Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol.
OBJECTIVE
Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels.


METHODS
Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression.


RESULTS
Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent.


CONCLUSIONS
With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.
Peltola
Heikki
H
Helsinki University Central Hospital, Hospital for Children and Adolescents, 11 Stenbäck St, PO Box 281, 00029 HUS Helsinki, Finland. heikki.peltola@hus.fi
Roine
Irmeli
I
Fernández
Josefina
J
González Mata
Antonio
A
Zavala
Inés
I
Gonzalez Ayala
Silvia
S
Arbo
Antonio
A
Bologna
Rosa
R
Goyo
José
J
López
Eduardo
E
Miño
Greta
G
Dourado de Andrade
Solange
S
Sarna
Seppo
S
Jauhiainen
Tapani
T
D000284:Administration, Oral; D000293:Adolescent; D001299:Audiometry; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005990:Glycerol / Q000008:administration & dosage*; D034381:Hearing Loss / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008583:Meningitis, Haemophilus / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016017:Odds Ratio; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D002443:Ceftriaxone; D003907:Dexamethasone; D005990:Glycerol