title: Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.
abstract: BACKGROUND
  Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above.
  
  
  METHODS
  This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate.
  
  
  RESULTS
  In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19-6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4-67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1-75.5 %) at follow up 14-28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59-83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3-7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3-7, 95 % confidence interval 16.3-56.3 %; p = 0.031 at day 14-28, 95 % confidence interval 24.5-66.3 %).
  
  
  CONCLUSIONS
  The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.
authors.affiliation: Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. Joachim.Schmutzhard@i-med.ac.at.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schmutzhard
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. Peter.Lackner@i-med.ac.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. Raimund.Helbok@uki.at.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. helene.hurth@gmx.at.
authors.forename: Helene Verena
authors.initials: HV
authors.lastname: Hurth
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. faregger@gmail.com.
authors.forename: Fabian Cedric
authors.initials: FC
authors.lastname: Aregger
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. Veronika.Muigg@student.i-med.ac.at.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. Veronika.Muigg@student.i-med.ac.at.
authors.forename: Veronika
authors.initials: V
authors.lastname: Muigg
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. josua.kegele@gmail.com.
authors.forename: Josua
authors.initials: J
authors.lastname: Kegele
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. Sebastian.Bunk@student.i-med.ac.at.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bunk
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. Lukas.Oberhammer@student.i-med.ac.at.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. Lukas.Oberhammer@student.i-med.ac.at.
authors.forename: Lukas
authors.initials: L
authors.lastname: Oberhammer
authors.affiliation: Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. Natalie.Fischer@i-med.ac.at.
authors.forename: Natalie
authors.initials: N
authors.lastname: Fischer
authors.affiliation: Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. Leyla.Pinggera@i-med.ac.at.
authors.forename: Leyla
authors.initials: L
authors.lastname: Pinggera
authors.affiliation: Center for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya. gaotieno@gmail.com.
authors.forename: Allan
authors.initials: A
authors.lastname: Otieno
authors.affiliation: Center for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya. Bernhards.Ogutu@usamru-k.org.
authors.forename: Bernards
authors.initials: B
authors.lastname: Ogutu
authors.affiliation: Komfo Anokye Teaching Hospita & Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. tsiri@ghana.com.
authors.forename: Tsiri
authors.initials: T
authors.lastname: Agbenyega
authors.affiliation: Komfo Anokye Teaching Hospita & Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. ansongd@yahoo.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. a.a.adegnika@medizin.uni-tuebingen.de.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. a.a.adegnika@medizin.uni-tuebingen.de.
authors.forename: Ayola A
authors.initials: AA
authors.lastname: Adegnika
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. isaadou2002@yahoo.fr.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. isaadou2002@yahoo.fr.
authors.forename: Saadou
authors.initials: S
authors.lastname: Issifou
authors.affiliation: Department of Hearing, Speech and Voice Disorders, Medical University, Innsbruck, Austria. Patrick.Zorowka@i-med.ac.at.
authors.forename: Patrick
authors.initials: P
authors.lastname: Zorowka
authors.affiliation: St. George's University of London, London, UK. sgjf100@sgul.ac.uk.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Krishna
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. benjamin.mordmueller@uni-tuebingen.de.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. benjamin.mordmueller@uni-tuebingen.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mordmüller
authors.affiliation: Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria. Erich.Schmutzhard@i-med.ac.at.
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.affiliation: Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon. peter.kremsner@uni-tuebingen.de.|Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany. peter.kremsner@uni-tuebingen.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Kremsner
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005681:Gabon; D005869:Ghana; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007630:Kenya; D016779:Malaria, Cerebral / Q000150:complications*; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D017084:Otoacoustic Emissions, Spontaneous; D011446:Prospective Studies