title: Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol.
abstract: 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.
authors.affiliation: Helsinki University Central Hospital, Hospital for Children and Adolescents, 11 Stenbäck St, PO Box 281, 00029 HUS Helsinki, Finland. heikki.peltola@hus.fi
authors.forename: Heikki
authors.initials: H
authors.lastname: Peltola
authors.forename: Irmeli
authors.initials: I
authors.lastname: Roine
authors.forename: Josefina
authors.initials: J
authors.lastname: Fernández
authors.forename: Antonio
authors.initials: A
authors.lastname: González Mata
authors.forename: Inés
authors.initials: I
authors.lastname: Zavala
authors.forename: Silvia
authors.initials: S
authors.lastname: Gonzalez Ayala
authors.forename: Antonio
authors.initials: A
authors.lastname: Arbo
authors.forename: Rosa
authors.initials: R
authors.lastname: Bologna
authors.forename: José
authors.initials: J
authors.lastname: Goyo
authors.forename: Eduardo
authors.initials: E
authors.lastname: López
authors.forename: Greta
authors.initials: G
authors.lastname: Miño
authors.forename: Solange
authors.initials: S
authors.lastname: Dourado de Andrade
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Tapani
authors.initials: T
authors.lastname: Jauhiainen
mesh_terms: 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
chemical_list: D002443:Ceftriaxone; D003907:Dexamethasone; D005990:Glycerol