Hearing Loss among Patients With Acute Bacterial Meningitis Treated With Corticosteroids as Adjunctive Therapy: A Systematic Review and Meta-analysis
Jesabelle Dominguez Garcia1, Sherly Baez Arias2, Michelle Quezada Genao1, Marcos Brea Montes de Oca3, Milagros Niquen-Jimenez4, Natanael Duarte5
1Pontificia Universidad Catolica Madre y Maestra (PUCMM), Santiago, Dominican Republic, 2Universidad Autónoma De Santo Domingo, DR, 3Department of Knowledge Management and Epidemiology, Diagnostic Centers and Advanced Medicine and Telemedicine and Medical Conference (CEDIMAT), Santo Domingo, DR, 4Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru, 5Department of Medicine, Holy Name Medical Center, New Jersey, USA
Objective:
To evaluate the effect of adjunctive corticosteroid therapy on the risk of hearing loss in patients with acute bacterial meningitis (ABM).
Background:
Acute bacterial meningitis remains a serious infection associated with high rates of mortality and long-term neurological sequelae, including hearing loss. Inflammation of the subarachnoid space can lead to cochlear damage, making auditory impairment one of the most frequent and disabling complications among survivors. Corticosteroids have been used as adjunctive therapy to reduce meningeal inflammation and prevent neurological damage; however, their effectiveness in preventing hearing loss remains uncertain.
Design/Methods:
A systematic review of RCTs and cohort studies following the PRISMA guidelines was conducted. Eligible studies involved patients ≥14 years with ABM treated with corticosteroids as adjuvant. Searches covered PubMed, EMBASE, Cochrane Library and Scopus (2000-2025). The primary outcome was Hearing loss by Pure Tone Audiometry. Covidence was used for screening and data extraction. A meta-analysis was performed using random-effects (Hartung–Knapp) in RStudio.
Results:
Two RCTs (n= 238) were included, with 160 males (67.2%). All patients received dexamethasone during the first four days of hospitalization. In the dexamethasone group (n= 121), 42.1% had hearing loss and 25.4% of them were severe. In the placebo group (n= 115), 47.8% had hearing loss and 45.4% severe. Pooled analysis showed no difference for any hearing loss (RR = 0.83; 95% CI, 0.52–1.32; p = 0.25), but a reduced risk for severe loss (RR = 0.48; 95% CI, 0.26–0.89; p = 0.03).
Conclusions:
Dexamethasone as adjunctive therapy showed no significant benefit in preventing any hearing loss, but it effectively reduced the likelihood of severe auditory impairment among patients with ABM.
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