Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis.
OBJECTIVE
To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss.


METHODS
Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold >/=30 dB. The results of OAE screening were compared with the gold standard of ABR threshold.


RESULTS
Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold >/=30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0. 44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00).


CONCLUSIONS
OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.
Richardson
M P
MP
Bath Unit for Research into Paediatrics, Royal United Hospital, Bath, United Kingdom.
Williamson
T J
TJ
Reid
A
A
Tarlow
M J
MJ
Rudd
P T
PT
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016057:Evoked Potentials, Auditory, Brain Stem; D005240:Feasibility Studies; D034381:Hearing Loss / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000150:complications*; D015337:Multicenter Studies as Topic; D017084:Otoacoustic Emissions, Spontaneous; D011446:Prospective Studies