ro13-9904 and Hearing-Loss--Sensorineural

Is sudden sensorineural hearing loss associated with Lyme disease in adults?. A retrospective case report and a systematic literature search in PubMed and Embase were performed.. We describe a patient presenting with sudden sensorineural hearing loss, followed by a facial paralysis, which could be attributed to Lyme disease confirmed by positive serology and a positive immunoblot. She was successfully treated with ceftriaxone, with recovery of the facial paralysis, although no recovery of the hearing loss was observed. A systematic literature search resulted in 4 relevant and valid articles revealing that confirmed positive serology for Borrelia burgdorferi varies from 0% to 21.3%, suggesting active Lyme disease as a cause in patients with sudden sensorineural hearing loss. Two studies demonstrated a significantly higher incidence of confirmed positive serology for Borrelia burgdorferi as compared with the incidence in the general local population.. Literature suggests that sudden sensorineural hearing loss may coincide with Borrelia burgdorferi infection. A higher incidence of confirmed positive serology for Borrelia burgdorferi in patients with sudden deafness seems to be depending on the country and on the tests used to confirm Lyme disease. This should be taken into account if serologic testing for Lyme disease in patients with sudden deafness is considered.

Topics: Adult; Borrelia burgdorferi; Ceftriaxone; Facial Paralysis; Female; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Humans; Lyme Disease; Retrospective Studies; Treatment Outcome

To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae.. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year.. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio.. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year.. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission.. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later.. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups.. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

Topics: Ceftriaxone; Child; Child Development; Child, Preschool; Deafness; Dexamethasone; Drug Therapy, Combination; Female; Hearing Loss, Sensorineural; Humans; Infant; Male; Meningitis, Bacterial; Nervous System Diseases; Prospective Studies

Routine use of steroids as adjunctive treatment of bacterial meningitis remains controversial. We have carried out a prospective, placebo-controlled, double-blind study of dexamethasone in 115 children with acute bacterial meningitis in Switzerland. The patients were randomly assigned to receive either placebo (n = 55) or dexamethasone (n = 60) in addition to optimum antibiotic treatment (100 mg/kg daily ceftriaxone). Dexamethasone therapy (0.4 mg/kg) was started 10 min before the first dose of ceftriaxone and given every 12 h for 2 days. Baseline demographic, clinical, and laboratory features of the two groups were similar. After 24 h treatment meningeal inflammation as shown by cerebrospinal fluid (CSF) glucose concentration was significantly less with dexamethasone than with placebo (mean increase in glucose 63 [76] vs 40 [75]%, p = 0.008). However, other indices of inflammation showed similar changes in both groups. Addition of dexamethasone did not affect the rate at which CSF became sterile. Both groups showed prompt clinical responses and similar frequencies of complications (15 vs 12%). Monitoring for possible adverse effects of dexamethasone revealed no abnormalities. At follow-up examinations 3, 9, and 15 months after hospital discharge, 9 (16%) of 55 placebo recipients and 3 (5%) of 60 dexamethasone recipients had one or more neurological or audiological sequelae (p = 0.066); the relative risk of sequelae was 3.27 (95% CI 0.93-11.47). Our results and those of similarly designed studies lead us to believe that adjunctive dexamethasone therapy improves outcome from bacterial meningitis in infants and children. We recommend its use, preferably in the dose regimen used in this study.

Topics: Adolescent; C-Reactive Protein; Ceftriaxone; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Hearing Loss, Sensorineural; Humans; Infant; Injections, Intravenous; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Placebos; Prospective Studies; Risk Factors

