International Journal of Pediatric Otorhinolaryngology, @ Elsevier/North-Holland Biomedical Press
1 (1979)
97-101
HAEMOPHZL US ZNFL UENZA E MENINGITIS
AND HEARING
97
OLLE NYLfiN and ULF ROSENHALL Department
of Otorhinolaryngology,
University of Gothenburg,
Gothenburg
(Sweden)
(Originally presented at the First World Congress of Pediatric Otorhinolaryngology, in Sirminone, Italy on April 26-30th, 1977)
Haemophilus influenzae is one of the most common etiological agents for bacterial infections in childhood. One of the most serious diseases caused by this species is acute purulent meningitis. This disease is predominantly found in children from 2-3 months of age up to 3-4 years of age. There is a high rate of long-term sequelae after Haemophilus influenzae meningitis even after adequate antibiotic treatment. This paper presents the audiological results of a follow-up study of patients with Haemophilus influenzae meningitis. During the years 1968-1975, altogether 97 individuals were treated for Haemophilus influenzae meningitis in the GBteborg-MGlndal region in Sweden. The etiological diagnosis was based upon the demonstration of Haemophilus influenzae in the cerebrospinal fluid and/or blood. In three cases the diagnosis was based on an antibody titer increase against Haemophilus influenzae, as measured by a complement fixation test. Three of the 97 individuals died in the course of the disease. Eighty-three of the remaining 94 patients could be traced and were examined with audiological tests. Pure tone audiograms were performed in all cases, and speech audiograms were also performed in the older children. Fifteen of the 83 patients tested, l&l%, exhibited different degrees of sensorineural hearing loss. Three of these 15 patients had severe hearing loss exceeding 60 dB at the speech frequencies affecting both ears (Fig. 1). They all had residual hearing and only one child had a unilateral deafness. Unilateral severe hearing loss was the most common complication and was found in 9 cases. Six of these children had a severe hearing loss or deafness in one ear with a normal hearing capacity in the other ear. Three patients had unilateral severe hearing loss or deafness combined with a slight or moderate hearing loss in the other ear (Fig. 2). Three patients had only slight to moderate hearing loss, affecting both ears or only one ear (Fig. 3). The remaining 68 patients had a' normal hearing capacity with pure tone averages at 500-2000 Hz better than 20 dB. However, half of these individuals exhibited minor hearing deficiencies. The pure tone thresholds of these
Fig. 1. Pure tone audiograms of three children with severe bilateral hearing loss.
cases had a serrated appearance. In the low and high frequencies a few, often sharp dips were found, surrounding a plateau of normal hearing at the speech frequencies, as seen in Fig. 4. The patients in the present study had been treated according to three different principles. One group had been treated with ampicillin only, another group with chloramphenicol, penicillin and sulphonamide (triple therapy) and the third group with a combination of ampicillin and chloramphenicol. Of the 32 patients treated with only ampicillin, 9.4% had a hearing loss as a residual and of the 22 patients treated with triple therapy, 13.6% had a
Fig. 2. Pure tone audiograms of three children with severe hearing loss in one ear and slight or moderate hearing loss in the other ear.
hearing loss as a residual. Of the 28 patients treated with a combination of ampicillin and chloramphenicol as many as 32.1% had hearing loss as a residual. Accordingly, there is about the same frequency of post-infectiouq hearing complications in the groups treated with ampicillin and triple therapy. However, treatment with a combination of ampicillin and chloram~henicol showed a worse prognosis regarding hearing capacity in this limited material. Hearing loss is a common residual after Huemophilus influenzae meningitis.
N
10
K.2
,I
110
110
110
II
Fig. 3. Pure tone audiograms or both ears.
125
250
SO0
1K
of three children with slight to moderate
ZK
LK
BK
hearing loss in one
Hz
dEl 0
0
20
10 B
Fig. 4. This figure illustrates at the speech frequencies.
the sharp dips found surrounding
a plateau of normal hearing
101
AU children who have suffered from this disease should be examined with hearing tests after recovery. These testings should be repeated during the first year after the infection since the hearing capacity can show variations for a long time after the meningitis.