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Meningitis in cochlear implant recipients: the North American experience
Noel L Cohen1, J Thomas Roland, Michelle Marrinan
1Department of Otolaryngology, NYU School of Medicine, New York, NY 10016, USA. Noel.cohen@med.nyu.edu
Introduction:
Until recently, postimplant meningitis was infrequently reported and felt to be uncommon. However, in the spring of 2002, there was a sudden increase in the number of reported cases of postimplantation meningitis in both Europe and North America.
Objective:
Because complications of surgery often tend to be underreported, we decided to survey all cochlear implant centers in North America to determine the true incidence of postimplant meningitis and to learn more about the demographics and risk factors.
Study Design:
We conducted a prospective study. A survey instrument was designed asking surgeons the number of implants performed and whether they had seen any cases of meningitis after implantation. If the answer was affirmative, they were asked to respond to a 20-point questionnaire. This instrument was sent to all 401 cochlear implant centers in North America.
Setting:
Tertiary care referral centers.
Patients:
We studied all patients having received cochlear implants in North America.
Main Outcome Measures:
Number of cases of postimplant meningitis, age of patients, device used, cochlear and temporal bone abnormalities, treatment, and outcomes.
Results:
Meningitis is more common than previously thought. Risk factors included young age, cochlear dysplasia, temporal bone abnormalities, and the use of a two-part electrode system. This survey led to the involvement by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention in a much more intensive analysis of a subset of the cases.
Conclusions:
Postimplant meningitis is related to patient, surgical, and device factors. By being aware of the risk factors involved, adhering to sound surgical principles such as packing of the cochleostomy with soft tissue, appropriately vaccinating patients, and eliminating any potentially traumatic electrode arrays, the incidence of meningitis should be significantly diminished.
Insights
Post-implant meningitis is more common than previously believed, with young age and specific device factors increasing risk. Awareness and preventative measures can significantly reduce meningitis incidence after cochlear implantation.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Otolaryngology
Background:
- Postimplant meningitis was historically considered rare but saw an increase in reported cases in 2002.
- This rise prompted a comprehensive investigation into its incidence and contributing factors.
Purpose of the Study:
- To determine the true incidence of postimplant meningitis in North America.
- To identify demographic and risk factors associated with postimplant meningitis.
Main Methods:
- A prospective survey was distributed to all 401 cochlear implant centers in North America.
- The survey collected data on implant numbers, meningitis cases, patient demographics, device details, and outcomes.
Main Results:
- Meningitis following cochlear implantation is more frequent than previously recognized.
- Identified risk factors include younger patient age, cochlear dysplasia, temporal bone abnormalities, and two-part electrode systems.
Conclusions:
- Postimplant meningitis is associated with patient-specific, surgical, and device-related factors.
- Implementing preventative strategies like proper surgical techniques, vaccination, and careful electrode selection can decrease meningitis incidence.