Auditory brainstem implants

Back of a young girl's head showing her auditory brainstem implant

Auditory brainstem implants (ABIs) may be suitable for children and young people who are profoundly deaf and cannot use cochlear implants – usually because they do not have a cochlea or auditory nerve.

Instead of sending sound through the ear, ABIs bypass the ear entirely and stimulate the brainstem directly to create a sensation of hearing.

ABIs are still a fairly new development, and they are mainly used by adults. In the UK, just over 30 children have received an ABI.

A note on terms

Throughout this page, we use the term 'your child'. However, we understand that many deaf young people may be making this decision for themselves. Whenever you see 'your child', please know it also includes any deaf young person considering auditory brainstem implants.

Who can use an auditory brainstem implant

ABIs are considered for children who:

are profoundly deaf
have an absent or underdeveloped cochlea or auditory nerve

In these cases, hearing aids and cochlear implants do not help because sound cannot be sent from the inner ear to the brain.

UK guidelines

In 2005, the National Institute of Clinical Excellence (NICE) recommended ABIs only for adults and young people who had surgery on their hearing nerve. See NICE guidelines.
No official guidance currently exists for using ABIs in deaf children.

The British Cochlear Implant Group (BCIG) and other professionals do not recommend ABIs as a routine option for congenitally (born) deaf children in the UK, but some families may still wish to explore this option.

How auditory brainstem implants work

ABIs are similar in appearance and function to cochlear implants, but they stimulate a different part of the hearing system.

ABIs have two parts:

external part – microphone, sound processor (worn behind the ear or on the body), and lead and transmitter coil
internal part – implanted receiver and electrodes

Unlike cochlear implants, the electrodes are not inserted into the cochlea – they're placed directly onto the brainstem.

Getting an auditory brainstem implant

Children with no or very small auditory nerves may show little or no response to very loud sounds, even with hearing aids. In this case, they may be referred to a specialist cochlear implant team for assessment.

The assessment will include:

hearing tests
medical scans (MRI or CT)
evaluation of your child's communication and general development by speech and language therapists and/or Teachers of the Deaf

How to get a referral

If your child has been using a hearing aid for sufficient time with little benefit, contact your ear, nose and throat (ENT) consultant or audiologist.

If appropriate, they will refer you to a children’s implantation centre for specialist assessment.

ABI centres in the UK

Guy's and St Thomas' (London)
Manchester Royal Infirmary (Manchester)
Emmeline Centre for Hearing Implants (Cambridge)

Surgery

The operation is done under general anaesthetic and can take between 3 and 6 hours. During the surgery, the team will place an electrode array on the cochlea nucleus of the brainstem.

After surgery, your child will need long-term support to help them learn to listen to and understand the new signals from the implant.

Switch-on takes place around 6 weeks after implantation. A follow-up appointment will be made after the initial activation to fine-tune the processor with further appointments as required.

NHS funding

Following a request from the National Deaf Children’s Society, NHS England published Clinical Commissioning Policy: Auditory brainstem implant with congenital abnormalities of the auditory nerves of cochleae (NHS England | PDF | 261KB).

How sound is perceived

Since only a small number of children have had ABIs, it’s hard to predict results.

However, many children are able to:

recognise and discriminate environmental sounds (such as a doorbell or phone ringing)
follow the rhythm and intonation of speech
use ABIs alongside lip-reading and visual cues

Limitations of ABIs include:

Many noises sound the same at first and it may be difficult to identify sounds through the ABI.
Using an ABI to develop spoken language can be challenging and results vary widely. It is usually not possible to understand speech without lipreading using an ABI. Your child may still need to use sign language to communicate.
Some patients are unable to hear anything after the ABI.

Research on auditory brainstem implants in children

There is currently limited published research worldwide on the procedure, use of and benefits of ABI in deaf children, but there are clinical trials ongoing in America (The Hearing Review).

Some published research available:

Last Reviewed:May 2025

Full references for this webpage are available by emailing

informationteam@ndcs.org.uk