Sudden Onset Permanent Deafness as an Early Complication of Bacterial Meningitis

Abstract

To the Editor: Bacterial meningitis is a frequent cause ofacquired deafness in children. Clinically significant hearingimpairment has been documented in 10.5 % of affectedchildren and is bilateral or profound in 5.1 % [1]. Thoughdeafness is a common sequel of meningitis, sudden onsetpermanent deafness occurring as an early complication ofbacterial meningitis is unusual.A 9-y-old previously healthy girl was admitted to ourhospital with complaints of fever, vomiting and irritabilityfor last 3 d. She also complained of headache and neckstiffness and photophobia. There was no history of seizures,altered sensorium, or rash. On examination, she was alertbut irritable. She was able to answer our questions. She hadneck rigidity along with a positive Kernig’s sign withoutfocal neurological deficits. She was started on ceftriaxone,along with intravenous fluids. She did not receive dexa-methasone. Lumbar puncture revealed turbid cerebrospinalfluid (CSF), with cytology of 1,600 cells/mm [3], all poly-morphs. The CSF protein was elevated (160 mg/dL) andsugar reduced (CSF/Blood sugar ratio 0.4). The CSF cul-ture was sterile.The following day, she was better; the fever and irritabil-ity had reduced. On the third day of hospital stay, shecomplained of not being able to hear even loud sounds. Abrainstem evoked response audiometry showed absent re-sponses in both ears at 135 decibel stimulation. A contrastenhanced MRI of the brain revealed no abnormalities. Therewere no other neurologic sequelae. The pure tone audiom-etry at discharge revealed bilateral profound sensorineuralhearing loss. On follow-up after 3 mo, there was no im-provement in the hearing loss. She has been referred forcochlear implant surgery.Hearing loss develops early in the course of meningitis.Richardson et al., reported the results of ota-accoustic emis-sions performed as soon as possible after diagnosis, andrepeated at 6–12, 12–24, and 36–48 h, and at discharge, in124 children with bacterial meningitis [2]. The authorsdemonstrated that 3 children (2.5 %) had permanent deaf-ness. The cochlea was identified as the site of the lesion.The role of corticosteroids in reducing severe hearingloss among the survivors of meningitis is controversial [3].Two recent meta-analyses showed no difference in the au-ditory sequelae on combining steroids with the standardtreatment of bacterial meningitis [4, 5].Use of early testing by brainstem reflex audiometry orota-accoustic emissions can help in early recognition ofdeafness in children with bacterial meningitis and ensurefollow-up with appropriate and timely management.References