OBJECTIVES: To determine pneumococcal vaccination status of children with recent postmeningitic deafness and to review our current approach for achieving early implantation in this special population that is at significant risk for cochlear ossification. DESIGN: Review of imaging studies and test results. SETTING: Tertiary care/referral children's hospital. PATIENTS: Five children ranging in age from 15 months to 10 years who experienced recent onset of profound bilateral sensorineural hearing loss due to pneumococcal meningitis. INTERVENTIONS: All children underwent preoperative magnetic resonance imaging with 3-dimensional heavily T2-weighted steady-state free precession sequences. Four children underwent auditory steady-state response testing. All underwent bilateral cochlear implantation. MAIN OUTCOME MEASURE: Degree of electrode insertion using standard surgical procedures. RESULTS: All children developed meningitis despite a history of pneumococcal vaccination. Complete electrode insertion in both ears was achieved. CONCLUSIONS: Pneumococcal vaccination has reduced but not eliminated childhood deafness secondary to pneumococcal disease. Auditory steady-state response testing and 3-dimensional steady-state free precession imaging are modalities that expedite candidacy evaluation of this population. Early bilateral simultaneous implantation increases the likelihood of binaural hearing and ensures implantation of the better ear in this population of children whose course is often complicated by formation of scar tissue and ossification within the cochlea.