Dexamethasone Therapy for Children With Bacterial Meningitis

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Ellen R. Wald ◽  
Sheldon L. Kaplan ◽  
Edward O. Mason ◽  
Diane Sabo ◽  
Lawrence Ross Md ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Los Angeles ◽  
Bacterial Meningitis ◽  
Auditory Brainstem Responses ◽  
Haemophilus Influenzae Type ◽  
Controlled Clinical Trial ◽  
Developmental Outcome ◽  
Severe Hearing Loss ◽  
Significant Difference ◽  
Neurologic Sequelae

Objective. To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae. Design. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year. Setting. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio. Patients. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year. Interventions. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission. Main outcome measures. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later. Main results. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups. Conclusion. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

Sequelae of Acute Bacterial Meningitis in Children Treated for Seven Days

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 21-25
Author(s):  
T. Jadavji ◽  
W. D. Biggar ◽  
R. Gold ◽  
C. G. Prober
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Haemophilus Influenzae Type ◽  
Acute Bacterial Meningitis ◽  
Haemophilus Influenzae Type B ◽  
Type B ◽  
Speech Defect ◽  
Intravenous Antibiotic ◽  
Severe Handicaps ◽  
Meningitis In Children

The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively. The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months). Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10%. The mortality rate was 6.4%. No relapses occurred. Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness. One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps. The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%). The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%). The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days. Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children.

Critical Bandwidth and Sensitivity Prediction in the Acoustic Stapedial Reflex

1976 ◽  
Vol 41 (2) ◽  
pp. 244-255 ◽  
Author(s):  
Daniel M. Schwartz ◽  
Jay W. Sanders
Keyword(s):  
Hearing Loss ◽  
Hearing Impaired ◽  
Test Results ◽  
Acoustic Reflex ◽  
Severe Hearing Loss ◽  
Critical Bandwidth ◽  
Significant Difference ◽  
Stapedial Reflex ◽  
The Difference ◽  
The Relationship

Critical bandwidth measurements and sensitivity prediction from the acoustic reflex (SPAR) test results were obtained on 20 normal-hearing and two groups of 10 hearing-impaired subjects each representing mild-to-moderate and severe hearing loss. Results of critical bandwidth measurements indicated that for center frequencies of 1000 and 2000 Hz the critical bandwidth was significantly greater for the hearing-impaired subjects. A statistical analysis of the difference in critical bandwidth between those predicted by the SPAR test to have a mild-to-moderate hearing loss and those subjects for whom the test predicted severe hearing loss indicated no differences in critical bandwidth at 2000 Hz. A significant difference was found at 1000 Hz but in the wrong direction. Analysis of the relationship between predicted slope of hearing loss and critical bandwidth also failed to show significance. Although the data for hearing-impaired subjects fail to support the rationale for the SPAR test, the results for the entire research sample offer substantial support. Further, the ability of the test to predict categorically degree of hearing loss was also strongly supported.

scholarly journals Air and Bone Conduction Frequency-specific Auditory Brainstem Response in Children with Agenesis of the External Auditory Canal

2017 ◽  
Vol 21 (04) ◽  
pp. 318-322 ◽  
Author(s):  
Pricila Sleifer ◽  
Dayane Didoné ◽  
Ísis Keppeler ◽  
Claudine Bueno ◽  
Rudimar Riesgo
Keyword(s):  
Hearing Loss ◽  
External Auditory Canal ◽  
Conductive Hearing Loss ◽  
Bone Conduction ◽  
Auditory Brainstem ◽  
Auditory Brainstem Responses ◽  
Significant Difference ◽  
Brainstem Response ◽  
Conductive Hearing ◽  
Air Conduction

Introduction The tone-evoked auditory brainstem responses (tone-ABR) enable the differential diagnosis in the evaluation of children until 12 months of age, including those with external and/or middle ear malformations. The use of auditory stimuli with frequency specificity by air and bone conduction allows characterization of hearing profile. Objective The objective of our study was to compare the results obtained in tone-ABR by air and bone conduction in children until 12 months, with agenesis of the external auditory canal. Method The study was cross-sectional, observational, individual, and contemporary. We conducted the research with tone-ABR by air and bone conduction in the frequencies of 500 Hz and 2000 Hz in 32 children, 23 boys, from one to 12 months old, with agenesis of the external auditory canal. Results The tone-ABR thresholds were significantly elevated for air conduction in the frequencies of 500 Hz and 2000 Hz, while the thresholds of bone conduction had normal values in both ears. We found no statistically significant difference between genders and ears for most of the comparisons. Conclusion The thresholds obtained by bone conduction did not alter the thresholds in children with conductive hearing loss. However, the conductive hearing loss alter all thresholds by air conduction. The tone-ABR by bone conduction is an important tool for assessing cochlear integrity in children with agenesis of the external auditory canal under 12 months.

