Hearing Loss in Meningitis

Bacterial forms of the disease remain the predominate cause

Audiologist
Carmen MartA-nez BanAs / E+ / Getty Images
In This Article

One of the lesser-known consequences of meningitis is hearing loss. It is a condition that may affect as many as 50% of people diagnosed with certain forms of bacterial meningitis, mainly younger children. Once severe hearing loss occurs, it tends to improve little over time.

However, if diagnosed early, there are treatment approaches that may reduce the risk of hearing loss in children or adults. If permanent impairment occurs, treatment may involve hearing aids, cochlear implants, and support from hearing specialists and therapists.

Risk Factors

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, called the meninges. It is most commonly caused by a bacteria or virus but can also be the result of a fungal or parasitic infection as well as non-infectious causes (such as brain surgery, lupus, head trauma, certain medications, or cancers affecting the central nervous system).

Hearing loss is almost always associated with bacterial meningitis. According to a 2010 review in the journal Pediatrics, hearing loss can affect anywhere from 30% to 50% of people with pneumococcal meningitis, 10% to 30% of those with Haemophilus influenzae type B meningitis, and 5% to 25% of those with meningococcal meningitis.

Younger age and the rapid development of severe meningitis symptoms—including high fever, vomiting, seizures, light sensitivity, and bulging of the fontanelle ("soft spot") in infants—are the key risk factors for hearing loss.

The use of antibiotics—central to the treatment of bacterial meningitis—can further increase the risk of severe hearing impairment, as can a low leukocyte blood count (under 15,000 cells per microliter).

Hearing loss is considered rare with viral meningitis, with a number of studies suggesting little to no association. Fungal and parasitic meningitis are even less likely causes.

Why Hearing Loss Occurs

With severe meningitis, bacteria, bacterial toxins, or inflammatory compounds produced by the body to fight infection can infiltrate the inner ear and cause damage to nerve fibers and auditory cells in the cochlea (known as hair cells).

Outer hair cells are responsible for amplifying low-level sounds that enter the cochlea. Inner hair cells transform the sound vibrations into electrical signals that are relayed to the brain via the auditory nerve.

Because inner hair cells of the cochlea do not regenerate, any damage incurred tends to be permanent.

Less commonly, septicemia (blood infection) can accompany meningitis if the infection cuts off the blood flow to the cochlea or auditory nerve. In such cases, sensorineural hearing loss may occur, a condition that is almost invariably permanent.

Children are at a greater risk of hearing loss because the organs of the ears are still developing. If a child has hearing loss after a severe bout of meningitis, there is a risk of ossification (excess bone growth) in the cochlea in the weeks and months that follow. This can make any existing hearing loss worse and the treatment more difficult. 

With that said, not all hearing loss is permanent. Children who have had meningitis can often develop a condition called glue ear in which the middle ear fills with a viscous fluid, causing the dulling of sounds. In most cases, glue ear will resolve on its without treatment, although some children may require the insertion of ventilation tubes to help drain the ear if the condition persists.

Other children or adults may develop a persistent ringing in the ear called tinnitus. This believed to be caused by damage to the auditory nerve, resulting in ongoing and abnormal electrical signals to the auditory cortex of the brain.

Diagnosis

Sadly, hearing loss caused by meningitis is not usually detected until the damage has already been done. However, you shouldn't assume that the hearing loss is permanent until a proper medical evaluation has been performed.

If the hearing is impaired during or immediately following an acute bout of meningitis, the general practitioner will examine the ear with a lighted scope (called an otoscope) to see if there is any evidence of fluid in one or both ears. With glue ear, there should not be any pain but only the dulling of sounds (as if cotton has been stuffed in the ear).

If the symptoms are severe, persistent, or worsening, an appointment with a hearing specialist, called an audiologist, would be scheduled. The audiologist would typically perform a battery of tests, including:

Tests like the OAE and ABR as especially important for infants and toddlers who are too young to answer questions to behavioral tests. if the hearing loss occurs in older children (or is only recognized when a child is older), behavioral testing is often most useful.

Younger children typically benefit from pure-tone testing (in which the child indicates when a sound is heard through earphones) or visual reinforcement audiometry (to see if a baby's or toddler's head turns when a sound is made).

Based on the findings, the audiologist may be able to characterize the type of hearing loss and recommend the appropriate treatment. Follow-up tests are usually recommended after 1, 2, 6, and 12 months to see if there is any improvement or deterioration in the person's hearing.

