Outcomes in Pediatric Auditory Brainstem Implantation: Revisiting Performance Over Time

Background: Auditory brainstem implants (ABI) continue to serve an important role in the treatment of deafness for patients with neurofibromatosis type 2 (NF2). ABI is also demonstrating promising results for patients without NF2 yet still suffering from pathology that prevents reliable signal transmission from the cochlear nerve. As a technology still in its infancy, outcomes have shown wide variability between centers as candidacy criteria, device design, operative technique, and postoperative programming and rehabilitation strategies evolve. We sought to characterize the evolution of ABI performance at our center, and determine key factors influencing satisfactory postoperative outcomes over time.

Methods: A single-center retrospective chart review was completed for 28 patients from 2016 to 2022 who underwent ABI at a tertiary referral center. Demographic data, indication, contralateral cochlear implant status, surgical approach and use of intraoperative electrically evoked auditory brainstem response (EABR) were gathered. For patients implanted with NF2, tumor size and treatment history were also analyzed. Our primary outcome was open-set word recognition or age appropriate speech perception and production assessments. Secondary outcomes included hours per day of use and postoperative complications

Results: A range of auditory performance was found for ABI recipients, with improved audiological outcomes found in patients implanted more recently in the ABI program, and in patients who received an implant for an indication other than tumor. Complication rates were found to be low.

Conclusions: For patients not amenable to cochlear implantation, ABI continues to provide the possibility of improved communication and access to environmental sounds. Patients who undergo ABI for indications other than NF2 also demonstrate utility in carefully selected cases and should not be precluded from ABI candidacy. Further research into the use of pre-operative imaging to characterize auditory pathway integrity for ABI prognostication and ABI placement decisions is warranted.

Publication History

Article published online:
01 February 2023