Onset of Hearing Loss in Children with Bacterial Meningitis

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 575-578
Author(s):  
Sheldon L. Kaplan ◽  
Francis I. Catlin ◽  
Toni Weaver ◽  
Ralph D. Feigin
Keyword(s):  
Bacterial Meningitis ◽  
Auditory Brainstem ◽  
The Other ◽  
Auditory Brainstem Responses ◽  
Haemophilus Influenzae Type ◽  
Haemophilus Influenzae Type B ◽  
Type B ◽  
Repeat Testing ◽  
Brainstem Dysfunction ◽  
High Risk Children

Auditory brainstem responses were evaluated in 37 children with bacterial meningitis within 48 hours of admission. Four children (two with Haemophilus influenzae type b, and two with Streptococcus pneumoniae) had definite abnormalities of hearing detected at admission. Two of these children had severe-to-profound hearing losses which have persisted. Hearing losses were greatly reduced in the other two children (one child also was ataxic) when repeat testing was performed. Auditory brainstem responses in two additional children suggested brainstem dysfunction at admission (one child died and the other has had severe sequelae). Hearing losses occur early in the course of bacterial meningitis in some children. Further studies are required to confirm the use of auditory brainstem responses in detecting hearing losses early in high-risk children with bacterial meningitis.

Auditory Disorder Following Bilateral Temporal Lobe Insult: Report of a Case

1972 ◽  
Vol 37 (4) ◽  
pp. 523-535 ◽  
Author(s):  
James Jerger ◽  
Larry Lovering ◽  
Max Wertz
Keyword(s):  
Hearing Loss ◽  
Temporal Lobe ◽  
Sound Localization ◽  
Severe Hearing Loss ◽  
Present Patient ◽  
Sensitivity Loss ◽  
Significant Difference ◽  
Localization Ability ◽  
Bilateral Lesions ◽  
The Brain

Audiologic data are presented for a patient with bilateral temporal lobe damage. Neuropathology examination of the brain at autopsy confirmed site of lesion. Audiologic results on this patient are contrasted to results obtained in 1969 by Jerger et al. on another patient with presumed bilateral lesions of the temporal lobe. The two patients showed striking similarities. Both experienced transient aphasia but no hearing problems after the first (left-sided) episode. Both reported severe hearing loss after the second (right-sided) episode. In both cases, the presumed sensitivity loss had essentially recovered within three months of the second episode. Both showed marked inability to recognize either single words or sentences. This profound deficit did not improve significantly, even under ideal listening conditions, in either patient during the period of study. In contrast to the striking similarities between the two patients, there was one significant difference. Whereas the 1969 patient could not localize sounds in space, the present patient’s sound localization ability was unimpaired. This finding seemed related to an interaural imbalance in the relation between loudness and signal duration. The 1969 patient had such an imbalance and could not localize effectively. The present patient did not have an imbalance and localized accurately. This finding indicates that impairment in sound localization is not an invariable concomitant of temporal lobe disease.

scholarly journals Neuroprotective Effect of Near-Infrared Light in an Animal Model of CI Surgery

2020 ◽  
pp. 1-7
Author(s):  
Ira Strübing ◽  
Moritz Gröschel ◽  
Susanne Schwitzer ◽  
Arne Ernst ◽  
Felix Fröhlich ◽  
...  
Keyword(s):  
Animal Model ◽  
Hearing Loss ◽  
Hair Cells ◽  
Cochlear Implantation ◽  
Near Infrared ◽  
Outer Hair Cells ◽  
Auditory Brainstem Responses ◽  
Infrared Light ◽  
Residual Hearing ◽  
Significant Difference

