these non-albicans species are primarily colonizers of the oral mucosa that almost never cause symptomatic thrush. Up 10% of patients with advanced HIV infection develop resistant Candida species including strains of C. albicans. Darouiche reported that this rate is lower in non-HIV-infected immuno- compromised patients and that the development of resistance strains almost always occurs in severely immunosuppressed patients receiving either repeated or prolonged therapy with escalating dosages of fluconazole. 6 Although warranting fur- ther investigation with more long term studies, concerns regarding the development of resistant thrush in healthy infants receiving fluconazole may be more theoretical than practical. The small sample size of This study makes it impossible to draw statistically meaningful conclusions beyond clinical and microbiologic cure rates. Larger studies will have to be accomplished to test the validity of our preliminary observa- tions with regard to recurrence rates, complication rates and the efficacy of fluconazole in the treatment of concurrent candidal diaper rash. All of these clinical factors will signifi- cantly effect a cost-benefit analysis to determine the potential cost effectiveness of various treatment regimens of flucon- azole. Fluconazole is much more expensive than nystatin per unit volume. However, this cost does not reflect the cost of repeat physician visits or lost parental work time for failed initial therapy and these costs should be determined to accurately compare the costs of the two medications. Acknowledgment. Major David Bush, M.D., USAF, MC, Wilford Hall USAF Medical Center, conducted our statistical analyses. R. Alan Goins, M.D. David Ascher, M.D. Norman Waecker, M.D. John Arnold, M.D. Ebony Moorefield, P.N.P. Wilford Hall USAF Medical Center San Antonio, TX (RAG, DA, EM) Naval Medical Center San Diego, CA (NW, JA). Accepted for publication Aug. 8, 2002. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Air Force or Navy, Department of Defense or the United States Government. Key words: Infant, thrush, fluconazole. Reprints not available. DOI: 10.1097/01.inf.0000041820.25265.aa 1. Hoppe JE. Treatment of oropharyngeal candidiasis and can- didal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J 1997;16:885–94. 2. Hughes WT, Flynn PM. Candidiasis. In: Feigin RD, Cherry JD, eds. Textbook of pediatric infectious diseases. 4th ed. Philadelphia: Saunders, 1998:2303–11. 3. Hoppe JE, and the Antifungals Study Group. Treatment of oropharyngeal candidiasis in immunocompetent infants: a randomized multicenter study of miconazole gel vs. nystatin suspension. Pediatr Infect Dis J 1997;16:288 –93. 4. Flynn PM, Cunningham CK, Kerkering T, et al. Oropharyn- geal candidiasis in immunocompromised children: a random- ized, multicenter study of orally administered fluconazole suspension versus nystatin. J Pediatr 1995;127:322– 8. 5. Boon JM, Lafeber HN, Mannetje AH, et al. Comparison of ketoconazole suspension and nystatin in the treatment of newborns and infants with oral candidosis. Mycoses 1989;32: 312–15. 6. Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients: treatment issues. Clin Infect Dis 1998;26:259 –74. 7. Pons V, Greenspan D, Lozada-Nur F, et al. Oropharyngeal candidiasis in patients with AIDS: randomized comparison of fluconazole versus nystatin oral suspensions. Clin Infect Dis 1997;24:1204 –7. 8. Blomgren J, Berggren U, Jontell M. Fluconazole versus nys- tatin in the treatment of oral candidosis. Acta Odontol Scand 1998;56:202–5. MUMPS MENINGOENCEPHALITIS EFFECT ON HEARING Sensorineural hearing loss is an important com- plication of mumps. Audiologic tests of 26 children with mumps meningoencephalitis, 25 uncompli- cated mumps cases and 20 control cases were per- formed, and hearing level thresholds at speech and high frequencies were determined. The mean hear- ing level thresholds in the mumps meningoenceph- alitis group were higher than those of mumps cases at frequencies from 6000 to 18 000 Hz in the right ear and at 250 and from 4000 to 18 000 Hz in the left ear (P < 0.05). Mumps meningoencephalitis cases had higher mean hearing thresholds than did con- trol groups at all frequencies other than 125 and 250 Hz in the right ear and 10 000 Hz in the left ear. The mean hearing thresholds of mumps cases were higher than those of control group at frequencies of 1000 and 4000 Hz in the right ear and 1000 and 10 000 Hz in the left ear (P < 0.05). These results show that mumps meningoencephalitis causes a higher risk of hearing loss than does mumps. Mumps is one of the common causes of acquired sensori- neural hearing loss. 1 The risk of hearing loss in mumps infections is from 1 per 2000 to 1 per 30 000 cases. 2–4 Hearing loss after mumps infection is usually mild or moderate, and severe or bilateral hearing loss is rare. 3 Although it is suggested that development of hearing loss is not related to the clinical form of mumps infection, 3–5 there are a few reports in the medical literature about hearing loss associated with mumps meningoencephalitis. 4, 5 This study was de- signed to investigate whether mumps meningoencephalitis is more prone to cause hearing loss than mumps without central nervous system complications. Materials and methods. The audiologic tests were per- formed in 3 groups of cases. The first group consisted of 26 cases of mumps meningoencephalitis diagnosed and hospital- ized in Hacettepe University Children’s Hospital between 1990 and 2000. The criteria for the diagnosis of mumps meningoencephalitis were: presence of parotid swelling to- gether with fever, headache, vomiting and/or any sign of disturbance in consciousness; and findings of meningeal irri- tation by physical examination with the presence of pleocyto- sis in cerebrospinal fluid (CSF) determined by lumbar punc- ture. Also diagnosis was supported by negative bacteriologic studies including CSF cultures, CSF Gram-stained smears and latex agglutination test for bacterial antigens. The sec- ond group included 25 children with mumps who did not develop signs of meningoencephalitis during the same period. Both were recalled for audiologic testing between January and May 2001. The third group was the control group con- sisting of 20 healthy children who had negative serology by enzyme-linked immunosorbent assay for mumps. All 3 groups Vol. 21, No. 12, Dec. 2002 1167 THE PEDIATRIC INFECTIOUS DISEASE JOURNAL