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

Abstract

BackgroundSevere malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above.MethodsThis prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate.ResultsIn the control group, 92.6 % (n = 108, 95 % confidence interval 86.19–6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4–67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1–75.5 %) at follow up 14–28 days after diagnosis of malaria.The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59–83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3–7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3–7, 95 % confidence interval 16.3–56.3 %; p = 0.031 at day 14–28, 95 % confidence interval 24.5–66.3 %).ConclusionThe presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.

A retinal model of cerebral malaria

“…Unfortunately, there are very few longitudinal studies with malaria patients that have addressed this possibility. Yet, a recent study found that children who suffered from cerebral malaria experienced a marked loss of hearing function 4 suggesting a loss of neuronal cells in the cochlea. Whether a permanent loss of function occurs in the retina ( e .…”

“…Malaria is considered one of the most common and deadliest diseases that are afflicting mankind 1 . Cerebral malaria is a complication that is associated with a poor prognosis 2 and can lead to irreversible sequelae, which can have a profound effect, particularly, on child development, although such sequelae often remain unnoticed 3,4 . The precise pathological processes and mechanisms leading to cerebral malaria are still unclear, hampering the development of efficacious treatments.…”

Public Health Burden of Hearing Impairment and the Promise of Genomics and Environmental Research: A Case Study in Ghana, Africa

“…Severe malaria was suggested to influence the function of the inner ear in children; however, the loss of hearing caused by malaria is reversed after treatment. Out of 144 children who had severe malaria, 58 (40.3%) failed the otoacoustic emission test, suggesting the development of HI (Schmutzhard et al, 2015). Sickle cell disease is not a likely cause of HI or delay in speech in children.…”

Prevalence and nature of hearing loss in a cohort of children with sickle cell disease

“…Most studies included children and adults, making it difficult to discern the specific pediatric risk . Many studies were conducted in countries where sensorineural hearing loss (SNHL) due to endemic infections (such as bacterial meningitis, malaria, and congenital rubella) may be prevalent, limiting correlations between acquired hearing loss and SCD. Most studies were small and often only examined SNHL.…”