When To Choose Auditory Brainstem Implantation Instead of Cochlear Implantation in Children

For any deaf child, earliest intervention is critical. But not all can benefit from a cochlear implant (CI). Even when physiological and anatomical deficits are identified, it is not easy to answer the controversial question of which children should receive a CI or auditory brainstem implant (ABI). We have initiated an exciting new study that will provide important information about when to implant a child with abnormal inner ears with one of these devices to profit from increased sound awareness at the earliest age possible.

How does one make these evaluations in such small patients who cannot communicate directly with us? Along with audiological testing, electrophysiological testing can give us insight as to what the child perceives.  New advances in Magnetic Resonance Imaging (MRI) can help identify the potential absence of a cochlear nerve that would preclude benefit from cochlear implantation. However, imaging has not been entirely predictive of a child's response to CI, and surprisingly, some patients with apparent absence of auditory nerves have had satisfactory responses to CI. Possible reasons for this will be discussed.

Severe inner ear abnormalities may preclude placement of CI or indicate such poor prognosis as to lead to an early decision to implant ABI.  Additionally, while a CI is a less invasive procedure, if benefits are not seen quickly, patients may need to be speedily routed into the ABI pathway. In this presentation, examples will be discussed of cases where CI may be appropriate (open cochlea, present but possibly deficient nerve tissue) and where immediate ABI may be needed (significantly deformed or absent cochlea, completely absent nerve tissue).