To compare ceftriaxone with cefuroxime for the treatment of meningitis, we conducted a study in which 106 children with acute bacterial meningitis were randomly assigned to receive either ceftriaxone (100 mg per kilogram of body weight per day, administered intravenously once daily; n = 53) or cefuroxime (240 mg per kilogram per day, administered intravenously in four equal doses; n = 53). The mean age of the children was 3 years (range, 42 days to 16 years), and the characteristics of the two treatment groups were comparable at admission. Excluded from the study were eight other children who died within 48 hours of admission. After 18 to 36 hours of therapy, cultures of cerebrospinal fluid remained positive for 1 of the 52 children (2 percent) receiving ceftriaxone for whom cultures were available and 6 of 52 (12 percent) receiving cefuroxime (P = 0.11). In both groups the mean duration of antibiotic therapy was 10 days. The clinical responses to therapy were similar in the two treatment groups, and all 106 children were cured. Reversible biliary pseudolithiasis was detected by serial abdominal ultrasonography only in the children treated with ceftriaxone (16 of 35 vs. 0 of 35; P less than 0.001). The treatment of three children was switched from ceftriaxone to alternative antibiotics because these children had upper abdominal pain. Other side effects were infrequent in both groups. At follow-up examination two months later, moderate-to-profound hearing loss was present in two children (4 percent) treated with ceftriaxone and in nine (17 percent) treated with cefuroxime (P = 0.05); other neurologic abnormalities were similar in the two treatment groups. We conclude that ceftriaxone is superior to cefuroxime for the treatment of acute bacterial meningitis in children and that the benefits of milder hearing impairment and more rapid sterilization of the cerebrospinal fluid with ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Cerebrospinal Fluid; Child; Child, Preschool; Cholelithiasis; Female; Hearing Loss, Sensorineural; Humans; Infant; Injections, Intravenous; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Multicenter Studies as Topic; Prospective Studies; Random Allocation

The clinical manifestations of leptospirosis range from mild to life-threatening and can impact on multiple organ systems. A wide array of neurological manifestations of leptospirosis have been reported, although the pathophysiology of neuroleptospirosis remains incompletely understood. We present a case of leptospirosis complicated by bilateral sensorineural deafness, with nodular meningitis demonstrated in the internal auditory meatus on magnetic resonance imaging. The patient was treated with doxycycline, ceftriaxone, systemic and topical steroids, and hyperbaric oxygen therapy, with modest, but incomplete, improvement.

Topics: Ceftriaxone; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Hyperbaric Oxygenation; Leptospirosis

Topics: Anemia, Hemolytic; Ceftriaxone; Child; Cochlear Implantation; Hearing Loss, Sensorineural; Humans; Male; Vestibular Aqueduct

Topics: Animals; Ceftriaxone; Dexamethasone; Drug Resistance, Multiple, Bacterial; Emergencies; Food Handling; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Labyrinthitis; Male; Meat; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine

Topics: Borrelia burgdorferi; Ceftriaxone; Facial Paralysis; Female; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Humans; Lyme Disease

Topics: Borrelia burgdorferi; Ceftriaxone; Facial Paralysis; Female; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Humans; Lyme Disease

Topics: Anti-Infective Agents; Aortic Valve; Aortic Valve Insufficiency; Aza Compounds; Blindness; Ceftriaxone; Cough; Echocardiography, Transesophageal; Endophthalmitis; Fever; Fluoroquinolones; Hearing Loss, Sensorineural; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Moxifloxacin; Pneumococcal Infections; Quinolines; Streptococcus pneumoniae; Vancomycin; Vision Disorders

