Auditory Brainstem Implantation in Young Children

Inclusion Criteria:

- Pre-linguistic hearing loss (birth-5 yrs.; age at ABI 18 months-5yrs) with both:

- MRI +/- CT evidence of one of the following: Cochlear nerve deficiency, Cochlear
aplasia or severe hypoplasia, Severe inner ear malformation, Post-meningitis
ossification

- When a cochlea is present or patent, lack of significant benefit from CI despite
consistent use (>6 mo.)

- Post-linguistic hearing loss (<18 yrs. of age) with both:

- Loss or lack of benefit from appropriate CI without the possibility for revision or
contralateral implantation. Examples might include: Post-meningitis ossification,
Bilateral temporal bone fractures with cochlear nerve avulsion, Failed revision CI
without benefit

- Previously developed open set speech perception and auditory-oral language skills

- No medical contraindications

- Willing to receive the appropriate meningitis vaccinations

- No or limited cognitive/developmental delays which would be expected to interfere with
the child's ability to cooperate in testing and/or programming of the device, in
developing speech and oral language, or which would make an implant and subsequent
emphasis on aural/oral communication not in the child's best interest

- Strong family support including language proficiency of the parent(s) in the child's
primary mode of communication as well as written and spoken English.

- Reasonable expectations from parents including a thorough understanding:

- of potential benefits and limitations of ABI

- of parental role in rehabilitation

- that the child may not develop spoken language as a primary communication mode or
even sufficient spoken language to make significant academic progress in an
aural/oral environment

- Involvement in an educational program that emphasizes development of auditory skills
with or without the use of supplementary visual communication.

- Able to comply with study requirements including travel to investigation sites.

- Informed consent for the procedure from the child's parents/legal guardian.

Exclusion Criteria:

- Pre- or post-linguistic child currently making significant progress with CI

- MRI evidence of one of the following:

- normal cochlea and cochlear nerves or NFII

- brainstem or cortical anomaly that makes implantation unfeasible

- Clear surgical reason for poor CI performance that can be remediated with revision CI
or contralateral surgery rather than ABI.

- Intractable seizures or progressive, deteriorating neurological disorder

- Unable to participate in behavioral testing and mapping with their CI. If this appears
to be an age effect, ABI will be delayed until we can be assured that the child will
be able to participate, as reliable objective measures of mapping are currently not
available for mapping these devices.

- Lack of potential for spoken language development. This will be considered the case
when evidence of the following exist:

- Severe psychomotor retardation, autism, cerebral palsy, or developmental delays
beyond speech that would preclude usage of the device and oral educational
development. Autism is a special case where there is the potential for delayed
presentation. When early signs are considered present, our group routinely
requests a comprehensive developmental assessment for further evaluation prior to
considering routine evaluation. A specialized group is readily available at our
institution for such an evaluation.

- Unable to tolerate general anesthesia (cardiac, pulmonary, bleeding diathesis, etc.).

- Need for brainstem irradiation

- Unrealistic expectations on the part of the subject/family regarding the possible
benefits, risks and limitations that are inherent to the procedure and prosthetic
device.

- Unwilling to sign the informed consent.

- Unwilling to make necessary follow-up appointments.