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Background Bacterial meningitis is the commonest cause of acquired deafness (Fortnum, 1992) resulting in permanent sensorineural hearing loss (SNHL). Therefore, early audiological assessment is essential (Rahko et al, 1984). Currently, Streptococcus pneumoniae and Neisseria meningitidis are the most common organisms responsible for bacterial meningitis (Kutz et al, 2006). Labyrinthine ossification, a significant and rapid otological emergency, is more common after infection with Streptococcus pneumoniae (Douglas et al, 2008). Objectives The primary objective was to determine the post-meningitis auditory complications. The secondary objectives were to determine the pathogen, neuro-radiological changes and to ascertain the relationship with the auditory deficit. Methods This was a retrospective case-note audit of children who had at least 1 audiological assessment in a tertiary children’s hospital in UK following referral to the Audiovestibular Department with suspected or confirmed meningitis and/or septicaemia. Referrals made within 24-months (1st January 2018 to 31st December 2019) were considered. Patients that did not have an audiological assessment (e.g. child returned home and out of catchment area) were excluded. The audiological results (degree, type and laterality of deafness), microbiological details, radiological changes and audiological intervention were recorded. Results During the 24-months, 44 children had at least one audiological assessment following suspected or confirmed meningitis and/or sepsis. The majority were in-patient ward referrals (n=38, 86%) and others were from various referral sources (General Paediatric clinic, Newborn Hearing Screening Programme, Speech Therapist and Health Visitor). The age on admission ranged from 2days (2 children) to 16 years. 9 (20%) babies were As per British Society of Audiology guidelines, 39 children (89%) had satisfactory hearing on soundfield or ear-specific tests. 2 children had bilateral severe-to-profound SNHL. Further 2 had unilateral SNHL. One had unilateral conductive hearing loss due to underlying otitis media with effusion. Of the two with bilateral SNHL, one had Neisseria meningitides and bilateral significant labyrinthine ossification on neuro-radiology. The other had Streptococcus parasanguinis and intracranial fluid collections over the left cerebellar hemisphere and right frontal lobe. They both eventually underwent cochlear implantation for hearing rehabilitation. The microbiological profile of the cohort included Neisseria meningitides (including the above child) (n=15, 34%), Enterovirus (n=8, 18%), Streptococcus agalactiae (n=6, 14%), Streptococcus pneumoniae and E. coli (4 each), culture negative but neutrophilia in cerebrospinal fluid samples (n=3) and 1 each with Haemophilus influenzae, Streptococcus parasanguinous (above bilateral SNHL), Streptococcus gallalyticus and unknown organism. Post-meningitis neuro-radiological changes were noted in about 30% of children. These included bilateral labyrinthine ossification (n=1, above child), non-cystic focal lesions (n=5), significant intracranial fluid collections (including hydrocephalus) (n=4), subdural effusions (n=2) and gliosis (n=1). Conclusions The most prevalent organism in our cohort was Neisseria meningitides and 1 child had significant rapid cochlear ossification needing urgent cochlear implantation. Pneumococcal meningitis can result in unilateral SNHL (2 children). 30% of children had labyrinthine and intra-cranial radiological changes. Therefore, it is vital to consider the micro-organism, radiological findings and correlate these with the audiological findings to ascertain the audiological risk and prognosis after meningitis in children.

