European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 1, pp 3–13 | Cite as

Indications and contraindications of auditory brainstem implants: systematic review and illustrative cases

  • Paul MerkusEmail author
  • Fillipo Di Lella
  • Giuseppe Di Trapani
  • Enrico Pasanisi
  • Milo A. Beltrame
  • Diego Zanetti
  • Maurizio Negri
  • Mario Sanna
Review Article


The number of non-neurofibromatosis type 2 (NF2) indications for auditory brainstem implant (ABI) in the literature is increasing. The objective of this study was to analyze and discuss the indications for ABI. Retrospective chart review and systematic review were conducted at Quaternary referral skull base center and referring centers. Analysis of ABI cases with non-NF2 indications and systematic review presenting non-NF2 ABI cases were performed. Fourteen referred cases with ABI were identified. All cases had unsatisfactory results of ABI and all could have been rehabilitated with a cochlear implant (CI). Of these 14 cases, 9 improved with a cochlear implant, and 2 with a hearing aid, two are still planned for CI, one received bilateral CI, no ABI. In literature, we found 31 articles presenting 144 non-NF2 ABI cases with at least 7 different indications other than NF2. ABI should be restricted to those patients who have no other rehabilitation options. Patency of the cochlea and evidence of an intact cochlear nerve should be examined with imaging and electrophysiologic testing. Sometimes a CI trial should be planned prior to proceeding with ABI. We have shown that in many cases a CI is still possible and CI provided better results than ABI. In vestibular schwannoma in the only hearing ear, cochlear otosclerosis, temporal bone fractures, (presumed) bilateral traumatic cochlear nerve disruption, auto-immune inner ear disease and auditory neuropathy primarily CI are indicated. Traumatic bilateral cochlear nerve disruption is exceptionally unlikely. In cochlear nerve aplasia, testing should be performed prior to meeting indications for ABI. In malformations, ABI is indicated only in severe cochlear hypoplasia or cochlear aplasia.


Auditory brainstem implant Deafness Treatment Meningitis Otosclerosis Temporal bone fracture Cochlear nerve Vestibular schwannoma Auditory neuropathy Cochlear implant Labyrinth malformation 



We like to thank Spencer Voth, ENT surgeon, USA, for his excellent help.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Paul Merkus
    • 1
    Email author
  • Fillipo Di Lella
    • 2
  • Giuseppe Di Trapani
    • 2
  • Enrico Pasanisi
    • 3
  • Milo A. Beltrame
    • 4
  • Diego Zanetti
    • 5
  • Maurizio Negri
    • 6
  • Mario Sanna
    • 2
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryVU University Medical Center & EMGO+ Institute for Health and Care ResearchAmsterdamThe Netherlands
  2. 2.Department of Otology and Skull Base SurgeryGruppo OtologicoPiacenza-RomeItaly
  3. 3.Section of Middle Ear Microsurgery and Otoneurosurgery, Department of Otolaryngology-Head and Neck SurgeryUniversity of ParmaParmaItaly
  4. 4.Department of OtolaryngologyS. Maria del Carmine HospitalRoveretoItaly
  5. 5.Department of OtolaryngologyUniversity of Brescia and S. Gerardo HospitalMonzaItaly
  6. 6.Department of OtolaryngologyRamazzini HospitalCarpiItaly

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