<prompt> In a small child diagnosed with H.influenza meningitis, what investigation must be done before discharging him from the hospital ?BERAMBICT scanX-ray skull  <response>: Clinical description : Bacterial meningitis is characterized by acute onset of fever usually 38.5 degC rectal or 38.0 degC axillary, headache and one of the following signs: neck stiffness, altered consciousness or other meningeal signs. Hib, meningococcal meningitis and pneumococcal meningitis cannot be differentiated on clinical grounds alone Laboratory criteria for diagnosis Bacterial meningitis can be confirmed by three methods. 1 Culture method: isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood. 2 Antigen detection methods: identification of a bacterial antigen in normally sterile fluids i.e. CSF or blood by such methods as latex agglutination or counterimmunoelectrophoresis CIE. 3 Gram stain results Case classification Suspected: Any person with sudden onset of fever 38.5 degC rectal or 38.0 degC axillary and one of the following signs: neck stiffness, altered consciousness or other meningeal sign Probable: A suspected case with CSF examination showing at least one of the following: - turbid appearance; - leukocytosis 100 cellsmm3; - leukocytosis 10-100 cells mm3 AND either an elevated protein 100 mgdl or decreased glucose 40 Confirmed: A case that is laboratory-confirmed by growing i.e. culturing or identifying i.e. by Gram stain or antigen detection methods a bacterial pathogen Hib, pneumococcus or meningococcus in the CSF or from the blood in a child with a clinical syndrome consistent with bacterial meningitis. Acute bacterial meningitis ABM constitutes 1.5 of all admissions in the pediatric ward with a mean case fatality of 16. Sensorineural hearing loss SNHL is the most common neuropsychological sequel of ABM. It occurs in as many as 30 of patients with pneumococcal meningitis, 10 with meningococcal meningitis and 5-20 with Haemophilus influenzae type ;b; meningitis.The effect of SNHL on language is well-recognized and therefore early detection is mandatory. However, hearing assessment is difficult in infants and young children. Brainstem evoked response audiometry BERA can help to assess hearing in this population. BERA is a helpful tool for screening of SNHL, especially in the young children and infants in whom other conventional methods may not be of much use. There is significantly increased risk of developing SNHL if the CSF has increased cells, paicularly polymorphs and proteins. Reference: GHAI Essential pediatrics, 8th edition 