Experts recommend that children with suspected pneumococcal meningitis should empirically receive combination therapy with vancomycin plus either ceftriaxone or cefotaxime. The relationship between timing of the first dose of vancomycin relative to other antibiotics and outcome in these children, however, has not been addressed.. Medical records of children with pneumococcal meningitis at a single institution from 1991-2001 were retrospectively reviewed. Vancomycin start time was defined as the number of hours from initiation of cefotaxime or ceftriaxone therapy until the administration of vancomycin therapy. Outcome variables were death, sensorineural hearing loss, and other neurologic deficits at discharge. Associations between independent variables and outcome variables were assessed in univariate and multiple logistic regression analyses.. Of 114 subjects, 109 received empiric vancomycin therapy in combination with cefotaxime or ceftriaxone. Ten subjects (9%) died, whereas 37 (55%) of 67 survivors who underwent audiometry had documented hearing loss, and 14 (13%) of 104 survivors were discharged with other neurologic deficits. Subjects with hearing loss had a significantly shorter median vancomycin start time than did those with normal hearing (<1 vs 4 hours). Vancomycin start time was not significantly associated with death or other neurologic deficits in univariate or multivariate analyses. Multiple logistic regression revealed that hearing loss was independently associated with vancomycin start time <2 hours, blood leukocyte count <15000/microL, and cerebrospinal fluid glucose concentration <30 mg/dL.. Early empiric vancomycin therapy was not clinically beneficial in children with pneumococcal meningitis but was associated with a substantially increased risk of hearing loss. It may be prudent to consider delaying the first dose of vancomycin therapy until > or =2 hours after the first dose of parenteral cephalosporin in children beginning therapy for suspected or confirmed pneumococcal meningitis.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Female; Hearing Loss, Sensorineural; Humans; Infant; Male; Meningitis, Pneumococcal; Survival Rate; Vancomycin

Neurological impairment during pregnancy is also commonly found in otorhinolaryngology. Cranial nerve palsy, e.g. of the facial nerve or changes in signal processing of the hearing system, are described. Apart from changes in electrolyte balance, these neurological alterations are attributed to hormone fluctuations. The spontaneous remission of the neurological problems after delivery is frequently reported. This case report presents a 34 year pregnant patient suffering from binaural sensorineural hearing loss and tinnitus in the third trimester. Three weeks after delivery there was a spontaneous remission and a measurable improvement of the audiological findings. Although treatment with cortisone and antibiotics remained without effect, a pharmacological treatment during pregnancy has to be carefully and individually coordinated. An interdisciplinary approach in diagnostic and therapeutic measures together with gynaecologists appears obligatory.

Topics: Adult; Ceftriaxone; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Infant, Newborn; Infusions, Intravenous; Prednisolone; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Puerperal Disorders; Remission, Spontaneous; Tinnitus

Topics: Ceftriaxone; Child; Chloramphenicol; Egypt; Female; Hearing Loss, Sensorineural; Humans; Meningitis, Pneumococcal; Penicillins; Recurrence; Streptococcus pneumoniae

Bacterial meningitis, particularly that resulting from Streptococcus pneumoniae, is a common cause of acquired profound sensorineural deafness in children. The pathogenesis of meningogenic hearing loss has been investigated in an experimental rabbit model. In this study significant deafness was documented within the first 15 hours of infection. Initiation of antibiotic therapy at this time diminished the severity of hearing loss in most animals. The addition of dexamethasone to antibiotic therapy prevented the development of profound deafness. These results suggest this model will be useful in developing antiinflammatory strategies to improve the outcome of bacterial meningitis.

Topics: Animals; Ceftriaxone; Dexamethasone; Disease Models, Animal; Drug Therapy, Combination; Evoked Potentials, Auditory; Female; Hearing Loss, Sensorineural; Linear Models; Meningitis, Pneumococcal; Rabbits

Two leading causes of hearing loss in infants and young children have been bacterial meningitis due to Haemophilus influenzae Type b (Hib) and congenital toxoplasmosis. In this two-part review, we describe the essential nature and incidence of these two diseases and how the availability of a Hib vaccine effective and safe with infants as young as 2 mo of age; the prospect of universal immunization against Hib disease; the introduction of cephalosporin antibiotic and corticosteroid treatment; and the use of early and prolonged antimicrobial therapy with children with congenital toxoplasmosis promises significant reduction, if not complete eradication, of hearing loss in infants and toddlers attributable to Hib bacterial meningitis and congenital toxoplasmosis. As a result, there may be up to a third fewer children under the age of five with severe hearing impairment annually in the United States.

Topics: Ceftriaxone; Cefuroxime; Child, Preschool; Dexamethasone; Haemophilus influenzae; Hearing Disorders; Hearing Loss, Sensorineural; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Streptococcus; Toxoplasmosis, Congenital; United States