CNS Infections Effect on the Inner Ear

Nordsjaellands Hospital

Status: Unknown

Conditions: Inner Ear Inflammation; Vestibular Abnormality; Inner Ear Hearing Loss; CNS Infection; Hearing Loss, Sensorineural

Treatments: Diagnostic Test: Biomarker; Diagnostic Test: MOCA, eGOS; Diagnostic Test: Vestibular function; Diagnostic Test: Audiometry; Diagnostic Test: OAE/WBT

Study type: Observational

Funder types: Other

Identifiers

NCT03715569

PM52008

Details and patient eligibility

About

Study on patients with CNS infections.

Full description

Aims and objectives:

The present proposal aims to improve the outcome from central nervous system infections (CNS) by improving the understanding of when and why patients develop hearing loss and other neurological sequelae. The investigators will elucidate the temporal development and restitution of a sensorineural hearing loss and will clarify if any therapeutic window exists, where sequelae can be limited.

Also the investigators will investigate if communication between cochlea and cerebrospinal fluid is a window to the intracranial pressure.

Background:

CNS infections remain diseases with high mortality and morbidity. Among survivors from bacterial meningitis, 30 % suffer hearing loss or deafness arising from injury to the inner ear - the cochlea. From previous work it is known that brain inflammation, brain edema and subsequent pressure changes can be transduced to the inner ear due to communication between the cochlea and cerebrospinal fluid (CSF).

The viability of cochlear hair cells can evaluated by non-invasive measurement of otoacoustic (OAE) emissions which are low-intensity sounds from the cochlea (OAE).

Methods and materials:

The investigators will perform repeated measurements of OAE and Wide Band tympanometry (WBT) in all patients admitted with suspicion of a CNS infection. OAE and WBT will be compared to intracranial pressure (ICP) measured during lumbar puncture as well as clinical-, biochemical- and imaging data. An age-matched control group will be included. At discharge and at follow-up patients will receive a neurological, vestibulare examination, cognitive test and a regular hearing test.

Expected outcome and perspectives:

From repeated measures during a course of disease, the investigators will elucidate the development of a hearing loss and clarify if any therapeutic window exists, where sequelae can be limited. This is also an opportunity to assess OAE as a non-invasive measure of intracranial pressure which is believed to be among the clinical complications responsible for a poor outcome.

Enrollment: 700 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients with a CNS infection admitted to the hospital.

Exclusion criteria

• Patients with known hearing loss

Trial design

700 participants in 5 patient groups

Cohort with CNS infections

Description:

Otoacoustic emissions (OAE), Wide Band Tympanometry (WBT), Vestibular function tests. Audiometry. MOCA, eGOS are cognitive tests. Biomarker is a protein found in the inner ear examined in the cerebral fluid.

Treatment:

Diagnostic Test: MOCA, eGOS

Diagnostic Test: Biomarker

Diagnostic Test: OAE/WBT

Diagnostic Test: Vestibular function

Diagnostic Test: Audiometry

OAE/WBT control: Healthy individuals

Description:

Otoacoustic emissions in normal position with head. Otoacoustic emission in different head positions.

Treatment:

Diagnostic Test: OAE/WBT

OAE/WBT control: Systemic infection

Description:

Otoacoustic emission during admission

Treatment:

Diagnostic Test: OAE/WBT

OAE/WBT control: ICP changes

Description:

Otoacoustic emission on patients without an CNS infection before and after elective lumbare puncture with measurement of intracranial pressure (ICP).

Treatment:

Diagnostic Test: OAE/WBT

Biomarker control

Description:

Inner ear biomarkers in patients without CNS infection. Inner ear fluid examination from patients that underwent elective cochlea implantation.

Treatment:

Diagnostic Test: Biomarker