The World Health Organization has issued its first global meningitis guidelines which include recommendations about hearing loss screening and follow-up.
The evidence-based WHO guidelines on meningitis diagnosis, treatment and care launched in April 2025.
In line with the Defeating meningitis by 2030: a global road map, the WHO guidelines provide evidence-based recommendations for the clinical management of children and adults with community-acquired meningitis, including acute and long-term care.
They cover diagnosis, antibiotic therapy, adjunctive treatment, supportive care, and management of ongoing effects for viral and bacterial meningitis.
Improve care and outcomes
Australian contributors in the guidelines development group were paediatrican Dr Kate Milner from the Royal Children’s Hospital and the University of Melbourne, and disability and meningitis advocate Mr Bruce Langoulant AM, chairman of the Meningitis Centre Australia. Langoulant is father and co-carer of Ashleigh, who contracted pneumococcal meningitis at six months of age and as a result is profoundly deaf, has cerebral palsy and epilepsy.
“The inclusion of hearing loss screening and follow-up in the meningitis guidelines is a step forward,” he said.
“It acknowledges the long-term challenges survivors and typically their parents face and highlights the need for early detection and intervention.
“As someone who has witnessed the impact of profound deafness caused by pneumococcal meningitis, I believe this will drive change and help improve care and outcomes for survivors.
“Most importantly too is taking parents on an honest and open journey as the outcomes will vary with age and severity. Listening to parents is also an important factor in the relationship.”
The guidelines state that in 2019, there were an estimated 2.51 million cases and 236,000 deaths due to meningitis worldwide.
“The burden was greatest among children younger than five years of age, with 1.28 million cases and 112,000 deaths,” they state.
“Approximately one in five individuals affected by bacterial meningitis incurs long-term complications, including physical and neuropsychological sequelae, which may result in disability and have a profound impact on the quality of life.”
This includes hearing loss, with meningitis being one of the leading causes of acquired deafness.
“Hearing loss is probably the most common long-term effect of acute bacterial meningitis and occurs in a significant proportion of children and adults,” the guidelines state.
“It is more frequently associated with pneumococcal meningitis than any other form of bacterial meningitis and may occur at admission or during the disease course. Transient hearing loss is generally caused by a conductive disorder, while permanent hearing loss is associated with the involvement of the eighth cranial nerve, cochlea or labyrinth.”
Audiological screening
The guidelines strongly urge formal audiological screening be conducted before discharge in children and adults with acute meningitis from any cause.
“If audiological screening is not possible before discharge, it should be conducted within four weeks of discharge,” they state.
“When hearing loss is detected, urgent referral for hearing rehabilitation or evaluation for cochlear implantation should be arranged.
“This is crucial to prevent the rapid impairment of speech due to the loss of auditory feedback and to avoid cochlear ossification in individuals eligible for cochlear implantation.
“Individuals screened before discharge and found to have no hearing loss should undergo a second formal audiological screening test, as a small number may still develop hearing loss at a later stage.”
There is also a strong recommendation that children and adults with hearing loss from acute meningitis from any cause should be provided hearing rehabilitation as soon as possible.
Rehabilitation interventions include provision of, and training in, the use of hearing technologies (hearing aids, cochlear implants and middle ear implants), and speech and language therapy to enhance perceptive skills and develop communication and linguistic abilities.
Rehabilitation also includes training in the use of sign language and other means of sensory substitution such as speech reading, use of print on palm or Tadoma signed communication.
The guidelines found corticosteroids may reduce the risk of hearing loss in adults and children with pneumococcal meningtis.
The recommendations are intended to provide technical guidance for health care professionals working in first- or second-level health-care facilities, including emergency, inpatient and outpatient services, especially in low- and middle-income countries where the burden is greatest.
The WHO said the guidelines were also directed at policymakers, health-care planners and program managers, academic institutions, non-governmental and civil society organisations to inform capacity-building, teaching and research agendas.
Watch a webinar on the guidelines launch.
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