Background Vestibular Migraine (VM) and the migraine variant Benign Paroxysmal Vertigo of childhood (BPV) are the commonest causes of vertigo in childhood (Langhagen et al., 2016). Studies suggest VM and BPV are the cause in between 24–56% of childhood vertigo (Brodsky et al., 2016). Between 2–10.6% of school age children are affected by VM/BPV (O’Reilly et al, 2012). VM is a clinical diagnosis with no specific vestibular diagnostic features or other biomarkers (Langhagen et al, 2016). Whilst there are numerous studies on VM in adult patients, there is a paucity of evidence in paediatric patients, particularly on clinical characterisation. Currently diagnosis and management strategies are largely based on evidence from adult populations (Kacperski and Bazarsky, 2017). Objectives This study aims to describe a large cohort of patients diagnosed with VM at a tertiary Audiovestibular Medicine unit, describing clinical presentation, examination, diagnosis, and management. We hope to raise awareness of this common and treatable condition in children and young adults. Methods This is a retrospective electronic case note review of all patients presenting to Audiovestibular Medicine clinics in a tertiary unit between January and December 2018. All patients who were given a diagnosis of vestibular migraine/migraine variant during this time, or who were patients being followed up with a known diagnosis of vestibular migraine/migraine variant, were identified. Clinical letters were reviewed looking specifically at: presenting symptoms (including headache and vertigo, other symptoms, medical comorbidities and impact of symptoms); clinical examination findings; diagnostic test findings (including vestibular diagnostics, blood tests and neuroimaging); treatment and overall outcome. Results 81 children were identified with a mean age at presentation of 10.3 ±3.8 years (range 2–17). 53% were female. 65% reported episodes beginning ≥2 years ago. No headache was reported in 29 children, however photophobia and phonophobia were common (68 and 54 children respectively). Otological symptoms were not uncommon with tinnitus present in 22 children. Comorbidities often included neurodevelopmental difficulties. Impact on schooling and extra-curricular activities was high for a subgroup of children. 31 children had episodes weekly or more frequently. Clinical examination showed abnormal oculomotor signs in 5/77 children tested (2 central and 3 peripheral) and abnormal neuro-vestibular findings in 14/78 children tested. Videonystagmography showed abnormalities in 30/75 patients tested (8 central and 8 peripheral oculomotor; 28 neuro-vestibular). Video Head Impulse Test showed significant saccades in 11/94 tests. 37% of children showed normal examination and diagnostic findings. Treatment included lifestyle measures, medication (for acute treatment or for migraine prophylaxis) and vestibular rehabilitation. The most commonly used medications in this cohort were Pizotifen (44), Propranolol (29) and Topiramate (10). Symptoms fully resolved or improved in most patients (79%) with treatment. Conclusions VM and migraine variants are a common diagnosis in children. Early recognition of clinical symptoms, appropriate diagnosis and treatment are important for effective management of these children.

BackgroundCoronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.MethodBamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.ResultsThere was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).ConclusionWearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.

Background Coronavirus disease 2019(Covid-19) Personal Protective Equipment (PPE) has been reported to effect communication in healthcare settings. We sought to identify those challenges experimentally. Method Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for speech intelligibility with and without PPE both at normal speech and raised voice. Results There was a significant difference in speech discrimination scores between normal and PPE wearing subjects in theatre simulated background noise levels (70dB). Conclusion PPE wearing can impact communication and efforts should be made to remind staff about this burden and seek alternative communication paradigms, particularly in theatre environments.

Dizziness and balance problems in children can be multifactorial. Awareness regarding these disorders is limited. This paper reviews the existing literature in this field to raise the awareness of the discipline that can generate significant morbidity in children. It looks in detail into epidemiology, the aetiology, the diagnostic algorithm and the management of dizziness and balance problems in children. An accurate history followed by the latest diagnostic algorithm with the latest vestibular test battery that are utilised in adults can be used in children that lead to the diagnosis. The aetiological profile and natural history of different pathologies can be different from that in adults. Most cases can be managed successfully with multidisciplinary cognitive and customised rehabilitation approach. Diagnosis and management of dizziness and balance disorders in children require experience and skill to yield the best outcome. Research is needed to study application of individual tests for diagnosis in children and the behaviour of vestibular and central disorders in children.

Semicircular canal dehiscence is a bony abnormality in the otic capsule especially involving the superior semicircular canal. Since its identification in 1998, there is significant research regarding the pathology in the adult population. This condition generates a third window effect that is well-described in the literature. However, the entity is rare in the pediatric population with limited research. Difficulties encountered in children are obtaining a direct history that is essential for the diagnosis followed by neurovestibular tests that may be difficult to perform. This study presents observations regarding different clinical and diagnostic aspects of semicircular canal dehiscences in children as a retrospective audit in a tertiary pediatric vestibular center. Of 580 children assessed in a 30 months period undergoing comprehensive functional and objective audiovestibular assessment, 13 children (2.2%) were detected to possess radiological semicircular canal dehiscences (high resolution computed tomography scans at 0.625 mm slices reformatted in the axial, coronal and sagittal planes). The right superior semicircular canal was most commonly affected (66.6%). There were 4 bilateral semicircular canal dehiscences. Clinical suspicion of the condition was raised with reliable surrogate history from carers or from older children (100%), a mixed or conductive hearing loss (80% of hearing losses) in the presence of normal impedance audiometry (92.3%), normal transient otoacoustic emissions (84.6%) on the side of the dehiscence and the presence of replicable pathological saccades in the video head impulse test (76.9%). Disequilibrium symptoms and typical third window symptoms were absent or difficult to elicit in children (46.15 and 30.76% respectively). Only 3 (0.5%) fulfilled the adult criteria of a superior semicircular canal dehiscence syndrome. The abnormal video head impulse test characterized by pathological saccades may affect other non-dehisced ipsilateral canals. Semicircular canal dehiscences are rare in children but may be considered as an etiology for hearing losses and imbalance. Children with semicircular canal dehiscence may present differently from the classical superior semicircular canal dehiscence syndrome found in adults.