Otolaryngology–Head and Neck Surgery (2005) 133, 995-996 CASE REPORT Deafness after Bacterial Meningitis: An Emergency for Early Imaging and Cochlear Implant Surgery Antje Aschendorff, MD, Thomas Klenzner, MD, and Roland Laszig, MD, Freiberg, Germany B ilateral deafness after bacterial meningitis is a serious complication that occurs in up to 5% of cases.1 Cochlear implant surgery is an accepted mode of treatment for hearing rehabilitation postmeningitis. Surgery can be complicated by obliteration and ossification of the cochlea that may prevent complete electrode insertion and thus lead to poorer rehabilitation outcomes.2 Reports on the course of obliteration and ossification are rare; however, obliteration has been observed in up to 80% of postmeningitis cases3 and can start within the first 3 weeks after the infection4 as indicated in animal studies. both scala tympani was encountered, consequently a Nucleus Contour electrode (Cochlear Corp, Australia) was implanted entirely into the scala vestibuli on each side. The electrical evoked stapedius reflex presented with regular thresholds indicating a normal function of the auditory pathway. No intra- or postoperative complication occurred. Postoperatively, healing was noneventful, with the first fitting of 2 behind-the-ear speech processors occurring at 2 months postsurgery. Both processors were fitted with maps including the full electrode array. The child has demonstrated very good acceptance of the bilateral speech processors with good reaction and turning to environmental sounds and voices. CASE REPORT A 5-month-old (163 days) girl presented with suspected bilateral deafness due to Streptococcus pneumoniae meningitis at the age of 4 months. Audiological testing included a battery of assessments: behavioral audiometry, acoustic evoked brainstem responses, and electrocochleography confirming bilateral complete deafness. Computed tomography (CT), 4 weeks after meningitis, revealed a partial obliteration of the horizontal semicircular canals on both sides (Fig 1). This is a valuable indicator for obliteration or ossification of the cochlea even if high-resolution CT reveals a seemingly patent cochlea.5 After intensive counseling of the parents, it was decided to perform cochlear implant surgery immediately on both sides in a one-stage surgery. The surgery was carried out following the standard procedure: retroauricular access, mastoidectomy, posterior tympanotomy, and cochleostomy. Intraoperatively, ossification of From the Department of Otorhinolaryngology, University of Freiburg, Germany. Reprint requests: Dr Antje Aschendorff, HNO-Klinik, Universität Freiburg, Killianstr 5, D-79106 Freiburg, Germany. CONCLUSION Our report demonstrates the necessity of early imaging after bacterial meningitis in case of deafness regardless of the age of the patient. We observed ossification of both scala tympani only 4 weeks after the onset of meningitis. Nevertheless, a complete electrode insertion could be performed ensuring optimal conditions for rehabilitation, confirmed from our initial observations. Subsequent longitudinal evaluation of the child’s progress will help to determine the benefit of 2 devices versus 1 device. The surgical procedure also demonstrates that cochlear implant surgery can be accomplished without complications bilaterally in a 1-stage procedure in a 5-month-old infant. To our knowledge, this is the youngest child to undergo a bilateral implant worldwide. In case of suspected obliteraE-mail address: [email protected]. 0194-5998/$30.00 © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.03.036 996 Otolaryngology–Head and Neck Surgery, Vol 133, No 6, December 2005 dure is performed unilaterally only, the potential for implant surgery in the second ear may be either potentially lost or be considered suboptimal if delayed, ultimately compromising the results of the rehabilitation. REFERENCES Figure 1 Axial high resolution tomography of the cochlea (A) and lateral semicircular canal (B). Whereas the cochlea appears patent (arrows), partial obliteration is visible within the semicircular canals (arrows). tion or ossification, cochlear implant surgery is recommended bilaterally without delay, even in the very young child, to provide the optimal foundation for the development of speech and language. For such cases, if the proce- 1. Baraff LJ, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatric Infect Dis J 1993;12:389 –94. 2. Rauch SD, Hermann BS, Davis LA, et al. Nucleus 22 cochlear implantation results in postmeningitic deafness. Laryngoscope 1997;107(12 Pt 1):1606 –9. 3. Steenerson RL, Gary LB, Wynens MS. Scala vestibuli cochlear implantation for labyrinthine ossification. Am J Otol 1990;11(5): 360 –3. 4. Nabili V, Brodie HA, Neverov NI, et al. Chronology of labyrinthitis ossificans induced by Streptococcus pneumoniae meningitis. Laryngoscope 1999;109(6):931–5. 5. Muren C, Bredberg G. 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