Auditory Brainstem Implants

Auditory brainstem implants (ABI) bypass the need for a functioning auditory nerve by directly stimulating the auditory processing centers of the brainstem. (In contrast, cochlear implants require a functioning auditory nerve to transmit impulses from the cochlea to the auditory processing centers of the brainstem.) This class of auditory prosthesis currently represents the best auditory prosthesis for individuals with absence, malformation, or destruction of the auditory nerve. This device is commonly used in people with neurofibromatosis type II. [Colletti: 2012]
Currently, the U.S. Food and Drug Administration has limited approval for ABIs, and children must be 12 years of age or older with certain severe types of hearing loss to be candidates for these implants. Other countries have different regulatory requirements. A number of current clinical trials are examining the use of ABIs in pediatric patients, including younger patients and in conditions other than NFII. For a listing, see Auditory Brainstem Implants in Children and Adolescents (
ABI components are similar to those found in cochlear implants and consist of an external speech processor and receiver that transmit sound waves in the form of electrical impulses to a microelectrode array. This array is inserted through an opening in the mastoid bone and is advanced to the lateral recess of the fourth ventricle, adjacent to the ventral cochlear nucleus. The first generation of auditory brainstem implants were designed to stimulate the surface of the ventral cochlear nucleus in the auditory brainstem. [Hitselberger: 1984] These surface-electrode ABIs rarely provided the range of frequency information and resolution required for speech understanding, although speech reception in combination with lip-reading was markedly improved.
A new generation of ABIs has been designed that incorporates penetrating microelectrodes. These implants provide significant benefit in terms of hearing, language, and cognitive development for children who are not candidates for cochlear implantation. [Colletti: 2007]


Information & Support

For Professionals

Auditory Brainstem Implants (Barrow Quarterly)
Detailed information about the history and development of auditory brainstem implants that includes surgical approaches in the US and Europe; Vol 20, No 4, 2004.


Auditory Brainstem Implants in Children and Adolescents (
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.

Helpful Articles

Rauschecker JP, Shannon RV.
Sending sound to the brain.
Science. 2002;295(5557):1025-9. PubMed abstract

House WF, Hitselberger WE.
Twenty-year report of the first auditory brain stem nucleus implant.
Ann Otol Rhinol Laryngol. 2001;110(2):103-4. PubMed abstract

Lim HH, Lenarz M, Lenarz T.
Auditory midbrain implant: a review.
Trends Amplif. 2009;13(3):149-80. PubMed abstract

Authors & Reviewers

Initial publication: September 2008; last update/revision: February 2018
Current Authors and Reviewers:
Author: Richard Harward, AuD
Contributing Author: Jennifer Goldman, MD, MRP, FAAP
Authoring history
2008: first version: Karl White, Ph DA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Colletti L.
Beneficial auditory and cognitive effects of auditory brainstem implantation in children.
Acta Otolaryngol. 2007;127(9):943-6. PubMed abstract

Colletti L, Shannon R, Colletti V.
Auditory brainstem implants for neurofibromatosis type 2.
Curr Opin Otolaryngol Head Neck Surg. 2012;20(5):353-7. PubMed abstract

Hitselberger WE, House WF, Edgerton BJ, Whitaker S.
Cochlear nucleus implants.
Otolaryngol Head Neck Surg. 1984;92(1):52-4. PubMed abstract