Supplementary file 3: Studies reporting meningitis cases with different risk factors.

Table 1: Studies reporting all cochlear implantations occurring from 2003 onwards.

Study name Year Cochlear implantation year range No. of No. of

publishe patient meningitis
d s
Earliest year where Last year where
implantation implantation
occurred occurred
Afsharpaiman 2014 2007 2010 371 1
et al.
Ajallouyean et 2011 2006 2009 262 1
al.
Almosnino et 2018 2013 2017 188 0
al.
Amin et al. 2021 2008 2017 64 0
Awad et al. 2018 2014 2016 163 0
Broomfield et 2014 2010 2011 961 1
al.
Ciorba et al. 2012 2003 2009 438 0
Dalgic et al. 2021 2003 2019 97 0
Darlong et al. 2015 2007 2012 190 0
Dia et al. 2014 2011 2013 21 0
Eftekharian et 2019 2008 2018 18 0
al.
Estomba et al. 2017 2005 2015 57 0
Fakurnejad et 2020 2003 2016 3420 3
al.
Freni et al. 2020 2005 2018 202 0
Googe et al. 2016 2003 2014 156 0
Grover et al. 2021 2012 2019 25 0
Gudis et al. 2012 2009 2011 120 0
Guldiken et al. 2011 2007 2009 148 1
Halawani et al. 2019 2006 2017 1027 0
Halawani et al. 2020 2014 2018 177 0
Hao et al. 2015 2011 2014 24 0
Hashemi et al. 2012 2003 2009 275 1
Jeong et al. 2021 2009 2017 31 0
Jiang et al. 2016 2006 2015 1014 0
Kitano et. Al. 2021 2005 2018 70 0
Lavinsky et. Al. 2010 2003 Not stated 50 0
Li et al. 2014 2010 2013 260 0
Nisenbaum et 2020 2011 2016 246 0
 al.
Parent et al. 2020 2012 2016 5728 0
Piromchai et al. 2021 2016 2020 458 9
Polo et al. 2016 2004 2013 104 0
Sayed-Hassan 2019 2011 2015 1157 0
et al.
Sharma et al. 2021 2012 2020 24 0
Shiras et al. 2018 2006 2015 213 0
Smeds et al. 2017 2007 2015 10 0
Sokolov et al. 2016 2009 2013 118 1
Yang et al. 2020 2012 2018 89 0
Total 17976 18

Table 2: Studies reporting prophylactic antibiotic use.

 Study Year Antibiotic prophylaxis
name published

No. of No. of Antibiotics used for Time of administration Duration of

patients meningitis prophylaxis administration
implanted in this
who group
received
prophylac
tic
antibiotic
s
Ahn et al. 2008 73 0 Ceftizoxime Intraoperative and Given IV during surgery
postoperative and for the next 5 days.
Ajallouyea 2011 262 1 Ceftriaxone Intraoperative and 1 dose at induction and 2
n et al. postoperative further doses within 24
hours intravenously
Almosnin 2018 188 0 1st or 2nd generation Pre-operative and 30 minutes before
o et al. cephalosporins. postoperative surgery and for 5 days
postoperatively
Clindamycin,
vancomycin, or
trimethoprim/sulfame
thoxazole were used in
penicillin-allergic
patients
Awad et 2018 163 0 Not stated Intraoperative and During surgery and for 7
al. postoperative days postoperatively
Bhatia et 2004 300 0 Cefradine Intraoperative and 1 dose at induction and
al. postoperative two additional doses
within 24 hours
Black et 2007 228 0 Piperacillin, Postoperative IV piperacillin,
al. tazobactam, amikacin tazobactam, amikacin for
and co-amoxiclav 24 hours, followed by
oral co-amoxiclav for 7
days
Brito et al. 2012 550 1 Ceftriaxone or Postoperative 7 days oral antibiotics
cefalexin
Freni et 2020 202 0 Not stated Not stated 5 days of broad-spectrum
al. antibiotics by injection
Garrada 2021 148 0 3rd generation Intraoperative and Given IV intraoperatively
et al. cephalosporin postoperative and continued orally for
10 days after the surgery
Grover et 2021 25 0 Not stated Postoperative Given 3 days oral
al. antibiotics
Gysin et 2000 102 0 1st generation “Perioperatively” and All patients received a
al. cephalosporin postoperatively perioperative dose of IV
antibiotic. Postoperative
oral antibiotics were
given to half the patients
for 7 days.

Halawani 2019 892 0 Cefuroxime Perioperative “Perioperative injection”

et al.
Jiang et al. 2016 1014 0 Not stated Postoperative 3 days
Lavinsky 2012 50 0 Not stated “Perioperative” and Given perioperatively
et al. postoperative and continued for 7 days
 post-op
Lescanne 2011 140 0 Not stated Postoperative 7 days oral antibiotics
et al.
Nisenbau 2020 212 0 Not stated 62 patients: Not stated
m et al. intraoperatively
150 patients:
postoperatively
Ovesen et 2009 300 1 Not stated "Perioperatively” Not stated.
al.
N.B. Those with inner ear
malformations, prior
meningitis or skull base
fractures received 24h IV
antibiotics after surgery
followed by oral
antibiotics for 1 week.
However, the numbers of
these are not stated.
Sayed- 2019 1157 0 Includes Augmentin, Postoperative ≤ 48 hours = 523 patients
Hassan et cefazolin, cloxacillin > 48 hours = 634 patients
al. sodium
Sharma et 2021 24 0 Not stated Postoperative Given 3 days oral
al. antibiotics
Shiras et 2018 213 0 Cefuroxime Intraoperative Through surgery
al.
Smeds et 2017 10 0 Cefuroxime and Intraoperative and Given cefuroxime 30
al. amoxicillin postoperative minutes before surgery
and amoxicillin orally for
7 days post-op
Stamatiou 2011 212 0 Not stated Intraoperative Through surgery
et al.
Szymanski 2016 19 0 Dependent on "Perioperative" Not stated
et al. preoperative bacterial
culture of chronic
otitis media. Most
commonly, second-
generation
cephalosporin.
Tarkan et 2013 475 2 Ceftriaxone and Intraoperative and Ceftriaxone was given
al. amoxicillin postoperative intraoperatively and for 3
days post-op. Oral
amoxicillin- clavulanate
was then administered
until day 7.
Total 6959 5

Table 3: Studies reporting prophylactic pneumococcal vaccination.

 Study name Year Vaccination status against Streptococcus Type of
published pneumoniae pneumococcal
vaccine

No. of patients No. of Time of

with meningitis vaccination
pneumococcal in this
vaccine group

Al-Muhaimeed et 2009 117 0 Not stated but Not stated

al. vaccination for all
is part of
cochlear implant
program
Awad et al. 2018 163 0 All within 1 week Not stated
postoperatively
Garrada et al. 2021 148 0 doesn't say when Not stated
- but vaccination
part of CI
program
Halawani et al. 2019 892 0 Pre-operative Not stated
Lescanne et. Al. 2011 140 0 Pre-operative Not stated
Mey et al. 2016 55 0 Pre-operative Not stated
Ozeki et al. 2004 35 0 Pre-operative Not stated
Shiras et al. 2018 213 0 Pre-operative Not stated
Smeds et al. 2017 10 0 Pre-operative Pneumococcal
conjugate
vaccine
Stratigouleas et 2006 176 0 Pre-operative Prevnar and/or
al. pneumovax
Tarkan et al. 2013 475 2 Pre-operative Not stated
Velegrakis et al. 2008 51 0 Not stated but Not stated
vaccination for all
is part of the
cochlear implant
program
Total 2475 2

Table 4: Studies specifying the number of unilateral and bilateral cochlear implants placed.
Study name Year The number of unilateral and bilateral simultaneous cochlear
publishe implantations placed
d

Total number No. of No. of No. of patients No. of meningitis

of patients patients with meningitis in with bilateral in bilateral
implanted in unilateral unilateral simultaneous simultaneous
the study implants group implants group

Achiques et al. 2010 246 246 1 0 0

Ahn et al. 2011 11 11 2 0 0
Almosnino et al. 2018 188 164 0 0 0
Amin et al. 2021 64 64 0 0 0
Awad et al. 2018 163 163 0 0 0
Beltrame et al. 2013 19 19 0 0 0
Broomfield et al. 2014 961 131 0 436 0
Chang et al. 2010 133 133 0 0 0
Chen et al. 2013 445 437 0 0 0
Ciorba et al. 2012 438 438 0 0 0
Cullen et al. 2004 47 47 1 0 0
Cunningham et 2004 733 733 0 0 0
al.
Dalgic et al. 2021 97 0 0 50 0
Dankuc et al. 2015 99 98 0 0 0
Eftekharian et 2019 18 18 0 0 0
al.
Farinetti et al. 2014 403 331 1 8 0
Francis et al. 2008 188 167 0 4 0
Googe et al. 2016 156 64 0 51 0
Hansen et al. 2010 367 251 0 24 0
Hao et al. 2015 24 24 0 0 0
Holman et al. 2013 26 5 0 15 0
Jiang et al. 2016 1014 963 0 51 0
Kitano et. Al. 2021 70 54 0 8 0
Kontorinis et al. 2012 33 27 0 6 0
Lee et al. 2010 23 19 0 1 0
Li et al. 2014 260 260 0 0 0
Mey et al. 2016 55 29 0 12 0
Ozeki et al. 2004 35 35 0 0 0
Petersen et al. 2018 1017 811 1 79 0
Sayed-Hassan et 2019 1157 1082 0 0 0
al.
Smeds et al. 2017 10 5 0 0 0
Stamatiou et al. 2011 212 212 0 0 0
 Suhling et al. 2018 13 9 0 0 0
Tarkan et al. 2013 475 475 2 0 0
Wei et al. 2018 13 13 0 0 0
Wong et al. 2016 150 140 0 1 0
Xia et al. 2015 42 42 0 0 0
Yang et al. 2020 89 73 0 16 0
Total 7793 8 762 0

Table 5: Studies reporting postoperative acute otitis media (AOM), and postoperative
meningitis in this group.
 Patients with post-implantation acute otitis media (AOM)

Year
Study name No. of
published
patients
implanted No. of
who meningitis in Notes
developed this group
AOM after
surgery
Awad et al. 2018 3 0 None
Bhatia et al. 2004 4 0 None
Binnetoglu et 2020 None
6 0
al.
Bruijnzeel et al. 2016 Refers to the number of ears implanted that
14 0
developed postoperative AOM.
Ciorba et al. 2012 4 0 None
Cunningham et 2004 Only tracked complicated cases of otitis media,
al. defined as resulting in adverse sequelae such as
4 0
tympanic membrane perforations. Minor otitis
media not tracked.
Francis et al. 2008 5 0 None
Garrada et al. 2021 3 0 None
Googe et al. 2016 7 0 None
Green et al. 2004 2 0 None
Halawani et al. 2019 8 0 None
Hansen et al. 2010 8 0 None
Holman et al. 2013 2 0 None
Ikeya et al. 2013 Only tracked otitis media falling under major
10 0 complications. Minor cases of otitis media not
tracked.
Lescanne et. al. 2011 3 0 None
Loundon et. al 2010 One patient with AOM developed meningitis, while
3 1
2 others had AOM as a minor complication.
Migirov et al. 2004 47 0 None
Molony et al. 2010 Refers to the number of ears implanted that
5 0
developed postoperative AOM.
Sayed-Hassan 2019 Only tracked complicated cases of AOM requiring
2 0
et al. hospital admission. Minor otitis media not tracked.
Shiras et al. 2018 1 0 None
Tarkan et al. 2013 5 0 None
Venail et al. 2008 5 0 None
Vila et al. 2017 Refers to the number of ears implanted; there were
103 1
210 cases of repeat AOM in 103 ears.
Total 254 2
Abbreviations: AOM = Acute Otitis Media
Table 6: Studies reporting the number of patients implanted ≤ 5 years of age.

Study name Year

publishe Under 5 years
 d
Cochlear implantation year range No. of No. of
children meningiti
under 5 s in this
Earliest year where Last year where years group
implantation occurred implantation occurred implante
d
Ahn et al. 2011 1999 2010 8 1
Ajallouyean et 2011 2006 2009 262 1
al.
Beltrame et al. 2013 Not stated Not stated 15 0
Bruijnzeel et al. 2016 1996 2014 144 0
Ciorba et al. 2012 2003 2009 207 0
Dalgic et al. 2021 2003 2019 97 0
Ding et al. 2009 1998 2008 883 0
Eftekharian et al. 2019 2008 2018 7 0
Francis et al. 2008 Not stated Not stated 184 0
Grover et al. 2021 2012 2019 19 0
Hao et al. 2015 2011 2014 23 0
Holman et al. 2013 Not stated Not stated 26 0
Kontorinis et al. 2012 2000 2010 19 0
Lee et al. 2010 1999 2006 14 0
Li et al. 2014 2010 2013 186 0
Luntz et al. 1997 1988 1996 5 0
Luxford et. al. 1987 Not stated Not stated 66 0
Mylanus et al. 2004 1994 2002 14 0
Nisenbaum et al. 2020 2011 2016 172 0
Sharma et al. 2021 2012 2020 22 0
Shiras et al. 2018 2006 2015 213 0
Smeds et al. 2017 2007 2015 10 0
Suhling et al. 2018 1999 2016 8 0
Tarkan et al. 2013 2000 2012 404 2
Wei et al. 2018 Not stated Not stated 12 0
Yang et al. 2020 2012 2018 89 0
Total 3109 4

Table 7: Studies reporting the number of adults implanted (≥ 18 years).

Authors (1st et al Year Adults implanted (≥ 18 years)

 Study name Year No. of adults No. of meningitis
published implanted in this group
Amin et al. 2021 64 0
Binnetoglu et al. 2020 829 0
Chen et al. 2013 445 0
Ciorba et al. 2012 140 0
Cunningham et al. 2004 462 0
Dagkiran et al. 2020 156 1
Dankuc et al. 2015 11 0
Dia et al. 2014 13 0
Ding et al. 2009 33 0
Estomba et al. 2017 57 0
Fakurnejad et al. 2020 2965* 1
Farinetti et al. 2014 168 1
Freni et al. 2020 202 0
Garcia-Iza et al. 2018 94 0
Garrada et al. 2021 12 0
Green et al. 2004 214 0
Gudis et al. 2012 120 0
Halawani 2020 14 0
Halawani et al. 2019 135 0
Hansen et al. 2010 180 0
Hou et al. 2010 32 0
Ikeya et al. 2013 215 0
Jiang et al. 2016 141* 0
Kim et al. 2008 148 0
Kitano et al. 2021 38 0
Kontorinis 2012 5 0
Lee et al. 2017 55 0
Mey et al. 2016 26 0
Migirov et al. 2004 83 0
Molony et al. 2010 144* 0
Ovesen et al. 2009 120 0
Parent et al. 2020 3483 0
Petersen et al. 2018 463 0
Stamatiou et al. 2011 212 0
Stratigouleas et al. 2006 79 0
Suhling et al. 2018 2 0
Summerfield et al. 2005 1779 5
Szymanski et al. 2016 18 0
Velegrakis et al. 2008 35 0
Venail et al. 2008 178 0
Wei et al. 2018 1 0
Wong et al. 2016 150 0
 Total 6520 8

* The number refers to the number of adult ears implanted. The number of adult patients
implanted was not recorded in these studies.

Table 8: Studies reporting the technique used for electrode insertion (Round window vs
cochleostomy).

Study name Year Surgical technique

publishe
 d Cochleostomy Round window

No. of No. of No. of No. of

patients meningitis patients meningitis
Ozeki et al. 2004 35 0 0 0
Velegrakis
et al. 2008 51 0 0 0
Lavinsky et.
al. 2010 50 0 0 0
Lescanne
et. al. 2011 140 0 0 0
Migirov et.
al. 2004 292 0 0 0
Al-
Muhaimeed
et al. 2009 117 0 0 0
Bhatia et al. 2004 270 0 30 0
Black et al. 2007 242 0 0 0
Freni et al. 2020 0 0 202 0
Gudis et al. 2012 19* 0 111* 0
Gysin et al. 2000 102 0 0 0
Hao et al. 2015 0 0 24 0
Holman et
al. 2013 26 0 0 0
Eftekharian
et al. 2019 6 0 12 0
Halawani et
al. 2020 6 0 171 0
Kontorinis
et al. 2012 33 0 0 0
Luntz et al. 1997 8 0 0 0
Smeds et al. 2017 3* 0 12* 0
Jeong et al. 2021 9 0 22 0
Guldiken et 1 0 0
al. 2011 148
Total 157 1 22 0

* Reflects the number of ears implanted as the number of patients implanted not specified