Hearing Loss at School Age in Survivors of Bacterial Meningitis: Assessment, Incidence, and Prediction Irene Koomen, MD*‡; Diederick E. Grobbee, MD, PhD‡; John J. Roord, MD, PhD*; Rogier Donders, PhD‡§; Aag Jennekens-Schinkel, PhD; and A. M. van Furth, MD, PhD* ABSTRACT. Objectives. To establish the incidence of sensorineural hearing loss in children who survived non–Haemophilus influenzae type B (Hib) bacterial men- ingitis, to highlight the actual percentage whose hearing was evaluated, and to develop a prediction rule to iden- tify those who are at risk of hearing loss. Methods. In 1999, we compiled a cohort of 628 school- aged children who were born between January 1986 and December 1994 and had survived non-Hib bacterial men- ingitis between January 1990 and December 1995. Pres- ence of sensorineural hearing loss (>25 dB) was deter- mined, based on information from questionnaires and medical records. Potential risk factors for hearing loss were obtained from medical records; independent pre- dictors were identified using multivariate logistic regres- sion analysis, leading to the formulation of a prediction rule. Results. The incidence of hearing loss was 7%. The hearing of 68% of the children was evaluated as part of their routine follow-up after bacterial meningitis, result- ing in the detection of 75% of the cases of hearing loss. The remaining 25% were detected after this follow-up had ended. Using a prediction rule based on 5 factors— duration of symptoms before admission >2 days, ab- sence of petechiae, cerebrospinal fluid glucose level <0.6 mmol/L, Streptococcus pneumoniae, and ataxia— 62% of the postmeningitic children were selected as being at risk. All cases of hearing loss were in this at-risk group. Conclusions. Hearing loss can be predicted satisfac- torily. When the hearing of children who are predicted to be at risk is tested as part of their routine follow-up, no children with hearing loss need be missed. Pediatrics 2003;112:1049 –1053; bacterial meningitis, cohort study, hearing assessment, hearing impairment, prediction. ABBREVIATIONS. Hib, Haemophilus influenzae type B; CSF, cere- brospinal fluid; AUC, area under the curve. S ensorineural hearing loss is the most common severe consequence of childhood bacterial men- ingitis, affecting approximately 9% of the chil- dren. 1–5 Furthermore, bacterial meningitis is the leading cause of severe hearing loss acquired in childhood. 4,6 As a result of vaccination, Haemophilus influenzae type B (Hib) meningitis has virtually dis- appeared from most Western countries, 7,8 but it is not yet known to what extent this has influenced the incidence of hearing loss. Early identification and rehabilitation of hearing loss is essential for the ac- quisition of normal speech and language, as well as for the child’s educational and social development. 9 Early identification of hearing loss is also important because ossification of the cochlea after meningitis may complicate cochlear implantation. 10,11 Hearing evaluation, therefore, is recommended as part of the routine follow-up after bacterial meningitis. 1,5,12,13 However, as up to 25% of the children do not un- dergo a formal hearing test after bacterial meningi- tis, 12,13 identification of those who are at risk of hear- ing loss may help to ensure that they are evaluated. Previously proposed risk factors for hearing loss 1,5,12,14,15 have not resulted in satisfactory predic- tion. The purposes of the present study were to 1) establish the incidence of sensorineural hearing loss in children who survived non-Hib bacterial menin- gitis, 2) report on the actual percentage whose hear- ing was evaluated after bacterial meningitis, and 3) develop a prediction rule to identify those who are at risk of hearing loss. METHODS Postmeningitic Cohort Files of the Netherlands Reference Laboratory for Bacterial Meningitis were searched in 1999 for data on eligible patients. This laboratory collects bacterial isolates and data (eg, pathogen, name, date of birth, hospital of admission) from approximately 80% of all bacterial meningitis cases in the Netherlands. The diagnosis of bacterial meningitis was based on the presence of bacteria being demonstrated in the cerebrospinal fluid (CSF). The inclusion cri- teria were date of birth between January 1986 and December 1994 and recovery from meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, Escherichia coli, or Listeria monocytogenes between January 1990 and December 1995. The exclusion criteria were meningitis caused by Hib or other less common pathogens, “complex onset” of meningitis (defined as meningitis secondary to immunodeficiency states, central nervous system surgery, cranial trauma, or CSF shunt infections, or relaps- ing meningitis), cognitive or behavioral problems before menin- gitis, and diseases developed after meningitis (eg, cancer), which could have caused cognitive or behavioral problems. These last 2 exclusion criteria were applied because this cohort was compiled From the *Department of Pediatrics, VU Medical Center, Amsterdam, the Netherlands; ‡Julius Center for Health Sciences and Primary Care, Univer- sity Medical Center Utrecht, Utrecht, the Netherlands; §Center of Biostatis- tics, University Medical Center Utrecht, Utrecht, the Netherlands and Di- vision of Neuropsychology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands. Received for publication Dec 9, 2002; accepted Jul 7, 2003. Reprint requests to (A.M.v.F.) VU Medical Center, Department of Pediat- rics, Box 7057, 1007 MB Amsterdam, the Netherlands. E-mail: am.vfurth@vumc.nl PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- emy of Pediatrics. PEDIATRICS Vol. 112 No. 5 November 2003 1049