First Auditory Brainstem Implant in Region Performed at UH

January 1, 2015

Individualizing a life-changing surgery


Nicholas Bambakidis, MD

Director, Cerebrovascular and Skull Base Surgery, UH Neurological Institute, UH Case Medical Center; and Professor and Vice Chair for Clinical Affairs in the Department of Neurological Surgery, Case Western Reserve University School of Medicine

Cochlear implants have been used for more than 20 years to improve hearing. However, "people without a cochlear nerve do not benefit from this type of implant," says Nicholas Bambakidis, MD, Director of Cerebrovascular and Skull Base Surgery, University Hospitals Neurological Institute, UH Case Medical Center.

For patients who lack a cochlear nerve, an auditory brainstem implant (ABI) can instead be surgically placed. The ABI is implanted in the brainstem nucleus, ensuring that the exact placement will directly stimulate the cochlear nuclei. This type of complex neurosurgery is indicated for people with rare genetic auditory tumors, as well as for those who have congenital deafness, which is not uncommon.

ABI surgery has been around for several years, but only a few centers in the United States have the resources to make the procedure available to patients. Most centers offering ABI are located in major cities, such as Los Angeles and New York, making it necessary for patients to travel a great distance to receive care.

Earlier this year, a patient underwent successful ABI surgery at UH. "To our knowledge, this was the first ABI procedure in Northeast Ohio," says Dr. Bambakidis.

Dr. Bambakidis implanted the device in the patient's brainstem, assisted by Cliff Megerian, MD, and Maroun Semaan, MD. Dr. Megerian holds the Richard and Patricia Pogue Chair in Auditory Surgery and Hearing Sciences and is Chairman of Otolaryngology-Head and Neck Surgery at UH Case Medical Center. He is Professor of Otolaryngology at Case Western Reserve University School of Medicine. Dr. Semaan is Associate Director of Otology, Neurotology and Balance Disorders at UH Case Medical Center; and Assistant Professor of Otolaryngology at Case Western Reserve University School of Medicine.

"The surgical procedure is very intricate, and involves close collaboration with the audiologist," says Dr. Bambakidis. The procedure included implanting both the brainstem implant and an external receiver/stimulator placed behind the ear, similar to a cochlear implant, to manage the device after surgery. During surgery, the implant was tested to ensure proper placement in the brainstem and functionality of the implant and receiver/stimulator. "Intraoperative testing is 90 percent predictive that the device will function appropriately when turned on," says Dr. Bambakidis.

For the patient who received the first ABI at UH, the surgery went well. Although testing was performed during surgery, the implant was not turned on in the immediate postoperative period, allowing the surgical site time to heal before further stimulating the area. The implant will eventually be encapsulated by fibrous tissue, adhering it against the brainstem.

The patient's implant was activated six weeks after surgery, and her doctors report that she is hearing well. "Moving from deafness to hearing is a life­-changing experience for the patient and her family," says Dr. Bambakidis. The hope is that the patient will continue to adapt well to the hearing world.


The UH Audiology Department is responsible for patient selection, training and long-term follow-up. Auditory surgeons are vital for planning and assisting in ABI surgery.

REFER YOUR PATIENT. To refer a patient for ABI surgery or consult with a physician, call 216-844-1111 or 800-421-9199.

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