Roine Irmeli, Pelkonen Tuula, Cruzeiro Manuel Leite, Kataja Matti, Aarnisalo Antti, Peltola Heikki, Pitkäranta Anne
From the *University Diego Portales, Santiago, Chile; †Children's Hospital, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland; ‡Pediatric Hospital David Bernardino, Luanda, Angola; §National Institute for Health and Welfare; ¶Department of Otorhinolaryngology, Audiology Section; and ‖Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.
Pediatr Infect Dis J. 2014 Mar;33(3):253-7. doi: 10.1097/INF.0000000000000218.
Hearing loss from childhood bacterial meningitis is believed to develop early and have little tendency for recovery. We performed serial hearing evaluations in a large number of children with bacterial meningitis in Luanda, Angola to clarify if, and how often, the result changed.
Children with confirmed bacterial meningitis and hearing evaluations on admission, day 7 of treatment and the follow-up visit formed the study group. Hearing was tested by auditory brainstem response audiometry using stimuli of 40 dB, 60 dB and 80 dB. Threshold changes are described between the composite levels of 40/60 dB and 80/>80 dB.
In all, 235 ears were tested. While the ≤ 60 dB and ≥ 80 dB levels were maintained through all 3 examinations in 54% and 5% of ears, respectively, changes occurred in 41%. Deterioration from the ≤ 60 dB level to ≥ 80 dB was found in 10% of the ears transiently and in 7% permanently. Improvement from the ≥ 80 dB level to ≤ 60 dB occurred in 22% of the ears. Half of the ears with ≥ 80 dB impairment at the follow-up visit arrived with this finding; the others lost hearing later. Maintaining the ≤ 60 dB level throughout was associated with milder disease (P = 0.003), fewer convulsions (P < 0.0001) and older age (P = 0.009).
Almost half of the ears showed threshold changes after admission during recovery from bacterial meningitis, most frequently improvement of initially severely impaired hearing, but some normal ears or with moderate impairment became severely impaired.
儿童细菌性脑膜炎导致的听力损失被认为发病早且恢复趋势小。我们在安哥拉罗安达对大量细菌性脑膜炎患儿进行了系列听力评估，以明确结果是否以及多久会发生变化。
确诊为细菌性脑膜炎且在入院、治疗第7天和随访时进行了听力评估的儿童构成研究组。使用40分贝、60分贝和80分贝的刺激通过听觉脑干反应测听法测试听力。描述了40/60分贝和80/>80分贝复合水平之间的阈值变化。
总共测试了235只耳朵。≤60分贝和≥80分贝的水平在所有3次检查中分别在54%和5%的耳朵中保持不变，41%的耳朵发生了变化。10%的耳朵暂时从≤60分贝水平恶化到≥80分贝，7%永久恶化。22%的耳朵从≥80分贝水平改善到≤60分贝。随访时≥80分贝听力受损的耳朵中有一半在入院时就有此表现；其他耳朵后来失聪。整个过程中维持≤60分贝水平与病情较轻（P = 0.003）、惊厥较少（P < 0.0001）和年龄较大（P = 0.009）相关。
几乎一半的耳朵在细菌性脑膜炎恢复过程中入院后出现阈值变化，最常见的是最初严重受损的听力得到改善，但一些正常耳朵或中度受损耳朵会变得严重受损。
