Presence of sensorineural hearing loss (>25 dB) was determined in 628 school-aged children born between 1986 and 1994 and survived non-Hemophilus influenzae type B (HiB) bacterial meningitis between 1990 and 1995 in a study at VU Medical Center, Amsterdam; and University Medical Center and Wilhelmina Children’s Hospital, Utrecht, the Netherlands. The incidence of hearing loss was 7%; unilateral in 20 (3%) and bilateral in 23 (4%). Hearing loss was severe (71-90 dB) or profound (>90 dB), and 5 received cochlear implants. Three quarters of the cases were detected at routine follow-up after meningitis. Risk factors for hearing loss were as follows: symptoms of meningitis for >2 days before admission, absence of petechiae, CSF glucose <0.6 mmol/L, Streptococcus pneumoniae, and ataxia. Based on this prediction rule of 5 factors, 62% of postmeningitic children were considered at risk. All cases of hearing loss were in this at-risk group. 
COMMENT. The inclusion of hearing evaluation in the routine follow-up of children after bacterial meningitis should prevent the missed diagnoses of hearing loss. The occurrence of prediction factors should mandate repeated hearing tests to rule out fluctuating or late onset hearing loss. Vaccination against S pneumoniae in children aged 2 years or older with certain risk factors (AAP Red Book 2000) may prevent some cases and may alter the prediction rule established in this study.
The omission of some important references from the current report is unfortunate. A seminal study and prospective evaluation of hearing impairment as a sequel of acute bacterial meningitis was reported by Dodge PR and colleagues .. Post-meningitic sensorineural hearing loss pre-1980 occurred in up to 30% of patients with pneumococcal meningitis, 10% of meningococcal, and 5-20% of H Influenzae type B meningitis. Regardless of the bacteria, type of antibiotic therapy, or use of dextromethasone, audiological assessment was recommended in all meningitis patients before or soon after discharge from hospital.
Another report emphasized psychological and educational adverse outcomes as well as deafness in a group of 130 children examined at a mean age of 8 years, and 6 years after meningitis (see Ped Neur Briefs June 1995) . In this Australian study, even with optimal therapy, one in 4 children who recovered from meningitis had severe or functionally significant disabilities that affected school performance.