Early Prediction of Postmeningitic Hearing Loss in Children Using Magnetic Resonance Imaging

Abstract

Objective To determine whether early gadolinium-enhanced magnetic resonance imaging (GdMRI) can reliably detect meningitic labyrinthitis and thereby predict which children are at high risk for hearing loss. Permanent sensorineural hearing loss (SNHL) remains a common sequela of bacterial meningitis, and early diagnosis of the associated suppurative labyrinthitis can be difficult, especially in critically ill, sedated patients and young children. Design Retrospective cohort study. Setting Tertiary pediatric hospital. Participants Twenty-three survivors of bacterial meningitis (median age, 15 months [range, 3 months–14 years]) who had undergone brain GdMRI during the acute disease and had subsequent ear-specific audiometric data. Main Outcome Measure Blinded to disease and outcome, a neuroradiologist rated the relative enhancement of each cochlea on T1-weighted images using a 4-point scale. Scores were then correlated with the degree of hearing loss on subsequent testing. Results Sensorineural hearing loss occurred in 15 of 46 ears (8 of 23 patients). Enhancement on GdMRI was detected in 13 of the 15 ears that later developed SNHL but was absent in all 31 unaffected ears. Thus, GdMRI was 87% sensitive and 100% specific for predicting which ears would develop permanent SNHL. In the subgroup with pneumococcal meningitis (n=15), GdMRI was 100% sensitive and 100% specific. Labyrinthine enhancement was detectable as early as 1 day after diagnosis. Conclusion Gadolinium-enhanced MRI detected meningitic labyrinthitis at early stages and accurately predicted which patients would later develop hearing loss.

Bacterial Labyrinthitis in an Adult with Acute Otitis Media

“…Early diagnosis and treatment with corticosteroids and surgical decompression of the middle ear can potentially preserve vestibular and auditory function [3,4,7]. Close followup is crucial to evaluate residual inner ear deficits after the acute inflammatory response has resolved.…”

“…This supports the notion that bacterial labyrinthitis is a clinical diagnosis and may not be predicted or diagnosed based on CT imaging alone. In the acute phase, gadolinium-enhanced MRI images may reveal labyrinthine enhancement as consistent with labyrinthitis [4].…”

“…Topical antibiotic drops may be administered through the tubes postoperatively for additional coverage. Intravenous corticosteroid treatment, such as dexamethasone, has been shown to decrease long-term SNHL [3,4,7]. Early administration of IV dexamethasone may also salvage auditory and vestibular function and prevent further irreversible damage [4,7].…”

“…Intravenous corticosteroid treatment, such as dexamethasone, has been shown to decrease long-term SNHL [3,4,7]. Early administration of IV dexamethasone may also salvage auditory and vestibular function and prevent further irreversible damage [4,7]. During the acute phase of disease, patients with severe nausea and vomiting can be given IV fluids and vestibular suppressive medication such as meclizine, benzodiazepines, promethazine, or (in refractory cases) droperidol [9].…”

“…Vertigo and potentially permanent vestibular and sensorineural hearing loss (SNHL) often result [3]. While inflammation of the inner ear structures can be seen on MRI, acute suppurative labyrinthitis is typically a clinical diagnosis [4]. The differentiation of serous labyrinthitis from acute suppurative labyrinthitis can often be made from cultures from middle ear exudate following therapeutic myringotomy [3].…”