title: Hearing loss in adults surviving pneumococcal meningitis is associated with otitis and pneumococcal serotype.
abstract: We assessed the incidence of hearing loss and its relationship with clinical characteristics and pneumococcal serotypes in adults surviving pneumococcal meningitis. We analysed hearing loss in 531 adults surviving pneumococcal meningitis included in two prospective nationwide cohort studies performed from April 1998 through to October 2002 and March 2006 through to January 2009. Hearing loss was evaluated on admission and discharge for all patients. Severe hearing loss was assessed by pure tone average on audiology and corrected for age, or by the combination of hearing loss on discharge and a score on the Glasgow Outcome Scale below 5, which could not be explained by other neurological sequelae. A total of 531 episodes of pneumococcal meningitis with non-lethal outcome were included. Predisposing conditions for pneumococcal meningitis were present in the majority of patients (64%), most commonly otitis (36%). Hearing loss was present at discharge in 116 patients (22%) and was classified as mild in 53% and severe in 47%. Hearing loss was related to otitis (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.66-4.02; p < 0.001) and inversely related to serotype 23 F infection (OR, 0.36; 95% CI, 0.13-0.98; p = 0.025), but not with parameters of disease severity or indicators of cerebrospinal fluid inflammation severity. Meningitis due to pneumococcal serotype 3 was associated with the highest rate of hearing loss. Hearing loss frequently complicates pneumococcal meningitis. Risk factors for hearing loss were infection with pneumococcal serotype 23 F and otitis, but not disease severity. Otitis and resulting perilympathic inflammation contribute to meningitis-associated hearing loss.
authors.affiliation: Department of Neurology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: S G B
authors.initials: SG
authors.lastname: Heckenberg
authors.forename: M C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: A
authors.initials: A
authors.lastname: van der Ende
authors.forename: E F
authors.initials: EF
authors.lastname: Hensen
authors.forename: D
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010031:Otitis / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification