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Impact and challenges of hearing
loss following meningitis
Vicki Kirwin
After Meningitis Conference, London
November 2009
Meningitis and hearing loss
• Biggest cause of acquired sensorineural
hearing impairment in children (~6% all PCHI)
• Majority of children are deafened before their
3rd birthday
• Bilateral or unilateral
• Any level from mild to profound hearing loss
• Hearing loss normally occurs early in the
course of the illness
• Hearing loss often not immediately stable
Meningitis causes
hearing loss…
• Most commonly as result of infection
spreading into the cochlea
• Sometimes due to inflammation of the
auditory nerve
• Can also affect the vestibular organ
• Ossification
Protocol for early
referral - newborn babies
Newborn babies who have had bacterial
meningitis are excluded from the newborn
hearing screen and ref’d for full audiological
assessment
 1/10 following meningitis
 1/100 NICU/SCBU babies
 1/1000 for well babies
Protocol for early
referral - older infants
and children
"Immediate referral to Audiology for age-appropriate
assessment If these conditions occur at any point in
infancy or childhood after the screen then, on recovery,
immediate referral should be made to Audiology for an
age-appropriate audiological assessment within 4
weeks of discharge from hospital”
Guidelines for surveillance and audiological monitoring of infants & children
following the newborn hearing screen (NHSP Clinical Group, 2009)
http://hearing.screening.nhs.uk/cms.php?folder=88
125
250
500
1000
2000
4000
8000
0
10
HEARING LEVEL (dB HL)
20
z v
f th
s
p
h
30
ch
40
50
j mdb
n
ng
e i
u
l
o ar
g
sh
60
70
80
90
100
110
120
AUDIOGRAM OF FAMILIAR SOUNDS
FREQUENCY IN CYCLES PER SECOND (HZ)
Impact of hearing loss
• Pre-lingually deafened
• Post-lingually deafened
• Degree of deafness
Impact of hearing loss
• Home
• Education
• Social
Impact of hearing loss
pre-lingually deafened
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Language acquisition and use
Speech and communication
Incidental hearing for learning
Child’s behaviour may have changed
Attention span may be shorter
Temper tantrums
More clingy
Siblings may react to the focus of attention on
the deaf child
Impact of hearing loss
post-lingually deafened
• Maintaining speech and language skills
• Emotional impact of illness
• Emotional impact and acceptance of hearing
loss
• Support needed to find new ways of
communicating
• Incidental hearing for learning & gossip!
Impact of hearing loss
post-lingually deafened
• Different experiences to peers
• Unwanted/higher levels adult
direction/attention
• Professional intervention - ToD, SLT, support
assistants, social worker, Ed. Psychologist,
audiologist, GP, consultant, etc
• Higher risk mental health problems
Management of the
hearing loss - hearing aids
Sound enters the
microphone, is processed
and amplified and exits
via the receiver. The
amplified sound enters
the ear via the tubing and
ear mould.
Management of the
hearing loss - cochlear
implants
A surgically implanted
electronic device
which stimulates the
hearing nerves in the
cochlea directly.
Cochlear implants cont.
Sound enters the microphone.
The sound is transformed into
electrical signals and transfers
across the skin from the
receiver to the internal
electrodes. The electronic
signals are ‘de-coded’
by the brain and ‘heard’.
Management of the
hearing loss - other support
• voice to text software for computers
• subtitles on television, DVDs, cinemas and
theatres
• note takers and communication support
workers in school
• text phones that give access to phone calls
• lip-reading
• sign language
NDCS support
• Founded by parents for parents in 1944
• The UK’s largest national charity supporting
all deaf children and their families
• Supports all families regardless of deafness,
amplification, communication methodology
and educational placement.
NDCS objectives
• Offer clear, balanced information and support to
families
• Advocate for deaf children, young people and their
families
• Providing opportunities for young deaf people to
develop social skills, confidence and independence
• Work with professionals and policy makers to ensure
high quality services are available for all
• Campaign and lobby on issues affecting the lives of
deaf children, young people and their families
NDCS services
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Freephone helpline 0808 800 8880
Free membership to families and professionals
Family officers
Legal casework team
Regional directors team
Offices in London, Birmingham, Belfast, Cardiff and Glasgow
Membership magazine & email updates
Free publications
A purpose built listening bus
An equipment loan scheme
Grants to help parents on low incomes buy computers
Local DCS’s
Events for families and young deaf people including arts, sports, outdoor
activities and family weekends
Further references
& resources
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Balance and balance disorders factsheet, NDCS, 2008. www.ndcs.org.uk
Fortnum HM & Davis AC (1993). Hearing impairment in children after bacterial
meningitis: incidence and resource implications. Brit J Audiol 27, 43-52
Fortnum HM, Summerfield AQ, Marshall DH, Davis AC, Bamford JM (2001).
Prevalence of permanent childhood hearing impairment in the United Kingdom
and implications for universal neonatal hearing screening: questionnaire based
ascertainment study. Brit Med J 323(7312), 536-40
Guidelines for surveillance and audiological monitoring of infants & children
following the newborn hearing screen, NHSP, July 2009
http://hearing.screening.nhs.uk/cms.php?folder=88
Meningitis and childhood deafness, NDCS/The Meningitis Trust, 2009
www.ndcs.org.uk
Meningitis & Hearing Loss (Deafness Research UK, 2005)
http://www.deafnessresearch.org.uk/Factsheets+3565.twl
http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx
[email protected]
www.ndcs.org.uk