Abstract
BACKGROUND: Acute community-acquired bacterial meningitis remains a significant global health concern with significant mortality and morbidity, including neurological sequelae such as sensorineural hearing loss (SNHL). Early detection of meningitis-associated SNHL mitigates permanent deafness and poor outcomes, including cognitive decline, social isolation, and mental health disorders. This systematic review evaluates the optimal time point(s) to perform formal audiological diagnostic testing and follow-up in adult and pediatric meningitis patients to effectively detect hearing loss (HL) outcomes. METHODS: A literature search was conducted across Medline, Embase, and Cochrane databases. Studies reporting the time frames for HL detection secondary to acute meningitis using formal audiological tests were included. Data were analyzed descriptively for continuous and categorical variables. A meta-analysis calculated the pooled prevalence of outcomes, with subgroup analyses stratified by the time frame of audiological diagnostic assessment. RESULTS: A total of 41 studies were included, with n = 8105 meningitis patients comprising n = 1397 (17.2%) adults and 6708 (82.8%) children. In adults, most audiological testing occurred post-discharge (n = 530 vs. n = 145), yet the proportion of hearing loss diagnoses was higher before discharge than after (45.5% vs. 42.5%). Similarly, more audiological assessments were administered post-discharge compared to pre-discharge (n = 3340 vs. n = 1975) in children, but HL diagnoses were more frequent before discharge (33.9% vs. 25.3%). The pooled prevalence of HL diagnoses during hospitalization or at discharge was 30.4% (95% CI 22.9-38%), compared to 22.9% (95% CI 12.6-33.1%) within 1 month post-discharge, 20.3% (95% CI 8.8-31.9%) between 30 and 60 days post-discharge, 22.7% (95% CI 12.1-33.4%) between 60 and 180 days post-discharge, and 10.8% (95% CI 5.9-15.7%) more than 180 days after discharge. CONCLUSIONS: The considerable variability in the time frame of audiological test administration following an acute meningitis episode highlights the need for standardized auditory evaluations after meningitis diagnosis. Our findings emphasize that as hearing loss may occur and recover at different stages after an infectious meningitis episode, coordinated hearing assessments at discharge and during follow-up are important to ensure adequate detection and care.