We report a rare presentation of otogenic bacterial meningitis secondary to a stapes footplate malformation in a paediatric patient with an auditory brainstem implant.

A patient with Mondini's dysplasia developed meningitis six years after auditory brainstem implantation. The aetiology was believed to be otogenic, secondary to stapes footplate malformation.

To our best knowledge, this is the first report of otogenic bacterial meningitis secondary to stapes footplate malformation in a paediatric patient with an auditory brainstem implant. Subjects with inner ear malformations, especially Mondini's dysplasia, need to be carefully evaluated pre-operatively to reduce or eliminate any anatomical conditions which may predispose to meningitis. In children with an auditory brainstem implant and suspected ear malformation, we recommend pre-operative radiological investigation to look for the ‘bulging oval window’ sign. When radiological signs are positive, bilateral exploratory tympanotomy should be performed to detect any undiagnosed anatomical stapes footplate defects, which may predispose to bacterial meningitis.