Recommendations for audiometric follow up post paediatric bacterial meningitis based on an Australian experience: a retrospective cross-sectional study

Abstract

Background: Bacterial meningitis remains a significant public health burden in both the developed and developing world. Antibiotics have reduced mortality, however, significant morbidity including permanent sensorineural hearing loss (SNHL) remain of concern. Cochlear implantation allows early intervention and improved quality of life for those whom experience severe SNHL. The aim of this study was to review the current referral and audiological follow up time of children suffering bacterial meningitis including identifying the incidence of SNHL. We aimed to offer a standardised referral guideline to be implemented across Queensland hospitals which also contributes to the available published literature on the topic. Methods: A cross-sectional retrospective review was conducted of treatment and outcomes of all children from birth to 18 years diagnosed with bacterial meningitis at Queensland Children's Hospital (QCH) between November 2014 and December 2021 (7 years). Descriptive data including patient demographics, causative organism, length of hospital stay, audiological referral times and outcomes were collected. A review of recent literature was also conducted using PubMed with search terms including “meningitis”, “hearing loss”, “audiology”, “guidelines”, and “paediatric” to identify other published series on the topic and published guidelines from other health services. A review of our results plus published literature was then utilised to develop a post diagnosis audiology referral guideline for these children. Results: Fifty-seven children were identified to have been diagnosed and treated for bacterial meningitis. Fifty-two (91.2%) were aged less than 1 year and the most commonly isolated pathogen was E. coli. 80.7% of children were reviewed by audiology post treatment with wide variance in both referral time (0 to 97 days) and time to audiology review (8 to 304 days, median 36 days). Three children were diagnosed with SNHL post meningitis and all cultured Streptococcus sp. on cerebrospinal fluid (CSF) culture. One patient underwent successful cochlear implantation for their hearing loss. The wide variability in time to audiology review highlighted a lack of awareness and standardised pathway for audiology referral post bacterial meningitis. On review of the above and available local and international guidelines, the authors suggest audiology review within 2-4 weeks of meningitis diagnosis and if abnormal, either immediate referral to a cochlear implant team (if severe-profound SNHL) or repeat testing within 2 weeks plus otolaryngology referral if abnormal result but not severe. Conclusions: The incidence of SNHL post bacterial meningitis was 5.3%, comparable to that of other developed countries such as the United Kingdom (UK) and New Zealand. The review highlighted wide variation in time to audiology referral and review. This variation suggested a lack of awareness among non-otolaryngology specialist medical professionals regarding risk of SNHL and the urgency of assessment. Development and promotion of an evidence-based guideline aims to address this variation and improve patient outcomes for the future.