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Bacterial Meningitis Associated with Cochlear Implants

The benefits of these valuable devices come with a need to guard against infection.

Cochlear implants are surgically implanted devices that improve the sound perception of people with severe-to-profound hearing loss. In 2002, a manufacturer of cochlear implants notified the U.S. FDA of cases of bacterial meningitis associated with the device. In response, the CDC, the FDA, and numerous state and city health departments began an investigation to determine the incidence of and specific risk factors for this complication in 4264 children younger than 6 years who had received cochlear implants between January 1, 1997, and August 6, 2002.

Twenty-six children had 29 cases of bacterial meningitis. The incidence of meningitis caused by Streptococcus pneumoniae was 138.2 cases per 100,000 person-years (more than 30 times the incidence in a same-age general population). In a case-control study of the 26 children with bacterial meningitis and 200 children matched for implant manufacturer and year of implantation, multivariate analysis revealed that the risk was greatest for implants with a positioner (which were subsequently recalled) and for patients with a malformation of the inner ear or a cerebrospinal fluid leak. Although meningitis was more common in the perioperative period, the risk continued for the 6-year duration of follow-up.

Comment: The benefits of cochlear implants are clear, but the risks are significant. Physicians caring for children who receive these implants need to make sure that the children are properly immunized with Haemophilus influenzae type B and both 7- and 23-valent pneumococcal vaccines. Caretakers should be reminded that all unexplained febrile illnesses should be evaluated promptly. A detailed vaccination schedule for children with cochlear implants is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a5.htm#tab

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 8, 2003

Citation(s):

Reefhuis J et al. Risk of bacterial meningitis in children with cochlear implants. N Engl J Med 2003 Jul 31; 349:435-45.

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