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OBJECTIVES. The objective of this study was to evaluate long-term speech perception abilities of comparable groups of postmeningitic and congenitally deaf children after cochlear implantation. METHODS. This prospective longitudinal study comprised 46 postmeningitic deaf children and 83 congenitally deaf children with age at implantation of [less than or equal to] 5.6 years. Both groups were comparable with respect to educational setting and mode of communication and included children with additional disabilities. RESULTS. Both postmeningitic and congenitally deaf children showed significant progress after implantation. Most (73% and 77%, respectively) could understand conversation without lip-reading or use the telephone with a known speaker 5 years after implantation, whereas none could do so before implantation. At the same interval, the postmeningitic and congenitally deaf children scored a mean open-set speech perception score of 47 (range: 0-91) and 46 (range: 0-107) words per minute, respectively, on connected discourse tracking. The respective mean scores at the 3-year interval were 22 and 29 correct words per minute, respectively. None of these children could score a single correct word per minute before implantation. The progress in both groups was statistically significant. When the 2 groups were compared, there was no statistically significant difference. CONCLUSION. Postmeningitic and congenitally deaf children showed significant improvement in their auditory receptive abilities at the 3- and 5-year intervals after cochlear implantation. There was no statistically significant difference between the outcomes of the 2 groups, suggesting that, provided that children receive an implant early, cause of deafness has little influence on outcome. Although the prevalence of other disabilities was similar in both groups, for individual children, their presence may have profound impact. The study supports the concept of implantation early in life, irrespective of the cause of deafness. Key Words cochlear implant, speech perception, children, auditory perception, outcome, meningitis, congenital, etiology, results Abbreviations PMD--postmeningitic deaf CD--congenitally deaf CDT--connected discourse tracking CAP--categories of auditory performance, WHEN PEDIATRIC COCHLEAR implantation began, considerable doubts were expressed about the advisability of implantation for congenitally deaf children. In 1989, Shannon (1) suggested that, because of lack of auditory input, [...]