For many Australians, hearing technology means hearing aids or cochlear implants. But for a small number of people whose hearing pathway cannot be restored through conventional hearing implants, another technology exists. One that bypasses the inner ear altogether and connects directly with the brain.

It’s called an Auditory Brainstem Implant (ABI).

Pictured: Left to Right: Dr Jafri Kuthubutheen (surgeon) Hannah McPierzie (ABI recipient) Associate Prof Dayse Tavora-Vieira (ABI implant audiologist)

For hearing advocate, Deafness Forum Australia Board Director and ABI recipient Hannah McPierzie, raising awareness of that technology has become a personal mission.

“I love knowing that this little chip in my brain has given me re-entry into a world I thought I’d lost,” she says.

Hannah recently partnered with the Medical Technology Association of Australia to help raise awareness of auditory brainstem implants after her cochlear implant provider, MED-EL, put her name forward as one of four Australians whose lives had been transformed by medical technology.

For her, it was an opportunity to shine a light on a technology that remains largely unknown, even within parts of the hearing profession.

“I saw it as a wonderful chance to put ABIs, and my incredible surgical team, in the spotlight,” she says.

“I’ve spoken to surgeons who don’t consider ABIs because they’ve never met someone with one or seen what they can offer. I’m lucky my surgeons thought differently, and I want others to have that option on the table too.”

According to Dr Jafri Kuthubutheen, a Clinical Professor and Otology and Skull Base Surgeon, (also Hannah’s surgeon) an ABI represents an important advancement because it offers another pathway to hearing when a cochlear implant is no longer an option.

“It allows us a way to restore hearing by directly stimulating the brainstem, bypassing the cochlea and the cochlear nerve,” he explains.

Unlike a cochlear implant, where the electrode is inserted into the cochlea within the inner ear, an ABI places the electrode onto the brainstem where the cochlear nucleus receives hearing signals before they travel to the brain.

Dr Kuthubutheen describes it as “a step further along the auditory pathway.”

When is an ABI used?

ABIs are not designed to replace cochlear implants. Instead, they are reserved for people whose hearing cannot be restored through more conventional implant technologies.

Dr Kuthubutheen explains that patient suitability depends on several factors. These include:

  • the person’s condition
  • whether conventional hearing implants are appropriate
  • whether the brainstem can be safely accessed
  • and the availability of an experienced multidisciplinary team comprising ENT surgeons, neurosurgeons and audiologists.

For Hannah, the reason an ABI was the right solution for her, was due to her diagnosis of neurofibromatosis type 2 (NF2), a rare condition characterised by benign tumours growing on the cochlear nerves.

Because both cochlear nerves were affected, Dr Kuthubutheen says a cochlear implant would not have been effective.

“We were able to use the ABI technology to go directly to the brain and bypass the cochlear nerve.”

Every outcome is different

One of the challenges with auditory brainstem implants is that outcomes can vary considerably. Unlike cochlear implants, where electrode placement is highly predictable, placing an ABI requires surgeons to locate the cochlear nucleus on the brainstem. That target differs subtly from patient to patient.

“The most challenging part is to find the target,” Dr Kuthubutheen says.

“The variability in the anatomy is such that even small changes can make significant differences to outcomes.”

Hannah’s experience illustrates just how broad that spectrum can be.

Dr Kuthubutheen says being able to understand speech without visual cues is considered the pinnacle of ABI performance. Hannah has achieved that outcome, despite only having one ABI activated.

“She can perceive speech without visual cues with the ABI, which is really the pinnacle of ABI performance.”

Hannah is equally open about the reality that outcomes are not always predictable.

“I have two ABIs. One doesn’t give me access to sound, which can be a typical outcome, while the other works incredibly well.

“It’s important to be honest that ABIs can be hit and miss. But when you have no other option, shouldn’t it be up to you whether you take that shot?”

Raising awareness

Although ABIs have existed for many years, awareness remains limited.

“ABIs just aren’t spoken about enough,” Hannah says.

“I’d love to see them included as an option in surveys, questionnaires and audiology seminars. Sometimes, simply having ABIs on the page is enough to get people asking questions.”

For Dr Kuthubutheen, raising awareness is about more than a single technology. “Hearing loss is one of the most prevalent conditions out there,” he says.

“Because it’s not visible and because a lot of people are very good at hiding it, it often doesn’t receive the same attention as other illnesses.”

He believes increasing public understanding of hearing loss, and the technologies available to support people, is an important part of improving future care.

“Work like this is really important in bringing everyone’s awareness about the importance of hearing loss and the impact that hearing loss has on people’s everyday lives.”

For Hannah, the goal is simple. “I want people to know that ABIs exist and that they may be an option for people who are often told they have none.”

By sharing both the promise and the realities of auditory brainstem implants, she hopes more Australians will start asking questions, have conversations with their healthcare teams, and discover options they may never have known existed.

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