Cochlear implants have been associated with increased risks of bacterial meningitis in children, notably but not limited to implants with a sialastic accessory piece called a positioner. Because of the associated risks, these devices were ultimately recalled by the Food and Drug Administration in 2002. We present a case of a fully immunized 4-year-old child with a cochlear implant without a positioner who developed Streptococcus pneumoniae meningitis 3 years after implantation. The case highlights the increased risk for bacterial meningitis in the presence of cochlear implants regardless of device type, immunization status, or time after implantation especially in the context of middle- and inner-ear structural anomalies.