Outcomes following Pediatric Auditory Brainstem Implant Surgery

An auditory brainstem implant (ABI) is a surgically implanted central neural auditory prosthesis for the treatment of profound sensorineural hearing loss in children and adults who are not cochlear implant candidates due to a lack of anatomically intact cochlear nerves or implantable cochleae. The device consists of a multielectrode surface array which is placed within the lateral recess of the fourth ventricle along the brainstem and directly stimulates the cochlear nucleus, thereby bypassing the peripheral auditory system. In the United States, candidacy criteria for ABI include deaf patients with neurofibromatosis type 2 (NF2) who are 12 years or older undergoing first- or second-side vestibular schwannoma resection. In recent years, several non-NF2 indications for ABI have been explored, including bilateral cochlear nerve avulsion from trauma, complete ossification of the cochlea due to meningitis, or a severe cochlear malformation not amenable to cochlear implantation. In addition, growing experience with ABI in infants and children has been documented with encouraging outcomes. While cochlear implantation generally remains the first-line option for hearing rehabilitation in NF2 patients with stable tumors or post hearing preservation surgery where hearing is lost but a cochlear nerve remains accessible for stimulation, an ABI is the next alternative in cases where the cochlear nerve is absent and/or if the cochlea cannot be implanted. Herein, we review ABI device design, clinical evaluation, indications, operative technique, and outcomes as it relates to lateral skull base pathology.

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“…Early experiences with pediatric ABI in the United States also show promise but long-term studies have not been published. 29,30…”

Section: Discussionmentioning

confidence: 99%

Auditory Brainstem Implantation: An Overview

2019

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“…The number of active electrodes in our patients are very similar to other reported series in the literature. (21,37,38) All centers have experienced complications; in our center we had one CSF leak repaired with lumbar drainage, but have had no device failures and have had very limited non-auditory side effects (NASE), limited to vestibular effects seen in one patient requiring one electrode to be removed from the clinical map. In our center, even with lumbar drainage in place, patients can be managed on the hospital ward instead of the ICU.…”

Section: Discussionmentioning

confidence: 99%

Initial Results of a Safety and Feasibility Study of Auditory Brainstem Implantation in Congenitally Deaf Children

Wilkinson

Eisenberg²,

Krieger³

et al. 2017

Otology &Amp; Neurotology

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Objective To determine the safety and feasibility of the auditory brainstem implant (ABI) in congenitally deaf children with cochlear aplasia and/or cochlear nerve deficiency. Study Design Phase I feasibility clinical trial of surgery in 10 children, ages 2 to 5 years, over a 3 year period. Setting Tertiary children’s hospital and university-based pediatric speech/language/hearing center. Intervention(s) ABI implantation and post-surgical programming. Main outcome measure(s) The primary outcome measure is the number and type of adverse events during ABI surgery and post-surgical follow-up, including behavioral mapping of the device. The secondary outcome measure is access to and early integration of sound. Results To date, nine children are enrolled. Five children have successfully undergone ABI surgery and postoperative behavioral programming. Three children were screen failures, and one child is currently undergoing candidacy evaluation. Expected adverse events have been documented in three of the five children who received the ABI. One child experienced a cerebral spinal fluid (CSF) leak, which resolved with lumbar drainage. One child demonstrated vestibular side effects during device programming, which resolved by deactivating one electrode. One child experienced postoperative vomiting resulting in an abdominal radiograph. Four children have completed their 1-year followup and have speech detection thresholds of 30 to 35 dB HL. Scores on the IT-MAIS/MAIS range from 8 to 31 (out of a total of 40), and the children are demonstrating some ability to discriminate between closed-sets words that differ by number of syllables (pattern perception). Conclusions ABI surgery and device activation appears to be safe and feasible in this preliminary cohort.

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“…In its judicious use so far by experienced teams, ABI surgery in this population is safe and may be efficacious in well-selected pediatric patients [Noji et al, 2015;Puram and Lee, 2015;Puram et al, 2016;Shah et al, 2016;Wilkinson et al, 2017]. In one study, long-term outcomes in 35 children who received ABI due to severe inner ear malformations were evaluated.…”

Section: Introductionmentioning

confidence: 99%

Performance with an Auditory Brainstem Implant and Contralateral Cochlear Implant in Pediatric Patients

et al. 2018

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Objective: To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI). Methods: This is a retrospective case review performed at a tertiary referral center. Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. The main outcome measures included age-appropriate speech perception and production assessments. Results: Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject had only preliminary outcomes, but subjectively performed best with both devices. Conclusions: We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that ABI and CI have a synergistic effect, or it could simply be the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency.

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Outcomes following Pediatric Auditory Brainstem Implant Surgery

Cited by 31 publications

References 14 publications

Auditory Brainstem Implantation: An Overview

Auditory Brainstem Implantation: An Overview

Initial Results of a Safety and Feasibility Study of Auditory Brainstem Implantation in Congenitally Deaf Children

Performance with an Auditory Brainstem Implant and Contralateral Cochlear Implant in Pediatric Patients

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