Incidence of meningitis and of death from all causes among users of cochlear implants in the United Kingdom.
BACKGROUND
During 2002, there was an increase in reports of bacterial meningitis among people with cochlear implants in Europe and North America. One model of implant, which included a space-occupying 'positioner', was recalled. Implantation of a positioner was shown to be a risk factor for meningitis among children in the United States. The situation in the United Kingdom was not known.


METHODS
We ascertained the cohort of people who had received cochlear implants with intra-cochlear electrodes in UK hospitals prior to 1 October 2002 and were permanently resident in the United Kingdom. We compared the incidence of meningitis, and the causes and incidence of death from all causes, between the cohort and reference populations.


RESULTS
Of 1851 children (66 with positioners), none had contracted meningitis. Neither the incidence rate of meningitis, nor the cumulative mortality from all causes, differed significantly between implanted children and values expected for the general population. Of 1779 adults (139 with positioners), five had contracted meningitis with three fatalities. No case of meningitis involved a positioner and four of the cases, including the fatalities, possessed risk factors unrelated to implantation. Although the incidence rate of meningitis was significantly higher in implanted adults than the general population, cumulative mortality from all causes was never higher, and was significantly lower at some time points after implantation.


CONCLUSIONS
Specific evidence of the association between bacterial meningitis and implantation with a positioner that arose in the United States and mainland Europe during 2002 has not been found in the United Kingdom.
Summerfield
A Q
AQ
MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK. aqs1@york.ac.uk
Cirstea
S E
SE
Roberts
K L
KL
Barton
G R
GR
Graham
J M
JM
O'Donoghue
G M
GM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants / Q000382:microbiology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D018563:Disease Notification; D004866:Equipment Contamination; D006801:Humans; D015994:Incidence; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000401:mortality*; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D011474:Prosthesis Design; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology