2010 Copyright @ Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. Dutch Cochlear Implant Group (CI-ON) Consensus Protocol on Postmeningitis Hearing Evaluation and Treatment *Paul Merkus, †Rolien H. Free, ‡Emmanuel A. M. Mylanus, §Robbert Stokroos, kMick Metselaar, ¶Erik van Spronsen, LWilko Grolman, and **Johan H. M. Frijns *Cochlear Implant team Amsterdam VUMC, Department of Otorhinolaryngology, VU University Medical Center, Amsterdam; ÞCochlear Implant team Northern Netherlands, Department of Otorhinolaryngology, University Medical Center Groningen, Groningen; þCochlear Implant team Nijmegen, Department of Otorhinolaryngology, Radboud University Nijmegen Medical Center, Nijmegen; §Cochlear Implant team Maastricht, Department of Otorhinolaryngology, University Hospital of Maastricht, Maastricht; k Cochlear Implant team Rotterdam, Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam; ¶Cochlear Implant team Amsterdam AMC, Department of Otorhinolaryngology, Academic Medical Center, Amsterdam; LCochlear Implant team Utrecht, Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht; and **Cochlear Implant team CIRCLE Leiden, Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands Objective: One of the most devastating sequelae of bacterial meningitis is profound hearing loss or even deafness. Although cochlear implantation is able to restore (some) hearing abilities, obliteration due to fibrosis and especially calcification of the cochlea in the postmeningitis period is limiting the success rate of an implantation. A national consensus assembled in a post- meningitis follow-up protocol has to increase awareness and thus the chances of an early detection and possible intervention when profound hearing loss occurs. Setting: All cochlear implant (CI) centers of The Netherlands located in the 8 academic otorhinolaryngology and audiology departments of The Netherlands, gathered in the Dutch Cochlear Implant Group (CI-ON, Cochlear Implant Overleg Nederland). Intervention: A protocol proposed by 3 centers was sent to all other CI centers in The Netherlands to review and agree on. Main Outcome Measures: The CI centers agreed on the need for, and use of, the proposed protocol. Keystones of the protocol are treatment with dexamethasone before start of antibiotics, early magnetic resonance imaging and repeated audiological follow-up, and urgent referral to a CI center in all cases with greater than 30 dB SNHL. Conclusion: The Cochlear Implant Centers in The Netherlands (CI-ON) have agreed on a protocolized follow-up after bacte- rial meningitis to increase the chances of an early detection and possible intervention should profound hearing loss occur. Key Words: AlgorithmVAudiologyVBacterial meningitisV Cochlear implantVDiagnostic protocol VHearing lossVMagnetic resonance imagingVNetherlands. Otol Neurotol 31:1281Y1286, 2010. Bacterial meningitis is the most common cause of ac- quired hearing loss in children and an important cause of deafness in adulthood (1). Moreover, 5% to 35% of the patients with bacterial meningitis will develop per- manent sensorineural hearing loss (SNHL) and profound bilateral hearing loss will occur in up to 4% of patients (2Y5). However, such a SNHL is not always noticeable or present directly after treatment of the infection, leav- ing hearing loss sometimes undetected for a long period. Especially in some young children, hearing loss may only be discovered when formal assessment is done. It is espe- cially in these young children that it may critically affect the development of speech (6). According to the literature, the amount of children of whom hearing is not tested or severe hearing loss is even missed could be up to 25% to 30% (1,5,7). Also in adults hearing evaluation is not always performed even in the presence of a hearing problem. This Address correspondence and reprint requests to Paul Merkus, M.D., Ph.D., Department of Otorhinolaryngology Y Head and Neck Surgery, Cochlear Implant team Amsterdam VUMC, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands; E-mail: p.merkus@vumc.nl; ci@vumc.nl The authors declare no funding support or conflict of interest. Presented at the 4th Consensus in Auditory Implants Meeting, Parma, Italy, June 16Y19, 2010. Otology & Neurotology 31:1281Y1286 Ó 2010, Otology & Neurotology, Inc. 1281