Hearing Restored After Adult-Onset Deafness with an Auditory Brainstem Implant: A Narrative Review of Rehabilitation and Everyday Communication Outcomes
DOI:
https://doi.org/10.5281/zenodo.22236996Keywords:
Auditory Brainstem Implant, Neurofibromatosis Type 2, Speech Perception, Aural Rehabilitation, Patient ExpectationsAbstract
An auditory brainstem implant bypasses the cochlea and the auditory nerve entirely, delivering stimulation to the cochlear
nucleus. It is offered to people for whom a cochlear implant cannot work. What it delivers varies enormously, and the variation is
not random.
Objectives: To review the published evidence on auditory brainstem implantation in adults: what auditory outcomes are
achieved, how sharply they differ between tumour and non-tumour aetiology, what rehabilitation contributes, and how the results
should be described to a candidate before surgery.
Material and Methods: Narrative review of case series, systematic reviews, single-centre cohorts and device studies indexed in
PubMed and the major otolaryngology and audiology journals. No new patient data were generated; every estimate quoted is one
published by the original investigators.
Results: In the largest single-centre adult series with at least one year of follow-up, open-set speech perception averaged 59 per
cent in 48 non-tumour adults, with a range of 10 to 100 per cent, against an average of 10 per cent in 32 patients with
neurofibromatosis type 2, range 5 to 31 per cent (p = 0.0007). A systematic review of 36 studies covering 662 tumour and 267
non-tumour patients reported weighted mean speech recognition in tumour patients of 39.2 per cent for closed-set words, 23.4
per cent for open-set words and 21.5 per cent for open-set sentences.
Conclusion: For patients with neurofibromatosis type 2 the realistic expectation is environmental sound awareness and
substantial enhancement of lip-reading rather than telephone use. For adults deafened by cochlear or nerve pathology with an
intact central pathway, open-set speech is achievable in a majority. Conflating the two produces expectations that the device
cannot meet.
Abbreviations: ABI – Auditory Brainstem Implant, CAP – Categories of Auditory Performance, CI – Cochlear Implant, CUNY –
City University of New York sentence test, NF2 – Neurofibromatosis Type 2, SD – Standard Deviation.
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