Reversible Audiometric Threshold Changes in Children with Uncomplicated Malaria

Abstract

Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs) with hearing is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (n = 37), artemether-lumefantrine (n = 35), or amodiaquine (n = 8) in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared with those of a control group of children (n = 57) from the same area. Findings. During the acute stage, hearing threshold levels of treated children were significantly elevated compared with controls (P < 0.001). The threshold elevations persisted up to 28 days, but no differences in hearing thresholds were evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels during the acute illness, a finding that has implications for learning and development in areas of intense transmission, as well as for evaluating potential ototoxicity of new antimalarial drugs.

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions - a prospective multicenter cohort study

“…Transient OAE are absent at a cochlea with hearing loss of 20 dB or more [ 16 ]. Similar threshold shifts have recently been reported in uncomplicated malaria by Adjei et al [ 8 ]. Interestingly, the percentage of failures increased through the course of the disease in the cerebral malaria group and decreased in the severe non-cerebral malaria group, showing significant differences at day 3–7 and day 14–28, suggesting that cerebral malaria is more likely to influence cochlear function than severe malaria.…”

“…In an artemisinin combination therapy trial in children aged 0.5–-14 years, uncomplicated malaria has been suspected to be the cause of elevated hearing thresholds. Prior to therapy, hearing thresholds in children with malaria were significantly higher than those seen in the control group [ 8 ]. Carter et al suspected severe malaria to be a cause of acquired language disorders [ 9 ].…”