Auditory brainstem implantation (ABI) is a hearing rehabilitation method for patients with bilateral severe-to-profound hearing loss who are not candidates for cochlear implantation, particularly in cases of neurofibromatosis type 2, cochlear nerve aplasia or hypoplasia, severe inner ear malformations, cochlear ossification after meningitis, or extensive damage to the cochlea and cochlear nerve. In recent years, with advances in surgical techniques, audiology, and rehabilitation, the indications for ABI have gradually expanded, especially in non-tumor patients and in children.

A review of published studies shows that most patients undergoing ABI have preoperative hearing thresholds in the severe-to-profound range, with many presenting with complete bilateral deafness. After implantation, ABI can provide meaningful auditory benefits, including sound detection, environmental sound awareness, speech pattern discrimination, and closed-set speech recognition; in selected cases, some patients may achieve open-set speech perception. However, postoperative outcomes vary considerably among individuals and are influenced by several factors, including etiology of deafness, age at implantation, anatomical characteristics, number of effective active electrodes, programming strategies, and the quality of postoperative auditory-verbal rehabilitation. In general, non-tumor patients and children implanted at an earlier age tend to have more favorable outcomes.

Regarding safety, ABI is considered a relatively safe procedure when performed at experienced centers, although early complications such as cerebrospinal fluid leakage, prolonged fever, or the need for additional surgical intervention may still occur. Long-term complications are more commonly related to the device itself and include device failure, electrode displacement, reoperation, or non-use of the implant. Therefore, the success of ABI depends not only on surgery but also on long-term follow-up, repeated device programming, and continuous rehabilitation.

In conclusion, ABI is a valuable hearing restoration option for patients with severe-to-profound hearing loss who cannot benefit from cochlear implantation. Comprehensive evaluation of indications, preoperative hearing thresholds, postoperative outcomes, and complications is essential for patient selection, prognostic counseling, and long-term management.