Early Audiometric Intervention in Bacterial Meningitis: Cochlear Implantation in a 10-Week-Old Child

Author:

Schwartz Tyler R.12,Novak Jessica3,Scott Alison3,Patel Sachin4,Halvorson Kyle5,Jayawardena Asitha D.L.1

Affiliation:

1. aPediatric Otolaryngology

2. bPediatric Otolaryngology, SSM-SLUcare, St Louis University Department of Otolaryngology - Head and Neck Surgery, St Louis, Missouri

3. cPediatric Audiology

4. dPediatric Radiology

5. ePediatric Neurosurgery, Childrens Minnesota, Minneapolis, Minnesota

Abstract

Sensorineural hearing loss is a well-known complication of Streptococcus pneumoniae meningitis. Given the propensity for fibrosis and ossification of the cochlea in bacterial meningitis, implantation must be performed in a timely fashion because a delayed attempt at implantation can frustrate obtaining an optimal technical result or lead to an inability to implant. Obtaining optimal audiometric outcomes is reliant on early hearing screening in patients with streptococcal meningitis. In the absence of standardized protocols, audiometric testing is often overlooked or delayed in the workup and management of meningitis. Our institution implemented a meningitis protocol with a particular focus on timing of audiometric testing in patients with meningitis. We present a patient diagnosed with streptococcal meningitis in the first week of life. Early hearing screening allowed the diagnosis of profound unilateral sensorineural hearing loss and subsequent cochlear implantation at 10 weeks of age, the youngest described in the medical literature. Despite early implantation, there was cochlear fibrosis at the time of implantation. Fortunately, the majority of electrodes were implanted to achieve a serviceable hearing outcome. Serial magnetic resonance imaging scans were obtained because of her contralateral ventriculoperitoneal shunt that allowed unique visualization of the progression of cochlear fibrosis over time. This case demonstrates the importance of including audiometric testing in a standardized meningitis protocol to diagnose hearing loss in a timely and accurate way and to achieve optimal long-term hearing outcomes.

Publisher

American Academy of Pediatrics (AAP)

Reference11 articles.

1. Systematic review: incidence and course of hearing loss caused by bacterial meningitis: in search of an optimal timed audiological follow-up;Rodenburg-Vlot;Otol Neurotol,2016

2. Audiology Clinical Practice Guidelines. Meningitis. Available at: http://www.bcchildrens.ca/Audiology-Site/Documents/BCCHMeningitisClinicalPracticeGuideline.pdf. Accessed October 10, 2022

3. US Food and Drug Administration. Nucleus 24 cochlear implant system PMA supplement approval letter. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf/P970051S172A.pdf. Accessed July 5, 2023

4. Hydrocephalus-associated hearing loss and resolution after ventriculostomy;Dixon;Otolaryngol Head Neck Surg,2012

5. Hearing loss in hydrocephalus: a review, with focus on mechanisms;Satzer;Neurosurg Rev,2016

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