OBJECTIVE: Recently, the association of meningitis with cochlear implants has raised concern over the safety of these devices. We examined the incidence of all postoperative infections in patients undergoing cochlear implant surgery. Study design and settings A retrospective chart review of all patients undergoing cochlear implants at a private tertiary referral center from 1993 to 2002 was performed. Cochlear implant surgeries in 462 adults and 271 children were reviewed. Patients with evidence of a postoperative infection or infectious complication related to cochlear implantation were identified, and data on patient characteristics, surgery, and treatment outcome were obtained. RESULTS: The overall incidence of postoperative infection in our cochlear implant series was 4.1%. Major infectious complications occurred in 3.0% of cases, and the majority of infections required surgical intervention. A history of chronic ear disease may increase the risk of infectious complications. There were no cases of meningitis. CONCLUSIONS: Cochlear implants remain a safe procedure with a low complication rate. The majority of infections can be managed without removing the implant device. Advances in surgical technique and flap design have decreased the occurrence of wound-related complications. However, identification of risk factors for infection and optimization of treatment regimens will further reduce the complications associated with postoperative infection.