Reasons for performing an auditory brainstem transplant, the stages of the operation and all the complications that may occur, in addition to expectations of success and the best centers to perform it in Turkey
What is an auditory brainstem implant (ABI)?
Auditory brainstem implants are devices that are surgically implanted to provide a better sense of sounds.
It is a treatment option for people with severe hearing loss due to damage to the inner ear (cochlear) and the auditory nerve.
Patients' response to an abi auditory brainstem transplant varies widely, with many achieving better phonemic awareness and improved lip-reading, and others may be able to recognize a sound, word or sentence.
Who is the right person for an auditory brainstem transplant?
Auditory brainstem implants were first developed for people with neurofibromatosis type 2 (NF2) who have lost their hearing as a result of damage to the auditory nerve (sensorineural hearing loss).
Neurofibromatosis (NF2) is a rare genetic disorder in which tumors form along the acoustic nerve.
These tumors are called acoustic neuromas (also known as vestibulocochlear neuromas).
These tumors are treated by surgical removal or radiotherapy that may permanently damage the auditory nerves and deafness in both ears.
In this case, the patient does not benefit from the use of hearing aids (headphones) andCochlear implants.
Since auditory brainstem transplantation was first used in people with neurofibromatosis (NF2), a group of people have found benefit from the procedure.
This category includes:
- For babies born without a functioning auditory nerve in one ear (aplasia) or an improperly developing auditory nerve (hypoplasia).
- People with deafness resulting from an abnormal shape of the inner ear (cochlea), incomplete development of the inner ear (hypoplasia), absence of structures in the inner ear (cochlear aplasia), or an overgrowth of bone in the inner ear (otosclerosis or cochlear ossification).
- Trauma and damage to the auditory nerve as a result of fractures of the temporal bone (the bone of the skull above the ear) on both sides of the head.
- They have other causes of severe deafness that are not improved by Hearing aids or cochlear implants.
How does auditory brainstem implantation work?
The auditory brainstem implant device consists of two separate parts. One of the parts that is worn above the ear is called a processor.
This part contains a microphone that picks up ambient sounds.
The processor converts the sounds into an electrical signal and sends the signals to the internal implant, which consists of a receiver implanted just under the skin on the side of the head and terminated in an electronic receiver.
This receptor is placed on the surface of the brain stem in a region called the cochlear nucleus.
The electrodes on it stimulate different types of neurons in the brainstem, creating sound sensations in response to this stimulation.
Auditory brainstem implants use technology similar to that used in Electron cochlear.
But the main difference is where and what the electrodes are stimulated.
use Electron cochlearThe auditory nerve electrodes are stimulated in the cochlea.
As for the auditory brainstem, the electrodes are attached directly to the brainstem. So it completely bypasses the cochlea and the auditory nerve.
What tests are performed before the auditory brainstem implantation?
Before the auditory brainstem is implanted, specialized medical teams make sure that it is an appropriate option for the condition.
FirstDoctors collect a complete medical history (history, audiogram..), radiographs to examine the condition of the cochlea, the auditory nerve and surrounding structures; These tests include a CT scan and MRI.
The MRI helps to show the anatomy of soft tissues such as the auditory nerve.
Behavioral testing is also used to determine the ability to hear.
An assessment of the language of communication is conducted to examine language development and communication style as well.
An electrophysiological test is used to assess the extent and location of hearing impairment. A neuropsychological assessment examines a person's level of brain function (intellect, learning and memory, language development, motor abilities, organization/planning skills, and concentration).
How is auditory brainstem implantation surgery performed?
An auditory brainstem implant is a complex surgery performed by a team that usually includes a neurosurgeon, anesthesiologist and a neurologist. In addition, the electrophysiologist and audiologist perform extensive testing during the procedure to confirm function and help position the implant.
An auditory brainstem (ABI) implant is often implanted during acoustic neuroma removal in patients with neurofibromatosis (NF2) whose hearing is not expected to be preserved after surgery.
It can also be performed as a separate surgery in some cases such as previous surgery or radiotherapy,
Or in cases of abnormalities of the inner ear, after accidents and other causes of hearing loss that are not candidates for surgery cochlear implant.
What after the auditory brainstem transplantation?
The typical length of stay in the hospital after an auditory brainstem implant is 2 to 4 days.
Longer stay for patients with neurofibromatosis.
Programming of the device begins in the operating room while the implant is placed in the brainstem.
Auditory brainstem (ABI) implants are usually activated 4 to 6 weeks after surgery.
The programming of the device continues to be modified over a period of several days, then monthly for the first year.
Does auditory brainstem transplantation restore hearing? What results can be expected?
FirstIt is important to know that auditory brainstem implants do not restore normal hearing. But it can provide the following:
- Helps improve phonemic awareness.
- Improving the ability to detect and differentiate between sounds (eg, female vs. male; child vs. adult).
- Improved ability to identify environmental sounds (eg, dogs barking versus phone ringing).
- Improving face-to-face communication by improving lip-reading ability.
When examining the results of studies of auditory brainstem transplants, those without NF2 showed improved word recognition and had better auditory outcomes than those with NF2.
They have achieved sound environmental awareness and developed their language, including simple words and sentences.
As a result of the examinations, the children's hearing abilities continued to improve in the years following the brainstem auditory transplantation.
It is important to know that results vary widely.
And that researchers are still exploring possible causes, which include the cause of hearing loss, surgical approach, surgeon expertise, device design, signal processing, software issues in the device system, and other factors.
It is also important before deciding whether to have surgery, to discuss the expected results carefully with each patient and/or family.
What are the complications of auditory brainstem implantation surgery?
Complications of this procedure include cerebrospinal fluid leak, facial nerve paralysis (loss of facial movement due to nerve damage), wound infection, meningitis, incomplete excision of the tumor, implant failure (failure to provide useful auditory sensations or movement) and the brainstem is transplanted under anaesthesia. General complications of surgery may include anesthesia complications.
However, the rate of serious complications is low, especially when the surgery is performed in a medical facility with experienced staff.
There can also be minor complications that can be easily controlled if they arise and usually resolve completely.
Is an auditory brainstem implant a type of cochlear implant?
Although the design and function of ear implants are similar, the devices that are implanted in the brainstem are different.
Usually used Cochlear implants In people with cochlear damage but still having a healthy auditory nerve.
where you work Cochlear implants To bypass and repair the damaged areas of the inner ear.
Where a group of electrodes is used to stimulate the auditory nerve directly, the auditory nerve transmits the impulses resulting from the implant to the brain, and in turn the brain interprets the incoming signals as sound.
As for brainstem transplantation, the auditory nerve is bypassed and the device is connected to the brainstem, and therefore it is considered more complicated.
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