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Experiences from Cochlear Implantation and Auditory Brainstem Implantation in Adults and Children: Electrophysiological Measurements, Hearing Outcomes and Patient Satisfaction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cochlear implants (CIs) and auditory brainstem implants (ABIs) are prostheses for hearing used in patients with profound hearing impairment. A CI requires an operational cochlear nerve to function in contrast to an ABI. ABIs were initially designed for adult patients with neurofibromatosis type 2 (NF2), suffering from bilateral vestibular schwannomas. Now ABIs are also used for patients, both adults and children, with congenital cochlear malformations, cochlear nerve hypoplasia/aplasia, and cochlear ossification. The aims of this thesis are to evaluate hearing outcome in patients implanted with a CI after long-term deafness. An extended period of deafness has earlier been considered as a contraindication for CI surgery. Further, we analyzed if electrically evoked auditory brainstem responses (eABRs) can predict CI outcome and pinpoint the optimal selection of treatment such as CI or ABI. We also disclose our experiences from ABI surgery in Uppsala, such as implant use, hearing outcome, complications, and satisfaction among the patients. Finally, we evaluated the results and benefits of ABIs in non-NF2 pediatric patients.

Results show that patients with an extended deafness period and durations over 20 years can achieve speech understanding and benefit from CIs. Patients with long-term deafness and limited years of hearing before deafness did not perform as well as those with shorter deafness duration and longer hearing experience did. eABR seems to have a definite role in the diagnostic armamentarium, to better consider alternative surgical strategies such as ABI. No eABR waveform predicted a poor CI outcome. There was no correlation between speech perception and eABR waveform latencies or eABR waveform quality. A majority of the ABI patients used their ABIs and benefited from them for at least some period. ABI assisted voice control in a majority of the full-time users and they reported improved understanding of speech with the implant switched on. No severe complications from ABI surgery or ABI stimulation were noted. The patients were generally satisfied, even if their hearing remained very limited. All pediatric patients but one used the implant continuously and benefited from it.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 104 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1183
Keyword [en]
cochlear implant, auditory brainstem implant, electrically evoked auditory brainstem responses, long deafness duration, neurofibromatosis type 2
National Category
Medical and Health Sciences
Research subject
Medical Science
URN: urn:nbn:se:uu:diva-275091ISBN: 978-91-554-9483-4OAI: oai:DiVA.org:uu-275091DiVA: diva2:903300
Public defence
2016-04-15, Skoogsalen, ingång 78/79, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Available from: 2016-03-22 Created: 2016-01-29 Last updated: 2016-04-05
List of papers
1. Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
Open this publication in new window or tab >>Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
2014 (English)In: Audiology & Neurotology Extra, ISSN 1664-5537, Vol. 4, no 2, 46-55 p.Article in journal (Refereed) Published
Abstract [en]


The aim of the present study was to gauge factors that influence the outcome of cochlear implants (CI) in patients who have been deaf for an extended period.

Patients and Methods:

Twelve adult cases (13 ears) were operated on at the CI unit in Uppsala during the period of 2002-2013. These patients had a deafness duration ranging between 20 and 72 years in the implanted ear and severe to profound hearing loss or deafness in the other ear. Data concerning pre- and postoperative speech perception, deafness duration, hearing/deafness duration in the contralateral ear, age at implantation, intraoperative electrophysiological measurements, cause of deafness, and user status were collected.


Eleven of 12 patients (13 ears) benefitted from CI treatment.


The overall hearing experience, deafness duration, and age at onset of deafness are important issues to consider prior to CI.

National Category
urn:nbn:se:uu:diva-248579 (URN)DOI:10.1159/000365274 (DOI)
Available from: 2015-04-01 Created: 2015-04-01 Last updated: 2016-03-22Bibliographically approved
2. Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
Open this publication in new window or tab >>Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
2015 (English)In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 16, no 5, 254-261 p.Article in journal (Refereed) Published
National Category
urn:nbn:se:uu:diva-272679 (URN)10.1179/1754762815Y.0000000005 (DOI)
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2016-03-22
3. Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
Open this publication in new window or tab >>Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
Show others...
2014 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, no 10, 1052-1061 p.Article in journal (Refereed) Published
Abstract [en]


Even though sound perception may be limited after treatment with an auditory brainstem implant (ABI), it provides benefits and should be selectively offered to patients. Importantly the patients must be motivated, given reasonable expectations of outcome and offered long-term rehabilitation with a considerable 'learn to listen' period with the implant device.


To describe the clinical experiences and results of 24 ABI surgeries performed in Uppsala University Hospital between 1993 and 2013.


Most patients (n = 20) suffered from neurofibromatosis type 2 (NF2); a few patients (n = 4) were paediatric non-NF2 patients. The files were searched for information on the presurgery size of the vestibular schwannoma, whether the patient had undergone gamma knife treatment, the surgical approach, the side effects of the surgery and of the use of the implant, the electrode activation pattern and implant use, and categories of auditory performance (CAP) score.


Our results show that many patients greatly benefited from an ABI, and most of the patients used their implants even though the hearing improvements usually consisted of awareness of surrounding sounds and improved lip-reading. No severe side effects were observed from implant stimulation.

National Category
urn:nbn:se:uu:diva-233250 (URN)10.3109/00016489.2014.909051 (DOI)000342204900011 ()24881643 (PubMedID)

De två första författarna delar förstaförfattarskapet.

Available from: 2014-10-01 Created: 2014-10-01 Last updated: 2016-03-22Bibliographically approved
4. Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
Open this publication in new window or tab >>Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
2016 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 1, 62-67 p.Article in journal (Refereed) Published
Abstract [en]


The majority of the patients used their auditory brainstem implants (ABIs) all the time, reporting that he/she would make the decision to receive an implant again if the decision were reconsidered. The findings support that the ABI is a valuable treatment in patients with type 2 neurofibromatosis (NF2) and in children with congenital inner ear and nerve anomalies or cochlear ossification.


To evaluate the patients who underwent ABI implantation in Uppsala during 1993-2013. This study analyzed patients' implant use, perception of environmental sounds, perceived benefit from the implant, and quality-of-life (QoL).


The NF2-patients (n = 20) comprised the majority of the patients, and there were a few non-NF2 pediatric patients (n = 4). The exclusion criteria included deceased patients (n = 4) and patients with no hearing sensations from the implant, or those with an inactivated ABI (n = 2). The data were collected from a questionnaire survey.


Eleven adult patients and two pediatric patients answered the questionnaires. Eight of the adult patients used their implants 'always'. The two children always used their implants. Hearing problems had the largest negative effect on the QoL. The non-users and the users scored equally on the NFTI-QoL.

Auditory brainstem implants; QoL; benefit; NF2
National Category
urn:nbn:se:uu:diva-265777 (URN)10.3109/00016489.2015.1079925 (DOI)000365678800011 ()26426855 (PubMedID)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2016-03-22Bibliographically approved
5. Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
Open this publication in new window or tab >>Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
2016 (English)In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628Article in journal (Refereed) Epub ahead of print
National Category
Clinical Medicine
urn:nbn:se:uu:diva-275226 (URN)
Available from: 2016-02-01 Created: 2016-02-01 Last updated: 2016-03-22Bibliographically approved

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