A 3-year-old child developed profound bilateral sensorineural deafness after pneumococcal meningitis six weeks ago. MRI shows enhancement of the cochlear lumen and HRCT suggests early ossification of the basal turn of the cochlea. Auditory brainstem responses are absent bilaterally. What is the most appropriate management plan?
- A Wait 12 months to allow spontaneous recovery before deciding on implantation
- B Proceed with cochlear implantation urgently rather than waiting the usual observation period ✓
- C Offer an auditory brainstem implant as first-line treatment
- D Fit powerful conventional hearing aids and reassess yearly
Correct answer: B. Proceed with cochlear implantation urgently rather than waiting the usual observation period
Explanation
Post-meningitic labyrinthine ossification can progress within weeks to months, obliterating the scala tympani and making complete electrode insertion impossible. Once deafness is confirmed as permanent by absent ABRs, current practice is to implant early, ideally within two to three months of the meningitis, instead of following the routine observation window. Waiting a full year risks losing the opportunity for a standard scala tympani insertion altogether.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.