<b><i>Introduction:</i></b> The preservation of residual hearing has become an important consideration in cochlear implant (CI) recipients in recent years. It was the aim of the present animal experimental study to investigate the influence of a pretreatment with near-infrared (NIR) light on preservation of sensory hair cells and residual hearing after cochlear implantation. <b><i>Methods:</i></b> NIR was applied unilaterally (15 min, 808 nm, 120 mW) to 8 guinea pigs, immediately before a bilateral scala tympani CI electrode insertion was performed. The nonirradiated (contralateral) side served as control. Twenty-eight days postoperatively, auditory brainstem responses (ABRs) were registered from both ears to screen for hearing loss. Thereafter, the animals were sacrificed and inner hair cells (IHCs) and outer hair cells (OHCs) were counted and compared between NIR-pretreated and control (contralateral) cochleae. <b><i>Results:</i></b> There was no IHC loss upon cochlear implantation. OHC loss was most prominent on both sides at the apical part of the cochlea. NIR pretreatment led to a statistically significant reduction in OHC loss (by 39.8%). ABR recordings (across the frequencies 4–32 kHz) showed a statistically significant difference between the 2 groups and corresponds well with the apical structural damage. Hearing loss was reduced by about 20 dB on average for the NIR-pretreated group (<i>p</i> ≤ 0.05). <b><i>Discussion/Conclusion:</i></b> A single NIR pretreatment in this animal model of CI surgery appears to be neuroprotective for residual hearing. This is in line with other studies where several NIR posttreatments have protected cochlear and other neural tissues. NIR pretreatment is an inexpensive, effective, and noninvasive approach that can complement other ways of preserving residual hearing and, hence, should deserve further clinical evaluation in CI patients.

scholarly journals Evaluation of the Effects of Chronic Injection of D-Galactose on Auditory Brainstem Responses as a Model for Studying Age-Related Hearing Loss

2019 ◽  
Author(s):  
Elham Tavanai ◽  
Ghassem Mohammadkhani
Keyword(s):  
Hearing Loss ◽  
Wistar Rats ◽  
Natural Aging ◽  
Tone Burst ◽  
Auditory Brainstem ◽  
Young Group ◽  
Auditory Brainstem Responses ◽  
Age Related ◽  
Significant Difference ◽  
Age Related Hearing Loss

The D-galactose induced mimetic aging rat model has been widely used in studies of age-associated diseases recently. Evidence indicates that D-GAL could also play a key role in age-related hearing loss. However, there is conflicting data about the relationship between the D-GAL injection and tone-burst auditory brainstem responses (ABRs). The present study aimed to compare ABRs in D-GAL injected rats compared with young and naturally aged rats. Tone-burst ABR was recorded and analyzed at the frequencies of 4,6,8,12 and 16 kHz in male young (3-month-old, n=10), naturally aging (18-month-old, n=10) and D-GAL injected (3-month-old, 500 mg/kg D-GAL injection for 8 weeks, n=10) Wistar rats. When the ABRs thresholds obtained in the D-GAL group and the natural aging group were compared with the thresholds in the young group, we observed a significant increase in thresholds, which affected all of the frequencies (P<0.05). A statistically significant decrease in amplitude of wave PI at 4 and 8 kHz, PII at 4,8 kHz, PIV at 4,6,8,12 and 16 kHz was also observed in naturally aging group compared with young group. However, in D-GAL group, a significant difference was exclusively detected in amplitude of PIII at 4 kHz. Latency did not reveal any significant difference between the groups (P>0.05). The present study confirmed that experimental injection of 500 mg/kg/day D-GAL for 8 weeks to Wistar rats could lead to ABRs threshold shifts but not latency. Because there are several types of presbycusis, further studies are needed to determine what type of presbycusis is induced by D-GAL and where is the first region affected by it to provide the best treatment and prevention methods. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):281-288.

Comparison of auditory electrophysiological responses in normal-hearing patients with and without tinnitus

2011 ◽  
Vol 125 (7) ◽  
pp. 668-672 ◽  
Author(s):  
S Singh ◽  
S K Munjal ◽  
N K Panda
Keyword(s):  
Hearing Loss ◽  
Otoacoustic Emissions ◽  
Auditory Brainstem ◽  
Normal Hearing ◽  
Auditory Brainstem Responses ◽  
Control Group ◽  
Distortion Product ◽  
Significant Difference ◽  
Central Activity ◽  
Middle Latency

