Pneumococcal meningitis post-cochlear implantation: preventative measures.
OBJECTIVE
Both clinical data and laboratory studies demonstrated the risk of pneumococcal meningitis post-cochlear implantation. This review examines strategies to prevent post-implant meningitis.


METHODS
Medline/PubMed database; English articles after 1980. Search terms: cochlear implants, pneumococcus meningitis, streptococcus pneumonia, immunization, prevention.


METHODS
Narrative review. All articles relating to post-implant meningitis without any restriction in study designs were assessed and information extracted.


RESULTS
The presence of inner ear trauma as a result of surgical technique or cochlear implant electrode array design was associated with a higher risk of post-implant meningitis. Laboratory data demonstrated the effectiveness of pneumococcal vaccination in preventing meningitis induced via the hematogenous route of infection. Fibrous sealing around the electrode array at the cochleostomy site, and the use of antibiotic-coated electrode array reduced the risk of meningitis induced via an otogenic route.


CONCLUSIONS
The recent scientific data support the U.S. Food and Drug Administration recommendation of pneumococcal vaccination for the prevention of meningitis in implant recipients. Nontraumatic cochlear implant design, surgical technique, and an adequate fibrous seal around the cochleostomy site further reduce the risk of meningitis.
Wei
Benjamin P C
BP
Department of Otolaryngology, Bionic Ear Institute, University of Melbourne, Melbourne, Victoria, Australia. bwei@bionicear.org
Shepherd
Robert K
RK
Robins-Browne
Roy M
RM
Clark
Graeme M
GM
O'Leary
Stephen J
SJ
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants / Q000009:adverse effects*; D016503:Drug Delivery Systems; D007758:Ear, Inner / Q000293:injuries* / Q000473:pathology; D004566:Electrodes; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D012307:Risk Factors; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines