Vestibular Impairment after Bacterial Meningitis Delays Infant Posturomotor Development

Abstract

To examine the findings and impact of postmeningitis vestibular dysfunction on early posturomotor development. Meningitis in children is frequently associated with postural instability, which is often attributed to an undefined neurologic disorder but it could actually be due to vestibular impairment. In a retrospective cohort study, we compared groups with vestibular loss before versus after independent walking: 37 children (18 girls, 19 boys; median age: 2.3 years) hospitalized for bacterial meningitis and referred for postural instability. A complete vestibular evaluation included 3 tests for function of the 6 semicircular canals (caloric, earth vertical axis rotation, head impulse tests), 2 tests for otolith function assessment (vestibular evoked myogenic potentials, off vertical axis rotation), audiologic evaluation, neurologic examination, and brain and temporal bone imaging. Twenty-nine children (10.5% of the 276 children hospitalized with bacterial meningitis) had vestibular impairment. Vestibular loss was complete bilaterally in 16 of 37 children and partial in 13 of 37, and 8 cases had normal vestibular responses. Neurologically normal children who had meningitis before they walked independently and had complete bilateral vestibular loss walked significantly later and their postural instability lasted longer than children in the other groups. The degree of vestibular impairment correlated with the postural instability duration and with the degree of hearing loss. Bacterial meningitis in young children can impair vestibular function completely, leading to delayed posturomotor development if meningitis occurs before independent walking, even in absence of neurologic impairment. Vestibular evaluations are encouraged for postmeningitis evaluation, particularly in cases with postural instability exceeding 8 days, hearing impairment, and programmed cochlear implant.