gms | German Medical Science

Cochlear Implantation of patients with severe to profound sensorineural hearing loss allows the development of near-normal language skills and thereby a good social integration. As a big disadvantage in post-operative care, however, an – in comparison to the healthy reference group – up to 30-fold increased risk of evolving a bacterial meningitis has been reported. Inner ear malformations, which are frequently characterized by increased intracochlear pressure, are considered as further risk factors ("gusher phenomenon"). By drilling and opening up liquor-bearing cavities and inserting immunologically inert electrodes an artificial access way for pathogenic germs from the tympanic cavity and from blood circulation is created. The confirmed spectrum of pathogenic agents comprises Haemophilus influenzae b (Hib), Neisseria meningitides and mainly Streptococcus pneumoniae (Pneumococci), of which more than 90 different serotypes have been detected. For prophylaxis of invasive pneumococcal diseases (IPD) two different vaccine groups are used, whereas for children beyond 2 years three conjugated- and for patients older than the age of 2 an additional polysaccharide-vaccine are available. The first group offers protection against 7 or 13, the second one against 23 serotypes.

By means of a case report of an invasive pneumococcal meningitis after cochlear implantation the importance and necessity of a perioperative vaccination against Pneumococci is demonstrated. Particularly the serotype diversity and hence resulting problems are discussed, thereby claiming that a wide and premature vaccination of cochlear implant patients is reasonably.