Association between central serous chorioretinopathy and personality types: A systematic review and meta-analysis.

Meningitis is defined as the inflammation of the coverings of the brain or spinal cord. It remains a major global public health concern as morbidity and mortality from meningitis remain high. There were an estimated 2.51 million cases of meningitis worldwide in 2019 []. Approximately 20% of individuals affected with meningitis develop long‐term complications, and hearing loss (HL) is the most common one []. There is a classic triad of clinical presentation which consists of fever, neck stiffness, and altered mental status or headache. Constitutional symptoms, seizures, focal neurological deficits, and cranial nerve palsies can also be present []. Meningitis can be caused by either bacteria or virus. The most common cause of bacterial meningitis is , but and are other important causes []. It is particularly prevalent among individuals with contiguous infections, such as otitis media (OM), mastoiditis, and sinusitis []. Empiric antimicrobial treatment is indicated when bacterial meningitis is suspected, and early administration of systemic corticosteroids is indicated to reduce the risk of death and neurological complications, including HL, especially in pneumococcal and meningitis [, ]. Meningitis is a known potential complication of OM. is also the most common bacterial cause of acute OM. Otogenic meningitis is defined as the presence of concurrent OM in a case of meningitis. It is found in 31% of the cases []. The otogenic route, in which OM can access the central nervous system, occurs via direct and indirect pathways. The first includes normal anatomical pathways (the round and oval windows, modiolus, cochlear aqueduct, internal auditory canal) or areas of bone erosion [, , , ]. The latter includes haematogenous spread due to systemic bacteraemia or thrombosis of the emissary veins of the dura []. The concurrent OM can be identified through clinical presentation of otologic symptoms, alterations in otoscopy, imaging tests findings, or postmortem histopathology findings. In the cases of meningogenic route, the access to the inner ear is through cochlear aqueduct from the infected subarachnoid space, during the first days, and least likely via hematogenous invasion via the spiral ligament at later stages, as demonstrated in animal model studies [, ]. The prevalence of HL in pneumococcal meningitis ranges between 20% and 26%, and the prevalence of bilateral HL of at least 70 dB is 8% []. HL can occur at admission or during the disease course. Transient cases are usually associated with conductive disorders, and permanent HL is generally caused by the involvement of the eighth cranial nerve, cochlea, and labyrinth []. Labyrinthitis is the inflammation of the inner ear, and labyrinthitis ossificans is a process of ossification of the inner ear, which usually occurs after the first one. The latter is a known cause of permanent HL and of complicated cochlear implant electrode insertion. However, even cases without cochlear ossification may develop permanent hearing impairment requiring rehabilitation. Formal audiological screening tests should be performed as the goal is to minimize the time to initiation of early hearing rehabilitation. Unnecessary delays may increase the risk of rehabilitation failure, particularly due to cochlear ossification and its potential impact on cochlear implant feasibility []. Some studies have reported poorer rehabilitation outcomes after cochlear implant in some cases of post‐meningitis deafness even in the absence of cochlear ossification [, , ].