanent sensorineural hearing loss [1–3]. Other children experience a transient hearing loss [3–6]. Both types of hearing impairment are thought to develop during the first few days of the illness [5–7]. Kenyatta National Hospital, KNH, is Kenya’s national referral hospital. Estimates show that an average forty-five children are admitted into its pediatric wards each month with a confirmed diagnosis of bacterial meningitis. Behavioral tests of hearing may be used when an infant reaches the developmental age (as opposed to the chronological age) of six months. Infants not at this level of development and some of those with more than one disability will need to be tested by otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs). Unfortunately the equipment for these latter two sets was unavailable forcing the study to be carried out in children above 6 months of age using behavioural distraction testing. So far, in KNH no similar study had been undertaken to determine the prevalence, burden, and risk factors for hearing loss following bacterial
References
[1]
J. A. Dawson and R. Wardle, “Detection and prevalence of hearing loss in a cohort of children following serogroup B, meningococcal infection 1983–1987,” Public Health, vol. 104, no. 2, pp. 99–102, 1990.
[2]
H. M. Fortnum, “Hearing impairment after bacterial meningitis: a review,” Archives of Disease in Childhood, vol. 67, no. 9, pp. 1128–1133, 1992.
[3]
L. J. Baraff, S. I. Lee, and D. L. Schriger, “Outcomes of bacterial meningitis in children: a meta-analysis,” Pediatric Infectious Disease Journal, vol. 12, no. 5, pp. 389–394, 1993.
[4]
P. R. Dodge, H. Davis, and R. D. Feigin, “Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis,” The New England Journal of Medicine, vol. 311, no. 14, pp. 869–874, 1984.
[5]
H. Guiscafré, L. Benitez-Díaz, M. C. Martínez, et al., “Reversible hearing loss after meningitis: prospective assessment using auditory evoked responses,” Annals of Otology, Rhinology, and Laryngology, vol. 93, no. 3, part 1, pp. 229–232, 1984.
[6]
H. Vienny, P. A. Despland, and J. Lutschg, “Early diagnosis and evolution of deafness in childhood bacterial meningitis: a study using brainstem auditory evoked potentials,” Pediatrics, vol. 73, no. 5, pp. 579–586, 1984.
[7]
J. O. Klein, R. D. Feigin, and G. H. McCracken Jr., “Report of the task force on diagnosis and management of meningitis,” Paediatrics, vol. 78, pp. S959–S982, 1986.
[8]
J. W. Kutz, L. M. Simon, S. K. Chennupati, C. M. Giannoni, and S. Manolidis, “Clinical predictors for hearing loss in children with bacterial meningitis,” Archives of Otolaryngology, vol. 132, no. 9, pp. 941–945, 2006.
[9]
M. Zaki, A. S. Daoud, Q. ElSaleh, et al., “Childhood bacterial meningitis in Kuwait,” Journal of Tropical Medicine, vol. 93, no. 1, pp. 7–11, 1990.
[10]
K. Grimwood, V. A. Anderson, L. Bond et al., “Adverse outcomes of bacterial meningitis in school-age survivors,” Pediatrics, vol. 95, no. 5, pp. 646–656, 1995.
[11]
E. Molyneux, A. Walsh, A. Phiri, and M. Molyneux, “Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-1997,” Tropical Medicine and International Health, vol. 3, no. 8, pp. 610–618, 2000.
[12]
J. B. Nadol, “Hearing loss as a sequela of meningitis,” Laryngoscope, vol. 88, no. 5, pp. 739–755, 1978.
[13]
P. E. Brookhouser, M. C. Auslander, and M. E. Meskan, “The pattern and stability of postmeningitic hearing loss in children,” Laryngoscope, vol. 98, no. 9, pp. 940–948, 1988.
[14]
M. N. Wanyoike, P. G. Waiyaki, S. O. McLiegeyo, and E. M. Wafula, “Bacteriology and sensitivity patterns of pyogenic meningitis at Kenyatta National Hospital, Nairobi, Kenya,” East African Medical Journal, vol. 72, no. 10, pp. 658–660, 1995.
[15]
M. P. Richardson, A. Reid, M. J. Tarlow, and P. T. Rudd, “Hearing loss during bacterial meningitis,” Archives of Disease in Childhood, vol. 76, no. 2, pp. 134–138, 1997.
[16]
A. L. Woolley, K. A. Kirk, A. M. Neumann et al., “Risk factors for hearing loss from meningitis in children: the Children's Hospital experience,” Archives of Otolaryngology, vol. 125, no. 5, pp. 509–514, 1999.
[17]
N. Rasmussen, N. J. Johnsen, and V. A. Bohr, “Otologic sequelae after pneumococcal meningitis: a survey of 164 consecutive cases with a follow-up of 94 survivors,” Laryngoscope, vol. 101, no. 8, pp. 876–882, 1991.
[18]
C. J. Chang, H. W. Chang, W. N. Chang et al., “Seizures complicating infantile and childhood bacterial meningitis,” Pediatric Neurology, vol. 31, no. 3, pp. 165–171, 2004.
[19]
P. E. Brookhouser, M. C. Auslander, and M. E. Meskan, “The pattern and stability of postmeningitic hearing loss in children,” Laryngoscope, vol. 98, no. 9, pp. 940–948, 1988.
[20]
H. M. Fortnum and A. Davis, “Hearing impairment in children after bacterial meningitis: incidence and resource Implications,” British Journal of Audiology, vol. 27, no. 1, pp. 43–52, 1993.
[21]
M. Eisenhut, T. Meehan, and S. D. G. Stephens, “Risk factors for hearing loss in bacterial meningitis: delay in treatment and clinical manifestations,” Journal of Audiological Medicine, vol. 11, no. 2, pp. 86–97, 2002.
[22]
C. M. Benjamin, R. W. Newton, and M. A. Clarke, “Risk factors for death from meningitis,” British Medical Journal, vol. 296, no. 6614, p. 20, 1988.
[23]
M. Radetsky, “Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis,” Pediatric Infectious Disease Journal, vol. 11, no. 9, pp. 694–698, 1992.
[24]
T. Kilpi, M. Anttila, M. J. T. Kallio, and H. Peltola, “Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis,” Pediatric Infectious Disease Journal, vol. 12, no. 3, pp. 184–188, 1993.