AbstractIntroduction:Tinnitus is a disturbing symptom and is often the main reason for otology referral. It is usually associated with hearing loss of varying aetiology, and is thought to begin in the cochlea, with later abnormal central activity. We hypothesise that tinnitus without hearing loss may be caused by central and subcortical abnormalities and altered outer hair cell function.Aim:To compare the auditory brainstem responses, middle latency responses and otoacoustic emissions in normal-hearing individuals with and without tinnitus.Methodology:The audiological test results of 25 normal hearing subjects with tinnitus (age 18–45 years) were determined, and compared with those of a control group.Results:A statistically significant difference was found between study group tinnitus ears vs control group ears, as regards wave I latency prolongation, shortening of wave V and absolute I–III and I–V interpeak latency, enlargement of wave Na and Pa amplitude, and distortion product and transient evoked otoacoustic emission signal-to-noise ratios. There was no statistically significant difference between unilateral vs bilateral tinnitus ears.Conclusion:The pathogenesis and optimum management of tinnitus are still unclear. It often occurs with primary ear disease, usually associated with hearing loss, but may occur in patients with normal hearing. Observed changes in auditory brainstem and middle latency responses indicate central auditory alterations. Tinnitus involves both peripheral and central activity, and complete audiological and neurophysiological investigation is required. Management should be based on both audiological and neurophysiological findings.

Evaluation of Nonlinear Frequency Compression for School-Age Children with Moderate to Moderately Severe Hearing Loss

2010 ◽  
Vol 21 (10) ◽  
pp. 618-628 ◽  
Author(s):  
Jace Wolfe ◽  
Andrew John ◽  
Erin Schafer ◽  
Myriel Nyffeler ◽  
Michael Boretzki ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
High Frequency ◽  
Nonlinear Frequency ◽  
Speech Sounds ◽  
Severe Hearing Loss ◽  
Frequency Compression ◽  
Digital Hearing Aids ◽  
Significant Difference

Background: Previous research has indicated that children with moderate hearing loss experience difficulty with recognition of high-frequency speech sounds, such as fricatives and affricates. Conventional behind-the-ear (BTE) amplification typically does not provide ample output in the high frequencies (4000 Hz and beyond) to ensure optimal audibility for these sounds. Purpose: To evaluate nonlinear frequency compression (NLFC) as a means to improve speech recognition for children with moderate to moderately severe hearing loss. Research Design: Within subject, crossover design with repeated measures across test conditions. Study Sample: Fifteen children, aged 5–13 yr, with moderate to moderately severe high-frequency sensorineural hearing loss were fitted with Phonak Nios, microsized, BTE hearing aids. These children were previous users of digital hearing aids and communicated via spoken language. Their speech and language abilities were age-appropriate. Data Collection and Analysis: Aided thresholds and speech recognition in quiet and in noise were assessed after 6 wk of use with NLFC and 6 wk of use without NLFC. Participants were randomly assigned to counter-balanced groups so that eight participants began the first 6 wk trial with NLFC enabled and the other seven participants started with NLFC disabled. Then, the provision of NLFC was switched for the second 6 wk trial. Speech recognition in quiet was assessed via word recognition assessments with the University of Western Ontario (UWO) Plural Test and recognition of vowel-consonant-vowel nonsense syllables with the Phonak Logatome test. Speech recognition in noise was assessed by evaluating the signal-to-noise ratio in dB for 50% correct performance on the Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test, an adaptive test of speech perception in a multitalker babble background. Results: Aided thresholds for high-frequency stimuli were significantly better when NLFC was enabled, and use of NLFC resulted in significantly better speech recognition in quiet for the UWO Plural Test and for the phonemes /d/ and /s/ on the Phonak Logatome test. There was not a statistically significant difference in performance on the BKB-SIN test between the NLFC enabled and disabled conditions. Conclusions: These results indicate that NLFC improves audibility for and recognition of high-frequency speech sounds for children with moderate to moderately severe hearing loss in quiet listening situations.

Letter To The Editor

PEDIATRICS ◽  
1996 ◽  
Vol 97 (1) ◽  
pp. 148-148
Author(s):  
Ellen R. Wald
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Time Course ◽  
Letter To The Editor ◽  
Neurologic Sequelae ◽  
Dexamethasone Therapy

We appreciate Dr Long's comments regarding our article "Dexamethasone Therapy for Children With Bacterial Meningitis." The purpose of the study was to determine the effect, if any, of dexamethasone on hearing loss and other neurologic sequelae. By performing auditory-evoked brainstem responses (ABR) on children with bacterial meningitis as soon as possible after admission to the hospital, we hoped to learn about the time course of hearing loss and whether it is preventable or reversible by the administration of dexamethasone.

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