Treatment

The first-line treatment of acute bacterial meningitis are antibiotics delivered intravenously (through a vein), usually in a hospital. Unfortunately, just as meningitis can lead to hearing loss, potent antibiotic therapy can also cause impairment because certain types are ototoxic (toxic to the ear or its nerve supply). These include antibiotics such as:

  • Amikacin
  • Erythromycin
  • Gentamycin
  • Kanamycin
  • Minocycline 
  • Netilmicin
  • Streptomycin 
  • Tobramycin
  • Vancomycin

To counter this effect, corticosteroid drugs may be prescribed if there is an abrupt loss of hearing or the inflammation (as measured by blood tests) is extreme and sudden. Corticosteroids help reduce inflammation and, by doing so, may reduce the risk of auditory nerve damage.

Dexamethasone is the most commonly used antibiotic, although hydrocortisone and prednisone are also sometimes prescribed. The antibiotic may be delivered intravenously or by intratympanic injection into the ear canal.

According to 2015 Cochrane review of studies, corticosteroids reduce the rate of severe hearing loss from 9.3% to 6% and the rate of hearing impairment from 19% to 13.8%.

Time of the essence where acute meningitis is concerned. Studies have shown that children who are pretreated with antibiotics prior to hospitalization are at greater risk of hearing loss, suggesting that the rapid onset of inflammation combined with ototoxicity affects the hearing early on in the infection.

Even if hearing loss has already occurred, early diagnosis can identify the onset of ossification and allow for a successful cochlear implant before the bony overgrowth makes implantation impossible.

in addition to cochlear implants, other common treatments for hearing loss include hearing aids, speech and language therapy, auditory-verbal therapy, and teachers for the deaf.

When to See a Doctor

Hearing loss may not be immediately obvious after meningitis. Because of this, you need to be on the lookout for sign of impairment, especially in smaller children and babies. Among some of the key signs of childhood hearing loss:

  • The baby may not be startled by sudden loud noises.
  • Older infants, who should respond to familiar voices, show no reaction when spoken to.
  • A young child may favor one ear when spoken to or turn the good ear toward a sound they want to hear.
  • Children should be using single words by 15 months and simple two-word sentences by 2. If they do not reach these milestones, hearing loss may be the cause.

As a general rule, anyone who has had bacterial meningitis should have a hearing test as soon as possible. All hearing losses are different and generally require repeat tests to get a qualified evaluation of one's hearing.

A Word From Verywell

As scary as meningitis can be to a parent of a child or teen, there are vaccines that can help prevent two of the three most common types of bacterial meningitis.

According to the Centers for Disease Control and Prevention, all 11- to 12-year-olds should get a single dose of the meningococcal conjugate (MenACWY) vaccine along with a booster shot at age 16. Teens and young adults 16 through 23 may also get the serogroup B meningococcal (MenB) vaccine.

If prescribed as directed, the vaccines are between 85% and 100% effective.

Meningitis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man
Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Peltola H, Roine I, Fernández J, et al. Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. Pediatrics. 2010;125(1):e1-8. doi:10.1542/peds.2009-0395

  2. Centers for Disease Control and Prevention. Meningitis. Updated March 13, 2019.

  3. BC Children's Hospital/Provincial Health Services Authority. Audiology clinical practice guideline: meningitis. June 2013.

  4. Williamson JV. An overview of the symptoms and management of glue ear. Br J School Nursing. 2014 Sep;9(7):335. doi:10.12968/bjsn.2014.9.7.335

  5. Walker JJ, Cleveland LM, Davis JL, Seales JS. Audiometry screening and interpretation. Am Fam Physician. 2013 Jan 1;87(1):41-7.

  6. Rodenburg-Vlot MBA, Ruytjens L, Oostenbrink R, Van der Schroeff MP. Repeated audiometry after bacterial meningitis: consequences for future management. Otol Neurotol. 2018 Jun;39(5):e301-6. doi:10.1097/MAO.0000000000001808

  7. Bisht M, Bist SS. Ototoxicity: the hidden menace. Indian J Otolaryngol Head Neck Surg. 2011;63(3):255-9. doi:10.1007/s12070-011-0151-8

  8. Brouwer MC, Mcintyre P, De Gans J, Prasad K, Van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2010;(9):CD004405. doi:10.1002/14651858.CD004405.pub3

  9. Brouwer MC, Tunkel AR, Van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467-92. doi:10.1128/CMR.00070-09

  10. Roukema BY, Van Loon MC, Smits C, et al. Cochlear implantation after bacterial meningitis in infants younger than 9 months. Int J Otolaryngol. 2011;2011:845879. doi:10.1155/2011/845879

  11. World Health Organization. Childhood hearing loss: strategies for prevention and care. March 3, 2016.

  12. Centers for Disease Control and Prevention. Meningococcal vaccination. Updated March 18, 2019.