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July 31, 2003

Hearing Implants Rarely Linked with Meningitis

From: Reuters, UK - Jul 31, 2003

By Karla Gale

NEW YORK (Reuters Health) - Children with cochlear implants, surgically placed devices that allow a deaf person to hear, are at increased risk of bacterial meningitis, according to a report in The New England Journal of Medicine for July 31. Even so, this complication is quite rare, the authors of the study point out.

Since June of 2002, the three manufacturers of these implantable hearing devices have notified the Food and Drug Administration of reports of bacterial meningitis after the surgery. Therefore, the FDA, the Centers for Disease Control and Prevention, and state and local health departments conducted studies to determine the rate of this complication and to examine risk factors.

Dr. Jennita Reefhuis, of the CDC in Atlanta, and colleagues identified 29 episodes of bacterial meningitis among 4264 children who received a cochlear implant in the US between 1997 and August of 2002. Since September, six more cases occurred.

Nine episodes occurred around the time of surgery, while the rest occurred more than 30 days after surgery. Children who had an implant with a Silastic positioner, and those with inner-ear malformation and a cerebrospinal fluid leak were at higher risk for the infection.

The company that marketed the implants with a positioner recalled those products in July of 2002.

The authors recommend that patients be vaccinated at least 2 weeks before surgery against S. pneumonia and H. influenzae, and they emphasize that parents and doctors watch out for symptoms of meningitis.

However, they do not advocate removal of the implant, although this was done in three of the children.

"There are imaginable situations where it might not be wise to implant these devices," but those are rare, Dr. Reefhuis told Reuters Health. "If a child has all the potential risk factors for developing meningitis and a low odds of benefit from an implant, then I can imagine parents choosing not to have one implanted."

"In general, people should make an informed decision with all the information that is out there, of which this investigation is just a part," she added.

Dr. George A. Gates and Richard T. Miyamoto support these recommendations in an accompanying editorial. Dr. Gates is associated with the University of Washington in Seattle, and Dr. Miyamoto is on faculty at Indiana University School of Medicine in Indianapolis.

They also remind the public that "for most adults and children with severe-to-profound hearing loss, the use of an implant is the only viable choice for effective oral communication," and that complications are rare. SOURCE: The New England Journal of Medicine, July 31, 2003.

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