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March 2003

Prevention of MeningitisCochlear Implants and Inner Ear Abnormalities

Arch Otolaryngol Head Neck Surg. 2003;129(3):279-281. doi:10.1001/archotol.129.3.279

RECENTLY, the Food and Drug Administration (FDA) issued a Public Health Web Notification that recipients of cochlear implants are at risk for meningitis.1 The FDA noted that 91 cases of meningitis were reported worldwide in patients who received implants, and a total of 17 known deaths resulted from this infection. Most patients were younger than 7 years, but some adults also developed meningitis; among the 52 cases reported from the United States, the age at onset ranged from 18 months to 84 years. The pathogenesis of the episodes of meningitis remains uncertain, but the design of the implant and the surgical technique may be factors. Also, importantly, the FDA recognizes that some deaf patients who are implant recipients may have congenital malformations of the inner ear that would increase their risk for meningitis; children with inner ear anomalies have successfully undergone implantation.2 The manufacturers of the implants and implant surgeons are currently investigating the possible roles that the devices and the surgical techniques have in precipitating these attacks; they are also studying methods of prevention. One implant was identified as a possible source of meningitis and was recently removed from the market.1,3 All otolaryngologists should be aware of methods to prevent meningitis both in patients who have undergone implantation or are candidates for an implant and in other patients who have sensorineural hearing loss associated with inner ear abnormalities, such as those with a history of labyrinthitis and/or otitic meningitis, regardless of age.

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